Miss Lisa Chadwick
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On 26 August 2016, whilst registered as a Paramedic and employed by the
North West Ambulance Service, you attended Service User A and you:
1. Made inappropriate comments to the effect that:
a) Service User A was not unwell or was feigning illness
b) Regarding not lifting Service User A, you asked who would
look after your children if you hurt your back
c) You told Service User A to ‘get up’ or words to that effect
when she collapsed
2. Did not communicate appropriately with Service User A and/or
her family, in that:
a) Following Service User A’s collapse, you did not update
Service User A’s family before transporting Service User A to
b) You did not inform Service User A [or her family] of her potential
diagnoses and the risks associated with those.
3. Did not complete and/or record an adequate clinical
assessment and/or examination.
4. Walked Service User A to the ambulance, despite her being
tachypnoeic and/or without offering appropriate assistance.
5. Did not provide a wheelchair to Service User A despite this
being requested by Person B.
6. Did not assist Service User A to stand when she collapsed on
7. Did not provide care to Service User A in a timely manner following
8. Did not transport Service User A to the hospital in a timely manner
despite Service User A hyperventilating
9. Did not provide an adequate treatment plan in response to Service
User A’s hyperventilation
10. Did not complete and/or record regular observations of Service
11. Did not assist Service User A to travel down the stairs,
including by not using a track chair
12. Informed your employer that care was provided to Service User
A in a timely manner following her collapse, when this was not the
13. Your actions as described at paragraph 12 above were
14. Your actions as described at paragraphs 1 – 11 above
amounted to misconduct and/or lack of competence.
15. Your actions as described at paragraphs 12 – 13 above
amounted to misconduct.
16. By reason of your misconduct and/or lack of competence, our
fitness to practise is impaired.
Proceeding in the absence of the Registrant
7. It was clear, from the principles derived from case law that the Panel was required to ensure that the interests of fairness and justice were maintained when deciding whether or not to proceed in a Registrant’s absence.
Decision on Facts
• Photographs of the building where the incident took place showing the stairwell, and the façade of the building; and
41. It was not in dispute that the Registrant was the only female paramedic on the scene, although she arrived later in the ambulance with her colleague. Person B told the Panel that as she was helping her daughter to walk out of the flat, her daughter collapsed on the floor and both Paramedics had queried whether she was pretending to collapse. Person B said that she heard the female paramedic say, “stand up, why are you acting like that? I can’t bend down and lift you up, what if I hurt my back? Who will look after my children?”, or words to that effect.
46. Person B told the Panel that ‘the female Paramedic was the one who was talking too much and kept telling my daughter that she should “get up” and that she was not actually unwell’. Person B also told the Panel that the female paramedic had also said “why are you humiliating yourself lying in the dirt like that? Stand up, go to the ambulance.” or words to that effect.
47. The Panel accepted the evidence of Person B and concluded that such comments were inappropriate and unprofessional.
a) Following Service User A’s collapse, you did not update Service User A’s family before transporting Service User A to the hospital.
49. At the start of the hearing, Miss Constantine for the HCPC made it clear that where a Particular alleged that the Registrant “did not” do something, then there was an implicit assertion that the Registrant was under a duty to carry out that action.
b) You did not inform Service User A or her family of her potential diagnoses and the risks associated with those.
57. The Panel applied the principle of autonomous practitioners having shared responsibility in these circumstances, as articulated in the Panel’s decision in Particular 2(a) above.
61. The Panel was satisfied that the Registrant was under a duty to complete and record an adequate clinical examination and assessment of Service User A. Whilst she arrived later, at 23:02, once she received the handover of Service User A from Mr Morris, she also became responsible for the care and welfare of Service User A. As an autonomous practitioner she should have carried out her own examination and assessment of Service User A and not relied upon what she was told by Mr Morris. The fact that Mr Morris remained at the scene did not absolve the Registrant of her duty. In the Panel’s view, the Registrant’s shared responsibility extended to the recording of any examination or assessment that she conducted and to ensuring the accuracy of any records relating to her involvement in the incident.
