Miss Kathryn Chignell
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Allegation
The following Allegation was considered by a panel of the Conduct and Competence Committee at a Substantive Hearing which concluded on 31 January 2019.
While registered as a Paramedic and employed with South Western Ambulance Service, you:
1. On or about 04 January 2016, in relation to Patient A did not:
(a) complete and / or record an adequate assessment of Patient A in that:
(i) you conducted and / or recorded only one set of observations;
(ii) you did not complete and / or record an Electro Cardiograph;
(b) provide adequate treatment to Patient A in that you did not provide adequate pain relief;
(c) complete a comprehensive and / or adequate Patient Clinical Record in that you did not record an adequate rationale as to why Patient A was not taken to the emergency department.
2. On or about 24 April 2016, attended Patient B and did not:
(a) complete and / or record an adequate assessment of Patient B in that you:
(i) concluded that the patient was “unconclusive” in relation to the FAST test for stroke, rather than “positive”;
(ii) incorrectly circled “U” and “L” on the Patient Clinical Record, in relation to the FAST test for stroke;
(b) provide timely treatment to Patient B;
(c) request priority 1 back up;
3. On or about 28 November 2016, attended an elderly patient, Patient C, who was unresponsive, and you did not provide adequate and / or timely treatment to the patient in that you did not provide the patient with oxygen;
4. On dates between 13 and 17 December 2016, you:
(a) attended a seven-year-old patient, Patient D, and:
(i) you did not obtain an adequate history of the patient;
(ii) you had to be prompted regarding the correct pathway to be used;
(iii) you did not provide an adequate rationale for referring the patient to the out of hours service rather than conveying Patient D to Accident and Emergency.
(b) attended an elderly patient, Patient E, with sepsis markers and:
(i) did not demonstrate adequate knowledge of sepsis markers;
(ii) did not demonstrate adequate knowledge of the procedure to be followed in relation to a patient with sepsis markers;
(iii) failed to notice Sodium Chloride had run into Patient E's arm tissue rather than through the vein.
5. The matters described in particulars 1 - 4 constitute misconduct and / or lack of competence.
6. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.
The panel at the substantive hearing found the following:
Facts proved: 1(a)(i), 1(a)(ii), 2(a)(i), 2(a)(ii), 2(c), 3, 4(a)(i), 4(a)(ii), 4(a)(iii), 4(b)(i), 4(b)(ii), 4(b)(iii).
Facts not proved: 1(b), 1(c), 2(b).
Grounds: Lack of competence
Fitness to Practice Impaired: Yes
Sanction: Conditions of Practice Order (12 months) which was replaced with a Suspension Order (12 months) on review.
Finding
Preliminary Matters
Hearing by video conference
1. Given the government recommendations on containing the current COVID-19 pandemic, the HCPTS has decided to suspend all public hearings to protect the health and safety of its registrants and stakeholders. However, to ensure that the HCPC can continue to perform its statutory duties of protecting the public and maintaining the integrity of the HCPC register, the HCPTS has arranged for this hearing to be conducted by video conference facilities and for all communications with a registrant to be conducted by telephone or email. There is therefore currently no use of postal services as required by the Rules.
Proof of Service of the Notice of Hearing
2. The HCPC submitted that service of notice of the Hearing had properly been effected in accordance with the current guidelines. A Notice of Hearing letter was sent on 10 December 2020 by email to the Registrant’s registered email address. The Registrant’s email address is shown on the certificate of information held on the HCPC register, which is before the Panel.
3. This letter identified the date and time of the hearing and confirmed that the matter would be dealt with by way of a virtual hearing. The letter also requested that the Registrant provide any written representations at least 14 days before this hearing. There has been no response to the Notice of Hearing from the Registrant and no documentation provided in response to the email.
4. The HCPC informed the Panel that the email had not ‘bounced back’, and that delivery of the email has been confirmed. The HCPC submitted that the evidence supported a conclusion that there had been good service.
5. The Panel took legal advice and considered the unredacted documentation relating to service details from which it was able to confirm the accuracy of the information.
6. The Panel is satisfied that Notice of the Hearing had been properly served by email on 10 December 2020, to the Registrant’s email address. The Panel is therefore satisfied that service of the notice has been correctly effected in accordance with the current guidelines.
Proceeding in the Registrant’s absence
7. At the start of today’s hearing the Hearings Officer confirmed that an electronic invitation to attend the Microsoft Teams hearing had been declined by the Registrant. He showed to the Panel on screen a copy of the ‘decline’ invitation which was timed at 08.39 hours today.
