Miss Fiona Turner
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Whilst registered as a Paramedic and employed by South Central
Ambulance Service, you:
1. on 16 May 2017:
a) Inappropriately left Patient 1, who had been diagnosed with unstable
angina, at her home address with ECG changes and active chest pain; and
b) Provided inappropriate safety netting advice to Patient 1.
2. In relation to Colleague 1, behaved in an inappropriate manner towards
him, in that you:
a) Stated to him 'It may be a custom in your country but you are over here
now!' or words to that effect;
b) Raised your voice at him on numerous occasions;
c) Made reference to his Polish nationality without good cause;
d) On job number [redacted], made comments regarding his actions
and about him in front of bystanders;
e) On 16 February 2017, stated to Colleague 2 'He does not need to know
f) On or around 16 March 2017, stated 'I have broken my ECA'; or words to
g) On or around 9 May 2017, told him to '**** off!' during an IO
assessment or words to that effect;
h) Told him to 'Sit the **** down' during a F2F assessment or words to that
3. In relation to Colleague 3, behaved in an inappropriate manner, in that
a) Made remarks in front of patients and family members that he is 'only a
care assistant' or words to that effect.
4. In relation to Colleague 4, on or around 8 February 2017, behaved in an
inappropriate manner, in that you said to him or words to the effect of:
a) '**** off', on numerous occasions;
b) 'I told you, **** out from my station';
c) 'Just **** out of from my station you blood..foreigner';
d) 'Yes, we did once and you didn't impress me at all';
e) 'If you come over to my station and acting like a child banging
ambulance you **** out from here';
f) 'No I not and no point me to talk because you not understand my
anywhere you foreigner'.
5) In relation to Colleague 5, behaved in an inappropriate manner in that
you said to him words to the effect of:
a) 'NO, I'm not taking the piss and I do not take orders from someone like
you and I'm not being told to go home either'; and
b) 'Would never take orders from someone as low as myself'; or words to
6) In relation to Colleague 6, behaved in an inappropriate manner in that
you said to him:
a) 'Are you stupid or deaf, I told you to leave all bags on the ambulance'.
7) The matters described at particular 1(a) and (b) constitutes misconduct
and/or lack of competence.
8) The matters described at particulars 2 - 6 constitute misconduct.
9) By reason of your misconduct and/or lack of competence, your fitness to
practise is impaired.
Hearing partly in private
1. The Panel was told that matters relating to the health of Colleague 1 would be referred to in the hearing. Rule 10 of the Conduct and Competence Committee Rules enabled whole or part of the hearing to be held in private for the protection of the private life of the Registrant or witnesses. The Panel agreed that any references to the health of Colleague 1 should be heard in private.
Application to Amend the Allegation
2. At the commencement of the hearing, the Presenting Officer applied to amend a number of the particulars of the Allegation. Written notice that the HCPC intended to apply to make these amendments was sent to the Registrant on 1 April 2019. That letter stated, “This is to clarify the allegation against you and better reflect the evidence.”
3. The Registrant was present at the hearing and was represented. The Registrant’s Representative confirmed that the Registrant had no objection to the proposed amendments to the Allegation.
4. The Panel heard and accepted the advice of the Legal Assessor. The Legal Assessor advised the Panel that there is no specific Rule contained within the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules) governing a power to amend an allegation. The Panel should have regard to the merits of the case, the fairness of proceedings and consider whether the requested amendments can be made without injustice. The Panel should consider the wider public interest in ensuring that allegations accurately reflect the evidence that has been adduced. It is up to the Panel whether to accept all, none or some of the amendments proposed by the HCPC.
5. The Panel considered that the Registrant had been given plenty of notice and ample opportunity to consider the proposal. No issues of prejudice or unfairness had been raised on the Registrant’s behalf. In the Panel’s judgment, the proposed amendments were fair and were made on the basis of the material gathered during the HCPC's investigation. The Panel was satisfied that the amendments did not change the substance of the Allegation, served to clarify it and could be made without injustice to the Registrant. Accordingly, the Panel acceded to the Presenting Officer’s application to amend the Allegation. The amended Allegation is set out above.
6. At the outset of the hearing the Registrant, via her Representative, admitted factual particulars 1(a), 1(b), 2(b) (in the context of what happened at 2(g)), 2(g), 4(a) and 4(d). The Registrant denied the other particulars of the Allegation.
Applications relating to the admissibility of hearsay evidence
Day 1 - Skeleton Argument on behalf of the Registrant
7. At the outset of the hearing, and prior to the Panel reading the HCPC’s bundle, the Registrant’s Representative provided the Panel with a written Skeleton Argument. This set out the Registrant’s position and submissions in relation to three discrete areas of evidence that the HCPC intended to rely upon – namely Colleague 1’s evidence contained in a witness statement and various exhibited interview documents; material contained within the HCPC bundle from individuals not being called by the HCPC as witnesses; and material within the bundle in respect of which there is no charge.
8. In relation to the first matter, the Registrant’s Representative told the Panel that Colleague 1 would not be attending the hearing but had provided a signed witness statement on which the HCPC intended to rely. In relation to Colleague 1’s hearsay evidence, the Registrant’s Representative submitted that the Registrant did not object to the Panel receiving the written statement or the notes created by way of interview with Colleague 1, but that the Registrant reserved her position with regard to how the Panel should view Colleague 1’s statement.
9. Addressing the second matter, which the Registrant’s Representative referred to as the “matter of substance” for the Panel’s consideration, he told the Panel that the HCPC intended to rely upon “atmospheric” evidence gathered during the Trust’s investigation - in the form of letters, statements and/or emails - from ten individuals in the ambulance service, all of whom were critical of the Registrant, but were not called by the HCPC as witnesses. The Registrant’s Representative contended that no attempt had been made by the HCPC to address whether or not these witnesses could have attended. He said that the Registrant did not object to notes or emails in the HCPC bundle from witnesses who were due to give evidence at this hearing but that, “the idea that the HCPC can put into evidence disputed material which is not being provided by witnesses in person is bordering on the bizarre let alone legally questionable. It is plainly hearsay, derogatory about the Registrant and should not be allowed.”
10. Mindful that the Panel had not yet read the HCPC bundle, the Presenting Officer addressed the nature of the evidence from each of the relevant individuals objected to by the Registrant. The Presenting Officer drew the Panel’s attention to Rule 10 of the Rules and the following caselaw around the principles of hearsay evidence: Bonhoeffer v GMC  EWHC 1585 (Admin); Thorneycroft v NMC  EWHC 1565 (Admin); and NMC v Ogbonna (2010) EWCA Civ 1216. She reminded the Panel that some of the particulars to which this evidence relates had been admitted by the Registrant. Dealing with each individual in turn, the Presenting Officer made submissions that their evidence was not sole and decisive, was corroborated and should be admitted into evidence. It would be a matter for the Panel as to the weight to be afforded to each piece of evidence. The Presenting Officer told the Panel that, in preparing this case for a hearing, the HCPC had taken a proportionate stance and considered that it was not necessary to call the ten individuals. Further, the HCPC had only been made aware of the Registrant’s objections a week before the hearing, even though the bundle had been served on 8 October 2019.
11. The Panel accepted the advice of the Legal Assessor. She reminded the Panel that the Civil Evidence Rules govern the admissibility of evidence in these proceedings. Therefore, a piece of evidence should not be excluded solely on the ground that it is hearsay. The Legal Assessor endorsed the hearsay principles as referenced by the Presenting Officer in relation to Bonhoeffer, Thorneycroft and Ogbonna and also referred the Panel to Razzaq v Financial Services Authority  EWCA Civ 770. She advised that the relevant principles articulated by the above cases are as follows:
a) The Panel is entitled to receive hearsay evidence but the decision to admit hearsay evidence is not to be regarded as a routine matter. The Panel must specifically consider the issue of ‘fairness’ before admitting the evidence. Considerations of what weight can be attributed to the evidence once it has been admitted is not relevant to the question of whether it would be fair for the evidence to be admitted in the first place.
b) The existence of a good and cogent reason for the non-attendance of the witness is an important factor. However, the absence of a good reason will not automatically result in the exclusion of the evidence.
c) The courts have been reluctant to uphold decisions to admit hearsay evidence where i) the evidence was not admitted, and ii) the hearsay evidence in question was the sole or decisive evidence in relation to an allegation. The courts have been far less reluctant to uphold such decisions where i) the hearsay evidence is ancillary to other evidence in the case, and ii) it is not challenged.
d) The Panel should balance the probative value and prejudicial effect of admitting each piece of the evidence.
12. The Panel accepted the Legal Assessor’s advice. The Panel considered the detailed submissions from both parties and, on the information presented to it by way of those submissions, determined that it could make its decisions on admissibility without reading the relevant documents.
13. The Panel noted the timing of the bundle having been sent out on 8 October 2019 and the objections having been raised within a week of the opening of the hearing. It considered that the HCPC had been diligent in rearranging the schedule of witness attendance to accommodate the time needed for the application from the Registrant’s representative, a response from the Presenting Officer, legal advice and all that was needed for the Panel to make its decisions on admissibility.
