Mr Inderjit Singh Sagar

: Chiropodist / podiatrist

: CH13419

: Final Hearing

Date and Time of hearing:10:00 29/01/2018 End: 17:00 30/01/2018

: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Conditions of Practice

Allegation

In March 2011, whilst registered as a Chiropodist, you:

1. Did not complete an adequate assessment of Patient A prior to undertaking a nail ablation by not:

a) assessing Patient A's vascular supply;

b) obtaining Patient A’s medical history.

 

2. Did not complete adequate records in respect of Patient A.

 

3. Provided inappropriate treatment to Patient A's right toe nail in that:

(a) you used phenol for the nail ablation when this was contraindicated for Patient A;

(b) you did not refer Patient A to a GP or vascular consultant for assistance.

 

4. Did not obtain informed consent from Patient A prior to undertaking a nail ablation by not:

(a) providing Patient A with a sufficient explanation of the treatment options;

(b) providing Patient A with a sufficient explanation of the risks and benefits of each of the treatment options.

 

5. Your actions described in paragraphs 1- 3 amount to misconduct and/or lack of competence.

 

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

Finding

Preliminary Matters:

Application to Receive Evidence by Telephone Link

1. Ms Sheridan applied on behalf of the HCPC for the evidence of Consultant Vascular Surgeon (Witness 1) to be heard by telephone as there had been difficulties in arranging his attendance in person. Ms Sleeman did not object.


2. The Panel was satisfied, having accepted the advice of the Legal Assessor, that it was appropriate in all the circumstances to hear Witness 2’s evidence by telephone.


Application to Hear Part of the case in Private

3. Ms Sheridan on behalf of the HCPC made an application for the hearing to be conducted partly in private due to health matters relating to the witness Patient A, to which Ms Sleeman, on behalf of the Registrant, consented.


4. In considering the application, the Panel took into account the HCPTS Practice Note on “Conducting Hearings in Private” and accepted the advice of the Legal Assessor. The Panel decided that it was necessary to hold this hearing partly in private, to protect the private life of the witness, which the Panel considered outweighed the public interest in conducting  this hearing wholly in public.


Application to amend


5. At the outset of the hearing Ms Sheridan, on behalf of the HCPC, made an application to make the following amendments:


• Paragraph 1 add the words ‘or not adequately’ after the words ‘by not’
• Paragraph 4 - the second paragraph numbered ‘4’ delete ‘4’ and renumber as ‘5’.
• Paragraph 4 - change ‘1-3’ to ‘1-4’
•  Paragraph 5 delete the number ‘5’ and replace it with the number ‘6’.

6. Ms Sheridan submitted that the proposed amendments would assist both parties as they better particularised the HCPC’s case. Ms Sleeman did not oppose the application.


7. The Panel noted that the Registrant had been put on notice of the proposed amendments in a letter dated 5 July 2017. Having accepted the advice of the Legal Assessor, the Panel was satisfied that it was in the interests of justice to amend the Allegation as proposed because it more accurately reflected the HCPC’s case and there were no objections on behalf of the Registrant.

Background

8. The Registrant is a sole practitioner and owner of ‘The Chorley Chiropody Practice’ (The Practice) where he practises as a State Registered Chiropodist/Podiatrist in Chorley, England. Patient A received treatment from the Registrant in March and April 2011. It was as a result of that treatment that Patient A made a complaint to the HCPC in 2014 regarding the standard of that treatment.

Assessment of Witnesses
Patient A

9. Patient A provided the Panel with an account of his appointments with the Registrant. The Panel noted that his recollection was clear in parts and overall he was credible and reliable. However, he was not fully able to recall some of this information in detail, which resulted in minor inconsistencies. For example, he did not recall an appointment date but readily accepted it occurred when he was shown documentation. When he could not recollect matters, he indicated that he could not recall them. He did not seek to produce an answer. This added to his credibility.The Panel considered that Patient A gave his honest recollection of events.

