Ms Yasmin Beesley
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Whilst registered with the Health and Care Professions Council as a Paramedic and during the course of your employment with the East Midlands Ambulance Service, you:
1. On 5 January 2018, while operating as a solo responder, attended an incident where there was a query regarding sepsis and you:
a) did not book mobile for approximately 5 minutes after you were allocated the job;
b) reviewed the patient whilst you stood at the door of the ambulance;
c) did not undertake and/or record:
i . your own observations;
ii. your own physical assessment of the patient;
d) did not identify and / or treat sepsis
f) did not give the patient fluids
g) did not cannulate the patient
h) despite the presence of three red flags relating to sepsis:
i. left the emergency technician to ride in the back of the ambulance with the patient;
ii. did not travel with the patient to hospital;
i) did not complete a patient report form;
j) spent only approximately 8 minutes on the scene with the patient
2. On 6 January 2018, failed to respond to an allocated emergency call in a timely manner in that you:
a) did not travel to the scene of the emergency by the shortest route;
b) did not activate the blue lights when the call was allocated;
c) went to the scene via the ambulance station without good reason and/or permission from the EOC to do so.
3. The matters described in paragraphs 1 and 2 amount to misconduct and/or lack of competence.
4. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
1. The Registrant did not attend the hearing and was not represented. The Panel was satisfied that notice of the hearing dated 21 October 2020 had been properly served on her at her registered email address in accordance with the Rules.
Proceeding in the Absence of the Registrant
2. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note on ‘Proceeding in the absence of the Registrant’. The Panel took account of the fact that the Registrant will be unable to challenge the evidence or present her case if she is not present but noted that hearings should be adjourned only where there is a compelling reason to do so that overrides the key objective of public protection. The Panel has seen an attendance note of a conversation between the Registrant and the Health and Care Professions Council (HCPC) on 26 June 2019 and the Registrant’s responses in the Notice to Admit document dated 10 May 2020. In both the Registrant makes it clear that she is no longer practising as a paramedic, has no intention to return to the profession and would like to be voluntarily removed from the Register. In the Notice to Admit she states that therefore she will not attend the hearing. The Panel was also provided with emails dated 28 January 2021 and 29 January 2021 in which the Registrant confirmed she will not be attending the hearing. The Panel was satisfied that the Registrant had voluntarily absented herself.
3. The Panel noted that the Registrant had provided some response to the Allegation in the Notice to Admit document which it would take into account. It also had sight of the statement she had given in her employer’s investigation which contained additional information. The Panel was satisfied that these would help to address any prejudice to the Registrant. The Panel was mindful that two witnesses were ready to give their evidence today and the Allegation related to matters of three years ago. It was not in the public interest, or indeed in the Registrant’s interest, for there to be further delay.
4. The Panel was satisfied that an adjournment would serve no useful purpose; there was no reason to believe that the Registrant would attend the hearing if it was adjourned to a date in the future. Therefore, the Panel concluded that it would be fair, and in the public interest, to proceed in the Registrant’s absence.
5. At the start of the hearing the HCPC applied to amend the Allegation to delete some particulars and to correct a typographical error. The Registrant had been given notice of the application to amend the Allegation on 4 December 2019 and had not objected, which was not surprising as none of the proposed amendments were to her disadvantage. The Panel was satisfied that the changes clarified the evidence to be relied upon and were in the interests of justice. The Panel was satisfied that the amendments could be made without causing unfairness and so allowed the application for amendments to be made.
6. The Registrant joined the East Midlands Ambulance Service NHS Trust (EMAS) on 3 March 2008 as a Trainee Technician and progressed to the role of Paramedic in 2012.
7. On 6 January 2018 the Emergency Operations Centre reported that earlier that day the Registrant and her crew mate had failed to respond to a 999 call in a timely manner and to follow a management instruction. On 11 January 2018 DF, Duty Operations Manager was appointed to undertake an investigation into the matter. During the course of the investigation DF was told that the previous day, 5 January 2018, the Registrant had attended a Service User following a request for paramedic back up from a technician crew but failed to assess the Service User or to travel to hospital with him. The scope of the investigation was therefore widened to include this allegation.
8. On 13 April 2018 the Registrant made a self-referral to the HCPC in advance of her disciplinary hearing which took place on 20 April 2018.
