Miss Lucy J Bambridge

Preliminary matters:

Service and Proceeding in Absence

1. The Panel is satisfied that there has been good service of the Notice of Hearing.

2. The Registrant did not attend the final hearing. The Panel first considered whether it ought to exercise its discretion to continue with this hearing in the absence of the Registrant.

3. The Panel concluded that it was in the public interest to do so, having considered the HCPC Practice Note on “Proceeding in the Registrant’s Absence”, and having taken the Legal Assessor’s advice, and having considered the guidance in R v Jones [2002] UKHL 5 and GMC v Adeogba, R v Hayward [2001] EWCA Crim 168 and GMC v Visvardis [2016] EWCA Civ 162, for the following reasons:(a) The Panel is satisfied that the Registrant had notice of the hearing;

(b) The Panel had seen a pro forma response from the Registrant, in which she confirms she will not be attending the hearing, as she now resides in Australia;

(c) The Registrant was offered the opportunity to proceed by way of telephone or video link on 19 August 2019. She did not reply;

(d) The Registrant has previously provided written submissions at the Investigating Committee stage. In addition, the Registrant’s written response in the Trust’s internal investigation, is contained within the bundle.

(e) The Registrant has not sought an adjournment;

(f) The Panel concluded that even if these proceedings were adjourned there was very little likelihood that the Registrant would attend on a subsequent occasion;

(g) The Panel concluded that the Registrant had deliberately chosen not to attend this hearing, amounting to a deliberate voluntary waiver of her right to appear,

(h) There were two witnesses who have attended to give oral evidence. It was in the public interest that a hearing should take place within a reasonable time of the events to which it related,

(i) The Panel determined that it was reasonable and in the public interest to proceed, in all the circumstances, given that the events in question are now 2 years old, dating back to November 2017.

Application to Amend

4. There was an initial application by the HCPC to amend the Particulars of the Allegation. The Registrant was put on notice of the proposed amendment on 30 July 2019. There has been no objection raised by her to the proposed amendment.

5. The amendment to Particular 1(b)(i) added some additional words, to the factual allegation.

6. The second amendment related to Particular 1(b)(iii) adding a new factual allegation. However, the Panel noted that the Registrant had addressed this allegation in her response to the internal Trust enquiry.

7. The reason for the amendments is that the original Particulars of Allegation were drafted prior to the obtaining of witness statements and in particular, from Colleague A. The amended allegation now better fits with the evidence before the Panel, and in particular that of Colleague A.

8. The Panel granted the application, noting the lack of objection from the Registrant and the absence of any significant prejudice to the Registrant in doing so.

9. The Particulars of Allegation as set out above is therefore the amended allegation.

10. The Panel has been provided with a substantive bundle of documents which runs to 25 pages from the HCPC. There was one additional document provided, namely the formal response sent by the Trust to Person A’s complaint, dated 05 March 2018.

11. The Panel has also seen written submissions made by the Registrant and submitted at the Investigating Committee stage.

Background

12. The Registrant is a Paramedic. She was employed by the East of England Ambulance Service NHS Trust (hereafter, “the Trust”) between 07 January 2013 and her resignation on 11 December 2017. The Registrant was a Band 5 Paramedic at the time of the allegations.

13. The Panel has heard oral evidence on behalf of the HCPC from:

(1) Colleague A, Eyewitness, and Emergency Medical Technician, with the Trust,

(2) DS, Investigating Officer, and Leading Operations Manager with the Trust.

14. The referral to the HCPC arose out of an incident which occurred on 28 November 2017. The Registrant’s role was to attend patients in Accident and Emergency ambulances in response to 999 emergency calls. On that day, the Registrant was working with Colleague A, who was an Emergency Medical Technician (EMT hereafter). The Registrant, as the Paramedic was the lead clinician. They worked together as regular crew mates between September and December 2017.

15. Colleague A’s evidence was that she initially had a good working relationship with the Registrant. They became friends and saw each other socially outside of work. However, over time their relationship deteriorated. Colleague A felt that she could not challenge the Registrant and that it was “her way or no way.” She described the Registrant as being over confident and opinionated. She felt that she was “walking on eggs shells” around her.

