Miss Kathryn Chignell

Profession: Paramedic

Registration Number: PA34348

Interim Order: Imposed on 08 Aug 2017

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 24/01/2020 End: 13:00 24/01/2020

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

While registered as a Paramedic and employed with South Western Ambulance Service, you:


1. On or about 04 January 2016, in relation to Patient A did not:
(a) complete and / or record an adequate assessment of Patient A in that:
(i) you conducted and / or recorded only one set of observations;
(ii) you did not complete and / or record an Electro Cardiograph;
(b) provide adequate treatment to Patient A in that you did not provide adequate pain relief;
(c) complete a comprehensive and / or adequate Patient Clinical Record in that you did not record an adequate rationale as to why Patient A was not taken to the emergency department.
2. On or about 24 April 2016, attended Patient B and did not:
(a) complete and / or record an adequate assessment of Patient B in that you:
(i) concluded that the patient was “unconclusive” in relation to the FAST test for stroke, rather than “positive”;
(ii) incorrectly circled “U” and “L” on the Patient Clinical Record, in relation to the FAST test for stroke;
(b) provide timely treatment to Patient B;
(c) request priority 1 back up;
3. On or about 28 November 2016, attended an elderly patient, Patient C, who was unresponsive, and you did not provide adequate and / or timely treatment to the patient in that you did not provide the patient with oxygen;
4. On dates between 13 and 17 December 2016, you:
(a) attended a seven-year-old patient, Patient D, and:
(i) you did not obtain an adequate history of the patient;
(ii) you had to be prompted regarding the correct pathway to be used;
(iii) you did not provide an adequate rationale for referring the patient to the out of hours service rather than conveying Patient D to Accident and Emergency.
(b) attended an elderly patient, Patient E, with sepsis markers and:
(i) did not demonstrate adequate knowledge of sepsis markers;
(ii) did not demonstrate adequate knowledge of the procedure to be followed in relation to a patient with sepsis markers;
(iii) failed to notice Sodium Chloride had run into Patient E's arm tissue rather than through the vein.
5. The matters described in particulars 1 - 4 constitute misconduct and / or lack of competence.
6. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.

Finding

Preliminary Matters

1. The Registrant did not attend this review hearing. The Panel first considered whether it ought to exercise its discretion to continue with the hearing in the absence of the Registrant. The Panel concluded it was in the public interest to do so, having considered the HCPC Practice Note on “Proceeding in the Registrant’s Absence,” having taken the Legal Asessor’s advice, and considered the guidance in R v Jones [2003] 1 AC 1 HL and GMC v Adeogba and Visvardis [2016] EWCA Civ 162, for the following reasons:

• The Panel is satisfied that the Registrant had notice of the hearing and that the rules on service had been complied with;
• The Registrant has not sought an adjournment;
• Unlikely that the Registrant would attend any future hearing;
• The Panel determined that the Registrant had chosen not to attend the hearing and voluntarily waived her right to appear;
• There is a general public interest in the expeditious disposal of this matter as the order is due to expire on 28 February 2020.
Background
 
2. The Registrant is registered with the HCPC as a paramedic. At the time of the matters which are the subject of the proceedings that led to the current order, she was employed by South Western Ambulance Service Trust (the Trust). She commenced employment with the Trust on 18 December 2013 having worked as a paramedic in another region prior to commencing employment with the Trust.

3. The Registrant was placed on “Restriction of Practice” (ROP) by the Trust on 15 March 2016 as a result of concerns raised about her treatment of a patient in January 2016. The Registrant returned to unrestricted practice from March 2016 following a satisfactory review of her performance.

4. Further concerns were raised about the Registrant’s practice in April 2016 and the Registrant was placed on a further period of restricted practice from 5 May 2016. During that period further concerns about the Registrant’s practice were raised. An action plan was implemented to provide the Registrant with support and training to help her meet the standards expected. The action plan was extended by the Trust until January 2017 but the Registrant did not meet the standards required. Following this, the Trust commenced formal capability proceedings and the Registrant’s employment was terminated in March 2017.

5. At the hearing which concluded in January 2019 the Panel found proved a number of failings involving multiple patients over a sustained period of time and determined that these failings amounted to a lack of competence. That panel determined, that the Registrant’s fitness to practise was impaired and that the appropriate sanction to impose was a Conditions of Practice Order for a period of 12 months as set out below:
 
a) You must, when working in an emergency or unscheduled care environment [i.e. ambulances/emergency response vehicles, minor injury units, walk-in centres, urgent care centres etc.] confine yourself to working directly with an appropriate Health Care Professions Council (HCPC), Nursing and Midwifery Council (NMC) or General Medical Council (GMC) registered professional at all times;

b) You must not undertake the autonomous discharge of patients;

c) You must place yourself, and remain under, the supervision of a work place supervisor registered by the HCPC, NMC or GMC;

d) You must provide details of your work place supervisor to HCPC within 14 days of commencing employment. If your work place supervisor changes you must notify HCPC within 14 days of that change.

e) You must attend upon your work place supervisor as required and follow their advice and recommendations.

