Miss Channon Jacobs

Profession: Paramedic

Registration Number: PA33587

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 13/01/2020 End: 17:00 17/01/2020

Location: Health and Care Professions Tribunal Service, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

Allegation (as amended): 

During the course of your employment as a Paramedic with the South Central Ambulance Service NHS Foundation Trust (‘SCAS’):

1. You were called to a category red emergency call on 15 May 2014 in relation to Lilly-May Page and:

a) You did not ensure that early defibrillation was performed on Lilly-May Page.

b) In respect of Lilly-May Page's cardiac rhythm timed at 15:29 hours, you misinterpreted the results as showing a rhythm that should not be treated by shocking.

2. The facts as described in paragraph 1 constitute misconduct and/or lack of competence.

3. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.

Finding

Preliminary Matters:
 
Service of Notice

1. The Notice of this hearing was sent to the Registrant on 15 October 2019 at her address as it appeared on the HCPC Register, and by email. The Notice contained the date, time and venue of today’s hearing.

2. The Panel accepted the advice of the Legal Assessor and was satisfied that Notice of today’s hearing has been served in accordance with Rule 6(1) of the Conduct and Competence Committee Rules 2003 (the “Rules”).

Proceeding in the absence of the Registrant

3. The Panel then went on to consider whether to proceed in the absence of the Registrant, pursuant to Rule 11 of the Rules. In doing so, it considered the submissions of Mr Foxsmith on behalf of the HCPC.

4. Mr Foxsmith submitted that the HCPC had taken all reasonable steps to serve the Notice on the Registrant by registered post and email. He further submitted that the Registrant has engaged with the HCPC to the extent that she had submitted a bundle of documents for placing before the Panel. Mr Foxsmith referred to an email from the Registrant’s legal representatives. In that email, it was stated that “The Registrant will not be attending the hearing listed to take place next week. The Registrant has prepared a written reflection and provided supporting documents to be put before the Panel. Please note that there is no discourtesy intended by the Registrant non-attendance. The case has been ongoing for a considerable amount of time and had a significant impact on her….health…..she feels that by attending the hearing this will impact her further”. The Registrant’s solicitors subsequently confirmed in an email dated 10 January 2020 that the Registrant was not asking for the hearing to be adjourned.

5. The Panel accepted the advice of the Legal Assessor. He referred the Panel to the case of R V Jones & Hayward [2002] UKHL 5 and GMC v Adeogba and Visvardis [2016] EWCA Civ 162. He advised that the Adeogba case reminded the Panel that its primary objective is the protection of the public and the public interest. In that regard, the case of Adeogba was clear that, “where there is good reason not to proceed, the case should be adjourned; where there is not, however, it is only right that it should proceed”.

6. The Panel was mindful of the need to ensure that fairness and justice were maintained when deciding whether or not to proceed in the Registrant’s absence.

7. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPTS Practice Note entitled “Proceeding in the Absence of a Registrant”. The Panel weighed its responsibility for public protection and the expeditious disposal of the case against the Registrant’s right to be present at the hearing.

8. The Panel was satisfied that all reasonable efforts had been made by the HCPC to notify the Registrant of the hearing.

9. In reaching its decision, the Panel took into account the following:

• The Registrant had submitted documents in support of her defence in anticipation of those documents being considered by the Panel in her absence;
• The Registrant was not asking for an adjournment;
• There was a public interest in hearings being held expeditiously;
• Witnesses, including an expert witness, had attended to give evidence.

10. The Panel determined that it was unlikely that an adjournment would result in the Registrant’s attendance at a later date. Having weighed the public interest for expedition against the Registrant’s own interests, the Panel decided to proceed in the Registrant’s absence.

Application re anonymity

11. Mr Foxsmith made an application that the names of Child A and her mother, who was referred to in the papers as ‘Person 1’, need not be anonymised. Accepting that it would be usual practice for their names to be anonymised, he drew the Panel’s attention to two matters:

• That the details of the incident in question had been widely published in the press, both locally and nationally where Child A’s and her mother’s identity had been disclosed, and

• That Child A’s mother did not wish her daughter to be referred to anonymously in these proceedings but that she should be referred to by her name.

