Miss Elisa Stevens

Profession: Paramedic

Registration Number: PA36459

Interim Order: Imposed on 13 Aug 2021

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 26/07/2021 End: 17:00 03/08/2021

Location: Virtual via Video Conference

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

(as amended on Day 1)

As a registered Paramedic [PA36459] your fitness to practise is impaired by reason of your misconduct, in that:

1. On 18th March 2019 you received a conditional caution for the following:

a) Between February 2017 and September 2017 at Leeds stole morphine of a value unknown belonging to Yorkshire Ambulance Service, contrary to section 1 (1) and 7 of the Theft Act 1968.

2. Between approximately February 2017 and September 2017, self-administered morphine whilst on duty.

3. On 9th and/or 10th May 2018, you attended incident number 5449 and on the copy of the Patient Care Record kept by the Trust recorded that 15mg of morphine was administered to the patient but on the carbon copy kept by the hospital recorded that 5mg was administered.

4. On 10th and/or 11th May 2018 in relation to incident 8331 you did not complete a Patient Care Record for the patient and/or a full and thorough handover to the maternity unit at St James Hospital.

5. On 10th and/or 11th May 2018 you signed morphine onto call sign 1554 but changed to call sign 1505 part shift and did not re-sign the morphine onto the correct vehicle.

6. During your shift on 10th and/or 11th May 2018 you:

a) Signed out four vials of morphine but only signed three back in and did not record where the outstanding one vial of morphine had been used;

b) Provided inconsistent accounts of what happened to the outstanding vial described at particular 6a) in that you told Person A that you had attempted to administer morphine to a patient but disposed of it because you could not get IV access but later stated that the vial broke in your pocket;

c) Took the one vial of Morphine described at particular 6a) for your own personal use;

7. On 10th and/or 11th May 2018, in order to conceal your actions you deliberately removed a page from the vehicle morphine register.

8. Your actions described at paragraph 3 and/or 5 and/or 6 and/or 7 were dishonest.

9. The matters set out at paragraphs 2 - 8 amount to misconduct.

10. By reason of your caution and/or misconduct, your fitness to practise as a Paramedic is impaired.

Finding

Preliminary Matters

Service

1. The Panel was provided with a signed certificate as proof of the Registrant’s registered email address. The Panel noted that the Notice of Hearing had been sent to the Registrant on 16 June 2021, to the email address shown for the Registrant on the HCPC Register. The Notice of Hearing confirmed that the hearing would be conducted virtually via videoconference. The Panel noted that the delivery receipt confirmed that the Notice of Hearing was sent at 3.09pm.

2. The Panel was satisfied that the Notice of Hearing had been properly served in accordance with Rule 3 (Proof of Service) and Rule 6 (date and time) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (as amended) (the Rules).

Proceeding in Absence

3. Mr Walters made an application for the Panel to proceed in the Registrant’s absence. The Panel was advised by the Legal Assessor and followed that advice. The Panel also took into account the guidance as set out in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.

4. The Panel determined that it was fair, reasonable, and in the public interest to proceed in the Registrant’s absence for the following reasons:

• The Panel noted that the Registrant’s last communication with the HCPC was via email on 2 June 2021. In that email the Registrant stated, “I have not looked at any documents pertaining to this un [sic] well over a year and see little point ax [sic] any evidence I requested was not provided and I know how Yorkshire ambulance services [sic] works … I appreciate the Hcpc a [sic] efforts to involve me but as stated before it will unlikely make any difference”. The Panel was satisfied, based on the content of the Registrant’s email, that she had no intention of attending the hearing. In these circumstances, the Panel concluded that the Registrant’s non-attendance was a deliberate waiver of her right to attend and her right to participate in these proceedings.

• There had been no application to adjourn and no indication from the Registrant that she would be willing to attend on an alternative date. Therefore, re-listing this hearing would serve no useful purpose.

• The Panel noted that the HCPC had arranged for four witnesses to give evidence and that the earliest events date back to 2017. The Panel concluded that, in the absence of any good reason to reschedule the hearing, the witnesses should not be inconvenienced by an unnecessary delay and should give evidence whilst the events remained reasonably fresh in their minds.

• The Panel recognised that there may be a disadvantage to the Registrant in not being able to make oral submissions with regard to the Allegation. However, the Panel was satisfied that overall, based on the content of the Registrant’s email dated 2 June 2021, it was in her interests for the hearing to be concluded as soon as possible. There was also a strong public interest in ensuring that the substantive hearing proceeded expeditiously.

Application to Amend

5. Mr Walters made an application to amend particulars 1(a), 3, 4, 6 and 8 of the Allegation. The Registrant was put on notice of these proposed amendments in a letter dated 12 January 2021 (the original application). In addition, he made an application for the insertion of the words “and/or” between the particulars listed in the amended particular 8 (the additional application). The Registrant had not been put on notice of the additional application.

6. The Panel accepted the advice of the Legal Assessor. She advised the Panel that early notice and matters of clarification are less likely to cause injustice than late notice and substantial alterations that heighten the seriousness of the Allegation.

7. The Panel was satisfied that the Allegation should be amended as requested in the original application, as the proposed amendments contained one or more of the following features:

• minor in nature;
• provided helpful clarification;
• provided better particularisation;
• avoided ambiguity;
• did not alter the substance or meaning of the Allegation as originally drafted and did not widen the scope of the HCPC’s case.

8. The Panel concluded that the amendments would cause no injustice to the Registrant as they more accurately reflected the HCPC’s case.

