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Case studies

These case studies represent an example of the most frequent fitness to practise concerns, issues that panels take into account when making a decision and sanctions that were applied.

Case studies

  • Type of concern Bringing profession into disrepute / inappropriate comments on social media
    Profession Paramedic
    Standard

    Standards of conduct, performance and ethics (updated in August 2012)

    Standard 3. You must keep high standards of personal conduct

    Standard 13. You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in your profession

    Case study

    A paramedic self-referred after he posted inappropriate comments on social media, which caused his employer to suspend him. A Conduct and Competence Committee panel considered the allegation against the registrant, who attended the hearing and was represented. The registrant admitted all of the facts of the allegation.

    The Panel found some of the facts proved amounted to misconduct. The posts were on a public social media page and the registrant had included details of his employer. They felt the inflammatory and offensive posts on social media could damage the public’s perception of the profession. The Panel found that the registrant demonstrated insight, remorse and remediation. The Panel felt that there was a low risk of the incident being repeated. However, in considering the public interest the Panel felt that a finding of impairment was necessary to maintain confidence in the profession and the regulator.

    The Panel wanted to send a clear message to the public and other health professionals that offensive and inflammatory language towards others would not be tolerated. The Panel then went on to consider sanctions. They decided that, because of the strong mitigating factors in this case, the imposition of a caution order was proportionate. The Panel struck a proper balance between the need to mark the gravity of the registrant’s actions, whilst recognising the long and unblemished career, and personal, exceptional mitigation.

    Measures we put in place to protect the public The Conduct and Competence Committee Panel imposed a twelve-month caution order.
  • Type of concern Failure to provide adequate care
    Profession Paramedic
    Standard

    Standards of conduct, performance and ethics (updated in January 2016)
    Standard 3. Work within the limits of your knowledge and skills
    Standard 6. Manage risk
    Standard 10. Keep records of your work

    Standards of proficiency for paramedics (updated in August 2014)
    Standard 1. Be able to practise safely and effectively within their scope of practice
    Standard 2. Be able to practise within the legal and ethical boundaries of their profession
    Standard 3. Be able to maintain fitness to practise
    Standard 4. Be able to practise as an autonomous professional exercising their own professional judgement
    Standard 8. Being able to communicate effectively
    Standard 10. Being able to maintain records appropriately
    Standard 14. Being able to draw on appropriate knowledge and skills to inform practice
    Standard 15. Understand the need to establish and maintain a safe practice environment

    Case study

    A paramedic self-referred with an allegation that he carried out inadequate assessments. He failed to meet Clinical Performance Indicators, and failed to take a patient to the hospital who was complaining of chest pains. The registrant had not recorded the reason why he left the patient at home. Following another call to emergency services, the registrant attended with a second crew who found the patient unconscious. The patient subsequently passed away.

    The Panel found that these actions amounted to misconduct. The Panel took into account that, whilst this was an isolated incident, it was a serious issue. The Panel was of the opinion that the registrant had breached core tenets of the profession and had put the patient at ‘unwarranted harm’. Whilst the registrant had provided submissions at the ICP stage expressing some remorse for what had happened to the patient, he had stopped engaging with the fitness to practise process from then onwards.

    The registrant was an experienced paramedic and formerly a team leader. In his earlier submissions, he explained that he was no longer working in the profession and expressed a desire to retire from practice. Therefore, the Panel had no up-to-date information to demonstrate whether the registrant had shown insight, or that they were capable of remedying the failures. The Panel was not confident as to whether the registrant was currently in employment. In addition, the registrant was previously subject to FTP proceedings in 2014.

    The Panel found that the registrant had not learnt from that experience and that his intention to retire from practice demonstrated an unwillingness to resolve any deficiencies in his practice. The Panel took into account the seriousness of the incident. It also considered the effect on public confidence in the profession, and the regulatory body, when making its decision to strike the registrant from the Register.

