HPC Hearings

admin · Jun 30, 2007

Members do not see these Ads. Sign Up.
Just noticed these (names edited out) and posted the below in the interest of educating other practitioners:

Outcome: Hearing has not yet been held
Panel: Conduct and Competence Committee

Notice Of Allegation:
Your fitness to practise as a registered health professional is impaired by reason of your misconduct and/or lack of competence in relation to Patient CJ in particular that:-

1.

a) You provided and charged for orthotics which were inappropriate and resulted in an increase in knee and back pain and,

b) You failed to provide any advice or assistance in relation to the problems experienced in using the orthotics.

and in relation to Patient YP:

2.

a) You provided orthoses which were inappropriate;

b) You failed to arrange appropriate after care.
Click to expand...

Outcome: Conditions of practise
Hearing of the Conduct and Competence Committee

Notice Of Allegation:
Your fitness to practise as a registered health professional is impaired by reason of your misconduct and/or lack of competence in that you:

(i) Failed to deal safely with the risks of infection.
(ii) Failed to establish and maintain a safe practise environment.

Committees Finding:
1. The Panel is considering allegations of misconduct and lack of competence against Mr {edit}. The particulars of each are identical – namely that Mr {edit} failed to deal safely with the risks of infection and failed to establish and maintain a safe practise environment.

2. The HPC advances the case against Mr {edit} on the basis of the evidence of Mrs {edit}, a former patient of Mr {edit}.

3. The Panel does not propose to deal extensively with the evidence of Mrs {edit}. The Panel is entirely satisfied that Mrs {edit} was a truthful witness. However, there were a number of areas in relation to which the Panel could not feel sufficiently satisfied that her evidence was accurate.

4. Nevertheless, in the evidence given to the Panel today Mr {edit} has himself described his normal practice and the Panel feels that the practice he has described falls significantly short of an acceptable standard. In particular, the way in which he undertakes infection control and the decontamination process falls well below current standards because:

(i) he does not use the appropriate quality of water in his autoclave;

(ii) his method of disposal of contaminated waste water from both the autoclave and the ultrasonic cleaner is inappropriate;

(iii) he does not take accurate readings from his autoclave on a daily basis to ensure that it is operating effectively;

(iv) he has a lack of understanding of the techniques and standards of sterilisation;

(v) repeatedly moving the autoclave from the floor to a chair runs the risk of upsetting the calibration of it;

(vi) while accepting that at the relevant time there was the laminate flooring described by Mr {edit}, the Panel considers that a minimum acceptable standard would require a continuous, impermeable and washable surface which extends up the wall at the edges of the floor to include the level of the skirting board;

(vii) at the time relevant to the allegation it is acknowledged by Mr {edit} that he was using a hand towel. The Panel does not feel that that met acceptable hygiene standards. However, the Panel notes and records the fact that he has since changed his practice and is using appropriate paper towels.

5. The Panel does not find that these facts amount to misconduct, but being issues that demonstrate practise that falls well below an acceptable standard, it does amount to a lack of competence.

6. Paragraph 11 of the standards of conduct, performance and ethics makes clear that appropriate precautions must be taken to protect patients and others (including the health professional). The facts found by the Panel demonstrate a breach of this standard.

7. The Panel finds that {edit} fitness to practice is currently impaired by reason of the lack of competence demonstrated.

8. Since announcing the decision set out above the Panel has heard further submissions as to the appropriate sanction. The Panel reminds itself that the purpose of a sanction is not to be punitive, but rather to protect the public and to maintain public confidence.

9. It is submitted on behalf of Mr {edit} that a caution order would meet the circumstances of this case. The Panel does not agree, primarily because it is not satisfied that Mr {edit} has a sufficient understanding of the underlying principles in the areas of the identified shortcomings. In order for him to continue to practice it is necessary that he should acquire that understanding. Accordingly a conditions of practice order is both appropriate and proportionate.

10. The conditions are that within 12 months of the commencement of the order Mr {edit} should:

(i) Undertake self-directed learning relating to infection control, decontamination and sterilisation.

(ii) Before the review of the Order, submit a portfolio demonstrating both what has he has studied and its effect upon his practice.

(iii) Keep and maintain a daily log relating to decontamination of instruments, and before the review of this Order submit a copy of the log to the HPC.

(iv) To the extent that physical changes are made to his premises before the review of this Order, submit photographic evidence of the changes to the HPC (indicating the date on which the photographs were taken).

11. The Conditions of Practice Order will be reviewed before it expires, and the Panel reviewing it will have available to it all the sanction options currently available.

Committees Direction:
That the Registrar be directed to annotate the register entry of {edit} to show that, from the date this order takes effect (“the operative date”) and for a period of 12 months, {edit} must comply with the following conditions of practice:

(i) Undertake self-directed learning relating to infection control, decontamination and sterilisation.

(ii) Before the review of the Order, submit a portfolio demonstrating both what has he has studied and its effect upon his practice.

(iii) Keep and maintain a daily log relating to decontamination of instruments, and before the review of this Order submit a copy of the log to the HPC.

(iv) To the extent that physical changes are made to his premises before the review of this Order, submit photographic evidence of the changes to the HPC (indicating the date on which the photographs were taken).
Click to expand...