14. The Panel had regard to Rule 10(1)(b) and (c). It also had in mind the guidance from caselaw that reliance should not be placed on hearsay evidence that was based solely or to a decisive extent on the statement of a witness whom the accused has had no chance of cross-examining. The Panel noted that the content of the documents objected to was, in each case, not sole and decisive in relation to many issues and, in the main, was corroborated by the evidence of live witnesses from whom it would hear in due course. Further, on the information provided to the Panel thus far, the hearsay statements were not presented as throwaway remarks made but were given in the formal context of the investigation by South Central Ambulance Service in response to structured questions. The Panel was of the view that fairness could be ensured by the Registrant’s Representative and the Panel having the opportunity to test the evidence by questioning the witnesses who would be attending the hearing. In relation to evidence that was corroborative of what Colleague 1 said, the Panel was mindful that, although Colleague 1 would not be attending the hearing, the Registrant had not objected to Colleague 1’s evidence being admitted into evidence.
15. Having applied the principles set out in the cases referred to by the Legal Assessor, the Panel decided it would not be unfair to the Registrant to allow the evidence of the ten individuals to be admitted as hearsay. It should be stressed that in deciding that the evidence should be admitted, the Panel was clear that the hearsay nature of the evidence would necessitate careful consideration of what, if any, weight could properly be attributed to it when making its decisions.
16. The third matter, regarding the submission that the HCPC bundle contained evidence that was not relevant to the charges faced by the Registrant, was dealt with by way of agreement between the parties. Two pages of evidence were removed from the HCPC bundle.
Day 4 - Application to adduce the evidence of Colleague 5 as hearsay evidence
17. A witness, Colleague 5, had been due to give evidence at the hearing on Day 2. On the first day of the hearing, the HCPC received email notification from its solicitors, Kingsley Napley, that Colleague 5 had been admitted to hospital. The information shared with Kingsley Napley was brief and was from Colleague 5’s employer. On Day 4 of the hearing, when the HCPC was to close its case on facts, no further update had been received in relation to Colleague 5.
18. The Presenting Officer applied for the evidence of Colleague 5 to be adduced as hearsay evidence. Although the Presenting Officer conceded that the evidence of Colleague 5 (contained in a witness statement and two supporting exhibits) was sole and decisive in relation to Particular 5, she argued that it would be fair for the Panel to admit the evidence in light of Colleague 5’s health concerns which, she contended, was a good and cogent reason for his non-attendance at the hearing. The Presenting Officer accepted that she had no medical evidence to put before the Panel in support of her application.
19. The Registrant’s Representative opposed the application. He argued that only Colleague 5 could speak to Particulars 5(a) and 5(b) and that there was no independent third party or other corroborating evidence to support the alleged interaction between the Registrant and Colleague 5. He submitted that the admission of Colleague 5’s evidence would be unfair as it would be untested evidence which he would not be able to cross examine on behalf of the Registrant.
20. The Panel received and accepted advice from the Legal Assessor, who referred to relevant caselaw and, in particular, to the matters it should take into account in its careful balancing exercise, as set out in the case of Thorneycroft. After due consideration, and bearing in mind that the fairness of the hearing was of paramount importance, the Panel decided that it would not admit the evidence of Colleague 5. Colleague 5’s hearsay evidence was the sole evidence against the Registrant of Particulars 5(a) and (b) of the Allegation, which were denied by the Registrant. The Panel then considered Rule 10 and its discretion to admit evidence that is “necessary in order to protect members of the public.” Particular 5 comprised an allegation around the Registrant’s conduct and attitude towards Colleague 5 and the Panel considered that there were a number of other Particulars before it, of a similar nature, that the Panel would give proper consideration to in due course. In the context of the other Particulars of the Allegation, the Panel did not consider that admitting Colleague 5’s evidence under these circumstances was necessary to protect the public.
Half time submission
21. At the conclusion of the HCPC’s case, the Registrant’s Representative submitted that, in light of the Panel’s decision not to admit Colleague 5’s witness statement and relevant exhibits into evidence, Particular 5 in its entirety must fall away.
22. The Presenting Officer conceded that the evidence of Colleague 5 was the sole evidence in relation to Particulars 5(a) and (b).
23. The Panel took note of the HCPTS Practice Note on “Half-Time Submissions” and accepted the advice of the Legal Assessor in relation to R v Galbraith  1WLR. In light of the fact that Colleague 5’s evidence was the sole evidence in relation to Particular 5(a) and (b), and its decision that his witness statement and the relevant exhibits should not be admitted into evidence, there was no evidence to prove that Particular of the Allegation. It determined that the HCPC’s case in respect of Particular 5 of the Allegation in its entirety should be stopped and that the Registrant had no case to answer in relation to Particular 5.
24. The Panel received a bundle of documents from the HCPC, comprising a case summary, witness statements and a substantial body of documentary exhibits.
25. The Registrant submitted three bundles of documents which included written reflective pieces from the Registrant; evidence of further training undertaken by her; texts/WhatsApp messages between the Registrant and Colleagues 1 and 3; professional testimonials; and letters from patients cared for by the Registrant.
26. The Registrant is a registered Paramedic who was employed with the South Central Ambulance Service NHS Foundation Trust (SCAS) between May 2016 and December 2017. The Allegation faced by the Registrant falls into two broad categories; firstly, the Registrant’s allegedly inappropriate clinical care of Patient 1 on 16 May 2017; and secondly, the allegedly inappropriate way in which the Registrant has behaved in relation to a number of colleagues at work.
27. On 16 May 2017, the Registrant attended a 77-year-old patient (Patient 1) who had previously been diagnosed with unstable angina and had a presenting complaint of chest pain. It is alleged that the Registrant should have conveyed Patient 1 to hospital based on her presentation, but instead left her at home without appropriate safety netting. Witness AP, the Emergency Care Assistant who attended Patient 1 at home with the Registrant, escalated her concerns in light of SCAS’ policy and guidance. Witness JH reviewed the paperwork that had been completed for the incident and arranged for Patient 1 to be conveyed to hospital for further investigation and blood tests. On 1 August 2017, the Registrant made a self-referral to the HCPC in respect of this concern.
28. On 29 January 2018, the HCPC was made aware of a second investigation relating to bullying and harassment concerns. The bullying and harassment allegations related to the Registrant allegedly demeaning and belittling a number of colleagues (Colleagues 1, 3, 4 and 6) on various occasions.
29. The Panel heard oral evidence from a number of witnesses called by the HCPC and from the Registrant. The Panel considered the credibility and reliability of each witness called. The Panel also received documents in evidence, some of which included supporting exhibits with hearsay statements from a number of people, including Colleague 1, who were not called as witnesses. The Panel carefully considered this evidence. It also gave careful consideration to the context in which these allegations arose.
30. The Panel accepted the evidence of the HCPC witnesses as their evidence was credible, balanced and persuasive. The Panel found them all to be reliable.
31. The Registrant presented a clear, straightforward and generally consistent account and the Panel considered her to be broadly credible when giving evidence. She could offer no explanation for why her assessment and understanding of her working relationships differed from the numerous colleagues who complained. She suggested that her colleagues must be mistaken in their recollections of events but accepted in oral and written evidence that she could be abrupt and that some people may consider her to be rude. She also said that the nature of the SCAS investigation was suggestive of a witch-hunt.
Decision on Facts:
32. The Panel accepted the advice of the Legal Assessor. The standard of proof in HCPC proceedings is the civil standard, on the balance of probabilities, meaning that before finding a fact proved the Panel must be satisfied it is more likely than not that the alleged event occurred. The burden of proof was upon the HCPC which brought the allegation, it was not for the Registrant to prove her innocence. Although the Registrant admitted some of the particulars relating to factual matters, the Panel recognised that it had to be satisfied that those particulars of fact were capable of proof. The Panel made the following findings:
Particular 1(a) – On 16 May 2017: inappropriately left Patient 1 at her home address despite complaining of chest pain and/or giving a history and showing ECG changes suggesting an Acute Coronary Syndrome (ACS); and/or - Found proved
33. The Panel had sight of the electronic Patient Record (ePR) completed by the Registrant, partially in free text, which referenced “Unstable angina” as “Other known Cardiovascular Medical History” and recorded that Patient 1 “is known to have unstable angina.” The ECG from the Zoll monitor documented an “Abnormal finding.” JH also explained to the Panel that, amongst other factors, the patient’s blood pressure and heart rate were recorded on the ePR as abnormal.
34. It also had sight of a relevant section of the JRCALC Guidelines that that “Patients with…unstable angina manifestations of ACS are at significant risk of death and should be treated as medical emergencies” and a SCAS Clinical Directive of 2012 which provided that, “All patients with non-traumatic chest pain (where a cardiac cause cannot be excluded) must be conveyed to hospital, where a thorough assessment will be made.” The Panel accepted AP’s evidence that this Clinical Directive was “standard protocol.”