    Measures we put in place to protect the public The Conduct and Competence Committee Panel imposed a striking-off order.
  • Type of concern Breach of confidentiality
    Profession Social worker
    Standard

    Standards of conduct performance and ethics (updated in January 2016)
    Standard 1. Promote and protect the interests of service users and carers
    Standard 1.1. You must treat service users and carers as individuals, respecting their privacy and
    dignity
    Standard 5. Respect confidentiality
    Standard 5.1. You must treat information about service users as confidential
    Standard 9. Be honest and trustworthy
    Standard 9.1. You must make sure that your conduct justifies the public’s trust and confidence in you
    and your profession
    Standard 10. Keep records of your work
    Standard 10.3. You must keep records secure by protecting them from loss, damage or
    inappropriate access

    Case study

    A social worker’s employer raised concerns with us after the registrant left a notepad containing confidential information, pertaining to a number of service users, at the home address of a service user. Despite being aware that the notepad contained confidential information, the registrant did not recover the notepad in a timely manner.

    The registrant represented himself at the hearing and attended via telephone. The Panel found that because the registrant did not recover the notebook on the same day he realised he had left it, he had compromised the confidentiality of the information in the notebook. It also breached the right to privacy of service users and their families. This included highly sensitive contact and personal details of vulnerable families and an adoption placement.

    The Panel had no doubt that the registrant’s actions demonstrated a failing so serious as to constitute misconduct. The Panel heard the registrant’s account of changes he made in his practice. This ensures that matters of the kind found proved would not be repeated. The Panel recognised that the event was an isolated incident in a 30-year career. However, maintaining confidentiality is a fundamental requirement for social workers. Therefore, the Panel felt that members of the public would be concerned to learn of this breach of confidentiality by an experienced social worker.

    Accordingly, the Panel concluded that public confidence in the profession would be undermined if a finding of impairment was not made. The Panel decided that although they felt the risk of repetition was low, the seriousness of the misconduct needed to be marked by an appropriate sanction. This was to send a clear message to social workers and the public that such conduct is unacceptable and must not be repeated. The Panel decided to impose a twelve-month caution order.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a twelve-month caution order.

     

  • Type of concern Failure to maintain adequate records
    Profession Occupational therapist
    Standard

    Standards of conduct, performance and ethics (updated in August 2012)
    Standard 1. You must act in the best interests of service users. (…) You are responsible for your professional conduct, any care or advice you provide, and any failure to act. (…) You must protect service users if you believe that any situation puts them in danger
    Standard 7. You must communicate properly and effectively with service users and other
    practitioners
    Standard 10. You must keep accurate records

    Standards of proficiency for occupational therapists (updated in March 2013)
    Standard 2.8. Be able to exercise a professional duty of care
    Standard 4.2. Be able to make reasoned decisions to initiate, continue, modify or cease treatment or the use of techniques or procedures, and record the decisions and reasoning appropriately
    Standard 4.4. Recognise that they are personally responsible for and must be able to justify their decisions
    Standard 4.5. Be able to make and receive appropriate referrals
    Standard 9.10. Be able to work in appropriate partnership with service users in order to evaluate the effectiveness of occupational therapy intervention

    Case study

    An occupational therapist’s employer raised concerns relating to their clinical practice and conduct, following a number of incidents relating to nine different cases. The concerns included a failure to maintain adequate case files; not completing case notes about contacts with service users, assessment reports and care plans.

    The registrant was not present at the hearing nor was represented. The Panel found that the registrant had breached significant parts of the standards. In addition, incidents involved in the allegation related to vulnerable service users in complex and / or urgent cases. The Panel concluded that the proven facts did not amount to a lack of competence, as it was not satisfied that the allegation represented a fair sample of the registrant’s work. It also found that the registrant competently dealt with other cases. However, having proven some of the facts the Panel determined that the matters constituted misconduct.