12. Having heard and accepted the advice of the Legal Assessor, the Panel granted the application, recognising that there was no unfairness or injustice in referring to Child A or her mother by name.

Application to amend the Allegation:

13. At the outset of the hearing Mr Foxsmith, on behalf of the HCPC made an application to amend the Allegation. The Registrant had been put on notice of the proposed amendments in a letter dated 30 April 2019. He submitted that the proposed amendments did not change the substance of the allegation the Registrant faced, but merely ensured that the allegation better reflected the issues involved.

14. The Registrant has not raised any objection to the particulars being amended.

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

i. the Registrant had been provided with significant notice of the HCPC’s intention to amend the Allegation, having been put on notice over 8 months before the commencement of the substantive hearing;

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

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

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

Background:

17. The Registrant was employed by the South Central Ambulance Service (“SCAS”) as a Paramedic in 2011.

18. On 15 May 2014, the Registrant was called to a category red emergency call in respect of Lilly-May, a five year old child, who had collapsed after running outside school. The Registrant arrived at the scene first with an Emergency Care Assistant, RW, collected Lilly-May from the playground and proceeded to treat her in the back of the ambulance. 

19. Whilst attending to Lilly-May, the Registrant perceived the readings of the initial heart rhythm check as ventricular fibrillation (“VF”) changing to fine VF; and continued to perform CPR. A second ambulance crew and an air ambulance team arrived at the scene. The Registrant completed a handover to them. Lilly-May was subsequently transported to hospital where a resuscitation team attended to her. A decision was made to defibrillate Lilly-May, but this attempt at resuscitation proved unsuccessful.

20. On 8 May 2017, the mother of Lilly-May made a fitness to practise referral to the HCPC in respect of the Registrant.
 
Assessment of witnesses:

21. The Panel first considered the credibility of the witnesses who had given oral evidence. The Panel first heard from witness RW, the Emergency Care Assistant who attended Lilly-May with the Registrant. He gave some evidence in relation to the Registrant’s attendance on and treatment of Lilly-May, although he was unable to recall many details of the events. Whilst it appeared to the Panel that he found the process of giving evidence difficult, the Panel considered his evidence, although very limited in its scope, was generally credible, consistent, and reliable.

22. The Panel also heard from witness MJ, an expert instructed by the HCPC. He is a Fellow of the College of Paramedics. His specialist field is paramedic practice and pre-hospital care. He gave evidence in relation to the standard of care that the Registrant provided to Lilly-May. He produced a detailed report, dated 29 December 2018, which addressed a number of issues in relation to:

• the timescales in which the Registrant should have assessed Lilly May’s heart rhythm;
• the guidelines and procedures in place at the time;
• whether the Registrant complied with them; and
• in relation to Lilly-May’s rhythm, what it was indicative of, and whether the rhythm was shockable.

23. In summary, in his opinion, the Registrant should have assessed Lilly-May’s cardiac rhythm within 60 seconds of arriving at the scene and that the Registrant failed to adhere to the Joint Royal Colleges Ambulance Liason Committee National Clinical Guidelines (2013) (“Royal Colleges Guidelines”) and the UK Resuscitation Council Paediatric Basic and Advanced Life Support Guidelines (2010) (“UK Council Guidelines”). He stated that the paper printout of the initial cardiac rhythm acquired from Lilly-May was indicative of VF, which is a shockable rhythm in prehospital and hospital care. The Panel considered he gave informed, reasoned and credible evidence. The Panel did note that there were some inaccuracies in his report, for example making references to allegations that had not yet been amended, and making an error in the date of Dr Burch’s report when referring to it. However, the Panel concluded that these matters did not materially undermine the general credibility or reliability of his evidence. 