35. JH was clear in his mind about the working systems in place, for example, the requirements and procedure around documenting a patient’s refusal to go to hospital. The Panel found JH to be a helpful witness and his evidence to be clear and credible. He told the Panel that, having received the email of concern from AP, he reviewed Patient 1’s ePR. He told the Panel that the ePR showed an “abnormal ECG” and he concluded that Patient 1, who had unstable angina, “must be conveyed to hospital immediately.” In answer to a question from the Panel, JH stated that this was a clear case where the patient should have been taken to hospital; it was not a complex situation or decision.
36. The Panel took into account the Registrant’s admission in relation to this sub-particular. The Registrant told the Panel that, in relation to the Past Medical History section of the ePR, she had typed in the references to Patient 1’s unstable angina, 4 “MIs” (heart attacks), 2 stents having been fitted and Patient 1 having had a stroke. The Registrant said that Patient 1 expressed her wish, twice, not to go to hospital and that the Registrant understood that this was a refusal to go, although she accepted that she did not document it as such.
37. The Panel was satisfied that, as the Paramedic attending Patient 1, the Registrant was in charge. It found that her decision not to convey Patient 1 was inappropriate in light of Patient 1’s presenting condition, abnormal observations and a previous history of unstable angina. Accordingly, it found this sub-particular proved on the balance of probabilities.
Particular 1(b) – On 16 May 2017: Provided inappropriate ‘safety netting’ advice to Patient 1 - Found proved
38. The Panel took into account the Registrant’s admission in relation to this sub-particular. The Registrant’s admission was made on the basis of her acceptance at Particular 1(a) that she should have conveyed Patient A to hospital.
39. The Panel had sight of the ePR in which the Registrant documented, “PLAN – pt advised to take own GTN as required. Pt also advised to see own GP before the end of the week if has any concerns or would like her angina reviewing, however, advised to call 999 if pain does not resolve with GTN.” The Panel considered that this advice was inappropriate and that it should have been more robust, detailed and specific. It came to this conclusion having heard the evidence of JH.
40. The Panel bore in mind its finding in relation to Particular 1(a) that the Registrant should have taken Patient 1 to hospital and considered, as a consequence, that the safety netting advice was, therefore, inappropriate. Notwithstanding that logical conclusion, the Panel also considered that the clinical safety netting advice documented in the ePR was inadequate in any event, as there was no explanation of the risks to Patient 1 of her remaining at home. The Panel found this sub-particular proved.
Particular 2 – In relation to Colleague 1, behaved in an inappropriate manner towards him, in that you:
Particular 2(a) Stated to him ‘It may be a custom in your country, but you are over here now!’ or words to that effect - Found not proved
41. The Panel had sight of Colleague 1’s signed witness statement of 3 October 2019 in which he detailed the context to this alleged comment. He stated, “As the bags were quite heavy, I picked them up to carry them over. In Poland there is a custom for the man to carry heavy bags. I took the bags because this is how I was brought up… [The Registrant] told me not to do it and I apologised and tried to explain why I had taken the bags. I cannot recall exactly what [the Registrant] said to me when I did this. It was something like “we are not in your country.” She said this as if she was speaking to a child and was telling me to behave.”
42. In oral evidence, the Registrant said that Colleague 1 offered to carry the bags and then told her about the custom in Poland. The Registrant told the Panel that she responded to Colleague 1 by saying words to the effect of “it used to be like that in this country but not anymore.” The Registrant said that “It was chit-chat, nothing more.”
43. The Panel concluded that it was more likely than not that the Registrant had said the alleged comment, or words to that effect. It then considered carefully the context in which the Registrant made the comment and whether it was an inappropriate comment to make in the particular circumstances. The Panel noted that, on Colleague 1’s own account, he had first mentioned the custom in Poland and the Registrant had responded. On the balance of probabilities, the Panel did not find this to be an inappropriate comment in the circumstances and, accordingly, did not find this sub-particular proved.
Particular 2(b) – Raised your voice at him on one or more occasions - Found proved
44. The Panel accepted the evidence of Colleague 1 that, on one occasion, he was observing the Registrant completing a paediatric life support assessment and the Registrant shouted at him. The Registrant addressed this occasion in her evidence and accepted that she shouted at Colleague 1 during her Intra-Osseous assessment on 9 May 2017. She said that she had been startled to suddenly find Colleague 1 a metre or so away from her when she was undertaking a challenging practical assessment, and that she shouted at him. The Panel took into account the Registrant’s admission in relation to this sub-particular.
45. On the Registrant’s account, although she accepted that she and Colleague 1 “snapped” at each other at times, particularly during the latter part of the 3 months they worked together, she only raised her voice at him on one occasion (as detailed in paragraph 44). On Colleague 1’s account, however, when he was with the Registrant in the ambulance, “She would be shouting and raising her voice at me. This would happen almost every shift and especially if we were working a morning shift…if I said something I would get shouted at, and if I did not say anything she would try to get me to say something to then shout at me.” The Registrant denied this and told the Panel in evidence that she did not recognise herself at all in this description. In cross-examination, when asked whether Colleague 1 misconstrued her behaviour, the Registrant replied, “Potentially, yes.”
46. The Panel heard evidence from Colleague 2 that she had heard the Registrant raise her voice to Colleague 1 when transporting a patient on a carry chair.
47. The Panel was satisfied that it was more likely than not that the Registrant raised her voice at Colleague 1 on two occasions and that this was inappropriate, being in the workplace and in a professional situation. It found this sub-particular proved on the balance of probabilities.
Particular 2(c) – Made references to his Polish nationality without good cause - Found not proved
48. The Panel took into account Colleague 1’s written evidence that, “I am from Poland originally and [the Registrant] would sometimes refer to this as if making a mockery or implying that this was the reason that I didn’t know how to do something. She would usually refer to my Polish nationality in front of patients. She was careful not to do this in front of colleagues.” The Panel considered that both the wording of this sub-particular and Colleague 1’s evidence in relation to it lacked detail and specificity. There was no corroborating evidence in support of it and, for example, no contemporaneous note made by Colleague 1. The Panel further noted that in the meeting of 5 June 2017, when Colleague 1 detailed his concerns around the Registrant’s treatment of him, he did not mention her making reference to his nationality.
49. The Registrant denied this sub-particular and, when pressed in cross-examination, said that she thought Colleague 1 was making this allegation up. The Panel took into account the Registrant’s comment within her written statement, prepared for the SCAS local investigation that, “Another cause for concern in my eyes is that I have once in the past heard [Colleague 1] say to me (in the context of a conversation) that he could claim racism if he ended up not getting his way in a situation: “you only treat me like this because I’m [redacted].” At the time this seemed to be in a jokey manner, although this has now joined the lengthening list of my concerns.”
50. The Panel considered the wording of this sub-particular very carefully. In order for the HCPC to prove its case, the Panel would need to be satisfied that the Registrant made references to Colleague 1’s Polish nationality “without good cause”. Without any information before it as to when the Registrant is said to have made the alleged comments, what the comments were or the context in which they were allegedly said, the Panel could not be satisfied that such comments were made without good cause or that they were inappropriate. Accordingly, the Panel did not find this sub-particular proved on the balance of probabilities.
Particular 2(d) – On job A, made critical comments regarding his actions and about him in front of bystanders - Found not proved
51. The Panel considered that Colleague 1’s evidence in his witness statement in relation to this sub-particular, which specifically concerned one job attended by Colleague 1 and the Registrant, ‘job A’, was non-specific: “The Registrant was making comments about me in front of these bystanders. I cannot recall anything specifically that she said but I remember the feeling; the feeling that I was a stupid Polish person who could not understand. I felt that she was putting me down to amuse the bystanders. They heard what she had said and reacted by laughing...I was waiting in the ambulance and wondering what she was talking about with them. I thought she might me speaking to them about me.” The Panel also took into account Colleague 1’s statement of 5 June 2017, submitted as part of the SCAS investigation, that “…quite often [the Registrant] was…making comments to the patients and bystanders…regarding me not being professional and not doing job properly – and explaining it because I was new in service. Worst situation…was accident with woman overdosing…where [the Registrant] was rude towards me, making mockery out of me in front of all bystanders (about 10 people) by preaching, making comments of my actions and about me.” The Panel noted that Colleague 1’s reference in that statement to “quite often” and the alleged comments concerning his professionalism did not relate to Job A. His recollection of Job A was the Registrant being rude towards him and passing “comments of my actions” without providing further detail.
52. The Registrant had no recollection of Job A. She denied this allegation and, when pressed in cross-examination, said that she thought Colleague 1 had made it up.
53. On the evidence before the Panel, it could not be satisfied, on the balance of probabilities, that the Registrant made “critical comments about Colleague 1’s actions” on Job A. Accordingly, it found this sub-particular not proved.
