Stefania Antonucci

Preliminary Matters
Service
1. The Panel was satisfied that service of notice of today’s hearing had been effected in accordance with the Health Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”). It took into account that the Notice of Hearing had been sent to the Registrant’s registered email address on 10 June 2024 at 19.07.46. Further, the Panel was provided with confirmation from Microsoft Outlook, timed at 19.07.51 the same day, that: “Delivery to these recipients or groups is complete, but no delivery notification was sent by the destination server.” The Panel therefore was satisfied that the Notice of Hearing had been delivered to the Registrant’s email address on the register.
Proceeding in absence

2. The Registrant did not appear nor was she represented.

3. On behalf of the HCPC, Ms Khorassani applied for the hearing to be conducted in the absence of the Registrant under Rule 11 of the Rules, on the basis that all reasonable steps had been taken to serve the Notice of Hearing on the Registrant and therefore that the Registrant had been notified of the time and date of the hearing at her registered email address. In addition, the Panel was to note that an additional attempt had subsequently been made to contact the Registrant by Ms Khorassani, by email, to which there had been no reply. Accordingly, Ms Khorassani submitted that all reasonable steps had been taken by the HCPC to bring this matter to the Registrant’s attention.

4. Ms Khorassani asked the Panel to note that the Registrant had not attended the original substantive hearing and had not otherwise engaged with the HCPC. The Registrant had not asked for an adjournment and Ms Khorassani submitted that an adjournment would not be likely to result in the Registrant’s attendance on a later date. Accordingly, she submitted that it was in the public interest for the hearing to proceed expeditiously, bearing in mind, not only that this was a mandatory review, but also that the order would lapse on 22 August 2024 if there were further delay.

5. After Ms Khorassani had completed her submissions, it came to light that the Hearings Officer had received a reply to her separate email to the Registrant dated 10 July 2024 asking whether the Registrant intended to attend the hearing. The Registrant had confirmed, by email later that day, that she was not going to attend the hearing, but gave no additional information.

6. Having considered the HCPTS Practice Note entitled “Proceeding in the Absence of the Registrant” and the advice of the Legal Assessor on the case of GMC v Adeogba [2016] EWCA Civ 162, the Panel determined that there was a burden upon a registrant to keep her contact details updated and to engage with their regulator. The Panel therefore accepted that the HCPC had “taken all reasonable steps” to serve the Notice of Hearing upon the Registrant.

7. The Panel noted that the Registrant had been unequivocal in stating that she did not intend to attend the hearing and, in particular, had not applied for an adjournment. Further, the Panel noted that the Registrant had not otherwise engaged with the regulatory process nor had she attended the previous substantive hearing in February of this year. The Panel therefore concluded that she had voluntarily absented herself and had waived her right to appear. The Panel also reminded itself of the overriding public interest in dealing with matters in a timely manner and that this was a mandatory review. In balancing the Registrant’s interests and the public interest, the Panel decided that the matter should be heard in the absence of the Registrant.

Background
8. The Panel took account of the previous Panel’s summary of the background to this matter, as set out in its determination from February 2024, as follows:
“5. The Registrant is registered with the HCPC as a Speech and Language Therapist. She was employed by The Royal Devon and Exeter NHS Foundation Trust (‘the Trust’) as a Specialist Speech and Language Therapist in Head and Neck Cancer, from 4 August 2014 until 22 June 2021 when she resigned from her post.
6. A written referral was sent by email to the HCPC on 7 July 2021 by the Trust’s Head of Acute Therapy, raising concerns about the Registrant’s conduct regarding her work for the Royal Devon and Exeter Hospital (‘the Hospital’).
7. The first concern related to an incident on 5 October 2020. It was alleged that the Registrant had asked a newly qualified nurse to complete a swallow assessment on a patient who had undergone major head and neck surgery four days previously. It was alleged that the Registrant had asked the nurse to give the patient sips of water and look out for adverse signs such as coughing and ‘wet’ voice, but these would not have been present as they had an insensate larynx.
8. The second concern raised in the referral concerned events later in November 2020. It was alleged that the Registrant had not completed a full swallow assessment for a patient and that when this was raised with her she had stated that she had carried out the assessment but the new electronic record system had not worked properly when she recorded the assessment. However, investigation by her Line Manager showed that she had not accessed the record until after the incomplete swallow assessment had been raised with her and that she subsequently amended the record.”