Outcome: Hearing has not yet been held

Application for Interim Order
Finding:

The HPC applies against Ms Foster under Article 31(2) of the Health Professions Order 2001 for an Interim Suspension Order.

Ms {edit} has not attended the hearing for the application nor has she been represented. However, the Panel is satisfied that {edit} has been given proper notice of this application and that therefore it has jurisdiction to proceed in her absence and that it is appropriate that it should do so.

The application is founded upon information communicated to the HPC by the family of an elderly gentleman for whom the registrant, a chiropodist, worked as a carer. Following the death of the gentleman, there was a Police investigation into financial irregularities concerning his estate and the alleged misuse of a credit card by the registrant.

The panel is satisfied that the allegations, although untested, are of a very serious nature and involve a breach of trust. The panel has considered whether an interim conditions of practise order should be made, but has decided that in the circumstances, appropriate conditions could not be formulated and in any case would be impracticable. The panel has therefore decided that it is necessary for the protection of the public, and is in the public interest, for an interim suspension order for a period of 18 months to be made.

ORDER: The panel directs the registrar to suspend the registration of {edit} for a maximum period of 18 months.
Click to expand...

Admin2 · Jun 30, 2007

Related threads:
Is this relevant for the HPC?
HPC hearing: "not gulity of locking out husband"!!
HPC Disciplinary Hearings
Foot specialist cautioned after wrong diagnosis

George Brandy · Jul 2, 2007

To pick up on some of the points the HPC have made after placing a Conditions of Practice order on registrant podiatrist:

(ii) his method of disposal of contaminated waste water from both the autoclave and the ultrasonic cleaner is inappropriate;

I cannot find the appropriate method of disposal of contaminated waste water. I have taken this question to a Professor of Microbiology responsible for infection control within a UK hospital and his appropriate method would be into the waste water system. My professional body has no written recommendations.

(v) repeatedly moving the autoclave from the floor to a chair runs the risk of upsetting the calibration of it;

OK moving from floor to chair has more implications to the operator lugging the autocalve up and down but some time ago I asked a development engineer of a company manufacturing autoclaves what is the likely hood of this happening. The answer was unlikely. I assume the HPC then do not recommend moving the autoclave along a bench top to clean the detritous from underneath it? I also assume the HPC do not recommend group sessions where the engineer comes to one venue to service many autoclaves?

(vi) while accepting that at the relevant time there was the laminate flooring described by Mr {edit}, the Panel considers that a minimum acceptable standard would require a continuous, impermeable and washable surface which extends up the wall at the edges of the floor to include the level of the skirting board;

So the HPC are dictating a minimum acceptable standard. My professional body suggests this is an ideal but has not made this mandatory. So how many NHS clinics are now falling below the HPC minimum acceptable standard and as the registrant, the HPC will possibly make you responsible for infection control should a complaint be made against your standards of practice in this area.

If the HPC have set Infection Control Standards I assume then it is only fair to the registrants affected by these standards to let us know what they are. I feel this registrant has been made an example of by the HPC because they can and if the alleged leading UK professional body has not advised its members according to HPC infection control guidelines because they don't know what they are, then I feel that Mr {edit} has every right to appeal against the decision of the board in this particular case.

GB

Graeme Franklin · Jul 2, 2007

ii) his method of disposal of contaminated waste water from both the autoclave and the ultrasonic cleaner is inappropriate;

I cannot find the appropriate method of disposal of contaminated waste water. I have taken this question to a Professor of Microbiology responsible for infection control within a UK hospital and his appropriate method would be into the waste water system. My professional body has no written recommendations.
Click to expand...

Maybe we will have to wait until the transcript comes out. I wonder if he was disposing the material down the hand-washing sink? The case is perturbing.

Graeme

Mark Russell · Jul 2, 2007

Am I alone in thinking the world has gone mad??

Chiropodists / Podiatrist
Registration Number: CH 21667
Allegation Number: FTP 00568

Date & Time of hearing: 08/12/2006 - 00:00

Outcome: No further action

Hearing of the Conduct & Competence Committee

Region: Scotland

Registrant Name: James MacCabe

Panel: Conduct and Competence Committee

Notice Of Allegation:

Your fitness to practise as a registered health professional is impaired by reason of your misconduct and/or lack of competence in relation to your treatment of DG, in that you:

1. Falsely claimed that you could administer anaesthetic

2. Failed to communicate appropriately with her during the course of the treatment and did not gain informed consent

3. Did not provide appropriate treatment and did not take account of the patients requests

4. Failed to apply an appropriate dressing following treatment

5. To not take appropriate measures to minimise the risk of infection.

Committees Finding:

The registrant, Mr. McCabe, is registered in the Chiropody part of the HPC Register. He attended the hearing and was represented by Mr. Donald Cameron, Advocate. Mr. McCabe denied each of the allegations. The Complainer, Ms. DG and Mr. Billy Mauchline (who is described in the bundle as her boyfriend) both attended and gave evidence.

The Panel considered all of the evidence contained in the documents of appeal as well as the oral evidence given at the hearing today. The allegations arose from a consultation with Ms. DG which took place at the Mr. McCabe's clinic on 12th July 2005.