Particular 2(e) – On 22 April 2017, stated to Colleague 2 ‘He does not need to know that!’ in front of the patient - Found not proved
54. The Panel considered the evidence of both Colleague 1 and Colleague 2 in relation to this sub-particular, that Colleague 2 was showing Colleague 1 the clubbing fingernails on the patient, explaining what it indicated, and that the Registrant said that Colleague 1 did not need to know about it. Colleague 1 stated, “I felt she was saying that I did not ever need to know this, that I am not going to need it here.” As Colleague 1 had not attended the hearing, the Panel was not able to seek clarification from him as to the apparent conflict in his statement between him not needing the knowledge “here”, which the Panel considered could have meant at that job, and “ever”.
55. The Registrant gave clear evidence to the Panel in relation to her assessment of the gravity of the patient’s condition - the Registrant was concerned that there had been a bursting of metastases on the brain and the patient was critically ill - and that the patient needed to be taken to hospital urgently. She said, “This job, for me, felt time critical.” In the Registrant’s view, Colleague 2 had not grasped the severity of the patient’s condition; the Registrant accepted that she did not tell Colleague 2 about her assessment of the gravity and urgency of the situation until the Registrant was about to pull away in the ambulance, with the patient in the back. The Panel accepted the Registrant’s evidence that she said, “He [Colleague 1] doesn’t need to know about that now.”
56. The Panel considered that the context in which the Registrant made the comment was important, it being in the middle of a challenging job, where the focus was the welfare of what the Registrant understood to be a critically ill patient. The Panel was satisfied that it was more likely than not that the Registrant stated to Colleague 2 that Colleague 1 did not need to know about clubbing fingernails “now” and that this was not an inappropriate comment in the particular circumstances. It therefore found this sub-particular not proved on the balance of probabilities.
Particular 2(f) – On or around 16 March 2017, stated ‘I have broken MY ECA’, or words to that effect - Found not proved
57. The Panel considered the context in which it is alleged that the Registrant made this comment about Colleague 1. It noted that Colleague 1 had hurt his back when physically supporting a patient at the scene of a road traffic accident.
58. In his witness statement, Colleague 1 stated, “My team leader, [the Registrant] and I then started filling out an incident report about the back issue. She said to my team leader, “I have broken my ECA” or words to that effect. I cannot recall the tone she said this in but I felt shocked that she would say this to my team leader. I do not think anyone else was around to hear this comment.”
59. The Registrant’s evidence was that she could not remember saying this at all; that, to her mind, such a comment would not be considered to be banter; and that it was not part of her character to say that she had “broken a person.”
60. The Panel noted that there was no corroborative evidence before it that the team leader referred to by Colleague 1 had responded or demonstrated any concern about the alleged comment or the appropriateness of it. The Panel noted that Colleague 1 specifically stated that he could not recall the tone in which the alleged comment was made. The Panel considered that evidence around the tone of any such comment would be pivotal in determining whether the comment was appropriate or not. The Panel was of the view that if the comment had been said, and if the team leader had felt it to be inappropriate, he would have said so. Accordingly, the Panel found this sub-particular not proved on the balance of probabilities.
Particular 2(g) – On or around 9 May 2017 told him to ‘Fuck off!’ and/or ‘Sit the fuck down’ during a Face to Face (F2F) assessment, or words to that effect - Found proved
61. The Panel took into account the evidence of Colleague 1 that, on one occasion, he was observing the Registrant completing a paediatric life support assessment and the Registrant shouted at him. He stated, “I cannot recall specifically what she said or whether she swore at me. I remember it being something to the effect of “What the hell are you doing?” but I cannot be certain exactly what she said to me. Even the instructor looked taken aback by her outburst.”
62. The Registrant addressed this occasion in her evidence and accepted that she shouted and swore at Colleague 1 in the way alleged during her assessment on 9 May 2017, and that this was inappropriate. She said that she had been startled to suddenly find Colleague 1 a metre or so away from her when she was undertaking a challenging practical assessment which involved completing an Intra-Osseous, and that she sworn at him. The Panel took into account the Registrant’s admission in relation to this sub-particular. Her admission was corroborated by Colleague 6’s evidence that “[the Registrant] snapped at [Colleague 1] and told him to “Fuck off”, which Colleague 6 considered to be a “wow moment” as it would not be normal to use that phrase at work.
63. In light of the evidence before it, the Panel found that the Registrant did tell Colleague 1 to “Fuck off”, or words to that effect. In relation to the stem of Particular 2, the Panel considered that the Registrant’s swearing at Colleague 1 at the training session was inappropriate behaviour in the workplace, in front of colleagues. Accordingly, it found this sub-particular proved.
Particular 3 – In relation to Colleague 3, behaved in an inappropriate manner, in that:
Particular 3(a) – In or around March 2017, you stated in front of a patient and his family members that you “cannot trust the opinion of an ECA” or words to that effect - Found proved
64. Colleague 3 gave evidence to the Panel and had a clear recollection of the alleged incident. Colleague 3 told the Panel that the Registrant made this comment when he had made an assessment of the patient and was discussing his assessment with the patient and family members. He said that the Registrant then said, in front of everybody, “Don’t worry, I will do an assessment myself because I can’t trust the opinion of an ECA”…Her remark meant that the family then lost confidence in me and it gave an impression that I did not know what I was doing or did not seem capable of doing my job.” In oral evidence, Colleague 3 told the Panel that he had been advised by a SCAS manager to collate a group grievance against the Registrant but that he considered this to be an extreme course of action. The Panel accepted Colleague 3’s evidence as being balanced and credible and considered him to be a compelling witness.
65. The Registrant denied this allegation and said that she would have had no reason to make the comment during or following Colleague 3’s assessment of the patient as “he was very good at assessments.” On balance, the Panel preferred Colleague 3’s evidence to the Registrant’s and did not accept her account that the comment had been taken out of context and was, in fact, made in relation to her signing off on the iPad. In coming to this conclusion, the Panel noted the statement made by Colleague 3 in June 2017. The Panel considered Colleague 3’s version of events to be plausible and accepted that he had a clear recollection of an event that had impacted adversely upon him.
66. In relation to the stem of Particular 3, the Panel was in no doubt that this comment made by the Registrant about her professional colleague had the effect of undermining him and was inappropriate. Accordingly, it found this sub-particular proved.
Particular 4 – In relation to Colleague 4, on or around 9 February 2017, behaved in an inappropriate manner, in that you said to him or words to the effect of:
67. Colleague 4 told the Panel that his interactions with the Registrant on the day in question fell into two parts - the first when the Registrant was in the ambulance and Colleague 4 banged on the side “as a joke”; the second interaction was in the garage, soon after, when the Registrant continued to swear at him. He accepted that banging on the ambulance might have caused alarm to the driver and said that he had tried to resolve the matter with the Registrant in the hope that they could “move on.” The Panel found his evidence to be consistent and credible and considered Colleague 4 to be an honest and plausible witness. Colleague 4 had a clear recollection of precisely when and where the comments were made and the Panel considered that the fact that Colleague 4 confirmed his concerns in writing the next day, by way of a detailed statement, supported his account. In oral evidence, Colleague 4 did not try to embellish his written evidence and the Panel considered that this added to his credibility.
68. The Registrant’s evidence in relation to Particular 4 was that it was Colleague 4 who was the aggressor and that, after the first altercation in the ambulance, he went back to the station “to have another go.” The Registrant recalled Colleague 4 aggressively saying to her, “Don’t forget my name” and that she felt threatened by him. It was the Registrant’s position that Colleague 4 had fabricated these allegations, save for Particular 4(a).
69. In this context the Panel then went on to consider each element of Particular 4.
Particular 4(a) – ‘Fuck off’, on numerous occasions - Found proved
70. The Panel took into account the Registrant’s admission in relation to this sub-particular.
71. The Panel considered the meaning of the word “numerous” in the allegation and took this to mean many times. The Panel considered the detailed ‘near-contemporaneous’ statement prepared by Colleague 4 on 10 February 2017 which referenced the Registrant saying “fuck off” to him 8 times, and was satisfied that it was more likely than not that the Registrant told Colleague 4 to “fuck off” numerous times. The Panel accepted Colleague 4’s oral evidence that the Registrant was aggressive when she said this. In relation to the stem of Particular 4, the Panel was in no doubt that telling a professional colleague to ‘fuck off’ in an aggressive way, one or more times, was inappropriate. Accordingly, it found this sub-particular proved on the balance of probabilities.
Particular 4(b) – ‘I told you fuck out from my station’- Found proved
72. The Registrant said that she did not recall saying this and contended that, as the ambulance station was not “her” station, she would not have said the words alleged.
73. The Panel took into account Colleague 4’s evidence that he was a visiting staff member from another station. There was no dispute that, at the relevant time, the Registrant was based at the ambulance station. The Panel preferred the evidence of Colleague 4 about this matter, who recalled the incident clearly and documented it in detail the day after the incident. The sort of detail that Colleague 4 gave as to the context in which the words were said supported the Panel’s conclusion that his evidence was credible. The Panel did not accept the Registrant’s assertion that Colleague 4 had made up this allegation.
