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 8 November 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 were 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 Sampson, 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:

• The Panel noted that the Registrant did not attend the substantive hearing in October 2021, nor the subsequent reviews. The Registrant confirmed in advance of each hearing that she would not be attending and had decided to change career. In an email dated 10 January 2024, she stated:

“I will not be able to attend the hearing due to work commitments.

I have received the HCPC’s bundle of documents and will not be providing any supporting documents.

I have also signed the voluntary removal form (which your colleague [named] is aware of as I am no longer practicing as a Physiotherapist and will not be returning to practice as a Physiotherapist in the future.”

• The Panel also noted that, other than a number of similar emails from the Registrant, there had been no material engagement from the Registrant since the substantive hearing. 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.

• There had been no application to adjourn and no indication that the Registrant would attend on an alternative date. Therefore, it was unlikely that relisting this review hearing would serve any useful purpose.

• 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 had not taken up that opportunity.

• As this is a mandatory review, any potential disadvantage to the Registrant was significantly outweighed by the strong public interest in ensuring that the hearing proceeded 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 reiterated her desire to change career and to no longer practise 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. At the review hearing on 12 July 2023, the Registrant did not attend and again explained that she had changed career and no longer practiced as a Physiotherapist. The reviewing panel imposed a further Suspension Order for a period of 6 months and stated as follows:

“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 do so, Alternatively, if the Registrant remains committed to her stated intention to cease to 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.”

14. In June 2023, the Registrant had made an application for voluntary removal which had been agreed but not yet formally concluded. However, a Voluntary Removal hearing scheduled on 10 November 2023 was adjourned as the Registrant had not returned the signed Voluntary Removal Agreement. On 10 January 2024, the Registrant returned by email a Voluntary Removal Agreement which appeared to be signed and witnessed, but instead of handwritten signatures contained typed name entries. This was insufficient to authenticate the deed. In response to a request to submit an authenticated signed copy, the Registrant sent an email response on 12 January 2024 stating that she could not do as requested because she did not have access to a printer or other facilities to enable this.

Submissions

HCPC

15. Ms Sampson, on behalf of the HCPC, reminded the Panel that the purpose of this hearing was to review the current Suspension Order imposed on the Registrant by a panel of the Conduct and Competence Committee on 14 October 2021 under Article 30 of the Health Professions Order 2001.

16. Dealing with an absence of remediation, Ms Sampson submitted that because the Registrant had not engaged with these proceedings since the substantive hearing other than the periodic emails that she had sent to the HCPC, there was no evidence to show that the Registrant had taken any steps to remediate her practice. There was no reflection, evidence of training and education, or any other information that would suggest an improvement in the Registrant’s insight or any commitment by her to secure a safe and effective return to the Register.

17. Ms Sampson said that whilst the Panel must always approach the matter of sanction proportionately, the absence of engagement and remediation suggested that the succeeding periods of suspension had been ineffective. The Registrant had instead stated several times that she no longer wished to pursue a career in Physiotherapy. In these circumstances, Ms Sampson submitted that a Striking Off Order would be the most appropriate and proportionate order today.

Registrant

18. There were no submissions for or on behalf of the Registrant other than the email correspondence already referred to.

Decision

Panel’s approach

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

20. The Panel accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt, namely:

• The purpose of the review is to consider the issue of impairment based on the previous panels’ 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 panels’ findings of impairment;

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

• The Panel should have regard to the HCPTS Practice Note “Fitness to Practise Impairment” 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 determines 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”, 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 a 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.

Current impairment

21. The Panel noted that the Registrant appears to have conclusively decided to leave the profession of Physiotherapy as she has repeatedly indicated in her emails, including the latest dated email of 12 January 2024. The Registrant decided to make an application for Voluntary Removal from the Register but has not taken the opportunity to complete this process. The Registrant’s reasons for her inability to do so were puzzling, but despite several opportunities offered to her and repeated helpful emails to support her, she has not been able to sign, have witnessed, and return the necessary form. This has become a pattern of miscommunication, which assisted the Panel in deciding that it should approach today’s review on the basis that the Voluntary Removal process, though ineffective, indicated the Registrant’s concluded decision not to return to the profession of Physiotherapy.

22. There was no evidence before this Panel that the Registrant fully appreciates the gravity of her lack of competence, nor the impact on the safety of patients. The Registrant had not 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 had been no material change in circumstances since the finding of impairment in October 2021 to suggest that the Registrant is no longer impaired. The Panel concluded that, if anything, the deficiencies in the Registrant’s practice are likely to have increased due to the passing of a significant period of time since she last practised as a Physiotherapist.

23. The Panel noted that a significant aspect of the public component is upholding proper standards of conduct and behaviour. Members of the public would be extremely concerned to learn that a Physiotherapist had failed to meet the standards expected of them and further, 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 and 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.

24. The Panel concluded that the Registrant’s fitness to practise remains impaired on the basis of both the personal and public components.

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

Sanction

26. 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.

27. The Panel considered a Caution Order. As the Registrant has demonstrated an absence of 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.

28. The Panel went on to consider a Conditions of Practice Order. The Panel took the view that the Registrant is 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.

29. Although the Panel acknowledged that the Registrant’s failings are potentially capable of being remedied, in the absence of meaningful 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.

30. The seemingly concluded decision by the Registrant to leave the profession entirely was also inconsistent with the purposes of a Conditions of Practice Order.

31. The Panel concluded that there were no conditions it could devise which would be appropriate, workable, and measurable.

32. The Panel next considered extending the current Suspension Order for a further period of time. A Suspension Order would reaffirm to the Registrant, the profession, and the wider public the standards expected of a registered Physiotherapist. The Panel noted that a Suspension Order would prevent the Registrant from practicing 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.

33. The Panel noted that the Registrant’s most recent communication with the HCPC was once again clear that she has made the conscious decision to relinquish her practice as a registered Physiotherapist. In these circumstances, the Panel concluded that an extension of the existing Suspension Order would not serve any purpose. Further, there was a risk that the reasonable and informed member of the public would have a real concern that the central purpose of a restriction on the Registrant’s practice, namely safety of the public, was not being fully and realistically addressed by a panel which appeared not to take fully into account the impact of the Registrant’s unwillingness to engage.

34. The Registrant’s practice has been restricted for a period of more than two years. Accordingly, the Panel now had the option of considering a Striking Off Order.

35. The Panel considered paragraph 131 of the HCPC Sanctions Policy, which states that:

“A Striking Off Order is likely to be appropriate where the nature and the gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the Registrant:

• Lacks insight

• Continues to repeat the misconduct or [in the case of lack of competence or health matters], where a Registrant who has been suspended for two years continuously, fails to address a lack of competence; or

• Is unwilling to resolve matters.”

36. The Registrant has demonstrated a continuing absence of any meaningful engagement. She has repeatedly informed the HCPC that she has changed careers and does not intend to return to practice as a Physiotherapist in the future. The Panel considered that it may now safely conclude the Registrant is unlikely to address her lack of competence or to resolve matters in the future.

37. In these circumstances, and taking account of the guidance, the Panel concluded that the only appropriate and proportionate order at this point in time was a Striking Off Order.

The Registrar is directed to strike the name of Miss Sreenithi Sudhakar from the Register on the date that this Order comes into effect.

The Order imposed today will apply from 11 February 2024.

History of Hearings for Sreenithi Sudhakar