Paula Burton

Profession: Paramedic

Registration Number: PA13605

Interim Order: Imposed on 22 Jun 2015

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 18/04/2016 End: 16:00 21/04/2016

Location: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

During the course of your employment as a Paramedic with East of England Ambulance Service NHS Trust, on 30 October 2013;

 

1. When tasked to attend CAD A3010130533 you did not provide adequate care and/or carry out an accurate assessment of Patient A in relation to Systemic Inflammatory Response Syndrome (SIRS), in that;

 

a. You did not respond appropriately to Patient A’s temperature recorded as 38.5c

 

b. You did not respond appropriately to Patient A’s heart rate of 120 beats per minute as recorded on the “Zoll Monitor readout”, and:

 

i. you did not wait for Patient A’s heart rate to return to

a resting value of 90 before leaving the address

 

c. You did not respond appropriately to Patient A’s blood glucose reading of 12.2mmmo/l, and;

 

d. You did not transport Patient A to hospital

 

2. You falsified the Patient Care Record (PCR) in relation to Patient A, in that

 

a. You recorded that at 09:27 the Patients oxygen saturation, “SPO2” levels on the Patient Care Record (PCR) was 96, and:

 

b. You recorded that at 09:27 and 09:40 the Patient had a Glasgow Coma Scale (GCS) of 15.

 

3. Your actions as described at paragraph 2 are dishonest.

 

4. The matters as described at paragraph 3 amount to misconduct.

 

5. The matters as described at paragraphs 1-2 amount to misconduct and/or lack or competence.

 

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

Finding

Preliminary Matters


1) The Registrant, Ms Paula Burton, attended the hearing and was represented by her advocate, Mr Edward Ellis, instructed by Blackfords’ Solicitors. The Health and Care Professions Council (“HCPC”) was represented by Ms. Lizzy Acker of Counsel instructed by Kingsley Napley, Solicitors. 

2) At the outset of the hearing an application was made by Ms Acker to amend the allegation. She said that the proposed amendment was to clarify the particulars of the allegation but that there would be no change to the substance of them. The proposed amendment was set out in the version of the allegation which appears at page 2 of the Hearings Bundle and was to the effect that paragraph 1b.i be amended by deleting the words “of 90” and replacing them with “between 80-100”. She submitted that the proposed amendments could be made without prejudice to the Registrant. On behalf of the Registrant, Mr Ellis confirmed that there was no objection to the proposed amendment. After deliberation, the Panel acceded to the application on the basis that the amendment properly reflected a more accurate reflection of the evidence and could be made without unfairness or prejudice to the Registrant.

3) The allegation is framed in terms of misconduct and/or lack of competence under articles 22(1)(a)(i) and (ii) of the Health and Social Work Professions Order 2001. The Panel has considered each part of the allegation separately under each head. The Panel has approached the issue by considering and deciding what facts have been proved and whether those facts amount to misconduct; whether they amount to a lack of competence; or whether they amount to both misconduct and a lack of competence. The Panel then went on to consider whether such misconduct and/or lack of competence as may have been established amounted to an impairment of Miss Burton’s fitness to practise.

4) The Panel reminded itself that it is for the HCPC to prove its case against the Registrant. It is not for the Registrant to disprove the allegations. The standard of proof to be applied in this case is the civil standard of the balance of probabilities; namely whether the matters set out in the allegation are more likely than not to have occurred.

5) The Panel heard that the matters set out in the allegations occurred during the course of an incident attended by the Registrant and an Emergency Care Assistant identified at this hearing as Witness 2 (or in some of the documents in the bundle as “Colleague E”). The Registrant and Witness 2 had been tasked to attend a patient (identified at this hearing as “Patient A”) at her home following an emergency call by her son. Following a number of assessments, the Registrant and Witness 2 departed leaving Patient A at home.

6) Another Emergency Care Practitioner had been called to attend to Patient A at home the following day, 31 October 2013. Patient A was in cardiac arrest. She was conveyed to hospital where she died.

