Mr Andrew S Woodall

: Occupational therapist

: OT33880

: Final Hearing

Date and Time of hearing:09:30 28/10/2014 End: 17:00 29/10/2014

: Health and Care Professions Council, Park House, 184 Kennington Park Road, London, SE11 4BU

: Conduct and Competence Committee
: Suspended

Allegation

As amended


During your employment as an Occupational Therapist for Chesterfield Royal Hospital NHS Foundation Trust between September 2003 and May 2013, you:


1. Failed to maintain adequate records in that:
a) You did not make entries on the clinical case notes for significant periods of times in that in relation to:


i. Child 19, you did not make any entries after 20 June 2007;
ii. Child 16, you did not make any entries after 27 July 2007;
iii. Child 17 you did not make any entries between 12 September 2009 and 11 September 2012;
iv. Child 23, you did not make any entries;
  a) between 20 February 2008 and 11 July  

  2010 ; and/or
  b) between 13 July 2010 and 4 May 2011;

  and/or
  c) after 10 November 2011;
v. Child15, you did not make any entries between;
  a) 24 April 2010 and 22 December 2010;

  and/or
  b) between 24 December 2010 and 9 October

  2012;
vi. Child 14, you did not make any entries;
  a) between 12 June 2010 and 26 January

  2011 ; and/or
  b) between 10 February 2011 and 30

  November 2011; and/or
  c) after 23 December 2011;
vii. In relation to Child 13, you did not make any entries after 16 February 2009.
viii. Child 20, you did not make any entries after 3 December 2009;
ix. Child 3, you did not make any entries after 29 June 2006;
x. Child 4, you did not make any entries after 10 September 2007
xi. Child 9, you did not make any entries after 18 February 2009;
  b) You did not record visits that you had

  undertaken in relation to the following cases:
xii. Child 12 ;
xiii. Child 11 ;
xiv. Child 14 ;
xv. Child 13 .
c) Your notes for the following cases contained incomplete entries:
i. Child 22
ii. Child 10
iii. Child 21

 

2. Did not undertake and/or record visits in relation to the following cases:
a. Child 8 ;
b. Child 7 ;
c. Child 6 ;
d. Child 5 .

 

3. Did not complete statement reports in relation to the following cases:
a. Child 18 due on or around 11 October 2012;
b. Child 15 due on or around 10 April 2012.

 

4. Failed to complete requested and/or required actions in that:
a. In relation to Child 1 :
i. Between on or around 24 March 2011 and September 2012, you did not arrange for an improved head support to be provided for her class chair;
ii. Between on or around November 2011 and September 2012 did not complete a sling assessment.
b. In relation to Child 2, you did not provide the school and/or Child 2’s parents with any exercise programmes following your assessment of the child in around June or July 2012.

 

5. Failed to discharge service users in the following cases:
a. Child 3
b. Child 4
c. Child 9
d. Child 19

 

6. Stored confidential information in an inappropriate manner in that you had approximately 56 patient case files at home.

 

7. The matters described in paragraphs 1 –5

constitute misconduct and/or lack of competence.

 

8. The matters described in paragraph 6 constitute misconduct.

 

9. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary matters:

Service and proceeding in absence

1. The Panel saw evidence that the notice of hearing had been sent to Mr Woodall’s registered address as required by the rules and was satisfied that service had been complied with. The Panel went on to consider whether the hearing should proceed in Mr Woodall’s absence and decided that it should because he had contacted the HCPC on 22 September 2014 confirming that he was aware of the hearing today and that he did not intend to attend or be represented at it.  Mr Woodall did not suggest that he would attend on another date if the hearing was adjourned and therefore the Panel is satisfied that Mr Woodall has voluntarily absented himself from the hearing and that the hearing should proceed as scheduled. 

Application to amend the allegation

2. On 1 August 2014 the HCPC wrote to Mr Woodall informing him of their intention to apply to amend some of the particulars of the allegation and enclosing a copy of the proposed amendments. Mr Woodall did not indicate any opposition to the application and the Panel notes that the proposed amendments do not alter the nature or substance of the HCPC case against Mr Woodall, and are intended to provide greater clarity to the allegation. The Panel was therefore satisfied that the amendments could be made without injustice and granted the application. 

Decision on Facts:

3. Mr Woodall started employment at Chesterfield Royal Hospital NHS Foundation Trust (the Trust) in September 2003 as an Occupational Therapist. He was based in the Children’s Community Occupational Therapy Department where from 2009 he was managed by Helen Burgess.  Mr Woodall was responsible for a mixed caseload of children aged 0 to 19 with learning and physical impairment.  His main role was to assess the children, determine their physical disabilities and review the equipment and environment.

