Mrs Kelly Coburn

: Occupational therapist

: OT43697

: Final Hearing

Date and Time of hearing:10:00 01/07/2015 End: 17:00 01/07/2015

: Park Plaza Cardiff, Greyfriars Road, Cardiff, CF10 3AL

: Conduct and Competence Committee
: Suspended

Allegation

During the course of your employment as an Occupational Therapist with Rhondda Cynon Taf County Borough Council between June 2008 and July 2012 you:

 

1. Did not identify and/or undertake the appropriate assessment based on the service users' presenting condition;

 

2. Did not conduct assessments in an appropriate manner in that you:

 

a) Asked inappropriate and/or irrelevant questions;

 

b) Gave inappropriate and/or incorrect advice;

 

c) Diagnosed service users' conditions when you should not have;

 

3. Recommended and implemented adaptations which were not

necessary;

 

4. Did not demonstrate a basic level of competency in:

 

a) Problem solving;

 

b) Analysis of complex information;

 

c) Manual handling;

 

d) Technical knowledge in relation to clinical reasoning;

 

e) Report writing;

 

f) Record keeping;

 

g) Decision making;

 

5. Did not communicate properly and effectively with service users and/or carers;

 

6. The matters set out in paragraphs 1 - 5 constitute a lack of competence.

 

