Mrs Mandy Bradley

Profession: Paramedic

Registration Number: PA03319

Hearing Type: Review Hearing

Date and Time of hearing: 12:30 20/11/2019 End: 17:00 20/11/2019

Location: HCPTS, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

Allegation:

(As amended at the final hearing commencing 19 November 2018).

During the course of your employment as a Paramedic, you:

1. On 23 March 2016, you did not complete a Medical Assessment Form in respect of Patient A;

2. In a 24 March 2016 statement, you stated:

a) “I entered the cell on regular intervals” which was not the case;

b) Not Proved.

3. In a 29 March 2016 meeting, you stated:

a) that you undertook two sets of observations on Patient A, which was not the case;

b) That you "kept popping in every 15 to 20 minutes" to check on Patient A, which was not the case;

4. The actions set out at paragraphs 2 and / or 3 were dishonest - Not Proved for 2b) and 3a)

5. The matters set out at paragraphs 1 - 4 constitute misconduct.

6. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Matters

Service
1. The Panel was provided with a copy of the Notice sent by first class post to the Registrant’s registered address on 18 October 2019, setting out the time, date and venue for this review and the possibility of the Panel proceeding without the Registrant in the event that she did not attend. The Panel was provided with proof of postage by way of a signed declaration by an HCPC employee. The Panel was thus satisfied with service in this case.

Proceeding in the Absence of the Registrant

2. The Registrant did not attend the review hearing. In an email to the HCPC dated 19 November 2019, the Registrant stated that she had been unable to work in the last twelve months and her financial situation was somewhat “non-existent, therefore i will be unable to attend the Review Hearing.” She also indicated that she had decided to take early retirement and no longer wished to practise as a Paramedic.

3. Ms Navarro, on behalf of the HCPC, made an application to proceed in the Registrant’s absence.

4. When deciding whether to proceed in the absence of the Registrant, the Panel took into account the submissions made by Ms Navarro and accepted the advice of the Legal Assessor. It bore in mind that, although it had a discretion to proceed in the absence of the Registrant, this discretion should be exercised with the utmost care and caution. The Panel was cognisant of the fact that its purpose was to undertake a statutory review of a Suspension Order before the date it was due to expire.

5. The Panel noted the content of the Registrant’s email, referred to above, and whilst it appeared the Registrant was saying she could not afford to attend the hearing she also made it clear that she has decided to take early retirement. The Notice of Hearing did make it clear that the Registrant could attend by telephone if she so wished and indeed that was the way in which she had attended the final hearing. Ms Navarro told the Panel that she had attempted to call the Registrant yesterday, but that the telephone had not been answered. The Panel noted that the Registrant had not requested an adjournment. There was, therefore, nothing to suggest the Registrant would attend on another occasion, if this matter were to be adjourned.

6. In light of the Registrant’s clearly stated intent, in the aforementioned email, the Panel decided that the Registrant had voluntarily absented herself and thereby waived her right to be present. The Panel considered there was a public interest in the matter proceeding and it was also in the Registrant’s own interests that the order be reviewed.

7. In all the circumstances, the Panel decided to proceed in the absence of the Registrant.

Background
8. In March 2016, the Registrant was employed by G4S and practising as a healthcare professional. On 23 March 2016, she was tasked with attending to Patient A, a detainee of the Mansfield Custody Suite. The Registrant conducted an initial assessment of the patient, recording brief notes on the police computer system, NICHE. She noted that the patient had “collapsed to the floor in a controlled manner” on one occasion but did not require a referral to emergency services at that time.

9. The Registrant failed to complete a G4S Medical Assessment Form, as she was under a duty to do, in respect of Patient A.

10. CCTV footage showed the Registrant in the same cell as Patient A on two occasions. On several other occasions she was seen to walk past or stand outside the patient’s cell but not go in.

11. The healthcare professional who attended to Patient A after the Registrant had finished her shift, observed the patient to be unresponsive and decided that an ambulance was required.

12. The Registrant maintained, in a statement dated 24 March 2016 and later during an interview on 29 March 2016, that she conducted two sets of observations of the patient and attended to the patient at regular intervals. She admitted that she failed to complete a Medical Assessment Form, but stated that when she left the patient at the conclusion of her shift, he was alert, conscious and talking.