69. The Panel has interpreted this Particular to mean that Service User A was permitted to walk despite her condition and without appropriate assistance from the paramedics. The Panel interpreted it as walking for any part of the journey to the ambulance. Tachypnoea is where a person experiences abnormal and rapid breathing.
76. Person B told the Panel that she had specifically requested a wheelchair of the Registrant. This was corroborated by Person C and accepted by Mr Morris. Person B told the Panel that the Registrant replied, “no, we can’t waste our time giving you the wheelchair, she can walk.”
78. JP told the Panel that a wheelchair was standard equipment in all the ambulances of NWAST and it was not disputed that the ambulance in which the Registrant arrived had a wheelchair.
80. The Panel considered the oral evidence it heard, particularly from Person B. It considered that there were three occasions when Service User A collapsed where she could have been assisted to stand up by the Paramedic team. One was when Service User A exited the property, and two occasions whilst she was going down the stairs. The Panel excluded the final collapse of Service User A at the bottom of the stairs because it was clearly inappropriate to get her to stand up at that stage.
85. The Panel interpreted this factual particular is referring to the collapse by Service User A at the bottom of the stairwell. The Bodycam footage is evidence of what transpired after the Police Constable's arrival. The footage shows the Registrant shining a light into the eyes of Service User A and inserting a Nasopharyngeal Airway. She is then seen to go to the ambulance to get a second Nasopharyngeal Airway. She is subsequently seen to go to the Ambulance to fetch a stretcher for Service User A.
90. The Registrant's responsibility for Service User A began at 23:02 when she arrived. In her statement she stated that she observed Service User A hyperventilating when she arrived.
98. The Panel is satisfied that on the evidence before it, there was an adequate treatment plan in response to Service User A's ventilation. That plan was to transfer her to hospital as soon as possible, and it was in place before the Registrant's arrival on scene and continued to be the treatment plan after she had arrived. The problem that arose is not in the adequacy of the treatment plan but rather in its execution.
99. Therefore, the Panel determined that Particular 9 is not proved.
100. The Panel was satisfied that the Registrant was under a duty to complete and record regular observations of Service User A whilst she remained under her care.
106. It was not in dispute that the paramedics who attended Service User A on the night in question had a duty to assist her to travel down the stairs because of her presenting condition. This duty included consideration of any and all alternatives in order to expedite Service User A's transfer from the flat to the ambulance downstairs.
"When assessing the probabilities the court will have in mind as a factor, to whatever extent is appropriate in the particular case, that the more serious the allegation the less likely it is that the event occurred and, hence, the stronger should be the evidence before the court concludes that the allegation is established on the balance of probability. Fraud is usually less likely than negligence. Deliberate physical injury is usually less likely than accidental physical injury. ... Built into the preponderance of probability standard is a generous degree of flexibility in respect of the seriousness of the allegation. … The more improbable the event, the stronger must be the evidence that it did occur before, on the balance of probability, its occurrence will be established.”
129. Ms Hastie submitted that the HCPTS has taken all reasonable steps to serve the notice on the Registrant. She further submitted that the Registrant has not engaged with the HCPC, nor with the HCPTS, since the start of the substantive hearing on 3 February 2020 and that an adjournment would serve no useful purpose. Ms Hastie reminded the Panel that there was a public interest in this matter being dealt with expeditiously.
130. The Panel accepted the advice of the Legal Assessor. He advised that, if the Panel is satisfied that all reasonable efforts have been made to notify the Registrant of the hearing, then the Panel has the discretion to proceed in the absence of the Registrant. He cautioned the Panel that the discretion should be exercised with care and caution as set out in the case of R v Jones  UKHL 5.
131. The Legal Assessor also referred the Panel to the case of GMC v Adeogba and Visvardis  EWCA Civ 162 and advised that the Adeogba case reminded the Panel that its primary objective is the protection of the public and of 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”.
132. It was clear, from the principles derived from case law, that the Panel is required to ensure that fairness and justice are maintained when deciding whether or not to proceed in a Registrant’s absence.