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

Finding

Preliminary Matters:
No evidence offered by the HCPC in relation to particulars 4(b), 4(d) and 4(f)
1.             At the outset of the hearing Ms Lister indicated that the HCPC proposed to offer no evidence in relation to particular 4f of the allegations. On 23 February 2015, the first day of the resumed hearing, Ms Lister further indicated that, having reviewed the evidence, the HCPC would not pursue particulars 4b and 4d of the allegation. Ms Hurn did not object to the withdrawal of these particulars.
Application for the hearing to be held in private
2.             Ms Lister submitted that there would be frequent references to the Registrant’s health condition during the course of her opening statement and in the evidence. Ms Lister suggested that it might not be practical to move in and out of private session and so she invited the Panel to consider hearing the whole of the evidence in private. Ms Hurn supported the HCPC‘s application. The Panel considered the HCPC practice note on ‘Conducting Hearings in Private’ and accepted the advice of the Legal Assessor
3.             The Panel accepted that Ms Coburn’s health condition was a thread which was effectively woven through the factual background of this case. It determined that because the hearing required some exploration of the detail of the Registrant’s health condition, it was justified in holding the hearing in private in order to protect the Registrant’s privacy. The Panel advised the parties that it would keep the question of whether or not the hearing should remain in private session under review.
At the resumed hearing the Panel reviewed its decision in the light of the October hearing days. It was apparent that the Registrant’s health condition had not been referred to as extensively as anticipated by the parties. The Panel determined that the Registrant’s privacy could be adequately protected by moving into and out of private session when matters which concerned her health condition were raised in evidence.
Background:
4.             Ms Kelly Coburn qualified as an Occupational Therapist (”OT”) in 2005. She previously worked at Gwent NHS Trust as a Band 5 OT in a mental health setting.
5.             On 30 June 2008 Ms Coburn was appointed as a community Occupational Therapist (“COT”) in the Adaptations and Community Equipment Team of Rhondda Cynon Taff County Borough Council (“the Council”).
6.             In her role as a COT Ms Coburn assessed patients in the community to find out whether they needed any equipment or housing adaptations to assist them with their daily living. She also was expected to take the needs of carers into consideration. The patients Ms Coburn worked with had long term health conditions and/or substantial disabilities.
7.             Ms Coburn’s role involved assessing and balancing the risks to service users and their carers in a way that promoted the independence of service users and assisted their carers. Ms Coburn played a part in managing the process by which decisions about the allocation of resources were made. Ms Coburn was required to account for her actions through effective and accurate recording of her assessments, decisions, plans and outcomes.
8.             Ms Coburn was diagnosed with a health condition whilst she was at university. She did not disclose her diagnosis on her application form for employment with the Council.
9.             At the start of her employment Ms Coburn was allocated MW, senior Occupational Therapist, as her supervisor. As her supervisor MW was responsible for authorising formal assessment documentation and clarifying the clinical reasoning it contained where appropriate. In the first three months of Ms Coburn’s employment MW became aware of issues concerning Ms Coburn’s report writing. These were primarily to do with the structure, spelling and grammar of Ms Coburn’s reports.
10.           In a supervision session in October 2008 Ms Coburn disclosed her diagnosis of a health condition to MW. MW shared that information with the Team Manager, Mrs HT. Ms Coburn was referred to the Council’s Occupational Health department who confirmed a diagnosis of a health condition and referred her to the Workstep programme on 21 January 2009. The Workstep programme was designed to offer support to disabled employees in the workplace. A number of recommendations were made to assist Ms Coburn at that time including the provision of a Dictaphone and read back software.
11.           Ms Coburn undertook a range of training during the course of her employment with the Council. In November 2008 she completed modules C, D and F of the “All Wales Manual Handling Passport Training”. The passport training scheme was a national scheme designed to ensure consistency in manual handling training within the NHS in Wales. Module C of the course concerned ‘sitting, standing and walking’; module D ‘bed mobility’ and module F ‘hoisting’.
12.           In January 2009 Ms Coburn also received manual handling training delivered by the Council’s own manual handling team.
13.           Attempts had been made to introduce Ms Coburn to the manual handling elements of the OT role. She had undertaken a number of manual handling assessments. Ms Coburn made a number of high risk errors whilst on manual handling visits with her supervisor MW and with Mrs TM, a senior OT who oversaw manual handling practice within the team. As a result of these errors from 26 July 2009 Ms Coburn was not permitted to undertake the manual handling elements of her role.
14.           In April 2009 concerns were raised by the Council’s Private Sector Housing Unit about the accuracy of Ms Coburn’s recommendations for the installation of stair lifts. Further concerns were raised in June 2009 which included concerns that Ms Coburn often did not complete the necessary functional assessments on visits but nevertheless proceeded to make recommendations for service users.
15.           As a result of these concerns it was agreed that MW would check Ms Coburn’s written work before it was uploaded to patient files. Ms Coburn was encouraged to use a camera to assist in her analysis of adaptation requests; provided with a typed summary of the Council’s processes which she could refer to during her assessment visits and advised to contact the team’s advice line if issues arose while she was away from the office.
16.           Ms Coburn commenced a period of maternity leave on 11 September 2009. During her absence her cases were allocated to other OTs and further concerns came to light. The Council was required to resolve eight cases where ineffective adaptations had been made on Ms Coburn’s recommendation, many of which needed to be removed. As a result of these matters HT resolved that Ms Coburn should be more closely supervised on her return to work from maternity leave.
17.           Ms Coburn returned to work on 28 June 2010. She attended a return to work meeting where she was allocated a new supervisor, Ms JJ and was advised of the concerns that had arisen in her absence. At the return to work meeting Ms Coburn agreed that the key areas of her development needs were: making clinical decisions, critical evaluation of information and assessment. It was agreed that Ms Coburn would benefit from revisiting the COT process from the beginning building up to the full range of OT duties and responsibilities, including manual handling, in the long term.
18.           Ms Coburn was willing to participate in the development work. She acknowledged the importance of becoming a fully rounded OT and remained willing and enthusiastic in working towards achieving these goals.
19.           Ms Coburn was allocated OT assessments in respect of minor works, known as Community Care Worker Assessments, when she first returned to work. These assessments could be undertaken by staff that were not qualified OTs and generally involved less complex cases with minor aids and adaptation referrals.
20.           By October 2010 Ms Coburn was working on the less complex OT assessments such as Adapted Housing Assessments. These required full functional assessments and recommendations in respect of future housing having regard to patient needs. All of the cases allocated to Ms Coburn were carefully screened to ensure that she could practise elements of her role without placing patients at undue risk. Ms Coburn continued to work on these less complex cases until she ceased to work as a COT and was redeployed in July 2012.
21.           Between June and December 2010 further concerns were raised about Ms Coburn’s practice following a number of observed visits known as L20 observations. The Department’s policy required all OTs to undertake two such visits each year where they would be observed by a senior OT. Issues highlighted on these visits included a lack of knowledge in relation to medical conditions and OT skills, poor listening and interviewing skills and the production of subjective rather than factual functional assessment reports and documents.
22.           In December 2010 Ms Coburn and HT held a number of meetings to discuss her work. It was agreed that Ms Coburn could type and edit her assessments before submitting them to her seniors. It was also agreed that observed visits would continue and seniors would intervene only where it was essential to do so.
23.           On 2 February 2011 Ms Coburn was referred to occupational health for an urgent assessment of her abilities to undertake the role of COT. Ms Coburn was reviewed by occupational health (“OH”) on 15 February 2011 and referred for a thorough psychological assessment “to try and work out what her capabilities are and what adaptations would be required to keep her in the workplace.”
24.           The assessment took place on 15 June 2011 and a report was produced dated 22 June 2011.
25.           Following on from this report Ms Coburn was assessed by ‘Access to Work’ on 4 July 2011 and further recommendations as to equipment which might assist her were made.
26.           On 19 July 2011 the Council received further OH advice which indicated that on balance some of the performance issues identified in relation to Ms Coburn were due to her underlying medical condition and supported the provision of various pieces of IT equipment to Ms Coburn. By 4 November 2011 the adaptations recommended in the Access to Work assessment had been provided to her.
27.           TM attended observational visits with Ms Coburn on 16 and 21 December 2011 and on 11 January 2012. MW attended observational visits with Ms Coburn on 12, 14 and 15 December 2011. As a result of the observations made Ms Coburn was asked to undertake the even less complex work of disabled parking bay assessments
28.           Ms Coburn was on sick leave between 17 January 2012 and 8 February 2012. HT invited Ms Coburn to a meeting in March 2012 under the Council’s Capability procedure to discuss issues relating to her work performance. Her letter identified the issues which she wished to discuss at the meeting. They were:
·          Gathering and recording factual assessment information
·          Clinical judgment/rationale and risk analysis to support recommendations
·          Conduct of the assessment; and
·          Imparting accurate information to the client in respect of the grant/adaptation process.
29.           HT conducted an informal capability interview with Ms Coburn and her trade union representative on 8 March 2012, an action plan was formulated and a support contract agreed on 14 March and both were put in place with effect from 21 March 2012. It was agreed that Ms Coburn would seek to demonstrate sound clinical reasoning and identify, justify and rationalise clinical decisions made in relation to client needs during the course of observed visits, two way reviews, discussions of recommendations and rationale on assessment reports. There would be constructive critique of the visits, outcomes and reflections. It was also agreed that supervisors would offer support by reviewing referral documents and assessment outcomes before Ms Coburn signed off her reports.
30.           TM undertook further observational visits with Ms Coburn on 27 March and 30 April 2012. MW also undertook further observational visits with Ms Coburn on 22 March and 27 April 2012.
31.           The action plan was reviewed at a meeting on 30 April 2012. At the meeting HT confirmed that Ms Coburn had not yet met an acceptable competency level in relation to the areas of concern. She told Ms Coburn that she could not consider any request to allocate her more complex cases because of a risk to clients.
32.           On 2 May 2012 the informal capability process was suspended at Ms Coburn’s request so that she could consider redeployment. On 15 May 2012 Ms Coburn met with HT, accompanied by her trade union representative and confirmed that she wished to be redeployed. In that meeting Ms Coburn accepted that she was unable to carry out her full role as an OT and confirmed that she had not worked across the full range of OT duties since 2011.
33.           On 12 July 2012 Ms Coburn accepted a post as a support worker in the Council’s mental health team. She subsequently brought employment tribunal proceedings against her employer and left her employment with the Council under the terms of an agreed settlement of her claims. She has not worked as an OT since 2012 and is now running a child minding business.
34.           On 3 May 2013 the Council’s OT department referred Ms Coburn to the HCPC.
Decision on Facts:
35.           The Panel read witness statements and heard oral evidence from three witnesses called on behalf of the HCPC over the course of the first four days of this hearing in October 2014. The witnesses were: Mrs HT, Team Manager, Mrs MW and Mrs TM, Senior Community Occupational Therapists. All three worked with Ms Coburn in the Council’s Adaptations and Community Equipment Team (“ACE”). The case was then adjourned part heard due to a lack of time.
36.           At the October 2014 hearing the Panel read Ms Coburn’s witness statement. It carefully considered the documents provided by the parties. These included the HCPC exhibits bundle and Ms Coburn’s written responses to the HCPC allegation together with supporting documentation, and a timeline.
37.           At the resumed hearing in February 2015 the Panel heard oral evidence from Ms Coburn over the course of three days (23-25 February 2015) and read further written representations provided by her, a further commentary and response document together with a summary of CPD activities and relevant work related duties and responsibilities undertaken since Ms Coburn ceased to work as an OT.
38.           The Panel also heard detailed submissions from the representatives. Ms Lister submitted that witnesses on behalf of the HCPC had given persuasive and fair evidence which supported the factual allegations in this case. She characterised the Registrant’s evidence as unsatisfactory and contradictory. Ms Lister contended that the oral and documentary evidence fully supported the facts relied on by the HCPC.