7) The Panel heard oral evidence from Witness 1, Senior Locality Manager with East of England Ambulance Service NHS Trust (the “Trust”) who is a registered Paramedic. It was her evidence that she had conducted a formal investigation into the Registrant’s conduct. This had resulted in a Report which was submitted to the Locality Director. A disciplinary hearing had been held on 4 August 2014 at which the Registrant had been summarily dismissed. The Panel has accepted the evidence of Witness 1 as cogent and credible and has also accepted her evidence of proper professional practice for Paramedics.

8) The Panel also heard oral evidence from Witness 4, the Sister of Patient A; Witness 5, Patient A’s father and Witness 3, Patient A’s husband. The Panel has also accepted the evidence of Witnesses 3, 4 and 5 as credible. Each of them had given an independent account of what they remembered. All of their accounts were broadly consistent with previous statements given by them to Witness 1 in the course of her investigation. Significantly each of them was quite clear about the limits of their knowledge and recollection, and in particular, when they had observed a particular matter or when they were out of the room.

9) The Panel had before it two Written Statements from Witness 2: the first given on 31 October 2013 the day after the incident and the second on 7 November 2013.  These Statements had been provided to Witness 1 and Witness 2 was subsequently interviewed by Witness 1 on 18 December 2013 for the purposes of her investigation. A copy of the transcript of that interview was provided to the Panel and Witness 1 gave an account of it. 

10) Witness 2 has not attended this hearing. Efforts made by Kingsley Napley, the solicitors appointed by the HCPC to investigate the allegations against the Registrant, to contact Witness 2 were not successful. The Panel had regard to the Witness Statement of Rebecca Ryan of Kingsley Napley which detailed the significant efforts which had been made by her and by Clare Howard, the HR Business Partner at the Trust, to contact Witness 2. Ms. Howard told Ms. Ryan that Witness 2 had certain health problems but had consented to her contact details being passed to the HCPC. Ms. Howard said that Witness 2 had also expressed her worries about attending this hearing. Although Ms. Ryan had sent an email to Witness 2 and had followed it up with a telephone call, no direct contact was ever made. The Panel has therefore not had an opportunity to hear directly from Witness 2 and to see her evidence tested at this hearing. Accordingly, the Panel has been able to accord little weight to it. However, the Panel noted that the first Statement provided by Witness 2, written the day after the incident, was largely supportive of the Registrant and it was noted from the evidence of Witness 1 that the second Statement was written by Witness 2 after discovering that Patient A had died. In her interview with Witness 1, Witness 2 is recorded as saying that she had not seen the entries made by the Registrant at the point when making the first Statement. She is also recorded as having told Witness 1 that the Registrant had told her to keep quiet about what had happened.  However, when she saw the patient records after Patient A had died, she realised that they had been completed dishonestly and she made her second Statement. She told Witness 1 that she was not prepared to “lie and cover for her [the Registrant]”. In assessing the weight to be placed on the evidence of Witness 2, the Panel has had regard to the fact that there was no reason for Witness 2 to give a false account. She had not previously worked with the Registrant and had no history of animosity with her. Indeed, as a result of the second Statement, Witness 2 was suspended and faced disciplinary action: a consequence which she could have avoided by adhering to her original Statement. The Panel has noted the degree to which the factual account of the Registrant’s actions as given by Witness 2 in her second Statement confirms the accounts given by Witnesses 3, 4 and 5 in their written and oral evidence.  

11) The Panel also heard from the Registrant herself. The Registrant explained that she had self-referred to the HCPC when she had been suspended following advice from her Union Representative. She said that she had had a varied career in the retail sector before becoming an Ambulance Care Assistant in 2001. She had progressed through the Ambulance Service and had qualified as a Paramedic in 2004. She had enjoyed her work and had taken a mentoring qualification through the Open University. This had led to her undertaking ride outs with different ambulance crews to observe their performance and provide feedback. She said that she had never worked with Witness 2 prior to 30 October 2013 but had observed her on two occasions. She described her as “a pleasant lady who was competent” and who “took on board feedback”. She agreed that she knew of no reason why Witness 2 should give an untrue account of the incident.

