Ms Margaux Ducker

Profession: Paramedic

Registration Number: PA30365

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 02/11/2020 End: 17:00 05/11/2020

Location: This hearing is being held virtually.

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

Whilst registered with the Health and Care Professions Council as a Paramedic, and employed as a Clinical Advisor with Barnsley Healthcare Federation, you

1. On 30 May 2018:

a) in relation to Patient A, did not appropriately triage the patient in relation to their:

 i. presenting condition;
 ii. medical history;
 iii. allergies.
 

b) in relation to Patient B:

i. did not appropriately triage the patient in relation to their:

a. presenting condition;
  b. medical history;
  c. allergies.

ii. did not assess whether the patient was able to attend hospital as you advised them to do.

2. On 16 July 2018:

 a) in relation to Patient C:

i. said that no appointments were available, which was incorrect;
ii. [Not Proven]

b) in relation to Child A:

i. told Child A's mother that no appointments were available, which was incorrect;
 ii. did not appropriately triage Child A in relation to their:

 a. presenting condition;
   b. medical history;
  c. allergies.

c) in relation to Patient D:

i. [Not Proven]

 ii. did not appropriately triage Patient D in relation to their: 

 a. presenting condition;
  b. medical history;
  c. allergies.
 

d) in relation to Patient E:

 i. said that no appointments were available, which was incorrect;
 ii. did not appropriately triage Patient E in relation to their:

a. presenting condition;
  b. medical history;
  c. allergies.

e) in relation to Patient F:

 i. said that no appointments were available, which was incorrect;
 ii. did not appropriately triage Patient F in relation to their:

a. presenting condition;
  b. medical history;
   c. allergies.

3. The matters set out in particulars 2a, 2b(i), 2c(i), 2d(i) and 2e(i) were misleading and/or dishonest.

4. The matters set out in particulars 1 - 3 constitute misconduct and/or lack of competence.

5. As a result of your misconduct and/or lack of competence, your fitness to practise is impaired.

Finding

Preliminary Matters

Service and Proceeding in the Registrant’s absence


1. The Registrant did not attend the hearing, but had submitted representations which she labelled “to be read as part of the hearing in my absence”. The Panel first considered whether proper service had been effected; and then whether it ought to exercise its discretion to continue with the hearing in the absence of the Registrant. The Panel was satisfied that the Registrant had notice of the hearing and that the Rules on service had been complied with.
2. The Panel concluded it was in the public interest to hear the case in the absence of the Registrant, having considered the HCPC Practice Note on “Proceeding in the Registrant’s Absence,” having taken the Legal Assessor’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 Registrant confirmed in her emails to HCPC that she was aware of the hearing and did not wish to participate;
• The Registrant has not sought an adjournment;
• The Panel considered it was very 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 was a general public interest in the expeditious disposal of this matter as the allegation is serious. In addition, there were witnesses due to give evidence and any delay would have inconvenienced them and would have had an adverse effect on recollection.

Amendment of the Allegation


3. At the outset of the hearing Mr Bridges on behalf of the HCPC sought to amend the allegation to make particulars clearer. It was proposed that at particular 1a) and b, 2b)ii, 2c)ii, 2d)ii and 2e)ii the words “in relation to their:” were added to the stem and in addition to presenting condition the sub clauses medical history and allergies were added.
4. It was proposed to amend particular 1b)ii to insert the word “you” between "as" and "advised" and add the “them to do” after advised.
5. It was proposed to amend particular 2c)i to delete the word “no” and insert the words “could not be booked for the next day” after appointments and delete “were available”.
6. Mr Bridges submitted that the amendments proposed served to clarify the particulars of the allegation; did not extend their scope; and that the proposed amendments did not alter the nature of the case against the Registrant.
7. The Panel was mindful of the issues of fairness and natural justice. The Panel noted that the Registrant had been advised of the proposed amendments in January 2020 and had not raised any objections. The Panel considered that it was fair to allow the application to amend the particulars of the allegation as they did not alter the case against the Registrant or widen its scope in any way and ensured that the wording of the allegation was clear. There was no prejudice to the Registrant and the Panel considered the amendments could be made without injustice.

Background
8. The Registrant is a registered Paramedic and at the time of the allegation was employed as a Clinical Adviser by iHeart, part of the Barnsley Healthcare Federation (the Federation). iHeart is a triage and referral service that provided extended access to General Practitioner (GP) appointments for the population of Barnsley.

