Mr Manush Kaushik

: Occupational therapist

: OT35443

: Review Hearing

Date and Time of hearing:12:30 20/04/2016 End: 17:00 20/04/2016

: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Conditions of Practice

Allegation

During the course of your practise as an Occupational Therapist, you:

1. Were unable to work independently in that you required excessive support from your colleagues.

2. Were unable to manage your workload adequately, in particular that you:

a) Did not provide  timely treatment to service users (this head of the allegation with regard to service user B was not made out in as much as the file notes appeared to support the Registrant’s assertion that he had contacted B);

b) Had difficulty making autonomous decisions on cases;

c) On some occasions, spent an excessive amount of time with service users

d) Demonstrated a lack of knowledge and understanding regarding necessary actions and the need to act urgently in some cases.

3. Did not keep accurate records in that:

a) You did not sign Subjective Objective Analysis Plan (SOAP) notes;

b) Risk assessments were not signed or dated;

c) Several home visits reports conducted were not filed in client files;

d) Notes did not include sufficient information to allow other members of staff to understand what action was required;

e) Treatment plans were not dated or signed;

f) Nine home visit reports were identified after 5 November 2007 as not being stored in the client’s case files;

g) Information was stored in the wrong client’s files;

h) In relation to Service User AAP, functional assessments were incomplete in that:

i. Observed scores were not recorded in any section of the standard-functional assessment form (STA); and

ii.  The assessment was not signed or dated.

4. You did not complete thorough home visit assessments, in particular, on 7 March 2011, in relation to Service User PB, you did not:

a) Take Service User PB’s medical history into consideration (this head of the allegation was not made out);

b) Comment on the posture or positioning of the service user (this head of the allegation was not made out);

c) Conduct a holistic assessment of all transfers and needs of the client and/or carer; and

d) Consider the use of a hoist/ceiling track and/or adjustments to full height shower doors for low level access tray.

5. Following a performance/capability meeting that was held on 17 March 2011, it was identified that there were twenty two outstanding files that needed to be closed which you had not actioned.

6. This head of the allegation was not found proved (namely: On 25 October 2010, 22 March 2011 and 13 June 2011, you conducted a home visit for Service User GS, and you:

a) Did not issue recommendations either before or after the visit;

b) Did not update the service user regarding recommendations for a stair lift for approximately four months after 13 June 2011);

c) Did not conduct a thorough assessment, in that you did not assess the rear garden.

7. Did not undertake clinical reviews of:

a) Treatment goals; and

b) Treatment plans.

8. Did not work adequately with your colleagues, in that you did not provide the Occupational Therapy Assistants enough verbal or written information to allow them to do their jobs competently.

9. Did not make timely clinical decisions, in particular that:

a) On 13 June 2011, you assessed Service User GS and did not inform him of the outcome of that assessment; (This head of the allegation was not found proved);

b) On 2 January 2009, Service User CP was admitted and on 5 March 2009, she was discharged, but when the case was reviewed on 10 August 2009, no discharge outcome sheet or follow-up calls had been made.

10. The matters set out in paragraphs 1-9 amount to misconduct and/or lack of competence.

 

11. By reason of this misconduct and/or lack of competence, your fitness to practise is impaired.

Finding

Background:

1. Mr Kaushik was employed as an Occupational Therapist by Kent County Council (“The Council”) from 1 May 2006 until October 2011. During the course of that employment, concerns were raised by the Council with Mr Kaushik as to his competence. The Council started formal capability procedures on three occasions. The last such process started in July 2011. On 27 September 2011, Mr Kaushik was suspended from his employment whilst an investigation was undertaken as to his conduct and competence. Mr Kaushik resigned from his employment on 3 October 2011.

2. At the Final Hearing, after finding the above particulars proved, that panel determined, “... the failures on the part of Mr Kaushik were as a result of his inability to achieve proper standards. The failures were not as a result of any wilful or reckless conduct. They do not amount to misconduct.”

3. That panel determined that Mr Kaushik failed to meet the following standards for Occupational Therapists:

1. You must act in the best interest of service users.

6. You must act within the limits of your knowledge, skills and experience and, if necessary, refer the matter to another practitioner.

7. You must communicate properly and effectively with service users and other practitioners.

10. You must keep accurate records.

4. Today, the Registrant has produced a bundle of documents containing the following:

a) Personal reflective statement;

b) An assessment of the Registrant’s abilities in line with the HCPC Standards of Proficiency of Occupational Therapists. This assessment, dated 11 April 2016 was completed by Sylvia Baldock at Carers First,  his current employers;

c) The job description of a Home and Community Care Support Worker employed by Carers First;

d) A letter dated 19 April 2016 from a Specialist Occupational Therapist at Kent and Medway NHS and Social Care Partnership Trust, with whom the Registrant had 10 supervisions sessions;

e) Information about his role as a council canvasser.

f) Evidence of 11 courses attended by the Registrant since 4 February 2015. This is in the form of certificates of completion for those courses.