The Panel heard the evidence of Mr. Mauchline first. This was because, prior to the commencement of the hearing, Ms. DG had been too upset to go into the hearing room unaccompanied. It was therefore agreed by the Panel and the respective representatives that Mr. Mauchline would be called first. The Panel considered his written Statement at pages 52 to 54. His evidence, in so far as relevant to the Complaint, was that he had been at work, returning home at l-2pm. He stated that he had not spoken to Mr. McCabe on the telephone and had not accompanied Ms. DG to her appointment He had been called by Ms. DG after her appointment and had gone to Mr. McCabe's clinic and spoken to
Ms. DG. He had then confronted Mr. McCabe and had enquired why local anaesthetic had not been used. It was his evidence that Mr. McCabe had replied that he did not do anaesthetics and that in any event, Ms. DG had not needed one.

The Panel then heard the evidence of Ms. DG. Ms. DG, whose principal statement appears at pages 5 to 9 of the bundle, gave evidence that she is prone to in-growing toenails on the first toes of both feet. She normally consulted a chiropodist, Ms. Gillian Duncan at a different clinic. She had consulted Ms. Duncan on 9lh July but because Ms. Duncan had been unable to obtain a supply of local anaesthetic in a reasonable time, she had referred her to a former colleague, Ms. Sharon Jolly. Ms. DG stated that she contacted Mr. McCabe by telephone on 12th July as no appointments were available for three weeks with Ms. Jolly and had asked if he was qualified to administer local anaesthetic. It was her evidence that he replied that he was qualified to do so but that he cautioned her that local anaesthetic was not always necessary and would add to the cost of her treatment. He arranged that she would come to see him at 3pm that day. She stated she arrived alone. Mr. McCabe started by filing and cutting her toenails but that he then gripped her foot very firmly and started to cut the affected nail. Ms. DG stated that this was extremely painful, that she screamed and asked him to stop on several occasions which he ignored. She also stated that she tried to wriggle from the seat to get away from him but that he would not release her foot and continued cutting the nail and finally pulling out a piece of nail with tweezers. Ms. DG said that she tried to reach for her bag to get her mobile phone to call her boyfriend, her father or the police, but could not reach the bag because of the raised chair. She went on to say that Mr. McCabe then applied a piece of sticky tape without any dressing and that the blood came through this into her sock. She said that the wound did not dry up until the next day. She stated that, after the procedure, Mr. McCabe had insisted that she try to walk despite her protests that it would be painful because of the absence of any protective padding. After paying for the treatment and leaving the clinic, Ms. DG said that she had phoned her boyfriend, Mr.
Mauchline, because she was hysterical and upset and he came to collect her. In the course of a discussion which ensued between Mr. Mauchline and Mr. McCabe, Mr. McCabe was asked why he had not administered local anaesthetic and Mr. Mauchline said that Mr. McCabe had replied that he did not have local anaesthetic on the premises and, subsequently, that he was not qualified to administer it. It was her evidence that Mr. Mauchline had not driven off at speed but that she and Mr. Mauchline had remained in the car and watched Mr. McCabe return to his surgery before Mr. Mauchline had driven off. Ms. DG said that the following day her toes and foot were bruised and swollen and that she had to visit her doctor on 15th July because her toe was throbbing and her whole leg was sore and she was unable to walk properly because of pain. She said that she was prescribed antibiotic cream because the toe was infected as well as receiving advice on analgesia.

A copy of the notes of Dr. Howe, Ms. DG's GP, are contained in the papers at pages 11 to 15. Dr. Howe recorded on 15th July "Attended chiropodist 3 days ago for left ingrowing toenail. Ongoing inflammation, Fusidic acid cream and advice regarding analgesia". Dr. Howe also records that Ms. DG was seen by the practice nurse on 19th July and she recorded "left ingrowing toenail infection settling".

The Panel considered the written Statement of Ms. Gillian Duncan, a chiropodist registered with the Health Professions Council. Ms. Duncan set out some information concerning Ms. DG's case history and the events which led up to the consultation with
Mr. McCabe. She described Ms. DG as having a low pain threshold and said that she could become quite nervous. Ms. Duncan stated that she had offered to see Ms. DG on Sunday 10th July but that she had sent text messages to her late in the evening of Saturday 9th July about the lack of local anaesthetic and to cancel the appointment for the following day. She also confirmed that she always used a local anaesthetic when she had treated Ms. DG in the past. However, evidence of medical records from Boots where Ms Duncan had worked, show this not to be the case.

The Panel also considered the evidence of Mr. McCabe contained in his letters of 23rd September 2005 (pages 15 to 19) and 8th November 2005 (pages 22 to 24), as well as his oral evidence today. Mr. McCabe stated that he told Ms. DG, both in her initial telephone call and subsequently when she arrived for her appointment that he did not administer, or hold, local anaesthetics. He also stated that he had told her that local anaesthetics were not always necessary. He agreed to see her at three hours notice because he was concerned at the possible seriousness of the symptoms which she had described to him.

