Vanessa K Laver

Profession: Paramedic

Registration Number: PA08598

Hearing Type: Review Hearing

Date and Time of hearing: 12:00 25/08/2015 End: 16:00 25/08/2015

Location: Health and Care Professions Council, Park House, 184 Kennington Park Road, London, SE11 4BU

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

As found proved by the panel at the Conduct and Competence Committee final hearing on 02 December 2014. The panel found that the facts proved amounted to misconduct and impairment, and imposed a Suspension Order for a period of 12 months.

During the course of your employment as a Paramedic with East Midlands Ambulance Service NHS Trust:

1 You attended a ‘999’ emergency incident on 17 September 2013 and you:

b) Did not complete an adequate assessment of Patient A, in that you:

i. Did not carry out a full set of secondary patient observations;
iii. Did not use an oxygen saturation probe;
iv. Did not otherwise listen to the Patient’s chest.
vi. Did not carry out a 3-lead ECG;

c) Did not complete a Patient Referral Form for Patient A to satisfactory standards, in that you:

i. Did not record a full set of secondary patient observations in your clinical records for Patient A;

d) Did not obtain Patient A’s signature for refusal to travel by ambulance.

2.  You recorded on Patient A’s PRF that you performed a 3-lead ECG, when you had not.

3.  You  did  not  consistently  carry  out  full  and/or  accurate  sets  of  secondary observations on service users.

4.  You  did  not  consistently  record  full  and/or  accurate  sets  of  secondary observations on service user PRFs.

5. Your actions described in paragraph 2 were dishonest.

6. The matters described in paragraphs 1-4 constitute misconduct and/or lack of competence.


7. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary matters

Service

1 The Panel is satisfied that the Registrant was properly served with Notice of today’s hearing by way a letter which was sent by first class post on 22 July 2015 to the Registrant’s registered address. The Panel has seen a copy of the Notice letter which contains all relevant information and a certificate certifying the fact of postage. Further the Council has used all reasonable means to bring this matter to the Registrant’s attention by also sending a copy of the notice letter to her by email.

Proceeding in the absence of the Registrant

2 The Council submitted that the hearing should proceed in the absence of the Registrant and that there was public interest in this mandatory review taking place without delay.

3 The Panel heard and accepted the advice of the Legal Assessor.

4 The Panel was aware of the need to exercise its discretion to proceed in the absence of the Registrant with great care and in a judicious manner. 

5 The Panel has decided to proceed in the absence of the Registrant; its reasons are as follows:
• The Registrant has not made an application to adjourn today’s hearing.
• Reasonable steps have been taken to ensure that the Registrant is aware of today’s hearing.
• The Registrant did not attend the Final Hearing in December 2014 and was not represented at that hearing.
• The Registrant has not engaged with the Council.
• There is no reason to suppose that if an adjournment was granted the Registrant would attend a resumed hearing.
• In all the circumstances it is right to treat the absence of the Registrant as being voluntary.
• There is public interest in this mandatory review proceeding without delay and that public interest, in the circumstances outlined above, outweighs that of the Registrant in this instance.

Background

6 The Registrant was employed as a Paramedic with East Midlands Ambulance Service (EMAS) based at Grimsby Ambulance Station. She was a Band 5 Paramedic. She worked in the Accident and Emergency Operations Department and primarily in the Fast Response Vehicle as a solo paramedic.

7 The Registrant was off work between March and July 2013 due to a family bereavement in June 2013. She returned to work in August 2013 on a 4 week phased return.

8 On the 17 September 2013, the Registrant responded to a 999 call in respect of Patient A, a 93 year old female, at approximately 00.40 hours. Patient A’s daughter Adult B arrived shortly after the Registrant. The Registrant left Patient A’s home at 01.22 hours, alone, having not transported Patient A to hospital.

9 A further 999 call was placed at 09.30 hours that day by Adult B. Patient A was subsequently transported to hospital by a double crewed ambulance and remained in hospital until she died at 15.34 hours.

10 A subsequent complaint was made by the crew of the double crewed ambulance, regarding an incomplete clinical assessment being carried out by the Registrant. The Registrant was interviewed by Ms Amanda Davidson, Investigating Officer, at EMAS on 11 October 2013. The Registrant was stood down from duties on the same date.

