Mazen Alkasem

Background

1. The Registrant is an HCPC Registered Physiotherapist. The factual particulars date from 16 July to 24 September 2018, when he was working for the Salford Royal NHS Foundation Trust for a probationary period. The matter was referred to the HCPC on 4 October 2018 and considered by the Investigating Committee on 4 May 2020.

Documentary evidence

2. The Panel had before it the HCPC documentation including the witness statements of AW and BL. In addition, in separate bundles were the Registrant’s witness statement and other documents, including testimonials and evidence of Continuing Professional Development
(CPD).

Registrant’s evidence

3. The Registrant provided information concerning his background and qualifications. He stated that he trained as a physiotherapist in Saudi Arabia, in the Rehabilitation and Physical Therapy department, King Saud University, College of Applied Medical Sciences, Riyadh. He graduated in 2001 in physical therapy and rehabilitation. As part of his internship year in 2001 he worked at the Central Riyadh Hospital for five months and the King Faisal Specialist Hospital and Research Centre in Riyadh for seven months. He was also a trainee in the physical therapy department in the Dallah Hospital, Riyadh.

4. From 2002 to 2005 he worked as a junior physiotherapist at the King Faisal Specialist Hospital and Research Centre in Jeddah, Saudi Arabia (‘King Faisal, Jeddah’). He was then a senior physiotherapist from 2005 to 2007 at King Faisal, Jeddah. During this employment he worked in physiotherapy outpatient clinics and in inpatient departments, such as neurosurgery, orthopaedic, cardiovascular, paediatric, oncology and internal medicine. He moved to the UK in December 2007, studied English in 2008 and in 2009 commenced an MSc course in applied physiotherapy, specialising in musculoskeletal physiotherapy, at Sheffield Hallam University for two years. In 2010 and 2011 he undertook shadowing at a private clinic in Sheffield: Prime Physiotherapy for approximately eight weeks. He saw a wide range of musculoskeletal-related conditions, assessments (mainly acute spinal pain, sport injuries and work-related injuries) and treatment provided. In February 2011 he completed his MSc degree qualification.

5. In October 2011 he started a PhD in sport injury rehabilitation at Salford University. His thesis title was ‘Investigation of causes and management for patients with patellofemoral pain syndrome’. He also obtained a Diploma in Community Development from Manchester Trinity College in May 2013. In 2015 and 2016 his papers on patellofemoral pain syndrome were published in the British Journal of Sports Medicine, the Physiotherapy Journal and an international conference journal. He was employed as a physiotherapy assistant from September 2016 to January 2017 at the Alfa Physio Clinic, Manchester. He was unemployed from July 2017 to July 2018. He had gained HCPC registration at the end of 2017 and started applying for work as a physiotherapist. In 2018 he was granted indefinite leave to remain in the UK. He has had no patient complaints or other issues raised, other than the fitness to practise allegations being considered by this Panel. He has supplied testimonials and letters of recommendation.

6. The Registrant stated that after his employment ended in September 2018, he applied for other physiotherapy roles. In November 2019 he started working as a musculoskeletal physiotherapist at the Aactiv Physio Clinic in Manchester city centre. He treated around 500 patients, with most seeing good improvement as the result of his treatment and he has supplied a testimonial from Aactiv’s managing director GA.

7. The Registrant had to cease practising in June 2020 when an Interim Order of suspension was made. This was changed to conditions of practice in November 2021 but he has not been able to find physiotherapy work. This is partly because he provides a significant amount of care for a family member. He is currently working as an administrator. He is looking at options to continue his PhD studies.

8. The Registrant stated it is essential that physiotherapists meet the HCPC’s Standards of Proficiency for Physiotherapists. Not only is it a requirement of being a registered physiotherapist but the standards are there to ensure that patients receive safe, clinically justified treatment provided by a professional who can practise autonomously. He admits that the factual allegations which are admitted demonstrate a lack of competence. He regularly attended CPD events and has undertaken research and attended courses to improve his knowledge. Due to the length of time since he last practised, he will need to meet the HCPC’s return to practice requirements and continue to keep his knowledge and skills up-to-date, by attending webinars and courses and by undertaking supervised practice.