He said that in the course of his telephone conversation with Ms. DG, Mr. Mauchline had come on the phone demanding to know whether or not Mr. McCabe administered local anaesthetics. Mr. McCabe stated that he reiterated that he did not hold and did not administer local anaesthetics. Mr. McCabe stated that Ms. DG arrived with Mr. Mauchline and that she was tearful and anxious and that he was jittery and agitated. He stated that Mr. Mauchline had behaved aggressively and asked him if gave anaesthetics and insisted that he gave one to Ms. DG. It was Mr. McCabe's evidence that he had the impression that neither of them were listening to his answers at that stage. Mr. Mauchline had stated that he was a nurse. He had then left. At that point, Mr. McCabe had proceeded to take some details from Ms. DG and she had then taken off her shoes and socks. Mr. McCabe then checked her feet. His conclusion was that the ingrown toenail was very minor and that there was very slight inflammation which was hardly noticeable. His opinion was that the ingrown toenail could be dealt with easily without local
anaesthetic and that if she just said "ouch" it would be gone. He stated that he dealt expeditiously with the nail. When she asked him to stop he did so. He explained that all that remained was to extract the sectioned nail. He stated that she put her foot towards him and he did so. He then indicated that he would dress her foot and she again proffered it for that purpose. He applied a sterile cotton wool wick to the sulcus and dressed the toe. He described her as calm and said that he took her to the front of the surgery where she paid for the treatment and he gave her his card and indicated that she should contact him if there was any problem. He stated that she left the surgery apparently walking normally. Around fifteen minutes later, Mr. Mauchline appeared, again in a very agitated state, demanding to know why local anaesthetic had not been given. He again asserted that he was a nurse. Mr. McCabe went to see Ms. DG who was sitting in Mr. Mauchline's car.
He described her as quiet but tearful. Mr. McCabe noticed that the dressing had been removed and hurriedly put back but not in place. He stated that, at that point, Mr. Mauchline had driven off at high speed.

The Panel then considered each of the allegations:

The First Allegation - that Mr. McCabe "falsely claimed that [he] could administer anaesthetic"

The Panel noted that Mr. McCabe is not authorised to administer local anaesthetic and that this is reflected on the Register of the Health Professions Council. It was noted that he had recently been registered by the Health Professions Council and that he would be aware of the limitations placed on his registration. The evidence on this issue was therefore restricted to the conflicting statements made by Ms. DG and Mr. Mauchline, on the one hand, and Mr. McCabe, on the other. The Panel noted carefully the evidence on this point and concluded that it was inherently improbable that a chiropodist who had been in practice for more than eighteen years and who was not authorised to administer local anaesthetics and who did not hold stocks of local anaesthetic, would be likely to advise a caller that he could do so. In particular, the Panel did not accept the assertion that he did so to get a new patient "into my surgery on false pretences". The Panel accepted that Mr. McCabe had agreed to see a new patient at short notice because of the serious symptoms which she had described. The Panel also considered it credible that Mr. McCabe would have explained that some chiropodists would use local anaesthetic and some would not and that certain procedures can readily be carried out without local anaesthetic. Even then, the Panel considered that it was highly improbable that any registered chiropodist authorised to administer local anaesthetic would make a commitment to do so without having examined the patient and assessed the clinical need for it. Accordingly the Panel did not accept on balance of probability that Mr. McCabe had claimed that he could administer local anaesthetic.

The Second Allegation - that Mr. McCabe failed to communicate appropriately with her [Ms. DG] during the course of the treatment and did not gain informed consent.

The Panel noted that, again there were conflicting accounts of the communication between Mr. McCabe and Ms. DG. Mr. McCabe's evidence was to the effect that it was becoming clear to him that Ms. DG was not listening to what he was saying. In the circumstances, and with the benefit of hindsight, it might have been better for Mr. McCabe to have refrained from any further examination or treatment until he was satisfied that she had fully understood that he could not administer local anaesthetic.

However, given the seriousness of the symptoms which she had described and the fact that she was content to be examined and removed her shoes and socks, the Panel considered that it was not unreasonable for him to proceed to examination. Ms DG inferred that he proceeded to deal with her ingrown toenail without explaining what he was going to do. In his evidence, Mr. McCabe was confident that he had fully explained to Ms. DG what the problem was and what he was going to do about treatment. Having formed his professional opinion that the ingrown toenail was minor and that local anaesthetic would not be required, and further, having explained the nature of the problem and what he was going to do, it was reasonable for him to believe that she had consented to treatment. She also claimed that Mr. McCabe ignored her request to stop treatment.

The Panel sought advice from the Legal Assessor on the issues of consent and informed consent. He advised that it is well established in law that consent to treatment may be implied from a patient's conduct. For example, the patient who goes to a GP and lies on the GP's couch may be deemed to have consented to examination. Similarly, the patient who rolls up his sleeve for an injection would be deemed to have consented to that procedure. The Legal Assessor explained that the concept of informed consent related to providing a patient with sufficient information to enable the patient to be reasonably informed about the nature of the procedure to be undertaken and the risk involved. The legal tests about information provision were usually conformity with responsible professional opinion (the "Bolam Test") or alternatively the "reasonable patient test" which asks whether the information that a reasonable patient would want to know has been provided.

