Kleoniki Tzanidou

Preliminary Matters

Service

1. The Panel was satisfied by the documents in the service bundle that the Registrant was properly served with notice of this hearing, by an email dated 25 January 2024 in accordance with the Rules.

Proceeding in the Absence of the Registrant

2. Ms Strickland made an application for the hearing to proceed in the absence of the Registrant. She referred the Panel to correspondence between the Registrant’s legal representative and the HCPC. The correspondence referred to the Registrant’s agreement to the proposal that she should be removed from the register.

3. Ms Strickland submitted that in the circumstances it would be fair, proportionate, and appropriate for the Panel to proceed with the hearing in the Registrant’s absence.

4. The Panel took into account the HCPTS Practice Note on “Proceeding in the Absence of the Registrant” and accepted the advice of the Legal Assessor. Her advice included reference to the case of General Medical Council v Adeogba [2016] EWCA Civ 162.

5. The Panel noted that the Registrant is content for the hearing to be considered in her absence and in the absence of her legal representative. The Registrant has engaged with the process. In the circumstances, the Panel was satisfied that the Registrant had waived her right to attend the hearing and it considered that an adjournment would serve no purpose. It is in the public interest and the Registrant’s interests for the consideration of the proposal for a Voluntary Removal Agreement (VRA) to be determined expeditiously. The Panel decided that it would be fair and appropriate to proceed with the hearing in the Registrant’s absence.

Background

6. The Registrant is a registered Physiotherapist who was employed by Lewisham and Greenwich NHS Trust at the time of the Allegation (November 2017 – November 2018). As a result of concerns about her practice, and having been through an informal capability process, her employer placed her on a formal capability process in November 2017. In November 2018, the Registrant made a self-referral to the HCPC.

7. The Registrant has not been and is not currently subject to an Interim Order.

8. On 4 August 2020, an Investigating Committee Panel (ICP) considered the matter and found a case to answer. It referred an allegation to the Conduct and Competence Committee (CCC).

9. The Allegation (without its schedules) read as follows:

“As a registered Physiotherapist (PH56955) your fitness to practise is impaired by reason of your misconduct and/or lack of competence. In that:

1) Between November 2017 and November 2018, during your employment with Lewisham and Greenwich NHS Trust, you:

a) Did not provide safe and/or appropriate treatment to the patients set out in Schedule A;

b) Were unable to work autonomously and independently, in that:

i) A senior Physiotherapist was required to attend assessments with you for the patients set out in Schedule B;
ii) A senior Physiotherapist was required to intervene during your assessments for the patients set out in Schedule B.

c) Did not manage your cases effectively, in that:

i) You did not prioritise cases for the patients as set out in Schedule C.

d) Were unable to provide adequate clinical reasoning and/ or did not document your clinical reasoning for the patients set out in Schedule D.

e) Demonstrated poor record keeping in patient notes set out in Schedule E.

f) Demonstrated poor communication to the patients set out in Schedule F.

2. The matters set out at paragraphs 1a) - 1f) constitute lack of competence.

3. By reason of your lack of competence your fitness to practise is impaired.”

10. From the ICP decision, it appears that the inclusion of the words “misconduct and/or” in the stem of the Allegation, referred to the CCC, was an error. In its decision, the ICP had previously concluded that there was no realistic prospect of the statutory ground of misconduct being made out.

11. Expert evidence was sought in this case. The expert’s opinion supported some, but not all, of the particulars of the Allegation referred by the ICP, and in respect of some, but not all, of the patients set out in the schedules in respect of the Allegation.

12. If this matter were to proceed to a full hearing, the HCPC would have to apply to discontinue parts of the Allegation. The Allegation reflecting the findings of the expert, and removing the error discussed in paragraph 10, is set out above. This Allegation represents the proposed amended allegation that would go before a full hearing (set out in full above under the section entitled Allegation).

13. In November 2022, the Registrant was informed that the HCPC intended to apply to discontinue parts of the Allegation, but the firm instructed on behalf of the HCPC did not at that stage indicate which parts of the Allegation it intended to discontinue. Further, at that stage the expert report was not served. There has been a significant delay in this case, which was contributed to by the HCPC changing its firm of solicitors.

14. In October 2023, the Registrant’s representative contacted the HCPC to prompt that this matter be brought to a conclusion. The Registrant’s representative indicated that the Registrant was interested in seeking voluntary removal.

15. In December 2023, Blake Morgan LLP, on behalf of the HCPC, confirmed that the HCPC considered it appropriate to explore voluntary removal, and provided the relevant guidance together with a Pro-Forma for the Registrant to complete and sign.

16. On 19 January 2024, the Registrant’s representative returned a signed copy of the Pro-Forma confirming the Registrant admitted to the Allegation, that the Registrant had read through the guidance on disposal by consent, and that the Registrant wished for the HCPC to consider voluntary removal.