39.           Ms Hurn submitted on behalf of Ms Coburn that this case was not really about Ms Coburn’s fitness to practise at all. She explained that part of Ms Coburn’s defence to the factual allegation is that employees of the Council who were called as witnesses by the HCPC were hostile towards her and bullied her during the course of her employment. It was asserted on behalf of Ms Coburn that the concerns expressed in evidence by HCPC witnesses were not genuine concerns and that individuals had acted maliciously in referring these matters to the HCPC because Ms Coburn had succeeded in obtaining a redeployed role.
40.           Ms Hurn also submitted that the honesty and integrity of the HCPC witnesses was called into question by the timing of the referral to the HCPC. She observed that the witnesses relied heavily on their recollection of events and noted that memory is subjective and often unreliable. She also contended that key facts were not contained within contemporaneous documents. Ms Hurn contrasted the demeanour of HCPC witnesses in giving evidence with that of Ms Coburn who she described as an extremely honest witness who gave thoughtful evidence and conducted herself appropriately throughout the course of the hearing.
41.           In the light of these submissions the Panel has carefully considered the question of whether some or all of the HCPC witnesses had a collateral and improper purpose in raising concerns as to Ms Coburn’s professional competence. However, the Panel notes that concerns as to Ms Coburn’s competence were raised by her supervisors well before her case was referred to the HCPC. The Panel has had particular regard to the demeanour of all of the witnesses that it has heard and to the issues of credibility and integrity which have been raised.
42.           There were substantial conflicts in the evidence which the Panel heard as Ms Coburn denied most of the factual particulars. In making its findings on the facts the Panel has sought to resolve those conflicts where they are material to the particulars of the allegation it has to decide. The Panel is mindful that it is for the HCPC to prove the facts which it alleges and that the standard to which those facts must be proved, is on a balance of probabilities.
43.           The Panel notes that all three HCPC witnesses were experienced OTs.
44.           The Panel is satisfied that each of the witnesses gave evidence of their own independent recollection of events. This was demonstrated by the fact that the HCPC witnesses gave evidence which was largely supported by the contemporaneous documents in this case. There were some conflicts between the witnesses’ recollections of events but on the whole these were not material. The Panel is persuaded that there has not been collusion between the witnesses called by the HCPC.
45.           The HCPC witnesses gave evidence which was clear, balanced and consistent. They were patient during extensive cross examination. The HCPC witnesses offered their professional views and demonstrated by their demeanour and answers that they had sought to support Ms Coburn in her professional development.
46.           Following Ms Coburn’s return to work from maternity leave in June 2010 HT documented that she was “willing to participate in the developmental work…..and remains enthusiastic and willing to work toward achieving her goals with support from her supervisors.” In August 2011 Ms Coburn wrote to HT commenting on “how supportive, helpful and understanding Terri [TM] has been while you have been on annual leave.” In a December 2011 supervision session HT noted that Ms Coburn “has made progress in report writing and presentation. There is no doubting her commitment and motivation as she makes every effort to comply with requirements.” In her oral evidence to the Panel HT commented that Ms Coburn worked very hard and tried very hard but ultimately was not able to conquer the capability issues identified.
47.           Ms Coburn was engaged, if understandably nervous, during the course of her evidence. She referred to relevant documents and negotiated her way through the various bundles without apparent difficulty. In recognition of her health condition, the Panel afforded Ms Coburn regular breaks and additional time to read and assimilate material when it was needed. The Panel noted that Ms Coburn’s evidence was on occasion inconsistent with contemporaneous documentation and with her own more recent written statements of evidence. The Panel was concerned that Ms Coburn was not able to explain adequately the inconsistencies in her evidence. Where she was able to offer an explanation, the Panel found Ms Coburn’s explanations for changes in her account of events, unconvincing.
48.           The Panel noted that a feature of Ms Coburn’s evidence was that after the October hearing she prepared a commentary on the HCPC witnesses’ evidence. In that commentary Ms Coburn provided a contrary account, justification or explanation for each of the factual particulars. Many of these matters had not been put to the HCPC witnesses when they gave their evidence. The Panel notes that this evidence was critical and fundamental evidence about Ms Coburn’s reasoning and decision-making which was not put to the HCPC witnesses. The Panel recognised that Ms Coburn was represented by her aunt who is not a lawyer, but it was made clear that issues of conflict needed to be raised with the HCPC witnesses so that they could respond. This raised a question for the Panel as to the credibility of Ms Coburn’s later explanations and the weight, if any, to be attached to them.
49.           As part of the evidence before it the Panel has received contemporaneous reflective notes of observed visits. Some were compiled by Ms Coburn and some by the supervisor who attended on the visit. In a large number of cases the reflective notes are jointly signed as a correct and accurate record of the visit. Some of the signed observed visit notes also include the words “Kelly agrees that the information recorded is a true reflection of the observational assessment.” The Panel considers that these records, completed shortly after the visits, are a fair and accurate reflection of what occurred.
50.           In her oral evidence Ms Coburn suggested that she had reflected the observer’s criticisms of her performance in her personal notes. She also said that she counter-signed the notes simply to confirm that she had read them. She stated that she felt under pressure to agree with her senior colleagues’ observations.
51.           The Panel has carefully considered Ms Coburn’s evidence that she felt under pressure to agree the notes. Whilst the Panel accepts that this may have been Ms Coburn’s perception, it is not supported by the evidence it has heard and read. The Panel notes that there are examples of handwritten notes made by Ms Coburn in the margin of some of the typed documents in which Ms Coburn clarifies or sets out her view of events. The Panel places greater reliance on the contemporaneous notes than on the explanations given by Ms Coburn several years later. In addition, the Panel cannot accept the suggestion that Ms Coburn was under scrutiny for the whole of the period of time covered by the observations. Many of the notes were compiled before the capability process started.
52.           The HCPC identified specific examples of patients by which it sought to prove each particular of the allegation. The Panel has considered each of these patients separately in relation to each particular and made findings of fact in respect of each one in order to decide whether or not the particular of the allegation is proved.
Particular 1
Did not identify and/or undertake the appropriate assessment based on the service users' presenting condition;
Patient E
53.           Patient E had cognitive impairment and communication difficulties caused by dementia. She had been referred by her in-house care services who were concerned about the suitability of transfer equipment installed in her home. Ms Coburn visited Patient E to complete a manual handling assessment on 13 January 2011. TM attended to observe the assessment.
54.           The Panel accepts TM’s account of the assessment visit.
55.           Her carers demonstrated the method they were using to transfer Patient E which involved the use of a Stand Aid Hoist and sling. This showed that whilst Patient E was on the equipment she was unable to bear her own weight. Her carers had to provide such significant physical assistance to Patient E that they placed both Patient E and themselves at risk of harm.
56.           The HCPC alleges that whilst Patient E was in the Stand Aid Hoist and sling Ms Coburn asked her to hold her hand and squeeze it as hard as she could in order to ascertain the strength of her grip. TM told the Panel that this assessment was not necessary as Patient E’s upper body strength was not relevant to the issues raised on referral. In addition TM stated that Ms Coburn’s action posed a potential risk to Patient E because the hoist was designed to transfer patients and not to hold them. If an assessment of grip had been necessary it should have been carried out when Patient E was sitting or lying down.
57.           In her evidence Ms Coburn maintained that an assessment of Patient E’s grip was necessary and appropriate. She denied that Patient E remained in the hoist whilst she conducted the assessment. Her evidence was that she asked Patient E to squeeze her hand whilst she was sitting on the bed not in the hoist.
58.           The Panel notes that in her reflection written shortly after the visit Ms Coburn observed that she “was so concerned about the solution that [she] did not concentrate on undertaking an assessment.” She recorded that she had worried about the assessment and the outcome for two days before it took place and was nervous at being assessed by a senior.
59.           The Panel finds that the upper limb assessment conducted by Ms Coburn was not an appropriate assessment to undertake however it was conducted, since it could not assist in determining Patient E’s weight bearing capacity. In addition Ms Coburn failed to identify potential risks to Patient E and her carers during this assessment. She did not use appropriate observational skills or pay proper regard to the working environment.
60.           The Panel finds this particular proved in relation to Patient E.
Patient K
61.           Patient K had a complex medical history, of particular relevance to his referral for assessment was that he suffered from Neuropathy. As a result of this and diabetes he had reduced sensations in both feet. On 14 December 2011 Ms Coburn visited Patient K and his wife at their home; she was accompanied by MW.
62.           The Panel finds that Ms Coburn began a functional assessment of Patient K in respect of his use of the stairs in his home. He had significant difficulty elevating his feet when negotiating each stair. His difficulties were such that it was not appropriate to ask him to undertake a transfer into a bath which would require him to elevate his lower limbs to an even greater extent. In a contemporaneous reflection and in her oral evidence Ms Coburn accepted that she may have asked Patient K to demonstrate a bath transfer. She also said in evidence that she meant Patient K to describe rather than to actually undertake such a transfer. The Panel does not accept Ms Coburn’s explanation. It finds this particular proved in relation to Patient K.
Patient Q
63.           Patient Q had breast cancer and was referred to the Council’s service because of difficulties she had with bathing. A community care worker had carried out an initial screening and HT attended on an observed visit with Ms Coburn and Patient Q’s husband which took place on 12 January 2012.
64.           The Panel finds that the community care worker had already undertaken an assessment of the patient’s use of the stairs and assessed a bed transfer. There is no dispute that Ms Coburn undertook a stair assessment but did not undertake the bath transfer assessment which had been requested. The Panel finds that the stair assessment was unnecessary and inappropriate. It does not accept Ms Coburn’s explanation that she undertook the assessment again to check on the previously installed adaptation. The Panel finds this particular proved in relation to Patient Q.
Patient R
65.           On 22 March 2012 Ms Coburn visited Patient R who had been referred because she was finding it difficult to access her toilet and to negotiate the steps which provided access to her rear garden. MW accompanied Ms Coburn on this visit which was the first observed visit under the informal capability process.
66.           It is common ground that Ms Coburn was asked to undertake a functional assessment of Patient R using the rear external steps to access the garden, which she did. Ms Coburn then asked her to undertake a transfer from the toilet when this had not been identified as an issue of concern in the referral or by Patient R. Ms Coburn explained that she was just checking and being thorough, however she was not able to explain her clinical reasoning for doing this assessment. The Panel finds that this assessment was unnecessary and finds particular 1 proved in relation to Patient R.
Patient T
67.           Patient T had multiple health issues including osteoarthritis, spina bifida and carpal tunnel syndrome. He was referred because he had lost confidence in using his bath. Ms Coburn undertook an observed visit to Patient T with TM on 3 April 2012.
68.           The Panel accepts TM’s evidence that Ms Coburn asked Patient T to demonstrate a toilet transfer, even though Patient T and his wife had informed them that Patient T could manage most transfers independently with the use of aids which had been provided as a result of an Occupational Therapist assessment previously conducted by health workers. Given that the patient had stated that he had no problems with this transfer and that appropriate equipment and aids were in place, it was not an appropriate assessment to seek to undertake and it was not supported by any clinical reasoning on Ms Coburn’s part; she simply ‘wondered about’ a toilet transfer.
69.           The Panel finds this particular proved in relation to Patient T.
Patient M
70.           Patient M had undergone a hip replacement operation which had not been successful. As a result he had an open wound and one leg which was approximately two and a half inches shorter than the other. The referral was made by his wife as Patient M was unable to access the bath and was having difficulty maintaining his personal hygiene.
71.           Ms Coburn attended Patient M on an observed visit accompanied by TM on 16 October 2011.