9. The Registrant states he was interviewed for 30-45 minutes in 2018 for the post as a band 5 physiotherapist with the Salford Royal NHS Foundation Trust and was asked some questions about a role in a hospital and around a case study. In July 2018 he started work as a band 5 physiotherapist in Salford. This employment was for a short period and it ended four years ago. The Registrant does not have a good recollection of this employment and it was the first time he had worked in the area of intermediate care/falls. He had also not dealt with orthopaedic falls in the home environment before. This was also the first time he had worked for the NHS and there were some differences in writing forms or documents, compared to his previous employment.

10. He started the role in Salford at a difficult time in his personal life. He had been struggling with his PhD studies and there were issues with his children’s immigration status. Two of them had to stay in Saudi Arabia as he could not renew their visas. In addition, he had not practised since 2008. He stated that “in hindsight I should have taken steps to refresh my knowledge before returning to practice”. He did not feel comfortable because his supervisors BL and AW were focussing on picking up mistakes instead of giving support. As a result of this he lost confidence, was put on an action plan and dismissed from this employment in September 2018. During his induction with BL, he may have asked some questions to clarify certain points but he understood what she was saying. He had a good knowledge of physiotherapy terms from his training and previous employment and knew what SMART and SOAP terms mean and how to document and formulate them. He explained them and that in previous physiotherapy roles he had been required to write SOAP in a simple manner. He wanted to double check how they expected SOAP to be recorded. He knew that consent should be obtained and recorded before any assessment and treatment.

11. He disputes that he often recorded inaccurate information in relation to patients’ clinical history or recorded it in the incorrect place and does not recall the examples of this taking place. He recalls the patient who had a suspected DVT and he answered correctly by saying this was deep vein thrombosis and that the DVT is a blood clot in the vein, with symptoms such as red skin, swelling in the leg and warm skin around the painful area. He knew the meaning of ADL’s (Activities of Daily Living). He may have said “yes” as part of a conversation; but this did not mean that he did not understand what was being said or lacked knowledge. Patients would sometimes speak directly to the more senior physiotherapist, but this did not mean that the patients did not have confidence in him.

HCPC’s submissions

12. Mr Foxsmith on behalf of the HCPC submitted that the Registrant was an aspiring physiotherapist who had practised in Saudi Arabia, before moving to the UK to continue his extended studies. In 2018 he obtained employment in Salford as a Band 5 physiotherapist. He was on probation under supervision and was made subject to an Action Plan, but was unable to meet the standards required. He was academically able and could maintain CPD but still lacked competence and his clinical practice was not of the required standard. There were factors that mitigated his failings such as the language barrier and his difficult personal circumstances.

13. The oral evidence of the HCPC witness, and that of the Registrant was tested. The HCPC witness was clearly an honest and fair witness, with no reason to lie. The evidence from BL was hearsay but she has signed a declaration of truth and produced contemporaneous documents. Her evidence is consistent with the documents and the evidence of AW and can still carry some weight. Therefore, the Panel can find all the facts proved and that there is a lack of competence and current impairment under the personal and public component.

Registrant’s submissions

14. Ms Williamson on behalf of the Registrant submitted that the HCPC brings this case and the HCPC must prove the particulars which are not admitted to the civil standard, of the balance of probabilities. In respect of the particulars which are not admitted the Panel must examine the cogency of the HCPC’s evidence critically and anxiously. The Registrant is not required to prove anything or to give evidence. The Panel must carry out an assessment of the circumstances taking into account all the evidence; including the Registrant’s evidence and the testimonials he has supplied. The particulars which are not admitted have not been proved. The HCPC relies on the evidence of AW as their only live witness. She can only speak directly with regard to one date (17 August). In her evidence she stated that the Registrant’s communication was good.

15. The Panel should afford little weight to the hearsay evidence, including the statement of BL and it would be wrong to prefer the evidence of BL to the live evidence of the Registrant, which has been tested by cross-examination. The Panel should find only the admitted facts proved and it is admitted that those facts give rise to a lack of competence.