12) The Panel has noted that the Registrant has given a number of conflicting accounts of her actions during the incident on 30 October 2013. When cross-examined about the differences between the various accounts she has given during the investigation by Witness 1 and at this hearing, the Panel considered that the Registrant did not give a satisfactory response. She denied that she shifted her position in order to address the different accounts as they emerged. She insisted that she had had conversations/discussions with Patient A whereas the evidence of Witnesses 3, 4 and 5 was that Patient A was largely responding with grunts or one word answers with difficulty. It was the evidence of Witness 3 that Patient A appeared not to be able to take in much of what was being said. The Registrant did not accept the accounts of Witnesses 3, 4 and 5 where they differed from her account and stated that they must be lying. She drew attention to the favourable account of her actions provided in the first Statement of Witness 2 but she could not think of any reason why Witness 2 had changed her Statement.

13) The Panel found that the Registrant’s evidence was at times guarded and unconvincing and the Panel did not consider that she has given an honest and open account of the matters alleged against her at this hearing or during the investigation. Indeed, her account was described by Ms. Ackers as an “evolving account” which changed to meet the evidence against her. Accordingly the Panel found that the Registrant was not a credible witness and preferred the evidence of Witness 1, Witness 3, Witness 4 and Witness 5. As noted, the Panel has also given a degree of weight to the evidence of Witness 2 as recorded in her second Statement and in the transcript of her interview with Witness 1.
Decision on Facts

The Panel has made the following findings of fact in respect of each part of the allegation:-

1. When tasked to attend CAD A3010130533 you did not provide adequate care and/or carry out an accurate assessment of Patient A in relation to Systemic Inflammatory Response Syndrome (“SIRS”), in that:

(a) You did not respond appropriately to Patient A’s temperature recorded as 38.5C

14) The Panel noted that it was recorded that Patient A had a temperature of 38.5C at 9.40am on 30 October 2013. No temperature is recorded as having been taken when the first observations were carried out at 9.27am. It was the evidence of Witness 1 that a temperature of 37C is the average. An elevated temperature is not necessarily an indicator that immediate intervention is needed. However, Witness 1 stated that an elevated temperature required to be considered holistically in the context of other observations or symptoms. The Panel found this part of the allegation proved on the balance of probabilities.

(b) You did not respond appropriately to Patient A’s heart rate of 120 beats per minute as recorded on the “Zoll Monitor readout”

15) The Panel heard from Witness 1 that the normal heart rate for a fit and healthy adult would be expected to be between 60 and 100 beats per minute. Again, Witness 1 expressed the view that a reading of 120 at 9.27am and 122 at 9.40am should have been looked at holistically. Faced with an elevated temperature, and abnormal ECG, a high heart rate and a patient who looked unwell, the patient should have been conveyed to hospital. The Panel found this part of the allegation proved on the balance of probabilities.

(b)(i) You did not wait for Patient A’s heart rate to return to a resting value between 80-100 before leaving the address

16) The Panel accepted the evidence of Witness 1 who referred to the SIRS guidance in the IHCD Paramedic Training Manual. Witness 1 said that the normal pulse rate for an adult who was fit and well should be between 60 and 100 beats per minute. She said that a paramedic should have been very concerned if a patient’s pulse rate was recorded as 120 at 9.27am and then as 122 at 9.40am. At the time of the arrival of the ambulance crew, Patient A had been sitting two thirds of the way up a small flight of stairs. She was reported by the Registrant and Witness 2 as holding a bowl of her own vomit. Patient A was described as a “large” lady who was estimated to weigh around 28 stone. At the Registrant’s insistence, Patient A was helped down the stairs by her husband to a sofa in the front room. She lay slumped on the sofa. Witness 1 gave evidence that Patient A’s pulse rate might have been expected to decrease rather than increase because the patient was at rest. Indeed the readings were double the minimum normal reading. It was the Registrant’s evidence that Patient A was overweight and that the exertion of coming down the stairs and also having vomited may have accounted for the high pulse rate. In addition she repeatedly stated that each person had a different pulse rate and she referred to a friend who had a normal pulse rate of 98. The Panel was concerned that the Registrant did not appear to be able to distinguish between a rate which was within the normal range and a rate which was well above it; nor did she appear to understand the significant concerns raised by such an elevated rate. It was the evidence of Witness 1 that a paramedic in the Registrant’s position should have been expected to look at “the whole patient” including her medical history and her presentation and respond appropriately. The Panel found this part of the allegation proved on the balance of probabilities.