11 The Registrant was interviewed on the 18 December 2013 by Mr Richard Hunter, Locality Manager with EMAS. The investigation concluded that the Registrant committed a series of failings when attending upon Patient A, and that, if the correct procedures had been followed, this might have led to an earlier diagnosis of Patient A’s pneumonia and might have extended her life. He produced an investigation report which was submitted on the 17 January 2014, as part of the disciplinary investigation.

12 A disciplinary hearing took place on the 31 January 2014. As a consequence, the Registrant was demoted to the position of Emergency Care Assistant with effect from the 01 February 2014.

13 The matter was then referred to the HCPC for investigation and in due course the matter resulted in the Registrant facing the following allegation at a hearing that took place on 01 - 02 December 2014.

During the course of your employment as a Paramedic with East Midlands Ambulance Service NHS Trust:

1.  You attended a ‘999’ emergency incident on 17 September 2013 and you:

b) Did not complete an adequate assessment of Patient A, in that you:

I. Did not carry out a full set of secondary patient observations;

III. Did not use an oxygen saturation probe;

IV. Did not otherwise listen to the Patient’s chest;

VI. Did not carry out a 3-lead ECG;

c) Did not complete a Patient Referral Form for Patient A to satisfactory standards, in that you:

I. Did not record a full set of secondary patient observations in your clinical records for Patient A;

d) Did not obtain Patient A’s signature for refusal to travel by ambulance.

2.  You recorded on Patient A’s PRF that you performed a 3-lead ECG, when you had not.

3.  You  did  not  consistently  carry  out  full  and/or  accurate  sets  of  secondary observations on service users.

4.  You  did  not  consistently  record  full  and/or  accurate  sets  of  secondary observations on service user PRFs.

5. Your actions described in paragraph 2 were dishonest.

6. The matters described in paragraphs 1-4 constitute misconduct and/or lack of competence.

7. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.

14 At the Final hearing particulars 1(b)(i), 1(b)(iii), 1(b)(iv), 1(b)(vi),1 (c)(i), 1(d), 2, 3, and 4 were found proved, and 1(a), 1(b)(ii), 1(b)(v), 1(b)(vii), 1(c)(ii) and 1(e) not proved. 

15 The Registrant did not attend the Final Hearing nor was she represented. The Final Hearing Panel found that the matters proven amounted to misconduct and adjudged the Registrant’s fitness to practise to be impaired. The Final Hearing Panel imposed the sanction of a 12 month Suspension Order.

16 When considering whether the Registrant’s behaviour had constituted misconduct the Final Hearing Panel made the following observations:

‘The Panel took the view that the Registrant was fully trained and had 13 years’ experience. She was aware of the standards expected of her, but had failed to undertake them to the required standard, for example, failing to carry out an ECG test and failing to carry out and record secondary observations.

The Panel has also found dishonesty on the part of the Registrant. The public would expect higher standards of Paramedics in these circumstances.’

17 The Panel concluded that the Registrant’s fitness to practise was impaired by virtue of the following:

‘(a) Although this was a single isolated incident in relation to patient care, the Panel considers that the failings identified above were very serious,

(b) There is substantial evidence in relation to recording observations and making clinical notes that there is a pattern of failings over a period of time.

(c) The  ability  to  write  accurate  notes  is  a  fundamental  tenet  of  the profession,

(d) There is some very limited evidence of remorse at the disciplinary hearing but no evidence in relation to insight, other than the admissions made having regard to the quality of the PRF completed in respect of Patient A.

(e) The Registrant has not played any active part or engaged in these proceedings.

(f) In addition, by not attending these proceeding, the Registrant has not been able to place before the Panel evidence that she has made any attempt to remedy any of the shortcomings identified in these proceedings.

(g) There is insufficient evidence of appropriate reflection and that if she found herself in similar circumstances there would not be a repetition. The Panel can only address the questions of current impairment on the basis of the evidence advanced in these proceedings.

(h) Although there is some limited evidence of problems in the Registrant’s personal life, these do not detract from the seriousness of the deficiencies identified.

(i)  The Registrant remains employed as an Emergency Care Assistant, but this role is largely confined to driving, and undertaking practical skills under the supervision of a Paramedic or another clinician.

(j) The actions of the Registrant have damaged public confidence in the profession of being a Paramedic and brought the profession into disrepute.’

18 At the sanction stage the Final Hearing Panel identified the following aggravating and mitigating factors:

‘(a) The misconduct was serious having regard to issues of failing to examine Patient A adequately, record keeping, and in particular the finding of dishonesty.