16. As regards impairment the Registrant is highly qualified and there is no reason why he cannot put this knowledge into practice. He is honest and of great integrity. He has accepted the facts which are proved and thereby demonstrated insight. There have been no complaints while he has been working in a private practice role more recently. He has undertaken training and produced testimonials. He has a keen interest in physiotherapy and a desire to learn. He is desperate to “get it right”. He did not receive advice on return to practice courses and he is not currently impaired. The lack of competence was remediable and he is intelligent and able to put his knowledge into practice.

Legal Assessor’s advice

17. The burden of proving each factual particular is upon the HCPC. That burden is to the civil standard of the balance of probabilities.

18. The evidence upon which the Panel must base its conclusions is that which it has heard and read during this hearing. It is for the Panel to decide what weight to place upon that evidence.

19. Hearsay evidence is admissible but should be approached with caution, because it has not been tested by cross-examination. The Panel should consider and decide what weight to afford to the hearsay evidence before taking it into account. The Civil Evidence Act 1995 considerations relevant to weighing of hearsay evidence are:
(a)whether it would have been reasonable and practicable for the party by whom the evidence was adduced to have produced the maker of the original statement as a witness;
(b)whether the original statement was made contemporaneously with the occurrence or existence of the matters stated;
(c)whether the evidence involves multiple hearsay;
(d)whether any person involved had any motive to conceal or misrepresent matters;
(e)whether the original statement was an edited account, or was made in collaboration with another or for a particular purpose;
(f)whether the circumstances in which the evidence is adduced as hearsay are such as to suggest an attempt to prevent proper evaluation of its weight.

20. The Panel may take into account admissions made by the Registrant but they are not sufficient alone to prove the factual particulars concerned and other evidence must also be considered. A lack of competence connotes a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the practitioner’s work. Registrants are required to comply with the HCPC Standards of Proficiency for Physiotherapists, but a breach of these standards does not in itself establish a lack of competence.

21. The HCPTS Practice Note on Finding that Fitness to Practice is Impaired states: in determining whether fitness to practise is impaired, Panels must take account of a range of issues which, in essence, comprise two components: the ‘personal’ component: the current competence, behaviour etc. of the individual registrant; and the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession. Current impairment is a matter for the judgment of the Panel; there is no burden or standard of proof to be applied at this stage. It is important to note that the test of impairment is expressed in the present tense, is the Registrant impaired at the current date?

22. The Panel’s decision should be recorded in a manner which explains what the Panel has decided and why it did so. The decision should enable readers, without the need to refer to any other materials, to understand the nature and seriousness of the issues before the Panel, the decision and the reasons for it. The detail required will depend upon the nature and complexity of the issues, but the decision should include the allegations and the Panel’s findings on all material questions of fact.

Decision
Findings of Fact

23. The burden of proving the factual particulars is upon the HCPC. That burden is to the civil standard of the balance of probabilities. The Panel accepted the advice from the Legal Assessor. The Panel has based its conclusions on the evidence it has heard and read during this hearing, after deciding what weight to place upon that evidence.

24. The oral evidence of one HCPC witness AW and that of the Registrant was tested at the hearing. AW adopted her statement and expanded on the contents. She maintained her account, was a clear and fair witness. She had no personal issue with the Registrant, wanted him to succeed and provided support. The Panel rejects the Registrant’s allegation, in his statement, that she focused on mistakes rather than supporting him. She had been a supervisor for 12 years. The hearsay evidence of BL was supported by contemporaneous documents and was consistent with the evidence of AW and some aspects had been agreed by the Registrant at the time. The panel took into account that BL had not been cross-examined but her statement was clear and consistent with the other documents.