72.           The Panel finds that Ms Coburn asked Patient M to undertake a functional assessment. He told her that he would experience too much pain if he attempted all the transfers she requested. Ms Coburn did offer to come back on another day to undertake the parts of the assessment he did not complete on that visit. Patient M then agreed to attempt the transfers requested. On moving to transfer from his armchair, Patient M experienced such acute pain that TM intervened to stop the functional assessment being carried out. The notes of the visit which Ms Coburn signed agreed that there was a risk of exacerbating Patient M’s pain levels and causing him harm if the functional assessment had been carried out. Further, Patient M had already been provided with information about stair lifts which suggests an assessment in relation to matters that were already known was inappropriate.
73.           The Panel finds this particular proved in relation to Patient M.
Patient X
74.           Patient X had chronic epilepsy which caused him to experience seizures which would cause him to lose consciousness without any warning. During his recovery from seizures his speech would become slurred and his mobility was affected.
75.           Ms Coburn undertook an observed visit with Patient X on 20 August 2010. MW accompanied her.
76.           Although there are no notes of this observed visit MW recollection of the visit is specific and detailed. The Panel considers that MW’ account of the visit which she gave in evidence is accurate.
77.           Although Ms Coburn has cast doubt on MW’ ability to recall events which took place almost five years ago, her own account confirms that she did undertake these assessments.
78.           The evidence before the Panel, including Ms Coburn’s oral evidence and her written statement, suggests that various functional assessments were completed by Patient X even though he had no physical limitations. Ms Coburn acknowledged that these assessments were not necessary. The Panel finds that these assessments were unnecessary that this particular is proved in relation to Patient X.
79.           Overall, based on its findings of fact in relation to these patients, the Panel finds particular 1 proved.
Particular 2a:
Did not conduct assessments in an appropriate manner in that you asked inappropriate/irrelevant questions
Patient H
80.           Patient H suffered from heart problems, asthma, arthritis, severe anxiety and depression. HT completed an informal joint visit to Patient H with Ms Coburn on 18 November 2011. When they arrived Patient H told them that she was due to move house to a property that would fully meet her functional needs within the next two weeks. The Panel accepts HT’ evidence that upon receiving this information Ms Coburn should have concluded the interview since community OT input was no longer needed.  However, the Panel finds that Ms Coburn continued to interview Patient H for about fifty minutes. The Panel finds that HT intervened when Ms Coburn asked Patient H to undertake a bath transfer. The Panel does not accept that Ms Coburn’s explanation that Patient H might require additional support during the relocation process justified prolonging the interview or requesting a bath transfer. Accordingly, the Panel finds that inappropriate questions were asked about health and social care issues in relation to Patient H.
81.           This particular is proved in relation to Patient H.
Patient Q
82.           The Panel has already found that Ms Coburn conducted an unnecessary assessment as she asked a series of questions which were unrelated to the bathing assessment which she was visiting Patient Q to undertake. Those questions referred to the stairs and other possible access options which Ms Coburn did not specify. These questions had the potential to confuse and/or raise expectations on the part of patients. The Panel also finds that Ms Coburn asked irrelevant questions about Patient Q’s GP which were unrelated to the assessments.
83.           This particular is proved in relation to Patient Q.
84.           Based on its findings in relation to patients H and Q the Panel finds particular 2a proved.
Particular 2b:
Did not conduct assessments in an appropriate manner in that you gave inappropriate and/or incorrect advice.
Patient E
85.           TM told the Panel that Ms Coburn recommended that Patient E be provided with a Stand Assist sling and that the existing Stand Aid Hoist remain in place. TM’s evidence was that the existing hoist was no longer suitable for Patient E because she was no longer able to bear her own weight. As a result she required a passive hoist. TM added that the suggestion of a Stand Assist Hoist was not appropriate because it would require Patient E to actively participate in the transfer. Their earlier observation of the transfer process had shown that Patient E was unable to do this safely.
86.           In her reflection written at the time Ms Coburn recognised that her recommendation was inappropriate. In evidence to the Panel Ms Coburn said that she simply considered a Stand Assist Sling rather than recommending it to Patient E.
87.           The Panel does not accept Ms Coburn’s evidence that she made no recommendation. It prefers the account she gave closer to the events in question. The Panel notes that this explanation was not put to TM to comment on despite a clear direction to Ms Coburn and her representatives that any challenges to the evidence given by HCPC witnesses should be made by cross examining those witnesses while they were giving their evidence.
88.           The Panel finds that Ms Coburn did give incorrect advice and made an inappropriate recommendation in relation to Patient E which had the potential to place Patient E and her carers at high risk of harm.
Patient F
89.           Patient F was a 79 year old female patient who was referred to the community OT service having suffered a heart attack. She also had a painful arthritic condition. 
90.           HT visited Patient F with Ms Coburn on 26 July 2011. Ms Coburn advised Patient F that she was going to recommend a stair lift and that whilst she was awaiting the installation of the stair lift she should sleep downstairs. The Panel finds that this was inappropriate advice since Patient F did not have a single bed and would have been required to move a substantial amount of furniture to implement Ms Coburn’s advice. She would lose access to her shower and have to strip wash in the kitchen without privacy. She would also have to store her clothing downstairs. In addition, Patient F’s downstairs toilet facilities were outside and lacked adequate heat and lighting. The Panel finds that this advice would have caused substantial upheaval to Patient F for a period of approximately one month. The Panel accepts HT’s evidence that this advice was inappropriate for an active woman. Ms Coburn did not recognise the increased potential risk to Patient F this advice would cause. Ms Coburn was unable to tailor her advice to the individual patient. She recognised that there was potential risk to Patient F in negotiating the stairs but did not evaluate this risk against other relevant factors. Ms Coburn’s clinical reasoning and judgment were lacking in her dealings with Patient F. In her reflective note Ms Coburn recognised that she should have thought more about her recommendations before she made them.
91.           The Panel finds this particular proved in relation to Patient F.
Patient I
92.           Patient I suffered from rheumatoid and osteo-arthritis, fibromyalgia and carpal tunnel syndrome. Ms Coburn visited Patient I on 6 and 12 December 2011. MW observed the second visit where Ms Coburn was asked to conduct a seating assessment for Patient F.
93.           The HCPC alleges that Ms Coburn advised Patient I to sleep on a sofa bed and required lateral seating support. MW stated that Ms Coburn recorded the need for lateral support but the Panel saw no documentary evidence to support this allegation. The HCPC produced evidence which related to the second visit to Patient I on 12 December 2011.
94.           The HCPC has not provided sufficient evidence to support this particular in relation to this patient. The Panel finds the HCPC has not proved this particular in relation to Patient I.
Patient N
95.           Patient N had a range of health conditions. She suffered from osteoporosis of the spine which also affected her hips and hands. She had a pacemaker and wore a hearing aid. She suffered from glaucoma and chronic obstructive pulmonary disease. Patient N was struggling on the stairs and to stand in the shower. She had also recently lost her husband.
96.           Ms Coburn visited Patient N on 21 December 2011 when she was accompanied by TM. Ms Coburn advised Patient N that she required a stair lift and that she should not use her stairs until this was installed. Ms Coburn advised Patient N to sleep downstairs in the lounge and make use of a chemical toilet until the work was carried out. She also gave advice about the grants process which Ms Coburn accepted in her evidence she had struggled to explain.
97.           The Panel finds that this advice had a significant impact on Patient N who became distraught. TM considered this advice was not appropriate in view of the fact that Patient N only negotiated stairs when her family, who were regular and frequent visitors, were present. The Panel considers that Ms Coburn failed to evaluate the impact of her interventions on Patient N’s wellbeing and overall situation or the way in which the risk to Patient N could be managed.
98.           The Panel finds this particular proved in relation to Patient N.
Patient O
99.           Patient O suffered from Crohn’s disease, pancreatitis and asthma. She was hoping to relocate to an adapted property which would be more suitable for her needs. Patient O was staying in temporary accommodation waiting for a suitable property to be identified. Ms Coburn conducted a visit to Patient O on 17 January 2012.
100.         The Panel notes that Ms Coburn recorded that Patient O had the functional ability to use a bath aid. However, she also records that Patient O would benefit from a level access shower. This conflicting advice, namely to suggest a shower when the patient could use a bath, is clearly established on the face of the assessment documents. In her oral evidence to the Panel Ms Coburn stated for the first time that the apparent conflict in the assessment document was the result of a typographical error in that she had omitted the word ‘not’. On further questioning from the Panel Ms Coburn conceded that two different typographical errors, both omitting the word ‘not’ would have had to have been made for her explanation to be satisfactory. She was not able to explain why her explanation for this apparent conflicting advice had not been given at the time nor was she able to explain why that explanation had not been put to the HCPC witnesses for their comment.
101.         The HCPC also submitted that there was incorrect advice which recommended the installation of a stair lift. In their written statements both TM and HT said that Ms Coburn had made this recommendation. However the Panel concludes that no formal written recommendation to this effect was made or at least this recommendation was not evident in the final version of the assessment report.
102.         The Panel finds this particular proved in part in relation to Patient O.
103.         The Panel was concerned by Ms Coburn’s explanation in her evidence. This was an important example of conflicting professional advice (i.e. recommending a shower when the patient could use a bath) on which Ms Coburn’s supervising managers had taken her to task. In the Panel’s view the explanation given by Ms Coburn in evidence that the word ‘not’ had been omitted as a typographical mistake is not believable. The Panel concludes that Ms Coburn’s explanation at such a late stage of the hearing was an attempt on her part to avoid responsibility for the obvious conflict in the assessment reports.
Patient P
104.         Patient P had sustained a brain injury; as a result he had difficulties with memory, comprehension and balance. Patient P also had substance dependency issues.
105.         Ms Coburn visited Patient P on 11 January 2012. She was accompanied by TM. A stair lift had been installed at the property to assist Patient P’s sister. Ms Coburn observed Patient P on the stairs; she expressed surprise that he did not use the lift.
106.         The Panel finds that Patient P had a full range of movement and was capable of using the stairs as he evidenced by his actions on the assessment visit.  He ran up the stairs to switch on the stair lift. It was not correct for Ms Coburn to advise Patient P that if he did use the stair lift he should only do so under supervision. The Panel finds that there was in fact no clinical reason for him to use the stair lift at all so the only correct advice was how to use the stairs safely. The advice Ms Coburn gave about the use of the stair lift was superfluous, potentially confusing and not clinically required.
107.         The Panel finds this particular proved in relation to Patient P.
Patient T
108.         The Panel finds that Ms Coburn gave two pieces of inappropriate advice to Patient T during the assessment visit on 3 April 2012 in relation to the height of his arm chair. She suggested that ‘raisers’ might be provided or alternatively that a platform could be constructed for the chair to rest on. The first suggestion was inappropriate because of the style of the chair. The second suggestion was inappropriate because the platforms were no longer available. The correct solution was a ‘raise and recline’ chair which Ms Coburn did not recommend. The Panel consider that Ms Coburn gave the wrong advice to this Patient.
109.         The Panel finds this particular proved in relation to Patient T.
Patient M
110.         The Panel accepts Ms Coburn’s evidence that she had little current experience of the Council’s grant system and had trouble explaining the process to Patient M. The Panel finds that she continued to seek details of Patient M’s financial position and gave advice about the timescale for adaptation works. The Panel finds that the information she gave about both matters was wrong.
111.         This particular is proved in relation to Patient M.
112.         Based on its findings in relation to patients E, F, I, N, T and M the Panel finds particular 2b proved.
Particular 2c:
Did not conduct assessments in an appropriate manner in that you diagnosed service users’ conditions when you should not have
Patient K
113.         Ms Coburn is alleged to have told Patient K that he had ‘restless leg syndrome’ when this was inappropriate.
114.         The Panel finds that Ms Coburn used these or similar words. However, when she did so, Ms Coburn did not intend to make a diagnosis.
115.         The Panel does not consider that the HCPC has proved this particular.
 