(c) You did not respond appropriately to Patient A’s blood glucose reading of 12.2 mmmo/l;

17) The Registrant stated that she did not attach particular significance to the elevated blood glucose reading. She had asked Patient A if she was diabetic and was told that she was not. She was told that Patient A had taken a small amount of Lucozade that morning but otherwise had taken no food or drink. The Registrant conceded that she had not examined the vomit. However, it was her evidence that she considered that the elevated blood glucose was probably due to the Lucozade. Witness 1 told the Panel that an elevated blood glucose reading in a patient who was not diabetic was one of the recognised markers for sepsis. Again, in conjunction with all the other available information, Witness 1 considered that Patient A should have been conveyed to hospital. The Panel found this part of the allegation proved on the balance of probabilities.

(d) You did not transport Patient A to hospital

18) As noted in its findings in relation to the other parts of paragraph 1 of the allegations, the Registrant took observations and noted a number of readings which were well outside normal parameters. The Panel has accepted the evidence of Witness 1 and was also aware from its own expertise, that the totality of the information available to the Registrant including three SIRS indicators, the fact that Patient was in a collapsed state and the abnormal ECG reading, viewed holistically, meant that Patient A should have been transported to hospital. In addition, Patient A was described as pale and clammy and was slumped on a sofa. Witness 3, her sister, gave evidence that Patient A was not able to hold a proper conversation and was not responding normally.

19) In addition, the Panel noted the Registrant’s original position was that Patient A did not need to go to hospital. However, at this hearing, her position had changed to an assertion that she had asked Patient A if she wanted to go to hospital but Patient A had declined. This was what the Registrant recorded on the PCR. However, there was no evidence that Patient A was given sufficient relevant information about her health to enable her to make an informed decision. In her evidence at this hearing, the Registrant was unable to explain what information about her health and the risks associated with it that she had given to Patient A. Similarly, having regard to the evidence that Patient A may not have been capable of fully taking in such information, there was clear evidence from the three family members that there was no discussion of these issues with them and Witness 3 gave evidence that she had pointed out to the Registrant that Patient A did not appear to have been taking in much if any information.

20) The evidence of members of Patient A’s family was that the Registrant suggested to Patient A that she may have a self-limiting virus which other members of the family had recently suffered from. The Registrant said that she herself had suffered from a similar virus and was familiar with the symptoms and that it had been “horrible”. She had advised Patient A and her family that Patient A should take 24 hours of rest, take Lemsip or paracetamol, and fluids and that if there was no improvement she should contact her GP in the next 24/48 hours.

21) The Panel has had regard to what is recorded on the Patient Care Record that Patient A had declined to go to hospital and finds that, while Patient A may not have wished to go to hospital, she had not been provided with appropriate and relevant information to enable her to make an informed decision.

22) The Panel has considered this part of the allegation in the light of its findings on paragraph 2 of the allegations. It appears to the Panel that the falsification of the Patient Care Record (“PCR”) as well as the failure to reach a proper clinical decision in the context of the indicators which had been identified, demonstrated that the Registrant had made a conscious decision not to transport Patient A at an early stage. The Panel noted that this was consistent with the evidence of Witness 2 that, shortly before entering Patient A’s home, the Registrant had said words to the effect “I am not lifting anyone today” because she did not want risk her back and saying that the job was a “waste of time” because Patient A lived two minutes from the hospital. Witness 2 stated in her second Statement and in her interview with Witness 1 that she could not recall the Registrant having discussed with Patient A or family members the need for Patient A to go to hospital. The Panel has accepted the evidence of the family members that they had experienced a collapse by Patient A, had called an ambulance and had also been to hospital with Patient A quite recently. The Panel is satisfied that, had the need for Patient A to go to hospital been explained to them by the Registrant, the family would have followed that advice.

