Mrs Sarah Holt

Profession: Paramedic

Registration Number: PA38872

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 12/08/2019 End: 17:00 16/08/2019

Location: Health and Care Professions Tribunal Service, 405 Kennington Road

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

Whilst registered as a Paramedic and employed by North West Ambulance Service:

 

1. On 5 March 2016:

 

a)      In relation to Patient A, you:

 

i. Did not undertake a full set of observations and/or examinations;

 

ii. Recorded that Patient A refused to attend hospital, when this was not the case.

 

b) In relation to Patient B, you:

 

i. Did not undertake a full set of clinical observations and/or examinations;

 

ii. Did not request Colleague A to undertake the clinical observations in the event you were unable to;

 

iii. Did not provide appropriate pain relief;

 

iv. Did not take the patient to hospital;

 

v. Inappropriately said to Patient B A ‘There’s nothing much we can do for you, you’ve got a stomach bug, you need to man up and get on with it’ or words to that effect.

 

vi. Recorded that Patient B refused to attend hospital, when this was not the case.

 

c) In relation to Patient C, you:

 

i. Did not undertake a full set of clinical observations and/or a complete assessment;

 

ii. Did not make a referral to an urgent care centre;

 

iii. Did not complete the PRF adequately.

 

2. On or around 13 March 2016, in relation to Patient D, you: 

 

i. Did not undertake a full set of clinical observations and/or examinations and/or did not make adequate attempts to undertake a full set of observations and/or examinations;

 

ii. Did not complete the PRF adequately.

 

3. You recorded observations on Patient A’s PRF when one or more of these observations had not been undertaken.

 

4. You recorded observations on Patient B’s PRF when one or more of these observations had not been undertaken.

 

5. The matters described in particulars 1a)ii), 1b)vi), 3, and 4 were dishonest.

 

6. The matters described at particulars 1 and 2 amount to misconduct and/or lack of competence.

 

7. The matters described at particulars 3 to 5 amount to misconduct.

 

Finding

Preliminary Matters

Application to hear part of the hearing in private.

1.The Panel heard that matters relating to the Registrant’s health and other matters relating to her private life may be referred to during the course of the hearing. Mr Dite submitted that it was appropriate that those parts of the hearing be held in private and the Registrant supported the application.

2.The Panel accepted the Legal Assessor’s advice and it noted Rule 10(1)(a) of the Health and Care Professions Council (Conduct and Competence Committee) Procedure Rules 2003 (“the Rules”) whereby matters pertaining to the private life of the Registrant, the complainant, any person giving evidence or of any Patient or Client should be heard in private. The Panel therefore agreed that those parts of the hearing where reference was to be made to the Registrant’s health and other private matters, should be heard in private.

Application to amend the charge.

3.At the outset of the hearing Mr Dite, on behalf of the HCPC made an application to amend the Allegation. The Registrant had been put on notice of the proposed amendments in a letter dated 16 October 2017. He submitted that the proposed amendments did not change the substance of the allegation the Registrant faced, but merely ensured that the allegation better reflected the evidence available.

4.The proposed amendments are set out above.

5.The Registrant accepted the amendments and raised no objection to the particulars being amended.

6.The Panel accepted the advice of the Legal Assessor and carefully considered the HCPC application to amend the particulars. The Panel concluded, after reviewing each of the proposed amendments, that it would agree to the particulars being amended for the following reasons:

i.the Registrant had been provided with significant notice of the HCPC’s intention to amend the Allegation, having been put on notice in October 2017, some twenty two months before the commencement of the substantive hearing;

ii.the Registrant had not objected to the proposed amendments and;


iii.the proposed amendments do not widen the scope of the Allegation, but merely seek to better reflect the evidence.

7.The Panel concluded that the proposed amendments of the particulars did not materially affect the nature or seriousness of the Allegation. In all the circumstances, there was no likelihood of injustice to the Registrant. The Panel therefore agreed to the proposed amendments.

Background

8.The Registrant was employed by North West Ambulance Service (NWAS) as a Band 5 Paramedic.

9.On 16 March 2016, IM, an Emergency Medical Technician, raised a complaint about the Registrant in relation her conduct towards three service users.

10.It is alleged that IM attended Patient A with the Registrant on 5 March 2016. Patient A was experiencing lower back pain and a pain in her left leg. IM was concerned that a full set of observations had not been carried out by the Registrant. However, it is alleged that a full set of observations were recorded on Patient A’s Patient Report Form (PRF).