Witness 1 – Vascular Surgeon

10. Witness 1 was the Consultant Vascular Surgeon at Lancashire Teaching Hospital NHS Foundation Trust who worked with the Consultant Physician in treating Patient A’s critical limb ischaemia. Witness 1 provided evidence as to the likely progress of Patient A’s vascular condition affecting his right foot at the time of the March 2011 assessments by the Registrant. This was based on his examination of Patient A on 22 July 2011 and his records  including the angioplasty report, from which he concluded that Patient  A’s circulation issues,  arose from calcification of the arteries which developed gradually over a period of time. He referred to the findings in May 2011 when Patient A had attended a hospital in Malta. Patient A was found to have no pulse palpable in his foot. It was noted Witness 1 explained the right foot pulse referred to by a Senior House Officer at a later examination was likely to have developed, albeit weakly, as a result of the angioplasty surgery. The Panel found that witness Witness 1 was objective and consistent in giving his evidence. The Panel considered that he was a credible, reliable witness who gave his evidence in a fair and balanced manner.

Witness 2 – Expert Witness


11. Witness 2 was an Expert Witness instructed by the HCPC, in his capacity as a practising Podiatrist, to provide expert evidence in relation to the Registrant’s alleged conduct. Witness 2 accepted that he had not seen Patient A. He relied on the available documentation to provide evidence as to the examination and tests that should have been undertaken by the Registrant at the March 2011 appointments with Patient A. The Panel considered that Witness 2 gave his evidence in a fair and balanced manner. He had a good general understanding of the long term nature of calcification development. The Panel found Witness 2 to be a helpful, credible and reliable witness.


The Registrant


12. The Registrant chose to give evidence at the hearing. The Panel noted that the Registrant was of previous good character and had worked as a Chiropodist / Podiatrist for approximately twenty years and had built up a large practice in Chorley where he now lives.


13. The Panel recognised that giving evidence is a stressful event and made appropriate allowances. However, there were aspects of the Registrant’s evidence, which could not be adequately explained on the basis of stress alone. The Registrant frequently gave long unfocussed answers.  Although he appeared to understand the questions posed, the Panel was sometimes unable to understand his explanations.


14. The Panel also took the view that the Registrant’s oral evidence demonstrated that his insight was not as well developed, as his witness statement suggested. Furthermore, the Panel noted that, having made three admissions at the outset of the hearing, subsequently, the admission relating to Particular 3(b) was withdrawn.  This was because it became clear from the Registrant’s oral evidence that his admission related to a different timescale to that referred to in this particular.


15. The Registrant was asked about the appointments Patient A attended in March 2011. Despite the Registrant accepting that he had not completed adequate records in March 2011, he stated that he could now recall all the details of the appointments. This included the pulse readings and treatment options discussed. In view of the number of patients at the practice and the lapse of six years since the treatment, the Panel found the Registrant’s account of this to be implausible. In his reflective statement he used the word  ‘suggests’ in reference to pulse palpating he would have carried out. When questioned about the use of ‘suggests’ as being a word indicative of a practice not actual performance, he stated that its use was his 'bad English'. This was inconsistent  with his earlier evidence when he had already confirmed that he had not drafted this statement hence the use of the word  could not be attributable to his ‘bad English’.  These features undermined the Registrant’s overall reliability.


Decision on Facts

Panel’s Approach

16. The Panel was aware that the burden of proving the facts was on the HCPC and that the standard of proof is the ordinary civil standard, namely the balance of probabilities.


17. In reaching its decision the Panel took into account the oral evidence of the HCPC witnesses including Patient A, the Registrant’s oral evidence, the written and documentary evidence (the witness statements including Witness 1’s, the expert witness’s statement and the Registrant’s reflective witness statement and testimonials submitted on his behalf ) as well as the oral submissions made on behalf of both parties.


18. The Panel accepted the advice of the Legal Assessor.


19. The Panel noted that the Registrant admitted paragraphs 1(b), 2, and 3(b), at the outset. The admission to paragraph 3(b) was withdrawn after the Registrant had given his evidence as it contradicted that admission. The Panel took the remaining admissions into account when determining the facts of the case.