23) While the Panel has placed little weight on the evidence of Witness 2, her evidence on this issue is consistent with, and corroborates, the accounts of Witness 1 and the three family members. For these reasons, the Panel found this part of the allegation proved on the balance of probabilities.
 
2. You falsified the Patient care record (“PCR”) in relation to Patient A in that:
(a) You recorded that at 09.27 the Patient’s oxygen saturation, SPO2 levels on the PCR was 96

24) The Panel found that the Registrant had falsified two readings on the PCR. The Panel noted the oxygen saturation levels (“SPO2”) on the PCR as 96 and 95 at 9.27 am and 9.40 am, respectively. However, as noted in the evidence of Witness 1, these readings were inconsistent with the printouts from the Zoll monitor which show 92 and 87 at around those times. It was the Registrant’s evidence that she initially thought that the finger probe for measuring SPO2 was faulty or incorrectly sited and so she put it on her own finger, obtaining a reading of 98. Witness 1 told the Panel that, having used the probe on herself, the Registrant should have left it for at least 30 seconds to allow it to settle and then pick up a proper reading. It was the evidence of Witness 2 that she called out the readings to the Registrant but that the Registrant had been in a position to see the monitor. This account was contradicted by the Registrant in her oral evidence to the Panel that she had written down the first reading from the monitor, with the second being passed to her from witness 2. It was clear from the evidence of Witness 1 that in her interview with Witness 2, Witness 2 had stated that she did not see the readings go above the high 80’s and the low 90’s. The Panel determined that the evidence of Witness 2 was consistent with the Zoll printouts. Furthermore, Witness 2 stated to Witness 1 that she had not seen what had been recorded by the Registrant on the PCR and that she regarded the entries of 96 and 95 as a falsification. Furthermore in the Registrant’s interview with Witness 1 of 11 December 2013, she stated she had checked the reading of 96 with Witness 2 whilst walking back to the ambulance. The Panel finds that this part of the allegation is proved. 

(b) You recorded that at 09.27 hrs and 09.40 hrs the Patient had a Glasgow Coma Scale (“GCS”) of 15

25) The Panel heard evidence from Witnesses 3, 4 and 5 as well as from the Registrant. The Panel has also had regard to what was said on this point by Witness 2. The Panel was satisfied that there was sufficient evidence to suggest that Patient A was orientated, knew her surroundings and that she was at home. She had been able to give some answers even if just in the form of grunts or single words. It was a matter of agreement among the witnesses that she opened her eyes sometimes. While a score of 14 might have been indicated, the Panel considered that an assessed score of 15 was not unreasonable. Accordingly, the Panel found this part of the allegation not proved. 

3. Your actions as described at paragraph 2 are dishonest.


26) Having regard to its findings at paragraph 2(a), the Panel considered that the Registrant’s conduct was dishonest by the ordinary standards of reasonable and honest people and that she herself would have realised that by those standards her conduct was dishonest. As noted, the Panel has found that the Registrant had made a conscious decision not to transport Patient A to hospital. The Panel has concluded that the only reason for falsifying the SPO2 readings was to make those readings appear normal and thus eliminating what would have otherwise been a clear requirement to transport Patient A. Accordingly, the Panel finds this part of the allegation proved.

Decision on Grounds

27) The Panel gave careful consideration to whether the parts of the allegation found proved amounted to a lack of competence. The Panel was satisfied that there was no evidence that the Registrant’s knowledge and skills were in any way deficient. The Panel heard that the Registrant was an experienced Paramedic described by her representative as a “seasoned veteran”. She was also a qualified mentor and also a qualified instructor. The Panel had no evidence before it to suggest that the Registrant’s competence had fallen below the standard expected of a registered Paramedic.
 
28) On the contrary, the Panel was satisfied that the evidence demonstrated a repeated and deliberate failure on the Registrant’s part to follow accepted practice for Paramedics in carrying out observations and assessments on Patient A and reaching proper clinical decisions and treatment plans. As noted, the Panel determined that the Registrant’s acts and omissions were wilful in the sense that she had decided that she was not going to transport Patient A to hospital. This extended to the dishonest recording of information on the PCR.