9. On the afternoon of 16 July 2018 Lynn Jones (LJ) who was an Advanced Nurse Practitioner, also undertaking the role of a Clinical Adviser for the Federation, overheard the Registrant on a call with a service user. LJ was concerned that the Registrant had allegedly told the service user that no appointments were available without undertaking an appropriate triage of the presenting complaint. LJ reported her concerns to the Registrant’s line manager Sarah Clark (SC) as she did not consider that the Registrant had safely dealt with the caller.

10. SC undertook a review of the call that LJ had overheard. SC also reviewed a number of other calls that had been taken by the Registrant on the 16 July and 2 calls that had been handled by the Registrant on 30 May 2018. It is alleged by the HCPC that the Registrant had incorrectly told callers that appointments were not available and that she had failed to triage patients appropriately.

11. The Registrant stated in her written submissions that she did not contest the factual allegations but pointed to a number of extenuating circumstances and reasons for her actions. The Panel noted that nevertheless the HCPC is required to prove the factual particulars.
Decision on Facts
12. On behalf of the HCPC the Panel heard live evidence from SC who was the Registrant’s line manager at the relevant time and investigated the concerns that were brought to her attention. The Panel also heard live evidence from LJ who had overheard the Registrant’s call on 16 July 2018 and had worked as an Advanced Clinical Practitioner for iHeart at the relevant time. The statement of a third witness Jenny Oppong was read into the record. The Panel was provided with a bundle of documents together with closing submissions on facts from the HCPC. The Registrant also provided a bundle of documents which included her submissions which the Panel read, and which were read into the record, together with letters written by colleagues who had resigned from iHeart. 

13. The Panel heard and accepted the advice of the Legal Assessor. In respect of the disputed facts, the Panel understood that the burden of proving each individual fact is on the HCPC and that the HCPC will only be able to prove a particular fact if it satisfies the required standard of proof: namely the civil standard, whereby it is more likely than not that the fact occurred as alleged.

14. The Panel considered the evidence of all of the witnesses. It considered SC to be a credible witness and that she was able to give a clear account of what she found during her investigation and what was expected of the Clinical Advisers working within the service. SC had a good recollection of the events and was able to describe to the Panel the structure of the iHeart service.

15. The Panel considered the evidence of LJ. She did her best to assist and was a helpful witness. She gave evidence regarding the conversation with the service user that led to the allegations. However, the Panel noted that she was unable to recall the chronology. In addition, she was unable to assist the Panel with her conversation with the Registrant at the time of the call. LJ confirmed that the role at iHeart was not her main role and she accepted that she may not have been sent all of the emails relating to policy and procedure.

Particular 1 a) i-iii - Found Proved
1. On 30 May 2018;
a) in relation to Patient A, did not appropriately triage the patient in relation to their:
 i. presenting condition;
 ii. medical history;
 iii. allergies.

16. In making this finding the Panel had particular regard to the oral and documentary evidence about what was expected of the Registrant in her role. The Panel also listened to the call recording and had regard to the transcript of the call.

17. The Panel accepted the evidence of SC and LJ that the Registrant would have been expected to ask for the patient’s name and date of birth in order to access the Patient’s medical records and complete the triage template within the electronic record on SystmOne. Both SC and LJ explained that it was important for this to be completed in order to provide a record for clinicians to look at if patients went on to access services in the future. It was clear to the Panel from listening to the call that the Registrant did not ask for these details and did not ask the caller on behalf of Patient A any questions about the presenting complaint, medical history or allergies, or speak to Patient A directly. There was no evidence that the triage form was followed or completed on the system for this patient. The Panel concluded that the Registrant did not appropriately triage Patient A.

 


 Particular 1b)i and ii - Found Proved
b) in relation to Patient B:
i. did not appropriately triage the patient in relation to their:
  a. presenting condition;
  b. medical history;
  c. allergies.
ii. did not assess whether the patient was able to attend hospital as you advised them to do.

18. The Panel considered the call recording in relation to this patient and noted that the Registrant did not ask for a name and date of birth in order to access Patient B’s clinical record. There was no evidence that the triage template was followed or completed on the system for this patient. The Panel considered that it was clear from listening to the call that the Registrant did not ask Patient B the relevant questions about his presenting complaint, medical history or allergies in order to triage him appropriately. There was no evidence from listening to the call that the Registrant assessed whether Patient B was able to attend hospital or asked him any questions about whether he would be able to attend hospital as advised.