16. The Registrant and Colleague A responded to an emergency 999 callout relating to Person A, who had suffered a miscarriage. The manner in which the Registrant and Colleague A responded to the callout resulted in a formal letter of complaint dated 05 January 2018 from Person A.

17. DS was tasked with investigating the complaint from Person A which involved a number of allegations. The Registrant had left the employment of the Trust by the time the complaint was received from Person A. However, the Registrant did engage with the investigation by her then former employer by producing a written response. Person A chose not to further involve herself in the investigation after the initial letter of complaint.

18. The final report was submitted to the Trust’s Datix (incident reporting system) on 13 April 2018. A subsequent letter, by way of formal response was subsequently sent to Person A on or about the 05 March 2018.

19. Person A’s complaint made a number of allegations against both the Registrant and Colleague A of unacceptable behaviour/conduct. These included that the Registrant had made a number of inappropriate comments to Person A.

20. Person A, was under the care of the Rosy Maternity Unit of Addenbrookes Hospital. She had had a scan which sadly showed that the baby had died. This was medically managed with oral tablets intended to induce labour. Person A was sent home to return 48 hours later to deliver in a controlled and safe environment. However the process occurred quicker than expected whilst at home. Person A began to experience contractions and bleeding. She called 999 and the Registrant and Colleague A attended her home. Person A delivered the deceased baby whilst the Registrant and Colleague A were present at her home.

21. The Panel’s view on the witnesses was as follows:

(a) The Panel found Colleague A to be a genuine, credible and helpful witness. She was willing to concede where appropriate during her evidence, noting when she could not recall specific events and explaining discrepancies, between her witness evidence before the Panel and in the internal Trust enquiry.

(b) The Panel found DS to be a credible and reliable wit-ness. He was a highly experienced Paramedic and the Panel felt able to place weight on his opinion regarding the perceived severity of the Registrant’s actions and comments.

22. The Panel has heard and accepted the Legal Assessor’s advice and exercised the principle of proportionality at all times. In approaching the task of deciding the facts, the Panel has kept at the forefront of its deliberations, the importance of requiring the HCPC to prove matters against the Registrant. The standard of proof to which the HCPC is required to prove matters is the civil standard – on the balance of probabilities.

23. The Panel was very conscious that when a witness has not given oral evidence, this is hearsay evidence. When considering hearsay evidence, which is admissible, the Panel has paid due regard to the weight which it can attach to it, bearing in mind that it has not been possible for that evidence to be challenged or probed.

Decision on Facts

Particular 1(a) (i) Proved

24. The Panel found Particular 1(a)(i) proved.

25. The background to the incident was that Person A lived approximately halfway between Kings Lynn Hospital and Addenbrookes hospital in Cambridge. Person A was requesting that she be transported to Addendbookes, as this was where she was being treated. Colleague A describes in her statement that the Registrant made the decision, before they arrived, that they would only transport Person A to Kings Lynn, as this was the closer hospital ignoring Person A’s wishes.

26. Upon their arrival at Person A’s home address, she was upstairs. Colleague A’s evidence is that the Registrant told Person A that they would only transport her to Kings Lynn hospital and this took place at the beginning of the conversation and prior to any assessment taking place. Colleague A was shocked by this. She did not challenge the Registrant on this issue and felt the additional distance to Addenbrookes was not significant. She thought the decision had been made for personal reasons, as the Registrant thought they would be late returning from Cambridge.

27. The Registrant did telephone the Rosie Centre at Addenbrookes Hospital for further information on Person A’s condition. During the course of the conversation, Colleague A observed that Person A was starting to feel more unwell.

28. Both Colleague A and Person A were in the bedroom. Person A indicated that she needed to go to the bathroom, as she could feel heavy blood loss. Colleague A describes hearing screaming coming from the bathroom. This was because Person A had delivered her deceased baby into her underwear.

29. At this point, Person A’s husband entered the bedroom and asked that Colleague A and the Registrant provide assistance to his wife. As Colleague A entered the bathroom, Person A was on the floor with her back facing away from them. There was a large amount of blood on the floor.

