Miss Marion Hazel Le Cornu
(As found at the Final Hearing)
During the course of your employment as a Physiotherapist at Jersey General Hospital, between November 2012 and May 2013, you:
1) On the 23rd November 2012, in respect of patient A;
a) you did not conduct an effective abdominal assessment in that you advised the patient to get into a brace position
b) you did not identify this patient’s main problem
c) you did not suggest relevant techniques to strengthen her abdominal muscles and function
2) On 29th November 2012, in respect of patient B;
a) you did not establish that this patient had been on bed-rest for one week and not referred for physiotherapy input
b) you did not establish any information from the midwife in respect of the patient’s bowel movements
c) you did not identify the patient’s main problem
d) you gave the patient pelvic floor exercises, which they had been specifically advised not to do due to a risk of preterm labour at 27 weeks of pregnancy
3) On 30th November 2012, in respect of patient C;
a) you did not position the patient appropriately in order to make a thorough assessment of the abdominals
b) you did not advise the patient to complete pelvic floor exercises
c) you offered the patient contradictory advice about the forms of exercise she should undertake after giving birth
4) On 17th January 2013, in respect of patient D;
a) you did not look up the patient’s x-ray as part of the assessment
b) you did not establish that the patient had a lobe removed
c) Not found proved
d) you did not educate the patient on the importance of self-clearing chest
e) you did not educate the patient on mobilising
f) you did not complete adequate notes in that;
i) you wrote notes about the patient's condition in the section reserved for the treatment plan
ii) Not found proved
5) On 21st January 2013, in respect of patient E;
a) you did not establish that the patient had suffered a number of falls
b) you did not establish that the patient had low blood pressure, as noted in the patient’s chart
6) On 22nd January 2013, in respect of patient U;
a) you did not establish whether the patient had stairs at home
7) On 23rd January 2013, in respect of patient F;
a) you did not adequately assess the height of the patient's walking aid when assessing the patient's mobility
8) On 31st January 2013, in respect of patient G;
a) you continued to walk the patient despite him swaying upon standing
b) Not found proved
c) Not found proved
9) On 6th February 2013, in respect of patient H;
a) you did not look at the latest medical notes in your assessment of the patient
b) you did not look at the x-ray report in your assessment of the patient
c) you did not ascertain the ROM or power in the patient’s hip or left leg before getting the patient to stand and walk
d) Not found proved
10) On 19th February 2013, in respect of patient I, you were not able to carry out a neuro assessment in an appropriate manner
11) On 14th March 2013, in respect of patient J;
a) you did not carry out an objective assessment of the patient's mobility
b) you did not ascertain the strength of the patient when making your assessment
c) you did not produce adequate notes for the assessment of the patient's mobility
12) On 18th March 2013, in respect of patient K, you;
a) did not conduct an assessment of the patient to ascertain where her pain was located.
b) Not found proved
c) did not provide advice and/or recommend treatment to the patient to alleviate her pain
d) Not found proved
13) On 18th March 2013, in respect of patient L;
a) you did not read the previous Ax and Rx plan when making your assessment
b) you did not assess the patient in standing as part of your assessment
14) On 18th March 2013, in respect of patient M;
a) Not found proved
b) you did not provide appropriate advice to the patient on how she could progress abdominal exercises
c) you did not provide appropriate advice against doing sit-ups
15) On 20th March 2013, in respect of patient N;
a) Not found proved
b) you did not provide adequate and/or correct notes of the assessment in that you stated that the patient had lower back pain
c) Not found proved
d) you did not gather sufficient information from the patient in respect of cauda equine symptoms
16) You were not able to time manage your patient assessments efficiently in respect of;
a) patient D
b) patient E
c) patient I
d) patient P
e) patient Q
f) patient R
g) Not found proved
17) The matters set out in paragraph(s) 1 - 17 constitute misconduct and/or lack of competence.