    The Panel felt that the registrant was aware of the risks and the impact on vulnerable services users of not recording her actions and decisions. They agreed that the registrant displayed a reckless disregard for the risk in failing to record her actions and decisions about service users. The Panel found that the registrant’s failings were remediable, but had no evidence of any steps the registrant had taken to address the failings. The Panel reached the view that the registrant had not demonstrated insight or remorse, and posed a risk of repetition. The Panel considered that a finding of impairment was necessary in order to protect members of the public, to uphold proper standards and to protect the reputation of the profession and the regulator.

    The Panel then went on to consider which sanction to impose to protect the public. It identified aggravating and mitigating factors, and considered the sanctions available to them in ascending order. It noted that there was nothing that may have prevented the registrant from remedying their failings and concluded a suspension order was appropriate in this case. The Panel was of the view that a period of six months would be appropriate and proportionate to protect the public, to satisfy the wider public interest and to allow the registrant an opportunity to demonstrate full insight and remediate her failings.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a twelve-month caution order.

     

  • Type of concern Failure to provide adequate care
    Profession Social worker
    Standard

    Standards of conduct, performance and ethics (updated in August 2012)
    Standard 1. You must act in the best interests of service users
    Standard 6. You must act within the limits of your knowledge, skills and experience and, if necessary, refer the matter to another practitioner

    Standards of proficiency – social workers in England (updated in January 2017)
    Standard 1. Be able to practise safely and effectively within their scope of practice
    Standard 1.1. Know the limits of their practice and when to seek advice or refer to another professional
    Standard 1.3. Be able to undertake assessments of risk, need and capacity and respond appropriately
    Standard 2. Be able to practise within the legal and ethical boundaries of their profession
    Standard 2.2. Understand the need to promote the best interests of service users and carers at all times
    Standard 2.3. Understand the need to protect, safeguard and promote the wellbeing of children, young people and vulnerable adults

    Case study

    A social worker’s employer raised a concern that the registrant acted beyond his scope of practice. The registrant did not record or undertake an assessment about the impact of legal proceedings on the service user’s physical or mental wellbeing. This was whilst he was the service user’s designated care coordinator.

    The registrant attended the hearing and was represented. The Panel found that the registrant’s conduct fell short of the standards expected of a social worker. His proactive engagement in the service user’s legal proceedings gave the service user false hope, despite being aware that a legal representative had advised them on a number of occasions that their claim had no realistic prospect of success. As a consequence, the Panel felt the registrant put the service user at risk of financial loss as they were made subject to an order for costs.

    The registrant’s use of company letter-headed paper to correspond on behalf of the service user gave the impression that he was acting on behalf of the service user in his capacity as a social worker, making his employer susceptible to reputational damage. The Panel also found that by not conducting a sufficiently analytical and comprehensive mental health assessment of the vulnerable service user, the registrant was in breach of our standards.

    The Panel felt that although misconduct of this nature could be remedied, the registrant was lacking insight and unable to demonstrate effective remediation. The Panel also felt that the public would expect a registered social worker to follow accepted practices. The Panel felt they should act only within the scope of their practice. The Panel decided that a suspension order was sufficient and necessary to protect the public in the view of the registrant’s lack of insight and remediation.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a twelve-month suspension order.

     

  • Type of concern Inappropriate relationship with patient
    Profession Psychologist
    Standard

    Standards of conduct, performance and ethics (updated in August 2012)
    Standard 1. You must act in the best interest of service users
    Standard 3. You must keep high standards of personal conduct
    Standard 13. You must behave with honesty and integrity and make sure your behaviour does not damage the public’s confidence in you or the profession

    Case study

    A psychologist’s employer raised concerns that the registrant had taken a service user on a trip involving an overnight stay in a shared hotel room, bought the service user alcohol and appeared to be under the influence of alcohol in the presence of the service user/

    The registrant was present and represented at the final hearing. The Panel was in no doubt that there was an intimate relationship between the registrant and the service user. The Panel was, also, in no doubt that the boundaries of the personal and professional relationship were blurred between the registrant and service user. The Panel found that the failure of the registrant to maintain appropriate boundaries was serious and amounted to misconduct. During the registrant’s evidence, the Panel felt that the registrant still did not fully understand the extent of the risks and danger that her actions caused to the service user and the risks other members of the public were exposed to. Therefore, the registrant had not demonstrated full insight.