30. Colleague A states thereafter: “…I do not know if Lucy Bambridge thought she was whispering, but she looked at me and said “I don’t know what to do” or words to that effect with her hands facing outwards. There was a good two to three feet in distance between where I was standing and where Lucy Bambridge was so if I heard her make this comment, I would say that Person A was likely to have also heard as she was positioned in between us.”

31. Person A’s letter of complaint states: “…As my husband frantically pulled out towels from our airing cupboard and laid then on our bathroom floor, the paramedics came in to join us. I was asked to get down on the floor onto all fours and then was very shocked to hear one exclaim to the other “I don’t know what to do.” I can’t begin to tell you how terrifying it is to hear that in a situation like this….”

32. The Registrant in her written statement for the internal investigation denied that she ever made such a comment. Her account is: “We asked the husband to get some towels for us and I sent my crew mate to the ambulance to get the maternity pack. I asked the lady to move to the floor ideally on all fours supported by a chair that was already in the bathroom. This was to allow me to examine and assess what had happened and due to her saying she felt a bit faint. At no point did either of us exclaim “I don’t know what to do.” I explained to the patient that she had delivered the foetus and constantly reassured her in a calming professional manner. I opened the maternity pack and used the kidney dish inside to support the foetus…”

33. The Registrant repeated this denial in her submissions: “As per my statement I do not recall saying those words or words to that effect. As per my training you are taught to appear calm and in control in all situations and words of that nature are not behaviour I would’ve demonstrated.”

34. The Panel accepted the evidence of Colleague A on this issue, corroborated by the letter of complaint from Person A.

35. DS’s evidence was that the comment was inappropriate, given the level of physical and emotional stress which Person A and her husband were going through. He adds: “ I would never expect, and have never experienced, a Paramedic to make this type of comment in front of a patient so that they can hear it; certainly not in this situation where emotions were running high.”

Particular 1(a)(ii) Proved

36. The Panel also found Particular 1(a)(ii) proved.

37. The background is that the Registrant handed the kidney dish with the foetus to Colleague A. The baby was very small. Colleague A describes being “distraught” and trying to think of the best way to look after both Person A and her baby. The kidney dish did not have a cover. She wrapped it in some towels.

38. Colleague A placed the foetus into the front of the ambulance, as Person A had already indicated that she did not want to see her deceased baby. She describes placing the baby on top of a box between the passenger and driver’s seats. She secured it and tucked it in, so it was safe.

39. Colleague A thereafter says: “As I was driving, I was crying and I was not holding the baby, but I had one hand on the towel just to make sure it was not going anywhere and that it was safe and secure. Lucy Bambridge then popped her head through the window between the front and the back of the ambulance and found it funny that I was doing this. She laughed and said “why are you holding it for? It’s not going anywhere” or words to that effect. I heard this comment but I did not know if Person A did. I thought this comment was horrific. I did not say anything back to Lucy Bambridge when she said this. I was thinking “how could she be so heartless about this? She was making jokes and she was laughing about certain things and I did not understand how…”

40. The Registrant did not respond to this specific allegation in her written statement. However, in her submissions she says: “As to the statement above regarding hold the baby, I did ask colleague A as to why she was holding the baby as I had made sure it was secure, if she felt the baby was not secure she should have alerted me. As it is unsafe to drive without full control on the steering wheel, especially under blue light conditions…”

41. The Panel accepted Colleague A’s evidence on this issue. The Panel concluded that the Registrant’s account was inaccurate and designed to deflect criticism onto Colleague A.

42. DS’s evidence was that this comment was “not appropriate at all. I cannot think of a reason why you would say something like that; it is incredibly inappropriate given the circumstances. I would never expect a Paramedic to make such a comment about a patient’s deceased baby.”

Particular 1(b) (i) Proved

43. The Panel also found Particular 1(b)(i) proved.

44. The written evidence from Colleague A is: “Person A was quite upset when she was in the bathroom. In the shock of the situation, Person A said “I’m sorry there’s so much blood” or words to that effect. Lucy Bambridge replied “at least its not poo - all we ever see is poo and anyway, red is festive” or words to that effect. It appeared to me that this comment was made in relation to the festivities of Christmas as it was November when this incident occurred. In my view, this comment was incredibly misjudged and inappropriate for the situation. Lucy Bam-bridge made this comment directly to Person A. I do not think that Person A said anything in return, I think she was just so shocked about everything that she did not say anything. I also did not say anything and it bothers me that I did not confront Lucy Bambridge about this comment. I thought that it was not appropriate and I kept thinking that she did not seem to care at all. She was laughing at the situation when that is the opposite of what she should h
ave been doing.”