5. Ms Akintobi, on behalf of the HCPC, outlined the background to the case to the Panel. She reminded the Panel that this was a case where a lack of competence on the part of the Registrant was found by the panel at the Final Hearing and as such, the Panel should be looking to see evidence that the Registrant has remedied the shortcomings in his practice.

6. Mr Kaushik gave evidence on oath. He told the Panel that it was his wish to return to practise as an Occupational Therapist and that he is currently working as a support worker. He told the Panel that his current role involved supporting children with disabilities by way of activities, and also the input of data in relation to those cases.

7. Mr Kaushik referred to the assessment dated 11 April 2016. He told the Panel that this assessment document was designed by him, together with his mentor, to be in accordance with the HCPC Standards of Proficiency for Occupational Therapists. This was done so that his line manager would then be able to comment on his abilities in accordance with those standards, in particular the shortcomings identified in his practice. He told the Panel that his line manager’s background is in domiciliary care and that she is not an Occupational Therapist.

8. Mr Kaushik then referred the Panel to his reflective statement and the contents. He pointed out that, in it, he sets out his understanding of the deficiencies in his practice in the past, their underlying causes, and the efforts that he has made to remedy those deficiencies. In support of that, he also referred the Panel to the certificates of training courses he has completed to date. In particular, the Registrant pointed out to the Panel that he attended the Return to Practice Study Day on 10 September 2015 at the College of Occupational Therapists. He told the Panel that he attended this course because he wanted to keep his knowledge current, and also because he thought it was a very relevant and useful course to enable him to return to practice as an Occupational Therapist.

9. Mr Kaushik outlined to the Panel the responsibilities of the various roles he has held since the Final Hearing on these matters and how they relate to his remediation of his lack of competence as an Occupational Therapist.

10. In response to questions, Mr Kaushik told the Panel that because of the personal issues that have affected him over last year, he was not sure that he could demonstrate fully that he was yet fit for unrestricted practice as an Occupational Therapist. He clarified that what he meant was that if he returned to practice he would either expect conditions to be placed on his practice, or that he would seek supervision of his own accord.

11. In relation to his repeated difficulty in clinical reasoning and case management despite support from his employers, he stated that was due to his not being proactive in finding out information, personal stress, not always working systematically. He stated that now he works systematically, is more assertive, has insight into the limitations of his practice and is able to prioritise.

12. The Registrant stated that, if permitted to return to practice, he would continue with his mentor, consult with colleagues and utilise a variety of learning resources to ensure that he is a safe practitioner, and to ensure that his knowledge is current.

13. In relation to case management and time management, the Registrant stated that in his current role, he ensures that he manages his caseload, that he completes his notes on time and that he prioritises his work. He told the Panel that these were transferrable skills.

14. The Registrant told the Panel that he has acquired the skills that address the previous shortcomings in his practice, and that he has honed those skills. He stated that he would not repeat the same mistakes again if faced with the same situation as he did in 2013. If faced with a complex situation, he would identify if there were any gaps in his knowledge which would indicate it was outside the scope of his practice. If there were, then he would seek the assistance and opinion of his line manager and of his colleagues to resolve the situation and/or address any gaps in his knowledge.

15. Mr Short, on behalf of the Registrant, submitted that the Registrant has demonstrated that he has, to the best of his abilities, done all that he can to remediate the shortcomings identified in his practice. Mr Short pointed out that despite being suspended, the Registrant has been very proactive and found employment in roles that are directly relevant to his remediation of the shortcomings identified in his practice.

Decision:

16. The Panel accepted the advice of the Legal Assessor. The Legal Assessor reminded the Panel that its purpose today was to conduct a comprehensive appraisal of the Registrant to determine if he is fit to return to unrestricted practice. Its role is not to conduct a rehearing of the allegations nor is it to go behind the previous findings. He advised that in carrying out this assessment, the Panel must exercise its own independent judgment.

17. The Legal Assessor advised that the Panel might find the questions formulated in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin) of some assistance, albeit slightly modified for these proceedings:
‘Does the evidence before the Panel today show that the Registrant’s fitness to practice remains impaired in the sense that he:

a) is liable in the future to act so as to put a service user at unwarranted risk of harm; and/or

b) is liable in the future to bring the Occupational Therapy profession into disrepute; and/or

c) is liable in the future to breach one of the fundamental tenets of the profession;

18. The Legal Assessor advised the Panel that if it determined that the Registrant’s fitness to practise remained impaired all the options under Article 30 of the 2001 Order could be exercised by the Panel. He advised the Panel that it should bear in mind the principle of fairness and proportionality and have regard to the Indicative Sanctions Policy document issued by the HCPC. He reminded the Panel that any order that it makes under Article 30 should not be punitive in purpose, and that it should be the least restrictive order that would suffice to protect the public and/or is otherwise in the public interest.

19. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel took into consideration all the documentation before it, the oral evidence of the Registrant and the submissions of both parties. In particular it noted the following:

a) The engagement of the Registrant with the process and his commitment to remaining in the profession;

b) The assessment by his current line manager in relation to the transferrable skills from his current role;

c) The Registrant has been proactive in finding a mentor and learning from that mentor;

d) The 10 supervision sessions of around 2 hours each which the Registrant had with the Specialist Occupational Therapist at Kent and Medway NHS and Social Care Partnership Trust.

