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1. On 7 August 2015, did not provide the appropriate level of care for Patient A, in that you did not supervise work you had delegated to the ECA, in that you:
a) did not ensure that all appropriate observations were carried out on Patient A to the required standard; and/or
b) did not look at and/or evaluate the 3 lead ECG which showed a significant ST segment depression and/or subsequently did not perform a full 12 lead ECG;
c) did not read the EPRF prior to finalisation and so failed to see comments recorded by the ECA such as 'Patient alert, cyanosed on nose and fingers';
d) did not carry out and/or evaluate Patient A's National Early Warning Score of 5;
e) did not convey Patient A to an acute hospital.
2. Were not aware of the role and scope of an ECA.
3. Were not aware of your role and responsibility as lead clinician.
4. On 14 July 2015, you:
a) delayed responding to a G2 call which was allocated to your call sign in order to take your car to a garage without management authorisation, and;
b) at the end of your shift, you denied to your manager that you had taken your car to the garage.
5. Your action as set out in paragraph 4 b) was dishonest.
6. The matters set out in paragraphs 1-3 constitute misconduct and/or lack of competence.
7. The matters set out in paragraph 4 constitute misconduct.
8. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
Service of the Notice of Hearing
1. The Panel concluded that the HCPC had served the Notice of Hearing dated 5 January 2017 by first class post to the Registrant’s last known registered address and also by email on the same date. The letter and email contained the date, time and venue of this hearing. Therefore, the Panel concluded that there was good service in accordance with the HCPC’s procedural rules.
Proceeding in Absence
2. The Panel noted the submission of Mr Chalmers and it accepted the Legal Assessor’s advice. The Panel also considered the HCPC’s Practice Note on Proceeding in the Absence of the Registrant. The Panel took into consideration that the Registrant has not requested an adjournment and that she has had good notice of the hearing. The Panel also noted that the HCPC witnesses are present and ready to give their evidence today. In those circumstances, the Panel has determined that it is in the wider public interest and in the Registrant’s own interests to ensure the expeditious disposal of this case and therefore to proceed without any adjournment. In any event, the Panel did not consider it likely that, if adjourned, the Registrant would attend on any future date in light of her voluntary decision not to attend today.
3. The case concerns the alleged failures of the Registrant on 14 July and 7 August 2015, whilst employed as an Operational Paramedic by the East Midlands Ambulance Service (EMAS) in the Northamptonshire Division. She had commenced employment with EMAS on 21 September 1999, becoming a registered Paramedic on 1 November 2007.
4. On 14 July 2015, she and a colleague, RC, were allocated to attend a call requiring a blue light response within 30 minutes. They diverted to a garage where the Registrant left her car, having travelled to the garage in it, with RC following in the ambulance. They then proceeded to the incident and attended. The EMAS control centre had noticed the delay in the response by the Registrant and RC. The Registrant told her manager, MC, when asked, that she had not taken her car to the garage first and that her partner had taken it, but she subsequently admitted to MC that she had taken her car to the garage first. The HCPC alleges that this was a lie and dishonest. After an investigation by MC, a disciplinary hearing took place on 2 October 2015.
5. On 7 August 2015, the Registrant was working on a double crewed ambulance (DCA) with a colleague, RH, an Emergency Care Assistant (ECA). They were called to Patient A, a male patient with a fast pulse rate, palpitations, heavy breathing on exertion and anxiety. They carried out observations on Patient A and they jointly compiled the electronic patient record form (ePRF), with RH completing most of the observations and the ePRF. RH performed a 3 lead electrocardiogram (ECG) and listened through a stethoscope to Patient A’s chest. ECAs are not trained in this latter procedure nor in the interpretation of ECGs. The ECG revealed cardiac irregularities and the Registrant and RH did not perform a 12 lead ECG, which was a recommended practice in those circumstances.
6. EMAS had introduced a National Early Warning System (NEWS) in 2014, which required a crew to ensure that further investigations on patients were undertaken. Where it was shown that a patient was sufficiently unwell they were required to be transported to hospital. Part of the NEWS system was to score patients as to their pulse rate, blood pressure, respiratory rate, oxygen saturation levels, temperature and consciousness. Patient A’s results showed a medium score (5 out of 20), but the 5 result consisted only of two elements of the NEWS assessment, the pulse and respiration levels. This overall result demonstrated that Patient A was sufficiently unwell to justify, at least, a 12 lead ECG being done. The ePRF completed by the Registrant and RH recorded that a 12 lead ECG had been done, but when the LifePak Defibrillator was checked later the same day, no 12 lead ECG was shown as having been performed.