9. Following the HCPC investigation, the matter proceeded to a hearing in February 2024, at which the Registrant did not attend. The Substantive Hearing Panel found the following Particulars of the Allegation proved, namely:
“1) On 5 October 2020, you:
a) Did not obtain a sufficiently detailed history of Service User C before considering whether a swallow assessment was appropriate;
6
b) Instructed Colleague A to conduct a swallow assessment on Service User C, when it was not appropriate to do so:
i. In that, it was your responsibility in your role as a Speech and Language Therapist to conduct such assessments;
ii. In light of Service User C's history.
2) On or around 12 November 2020 you retrospectively recorded a swallow assessment for normal fluids (Level 0) with Service User A that took place on 11 November 2020. In that when…
…b) You recorded you had undertaken a swallow assessment for normal fluids for Service User A, when you had not undertaken such an assessment. You told your Line Manager that you had recorded a swallow assessment for normal fluids 8 3 (Level 0) for Service User A on 11 November 2020 when you had not in fact done so. ”

10. The Substantive Hearing Panel did not find the allegations of dishonesty proved. It subsequently found that the Registrant was impaired on the basis of her misconduct and went on to consider the level of restriction that was appropriate and proportionate in all the circumstances of this case. In deciding to impose a Suspension Order for a period of five months, the Substantive Hearing Panel stated:
“97. The aggravating factors were these: -
• the Registrant has shown very limited insight;
• she has taken no meaningful steps in remediation of the misconduct;
• she has neither apologised nor shown remorse for the misconduct;
• her misconduct created a risk of harm to a patient.
98. The Panel considered the following to be mitigating factors: -
• the incident was isolated;
• the Registrant was working from home and therefore could not access the patient’s medical records or attend on the patient at the Hospital;
• she was suffering from stress at the time;
• no actual harm was caused to the patient.
99. In making an overall assessment of the seriousness of the misconduct, the Panel has concluded that the Registrant has been culpable of conduct that brought the profession into disrepute and breached a fundamental tenet of the profession, placing a service user at risk of serious harm. She has taken no steps to address the misconduct and there is a real risk of its repetition…
…108. A suspension order would provide public protection against the risk of repetition and adequately mark the gravity of the misconduct. It would also give the Registrant the opportunity of reflecting on the Panel’s findings and persuading a panel reviewing her case that a repetition of the misconduct would be unlikely, so that she could return to practice if her fitness to practise were no longer impaired. The Panel considers this to be an appropriate opportunity to grant to the Registrant, bearing in mind that her misconduct took place on an isolated occasion, that she has an otherwise clear fitness to practise record and no actual harm was caused to the patient.
109. The Panel is aware that even a short period of suspension may result in the termination of a registrant’s employment and that, more generally, a period of suspension may have adverse financial effects on a practitioner. The Panel is not aware of the Registrant’s current professional circumstances. However, a period of suspension is necessary to protect service users from the risk of a repetition of the misconduct.
110. The Panel is required to determine a period of suspension that is necessary and proportionate in the circumstances. It has concluded that a period of five months is sufficient for the Registrant to take the necessary remedial action in response to her misconduct. That period of suspension is also adequate to mark the gravity of the misconduct in all the circumstances.
111. In considering whether or not a suspension order would be a sufficient and proportionate sanction, the Panel did also consider whether a striking off order would be the appropriate sanction in the circumstances. The Panel took into account the matters set out in the SP that address a striking off order (paragraphs 127 – 131). The Panel considered that it would be incorrect to conclude at this stage that the Registrant is unwilling to resolve matters (paragraph 131) despite her failure to date to engage with the fitness to practise process. In the circumstances of this case, the Registrant’s removal from the profession for five years would be unnecessary and disproportionate. Therefore, the Panel decided that a striking off order would be inappropriate.
112. Therefore, the Panel has decided to impose a suspension order for a period of five months.”