Particular 2a)i – Found Proved
2. On 16 July 2018:

 a) in relation to Patient C:
i. said that no appointments were available, which was incorrect;

19. The Panel had regard to the evidence of SC and LJ who explained the appointments system within the iHeart service. SC set out in her witness statement that the role of the Registrant was to triage callers and, if appropriate, offer them a GP appointment in one of two GP practice “hubs”. If there were no appointments at either of the hubs then the Registrant was able to book a service user an appointment with an out of hours service based within Barnsley General Hospital. This was known as the Primary Care Centre (PCC). LJ confirmed in her witness statement and oral evidence that if, following triage, a patient needed to be seen on the same day and there were no appointments available at the hubs then it would be expected that an appointment would be made at the PCC.

20. The Registrant in her written evidence stated that she had been told, by her manager at the time the PCC service was introduced, that only 2 appointments at the PCC could be taken by iHeart and the rest were to be reserved for 111 callers. The Registrant stated that on the 16 July 2018 she had been working at the hospital and did not attend for her shift until around 16.30. The Registrant stated that she was told on arrival by a colleague that all of the hub appointments were fully booked and that only PCC appointments were available for later calls from 111.

21. The Panel accepted the evidence of SC who had checked the lists during her investigation and noted that at the time that the Registrant took the call from Patient C at 15.48 there were 12 appointments available at the PCC. In addition, SC had commented that on her examination of the records, that the Registrant had booked a 7pm appointment for another patient at the PCC at 15.10.

22. The Panel was satisfied on a balance of probabilities that there were appointments available at the PCC at the time of the Registrant’s call with Patient C and it was therefore incorrect to say to Patient C that there were no appointments available.

Particular 2a)ii – Found Not Proved
ii. said that appointments could not be booked for the next day, which was incorrect.
23. In making this decision the Panel had regard to the evidence of SC, LJ and the submissions of the Registrant. The Registrant explained in her submissions that it was an ‘on the day service for urgent need only’. LJ explained in her witness statement that in her view advisers should not have been booking service users into appointments the following day. LJ further stated in her witness statement that she had been aware of information that was circulated to call handlers that set out that it was not acceptable to book appointments for the following day. LJ confirmed her view in her oral evidence that clinical advisers should not be booking appointments for the following day. LJ explained in her oral evidence that this was because if a service user was able to wait until the following day then they should be trying to book in to see their own GP and there was a possibility that they would see their own GP the following day and not attend the booked appointment.
 
24. SC stated in her witness statement that it was acceptable for service users to be given an appointment for the following day if, after triage, they were well enough to wait. SC stated in her oral evidence that this was not in any written policy. When asked whether this was communicated to the staff, SC stated that it was likely to have been sent in an email, but there was no supporting email submitted in evidence and SC was unable to recall exactly when such an email might have been sent.  

25. In these circumstances, the Panel considered that it was more likely than not that contrary information had been given to clinical advisers about whether it was acceptable to book appointments for the following day. The Panel could not be satisfied that it was made clear to the Registrant that she was able to book service users an appointment the following day. In these circumstances the Panel considered that it had not been incorrect for the Registrant to tell Patient C that appointments could not be booked for the following day.

Particular 2b)i – Found Proved

b) in relation to Child A:

i. told Child A's mother that no appointments were available, which was incorrect;
 
26. The Panel listened to the call recording and had regard to the earlier evidence of SC. The Panel noted that this call was taken at 16.02 on the 16 July 2018. SC confirmed that 12 appointments were still available from her review of the lists. For the same reasons as outlined above in relation to the Panel’s findings for Particular 2(a)i the Panel is satisfied that there were appointments available at the PCC at the time of this call and it was incorrect to tell Child A’s mother that no appointments were available. 

Particular 2b)ii – Found Proved
ii. did not appropriately triage Child A in relation to their:
  a. presenting condition;
   b. medical history;
  c. allergies.

27. The Panel considered the call recording in relation to this patient and noted that the Registrant did not ask for a name and date of birth of Child A in order to access Child A’s clinical record. There was no evidence that the triage template was followed or completed for this patient. The Panel considered that it was clear from listening to the call that the Registrant did not ask Child A’s mother the relevant questions about the presenting complaint, medical history, or allergies in order to triage Child A appropriately.