7. Patient A was not transported to hospital. Some members of his family were present and the Registrant telephoned Patient A’s GP to ask him to telephone Patient A and possibly carry out a home visit.
8. Later on 7 August 2015, an EMAS Team Leader, CL, attended a second 999 call to Patient A’s home where he was declared “life extinct”. A Police Forensic Medical Examiner, Dr L, was in attendance and identified that a 3 lead ECG had been performed on Patient A by the previous crew i.e. the Registrant and RH. When he saw the read out which had been left with the patient, he stated that it showed clear signs of a Myocardial Infarction (“heart attack”), which appeared to have been missed by the Registrant.
9. An investigation was carried out by MC and a disciplinary hearing took place on 25 November 2015.
10. The case was referred to the HCPC by EMAS.
11. In reaching its decisions, the Panel heard evidence from:
MC, Locality Manager and Investigating Officer for EMAS;
RH, now an Emergency Medical Technician with EMAS;
CL, the Registrant’s Team Leader.
12. The Panel read the documentation before it, including all the HCPC witness statements and the bundle of exhibits. The Panel accepted the Legal Assessor’s advice. The Panel noted that, at the Facts stage, the facts must be proved on the balance of probabilities by the HCPC and that, at the Grounds and Impairment stages, the Panel should exercise its judgement. The Panel also paid regard to the HCPC’s Standards for Conduct, Performance and Ethics (the Standards), the Standards of Proficiency for Paramedics and the HCPC’s Practice Note on Impairment, as appropriate.
Decision on Facts:
13. The Panel reached the following conclusions as to each Particular of Allegation, taking them individually:
14. In the Panel’s judgement, all three HCPC witnesses were credible, clear and measured in their written and oral evidence. In the Panel’s opinion, MC had conducted a thorough and fair investigation, where he carefully examined the facts and asked the Registrant appropriate questions.
15. The Panel accepted the evidence of MC. The observations that were required were not done to the required standard; for example, the 12 lead ECG was necessary and the evidence from MC and CL was clear that this 12 lead ECG should have been done. This would have been triggered by looking at and assessing the 3 lead result, which the Registrant admitted she had failed to do. She could not remember looking at or interpreting the 3 lead result which was wholly her responsibility.
16. MC’s evidence on this was accepted by the Panel. The Registrant admitted it in her interview with MC. She was shown the 3 lead ECG and was shocked at seeing the abnormality of the ST segment depression. The Registrant admitted that she did not perform the required 12 lead ECG. The ePRF documentation shows that someone recorded that the 12 lead ECG had been performed. Even if the ECA had erroneously recorded it, the evidence from MC was clear that it was the Registrant’s duty to check the record and not to leave the ECA to perform these tasks unsupervised.
17. The Panel accepted the evidence of MC and noted that the Registrant admitted this in her interview with MC.
18. The Panel accepted MC’s evidence. He stated that patients should be admitted to hospital with a National Early Warning Score of over 4. In Patient A’s case, his score was 5, but, in any event, the evidence from MC and the documentation was that the 5 score came only from Patient A’s pulse and respiration findings and that should have been of concern, had the results been analysed at all by the Registrant. The Registrant admitted that she did not know how to use the NEWS system.
19. The Panel accepted MC’s evidence. This was admitted by the Registrant in her interview with him.
1 Stem: Proved
20. In the Panel’s judgement, the facts found proved in 1a to 1e demonstrate clearly that the Registrant did not supervise the work she had delegated to the ECA. She ignored the fact that RH, as an ECA had not been trained in evaluating an ECG or in assessing whether a 12 lead was necessary and she failed herself to ascertain whether the 12 lead ECG was necessary in a situation where, as a professional Paramedic, she knew or should have known that the undertaking of a 12 lead ECG was crucial. In failing to do all the matters found proved in 1a to 1e and in failing to delegate and supervise her ECA colleague, the Registrant did not provide the appropriate level of care to Patient A.
