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During the course of your employment as a Paramedic with Yorkshire Ambulance Service NHS Trust on 7 July 2014, you were called to a Red 2 emergency call in relation to Patient A, and you:
1. Did not take or instruct Colleague A to take the Life pak machine into Patient A’s home.
2. Whilst Patient A was hypoglycaemic and/or presenting with chest pain, you did not take and/or instruct Colleague A to take the following observations and/or conduct the following checks:
(i) a pulse oximetry;
(ii) a pulse check;
(iii) a blood sugars check;
(iv) a 3 lead and/or a 12 lead an ECG;
(v) Patient A’s temperature;
(vi) chest auscultation;
(vii) Glasgow Coma Score;
(x) Capillary refill;
(xi) FAST test
3. Did not turn on the Life pak machine for the duration of the call.
4. Left Patient A in her home, having taken no, or insufficient observations
5. Falsely recorded three sets of observations which had not been taken on Patient A’s Patient Report Form.
6. Your actions as set out at paragraph 5 were dishonest.
7. Your actions set out at paragraphs 1-4 constitute misconduct and/or lack of competence.
8. The matters set out at paragraph 5 and 6 constitute misconduct.
9. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
1. The Panel found that there had been good service of the proceedings, in accordance with rule 3 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 by notice dated 27 August 2015.
2. The Panel considered whether to proceed with the hearing in the absence of the Registrant, in accordance with rule 11 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003. The Panel was advised by the Legal Assessor to consider the guidance in the HCPC Practice Note entitled Proceeding in the Absence of the Registrant and followed that advice.
3. The Panel finds the Registrant has made a conscious decision not to attend the hearing. There has been no indication that she wants an adjournment or would attend on a future date and she has confirmed receipt of email correspondence from the HCPC’s solicitors in relation to these proceedings, in an email sent to Kingsley Napley dated 9 September 2015.
4. The Panel decided to proceed with the hearing in the absence of the Registrant, on the basis that:
(a) the Registrant is aware of the hearing today;
(b) she has voluntarily absented herself and waived her right to attend;
(c) it is in the public interest that HCPC proceedings are conducted expeditiously;
(d) the three HCPC witnesses have attended to give evidence and the relevant events occurred in July 2014.
5. The Panel permitted minor amendments of the particulars to be made under the general power to allow amendments where there is no prejudice to the Registrant. Notice of the majority of the proposed amendments was sent to the Registrant and no objection was raised by her. The amendments serve to clarify the HCPC’s case, in accordance with the witness evidence and there is no prejudice caused to the Registrant by granting the application to amend the particulars.
6. The Panel accepted the advice of the Legal Assessor to adopt the civil standard of proof namely the balance of probability, in respect of the factual particulars. The burden of proof is upon the HCPC as to the facts. The Panel adopted a three stage approach to decide: which of the facts are proved; whether or not the proved facts amount to the grounds of misconduct and/or lack of competence; and, one of the grounds is established, to consider whether the Registrant’s fitness to practice is currently impaired.
7. The Registrant is registered as a Paramedic on the HCPC Register. In July 2014 she had been a Paramedic for four years and had worked for Yorkshire Ambulance Service NHS Trust (the Trust) for two years. The above allegation that the Registrant’s fitness to practice is impaired arises from a “Red 2” (eight minute response) emergency call-out on 7 July 2014, when she attended upon Patient A, who was pregnant and diabetic. The Registrant was undertaking a late shift (14:00 to 00:00) in a Double Crewed Ambulance (DCA) with Colleague A, an Emergency Care Assistant (ECA).
8. On arrival at the home of Patient A, the Registrant was the clinical lead practitioner but it was alleged that she failed to take a “Life Pak 15” machine with her into the Patient’s flat, or instruct Colleague A to do so. A “Life Pak 15” is an essential piece of equipment required to conduct baseline observations and should be taken from the ambulance by a member of the DCA crew when they attend a patient. Patient A was hypoglycaemic and presenting with chest pain, however, the Registrant allegedly did not carry out key observations or checks, nor instruct Colleague A to do so. The Registrant was the senior clinician and therefore had overall responsibility for Patient A’s assessment and treatment. The “Life Pak 15” machine was not activated during the duration of the call-out although it should have been used. In addition the Registrant then left Patient A in her home, despite having undertaken insufficient observations.