Decision on Facts
9. The Panel reminded itself that the burden of proof is on the HCPC at all times and that the standard of proof is the balance of probabilities. As the Registrant was not present and not represented, in accordance with the HCPTS Practice Note, the Legal Assessor asked the witnesses some questions to test the HCPC evidence as far as practicable. The Panel has taken account of the answers to those questions when considering whether the HCPC has proved its case on the facts.
10. The Panel accepted the advice of the Legal Assessor that the decision of a previous tribunal or enquiry represented no more than the views and opinions of those people on the evidence that it heard, and that means that the Panel today is required to make its own assessment of the evidence that it heard during the hearing.
11. The Panel also accepted the advice of the Legal Assessor that it should consider each paragraph of the Allegation separately and that its decision need not be the same on each part; in other words that the different parts do not stand or fall together.
12. The Panel received and accepted advice from the Legal Assessor that the best evidence of the truth of the facts alleged is an informed admission by the person accused and that therefore it would be inappropriate to continue to test the facts as the Panel would do if the facts were denied.
13. The Panel had a copy of a Notice to Admit Facts dated 10 May 2020 in which the Registrant had admitted many but not all of the Particulars of the Allegation. Although the facts admitted were capable of being proved by the Registrant’s admissions on their own, two of the HCPC’s witnesses had attended the hearing remotely and so were available to give evidence to the Panel. The Presenting Officer called both to give evidence on the parts of the Allegation which were not admitted and so that the Panel could ask them any questions that it wished.
14. The Panel saw and heard DF and JS give evidence and considered them to be credible and helpful witnesses. DF was appointed to investigate the Registrant’s case because he was an independent person and did not know the Registrant. The Panel found DF to be objective and he had no difficulty telling the Panel when he did not know something and when he was unable to answer a question. The Panel received no evidence to cast any doubt on what he said and the Panel accepts his evidence in full.
15. DF interviewed the Registrant and the Panel had the benefit of reading the evidence he obtained in 2018 for the Trust investigation. The Panel bore in mind that DF had no first-hand knowledge of the events of 5 and 6 January 2018.
16. The Panel found JS to be a credible witness. The answers that she gave were clear and she volunteered when she did not know something she was asked about. She was calm and measured and not defensive when asked questions by the Legal Assessor. The Panel noted that she was not critical herself of the Registrant’s conduct; she just told the Panel what happened, in a factual way. The Panel accepts that it is now three years since the incident and that as a result JS did not recall all of her conversation with the Registrant, but JS had a clear memory of the Registrant saying to her ‘what are you doing to me’, referring to the fact that she had called her out towards the end of her shift. However, JS was simply following the correct procedure and the Panel considered it was quite right for her to call for backup from a paramedic. JS had treated the Service User appropriately and did everything she was supposed to do; she identified the sepsis red flags and acted on them. The Panel accepts her evidence in full.
17. The Panel had regard to all of the evidence contained in the witness statements submitted on behalf of the HCPC and to the written submissions made on behalf of the Registrant. The Panel gave less weight to statements which were not agreed and where the HCPC had chosen not to call the witnesses at the hearing, unless the evidence was consistent with the facts admitted by the Registrant, or with other contemporaneous records. The Panel then adjourned the hearing for it to make a decision on the facts, grounds and impairment. Although the Panel considered all three stages during the same session, it was careful to make sure that it considered each separately and sequentially.
18. The Registrant was scheduled to finish her shift at 19:00hrs on 5 January 2018 and had personal reasons for wishing to finish on time. At 17:53hrs two technicians arrived at the Service User’s address and began a series of assessments. JS recognised at least one red flag marker for sepsis and followed the EMAS Sepsis Toolkit which requires that the Service User is given fluids. Technicians are not licenced to cannulate service users and therefore are unable to provide fluids and so JS called for the assistance of a paramedic. The Registrant was allocated the call at 18:23hrs and asked the call handler if someone else could cover the call.
Particular 1(a); you did not book mobile for approximately 5 minutes after you were allocated the job
19. This part of the Allegation was admitted by the Registrant and the Panel found it proved. The Panel had a copy of the CAD (Computer Aided Dispatch) report which shows that the Registrant received a backup priority Red 2 (R2) at 18:23:53 and not a lower grade Green 4 (G4) as she said in the Notice to Admit Facts. It is not clear from the contemporaneous log why the Registrant thought it was a G4 and the Panel noted that in her statement to the Trust investigation she accepted that she was aware that it was a red back up.