Particular 2c)i – Found Not Proved
2c) in relation to Patient D:
i. said that no appointments could be booked for the next day, which was incorrect;

28. For the same reasons as set out in the Panel’s decision in relation to Particular 2a)ii the Panel considers that this particular is not proved. 

Particular 2c)ii – Found Proved

ii. did not appropriately triage Patient D in relation to their:
  a. presenting condition;
  b. medical history;
  c. allergies.

29. The Panel considered the call recording in relation to this patient and noted that the Registrant did not ask for a name and date of birth of Patient D in order to access Patient D’s clinical record. There was no evidence that the triage template was followed or completed for this patient. The Panel considered that it was clear from listening to the call that the Registrant did not ask Patient D the relevant questions about the presenting complaint, medical history or allergies in order to triage Patient D appropriately.


Particular 2d) – Found Proved

d) in relation to Patient E:
i. said that no appointments were available, which was incorrect;
  ii. did not appropriately triage Patient E in relation to their:
   a. presenting condition;
   b. medical history;
    c. allergies.

30. The Panel considered the call recording in relation to this call and noted that the Registrant told the caller that no appointments were available at 16.38 on the 16 July. SC confirmed that 12 appointments were still available at this time from her review of the lists. The Panel also noted that the Registrant did not ask for the Patient’s name or date of birth in order to access the electronic patient records. There was no evidence that the triage template was followed or completed for this patient. The Panel considered that it was clear from listening to the call that the Registrant did not ask Patient E any questions about the presenting complaint, medical history or allergies in order to triage Patient E appropriately. For the same reasons given above the Panel concluded that the Registrant had incorrectly told Patient E that no appointments were available and did not appropriately triage Patient E.

Particular 2e – Found Proved
 2e) in relation to Patient F:
 i. said that no appointments were available, which was incorrect;
 ii. did not appropriately triage Patient F's in relation to their:
  a. presenting condition;
  b. medical history;
   c. allergies.

31. The Panel considered the call recording in relation to this call and noted that the Registrant told the caller that no appointments were available at 17.25 on the 16 July. SC confirmed that 12 appointments were still available at this time from her review of the lists. The Panel also noted that the Registrant did not ask for the Patient’s name or date of birth in order to access the electronic patient records. There was no evidence that the triage template was followed or completed for this patient. The Panel considered that it was clear from listening to the call that the Registrant did not ask Patient F any questions about the presenting complaint, medical history or allergies in order to triage Patient F appropriately. For the same reasons given above the Panel concluded that the Registrant had incorrectly told Patient F that no appointments were available and did not appropriately triage Patient F.

Particular 3 – misleading and dishonesty found proved in relation to particulars 2a)i, 2b)i, 2d)i and 2e)i  

32. The Registrant stated that she was told that the appointments on the PCC list could only be used for 111 callers save for the first two. The Registrant stated that when she arrived for work at around 16.30 she was told by a colleague that all the appointments were booked. The Panel preferred the evidence of SC and LJ who stated in their witness statements and confirmed in oral evidence that there was no instruction to save the PCC appointments for 111 callers and the appointments were available to be booked for service users following completion of appropriate triage.
 
33. The Panel was satisfied that the evidence of SC and LJ was more likely to be correct. The Registrant had not produced any evidence in support of her assertion and LJ and SC were clear in their evidence that this was not the case. The Panel considered it was more likely that these appointments were available to be booked.

34. The Panel considered it was likely that the Registrant knew there were appointments on the PCC list available as she had access to the list. The Panel accepted the evidence of SC that on the 16 July at 15.10 the Registrant had made an appointment for a service user on the PCC list. The Panel concluded that it was likely that the Registrant was mistaken in her account about when she arrived for her shift. There were PCC appointments available and there was evidence that the Registrant was aware of this.

35. The Panel was satisfied that it was likely that the Registrant knew there were appointments available on the PCC list at the time she told Patient C, Child A’s mother, Patient E and Patient F that no appointments were available. The Panel was not persuaded by the Registrant’s account that she genuinely believed that she needed to keep those PCC appointments free for 111 callers.

36. The Panel concluded that the Registrants actions misled these patients about the availability of appointments.

37. The Panel also determined that the Registrant’s actions in telling the above patients that no appointments were available was dishonest and would be considered dishonest by the standards of ordinary decent people.  