Decision

Particular 1(a) – Proved


In March 2011 whilst registered as a Chiropodist, you:

1. Did not complete an adequate assessment of Patient A prior to undertaking nail ablation by not or not adequately

 (a) assessing Patient A’s vascular supply;


20. The Panel noted there was no record of an adequate assessment. The Panel was not satisfied as to the Registrant’s recollection with regard to his assessment of Patient A’s vascular supply. The Registrant stated that he recalled taking Patient A’s foot pulses and accepted that he had only considered the presence of the pulses and did not assess the quality of them.  The Panel found it implausible that, without adequate records, the Registrant had an accurate independent recall of his own assessment of Patient A’s pulses at the pre surgery appointments in March 2011. The Panel preferred the evidence of Witness 1 and Witness 2 to the effect that, taking account of all the information, an adequate assessment of Patient A’s vascular supply would very likely have detected an indication of arterial disease. Such an adequate assessment should have resulted in a referral to Patient A’s General Practitioner or directly to a vascular surgeon. The Registrant did not make such a referral. Witness 1 confirmed that the calcification of Patient A’s arteries, and the fact that the pulse was not palpable when he examined him in July 2011, would have been a gradual process. Witness 2 therefore concluded that it was very likely that the pulse would not have been palpable in March 2011. The Registrant conceded in his evidence that he could have been more thorough in his assessment of Patient A. Accordingly, Particular 1(a) was found proved.


Particular 1(b) – Admitted and Proved


In March 2011 whilst registered as a Chiropodist, you:

1.Did not complete an adequate assessment of  Patient A, prior to undertaking nail ablation by not or not adequately;

(b) obtaining Patient A’s medical history.


21. The Registrant admitted that he did not adequately obtain Patient A’s medical history. The Registrant was not aware of a significant, relevant health condition experienced by Patient in 2005, nor the medication prescribed in respect of it. The Panel took account of the Registrant’s evidence and Witness 2’s expert evidence as to what would reasonably be expected to be obtained by way of a patient’s medical history prior to undertaking nail ablation. The Panel also had regard to the documentation of the assessments in Patient A’s medical notes .The Panel was satisfied that whilst some of Patient A’s medical history had been obtained, it was not adequately obtained.


Particular 2  - Admitted and Found Proved

Did not complete adequate records in respect of Patient A.


22. The Registrant admitted that he did not complete adequate records in respect of Patient A in March 2011.The Panel heard and accepted expert evidence that the Registrant’s records in respect of Patient A were not adequate. They had insufficient details including an absence of medical history, medications, allergies and what tests had been performed on Patient A at his assessment. The ‘consent form’ (for treatment) did not indicate possible alternative treatment options or any details of the risks and benefits of the proposed treatment.


Particular 3(a) -  Proved

Provided inappropriate treatment to Patient A’s right toe nail in that:

(a)You used phenol for the nail ablation when this was contra indicated for Patient A

23. The Panel accepted the expert evidence of Witness 2 that in March 2011 Patient A’s vascular condition was mostly likely to have been already compromised. The use of phenol in his treatment was contra-indicated as his capacity to heal post operatively was adversely affected by vascular insufficiency, later diagnosed as critical limb ischemia.


 Particular 3(b) –  Proved

Provided inappropriate treatment to Patient A’s right toe nail in that:

(b) You did not refer Patient A to a GP or vascular consultant for assistance.

24. The Panel accepted the expert Witness 2’s evidence that the patient would already be suffering a vascular condition in March 2011. This would have resulted in no foot pulse or a weak foot pulse. The Panel determined that on each of the appointments on 3,7,10 and 25 March 2011 when Patient A attended the Registrant at his Practice, the Registrant should have referred Patient A to a vascular surgeon or a GP. By not seeking appropriate assistance, it follows the surgery performed was inappropriate treatment.


Particular 4 - Proved

Did not obtain informed consent from Patient A prior to undertaking a nail ablation by not: (a)Providing Patient A with a sufficient explanation of the treatment options; (b)Providing Patient A with sufficient explanation of the risks and benefits of each of the treatment options.