8. The HCPC made an application to proceed in the Registrant’s absence and drew the Panel’s attention to Rule 11 of the Health Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003. This section provides a Panel of the Conduct and Competence Committee with the discretion to proceed in the Registrant’s absence if it is satisfied that all reasonable steps have been taken to serve the Notice of Hearing on the Registrant. The Panel has already made the decision that there has been good service.
9. The HCPC reminded the Panel that there has been no response received from the Registrant. The HCPC drew the Panel’s attention to the fact that the Registrant had not attended, nor been represented, at the previous review hearing. It was submitted that this lack of engagement by the Registrant supported the position that the Registrant had voluntarily absented herself from these proceedings, and further, does not wish to provide evidence.
10. The Panel was reminded that this is a mandatory review of a Suspension Order which is due to expire on 28 February 2021, and therefore in the public interest should be reviewed prior to its expiry. The HCPC submits that an adjournment to a later date, before the order’s expiry, would, on the evidence, not be likely to secure the Registrant’s attendance. The declined electronic invitation from the Registrant today is further evidence for the Panel that the Registrant has no intention to engage in this process.
11. The Panel heard and accepted the advice of the Legal Assessor that the Panel’s discretion to proceed in the Registrant’s absence should only be exercised with extreme care and caution. She referred the Panel to the HCPTS guidance which encapsulated the key points of the case of R v Hayward, Jones & Purvis in the Court of Appeal ([2001] EWCA Crim 168), a case where the judge had identified matters which would influence a judge’s decision to proceed in the absence of a defendant. The Legal Assessor also referred to the case of GMC v Adeogba and Visvardis [2016] EWCA Civ 162, where it was highlighted that a Panel’s primary objective is the protection of the public and the public interest and that the “fair, economical, expeditious and efficient disposal of allegations made against medical practitioners is of very real importance”. It further stated 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”.
12. The Panel has taken into account the HCPC’s submissions and considered carefully whether to proceed today, noting the public interest in ensuring that the current order does not lapse on 28 February 2021. The Panel has noted that the Registrant has not stated that she wishes to attend the hearing pursuant to Rule 13(3) of the Rules.
13. The Panel has therefore concluded that the Registrant has voluntarily absented herself and so it will continue with the hearing today. Its reasons for that decision are as follows:
• There has been good service of the Notice of Hearing and subsequent emails to the Registrant, none of which have elicited a response from the Registrant.
• The invitation to attend the hearing electronically was declined.
• The Panel therefore has no information as to the reasons why the Registrant is not present today or has decided to absent herself.
• There has been no application for an adjournment.
• The Registrant has given no indication as to whether she is likely to attend if this matter were to be adjourned to another date but this appears unlikely given her most recent action was to decline today’s invitation to attend.
• The Registrant did not attend the previous review hearing.
• The Panel considered that the public interest in this matter proceeding outweighed the Registrant’s interest in this instance.
Background
14. The Registrant is registered with the HCPC as a paramedic having qualified from Teeside University on 26 January 2012, and obtained her first registration on 3 February 2012.
15. On 18 December 2013, the Registrant commenced employment with the South Western Ambulance Service Trust (the Trust) having worked as a paramedic in another region prior to that.
16. The Registrant was placed on “Restriction of Practice” (RoP) by the Trust on 15 March 2016. This was as a result of concerns that had been raised about the Registrant’s treatment of a patient in January 2016.
17. The Registrant returned to unrestricted practice from the end of March 2016 following a satisfactory review of her performance.
18. Further concerns were raised about the Registrant’s practice in April 2016 and the Registrant was placed on a further period of RoP from 5 May 2016. During that period further concerns about the Registrant’s practice were raised. An action plan was implemented to provide the Registrant with support and training to help her meet the standards expected. The action plan was extended by the Trust until January 2017, but the Registrant did not meet the standards required. Following this, the Trust commenced formal capability proceedings and the Registrant’s employment was terminated in March 2017.
19. At a Substantive hearing which concluded in January 2019, the Panel found proven a number of failings involving multiple patients over a sustained period of time and determined that these failings amounted to a lack of competence. That panel determined that the Registrant’s fitness to practise was impaired and that the appropriate sanction to impose was a Conditions of Practice Order for a period of 12 months.
20. At the review hearing on 24 January 2020, the Reviewing Panel considered that a further Conditions of Practice Order was not appropriate and would serve no useful purpose as the Registrant had not engaged with the conditions of the previous order. That Reviewing Panel noted the Registrant’s intention to apply for voluntary removal from the Register.
21. The Reviewing Panel imposed a 12 month Suspension Order stating that this was the most appropriate and proportionate order in the circumstances. The Panel considered that this would be sufficient to protect the public and would allow the Registrant a period of time to reflect on whether she wished to remove herself from practice or take steps to remedy the concerns.