20. DF told the Panel that once an incident has been allocated the equipment requires a crew member to press a button which indicates the crew are mobile and tracks the vehicle to the incident. This is called to ‘book mobile’ and indicates that the crew are on their way to the incident. He said that the usual requirement is that a crew member books mobile within 30 seconds of accepting the call. The CAD records that the Registrant booked mobile at 18:28:52; five minutes later.
Particular 1(b); you reviewed the patient whilst stood at the door of the ambulance
21. This part of the Allegation was admitted by the Registrant and the Panel found it proved. JS told the Panel that the Registrant was standing at the door of ambulance and that she did not enter the ambulance at any time. The Registrant confirmed this to the Trust in their investigation and she admitted it in the Notice to Admit Facts.
Particular 1(c)(i); you did not undertake and/or record your own observations
22. The Registrant has admitted that she did not record observations, JS confirmed this and there is no record of any observation done by the Registrant. However, the Registrant told the Trust investigation that by the time she arrived the Service User was attached to a monitoring device in the ambulance and that she was able to see that his oxygen levels were good. JS accepted this was accurate. Therefore, the Panel found it proved that the Registrant did not record observations, but it was not proved that she did not undertake them.
Particular 1(c)(ii); did not undertake and/or record your own physical assessment of the patient
23. This part of the Allegation was denied by the Registrant and has been found proved by the Panel. Although it was denied, in fact the Registrant has always accepted that she did not get on the ambulance with the Service User and undertake or record her own physical assessment. The Registrant stated on the Notice to Admit; “Patient stated to me that he had passed urine just before the crew’s arrival and that he had a past history of urinary retention. I asked the patient if he was in any pain and required pain relief, patient stated he was in no pain and did not require any form of pain relief.” The Panel accepts the evidence of JS that the Registrant did not get into the back of the ambulance with the Service User and that JS had asked him and his family several times if he had passed urine. Both had said that he had not passed urine for 24 hours.
Particular 1(d); you did not identify and/or treat sepsis
24. This part of the Allegation was admitted by the Registrant and the Panel found it proved. The Registrant says she did not identify sepsis, and therefore clearly did not treat it. She stated in the Notice to Admit facts that she found no red flag markers for sepsis but that is inconsistent with JS’s evidence which is supported by the computer generated incident report which records the Service User’s oxygen saturation level and respiratory rate. The computer records that JS had done two sets of observations before the Registrant arrived and that she did another set of observations after the Registrant arrived. The EMAS Sepsis Toolkit sets out what are red flags, and JS correctly identified that there was more than one red flag on each set of observations; the Service User’s respiratory rate was raised, his oxygen saturation levels without supplementary oxygen were low and he had not passed urine for more than 18 hours. JS told the Panel that when she took the Service User off oxygen for five minutes he was unable to maintain a satisfactory level and she had to put him back on oxygen again. Although JS did not record what the Service User’s level was when he deteriorated, the computer record shows that he was on oxygen from 18:25hrs to 18:57hrs and again at 19:04hrs. The Panel accepts that there would have been no reason to reinstate supplementary oxygen unless his saturations had dropped to an unacceptable level.
25. The computer generated incident report records that at first observations at 17:56hrs the Service User showed two red flags in addition to the red flag of no urine output for more than 18 hrs. His respiration was high and his oxygen was low. When the second observations were taken at 18:17hrs, his oxygen had risen but only because he was receiving supplementary oxygen via a machine. He still had one red flag (high respiratory rate) in addition to the urine red flag. The Registrant arrived at 18:31hrs and another set of observations were recorded at 18:33hrs by JS. At this time, two minutes after the Registrant arrived, the Service User still showed two red flags for sepsis; high respiratory rate and lack of urine output. At 18:41hrs the Service User still had a high respiratory rate. Even if the Panel was to disregard the evidence the Registrant disputes that the Service User said he had not urinated for more than 18 hours, he still had at least one red flag to identify possible sepsis and therefore clearly did meet the criteria for sepsis.
Particular 1(f); you did not give the patient fluids and 1(g); you did not cannulate the patient
26. The Registrant had accepted that she did not cannulate or give the Service User fluids and JS confirmed this in her oral evidence. The Registrant admitted these particulars of the Allegation and the Panel found them proved. The EMAS Sepsis Toolkit states that where systolic blood pressure is at or less than 90mmHG, the Service User should be given one 250ml bolus of 0.9% sodium chloride. Therefore, the Registrant should have given this Service User fluids which would have required her to give him a cannula. The Toolkit is guidance, but the Panel has no doubt that registrants are expected to apply the guidance and to be able to justify a departure from it.