25. The Panel preferred the evidence of Patient A who was very clear in his recollection that he had not been given an explanation of alternative treatment options and the risks and benefits of each of the treatment options. The Registrant gave evidence that he had informed the Patient of all alternative treatments and had explained the risks and benefits of each treatment to Patient A. Given the lapse of six years since 2011, and in the absence of contemporaneous records, the Panel found this purported recall implausible. Such recall was considered especially unlikely in light of the large number of patients in The Practice whom the Registrant had treated in the interim. The Registrant stated that he assumed Patient A had understood his explanation. The Panel was not satisfied that informed consent was obtained where an explanation was given without ensuring the Patients’ understanding. The Registrant latterly conceded that an assumption of Patient A’s understanding did not meet the requirement for a sufficient explanation.


Decision on Grounds

Panel’s Approach

26. The Panel took into account all the documentation as well as the oral submissions of Ms Sheridan, on behalf of the HCPC and those made by Ms Sleeman, on behalf of the Registrant. The Panel accepted the Legal Assessor’s advice.


Lack of Competence


27. The Panel noted that a lack of competence, connotes a standard of professional performance which is unacceptably low and has usually been demonstrated by reference to a fair sample of the Registrant’s work.


28. The Panel noted that the concerns raised with regard to the Registrant’s work related to one patient during the month of March 2011. In the context of a busy podiatry clinic, where the Registrant was a sole practitioner, treating several patients each day, the Panel concluded that this did not represent a fair sample upon which the Panel could make a judgment as to the Registrant’s overall competence.


29. The Panel concluded that the Registrant’s acts and omissions did not amount to a lack of competence.


Misconduct

30. The Panel next determined whether the facts found proved amounted to misconduct. The Panel accepted the advice of the Legal Assessor. It bore in mind that there is no standard of proof to be applied at this stage; consideration as to whether the threshold for misconduct has been reached is a matter in its own judgment. In considering the ground, the Panel first considered the individual particulars found proved and then the behaviour in the round.


31. The Panel had specific regard to the helpful guidance provided in Roylance -v- GMC (No 2) [2000] 1 AC 311, Meadows v GMC [2007] QB 462 and Shaw v GOsC [2015] EWHC 2721. It noted that misconduct involves an act or omission which falls short of what would be proper in the circumstances and that in order to amount to misconduct, the act or omission needs to be serious and one which would attract a degree of strong public disapproval.


32. The Panel then considered whether the proven facts amounted to breaches of the HCPC Standards of Conduct, Performance and Ethics 2008 (“the HCPC Standards”), and/or breaches of the HCPC Standards of Proficiency applicable to Chiropodists/Podiatrists, which were relevant at the time. It bore in mind that breaches of any of these Standards did not, in themselves, necessarily constitute misconduct. 


33. The Panel determined that the following HCPC Standards had been breached:


1 You must act in the best interests of service users.
5 You must keep your professional knowledge and skills up to date.
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.
9 You must get informed consent to give treatment (except in an emergency).
10 You must keep accurate records.


34. The Panel also determined that the following HCPC Standards of Proficiency applicable to Chiropodists had been breached. Registrant chiropodists/podiatrists must:


1a.4   understand the importance of and be able to obtain informed consent
1a.5   be able to exercise a professional duty of care
-1a.6 be able to practise as an autonomous professional, exercising their own professional judgement
-be able to assess a situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem
-be able to initiate resolution of problems and be able to exercise personal initiative
-know the limits of their practice and when to seek advice or refer to another professional
-recognise that they are personally responsible for and must be able to justify their decisions.


1b.1 be able to work, where appropriate, in partnership with other professionals, support staff, service users and their relatives and carers;
-understand the need to engage service users and carers in planning and evaluating diagnostics, treatments and interventions to meet their needs and goals;
- be able to make appropriate referrals;


1b.3 be able to demonstrate effective and appropriate skills in communicating information, advice, instruction and professional opinion to colleagues, service users, their relatives and carers
-understand the need to provide service users (or people acting on their behalf) with the information necessary to enable them to make informed decisions


1b.4 understand the need for effective communication throughout the care of the service user


2a.1   be able to gather appropriate information
2a.2 be able to select and use appropriate assessment techniques
-be able to undertake and record a thorough, sensitive and detailed assessment, using appropriate techniques and equipment
2a.3 be able to undertake or arrange investigations as appropriate
- be able to conduct neurological, vascular, biomechanical, dermatological and podiatric assessments in the context of chiropody and podiatry


2a. 4 be able to anaylse and critically evaluate the information collected

Particular 1(a)


35. The Panel considered the Registrant’s failure to complete an adequate assessment of Patient A’s vascular supply prior to undertaking nail ablation constituted a serious falling short which would  be considered deplorable by fellow professionals considering the impact and effect of this and the risk of consequential harm.