133. The Panel was satisfied that all reasonable efforts had been made by the HCPTS to notify the Registrant of the Hearing.
134. 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 with the Registrant’s right to a fair hearing.
135. In reaching its decision the Panel took into account the following:
• The Registrant has not made an application to adjourn today’s Hearing and implicit from her correspondence received before the start of this substantive hearing was an expectation on her part that she would not be participating in these proceedings, and that the proceedings will continue in her absence;
• There is a public interest that these matters are dealt with expeditiously.
136. The Panel was satisfied that the Registrant was absent voluntarily. It determined that it was unlikely that an adjournment would result in the Registrant’s re-engagement with these proceedings, in the light of her non-engagement thus far. Having weighed the public interest for expeditious hearing of the case against the Registrant’s own interest, the Panel decided to proceed in the Registrant’s absence.
Consideration of Statutory Ground
137. The Panel then went on to consider whether the factual particulars found proved amounted to misconduct and/or lack of competence. The Panel heard the submissions of Ms Hastie on behalf of the HCPC.
138. Ms Hastie submitted that the Panel might consider that this was a case where the appropriate statutory ground is that of misconduct rather than lack of competence. This is because the allegation arises out of a single episode, of which the Panel might consider not to be a representative sample of the Registrant's work sufficient to show lack of competence.
139. Ms Hastie submitted that the Registrant's conduct fell substantially below that which would be expected of a registered Paramedic. She reminded the Panel of their factual findings in relation to the Registrant's comments and conduct and submitted that those comments and conduct were unprofessional, dismissive and demeaning. Ms Hastie submitted that they demonstrated a serious failing by the Registrant to provide appropriate care for Service User A.
140. Ms Hastie submitted that completing an adequate clinical assessment and/or regular observations is a fundamental part of the paramedic’s duty and that the Registrant failed in this duty. She further submitted that the Registrant failed to provide Service User A with the required level of care including allowing her to walk despite her condition and without appropriate assistance, not providing her with a wheelchair or using a track-chair, not assisting her when she collapsed and not transporting her to hospital in a timely manner.
141. Ms Hastie also reminded the Panel of what was seen on the video evidence presented during the hearing. She submitted that the video evidence demonstrated a lack of urgency on the part of the Registrant after Service User A had collapsed at the bottom of the stairwell. She submitted that the Registrant's behaviour resulted from assumptions made by her that Service User A was feigning illness.
142. Ms Hastie submitted that the Registrant’s actions breached the following paragraphs of the HCPC’s standards of conduct, performance and ethics (2016 edition): 1.1, 2.1, 2.2, 6.1, 6.2 and 9.1.
143. The Panel accepted the advice of the Legal Assessor. He referred the Panel to the decisions in the following cases:
a) Calhaem v GMC  EWHC 2606 (Admin)
b) Roylance v GMC (2000) 1 AC 311
c) Andrew Francis Holton v General Medical Council  EWHC 2960
d) Hindmarsh v NMC  EWHC 2233 (Admin)
144. The Legal Assessor advised that misconduct is “a word of general effect, involving some act or omission, which falls short of what would be proper in the circumstances.” He stressed that Misconduct is qualified by the word “serious” and that it is not just any professional misconduct, which will qualify.
145. The Legal Assessor also advised that not every instance of falling short of what would be proper in the circumstances, and not every breach of the HCPC standards would be sufficiently serious such as to amount to misconduct in this context.
146. The Legal Assessor also reminded the Panel that the fact that although there could have been, and possibly were, serious consequences as a result of the Registrant's conduct, this is only one factor to be taken in consideration when considering whether her actions amounted to serious misconduct; it was not to be the main factor.
147. The Panel has had careful regard to the context and circumstances of the matters found proved. The Panel determined there was not a representative sample of the Registrant’s work sufficient to conclude that there was a lack of competence.
148. The Panel then went on to consider whether or not these matters found proved amounted to misconduct. It reminded itself that these matters related to a single incident in which the Registrant was not the first upon the scene but had arrived after another paramedic had been on scene and had already attended to Service User A for a significant period of time.