25. The Panel found the oral evidence of the Registrant was sometimes difficult to understand and he appeared to have difficulty in fully understanding the questions asked.
Particular 1(a)i
you did not adequately conduct and/or record patient assessments in that you:
i. did not routinely obtain and/or routinely record obtaining patient consent to treatment without prompting;

26. The Registrant denies this allegation. The Panel finds there is no clear reference to consent in the notes made by the Registrant and he had to be prompted to record consent by patients according to BL. This is confirmed by the meeting notes and records seen by the Panel. He did not understand why he was obtaining and recording patient consent to assessment. The need to obtain and record consent was discussed during a Probation Meeting on 3 August 2018. It was agreed that he would continue to carry out new patient assessments and to complete the associated documentation, under supervision. This was discussed during a meeting on 13 August 2018 as there was no improvement. In his patient clinical notes in relation to two patients he had not documented consent for either. He stated that he got confused as to where consent is documented and that he did not know he had to gain it each visit. This was discussed on a number of occasions but he was not documenting consent when attending follow up visits and had to be prompted to obtain and record consent. The Panel finds that this particular is proved.

Particular 1(a)ii
you did not adequately conduct and/or record patient assessments in that you:
ii. did not routinely obtain and/or record adequate and/or accurate patient clinical histories;

27. The Registrant admits this allegation. He states he mostly obtained/recorded adequate/accurate patient clinical histories but accepts that he was not always doing so; based on the criticisms that were made about his practice. The Panel finds that this particular is proved on the basis of both the admission and consistent supporting evidence from BL and AW.

Particular 1(a)iii
you did not adequately conduct and/or record patient assessments in that you:
iii. did not routinely record and/or appropriately act upon responses to questions asked during assessment;

28. The Registrant admits this allegation. He states: I believe I mostly routinely recorded/appropriately acted on responses to questions asked during assessments. I accept that I was not always doing so based on the criticisms that were made about my practice. The Panel finds that this particular is proved on the basis of both the admission and consistent supporting evidence from BL.
Particular 1(a)iv
you did not adequately conduct and/or record patient assessments in that you:
iv. did not routinely record and/or demonstrate sufficient clinical reasoning;

29. The Registrant admits this allegation and there is evidence of this in meeting notes. The Panel finds that this particular is proved on the basis of both the admission and consistent supporting evidence from BL and AW.
Particular 1(a)v
you did not adequately conduct and/or record patient assessments in that you:
v. did not routinely set and/or adequately record SMART patient goals;

30. The Registrant admits this allegation and it is confirmed by the documents. BL states “he was not familiar with how to document ‘SOAP or what ‘SMART’ goals were and how to formulate them. These terms are taught to students undertaking their Physiotherapy degree at University”. The Panel finds that this particular is proved on the basis of both the admission and consistent supporting evidence from BL.
Particular 1(b)
you used non-specific and/or non-clinical terminology in patient notes;

31. The Registrant admits on one occasion he used non-specific/non-clinical terminology in patient notes. This is confirmed by the evidence of AW, BL and the documents.
Particular 1(c)i
you demonstrated a lack of knowledge regarding clinical and/or non-clinical terms and/or physiotherapy practices in that you i. did not understand and/or demonstrate an understanding of consent and/or mental capacity;

32. The Registrant partly admits this allegation. He states: I did understand/demonstrate consent but admit that I did not properly understand mental capacity. I have undertaken courses since to address this. The Panel accepts the evidence from BL which stated that “he did not understand what consent was and he answered questions as though this was not something he had heard of before. It became apparent he had never heard of mental capacity and did not understand its relevance within his role”. He did not understand the provisions contained within the Mental Capacity Act or the meaning of acting in someone’s best interest according to BL. The Panel finds that this particular is proved on the basis of the evidence of BL and the supporting documents.

Particular 1(c)ii
you demonstrated a lack of knowledge regarding clinical and/or non-clinical terms and/or physiotherapy practices in that you ii. did not understand and/or demonstrate an understanding of SOAP notes;

33. The Registrant denies this allegation. He states: I realised that there were differences in the way SOAP notes were taken in Saudi Arabia and the UK and therefore changed the way I wrote SOAP notes. The Panel find the Registrant did not understand some basic Physiotherapy terms. It accepted the evidence of BL that “he was not familiar with how to document ‘SOAP or what ‘SMART’ goals were and how to formulate them. These terms are taught to students undertaking their Physiotherapy degree at University”. The Panel finds that this particular is proved on the basis of the evidence of BL and the supporting documents.