24. The Panel carefully considered the weight, credibility and reliability to be attached to the Registrant’s written submissions. The Panel is mindful that no adverse inference can be drawn from the Registrant’s non-attendance at this hearing. However, it considered that her evidence should be given less weight than that of the HCPC’s witnesses. This was because, she had not attended and therefore her evidence could not be subject to the same level of scrutiny by way of cross examination by the HCPC. However, the Panel noted that her statements were broadly consistent with each other including her oral evidence given under oath to the Coroners Court.

Panel’s Approach

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

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

27. The Panel also accepted the advice of the Legal Assessor, which, together with Mr Foxsmith’s submissions, are a matter of record.

Decision on Facts:

28. It is not in dispute that the incident in question is alleged to have occurred during the course of the Registrant’s employment as a Paramedic with SCAS. It is also not disputed that the Registrant was called to a category red emergency call on 15 May 2014 in relation to Lilly-May.

Particular 1a)

29. The Panel found the facts of particular 1a) proved for the following reasons.

30. It is not disputed evidence that on the day in question, Lilly-May, a five year old child, collapsed in the playground at school by the school gates. At the time of the Registrant’s arrival at the school, Lilly-May was being attended to by two bystanders who were believed to be off-duty nurses who were administering CPR.

31. It is the HCPC’s case that the Registrant did not ensure that early defibrillation was performed. The Panel has noted the contents of the Registrant’s statement dated 7 July 2014. In it she accepts that “There was no shocks given [sic] pre hospital with this patient”. She stated that she had initially identified VF, but that, it had become fine VF. She stated that she had been taught at University that in those circumstances, “a shock should not be administered but that CPR should be continued with a view to trying to convert fine VF into a coarse VF that could be shocked. I therefore recommended CPR”.

32. MJ, the expert instructed by the HCPC, referred the Panel to both the Royal Colleges Guidelines and the UK Council Guidelines. He stated that these indicated that shocking was appropriate in these circumstances. MJ went on to say, that performing defibrillation was time critical and that each minute of delay materially reduced the chances of successful resuscitation.

33. The Panel has received a great deal of evidence in relation to alleged delay in performing defibrillation. RW stated that, on arrival at the scene, he remained in the ambulance to prepare equipment, while the Registrant went to bring Lilly-May back to the ambulance. He stated that the Registrant was “back in a flash” or words to that effect. MJ was critical of the Registrant’s decision not to take the defibrillator from the ambulance to Lilly-May and he asserted that valuable time was lost in picking her up and bringing her back to the ambulance. He stated that a competent Paramedic would have taken the defibrillator and all necessary basic lifesaving equipment to Lilly-May and that pads should have been attached within one minute of arrival at the location to identify the underlying cardiac rhythm. 

34. The Panel has noted that when the Registrant returned to the ambulance with Lilly-May, the equipment had still not been prepared. Furthermore, approximately two and a half minutes elapsed between switching on the machine and taking a first reading. It is a moot point as to whether the pads would have been attached more quickly if the defibrillator was taken to Lilly-May, rather than her being carried to the ambulance. However, no evidence has been presented to the Panel as to how far away the ambulance was from Lilly-May or how long it would have taken to reach her.

35. Importantly, the Panel is mindful that it is not tasked to determine whether there was undue delay in assessing Lilly-May’s cardiac rhythm. The HCPC specifically made an application at the commencement of the hearing to amend the charge as referred to above. In the circumstances, the Panel makes no such determination as to whether the Registrant’s actions caused undue delay.

36. It is agreed evidence that no defibrillation was performed at the scene of the incident. Therefore, the Panel found that the Registrant did not ensure that early defibrillation was performed.

Particular 1b)

37. The Panel found the facts of particular 1b) proved for the following reasons.

38. The Panel has had sight of the relevant print out of Lilly-May’s cardiac rhythm timed at 15.29. This was printed off after the event. It showed Lilly-May’s cardiac rhythm over a six to ten second period. MJ was unequivocal that “It is my opinion the rhythm strip clearly identifies VF. I say this as it is clear there is uncoordinated and erratic electrical activity displayed on the ECG strip which represents ventricular fibrillation. This rhythm is considered what is termed a shockable rhythm…..The identification of the cardiac rhythm is a fundamental aspect of the management of any cardiac arrest”. He also accepted that the cardiac rhythm can fluctuate between coarse and fine VF over time. He stated that the Joint Colleges Guidelines advised shocking in these circumstances and that they did not differentiate between coarse or fine VF.