149. The Panel also looked to the HCPC's Standards of Conduct Performance and Ethics (2016 edition, in force at the time) to consider whether there were any breaches of the standards set out therein.
150. As this was a single incident that took place over a single hour on a single night, the Panel looked at the factual particulars found proved as a whole, rather than as individual and unconnected behaviour. The factual particulars found proved represent a continuous course of conduct by the Registrant in relation to Service User A on the night in question.
151. The Panel excluded Particular 12 from its consideration at this stage because it had determined at the factual stage that the error as to timing in her statement appeared to be as a result of relying upon the PRF written by her colleague, Mr Morris, who had recorded the wrong times. The Panel could not be satisfied that the Registrant was aware that the timings recorded in the PRF were wrong when she wrote her statement.
152. The Panel considered each of the remaining factual particulars and determined that the Registrant’s behaviour towards Service User A, and the care that she provided to Service User A, fell far short of what would be expected of a registered Paramedic in the circumstances. This is demonstrated by the phrases used by the Registrant towards Service User A and her family, which included:
• "we cannot waste our time giving you a wheelchair"
• “why are you acting like that?”
• “stop pretending”
• "why are you humiliating yourself"
153. The manner in which she spoke to Service User A and her family was disrespectful to such a degree that fellow practitioners would find it inexcusable and deplorable. It demonstrates an attitudinal problem on the part of the Registrant.
154. The Registrant did not carry out her duties diligently but rather relied upon the assessment made by her colleague, Mr Morris. After Mr Morris had given her a 'handover' briefing, she did not carry out her own clinical assessment of Service User A. Even after Service User A had collapsed in the stairwell, the Registrant took limited action to ensure the safety and well-being of Service User A, relying instead on her mistaken belief that Service User A was pretending to be ill. The Registrant’s demeanour on the Body Cam footage shortly after Service User A had collapsed in the stairwell was not one of urgency but of nonchalance, with the focus being on the perceived non-compliance of Service User A rather than on rapidly treating a gravely ill person. In the Panel’s view fellow practitioners would find her actions inexcusable and deplorable.
155. The Panel considered that on the facts found proved the Registrant had breached the following paragraphs of the HCPC’s standards of conduct, performance and ethics (2016 edition):
1.1 You must treat service users and carers as individuals, respecting their privacy and dignity.
1.2 You must work in partnership with service users and carers, involving them, where appropriate, in decisions about the care, treatment or other services to be provided.
Communicate with service users and carers
2.1 You must be polite and considerate.
2.2 You must listen to service users and carers and take account of their needs and wishes.
Work with colleagues
2.5 You must work in partnership with colleagues, showing your skills, knowledge and experience where appropriate, for the benefit of service users and carers.
Identify and minimise risk
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
6.2 You must not do anything, or allow someone else to do anything, which would put the health or safety of a service user, carer or colleague at acceptable risk.
156. The Panel determined that these failings related to fundamental areas of practice of a registered Paramedic and the Panel considers the Registrant’s failings to be serious. The Panel did not find that there were any circumstances that mitigated the seriousness of the Registrant's conduct.
157. The Panel determined that the Registrant's failings in her care of Service User A amounted to misconduct.
Consideration of Impairment of Fitness to Practise
158. The Panel then went on to consider, whether the Registrant’s fitness to practise is currently impaired by reason of her misconduct. The Panel heard the submissions of Ms Hastie.
159. Ms Hastie submitted that the Registrant's fitness to practise was impaired. She reminded the Panel that the purpose of fitness to practise proceedings is not to punish a practitioner for past misconduct but rather to protect the public against the acts and omissions of those who are not fit to practise. She also reminded the Panel that not every finding of misconduct would result in a finding of impairment of fitness to practise.
160. Ms Hastie submitted that the lack of engagement by the Registrant meant that the Panel could not ascertain whether or not she had gained insight into her misconduct in order for her to make changes to her behaviour and attitudes. She submitted that the character references provided by the Registrant do not provide cogent evidence of the Registrant's insight and remediation.