18) By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
1. The Panel was satisfied that notice of today’s hearing had been properly served on the Registrant in terms of rules 3 and 6 of the Conduct and Competence (Procedure) Rules 2003 and thereafter considered Mr Demissie’s application to proceed in the Registrant’s absence. The Panel is aware that its discretion to proceed in absence is one which should be exercised with the utmost care and caution. In reaching its decision, the Panel has had regard to the HCPC’s Practice Note on Proceeding in the Absence of the Registrant. The Panel has also taken account of the fact that this is a mandatory review and this order must be reviewed prior to its expiry on 19 May 2017. The Panel notes that the Registrant did not attend the substantive hearing and there has been no contact from the Registrant since September 2014, when she submitted a response to the Investigating Committee. There has been no request for an adjournment. The Panel is of the view that the Registrant has voluntarily absented herself and would be unlikely to attend at a future date, if the matter were adjourned. In these circumstances the Panel has agreed to proceed in her absence as it is satisfied that it is both in the public interest and the Registrant’s interest to do so.
2. On 21 April 2016, a panel of the Conduct and Competence Committee found that the Registrant’s fitness to practise was impaired by reason of a lack of competence and imposed a twelve month Suspension Order. The panel’s findings related to: flawed assessments; inaccuracies in documentation; poor clinical reasoning in identifying patients’ main problems and basic lack of knowledge and an inability to improve that knowledge, despite a structured development plan put in place by her employer. The previous panel found that the Registrant’s practice had persistently fallen below the standard expected of a physiotherapist over a considerable period of time and as judged against a fair sample of her work.
3. The Panel today is conducting a review of the Suspension Order in terms of Article 30(1) of the Health and Social Work Professions Order 2001.
4. The Panel heard from Mr Demissie who outlined the background to the case and the circumstances which led to the imposition of the Suspension Order. Mr Demissie advised the Panel that the allegation found proved was serious and wide ranging and occurred over a considerable period of time. He submitted that in the absence of evidence of remediation, reflection or insight, the HCPC was seeking to have the current Suspension Order extended.
5. The task of the Panel today is not to go behind the decision of the previous panel but to determine whether or not the Registrant’s fitness to practise remains impaired and if there is current impairment, what, if any, order should be made when the current order expires. The Panel has considered the submissions of Mr Demissie together with the advice of the Legal Assessor. The original panel was of the view that the Registrant’s actions and omissions placed patients and service users at risk and found that there was no evidence before it to indicate that the Registrant had subsequently reflected on her practice so as to achieve sufficient insight into it. That panel also found that while the Registrant’s practice was, in theory, capable of remediation, there was no evidence of remediation and there remained a real risk of repetition. This Panel has no information from the Registrant and therefore no evidence that she has taken steps to address the deficiencies identified by the previous panel. In these circumstances the Panel has concluded that her fitness to practise remains impaired.
6. The Panel considered that to take no further action or to impose a Caution Order would not be sufficient to address the wider public interest considerations or to protect the public, in the absence of evidence of remediation, given the risk of repetition identified by the previous panel. The Panel also considered that a Conditions of Practice Order would not be appropriate as it would not be confident that the Registrant would be willing or able to comply with conditions, given her lack of engagement. In addition the Panel has no information in respect of her current circumstances.
7. The Panel next considered extending the current Suspension Order. The Panel is satisfied that this would achieve the necessary degree of public protection and that it would also give the Registrant a further opportunity to demonstrate to a future reviewing panel that she has addressed the matters which brought her before the HCPC. The Panel has concluded that this would be a proportionate sanction in all the circumstances. The Panel is aware that it does not currently have the option of imposing a Striking Off Order as the Registrant has not been continuously suspended for a period of two years. The Panel is agreed that a Suspension Order for a period of twelve months would allow the Registrant sufficient time to reflect on her actions and to demonstrate full insight and remediation.
8. This Order will be reviewed by another panel prior to its expiry. That panel may be assisted if, the Registrant:
• were to engage with the process and attend a future review hearing;
• provides evidence of any relevant training activities and/or professional development undertaken by her;
• provides evidence of reflection, such as a reflective piece, demonstrating insight into her lack of competence and the associated consequences for patients and her profession and any other evidence that the Registrant considers might be useful to the reviewing panel.
The order imposed today will apply from 19 May 2017.
This order will be reviewed again before its expiry 19 May 2018.