Particular 3:
Recommended and implemented adaptations which were not necessary
Patient Z
116.         The Panel finds that a ceiling track hoist was installed in Patient Z’s bathroom on Ms Coburn’s recommendation. Ms Coburn’s case notes recorded that Patient Z was able to stand with the use of a grab rail and carer support. A subsequent re-assessment found that Patient Z did not require a passive hoist as she had weight bearing abilities and could manage transfers with an active stand hoist. As a result the ceiling track hoist which cost in the region of £2500 was removed and replaced with a standing hoist.
117.         The Panel noted that Ms Coburn made this recommendation at an early stage in her employment. She said in evidence that she had little experience of manual handling and had not made a recommendation of a ceiling track hoist before this assessment. Nonetheless the Panel is satisfied that this was an inappropriate recommendation. If Ms Coburn felt unable to make a recommendation then she should have sought advice and assistance from more experienced colleagues. As an autonomous practitioner Ms Coburn is required to act within the limits of her expertise.
118.         The Panel finds this particular proved in relation to Patient Z.
Patient AA
119.         Ms Coburn had recommended the installation of a stair lift and a bath lift for this patient. TM reviewed Ms Coburn’s assessment and because of an absence of clinical reasoning in the case notes TM conducted a further assessment of Patient AA on 2 November 2009 following her discharge from a stay in hospital. TM concluded that Patient AA was safely and independently demonstrating an appropriate range of movement necessary to access the existing shower cubicle and to negotiate the stairs in her home using the existing handrails.
120.         Ms Coburn told the Panel that she had a clear recollection of Patient AA’s case yet she was unable to explain why she came to the conclusions she did in respect of installations and adaptations.
121.         The Panel finds this particular proved in relation to Patient AA.
Patient A
122.         Patient A was a wheelchair user. The Panel finds that before starting her maternity leave Ms Coburn approved the installation of a portable ramp to assist Patient A with front entrance access to his ground floor property. The property also had level access at the rear. The ramp prescribed was to be substantial enough to support Patient A’s mobility scooter and wheelchair but portable enough so that Patient A’s wife could remove it when the ramp was not in use. The ramp installed was too heavy for Patient A’s wife to manoeuvre. She contacted the OT service in September 2009. Although the ramp was modified it still proved to be too heavy and on 20 November 2009 Patient A advised TM that he no longer wished to keep the ramp as he was able to enter and exit his building using level access to the rear of the property.
123.         The recommendation and the adaptation made in relation to Patient A was unnecessary. It was also contrary to the Council’s eligibility criteria. Ms Coburn asserted that TM, her supervisor, had approved the recommendations for the ramp. The Panel read Ms Coburn’s notes from the electronic case recording system ‘Swift’. Ms Coburn does not mention in her notes that the property benefits from level access at the rear which would have rendered the ramp unnecessary and inappropriate, although she told the Panel in her evidence that she was aware of this at the time.
124.         The Panel finds this particular proved in relation to Patient A.
Patient B
125.         Patient B was an older female patient who had arthritis and a chest condition. A stair lift had been fitted in her home.
126.         Ms Coburn had carried out an assessment of Patient B and authorised the installation of the stair lift before starting her period of maternity leave. In October 2009 Patient B’s daughter contacted the service and asked for the stair lift to be removed. MW attended Patient B’s home on 11 November 2009 on a follow up visit during which she noted that Patient B was able to mobilise into and out of her property on the first floor without any shortness of breath. MW reassessed Patient B based on her observed level of function and recommended that the stair lift be removed.
127.         In her evidence Ms Coburn argued that Patient B’s condition at the time that she carried out her assessment justified the installation of a stair lift. The Panel does not accept Ms Coburn’s evidence. It finds that Ms Coburn’s recommendation was significantly affected by the wishes of Patient B’s daughter who had initiated the original assessment and who was anxious that her mother be given a stair lift. The Panel is satisfied that there is sufficient evidence available to it to demonstrate that Patient B was capable of negotiating the stairs safely. This was further demonstrated by her subsequent actions in requesting that the stair lift be removed. The Panel accordingly finds that the adaptation recommended by Ms Coburn and approved for implementation by her was not necessary and that her proposed recommendation was influenced by the expectations of Patient B’s daughter.
128.         The Panel finds this particular proved in relation to Patient B.
Patient EE
129.         Patient EE had mobility issues as a result of a medical condition affecting her left knee joint. She was also incontinent of urine. 
130.         In September 2009 Ms Coburn recommended the installation of ground floor bathing and toilet facilities for Patient EE. She made this recommendation based on an incorrect assumption that a stair lift could not be installed in the property. The Panel finds that she did so without first adequately assessing the possibility of installing a stair lift. On re-assessment it became clear that the provision of a stair lift was the most cost effective and appropriate intervention since it would enable Patient EE to access existing toilet and bathing facilities in her home.
131.         The Panel finds that Ms Coburn’s recommendation was not appropriate. This particular is proved in relation to Patient EE.
132.         The Panel does not find this particular proved in relation to Patients BB, T and Y  but based on its findings in relation to Patients Z, AA, A, B  and EE the Panel finds this particular proved.
Particular 4a:
Did not demonstrate a basic level of competency in problem solving
Patient D
133.         Patient D had experienced a stroke. A subsequent injury to his shoulder had rendered equipment which had previously been provided to Patient D useless. His wife and daughter were having difficulties moving Patient D in bed.
134.         TM accompanied Ms Coburn on a visit to Patient D on 17 December 2010. TM attended as an observer. It was agreed before the visit that she would not intervene unless the patient or some other person was at risk during the assessment
135.         Ms Coburn had undertaken a two day training course in aspects of manual handling following her return from maternity leave in June 2010. This was the first manual handling assessment she had undertaken since her return from maternity leave. In her evidence Ms Coburn told the Panel, “I admit I was out of my depth with this assessment and I had limited experience of manual handling.”
136.         The Panel finds that Ms Coburn did not assess Patient D correctly. Patient D described his shoulder as having “popped out.” The Panel finds that Ms Coburn demonstrated a lack of competence by failing to investigate the nature and impact of Patient D’s shoulder problem and its ongoing prognosis. Ms Coburn assumed that Patient D’s shoulder had dislocated when a simple investigation and questions about his injury could have enabled her to gain more information about the nature of the problem and make appropriate recommendations.
137.         The Panel finds this particular proved in relation to Patient D.
Patient E
138.         Patient E was a patient with cognitive impairment and communication difficulties caused by dementia. Patient E’s in-house carers were concerned about the suitability of existing transfer equipment. In particular Patient E was being transferred using a Stand Aid Hoist and sling but was unable to bear her weight whilst on the equipment.
139.         Having listened carefully to the evidence of TM and Ms Coburn the Panel is satisfied that Ms Coburn was unable to identify which, if any, item of manual handling equipment was appropriate for Patient E. As a result, in part, of taking into account irrelevant factors in conducting her assessment Ms Coburn was unable to demonstrate a basic level of competency in problem solving in relation to Patient E.
140.         This particular is proved in relation to Patient E
Patient T
141.         The Panel finds that Ms Coburn did obtain a sufficient range of information in relation to Patient T’s bathing and limited movement. The Panel finds that it was reasonable for her not to undertake a bathing assessment of this patient. Her recommendation of a level access shower was the correct one and is supported by her assessment of the way in which Patient T managed and maintained his hygiene. A senior OT accepted that Ms Coburn had identified a correct and appropriate solution.
142.         In the Panel’s view issues with requiring this patient to conduct an unnecessary toilet transfer and giving inappropriate advice in relation to his arm chair were not problem solving issues, nor did the HCPC rely on them as such.
143.         The Panel finds this particular is not proved in relation to Patient T.
Patient I
144.         In the light of the Panel’s decision in relation to particular 2b of the allegation, the Panel also finds this particular is not proved in relation to Patient I.
Patient U
145.         Ms Coburn visited Patient U on 27 April 2012. She was accompanied by MW.
146.         Patient U was recovering from testicular cancer. As a result he was sitting on a pressure cushion during the assessment. Ms Coburn did not ascertain the reason for the cushion or consider the implications for the patient’s skin integrity. Patient U also had arthritis in his hands, angina and type two diabetes.
147.         During the assessment Ms Coburn noticed that Patient U was short of breath when ascending the stairs. She suggested a survey but was unclear about what sort of survey might be undertaken and what it might achieve. Although Ms Coburn recognised that Patient U had problems getting up the stairs she did not clarify the variety of options that were available to solve the problem and to enable him to access the facilities he needed.
148.         It became clear during the assessment process that Patient U had difficulties transferring from the toilet in the bathroom and would be assisted by the provision of grab rails yet Ms Coburn did not take relevant measurements whilst Patient U was in the bathroom. Instead she sought to take proxy measurements estimating the height of the rails in the bedroom following a bed transfer. The Panel did not consider this to be the most effective way of solving this problem.
149.         Patient U also told Ms Coburn that he was urinating in a bucket in the kitchen in order to avoid ascending the stairs.  Ms Coburn showed a lack of basic competence in failing to question him about this and provide a solution to the problem. In her written statement to the Panel Ms Coburn suggested that urinating in a bucket in the kitchen was an acceptable practice for a male patient. The Panel disagrees.
150.         The Panel finds this particular proved in relation to Patient U.
151.         Overall, based on its findings in relation to Patients D, E, T, I and U, the Panel finds this particular proved.
Particular 4c:
Did not demonstrate a basic level of competency in Manual Handling
Patient D
152.         The Panel has already commented on Ms Coburn’s manual handling training in relation to Patient D.
153.         The Panel finds that Ms Coburn picked up a one way tubular glide sheet from a table in the room where the assessment was taking place. There is a dispute about her intention. Ms Coburn told the Panel that she had no intention of using the glide sheet she simply wanted to clarify what it was and how it was used. However, in the recorded observation of this assessment which occurred in December 2010 TM records that “Kelly gained the one way glide sheet off the table and requested that she and I proceed to use the equipment to position the client up the bed.” Ms Coburn has counter-signed that observation. Later in the same document Ms Coburn states that she “did not know what she was going to do with the glide sheet.” The Panel has concluded that given Ms Coburn’s statement that she had limited experience and knowledge of manual handling she did pick up the glide sheet with a view to using it to reposition Patient D. This demonstrated a lack of basic competence in manual handling.
154.         In addition the Panel notes that earlier in the assessment Ms Coburn asked Patient D’s wife to demonstrate how they were currently managing the bed transfer. Patient D’s wife attempted to do this without assistance but stopped the demonstration because she felt it was too dangerous to do it without her daughter’s support. TM, who was observing the assessment, told the Panel that had Patient D’s wife not stopped of her own accord she would have intervened because of the risk to the patient and the carer. Ms Coburn did not intervene. This further demonstrates Ms Coburn’s lack of basic competence in manual handling and a failure to conduct and act on risk assessments during the course of her practice.
155.         The Panel finds this particular proved in relation to Patient D.
Patient E
156.         The Panel finds that Ms Coburn asked Patient E’s carers to demonstrate the procedure they used to move Patient E from the bed to the Standing Hoist. Ms Coburn did not recognise the risks to the patient or to the carers whilst they performed this task. In her evidence Ms Coburn did not comment on her role in relation to this demonstration. The Panel accepts the evidence of TM that Ms Coburn did not intervene or do anything to minimise the potential risks to Patient E and her carers by the level of physical assistance they were required to provide during the transfer. In her contemporaneous reflection Ms Coburn acknowledged that the bed transfer was an issue which she was struggling to address.
157.         The Panel finds this particular proved in relation to Patient E.
158.         Overall, based on its findings in relation to Patients D and E the Panel finds this particular proved.
Particular 4e:
Did not demonstrate a basic level of competency in report writing
Patient N
159.         The Panel has noted that Ms Coburn conducted an observed visit to Patient N on 21 December 2011. Her assessment report in relation to this visit does not refer to a toilet transfer having been undertaken; indeed such notes as there are suggest that no assessment of a toilet transfer took place. The Panel notes that the ACE team assessment summary also does not refer to Ms Coburn having undertaken a toilet transfer assessment even though that was one of Patient N’s identified needs. In the Panel’s view this constitutes a deficiency in Ms Coburn’s report writing. A problem with toilet transfer was identified in the assessment report but there is no evidence that this problem was addressed or resolved.
160.         During the course of the hearing criticism of Ms Coburn’s report writing in relation to Patient N related to a reference in the report to the patient using a radiator for support when completing a toilet transfer. The Panel finds that TM was mistaken in her written evidence on this matter in that her evidence on this issue related to another patient.
161.         Nonetheless the Panel is satisfied that by reason of her failure to address the toilet transfer issue in her report Ms Coburn did not demonstrate a basic level of competency in report writing. Accordingly, the Panel finds this particular proved in relation to Patient N.
Patient O
162.         The Panel has already rejected Ms Coburn’s explanation that the confusion in her assessment report arose from a typographical error. The Panel has therefore proceeded on the basis of the words recorded in the assessment. The Panel accepts the evidence from both HT and TM that they found Ms Coburn’s assessment report in relation to Patient O to be confused, lacking in substance and containing inadequate clinical reasoning. HT asked TM to revisit Patient O with Ms Coburn in order to clarify the recommendations that were being made.
163.         The Panel considers Ms Coburn’s assessment report to be confusing in at least two respects. Firstly, Patient O had the functional ability to use a bath aid but Ms Coburn proposes a level access or one step shower facility without setting out adequately her reasoning. The Panel notes that no functional assessment was carried out in relation to bathing. Such an assessment would be necessary in order to make any recommendation in relation to bathroom facilities. Secondly, the Panel finds that the discussion about the installation of a stair lift in the report is confusing. Patient O declined a functional assessment on the stairs. Ms Coburn canvassed the possibility of a stair lift in circumstances where this may not have been necessary in view of Patient O’s proposed move to more suitable accommodation with facilities on one floor.
164.         The Panel finds the recommendations within Ms Coburn’s assessment report to be unclear and confusing. Accordingly, this particular is proved in relation to Patient O.
Patient Q
165.         The Panel finds that Ms Coburn included details of the method this patient used to wash herself in her assessment report. HT who attended the visit was not present when this discussion between Ms Coburn and Patient Q’s husband took place and in feedback of the visit HT suggested that this information was inserted to justify the fact that Ms Coburn had not carried out a bathing assessment. Ms Coburn maintained that the information was provided to her in a discussion with Patient Q and her husband upstairs in her home whilst HT was downstairs. The HCPC has not proved that the conversation between Ms Coburn, Patient Q and her husband did not take place.
166.         The Panel finds that this particular is not proved in relation to Patient Q.
Patient X
167.         MW gave evidence of this observed visit on 20 August 2010 and told the Panel that Ms Coburn had recorded in her assessment report that Patient X had demonstrated low self esteem. MW did not agree with this assessment. The Panel finds that in the absence of the written assessment report where the words “low self esteem” is alleged to have been written there is insufficient evidence for the Panel to find this particular proved. Whilst the Panel accepts that MW’ recollection of events during the visit is vivid it does not consider it satisfactory to rely only on her recollection of specific words contained in an assessment report when that report has not been presented in evidence.
168.         The Panel finds that this particular is not proved in relation to Patient X.
169.         Although the Panel has not found this particular proved in relation to Patients Q and X the Panel finds this particular proved overall in the light of the significance it attaches to the cases of Patients N and O.
Particular 4g:
Did not demonstrate a basic level of competency in decision making
Patient E
170.         The Panel finds that Ms Coburn was unable to justify her decision to provide a Stand Assist Sling when she was challenged by Patient E’s daughter to provide the rationale for her recommendation. This conclusion is supported by Ms Coburn’s feedback of the visit. In fact Ms Coburn’s decision was incorrect. The manner in which Ms Coburn arrived at the decision in relation to testing Patient E’s grip appeared to have been influenced by her recent experience on an observed visit. Her decision as to the type of sling to be prescribed appeared to have been influenced by her recent attendance on a one to one manual handling course.
171.         Because Ms Coburn’s assessment of Patient E was inadequate and confused and did not follow a correctly reasoned analysis she was unable to select the correct sling and hoist to resolve Patient E’s difficulties. TM intervened at Ms Coburn’s request so that the correct sling and hoist could be identified and the correct advice offered. Ms Coburn accepted in her reflection on the visit that she was having difficulties in reaching the right decision, that her recommendation was not appropriate and “possibly could have placed the client at risk.”