Particular 1(c) iii
you demonstrated a lack of knowledge regarding clinical and/or non-clinical terms and/or physiotherapy practices in that you iii. did not understand and/or demonstrate an understanding of SMART goals;

34. The Registrant admits this allegation. It accepted the evidence of BL that “he was not familiar with how to document ‘SOAP or what ‘SMART’ goals were and how to formulate them. These terms are taught to students undertaking their Physiotherapy degree at University”. The Panel finds that this particular is proved on the basis of the evidence of BL and the supporting documents.

Particular 1(c) iv
you demonstrated a lack of knowledge regarding clinical and/or non-clinical terms and/or physiotherapy practices in that you iv. did not understand and/or demonstrate an understanding of Deep Vein Thrombosis;

35. The Registrant denies this allegation. The Panel accepts the evidence of BL that “he did not recognise the ‘red flags’ relating to a possible DVT or ask the appropriate questions despite training on managing patients with total knee replacements on 31 July 2018 including how to ‘describe signs and symptoms of a Deep Vein Thrombosis and what to do if one is suspected”. The Panel finds that this particular is proved on the basis of the evidence of BL and the supporting documents.
Particular 1(c) v

you demonstrated a lack of knowledge regarding clinical and/or non-clinical terms and/or physiotherapy practices in that you v. did not understand and/or demonstrate an understanding of what a hip screw is;

36. The Registrant admits this particular. The Panel finds that this particular is proved on the basis of the admission, the evidence of BL and the supporting documents.

Particular 1(c) vi

you demonstrated a lack of knowledge regarding clinical and/or non-clinical terms and/or physiotherapy practices in that you vi. did not understand and/or demonstrate an understanding of what baseline means;

37. The Registrant admits this particular. The Panel finds that this particular is proved on the basis of the admission, the evidence of BL and the supporting documents.

Particular 1(c) vii
you demonstrated a lack of knowledge regarding clinical and/or non-clinical terms and/or physiotherapy practices in that you vii. did not understand and/or demonstrate an understanding of the difference between elective and trauma in relation to orthopaedic patients;

38. The Registrant admits this particular. The Panel finds that this particular is proved on the basis of the admission, the evidence of BL and the supporting documents.
Particular 1(c) viii
you demonstrated a lack of knowledge regarding clinical and/or non-clinical terms and/or physiotherapy practices in that you viii. did not understand and/or demonstrate an understanding of Activities of Daily Living;

39. The Registrant denies this allegation. The Panel accepts the evidence of BL that the Registrant “did not understand the meaning of ADL’s (Activities of Daily Living) and he was recording hobbies in the ADL section. He asked on a number of occasions what ADL’s were”. The Panel finds that this particular is proved The Panel finds that this particular is proved on the basis of the admission, the evidence of BL and the supporting documents.

Particular 1(c) ix
you demonstrated a lack of knowledge regarding clinical and/or non-clinical terms and/or physiotherapy practices in that you ix. did not understand and/or demonstrate an understanding of red flags and/or sinister pathologies;

40. The Registrant admits this allegation. The documents confirm this particular. The Panel finds that this particular is proved on the basis of the admission, the evidence of BL and the supporting documents.

Particular 1(d)
you demonstrated poor communication with patients.

41. The Registrant denies this allegation. He states “on some occasions I did double check what patients had said to make sure I documented their responses adequately”. The Panel found the Registrant had communication difficulties when giving his evidence. The Panel finds there is ample evidence from BL, AW and the supporting documents with regards the understanding of what the Registrant said and how he interpreted accounts from patients and colleagues. The Panel finds that this particular is proved.

Particular 1(e)
did not adequately prepare for patient assessments.

42. The Registrant partly admits this allegation. He states: “at times I did not adequately prepare for patient assessments”. The documents confirm the Registrant was not checking referrals. The Panel finds that this particular is proved on the basis of the admission, the evidence of BL and the supporting documents.