20. The Panel was particularly impressed by the efforts and progress made by the Registrant whilst his practice has been suspended. The Panel agrees with his self-assessment that, notwithstanding the progress made, there is still some way to go and that he is not yet ready to return to unrestricted practice. Accordingly the Panel determined that the Registrant remains impaired by reason of his lack of competence.

21. Having determined that the Registrant’s fitness to practice remains impaired by reason of his lack of competence the Panel went on to consider what action to take today. The Panel took into account the HCPC’s Indicative Sanctions Policy document and considered its powers under Article 30(1).

22. The Panel first considered taking no further action and allowing the Order to lapse upon expiry. The Panel determined that this was not appropriate as the Registrant’s fitness to practise remains impaired today and taking no action would neither protect the public nor be in the public interest. 

23. The Panel went on to consider whether to impose a Caution Order upon the expiry of the current order. For the reason set out above, the Panel determined that the imposition of a Caution Order upon expiry of the current order is not the appropriate action to take today.

24. The Panel next considered the imposition of a current Conditions of Practice Order and determined that it was the appropriate and proportional response that would protect the public and also protect the public interest. It determined that workable and measurable conditions could be drafted that would not only protect the public and the public interest but which would also enable Mr Kaushik to ultimately return to unrestricted safe practice.

25. The Panel considered extending the order for suspension but considered that this would be disproportionate taking into account in particular the Registrant’s engagement with the process, his level of insight and the active remediation that he has undertaken.

26. The Panel has determined that pursuant to Article 30(1) of the 2001 Order the conditions of practise be imposed upon the Registrant’s practice for a period of 18 months upon the current Order lapsing on 17 May 2016. The Order would provide a framework, structure and time to enable Mr Kaushik to fully remediate the shortcomings in his practice and demonstrate that his practice is no longer impaired by reason of his lack of competence.

Order

Order: The Registrar is directed to annotate the Register to show that, for a period of 18 months from the date that this Order comes into effect (“the Operative Date”), you, Mr Manish Kaushik, must comply with the following conditions of practice:

Terms of the Conditions of Practice Order:

Conditions relating to your practice as an Occupational Therapist

1. You must promptly inform the HCPC if you take up employment as an Occupational Therapist.

2.  You must promptly inform the HCPC of any disciplinary proceedings taken against you in your role as an Occupational Therapist by your employer.

3. You must confine your professional practice to a community rehabilitation setting.

4. When employed as an Occupational Therapist, you must place yourself and remain under the supervision of an Occupational Therapist of at least Band 7 level, and supply details of your supervisor to the HCPC within 6 weeks of the operative date when such person becomes your supervisor. You must attend upon that supervisor as required and follow their advice and recommendations.

5. When employed as an Occupational Therapist, you must meet with your supervisor and formulate a Personal Development Plan designed to address the following areas:

a. Your ability to work independently on your cases;

b. Your time management, and ability to prioritise within reasonable time limits;

c. Accurate and appropriate record keeping, the appropriate storage of files and other data, and the closing of files promptly where appropriate;

d. Your ability to undertake clinical reviews of:

i. Treatment goals; and

ii. Treatment plans

e. Your ability to follow up on such goals and plans (as and when necessary);

f. Your ability to communicate effectively with your colleagues, both orally and in writing.

6. Within 3 months of obtaining employment as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC.

7. When employed as an Occupational Therapist you must meet with your supervisor on at least a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

8. If employed as an Occupational Therapist, you must provide a report from your supervisor about your progress towards achieving the aims set out in your Personal Development Plan not later than 28 days and not earlier than 56 days before this Order is reviewed. This should include testimonials where possible.

9. You must inform the following parties that your registration is subject to these conditions:

a) any organisation or person employing or contracting with you to undertake work as an Occupational Therapist;

b) any agency you are registered with or apply to be registered with as an Occupational Therapist (at the time of application)

c) any prospective employer seeking to employ you as an Occupational Therapist ( at the time of application)

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

The order imposed today will apply from 17 May 2016.

This order will be reviewed again before its expiry on 17 November 2017.

Right of Appeal:
You may appeal to the appropriate court against the decision of the Panel and the order it has made against you.  The appropriate court is the High Court in England and Wales.
Under Articles 30(10) and 38 of the Health and Social Work Professions Order 2001, an appeal must be made to the court not more than 28 days after the date when this notice is served on you. 

 

Notes

No notes available

Hearing history

History of Hearings for Mr Manush Kaushik

Date Panel Hearing type Outcomes / Status
20/10/2017 Conduct and Competence Committee Review Hearing Struck off
20/04/2016 Conduct and Competence Committee Review Hearing Conditions of Practice
07/04/2015 Conduct and Competence Committee Review Hearing Suspended
25/04/2014 Conduct and Competence Committee Review Hearing Suspended
16/04/2013 Conduct and Competence Committee Final Hearing Suspended