11.IM also attended Patient B on the same day with the Registrant. Patient B was presenting with severe abdominal pain and had been vomiting. It is alleged that when the Registrant attended Patient B, she made a remark about having a stomach bug and told him to “man up”. IM did not recall a full set of observations being carried out by the Registrant. However, it is alleged that a full set of observations were recorded on Patient B’s PRF.

12.It is also alleged that in relation to Patient B, that the Registrant did not convey Patient B to hospital and did not discuss treatment options with him.

13.IM and the Registrant also attended Patient C the same day. Patient C was presenting with peri-rectal (PR) bleeding. It is alleged that no observations were taken in relation to Patient C by the Registrant and that he was not transferred to hospital.

14.On 13 March 2016, the Registrant was working with TJ, an Emergency Medical Technician, when they attended Patient D. Patient D was presenting with PR bleeding and dizziness. It is alleged that no observations were taken in relation to Patient D by the Registrant and she was not transferred to hospital.

15.At the outset of the hearing, the Registrant admitted the following particulars: 1b) in its entirety; 1c)i; 1c)iii; 2ii; 4 and 5 in respect of particulars 1b)vi) and 4. All the other particulars were denied.

Decision on Facts

Assessment of witnesses

16.The Panel firstly considered the credibility of the witnesses who had given live evidence. The Panel first heard from witness IM. He gave evidence as to the events of 5 March 2016 in relation to Patients A, B and C. The Panel considered that his evidence was measured and balanced and not prone to exaggeration. The Panel considered that he was an honest, credible, consistent, and reliable witness.

17.The Panel also heard evidence from witness TJ, an Emergency Medical Technician. He gave evidence in relation to Patient D and the events of 13 March 2016. The Panel also found him to be an honest, clear, reasoned and credible witness.

18.The Panel also heard evidence from witness PA, an Investigating Officer. The Panel found him to a balanced, credible, consistent, and reliable witness. The Panel considered his investigation report to be thorough, objective and balanced.

19.The Panel is mindful of the hearsay nature of some of the HCPC evidence, but has nevertheless attributed substantial weight to it given its consistency with other HCPC witnesses, the documentary evidence before the Panel, and in numerous instances, the Registrant’s admissions.

20.The Panel also heard from the Registrant and carefully considered the weight, credibility and reliability of her evidence. In doing so the Panel bore in mind that that her defence is principally that she does not recall her attendance on Patient A, and that she disputes she was with TJ when he attended on Patient D. The Panel therefore concluded that, given its assessment of the HCPC witnesses as credible and reliable witnesses, who were consistent with each other and the supporting documentary evidence, where there was a conflict between their evidence and that of the Registrant, the evidence of the HCPC witnesses was to be preferred.

Panel’s Approach

21.The Panel was aware that the burden of proving the facts was on the HCPC. The Registrant did not have to prove anything and the individual particulars of the allegation could only be found proved if the Panel was satisfied that that was the case on the balance of probabilities.

22.In reaching its decision, the Panel took into account the oral evidence of the HCPC witnesses, together with all the documentary evidence provided to it, including the Registrant’s evidence, documents submitted by her and her submissions, as well as the oral submissions made by Mr Dite on behalf of the HCPC.

23.The Panel also accepted the advice of the Legal Assessor, which, together with Mr Dite’s and the Registrant’s submissions, are a matter of record.

Particular 1

Particular a)i

24.The Panel found the facts of particular a)i proved for the following reasons.

25.The Panel heard and accepted the evidence of IM. He stated that he attended Patient A with the Registrant. Patient A was suffering from back pain. He stated that, he did not recall the Registrant carrying out any observations or examinations on Patient A other than using the pulse oximeter. The Panel also had regard to the contents of PA’s interview with Patient A, which was consistent with IM’s evidence that no physical examination or observations took place.

26.The Registrant stated that she could not recall this patient. However, given the consistent evidence of IM and PA, the Panel finds that the Registrant did not undertake a full set of observations and/or examinations on Patient A.

27.The Panel therefore finds the facts of particular a)i proved.

Particular a)ii

28.The Panel found the facts of particular 1a)ii not proved for the following reasons.

29.The Panel has had regard to the contents of Patient A’s PRF which stated that Patient A refused to go to hospital. The Panel also notes that in the interview of Patient A with PA, Patient A is recorded as having stated that “She wrote all my details down and then told me that they could either take me to Blackburn Hospital or I could take myself to the Urgent Care Centre at Burnley”.

