Maria Efthymiou

Preliminary Matters

Part of the hearing in private

1. The Panel raised the issue of whether part of the hearing should take place in private if matters of the Registrant’s health were referred to.

2. The Registrant told the Panel that she did not want any of the hearing to be in private, and requested that all of it be considered as a public hearing. Ms Constantine, on behalf of the HCPC, did not make any submissions on this point.

3. The Panel had in mind the HCPTS Practice Note on “Conducting Hearings in Private”, which states that as a general rule hearings are to be in public; however, the hearing may take place wholly or partially in private to protect the private life of the Registrant. This can be the case where matters relating to health are to be referred to.

4. The Panel was aware that the matter was for its own decision, but took into account the Registrant’s strong view on this point and acceded to her request to have the hearing entirely in public.

Background

5. The Registrant is a HCPC-registered Occupational Therapist (‘OT’).

6. The Registrant was employed by Manx Care for the Isle of Man Government as a Band 7 Advanced Wheelchair Occupational Therapist from January 2015 until 15 August 2018. Prior to this, she worked for the same employer as a Band 6 Occupational Therapist from 9 August 2006 until 23 January 2015.

7. On 13 April 2017, the Registrant was suspended from work pending an investigation into concerns raised.

8. On 4 September 2017, the HCPC received a self-referral from the Registrant. On 20 October 2017, the HCPC received documentation from the Registrant’s employer, Manx Care.

9. In January 2017, concerns regarding the Registrant’s practice had come to light after it was reported that one of her patients, Patient A, had developed a pressure ulcer from his wheelchair.

10. In April 2017, a second unrelated complaint had also come to light relating to an assessment of a child, Patient B. The employer confirmed that the concerns being investigated were as follows:

a. Poor clinical record-keeping;

b. Outstanding assessments/actions;

c. Poor communication between the Registrant and the contractor;

d. Inadequate assessment of patients;

e. Inadequate monitoring of a patient;

f. No routine monitoring of wheelchairs or pressure cushions;

g. Inability to draw on appropriate knowledge and skills to inform practice.

Submissions

11. Ms Constantine outlined the HCPC’s position, which was that it sought an extension of the current Suspension Order for a period of three months into order to allow the HCPC and the Registrant to explore the possibility of coming to a Voluntary Removal Agreement (‘VRA’). Ms Constantine referred to the request in the Registrant’s reflective written piece which was before the Panel today and which referred to her wish to be removed from the Register. Ms Constantine stated that the reflective piece highlighted the majority of the points requested to be covered by the previous reviewing panel, and that it demonstrated greater insight than the Registrant had shown previously.

12. Ms Constantine submitted that an Order was still necessary because the Registrant had been out of practice since 2017 and she had not undertaken the necessary Continuing Professional Development (‘CPD’) as requested by the previous panel. Therefore this Panel may find that her fitness to practise remained impaired. Ms Constantine submitted that it would be a matter to consider whether conditions of practice would be sufficient, although the HCPC took the view that a continuation of the Suspension Order for three months was appropriate in this case for the Voluntary Removal process to proceed.

13. The Registrant gave evidence under Oath. She told the Panel that she recognised her failings but highlighted that she had no experience of expertise in the fields of wheelchair and paediatric assessment, and acknowledged that she did not know enough in those fields. She told the Panel that she was unsupported in her role and that she had had a stress breakdown towards the end of her time at Manx Care. She did acknowledge the impact of her failings on the patients concerned but repeated the lack of support by her employer and that she thought another organisation had been brought in to support her and were carrying out the relevant assessments rather than her.

14. She told the Panel that she had worked as an Orthopaedic OT for many years and that this was what she was good at. She told the Panel that she had completed CPD by way of preparing and engaging with the hearing process.

15. The Registrant told the Panel that she did not wish to be suspended any longer and this was taking its toll upon her as she had been suspended for a long time. She acknowledged that it would be difficult for her to return to work as an OT in the Isle of Man and, in any event, she would need support. She had not been able to secure voluntary OT work on the Isle of Man.

16. The Registrant stated that she did not want to experience any of the stress that she had experienced in her previous role. She told the Panel that due to her age and energy levels, she was not sure if she wished to return to work as an OT. However, if she did return she would need significant support, including being shadowed, and would welcome direct supervision, as well as any conditions of practice surrounding a personal development plan and being required to undertake CPD. She stated that she would be able to return to Orthopaedics or to work in the community.

17. She stated that she did want to come off the Register but did not know what her future held and that she needed to hear the Panel’s decision today before she could decide what she wanted to do. She stated that she believed her insight had increased. She told the Panel that if she returned to work she would need structured support but if she chose not to return to work she would ask to be taken off the Register.

18. The Panel had before it an HCPC Bundle and a bundle of documents from the Registrant, which included a reflective piece of writing.

Decision

Impairment

19. In undertaking this review, the Panel took into account the documentary evidence, the submissions from both parties, and the Registrant’s oral evidence.

