Christopher J Turner

Profession: Paramedic

Registration Number: PA02601

Hearing Type: Review Hearing

Date and Time of hearing: 09:00 20/08/2018 End: 11:30 20/08/2018

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 at South Western Ambulance Service:

1. On 6 May 2015, in relation to Service User A, you:


 a. Did not carry out an adequate assessment on Service User A;


b. Did not complete and/or submit a patient care record (PCR) of the incident.


2. Between approximately 10 June and 15 September 2015, you did not complete and/or submit approximately 14 patient care records.


3.   The matters set out in paragraphs 1-2 constitute misconduct and/or lack of competence.


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

Finding

Preliminary Matters

Proof of Service

1. The Panel was provided with a signed certificate as proof that the Notice of Hearing had been posted on 16 July 2018 by first class post, to the address shown for the Registrant on the HCPC register.  The Panel was satisfied that Notice had been properly served in accordance with Rule 3 (Proof of Service) and Rule 6 (date, time and venue) of the Conduct and Competence Committee Rules 2003 (as amended).

Proceeding in Absence

2. Ms Senior, on behalf of the HCPC, made an application for the hearing to proceed in the absence of the Registrant. She informed the Panel that there had been no engagement from the Registrant since 21 March 2016. She stated that she telephoned the Registrant on 17 August 2018 and a pre-recorded message indicated that the mobile number belonged to ‘Chris Turner’. She left a telephone message for the Registrant to which there has been no response as of 09:00 am this morning.

3. The Panel was advised and followed the advice of the Legal Assessor. The Panel also took into account the guidance as set out in the HCPC Practice Note “Proceeding in the Absence of the Registrant”.

4. The Panel determined that it was fair, reasonable and in the public interest to proceed in the Registrant’s absence for the following reasons:

a) There has been no communication from the Registrant since March 2016 and, in particular, no response from him following the last review. The Panel also noted that there has been no response from the Registrant to the telephone message that was left for him. In these circumstances, the Panel was satisfied that it was reasonable to conclude that the Registrant had chosen not to engage further with these proceedings. Therefore, the Panel was satisfied that the Registrant’s absence was deliberate and demonstrated a voluntary waiver of his right to be present.

b) There has been no application to adjourn and the Registrant lack of response indicates that he would be unlikely to attend ‘any further hearing’. Therefore, re-listing this review hearing on an alternative date would serve no useful purpose.

c) As this is a substantive review hearing there is a strong public interest in ensuring that it is considered expeditiously. In addition the panel noted that this Order is due to expire on 22 September 2018 and it would not be realistic to schedule another review date before the expiry of their Order. It is also in the Registrant’s interest that this review is considered as soon as possible.

Background

5. The Registrant commenced employment as a Paramedic in what is now known as South Western Ambulance Service [SWAS] NHS Foundation Trust in 1992. On 27 July 2015 the Trust received an incident report that was completed by a Senior Paediatric Consultant who had treated Service User A, who at the time of the incident was under 2 years old. The complaint outlined concerns raised by the mother of Service User A [Mother A] regarding the standard of care afforded to Service User A by the Registrant, who was the Paramedic sent to attend Service User A on 06 May 2015, following a 111 call made by Mother A.

6. It was alleged in the complaint that the Registrant did not carry out an adequate assessment of Service User A. Service User A was subsequently admitted to hospital later that evening. Service User A was treated for a number of days before being discharged.

7. The complaint was investigated by the Trust. The investigation officer was unable to find the relevant Patient Care Record (PCR). Further investigation revealed that a number of PCRs, which should have been completed by the Registrant were missing. It was concluded at the internal investigation that the Registrant did not complete these PCRs.

8. These concerns were reported by the Registrant’s employer to the HCPC.

9. The Registrant did not attend, and was not represented at, the final hearing which took place on 20-22 February 2017. That panel found all the particulars of the allegation proved. That panel determined that the proven facts amounted to misconduct and that the Registrant’s fitness to practise was currently impaired. That panel considered that the Registrant had shown only limited insight in relation to his actions and the potential consequences of his failings. He had not shown an understanding as to how his assessment of Service User A had been deficient. Nor had he reflected on the impact on the child, the family or the wider implications of his failings. That panel found no evidence of remediation. It also determined that there had been a total denial by the Registrant of the facts set out in particulars 1b and 2.