f) You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in your practice in respect of time-critical patients in the following areas:

i. Assessment;
ii. Knowledge;
iii. Understanding; and
iv.  Management.


g) Within 28 days of the appointment of the work place supervisor, you must forward a copy of the Personal Development Plan to the HCPC.

h) You must meet with your work place supervisor on a fortnightly basis to assess your progress towards the aims set out in your Personal Development Plan.

i) You must allow your workplace supervisor to provide reports to the HCPC that address your progress against the objectives set out in your Personal Development Plan. The first report must be provided within 2 months of the appointment of the workplace supervisor and thereafter every 3 months.

j) You must inform the HCPC in writing within 14 days if you cease to be employed by your current employer or take up any further registered employment;

k) You must inform the HCPC in writing within 14 days of any disciplinary proceedings taken against you by your employer.

l) You must inform the following parties that your registration is subject to these conditions:

i. Any organisation or person employing or contracting with you to undertake or for whom you voluntarily undertake professional work;
ii. Any agency you are registered with or apply to be registered with (at the time of the application); and
iii. Any prospective employer (at the time of your application).

m) You will be responsible for meeting any and all costs associated with complying with these conditions.

n) Any condition requiring you to provide any information to the HCPC is to be met by you sending the information to the offices of the HCPC, marked for the attention of the Director of Fitness to Practise or Head of Case Management.

Decision

5. Ms Ktisti for the HCPC set out the relevant background to the matter and submitted that the Registrant had not engaged with the conditions and there was no evidence that they had been complied with. She drew the Panel’s attention to an email from the Registrant dated 20 January 2020 in which she stated that she wished to apply for voluntary removal from the HCPC Register. Ms Ktisti submitted that it was clear from the Registrant’s email that she no longer had the intention to remedy the failings in her practice. She submitted that there was no evidence before the Panel that the Registrant had complied with the conditions. In the circumstances she submitted that the Registrant had been unable to demonstrate insight and remediation of the concerns and her fitness to practise remained impaired. She submitted that the HCPC’s position was that a suspension order may be appropriate given the Registrant’s lack of engagement with the current conditions.
 
6. The Panel considered the submissions of the HCPC together with all of the evidence it had before it. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note ‘Finding that Fitness to Practice is Impaired’.

7. In determining current impairment, the Panel exercised its own professional judgement. The Panel considered that the Registrant has not engaged with the conditions of practice order and has not been working as a paramedic. As a result, the Panel concluded that the Registrant has not been able to demonstrate her competence or remedy the concerns that led to the original proceedings.

8. In the absence of any evidence that the Registrant has taken steps to remedy the deficiencies identified in her practice the Panel considered that there remains a risk of repetition of the concerns that led to the substantive order. The Panel determined that the Registrant’s fitness to practise is currently impaired on public protection grounds.

9. The Panel also considered the public interest in upholding proper professional standards and considered that a finding of current impairment on public interest grounds was also required. The public would expect the regulator to act in circumstances where there was a risk of repetition of concerns that had the potential to cause patient harm.

10. Having determined that the Registrant’s fitness to practise remains impaired the Panel went on to consider what order was appropriate. It had regard to the need to act proportionately and to balance the public interest with the Registrant’s own interests.

11. The Panel first considered allowing the order to lapse but considered that this would be inappropriate given the risk of repetition identified. A caution order would not restrict the Registrant’s practice and the Panel therefore considered this was also not appropriate to protect the public.

12. The Panel then considered whether a further conditions of practice order was appropriate. The Panel considered that the concerns were remediable however the Registrant had not taken any steps to work under the current conditions. The Panel noted that the Registrant had clearly stated her intention to remove herself from the HCPC register. The Panel therefore concluded that the Registrant does not wish to work as a paramedic at this time and has no current intention of returning to practice in the near future.

13. The Panel considered that in these circumstances a further conditions of practice order was not appropriate and would serve no useful purpose. In light of the Registrant’s stated intention to apply for voluntary removal and her confirmation that she does not currently intend to return to practice the Panel concluded that it could not formulate workable conditions that the Registrant would be likely to engage with.

14. The Panel then considered a suspension order and concluded that this was the most appropriate and proportionate order. The Panel considered that this would be sufficient to protect the public and would allow the Registrant a period of time to reflect on whether she wished to remove herself from practice or take steps to remedy the concerns. Should the Registrant’s position change the panel noted that it was open to her to apply for an early review of the suspension order.

15. The Panel concluded that, in all the circumstances, the appropriate and proportionate sanction is to impose a suspension order for a period of 12 months to come into effect on expiry of the current order.

Order

The Suspension Order imposed today will apply from 28 February 2019 (the Operative Date). 

Notes

No notes available

Hearing History

History of Hearings for Miss Kathryn Chignell

Date Panel Hearing type Outcomes / Status
24/01/2020 Conduct and Competence Committee Review Hearing Suspended
28/01/2019 Conduct and Competence Committee Final Hearing Conditions of Practice
10/09/2018 Conduct and Competence Committee Final Hearing Adjourned part heard