Mr Klearcho Antoni

Background:

1. The Registrant is registered with the HCPC as a Physiotherapist. At the material time, he was employed as a Band 5 Physiotherapist in the Musculoskeletal Adult Physiotherapy Outpatients Department within the University hospitals of Leicester NHS Trust (the Trust) from October 2018 to March 2020. The Registrant first began work at Leicester Royal Infirmary before transferring to Glenfield Hospital in December 2019.

2. A review of the Registrant's clinical notes revealed concerns relating to instances of their being incomplete, unsigned and inadequate in detail. On 18 January 2019, the Registrant met his line manager, ML, to discuss this and there followed an Informal Capability Monitoring process (ICM) which was concluded in March 2019. The Registrant had demonstrated sufficient progress to exit the ICM.

3. The Registrant then commenced work at Glenfield Hospital in December 2019. His caseload at Leicester was taken over by colleagues who observed that the Registrant’s clinical notes appeared to be incomplete and a number of patient discharge letters had not been sent. An audit of the records found evidence of discharge letters not being sent in relation to 21 patients, partially incomplete clinical records in respect of eight patients and the absence of any clinical notes for a further seven patients. An internal investigation was commenced and conducted by SS, Therapy Clinical Team Leader. On 16 January 2020, the matter was referred to the HCPC. The Registrant resigned from his post in January 2020.

4. The substantive hearing took place before a panel of the Conduct and Competence Committee on 6 March 2023, at which the Registrant was present and represented.

5. At the outset of the hearing, the Registrant admitted the factual particulars of the Allegation but denied that that they constituted misconduct or that his fitness to practise was thereby impaired.

6. The panel found the facts proved on the basis of the witness statements and the Registrant’s own admissions.

7. The panel found that the Registrant’s fitness to practise to practise was impaired by reason of his misconduct. In that context, the panel found the Registrant to have been in breach of the Standards of Proficiency for Physiotherapists (2013), in particular:

Standard 1.2 - recognise the need to manage their own workload and resources effectively and be able to practise accordingly

Standard 3 - be able to maintain fitness to practise

Standard - 10 be able to maintain records appropriately

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

- recognise the need to manage records and all other information in accordance with applicable legislation, protocols, and guidelines

Standard 12 - be able to assure the quality of their practice

8. The panel also found the Registrant to have been in breach of Standard 10 of the HCPC Standards of Conduct, Performance and Ethics (2016, which required him to keep records of his work.

9. In summary, the panel found that the proven facts constituted misconduct, having regard to the fact that his record-keeping failures occurred:

• over an extended period of time,
• having successfully exited from a capability process, and
• having available the guidance and support of experienced seniors.

10. With regard to impairment of fitness to practise, the panel recognised that:

• the Registrant's record-keeping failures were the only concerns relating to his fitness to practise

• he had repeated expressions of remorse for his past clinical record keeping failings

• he had shown real and material insight in making the admissions that he did.

• he had taken some steps, in recognition of his shortcomings, to ensure that these would not be repeated.

11. The panel considered, however, that the Registrant’s insight was not fully developed. Although the Registrant had produced a list of mandatory training that he had completed for his current role, he had not produced evidence of CPD or other professional practice development which focused on clinical record keeping and time management. There was no evidence that he had undergone training specific to the practice of physiotherapy clinical record keeping, dealing with the SOAP format. There was no evidence that the Registrant's current practice in a digital format met the standards expected of him for paper based systems of record keeping. Evidence of remediation was therefore lacking. In the circumstances, the panel could not be satisfied that the Registrant had remediated his past misconduct so that it was very unlikely to be repeated. Accordingly, the panel considered that the Registrant’s fitness to practise remained impaired in respect of the personal component.

12. With regard to the public component of impairment, the panel noted that the Registrant had been responsible for gaps in patient records and an absence of discharge letters which placed patients at risk of harm, even though there was no evidence that harm had been caused. In the absence of full remediation, there was a risk of repetition and a consequential risk of harm to patients.

13. The panel considered that it would undermine public confidence in the profession and the regulatory process if a finding of current impairment were not made. The Panel considered that a reasonable and informed member of the public would be dismayed and troubled if a finding of impairment were not made in all the circumstances.

14. With regard to sanction, the panel decided to impose a Conditions of Practice Order. The panel was of the view that the Registrant’s failings were limited to record-keeping and were capable of being remedied.

15. The panel imposed the following conditions of practice for a period of 12 months:

1) You must place yourself and remain under the supervision of a workplace supervisor who is a Physiotherapist registered by the HCPC and supply details of your supervisor to the HCPC within 14 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

2) You must work with your workplace supervisor to formulate a Personal Development Plan to address your deficiencies in the following areas of your practice:

• Accurate, timely and complete notes of appointments for patients;
• Accurate, timely and complete records of treatment;
• Accurate, timely and complete records of assessments; and
• Accurate, timely and complete records of prescribed treatment plans.

This must include some examples of maintaining paper based clinical records.

3) Within three months of the Operative Date:
You must forward a copy of your Personal Development Plan to the HCPC.

4) You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

5) You must allow your workplace supervisor to provide information to the HCPC about your progress towards the objectives, as set out in your Personal Development Plan, as requested by the Case Manager of the HCPC.

6) 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.

7) You must supply the HCPC with evidence of Continuing Professional Development (CPD), in respect of record keeping and time management and evidence how the learning has been applied to your current practice and supplied for a future reviewing panel.

8) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer. 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).