(b) The Panel regarded the fact that the dishonesty was to cover up for poor clinical treatment, having not undertaken an ECG test as being particularly serious.

(c) The Panel has seen very little evidence of insight or reflection on the part of the Registrant in relation to her misconduct. She has not engaged with the regulatory process and the only evidence is of some remorse in the EMAS disciplinary hearing.

(d) The Registrant has taken no steps to remedy the deficiencies identified in her practice.’

19 When considering the appropriate and proportionate sanction the Final Hearing Panel made the following observations:

‘The Panel took the view that the failings identified in these proceeding are potentially remediable in the future, if the Registrant were to provide evidence of insight. The Panel cannot be satisfied that the issues identified in these proceedings have been resolved. This sanction, in this instance, provides an opportunity for the Registrant to address the deficiencies identified, and to provide evidence of reflection on the findings that have been made. The Panel concluded that a suspension order for 12 months allowed the Registrant sufficient opportunity to remedy her shortcomings whilst providing an appropriate degree of public protection.’

20 The Final Hearing Panel then went on to observe:

‘Whilst in no way seeking to bind any future Panel, at a subsequent review hearing, the Panel envisages that the following matters would be of assistance:

(a) The Registrant should provide clear evidence of insight into the failings identified in these proceedings,

(b) Evidence of remedial steps which have been taken to address the concerns which have been identified,

(c) Evidence of continued, and up-to-date, training, and maintaining the necessary skills and competence to practise as a paramedic.’

Decision

21 In undertaking its task today the Panel is conducting a comprehensive appraisal of the Registrant’s current abilities with a view to establishing whether she is now fit to return to unrestricted practice.  The Panel is not undertaking the task of rehearing the matters that had been brought against the Registrant nor going behind the previous findings. 

22 This Panel has taken into account all documentation placed before it and has heard and taken into account the Council’s representations. The Panel has taken and accepted the advice of the Legal Assessor and it has reminded itself of the terms of the Council’s Practice Note.

23 The Panel has no information before it of any steps taken by the Registrant to address her former misconduct. There being no communication from the Registrant, the Panel was unable to ascertain whether the period of suspension has been used by the Registrant to undertake reflection and gain insight into her previous behaviour nor any evidence that the Registrant has undertaken suitable training such to maintain her skills and competences as a paramedic.

24 In the absence of this information the Panel has come to the conclusion that the Registrant’s fitness to practise remains impaired and so the current order should not be allowed to lapse when it comes to an end in December 2015.

25 Having made this decision, the Panel moved on to consider what restriction to impose on the Registrant’s registration such that it will be a proportionate balance between the Registrant’s interests and will ensure continued service user protection whilst also being in the wider public interest. As directed the Panel approached this matter by attempting to identify the minimum level of sanction that will be appropriate and proportionate in all the circumstances of this case.

26 The Panel considers that mediation is neither appropriate nor practical in this instance. A Caution Order would not provide any degree of service user protection and was therefore also discounted as a suitable measure. In the absence of any information from the Registrant as to her future intentions, or whether she is willing and able to secure employment as a paramedic in the future, the Panel found it impracticable and unworkable to formulate conditions of practice. A Suspension Order would provide the appropriate level of service user protection. The Panel therefore gave careful consideration as to whether a further period of suspension would be in the interests of the wider public or the Registrant’s own interests. These are serious matters involving, as they did, dishonesty. The Registrant has not engaged with the HCPC process and has not given any indication that she will do so in the future. Since the Final Hearing in December 2014 the Registrant has been aware of the measures she could have adopted to remedy her former misconduct and the evidence she could have produced that would satisfy a Panel that she was fit to return to practise as a paramedic at some point in the future. She has not taken the opportunity that a period of suspension has given her to address her failings and there is no indication that she would do so in the future. The Panel has therefore come to the decision that a further period of suspension would therefore serve no purpose and that the proportionate and appropriate measure is of a Strike-Off Order.



 

Order

The Panel decided to strike the Registrant from the HCPC register upon the expiry of the current Suspension Order.

Notes

The Order comes into effect on/around 30 December 2015.

This was a Conduct and Competence Committee hearing held at the HCPC on the 25 August 2015.

Hearing History

History of Hearings for Vanessa K Laver

Date Panel Hearing type Outcomes / Status
25/08/2015 Conduct and Competence Committee Review Hearing Struck off