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Physio struck off following suspension for failing to carry out assessments or keep adequate records

HCPTS Panel strikes off physio who has failed to engage with regulator during his suspension for failing to carry out assessments or keep adequate records

Published on 11th November 2019

A physiotherapist has been struck off the register after failing to carry out complete subjective and/or objective assessments for patients, failing to complete written records and not prescribing appropriate exercise programmes for his patients.

Mr Boben Zacharia was struck off following three periods of suspension by the regulator to address shortcomings in his practice.

"The Registrant has not engaged with the HCPC. He has provided no evidence since the last hearing that demonstrates that the concerns in relation to his practice have been addressed. This Panel is in the same position as the previous panels. It has no evidence to satisfy it that the Registrant has insight into the shortcomings identified by the original panel or that he has taken any steps to remedy his shortcomings. The Panel considers that there remains a risk of a repetition of the Registrant failing to offer patients an adequate level of care," said the Panel.

Mr Zacharia began working with Greater Glasgow and Clyde NHS in July 2012 as a Band 2 Nursing Auxiliary. He was employed as a Band 5 Physiotherapist from 1st August 2014 until 4th March 2016.

Whilst working as a physiotherapist, Mr Zacharia worked within the Community Rehabilitation Team in Primary Care. Concerns were highlighted regarding his practice very soon after he started in August 2014, that Mr Zacharia was not able to complete work without promptings from his supervisor and that he required guidance in order to complete his written assessments and patient notes.

Mr Zacharia was made subject to an Informal Supported Improvement Framework in October 2014, which was to include additional supervision and support. He was on a period of sickness leave from 9th October 2014 until 18th August 2015; the Support Improvement Plan re-commenced on his return to the Trust.

Mr Zacharia went on a further period of sick leave on 23rd October 2015; whilst away from work, he resigned from his physiotherapy post and requested redeployment in a Band 2 role.

The allegations went before the Health and Care Professions Tribunal Service initially in May 2017. The Panel found that between 1 August 2014 and January 2016, during his employment as a physiotherapist with NHS Greater Glasgow and Clyde, he did not carry out complete subjective and/or objective assessments for his patients.

For example, while assessing Patient A on or around 14 September 2015 and/or 22 September 2015, he did not question the patient specifically enough, to identify a pattern of pain. On 23 September 2015, while assessing Patient B and/or Patient C, he did not extract relevant information from the patient and/or the patient’s carer without prompting. On 6 October 2015, during an objective assessment of Patient E, he did not assess the patient's hamstring and/or ankle strength adequately or at all.

The Panel also found that Mr Zacharia did not complete full and/or written records of assessments for his patients. For example, following an assessment of Patient A on 22 September 2015, he did not document the assessment in the SOAP format and did not make an accurate recording of what had been discussed and/or assessed. On 6 October 2015, during an objective assessment of Patient E, he documented the patient’s hamstring and/or ankle strength as 3+ in the notes, even though this was not assessed adequately or at all.

The Panel also found that Mr Zacharia did not prescribe appropriate exercise programmes for his patients. On 2 October 2015, he provided Patient D, who had Chronic Obstructive Pulmonary Disease (COPD), with a treatment plan of sitting strength exercises, despite the patient being independently mobile. On 2 October 2015 he did not provide Patient F with a programme appropriate for a Total Knee Replacement Patient. Furthermore, on 12 October 2015, Mr Zacharia developed an exercise plan for Patient G in a lying position, despite the patient being independently mobile.

The final hearing Panel said; "The Registrant failed to demonstrate the standards of knowledge, skill and judgment required to practise as a band 5 Physiotherapist from shortly after he was appointed. The Panel was satisfied that the Registrant was subsequently provided with opportunities to address the deficiencies in his practice that had been identified and that his performance had been continuously monitored, supervised and assessed. It was clear that his colleagues and managers made efforts to help the Registrant address his shortcomings.

The final hearing Panel determined that the facts found proved constituted serious departures from the standards expected of a physiotherapist and demonstrated a lack of competence in Mr Zacharia.

The final hearing Panel determined said that Mr Zacharia's lack of competence was remediable as his shortcomings are the most basic of knowledge and skill expected of a physiotherapist. However, he had not demonstrated that he is capable, currently, of remedying his shortcomings.

The evidence before the Panel from all the witnesses, supported by the documentary evidence was that Mr Zacharia lacks insight into his shortcomings. His colleagues were clear that Mr Zacharia was well liked, and pleasant, but phrases to the effect that ‘he was more confident in his abilities than he should be’ was a recurring theme amongst the witnesses. This was borne out by the evidence, both oral and documentary, that despite his shortcoming being drawn to his attention, on several occasions, he did not alter his approach.

The Panel had not heard any further information and Mr Zacharia did not provide any evidence or representation that the Panel could be satisfied that he has sufficient insight into his shortcomings or has remedied his shortcomings. His last email to the HCPC indicated an intention to leave the profession, and therefore he is unlikely to have remedied the deficiencies in his practice.

The final hearing Panel suspended Mr Zacharia for 12 months and said that if at the conclusion of the period of suspension he had changed his current position and wanted to continue practising in the profession, a future Panel reviewing this Order may be assisted by the following:

- His attendance at the hearing.

- A reflective piece by Mr Zacharia concentrating on:

i) the areas of his practice where he lacked competence at the time of these matters and at the time of the review; and the knowledge and skills he would need to practise safely

ii) how his actions impacted, or could have impacted, on patients and colleagues;

- Information about any employment, paid or unpaid, since these matters

- An indication as to his future plans;

- Evidence of Mr Zacharia keeping his knowledge and skills up to date either by attending CPD courses, or being employed in a voluntary capacity in allied and relevant roles;

- Up to date references from persons who are aware of these proceedings.

However, at a review hearing in April 2018, Mr Zacharia had not engaged with the proceeedings at all and was issued with another 12 month suspension order.

In May 2019, at a review of that suspension, there was still no evidence that Mr Zacharia has any meaningful insight into the serious nature of the failings identified by the original panel. That panel suspended Mr Zacharia for six months to provide Mr Zacharia with a final opportunity to engage with the process and seek to address the issues relating to his practice. That panel stated that Mr Zacharia should be aware that if he fails to engage with the process a future panel is likely to give consideration to making a Striking Off Order.

A reviewing panel met last week but Mr Zacharia failed to attend or provide the panel with any material to show that he had taken steps to address his shortcomings.

The Panel considered whether a Striking Off Order is appropriate. A Striking Off Order is a sanction of last resort and it can be appropriate in cases where a registrant has been suspended for at least two years continuously and has failed to address a lack of competence or has demonstrated that they are otherwise unwilling to resolve the concerns in relation to their practice.

"In the present case, the Registrant has been given every opportunity to address the concerns that were identified by the original Panel. This is notwithstanding the warning provided by the previous Panel that a failure to engage with the process could result in the Registrant being struck off the Register. The Registrant has not provided any material to suggest that he has taken any steps to address his lack of competence," said the Panel.

The Panel concluded that Mr Zacharia has repeatedly failed to address his lack of competence and there is no evidence to suggest that he is prepared to take any steps aimed at remediation.

"In these circumstances, the Panel has concluded that it is not appropriate for the Registrant to remain as a registered Physiotherapist. A Striking Off Order is appropriate and proportionate," the Panel concluded.

 

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