Decision on Grounds

38. The Panel went on to consider whether the facts found proved amounted to the statutory grounds as alleged of misconduct and/or lack of competence.

39. The Panel does not consider the facts amount to a lack of competence. The Panel had regard to the certificate of training which demonstrated that the Registrant had completed a triage training course by 6 April 2018 and the Panel saw evidence of audits of the Registrant’s work. There was no evidence before the Panel that the Registrant lacked the necessary skills to appropriately triage patients. Rather, the Registrant had not carried out the basics of triage as she had told the callers no appointments were available.

40. The Panel does not consider particular 1(b)ii to amount to serious misconduct. The Registrant ought to have checked whether the patient was able to attend hospital unassisted but there was nothing in the call to suggest Patient B was unable to do so as he had indicated he had attended the hospital and his own doctors that day. The Panel considered that whilst it would have been best practice to assess whether Patient B was able to attend the Hospital unassisted it did not cross the threshold into serious misconduct.

41. The Panel considered that the failure to appropriately triage the patients was a serious falling short of the standards expected of a registered Paramedic. It was a basic requirement of the Registrant’s role to assess the needs of the callers and ensure they were kept safe. The failure to triage appropriately meant that the Registrant was unable to determine safely whether these patients were safe to wait until they could be seen. The advice she gave was not based on an appropriate history and did not take account of the full medical needs of the patients. The Panel considered that the failure of the Registrant to triage the patients placed them at serious risk of harm and amounted to misconduct.

42. The Panel determined that the Registrants conduct in dishonestly telling patients that no appointments were available was serious misconduct and was behaviour which fellow practitioners would find deplorable. The Registrant’s actions had the potential to place those patients at serious risk of harm. The effect of her conduct was such that those patients were unnecessarily kept waiting to be triaged and the appropriate action taken. This could have resulted in a deterioration in their condition. The Registrant’s actions had the potential to place pressure on other healthcare professionals to deal with these patients at a later time.      

43. The Panel considered that the Registrant had breached standards 1,2,6,9 and 10 of the HCPC’s Standards of conduct, performance and ethics and standards 1,2,4,8 and 10 of the HCPC’s Standards of proficiency for paramedics. The Panel considered that the facts found proved involved serious and wide-ranging failures including dishonest conduct in respect of more than one patient. In these circumstances the Panel was satisfied that the facts found proved (with the exception of 1b) ii) individually and collectively amount to misconduct.

Decision on Impairment

44. The Panel went on to consider the issue of impairment by reason of the Registrant's misconduct. It had careful regard to all the evidence before it and to the submissions of Mr Bridges for the HCPC and those prepared by the Registrant. It accepted the advice of the Legal Assessor and had particular regard to the HCPTS Practice Note on “Finding that Fitness to Practise is ‘Impaired’”.

45. The Panel first considered past impairment. It noted its findings that the Registrant had dishonestly told patients that no appointments were available and had failed to triage them appropriately, which placed them at risk of harm. It had also found that the Registrant’s misconduct had breached key standards of the HCPC’s “Standards of conduct, performance and ethics” as set out above, had brought the profession into disrepute and had undermined confidence in the profession.

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

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

48. The Panel noted the evidence from SC and LJ, as well as the representations from the Registrant and the letters of resignation from fellow workers at iHeart referring to the working environment during the period in question. The Panel considered that the Registrant had been working in an environment that had been subject to significant change in a short period of time. It noted the evidence of SC that the service had been rated as “needing improvement” in a Care Quality Commission Inspection in January 2018 and she had recently taken over as manager at that time. It noted that the Registrant was not subject to clinical audit and supervision until mid 2018. The Panel also noted that although the Registrant had completed a triage course in April 2018, her initial training had been on the job and involved observing colleagues. The Panel considered that the Registrant’s dishonesty, in telling patients there were no appointments on one shift during a short period of time, had to be viewed in the context of this unusually stressful working environment. It did not consider it was part of a deep-seated attitudinal problem. Rather, it concluded that it was closely linked to that working environment and the pressure under which the Registrant was working.

49. In the Panel’s view the Registrant has demonstrated developing insight into the seriousness of her misconduct and its impact on patients and the profession. The Panel noted that the Registrant had accepted that her handling of the calls fell below the standard expected; and she apologised for her conduct. The Panel was concerned that the Registrant had not appreciated the potential for harm to the patients she dealt with and she expressed the view that there was no actual harm as the patients could approach others for help. The Panel did not consider that the Registrant had demonstrated complete insight as she did not have an appreciation of the seriousness of her failings and had little understanding of its impact on the wider public interest. In addition, she did not appear to have taken full responsibility for her actions and was to an extent seeking to blame others in her submissions.