36. The Panel was satisfied the behaviour in Particular 1(a) was serious and amounted to misconduct.

Particular 1 (b)

37. The Panel considered that obtaining a full and accurate medical history is a critical prerequisite to identifying material issues, treatment options, risks and benefits and obtaining informed patient consent. The Panel considered that the Registrant’s failure to do so constituted a serious falling short which would be considered deplorable by fellow professionals. The Panel was satisfied the behaviour in Particular 1(b) in respect of Patient A was serious and amounted to misconduct.

Particular 2


38. The Panel considered the Registrant’s conduct in particular 2, that he did not complete adequate records in respect of Patient A over a course of five appointments. The expert had commented on how poor the records were. The Panel noted the records were not completed in respect of matters which were critical to patient care. The Panel was therefore satisfied the behaviour in Particular 2 was serious and amounted to misconduct.


Particular 3


39. The Panel considered the Registrant’s conduct in particulars 3(a) and 3(b) whereby he provided inappropriate treatment to Patient A’s right toe nail in that he  used phenol for the nail ablation when this was contra indicated for Patient  A  and  he did not refer Patient A to a GP  or vascular consultant for assistance.


40. The Panel noted the expert evidence that phenol was contra - indicated to use for Patient A’s health condition. This failure followed from the failure to complete the fundamental assessments identified at Particular 1.  It was a serious error to use phenol in these circumstances and one that would be deplored by fellow professionals.


41. The Panel considered that carrying out treatment on Patient A when his condition should have been referred to a GP or directly to a vascular consultant was serious and may have put Patient A at risk of harm. The Panel was satisfied that this would be viewed as deplorable by fellow professionals. The Panel was satisfied the behaviour in Particulars 3(a) and 3(b) was serious and amounted to misconduct.


Particular 4


42. A sufficient explanation of the treatment options, risks and benefits was required in this case. Sufficiency of explanation requires confirmation that the patient actually understood what he had been told. This was a serious communication failure and the patient’s ill-informed agreement to inappropriate treatment exposed him to the risk of harm. Obtaining informed consent is fundamental to the safe treatment of patients. Accordingly, the Panel was satisfied that this was a serious departure from the standards expected, would be considered deplorable by fellow professionals and amounted to misconduct.


43. The Panel found that each of the particulars found proved was capable of amounting to misconduct.  The Registrant, despite over twenty years of experience as a Podiatrist, repeatedly failed to meet the standards expected of him. The Registrant’s behaviour cannot be described as a momentary failure or a temporary lapse of judgement, particularly as concerns about his behaviour occurred during several appointments with Patient A in March 2011. The Panel noted that the Registrant had a busy professional and family life around this time, however, it concluded that the Registrant’s serious omissions in three significant areas of patient care: assessment, record keeping and obtaining informed consent from patients amounted to misconduct. The Panel was satisfied that the Registrant’s behaviour in the particulars amounted both individually and cumulatively to serious misconduct which fell far short of that which would be expected of a registered Chiropodist/Podiatrist.


Decision on Impairment

Panel’s Approach

44. Having found misconduct the Panel went on to consider whether the Registrant’s fitness to practise is currently impaired. The Panel took into account the HCPTS Practice Note: “Finding that Fitness to Practise is Impaired” and accepted the advice of the Legal Assessor.


45. In determining current impairment the Panel had regard to the following aspects of the public interest:


• The ‘personal’ component: the current behaviour etc. of the individual registrant; and
• The ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

Panel’s Decision

46. The Panel found that the Registrant displayed a persistent lack of judgment and disregarded the safety and wellbeing of Patient A by serious omissions in three significant areas of patient care: assessment, record keeping and obtaining informed consent.