29) The Panel considered that the facts found proved in paragraphs 1 and 2 of the allegations amount to misconduct. The Panel has accepted the evidence of Witness 1 that the individual observations and assessments should have rung alarm bells but, taken together, there were clear indications that Patient A should have been transported to hospital. The Panel takes the view that the fact that the Registrant failed to take a holistic view of her observations and assessments of Patient A, was a wilful decision to avoid having to take Patient A to hospital. 

30) The Panel has found that the Registrant has been dishonest in her accounts of various aspects of the incident. The Panel was very concerned that her account of such matters as the decision not to transport Patient A to hospital evolved during the course of the investigation.

31) The Panel considers that the Registrant’s acts and omissions fell well short of the standards expected of a registered Paramedic as set out in the Standards of Conduct Performance and Ethics of the Health and Care Professions Council and in particular standards 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 patients and other practitioners) and 10 (you must keep accurate records). In all the circumstances, the Panel has concluded that the Registrant’s conduct on 30 October 2013 fell short of the Standards of Conduct, Performance and Ethics of the Health and Care Professions Council and amounted to misconduct.


Decision on Impairment

32) The Panel went on to consider whether the misconduct on the Registrant’s part had crossed the threshold and amounted to impairment. In doing so, it has had regard to the HCPC’s Practice Note “Finding that Fitness to Practise is Impaired”. As indicated earlier, the Panel considered that the Registrant’s actions marked a departure from the standards expected of a registered Paramedic.

33) The Panel considered the personal and public elements in this case as outlined by Mr. Justice Silber in the case of Cohen v GMC [2008] EWHC 581 (Admin). The Panel has carefully reflected on the submissions which it has heard from Ms Acker and Mr Ellis as well as on all the documentation received from the Registrant and also on the advice received from the Legal Assessor.

34) In regard to the personal element, the Panel did not consider that the Registrant has shown any insight into her misconduct. She has denied the matters alleged against her. She has asserted that Witnesses 2, 3, 4 and 5 are lying and it has been put on her behalf that Witness 1 was not present at the incident and that her evidence of what happened, and of what should have happened, is of limited value. The only concession which the Registrant has made about her actions is that she considered on reflection that she ought to have telephoned Patient A’s GP.

35) The Registrant has not provided any evidence of steps taken in remediation and the Panel considers that she has not recognised the seriousness of her misconduct until perhaps, belatedly, at this hearing. She has not provided any evidence of reflection on what happened, nor has she been prepared to admit her shortcomings on this occasion. The Panel wishes to emphasise that it is not alleged that the Registrant was responsible for the death of Patient A but it is a matter of concern to the Panel that there has been no acknowledgement by the Registrant of any reflection on the possibility of a different outcome for Patient A had she acted properly that day. In the absence of any attempt at remediation, the Panel is very concerned about the risk of this type of conduct being repeated.

36) In regard to the public component, the Panel considers that the public would expect a Paramedic, particularly an autonomous practitioner to perform their duties in accordance with established professional practice and in accordance with relevant professional standards. The Registrant’s actions and the attitude disclosed by them, have the potential to cause harm to members of the public who may require her services. Furthermore members of the public would be very concerned about the integrity of a health professional who wilfully failed to follow professional practice. Such conduct has the potential to undermine public confidence in the paramedic profession as well as in the Health Professions and the regulatory process.

37) In the absence of any evidence of any insight or remorse and indeed in the absence of any evidence of steps taken by the Registrant to remediate her misconduct, the Panel is very concerned about the risk of repetition. The Panel noted that it is more than two years since the incident took place. The Panel also noted that the Registrant was dismissed from her employment with the Trust following the Disciplinary Hearing. The registrant told the Panel that she has not undertaken work as a Paramedic since then albeit that she works for ATOS in preparing reports on claims for Personal Independence Payments for the Department for Work and Pensions, a role for which registration with the HCPC is a requirement. Accordingly, the Registrant has not been working in a clinical role since she was suspended by the Trust. She stated that she has maintained her CPD but the Panel has been provided with no evidence of any CPD activity or steps taken in remediation. For all these reasons, the Panel can only conclude that her fitness to practise is currently impaired by reason of her misconduct.