39. He concluded that “it is my opinion the rhythm strip timed at 15.29 identifies VF and is not asystole and therefore a DC shock from a defibrillator was indicated” and that “a competent paramedic would have recognised [Lilly-May] presented with a cardiac rhythm of ventricular fibrillation and would have delivered a DC shock immediately” in accordance with the guidelines referred to above.

40. The Registrant stated in her letter of 7 July 2014 that “It appeared like the patient may have been in ventricular fibrillation. As I was assessing the rhythm on the monitor, the VF appeared to become more fine, so I decided to carry on performing CPR”.

41. The Panel has also had sight of the UK Resuscitation Council and European Resuscitation guidelines 2010. This states that “when fine VF is difficult to distinguish from asystole then it is very unlikely to be shocked successfully into a perfusing rhythm”.

42. However, the Panel notes that the Registrant has not asserted that Lilly-May’s cardiac rhythm could not be distinguished from asystole. She had identified VF which had become fine VF. She had taken the decision not to defibrillate, because that was consistent with what she said she had been taught in her training at university. Furthermore, she accepted in her statement dated 29 November 2016, prepared for the inquest, that “Since this time, I have attended a core skills refresher course and I know that any patient presented in fine VF should be shocked regardless of the amplitude”.

43. By failing to treat Lilly-May in accordance with current guidelines by continuing with CPR at the expense of defibrillation, the Panel finds that the Registrant misinterpreted the results of Lilly-May’s cardiac rhythm as showing a rhythm that should not be treated by shocking.

44. In all the circumstances, the Panel found particular 1b) proved.

Decision on Grounds:

45. On the basis of the facts found proved, the Panel went on to consider whether the Registrant’s conduct amounted to misconduct or a lack of competence. It took into account the submissions made by Mr Foxsmith on behalf of the HCPC and has accepted the advice of the Legal Assessor.

46. In considering whether the facts found proved amounted to misconduct, it noted that not all breaches of the HCPC’s Standards of Performance, Conduct and Ethics need to amount necessarily to a finding of misconduct.

47. Mr Foxsmith submitted that the Registrant’s conduct marked a serious departure from the standards expected of a registered Paramedic and was sufficiently serious to amount to misconduct. He referred the Panel to the evidence of MJ who stated that the Registrant’s conduct fell significantly below that which would be expected. 

48. He invited the Panel to conclude that the Registrant had breached Standards 1 and 5 of the HCPC Standards of Conduct, Performance and Ethics (2012). The Panel noted these are:

• 1 - you must act in the best interests of service users. You are responsible for your professional conduct, any care or advice you provide, and any failure to act. You are responsible for the appropriateness of your decision to delegate a task. You must be able to justify your decisions if asked to;

• 5 - You must keep your professional knowledge and skills up to date. You must make sure that your knowledge, skills and performance are of good quality, up to date, and relevant to your scope of practice.

49. He further submitted that the Registrant’s actions had breached the following Standards of the HCPC Standards of Proficiency for Paramedics (2012) which are:

• 1a.6 - be able to practise as an autonomous professional, exercising their own professional judgment – be able to assess a situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem

• 1a.8 - understand the obligation to maintain fitness to practise – understand both the need to keep skills and knowledge up to date and the importance of career-long learning

• 2a.4 - be able to analyse and critically evaluate the information collected

• 2b.4 - be able to conduct appropriate diagnostic or monitoring procedures, treatment, therapy or other actions safely and skilfully – know the indications and contra-indications of using specific paramedic techniques, including their modifications.

50. Mr Foxsmith also drew the Panel’s attention to the fact that although the allegation was framed on the basis of both misconduct and a lack of competence, he conceded that the case was more suited to a finding of misconduct. This was because a finding of a lack of competence would require the standard of the Registrant’s care to be viewed  against a fair sample of her work. He accepted that there had been no previous concerns about the Registrant’s practice and that, from the documentation supplied by the Registrant, there have been no concerns since.