30.In the circumstances, the Panel finds that Patient A was offered the option of being taken to hospital, but that she had refused to go. The Panel therefore finds the facts of particular 1a)ii not proved.

Particular b)

31.In relation to particular b), the Panel has borne in mind that the HCPC have relied in the statement of Patient B which has been adduced by way of hearsay evidence because Patient B cannot now be located and therefore called to give live evidence. In considering the weight to be attached to Patient B’s statement generally, the Panel has taken into account the advice of the Legal Assessor, but has balanced this with the following:

•That the contents of Patient B’s statement is consistent with the evidence of IM and PA and the documentary evidence adduced, and

•That the Registrant admits the factual particulars alleged in relation to Patient B.

32.In the circumstances, the Panel has concluded that weight can be placed on Patient B’s statement as being credible and reliable as to its contents.

Particular b)i

33.The Panel found the facts of particular b)i proved for the following reasons.

34.The Panel accepts the evidence of IM who stated that the Registrant did not undertake a full set of clinical observations and/or examinations. His evidence is corroborated by the statement of Patient B and Patient B’s PRF. In his interview with PA, Patient B stated that “I can’t really recall the female doing anything actually” and stated that he did not recall the Registrant taking his temperature, pulse or undertaking an abdomen examination despite stating that he was in pain. In addition, the Registrant admits the facts of this particular to the extent that she accepted that she did not take Patient B’s blood pressure.

35.The Panel therefore finds the facts of particular b)i proved.

Particular b)ii

36.The Panel found the facts of particular b)ii proved for the following reasons.

37.Having found that the Registrant had not undertaken a full set of observations and/or examinations, the Panel had regard to the fact that the Registrant conceded in evidence that she did not ask her colleague, IM, to undertake the clinical observations.

38.The Panel therefore finds the facts of particular b)ii proved.

Particular b)iii

39.The Panel found the facts of particular b)iii proved for the following reasons.

40.In reaching its decision, the Panel had regard to the contents of PA’s interview with Patient B. In it, he stated that he was told that, despite complaining of being in a lot of pain, “there wasn't anything she could give me”. This was corroborated by the evidence of IM who stated that the Registrant had said that there was nothing that could be done for him.

41.The Panel has also noted the contents of Patient B’s PRF, noting that the medications section of the form is blank. The Panel also notes that the factual particular is admitted by the Registrant.

42.The Panel therefore finds the facts of particular b)iii proved.

Particular b)iv

43.The Panel found the facts of particular b)iv proved for the following reasons.

44.Patient B in his interview to PA stated that he was not taken to hospital. This was confirmed by IM in his evidence and is consistent with Patient B’s emergency call log.  Furthermore, the Registrant admits that Patient B was not taken to hospital.

45.The Panel therefore finds the facts of particular b)iv proved.

Particular b)v

46.The Panel found the facts of particular b)v proved for the following reasons.

47.Patient B in his interview with PA stated that the Registrant used the words alleged. This was corroborated by the evidence of IM. In addition, the Registrant admitted that she used the words alleged, albeit that she did so in the mistaken belief that it would “lighten the mood”.

48.The Panel therefore finds that the Registrant did use the words alleged or words to that effect. The Panel also notes that the Registrant had not undertaken a full set of clinical observations and was therefore unable to assess the true state of Patient B’s condition at the time she made the comments in question. The Panel therefore concluded that, in the circumstances, the words used by the Registrant were inappropriate. 

49.The Panel therefore finds the facts of particular b)v proved.

Particular b)vi

50.The Panel found the facts of particular b)vi proved for the following reasons.

 


51.It is not disputed that the Registrant recorded that Patient B refused to attend hospital by ticking the appropriate box that he had refused transport. She stated that she was confused about how to complete the form. However, the Panel notes that in the ‘History’ section of the Patient’s PRF, it was unequivocally stated that the patient did not wish to attend hospital and this is noted on Patient B’s emergency call log.

52.The Panel has noted, and accepts the evidence of that Patient B, that he stated that the Registrant “refused to take me to the hospital”. This was consistent with the evidence of IM who stated that the Registrant did not give Patient B the option of going to hospital.

53.In the circumstances, the Panel finds that the Registrant recorded that Patient B refused to attend hospital when this was not the case. The Panel therefore finds the facts of particular b)vi proved.

Particular c)i

54.The Panel found the facts of particular c)i proved for the following reasons.