10. By way of sanction the substantive hearing panel imposed a Suspension Order for 12 months, having regard to the seriousness of the misconduct and the lack of remediation. That panel advised the Registrant of what would assist a future review panel.

11. The Registrant did not attend the first review hearing which took place on 1 March 2018. The reviewing panel found that the Registrant’s fitness to practise remained impaired. It imposed a further period of suspension for 6 months. As there had been no engagement, or any new information from the Registrant that panel advised the Registrant that a future review panel would be assisted by:

• the Registrant’s attendance;

• a reflective piece from the Registrant indicating:

(i) a recognition of his failings;

(ii) what he learned from these events;

(iii) his understanding of the impact of an inadequate assessment   could have on the clinical condition of a child under 2 and on the reputation of the profession;

(iv) his understanding of the importance of completing and submitting PCRs, and the potential implications of failing to do so;

• evidence from the Registrant as to his plans for the future with
regarding to practising as a Paramedic;

• evidence of the steps that he has taken to maintain his
professional skills;

• evidence as to what the Registrant has been doing by way of work, whether paid or unpaid, since he left the employment of
the Trust;

• testimonials from his employers and colleagues at work.

Hearing of 20 August 2018

HCPC Submissions

12. Ms Senior, on behalf of the HCPC, outlined the history of this case. She reminded the Panel of the findings made at the substantive hearing in February 2017 and the first review hearing in March 2018. She referred the Panel to guidance that the previous panels had given to the Registrant as to what information to provide. She also drew attention to the previous panel’s warning as to the potential for a striking off order. She stated that the Registrant had failed to take the two opportunities he had been given to him to demonstrate that he is no longer impaired and invited the Panel to impose a Striking Off Order.

Panel’s Approach

13. In undertaking this review, the Panel took into account the documentary evidence and the submissions from Ms Senior on behalf of the HCPC.

14. The Panel accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt. In particular that:

• The purpose of the review is to consider the issue of impairment based on the previous panel’s findings of fact, the extent to which the Registrant has engaged with the regulatory process, the scope and level of his insight and the risk of repetition.

• In terms of whether his previous misconduct has been sufficiently and appropriately remedied relevant factors include whether the Registrant:

(i) fully appreciates the gravity of the previous panel’s finding of impairment;

(ii) has maintained his skills and knowledge;

(iii) is likely to place service users at risk if he were to return to unrestricted practice

• The Legal Assessor advised that The Panel should have regard to the HCPTS Practice Note: Finding that Fitness to Practise is impaired and must take account of a range of issues which, in essence, comprise two components:

(i) the ‘personal’ component: the current competence, behaviour etc. of the individual registrant; and

(ii) the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

• It is only if the Panel determine that the Registrant’s fitness to practise remains impaired, that the Panel should go on to consider sanction by applying the guidance as set out in the HCPTS Indicative Sanctions Policy (ISP), and the principles of proportionality which require the Registrant’s interests to be balanced against the interests of the public.

Decision  

15. This Panel noted that at the first review hearing the Registrant did not provide any of the evidence the substantive hearing panel indicated would be of assistance. Further no new information has been provided by the Registrant for the purposes of this review.

16. This Panel noted that at the substantive hearing the Registrant’s fitness to practise was found to be impaired for the following reasons:

(i) The Registrant had failed in his duty of care to Service User A and as a result the child had been put at unwarranted risk of harm.

(ii) As a consequence of the Registrant’s conduct, Mother A’s confidence in the ambulance service had been undermined; she described her subsequent fear of having to call the ambulance service. The Registrant’s failure to complete clinical records (PCR’s) flouted Trust policy and had the potential to put service users at the risk of serious harm.

17. The Panel noted that the factual findings relate to serious failings with regard to the assessment of Service User A and the non-completion, or submission of 14 patient records. Since those findings have been made, the Registrant has provided no evidence that he recognises the seriousness of his misconduct, or the impact on service users, nor has he demonstrated that he has taken any steps towards remediation. In the absence of any positive evidence of insight and remediation, the Panel was satisfied that there has been no material change in circumstances, since the last review. Therefore there remains a risk to service users and a risk of repetition remains. Furthermore, the Panel concluded that as a consequence of the risk to the public, public trust and confidence would be seriously undermined if a finding of impairment was not made. Therefore, the Panel was led to the inevitable conclusion that, the Registrant’s fitness to practise remains impaired on the basis of both the personal and public components.  