Decision on Sanction

38) The Panel has fully considered the submissions of Mr. Ellis on the Registrant’s behalf and those of Ms Acker on behalf of the HCPC. The Panel has also taken account of all of the Registrant’s written submissions. As previously noted, the Panel considered from her evidence that she has demonstrated very little insight and has also expressed very little remorse. On her behalf, Mr. Ellis conceded at this stage that the Registrant acknowledged that her actions were not as they should have been when she attended the call-out to Patient A. He said “she has acknowledged the incident and it has caused her personal difficulties”. 

39) Mr. Ellis explained that any order which prevented her from carrying out her duties with ATOS would cause her financial hardship. It was his submission that she was in a hybrid position because, although she was in an employment for which registration with the HCPC was a requirement, she was not working as a Paramedic. Accordingly, it was his submission that in her present role, she did not present a risk to the public. Mr. Ellis told the Panel that if she wished to return to work as a Paramedic, she would have to undertake a return to practice course.  

40) The Panel considered that the primary function of any sanction is to address public safety from the perspective of the risk which a health professional may pose to those who use or need his or her services. The Panel was conscious that in reaching its decision, appropriate weight must be given to wider public interest considerations, including the deterrent effect to other health professionals, the reputation of the Paramedic profession, as well as maintaining public confidence in the regulatory process.

41) The Registrant has supplied some positive testimonial evidence and the Panel has given careful consideration to it. The Panel accepted the Registrant’s assurance that she has never done anything like this in her career and that she was well-regarded by some of her colleagues at the Trust, who had provided letters of support. It was also noted by the Panel that some letters from patients and relatives expressing gratitude to the Registrant had been provided. The Panel has also taken account of what was said by Mr Ellis about this being an isolated incident in the Registrant’s career as a Paramedic. The Panel accepted that there was no evidence before it of any previous incident. However, the range and extent of the Registrant’s misconduct during the incident were serious matters of concern.  

42) The Panel has also considered matters in aggravation. The Panel considered that the Registrant’s behaviour in dishonestly falsifying a patient’s PCR in order to avoid transporting that patient to hospital was wilful, reckless and dishonest. The Panel has considered her insight and, as noted at an earlier stage, the fact that she sought to accuse other witnesses of lying in order to cover up her acts and omissions suggests that the Registrant does not accept full responsibility for her misconduct. In regard to remorse, the Registrant has made no apology and does not appear to have recognised any need to do so.

43) The Panel has looked carefully at the question of remediation in the context of the issues which it has identified. The Panel recognises that misconduct involving dishonesty can be difficult to remediate. In the Registrant’s case, there is no evidence before the Panel that she has recognised why her misconduct is so serious. Members of the public are entitled to expect high standards of registered health professionals and that includes demonstrating that proper professional standards of conduct are adhered to at all times. Conduct of this kind also has the potential to damage the reputation of the Paramedic profession as well as public confidence in that profession.  

44) The Panel considered all the sanctions available to it under article 29 of the Health and Care Professions Order 2001 and took into account the guidance contained in the Health and Care Professions Council’s Indicative Sanctions Policy. Following the approach set out in Giele v. General Medical Council, the Panel considered the sanctions in ascending order. The sanctions included taking no action, mediation, a caution order, a conditions of practice order, a suspension order and given the Panel’s findings on misconduct in this case, striking off.

45) The Panel concluded that to take no action would not adequately protect the public because of the seriousness of the misconduct and the lack of insight demonstrated in this case. The Panel also considered that mediation would serve no purpose. The Panel then considered a caution order. The Indicative Sanctions Guidance states that a caution order may be appropriate for an isolated lapse of a minor nature or where there was a low risk of repetition and the Registrant had shown insight and had taken remedial action. The Panel finds that the Registrant has demonstrated no insight or remorse, and while this might be characterised as an isolated case, the misconduct was extensive and was not of a minor nature. In addition, the Registrant has not provided any evidence of steps taken by way of remediating her misconduct. The Panel has therefore concluded that a caution order would not be sufficient in the circumstances of this case.