13. The original panel found a number of the facts proved, as shown above, and that they amounted to misconduct. In its decision on impairment, the panel stated:

“The Panel first considered past impairment. It noted its findings that the Registrant had deliberately misled an investigation, had been dishonest on two occasions and had failed to complete a Medical Assessment Form which was important to the safety of Patient A. It had also found that the Registrant’s misconduct had breached key standards of the HCPC’s “Standards of conduct, performance and ethics” as set out above, had brought the profession into disrepute and had undermined confidence in the profession. In addition, the Registrant’s misconduct had put Patient A at unwarranted risk of harm. In these circumstances, the Panel had no doubt that, at the times in question, the Registrant’s fitness to practise had been impaired by reason of her misconduct.

The Panel went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of that misconduct. In addressing the personal component of impairment, the Panel asked itself whether the Registrant is liable, now and in the future, to repeat misconduct of the kind found proved. In reaching its decision, the Panel had particular regard to the issues of insight and remediation.

The Panel noted that in the case of CHRE v NMC & Grant [2011] EWHC 927 (Admin) Mrs Justice Cox stated: “When considering whether or not fitness to practise is currently impaired, the level of insight shown by the practitioner is central to a proper determination of that issue.”

The Registrant made several formal admissions and attended to give evidence before the Panel by way of telephone link. Further, the Panel has had the benefit of reading the Registrant’s responses to questions put to her in interview with RF. It has also read her own written accounts of the incidents in question.

In the Panel’s view the Registrant has demonstrated only limited insight into the seriousness of her misconduct and its impact on colleagues, patients and the profession. The Panel was concerned that the Registrant did not seem to appreciate the seriousness of her failings and their impact on the safety of Patient A and on public confidence in Police Custody Suites and in the paramedics who work in them. The Panel noted that the Registrant had expressed remorse for her failure to complete the Medical Assessment Form but considered that she had minimised the seriousness of that failure, in particular by expressing the view that there had been no consequential risk to Patient A. The Panel was also concerned to note that it had received no evidence of formal reflection by the Registrant on what had occurred, either in terms of its potential impact or in terms of what she should have done to avoid it.

The Panel had careful regard to Silber J’s guidance in Cohen v GMC [2008] EWHC 581 (Admin) that Panels should take account of:

Whether the conduct which led to the charge is easily remediable;

Whether it has been remedied; and

Whether it is highly unlikely to be repeated.

The Panel recognised that remediation of misconduct which involves dishonesty may be less easy than remediation of misconduct involving clinical failings. However, it considered that with the development of meaningful insight the Registrant’s misconduct is remediable. It noted the Registrant’s assurances that she has learned from this experience and would not repeat the failings found proved. The Panel also noted that the Registrant has continued to work as a Registered Paramedic since the incidents in question, and that there has been no repetition. However, the Panel received no evidence of any specific relevant remediation which the Registrant may have undertaken.

In light of its findings in relation to insight and remediation, the Panel considered that there is currently a risk that the Registrant would repeat matters of the kind found proved. For these reasons, the Panel determined that a finding of impairment is required with regard to the personal component, including the need for public protection.

The Panel then went on to consider whether a finding of impairment is necessary on public interest grounds. In addressing this component of impairment, the Panel had careful regard to the critically important public issues identified by Silber J in the case of Cohen when he said:

“Any approach to the issue of whether .... fitness to practise should be regarded as ‘impaired’ must take account of…the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour.”

The Panel considered that keeping full and accurate records is a fundamental requirement of the paramedic profession. However, the Panel considered that in light of the Registrant’s long and previously unblemished service as a healthcare professional, a single, isolated failure to complete a Medical Assessment Form would not be regarded by informed and reasonable members of the public as requiring a finding of impairment of fitness to practise on public interest grounds.

The Panel considered that acting with honesty and integrity is a fundamental requirement of the paramedic profession. The Panel considered that the public would be concerned to learn of the Registrant’s dishonesty in this matter. Further, the Panel had no doubt that the need to maintain public confidence in the profession, and to declare and uphold proper standards, would be undermined if a finding of impairment of fitness to practise was not made in the circumstances of this case in relation to the Registrant’s dishonesty.

For all the reasons set out above, the Panel determined that the Registrant’s fitness to practise is currently impaired, both on the grounds of public protection and in the public interest.”

14. When deciding on the appropriate sanction, the panel said:

“The Panel had regard to all the circumstances, including the following mitigating and aggravating features of the case:
Mitigating:
The Registrant’s previous good character over a 22 year career in healthcare.

The Registrant has continued to work as a Registered Paramedic since the incidents and there has been no repetition of misconduct.

The positive testimonial of MVF.

The Panel has found the Registrant’s misconduct to be remediable.

The Registrant has fully engaged with the regulatory process and has assured the Panel that she is totally committed to the remediation of her misconduct. The Panel considered that this reflected a small degree of increased insight during the course of the hearing.

