Victoria Parker

Profession: Operating department practitioner

Registration Number: ODP32175

Interim Order: Imposed on 01 Apr 2013

Hearing Type: Review Hearing

Date and Time of hearing: 08:30 16/07/2015 End: 11:30 16/07/2015

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

During the course of your employment as an Operating Department

Practitioner at Nuffield Health Guildford Hospital (the Hospital):

 

1. On 26 March 2012, during a pre-operation check you:

a) failed to identify the discrepancy on the patient consent form, in that it showed that the patient had consented for knee arthroscopy when it should have been for an ACL (Anterior Cruciate Ligament) procedure.

 

2. On 3 April 2012 you were asked to carry out four Work Place Scenarios'

and

a) In relation to Scenario 1 relating to an endoscopy you did not know:

i) the lower parameters for blood pressure;

ii) what type of drug Buscopan is;

iii) which types of patient would be contra indicated for Buscopan;

iv) any of the complications associated with Buscopan;

v) the name of the reversal drug for Midazolam;

vi) the half-life of flumazenil.

b) In relation to Scenario 2 relating to pre-lists checks you:

i) did not demonstrate to a satisfactory level how you would perform an anaesthetic machine check in that you did not:

a. check the oxygen alarm without being prompted;

b. check or calibrate the oxygen analyser;

c. check piped gases until prompted;

d. recognise and/or detect a leak in the circuit;

e. identify the cause for the alarm before switching it off;

f. know that nitrous oxide alone could kill someone;

g. notice the ventilator suction was not connected even after you had

tested it.

ii) did not know what a yellow patient wrist band indicated.

iii) were unable to list the equipment needed for a PFC Knee replacement and a laparoscopic cholecystectomy without prompting and you:

a. were unable to demonstrate the positioning for the lateral supports;

b. did not know where the stack would go for a laparoscopic

cholecystectomy;

c. missed the turning table for laparoscopic cholecystectomy.

iv) did not demonstrate a basic understanding of diathermy.

v) did not demonstrate to a satisfactory level how to apply a tourniquet on the arm, in that you:

 

a. did not know why there are time limits;

b. did not know why a patient wearing a ring On the finger of the

tourniquet side could cause problems.

 

c. In relation to Scenario 3 relating to potential complications in an

anaesthetic room, you:

i) did not know how to check if the endotracheal (ET) tube was in the

correct position;

ii) did not know what to do if the oesophagus was intubated;

iii) used incorrect terminology when describing the equipment used in

intubation;

iv) did not know where to obtain a tracheostomy kit from;

v) did not know what the abbreviation RSI (Rapid Sequence Induction)

stood for;

vi) were unable to give an example for when an RSI is required in the

Hospital's operation;

vii) were unable to demonstrate the location of the cricoid ring;

viii) did not know the related anatomy or positioning of a patient for a

Central Venous Pressure (CVP) line.

d. In relation to Scenario 4 relating to working in Theatre, you:

i) did not know what you would check for to identify an airway circuit

disconnection and/or leak;

ii) said in the case of a ventilator leak/disconnection you would attach a bag and mask to the failed machine;

iii) did not provide the correct terminologies for the patient's position and/or support required for the:

a. knee

b. hip

c. shoulder

d. laparoscopy (Gynae/Bowel)

iv) were not aware of the risks involved with the position of lateral supports;

v) did not fully explain the types of equipment needed for a laparoscopic

case;

vi) did not know what the abbreviations FFP (Fresh Frozen Plasma) and/or MH stood for;

vii) did not know the signs and/or common triggers for MH.

 

3. The matters described in paragraphs 1 and 2 constitute misconduct

and/or lack of competence.

 

4. By reason of that misconduct or lack of competence your fitness to

practise is impaired.

Finding

Preliminary matters

Notice of hearing
1. The Panel had evidence that Notice had been sent by way of letter containing the correct information about today’s hearing and had been sent by the appropriate postal means. That letter had been sent to the address shown on the Register for the Registrant and in sufficient time in advance of the hearing in accordance with the rules. The Panel heard and accepted the advice of the Legal Assessor. The Panel accepted this as evidence of good service.

Proceeding in the Registrant’s absence
2. At the Panel’s request the Council made a call to the Registrant’s telephone number as shown on the HCPC register. The number was found to be invalid.

3. The Council made an application to proceed in the Registrant’s absence and highlighted the following issues as matters that supported the Panel proceeding today.
• The Registrant did not attend the final hearing and relied on written representations.
• There has been no engagement with the HCPC process since.
• There is no application for any adjournment.
• There is no information as to whether the Registrant would be willing to attend at a future date should this matter be adjourned.
• There is public interest in this mandatory review being heard before the expiration of the order.

