Mr Alexander Fawcett

: Physiotherapist

: PH10579

: Review Hearing

Date and Time of hearing:12:30 27/10/2017 End: 17:00 27/10/2017

: ETC Venues, Avonmouth House, 6 Avonmouth Street, London, SE1 6NX

: Conduct and Competence Committee
: Suspended

Allegation

During the course of your employment as a Physiotherapist at Medway NHS Foundation Trust between 21 January 2015 and 14 September 2015, you:

1. Did not complete your probationary period during which there were concerns regarding:

a. your note keeping, in that you;

i. completed patient notes with illegible handwriting on at least four occasions between March 2015 and May 2015

ii. completed patient notes with spelling errors on at least three occasions between March 2015 and May 2015

iii. did not structure your patient records according to the ‘whole systems’ approach on more than one occasion between March 2015 and May 2015

iv. did not include the patient’s subjective history in the patient’s records on more than one occasion between March 2015 and May 2015

v. failed to demonstrate adequate clinical reasoning in the patient records on more than one occasion between March 2015 and May 2015

vi. problem lists consistently lacked sufficient detail

b. your assessment skills, in that you:

i. during your probation period frequently did not complete comprehensive whole systems assessments;

ii. on at least two occasions in or around April 2015, stated that two unidentified patients chests were clear, yet on assessment both patients had significant loads of sputum

iii. did not link patient history and then adapt your assessment skills accordingly.

iv. on 19 and 20 May 2015 failed to auscultate the lower zones of the lungs of Patient 1 on two occasions and Patient 2 on one occasion.  

c. your use of monitoring during treatment sessions, in that you:

i. on an unknown date in April 2015, removed monitoring equipment from an unidentified patient and instructed the unknown patient to sit at the side of the bed.

ii. on an unknown date and in relation to an unidentified patient, took a blood pressure despite the patient being stable for several days;

iii. on an unknown date and in relation to an unidentified patient, did not reconnect an HDU patient back to the ECG monitoring equipment.

d. your identification of patient problems, in that you;

i. on 19 May 2015, failed to identify the circumstances of when a troponin blood test is required in relation to Patient 1

ii. on 19 May 2015, failed to identify that Patient 1 had metabolic alkalosis

e. your clinical reasoning, in that on 20 May 2015 you used technical terms incorrectly

f. your treatment selection, in that you;

i. on one or more occasion in or around April and May 2015 did not alter treatment plans according to the patient’s needs

ii. did not prepare bed space adequately

iii. did not sufficiently frequently provide patients with exercises for their trunk;

iv.  on 21 April 2015 did not return a patient’s table within reach of an unidentified HDU patient

v. on 21 April 2015 left Oxygen cylinders by an unidentified HDU patient’s bed

vi. on or around May 2015  needed to be prompted regarding the safe placement of a catheter when treating an unknown patient

vii. on 19 May 2015 selected an inappropriate treatment for Patient 1

g. your communication skills, in that you:

i. on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient age;

ii. on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient needs;

iii. on more than one occasion between March 2015 and May 2015 raised your voice unnecessarily to patients;

2. The matters set out in paragraph 1 constitute lack of competence.

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

 

Finding

Preliminary matters:

Notice of hearing

1. The Panel had sufficient evidence that notice had been served in the correct form, sent in sufficient time in advance of the hearing, and by the appropriate postal service. As an additional precaution the HCPC had also sent a copy of the notice to the email address given by the Registrant.

2. The Panel noted that it was the Registrant’s responsibility to ensure that his address, as shown on the Register was the correct one. The Panel also noted that the HCPC had to demonstrate that it has posted the notice, not that there had been receipt of the notice. There was evidence before the Panel that the Registrant had changed his address after service of the notice but there was also evidence that he was aware of today’s hearing. The Pane noted that the Registrant would need to contact the Registrations Department in order to be able to access his account and update his address. This is his responsibility.

3. The Panel concluded that there had been good service of the notice.

Registrant’s application for an adjournment and proceeding in the Registrant’s absence

4. The Panel had before it a written application from the Registrant for an adjournment of today’s hearing. This application had initially been made verbally on the 2 October 2017. The Registrant had been informed that he must make his application in writing. This written confirmation of his request was sent on 10 October 2017. The written application had been received in sufficient time in advance of the hearing for it to be considered by the Chair on the paperwork in accordance with the HCPC guidance. There was no consideration of this application before today’s hearing.

5. The reason given by the Registrant for requiring a delay in the hearing taking place, was that he needed to give his current employer eight weeks’ notice before being granted time off work. He requested that the hearing be rescheduled for a date when he would be able to secure approved time off work and could attend to present his evidence.

6. The HCPC opposed this application, stating that to comply with the Registrant’s request that he is given more than eight weeks’ notice before a rescheduled date for this hearing would take the substantive review beyond the date when the Suspension Order comes to an end. In the absence of any information from the Registrant that he has addressed his previous failings it would not be in the interests of service users or the wider public to allow him to return to unrestricted practice by letting the order lapse. The HCPC has made efforts to secure his attendance by teleconference, which the Registrant has said is not possible. It was notable that the Registrant had not presented any information in advance of the hearing which would have demonstrated that he had anticipated and prepared for this review.

7. The Panel considered that it was necessary that this mandatory review was carried out in a timely manner and certainly before the order lapsed. The Panel refused the application for an adjournment. It considered that service user and public interest in this case outweighed that of the Registrant.