51. The Panel heard and accepted the advice of the Legal Assessor, which included reference to the cases of: Roylance v General Medical Council (No 2) [2000] 1 A.C. 311, Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) and Cohen v GMC [2008] EWHC 581, Remedy UK v GMC [2010] EWHC 1245, Royal College of Veterinary Surgeons v Samuel [2014] UKPC 13, Calhaem v General Medical Council [2007] EWHC 2606 (Admin) and Holton v GMC [2006] EWHV 2960 (Admin).

52. The Panel was referred to the case of Roylance v GMC (No.2) [2000] 1 AC 311, where it was stated that:

“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a … practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”

53. In Nandi v GMC [2004] the Court referred to Roylance v GMC [1999], where the Court described misconduct as “a falling short by omission or commission of the standards of conduct expected among medical practitioners, and such falling short must be serious” such that it would be “regarded as deplorable by fellow practitioners”.

54. The Panel first considered whether the facts found proved amounted to misconduct or a lack of competence.

55. The Panel carefully considered all the evidence and submissions presented to it and considered the facts of the case in the round.

56. Given the Panel’s findings in relation to the facts found proved, it concluded that the Registrant breached Standards 1 and 5 of the HCPC’s Standards of Conduct, Performance and Ethics (2012) and Standards 1a.6, 1a.8, 2a.4 and 2b.4 of the HCPC Standards of Proficiency for Paramedics (2012). However, the Panel was mindful that a finding of misconduct does not necessarily follow as a result.

57. The Panel carefully considered the seriousness of the Registrant’s failings. In his oral evidence, MJ stated, and the Panel accepts, that the Registrant’s actions marked a significant falling short of the standard expected. This was because of the time critical nature of defibrillation for cardiac arrest cases and the risk of potential consequences in failing to perform defibrillation when required.

58. The Panel therefore concluded that the Registrant’s conduct and subsequent breaches of the HCPC’s Standards of Conduct, Performance and Ethics (2012) and Standards of Proficiency for Paramedics (2012), both individually and collectively, marked a serious departure from the standards expected of a registered Paramedic.

59. Having accepted the advice of the Legal Assessor, the Panel concluded that the Registrant’s behaviour could properly be categorised as misconduct. For the avoidance of doubt, the Panel made no finding of a lack of competence as, in this case, the facts did not represent a fair sample of the Registrant’s work.

Decision on Impairment:

60. The Panel went on to decide whether, as a result of her misconduct, the Registrant’s fitness to practise is currently impaired. In doing so, it had regard to all the evidence presented in this case and the submissions of Mr Foxsmith that the Registrant’s fitness to practise was currently impaired on both the personal and public components. It heard and accepted the advice of the Legal Assessor and took into account the HCPTS Practice Note on “Finding that Fitness to Practise is ‘Impaired’”.

61. In considering this matter, the Panel exercised its own judgement. The Panel also took into account the public interest, which includes protection of the public, maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour.

62. Paramedics are expected at all times to act in a professional manner. They must make sure that their conduct at all times justifies both service users’ and the public’s trust in the profession. In this regard, the Panel considered the judgement of Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) in reaching its decision. In paragraph 74, she said:

“In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.”

63. Mrs Justice Cox went on to say in Paragraph 76:

“Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:

a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or
b. has in the past brought and/or is liable in the future to bring the medical 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 medical profession; and/or
d…”

64. Given its findings regarding ‘seriousness’, the Panel considered that limbs a, b and c were engaged by the Registrant’s past actions.

65. The Panel firstly considered whether the Registrant’s misconduct which was a failure to act in accordance with professional guidelines was remediable. It concluded that her misconduct was remediable as it related to identifying and administering effective treatment for a cardiac arrest.