4. The Panel accepted the legal advice and as advised gave this matter careful consideration. There is a history of non-engagement and from this the Panel adduced that the Registrant had voluntarily absented herself and that in the absence of any information that she is intending to re-engage no purpose would be served in adjourning this matter.  The Panel therefore in this instance considers that the public interest in this matter proceeding outweighs that of the Registrant’s.

Background
5. The Registrant undertook her ODP training at Surrey University qualifying in 2009. The Registrant was employed by the Nuffield Hospital, Guildford (the Hospital) as an Operating Department Practitioner (ODP) in 2011. Concerns were raised in relation to the Registrant’s competence by a number of theatre colleagues. Arrangements were made for her to be supervised by another ODP who undertook a review of the Registrant’s competence in 2012. Subsequently a disciplinary/performance process commenced and following a disciplinary meeting held on 23 October 2012 a first written warning was issued to the Registrant and the matter was referred to the HCPC.

6. The HCPC investigation proceeded to a hearing on the 28 and 29 July 2014 where the Registrant faced the following Allegation:

During the course of your employment as an Operating Department Practitioner at Nuffield Health Guildford Hospital (the Hospital):

1. On 26 March 2012, during a pre-operation check you:
a) failed to identify the discrepancy on the patient consent form, in that it showed that the patient had consented for knee arthroscopy when it should have been for an ACL (Anterior Cruciate Ligament) procedure.

2. On 3 April 2012 you were asked to carry out four 'Work Place Scenarios' and
a) In relation to Scenario 1 relating to an endoscopy you did not know:
i) the lower parameters for blood pressure;
ii) what type of drug Buscopan is;
iii) which types of patient would be contra indicated for Buscopan;
iv) any of the complications associated with Buscopan;
v) the name of the reversal drug for Midazolam;
vi) the half-life of flumazenil.

b) In relation to Scenario 2 relating to pre-lists checks you:
i) did not demonstrate to a satisfactory level how you would perform an anaesthetic machine check in that you did not:
a. check the oxygen alarm without being prompted;
b. check or calibrate the oxygen analyser;
c. check piped gases until prompted;
d. recognise and/or detect a leak in the circuit;
e. identify the cause for the alarm before switching it off;
f. know that nitrous oxide alone could kill someone;
g. notice the ventilator suction was not connected even after you had tested it.
ii) did not know what a yellow patient wrist band indicated.
iii) were unable to list the equipment needed for a PFC Knee replacement
and a laparoscopic cholecystectomy without prompting and you:
a. were unable to demonstrate the positioning for the lateral supports;
b. did not know where the stack would go for a laparoscopic
cholecystectomy;
c. missed the turning table for laparoscopic cholecystectomy.
iv) did not demonstrate a basic understanding of diathermy.
v) did not demonstrate to a satisfactory level how to apply a tourniquet on
the arm, in that you:
a. did not know why there are time limits;
b. did not know why a patient wearing a ring on the finger of the tourniquet side could cause problems
c. In relation to Scenario 3 relating to potential complications in an anaesthetic room, you:
i) did not know how to check if the endotracheal (ET) tube was in the correct position;
ii) did not know what to do if the oesophagus was intubated;
iii) used incorrect terminology when describing the equipment used in intubation;
iv) did not know where to obtain a tracheostomy kit from;
v) did not know what the abbreviation RSI (Rapid Sequence Induction)
stood for;
vi) were unable to give an example for when an RSI is required in the Hospital’s operation;
vii) were unable to demonstrate the location of the cricoid ring;
viii) did not know the related anatomy or positioning of a patient for a Central Venous Pressure (CVP) line.

d) In relation to Scenario 4 relating to working in Theatre, you:
i) did not know what you would check for to identify an airway circuit disconnection and/or leak;
ii) said in the case of a ventilator leak/disconnection you would attach a
bag and mask to the failed machine;
iii) did not provide the correct terminologies for the patient’s position and/or support required for the:
a. knee
b. hip
c. shoulder
d. laparoscopy (Gynae/Bowel)
iv) were not aware of the risks involved with the position of lateral supports;
v) did not fully explain the types of equipment needed for a laparoscopic
case;
vi) did not know what the abbreviations FFP (Fresh Frozen Plasma) and/or
MH stood for;
vii) did not know the signs and/or common triggers for MH.

7. The HCPC case was that the Registrant lacked the basic knowledge and skills required of an ODP and due to her denials and lack of insight she has failed to address the matters which had been raised concerning her competence.  The Panel accordingly made findings of lack of competence, current impairment, and imposed a period of suspension.  The Registrant had not been present at the Final Hearing.

8. At the impairment stage the Final Hearing Panel had taken into account the Registrant’s dyslexia and her family difficulties.  It acknowledged that ‘she was inexperienced in major surgical procedures’ however ‘there was a wide ranging lack of basic and fundamental skills.  There is no indication that these defects have been remedied by the Registrant. She failed to meet the required standards of an ODP or to act as an autonomous professional.’

