Klearcho Antoni

Profession: Physiotherapist
Registration Number: PH109166
Hearing Type: Review Hearing
Date and Time of hearing: 10:00 16/09/2024 End: 17:00 16/09/2024
Location: Virtually via video conference
Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation Finding Order Notes Hearing History

Allegation

As a registered Physiotherapist (PH109166) your fitness to practise is impaired by
reason of misconduct and/or lack of competence. In that:
1. Between 11 June 2019 and 13 January 2020, you did not maintain accurate
and complete records, in that;
a. you did not complete notes of appointments for fully complete
notes on the patients on dates as set out in Schedule A,
b. you did not undertake and/or record undertaking any and/or any
adequate notes of the treatment you complete any notes for
treatment provided to the patients set out in Schedule B,
c. you did not complete assessments on the patients set out in Schedule
C,
cd. you did not undertake and/or record undertaking any and/or any adequate
assessment complete adequate assessments for the patients set out in Schedule
CD,
de. you did not complete a prescribe and/or record prescribing any
and/or any adequate treatment plan for the to the patients as set out in
Schedule C.
2. The matters set out in allegation 1 above constitutes misconduct and/or lack
of competence.
3. By reason of your misconduct and/or lack of competence, your fitness to
practise is impaired

Finding

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). He was employed from October 2018 to March 2020.

2. The Registrant began work at Leicester Royal Infirmary. A review of the Registrant's clinical notes revealed that they were 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 demonstrated sufficient progress to exit the ICM.
 
3. The Registrant was then transferred to Glenfield Hospital in December 2019. It was observed whilst there that the Registrant’s clinical notes were incomplete and a number of patient discharge letters had not been sent. An audit of the records revealed evidence of:
- discharge letters not being sent in relation to 21 patients, 
- partially incomplete clinical records in respect of 8 patients, and
- the absence of any clinical notes for a further 7 patients. 

4. 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.

5. At the outset of the substantive hearing held by the Conduct and Competence Committee on 6 March 2023, 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 substantive panel found the facts proved on the basis of the witness statements and the Registrant’s own admissions.

7. The substantive 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 substantive 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. The substantive 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 substantive panel recognised that:
 
• the concerns were limited to record-keeping failures 
 
• the Registrant had repeatedly expressed his remorse 
 
• the Registrant had admitted the allegation 
 
• the Registrant had taken some steps, in recognition of his shortcomings, to ensure that they would not be repeated.
 
11. The substantive panel considered, however, that the Registrant’s insight was not fully developed. The Registrant had produced a list of mandatory training for his current role, but had not produced evidence of CPD or other professional practice development focusing 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 substantive panel was not satisfied that the Registrant had remediated his past misconduct and concluded that it could not be said that it was very unlikely to be repeated. The substantive panel concluded that there was a risk of repetition and a consequential risk of harm to patients.
 
12. Accordingly, the substantive panel considered that the Registrant’s fitness to practise remained impaired in respect of the personal component.
 
13. The substantive panel also considered that it would undermine public confidence in the profession and the regulatory process if a finding of current impairment were not made. 
 
14. In considering sanction, the substantive panel decided to impose a Conditions of Practice Order on the basis 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.
 
13 March 2024 Review Hearing
 
16. At the first review hearing, held on 13 March 2024, the Panel extended the Conditions of Practice Order for a further 6 months, for the following reasons:

“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.

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.
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.

The Panel considered that the concerns about the Registrant’s fitness to practise were too serious for the imposition of a Caution Order.
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”.
 
16 September 2024 Review Hearing: Submissions 
 
17. The Registrant provided further documentation on the morning of the hearing, comprising:
 
- A Certificate of Continuing Professional Development in Documentation and Record Keeping, Level 2 (2 hours)
 
- A Certificate of Completion of Advanced Skills and Reasoning in advanced neuromusculoskeletal physiotherapy Level  2b, based on the Maitland Concept (80 hours face to face contact time)
 
- A September 2024 reflective statement
 
- Screenshots of attempts made to obtain employment as a physiotherapist since the last review hearing, together with the responses given by the relevant employers.
 