9. At the end of her shift the Registrant recorded on Patient A’s Patient Report Form (PRF) that three sets of observations had been undertaken, when this was not true. Colleague A raised concerns with her supervisor shortly after returning from the call-out and Witness 3 was instructed to conduct an immediate welfare check of Patient A. A few hours later Patient A was admitted to hospital on the advice of Witness 3 and a General Practitioner.
10. Witness 1 conducted an investigation for the Trust into this matter and a disciplinary hearing was held on 26 September 2014 which resulted in the Registrant’s dismissal. The Registrant’s behaviour put Patient A at severe risk of harm according to Witness 3. The Registrant said that she could not explain her behaviour.
Decision on Facts:
12. The Panel heard oral evidence from: Witness 2/Colleague A (ECA) who was working with the Registrant on the shift in question, Witness 3 (Paramedic) who also attended to Patient A and Witness 1 (Paramedic and the Trust’s Investigating Officer). The Panel found their evidence to be clear, compelling and credible.
13. The Registrant was the senior clinician and practitioner in a DCA on the date in question. She was the HCPC Registrant crew member and the clinical lead practitioner. Colleague A was the DCA driver providing support to the Registrant who was the person responsible for Patient A’s care.
Particulars 1 and 3
14. Colleague A states that she and the Registrant took neither the Life pak nor any other equipment into Patient A’s home. It was the Registrant’s responsibility as the lead clinician to ensure that the patient was assessed fully. This would require the use of specialist equipment. Colleague A says she asked the Registrant about getting the equipment but the Registrant replied “there’s no point”. The emergency call required that the patient was attended to immediately, with all the necessary equipment. The Registrant later said that she did not carry out the required observations because she was tired. The admissions made by the Registrant in her Trust interview included that the Life pak machine was not taken into the property. Witness 3 did not see an ECG printout on arrival at the scene, and was told by Patient A, who had experienced ambulances being called out to her before, that a machine hadn’t been brought into her home. In addition, the Life pak report states that it was not switched on while the Registrant was at the property of Patient A. The Panel finds particulars 1 and 3 proved.
Particulars 2(i) to 2(xi) inclusive
15. The Panel finds that various observations and checks were not completed, in circumstances where Patient A was hypoglycaemic and presenting with chest pain. The Registrant is responsible for the fact that the important checks set out in particulars 2(i), 2(iv) and 2(v) were not carried out. However she stated in her interview that she checked the patient’s pulse and the Panel cannot be satisfied that the other checks were not completed. In particular a blood sugars check was completed using the patient’s own device. In respect of the other clinical observations, the Panel is not satisfied that sufficient evidence has been presented to allow the Panel to conclude that the Registrant failed to undertake a physical examination prior to Witness 2 entering Patient A’s house. These points were not put to her in detail during her investigatory interview. The Panel concludes that the HCPC has failed to prove that the relevant observations and checks, set out in particulars 2(ii), 2(iii), 2(vi), 2(vii), 2(viii), 2(ix), 2(x) and 2(xi) were not properly completed. Accordingly only particulars 2(i), 2(iv) and 2(v) are proved.
16. The Panel finds Patient A was left at home by the Registrant although insufficient observations had been completed. The Registrant admitted in her investigatory interview with the trust that she did not carry out a full set of observations and this was promptly raised as a concern by Witness 2. The Panel finds particular 4 proved.
Particulars 5 and 6
17. The Panel finds the Registrant recorded three sets of false observations on Patient A’s PRF, which were wholly or in part manufactured. These included pulse oximetry, respiratory rate, the third blood sugar reading and the latter two pulse and capillary refill tests.
18. The Panel applied the following two stage test in respect of the alleged dishonesty in particular 6:
i. Were the Registrant’s actions dishonest by the standards of ordinary reasonable practitioners?
ii. If they were, would the Registrant have realised that her actions were dishonest by those standards?