45. The account given by Colleague A in her statement for the Trust’s in-ternal investigation is slightly different: “…Lucy and I got a flannel and some towels and cleaned the blood from the patient’s legs and feet as best we could. At this point Lucy said to the patient “I think we’ve got the worst of it but at least it’s not poo, all we ever see is poo”. I believe Lucy was trying to make light of the situation and I did not feel this was appropriate.”

46. In oral evidence, Colleague A confirmed that her witness statement in these proceedings is accurate. She accepted that her initial account to the Trust did not make any reference to “red is festive.” She told the Panel that as she had reflected on her initial account, she recalled the additional words, noting that her first account was not the complete sentence.

47. Person A also describes similar comments being made. She says: “…There was a bit of confusion with the clothes I was wearing. They helped me out of them. Obviously we had to be careful of our baby and I was trying not to look or let it fall. During my distress at this I was horrifically asked if we had anything to put our baby in??? “A tupperware box or something in your kitchen?” We were speechless. They giggled nervously. Regardless of how awkward this situation was for them this was by no means a time to laugh. In trying to disperse the awkward atmosphere, one girl knelt forward to me and said “At least its not poo! We are bored of poo! And anyway, red is festive.”

48. The Registrant did not comment on this specific allegation in her writ-ten response to the Trust. However, in her written submissions, she denies any reference to “poo” and maintained that she did not say these words. She has not commented on the amended allegation and the reference to “…red is festive.”

49. The Panel accepted the evidence of Colleague A on this issue. Her evidence as to the words used was corroborated by Person A, albeit within a slightly different context. The Panel concluded that it was highly unlikely that both were mistaken about the references to both “poo” and “red is festive.”

50. DS concluded that the Registrant was “…probably trying to make light of the situation but I think that most Paramedics would think that this was not the way to do it. I thought that the comment was out of order, inappropriate and insensitive….Person A did not want to hear about poo at this time.”

Particular 1(b)(ii) Proved

51. The Panel also found Particular 1(b)(ii) proved.

52. The background is that after Person A’s deceased baby was delivered in the bathroom, the umbilical cord was still attached to the baby. The baby had been placed in the kidney dish, but was still attached to Person A, as the placenta had not been delivered.

53. Colleague A’s statement says: “Lucy Bambridge was kneeling between Person A’s legs whilst I kneeled at Person A’s side. Lucy Bambridge said to Person A “I’ve spoken to the midwives, so let’s get this cord cut, you don’t want all of this hanging out of you, do you?” or words to that effect, referring to the umbilical cord that was still attached to the baby. When I heard this remark, again it was a moment of thinking ‘oh my god, I can’t believe you’ve just said that’. At the same time, I did not say anything as I did not want to draw more attention to this comment in front of the patient. I was hoping that perhaps Person A had not heard what Lucy Bambridge had said.”

54. Person A gives a slightly different account of the events leading up to the comment, but recalls similar words being used: “…The time had now come to cut the dreaded cord. A very significant part of any normal labour and normally celebrated. You can imagine my surprise and shock when the pair of scissors was waved in celebration with a big grin in the direction of my husband implying that he could do it for them. I just looked up at her and said “you must be joking.” They went to cut the cord. The girl holding the scissors said to me, “Let’s get this cut. You don’t want all of this hanging out of you do you?” Another un-forgivable remark…”

55. The Registrant did not directly address this comment in her statement for the Trust’s internal investigation. However, in her submissions, she rejects the allegation: “I explained to the patient that I would be clamping and cutting the cord in a professional manner. Words to that effect as stated above would be disrespectful and inappropriate and are not words I would ever use when talking to a patient.”