11. Finally, that Panel suggested:
“113. The Panel considered that the reviewing panel may be assisted by the following:
• The Registrant’s attendance at the hearing;
• A written reflection from the Registrant regarding this Panel’s findings;
• Evidence of remediation including any training or CPD focused on the misconduct found proved;
• Any testimonials from work colleagues (from either paid or unpaid work).”
Submissions

12. Ms Khorassani reminded the Panel of the factual background to the case, the decision of the previous panel, and the Panel’s powers as to extending, continuing, varying or revoking the current Order. She referred the Panel to the HCPTS Practice Note on “Review of Article 30 Sanction Orders” and submitted that the key issue to consider was what had changed since the Order was imposed. The reviewing panel’s task was to “consider whether all the concerns raised in the original finding of impairment have been sufficiently addressed”. The Practice Note explicitly set out relevant factors to take into account, which included: “the steps taken to address specific failings or other issues identified in the previous decisions; the degree of insight shown and whether this has changed; whether any other fitness to practice issues have arisen; and whether the Registrant has complied with the existing Order.”

13. Moreover, Ms Khorassani submitted that, as the decision in Abraheam v GMC [2008] EWHC 183 (Admin) indicated, in practical terms there was a “persuasive burden” on the Registrant to demonstrate at a review hearing that she had fully acknowledged the deficiencies which led to the original finding and had addressed that impairment sufficiently “through insight, application, education, supervision or other achievement…”. However, she contended that there had been a total absence of engagement on the Registrant’s part and there was no further update or any other information from or about her. In particular, she had not addressed the recommendations made by the previous panel. There was, accordingly, no evidence of improvement, insight or remediation. The Registrant had failed to take the opportunity: to engage; to remedy the concerns; or to show any renewed commitment to the profession. Ms Khorassani therefore contended that the Registrant had not discharged the persuasive burden to address the concerns about her fitness to practise.

14. Ms Khorassani therefore submitted that the Registrant’s fitness to practise remained impaired on a personal basis because the risk of harm to the public remained high in the absence of any new information about her practice. She further contended that a finding of impairment was necessary in order to maintain public confidence in the profession.

15. In relation to sanction, Ms Khorassani reminded the Panel to consider not only the need to balance the rights of the Registrant against the duty to protect the public, but also the wider public interest, together with the perception of the profession and regulatory process. She invited the Panel to conclude that an extension of the current suspension order by a period that the Panel considered appropriate was the proportionate sanction in the circumstances. A further period of Suspension would give the Registrant an additional opportunity: to engage in the process; to provide the information and evidence requested; and therefore to address the findings of the original Panel.

Decision

Decision on Impairment
16. In reaching its decision, the Panel considered the previous panel’s decision and had regard to the principles set out in the HCPTS Practice Notes entitled “Fitness to Practise Impairment” and “Review of Article 30 Sanction Orders”. The Panel accepted the advice of the Legal Assessor, who confirmed that the Panel would be entitled to presume impairment and see whether there have been any changes in the Registrant’s situation since the last hearing. Further, it was to have regard to the HCPTS’ “Sanctions Policy”.

17. The Panel also had regard to the case of Abrahaem v GMC 2008 EWHC 183 (Admin) in which it was held that there is in practical terms a “persuasive burden” on a registrant to address the concerns that were highlighted by previous panels. This required the Registrant to acknowledge the deficiencies which led to the original findings and to address impairment through evidence or material demonstrating insight, application, education, supervision or some other achievement.

18. The Panel noted that the Registrant had not submitted any such evidence or material to indicate any insight or reflection, or any indication that she had addressed her misconduct. She had not responded to any of the recommendations made by the previous panel, notwithstanding the reminder sent by Ms Khorassani prior to the current hearing.

19. Accordingly, in answer to the key question, namely “what had changed since the Order was imposed” the Panel had little hesitation in concluding that nothing had changed. There was no evidence of remediation and therefore there was still a risk of repetition.

20. The Panel therefore concluded (as the Legal Assessor indicated that it was entitled to do) that the Registrant remained impaired in relation to both the personal and the public components of impairment. It therefore moved on to consider what the appropriate sanction should be in this case.
Decision on Sanction

21. The Panel considered the Sanctions Policy of the HCPTS and accepted the advice of the Legal Assessor that a sanction should be the least that is necessary to ensure public protection. The Panel reminded itself that the purpose of a sanction is not to punish the Registrant and that a sanction must be reasonable and proportionate.