46) The Panel next considered conditions of practice. The Indicative Sanctions Guidance states that conditions of practice will be most appropriate where a failure or deficiency is capable of being remedied and where the Panel is satisfied that allowing the Registrant to remain in practice, albeit subject to conditions, poses no risk of harm or future harm. The Guidance goes on to state that before imposing conditions, a Panel should be satisfied that there is no general failure, that the matter is capable of correction and that appropriate, realistic and verifiable conditions can be formulated. The Registrant has told the Panel that she is not presently working as a Paramedic although she did not rule out the possibility of a return to practise in the future. However, the Panel could not be certain about the risk of repetition were she to return to front-line work as a Paramedic. In her current role with ATOS, the Registrant undertakes reports on claims for Personal Independence Payment. Although this is a role which requires, inter alia, registration with the HCPC, it is not a role in which conditions of practice would be appropriate, workable or verifiable. In any event, the Panel also has reservations as to whether it would be possible to formulate conditions which meet these criteria and with which the Registrant could be expected to comply given the nature of her misconduct and her dishonesty. The Panel has therefore concluded that a conditions of practice order would not be a sufficient or an appropriate order to make in this case.

47) The Panel then went on to give careful consideration to whether a suspension order should be imposed. The Indicative Sanctions Guidance states that a suspension order may be appropriate where lesser sanctions are insufficient or inappropriate to protect the public but where there is a realistic prospect that repetition will not occur. The Guidance emphasises that suspension is punitive in effect and that this must be borne in mind. It goes on to say that if the evidence suggests that a Registrant will be unable to resolve or remedy her failings, then striking off may be the more appropriate option unless there is a realistic prospect that the Registrant can resolve her difficulties whilst suspended. In this case, the Panel has concluded that the Registrant does not fully recognise the seriousness of her actions. As noted, the Panel considered that she has demonstrated very little if any insight and that her very limited expressions of remorse at this late stage of the hearing had more to do with the position in which she now finds herself rather than sincere apologies for the harm which she has caused. In addition, she has not taken any steps by way of remediation. In this regard, a registered Paramedic is expected to maintain high standards of personal and professional conduct and, as noted, the Panel has nothing before it to suggest that the Registrant has taken any steps towards recognising and remediating her behaviour. In all the circumstances, the Panel has serious reservations about the Registrant’s ability to resolve or remedy her failings during a period of suspension. For all these reasons, the Panel does not consider that a suspension order is appropriate in this case.

48) Finally, the Panel considered a striking off order. The Indicative Sanctions Guidance states that a striking off order is a sanction of last resort for serious, deliberate or reckless acts involving dishonesty. The Panel was satisfied that the nature of the Registrant’s misconduct demonstrated conduct which was serious, deliberate and reckless. It was also dishonest. As noted, the Panel considered that she has demonstrated very little if any insight and very limited remorse, has demonstrated no remediation, and has failed to demonstrate any real understanding of the seriousness of the allegations.  The Panel considered that the dishonesty involved in falsifying a patient’s PCR, demonstrates behaviour which is fundamentally incompatible with continued registration. The Panel considers that a lesser sanction would lack deterrent effect and would undermine public confidence in the Paramedic profession and in the Health and Care Professions generally. In all the circumstances, the Panel has decided that a striking off order is the only appropriate and proportionate order which can be made in this case.

 

Order

Order: That the Registrar be directed to strike the name of Paula Burton from the Register on the date on which this order comes into effect. 

Notes

This was a Conduct and Competence Committee Final Hearing to take place at HCPC, London on Monday 18 April 2016 to Thursday 21 April 2016 at 10:00am.

Hearing History

History of Hearings for Paula Burton

Date Panel Hearing type Outcomes / Status
18/04/2016 Conduct and Competence Committee Final Hearing Struck off