66. The Panel then considered whether the Registrant had remediated her failings. In reaching its conclusion, it took account of the following:

• that in 2018 she had successfully undertaken a Core Skills Refresher Course on Basic and Advanced Life Support. The Panel has had sight of the achievement record from that course and noted that the course addressed relevant areas of practice including, but not limited to, ‘attendance at a cardiac arrest’, ‘using page per age in pocket book for paediatric patients’ and ‘VF is a reversible pathology’;

• Mr Foxsmith, on behalf of the HCPC acknowledged that her practice has not been called into question in the nearly six years that have elapsed since the incident.

67. The Panel also considered the Registrant’s level of insight. It noted that the Registrant immediately self-referred to her employer and that she had reflected on her failings. In her statement dated 29 November 2016 prepared in anticipation of the inquest, the Registrant acknowledged her failings stating “Since this time, I have attended a core skills refresher course further and I now know that any patient present in fine VF should be shocked regardless of the amplitude”. In addition, when questioned at the inquest, when asked “So, presented with the same circumstances again, you would now shock, even if you interpret it as fine VF”, she responded “Yeah”.

68. The Panel, having determined that the Registrant’s failings were capable of remediation, concluded that she has demonstrated significant insight and that she has taken appropriate steps to remediate her failings.

69. In all the circumstances, the Panel therefore concluded that it was highly unlikely that her misconduct would be repeated. The Panel therefore determined that on public protection grounds, the Registrant is not currently impaired.

70. The Panel has also taken into account its overarching responsibility to promote and maintain professional standards, and to uphold and protect the wider public interest, which includes promoting and maintaining public confidence in the Paramedic profession.

71. The Panel considered that the public would be seriously concerned if the failings identified were not marked appropriately. This is because the Registrant’s failure to comply with the appropriate standards was so serious that there needed to be a clear message sent both to the profession and to the wider public of the importance of adhering to professional standards. In the Panel’s view, public confidence in the profession would be undermined if a finding of impairment were not made in all the circumstances.

72. Having regard to all of the above the Panel found that, by reason of her misconduct, the Registrant’s fitness to practise is currently impaired on the public component of impairment.

Decision on Sanction:

HCPC’s submissions

73. Mr Foxsmith made submissions to the Panel on sanction. He referred to the HCPC’s Sanctions Policy (2019) (SP) and reminded the Panel of the need to act proportionately.

74. Mr Foxsmith reminded the Panel that its role was not to punish a Registrant, but to protect the public and the public interest. It was, he submitted, an exercise in addressing public safety having regard to the wider public interest, the deterrent effect of any sanction, the reputation of the profession and confidence in the regulatory process. He set out the available sanctions open to the Panel, reminding it that it should consider these in an ascending order of severity, not imposing any more severe a sanction than is necessary to achieve its objective. In doing so, the Panel should balance the public interest with the Registrant’s interests. He invited the Panel to take into account any aggravating and mitigating factors identified.

75. Mr Foxsmith stated that he was not making a specific proposal on sanction, but submitted that taking no action would not be proportionate to reflect the seriousness of the Registrant’s misconduct.

76. Turning to Mediation, Mr Foxsmith submitted that the facts of this case were such that Mediation was not a relevant sanction.

77. He referred to the relevant paragraphs of the SP that he submitted the Panel should take into account in considering whether to impose a Caution Order, an order of Suspension or a Striking Off Order.

78. No specific submissions regarding sanction have been made by the Registrant, but the Panel has received her reflective statement and supporting documents which includes evidence of ongoing training and a number of positive references.

The Panel’s decision

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

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

• the Registrant’s failings represented a serious falling short of the standard of care expected. She failed to ensure that Lilly-May received early defibrillation.