74. The Panel concluded that it was more likely than not that the Registrant had said the words alleged, or words to that effect, to Colleague 4 and that this was inappropriate. Accordingly, it found this sub-particular proved.
Particular 4(c) – ‘Just fuck off from my station you bloody…foreigner’- Found proved
75. The Panel preferred the evidence of Colleague 4 detailing this occasion and found his account compelling. He remembered that this statement was made by the Registrant in the “second phase” of their altercation, in the ambulance garage. The sort of detail that Colleague 4 gave as to the context and timing in which the words were said, including the Registrant pointing her finger towards the door, led the Panel to conclude that his evidence was credible. The Panel noted that Colleague 4’s email that accompanied his detailed statement on 10 February 2017 expressed that, because of the incident, he felt discriminated against on the basis of his nationality. In oral evidence, he told the Panel that her comment made him feel “small”.
76. The Panel did not accept the Registrant’s assertion that Colleague 4 had made up this allegation.
77. The Panel concluded that it was more likely than not that the Registrant had said the words alleged, or words to that effect, to Colleague 4 and was in no doubt that this was inflammatory and wholly inappropriate. The Panel considered that the inclusion of the word ‘foreigner’ aggravated the situation further and that there would be no occasion when it would be appropriate to make such a comment about a colleague being a ‘foreigner’. Accordingly, it found this sub-particular proved.
Particular 4(d) – ‘Yes, we did meet once, and you didn’t impress me at all’- Found proved
78. The Panel took into account the Registrant’s admission in relation to this sub-particular. The Registrant said that when she had met Colleague 4 previously on a job they attended together, she had considered that he was clinically unsound.
79. The Panel accepted Colleague 4’s recollection of events and the context in which he remembered the Registrant making the statement in the station garage. In relation to the stem of Particular 4, the Panel considered that this second part of the comment, about Colleague 4 not impressing the Registrant, was intended by her to turn what would have been a neutral comment into a strongly negative one. The Panel considered that this aggravated the situation and was inappropriate. Accordingly, it found this sub-particular proved
Particular 4(e) – ‘If you come over to my station and acting like a child banging ambulance you fuck out from here’- Found proved
80. The Panel found that Colleague 4’s evidence, detailing the occasion on which the Registrant said this, or words to that effect, was compelling. Again, the sort of detail Colleague 4 gave in his near-contemporaneous note as to the context in which the words were said led the Panel to conclude that his evidence was credible. The Panel also noted the evidence of GB, who had been reversing the ambulance, who said that the Registrant “backed up her point by telling [Colleague 4] how childish it was to hit the side of a moving ambulance…” and considered that this corroborated Colleague 4’s evidence in part.
81. In oral evidence, the Registrant appeared to accept that she had said words to this effect.
82. In relation to the stem of Particular 4, the Panel was in no doubt that the Registrant’s behaviour in telling Colleague 4 to ‘fuck off’, or words to that effect, was inappropriate. Accordingly, it found this sub-particular proved.
Particular 4(f) – ‘No I not and no point me to talk because you not understand my anywhere you foreigner’- Found proved
83. Colleague 4 was clear in his recollection of precisely when the Registrant had said this to him and the context in which it was said. His account in his near-contemporaneous statement was that he asked the Registrant if she had finished because he wanted to say something and that this was her response. The Panel accepted his evidence as credible.
84. The Panel rejected the Registrant’s evidence that she had not made this comment to Colleague 4. The Panel concluded that it was more likely than not that the Registrant said words to the effect that there was no point her talking to him because he couldn’t understand her as he was foreign. In relation to the stem of the charge, for the same reasons as the Panel set out at Particular 4(c), the Panel concluded that the comment was insulting and wholly inappropriate for the Registrant to make; there was no occasion where it would be appropriate to make such a comment. Accordingly, the Panel found this sub-particular proved on the balance of probabilities.
Particular 6 – In relation to Colleague 6, behaved in an inappropriate manner in that you said to him:
Particular 6(a) – ‘Are you stupid or deaf, I told you to leave all bags on the ambulance.’ – Found proved
85. The Panel heard evidence from Colleague 6 that, when attending an incident with the Registrant for the first time, he jumped out of the ambulance and took the primary response bag with him. In his witness statement, Colleague 6 said, “It is normal practice to take the green response bag on scene to any emergency call out. When I got out of the ambulance, [the Registrant] was speaking to the two police officers who were on scene. When she saw me, she turned around and said, “Are you stupid or deaf, I told you to leave all bags on the ambulance” ...I was very angry with the way she had spoken to me and, at the end of the shift, I spoke with my team leader and asked to never be put on shift with [the Registrant] again.” The Panel also noted an email from Colleague 6 dated 18 December 2017 for the purposes of the SCAS investigation which contained consistent evidence in relation to this allegation to that in his witness statement. In oral evidence, Colleague 6 said that he had never been spoken to in such a way before.
86. The Registrant could not recall the specific occasion. She appeared to accept that she must have said something to Colleague 6 that upset him but said that she would not have said that he was either deaf, because she knew that he was not, or stupid, because she found this to be a cutting and unnecessary comment. The Registrant, via her Representative, apologised to Colleague 6 at this hearing.
87. The Panel found Colleague 6’s evidence detailing the occasion on which the Registrant said these words to be consistent, clear and compelling. The Panel preferred Colleague 6’s evidence because he recalled the specific occasion and the way that it made him feel. The sort of detail that Colleague 6 gave as to the context in which the words had been said led the Panel to conclude that his evidence was credible.
88. The Panel was satisfied that it was more likely than not that the Registrant had said the words alleged and it determined that, in relation to the stem of Particular 6, such words were offensive and wholly inappropriate. Accordingly, it found this sub-particular proved on the balance of probabilities.
Decision on Grounds and Impairment:
89. The hearing resumed on 19 August 2020. In light of the Government’s advice on containing the current Covid-19 pandemic, the HCPC has suspended all public hearings to protect the safety of its registrants and stakeholders. The resumed hearing was conducted remotely via video-link. All relevant documentation had been distributed in advance of the hearing.
90. The Panel considered, on the basis of the facts found proved, whether the grounds of misconduct and/or lack of competence were established. The Panel noted that there is no burden or standard of proof at this stage and exercised its own professional judgement, keeping at the forefront of its consideration the overarching objectives of the HCPC.
91. The Registrant did not give further oral evidence at this stage of the hearing but provided a bundle of documentary evidence comprising an updated summary of Continuing Professional Development (CPD) activity undertaken to August 2020; a Certificate of Attendance and related course content slides for a one day face-to-face course called Practical Skills for Effective Communication attended by the Registrant on 10 March 2020; and an updated testimonial dated 16 August 2020 from an Ambulance Care Assistant.
92. The Presenting Officer made submissions regarding the issue of grounds and addressed the Panel on both lack of competence and misconduct. She also referred to the HCPC Standards of Conduct, Performance and Ethics (2016) referencing Standards 1, 2 and 6 and the relevant HCPC Standards of Proficiency for Paramedics (2014) as being paragraphs 1, 2, 3, 4, 6, 8, 9 and 14.
93. The Presenting Officer submitted that, in relation to the clinical issues in Particulars 1(a) and (b) where the HCPC pleaded the statutory grounds of lack of competence and misconduct in the alternative, the Registrant’s actions in leaving Patient 1 at home, despite clear guidelines and a Directive that the patient should have been conveyed to hospital, fell short of what was proper in the circumstances. She reminded the Panel that at the time of the incident in 2017, the Registrant had been qualified as a Paramedic for 8 years without any clinical concerns having been raised. The Presenting Officer contended that whilst a lack of competence would usually be determined by reference to a fair sample of a registrant’s work, a single incidence of negligent conduct could connote a lack of competence. In relation to Particulars 2-6, the Presenting Officer contended that the Registrant’s conduct towards four colleagues was offensive, aggressive and inappropriate, amounted to a pattern of behaviour, would be considered deplorable by fellow practitioners and was so serious as to amount to misconduct.
94. As to current impairment, the Presenting Officer referenced the documentation submitted by the Registrant including her reflective piece in relation to the incident concerning Patient 1, her ongoing CPD activity, professional testimonials and a letter from a patient. In relation to the personal component of current impairment, the Presenting Officer submitted that the Registrant had given candid evidence in relation to Particular 1 and demonstrated insight. She submitted, however, that the Registrant had shown limited insight in relation to her behaviour directed towards colleagues. She reminded the Panel that the Registrant had accepted in evidence that she could be abrupt, that people could consider her to be rude and that she had not been able to provide an explanation as to why her recollection of events differed from those of her colleagues. The Presenting Officer asked the Panel to consider whether the one-day communication course undertaken by the Registrant was sufficient to remedy a pattern of inappropriate behaviour towards colleagues. In relation to the public component, the Presenting Officer referenced the test set out by Dame Janet Smith in her Fifth Shipman report. The Presenting Officer submitted that limbs (b) and (c) of the test were engaged in this case and that public confidence in the Paramedic profession would be undermined if no finding of current impairment were made in this case.
