Nahashon Ngugi Ngugi
Whilst registered as an Occupational Therapist and employed by Sandwell and West Birmingham Hospitals NHS Trust, you:
1. On or around 10 January 2014, in relation to Service User A, did not:
a) Speak to a member of the multi-disciplinary team ('MDT') about Service User A before making a decision about seeing the service user;
b) Assess whether he was fit for therapy by undertaking appropriate assessments, In that you did not:
i) Speak to him to see how alert or orientated he was;
ii) Speak to him to establish whether he wanted to participate in therapy;
iii) Review blood results to establish whether he was fit for therapy;
c) Record clinical reasoning in relation to his lack of treatment:
2. On or around 14 January 2014, in relation to Service User B, did not take note of the entry made by the Physiotherapist before assessing him.
3. On or around 25 June 2013, in relation to Service User C, you did not:
a) Did not carry out and/or record an assessment of Service User C;
b) Recorded an inappropriate discharge plan in that Service User C required further medical intervention;
4. On or around 19 August 2013, in relation to Service User D, did not identify areas of cognitive deficit and how these may be treated further and/or managed.
5. On or around 21 October 2013. in relation to Service User E you:
a) Discussed and/or attempted to discuss discharge plans with his
family without obtaining and/or recording his consent;
b) Inappropriately arranged a discharge plan;
6. Between 2 and 8 July 2013. In relation to Service User F:
a) Arranged an inappropriate discharge plan;
b) Demonstrated poor clinical reasoning, in that you:
(i) did not reference and/or take into account Service User F's cognitive and/or mental health issues
(ii) did not assess and/or record Service User F's capacity to live at home
(iii) did not take into account the opinions and/or assessments of the rest of the multidisciplinary team ('MDT')
7. Your actions described in paragraphs 1 - 6 constitute misconduct and/or lack of competence.
8. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired
1. The Panel had sight of a letter dated 23 May 2017, sent to the Registrant at his registered address on 23 May 2017, giving notice of today’s hearing, and determined that service had been properly complied with in accordance with the requirements of the Health Professions Council (Conduct and Competence Committee) Rules 2003 (“the Rules”).
Proceeding in absence
2. The Panel accepted the advice of the Legal Assessor, who took the Panel to the Practice Note on Proceeding in the Absence of the Registrant, to Rule 11 and to the guidance given in the cases of R –v- Jones  1 AC 1, Tait v The Royal College of Veterinary Surgeons  UKPC 34 and GMC –v- Adeogba  EWCA Civ 162.
3. The Panel was provided with two emails sent by the Registrant to the HCPC. The first, dated 6 June 2017, stated: “I will not be able to attend the hearing….. I’m will [sic] to accept any decision the Council will impose”. The second, dated 12 June 2017, stated: “I’m in Kenya at the moment that’s why I will not be able to attend but I have full confidence with the Panel…”.
4. It was clear from the Registrant’s emails and from information referred to in the determination of the substantive hearing that the Registrant was not currently residing at his registered address. However, the Panel was satisfied that the Registrant had received notice of today’s hearing by means of email, as evidenced by documentation placed before the Panel and by the Registrant’s response by email. The Registrant had not applied to adjourn the proceedings and the Panel concluded that it was unlikely that he would attend if the matter were to be adjourned indeed, in his emails the Registrant implicitly accepted that the hearing would proceed in his absence. The Panel concluded from the content of the emails sent by the Registrant that he had absented himself voluntarily from the proceedings. The Panel bore in mind that it was in the public interest to hear cases expeditiously. Accordingly, the Panel decided to proceed in the absence of the Registrant.
5. At the relevant time the Registrant worked as a Band 6 Occupational Therapist at Sandwell and West Birmingham NHS Trust. He was responsible for assessing and treating elderly in-patient service users.
6. Issues with the Registrant’s performance were first raised at the beginning of 2012. An action plan was implemented with set objectives. By August 2012 the Registrant was deemed to have met the objectives and was signed off, on the understanding that the capability process would be initiated if further concerns were raised.
7. In March 2013 the Registrant’s colleagues raised further concerns about his practice and communication. The Registrant’s work was monitored and he was asked to meet with senior members of staff for his case notes to be reviewed. It was discovered that his clinical reasoning was not clear and that in some cases he had been working to plans which differed from those used by other professionals.
8. In July 2013 the Registrant was asked to participate in a new “counselling process”. New objectives for the Registrant were agreed and from July to September 2013 regular meetings were held with senior staff in which several concerns were raised in relation to the Registrant’s case notes and plans.
9. In October 2013 the capability process was initiated for the Registrant who was not making significant progress. He was absent on sick leave on a number of occasions. Capability meetings were held between October 2013 and February 2014, and further concerns with the Registrant’s practise were identified. On 27 February 2014 the Registrant went on sick leave and did not return to work after this date. The capability process was never finalised.
10. The Panel heard that whilst the Registrant had been referred to Occupational Health where he was deemed fit, his health remained a concern to some of his colleagues.
11. This Panel considered the issues carefully. It listened to and accepted the advice of the Legal Assessor. It paid attention to the HCPC’s Indicative Sanctions Policy.
12. The Panel was provided with an email from the Registrant which stated: “I will not be able to attend the hearing but I wish to express my sincere regrets for what happened. I’m not the best Occupational Therapist but feel that offered the chance to improve my skills I can still practice at the required level. I’m sorry for everything …I’m will [sic] to accept any decision the council will impose”.
13. The Panel concluded that in his email of 6 June 2017 the Registrant had accepted his failings to some extent and had expressed some remorse. However the Panel concluded that the Registrant remained impaired by reason of his lack of competence. It appeared that his circumstances remained unchanged. The Registrant had not provided any evidence of remediation, nor had he engaged with the hearing by attending this review. The Panel could only conclude that there remained a likelihood of repetition of the Registrant’s failings if he were to be allowed to practise unrestricted. Accordingly, the Registrant remained a risk to the public if permitted to practice as an Occupational Therapist unrestricted.
14. The Panel also found that public confidence in the profession and the declaring of proper standards of conduct and performance demanded a finding of impairment given the Registrant’s lack of competence and the fact that he had chosen not to attend or demonstrate remediation and insight into the proven allegations.
15. The Panel considered whether to make no order or to impose a Caution Order but concluded that this would not be sufficient to protect the public or satisfy the public interest.
16. The Panel considered whether to impose a Conditions of Practice Order but concluded that it was not possible to draft any workable conditions because the Panel had not been provided with any information regarding the Registrant’s current occupation or willingness to comply. The Panel had been informed that the Registrant has been living outside the UK for a number of years. The Panel had been provided with no evidence that he has kept his practice or CPD up to date.
17. The Panel therefore concluded that a Suspension Order was the only appropriate sanction in the circumstances. The Registrant has not undertaken any remedial action to ensure that his lack of competence has been addressed, nor provided any evidence which indicates how the risk to vulnerable service users which he presents has been addressed in order to prevent a repetition of his failings.
18. The Panel decided to suspend the Registrant for a further period of 12 months to enable the Registrant to demonstrate remediation and insight into his failings.
The Order imposed today will take effect from the expiry of the current order on 29 July 2017.
This Order will be reviewed again before its expiry on 29 July 2018.