50. The Panel had careful regard to Silber J’s guidance in Cohen v GMC [2008] EWHC 581 (Admin) that Panels should take account of:
• Whether the conduct which led to the charge is easily remediable;
• Whether it has been remedied; and
• Whether it is highly unlikely to be repeated.

51. The Panel recognised that remediation of misconduct which involves dishonesty may be less easy than remediation of misconduct involving clinical failings. However, the Panel had regard to the context of the dishonesty and the fact that the Registrant was working in difficult circumstances. The Panel did not consider that there had been a deliberate intention to mislead, rather, a misguided attempt to divert the caller. The Panel noted that the Registrant’s dishonesty took place during one shift over a very short period of time. The Panel took account of the evidence submitted that the Registrant was a good clinical practitioner. It considered that with the development of meaningful insight the Registrant’s misconduct is remediable. The Panel considered that the Registrant was unlikely to repeat her dishonest conduct.

52. It noted the Registrant was not currently working as a Paramedic. In these circumstances she had been unable to demonstrate to the Panel that she had undertaken the necessary training to assure the Panel that she had learned from her mistakes and had developed strategies to prevent any repetition of the misconduct in relation to the failure to adequately triage.

53. In light of its findings in relation to insight and remediation, the Panel considered that there remained a risk that the Registrant would repeat matters of the kind found proved. For these reasons, the Panel determined that a finding of impairment on public protection grounds was required.

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


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

55. The Panel considered that honesty and integrity is a fundamental tenet and a cornerstone of the profession. The public rightly expects professionals to be honest and truthful when giving information. The Panel considered that the public would be concerned to learn of the Registrant’s conduct in this matter. Further, the Panel had no doubt that the need to maintain public confidence in the profession, and to declare and uphold proper standards, would be undermined if a finding of impairment of fitness to practise in relation to the Registrant’s failings was not made in the circumstances of this case.

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

Decision on Sanction

57. Having determined that the Registrant’s fitness to practise is currently impaired by reason of her misconduct, the Panel next went on to consider whether it was impaired to a degree which required action to be taken on her registration by way of the imposition of a sanction.

58. The Panel had regard to all of the evidence in the case and the submissions made by Mr Bridges and the information supplied by the Registrant.

59. The Panel accepted the advice of the Legal Assessor and exercised its independent judgement. The Panel had regard to the Sanctions Policy (the Policy) and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive but to protect members of the public and to safeguard the wider public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.

60. The Panel first identified what it considered to be the principal aggravating and mitigating factors in this case.

Aggravating factors:
• The Registrant's conduct put patients at risk of harm.
• The Registrant’s conduct involved multiple patients on two separate occasions.
• The Registrant has not demonstrated remediation.

Mitigating factors:
• The Registrant admitted her conduct fell below the standard required;
• The Registrant was working in a particularly difficult environment at the time of the misconduct;
• The Registrant had apologised and expressed genuine remorse;
• The Registrant has developing insight;
• The Registrant had engaged, and cooperated fully, with the HCPC throughout this process.

61. The Panel considered the sanctions available, beginning with the least restrictive. The Panel did not consider the options of taking no further action, or mediation, to be appropriate or proportionate in the circumstances of this case. The Panel considered that in light of the findings made in relation to impairment and the need to uphold proper professional standards these options would not reflect the seriousness of the case.

62. The Panel next considered the imposition of a Caution Order. The Panel took into account the factors at paragraph 101 of the policy which might make this sanction appropriate. It considered that the misconduct was not isolated or minor. It reminded itself that it had found there remained a risk of repetition. In addition it considered that the Registrant had not demonstrated remediation or complete insight. For these reasons the Panel concluded that a Caution Order would not be appropriate to address the misconduct and would not provide sufficient public protection.

63. The Panel then considered a Conditions of Practice Order. It considered the factors set out at paragraph 106 of the Sanctions Policy that could make this order appropriate. It was satisfied that the Registrant had sufficient insight and the conduct was capable of remedy. The Panel reminded itself that it did not consider that there were any deep-seated attitudinal issues or other issues that would prevent the Registrant from remediating. The Panel considered that the failings involved a specific aspect of the Registrant’s clinical practice which could be addressed by conditions. The Panel considered it was possible to formulate appropriate and workable conditions which would protect the public whilst they were in force.