20. The Panel accepted the advice of the Legal Assessor as to the proper approach it should adopt. The Panel was aware that its purpose today was to conduct a comprehensive review of the Registrant’s fitness to return to unrestricted practice and considered the HCPTS Practice Notes entitled “Review of Article 30 Sanction Orders” and “Fitness to Practise Impairment”. The Panel must exercise its own independent judgement with regard to impairment. Only if impairment remained would the Panel then go on to consider what sanction, if any, to impose.

21. The Panel first considered whether the Registrant’s fitness to practise was currently impaired. The Panel took into account all of the material and evidence before it.

22. The Panel considered that the Registrant’s insight remained limited. While in her oral evidence the Registrant did refer to the impact of her misconduct on patients, she spent a great deal of her evidence speaking about the lack of support she had from her employer and appeared to attempt to deflect blame. She asked that she give evidence by way of being asked questions rather than give an oral statement; however, when asked detailed questions by the Panel, she found it difficult to focus on what was being asked, instead revisiting the lack of support she had as well as her lack of knowledge and experience in the fields of wheelchair and paediatric assessment.

23. The Panel took into account her reflective written piece as well as her oral evidence, but found that she had been unable to articulate to any meaningful degree the impact of her misconduct not only on the patients in question, but also upon public confidence in her and in the profession as a whole. As such, taking into account all of the evidence put forward by the Registrant, the Panel did not accept that the Registrant’s insight had increased to any palpable degree from the last hearing.

24. The Panel noted the Registrant’s view that she had completed CPD by preparing for and engaging in the hearing process, but the Panel did not consider that this was sufficient. She had been out of practice since 2017 but there was no evidence of courses or training which she had undertaken which were targeted at the misconduct found. The Panel concluded that she was hampered in this due to her minimal insight. The Panel noted that she was clear that she would abide with conditions, including direct supervision and training, but considered that as an autonomous practitioner she had very little to propose in terms of a clear action plan for return to practice. Rather she expressed willingness to abide by supervision or conditions and there was an element of passivity in her approach. This was, in the Panel’s view, likely to be caused by her expressed wish to be removed from the Register, a wish expressed both in her written reflection and in her oral evidence, and which was often at odds with statements she made in her oral evidence that she may wish to return to practice.

25. In light of these factors, the Panel concluded that there was a real risk of repetition of the misconduct.

26. Therefore the Panel determined that the Registrant’s fitness to practise remains impaired on the personal component.

27. The Panel went on to consider the public component. Due to the ongoing risk of repetition, the Panel found that the need to uphold standards and confidence in the profession would be undermined if no finding of impairment were made, in light of the lack of accountability in the development of fundamental skills as an OT.

28. Accordingly, the Panel found that the Registrant’s fitness to practise is impaired on the public component.

Sanction

29. The Panel approached the question of sanction from the least restrictive upwards. It was aware that the purpose of sanction is to protect the public and uphold the public interest, and not to punish. It exercised the principle of proportionality, being mindful that the least restrictive sanction necessary and sufficient to address the concerns and risks, and no more, should be imposed. The Panel accepted the advice of the Legal Assessor and took into account the HCPC Sanctions Policy.

30. The Panel first considered whether to take no action. It concluded that this would be wholly inappropriate and would provide no restriction on the Registrant’s practice which would be needed to protect the public, nor would it be sufficient to address the public interest concerns in the case. A caution would be insufficient for the same reasons, bearing in mind the level of seriousness of the misconduct and the real risk of repetition.

31. The Panel next considered conditions of practice. However, it did not consider that it could formulate workable conditions. As a result of the limited insight and real risk of repetition, any conditions would have to be so restrictive that they would be unworkable. As such, no conditions could be formulated to protect the public and be sufficient to uphold the public interest.

32. The Panel next considered suspension and decided that in light of the limited insight and real risk of repetition, as well as the seriousness of the misconduct, a period of suspension would be appropriate. In these circumstances, the Panel decided that a period of 12 months would be proportionate and necessary because it would reflect the minimal insight still shown by the Registrant, the lack of remediation, and that she is yet to move into true acceptance of her misconduct without seeking to deflect culpability. A 12-month Suspension Order would protect the public and uphold the public interest. In addition, a period of suspension would allow the parties to explore the VRA process, which is in the background.

33. The Panel went on to consider whether a strike off would be appropriate and concluded that due to the Registrant’s engagement and her stated wish to be removed from the Register which may be achieved by a VRA, which is in the pipeline, a striking off order would be disproportionate.

34. In coming to its decision the Panel took into account the impact this decision will have on the Registrant’s right to practise, as well as the potential financial and reputational impact, but decided that the need to protect the public and uphold the public interest outweighed her interests in this respect.

The Registrar is directed to suspend the registration of Maria Efthymiou for a further period of 12 months on the expiry of the existing Order.

The Order imposed today will apply from 19 June 2025.

This Order will be reviewed again before its expiry on 19 June 2026.

History of Hearings for Maria Efthymiou