Miss Danielle Asnan
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Your fitness to practise as a Paramedic is impaired by reason of your health.
1. The Panel received information that service of the Notice of today’s hearing was sent to the Registrant at her registered address on 15 September 2017 by first class post. The Panel accepted the advice of the Legal Assessor and was satisfied that notice had been effected in accordance with Rules 3 and 6 of the HCPC (Health Committee) (Procedure) Rules 2003 (the Rules).
Proceeding in Absence
2. Miss Eales, on behalf of the HCPC, applied for the hearing to proceed in the absence of the Registrant. She outlined to the Panel a chronology of communication passing from the HCPC to the Registrant, and informed the Panel that no response has been received from the Registrant to the Notice of Hearing, to a notification of intention to amend the Allegation, or to being sent the bundle for today’s hearing. A telephone call was made by the HCPC on 12 October 2017 to ascertain if the Registrant intended to attend today’s hearing but she did not respond.
3. The Panel took into account the HCPTS Practice Note entitled “Proceeding in the Absence of the Registrant” and accepted the advice of the Legal Assessor who referred to R v Jones  UKHL 5 and GMC v Adeogba  EWCA Civ 162. The Panel noted the Registrant’s self-referral to the HCPC, and emails from the Registrant. However, no response has been received from the Registrant to the Allegation or to the Notice of Hearing. No request for an adjournment has been made by her. In deciding whether or not to proceed in her absence, the Panel took into account the potential disadvantage to her in not being here. However, the Panel concluded that the Registrant had voluntarily waived her right to attend today’s hearing.
4. This, coupled with the public interest in the expeditious disposal of the case, meant that, in the Panel’s view, it was fair and in the interests of justice to proceed today.
Application to hold hearing in private
5. Miss Eales on behalf of the HCPC applied for the hearing to be heard in private.
6. The Panel took into account the HCPTS Practice Note entitled “Conducting Hearings in Private” and accepted the advice of the Legal Assessor.
7. The Allegation relates to the Registrant’s health and the Panel decided to hear the whole of the hearing in private on the basis that this would be appropriate to protect the private life of the Registrant, pursuant to Rule 10(1)(a) of the Rules.
Application to amend Allegation
8. Miss Eales on behalf of the HCPC applied to amend the Allegation. She referred the Panel to a letter dated 14 August 2017 which notified the Registrant of the intention to apply for the amendment. Miss Eales informed the Panel that the Registrant did not reply to this letter.
9. The Panel accepted the advice of the Legal Assessor. It took account of the prior notification of the application to the Registrant by letter dated 14 August 2017. The Panel granted the application, and was of the view that there was no prejudice to the Registrant resulting from the proposed amendment.
Application to read witness statement
10. Miss Eales on behalf of the HCPC applied for the statement of W2 to be read as he was not present at the hearing to give live evidence.
11. The Panel accepted the advice of the Legal Assessor who referred to NMC v Ogbonna  EWCA Civ 1216 and Thorneycroft v NMC  EWHC 1565 . The Panel decided to allow the statement of W2 to be read in his absence on the basis that it decided that it was fair. The reasons for this are as follows:
i. it was not the sole or decisive evidence in respect of the Allegation;
ii. there is no suggestion of any challenge to it by the Registrant;
iii. there is no suggestion that W2 had any reason to fabricate his evidence;
iv. the Allegation is a health matter, which the Panel will hear about from the expert;
v. there is a good –reason for his non-attendance;
vi. The HCPC had taken reasonable steps to secure his attendance
12. The fact that the Registrant did not have prior notice that the witness statement was to be read did not go to outweigh the factors set out above in the balancing exercise carried out by the Panel.
13. The Panel was aware that the question of what weight to give the statement would be an ongoing one which the Panel would consider having heard all of the evidence.
14. The Registrant is a registered Paramedic and worked as a Paramedic at the East of England Ambulance Service NHS Trust (the Trust) from 9 January 2001 until 10 November 2016.
Decision on the facts
15. The Panel heard live evidence from the expert witness. The Panel also read the witness statement of W1.
16. The Panel heard the submissions of Miss Eales on behalf of the HCPC and accepted the advice of the Legal Assessor. The Panel was aware that the burden of proof lies on the HCPC to prove the Allegation to the civil standard, namely the balance of probabilities.
17. The Panel took into account the evidence of W2. While he was not here to give oral evidence, the Panel found that considerable weight could be given to his evidence which mostly set out the Registrant’s employment background and exhibited a number of documents.