Particular 1(h) despite the presence of three red flags relating to sepsis you (i); left the emergency technician to ride in the back of the ambulance with the patient and (ii); did not travel with the patient to hospital
27. The Registrant disputes that there were any red flags signs for sepsis but the Panel has already found proved that there were and has explained the reasons why above. The Registrant accepts that she did not travel with the Service User to the hospital.
28. The Registrant has stated that she asked the second technician JB to take the Service User’s temperature and that she was told it was 37.1c. However, JB does not mention this in her statement dated 8 March 2018 given during the investigation and it is inconsistent with the computer records of the observations completed by JS. At 17:56hrs the Service User’s temperature was 39.7c, at 18:17hrs it was still 39.7c and at 18:54hrs it was 37.9c. Therefore, the Panel is satisfied that it was unlikely to have been 37.1c when the Registrant was on the scene.
29. The Registrant also says that the Service User’s respiratory rate was 18bpm. However, this is not consistent with the computer records; at 17:56hrs his respiratory rate was 28bpm, at 18:17hrs it was 30bpm, at 18:33hrs it was 28bpm and at 18:54hrs it was 24bpm. There is no contemporaneous record to support the Registrant’s assertion that it was 18bpm. For the reasons already set out, the Panel is satisfied that there were three red flags relating to sepsis when the Registrant arrived on the scene; the Service User and his family reported that he had not urinated for 24 hours, his respiratory rate was greater than 25bpm and his oxygen saturation were only above 92% because he was receiving supplementary oxygen. In these circumstances, the EMAS Guidance and toolkit indicates that a paramedic should have travelled to hospital with the Service User and it should not have been left to a technician. The Registrant has admitted that she left the technician to accompany the Service User to hospital and has explained that she did that; because she did not believe that there were any red flags for sepsis. However, the Panel has already rejected her evidence on that point and found proved that there were red flags for sepsis, because they are documented in the computer record of the incident. The Panel found this particular proved.
Particular 1(i); you did not complete a patient report form
30. The Registrant admits that she did not complete a patient report form. There is no evidence of a completed report form. The Panel found this particular proved.
Particular 1(j); you spent only approximately 8 minutes on the scene with the patient
31. The Registrant admits that she spent only eight minutes on the scene with the Service User. The computer record shows that the Registrant arrived at 18:31hrs and left at 18:39hrs which is approximately 8 minutes and therefore the Panel found this particular proved.
32. This particular relates to the day following the first part of the Allegation. Again, it was not in dispute that the Registrant was due to finish work at 19:00hrs on 6 January 2018. It appeared from the investigation documents that she had personal reasons for wanting to finish on time. The Registrant was allocated the call to attend an incident at 17:58hrs. The Registrant asked the call handler for another crew to cover the call even though the call came in before the next crew would have started their shift at 18:00hrs. This was an hour before she was due to finish her shift.
Particular 2(a); on 6 January 2018 you failed to respond to an allocated emergency call in a timely manner in that you did not travel to the scene of the emergency by the shortest route
33. The Registrant admitted this particular in her Notice to Admit Facts. She said that the initial information about the destination was unclear and that she thought they were going to Chapel en le Frith and not Combs. She says that a reasonable route to Chapel en le Frith from their starting point when the call came in, was to head south via Buxton, where Buxton Ambulance Station is located. DF confirmed in evidence that information is relayed to a paramedic immediately as received and could change as further information is taken from the caller. The Panel accepts that it is possible that the Registrant thought the destination was initially in Chapel en le Frith. However, from the maps that DF provided to the Panel it is clear that the fastest route to either Combs or Chapel en le Frith was to go north not south. DF told the Panel that the Registrant should not have headed back to the base in Buxton without prior authorisation.
34. The Registrant accepted that she and her crew mate had headed back to base without telling the call handler or obtaining authorisation. In addition to it not being the shortest route by road, additional delay was caused by the Registrant spending some minutes at the base, apparently trying to negotiate for another crew to attend the call. DF told the Panel that the Registrant ought to have arrived at the Service User’s address approximately 6 minutes after accepting the Red 2 call, but because they came back to base, the total response time was 25 minutes. This clearly indicates that they did not take the shortest route. The Panel found this particular proved.