56. The Panel accepted the evidence of Colleague A on this issue, corroborated by the original complaint from Person A. The Panel concluded it was unlikely that they were both mistaken regarding this issue.

57. DS’s evidence was that this was an inappropriate comment: “…particularly when at the end of this cord was the remains of Person A’s baby. I would imagine that the majority of Paramedics would agree. When I read this comment I was astonished. I could not understand what she was thinking or what her thought process was when talking to the patient. I have investigated a lot of complaints over the years and when I read the complaint, albeit not all of it was as Person A recalled, it was the most concerning complaint that I have ever read. After reading comments like that I just could not understand why she would make these comments to any patient. It is the wrong choice of words. There does not seen to be any empathy or sympathy shown at all.”

Particular 1(b)(iii) Not Proved

58. The Panel found Particular 1b(iii) not proved.

59. Colleague A’s written evidence was: “While on our way to the hospital, Person A said “where’s my baby?” and I thought Lucy Bambridge would say “my crew mate has the baby, don’t worry” or something along those lines. However, Lucy Bambridge said “oh, it’s over there” and pointed to some clinical waste bags on the floor in the back of the ambulance. When I heard this remark, I was horrified. I had tried my hardest to keep the baby safe and out of sight of Person A, as she had requested, and I was horrified to hear Lucy Bambridge speak so dismissively about the baby and lie about the baby’s location when there was no reason to do so.”

60. Person A, in her account of the incident, describes being in the back of the ambulance on the way to hospital with the Registrant in the rear of the ambulance. Person A describes there being a conversation between her and the Registrant. “…I suddenly remembered our baby and asked where it was. “Just down there.” She pointed to a pile of stuff just dumped by the side doors sliding about as we went round as roundabout. I sobbed…”

61. This account is disputed by the Registrant. In her statement for the internal investigation, she says: “…The patient told me that she did not wish to see the baby so I suggested that the baby was to be trans-ported in the front of the ambulance.” She later adds: “On route to the hospital we used the blue lights and sirens and I pre-alerted the delivery suite on our ETA. I repeated observations and spoke to the patient. She was conversing throughout. She did ask where the baby was and I replied that the baby was in the front with the driver safe and secure.”

62. The Panel concluded that the HCPC had not established this Particular on the balance of probabilities. Firstly, there is some difference in the alleged words used, as between Colleague A and Person A.

63. Secondly, the Panel felt that it would have been difficult for Colleague A to hear and see clearly what was being said/done in the rear of ambulance, as she was driving under blue light conditions (with sirens at times), in some emotional distress and whilst trying to keep Person A’s deceased baby secure. The Panel was not convinced that Colleague A would have been able to observe the Registrant making the comment and pointing towards the back of the ambulance.

64. Finally, the Panel was unconvinced that the Registrant would have deliberately misled Person A as to the location of her baby - pointing to clinical waste in the rear of the ambulance, when on any account, she was aware that Colleague A had the baby in the front of the ambulance.

Particular 2 Proved

65. The Panel found Particular 2 proved. The allegation is that there was a failure to properly asses Person A in relation to her ability to safely walk down the stairs.

66. The Panel heard evidence from Colleague A that Person A was up-stairs in her home address and needed to go down the stairs in order to reach the ambulance. Person A had told her and the Registrant that she was feeling dizzy before she reached the stairs and noted she had lost quite a lot of blood. Her account is: “…I told Lucy Bambridge that we should get the carry chair from the ambulance to carry Person A down the stairs. I also suggested that we take Person A’s blood pressure because of the blood loss and dizziness as this signals low blood pressure. Lucy Bambridge said that we did not need to take Person A’s blood pressure as we knew it was going to be low because of the blood loss. I then offered to get the carry chair from the ambulance and Lucy Bambridge said “no, we will walk down” or words to that effect. Lucy Bambridge also said that we could stop on the stairs if we needed to. I was surprised by this because we had not checked the patient’s blood pressure…I remember thinking ‘why would we make
a dizzy pa-tient with blood loss walk? This is the opposite of what we should be doing’.”