Aggravating:

The Registrant’s failure to complete the Medical Assessment Form put Patient A at unwarranted risk of harm.

The matters found proved included two incidents of dishonesty on 24 and 29 March 2016.

There is a risk of repetition due to the Registrant’s lack of sufficient insight and remediation.

 The Panel first considered whether it would be appropriate to impose no sanction in this case. It gave careful consideration to Paragraph 8 of the HCPC’s “Indicative Sanctions Policy”. The Panel determined that in light of its findings on insight and remediation and that there remains a risk of repetition, the imposition of no sanction would neither protect the public nor serve the wider public interest in maintaining confidence and declaring and upholding proper standards.

 The Panel next considered the potential for mediation in this matter. It gave careful consideration to Paragraphs 26 and 27 of the HCPC’s “Indicative Sanctions Policy”. It noted that such a course may only be used if the Panel is satisfied that the only other appropriate course would be to take no further action. The Panel had no doubt that this is not such a case.

 The Panel went on to consider the imposition of a Caution Order. It gave careful consideration to the factors set out in Paragraphs 28 and 29 of
the HCPC’s “Indicative Sanctions Policy”. The Panel considered that there remains a risk of repetition, the Registrant has demonstrated limited insight and no remediation, and the dishonesty, although isolated was not minor in nature. For these reasons, the Panel determined that a Caution Order would be inappropriate. Further, it would neither protect the public nor be sufficient to mark the wider public interest.

 The Panel then considered the imposition of a Conditions of Practice Order. It gave careful consideration to Paragraphs 30-38 of the HCPC’s “Indicative Sanctions Policy”. In considering the suitability of a Conditions of Practice Order, the Panel kept in mind its finding that the Registrant’s misconduct is remediable and that there had been no evidence of a general lack of competence. The Panel considered that conditions of practice may be highly appropriate where there is a need to address clinical failings, but may not be so where there are probity issues involved. In this case the Panel was unable to formulate conditions to address the dishonesty found proved. The Panel determined that a Conditions of Practice Order would be neither appropriate nor sufficient at this time.

 The Panel went on to consider the imposition of a Suspension Order. It gave careful consideration to Paragraphs 39-45 of the HCPC’s “Indicative Sanctions Policy”.

 The Panel noted that Paragraph 41 of the HCPC’s “Indicative Sanctions Policy” states: “If the evidence suggests that the registrant will be unable to… remedy his … failings then striking off may be the more appropriate option. However, where there are no … difficulties preventing the registrant from understanding and seeking to remedy the failings then suspension may be appropriate.” The Panel had no doubt that the information currently before it is not such that it could reasonably conclude that there are difficulties which would prevent the Registrant from developing full insight and remedying her failings.

 The Panel considered that a Suspension Order would, in the short term, protect the public and also satisfy the public interest in marking the unacceptability of the Registrant’s misconduct, as well as upholding proper standards and maintaining confidence in the profession.

 For all the reasons set out above, the Panel considered that a Suspension Order for a period of 12 months is the proportionate and appropriate response at this time.”

15. The panel considered the Registrant’s dishonesty rendered a Striking Off Order a real possibility, but noted that it was a sanction of last resort. Accordingly, in light of its view that, with the development of full insight, the Registrant’s misconduct was remediable, the panel decided that a Striking Off Order would have been disproportionate at that time.

16. The panel said that a revision panel would be assisted by:
•  The Registrant’s attendance;

•  An up to date reflective piece completed by the Registrant, reflecting as to why when asked to account for her conduct, her response was dishonest; and how she will ensure that this would not happen again in a similar situation. The Registrant’s professional body, journals and the HCPC “Standards of conduct, performance and ethics” may be of assistance to her in this regard;

•  Up to date character references from employers or any other person which attest to her honesty and integrity;

•  A reflective piece considering the importance of timely and accurate record keeping;

•  Evidence of any remedial action the Registrant has taken since the incidents in question;

•  Details of any paid or unpaid work undertaken during the period of suspension; and / or

•  Any continuing professional development undertaken by the Registrant, including the reading of professional journals.

Decision
17. The Panel considered with care the documentation provided and the submissions made by Ms Navarro. The Panel accepted the advice of the Legal Assessor and in reaching its decisions referred to the HCPTS’s Practice Note on ‘Finding Fitness to Practise is Impaired’. The Panel carried out a comprehensive review of the current order in light of the circumstances as they existed today.

18. The Panel first considered the issue of current impairment. The Panel took account of the principle set out in Abrahaem v GMC [2008] EWHC 183 (Admin) that there is, in practical terms, a persuasive burden at a review hearing for the Registrant to demonstrate that he has “fully acknowledged why past performance was deficient and through insight, application, education, supervision or other achievement sufficiently addressed the past impairments.”