The Panel considered that it was apparent from the evidence that Mr. McCabe had treated Ms. DG as a nervous patient and had tried to put her at her ease and had taken the initiative by trimming her toenails while talking to her about the treatment. In this case, the procedure was restricted to the trimming of an ingrown toenail, a procedure which by her own evidence, Ms. DG had undergone on a regular basis over a number of years. She was therefore not in the same position as someone for whom this was a new and unfamiliar experience. The fact that she had made the appointment with Mr. McCabe, had removed her shoes and socks, and had allowed herself to be examined and treated, all indicated her consent to treatment. The Panel felt that it was reasonable for McCabe to have taken a firm grip of Ms. DCs foot since experience suggests that a nervous or agitated patient who suddenly moves a foot may be at risk of injury. In the light of the evidence given by Ms. DG and Mr. McCabe, the Panel concluded that Ms. DG had consented to treatment and that such consent was reasonably informed. Her considerable experience of this procedure suggested that she was likely to have been well-informed about it. It was likely that this aspect of the allegation related only to a misplaced expectation of receiving local anaesthetic. From its observation of Ms. DG, the Panel felt that she would have been capable of withdrawing her consent any time. The Panel considered that Ms. DG's account of her treatment, and in particular the assertion that Mr. McCabe continued to cut her toenail while she screamed in agony and struggled to get away from him and that she had tried unsuccessfully to get hold of her telephone to call for help from, amongst others, the police, to be somewhat exaggerated. On balance of probability, the Panel therefore did not accept that this allegation was well-founded.

The Third Allegation - that Mr. McCabe did not provide appropriate treatment and did not take account of the patient's requests

Ms. DG had referred to the treatment which she had previously received from the chiropodists at Boots. However, the Panel considered that the fact that a different chiropodist might have provided treatment in a different manner was not relevant. The
Panel noted that in Mr. McCabe's professional judgement, a local anaesthetic was not required. In any event, he was not authorised to administer it. While it is a matter of conjecture that Ms. DG may not have understood what Mr. McCabe had said to her, it is nevertheless, well established that a patient may request, but has no right to demand, treatment of a particular kind. Had Ms. DG been concerned about this, it was open to her to consult another chiropodist. It is plain from his evidence that Mr. McCabe was aware of Ms. DG's request for local anaesthetic to be administered but that he considered that he had adequately explained why, in his clinical judgement, it was unnecessary.

Furthermore, as found by the Panel in regard to the first allegation, it is inherently improbable that Mr. McCabe did not explain that he was not authorised to administer local anaesthetic. The Panel considered that Mr. McCabe's professional approach had been robust and accepted that he had said that if she just said "ouch" it would be gone.

The Panel noted that, significantly, there was no evidence that Ms. DG had made any reference to having a low pain threshold. The Panel took the view that, by remaining and allowing the procedure to be carried out, Ms. DG had accepted the form of treatment which Mr. McCabe had proposed. The Panel drew support from the act that the treatment by Mr. McCabe had resulted in a positive outcome with no further chiropody intervention to date. Accordingly, the Panel concluded that the third allegation was not well-founded.

The Fourth Allegation - that Mr. McCabe failed to apply an appropriate dressings following treatment

The Panel noted the written evidence of Ms. Duncan at page 56 regarding the type of dressing which she would apply. The Panel also noted the evidence of Mr. McCabe recorded at page 51 of the type of dressing which he had applied. The Panel considered that the type of dressing described by Mr. McCabe would have been adequate for the purpose. The Panel further noted the evidence from Mr. McCabe that, on observing the dressing on Ms. DG's toe very shortly after she had left the clinic, it had been removed and was not properly in place. The Panel consider that different practitioners might approach the dressing of a toe in different ways. On the basis of his evidence, the Panel did not accept that the dressing applied by Mr. McCabe was inappropriate. The Panel drew support for their conclusion from the fact that there is no suggestion that Ms. DG raised the matter with Mr. McCabe at the time or that she had sought further attention from a hospital or another chiropodist or that she raised it with her GP three days later.
The Panel therefore do not accept that there is any substance in this allegation.

The Fifth Allegation - that Mr. McCabe did not take appropriate measures to minimize the risk of infection.

Having heard from Mr. McCabe regarding sterilisation of his instruments and as well as the measures taken to regarding cleanliness in his surgery as well as personal hygiene, the Panel was satisfied that Ms. DG's assertion that there were a large number of instruments lying around uncovered did not give cause for concern. The Panel noted that, on examination of Ms. DG's toe, Mr. McCabe had expressed the opinion that the ingrown toenail was very minor and that there was very slight inflammation. He considered that the inflammation was too minor to justify referring Ms. DG to her GP for antibiotics and that having dealt with the ingrown loenail, the inflammation would be expected to resolve in a few days. The fact that on 15th July, Dr. Howe described "ongoing inflammation" was not conclusive that this was in any was attributable to the treatment given by Mr. McCabe rather than the ingrown toenail itself. On the balance of probability, the Panel accepted that the sterilisation and hygiene regimes adopted by Mr. McCabe were adequate.

Committees Direction:

The Panel does not accept that any of the allegations against Mr. James McCabe are well-founded.