    The Panel felt that the public, knowing the facts and findings in this case, would have great concern. Their confidence in the profession would be undermined if they did not find that the registrant’s fitness to practise was impaired. The Panel decided that the issues identified were capable of correction. There was no persistent or general failure which would prevent the registrant from doing so. Therefore, the Panel felt a conditions of practice order to be a proportionate and appropriate response to the risks identified. The Panel felt that this would provide sufficient protection to the public.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a twelve-month conditions of practice order.

     

  • Type of concern Failure to maintain adequate records
    Profession Dietician
    Standard

    Standards of proficiency for dietitians (updated in March 2013)
    Standard 1. Be able to practise safely and effectively within their scope of practice
    Standard 8. Be able to communicate effectively
    Standard 10. Be able to maintain records appropriately
    Standard 11. Be able to reflect on and review practice
    Standard 12. Be able to assure the quality of their practice
    Standard 14. Be able to draw on appropriate knowledge and skills to inform practice

    Case study

    A psychologist’s employer raised concerns that the registrant had taken a service user on a trip involving an overnight stay in a shared hotel room, bought the service user alcohol and appeared to be under the influence of alcohol in the presence of the service user.

    A dietitian’s employer raised concerns about their clinical practice and conduct, following a number of incidents relating to six different service users. This included a failure to record sufficient details of dietetic assessments, failure to address the needs of a service user adequately and failure to make the necessary referrals within a reasonable timeframe.

    The registrant was not present at the hearing nor was represented. The Panel considered that the shortcomings occurred during a period when additional supervision and support for the registrant had been put in place. The evidence given suggested that the registrant’s failure to perform tasks was not wilful or deliberate. However, the Panel agreed that the shortcomings were serious because they had the potential to result in harm to the service users concerned. The Panel determined that the matters constituted a lack of competence and found that the registrant’s fitness to practise was impaired.

    The Panel agreed that the registrant’s failings had not been remediated. Moreover, the Panel found it necessary to reassure members of the public. Otherwise, they would lose confidence in the profession and the regulatory process if a practitioner whom had not remediated their shortcomings were permitted to return to practise unrestricted. The Panel then went on to consider which sanction to impose to protect the public. It decided that a twelve-month suspension order would prevent the registrant from practicing until they were able to demonstrate safe and effective practice.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a twelve-month suspension order.

     

  • Type of concern Driving under the influence of alcohol
    Profession Chiropodist / podiatrist
    Standard

    Standards of conduct, performance and ethics (updated in August 2012)
    Standard 3. You must keep high standards of personal conduct

    Case study

    A podiatrist self-referred following a conviction for driving under the influence of alcohol. The Conduct and Competence Committee Panel considered the allegation. The registrant did not attend the hearing but had provided his own account of the incident. He expressed his sorrow and a wish to resume his career in podiatry. When considering current impairment, the Panel determined the registrant’s conviction for the offence and damaged public confidence in the profession. It felt that there was some risk of repetition and a lack of engagement. It, therefore, found the registrant’s fitness to practise to be impaired by reason of the conviction.

    The Panel concluded that the registrant’s conduct in committing the offence was remediable. This was by, for example, attending an appropriate rehabilitative course and by re-engaging with his profession. It felt a six-month suspension order would maintain public confidence in the profession. This would allow the registrant to develop further insight and reflect on the gravity of the offence.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a six-month suspension order.