4. Between 20 November 2012 and 4 December 2012, Mr Woodall had a period of annual leave and sick leave. During this time a number of staff members expressed their concerns about his case files which prompted Helen Burgess to review a sample of his case files. She found a concerning lack of information in the ten files that she reviewed and therefore conducted a fuller review of 50 files which revealed that 90% of Mr Woodall’s files were not up to the standard expected. In total 214 case files were audited, of which 153 required further action. 

5. The audit and investigation conducted by Helen Burgess concluded that Mr Woodall, working as an autonomous practitioner, had given the impression that he was in control of his workload. She further concluded that his lack of action had negatively impacted on patient care and numerous children were left without assistance, support and the equipment that they needed.

6. The Trust disciplinary hearing took place on 8 May 2013 following which Mr Woodall was dismissed from his post. He appealed this decision on 23 May 2013 and on 22 October 2013 his appeal was dismissed. 

7. The Panel accepted the advice of the Legal Assessor that the burden of proving the facts lies with the HCPC and that the standard of proof required is the balance of probabilities. The HCPC offered no evidence in respect of paragraphs 1(a)(iv)(a), 1(a)(vi)(a) and (b) and 1(a)(viii) of the allegation against Mr Woodall because the evidence does not support them to the required standard.  Therefore these parts of the allegation are found not proven.

8. Mr Woodall indicated in writing dated 22 September 2014 that he admits the facts as set out in the amended allegation and therefore the Panel found the remaining facts proved. 

Decision on Grounds:

9. The Panel went on to decide if the facts found proved amount to misconduct and/or a lack of competence. The Panel accepted the advice of the Legal Assessor that misconduct involves some act or omission which falls short of what would be proper in the circumstances and that the standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a practitioner in the particular circumstances.  The Panel is entitled to have regard to the cumulative effect of the incidents proved. 

10. The Panel accepted the advice of the Legal Assessor that in order to establish a lack of competence the HCPC must show that the Registrant’s care fell below the standard of a reasonably competent practitioner of the Registrant’s experience and which has been demonstrated by reference to a fair sample of the practitioner’s work. Deficient professional performance is a much wider concept than negligence since it can extend to such matters as poor record-keeping and poor maintenance of confidentiality.

11. As Mr Woodall was neither present nor represented at the hearing Ms David on behalf of the HCPC brought to the Panel’s attention the documents in which Mr Woodall had set out his response to the allegation, both at Trust level and to the HCPC (received 27 February 2014) and the Panel was careful to ensure that they took that information into account on his behalf. 

12. The Panel heard evidence from Mrs B that Mr Woodall possessed the skills and knowledge to perform satisfactorily as an Occupational Therapist and that he had done so initially when employed by the Trust.  The Panel noted that as time went on Mr Woodall failed to manage his caseload effectively.  Although he stated that this was as a result of an extended period of extreme stress, the evidence from Helen Burgess showed that during the same time period he had been able to demonstrate an “impeccable” standard of documentation on some cases which required interactions with other professionals. This gave the impression that he was managing his caseload effectively. 

13. The Panel noted that examples of poor performance, as reflected in the facts found proved, started as long ago as 2006 and persisted through to the end of 2012.  The Panel accepted that during this time Mr Woodall had suffered stress as a result of events in his personal life but the Panel would have expected to see evidence from a medical practitioner if this had caused a condition that interfered with his ability to function properly during such an extended period of time. The Panel notes that it was not until December 2012 that Mr Woodall sought help from his General Practitioner and the Trust’s Occupational Health department. The Panel has reminded itself that it is the responsibility of the Registrant to limit or stop practising if that person’s performance or judgment is affected by ill health.

14. The Panel accepted some of Mr Woodall’s observations that the department’s systems needed to be improved, for example computerisation of client records, but noted that other members of the team were nevertheless able to carry out their duties to the required standard. 

15. The Panel concluded that Mr Woodall’s conduct fell well short of what would be proper in the circumstances, and that it persisted over an extended period of time with a large number of cases involving particularly vulnerable clients. The evidence showed that support was available to Mr Woodall.  He had accepted help for a short period in 2011 but he then told Mrs B in January 2012 that he no longer needed support and took steps to conceal the extent of his difficulties by understating the total number of cases he was holding.  By so doing he put his own concerns of being discovered above the needs of the vulnerable children on his caseload. During periods of supervision Mr Woodall did not take a representative sample of his cases to be reviewed and the Panel noted that when a sample of 50 of his cases were later reviewed, 90% were found to be below the expected standard. 