55.The Panel has had regard to the contents of Patient C’s PRF on which no observations have been logged. IM also stated in evidence that the Registrant had not undertaken a full set of clinical observations. The Registrant accepted that she had not undertaken a full set of clinical observations, but stated that this was because she stated that the patient had refused to allow it to be done.

56.In the circumstances, the Panel finds that, as a matter of fact, that the Registrant did not undertake a full set of clinical observations or, as a result, a complete assessment. The Panel therefore finds the facts of particular c)i proved. Whether this finding raises issues of culpability will be addressed when the Panel considers the question of misconduct and/or lack of competence.

Particular c)ii

57.The Panel found the facts of particular c)ii proved for the following reasons.

58.It was the Registrant’s evidence that, whilst accepting that she did not make a referral to an urgent care centre, she was not in a position where she could have done so. The practice, she submitted, was to suggest that a patient attend an urgent care centre, but she could not formally make a specific referral.

59.In the circumstances, the Panel finds that, as a matter of fact, the Registrant did not make a referral as alleged. The Panel therefore finds the facts of particular c)ii proved. Whether this finding raises issues of culpability will be addressed when the Panel considers the question of misconduct and/or lack of competence.

Particular c)iii

60.The Panel found the facts of particular c)iii proved for the following reasons.

61.The Panel has had sight of Patient C’s PRF. It shows that no observations, including any passive observations, were recorded. The Panel has found, for the reasons set out above, that the Registrant failed to undertake a full set of clinical observations.

62.The Panel has accepted the evidence of PA that a full set of clinical observations should be carried out. If refused by the patient, the PRF should reflect this, but Patient C’s does not.

63.The Panel in reaching its decision, has also taken into account the fact that the Registrant admits the factual particulars alleged.

64.The Panel therefore finds that patient C’s PRF was not adequately completed. The Panel therefore finds the facts of particular c)iii proved.
 
Particular 2

Particular 2i

65.The Panel found the facts of particular 2i proved for the following reasons.

66.The Panel first considered whether the Registrant attended on the call to Patient D on 13 March 2016.

67.The Registrant submitted that the evidence of TJ was incorrect in that she did not attend the patient with him. The Panel has, however, perused the contents of the emergency call log for this patient which identifies that TJ and the Registrant were crew together on a double maned ambulance on the date in question. The Panel is therefore satisfied, that both TJ and the Registrant were the allocated crew members.

68.TJ gave unequivocal evidence that the Registrant had not undertaken any observations and that he would have expected basic observations, including heart rate, blood pressure, oxygen saturation and blood sugar to have been taken.

69.The Registrant stated that she had not undertaken a full set of observations because the patient did not want it to be done.

70.In the circumstances, the Panel finds that, as a matter of fact, the Registrant acted as alleged and therefore finds the facts of this sub-particular proved. Whether this finding raises issues of culpability will be addressed when the Panel considers the question of misconduct and/or lack of competence.

Particular 2ii

71.The Panel found the facts of particular 2ii proved for the following reasons.

72.The Panel has had sight of Patient C’s PRF. This shows that, despite the Registrant’s assertion that the patient refused to have observations undertaken, the relevant box on the PRF has not been completed to that effect.

73.The Panel has also taken into account that the Registrant admits the facts of this sub-particular.

74.The Panel therefore found the facts of particular 2ii proved.
 
Particular 3

75.The Panel found the facts of particular 3 proved for the following reasons.

76.It notes that it has found that the Registrant did not undertake a full set of observations and in reaching that finding, has taken account of the contents of Patient A’s interview with PA in which Patient A stated that observations were not carried out and IM’s evidence that no observations were carried out save for a pulse oximeter.

77.The Panel has considered the contents of Patient A’s PRF in which readings have been recorded for blood pressure, blood sugar and temperature.

78.In the circumstances, the Panel finds that the Registrant has recorded observations when one or more of the observations had not been undertaken.

79.The Panel therefore found the facts of particular 3 proved.

Particular 4

80.The Panel found the facts of particular 4 proved for the following reasons.

81.The Panel has found that the Registrant did not undertake a full set of observations and in reaching that finding, has taken account of the contents of Patient B’s interview with PA in which Patient B stated that observations were not carried out and IM’s evidence that no observations were carried out.

82.The Registrant accepts that a blood pressure reading was not taken. The Panel however notes that a reading for blood pressure was recorded on Patient B’s PRF. 

83.In the circumstances, the Panel finds that the Registrant has recorded observations when one or more of the observations had not been undertaken.