161. The Panel also accepted the advice of the Legal Assessor. He drew the Panel’s attention to the approach set out in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin) and reminded the Panel that there was a personal and public component when considering whether the Registrant’s fitness to practise was currently impaired.
162. For this purpose, 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 service users 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 Paramedic profession?”
163. The Panel took into account the following factors:
(a) promoting and protecting the interests of service users as a fundamental tenet of the profession;
(b) the Registrant has not engaged with the Hearing and has not attended to tell the Panel what, if any, insight she has gained into her actions. The Panel did note that one of the references sent by the Registrant mentions the insight and remorse demonstrated by the Registrant during her discussions with the author of that reference. However, the Panel could only place little weight upon the opinion of that person because it was not in a position to test the veracity of that person's opinion;
(c) the Registrant has not provided any evidence of her personal reflection, if any, into her actions on the night in question. As such, there is no cogent evidence of any insight on the part of the Registrant. This is a matter of misconduct, and there can only be very limited remediation without insight. There has been no evidence of any action taken by the Registrant to remediate her misconduct. Therefore, there is a real risk of repetition on the part of the Registrant;
(d) the Panel determined that the Registrant's misconduct was easily remediable, but that there was no evidence upon which it could be satisfied that the Registrant had begun to or has already remediated her misconduct.
164.Taking the above into consideration, the Panel determined that the Registrant's fitness to practise is currently impaired due to the lack of evidence of insight and remediation. The Panel determined that the answers to all the above questions of Dame Janet Smith’s test were in the affirmative in relation to past, and future possible conduct.
165.The Panel also determined that the Registrant’s misconduct was such that the need to uphold professional standards and public confidence in the professions would be undermined if a finding of impairment were not made in these circumstances. This is not just because there remains a real risk to the public due to the lack of evidence of insight and remediation. Even if there was full insight and remediation on the part of the Registrant, a member the public with full knowledge of the facts and information before the Panel today, would be shocked if no finding of impairment were made. This is because of the serious nature of the Registrant's misconduct.
166.Therefore, Panel determined that the Registrant’s fitness to practise is currently impaired on both personal and public interest considerations.
167.Following submissions made by Ms Hastie and advice from the Legal Assessor, a decision had been made by the Panel that the Registrant’s fitness to practise was impaired on both the personal and public components. That decision on impairment is a matter of record.
168.However, at the beginning of the sanction stage it was revealed that the Interim Orders Committee had imposed an Interim Suspension Order on the Registrant’s registration on 29 September 2017 and that that order had subsequently been changed to one of Conditions of Practice on 21 June 2018. That Conditions of Practice Order remains in place, having been extended at the High Court in March 2020.
169.Given that this information potentially indicated that the Registrant had been engaging with HCPC proceedings previously, and complying with conditions, the Panel considered that the associated documentation may be relevant to the sanction stage. The Panel therefore requested copies of relevant interim order determinations from the HCPC.
170.On receipt of two interim order determinations it became apparent to the Panel that the Registrant had previously submitted material to the HCPC that related to reflection and remediation. Given that the Registrant had not submitted any such documents to the Panel for this Hearing, the Panel requested any documents that might assist in the assessment of insight and/or remediation at this stage.
171.The Panel received further documents, which included the Registrant’s reflection, evaluation and analysis of the events, an action plan, references to CPD undertaken and a further reference.
172.The Panel notes that information associated with interim orders is not ordinarily provided to panels prior to the sanction stage. However, given the absence of any information related to insight or remediation, and the relevance of the new material to the decision on impairment, the Panel decided to take the documents pertaining to reflection and remediation into account. The Panel also concluded that an unrepresented and absent registrant may have incorrectly assumed that all material previously submitted, for any purpose, would be viewed by the Panel in a Final Hearing.
173.Taking all the above into account and in fairness to the Registrant, the Panel decided to review its decision on Impairment.
Reviewed Decision on Impairment
174.The Panel then went on to consider, whether the Registrant’s fitness to practise is currently impaired by reason of her misconduct.
175.The Panel heard the further submissions of Ms Hastie.