17. The Panel was provided with a copy of the proposed VRA, signed by the parties on 25 January 2024.

Decision on Application

18. Ms Strickland, on behalf of the HCPC, helpfully set out the background of this case in detail, and submitted that voluntary removal from the Register would be an appropriate means of resolving the matter.

19. Ms Strickland noted that as this matter is not proceeding to a full hearing, it was not necessary at this stage for the HCPC to formally discontinue those parts of the Allegation which are no longer supported by the evidence. Instead, Ms Strickland submitted that the Panel considering the VRA could properly take account of the background outlined above when deciding whether this case is suitable for VRA.

20. Ms Strickland submitted that the substance of the Allegation remains that the Registrant demonstrated a lack of competence, in that, on occasions over a one-year period while undergoing a formal capability process, she did not provide safe and/or effective treatment to patients, was unable to provide and/or did not document her clinical reasoning, and demonstrated poor record keeping and communication with patients.

21. Ms Strickland highlighted that in October 2023, the Registrant’s representative contacted the HCPC to request voluntary removal. The Registrant’s representative indicated that the Registrant had reached retirement age, had suffered from a significant health condition and did not intend to return to work as a Physiotherapist. He noted that the Registrant only remained on the HCPC’s register because she was unable to leave as a result of the fitness to practise proceedings and submitted that she was at that stage unable to indicate whether or not she accepted the Allegation in full, as she had not been informed which particulars of the Allegation the HCPC intended to pursue at a final hearing.

22. Ms Strickland referred to the consensual disposal request pro forma dated 19 January 2024, in which the Registrant admits the substance of the ground of lack of competence (subject to the amendments that would be made should the matter proceed to a full hearing). Ms Strickland noted that the Registrant had not practised as a Physiotherapist since 2018, and that she has been in receipt of a pension for some time.

23. Ms Strickland submits that this matter is suitable for disposal by way of VRA on the basis that the Registrant has admitted the substance of the Allegation, that this amounts to a lack of competence, and her fitness to practise is impaired as a result.

24. Ms Strickland noted that a VRA would adequately protect the public. She stated the Registrant would be removed from the HCPC register and would not be entitled to practise as a Physiotherapist. Ms Strickland noted that the Registrant’s personal circumstances were such that there was no realistic prospect of her seeking to return to practice in the future. Ms Strickland noted that the Registrant had not sought to return to the register within a period of five years, and should she attempt to do so, she would have to demonstrate that she had fully remediated her current impairment.

25. Ms Strickland noted that voluntary removal was not detrimental to the wider public interest. She noted that the Allegation related to the Registrant’s lack of competence. Ms Strickland noted that the ICP found that there was no evidence to suggest deliberate acts or omissions that might amount to misconduct. In all the circumstances, she submitted the public interest in maintaining public confidence in the professions and promoting proper professional standards was best served by removing the Registrant from the register at the earliest opportunity.

26. The Panel accepted the advice of the Legal Adviser and had regard to the guidance in the HCPTS Practice Note “Disposal of Cases by Consent”. In particular, the practice note highlights the HCPC’s overarching statutory objective of protecting the public. A Panel should not agree to a case being resolved by consent unless:

• The appropriate level of public protection is being secured; and

• Doing so would not be detrimental to the wider public interest

27. The Panel was satisfied that the proposed VRA would adequately protect the public because the VRA has the equivalent effect of a Striking Off Order. The Panel noted that this is a more restrictive option than could be imposed if the case were to proceed to a Final Hearing.

28. The Panel next considered the wider public interest. It noted that the Registrant has the benefit of a legal representative to protect her interests and assist her in understanding the voluntary removal process. She has made full admissions, and she has signed the proposed VRA.

29. In considering whether or not the proposal for voluntary removal was in the public interest, the Panel considered the alternative option, which would be that the case would proceed to a Final Hearing. The Panel noted the submission made in respect of the Registrant’s personal circumstances and concluded that there was no realistic prospect of her seeking to return to practice in future. Given the Registrants admissions to a lack of competence, the significant passage of time since these incidents occurred and the Registrant’s established retirement from the profession, the Panel considered the proposal for voluntary removal was in the public interest.

30. The Panel identified no persuasive public interest reasons why this case should proceed to a Final Hearing rather than being disposed of at this stage by a VRA. It considered that a fully informed member of the public would consider that the proposed VRA was an appropriate and proportionate disposal of the case. The Allegation relates solely to the Registrant’s lack of competence and there is no evidence to suggest deliberate acts or omissions that might amount to misconduct. As such, the Panel considered that the proposed VRA was a sufficient regulatory response to maintain public confidence in the profession.

31. The Panel therefore agreed to the proposed Voluntary Removal Agreement.

ORDER: The Registrar is directed to remove the name of Ms Kleoniki Tzanidou from the Register with immediate effect.

No notes available

History of Hearings for Kleoniki Tzanidou