64. The Panel noted the guidance at paragraph 108 that indicated that conditions of practice may not be appropriate for cases involving dishonesty. However, it considered that the dishonesty in this case was very closely linked to the clinical working environment. The Panel considered that this was a very specific set of circumstances. It did not consider that the Registrant set out to be dishonest and she had not sought to cover up what she had done. The dishonesty occurred during one shift, over a short period of time. There was no evidence before the Panel that this was a habitual practice of the Registrant and the Panel therefore considered it was isolated and out of character. The Panel considered that it was unlikely that the Registrant would repeat her dishonesty or that she was at risk of acting dishonestly in the future. In these circumstances the Panel considered that a conditions of practice order was the appropriate and proportionate sanction. 


65. The Panel determined that an order of suspension would be disproportionate and it did not consider that the Registrant’s failings were such that it would be appropriate to remove her from practice. The Panel considered that this would deprive her of an opportunity to remediate her failings, whilst a Conditions of Practice Order would allow the Registrant to return to practice, albeit with conditions.

66. The Panel therefore determined that a Conditions of Practice Order for a period of 12 months would allow sufficient time for the Registrant to remediate the identified deficiencies in her practice and to mark the wider public interest including upholding proper professional standards.

67. This order will be reviewed before its expiry. On such a review, the reviewing panel may be assisted by the Registrant attending the review hearing and providing details of the steps she has taken to comply with the conditions of practice order. The reviewing panel may also be assisted by a reflective statement from the Registrant that addresses the concerns found by this Panel.

 

Order

ORDER: The Registrar is directed to annotate the HCPC Register to show that, for a period of twelve months from the date that this Order takes effect (“the Operative Date”), you, Ms Margaux Ducker, must comply with the following conditions of practice:
1. You must promptly inform the HCPC if you return to work as a paramedic or take up any role that requires you to be registered with the HCPC and provide your employment details.

2. You must inform the following parties that your registration is subject to these conditions:
a) any organisation or person employing or contracting with you to undertake professional work;
b) any agency you are registered with or apply to be registered with (at the time of application); and
c) any prospective employer (at the time of your application).
3. You must promptly inform the HCPC of any disciplinary or capability proceedings taken against you by any employer employing you to undertake any role that requires you to be registered with the HCPC.

4. If you return to work as a paramedic or take up any role that requires registration by the HCPC, you must place yourself and remain under the supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within 3 weeks of the Operative date. You must attend upon that supervisor as required and follow their advice and recommendations.

5. You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:
i) Patient Assessment
ii) Record Keeping
6. Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

7. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

8. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

9. You must provide a copy of your completed Personal Development Plan to the HCPC no later than 3 weeks before any review hearing.

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

Notes

The Order imposed today will apply from 3 December 2020.
This Order will be reviewed by the Committee before its expiry, no later than 3 December 2021.

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.

European Alert Mechanism
In accordance with Regulation 67 of the European Union (Recognition of Professional Qualifications) Regulations 2015, the HCPC will inform the competent authorities in all other EEA States that your right to practise has been restricted.
You may appeal to the County Court against the HCPC’s decision to do so.  Any appeal must be made within 28 days of the date when this notice is served on you. This right of appeal is separate from your right to appeal against the decision and order of the Panel.

Interim Order:
The Panel considered the application by the HCPC for an Interim Order to cover the appeal period. The Panel was satisfied that the Registrant had been served with the appropriate notice of the Panel’s powers to consider an interim order in the email dated 31 July 2020. The Panel considered it was appropriate to proceed in her absence for all the reasons outlined in its earlier determination.

The HCPC’s application is made on the 2 statutory grounds as follows:

• it is necessary for the protection of members of the public

• is otherwise in the public interest.

The Panel makes an Interim Conditions of Practice Order in the same terms as the substantive Order 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. The Panel considered that to do otherwise would be inconsistent with its earlier findings and would not protect the public against the risk of repetition identified.

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 to cover the length of any appeal.

 

Hearing History

History of Hearings for Ms Margaux Ducker

Date Panel Hearing type Outcomes / Status
02/11/2020 Conduct and Competence Committee Final Hearing Conditions of Practice