172.         The Panel finds this particular proved in relation to Patient E.
Patient N
173.         The Panel is satisfied that its findings in relation to particulars 2b and 4e also support a finding that Ms Coburn did not demonstrate basic competency in decision making. The Panel finds this particular proved in relation to Patient N.
Patient Q
174.         The Panel is satisfied that its findings in relation to particulars 1 and 2a together support a finding that Ms Coburn did not demonstrate basic competency in decision making. The Panel finds this particular proved in relation to Patient Q.
Patient T
175.         The Panel is satisfied that its findings in relation to particulars 4a support a finding that Ms Coburn did not demonstrate basic competency in decision making. The Panel finds this particular proved in relation to Patient T.
Patient H
176.         The Panel has already found that Ms Coburn undertook an unnecessary assessment and conducted a prolonged discussion of factors which were not relevant to any decision she could have been required to make. The Panel has noted that because Patient H was to move to a different property there was no need for Ms Coburn to continue the assessment. Her decision to ask questions about Patient H’s meals on wheels service eight years previously, which was also irrelevant, was a further indication of poor decision making by Ms Coburn.
177.         The Panel finds this particular proved in relation to Patient H.
178.         Overall in the light of its findings in relation to these patients the Panel finds this particular proved.
Particular 5:
Did not communicate properly and effectively with service users and/or carers
Patient D
179.         The Panel finds that Ms Coburn asked Patient D what his name was. The manner in which a question is asked and the tone used are important factors. The Panel is not satisfied that sufficient evidence has been adduced to prove that in asking this question of Patient D Ms Coburn was not communicating properly and effectively with Patient D.
180.         The Panel finds that this particular is not proved in relation to Patient D.
Patient E
181.         In her evidence Ms Coburn accepted that she was nervous about this assessment and that she was experiencing difficulties in expressing herself clearly. She chose to communicate by telephone with Patient E who had cognitive impairment to arrange an appointment and said that Patient E had difficulty understanding her. The Panel finds that the contemporaneous feedback notes of the assessment record that communication at the assessment was haphazard and chaotic with no logic or sequence to the pattern of questions Ms Coburn asked Patient E. Ms Coburn also had difficulty explaining the principle of hoist equipment to Patient E’s daughter who was left confused and uncertain about Ms Coburn’s proposed recommendations as a result. Ms Coburn also included a statement that Patient E had agreed to a particular intervention when in the light of her cognitive impairment she was unable to understand the recommendation or give effective consent to it.
182.         In the light of these findings of fact the Panel is satisfied that Ms Coburn did not communicate properly or effectively with Patient E or her carer.
Patient F
183.         The Panel has noted Ms Coburn’s record of reflection and HT’ account of the manner in which Ms Coburn conducted her assessment of Patient F. HT suggested that Ms Coburn may have come across as ‘a bit bossy’. She suggested that Ms Coburn was nervous and that this affected her speech and the way in which she asked questions and explained things. The Panel accepts HT’ evidence that the assessment interview needed to flow in a logical and non-repetitive manner with key pieces of information being explored and recorded appropriately. The Panel notes that the reflective feedback notes were signed by both Ms Coburn and HT. Whilst the evidence it has heard in relation to the tone of the interview is not conclusive the Panel finds that the overall picture of Ms Coburn’s communication during her discussion with Patient F is that it was neither effective nor focussed.
184.         The Panel therefore finds this particular proved in relation to Patient F.
Patient J
185.         Patient J had survived three strokes and experienced recurrent transient ischemic attacks. He also had epilepsy which was controlled by medication. Patient J received support from his two daughters who lived locally. He had been referred for assistance with access to the front of his property which had several steps.
186.         MW observed Ms Coburn’s assessment of Patient J. His wife, two daughters and a granddaughter were also present during the assessment. The Panel finds that this was a challenging assessment for Ms Coburn in a difficult environment with a lot of people present. She was deemed to have completed the assessment correctly. One of Patient J’s daughters disclosed that she was attending Patient J’s home up to five times a day to assist him. This information made it clear that her assistance was essential to Patient J’s welfare and that his welfare would be affected if this arrangement failed. The daughter advised Ms Coburn that she was struggling with the level of support required. The assessment tool contains a prompt on the last page of the form which asks the OT whether a carer’s assessment has been offered. Ms Coburn did not use the prompt to consider whether Patient J’s attention should be drawn to the availability of a carer’s assessment.
187.         The Panel finds that in this regard Ms Coburn did not demonstrate effective communication with Patient J and his carers. It finds this particular proved.
Patient K
188.         Patient K had a complex medical history which included neuropathy and diabetes both of which resulted in lowered sensation in his feet. He was referred to Ms Coburn because of his difficulty in managing the stairs which gave access to his bedroom and bathroom. As the Panel noted MW visited Patient K with Ms Coburn. In her evidence MW observed that Ms Coburn was unable to formulate her questions to Patient K clearly. She suggested that the manner in which Ms Coburn formulated her question to Patient K about his sensitivity to hot water could have been phrased more clearly. She told the Panel that Ms Coburn had said “and what about hot water?” The Panel accepts that the question could have been phrased more clearly, however, in the context of the conversation Ms Coburn was having with Patient K the words used and her meaning may well have been appropriate and understood. Accordingly, the Panel does not find this particular is proved in respect of Patient K
Patient L
189.         Ms Coburn visited Patient L on 15 December 2011; her daughter was concerned about how she was meeting her bathing needs. During the course of the visit Ms Coburn was asked how a pillow lift would assist Patient L with her transfer from bed. The Panel accepts MW’ evidence that this is a routine and non-complex piece of equipment that sits on top of a mattress to assist the patient in achieving a seated position. Ms Coburn accepted in her reflective notes of the visit that she “did struggle to explain things especially when I have not done them for a while and when under pressure.” Although Ms Coburn disputed this, the Panel finds that she also did not explain the loan arrangements for the pillow lift to Patient L. The Panel finds that because of her anxiety Ms Coburn did not provide satisfactory explanations to Patient L or her carer. The Panel finds that Ms Coburn did not communicate properly or effectively with Patient L or her carer and concludes that this particular is proved in relation to Patient L.
Patient N
190.         The Panel finds that Ms Coburn repeatedly asked Patient N questions which she had already answered during the course of her assessment. Furthermore, during the course of a stair assessment Ms Coburn asked Patient N questions. This might have distracted her and posed a risk to her safety. Ms Coburn gave Patient N incorrect information about the grant process in relation to the provision of a chair lift and failed to give an adequate explanation of the purpose of a carer’s assessment.
191.         The Panel finds that these deficiencies taken together demonstrate that Ms Coburn did not communicate properly or effectively in her assessment of Patient N with Patient N or with her carer. The Panel finds this particular proved in relation to Patient N.
Patient Q
192.         The Panel prefers the evidence of HT about a number of comments or statements which Ms Coburn made during the course of the assessment which were inappropriate. These included sharing information about Patient Q’s financial circumstances with her, asking questions about Patient Q’s contact with her GP and why Patient Q was dissatisfied with her GP and commenting on Patient Q’s state of health and suggesting that she would not be “around for much longer.” The Panel accepts that although there had been some improvements in Ms Coburn’s communication; these examples reveal that her communication on some matters remained inappropriate, intrusive and insensitive.
193.         The Panel is satisfied that this evidence is sufficient to establish that Ms Coburn did not communicate properly or effectively with Patient Q. It finds this particular is proved in relation to Patient Q.
Patient S
194.         Patient S lived alone in a first floor flat. She suffered from a range of health conditions including congestive heart failure and osteoporosis. She was referred by her daughter who was concerned that Patient S experienced difficulties on the stairs leading up to her flat. Ms Coburn attended Patient S on 27 March 2012. A senior OT Ms Pearson observed the visit.
195.         During the visit Ms Coburn advised Patient S that a functional assessment on the stairs was required. The Panel finds that because Ms Coburn was anxious about the potential risk to Patient S posed by a functional assessment on the stairs she did not give Patient S clear instructions. In the absence of clear instructions from Ms Coburn Patient S went up and down the stairs of her own volition. The Panel finds that when Patient S’s daughter asked her a question Ms Coburn became flustered. The Panel has taken note of the degree of oversight and scrutiny Ms Coburn was subject to at this time. However, the Panel does not consider that this justified Ms Coburn’s lack of clarity in her communications to Patient S in relation to the stair assessment or in providing responses to Patient S’s daughter.
196.         The Panel therefore find this particular proved in relation to Patient S.
Patient T
197.         Ms Coburn accepted that she called Patient T’s wife by the wrong name throughout the assessment. The Panel considers that this was an issue of proper and effective communication with service users and their carers. It finds this particular proved in relation to Patient T.
Patient U
198.         The Panel has made findings in relation to Ms Coburn’s visit to Patient U on 27 April 2012.  Upon arrival Ms Coburn asked Patient U and his wife (his carer) for their first names. Patient U had two wheelchairs. Ms Coburn did not ask him who had prescribed these or how they were manoeuvred in and out of his car. As previously observed Ms Coburn did not ask further questions when Patient U told her that he was urinating in a bucket in the kitchen to avoid negotiating the stairs in his property. She did not ask him about the pressure cushions which he used during her assessment nor did she offer Patient U a carer’s assessment.
199.         Ms Coburn did not explain to Patient U or his carer what other options might be explored if installing a stair lift proved not to be feasible. In particular, when Patient U and his wife raised the possibility that they might move, Ms Coburn did not point out to them that if a grant for adaptations to a property was made it would have to be repaid if they moved within five years of the work. The Panel consider that this fact would be a relevant and important factor in a service user’s decision making. The Panel also considered that Ms Coburn’s offer to put a leaflet in the post which explained the grant process was not the most effective way of communicating the relevant information. In fact, the observer MW provided the required explanation to Patient U and his carer.
200.         The Panel consider that these matters are sufficient to establish that Ms Coburn did not communicate properly or effectively with Patient U and his carer. This particular is proved in relation to Patient U.
Patient M
201.         Ms Coburn admitted that she called Patient M by the wrong name on a number of occasions during the assessment. She said that she did so because she was under stress. Ms Coburn accepted that she had initially asked Patient M and his wife their names and written them down but nonetheless she continued to call Patient M by the wrong name until TM who observed the visit corrected her.
202.         The Panel considers that calling a service user by an incorrect name is or may be a bar to effective communication since the service user may find it distracting and/ or confusing. The Panel finds this particular proved in relation to Patient M.
Patient X
203.         The Panel has already found that MW’ evidence about the visit to Patient X was clear and persuasive. It has accepted her evidence that her recollection of the visit is vivid. She told the Panel that upon arriving Ms Coburn had said “I’m Kelly, this is Mair, who are you then?” When asking for information about Patient X’s condition Ms Coburn said “I am not aware of tonic clonic seizures” which caused Patient X’s mother visible concerns that she was not sufficiently informed about her son’s condition. Ms Coburn denied that she asked Patient X’s mother “Who are you then?” In her evidence she agreed that she made the remark about tonic clonic seizures and explains that she did so in order to gain information from the perspective of Patient X and his mother.
204.         Ms Coburn’s suggestion that there was an appropriate context to these remarks was not put to MW to consider. The Panel prefers MW’ evidence and finds that these remarks represent a failure to communicate with Patient X and his carer properly or effectively. The Panel finds this particular proved in relation to Patient X.
205.         Overall, in the light of its findings in relation to Patients E, F, J, K, L, N, Q, S, T, U, M and X the Panel finds this particular proved.
Decision on Grounds:
206.         The Panel is satisfied that the facts which it has found proved constitute a lack of competence. Despite appropriate training and significant support Ms Coburn’s standard of professional performance was unacceptably low across a broad range of OT activities.
207.         Ms Coburn was not fulfilling the full range of duties and responsibilities of an Occupational Therapist as set out in her job description. On her own account she ceased to carry out manual handling, which the Panel accepts was a key component of the role of an OT, in February 2011. For significant periods of time Ms Coburn was undertaking low level work on non-complex cases. In a capability review meeting on 30 April 2012 Ms Coburn told HT and TM, “I know what to do but I can’t consider all the factors at once.” She said that she experienced information overload. When asked by her representative whether she could attain an acceptable level in her OT role Ms Coburn replied “I don’t know how to do it.” By the time Ms Coburn asked for the capability process to be brought to an end in May 2012 she had accepted that she could not carry out the full duties of the role.
208.         The Panel finds that Ms Coburn carried out inadequate questioning of service users and conducted assessments which were not correct or systematic. She lacked awareness of safety or risk. Ms Coburn had poor technical knowledge in relation to manual handling, equipment, the adaptation process and eligibility criteria. Her communication skills were poor. The reports she produced were unclear in that they lacked clinical reasoning and were inaccurate in a number of material respects.
209.         On the evidence before it the Panel has concluded that Ms Coburn failed to make sure that she was practising safely and effectively even within the limited scope of her practice at the Council.
210.         In relation to particulars 1,2a and 2b, 3, 4a, 4c and 4g
Ms Coburn has failed to meet standard 1a.6 of the HCPC Standards of Proficiency for Occupational Therapists. Standard 1a.6                provides that a registrant should be able to practise as an autonomous professional, exercising their own professional judgment. Ms Coburn was unable to assess a situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem. She was unable to exercise personal initiative and judgment. There were numerous occasions demonstrated in the evidence where senior OTs had to intervene because of their concerns.
211.         In relation to particulars 2a, 4e and 5
Ms Coburn has failed to meet standard 1b.3 of the HCPC Standards of Proficiency for Occupational Therapists. Standard 1b.3 requires that a registrant should be able to demonstrate effective and appropriate skills in communicating information, advice, instruction and professional opinion to colleagues, service users, their relatives and carers. Ms Coburn was not able to select, move between and use appropriate forms of verbal and non-verbal communication with service users and others. Ms Coburn also failed to understand the need to provide service users or people acting on their behalf with the information necessary to enable them to make informed decisions.
212.         In relation to particulars 2b and 5
Ms Coburn has failed to meet standard 1b.4 of the HCPC Standards of Proficiency for Occupational Therapists. Standard 1b.4 asks registrants to “understand the need for effective communication throughout the care of the service user.” Ms Coburn was unable to recognise the need to use interpersonal skills effectively to encourage the active participation of service users.
213.         In relation to particulars 1, 2a, 2b, 4a and 4c
Ms Coburn failed to meet standards 2a.1 2a.2 and 2a.4 of the HCPC Standards of Proficiency for Occupational Therapists which require registrants to “be able to gather appropriate information; to be able to select and use appropriate assessment techniques”; and to “be able to analyse and critically evaluate the information collected.”
214.         Looking at the evidence as a whole the Panel is satisfied that Ms Coburn was unable to analyse information from assessments in order to formulate and deliver plans and strategies for meeting the needs of service users. This amounts to a failure to meet standards 2b.1 and 2b.4 of the HCPC Standards of Proficiency for Occupational Therapists which require registrants to “be able to use research, reasoning and problem-solving skills to determine appropriate actions”; to “be able to conduct appropriate diagnostic or monitoring procedures, treatment, therapy or other actions safely and skilfully.”
215.         Ms Coburn appeared unable to engage in evidence-based practice or to evaluate her practice systematically. She was unable to demonstrate a logical and systematic approach to problem solving or to evaluate other evidence to inform her practice. Ms Coburn did not demonstrate a proper understanding of the need to maintain the safety of service users and those involved in their care.
216.         Ms Coburn failed to meet standard 3a.1 which requires registrants to “know and understand the key concepts of the bodies of knowledge which are relevant to their profession-specific practice”. Her evidence in relation to Patients D and E demonstrated that she did not understand the structure and function of the human body relevant to her practice or have sufficient knowledge of health, disease, disorder and dysfunction. Her evidence in respect of Patients F and N demonstrated that she was unable to understand and analyse activity and occupation and their relation to health and wellbeing.
217.         The evidence before the Panel is sufficient to establish Ms Coburn did not meet standard 3a.3 of the HCPC Standards of Proficiency in that she did not “understand the need to establish and maintain a safe practice environment.” In particular, on her own admission, Ms Coburn did not know and was not able to apply appropriate moving and handling techniques. For example in relation to Patients D, E and S she was unable to recognize that her assessment created a risk to the patient and their carers.