67. Colleague A continues: “Person A then started walking down the stairs. She stopped a couple of times and she paused when she was approximately half way down the stairs and said ‘I can’t go any further” or words to that effect and told us she would have to stop. She then sat on the steps. When we got to the bottom of the stairs, she said that she felt dizzy and I said “okay, sit there, I’ll go and get the stretcher” or words to that effect. Person A sat down. Lucy Bambridge the said “no, she’ll walk” and “we’ll just have a rest here and go to the ambulance in a minute” or words to that effect. Person A was still losing blood…”

68. A carry chair is used to carry patents down stairs, being a wheelchair with only 2 wheels. The chair can be tipped back so that the patient can be reclined.

69. In oral evidence, Colleague A stated that she thought the best option for Person A was to use the carry chair, given Person A’s health. She was very concerned about Person A walking, describing it as “very risky”.

70. DS’s evidence was that reading the contemporaneous Patient Care Record, Person A’s observations suggested that she may well have benefited from being taken down the stairs on a carry chair. Person A’s blood pressure was stable, but her pulse was relatively high. The observations indicated emotional stress and that she had lost a significant amount of blood - her body compensating by increasing her heart rate. He states: “In this situation, I would expect the clinicians to use a carry chair to assist Person A to walk down the stairs.” He adds that 9 out of 10 Paramedics would, if asked, in his view, have carried the patient down the stairs. If a patient is struggling to get down the stairs and sat down and if the clinicians can see the patient is not able to walk normally down the stairs, then a carry chair or a stretcher should be used.

71. DS also commented: “It sounds as if Person A almost collapsed on the way down the stairs so using a carry chair would have prevented this. If a patient is bleeding significantly walking down the stairs would in-crease their pulse and thereby increase the bleed. The impact of this is that Person A would feel even more unwell and would become increasingly unwell if she was losing her blood at an even greater rate due to having a higher pulse rate.”

72. Person A’s account was: “…I stumbled across the bathroom floor and slowly made my own way downstairs. I was feeling weak again and lost control of my legs. On the third from last step I collapsed and had another big bleed. My body went into shock and I started to shake violently…Again I was expected to walk down our drive and climb into the back of the ambulance.”

73. The Registrant’s account to the internal Trust investigation was: “…We asked the patient if she felt she could manage the stairs and she said she would try and we explained that if she couldn’t we would look at other options to help her to the ambulance. She managed the stairs without an issue and at the bottom she sat down on the step and spoke to her husband…”

74. In her written submissions, the Registrant denies the allegation. “As in my statement the patient was asked if she felt she could manage the walk down the stairs and she said she would try, the patient managed this without difficulty and as I have mentioned spent considerable time taking to Person B and her brother at the bottom, until prompted to continue to make her way to the ambulance.”

75. The Panel accepted the evidence from Colleague A, corroborated by both Person A and to some extent by DS’s observations. The Panel was unable to reconcile the differing accounts given by Person A and Colleague A, in comparison to the Registrant. It is clear that Person A was suffering from dizziness, blood loss and emotional distress. Both Colleague A and Person A describe her as having to stop on the stairs, albeit it at slightly different positions. It is clear that she was unable to descend the stairs “without an issue”, as alleged by the Registrant.

76. In addition, the decision as to whether Person A could safely descend the stairs was a clinical one, to be taken by the Registrant, and not one which should have been left to Person A in these circumstances. An appropriate assessment would have led the Registrant to the conclusion that the carry chair was required, not only to address patient safety but also to maintain patient dignity.

Decision on Misconduct

77. The Panel then considered, in light of all the evidence it had heard, whether the Registrant’s actions amounted to misconduct.

78. The Panel accepted the Legal Assessor’s advice on the definition of misconduct. In particular, the Panel paid regard to the definition given by Lord Clyde in Roylance v General Medical Council (No.2) [2000] 1 AC 311: “Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances…”

79. The Panel also had regard to the guidance in Nandi v GMC [2004] EWHC 2317, where Collins J suggested that misconduct could be defined as: “conduct which would be regarded as deplorable by fellow practitioners…”

80. The Panel concluded that the Registrant’s failings were sufficiently serious to amount to misconduct, noting in particular the comments of DS which are set out above.