21. The Panel accepted the evidence of MC, including his interview with the Registrant, in which she admitted that she was not aware of the role and scope of an ECA.
22. In her interview with MC, the Registrant claimed that she would not let an ECA operate outside of the scope of her practice yet her own actions demonstrated that she did just that. It was clear from the Registrant’s answers in interview to MC that the Registrant was unaware of her own role and responsibilities as a lead clinician.
23. The ambulance which the Registrant and her colleague were using for the call was tracked and the Panel noted from the map the Registrant’s deviation from the route that she was supposed to take. It was clearly a longer journey in distance and time. The Emergency Operation Centre transcript clearly showed that the Registrant had not been authorized by the Control Centre to go to the garage. On the contrary, the Control Centre had expressly stated that she should “standby” as there was “a job coming in”.
24. MC’s evidence demonstrated that the Registrant had lied twice to her employer when first asked if she had attended a garage on the way to a call on 14 July 2015. On the first occasion, she denied visiting the garage and on the second occasion falsely stated that the Control Centre had given her permission. These lies were exposed by MC in his interview with the Registrant. In that interview, the Registrant admitted to having told lies about taking her car to a garage.
25. Applying the appropriate test for dishonesty and approaching its deliberations on dishonesty with care, the Panel has concluded that an ordinary and informed member of the public would consider that, by not telling the truth about her actions on 14 July 2015 on two occasions, she was dishonest. Applying the standards of a reasonable and honest person, the Panel also considered that the Registrant herself knew that what she said at the end of her shift to her manager was dishonest. She herself, in interview with MC, admitted that she had lied on a number of occasions and the Panel concluded that these admissions speak clearly as to her own state of mind at the time of the dishonest acts, as well as at interview. A reasonable and honest person would not have lied once and then again shortly afterwards about the route she took on 14 July 2015.
Decision on Grounds:
26. The finding of dishonesty and the facts underpinning it amount to a serious falling short of the standards expected of a professional. In the Panel’s judgement, the Registrant’s behaviour was deplorable and brought the profession into disrepute. It demonstrated an unacceptable lack of integrity. The Registrant’s web of deceit involved her colleague in the ambulance and the staff in the emergency control centre thereby aggravating her lack of integrity.
27. In respect of the facts proved in relation to 7 August 2015, such was the level of the Registrant’s lack of skill, knowledge and responsibility in relation to Patient A that she missed an obvious and potentially fatal heart condition. In the Panel’s opinion, the level of seriousness was measured by CL’s alarm when she saw Patient A’s 3 lead ECG result. In the Panel’s judgement, the Registrant demonstrated a cavalier disregard of all the necessary checks and balances instigated by employers, such as EMAS, so as to prevent the avoidable outcomes that happened in the case involving this Registrant. The Panel has concluded that the Registrant held either no regard, or a reckless disregard, for her patients’ conditions, her colleagues’ sensitivities when she was lying to her employer and a complete disregard for the public’s view of her and of her profession.
28. Dishonesty in a professional is a very serious falling short of the conduct expected of a professional, she compounded her behavior by her inability to understand and recognise her role as lead clinician and the effects of that ignorance on her ability to monitor and supervise her junior colleague. This put, and in the Panel’s opinion continues to put, the public at serious risk of harm.
29. For these reasons, in the Panel’s judgement, the facts found proved amount to misconduct.
30. The Panel has concluded that the facts found proved do not amount to lack of competence. There was no fair sample of her work and, in the Panel’s judgement, dishonesty cannot amount to a lack of competence. The Panel determined that the falling short of the standards expected of a professional was too serious to merit a finding of lack of competence in relation to all the Particulars of the Allegation.
31. In the Panel’s view, the HCPC’s Standards that were breached by the registrant are as follows:
1: You must act in the best interests of service users.
8: You must effectively supervise tasks you have asked other people to carry out.
13: You must behave with honesty and integrity and make sure that your behavior does not damage the public’s confidence in you or your profession.
32. In addition, the Panel also considers that the following Standard of Proficiency for Paramedics was breached by the Registrant:
4: be able to practise as an autonomous professional, exercising their own professional judgement.