 

218.         Ms Coburn relied on her health condition as mitigation and criticized the Council for being slow to make reasonable adjustments. The Panel considered carefully the medical and occupational health assessments which were made available to it. The Panel noted that there was some evidence to support the impact of Ms Coburn’s health condition on certain areas of her practice such as report writing and record keeping. It accepted this evidence. However, it did not have evidence that Ms Coburn’s health condition impacted across all the areas of concern. The Panel notes that when her employer referred Ms Coburn to occupational health for advice as to her fitness to carry out the role she was employed to do, the advice received was that she was fit to work in that role.

 

219.         Ms Hurn submitted that Ms Coburn’s employer had very little understanding of her health condition and was reluctant to assist her. The Panel notes that Ms Coburn did not disclose her health condition on her application form. The Panel has noted the steps taken by Ms Coburn’s employers to address the impact of her health condition on her work once it became aware of it as a result of a supervision session. The Panel considers that whilst there was a period of delay in implementing some of the adjustments recommended by its advisors, they did make appropriate and reasonable adjustments which included reducing and simplifying Ms Coburn’s caseload, providing equipment, software and additional training and acceding to a request to reduce her working hours. Ms Coburn was also provided with additional support by colleagues.

 

220.         Ms Coburn has also suggested that her poor performance in relation to moving and handling resulted from a lack of training. The Panel is unable to accept this contention. The oral and documentary evidence demonstrates that Ms Coburn received adequate and appropriate moving and handling training. In addition to the standard training received on induction Ms Coburn was able to shadow colleagues on visits and attended manual handling courses in 2008 and 2009. She received C, D and F manual handling update training in July 2010 and attended a 2.5 hour one to one manual workshop in January 2011. The Panel finds that Ms Coburn did receive considerable extra training and time but still failed to reach the required standard. In the Panel’s view by the time of this fitness to practise hearing Ms Coburn is using the argument that she lacked training to justify her mistakes.

 

221.         Ms Hurn submitted that there was nothing in the evidence to suggest that with support, structure and time Ms Coburn would not achieve the required standard.

 

222.         In the light of the evidence it has heard, read and summarised above the Panel is unable to agree and finds Ms Coburn’s lack of competence proved.