9) You will be responsible for meeting any and all costs associated with complying with these conditions.

Today's hearing:

16. The Panel was provided by the HCPC with a hearing bundle which included the decision of the panel at the substantive hearing on 6 March 2023 and subsequent correspondence between the Registrant and the HCPC.

17. The Registrant provided the Panel this morning with a reflective piece.

18. The Registrant gave evidence on affirmation. He told the Panel that, despite having made “quite a few” applications for employment as a Physiotherapist, he had not received any offers of employment as a result of the conditions of practice to which he was subject. Having failed to obtain employment as a Physiotherapist, he had been working as a massage therapist.

19. The Registrant said that he had completed a course in acupuncture but had not undertaken any course or CPD in record keeping. He acknowledged that his fitness to practise in 2019 had been impaired by reason of his inadequate record keeping but said that his record keeping since 2019 had been of good quality.

20. Ms Khorassani submitted that, as the Registrant had not been able to obtain employment as a Physiotherapist since the date of the substantive order, he was unable to demonstrate that he had remediated his practice. In these circumstances, she submitted that the Panel must inevitably conclude that his fitness to practise remains impaired. She invited the Panel to consider extending the Conditions of Practice Order for a further period of 12 months.

The Panel’s decision:

21. The Panel took into account the HCPTS Practice Notes “Review of Article 30 Sanction Orders” and “Fitness to Practise Impairment” and accepted the advice of the Legal Assessor.

22. The Panel first considered whether the Registrant’s fitness to practise is currently impaired by reason of his misconduct, as identified at the substantive hearing.

23. The Panel took into account the decision of the High Court in Abrahaem v GMC [2008] EWHC 183 (Admin) where it was stated that in practical terms there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that he has fully acknowledged the deficiencies which led to the original findings and has addressed his impairment sufficiently “through insight, application, education, supervision or other achievement”.

24. The Panel found that the Registrant had failed to take any effective steps to discharge this burden by addressing the fitness to practise concerns identified at the substantive hearing. The Panel did not consider that his reflective statement adequately demonstrated that he had reflected on his own failures regarding record keeping identified at the substantive hearing, the risk to service users and colleagues resulting from his failures, or what he had since done to address the shortcomings in his record keeping. Furthermore, there is no evidence of any CPD undertaken by the Registrant related to the concerns.

25. In these circumstances, the Panel could not be satisfied that the Registrant had addressed any of the concerns relating to his fitness to practise. It followed that the Registrant had not discharged the persuasive burden referred to above. The Panel considered that the Registrant would not be safe to practise without restriction until he had demonstrated that his record keeping was adequate. The Panel therefore found that his fitness to practise remains impaired having regard to both the “personal” and “public” components of impairment.

26. With regard to sanction, the Panel took into account the HCPC’s Indicative Sanctions Policy. The Panel gave appropriate weight to the wider public interest, which includes the reputation of the profession and public confidence in the regulatory process. The Panel applied the principle of proportionality and considered the available sanctions in ascending order of seriousness.

27. The Panel considered that the concerns about the Registrant’s fitness to practise were too serious for the imposition of a Caution Order.

28. The Panel considered whether to extend the Conditions of Practice Order on the expiry of the current order. The Panel was of the view that the Registrant’s failures in record-keeping are remediable and that he should be given a further opportunity to remediate them. The Panel considered that a further period of six months should provide the Registrant with enough time to demonstrate that he had remediated his failures.

29. Regardless of whether the Registrant secures employment as a Physiotherapist before the next review hearing, the Panel considers that the next review panel would be assisted by the following;

• A reflective statement on his past failures in record keeping, the negative implications for service users and colleagues, what he has learnt from the findings made against him by the substantive hearing panel and what he has since done to ensure that his record keeping is of a satisfactory standard;

• Evidence that the Registrant had attended and completed a training course and undertaken CPD in record keeping relevant to clinical practice as a Physiotherapist;

• Evidence that his record keeping in whatever employment he is currently undertaking is satisfactory;

• Testimonials from professional colleagues as to the current standard of his record keeping; and

• His attendance at the next review hearing.

The Registrar is directed to annotate the HCPC Register to show that for a period of 6 months from the date that this Order takes effect, you, Mr Klearcho Antoni, must comply with the following conditions of practice:

1. You must place yourself and remain under the supervision of a workplace supervisor who is a Physiotherapist registered by the HCPC and supply details of your supervisor to the HCPC within 14 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

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

• Accurate, timely and complete notes of appointments for patients;
• Accurate, timely and complete records of treatment;
• Accurate, timely and complete records of assessments; and
• Accurate, timely and complete records of prescribed treatment plans.
This must include some examples of maintaining paper based clinical records.

3. Within three months of the Operative Date:
You must forward a copy of your Personal Development Plan to the HCPC.

4. You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

5. You must allow your workplace supervisor to provide information to the HCPC about your progress towards the objectives, as set out in your Personal Development Plan, as requested by the Case Manager of the HCPC.

6. 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.

7. You must supply the HCPC with evidence of Continuing Professional Development (CPD), in respect of record keeping and time management and evidence how the learning has been applied to your current practice and supplied for a future reviewing panel.

8. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer. 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).

9. You will be responsible for meeting any and all costs associated with complying with these conditions.

The Order imposed today will apply from 6 April 2024, on the expiry of the existing Order.

This Order will be reviewed again before its expiry on 6 October 2024.

History of Hearings for Mr Klearcho Antoni