This false recording of information was dishonest by the standards of ordinary reasonable practitioners and the Registrant would have known that what she was doing was dishonest by those standards. The Panel finds particulars 5 and 6 proved.
Decision on grounds:
19. The Panel, in reaching its decision, accepted the advice of the Legal Assessor that: Misconduct is a word of general effect, involving some serious act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a practitioner in the particular circumstances.
20. In relation to lack of competence, the standard to be applied is that applicable to the post held and the work being performed. A lack of competence connotes a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the practitioner’s work.
21. The Panel found that the Registrant has failed to comply with the following HCPC standards of conduct, performance and ethics:
1. You must act in the best interests of service users.
3. You must keep high standards of personal conduct.
7. You must communicate properly and effectively with service users and other practitioners.
10. You must keep accurate records.
13. You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.
22. The Registrant was appropriately experienced as a Paramedic in 2014, having been fully qualified for four years and had been working for two years at the Trust.
23. The Panel finds the proved factual particulars were caused by misconduct rather than a lack of competence. The Registrant had the necessary training, skills, resources and experience to perform her job properly, but chose not to do so. She admitted this at the investigatory interview, and could not explain her behaviour.
24. Witness 3 described the Registrant’s decision to leave Patient A at home as shocking. He described her actions in recording observations on the PRF which had not been undertaken, as totally dishonest. Witness 1 described the Registrant’s conduct as “appalling”. The Panel concludes from this evidence that the Registrant’s fellow professionals would consider her actions to be deplorable. During her Trust interview she described her conduct as a “moment of madness” and “not acceptable”. She could not explain why a full set of observations were not undertaken, saying she was: “stupid or lazy or something - I just wanted to go home to bed”. She accepted recording false observations on the PRF; and “binning” the patient’s copy of the PRF.
25. The Panel finds the Registrant’s conduct towards Patient A was deplorable. The proved facts each amount to misconduct.
Decision on Impairment:
26. The Panel accepted the advice of the Legal Assessor to consider the HCPC Practice Note on Finding that Fitness to Practice is Impaired. The Panel has considered the HCPC Practice Note entitled ‘‘Finding that Fitness to Practise is “Impaired”.
27. Rule 9 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 states: Where the Committee has found that the health professional has failed to comply with the HCPC standards of conduct, performance and ethics the Committee may take that failure into account, but such failure shall not be taken of itself to establish that the fitness to practise of the health professional is impaired.
28. In determining whether fitness to practise is impaired, Panels must take account of a range of issues which, in essence, comprise two components:
1. the ‘personal’ component: the current competence, behaviour etc. of the individual registrant; and
2. the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession. Dame Janet Smith identified the circumstances where impairment might arise as: (a) where a registrant presents a risk to service users (b) has brought the profession into disrepute (c) has breached one of the fundamental tenets of the profession or (d) has acted in a way that her integrity can no longer be relied upon. Whether fitness to practice is impaired must therefore take account of the critically important public policy issues.
29. The Registrant has not attended the hearing or provided written representations. Therefore her views on this case are not known, save as recorded in the Trust interview and the Registrant’s self-referral to the HCPC in July 2014. There is no evidence before the Panel of reflection or remediation by the Registrant since July 2014. Therefore the Panel finds the Registrant is impaired on personal grounds, due to her poor personal conduct, lack of remediation and the risk of repetition.
30. Furthermore, it is doubtful whether the finding of dishonesty made in this case can be remediated and a finding of impairment on public interest grounds is also appropriate. The proved factual allegations and the findings of misconduct including dishonesty are serious. In order to declare and uphold the HCPC standards of conduct and to maintain the reputation of the Paramedic profession the Registrant’s fitness to practice is impaired on public policy grounds.