18. Having determined that the Registrant’s fitness to practise remains impaired the Panel went on to consider what sanction, if any, to impose.

No Action

19. The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s misconduct which remains un-remediated to take no action on his registration would be inappropriate. Furthermore, it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

Caution Order

20. The Panel went on to consider a Caution Order. As the Registrant has demonstrated very limited insight into his misconduct, provided no evidence of insight or remediation whilst the risk of repetition remains.  The Panel therefore concluded that a Caution Order would be inappropriate and insufficient to protect the public and meet the wider public interest.

Conditions of Practice Order

21. In considering conditions of practice the Panel took into account paragraph 33 of the ISP which states:

‘Conditions will rarely be effective unless the registrant is genuinely committed to resolving the issues they seek to address and can be trusted to make a determined effort to do so. Therefore, conditions of practice are unlikely to be suitable in cases:

• where the registrant has failed to engage with the fitness to practise process, lacks insight…;

• where there are serious or persistent overall failings.

22. The Panel took the view that the Registrant is either unwilling or unable to provide the information and evidence that was suggested by the substantive hearing panel and the first review panel. Although the Panel acknowledged that the Registrant’s failings are potentially capable of being remedied, in the absence of engagement from the Registrant, there was no indication that the Registrant is committed to addressing the issues which led to the previous findings of impairment. In these circumstances the Panel could have no confidence that he would comply with a Conditions of Practice Order, even if suitable conditions could be formulated. The Panel was aware that the suggestions made by the previous panel are only indicative and do not have any binding authority, unlike conditions which require compliance. However, both involve willingness on the part of the Registrant and a determined effort. In the absence of any evidence that the Registrant is willing and able to remediate his previous misconduct the Panel concluded that there were no conditions it could devise which would be appropriate, workable and measurable.

Suspension Order

23. The Panel next considered extending the current Suspension Order for a further period. The Panel noted that a Suspension Order would prevent the Registrant from practising during the extended suspension period, which would therefore protect the public and the wider public interest. However, the Panel took into account the fact that the Registrant was warned by the first review panel that ‘[he] should be in no doubt that there will be a significant risk of a Striking Off Order at the next review if he fails to make use of this opportunity to address his failings and engage with the HCPC in these proceedings’. The panel noted that for a second time the Registrant has failed to take advantage of the opportunity that was presented to him and the Panel concluded that no useful purpose would be served by providing him with a further opportunity.

24. The Panel took into account paragraph 41 of the ISP which 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.’

25. The Panel concluded that this paragraph applied to the Registrant. The Panel was satisfied that he had exhausted both opportunities to demonstrate that he is fit to return to practise. The Panel was also satisfied that the Registrant’s repeated failure to demonstrate further insight and any steps taken towards remediation strongly indicated that he had no intention of doing so.

Striking Off Order

26. The Panel took into account paragraph 48 of the ISP which states:
‘Striking off should be used where there is no other way to protect the public, for example, where there is a lack of insight, continuing problems or denial. A registrant’s inability or unwillingness to resolve matters will suggest that a lower sanction may not be appropriate.’

27. The Panel concluded that the Registrant’s repeated failure to address the serious concerns that have been identified, the absence of insight and his inability or unwillingness to engage with these proceedings is fundamentally incompatible with continued registration. Furthermore, the Panel concluded that there was no public interest in continuing to review this case given the Registrant’s persistent non-engagement. The Panel was satisfied that removal from the register is the only means to protect service users and the wider public interest.

28. Accordingly, the Panel concluded that the appropriate and proportionate sanction would be a Striking Off Order.

 

Order

Order: The Registrar is directed to Strike the name of Christopher Turner from the register upon the expiry of the current Order

Notes

No notes available

Hearing History

History of Hearings for Christopher J Turner

Date Panel Hearing type Outcomes / Status
20/08/2018 Conduct and Competence Committee Review Hearing Struck off