9. At the Sanction stage the Final Hearing Panel suggested to the Registrant that a reviewing Panel may be assisted by one or all of the following:

• The attendance of the Registrant.
• A letter from her General Practitioner regarding her health.
• Evidence of insight gained from reflection on the ODP practice issues raised by these proceedings.
• Attending a University or Hospital return to practice course or student clinical placement under the supervision of a professional mentor.
• Evidence that issues relating to anaesthetic ODP practice in particular have been addressed.
Decision: 
10. 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. 


11. This Panel has taken into account all documentation placed before it.  It has heard the Council’s submissions, taken and accepted the advice of the Legal Assessor, and it has reminded itself of the terms of the Council’s Practice Notes.


12. The Panel approached this matter by considering first the evidence as to whether the Registrant has addressed her previous lack of competence or whether there is continuing, current impairment.


13. The Panel had nothing before it from the Registrant and in the absence of any information from her had to conclude that the impairment of her fitness to practise remained.


14. Having reached its decision that there was no evidence that any steps had been taken to address the failings the Panel moved on to consider what level of restriction would provide the requisite level of protection for patients, fellow members of the profession, and the wider public interest. 


15. The Panel noted that this is a lack of competence case and that therefore by virtue of Article 29(6) of the Health and Social Work Professions Order 2001 (as amended) this Panel’s powers are limited in relation to the issue of which restriction to place upon the Registrant’s registration.  Under that provision a Panel cannot strike the Registrant’s name from the Register in a case founded on health or lack of competence until there has been a continuous period of suspension or conditions of practice in excess of two years from the date that the substantive order took effect.


16. The Panel started its deliberations at the bottom of the scale and discounted taking no action and mediation as they were inappropriate in the circumstances of this case.  A Caution Order would not provide any degree of patient protection, which, in a case of lack of competence, was paramount, and so this level of sanction was inappropriate in this case. No details of any steps of remediation of skills led the Panel to the conclusion that Conditions of Practice were impractical as well as inappropriate in this case.


17. The Panel therefore concluded that the proportionate and appropriate measure in this case was for a further period of suspension. The Panel gave careful consideration to the issue of how long this period of suspension should be and came to the conclusion that it was in the Registrant’s interests that at this stage it was a short period of six months for the following reasons:
• The HCPC would not be put at any disadvantage or further expense by this decision as two further substantive order review hearings were required to be convened before any consideration could be given as to whether the Registrant’s lack of competence was such that it then warranted a strike off order.
• There are unanswered questions about the Registrant’s current whereabouts.  This is evidenced by the fact that the call made to the Registrant today disclosed that this telephone number is not a current valid one. There is some evidence from the Final Hearing that personal circumstances and the Registrant’s place of residence may have changed since that final hearing. At this point the Panel was mindful of the Legal Assessor’s advice that it was incumbent on the Registrant to ensure that the HCPC had her most up to date contact details. To ensure that a future reviewing Panel has no unanswered concerns about whether the Registrant is aware that the review process is continuing after a short period of suspension, which will facilitate further investigations to be undertaken by the HCPC and, if possible, contact made with the Registrant.
• The Panel was concerned to ensure that the Registrant was aware that the review process was proceeding in her absence as the lack of any information from her was entrenching her position and which may, in time, result in a strike off order being made on or after 26 August 2016.
• The Registrant’s failings as found at the hearing were capable of remedy and the sooner that this process of remediation is started by the Registrant the better. There was evidence that at the time of the Final Hearing the Registrant was in a state of ‘trauma’ and therefore not assessing things dispassionately. Whilst the Panel cannot speculate on the Registrant’s current position it must take into account that this may no longer be the case and her lack of engagement is for other reasons. Given that the Registrant has been out of practice for some time, the need for her to be fully aware to the requirement for this evidence of remediation to be put before a Panel was in her interests.


18. This Panel is adding a new recommendation as well as restating the recommendations made by the previous panel hearing and which it commends to the Registrant as actions she should take before the next review if she wishes to return to practise her profession in the future.
• A clear indication from the Registrant regarding whether she has future plans to use her registration as an ODP.
• The attendance of the Registrant.
• A letter from her General Practitioner regarding her health.
• Evidence of insight gained from reflection on the ODP practice issues raised by these proceedings.
• Attending a University or Hospital return to practice course or student clinical placement under the supervision of a professional mentor.
• Evidence that issues relating to anaesthetic ODP practice in particular have been addressed.

 

Order

Order: The Registrar is directed at the expiration of the current order to place a suspension order against the name of Victoria Parker for a period of six months.

Notes

This order will come into effect on 26 August 2015.

Hearing History

History of Hearings for Victoria Parker

Date Panel Hearing type Outcomes / Status
20/01/2016 Conduct and Competence Committee Review Hearing Voluntary Removal agreed
16/07/2015 Conduct and Competence Committee Review Hearing Suspended