81. The Panel also had regard to the following Standards of Conduct, Performance and Ethics which it concluded had been breached:

• Standard 1 Promote and protect the interests of service users and carers

• 1.1 You must treat service users and carers as individuals, respecting their privacy and dignity;

• 1.7 You must keep your relationships with service users and carers professional;

•Standard 2 Communicate appropriately and effectively

• 2.1 You must be polite and considerate

• 2.2 You must listen to service users and carers and take account of their needs and wishes

• 2.3 You must give service users and carers the information they want or need in a way they can understand.

• Standard 6: Manage Risk

• 6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.

82. The Panel also had regard to the Standards of Proficiency for Para-medics and concluded that the following had been breached:

• Standard 1 be able to practise safely within their scope of practice

• 1.3 be able to use a range of integrated skills and self-awareness to manage clinical challenges independently and effectively in unfamiliar and unpredictable circumstances and situations;

• Standard 2 be able to practise within the legal and ethical boundaries of their profession

• 2.1 understand the need to act in the best interests of service users at all times

• 2.3 understand the need to respect and uphold the rights, dignity, values and autonomy of service users including their role in the diagnostic and therapeutic process and in maintaining health and wellbeing;

• 2.4 recognise that relationships with service users should be based on mutual respect and trust, and be able to main-tain high standards of care even in situations of personal incompatibility.

• Standard 8 be able to communicate effectively

• 8.4 be able to identify anxiety and stress in patients, carers and others and recognise the potential impact upon communication.

• Standard 9 be able to work appropriately with others

• 9.1 be able to work, where appropriate, in partnership with service users, other professionals, support staff and others.

Decision on Impairment

83. The Panel had to consider whether the Registrant’s fitness to practise is currently impaired, in light of the Registrant’s misconduct. The Panel had regard to the HCPTS practice note ‘Finding that Fitness to Practise is Impaired’ and has accepted the advice of the Legal Assessor. The Panel has also exercised the principle of proportionality.

84. The Panel is mindful of the forward looking test for impairment.

85. The Panel heard submissions on the issue of impairment from the HCPC.

86. The Panel has seen the Registrant’s Personal Statement which was included with her submissions. She notes that she was required to work under “challenging conditions” as a newly qualified Paramedic. She made the decision to leave the Trust’s employment, because of a perceived lack of management support. She states: “I feel deeply saddened that the patient feels this way regarding this incident, at the time I did the best I could with the limited training I had received from the trust. I had no intention of ever making anyone feel uncomfortable or unduly distressed. I have always maintained a high standard of professionalism required of me.”

87. The Panel noted the inconsistency in the Registrant’s position. On the one hand, she noted that she had been taught to “appear calm and in control in all situations,” whilst, on the other, seeking to excuse or justify her behaviour by an alleged lack of training, despite denying the allegations and maintaining that she demonstrated a high standard of professionalism. This, in the Panel’s view did not sit well with the clear observations by Colleague A who was a more junior and less experienced employee.

88. The Registrant has provided only limited details of her current employment situation: “Currently I am residing abroad and I am no longer in the health sector and have no intention of returning to it. To that end I also have no intention of continuing my registration once this investigation has concluded. I no longer feel that I wish to carry on my Para-medic profession nor would I join another similar organisation…” She concludes: “…On reflection, I do not feel enough support is given to frontline staff to manage these difficult situations. The whole experience of becoming a registered professional has made me realise that I wish to pursue other career avenues.”

89. The Panel concluded that the Registrant’s current fitness to practice is impaired, having regard to both the public and personal components of impairment, for the following reasons:

(a) The Registrant’s misconduct was serious, as is set out above. The Registrant has not provided any evidence in mitigation;

(b) The Registrant offered no remorse or regret for her actions. She has continued to flatly deny the factual allegations and to defer blame elsewhere, without any acknowledgement of personal responsibility. Her integrity has been brought into question, by her lack of candour in relation to this incident;

(c) The Registrant’s actions could have had serious consequences, if Person A had fallen, whilst descending the stairs;

(d) The Panel concluded there was no evidence of insight or remediation. The Panel could have no confidence that there would not be a repetition of similar events in the future.

(e) The Registrant has provided no documentary or character evidence demonstrating any modifications in her practice, since the events in question. There is no information available from her current employer.