     

  • Type of concern Dishonesty by falsifying time sheet and travel expense claims
    Profession Physiotherapist
    Standard

    Standards of conduct, performance and ethics (updated in August 2012)
    Standard 3. You must keep high standards of personal conduct
    Standard 13. You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession

    Standards of proficiency for physiotherapists (updated in August 2013)
    Standard 3. Be able to maintain fitness to practise
    Standard 3.1. Understand the need to maintain high standards of personal and professional conduct

    Case study

    The NHS Counter Fraud Unit of the local NHS Trust raised concerns about a physiotherapist. On numerous occasions, the registrant submitted timesheets and claimed payments for hours they did not work. They, also, submitted timesheets purporting to be signed by a colleague when they had not been and claimed travel expenses which they were not entitled to and after they were no longer employed.

    A Conduct and Competence Committee panel considered the allegation against the registrant, who did not attend the hearing. Having found most of the facts proved, the Panel determined that the registrant’s actions were dishonest and that they would have known they were. The Panel decided that such behaviour fell far below the standards expected of a registrant and amounted to misconduct.

    Although this allegation did not concern issues of public protection, the Panel decided that a finding of impairment was necessary. It was necessary to uphold and maintain proper standards, and maintain confidence in the profession. As the registrant did not engage with the process, the Panel had no evidence of remorse or insight. The Panel considered that there were no mitigating factors in this case. The Panel agreed that any lesser sanction than a striking-off order would not meet the wider public interest. The Panel thought that any lesser sanction would not act as a deterrent to other registrants. It would, also, not uphold the reputation of the profession and maintain public confidence in the regulatory process.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a striking-off order.

     

  • Type of concern Dishonesty – fraud
    Profession Operating department practitioner
    Standard

    Standards of conduct, performance and ethics (updated in August 2012)
    Standard 3. You must keep high standards of personal conduct
    Standard 13. You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession

    Standards of proficiency for physiotherapists (updated in August 2013)
    Standard 3. Be able to maintain fitness to practise
    Standard 3.1. Understand the need to maintain high standards of personal and professional conduct

    Case study

    An employer raised concerns about an operating department practitioner’s (ODP) conviction of fraud. For this conviction, she was sentenced to 18-months imprisonment and suspended for 24 months. The registrant had withdrawn money from her stepfather’s bank accounts, whilst registered as Power of Attorney for his property and finances. She used this money for her personal gain.

    The registrant was not present at the hearing nor was represented. The Panel was satisfied that the facts were proven, and amounted to the statutory ground of conviction. The registrant had pleaded guilty to the offence at the Crown Court. However, she had not provided any evidence to demonstrate insight, remorse or remediation. In the absence of such information, the Panel was of the view that there remained a risk of repetition. The Panel agreed that the case was serious.

    The registrant had pleaded guilty to an offence of dishonesty. She had abused the position of trust in which she had been placed. Namely, to act as the Power of Attorney for her vulnerable stepfather who lacked the capacity to manage his own affairs and finances. The offence had taken place over a number of years.

    The Panel felt that the registrant’s conduct had brought the profession into disrepute. The Panel felt that it would have a detrimental effect on the reputation of the regulator and would undermine public confidence in the profession if they were to find no current impairment. The Panel was also of the view that a finding of impairment was required to declare and uphold proper standards of conduct and behaviour.

    The Panel then went on to consider which sanction to impose to protect the public. It was clear to the Panel that any reasonably well-informed member of the public would be profoundly concerned if an ODP, convicted of such an offence, was not removed from the Register. Therefore, the Panel concluded that the nature and gravity of the registrant’s offending was such that a striking-off order was required.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a striking-off order.