8. In coming to this decision, the Panel noted that there had been administrative failings by the HCPC in processing the Registrant’s adjournment application. However, given the time constraints that undermined the Registrant’s request, the Panel considered that these administrative failings had not adversely affected the situation.

9. The Panel also noted, that the Registrant had to a degree contributed to the situation in that he has known for the last year that this review would take place. He had not sent in advance any information that would inform the Panel of his actions in the last year nor had he taken the prudent step of contacting the HCPC in advance indicating that due to his working restrictions he required more than eight weeks’ notice.

Background:

10. The matters set out in the Allegation above were considered by a panel of the Conduct and Competence Committee on the 1-4 November 2016. The Registrant started work as a newly qualified practitioner in January 2015 and the matters identified in the Allegation arose during a period from January 2015 to September 2015.

11. The Registrant did not attend the Final Hearing, however he had made full admissions of the facts and sent in written submissions. The factual particulars were found proven by the panel with the exception of particular 1(g)(iv). The panel identified that the Registrant’s practice had fallen short in relation to 10 of the 15 Standards of Proficiency for Physiotherapists expected of a practitioner and had made a finding of lack of competence. In the absence of evidence of remediation, the Panel found impairment and imposed a period of suspension of twelve months.

12. At the time of the Final Hearing the Registrant was undertaking a course in dementia care and working as a Band 3 Therapy support worker.

13. The Final Hearing panel set out clearly that it considered that a future reviewing panel may be assisted by the Registrant providing the following:

• Testimonials or references relating to any recent work he has undertaken;

• A reflective piece on his shortcomings that demonstrates insight;

• Evidence of recent training/CPD including CPD portfolio.

• Evidence of remediation of his shortcomings, for example, evidence of his current communication skills with patients and evidence he is able to write legibly;

• Evidence of continued reading/learning specific to current physiotherapy practice.

Evidence and Submissions

14. The HCPC stated that the only engagement with the Registrant has been in relation to this hearing and the issue of adjournment. The HCPC has no details of the Registrant’s current situation other than his statement that he works within ‘a hospital setting’.

15. In the absence of any evidence from the Registrant there is no information for the Panel to consider and the HCPC maintained that a Suspension Order remained the appropriate sanction in the circumstances.

Decision: 

16. The Panel is conducting a comprehensive appraisal of the Registrant’s current abilities with a view to establishing whether he is now fit to return to unrestricted practice.  The Panel is not undertaking the task of rehearing the matters that had been brought against the Registrant nor going behind the previous findings. 

17. This Panel has taken into account all documentation placed before it. It has heard the HCPC’s submissions; taken and accepted the advice of the Legal Assessor and it has reminded itself of the terms of the Council’s Practice Note on Sanction and ‘Article 30 (2) Reviews’.

18. In particular, the Panel noted the Legal Assessor’s advice that this being a competence matter under Article 29(6), this Panel does not have the right to impose a Strike off Order until there has been a continuous uninterrupted period of suspension. Further, given the request for an adjournment, and the indication by the Registrant that he wishes to attend and present evidence, the Panel should consider bringing to the Registrant’s attention that he could call for an early review of his case pursuant to Article 30(2).

19. The Panel noted that notwithstanding his application for an adjournment, the Registrant had not taken the opportunity, as he had at the Final Hearing, of presenting any written representations. In the absence of any information from the Registrant, other than that he is working in a ‘hospital setting’, there is therefore nothing on which this Panel can assess whether the Registrant has addressed and corrected his lack of competence. There was nothing on which this Panel could make a finding that he is no longer impaired. This being the case, the Panel considered that there remained a need for some form of restriction on the Registrant’s registration.

20. As guided by the Legal Assessor the Panel considered the appropriate and proportionate restriction. A Caution Order would provide no service user protection and in the absence of any information that the Registrant had undertaken remediation of the ten areas of his practice which had been found wanting the Panel concluded that this was inappropriate. A Condition of Practice Order was considered inappropriate and impractical as well as insufficient in the current circumstances where there is no information from the Registrant which would assist with drafting any workable conditions.

21. The Panel has therefore come to the decision that the only appropriate and proportionate order in this instance is a further Suspension Order.

22. The Panel noted that the Registrant had not attended the Final Hearing as he had considered that it would be detrimental to his wellbeing to do so. The Registrant has stated in his adjournment application that he wishes to attend a review. This indicates that the Registrant may now feel able to engage in a further review. The Panel has mentioned above that the Registrant is able to call for an early review of this Suspension Order under Article 30(2). If the Registrant were to do this, it would allow him  the opportunity to provide information which had been requested by the Final Panel, and which is set out in the background section of this decision but also to arrange a further review at a date that will accommodate his need to give his employer sufficient notice of absence.

23. If, however, the Registrant is not yet prepared to demonstrate how he has been seeking to address his competency issues (and this may be inferred from his failure to provide any evidence to date), the Panel considered that he may require some time to adequately address his failings. Therefore, the Panel concluded that the period of suspension should be a further 12 months. If the Registrant should choose to ask for an early review then his case may be reviewed sooner.

Order

ORDER: The Registrar is directed to suspend the registration of Alexander Fawcett for a further period of 12 months on the expiry of the existing order.

Notes

This Order will be reviewed again before its expiry on 02 December 2018 or earlier if new evidence relevant to the Order becomes available after it was made.  

Hearing history

History of Hearings for Mr Alexander Fawcett

Date Panel Hearing type Outcomes / Status
27/10/2017 Conduct and Competence Committee Review Hearing Suspended