22. The Panel determined that the nature of the concerns in this case were too serious to make no Order.

23. The Panel considered whether to impose a Caution Order but decided that it was inappropriate because a Caution Order would not provide sufficient public protection.

24. The Panel determined that a Conditions of Practice Order was not appropriate because the Registrant had not shown insight and had not engaged with her regulator to any significant degree. A Conditions of Practice Order would not be workable or verifiable in the absence of engagement on the part of the Registrant.

25. The Panel then considered an extension of the current Suspension Order, which was the option promoted by Ms Khorassani. It noted, however, that, since the imposition of the Suspension Order in February 2024, the Registrant had failed to engage with the process (other than to confirm that she did not intend to attend the hearing) or to demonstrate insight, reflection and remediation. The Panel found this frustrating as it would have appreciated hearing from the Registrant, especially considering that her misconduct, although serious, essentially amounted to two isolated incidents in an otherwise unblemished career spanning some seven years in the UK (from 2014 to 2021).

26. The Panel was aware that, in the absence of a significant response from the Registrant, it was entitled to consider the alternative to an extension of the suspension order, namely that of a striking off order. It noted, in particular, that the Sanctions Policy, in paragraph 131, stated:
“A striking off order is likely to be appropriate where the nature and 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…or
• is unwilling to resolve matters.”

27. The Panel considered that a persuasive argument could therefore be made that, as the Registrant, by her failure to engage to any significant degree with the HCPC, continued to lack insight and/or was unwilling to resolve matters, a striking off order could be justified. These matters had first arisen in 2020, some five years ago, so the Registrant had arguably had sufficient time to address her failings, so the Panel felt entitled to wonder what benefit there would be to the profession and/or to the public by further extending the Suspension Order.

28. However, the Panel also noted paragraph 130 of the Sanctions Policy, which stated: “A striking off order is a sanction of last resort…”. The Panel noted that: the suspension had only been effective for five months; the Registrant had otherwise had an unblemished career spanning some seven years in the UK; although serious, in that the patient contracted pneumonia, the Registrant’s misconduct could be remediated; and that the Registrant had not completely ignored the HCPC but had responded to the Hearings Officer to advise that she would not be attending the hearing. Accordingly, the Panel considered that the point of no return had not been reached and that the Registrant should be given a further opportunity to address her failings

29. Accordingly, the Panel concluded that an extension of the current order by a further six months (which effectively meant that she would have been suspended for a year in total) was the proportionate and appropriate sanction in this case. It would come into effect at the expiry of the current Suspension Order on 22 August 2024.

30. The Panel further directs that there be a review of the Suspension Order before it is next due to expire on 22 February 2025. Bearing in mind its observations above about the possibility of striking off the Registrant on this occasion, the Panel would remind the Registrant that a future reviewing panel would be able to consider that as a sanction if the Registrant continued not to engage with the process.

31. In addition, the Panel noted that the Registrant’s registered postal address is in Italy and wondered (in the absence of any information about her current circumstances) whether she had returned to Italy permanently and perhaps had no intention to work again as a Speech and Language Therapist in the UK. If that was the case, then the Panel would suggest to the Registrant that she advise the HCPC about her long-term intentions as she may be eligible for voluntary deregistration.

32. In any event, the Panel considered that the reviewing panel would be assisted by the following:
• The Registrant’s attendance, in person or virtually, at the hearing;
• A written reflection from the Registrant regarding this Panel’s findings, in particular an indication of her long-term intentions about practising in the UK;
• Evidence of remediation including any training or CPD focused on the misconduct found proved;
• Any testimonials from work colleagues (from either paid or unpaid work)

ORDER: That the Registrar is directed to suspend the registration of Ms Stefania Antonucci for a further period of 6 months, from the date the current Suspension Order expires, namely from 22 August 2024.

This Order will be reviewed again before its expiry on 22 February 2025.

History of Hearings for Stefania Antonucci