Particular 2(b); you did not activate the blue lights when the call was allocated
35. The Registrant admitted that she did not activate blue lights but says that as there was no traffic it was safer not to use them on that particular road as they make visibility for the driver more difficult. The Panel accepted DF’s evidence that as soon as an emergency call is accepted the crew is required to activate blue lights so that any road or foot traffic is aware that the vehicle is travelling under emergency conditions. The Registrant accepts that she did not do that and the Panel found this particular proved.
Particular 2(c); you went to the scene via the ambulance station without good reason or permission from the EOC to do so
36. The Registrant admitted this particular of the Allegation and the Panel found it proved. She accepts she was wrong in doing this as she states “the decision taken to call into base was incorrect”. There is no factual dispute that this happened and it was without permission.
Decision on Grounds
37. The HCPC submitted that the facts found proved amount to misconduct and/or a lack of competence because the Registrant has breached a number of the Standards of conduct, performance and ethics and that her omissions were serious. The Panel accepted the advice of the Legal Assessor that; “misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a practitioner in the particular circumstances.” The Panel also accepted the advice of the Legal Assessor that “misconduct is of two kinds. First, it may involve sufficiently serious misconduct in the exercise of professional practice such that it can properly be described as misconduct going to fitness to practise. Second, it can involve conduct of a morally culpable or otherwise disgraceful kind which may, and often will, occur outwith the course of professional practice itself, but which brings disgrace upon the registrant and thereby prejudices the reputation of the profession.”
38. The Panel accepted the advice of the Legal Assessor that a lack of competence refers to a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the practitioner’s work. The Panel reminded itself that whether the facts found proved amount to misconduct or a lack of competence is not a matter of proof but for the Panel’s own judgement.
39. The Panel is aware from the evidence that the Registrant had been working for EMAS for ten years when concerns were first raised about her practice in 2018. The Panel was therefore aware that this Allegation is out of character and that the Registrant was capable of practising to an acceptable standard. The Panel therefore decided that the Registrant had the knowledge and skills necessary to carry out the tasks required of her and that her failure to do so was not as a result of a lack of competence.
40. The Panel went on to consider if the facts found proved amounted to misconduct. The Panel bore in mind that not every breach of the applicable standards would necessarily amount to misconduct and that the Panel was required to judge each case on its own facts.
41. The Panel is satisfied that the Registrant’s aim was to make sure that she finished work on time and in doing that she placed Service Users at potential risk. She behaved irresponsibly on both occasions by questioning why she was being allocated work in the last hour of her shift.
42. On 5 January 2018 the Registrant should have travelled in the ambulance with the Service User so as to perform paramedic interventions and monitor him in case his condition deteriorated. The Panel has rejected her explanation that the Service User told her he had urinated and that there were no other red flags for sepsis. The Panel has no doubt that the Registrant knew that if she travelled in the ambulance to hospital that she was less likely to finish her shift on time and that she allowed this to cloud her judgement in respect of the Service User’s condition. In so doing, the Registrant did not act responsibly or support her junior colleagues who had called her because they needed someone more senior to assist.
43. The Panel has found that the Registrant did not do her own physical assessment of the Service User and did not complete the records that she ought to have done. The Panel is satisfied that the Registrant was taking short cuts so that she could finish at 19:00hrs and not be delayed beyond the end of her shift. However, that meant that she did not take responsibility for the Service User or meet her role as a paramedic, which is what she was called out to do.
44. The second incident on 6 January 2018 was categorised as a C2 call. DF told the Panel that a category 2 call, although less urgent than a C1 which is ‘immediate life threatening’, could nevertheless be life threatening.
45. The Panel noted that the Registrant’s crew member was the person who had pressed ‘mobile’, whereas she was wasting more time going into the station and talking to colleagues. The Panel concluded that he seemed to be more concerned about the delay. The Registrant had delayed going mobile because she knew there was a vehicle available at base which had equipment missing and she wanted to ensure that her vehicle which had all the equipment, was available for the hand over crew to use. Because the Registrant had not told her colleagues in Control that she was returning to base, they may have assumed she was closer to the incident than she actually was. They would not have known she was heading back to base unless they actively checked the vehicle tracking system. In relation to the use of blue lights, the Registrant ought to have understood that blue lights should be illuminated when the vehicle is responding to an emergency, regardless of the road conditions.
