Mrs Cavel Callender
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The following allegation was found proved by a Panel of the Conduct and Competence Committee at the substantive hearing on 20 – 22 March 2017.
While employed as an Operating Department Practitioner by the Heart of England NHS Foundation Trust:
1. Between 16 June 2014 and 4 July 2014 you:
a) Did not check the anaesthetic machine correctly during a simulation exercise with Colleague A.
b) Did not demonstrate to Colleague C general knowledge about anaesthetic machines and how to check them.
2. On or around 4 July 2014, whilst recovering post-theatre patients, you copied observations and/or documentation from a previous recovery phase instead of taking and recording new observations and/or documentation of the patient.
3. On or around 28 July 2014, whilst being supervised by Colleague A:
a) You were unable to distinguish between safe and unsafe thoracic suctioning.
b) You incorrectly measured a patient’s respiration rates.
c) Regarding at least one of your patients that day, you:
i) Did not regularly measure the patient’s respiration rate;
ii) Did not regularly measure the patient’s temperature;
iii) Did not accurately record the patient’s respiration rate;
iv) Did not accurately record the patient’s temperature.
4. On or around 31 July 2014, while recovering a patient who had undergone surgery, you did not conduct a complete handover to the medical team.
5. [Found Not Proved]
6. On or around 27 October, whilst observed by Colleague C, you:
a) Suggested an inappropriate and/or unsafe treatment plan for a patient which high blood pressure.
b) Gave an incorrect handover to a medical team.
c) Were unable to state the side effects of and/or appropriate doses for cyclizine.
d) Did not identify that the wrong pressure had been set and/or implement the correct chest pain drain pressure for a patient.
7. On or round 4 November 2014, while working with Colleague A, you:
a) Did not regularly measure the respiratory rate for at least one patient.
b) Did not accurately record the respiratory rate for at least one patient.
8. On or around 21 November 2014, while being observed by Colleague C and/or Colleague D, you:
a) Did not set up the theatre correctly.
b) Did not complete the required paperwork as requested.
9. On or around 27 November 2014, while working with Colleague C, you did not load the echelon gun correctly.
10. On or around 3 December 2014, while working with Colleague D, you did not recall that a large swab was in the chest of a patient when performing a swab check.
11. The matters described in paragraphs 1 -11 constitute misconduct and/or lack of competence.
12. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
Service of Notice
1. The Panel found that there had been good service of the Notice of Hearing by letter, dated 12 February 2019 (to the Registrant’s registered address), and by email which informed the Registrant of the date, time and venue of the review hearing.
2. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied, on the documentary evidence provided, that the Registrant had been served notice of this hearing in accordance with the Rules.
Proceeding in the absence of the Registrant
3. Ms Iskander, on behalf of the HCPC, made an application for the hearing to proceed in the absence of the Registrant.
4. The attention of the Panel was drawn to documentation within the bundle which demonstrated that attempts had been made by the HCPC to make contact with the Registrant by email on 04 March 2019 and by telephone (twice) on 13 March 2019. All of these attempts were fruitless.
5. The Panel accepted the advice of the Legal Assessor and applied the guidance in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.
6. Given that good service has already been found and that this is a mandatory review, the Panel has decided that it is appropriate to proceed in the absence of the Registrant. It notes that the Registrant has not appeared in the past and that the last time she appears to have engaged with the HCPC, in any form, was by telephone on 01 March 2018. There has been no application from her to adjourn today’s hearing and it is the Panel’s decision that it is in the public interest to grant this application.
7. The Registrant is registered with the HCPC as an Operating Department Practitioner (ODP). The Registrant started her employment as an ODP at the Heart of England NHS Foundation Trust on 16 June 2014. She was a Band 5 Practitioner.
8. During the course of the Registrant’s employment with the Trust she was exposed to all the areas in which she would be expected to work, e.g. Scrubs (surgery), Anaesthetics and Recovery. Her probationary period was meant to last for 12 weeks but this was extended for a further 3 months due to both the Registrant’s lack of progress and her sick leave. This additional time was to give her the best chance to improve her performance. Notwithstanding the additional support, the Registrant did not pass her probation.
