Dublin physio censured for poor record-keeping after runner’s pain found to be cancer

Seán McCárthaigh

A physiotherapist has been censured for updating a patient’s records to support her original “inadequate” assessment that the woman’s pains from running were improving when it was actually diagnosed a short time later that cancer had spread to her bones.

The sanction was imposed by CORU – the regulatory body of health and social care professionals – after findings of professional misconduct and poor professional performance were made against physiotherapist Niamh Fehily.

An inquiry committee of CORU ruled Fehily, while working as a physiotherapist with Spectrum Health, Amiens Street, Dublin 1, had failed to maintain accurate and adequate records of the patient who was a keen runner but who had a history of cancer.

The committee claimed patient records updated by Fehily over three and a half months after her final treatment of the woman and after she was aware a complaint had been made against her were “unreliable” and “self-serving.”

An expert witness said the physiotherapist’s assessments of the patients were “inadequate and unchanging” even though “a real red flag” had been raised when the woman’s condition had not improved.

The committee described updated records which contained “meticulous detail” and suggested the woman’s pain had settled as “disquieting in the extreme.”

“If it was the case that the pain had settled, that should have been recorded at the time as it was critically important information,” the committee noted.

It found Fehily’s claim was “simply not credible” that she had removed a record which noted that the woman was “feeling twinges” because she thought she had misspelled the word “twinges”.

The committee also found separate allegations of poor professional performance proven that Fehily had failed to afford proper treatment to the woman as well as failing to refer her for further diagnostic investigation.

The inquiry chairperson, Geraldine Feeney, said Fehily’s actions constituted a failure to meet the standards of competence that might reasonably be expected of a registered physiotherapist.

Feeney said her failure to keep accurate records also represented breaches of the Code of Professional Conduct and Ethics for physiotherapists.

The inquiry arose following a complaint by the woman who had attended Fehily on seven occasions between August 2nd, 2022 and October 26th, 2022 with various complaints of decreasing running tolerance and increasing pain.

Fehily gave evidence that while the complaints were connected to running, the woman had not reported having any significant pain.

However, contemporaneous notes from the woman’s Garmin device show she claimed on September 19th, 2022 that she was “falling apart more”, while she was “steadily getting worse” on October 20th, 2022.

An expert witness said the profile of the woman’s symptoms had changed and Fehily should have reassessed her working diagnosis to find out why her earlier treatment was not working.

The complainant had returned to running in June 2022 after undergoing breast reconstruction surgery the previous month following chemotherapy and radiation for breast cancer a few years previously.

The inquiry heard that a different physiotherapist who examined her on November 7th, 2022 requested an urgent MRI scan to rule out stress fracture of her femur due to the level of pain, her medical history and use of Tamoxifen – a medication used to treat breast cancer.

After an MRI scan in December 2022, it was diagnosed that the cancer had spread to the woman’s bones.

The inquiry noted that there was no allegation that any treatment provided to the woman had caused or contributed to such a diagnosis.

The committee said the physio’s original records of four different consultations were sparse while there was no record from her first visit that the woman had a previous history of breast cancer or that she had been prescribed Tamoxifen.

“Such a significant medical history and treatment should be included as a matter of course,” said Feeney.

The committee said they found the updated records unreliable due to the “sheer unlikelihood” of anyone being able to remember the minutiae and detail inserted by Fehily some 3 months later given the passage of time as well as the number and variety of clients she had seen in the intervening period.

It also noted that the physiotherapist had prior knowledge of the complaint against her when making the updated records.

The committee said the patient’s contemporaneous Garmin records did not corroborate Fehily’s updated records.

Feeney said the physiotherapist had given oral evidence to support a narrative of an improvement in the woman’s condition.

However, she said the committee found it would be unsafe to rely on what was contained in the updated notes and it preferred the evidence of the complainant whom it found to be “an honest, truthful and credible witness” who admitted she had “gaps” in her memory.

The inquiry heard Fehily had moved to Portugal over two years ago but had been unable to register for work as a physiotherapist there due to the CORU case which had caused her financial issues.

In addition to censure, the committee required Fehily to be placed under the supervision of a senior physiotherapist for a period of two months under an individualised learning plan with a focus on note-taking and clinical decision-making.

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