46. The Panel concluded that a reasonable member of the public would be shocked that the Registrant had taken a detour back to base of her own choice instead of going to the Service User straight away, even though there was no evidence that the delay had caused the Service User harm. The Registrant could not have known that. She had shown poor judgment. In relation to the incident on 5 January 2018, the Registrant’s decision not to travel with the Service User in the ambulance meant that the Service User was not accompanied by a paramedic. As a result, intravenous fluids were not provided and there was a potential risk of harm to the Service User if he had deteriorated in the ambulance. The Registrant also failed to support her junior colleagues.
47. The Panel is satisfied that the facts found proved are sufficiently serious to amount to misconduct.
Decision on Impairment
48. The Panel went on to decide whether the Registrant’s fitness to practise is impaired. The Panel took account of the HCPTS Practice Note ‘Finding that fitness to practise is impaired’. It accepted the advice of the Legal Assessor that the test of impairment is expressed in the present tense and reminded itself that the purpose of Fitness to Practise procedures is not to punish the practitioner for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise. Although the Panel must look forward not back, in order to form a view as to whether the Registrant is fit to practise without restriction today it has to take into account the way in which the Registrant has acted in the past.
49. The Panel reminded itself that it is necessary to distinguish between cases where misconduct is, of itself, likely to lead to a finding of impairment and cases where misconduct does not necessarily lead to a finding of impairment, because of other factors to be taken into account. Such factors usually comprise events between the date of misconduct and the date of the Panel hearing, such as a one-off event of misconduct followed by the passage of substantial time, an otherwise unblemished record, or subsequent retraining.
50. The Panel considered the two elements to impairment; the personal element which includes the Registrant’s current conduct and performance and the public element which includes the protection of members of the public and the public interest
51. In the personal element the Panel considered the Registrant’s past acts in order to establish whether her fitness to provide paramedic services is currently below acceptable standards and whether she may pose a risk to those who may need to use her services in the future.
52. In assessing whether the Registrant’s fitness to provide paramedic services is currently below acceptable standards it is important to note that because the Registrant has not engaged fully with the HCPC in response to the final hearing, the Panel has no real information on what she has been doing since she left EMAS in 2018, save that she has stated she has not worked as a paramedic since then. The Panel has no information at all about her current ability to practise at a safe level and is aware that the Registrant has repeatedly said that she does not wish to return to work as a paramedic.
53. In assessing the likelihood of the Registrant causing harm in the future, the Panel has taken into account the extent of any harm caused by her to the Service Users referred to in the Allegation and her culpability for that harm. The Panel accepts that there is no evidence of harm being caused as a result of the Registrant’s misconduct, but it cannot ignore the fact that there was obviously potential for serious harm.
54. In assessing the Registrant’s culpability for her misconduct it considered her admissions and expressions of regret to the Trust investigation and the Panel. Although the Panel accepts that the Registrant is genuinely remorseful, she did not admit all parts of the Allegation and offered excuses for her misconduct. She admitted that her decision to go back to base on 6 January 2018 was incorrect and resulted in a delay to Service User care but attempted to excuse it as a consequence of miscommunication.
55. The Registrant accepted that she made errors during the incident on 5 January 2018 in not recording observations or her findings, and not completing a patient report form but she did not accept failing to perform a physical assessment. The Registrant accepted that she “made a fundamental mistake by not documenting findings, observations and medical opinions as well as my reasons for not travelling”. Of most concern to the Panel was that the Registrant did not acknowledge the red flags for sepsis at this incident on 5 January 2018. As the Registrant does not accept that she failed to recognise the clinical issues, there is a risk of her misconduct reoccurring. The Registrant is still a potential risk to the public because the Panel does not know if she would identify the red flags if placed in a similar situation again or what she would do differently now.
56. The Panel was satisfied that the Registrant had breached the following HCPC Standards of Conduct, Performance and Ethics;
• Standard 1 (protect the interests of service users),
• Standard 2 (communicate appropriately),
• Standard 6 (manage risk) and
• Standard 10 (keep records of your work).
57. The Panel is also satisfied that the Registrant breached the following Standards of Proficiency for Paramedics
• 2.1 understanding the need to act in the best interests of service users at all time;
• 3.1 understand the need to maintain high standards of personal and professional conduct;
• 4.4 recognise that they are personally responsible for and must be able to justify their decisions;
• 8.1 be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, colleagues and others; and
• 9.2 understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team.
58. If the Panel were to find that the Registrant’s current fitness to practise is not impaired there would be no regulatory reason preventing her from obtaining employment as a paramedic elsewhere and potentially repeating her misconduct.