19. The Panel noted the findings of the panel at the final hearing and in particular that the Registrant had deliberately misled an investigation, had been dishonest on two occasions and had failed to complete a Medical Assessment Form which was important to the safety of Patient A. The final hearing panel was of the view that the Registrant had demonstrated only limited insight into the seriousness of her misconduct and its impact on colleagues, patients and the profession. In addition, the Registrant had provided no evidence of any specific remediation. The final hearing panel concluded that, in the absence of appropriate insight and remediation, there was a risk that the Registrant would repeat matters of the kind found proved. It therefore found her fitness to practise to be impaired on public protection grounds.

20. The final hearing panel listed a number of matters that would assist the reviewing Panel. However, the Registrant had not provided this Panel with any new material, nor had she attended the review hearing. Consequently she had not demonstrated that her insight had developed any further than it had at the final hearing. In addition, the Registrant had provided no evidence of remediation and accordingly this Panel was in no better a position than the final hearing panel. It followed that the risks previously identified remained and the Panel therefore found the Registrant’s current fitness to practise continued to be impaired on public protection grounds.

21. When considering public interest grounds the Panel was satisfied that, in the absence of any reflection and insight, public confidence in the profession would be undermined if a current finding of impairment were not made.

22. The Panel thus determined that the Registrant’s current fitness to practise remained impaired on both public protection and public interest grounds.

23. The Panel then considered what sanction was both appropriate and proportionate in all the circumstances and in doing so considered the HCPC Sanctions Policy. The Panel noted that, according to the Registrant, she had decided to retire. She had not provided the necessary reflective piece and, therefore, had not been able to demonstrate that she had properly developed her insight into her dishonest behaviour, nor had she provided evidence of remediation of the matters complained of. Accordingly, there was no indication that she was committed to resolving her failings. In such circumstances to take no action or make a Caution Order would not be appropriate. It was also apparent that a Conditions of Practice Order would not be appropriate or workable because the Registrant was not committed to complying with such an order and in any event dishonest conduct is difficult to address with conditions.

24. In her email dated 19 November 2019, the Registrant indicated quite clearly that she had retired and no longer wished to practise as a Paramedic.

25. The Panel considered it had little choice but either to once again suspend the Registrant, or to remove her from the Register. The only purpose of further suspending the Registrant would be to allow her more time to reflect, show insight and demonstrate remediation. She had already had almost twelve months in which to do that. The Panel considered it was not sensible to continue the review process where it appeared that the Registrant was unwilling or unable to remediate her failings. The Panel was not persuaded that this was an appropriate case to further suspend the Registrant in order to allow the HCPC to explore the possibility of a Voluntary Removal Agreement, as suggested by Ms Navarro. The matters found proved against the Registrant were too serious for such a form of disposal. The final hearing panel had given her an opportunity to avoid a Striking Off Order, but the Registrant had chosen not to take any of the steps suggested, but instead to retire.

26. In the absence of appropriate remediation or insight, or any evidence that the Registrant was prepared to resolve her failings, the Panel was of the view that the only appropriate and proportionate sanction at this stage was to make a Striking Off Order.

27. Dishonesty is always said to be regarded as a particularly serious matter, whether or not it results in any harm to patients and whether or not it takes place within a registrant's professional practice. Honesty, integrity and trustworthiness are often said to be integral to practice and it can be said that a failure in these respects can undermine the trust the public place in the profession. It is against that background that Registrants found to have acted dishonestly will always be at severe risk of being struck off, particularly where they do not demonstrate remorse, a realisation that the conduct was dishonest and that there would be no repetition. The original panel gave the Registrant the opportunity to do this but she had chosen not to do so.

28. The Panel took into account the impact this may have on the Registrant, however this was outweighed by the need to protect the public. In any event, the Registrant had made it clear that she was retired and no longer wished to practise as a Paramedic. There was also a public interest in appropriately dealing with cases where a Registrant had chosen not to fully engage with her Regulator. Thus, whilst this may have been a disproportionate sanction at the time of the final hearing, the Panel did not consider it to be so now.

 

Order

The Registrar is directed to strike the Registrant from the Register with immediate effect, in accordance with Article 30(2) and (4).

Notes

No notes available

Hearing History

History of Hearings for Mrs Mandy Bradley

Date Panel Hearing type Outcomes / Status
20/11/2019 Conduct and Competence Committee Review Hearing Struck off
19/11/2018 Conduct and Competence Committee Final Hearing Suspended