18. In his September 2024 reflective statement the Registrant stated as follows:
 
“What event or topic are you reflecting on?
In 2019, 13 patient records were incomplete and in some cases there were missing pages in an NHS physiotherapy department.
 
Would you call this a positive or challenging event?
It is a negative event that has affected both service users and colleagues in terms of continuity of care and quality of service. Having the decision in the HCPC website and sanctions imposed, prospective employers are not hiring and in most cases not offering an interview.
 
What happened?
In 13 physiotherapy paper-hard copies patient records, I have been found to have parts of the sessions incomplete and in some cases there were missing entire pages. That has happened due to bad time management, workload stress, and the imposed from my clinical mentor to spend 30minutes actual time with the patients in the 30minues sessions.
 
Looking back
Time management plays a vital role in a physiotherapy workload. It is significant to be able to effectively manage the workload in order processes to be completed like timely and accurate patient record keeping, storing and checking the paper patient records, sending out GP letters and community referrals, picking patient records to discuss with colleagues and clinical mentor. My deficiency in time management and completing the patient records is seen in the 13 patient file that I have been accused with misconduct in the HCPC.
As the department physiotherapy team leader Sarah Sykes lectured us in October 2019, the follow up sessions with the each patient must last 20minutes in a 30min appointment, in order to give us enough time for record keeping, cleaning, preparing for the next patient.
I have worked in different physiotherapy positions all with electronic patient records. Having had training and shadowing colleagues, I have managed to keep very good and accurate patient records and improve on workload management. There were many cases I have provided paper based exercise sheets that were attached to the relevant electronic patient record. The process of electronic patient records can be faster and better handled compared to paper based records. Since the HCPC imposed the sanctions, prospective employers are not offering an interview so I can continue working in the filed of physiotherapy. Either not replying to emails or sometimes saying they can wait until the sanctions expire.
 
Looking forward
Valuing the patient records and following the HCPC standards, I am looking to get a physiotherapy or physiotherapist assistant role to work responsibly and improve on patient records and workload time management. 
This is fundamental to practice lawfully and safely, to provide continuity of care, effective and quality physiotherapy service. The patient records provides a basis for a multidisciplinary team to manage each patient effectively. I fully understand the HCPC sanctions are placed to protect the service users and safeguard the physiotherapy profession.
I will continue with personal and professional development in physiotherapy and follow the HCPC standards”.
 
19. The Registrant submitted that since the last review he had made numerous efforts to obtain a job as a physiotherapist but the Conditions of Practice had prevented employers from going ahead. 
 
20. When asked what coping strategies he had developed for documenting his work, he said that he had learnt to plan in advance, review and then look at the next patient’s files. When asked whether there was one thing he would change if permitted to practise in future, he said it would be to make a record of each session and allocate time to check the file before the next patient.  
 
21. Mr Rokad submitted on behalf of the HCPC that the persuasive burden falls upon the Registrant to establish that he has remediated his past misconduct, and that the Registrant had failed to establish this. 
 
22. Mr Rokad accepted that the material provided by the Registrant established that he had been refused employment with at least one employer by reason of the Conditions of Practice currently in place. However, Mr Rokad submitted that in relation to other applications for employment it was unclear whether it was the Conditions that were the issue or whether other factors had been responsible.
 
23. Mr Rokad submitted that the Registrant’s fitness to practise remains impaired and that the existing Conditions of Practice Order should be extended for a further period of 6 months to protect the public and the wider public interest.
16 September 2024 Review Hearing: Decision 
 
24. 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.

25. The Panel first considered whether the Registrant’s fitness to practise is currently impaired by reason of his past misconduct.

26. The Panel took into account the decision of the High Court in Abrahaem v GMC [2008] EWHC 183 (Admin) where it was said that in practical terms there is a persuasive evidential burden on the Registrant to demonstrate at a review hearing that he has remediated his past misconduct.