Decision on Impairment
18. The Panel heard the submissions of Miss Eales that the Registrant’s fitness to practice is currently impaired. The Panel took into account the HCPTS Practice Note entitled “Finding that Fitness to Practise is ‘Impaired’” and accepted the advice of the Legal Assessor who referred to the case of CHRE v (1) NMC (2) Grant  EWHC 927. The Panel was aware that the question of impairment is one for its own independent judgment.
19. In considering whether the Registrant’s fitness to practise is impaired by her health conditions, the Panel was mindful that the Registrant has not provided any further information. There would therefore seem to be a pattern of falling out of contact with those with whom the Registrant has a duty to remain in contact with, and the Panel was of the view that this undermined the Registrant’s insight into her health conditions.
20. The Panel considered the case of Grant and was of the view that there was no direct evidence that the Registrant had placed patients at unwarranted risk of harm in the past. However, the Panel was of the view that she is liable to put patients at unwarranted risk harm in the future. The Panel came to this conclusion in light of the factors set out above, her lack of full engagement with these proceedings, questions raising some doubts about her insight into the impact of her health conditions on her practice, and the lack of any update from her which would assure the Panel that she is continuing to be well in her day to day life.
21. The Panel also considered the wider public interest in this case. Having considered all of the evidence before it, the Panel was of the view that a well-informed member of the public, armed with knowledge of the evidence of the case, would be concerned to know that the Registrant, with her continuing health conditions, which have been continuing for a significant period of time, was practising unrestricted as a paramedic. This is particularly the case where she has not fully engaged in the HCPC proceedings, whether in person or in writing, to inform the Panel of her current situation. The Panel therefore concluded that the need to uphold public confidence in the profession and uphold proper professional standards, would be undermined if a finding of impairment were not made in the particular circumstances.
22. The Panel therefore found that the Registrant’s fitness to practise is currently impaired.
Decision on Sanction
23. The Panel heard the submissions of Miss Eales, took into account the HCPC’s Indicative Sanctions Policy and accepted the advice of the Legal Assessor. The Panel was aware that sanction is a matter for its own independent judgment, and that the aim of sanction is to protect and uphold the public interest, including maintaining public protection. The Panel was aware that any sanction must be proportionate, and that it must consider sanctions in ascending order.
24. The Panel first considered whether to take no further action, and decided that this would not be proportionate because it would not meet the public interest concerns in this case, nor would it provide protection to the public.
25. The Panel next considered a Caution Order but concluded that it would not be appropriate in this case. There are ongoing health issues and such a sanction would not restrict the Registrant’s practice. As such, it would not address the public protection concerns in this case. Further, a Caution Order would not satisfy the wider public interest concerns in this case.
26. The Panel next considered a Conditions of Practice Order, and concluded that this would be an appropriate sanction for a period of 12 months. The reasons for this are as follows:
i) The Panel was of the view that appropriate realistic and verifiable conditions could be formulated which would allow the Registrant to practise within the context of careful monitoring of her health conditions. The Panel was of the view that this was proportionate in the light of the expert evidence before it as well as all the circumstances of the case.
ii) The Panel carefully considered the issue of whether the Registrant is likely to comply with a Conditions of Practise Order. In this regard considered her lack of full insight into her health conditions, as well as the fact that she not fully engaged in the HCPC proceedings or with her employer in the past.
iii) Another reason for imposing a Conditions of Practice Order was that the Registrant has already demonstrated some remediation. She has therefore demonstrated a previous commitment to addressing her health issues. The Conditions which the Panel decided to formulate are primarily aimed towards addressing her health conditions.
27. The Panel was of the view that a period of 12 months was appropriate and proportionate in that it would allow the Registrant time to demonstrate that she has taken effective steps to address her health conditions in accordance with the conditions imposed.
28. The Panel did go on to consider a Suspension Order, but was of the view that it would be disproportionate and punitive at this stage and would not specifically address her health issues in the same way as conditions would.
The Registrar is directed to annotate the HCPC Register to show that, for a period of 12 months from the date that this Order takes effect (“the Operative Date”), you, Ms Danielle Asnan must comply with the following conditions of practice:
1. - 8. Redacted.
9. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
10. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
11. You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).
12. You will be responsible for meeting any and all costs associated with complying with these conditions.
13. Any condition requiring you to provide information or reports to the HCPC is to be met by you sending the information to the HCPC identifying your FTP number and marked for the attention of the Fitness to Practise department.