Decision on Grounds

43. The Registrant admits a lack of competence in respect of the admitted facts. The Panel finds that the Registrant failed to comply with the following HCPC Standards of Proficiency for Physiotherapists:

1. be able to practise safely and effectively within their scope of practice

1.1 know the limits of their practice and when to seek advice or refer to another professional
3 be able to maintain fitness to practise
3.3 understand both the need to keep skills and knowledge up to date
4. be able to practise as an autonomous professional, exercising their own professional judgement

4.1 be able to assess a professional situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem

4.2 be able to make reasoned decisions to initiate, continue, modify or cease techniques or procedures, and record the decisions and reasoning appropriately

4.3 be able to initiate resolution of problems and be able to exercise personal initiative

4.4 recognise that they are personally responsible for and must be able to justify their decisions

8. be able to communicate effectively

8.1 be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, colleagues and others

10. be able to maintain records appropriately

10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines

14. be able to draw on appropriate knowledge and skills to inform practice

44. A lack of competence connotes a standard of professional performance which is unacceptably low, and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the practitioner’s work.

45. The Panel is satisfied that the proved factual particulars do amount to lack of competence, with the exception of particular 1b (you used non-specific and/or non-clinical terminology in patient notes). Although the facts are proved in respect of this particular, it has not been established that it amounts to a lack of competence, because there is only an isolated example of the use of non-specific or non-clinical terminology in patient notes. On the evidence before the Panel, a lack of competence has not been demonstrated with regard to this particular by reference to a fair sample of the Registrant’s work.

Decision on Impairment

46. The Panel considered the HCPTS Practice Note on Finding that Fitness to Practice is Impaired. In determining whether fitness to practise is impaired, Panels must take account of a range of issues which, in essence, comprise two components:
1. the ‘personal’ component: the current competence, behaviour etc. of the individual registrant; and

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

47. The purpose of HCPTS proceedings is not for a Registrant to be punished. The Registrant has engaged with the HCPC process by providing documents and has given evidence to the Panel at this hearing.

48. Current impairment is a matter for the professional judgment of the Panel; there is no burden or standard of proof to be applied at this stage. It is important to note that the test of impairment is expressed in the present tense: that fitness to practise is impaired at the current date.

49. There is a lack of insight by the Registrant in respect of the matters giving rise to these proceedings. He has undertaken some Continuing Professional Development since these matters arose but this has not been sufficiently focused, to address the issues raised on the proved facts and his lack of competence. The Registrant has produced historic character evidence and a supportive testimonial from his employer who states there have been no complaints against the Registrant and he is professional. The current work being undertaken by the Registrant is of a limited nature. He has engaged with the HCPC and with this hearing but he has not focused sufficiently on the key issues raised.

50. These matters are remediable but in the current circumstances there is a high risk of repetition. The Registrant is currently impaired under the personal component for public protection reasons. His communication problems and lack of basic clinical skills show he is lacking in relation to the necessary attributes and the fundamental tenets of the profession, for safe practice. He did not recognise the risk to patients and demonstrated a lack of insight when he gave evidence to the Panel. He referred to “mistakes which anyone could make”. This demonstrated a limited understanding of the risk to patients and the concept of harm arising from the proved facts and the extent of his lack of competence. The Registrant does not accept that his fitness to practise is currently impaired. He states that he is safe to return to practice and appears to take the view that the incidents giving rise to the proved facts are not serious. The Panel finds he has no meaningful insight into the risks posed to service users, colleagues, members of the public and the profession.

51. The Panel has also taken into account there are important public policy issues. The Registrant is currently impaired on public policy grounds because public confidence in the profession and the regulatory process would be undermined, if a finding was made that his fitness to practice is not currently impaired. There is a high risk of harm due to the Registrant’s lack of competence and the nature of his impairment under the personal component. Despite the lapse of time there has been no significant improvement in the level of risk of harm to the public and the public interest posed by the Registrant, if he returns to practice.

52. Accordingly, the Panel finds that the Registrant’s fitness to practise is currently impaired on both the personal and public components.

53. The Panel considered the submissions made by Ms Williamson and Mr Foxsmith and accepted the advice of the Legal Assessor.