95. The Registrant’s Representative submitted detailed written submissions to the Panel. In relation to Particular 1 and the statutory ground of lack of competence, he referenced relevant caselaw and reminded the Panel that there was a single clinical event which could not be a fair representation of the Registrant’s practice and that the evidence in this case pointed to the Registrant being competent in all other respects. As to misconduct, the Registrant’s Representative submitted that it was accepted that Patient 1 should have gone to hospital, but he invited the Panel to consider carefully how far below the requisite standards the Registrant’s actions fell.
96. In relation to Particulars 2-6, the Registrant’s Representative submitted that not all inappropriate interactions between colleagues at work can or should amount to misconduct. He submitted that it was not appropriate for the Panel to ‘bundle up’ separate allegations of fact which do not themselves amount to misconduct.
97. As to current impairment, the Registrant’s Representative reminded the Panel that the allegations in this case arose over three years ago, that the matters have been hanging over the Registrant for a long time (further delay having resulted from the Covid-19 pandemic). He invited the Panel to determine that these events were relatively few in number, were location specific to SCAS during a relatively short period (February to May 2017) in an otherwise unblemished career of service. He submitted that the conduct found proved could properly be regarded as out of character, that the Registrant had insight and had sought to remediate her conduct by attending the Effective Communication course. He submitted that her fitness to practise was not currently impaired.
98. The Panel accepted the advice of the Legal Assessor who reminded it of the tests for misconduct and for lack of competence and referred to relevant case law including Roylance v GMC (No. 2)  1 AC 311 and Holton v GMC  EWHC 2960 Admin. The ground of lack of competence required an assessment, made of a fair sample of the Registrant’s work, that the Registrant was not meeting the required standards. The Legal Assessor advised the Panel that, in order to find lack of competence, it would need to have considered a fair sample of the Registrant’s work and that it should consider whether the Registrant has the knowledge, skills and judgment to practise safely on the proven facts. Lack of competence could be distinguished from misconduct in that it indicated an inability to work at the required level and connoted a standard of professional performance that was unacceptably low. Misconduct, on the other hand, was a different ground and required a serious departure from the proper professional standards that had caused or could cause real harm to service users, colleagues or the public or the wider public interest. The Legal Assessor reminded the Panel that a breach of the professional standards alone did not necessarily constitute misconduct. A single negligent act or omission was unlikely to amount to misconduct but could do so if particularly serious.
99. On the issue of impairment of fitness to practise, the Legal Assessor referred the Panel to the HCPTS Practice Note ‘Fitness to Practise Impairment’, and to the guidance on the assessment of impairment and consideration of the public interest in the case of CHRE v NMC & Grant  EWHC 927 (Admin). She reminded the Panel that it should consider the Registrant’s insight, her remorse, any steps taken to remediate and the risk of repetition of the behaviour leading to the facts found proved. The Panel should at all times keep in the forefront of its mind the central importance of the need to protect the public and the wider public interest.
100. While the Panel was deliberating in private session, it was informed that the Presenting Officer had been made aware that the Registrant had had a previous hearing at the HCPC in 2013. The following statement, agreed between both Counsel, was provided to the Panel: “The Registrant came before the HCPC PCC in 2013 regarding matters pertaining to her attendance at a road traffic collision in 2011. The PCC determined that one factual matter indicated a clinical decision taken by the Registrant at the scene had fallen below the standard of a registered paramedic, but no finding of misconduct or impairment was made. This matter is brought to the PCC’s [sic] attention by agreement between the parties so that the full context of her career as a paramedic is in evidence.” The Presenting Officer told the Panel that this agreed fact was before the Panel so that the full context of the Registrant’s career as a Paramedic was in evidence. The Legal Assessor advised that her previous advice to the Panel concerning the Registrant’s good character, given at the end of the Facts stage, remained appropriate in light of this new information and that her advice did not need to be modified or qualified.
101. The Panel carefully considered the facts and the submissions made. From all the evidence within the bundles and the oral evidence of witnesses and that given by the Registrant herself, the Panel concluded that the facts found proved in relation to Particular 1(a) and (b) did not connote a lack of competence on the Registrant’s part. The Panel was not satisfied that the Registrant lacked the knowledge, skills or judgment to practise safely. The Panel took the view that the Registrant was aware of the standards expected of her but, by way of an error of judgement, failed to meet those proper standards on that occasion. Accordingly, the proper statutory ground for the Panel to consider was that of misconduct.
102. The Panel next considered whether any of the facts proved could amount to misconduct. The Panel was aware that not every act falling short of what would be proper in the circumstances, and not every breach of the HCPC Standards, would be sufficiently serious that it could be properly described as misconduct. The Panel had in mind the HCPC Standards of Conduct, Performance and Ethics (2016) and concluded that the following standards were engaged and were breached:
• Standard 1.5: You must not discriminate against service users, carers or colleagues by allowing your personal views to affect your professional relationships or the care, treatment or other services that you provide. [In relation to Particular 4]
• Standard 2.5: Communicate appropriately and effectively – Work with Colleagues - You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers. [In relation to Particulars 3(a) and 6(a)]
• Standard 9.1: Personal and professional behaviour - You must make sure that your conduct justifies the public’s confidence in you and your profession. [In relation to Particulars 3(a), 4(a)(b)(c)(e)(f) and 6(a)]
103. Considering Particular 1 first, the Panel bore in mind the Registrant’s evidence that she had intended to take Patient 1 to hospital, but the patient had declined, and the Registrant had acceded to the patient’s wishes. The Panel considered that it would have been appropriate for the Registrant to strongly advocate the merits of hospital admission to the patient. Although the Registrant’s decision to accede to the wishes of the patient placed Patient 1 at risk of harm, there was no suggestion that there was any harm caused. The Panel considered that although it had made factual findings that the Registrant had inappropriately left Patient 1 at home and provided inappropriate ‘safety netting’ advice, in the Panel’s professional judgment the “falling short” was not so significant as to meet the threshold of misconduct.
104. The remaining facts found proved in this case related to the Registrant’s behaviour towards four colleagues. The Panel considered each of the facts found proved separately.
105. The Panel considered that the Registrant’s conduct in relation to 2(b) and (g) was inappropriate and unprofessional, but carefully considered the context of the incidents. The Panel had found that the Registrant raised her voice to Colleague 1 on two occasions and that one of those occasions was during a highly charged situation when Colleague 1 had unexpectedly approached her when undertaking a complex practical F2F assessment. Although the Panel did not in any way condone this way of speaking to a colleague, in its professional judgement, the Registrant’s raised voice on two occasions and telling Colleague 1 to ‘Fuck off’ during the practical assessment would not be considered deplorable by fellow practitioners and did not reach the threshold of misconduct. Further, the Panel considered that the Registrant’s comment to Colleague 4 at Particular 4(d), that they had met once before and that Colleague 4 had not impressed her, although disrespectful, did not amount to misconduct.
106. The Panel concluded, however, that each of the facts it had found proved in relation to Particulars 3(a), 4(a)(b)(c)(e)(f) and 6(a) fell significantly short of what would be proper in the circumstances. The Panel gave careful consideration to the context in which each of the comments was made. The Registrant was an experienced Paramedic. Her behaviour towards colleagues was not just unprofessional but was demeaning and belittling. The comments caused the colleagues to ‘lose face’ or risked diminishing the public’s trust in them (Particulars 3(a), 6(a)). Comments made by the Registrant were aggressive, offensive and inflammatory (all of Particular 4, including the repetition of “…my station” and “you foreigner”, and “Are you stupid or deaf” in Particular 6(a)). In the Panel’s professional judgment, the comments also indicated a pattern of inappropriate behaviour that was wholly unacceptable. The Panel considered that the Registrant’s conduct demonstrated behaviour that lacked professional integrity and that fellow registrants would consider to be nothing short of deplorable.
107. The Panel was in no doubt that the Registrant's behaviour had the clear potential to undermine public confidence in the profession and it found that to characterise it as other than misconduct would fail to uphold proper professional standards and would undermine public confidence in the profession and in the regulatory function of the HCPC. In these circumstances, the Panel determined that the ground of misconduct was well founded.
108. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of her misconduct. It was mindful that a finding of impairment does not automatically follow a finding on that ground. Having heard the submissions from the Presenting Officer and the Registrant’s Representative on the issue of impairment, the Panel also took account of the documentary evidence submitted by the Registrant. It accepted the advice of the Legal Assessor that the Panel had to consider whether the past misconduct leads to the Registrant’s fitness to practise being impaired now. Although the test of impairment is expressed in the present tense in relation to the need to protect the public against the acts and omissions of those who are not fit to practise, this cannot be achieved without taking account of the way a person has acted or failed to act in the past. There are two component parts of the test for impairment. First, there is what may be termed the personal component of this decision. The Panel should consider the proven past misconduct together with all the other evidence the Panel has in respect of the Registrant (e.g. insight, any evidence of the remedying of the deficiencies, the risk of repetition, and the risk to the public presented by any repetition of misconduct). Second, the Panel must also consider what may be termed the public component, namely, what would be the effect of not finding current impairment on the wider public interest? That wider public interest includes the maintenance of public confidence in the profession and its regulator and the declaring and upholding of proper standards of conduct.