84.The Panel therefore found the facts of particular 4 proved.
 
Particular 5

85.The Panel finds the facts of particular 5 proved in respect of particulars 1b)vi, 3 and 4 for the following reasons.

86.In considering whether the respondent acted dishonestly, the committee has applied the test for dishonesty as set out in Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67.

“When dishonesty is in question the fact-finding tribunal must first ascertain subjectively the actual state of the individual’s knowledge or belief as to the facts. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held. When once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the objective standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he has done is, by those standards, dishonest.”

Dishonesty in relation to particular 1a)ii)

87.The Panel having found the facts of particulars 1a)ii, not proved, the Panel has not gone on to consider the allegation of dishonesty in respect of this sub-particular.

Dishonesty in relation to particular 1b)vi)

88.The Panel having found the facts of particular 1b)vi, proved, then considered whether the Registrant’s conduct was dishonest.

89.The Panel concluded in respect of this Particular, that the Registrant recorded that Patient B refused to attend hospital when this was not the case. The Panel finds that the Registrant knew at the time that Patient B had not refused to attend hospital and relies on her admission to this effect. The Panel notes that the Registrant admits that she acted dishonestly as alleged. The Panel considered that ordinary members of the public would consider that recording Patient B's refusal to attend hospital in these circumstances would be considered dishonest.

90.The Panel therefore concluded that in relation to this Particular, the Registrant acted dishonestly. The Panel therefore finds this Particular proved in respect of particular 1b)vi.

Dishonesty in relation to particular 3

91.The Panel having found the facts of particular 3, proved, then considered whether her conduct was dishonest.

92.The Panel concluded in respect of this particular, that the Registrant recorded observations on Patient A’s PRF when one or more of the observations had not been done. The Registrant had not undertaken a full set of observations yet had recorded them as having been done. The Panel considered that the Registrant knew at the time that what she had recorded was not true and accurate.

93.In addition, in reaching its decision, the Panel noted that in respect of Particular 4, the Registrant admitted that she acted dishonestly to make her PRF “look good” knowing that its contents were false at a time when criticism was being made of her paperwork. The Registrant conceded in response to questions put to her in cross examination that she “might have” added observations to make the form look better. The Panel therefore considered that the Registrant adopted the same reasoning in relation to Patient A’s PRF, noting that both forms were completed on the same day.

94.The Panel considered that ordinary members of the public would consider that recording observations on a patient’s PRF knowing that they had not been done to be dishonest.

95.The Panel therefore concluded that in relation to this Particular, the Registrant acted dishonestly. This Particular is found proved in respect of particular 3.

Dishonesty in relation to particular 4

96.The Panel having found the facts of particular 4, proved, then considered whether her conduct was dishonest.

97.The Panel concluded in respect of this Particular, that the Registrant recorded observations on Patient B’s PRF when one or more of the observations had not been done. The Panel considered that the Registrant knew at the time that what she had recorded was not true and accurate and relies on her admission to this effect that she acted dishonestly to make her paperwork look better. The Panel considered that ordinary members of the public would consider that recording observations on a patient’s PRF knowing that they had not been done to be dishonest.

98.The Panel therefore finds that in relation to this particular, the Registrant acted dishonestly, and is found proved.

99.In summary, the Panel therefore finds the facts of particular 5 proved in relation to sub-particulars 1b)vi), 3 and 4.

Decision on Grounds


137.The Registrant submitted that she had learned from her mistakes and that the testimonial evidence provided as well as the oral evidence and that live evidence of FQ supported her assertion that her mistakes would not be repeated. She reminded the Panel that there had been no further issues raised about her practice. 

Decision on Sanction

138.The Panel accepted the advice of the Legal Assessor who referred it to HCPC’s SP. He reminded the Panel it should consider any sanction in ascending order, and to apply the least restrictive sanction necessary to protect the public and the public interest. It should also consider any aggravating and mitigating factors and bear in mind proportionality. He reminded the Panel that the primary purpose of imposing a sanction was protection of the public and the public interest and that there was a need to balance those interests with the interests of the Registrant.

139.In reaching its decision on whether to impose a sanction, and if so, which one, the Panel has reminded itself that in respect of its finding on impairment, it has found that the Registrant has developed insight into her failings and that it considered that her misconduct was highly unlikely to be repeated. The Panel did not therefore consider that the Registrant posed an ongoing risk to the public, but that any sanction should reflect the need to uphold the public interest and mark the seriousness of the misconduct found proved. In that regard, the Panel has had due regard to paragraphs 56-58 of the SP, noting the impact of dishonesty on public confidence.