9. The substantive hearing took place between 20 and 22 March 2017. That panel imposed a suspension order of 12 months. It found that the Registrant had breached fundamental standards of the profession and had failed to acknowledge her failings or to show any insight, remorse or remediation. The substantive panel considered that a less restrictive sanction would fail to protect the public and would undermine public confidence in the profession and the Regulator.
10. On 01 March 2018, the Registrant telephoned the HCPC and said, amongst other things, that she had been doing some volunteer work for an organisation that sends medical equipment to third world countries and added that “she has had some health issues which have been restrictive over the past few months”. This is the last communication that the HCPC has received from the Registrant.
11. At the first review hearing on 12 March 2018, the panel found that the Registrant’s fitness to practise remained impaired and, by way of sanction, it extended the suspension order by a further period of 12 months. That Panel repeated the view of the substantive hearing panel that the risks identified remained and therefore, the Registrant’s fitness to practise was impaired on the grounds of both public protection and the wider public interest. It echoed the views of that earlier panel that the Registrant’s lack of competence was wide ranging and profound and that there had been no evidence of remediation, insight or any acknowledgement of her failings and that her actions posed a risk to service users. A recommendation was made, by the reviewing panel, that a future reviewing Panel would be assisted if the Registrant were to participate at the second review and if she produced a number of documents to evidence any steps she may have taken to improve her knowledge and understanding. It also suggested that
a reflective piece about her practice at the Trust might also assist a future reviewing panel and that up to date information about her health would also be helpful.
12. As noted in paragraph 4 above, attempts since by the HCPC to make contact with the Registrant by email and by telephone have been in vain.
Review Hearing (today):
13. Ms Iskander submitted that the Registrant has completely disengaged herself from the process and that her fitness to practise remains impaired. She further submitted that the appropriate sanction, given that the imposition of a striking off order is not available today to the Panel, should be an extension of the suspension order for a further period of 12 months.
Decision on Impairment:
14. The Panel heard and accepted the advice of the Legal Assessor. The Panel exercised its independent judgement in determining whether the Registrant’s fitness to practise remains impaired. It had regard to the HCPTS Practice Note on Impairment and the Indicative Sanctions Policy (the Policy).
15. Noting that there has been no material change in circumstances over the past 12 months, the Panel accepted the contention of Ms Iskander that the Registrant has not engaged with her regulatory body and that the last contact that was made with her was over one year ago. The failings identified in her practice, at the substantive hearing, were extremely serious. They caused a witness called to give evidence at that hearing to describe her performance as “woeful and dangerous”.
16. In the view of the Panel, there remains a significant risk of harm to service users if the Registrant was permitted to return to unrestricted practice. There is no evidence that the Registrant has made any attempts to remedy her serious and wide ranging clinical deficiencies. Bearing this is mind and the need to protect the public and to maintain public confidence in the profession and the regulatory process, the Panel’s view is that the Registrant’s fitness to practise remains impaired.
Decision on Sanction:
17. In determining its approach to sanction, the Panel took into account the contents of the HCPC Indicative Sanctions Policy and applied the principles of proportionality.
18. The Panel reminded itself that the purpose of imposing a sanction is not to punish the practitioner, but to protect the public and the wider public interest.
19. The Panel adopted the approach of the previous panel, and shares the view that a conditions of practice order would be inappropriate in this case and that the only appropriate and proportionate sanction would be to impose a further period of suspension. The period is one of 6 months and is designed to give the Registrant a final opportunity to engage in the process and to provide the next reviewing Panel with the information that was recommended by the reviewing panel on 12 March 2018.
The Registrar is directed to suspend the registration of Mrs Cavel Callender from the Register for a further period of 6 months.
The order imposed today will apply from the expiry of the current order on 19 April 2019.
This order will be reviewed again before its expiry.