176.Ms Hastie submitted that the Registrant's fitness to practise was impaired. She reminded the Panel that the purpose of fitness to practise proceedings is not to punish a practitioner for past misconduct but rather to protect the public against the acts and omissions of those who are not fit to practise. She also reminded the Panel that not every finding of misconduct would result in a finding of impairment of fitness to practise.
177.Ms Hastie submitted that the lack of engagement by the Registrant meant that the Panel could not ascertain whether or not she had gained insight into her misconduct in order for her to make changes to her behaviour and attitudes. She submitted that the character references provided by the Registrant do not provide cogent evidence of the Registrant's insight and remediation.
178. The Panel considered the documents before it as follows:
179. The Panel accepted the advice of the Legal Assessor. He drew the Panel’s attention to the approach set out in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin) and reminded the Panel that there is a personal and public component when considering whether the Registrant’s fitness to practise is currently impaired.
b) has in the past acted and/or is liable in the future to act so as to put service users at unwarranted risk of harm; and/or
c) has in the past brought and/or is liable in the future to bring the Paramedic profession into disrepute; and/or
d) has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the Paramedic profession?”
181. The Panel took into account the following factors:
(i) promoting and protecting the interests of service users, and treating service users with respect and dignity, are fundamental tenets of the profession;
(ii) the decisions of the Interim Order review Panels and the documents submitted by the Registrant demonstrate that the Registrant has been engaging with the HCPC and this process, however she has not participated in this substantive hearing;
(iii) the reports from the Registrant’s supervisor in respect of the Registrant’s role as senior carer in an elderly care home are very positive;
(iv) there is evidence of some reflection and insight, particularly with regard to the clinical failings demonstrated by the documentation before the Panel;
(v) the Panel determined that the Registrant's misconduct was easily remediable, but that there was limited and untested evidence upon which it could be satisfied that the Registrant has fully remediated her misconduct.
182. The Panel was unable to fully test the level of the Registrant’s insight into her failings because she has not attended this substantive hearing. Therefore, based upon the evidence before it, the Panel determined the following:
(i) The Registrant has demonstrated significant insight into her clinical failings as shown in her reflective piece submitted to the HCPC in 2018. She speaks of not acting with independent thought, not carrying out her own assessment of Service User A, and not working with a level of urgency even after Service User A collapsed. She reflects that she should have challenged the presumptions made by her colleague and further that she should have provided a wheelchair for Service User A.
(ii) The Registrant has demonstrated limited insight into her attitudinal failings. In her reflection piece, the Registrant focusses on the clinical failings, but does not comment to any significant degree about her thoughts concerning her attitude and actions towards Service User A and her family and how these impacted upon how the Registrant had failed to carry out her clinical duties diligently. The Panel recognises that the Registrant has started to develop insight but there is insufficient evidence before the Panel that this is fully developed.
(iii) The Registrant submitted that she had undertaken CPD in relation to her clinical failings. However, no independent evidence of courses attended or CPD undertaken was presented to the Panel. Therefore, the Panel concluded that there was insufficient evidence of remediation in relation to either the clinical or attitudinal failings of the Registrant.
(iv) Without evidence of sufficiently developed insight or remediation the Panel concluded there remains a likelihood of repetition.
183. The Panel notes that the Interim Conditions of Practice Order stipulates that the Registrant must confine her professional practice to working as a registered Paramedic only at Shannon Court Care Centre, where she is currently employed. However, there is no evidence that the Registrant has been employed as a Paramedic by the Care Centre, nor is there a job description of her role at the centre, which is titled Senior Carer. If there had been evidence that the Registrant was employed as a Paramedic, the Panel could have placed more weight upon the reports prepared by her managers.
184. Taking all of the above into consideration, the Panel determined that the Registrant's fitness to practise is currently impaired. The Panel determined that the answers to all the above questions of Dame Janet Smith’s test were in the affirmative in relation to past, and future possible conduct.