140.The Panel considered all the information before it. In doing so, the Panel identified the following aggravating factors:

a.That the Registrant behaved dishonestly on two occasions in a work setting, albeit on the same shift, which posed a potential risk to patient safety;
b.The Respondent’s failure to undertake a full set of observations had the potential to put patients at risk.

141.The Panel identified the following mitigating factors:

a.These were isolated incidents in an otherwise unblemished career;
b.The Registrant self-referred to the HCPC and at that time accepted that she had behaved dishonestly;
c.The Registrant has engaged in the regulatory process and made early admissions to a number of particulars, including dishonesty, at the outset of the hearing;
d.The Registrant had difficult personal circumstances at the time that impacted on her performance.
e.The Registrant has provided a number of positive testimonials, and the Panel heard oral evidence from FQ attesting to her character and professionalism;
f.The Registrant has apologised on a number of occasions.

142.Considering all the circumstances in the round, the Panel considered the Registrant’s dishonesty to be towards the centre of the spectrum of dishonesty.

143.The Panel approached the issue of sanction starting with the least restrictive first, bearing in mind the need for proportionality and to take into account the Registrant’s interests. Taking no further action would not reflect the nature and gravity of the misconduct. The Panel therefore concluded that taking no action would not be adequate given the wider public interest of maintaining confidence in both the profession and the regulatory process. Such an outcome was therefore neither appropriate nor proportionate in the circumstances.

144.The Panel considered mediation, but having had due regard to the circumstances of this case, such an outcome was irrelevant to the issues raised and is therefore not an appropriate outcome.

145.The Panel then considered whether to impose a Caution Order and had regard to paragraphs 99-102 of the SP. It considered that whilst the dishonesty was not minor in nature, it was isolated and limited in time. The Panel has identified that the Registrant is highly unlikely to repeat her misconduct given that she has demonstrated sufficient insight into her failings and that there has been no recurrence of her failings during the course of her work over the last two years.

146.Notwithstanding the nature of the dishonesty proved, given the persuasive   mitigating factors present, the Panel concluded that a Caution Order was appropriate and proportionate to protect the public interest. In considering the length of the Caution Order, the Panel considered that the gravity of the misconduct could be adequately reflected by a 5 year order (the maximum period available).

147.The Panel considered whether a Conditions of Practice Order was appropriate. It has had regard to paragraphs 105-109 of the SP. This is not a case where there are ongoing concerns in relation to identifiable areas of the Registrant’s practice which could be addressed by the imposition of conditions of practice. The Panel has already determined that it considered it highly unlike that she repeat her misconduct. Having done so, it has concluded that such a sanction would neither be appropriate nor proportionate to address the public interest concerns identified.

148.In satisfying itself that a Caution Order was appropriate, and having concluded that a Conditions of Practice Order was inappropriate, the Panel went on to consider the sanction of suspension. The Panel has borne in mind that this might be an appropriate sanction to impose where the allegation is serious but is unlikely to be repeated. The Panel has borne in mind paragraphs 118 - 126 of the ISP which states such a sanction might be appropriate where “there is evidence to suggest that the Registrant is likely to be able to resolve or remedy their failings”. The Panel noted paragraph 124 of the SP in that a short period of suspension might be appropriate where there is no ongoing risk of harm, but where further action is required in order to maintain public confidence in the profession.

149.In light of its findings, and particularly, bearing in mind the mitigating factors present, the Panel considered that the need to protect the public interest by sending a clear message upholding and declaring proper standards of conduct and behaviour, could be met by the imposition of a Caution Order. The Panel was satisfied that in all the particular circumstances of this case a 5 year order is proportionate to address the public interest concerns and marks the unacceptability of the Registrant’s conduct. Applying the principle in Chaudhury v GMC [2002] UKPC 41, the Panel is mindful that any sanction imposed should be no more severe than is needs to be to achieve its ends. It therefore concluded that a Suspension Order would be disproportionate and unduly punitive.

Order

The Registrar is directed to annotate the register entry of Mrs Sarah Holt with a caution which is to remain on the register for a period of five years from the date this order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Mrs Sarah Holt

Date Panel Hearing type Outcomes / Status
12/08/2019 Conduct and Competence Committee Final Hearing Caution
25/03/2019 Conduct and Competence Committee Final Hearing Adjourned
15/10/2018 Conduct and Competence Committee Final Hearing Adjourned