16. Mr Woodall was unable to effectively manage his caseload and his failure to keep proper records of visits and actions could have resulted in colleagues not knowing what had been done and in Mr Woodall not being able to recall what he had done in a particular case. It could also have impacted his ability to notice changes in a child’s development over time.  In some cases it is not clear if visits took place at all. Mr Woodall failed to properly assess clients’ needs for equipment, to provide equipment and to share information as part of the Statement Reports.  This could have resulted in a child not receiving the support needed with the potential for long term impact on their comfort, development and education.

17. Mr Woodall’s actions also had a marked negative effect on the organisation, management and colleagues.  It took a year to deal with the back log of Mr Woodall’s outstanding cases. Mr Woodall explained that he experienced difficulty as a result of the size of his caseload but Mrs B told the Panel that when all the cases that should have been transferred or discharged were removed from his caseload, it was actually lower than anyone else’s in the team.

18. The Panel has concluded that Mr Woodall had the skills and knowledge to work to the required standard and is therefore satisfied that the facts found proved in paragraphs 1 to 5 of the allegation constitute misconduct as opposed to a lack of competence. 

19. The Panel heard that in February 2012 Mr Woodall had attended training which included understanding the legal requirements for record keeping.  This would have reinforced the Trust’s policies. He had approximately 56 files at home, some of which he admitted to his employer had been at his home for several years. Mr Woodall has always accepted that he knew that he should not store clients’ notes at home and therefore the Panel is satisfied that the matters described in paragraph 6 of the allegation constitute misconduct. 

20. The Panel is satisfied that Mr Woodall’s conduct breached a number of the standards as set out in the HCPC Standards of Conduct, Performance and Ethics including standard 1 (you must act in the best interests of service users), 2 (you must respect the confidentiality of service users), 10 (you must keep accurate records). The Panel is also satisfied that Mr Woodall breached standards 1.2 (managing workload), 4.2 (recording decisions appropriately), 7.1 and 7.2 (maintaining confidentiality) and 10 (maintaining records appropriately) of the HCPC Standards of Proficiency for Occupational Therapists. 

Decision on Impairment: 

21. The Panel went on to decide if Mr Woodall’s fitness to practise is impaired.  The Panel took account of the HCPC Practice Note “Finding that fitness to practise is impaired”. It accepted the advice of the Legal Assessor that the test of impairment is expressed in the present tense and reminded itself that the purpose of Fitness to Practise procedures is not to punish the practitioner for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise.  The Panel looks forward not back but in order to form a view as to whether the Registrant is fit to practise without restriction today it has to take into account the way in which the person concerned has acted or failed to act in the past. 

22. The Panel has considered the two elements to impairment; the personal element and the public element. In the personal element the Panel considered Mr Woodall’s past acts in order to establish if his fitness to provide professional services is below acceptable standards and whether he may pose a risk to those who may need to use his services in the future.  In assessing the likelihood of Mr Woodall causing harm in the future the Panel has taken account of the degree of any harm caused by the Registrant and his culpability for that harm. 

23. The Panel has reminded itself that it must also take account of the public interest which includes the need to protect service users and the collective need to maintain confidence in the profession by declaring and upholding proper standards of conduct and behaviour. 

24. The facts admitted and found proved reflect serious misconduct involving a large number of service users over a long period of time.  In the Panel’s view, such misconduct is potentially remediable but Mr Woodall has not shown the Panel evidence that his misconduct has been remedied.  The most recent information from him is contained in a letter received by the HCPC on 27 February 2014, therefore 8 months ago. That letter indicates that he has taken some steps towards learning to cope better with stress but provides no details or independent evidence of this.  The Panel has seen no evidence that Mr Woodall has addressed his failings in time management, organisational skills and record keeping.  He has not worked as an Occupational Therapist since he was suspended by the Trust on 4 December 2012, almost two years ago.  At the time of writing in February 2014 Mr Woodall was employed as a support worker but the Panel has no current information from him and no evidence from his employer about his working hours and responsibilities, or his performance. 

25. The Panel accepts that Mr Woodall has attended the training he refers to in his letter, in first aid, moving and handling and safeguarding but is of the view that this would be of limited use in a role as an Occupational Therapist and is not sufficient to show that he has remediated the shortcomings identified in the allegation.  In any event, the topics covered do not address the core concerns reflected by his misconduct, of poor documentation, case load management and an inability to seek support in a timely manner.  The Panel has not seen sufficient evidence to establish that Mr Woodall is fit to practise without restriction and notes that he accepts that he would need further training before being safe to return to unrestricted practice. 