Registrant’s engagement with HCPC
22. Since the last substantive review hearing on 24 January 2020, the Registrant has not engaged with the HCPC.
23. The last correspondence the HCPC had from the Registrant was just before the last review of the Substantive Conditions of Practice Order, an e-mail of 20 January 2020, to HCPC and to her then representative, stating she wished to be removed from the Register by way of voluntary removal. This position is noted in the Reviewing Panel’s decision.
24. With regard to today’s hearing, as already noted above:
• on 10 December 2020, the HCPTS scheduling team sent notice of today’s hearing by e-mail to the Registrant. She did not respond to this.
• on 12 January 2021, requesting the Registrant to provide any submissions or evidence for today’s hearing. However, the HCPC has not received a response to that e-mail or any communication from the Registrant.
Today’s Hearing
Submissions from the HCPC
25. The HCPC submitted that the Registrant’s impairment was found to be on the ground of lack of competence. There is no evidence of any steps to remedy those failings and so the Registrant’s fitness to practise remains impaired. It was therefore submitted that some form of order is required for public protection and in the wider public interest.
26. A Voluntary Removal Agreement would, in the HCPC’s view, secure an appropriate level of public protection and would not be detrimental to the wider public interest. The HCPC position is that without any engagement by the Registrant this option is not appropriate. Further, there is no certainty that a Panel would give approval to such a course of action.
27. There is no evidence that the Registrant would be willing to comply with any conditions of practice. Indeed, the Registrant previously has failed to comply with those imposed at the Substantive Hearing and when subject to ROP she had failed to demonstrate that her professional skills and knowledge met the appropriate standards of proficiency.
28. Under Article 29(6) of the Health Professions Order 2001 (as amended), this Panel does not have the power to impose a Striking Off Order in a lack of competence case until there has been a continuous period of conditions of practice or suspension for two years. Whilst there have been two 12-month Substantive Orders imposed, these took effect after the appeal period of 28 days. The two years uninterrupted period therefore expires is 28 February 2021.
29. The HCPC therefore considers that a further period of suspension is the appropriate and proportionate measure in this case. The HCPC submits that a further 6 month period of suspension would give the Registrant time to reflect whether she wishes to engage with the HCPC to pursue a Voluntary Removal or whether she wishes to continue to practice as a Paramedic and take steps to remedy her failings.
Legal advice
30. The Legal Assessor reminded the Panel that its purpose today was to conduct a comprehensive review to determine if the Registrant is fit to return to unrestricted practice. She referred the Panel to the case of Yussuff v GMC [2018] EWHC 13 (Admin) in relation to the approach to be adopted in relation to this review hearing. She reminded the Panel that its role was not to conduct a rehearing of the allegations nor was it to go behind the previous findings. She advised that in carrying out this assessment, the Panel must exercise its own independent judgment.
31. The Legal Assessor advised the Panel that if it determined that the Registrant’s fitness to practise remained impaired, then the Panel must go on to consider what restiction, if any, should be imposed. The Panel’s powers under Article 30(1) of the Health Professions Order 2001, are to extend the Suspension Order or make any order it could have made at the time of the original order being imposed.
32. She also advised the Panel that it should bear in mind the principles of fairness and proportionality and have regard to the Sanctions Policy document issued by the HCPTS. She reminded the Panel that any order that it makes under Article 30 should not be punitive in purpose, and that it should be the least restrictive order that would suffice to protect the public and/or would otherwise be in the public interest.
33. The Legal Assessor reminded the Panel of the terms of Article 29(6) of the Health Professions Order 2001 which states:
“A striking-off order may not be made in respect of an allegation of the kind mentioned in Article 22(1)(a)(ii), 'lack of competence' or (iv), 'health' unless the person concerned has been continuously suspended, or subject to a conditions of practice order, for a period of no less than two years immediately preceding the date of the decision of the Committee to make such an order.”
The Legal Assessor reminded the Panel that as the Registrant has not been the subject of conditions or suspensions for a continuous period in excess of two years, this Panel therefore does not have the option to strike the Registrant’s name from the register.
Decision
34. The Panel accepted the advice of the Legal Assessor. The Panel has had regard to the HCPTS’s Practice Note on Fitness to Practise Impairment and the terms of the Sanction Policy.
35. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel took into consideration all the documentation before it, and the submissions made by the HCPC. The Panel considered that this review required a registrant to demonstrate both developed insight and remediation of their failings before being considered suitable for return to unrestricted practice. This type of review process placed a persuasive burden on the Registrant to demonstrate that she is safe to return to practice.