(f) The Registrant’s actions have brought the reputation of the Trust, and the Paramedic profession into disrepute, damaging public confidence in the profession.

(g) The Registrant has breached a fundamental tenent of the profession of being a Paramedic.

(h) The Panel also had regard to the need to uphold the proper standards of behaviour, in concluding that the public component of impairment is clearly established. The Panel concluded that confidence in the Paramedic profession would be undermined, if there was no finding of impairment, given the serious nature of the misconduct which has been identified.

Decision on Sanction

90. The Panel has heard submissions on sanction on behalf of the HCPC. It has paid regard to the HCPC’s Sanctions Policy and has accepted the advice of the Legal Assessor. The Panel had particular regard to the principle of proportionality and the need to strike a careful balance between the protection of the public and the rights of the Registrant.

91. The Panel has also reminded itself that the purpose of fitness to practise proceedings is not to punish registrants but to protect the public. The primary function of any sanction is to address public safety. However Panels should also have regard to wider public interest and this includes the deterrent effect to other registrants, the reputation of the profession concerned and public confidence in the regulatory process.

92. The Panel has had regard to the aggravating and mitigating circumstances in this case.

93. The aggravating features are:

(a) The seriousness of the Registrant’s misconduct, which also called her integrity into question;

(b) The risk of harm to Person A as a service user;

(c) The lack of acceptance by the Registrant of any failings and her attempt to deflect her behaviour;

(d) The absence of any evidence of remorse, reflection, insight or remediation;

(e) The risk of repetition.

94. The mitigating features are:

(a) This appears to be a one-off incident and the Registrant is otherwise of good character.

(b) She appears to have had a previous unblemished employment record;

95. In light of the above factors, the Panel determined that given the nature and seriousness of the Registrant’s misconduct, to take no action, make a Caution Order or a Conditions of Practice Order, would not be in the public interest, and would not retain public confidence in the regulatory process or have the necessary deterrent effect on other registrants. The Panel further concluded that public confidence in the profession would be undermined by imposing any of these sanctions.

96. In addition, the Panel was unable to identify any suitable or workable conditions which could be imposed, in light of the Registrant’s serious misconduct, her lack of engagement in these proceedings, the fact she now resides in Australia and the lack of evidence as to her current working arrangements.

97. The Panel next considered whether to make a Suspension Order, and concluded that this was not an appropriate sanction, having regard to the Sanctions Policy. The Panel considered that the incident was serious but could not say that the misconduct was unlikely to be repeated in light of the findings set out above. The Panel also noted that there was no evidence that the Registrant understood her failings and was seeking to remedy them. This is in accordance with paragraphs 39-41 of the Sanctions Policy.

98. The Panel next considered a striking off order and concluded this was the appropriate and proportionate sanction to both protect the public and to address the wider public interest concerns which the Panel identified. The Panel considered that the incident was serious, and that any lesser sanction would have an insufficient deterrent effect or undermine confidence in the Paramedic profession or the regulatory process, having regard to the aggravating features set out above.

Order: That the Registrar is directed to strike the name of Lucy J Bambridge from the register on the date this order comes into effect

Application for Interim Order

1. The Panel heard an application on behalf of the HCPC for an Interim order, to have effect during the appeal period, either when that period expires or if the appeal is made, when the appeal is concluded or withdrawn. The Panel first considered whether to proceed to hear the application in the Registrant’s absence and decided to do so, on the same grounds as hearing the substantive case in her absence. The Registrant was on notice that such an application was likely to be made from a letter dated 23 August 2019.

2. The Panel had regard to the advice from the Legal Assessor and reviewed the HCPC’s Sanctions Policy. The Panel concluded that it was appropriate to make such an interim order, both in order to protect members of the public and was otherwise in the public interest, in light of the serious misconduct found proved and the sanction imposed. The Panel identified a serious and ongoing risk to the public and concluded that public confidence in the profession or the regulatory process would be undermined if the Registrant was allowed to remain in practice on an unrestricted basis.

Interim Order

The Panel makes an Interim Suspension Order under Article 31(2) of the Health and Social Work Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Miss Lucy J Bambridge