 
Decision on Impairment:    
223.         Before reaching its decision on impairment the Panel reminded itself of the submissions made on behalf of the parties. It read the HCPC Practice Note on ‘Finding that Fitness to Practise is “Impaired”’ and accepted the advice of the Legal Assessor. The Panel reminded itself that its task is to protect the public against the acts and/or omissions of those who are not fit to practise and that the test of impairment is expressed in the present tense.
224.         Ms Lister made submissions on both the personal and the public components of impairment. On the personal component she submitted that Ms Coburn’s clear and current lack of competence has a lasting and negative impact on her fitness to practise as an OT. She submitted that evidence from the HCPC’s witnesses indicated a genuine level of concern about Ms Coburn’s ability to work effectively without placing patients at risk. She reminded the Panel that as a result of Ms Coburn’s inadequate assessments, patients’ needs were not identified promptly or responded to appropriately; in addition ineffective communication caused some service users to undergo unnecessary assessments. Ms Lister submitted that as Ms Coburn had not worked as an OT since May 2012 her deficiencies and lack of competence have not been adequately addressed so as to ensure a future return to safe practice.
225.         On the public component of impairment Ms Lister submitted that members of the public would be greatly concerned if Ms Coburn was permitted to practice without restriction given the serious and legitimate concerns about her competence which had the potential to put patients at risk.
226.         On behalf of Ms Coburn Ms Hurn asserted that she did have insight together with a very clear understanding of her limits. She noted that Ms Coburn had not received any previous warnings in relation to her fitness to practise nor had she ever caused harm to any patient. She acknowledged that the stress which Ms Coburn experienced in the later stages of her employment incapacitated her and made it difficult for her to practice effectively. Once adjustments had been put in place there was evidence that Ms Coburn’s report writing improved. Since she ceased to work as an OT Ms Coburn has rebuilt her confidence, she is more assertive and has developed effective strategies for coping with stress and anxiety.
227.         Ms Hurn directed the Panel to the steps which Ms Coburn has taken to address concerns about her fitness to practice. Ms Coburn has established a child minding business and she has attended a number of courses. It is suggested on Ms Coburn’s behalf that these courses provided transferable skills which are relevant to Ms Coburn’s insight into her deficiencies and her competence as an OT. Ms Hurn urges the Panel to accept that Ms Coburn has addressed the competency concerns which the Panel has identified. The Panel does not consider that the courses which Ms Coburn has undertaken are sufficient to address these wide-ranging concerns. It notes that none of the courses are certified by the College of Occupational Therapists.
228.         Ms Hurn reminded the Panel that MW had described Ms Coburn as very motivated and accepting of constructive criticism and advice. Ms Coburn had engaged in comprehensive reflections which had identified her areas of weakness. Ms Hurn said that rather than seeing lack of knowledge as a weakness Ms Coburn saw it as an opportunity to learn. She had sought advice and guidance from colleagues. Ms Coburn had not been the subject of any complaint from members of the public. Ms Hurn stated that she was confident that Ms Coburn’s new approach would be maintained whatever the environment she found herself in and would lead to appropriate clinical reasoning.
229.         The Panel notes that it cannot adopt a simplistic view and conclude that fitness to practise is not impaired simply on the basis that the Registrant has learned her lesson. The Panel has found serious and persistent failure to meet standards in this case. The Panel has concluded that whilst the deficiencies in Ms Coburn’s competence may be capable of being remedied, there is no evidence that they have been remedied. Whilst the Panel accepts evidence from each of the witnesses it has heard that Ms Coburn has tried very hard to correct the shortcomings in her performance, it notes that she has been unable to do so.  Taking into account the evidence it has heard about Ms Coburn’s lack of competence and her actions since the allegation arose the Panel is bound to conclude that there is a risk that errors arising from Ms Coburn’s lack of competence will be repeated if she were to return to practise as an OT.
230.         In addition, the Panel is concerned at Ms Coburn’s lack of insight which is illustrated in part by her denial of the majority of the factual particulars in this case in the face of robust documentation, often counter-signed by her at the time.
231.         The Panel was also concerned at how Ms Coburn’s response to the factual particulars of the allegation developed following a three month adjournment. Issues of obvious factual dispute raised by Ms Coburn in the later stages of this hearing were not put to the HCPC’s witnesses during their cross examination. After the October hearing Ms Coburn provided a detailed written commentary on the HCPC’s witnesses’ accounts. In that commentary Ms Coburn provided a contrary account, justification or explanation for each of the factual particulars, many of which had not been put to the HCPC’s witnesses when they gave their evidence. The Panel notes that this was critical and fundamental evidence about Ms Coburn’s reasoning and decision-making which was not put to the HCPC’s witnesses. Since Ms Coburn and her representatives had been advised of the importance of challenging any aspect of the evidence which they did not accept, this raised a question for the Panel as to the credibility of Ms Coburn’s later explanations and justifications.
232.         The Panel has concluded that in her evidence Ms Coburn tailored her evidence in the most convenient way to rebut the HCPC allegation. This reflected adversely on the Panel’s view of her credibility.
233.         Turning to the public component the Panel has found that by her actions Ms Coburn did place frail and vulnerable service users at risk. The Panel is satisfied that any member of the public who had heard the facts of this case would have genuine concerns about Ms Coburn’s fitness to practise. The Panel is mindful that as an OT Ms Coburn is dealing with a highly vulnerable patient group with both physical and psychological problems. It is satisfied that its task of protecting service users, declaring and upholding proper standards of behaviour and maintaining public confidence in the profession require it to conclude that Ms Coburn’s fitness to practise is currently impaired.
Preliminary Matters at the Resumed Conduct and Competence Hearing on 1 July 2015
234.         The Panel is satisfied that good service of the notice of hearing has been effected.
235.         The Panel heard submissions on proceeding in the absence of Ms Coburn made by Ms Lister on behalf of the HCPC. It considered the HCPC Practice Note on ‘Proceeding in the Absence of the Registrant’ and accepted the advice of the Legal Assessor.
236.         The Panel had particular regard to email correspondence between Ms Coburn, her representatives and the HCPC which clearly indicated that Ms Coburn was aware of the hearing date and stated that she would not attend or be represented at the resumed hearing. Ms Coburn supplied written representations to be placed before the Panel for consideration at the resumed hearing. In these circumstances the Panel was satisfied that adjourning the hearing would not secure Ms Coburn’s attendance. It has concluded that Ms Coburn has voluntarily waived her right to be present or represented at this hearing and that it is in Ms Coburn’s interest and in the public interest that these proceedings are concluded today.
Decision on Sanction
237.         The Panel has carefully considered the written representations made by and on behalf of Ms Coburn. It has heard submissions from Ms Lister on behalf of the HCPC. The Panel has accepted the advice on the Legal Assessor and has considered the HCPC‘s Indicative Sanctions Policy.
238.         The Panel has approached the question of sanction by first deciding whether any sanction is necessary in this case. The Panel has found a lack of competence in relation to a wide range of core OT skills. As set out above, the Panel found that during the period it has considered, Ms Coburn was not able to assess a situation, determine the nature and severity of the problem faced by the service users; or call upon the required level of professional knowledge and experience to deal with the problem. In short Ms Coburn was unable to function as an autonomous practitioner.
239.         The Panel found that Ms Coburn was unable to communicate advice, instruction or professional opinion to colleagues and perhaps, most importantly, she was unable to communicate effectively with service users. The Panel has also found that Ms Coburn’s ability to analyse, reason, and solve problems fell below an adequate professional standard. Ms Coburn also lacked a logical and systematic approach to evaluating a situation. The Panel had particular concerns about Ms Coburn’s understanding of moving and handling techniques in the light of clear evidence that her instructions to patients put them at risk of injury in their home environment.
240.         By way of mitigation the Panel noted that Ms Coburn had been diagnosed with a health condition and had complained that her employer had not made sufficient reasonable adjustments to accommodate her condition.
241.         The Panel is concerned at Ms Coburn’s lack of insight as to the inadequacy of her professional performance. The Panel notes that Ms Coburn did acknowledge that she was unable to safely carry out moving and handling techniques but other deficiencies, which the Panel has found proved, were disputed by Ms Coburn.
242.         In these circumstances the Panel has concluded that there is a need to impose a sanction in this case. An appropriate sanction must protect those members of the public who may require Ms Coburn’s services in the future and must declare and uphold the proper standards of the profession.
243.         The Panel did not consider that mediation was an appropriate outcome in this case given the extent of Ms Coburn’s deficiencies and of her lack of insight.
244.         The Panel next considered the imposition of a caution. However, the matters which came before the Panel cannot properly be described as  isolated or minor lapses from the required standards; nor could it be said that there was a low risk of recurrence should Ms Coburn be permitted to return to practise without restriction on her registration. For these reasons the Panel has concluded that a Caution Order would not provide the necessary level of protection for the public.
245.         The Panel next considered a Conditions of Practice order. The Panel noted that Ms Coburn has not worked as an Occupational Therapist since 2012. Instead she has established a home based child-minding business. Ms Coburn  has drawn the Panel’s attention to the similarities of her work as an Occupational Therapist to supervising children, for example in manual handling, assessment, planning, record keeping and safeguarding. She has maintained contact with the Occupational Therapy profession by subscribing to the OT Journal.  In the Panel’s view Ms Coburn’s current work, whilst it draws on some of the skills she developed as an OT, is not comparable to the full range of work as an OT. Work as an OT requires reasoned assessment to support therapeutic interventions. That work is more complex and requires higher level observational, analytical and assessment skills.
246.         A Conditions of Practice Order is intended to be rehabilitative in nature giving the Registrant an opportunity to demonstrate improvement. However, the Panel is satisfied that allowing Ms Coburn to remain in practice, albeit subject to conditions, continues to pose a risk of harm or future harm. The Panel’s findings are that there has been a general and wide-ranging failure in the professional competence of Ms Coburn. Furthermore, Ms Coburn’s lack of adequate insight and her limited continuing engagement with the profession means that there are no appropriate, verifiable or realistic conditions which the Panel can formulate.
247.         The Panel’s only remaining option is to impose a Suspension Order.
248.         The Panel recognises that this will have serious implications for the Ms Coburn, who trained for her profession and has been qualified for a number of years. Accordingly the Panel has considered whether such an order is proportionate. These are serious failings which placed patients at risk. They concerned a large number of incidents and occurred over a period of time. Ms Coburn has submitted that as she is not currently practising as an OT there would be no benefit in suspending her. This submission disregards the wider public interest considerations that this Panel must weigh in the balance and by her submission Ms Coburn continues to demonstrate insufficient regard to matters of patient safety.
249.         The Panel’s primary concern is to ensure the safety of the public. It also has had regard to the need to declare and uphold standards in the profession.
250.         The Panel has concluded that an order of Suspension is the appropriate sanction in all the circumstances of this case.
251.         The Panel next considered the duration of any Suspension Order. It has concluded that a Suspension Order for a period of twelve months is proportionate. Such an order will have the necessary deterrent effect and preserve public confidence in the profession. In addition, a twelve month suspension order will provide Ms Coburn with sufficient time to consider whether she wishes to return to practice as an OT and if so, to begin to take steps to remedy the deficiencies that so concerned this Panel.
252.         The Suspension Order will be reviewed shortly before its conclusion. A reviewing Panel will be assisted by evidence which demonstrates that Ms Coburn has developed insight into her failings and by clear proposals which indicate how she intends to address the deficits in her core OT skills which this Panel has identified.

Order

ORDER:That the Registrar is directed to suspend the registration of Kelly Coburn for a period of 12 months from the date this order comes into effect. 

Notes

The Order will be reviewed before it expires.

Hearing history

History of Hearings for Mrs Kelly Coburn

Date Panel Hearing type Outcomes / Status
22/09/2017 Conduct and Competence Committee Review Hearing Suspended
21/06/2016 Conduct and Competence Committee Review Hearing Suspended
01/07/2015 Conduct and Competence Committee Final Hearing Suspended