54. In accordance with the Legal Assessor’s advice the Panel has had regard to the HCPC Sanctions Policy, which states that any sanction must be proportionate, is not intended to be punitive and should be no more than is necessary to meet the legitimate purposes of providing adequate protection to the public, to protect the reputation of the profession, maintain confidence in the regulatory system and declare and uphold proper professional standards.

55. The Panel’s primary function at this stage is to protect the public, while deciding what, if any, sanction is proportionate, taking into account the wider public interest and the interests of the Registrant. The Panel should start by considering the least restrictive sanction first, working upwards only where necessary. The final sanction should be a proportionate approach, and will therefore be the minimum action required to protect the public.

56. In July 2018 the Registrant started work as a band 5 physiotherapist in Salford. This employment was for a short period, it ended four years ago and it was the first time he had worked in the area of intermediate care/falls and there were some differences in writing forms or documents, compared to his previous employment. He started the role at a difficult time in his personal life. He had been struggling with his PhD studies and there were issues with his children’s immigration status and he had not practised since 2008.

57. The Registrant had to cease practising in June 2020 when an Interim Order of Suspension was made. This was changed to conditions of practice in November 2021 but he has not been able to find physiotherapy work, partly because he provides a significant amount of care for a family member. He is currently working as an administrator.

58. The Registrant accepts the facts give rise to a lack of competence and that he will need to meet the HCPC’s return to practice requirements. He will continue to keep his knowledge and skills up-to-date, by attending webinars and courses and undertaking supervised practice. Ms Williamson invited the Panel to consider that a Conditions of Practice Order is appropriate in this case.

59. The Panel identified the following aggravating factors:

• The Registrant’s insight is not yet fully formed.
• The Panel found the oral evidence of the Registrant was sometimes difficult to understand and he appeared to have some difficulty understanding questions.
• He has not focused sufficiently on the key failings raised.
• There is a high risk of repetition and his failings were wide-ranging.
• The Registrant is impaired under the personal and public components.

60. The Panel identified the following mitigating factors:

• The Registrant has engaged in the regulatory process.
• He has some insight and his lack of competence is remediable.
• He is willing to remediate his current impairment.
• His integrity, remorse, testimonials and academic achievements.
• The language barrier and cultural differences when moving to the UK and his difficult personal circumstances.

61. The Panel finds that due to the nature and extent of the current impairment in this case, taking no further action or mediation is not appropriate.

62. A Caution Order would be insufficient to mark the significance of the Panel’s findings. It would offer no restriction on the Registrant’s practice and would therefore be insufficient to protect the public and uphold the wider public interest. There is a high risk of repetition and the Registrant’s failings were not isolated incidents.

63. The Sanctions Policy states:

106. A conditions of practice order is likely to be appropriate in cases where:

• the registrant has insight;

• the failure or deficiency is capable of being remedied;

• there are no persistent or general failures which would prevent the registrant from remediating;

• appropriate, proportionate, realistic and verifiable conditions can be formulated;

• the panel is confident the registrant will comply with the conditions;

• a reviewing panel will be able to determine whether or not those conditions have or are being met; and

• the registrant does not pose a risk of harm by being in restricted practice.

116. Conditions of practice orders can be imposed for a period of up to three years. In determining the appropriate length of a conditions of practice order, the panel should consider all the information available to it to come to an appropriate and proportionate decision. It should provide clear written reasons for deciding on the particular length of the order.

64. The Panel had a particular concern in relation to the issue of the insight shown by the Registrant concerning the potential risks to service users through his failings in practice. The Panel noted the HCPC submission that in respect of the Registrant’s insight “it was not as fully formed as the regulator would wish”. The lack of full insight and the consequential increased risk of repetition required the Panel to ensure that any formulated conditions of practice would satisfy the primary responsibility to protect the public and the reputation of the profession.

65. The Panel is able to formulate workable and practicable conditions of practice that adequately address the risks and are proportionate to the proved facts and does not amount to suspension. The Registrant’s failures are capable of being remedied and allowing the Registrant to remain in practice, albeit subject to conditions, will protect the public and the wider public interest. This will also enable a future reviewing panel to determine whether sufficient remediation has been completed. Furthermore, the Panel is confident due to the Registrant’s integrity and commitment to learn he will be able to comply with the conditions set out below.