The Panel wish to record that it was satisfied that Mr. McCabe had carried out treatment in accordance with the standards of conduct and proficiency expected of a registered chiropodist. The Panel fully recognises that there was distress and discomfort caused to Ms DG but experience suggests that this may sometimes be expected from treatment of this type. The Panel also wish to record their concern at the immoderate language used by Mr. McCabe in his refutation of the allegations and counsel him that, should he find himself in a similar position in the future, he should be careful to conduct himself less emotively.
Click to expand...

Gaun yersel' Jimmy!

Mark Russell · Jul 10, 2007

The following case has serious ramifications for podiatry practice in the UK

Committees Finding:
1. The Panel is considering allegations of misconduct and lack of competence against Mr {edit}. The particulars of each are identical – namely that Mr {edit} failed to deal safely with the risks of infection and failed to establish and maintain a safe practise environment.

2. The HPC advances the case against Mr {edit} on the basis of the evidence of Mrs {edit}, a former patient of Mr {edit}.

3. The Panel does not propose to deal extensively with the evidence of Mrs {edit}. The Panel is entirely satisfied that Mrs {edit} was a truthful witness. However, there were a number of areas in relation to which the Panel could not feel sufficiently satisfied that her evidence was accurate.

4. Nevertheless, in the evidence given to the Panel today Mr {edit} has himself described his normal practice and the Panel feels that the practice he has described falls significantly short of an acceptable standard. In particular, the way in which he undertakes infection control and the decontamination process falls well below current standards because:

(i) he does not use the appropriate quality of water in his autoclave;

(ii) his method of disposal of contaminated waste water from both the autoclave and the ultrasonic cleaner is inappropriate;

(iii) he does not take accurate readings from his autoclave on a daily basis to ensure that it is operating effectively;

(iv) he has a lack of understanding of the techniques and standards of sterilisation;

(v) repeatedly moving the autoclave from the floor to a chair runs the risk of upsetting the calibration of it;

(vi) while accepting that at the relevant time there was the laminate flooring described by Mr {edit}, the Panel considers that a minimum acceptable standard would require a continuous, impermeable and washable surface which extends up the wall at the edges of the floor to include the level of the skirting board;

(vii) at the time relevant to the allegation it is acknowledged by Mr {edit} that he was using a hand towel. The Panel does not feel that that met acceptable hygiene standards. However, the Panel notes and records the fact that he has since changed his practice and is using appropriate paper towels.

5. The Panel does not find that these facts amount to misconduct, but being issues that demonstrate practise that falls well below an acceptable standard, it does amount to a lack of competence.

6. Paragraph 11 of the standards of conduct, performance and ethics makes clear that appropriate precautions must be taken to protect patients and others (including the health professional). The facts found by the Panel demonstrate a breach of this standard.

7. The Panel finds that {edit} fitness to practice is currently impaired by reason of the lack of competence demonstrated.

8. Since announcing the decision set out above the Panel has heard further submissions as to the appropriate sanction. The Panel reminds itself that the purpose of a sanction is not to be punitive, but rather to protect the public and to maintain public confidence.

9. It is submitted on behalf of Mr {edit} that a caution order would meet the circumstances of this case. The Panel does not agree, primarily because it is not satisfied that Mr {edit} has a sufficient understanding of the underlying principles in the areas of the identified shortcomings. In order for him to continue to practice it is necessary that he should acquire that understanding. Accordingly a conditions of practice order is both appropriate and proportionate.

10. The conditions are that within 12 months of the commencement of the order Mr {edit} should:

(i) Undertake self-directed learning relating to infection control, decontamination and sterilisation.

(ii) Before the review of the Order, submit a portfolio demonstrating both what has he has studied and its effect upon his practice.

(iii) Keep and maintain a daily log relating to decontamination of instruments, and before the review of this Order submit a copy of the log to the HPC.

(iv) To the extent that physical changes are made to his premises before the review of this Order, submit photographic evidence of the changes to the HPC (indicating the date on which the photographs were taken).

11. The Conditions of Practice Order will be reviewed before it expires, and the Panel reviewing it will have available to it all the sanction options currently available.

Committees Direction:
That the Registrar be directed to annotate the register entry of {edit} to show that, from the date this order takes effect (“the operative date”) and for a period of 12 months, {edit} must comply with the following conditions of practice:

(i) Undertake self-directed learning relating to infection control, decontamination and sterilisation.

(ii) Before the review of the Order, submit a portfolio demonstrating both what has he has studied and its effect upon his practice.

(iii) Keep and maintain a daily log relating to decontamination of instruments, and before the review of this Order submit a copy of the log to the HPC.

(iv) To the extent that physical changes are made to his premises before the review of this Order, submit photographic evidence of the changes to the HPC (indicating the date on which the photographs were taken).
Click to expand...

Given the foregoing, the vast majority of practitioners in the UK will be in breach of the, as yet, unpublished guidelines for minimum clinical standards. Further, these guidelines are dichotomous with those specified by the Society of Chiropodists and Podiatrists, including those laid down in the Society's Practice Accreditation Scheme. I have no knowledge of guidelines from the Institute or BChA, but I would suspect they may also follow those from the Society.

That being the case, it would appear that the vast majority of practitioners in the UK are practising illegally and may be subject to prosecution by the regulator. I have asked the Society for clarification on these matters, but would be grateful to members of the other membership bodies if they can give guidance to what current standards have been adopted by their respective organisations.