     

  • Type of concern Failure to conduct a full / accurate assessment
    Profession Social worker
    Standard

    Standards of conduct, performance and ethics (updated in August 2012)
    Standard 1. You must act in the best interests of service users
    Standard 6. You must act within the limits of your knowledge, skills and experience and, if necessary, refer the matter to another practitioner
    Standard 7. You must communicate properly and effectively with service users and other practitioners
    Standard 10. You must keep accurate records

    Standards of proficiency for social workers in England (updated in August 2012)

    Standard 1. Be able to practise safely and effectively within their scope of practice
    Standard 2.2. Understand the need to promote the best interests of service users and carers at all times
    Standard 2.4. Understand the need to address practices which present a risk to or from service users and carers, or others
    Standard 4. Be able to practise as an autonomous professional, exercising their own professional judgement
    Standard 4.1. Be able to assess a situation, determine its nature and severity and call upon the required knowledge and experience to deal with it
    Standard 4.2. Be able to initiate resolution of issues and be able to exercise personal initiative
    Standard 4.3. Recognise that they are personally responsible for, and must be able to justify, their decisions and recommendations
    Standard 4.4. Be able to make informed judgements on complex issues using the information available

    Case study

    An employer raised concerns about a social worker who did not report a service user’s suicidal thoughts to their managers or any other professionals. This was despite it happening repeatedly and after recording a case note. Following the visit, the service user made a suicide attempt and was taken to hospital. The registrant delayed informing her line manager about this despite having received a police report.

    The registrant attended the hearing and was represented. The Panel felt that the registrant owed a duty of care to the service use. At the time, the service user was extremely vulnerable and at risk of causing himself harm. The Panel was satisfied that by failing to complete an appropriate assessment and by not immediately informing her managers or other health professionals, the registrant failed to promote and protect the interests of service users.

    The registrant to be in serious breach of the standards, which it felt amounted to misconduct. The Panel found that the registrant lacked insight and lacked effective remediation. The Panel also determined there was a risk of repetition. It felt the registrant had brought her profession into disrepute by breaching a fundamental tenet of the profession. This was given that the primary duty of a social worker is to safeguard service users from harm. The Panel came to the conclusion that a striking-off order was the only way to protect the public, given the registrant’s inability to remedy her misconduct.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a striking-off order.

     

  • Type of concern Unsafe clinical practice
    Profession Biomedical scientist
    Standard

    Standards of conduct, performance and ethics (updated in August 2012)
    Standard 1. You must act in the best interests of service users
    Standard 7. You must communicate properly and effectively with service users and other practitioners

    Standards of proficiency for biomedical scientists (updated in November 2014)
    Standard 4. Be able to practise as an autonomous professional, exercising their own professional judgement

    Case study

    A biomedical scientist’s employer raised concerns following an incident where the registrant failed to follow procedure. When processing samples, the registrant failed to prevent contamination, which led to inaccurate results.

    The registrant attended the hearing and was represented. While it was a one-off incident, the Panel felt it was not due to a lack of understanding, knowledge or training. The Panel felt these were deliberate acts and contrary to the standard operating procedures. It resulted in blood samples having to be retaken. Additionally, there was a potential risk of harm if clinicians had acted on the contaminated results. Therefore, the Panel felt the registrant’s conduct fell well below the standards expected of a biomedical scientist. The incident was sufficiently serious to constitute misconduct. The Panel felt that the misconduct was remediable. However, it felt that the registrant had not demonstrated that it had been remedied. In addition, there was a risk of repetition, given the extreme pressures of the work environment. The Panel also felt the following clear message needed to be given to the public and to other registrants. It is not acceptable for a biomedical scientist to make a deliberate decision to not follow mandatory standard operating procedures. Therefore, the Panel found the registrant’s fitness to practise was impaired on both the personal and public component.

    The Panel then went on to consider what sanction to impose which would be sufficient to protect the public. The Panel felt a conditions of practice order would be sufficient. The conditions required the registrant to undertake training and the preparation of a personal development plan to ensure the registrant was able to manage their workload effectively, even when subject to stress, so that the registrant wasn’t tempted by shortcuts or to take risks.

    Measures we put in place to protect the public The Conduct and Competence Committee imposed a twelve-month conditions of practice order.

     

Page updated on: 27/11/2018
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