47. The Panel recognised that remediation would be possible in this case. However, although the Registrant had reflected on his previous behaviour the Panel noted that there was a disconnect between his written reflections and his oral evidence. While the Registrant stated that he acknowledged his shortcomings and fully appreciated the gravity of his misconduct, at the hearing, he denied most of the serious particulars. The Panel accepted the Registrant has shown some limited insight. He has submitted his reflections on obtaining the medical history and he produced documentation to demonstrate a change in his practice regarding record keeping and obtaining consent. The Registrant appeared to be developing some insight, but the Panel considered further insight would be required to remediate his behaviour.


48. The Panel noted that the Registrant had completed an online “good clinical record keeping” course and assessment a short time in advance of an earlier hearing date. Although formal courses are a useful starting point, the Panel took the view that it is the learning that has been achieved and the translation of that learning into development of the practitioners’ practice, which is of most significance. The Registrant has not yet adequately addressed his deficiencies in vascular disease detection, record keeping and obtaining informed consent that were the cause of serious concern. In the absence of a sufficient level of insight and remediation the Panel determined that there is a current and ongoing real risk of repetition and hence harm to patients.


49. The Panel concluded that for these reasons the Registrant’s fitness to practise is currently impaired based on the personal component. In considering the public component the Panel had regard to the important public policy issues which include the need to maintain confidence in the profession and the regulatory process and also to declare and uphold proper standards of conduct and behaviour. Members of the public would be extremely concerned to learn that a Podiatrist had the potential to compromise the safety and well-being of patients in the manner that Patient A experienced. It is critically important that colleagues and patients can rely on the professionalism of Podiatrists at all times.


50.  A significant aspect of the public component is upholding proper standards of behaviour. The Registrant’s conduct fell far below the standard expected of a registered practitioner. The Panel took the view that until the Registrant has fully remediated his misconduct he poses a serious risk of harm to patients. The Panel also concluded that the Registrant has brought the profession into disrepute and breached a fundamental tenet of the profession by failing to act in the best interest of his patients. The Panel considered that there is a risk that all of these failings may be repeated in the future.


51.  In all the circumstances, the Panel determined that public trust and confidence in the professional regulatory process would be undermined if a finding of impairment was not made.


52. The Panel concludes that the Registrant’s current fitness to practise is impaired on the basis of both the personal component and the wider public interest and therefore the HCPC’s case is well-founded.


Decision on Sanction


53. The Panel considered the submissions made by Ms Sheridan and Ms Sleeman. It considered further documentation submitted on behalf of the Registrant, comprising two additional testimonials and evidence of relevant Continuous Professional Development [CPD] undertaken since the last hearing. It accepted the advice of the Legal Assessor.


54. The Panel is aware that the purpose of any sanction is not to be punitive, though it may have a punitive effect. The Panel has borne in mind that its primary function at this stage is to protect the public, while reaching a proportionate sanction, taking into account the wider public interest and the interests of the Registrant. The Panel has taken into account the HCPC Indicative Sanctions Policy [the ISP] and applied it to the Registrant’s case on its own facts and circumstances.


55. The starting point for the Panel was that the misconduct was serious. The Registrant displayed a persistent lack of judgment and disregarded the safety and wellbeing of Patient A by serious omissions in significant areas of patient care, namely: assessment, record keeping and obtaining informed consent.  It constituted numerous breaches of  the HCPC Standards and the failings were associated with fundamental areas of the Registrant's  practice.


56.  The Panel identified the following mitigating factors.


• The Registrant made a number of admissions at the outset of the case without prevarication and accepted, in his evidence, that he could have provided a better standard of patient care;
• The Registrant has fully engaged in the regulatory process;
• The Registrant  has been registered since 1997, is of previous good character and there have been no further concerns raised about the standard of his practice since the relevant period more than 6 years ago;
• There were a number of positive testimonials on behalf of the Registrant from medical professionals and patients;
• The Registrant has expressed remorse and apologised to Patient A.


57. Although no further concerns have been raised, the Panel noted that the Registrant’s insight was limited. There was no evidence that he had yet adequately addressed and remediated the identified deficiencies in order to reduce the real risk of repetition. Furthermore, the Panel has found that the Registrant damaged the reputation of the profession. In light of all of these matters, the Panel has considered what sanction, if any, should be applied, in ascending order of seriousness.