109. The Panel adopted the approach formulated by Dame Janet Smith in her Fifth Report of the Shipman Inquiry by asking itself the following questions:
Do our findings of fact in respect of the Registrant’s misconduct show that her fitness to practise is impaired in the sense that she:
a) has in the past acted and/or is liable in the future to act so as to put patients at unwarranted risk of harm; and/or
b) has in the past brought and/or is liable in the future to bring the Paramedic profession into disrepute; and/or
c) has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession; and/or
d) has in the past and/or is liable in the future to act dishonestly?
110. The Panel determined that limbs (b) and (c) were engaged in this case. It considered that the Registrant had, in the past, brought the Paramedic profession into disrepute and breached the fundamental tenets of both acting professionally and communicating appropriately and effectively with colleagues. In considering whether she would be liable in the future to bring the profession into disrepute or to breach one of the fundamental tenets of the profession, the Panel had careful regard to matters of insight, remorse and remediation and the risk of repetition.
111. The Panel took account of the documentation provided by the Registrant. The Panel bore in mind that the Registrant has continued to work as a locum Paramedic, with no further issues raised. It was clear from testimonials provided to the Panel that the Registrant is a competent Paramedic in a clinical setting. However, the misconduct found in this case does not concern her clinical competence, rather it concerns repeated offensive and disrespectful comments that the Registrant made to a number of colleagues. The Panel had serious concerns about the Registrant’s judgment and understanding of how to conduct herself with colleagues in the workplace. In particular, the Panel considered that interpersonal relationships and team working are fundamental for effective practice as a paramedic. The Panel was of the view that, in theory, the Registrant’s misconduct is capable of remediation through meaningful reflection. The Panel noted that the Registrant had attended the Effective Communication course of 7 hours in March 2020 and had intended to undertake a further advanced course relating to Communication skills but that this had been postponed due to Covid-19. Although the Panel considered this to be a step in the right direction and demonstrated a limited level of insight, the Panel had nothing before it to satisfy it that the Registrant had reflected fully on the findings of the Panel in December 2019. There was no evidence of any reflection around the Registrant’s understanding of the importance of behaving professionally in the workplace or indeed the impact of her actions on her colleagues, her profession and the public. The Panel noted, for example, that the Effective Communication course notes suggested as a prompt for course attendees the development of an action plan, but the Registrant had not provided any such plan or any strategies addressing how she would conduct herself going forward. The Panel considered that the Registrant had not reflected fully on her actions and had not demonstrated full insight into her shortcomings or indeed any remorse other than that expressed during the previous component of the hearing in relation to Colleague 6. In light of this, the Panel could not be satisfied that the Registrant had learned from her serious departures from the standards expected of her or that similar conduct would not be repeated. There was no evidence before the Panel that the Registrant understood the gravity of the actions that had led to the finding of misconduct or the potential consequences of her actions. In the Panel’s view, the Registrant’s level of insight is far from fully developed.
112. In light of all the evidence before it, the Panel considered that there was a risk of repetition going forward. It therefore concluded that in relation to the personal component, the Registrant’s fitness to practise is currently impaired.
113. In relation to the wider public interest, the Panel reminded itself of the public component in Cohen v General Medical Council  EWHC 581: “the need to protect the individual and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect…and that the public interest includes, amongst other things, the protection of service users and the maintenance of public confidence in the profession.” The Panel had no doubt that an informed member of the public would consider that public confidence in the Paramedic profession would be undermined if there was no finding of impairment in this case. The nature of the misconduct towards a number of colleagues is such that public confidence in the profession would be undermined if no finding of impairment were made. A reasonable member of the public would expect a finding of impairment in the circumstances of this case in order to uphold proper standards of conduct and behaviour. The Panel also took the view that it would be failing in its duty to declare and uphold proper standards of conduct and behaviour in the Paramedic profession if it did not find impairment in this case. Paramedics should be in no doubt that this sort of behaviour is unacceptable.
114. Having regard to all the above, the Panel determined that the Registrant’s fitness to practise is currently impaired on both the personal and public components.
Decision on Sanction
115. The Registrant’s Representative informed the Panel that the Registrant wished to give sworn evidence at this Sanction stage by way of reading a prepared statement.
116. Under oath, the Registrant said that she had asked to give evidence today as she was stunned by the Panel’s determination on impairment and wished to have the opportunity to express her feelings regarding the situation that had developed over the past three years. The Registrant stated that she had accepted the findings of the Panel and that the gravity of the situation that she had caused had affected her deeply. She said that she was concerned that, by not giving evidence at the impairment stage of the hearing, she had given the Panel the wrong impression about her thoughts and feelings regarding her case and the degree to which she had reflected on the Panel’s findings since receiving the determination on facts in December 2019. The Registrant said that she was “mortified and extremely sorry” that her conduct had fallen so far below the standards expected of a healthcare professional such that it might bring her profession into disrepute. She was also “devastated that my behaviour has caused considerable upset to my colleagues, that they have felt demeaned, belittled and offended by my behaviour and that they have been upset as a result of my interactions with them.” She apologised to the HCPC, to the Panel and to her former colleagues. The Registrant stated that the proceedings had brought “a gradual realisation that how I intend to behave and how I actually behave are not the same. That is a huge realisation at my age and stage of life and is not something that can be fixed instantly or without the help of others. However, I have already begun to work on changing this and am determined to continue to improve.”
117. The Registrant provided evidence to the Panel around the British Medical Association Practical Skills for Effective Communication course that she had undertaken in March 2020. She explained the relevance of the course to her own situation in that it had contained sessions on essential communication skills, building professional relationships and improving intercultural communications. She provided detailed evidence in relation to the Action Plan that she had completed verbally with other course attendees on the day. The Registrant explained that, by way of further steps towards remediation, she had approached the course leader, who also works as a professional Learning and Development Consultant, with a view to receiving 1:1 professional coaching. She hoped that this would begin in the next month. The Registrant told the Panel that she had also paid for a further two-day course, Advanced Communication Skills for healthcare professionals, but that this had been cancelled due to the Covid-19 pandemic.
118. In relation to the risk of repetition, the Registrant stated the following: “Having accepted the findings of the Panel and taken genuine steps, at significant financial cost, to address my issues, I believe that the risk of repetition of my behaviour in the future is negligible. It is now over three years since the complaints about my behaviour arose while I was working at SCAS. I have found that I have been much happier since I resigned from SCAS and I have not been the subject of any other complaints or concerns. I do feel that how I expressed myself during that relatively short section of my career was out of character for me and was definitely influenced by unhappiness and stress, which I should not have allowed to impact my interactions with others. As I have mentioned earlier, I have loved being both a technician and now a paramedic and I cannot imagine continuing my working life as anything other. I can appreciate why the Panel might think there is still a risk of repetition but nothing could be further from reality.”
119. The Registrant answered questions under cross-examination and questions from the Panel. She spoke about her ongoing reflection, her intention to receive professional mentoring through the College of Paramedics on an ongoing basis, the support network around her and of strategies that she is developing to ensure that similar conduct would not be repeated. The Chair then invited the parties to address the Panel as to sanction.
120. The Presenting Officer referred the Panel to the Sanctions Policy (SP) adopted by the HCPC. She reminded the Panel that the purpose of imposing a sanction was not to punish the Registrant but to ensure that the public was protected, promote public confidence in the profession and provide a deterrent to other registrants. The Panel should address the sanctions in ascending order and identify the most appropriate and proportionate means of addressing the concerns identified. She addressed the Panel in relation to each available sanction but acknowledged that this was a matter for the Panel’s judgment.
121. The Registrant’s Representative reiterated to the Panel the impact that these ongoing proceedings have had on the Registrant and her willingness to improve. He said that she has continued to work as a Locum paramedic since she left SCAS in 2017. He asked the Panel to take into account the significant financial implications on the Registrant of being unable to pursue a career as a Paramedic in the short to medium term. The Registrant’s Representative reminded the Panel of the absence of any clinical concerns and submitted that the Registrant posed no risk to the public in this regard. He further submitted that, in relation to the SP and its specific paragraphs dealing with “Failure to work in partnership” at paragraphs 61 and 62, although the misconduct found by the Panel was serious, it was not at the top-end and did not reach the threshold of the listed examples of “bullying, discrimination or dishonesty” in the SP. He asked the Panel to “reappraise” its approach to ongoing risk, following the Registrant’s oral evidence this morning.
122. The Registrant’s Representative submitted that no sanction greater than a Conditions of Practice Order should be imposed and that Conditions in this case would be the “most relevant”. He reminded the Panel that the SP provides that a Conditions of Practice Order could be appropriate where the behaviour which was the subject of the allegation was capable of being remedied by the Registrant. He submitted that the Registrant has a real desire to make a determined effort to improve her practice and that appropriate and workable conditions could be formulated in this case. He asked the Panel to be cautious around the workability of a requirement for supervision in the workplace because of the Registrant’s Locum role.