27. The Panel concluded that the Registrant has shown some remorse and remediation. He admitted the allegation at the substantive hearing and has accepted the findings of the substantive panel. He provided a reflective statement for the first review hearing, and a further reflective statement for the current hearing. He has evidenced two areas of CPD completed by him.

28. The Panel accepted that the Registrant has not been employed as a physiotherapist since the last review hearing and has therefore been unable to evidence adherence to the Conditions of Practise currently in place. The Panel also accepted, on the basis of the material provided by the Registrant, that his inability to obtain employment appears to be have been linked to a reluctance to provide supervision on the part of at least two sets of prospective employers.

29. However, it was the judgement of the Panel that the Registrant’s remediation is not complete and his insight is only partial. Whilst he accepts his past misconduct, he has not evidenced that he fully  understands the importance of his past actions, either in relation to the potential effect on patients or the wider public. He has not sought to explain where he went wrong, or why, or what he needed to do to prevent a reoccurrence of the same issues in future. In the circumstances the Panel concluded that it could not be said that the risk of repetition was low.

30. In those circumstances the Panel concluded that there remains a likelihood of repetition of the Registrant’s past behaviour if he were to be allowed to practise unrestricted, and that the risk of harm to the public if permitted to practise unrestricted remains.

31. The Panel concluded that the Registrant remains impaired on the personal component.

32. The Panel also concluded that public confidence in the profession, and the declaring of proper standards of conduct, performance and ethics, demands a finding of impairment given the seriousness of the matters found proved.

33. 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.

34. In considering the issue of sanction, the Panel considered whether to make no order or to impose a Caution Order but concluded that this would not be sufficient to protect the public or satisfy the public interest in light of the seriousness of the misconduct.

35. The Panel considered whether a Conditions of Practice Order was sufficient to protect the public and the wider public interest, and concluded that it was. The Panel concluded that relevant, workable conditions could be devised. 

36. The Panel accepted that the Registrant had provided at least some evidence that his failure to be taken on by fresh employers had been due to Condition 1, which may have given the impression that direct supervision was required. Further, the Panel concluded that direct supervision of the Registrant’s work is not required, as his ability to work competently as a physiotherapist is not in question; it is his record keeping that has been found wanting.
 
37. In those circumstances the Panel decided that the appropriate course was to impose a fresh Conditions of Practice Order, to take effect on the date of the expiry of the previous order, in the same terms as the previous order but with a freshly worded Condition 1. The Panel reworded Condition 1 to include supervision in the sense of auditing the Registrant’s patient notes, rather than supervision of the Registrant’s overall clinical ability.

38. The Panel concluded that this was the appropriate order in the circumstances, and was proportionate, in that it should enable the Registrant to obtain employment with greater ease.
 
39. The Panel decided that the fresh Conditions of Practice Order should remain in place for a period of six months, to protect the public and wider public interest. The Panel was of the view that this would give the Registrant sufficient time to remediate his past failures.
 
40. Accordingly, the Panel imposed a Conditions of Practice Order for a period of 6 months in the terms set out below.

Order

ORDER: 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 have a named clinical supervisor, who is a Physiotherapist registered by the HCPC, and you must supply details of that supervisor to the HCPC within 14 days of the operative date. The supervision is to consist of weekly audits of a random selection of your patient notes.
 
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.

Notes

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

This Order will be reviewed again before its expiry on 6 April 2025.

Hearing History

History of Hearings for Klearcho Antoni

Date Panel Hearing type Outcomes / Status
24/03/2025 Conduct and Competence Committee Review Hearing Conditions of Practice
16/09/2024 Conduct and Competence Committee Review Hearing Conditions of Practice
13/03/2024 Conduct and Competence Committee Review Hearing Conditions of Practice
06/03/2023 Conduct and Competence Committee Final Hearing Conditions of Practice
;