No Further Action


58. The Panel considered that the public would not be protected and the wider public interest would not be upheld if it were to take no further action in a case of this nature which would inevitably attract a degree of strong public disapproval.


Mediation


59. The Panel considered that mediation has no applicability to the nature of the misconduct found proved.


Caution


60. The Panel decided that a Caution Order would be insufficient to mark the seriousness of the findings. It would offer no restriction on the Registrant’s practice and would therefore be insufficient to protect the public and uphold the wider public interest.


Conditions of Practice


61. The Panel was mindful of the fact that the failings identified are capable of remediation and the Registrant has started to develop some limited insight into them. The misconduct related to one patient, some 6 years ago, in an otherwise blemish-free career spanning more than 20 years.  The Registrant has been in unrestricted practice since the relevant period without further incident or concern, although in the Panel’s view there remains a real risk of repetition.  In these circumstances, the Panel concluded that it would be possible to formulate workable and practicable conditions that would adequately address the issues identified and also reflect the wider public interest. The Panel is satisfied that allowing the Registrant to remain in practice, albeit subject to conditions, will address the risks identified. Beyond the conditions imposed, the Registrant is capable of practising safely and effectively.


62. The Panel is mindful of the potential impact this order may have upon the Registrant.  However, it is satisfied that a Conditions of Practice Order for 12 months is an appropriate and proportionate sanction in these circumstances.  This is sufficient time for the Registrant to address the issues identified.  Any shorter period would not address the public protection issues raised nor would it allow sufficient time for the development of full insight and remediation.


63. The Panel is satisfied that the need to protect the public, and maintain confidence in the profession and the regulatory process, outweighs the impact upon the Registrant of working subject to conditions of practice for a period of 12 months.

Suspension and Striking Off Order


64. In the judgement of the Panel, a Suspension or Striking Off Order would be disproportionate and unduly punitive in the circumstances described. It would be contrary to the wider public interest as it would deprive the public of a practitioner who should eventually be  capable of practising without restriction, after a period when he is subject to Conditions of Practice.


65. Accordingly, the Panel determined that a Conditions of Practice Order, was the necessary and proportionate order at this time.

Order

Order: The Registrar is directed to annotate the Register to show that, for a period of one year from the date that this Order comes into effect (“the Operative Date”), you, Inderjit Singh Sagar, must comply with the following conditions of practice:


1. You must place yourself and remain under the supervision of  a workplace supervisor registered  by the HCPC  and supply details of your supervisor to the HCPC within 28 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

2. You must promptly inform the HCPC if you cease to be in self-employment or take up any other or further employment.

3. You must promptly inform the HCPC of any disciplinary proceedings taken against you by any employer.

4. 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 professional work;

(b) any agency you are registered with or apply to be registered with (at the time of application); and

(c) any prospective employer (at the time of your application).

5. You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies identified in this hearing, including:

  -vascular assessment and clinical reasoning
  -record keeping
  -obtaining informed consent

6. Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

7. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

8. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

9. You must maintain a record of reflective practice detailing every occasion when you undertake a procedure using local anaesthesia and must provide a copy of that profile to the HCPC on a monthly basis or confirm that there have been no such occasions in that period, the first profile or confirmation to be provided within 2 months of the Operative Date.

10. You must arrange an independent audit of your record-keeping every 4 months to demonstrate progress on remediating the record-keeping deficiencies identified in this hearing and provide details of each audit to the HCPC.

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

12. Any condition requiring you to provide any information to or obtain the approval of the HCPC is to be met by you.  You must send the information required to the offices of the HCPC, marked for the attention of the Director of Fitness to Practise or Head of Case Management.

Notes

A Final Hearing was concluded in London on 30 January 2018, and a Conditions of Practice Order imposed.

Hearing history

History of Hearings for Mr Inderjit Singh Sagar

Date Panel Hearing type Outcomes / Status
29/01/2018 Conduct and Competence Committee Final Hearing Conditions of Practice
15/11/2017 Conduct and Competence Committee Final Hearing Adjourned part heard
03/07/2017 Conduct and Competence Committee Final Hearing Adjourned