81. The Panel identified the following mitigating factors:

• As soon as she realised the mistake she made, the Registrant made an immediate referral to her employer. She had been candid and open to her then employer about her failings. In her letter to the HCPC of 25 October 2017, the Legal Services Manager of the South Central Ambulance Service NHS Trust stated “Her degree of insight into the case has never been in question and there has never been any concern that Channon acted deliberately or recklessly or that she may repeat the same mistake again”;

• In its finding on impairment, the Panel has identified that the Registrant has demonstrated significant insight into her failings;

• Even though the Panel could find no formal apology in the documents before them, the Registrant in her statement dated 29 November 2016 recognised the impact of her failings on Lilly-May’s family and stated “I would like to pass on my condolences to Lilly-May’s family for their loss”;

• There have been no previous adverse regulatory findings against the Registrant and nearly six years have elapsed since the incident without any concerns being raised about her practice;

• The Panel noted that the Registrant had submitted several positive testimonials highlighting her skills and her value to colleagues, the community and the profession. These included a reference from a Clinical Team Leader for the London Ambulance Service who stated that “she is safe to practice [sic] as a Paramedic and would have every confidence in her care were she to be sent to one of my family members”.  There were also references from a number of registered Paramedics and an Emergency Medical Technician attesting to her high standard of patient care and professionalism and confirming that her knowledge or abilities have not been called into question. A senior paramedic described the Registrant as “calm, professional and a safe clinician”.

82. In accordance with the SP guidance, the Panel approached the issue of sanction starting with the least restrictive first, bearing in mind the need for proportionality.

83. It considered that, taking no further action would not reflect the serious nature and gravity of the misconduct found proved. Nor would that be adequate given the wider public interest of maintaining confidence in both the profession and the regulatory process. Such an outcome was therefore neither appropriate nor proportionate in the circumstances.

84. The Panel considered Mediation, but considered that this was not an appropriate outcome given the facts of this case in that it would not be relevant to addressing public interest concerns identified.

85. The Panel then considered whether to impose a Caution Order and had regard to paragraphs 99 - 102 of the SP as to when such an order might be appropriate.

86. Paragraph 101 of the SP identifies when a Caution Order is likely to be an appropriate sanction. The Panel carefully reviewed its findings against these criteria. The Panel recognised that the misconduct found proved was not minor in nature. However, the Panel has identified that the Registrant’s misconduct was an isolated failing in an otherwise unblemished career.

87. In respect of the Registrant’s insight and the risk of repetition, the Panel found that she has recognised her failings; was candid with her then employer; and has undertaken appropriate remediation such that the Panel concluded there was little likelihood of further public harm. The Panel noted that the Registrant has continued to work as a Paramedic for nearly six years since the incident without concern. In the circumstances, the Panel concluded that, despite the seriousness of her failing, a Caution Order was the appropriate and proportionate sanction to impose to meet the public interest concerns.

88. In considering the length of the Caution Order, the Panel had regard to paragraphs 103 and 104 of the SP and concluded that the order should be imposed for a period of five years. This effectively balanced the seriousness of the misconduct with the Registrant’s interests and met the overarching need to maintain public confidence in the profession and the regulatory process.

89. Having concluded that a Caution Order was the appropriate sanction to impose, the Panel considered whether the next available sanction, namely a Conditions of Practice Order, was appropriate. It has had regard to paragraphs 105 - 117 of the SP. It has concluded that, given that the Panel’s finding was made on public interest grounds alone, a Conditions of Practice Order which focuses on the need to remedy practice deficiencies would not be appropriate.

90. Given that a Conditions of Practice Order was inappropriate, the Panel considered whether to impose the sanction of Suspension. However, the Panel concluded that such a sanction which would prevent the Registrant from practising for a period of up to 12 months, would be disproportionate and unduly punitive. The Panel did not consider that the public interest required that the public and the profession be deprived of an otherwise competent Paramedic who had recognised and addressed her isolated failing and who had continued to practise safely for nearly six years.

91. The Panel accordingly determined to impose a Caution Order for a period of five years.

Order

That the Registrar is directed to annotate the register entry of Miss Channon Jacobs with a Caution which is to remain on the register for a period of 5 years from the date this order comes into effect.

Notes

Right of Appeal:

You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you.  The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Hearing History

History of Hearings for Miss Channon Jacobs

Date Panel Hearing type Outcomes / Status
13/01/2020 Conduct and Competence Committee Final Hearing Caution