26. Therefore, on the evidence before it, the Panel is satisfied that there is a real risk of repetition of the misconduct and therefore an unacceptable risk to vulnerable service users if Mr Woodall was allowed to return to unrestricted practice.  In addition, the Panel is satisfied that a reasonable member of the public would be concerned to know that an Occupational Therapist, working with particularly vulnerable children, had failed in so many ways over such a long period of time, and that therefore a finding of impairment is required in order to maintain confidence in the regulatory process.  The Panel finds that Mr Woodall’s current fitness to practise without restriction is impaired.

Decision on Sanction:

27. The Panel then invited submissions on what sanction, if any, should be imposed.  The Panel had regard to the HCPC’s Indicative Sanctions guidance and accepted the advice of the Legal Assessor.  The Panel was reminded that it is not obliged to impose a sanction and in appropriate cases may decide that no further action is required. The Panel had no doubt that a sanction is proportionate in this case because no further action is only appropriate in cases involving minor isolated lapses where the Registrant has apologised, taken corrective action and fully understands the nature and effect of the lapse.  The misconduct found proved in this case is serious and occurred for a long period of time.  

28. The Panel bore in mind that the primary function of any sanction is to address public safety from the perspective of the risk which the Registrant concerned may pose to those who need to use his or her services.  However, the Panel must also give appropriate weight to the wider public interest which includes: the deterrent effect to other Registrants, the reputation of the profession concerned and public confidence in the regulatory process. 

29. The Panel had regard to the principle of proportionality and considered the sanctions starting with the lowest first. The Panel rejected both mediation and a caution order as these would allow Mr Woodall to return to unrestricted practice without demonstrating that he has remedied his failings and is safe to practise.  The Panel went on to consider whether a conditions of practice order would provide an adequate safeguard but concluded that there are no conditions of practice that are practicable and workable.  Mr Woodall has not worked as an Occupational Therapist for almost two years. Even if the Panel imposed a condition that Mr Woodall worked only as an entry level Occupational Therapist, this role would still require him to work autonomously in terms of caseload management and documentation. On the evidence that the Panel has seen, it cannot be sure that Mr Woodall is currently able to do so.  In addition, the Panel is aware that Mr Woodall was offered extra support, supervision and practical help by his former employer and that this did not resolve his difficulties. The Panel is also concerned that Mr Woodall may not be able to comply with such conditions as the evidence from Mrs B was that he minimised the extent of the difficulties that he was experiencing. The Panel is also concerned that a conditions of practice order would not adequately protect the public interest by maintaining confidence in the regulatory process. 

30. The Panel has decided that a suspension order for twelve months is the appropriate sanction in this case.  It will protect the public and address the risk of repetition by preventing Mr Woodall from returning to practice until he is able to demonstrate that he is safe to do so. It will also protect the public interest by maintaining confidence in the regulatory process. The Panel tested whether a suspension order was proportionate by going on to consider a striking off order.  The Panel has borne in mind that striking off is a sanction of last resort where there is no other way to protect the public, for example where there is a lack of insight and an inability or unwillingness to resolve matters. The Panel decided that a striking off order would be disproportionate as it has already decided that Mr Woodall’s misconduct is capable of remediation and it considers that it would be fair to give Mr Woodall the opportunity to remedy his failings and to provide evidence to support this.   

31. This order will be reviewed towards the end of the twelve month period and this Panel would expect any future Panel to be assisted by the following;
• Mr Woodall’s attendance at the review,
• independent evidence of his current health,
• evidence of his adherence to HCPC CPD standards,
• references from any paid or voluntary employment addressing issues of case management and record keeping,
• evidence of any training he has undertaken to address the misconduct identified, and
• evidence of the coping strategies he has developed to deal with stressful situations. 

For the avoidance of doubt, this list is not exhaustive and it is provided only for Mr Woodall’s assistance; he must understand that it does not bind the future Panel in any way.

 

Order

The Panel imposed a 12 month Suspension Order on the registration of Mr Andrew S Woodall.

Notes

The Order will be reviewed before its expiry.

An Interim Suspension Order was imposed to cover the 28 day appeal period. The Order takes immediate effect.

This was a Conduct and Competence Committee Final Hearing held at the HCPC between 28 - 29 October 2014.

Hearing history

History of Hearings for Mr Andrew S Woodall

Date Panel Hearing type Outcomes / Status
17/01/2018 Conduct and Competence Committee Review Hearing Hearing has not yet been held
29/09/2017 Conduct and Competence Committee Review Hearing Conditions of Practice
26/10/2016 Conduct and Competence Committee Review Hearing Conditions of Practice
23/10/2015 Conduct and Competence Committee Review Hearing Suspended
28/10/2014 Conduct and Competence Committee Final Hearing Suspended