185. The Panel also determined that the Registrant’s misconduct was such that the need to uphold professional standards and public confidence in the professions would be undermined if a finding of impairment were not made in these circumstances. This is because there remains a real risk to the public due to the lack of evidence of insight and remediation. Even if there were full insight and remediation on the part of the Registrant, given the serious nature of the misconduct, a member of the public with full knowledge of the facts and information before the Panel today, would be concerned if no finding of impairment were made.
186. Therefore, Panel determined that the Registrant’s fitness to practise is currently impaired on both personal and public interest considerations.
Decision on Sanction
187. Having determined that the Registrant’s fitness to practise is currently impaired, the Panel then considered what sanction should be imposed. It heard the submissions of Ms Hastie on behalf of the Council.
188. Ms Hastie reminded the Panel of the approach that it should take and that it should have regard to the Sanctions Policy issued by the HCPC.
189. The Panel accepted the advice of the Legal Assessor. He advised the Panel that as it has found the matters proved amounted to Misconduct, the full range of sanctions is available to the Panel. He advised the Panel that it should bear in mind that its over-arching duty is:
(i) to protect, promote and maintain the health, safety and wellbeing of the public;
(ii) to promote and maintain public confidence in the professions regulated by the HCPC;
(iii) to promote and maintain proper professional standards and conduct for members of those professions.
190. The Legal Assessor advised the Panel that any sanction it imposes must be the least restrictive sanction that is sufficient to protect the public and the public interest. It should take into consideration the aggravating and mitigating factors in the case. He reminded the Panel that the purpose of a sanction is not punitive, although it may have that effect. The purpose of a sanction is to protect members of the public and the wider public interest. The Legal Assessor advised that the Panel should consider the least restrictive sanction first and moving up the scale of severity only if the sanction being considered is inappropriate. He also reminded the Panel it must apply the principle of proportionality, weighing the Registrant’s interest against the public interest.
191. The Legal Assessor drew the Panel’s attention to the following cases in relation to proportionality when considering any sanction to be imposed:
(i) Kamberova v NMC  EWHC 2955 (Admin); and
(ii) McDermott v HCPC  EWHC 2899 (Admin)
Panel’s consideration and decision
192. The Panel has had regard to all the evidence presented, and to the Council’s Sanctions Policy and accepted the advice of the Legal Assessor.
193. The Panel considered the aggravating factors in this case to be:
i) the psychological harm to the family of Service User A; and
ii) the impact of her conduct has had upon their confidence in the profession, and by inference the public’s confidence in the reputation of the profession.
194. The Panel next considered the mitigating factors in this case. It considered them to be:
The Registrant has:
i) engaged with the process, albeit not with the Final Hearing;
ii) demonstrated partial insight;
iii) expressed remorse and an apology;
iv) a previously unblemished record as a Paramedic.
v) The Registrant was a newly qualified Paramedic at the time and was still on probation having qualified 4 months prior to the incident;
vi) This was a single episode of care;
vii) In the Panel’s view the circumstances were such that even experienced paramedics would have found challenging;
viii) There were no persistent or general failures in the Registrant’s practice;
ix) The Registrant has been working within an Interim Conditions of Practice order imposed upon her registration albeit in her role as a senior carer in a care home;
x) The positive reports from her supervisor about the Registrant’s work ethic and that she is valued and well-liked by the staff and service users where she works;
xi) The positive testimonials about the Registrant’s clinical ability from other paramedics who had worked with the Registrant prior to and after this incident, before she was dismissed from the Trust;
xii) The Registrant has started the process of remediation in respect of her clinical shortcomings.
195. The Panel first considered taking no action but concluded that, given the seriousness of the Registrant’s misconduct and the on-going risk to the public, this would be wholly inappropriate.
196. The Panel then considered whether to make a caution order. The Panel was mindful of its finding that a risk of repetition remains due to the Registrant’s lack of insight into her shortcomings. It bore in mind that a caution order would not restrict her practice. In these circumstances, the Panel concluded that a caution order would not be sufficient to protect the public from the risk posed by the Registrant or, in any event, to satisfy the wider public interest.
197. The Panel next considered the imposition of a Conditions of Practice Order. The Registrant has demonstrated a desire to remain in practice as a Paramedic by her continued engagement with the Fitness to Practise process despite her limited engagement with the final hearing process.