36. The Panel noted that following the substantive hearing, which the Registrant attended and was represented, there had been an opportunity to go away, consider and reflect and learn from the findings of that hearing. It was disappointing to note that the Registrant had not seized on the opportunity the Condition of Practice Order had given her, to take positive steps to overcome those failings. The imposition of that Substantive Order appears instead to have had the effect of discouraging the Registrant from returning to her profession, which would not have been its intention.
37. The Registrant has not supplied the Panel with any information and there is no evidence of remediation to support the Panel in allowing the Registrant to return to safe practise. The Panel has therefore concluded that there remains an ongoing need for a restriction on the Registrant’s practice. In those circumstances, it concluded that public confidence in the profession and in the regulatory process would be undermined if the Registrant were able to practise without restriction.
38. In the light of all the above, the Panel has determined that the Registrant’s fitness to practise remains impaired on the personal and the public components of its decision.
39. The Panel then went on to consider what the appropriate and proportionate sanction should be, starting with the least restrictive. It bore in mind that the purpose of a sanction was not to be punitive, although a sanction may have that effect.
40. The Panel also bore in mind that its over-arching objective is:
• to protect, promote and maintain the health, safety and wellbeing of the public;
• to promote and maintain public confidence in the profession; and
• to promote and maintain proper professional standards and conduct for members of the profession.
41. The Panel first considered taking no action but was satisfied that the Registrant’s failings were so serious that the public interest considerations could not be met by such an outcome. The Panel was not satisfied that there would be no risk to the public, or to public confidence in the profession by taking no action.
42. The Panel was also not satisfied that mediation was an appropriate sanction. The Panel next considered whether to impose a Caution Order. In this respect it took into consideration the guidance within the Sanctions Policy as to when such an order was appropriate. The Panel concluded that such an order would not be sufficient to protect the public, nor would it be in the public interest given that the Registrant’s failings were ‘not minor’. Such an order would not restrict the Registrant’s practice and therefore would not adequately protect the public or safeguard the public interest.
43. The Panel next considered whether to impose a Conditions of Practice Order. It concluded that it would neither be appropriate nor proportionate given the nature of the lack of competence found proved and the evidence that conditions and periods of restriction of practice had failed to provide improvement in the Registrant practice. In those circumstances the Panel concluded that it could not formulate appropriate conditions to address the Registrant’s failings other than those which would in practice be a suspension by another means. Further, there was no evidence to suggest that the Registrant would be willing and able to comply with any such conditions.
44. The Panel noted that the Registrant has only partially engaged in the regulatory process to date and has not availed herself of the opportunity of demonstrating to any panel that she is capable of returning to practice. Indeed, the last indication from the Registrant was that she wished to give up her registration by way of entering into a Voluntary Removal Agreement. In this regard the Panel noted that whilst the HCPC had in the last year contacted the Registrant, this had been in relation to the preparation for this review hearing. There appears to have been no attempt by the HCPC to engage with the Registrant on the specific issue of a Voluntary Removal Agreement.
45. In these circumstances the Panel has concluded that only a further period of suspension is appropriate and proportionate.
46. The Panel has carefully considered the length of time this further period of suspension should be for. The period should be sufficient for the Registrant to be able to consider afresh whether she wishes to take, what may possibly be a last opportunity to adopt steps to remedy her professional failings.
47. It should be a period which will also provide her with an opportunity to pursue the possibility of a Voluntary Removal Agreement, which whilst having the same effect as a Striking Off Order, provides the Registrant with an opportunity to contribute to a controlled exit from her profession.
48. The Panel has concluded that 6 months is sufficient in all the circumstances of this case. Any more time may prove a disincentive to the Registrant to take forward any resolve she may have acquired to either retrain and re-join her profession or leave voluntarily.
49. The Registrant should be fully aware that any future reviewing panel will have the power of removing her name from the register on a permanent basis through the imposition of a Striking Off Order, and may exercise that power in the absence of any further information or response from the Registrant.
Order
Order: The Registrar is directed to suspend the registration of Miss Kathryn Chignell for a further period of 6 months upon the expiry of the existing Order.
Notes
The Order imposed today will apply from 28 February 2021.
This Order will be reviewed again before its expiry on 28 August 2021.
Hearing History
History of Hearings for Miss Kathryn Chignell
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 19/07/2021 | Conduct and Competence Committee | Review Hearing | Struck off |
| 25/01/2021 | Conduct and Competence Committee | Review Hearing | Suspended |
| 24/01/2020 | Conduct and Competence Committee | Review Hearing | Suspended |