Decision on sanction:
31. The purpose of fitness to practise proceedings is not to punish registrants, but to protect the public and uphold professional standards. The Panel has considered the HCPC Indicative Sanctions Policy (ISP) dated September 2015, which includes the following guidance: It is important for Panels to remember that a sanction may only be imposed in relation to the facts which a Panel has found to be true or which are admitted by the registrant. Equally, it is important that any sanction addresses all of the relevant facts which have led to a finding of impairment.
32. The public interest includes the need to uphold the reputation of the profession and maintain public confidence in the HCPC regulatory process. In deciding what, if any, sanction to impose under Article 29 of the Health and Social Work Professions Order 2001, the Panel has had regard to the principle of proportionality and the need to balance the interests of the public with those of the Registrant, in accordance with the advice of the Legal Assessor.
33. The Panel heard submissions from Mr Orpin-Massey, in relation to the mitigating and aggravating factors before considering (in ascending order) what, if any, sanction to impose.
The aggravating features are:
• The Registrant’s failings put a pregnant Service User at risk of serious harm.
• The fact that the misconduct has several components:
o acts of deliberate omission;
o falsification of records;
• There is a significant risk that damage has been caused to the reputation of the Paramedic profession.
• There is a lack of engagement and no evidence of insight or remediation by the Registrant.
The mitigating features are:
• The allegation arises from a one-off incident in July 2014.
• The Registrant had a previously unblemished record.
• The Registrant was tired and stressed, made full admissions and explained that her health issues contributed to her misconduct.
34. The Panel has decided that it is necessary to impose a sanction, given the seriousness of the Registrant’s misconduct. The Panel finds a caution order would be contrary to the ISP, due to the Registrant’s dishonest behaviour. Furthermore, it is not in the public interest for the Registrant to remain in unrestricted practice until remediation has occurred and there may be a risk of repetition.
35. The ISP states in relation to conditions of practice that:
The imposition of conditions requires a commitment on the part of the registrant to resolve matters and therefore conditions of practice are unlikely to be suitable in cases involving dishonesty, breach of trust or the abuse of service users.
36. The Panel therefore concludes that conditions of practice are not an appropriate and proportionate sanction in this case.
37. The ISP also states:
If the evidence suggests that the registrant will be unable to resolve or remedy his or her failings then striking off may be the more appropriate option. However, where there are no psychological or other difficulties preventing the registrant from understanding and seeking to remedy the failings then suspension may be appropriate.
38. The Panel finds suspension is not appropriate due to the Registrant’s complete lack of engagement with the HCPC process. There is no evidence of insight into the severity of her misconduct. The Registrant abandoned a vulnerable pregnant patient in a potentially serious hypoglycaemic state. She then took steps to cover up her behaviour. Although the Registrant quite promptly admitted her failings, the Panel has no evidence from her as to insight, or a willingness to remedy her serious failings.
39. Therefore the Panel considered imposing a striking off order. The ISP states: Striking off is a sanction of last resort for serious, deliberate or reckless acts involving abuse of trust such as sexual abuse, dishonesty or persistent failure. The Panel concludes striking-off is merited in this case, because a suspension order is an insufficient deterrent to other registrants and will not maintain public confidence in the regulatory process and the reputation of the profession due to the serious, deliberate, reckless and dishonest actions of the Registrant. There is no evidence of insight or remediation and therefore no realistic prospect that the Registrant’s dishonesty is capable of remediation.
That the Registrar is directed to strike the name of Miss Deborah Barkham from the Register from the date this order comes into effect.
The order imposed today will apply from 8 December 2015.
Right of appeal:
You may appeal to the appropriate court against the decision of the Panel and the order it has made against you. In this case the appropriate court is the High Court in England and Wales.
Under Articles 29 and 38 of the Health and Social Work Professions Order 2001, an appeal must be made to the court not more than 28 days after the date when this notice is served on you. The order made against you will not take effect until that appeal period has expired or, if you appeal during that period, until that appeal is disposed of or withdrawn.
The Panel makes an Interim Suspension Order under Article 31(2) of the Health and Social Work Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.
History of Hearings for Deborah Barkham
|Date||Panel||Hearing type||Outcomes / Status|
|09/11/2015||Conduct and Competence Committee||Final Hearing||Struck off|