Miss Wilma Szwajcar
During your employment as an Occupational Therapist for NHS Lothian you:
1. Did not complete adequate Initial Assessments in that you:
a) Did not adequately explore and/or assess the mental health of the patient concerned as part of your Initial Assessment, including in relation to:
i. Patient A;
ii. Patient B;
iii. Patient D;
iv. Patient F;
v. Patient V;
vi. Patient L;
b) Did not complete all relevant sections of the Initial Assessment form, including in relation to:
i Patient J;
ii. Patient K;
iii. Patient L;
iv. Patient D;
v. Patient F;
vi. Patient A;
vii. Patient B;
viii. Patient V;
2. Did not complete adequate treatment plans in that you:
a) Did not include appropriate goals and/or interventions relating to the mental health of the patient concerned, including in relation to:
i. Patient D;
ii. Patient V;
iii. Patient F;
b) Suggested treatment for anxiety management without ascertaining whether symptoms of anxiety were present, (including) in relation to Patient M;
c) Were unable to devise appropriate treatment activities without prompting, including in relation to:
i. Patient V;
ii. Patient Q;
iii. Patient R;
iv. Patient T;
v. Patient J;
3. Not proved.
4. The matters as described in paragraphs 1 - 3 constitute misconduct and/or lack of competence.
5. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.
Proving service and proceeding in absence
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 Pye’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 HCPTS’ 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 14 September 2017. The Panel notes that the Registrant did not attend the substantive hearing. In addition the Panel has had sight of an email dated 11 August 2017 from the Registrant confirming that she will not be attending this hearing. 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. 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. On 17 August 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 inadequate assessments and inadequate/inappropriate treatment plans covering numerous patients over a prolonged period of time. The previous panel found that despite significant support, there was a pattern of the same issues being repeated and that save for a short period in 2009, the Registrant’s performance did not meet the foundation level for a Band 5 Occupational Therapist.
3. The Panel heard from Mr Pye who outlined the background to the case and the circumstances which led to the imposition of the Suspension Order. Mr Pye advised the Panel that the matters found proved were 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.
4. 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 Pye together with the advice of the Legal Assessor. The original panel was of the view that the Registrant’s lack of competence had the potential to place patients at risk of harm. The panel also found that the Registrant’s insight was limited, and that while the Registrant’s failings were, in theory, capable of remediation, there was no evidence of remediation and there remained a real risk of repetition. This Panel has limited information from the Registrant. She sent a letter to the HCPC in March 2017, but it provided no details of any steps to address the deficiencies identified by the previous panel. In these circumstances the Panel has concluded that her fitness to practise remains impaired.
5. The Panel considered that to take no further action or to impose a caution 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. The Panel also notes that previously the Registrant had considerable support from her employers over an extended period and was unable to meet the required standard. In addition the Panel has no information in respect of her current work or health circumstances.
6. 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 agreed that a Suspension Order for a period of twelve months would provide further time for the Registrant to reflect on her actions and to demonstrate full insight and remediation.
7. 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. It may also be assisted by evidence of any relevant training activities and/or professional development undertaken by the Registrant; evidence of reflection, such as a reflective piece, demonstrating insight into the Registrant’s 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.