Sincerely

Mark Russell

jack golding · Jul 21, 2007

Some of what the HPC are dictating mirrors what is required for registration with the Care Standards Commission. It is almost certain that those practitioners who carry out podiatric surgery on their own premises will have to register with that organisation. Having started on the process of registering, I would strongley advise the podiatry organisations not to be pushed down that route by the HPC.If colleagues dont believe me I would suggest they look at the regulations made under the Private and Voluntary Health Care( England) orders 2oo1. If the HPC try to impliment this type of regulation, it would be the end of many private practices Jack Golding

William Fowler · Aug 4, 2007

These cases should be compulsory reading for all HPC registered health professionals. Like it or not, they certainly point to the standards that are now expected.

jack golding · Aug 4, 2007

The question has to be asked, is it the remit of the HPC to order general podiatry practitioners to upgrade their premises to standards which would normally only apply to an acute hospital. Surely this would be out of all proportion to the work being carried out, and certainly not evidence based. If this is not nipped in the bud almost every GPP will find themselves with the HPC on their backs. Shout loudly dont let it happen by default,

Mark Russell · Aug 4, 2007

Transcript of the Baldwin Case is attached.

DTT · Aug 4, 2007

Hi Mark et al

Can anyone tell me if this woman is complaining she has got an infection of some description from this practitioner ?? or just she didn't like the decor ???

I gave up the will to live after the first twenty pages and came to the conclusion, "ain't it time these wankers got a life" ???

What is this costing the tax payer (us) with this bloody Political Correctness ??

It is a nonsense to have this medico-legal quangos for this absolute Taurean excrement.

Why didn't the practitioner tell them to stuff it (and the nutter that is complaining) and revert to a FHP ( bullet proof) ?? or don't the FTP lot believe tossers like this complainant exist ??

I have just finished a really hard day in surgery . I'm hot p****ed off coz I want to be with my family on this beautiful sunny warm day. and have just finished getting my notes on computer.

Tomorrow (Sunday) I have to autoclave my instruments ready for my next days work ,do a full back up of my pc,do a stock order and my accounts.

Now I have to worry if my next patient dosen't like my colour scheme in the surgery

I am on the verge of giving up !!!

Has ANYONE got ANY COMMON SENSE in this HPC ??????!!!

Where's that bottle of red

ARRRGGGGGGGGGGGHHHHH

Cheers
Derek

footmedic · Aug 4, 2007

I believe it is not the HPC alone to blame, what about those who sit on the panel from our own profession.

DTT · Aug 4, 2007

Hi Footmedic
Makes you wonder , with a national shortage of Podiatrists how these people find the time to sit on these committee's.
I suppose the MEP situation ( Talking rubbish for loadsamoney) or the "those that cant do Teach" analogy spring to mind

In my former life where I made life and death decisions on a daily basis, I was always confident that if I was ever brought to book over any job I had done for whatever reason the people judging me were my peers who had worked their way up through every aspect of the job to reach a senior position.

If you were wrong they would tell you but they would defend you fiercely against anyone if you were right.

Oh how times change

Cheers
Derek

George Brandy · Aug 5, 2007

In my former life where I made life and death decisions on a daily basis, I was always confident that if I was ever brought to book over any job I had done for whatever reason the people judging me were my peers who had worked their way up through every aspect of the job to reach a senior position.

If you were wrong they would tell you but they would defend you fiercely against anyone if you were right.
Click to expand...

DDT, I cannot endorse enough the total common sense statement you have made here.

I don't question the panel's ability and knowledge of infection control in the Baldwin case but what I do question is their application of this knowledge in all aspects of Chiropody and Podiatry. From the toenail cutter to the pod surgeon.

So the panel experts will tell us that you can't have one rule for one person and another rule for someone else. So to our infection control experts:

In a practice that cuts toe nails and pops off the odd bit of callus why on earth is a continuous washable flooring, sealed seams and splashbacks more effective in combating infection than a regularly washed vinyl floor with regularly washed and well painted skirting boards? Where is the evidence? Okay its a DoH minimum standard. Why? It stops dust/dirt collecting in nooks and crannies. Does it? Isn't effective removal of dust/dirt more appropriate? What risk is that dust to a person attending for nail cut, callus reduction and advice?

Please can we have application of knowledge, an understanding of differing practices, a panel member with a proven track record in all aspects of podiatry and common sense.

Oh dear, I do appear to have asked for the earth....

GB

Mark Russell · Aug 5, 2007

I've no idea how the HPC operates in terms of evidential criteria for fitness to practise hearings - whether it be similar to English Case Law or otherwise - but my initial concern with the Baldwin hearing was that a precedent may have been set whereby the standards upheld by the panel would therefore apply to all registrants, be that NHS or private practice, or general footcare or podiatric surgery. I do feel that it is invidious of the HPC to expect registrants to adhere to standards that the HPC have not formally adopted or published. The standards adopted in this case seem to be 'best practice' rather than 'acceptable minimum standard' - but if this is indeed the level by which the bar has been set, then I agree many - if not the majority - of podiatry registrants will be in breach of the HPC standards and therefore liable for sanction.