66. In the judgement of the Panel a Suspension Order would be disproportionate and unduly punitive, in the current circumstances. Accordingly, the Panel has determined that a Conditions of Practice Order is the necessary and proportionate order to ensure the safety of the public. This Order will be reviewed before it expires. A period of 12 months is required to reflect the seriousness and extent of the Registrant’s failings.

The Registrar is directed to annotate the Register to show that for 12 months from the date that this Order comes into effect (the operative date) you Mr Mazen Alkasem must comply with the following Conditions of Practice:
1. Within two months of the operative date:
You must produce a written reflective piece that explains your understanding of the potential impact of your identified practice deficiencies on service users, colleagues and the reputation of the physiotherapy profession. This must be forwarded to the HCPC and will be made available to any subsequent panel.

2. Prior to commencing work as a physiotherapist:
You must contact the HCPC and successfully complete it’s recommended process for a “Return To Practice”.

3. If you undertake employment as a registered physiotherapist, you must place yourself and remain under the supervision of a workplace supervisor, who is a physiotherapist of band 6 or higher and registered by the HCPC.

4. You must supply details of your supervisor to the HCPC within one week of returning to practice as a physiotherapist, attend upon that supervisor as required and follow their advice and recommendations.

5. You must work with your nominated supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:

a. Effective communication with service users and colleagues.
b. Conducting comprehensive and effective patient assessments.
c. Recording comprehensive and effective patient assessments.

6. Before undertaking physiotherapy practice without direct supervision, you must complete refresher training in the following subjects:

a. Obtaining and recording service user consent for treatment
b. Obtaining and recording service user clinical history.
c. Obtaining and recording service user assessments.
d. Obtaining and recording clinical reasoning.
e. Obtaining and recording SMART service user goals.
f. Obtaining and recording service user SOAP notes.
g. Mental capacity.
h. Activities of Daily Living.
i. Red flags and sinister pathologies.
j. Deep vein Thrombosis.

7. You must detail the areas of required refresher training within your Personal Development Plan and have them confirmed by your nominated supervisor when they are successfully completed.

8. You must meet with your nominated supervisor on a monthly basis to discuss and document your progress towards achieving the objectives set out in your Personal Development Plan and provide copies of these documents to the HCPC at least 28 days before the review hearing.

9. Once you have completed the specified refresher training you must undertake a period of directly supervised physiotherapy practice for a minimum of 3 months.

10. You must not commence physiotherapy practice without direct supervision until your nominated supervisor has confirmed your overall fitness for safe unsupervised practice and you have provided evidence of this to the HCPC.

11. Within three months of commencing practice as a physiotherapist you must forward a copy of your Personal Development Plan to the HCPC.

12. You must allow your nominated supervisor to provide information to the HCPC about your progress in attaining your objectives within your Personal Development Plan.

13. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

14. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

15. You must inform the following parties that your registration is subject to these conditions:

a. any organisation or person employing or contracting with you to undertake professional work;
b. any agency you are registered with or apply to be registered with (at the time
of application); and
c. any prospective employer (at the time of your application).

16. Any condition requiring you to provide information to the HCPC is to be met by you sending it marked for the attention of the relevant Case Manager or the FTP department. 

Right of Appeal

You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Reasons for the making of an Interim Conditions of Practice Order:

The Panel accepted the advice of the Legal Assessor to consider whether an interim order was necessary under Article 31, to protect the public or in the public interest or the Registrant’s own interest, because of the nature of the findings made in this case. The HCPC submitted that an interim order is necessary. The Panel is satisfied that it is appropriate to direct that the Registrant’s registration should be subject to Conditions of Practice on an interim basis, in the same terms as the substantive order set out above. This order is required for the protection of the public, is in the public interest and is in the Registrant’s own interest. The Panel concluded that the appropriate length of the Interim Conditions of Practice Order is 18 months, as an Interim Order would continue to be required pending the resolution of an appeal, in the event of the Registrant giving notice of an appeal within 28 days.

History of Hearings for Mazen Alkasem