198. This was a case involving serious misconduct that included:
(i) Making inappropriate comments to a service user and her family;
(ii) Failing to complete an adequate clinical assessment, examination and observations of the service user;
(iii) Walking Service User A to the ambulance when it was not appropriate to do so;
(iv) Not providing appropriate assistance to Service User A when she should have done so;
(v) Not providing care to Service User A in a timely manner; and
(vi) Not ensuring the expeditious transfer of Service User A to hospital.
199. The Panel determined that in the light of the significant mitigating factors outlined above, a Conditions of Practice order would satisfy the wider public interest, and that it was both fair and reasonable to provide the Registrant with the opportunity to return to unrestricted practice as a paramedic in the future.
200. Taking into account all of the above, the Panel concluded that conditions could be formulated which would adequately address the risk posed by the Registrant, and in doing so protect patients and the public during the period they are in force. In all of the circumstances, the Panel determined that a conditions of practice order is the appropriate and proportionate sanction.
201. The Panel decided to make a Conditions of Practice Order for a period of twelve months. In deciding on the period of the Order the Panel took into account the fact that this was a single episode of care, that the Registrant shows evidence of developing insight and of having started remediation. The Panel noted the positive content of the professional references provided by paramedic colleagues and that there are no persistent failings within her practice. With the right conditions, the Panel considers that the Registrant should be able to develop her insight further and to remedy the failings within the nine-month period whilst at the same time ensuring that the public is protected. A nine-month period of close supervision of the Registrant’s day-to-day practice by a registered paramedic is, in the Panel’s view, sufficient to satisfy public confidence in the profession and the regulatory process in the particular circumstances of this case.
202. The Panel went on to consider suspension and decided that this was not an appropriate sanction. It considered all the circumstances of the case and the relevant mitigation and concluded that it would be disproportionate and punitive to impose a suspension order.
• Managing challenging and non-compliant service users
• Treating service users and their families/others with respect and dignity
• Clinical assessment and examination
• Baseline observations
• Record keeping
• Appropriate extrication and conveyance of service users
• Timeliness of interventions
7. Within three months of commencing employment as a Registered Paramedic you must forward a copy of your Personal Development Plan to the HCPC.
• Your attendance at the review;
• A reflective statement.
Interim Conditions of Practice Order:
203. The Panel decided that it was appropriate to consider the Interim Order application in the absence of the Registrant. In reaching this conclusion the Panel took into account that the content of the Notice of Hearing sent to the Registrant included the following words, under the heading Interim Orders: “Please note that if the Panel finds the case against you is well founded and imposes a sanction which removes, suspends or restricts your right to practise, it may also impose an interim order on you (under Article 31 of the Health and Social Work Professions Order 2001). An interim order suspends or restricts a registrant’s right to practise with immediate effect.”
204. The Panel was satisfied that the Registrant is aware that an interim order application was a possible outcome at this Hearing. The Panel remained satisfied that the Registrant had waived her right to be present at the hearing by her failure to engage.
205. The Panel could see no reason to adjourn the hearing in order to allow the Registrant to attend on a later date because there was no indication that she would attend on any other occasion. The Panel took into account the fact that it had identified there to be a continuing risk to the public if the Registrant were allowed to practise without restriction and decided it was clearly in the public interest to consider the Interim Order application in the absence of the Registrant.
206. Having heard submissions from Ms Hastie on behalf of the HCPC and having taken advice from the Legal Assessor, the Panel makes an Interim Conditions of Practice Order in the same terms as set out above, for a period of 18 months under Article 31(2) of the Health and Social Work Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.
This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.
History of Hearings for Miss Lisa Chadwick
|Date||Panel||Hearing type||Outcomes / Status|
|22/06/2020||Conduct and Competence Committee||Final Hearing||Conditions of Practice|
|21/06/2018||Investigating committee||Interim Order Review||Interim Conditions of Practice|
|26/03/2018||Investigating committee||Interim Order Review||Interim Suspension|