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Fitness to practise case studies

These case studies provide examples of fitness to practise cases that GOsC has investigated.

Case study one - altering patient records

The concerns are that Mr B, the osteopath, retrospectively created patient records and/or made entries in the patient records in relation to several patients he performed acupuncture on. It is also alleged he did this dishonestly to cover up the fact he had not sought valid consent from each of the patients before performing the technique. One patient, Patient A, has written to the practice where Mr B worked as an osteopath at the time, stating that they came to see an osteopath for back pain. They state that Mr B did not inform them he was planning to insert an acupuncture needle into Patient A’s upper back area without notice. When Patient A screamed in shock and pain, Mr B is alleged to have become angry and dismissive. Patient A said there was blood on their clothing when they returned home that night. They took a photograph of this. Patient A then complained to the practice.

GOsC is made aware of these concerns by the practice manager. The practice manager provides a report of an audit he had conducted showing that several electronic patient records of patients had all been amended, apparently by Mr B, in the same afternoon. He also provides the concerns of Patient A (who has provided their consent for this disclosure). After risk assessing the concerns, it is decided that the threshold for an application for an interim suspension order is met. A Chair of the Investigating Committee decides whether an application for an interim order should be considered at a hearing. The Chair in this case decides that the concern should be referred for a hearing because the allegation is very serious and that it may be necessary for Mr B’s registration to be suspended while those allegations are fully investigated in order to protect the public.

The GOsC arranges a hearing to take place remotely in accordance with our interim remote hearings protocol. The Investigating Committee rules require that Mr B is entitled to at least five days’ notice of the hearing. He is given seven days’ notice. He is able to arrange legal representation for the hearing.

At the hearing (which takes place in private) the Committee hears submissions (oral representations) from the Presenting Officer on behalf of the GOsC and submissions from Mr B’s representative who states that the allegations are entirely made up by the practice manager because they have fallen out and he has since left the practice and is working successfully without incident elsewhere.

The Committee hears legal advice from the independent legal assessor who refers them to the GOsC’s Guidance for the Fitness to Practise Committees on Imposing Interim Suspension Orders.

The Committee goes ‘in camera’ (which means they go into a private part of the proceedings) to reach its decision. It also prepares written reasons for its decision which is called a ‘determination’.

The Committee reminded itself that it did not have a fact-finding role, but was undertaking a risk assessment of the concerns and exercising its judgment as to whether it was necessary on the sole statutory ground of public protection to impose an interim suspension order on Mr B. The Committee had serious concerns that the allegations suggested serious departures from the standards of practice laid down by the Osteopathic Practice Standards. The Committee noted that Mr B appeared to alter patient records after he had been told about Patient A’s complaint to the practice. The Committee was also concerned that this arose from an injury that Mr B was alleged to have caused to Patient A during an osteopathic appointment where he did not appear to acknowledge the distress caused to the patient. The Committee considered in all the circumstances that there was a real and continuing risk to patients if an interim suspension order was not granted while further investigations were undertaken.

Case study two - patient consent

Patient A emails a concern to the General Osteopathic Council. Patient A explains within their email that they went to see an osteopath, Mr B, because of ongoing back pain.

They state that at their previous appointment with Mr B, he asked them to remove their top and lie face down on the treatment table. Mr B then proceeded to put a lot of pressure on Patient A’s back using his elbow. Patient A asked him to stop and said they were in pain but he refused, saying “don’t worry, I know what I’m doing”.

When they complained again, he said “don’t be such a baby. No pain, no gain” and he continued to press down with considerable force. Since that appointment, a few weeks ago, Patient A has been in a lot of pain and unable to walk properly.

The Regulation Officer calls Patient A to explain the investigation process. She explains that we may need to take a witness statement from Patient A and that details of their concern will need to be disclosed to Mr B. She asks Patient A to complete our complaint and consent forms. Patient A agrees.

The Regulation Officer completes our internal case management and risk assessment forms. She notes that Patient A says they wrote directly to the practice to complain but were not satisfied with the response received.

The Regulation Officer then calls to ask Patient A for a copy of that correspondence. The concern is prepared and the papers are sent to a Screener (an osteopathic member of the Investigating Committee) to review the concern and consider whether the General Osteopathic Council can investigate. The Screener’s decision is to refer the case to the Investigating Committee (IC) to decide whether there is a case to answer (link to video).

The Regulation Officer informs Mr B that a concern has been raised about him. She also updates Patient A.

The Regulation officer investigates and obtains all the necessary information. This includes obtaining Patient A’s osteopathic notes from Mr B. She sends these notes to a clinical advisor.

The Clinical Advisor responds to say that it is not clear from the notes whether Mr B explained what he was going to do to Patient A before treatment. He suggests that Patient A should be asked what explanation they were given. The Regulation Officer then takes a witness statement from Patient A and liaises with them to amend the statement until Patient A is happy with it and ready to sign it.

She then instructs an expert witness to provide a report about whether Mr B met the standard expected of a reasonably competent osteopath in his treatment of Patient A. The Regulation Officer reviews the file, prepares a ‘bundle’ of the evidence which comprises the osteopathic notes, Patient A’s witness statement and the expert report. She redacts the bundle, which means she removes personal information and finalises the particulars of the allegation.

The allegation and bundle are sent to Mr B, and he is given 28 days to provide a response. Mr B’s response is received. In short, he denies the allegation. Mr B’s response is sent to Patient A for comment and they are invited to respond within 14 days.

The case is then considered by the IC at its next meeting. The IC decides that there is a case to answer and refers it to a hearing of the PCC. Under our standard case directions, the case is served on Mr B and he is asked to complete a listing questionnaire providing his dates of availability for a hearing, details of any witnesses he intends to call, and any preliminary arguments he intends to make. Patient A and the expert witness are asked for their availability to attend to give evidence at the hearing if required. Mr B provides his availability and confirms he does not intend to call any witnesses.

The hearing is listed for four days and notice is served on the parties that the hearing will take place remotely in accordance with our Interim Remote Hearings Protocol. Mr B’s response is received from his legal representative. He disputes that he carried on with treatment against Patient A’s wishes and denies that he said “don’t be such a baby, no pain, no gain”. The Regulation Officer contacts Patient A to explain that, as their evidence is disputed, they will need to attend the hearing as a witness. The hearing bundle is agreed between Mr B’s representative and the GOsC after some correspondence between them. The ‘skeleton arguments’, which are the written documents that are provided in advance of a hearing, summarise the issues to be addressed in the case of both the GOsC and Mr B.

These are exchanged and the papers are provided to the PCC panel members and their legal assessor in advance of the hearing. This is done via Caselines, the online document and electronic evidence preparation and presentation system. The hearing takes place and the PCC decide to issue Mr B with a conditions of practice order for two years after finding the allegation is well founded.

The PCC provide Mr B and the GOsC presenter with the written reasons for the decision reached. In reaching a decision the PCC take account of the Osteopathic Practice Standards and the Hearings and Sanctions Guidance. Mr B and his representatives have 28 days to appeal the decision to the High Court. The PCC decision is also provided to the Professional Standards Authority for Health and Social Care, which reviews every final decision made by the PCC and can appeal the decision if it decides that the sanction is not sufficient for public protection.