The impact of this may be far reaching and not only in private practice. I would think that the vast majority of NHS clinics fall below the standards quoted by the panel in the Baldwin Case. That being so, is the individual employee liable for the condition of State property and surroundings? What advice should be given to the registrant who is instructed to carry out podiatry work in NHS clinics that are substandard?

DTT · Aug 5, 2007

Hi George

I would imagine that 99.9% of patients that present for routine podiatry care in for non invasive procedures (unless you class corn enucleation as invasive).
The point one per cent that remains are the nail surgery patient that present with a septic pus filled digit containing necrosed tissue bacteria etc.

Can anyone think of a more "dirty" condition ??

So this patient is bringing all these bio hazards IN to your surgery

The procedure itself is contained within a small area of your couch and debris tray. What has that to do with skirting boards flooring and the rest??

The infection is already there ,cross infection is preventable by normal standards of hygiene in the localised area and clinically clean instruments for the treatment .That is it in a nutshell.

So where is the drama the life threatening situation which IMHO has never ever occurred, only in the minds of the imaginative.

Dust?? We all know the reduction of the cracker of a neglected Gryphotic nail causes dust, loads of it. I have the latest spray drills,ionizers in the surgery but after reducing a large nail about an hour later a thin white film of dust appears and after that is cleared an hour later another film of dust is back.

So what do we do?? I know

Lets ban all patients with septic toes and gryphotic nails IN CASE .......

That would appear to be the road we are going down.

If we all go down the route of the podiatric surgeon and are opening joint capsules and doing bone surgery (another "dirty " operation) then we will all have to review the situation.
Until that time perhaps these representative on the FTP panel could think more of protecting the registrant than condemning them
Cheers
Derek

footmedic · Aug 5, 2007

The problem with hpc, according to my personal communication /experience is that they do not have any crystal clear written standard or views. Easy to tarnish the law biding practitioners without given them any humane consideration which can affect their social life.

We the podiatrists may have different agenda / views but, when it come to certain allegations against our profession must drag together. The podiatrists who sit on the FTP panel will need to use common sense or one day IT COULD BE THEM ON THE DOCK!. No one is above the law even the hpc may be challenged the way they conduct business.

What really puzzle me is hpc using our fee to punish us, also we have to hire solicitor (cost a lot) and if by chance someone win the case no compensation. That is the reality we are all in.

DTT · Aug 5, 2007

Hi Footmedic

The problem with hpc, according to my personal communication /experience is that they do not have any crystal clear written standard or views. Easy to tarnish the law biding practitioners without given them any humane consideration which can affect their social life.
Click to expand...

Only 10% of the population need a police force the rest are law abiding citizens.

In 40 years in health care I can honestly say I have NEVER willfully caused anyone harm or injury.

Has anyone in a so called "Caring" profession ever done do ??

If the answer to that question is yes ,then bugger off to some other job

We all "joined up " to improve peoples quality of life.

None of us intentionally do a patient harm ( first maxim of medicine "do no harm") yes mistakes happen no one disputes that BUT does that really warrant hanging the practitioner out to dry on the probability they may or may not have done this dastardly deed and decided on by a group of Muppet's without any practical experience of the profession , or those with dubious reasons for sitting on the panel ??

Lets have some support from the professional bodies on this.

Why not publish the name and the practice location of the podiatrist who is sitting in judgment on the panel ??

We could all then watch them like a hawk and report any lack of decor ,wall covering ,floor covering etc

It is a nonsense from start to finish, perhaps Bill Gates can develop a PC with a common sense button on it??

I wont hold my breath whilst I'm waiting .

Cheers

Derek

Lesley Sutherland · Aug 5, 2007

Admin said:

Just noticed these (names edited out) and posted the below in the interest of educating other practitioners:
Click to expand...

Just found my next topic for CPD within my
private practice. Cannot rely on common sence.

HPC Hearings

admin Administrator Staff Member

Admin2 Administrator Staff Member

George Brandy Active Member

Graeme Franklin Active Member

Mark Russell MVP

Mark Russell MVP

jack golding Active Member

William Fowler Active Member

jack golding Active Member

Mark Russell MVP

Attached Files:

Baldwin_transcript.pdf

DTT Well-Known Member

footmedic Active Member

DTT Well-Known Member

George Brandy Active Member

Mark Russell MVP

DTT Well-Known Member

footmedic Active Member

DTT Well-Known Member

Lesley Sutherland Member

HPC Hearings

HPC Disciplinary Hearings

Chertsey, Surrey. Part-time Musculoskeletal HPC registered Podiatrist required

How long does HPCP registration take???

HPC Registed Looking For Work

HPC Registed Looking for work

HPC name change to HCPC

Share This Page

HPC Hearings

admin Administrator Staff Member

Admin2 Administrator Staff Member

George Brandy Active Member

Graeme Franklin Active Member

Mark Russell MVP

Mark Russell MVP

jack golding Active Member

William Fowler Active Member

jack golding Active Member

Mark Russell MVP

Attached Files:

DTT Well-Known Member

footmedic Active Member

DTT Well-Known Member

George Brandy Active Member

Mark Russell MVP

DTT Well-Known Member

footmedic Active Member

DTT Well-Known Member

Lesley Sutherland Member

Share This Page

Useful Searches