59. The Panel next considered the public interest which includes the need to protect service users and the collective need to maintain confidence in the profession by declaring and upholding proper standards of conduct and behaviour. The Panel reminded itself that it is highly relevant in determining if a practitioner’s fitness to practise is impaired that: the conduct which led to the charge is easily remediable; second it has been remedied; and that it is highly unlikely to be repeated.
60. The Panel accepted that the Registrant was, in 2018, ordinarily a proficient paramedic and therefore decided that her misconduct was out of character. The Panel accepts that the risk is remediable but the Registrant has not been working as a paramedic for three years and has not provided the Panel with any evidence that she has remedied her shortcomings. The Panel has such limited information from the Registrant it has been unable to satisfy itself that the risk of repetition is very low. In the absence of such evidence the Panel was unable to conclude that it is highly unlikely that she would bring the profession into disrepute in the future.
61. The Panel was satisfied that a reasonable member of the public would be concerned by the Registrant’s misconduct and would expect such misconduct, in the absence of full engagement with the regulatory process by the Registrant, to result in a finding of impairment. Her conduct does not maintain public confidence in the profession or uphold proper standards of conduct expected from paramedics.
62. For all the reasons set out above, the Panel was satisfied that the Registrant’s current fitness to practise is impaired and as a result the Panel finds the Allegation well founded.
Decision on Sanction
63. The Panel then invited submissions on what sanction, if any, should be imposed. The Panel had regard to the HCPTS’s Sanctions Policy and accepted the advice of the Legal Assessor. The Panel was reminded that it is not obliged to impose a sanction and that in appropriate cases may decide that no further action is required. The Panel is satisfied that a sanction is proportionate in the case because no further action is only appropriate in cases involving minor isolated lapses where the registrant has apologised, taken corrective action and fully understands the nature and effect of the lapse. For the reasons already referred to by the Panel in its decision on impairment the misconduct found proved in the case cannot be described a minor lapse.
64. The Panel was reminded that a sanction may only be imposed in relation to the facts which have been found proved and cannot be imposed on a wider basis than that revealed by the facts found proved.
65. The Panel has borne in mind that the purpose of Fitness to Practise procedures is not to punish the practitioner for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise. The primary function of any sanction is to address public safety from the perspective of the risk which the registrant concerned may pose to those who need to use her or her services. The Panel is aware that it must also give appropriate weight to the wider public interest which includes: the deterrent effect to other registrants, the reputation of the profession concerned and public confidence in the regulatory process.
66. The Panel identified the following mitigating factors;
• the Registrant admitted the majority of the facts underlying the Allegation
• the Registrant has not appeared before the HCPC previously
• the Registrant’s previous good clinical practice for about ten years, first as a trainee technician and then as a paramedic
• there is no evidence of either Service User suffering actual harm, and
• the Registrant has expressed genuine remorse.
67. The Panel identified the following aggravating factors;
• limited insight following qualified admissions of wrongdoing
• no evidence of remediation or training
• the Registrant exposed two Service Users to the risk of potential harm, and
• the Registrant was the senior clinician on duty and failed to properly support her more junior colleagues.
68. The Panel had regard to the principle of proportionality and considered the sanctions starting with the lowest first. The Panel rejected mediation because it would not address the public interest and service user safety concerns resulting from the Registrant’s misconduct.
69. The Panel went on to consider whether a Caution Order was appropriate. The Panel decided that the misconduct was sufficiently serious that a Caution Order would not protect the public or maintain confidence in the profession and the regulatory process. The misconduct was not minor in nature, and the Registrant had not provided sufficient evidence of remediation.
70. The Panel next considered whether conditions of practice were proportionate and workable. The Panel reminded itself of the Sanctions Policy that a Conditions of Practice Order is unlikely to be appropriate where the Registrant has failed to engage with the fitness to practise process. The Panel accepts that the Registrant did engage with the HCPC to an extent, that she made substantial admissions and recognises that was helpful. However, the Registrant has repeatedly told the HCPC that she does not wish to return to practice as a paramedic and did not attend the final hearing. That means that the Panel has not received any evidence to show that the Registrant is genuinely committed to resolving the issues that resulted in her misconduct. As the Registrant is not working as a paramedic at the moment and has not done so for about three years, the Panel was unable to safely conclude that a Condition of Practice Order is workable.
71. The Panel went onto consider the next most punitive sanction, a Suspension Order, which it has the power to impose for up to twelve months. A Suspension Order would protect the public while it is in force. A Suspension Order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a Conditions of Practice Order, but which do not require the Registrant to be struck off the Register.