Decision on Impairment:
33. The Panel determined that the Registrant’s fitness to practise was impaired by reason of the misconduct found proved at the time of the events. The matters raised by this case were, and remain, extremely serious. They undermine the trust and confidence that the public is entitled to have in a professional. The matters found proved also undermine the trust that the employer was entitled to have in the Registrant. The Panel concluded that, by her actions, the Registrant has brought the reputation of her employer and her profession into disrepute and she breached several fundamental tenets of her profession. She put a patient at real risk of harm and was dishonest. In the Panel’s opinion, this was a case involving both the Registrant’s attitude and her poor clinical judgement. The Panel has determined that the Registrant, by reason of her misconduct, demonstrated a cavalier attitude towards her patients, colleagues and the integrity required of a registered Paramedic.
34. The Panel concluded that whilst dishonesty is very difficult to remedy, her other failings could be remediable. However, the Registrant has not attended this hearing and has not provided any written submissions. Therefore, the Panel has no information before it as to whether the Registrant has developed any insight or remorse or whether she has remedied her clinical shortcomings. In the Panel’s view, even during her interview with MC, the Registrant demonstrated no insight. As a result, the Panel concluded that there is a very high chance of repetition of the matters found proved which puts the public at considerable risk of harm now and in the future.
35. The Panel also concluded that if the Registrant were to be declared fit to practise in such circumstances, public confidence in the profession and in the regulatory process would be seriously undermined.
36. For these reasons, the Panel has concluded that the Registrant’s fitness to practise is impaired.
Decision on Sanction:
37. The Panel noted the submission of Mr Chalmers. In reaching its decision, the Panel took into account the HCPC’s Indicative Sanctions Guidance and it accepted the Legal Assessor’s advice. The Panel approached the sanctions available by taking the least serious sanction first and working upwards where appropriate.
38. The Panel identified the following aggravating and mitigating factors:
• Seriously poor professional judgement;
• No evidence of insight;
• No evidence of remorse;
• No evidence of remediation;
• The Registrant’s acts and failures to act were, in nature, deliberate and reckless;
• The Registrant’s dishonesty was to protect the Registrant's own interests;
• The Registrant’s actions caused serious delay to patient care;
• The Registrant’s acts caused a real risk of significant harm to patients and service users;
• The risk of repetition was high.
• There is a high continuing and future risk to patients as the Registrant has not demonstrated any insight or intention to remedy her failings identified by this case;
• The Registrant’s deliberate and reckless acts and failures to act disproportionately compromised fellow work colleagues, and placed them each in an invidious position. In one case a colleague was made party to her deceit. As a result of the Registrant’s lack of supervision an ECA who had assisted to the best of her abilities was then subjected to investigation over a relatively long period.
• The Registrant has no known past matters before the HCPC;
• The Registrant continues to work at EMAS, albeit as an ECA.
39. The Panel first considered taking no action or imposing a Caution Order and rejected these on the grounds that neither sanction would restrict the Registrant’s practice and the Panel has found that there is a real risk of repetition.
40. The Panel next considered imposing a Conditions of Practice Order and rejected this. In the absence of any evidence from the Registrant of any attempt by her or any expressed desire to remedy her behaviour, the Panel concluded that there were currently no conditions that could be formulated to address the failings identified by this case, including the dishonesty, so as to adequately protect the public and uphold the wider public interest.
41. The Panel next considered imposing a Suspension Order. It noted that this might be appropriate and proportionate in cases where, although the allegation found proved was serious, the misconduct was unlikely to be repeated. In this case, the Panel has concluded that the likelihood of repetition is high. Therefore, in the Panel’s judgement, a Suspension Order would not adequately protect the public. Furthermore, if one were to be imposed, in light of the serious misconduct found proved and the aggravating factors, which, in the Panel’s view, greatly outweigh the mitigating factors, public confidence in the profession and in the regulatory process would be severely undermined.
42. For these reasons, the Panel has determined that the only appropriate and proportionate sanction in this case that would both protect the public and uphold the wider public interest is a Striking Off Order.
That the Registrar is directed to strike the name of Miss Beverley Robertson from the Register on the date this order comes into effect.
The order imposed today will apply from 3 May 2017.
An Interim Suspension Order was imposed to cover the 28 day appeal period.
History of Hearings for Beverley Robertson
|Date||Panel||Hearing type||Outcomes / Status|
|03/04/2017||Conduct and Competence Committee||Final Hearing||Struck off|