123. The Panel heard and accepted the advice of the Legal Assessor who reminded it that the purpose of sanction was not to be punitive. Rather, the primary function of a sanction is to address public safety issues although there will also be secondary considerations in the form of a deterrent effect on other professionals and in maintaining the reputation of the profession and public confidence in the regulatory process. She advised the Panel to firstly consider whether any sanction was necessary and, if it was, to consider sanctions in ascending order, settling with the least restrictive that met the Panel’s concerns. If a sanction is to be imposed, it must relate only to the facts proved or admitted. The Legal Assessor advised that all sanctions were available to the Panel, as the statutory ground found was misconduct. When determining the appropriate level of sanction, the Panel must be proportionate so that the sanction:
a) is appropriate in the circumstances;
b) secures the protection of the public;
c) takes account of the wider public interest;
d) is the least restrictive means of securing public protection;
e) is proportionate and strikes a proper balance between the rights of the Registrant and the public interest.
124. The Panel gave careful consideration to the evidence given by the Registrant at this Sanction stage. It acknowledged the Registrant’s acceptance of the Panel’s findings in this case, albeit late in the day. It was regrettable that the Registrant did not give evidence at the Impairment stage, but the Panel was encouraged by her stated commitment this morning to improve her practice and the evidence she gave regarding her ongoing reflection. The Panel found the Registrant’s demonstration of remorse to be compelling, not only towards her colleagues but to her profession. The Panel considered the Registrant’s level of insight, following the giving of her evidence this morning, to be greater than it had previously appreciated and the risk of repetition of the behaviour to have reduced significantly. It considered that the Registrant’s journey towards remediation was ongoing but was encouraged by the steps that she has taken to date.
125. The Panel found that the matter had the following aggravating factor:
• the misconduct identified in this case was repeated over a three-month period and involved more than one colleague.
126. The Panel identified the following as mitigating factors:
• the Registrant has already taken some steps towards good quality remediation and has stated a strong commitment to remediate fully;
• the Registrant had an unblemished regulatory record prior to and since these events. The Panel is not aware of any further complaints against the Registrant in the period of three years since the events at SCAS in 2017;
• the Registrant had engaged fully with the HCPC.
127. The Panel first considered imposing no sanction but was mindful that this is an exceptional outcome and concluded that a sanction was necessary to not just address the Registrant’s conduct but also to act as a deterrent and uphold public confidence in both the profession and the regulator.
128. The Panel noted that there was no outstanding dispute as the Registrant had left the employment of SCAS. It therefore concluded that mediation was also an inappropriate sanction in this matter.
129. The SP identifies that a Caution Order may be an appropriate sanction for cases where the issue is isolated, limited or relatively minor in nature; there is a low risk of recurrence; the registrant has shown good insight and has taken appropriate remediation. The matters proved in this case are not minor and are repeated. The Panel was of the view that the Registrant’s insight was not yet fully developed and that, although she was on a journey towards remediation, this was not complete.
130. The Panel next considered a Conditions of Practice Order and considered the following provisions of the SP:
“A conditions of practice order is likely to be appropriate in cases where:
• the registrant has insight;
• the failure or deficiency is capable of being remedied;
• there are no persistent or general failures which would prevent the registrant from remediating;
• appropriate, proportionate, realistic and verifiable conditions can be formulated;
• the panel is confident the registrant will comply with the conditions;
• a reviewing panel will be able to determine whether or not those conditions have or are being met; and
• the registrant does not pose a risk of harm by being in restricted practice.”
131. The Panel was of the view, as previously stated in its determination at the Impairment stage, that the Registrant’s failings in this case are capable of remedy. It took into account the Registrant’s full engagement in proceedings. As the Panel has already determined, the Registrant is developing insight and the Panel was satisfied that the Registrant has demonstrated a willingness to comply with conditions as well as a desire to improve her professional practice. The case had not concerned the Registrant’s competence as a Paramedic and there was no evidence before the Panel of persistent or general failures which would prevent remediation. The misconduct relates specifically to her communication with colleagues which, in the Panel’s view, is capable of being remedied and, for which there are workable conditions that can be formulated to allow her to remain in practice whilst ensuring the public interest issues are addressed.
132. The Panel was satisfied that a Conditions of Practice Order was a proportionate and appropriate sanction to protect the public interest; such an order was also appropriate to declare and uphold proper standards and maintain confidence in the profession. The Panel concluded that the Conditions set out at the end of this determination are adequate and proportionate in the circumstances of this case.
133. The Conditions of Practice Order will apply for a period of 18 months. The Panel believes that this will give the Registrant sufficient time to meet the Conditions (especially in light of likely delays in many aspects of employment due to the Covid-19 uncertainty), which will demonstrate that the deficiencies in her practice have been addressed.
134. The Panel also considered whether a period of suspension would be appropriate, however it determined that a suspension would be disproportionate and punitive given that Conditions of Practice could be formulated which were sufficient to meet public interest considerations. The Panel also considered that a Suspension Order would be contrary to the public interest, which includes the retention of a registrant who is able to make a valuable contribution to the profession and to patients.
135. Before this order expires, it will be reviewed by a panel of the HCPC and the Registrant will be invited to attend that review hearing. At that review, the reviewing panel is likely to be assisted by the Registrant attending to give oral evidence and providing up to date and relevant professional testimonials attesting to her appropriate and effective communication with colleagues.
136. The Registrant can apply for an early review of this Conditions of Practice Order should she wish to do so but her case will be reviewed, in any event, before the Order expires.
ORDER: The Registrar is directed to annotate the Register to show that, for a period of 18 months from the date that this Order comes into effect (“the Operative Date”), you, Fiona Turner, must comply with the following conditions of practice:
1. You must promptly inform the HCPC if you take up a substantive position with an employer, cease to be employed by that employer or take up any other substantive employment.
2. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
3. You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).
4. You must identify and work with a mentor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:
• Appropriate and effective communication with professional colleagues.
5. Within four months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.
6. You must meet with your mentor as frequently as that person considers necessary to assess your progress towards achieving the aims set out in your Personal Development Plan.
7. You must provide the HCPC with an account of your progress towards achieving the aims set out in your Personal Development Plan no later than 14 days prior to any review hearing. This account should include a report from your mentor on your development.
8. You will be responsible for meeting any and all costs associated with complying with these conditions.
1. The Panel heard an application from the Presenting Officer for the Panel to impose an Interim Conditions of Practice Order on the Registrant’s registration for a period of 18 months to cover the appeal period. The Presenting Officer reminded the Panel of its conclusions that the Registrant had engaged in a pattern of behaviour towards colleagues that was offensive, that the Registrant’s insight was not fully developed and that there remained a risk of repetition of the misconduct. She submitted that such an order was necessary to protect the public and was otherwise in the public interest.
2. The Registrant’s Representative acknowledged that the Panel’s power to impose an interim order was a discretionary one and invited the Panel to give careful consideration to paragraphs 134-135 of the Sanctions Policy in this regard, together with paragraphs 124-126 of its determination.
3. The Panel heard and accepted the advice of the Legal Assessor. It had regard to paragraphs 133-135 of the Sanctions Policy and to the HCPTS Practice Note on Interim Orders, which offers guidance on interim orders imposed at final hearings after a sanction has been imposed.
4. The Panel recognised that its power to impose an Interim Order was discretionary and that the imposition of such an order is not an automatic outcome of fitness to practise proceedings in which a Conditions of Practice Order has been imposed, and that the Panel must take into consideration the impact of such an order on the Registrant. The Panel was, however, mindful of its findings in relation to the repeated misconduct in this case and the residual risk of repetition.
5. The Panel decided to impose an Interim Conditions of Practice Order under Article 31(2) of the Health Professions Order 2001 in the same terms as the substantive order, being satisfied that it was necessary for the protection of the public and was otherwise in the public interest to maintain confidence in this regulatory process. In reaching its decision to impose an Interim Order, the Panel had regard to the misconduct found proved, the resulting public protection concerns (towards colleagues) and the risk of repetition, as well as the full reasons set out in its decision for the substantive order. In the circumstances, the Panel was also satisfied that the risks were sufficient that a fair-minded and informed member of the public would expect such a restriction, and that public confidence in the profession and the regulatory process would be undermined were the Registrant allowed to practise unrestricted during the appeal period.
6. The period of this order is for 18 months to allow for the possibility of an appeal to be made and determined.
7. If no appeal is made, then the Interim Conditions of Practice Order will be replaced by the Conditions of Practice Order 28 days after the decision is served on the Registrant.
History of Hearings for Miss Fiona Turner
|Date||Panel||Hearing type||Outcomes / Status|
|19/08/2020||Conduct and Competence Committee||Final Hearing||Conditions of Practice|
|26/11/2019||Conduct and Competence Committee||Final Hearing||Adjourned part heard|