72. In order to test whether a Suspension Order is proportionate the Panel moved onto consider a Striking Off Order. Striking off is a long-term sanction. Article 33(2) of the Order provides that, unless new evidence comes to light, a person may not apply for restoration to the Register within five years of the date of a Striking Off Order being made, and panels do not have the power to vary that restriction. The Panel had regard to the HCPTS Sanctions Policy which states that a Striking Off Order is a sanction of last resort for serious, persistent, deliberate or reckless acts involving a non exhaustive list of misconduct. Whilst the Panel recognised that the list is not exhaustive, it noted that the misconduct it has found proved in this case is not on the list and is of a less serious nature and character.
73. The Panel concluded that this case does not justify the ultimate sanction which striking off represents. The Panel reminded itself that these were isolated errors on two consecutive days in a career spanning ten years and that no actual harm was caused to a Service User. The Panel found that the Registrant was capable of working at a satisfactory standard and had demonstrated commitment to her career by working her way up to the position of paramedic from a trainee technician. The Panel is satisfied that a right minded member of the public, in possession of all the facts, would not be discomforted by the imposition of a Suspension Order as the Registrant has shown that she was ordinarily a proficient paramedic. The Panel is well aware that the Registrant has asked the HCPC to remove her name from the Register on more than one occasion. However, a period of reflection following this hearing may cause the Registrant to reconsider and the Panel considers it appropriate to leave that option open. This represents an opportunity for the Registrant to demonstrate that she is able to bring her professional performance up to an acceptable standard and return to practice if that is what she wishes to do. Alternatively, if she remains determined to leave the profession, a short period of suspension would allow the Registrant to apply for Voluntary Removal from the Register which would be a more proportionate way to end her career than an order striking her name from the Register.
74. When considering the appropriate length of the order the Panel has had regard to the Sanctions Policy which states that short term suspension may be appropriate in order to facilitate a staged return to practice, for example where the registrant concerned would be unable to respond to and comply with conditions of practice but may be capable of doing so in the future.
75. Accordingly the Panel has concluded that the appropriate length of the order is eight months.
76. This order will be reviewed towards the end of the eight month period and this Panel would expect any future panel to be assisted by the following;
• The Registrant’s attendance at the review,
• Evidence of her insight into the impact of her misconduct on service users, colleagues, the profession and the public,
• Evidence of her adherence to HCPC Continuing Professional Development requirements,
• Information and references concerning any paid or voluntary employment, and
• Evidence of any training she has undertaken to address the misconduct identified.
For the avoidance of doubt, this list is not exhaustive and it is provided only for the Registrant’s assistance; she must understand that it does not bind the future panel in any way.
That the Registrar is directed to suspend the registration of Ms Yasmin Beesley for a period of eight months from the date this order comes into effect.
1. The Panel considered the HCPC’s application for an Interim Order, pending the coming into force of the Suspension Order. The Panel was shown the letter dated 21 October 2020 addressed to the Registrant’s email address in the Register warning her that the HCPC may apply for an Interim Order. The Panel decided that it was fair to proceed in her absence because she has voluntarily waived her right to be present. The Panel had regard to the HCPTS Practice Note on Interim Orders.
2. The Panel has found that the Registrant is currently unfit to practise without restriction but without an Interim Order she would theoretically be able to do so pending an appeal and the Panel has decided that it would not be appropriate to leave that possibility open. The Panel has borne in mind that it is three years since the period of misconduct took place and that during that time the HCPC did not apply for an Interim Order restricting the Registrant’s ability to practise. Therefore, the Registrant has been free to practise without restriction until now, although she has told the HCPC and the Panel that she has not been working as a paramedic and does not intend to do so. The Panel has no evidence of any further episodes of misconduct during that time. However, the Panel’s findings of fact and decision on misconduct and impairment represent a significant change in circumstances. Therefore the Panel has decided that an Interim Suspension Order is necessary to protect members of the public and the public interest and that the appropriate period is 18 months to ensure that an order is in place during the during the appeal period and any subsequent appeal proceedings.
3. The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.
4. 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 Ms Yasmin Beesley
|Date||Panel||Hearing type||Outcomes / Status|
|22/09/2021||Conduct and Competence Committee||Review Hearing||Voluntary Removal agreed|
|01/02/2021||Conduct and Competence Committee||Final Hearing||Suspended|