9. The Panel also concluded that the additional application should be granted. The Panel was satisfied that the insertion of “and/or” made it clear that dishonesty could be found proved in relation to any one of the relevant particulars. Although the Registrant had not been put on notice of the additional application, the Panel was satisfied that it would not cause any injustice as it simply provided helpful clarification.

Application for proceeding partially in private

10. Mr Walters, on behalf of the HCPC, made an application for any part of the hearing relating to the Registrant’s underlying health conditions, health matters relating to those close to her, and personal matters relating to her private life to be heard in private. However, he submitted that matters relating to the alleged theft and misuse of morphine should be heard in public.

11. The Panel noted that Rule 10(1)(a) of the Rules states as follows:

“At any hearing— (a) the proceedings shall be held in public unless the Committee is satisfied that, in the interests of justice or for the protection of the private life of the registrant, … the public should be excluded from all or part of the hearing;”

12. The Panel was satisfied that any specific references to the Registrant’s underlying health, the health of members of her family, and personal matters should be heard in private and should not form part of the public record so as to protect the Registrant’s right to a private life. The Panel noted that this is not a health case and concluded that, in accordance with the ‘open justice’ principle, the allegation in relation to theft and misuse of morphine should be heard in public.

Background

13. The Registrant was employed by Yorkshire Ambulance Service NHS Trust (YAS) from 28 September 2009. Initially she was employed as an assistant practitioner. She subsequently commenced her student Paramedic training on 20 September 2010 and qualified as a Paramedic on 15 July 2013.

14. The evidence relates to two periods:

• before the Registrant went off sick in September 2017;
• after the Registrant returned from sickness absence on 23 March 2018.

15. YAS initially treated the concerns that had come to light as health-related only. It was not until the Registrant returned to work on 23 March 2018 that YAS concluded that the issues had not been resolved.

16. On 18 May 2018, the HCPC received a referral from YAS in relation to the Registrant. The main concerns raised by YAS related to an amount of morphine that was unaccounted for and a patient record that been amended, with the dose of morphine administered to the patient being altered. YAS also found that a Patient Care Record (PCR) had been amended following the submission of the carbon copy to the hospital.

17. On 30 May 2018, YAS commenced an internal investigation. During the course of the internal investigation YAS informed the police of their concerns.

18. On 6 November 2018, the HCPC was informed that the Registrant had been issued with a Conditional Caution in relation to the theft of morphine. The condition was for the Registrant to engage in a drug rehabilitation programme. The outcome of the Registrant’s participation in this programme is unknown.

Decision on Facts

18. The Panel considered with care the submission made by Mr Walters on behalf of the HCPC, together with all the evidence, oral and documentary, and the written submissions provided by the Registrant. The Panel heard and accepted the legal advice of the Legal Assessor and bore in mind that it was for the HCPC to prove its case and to do so on the balance of probabilities.

19. The Panel first considered the four witnesses who provided live evidence on behalf of the HCPC.

20. The Panel considered EO to be a credible, clear, and reliable witness, providing helpful background and contextual evidence, although it noted that much of her evidence which related to her investigation was hearsay. She was knowledgeable and had clearly investigated the matter very thoroughly. She was confident in explaining her methodology and findings, providing useful evidence in relation to the audit she carried out. That audit identified the significant number of morphine vials that were unaccounted for in the period from February 2017 to September 2017, some 67 vials in total.

21. The Panel considered Person A to be an experienced Paramedic and manager, who was credible and provided clear and helpful first-hand evidence of his interactions with the Registrant.

22. The Panel considered Person B to be a straightforward witness, who did her best to assist the Panel. She was candid in admitting she had a poor memory of what happened on the relevant shifts and this, the Panel considered, was not surprising given the passage of time. However, Person B and the Panel had the benefit of reference to the statement she made at the time when, she said, matters were much fresher in her memory. The Panel found her to be a credible witness. Her evidence was consistent and helpful in that she was able to give direct evidence of her interactions with the Registrant.

23. The Panel considered Person D to be a credible and reliable witness. The Panel were convinced that she was a caring and diligent manager with a professional approach. However, like EO, much of her evidence was hearsay, although she was able to provide helpful information about the support offered to the Registrant during the relevant period.

24. KR, a Legal Assistant, provided a statement producing documents. It was uncontroversial and was read.

25. The Registrant did not attend the hearing but had provided a number of responses to the various allegations at various stages. In response to YAS’s investigation, she provided two letters, one dated 7 June 2018 (although wrongly dated 2017) and the other undated but responding to YAS’s letter dated 30 May [2018]. There were also various text messages sent by the Registrant to EO and the Registrant’s written response to questions posed by EO. The Registrant also provided a statement (undated) to the police.

26. The Panel was aware that the Registrant had suffered health issues and had, by her own admission, turned to morphine to relieve the stress she was feeling. In her various written responses, she provided significant mitigation for her actions and this mitigation would be considered at later stages of this case. However, it did not impact upon the facts and whether or not she had done that which was alleged by the HCPC.

27. The Panel took all this evidence into account when reaching its decisions on the facts, although it bore in mind that the Registrant’s written material did not have the same status as evidence provided on Oath and subject to cross-examination and therefore carried less weight than evidence given on Oath.

Particular 1(a) - found proved

1. On 18th March 2019 you received a conditional caution for the following:

a) Between February 2017 and September 2017 at Leeds stole morphine of a value unknown belonging to YAS, contrary to section 1 (1) and 7 of the Theft Act 1968.

28. The Panel was provided with a copy of a police Conditional Caution in the Registrant’s name, signed and dated by the Registrant on 18 March 2019. The Conditional Caution recorded that between February and September 2017 at Leeds, the Registrant stole morphine of a value unknown belonging to YAS.

29. This was not disputed by the Registrant. The Conditional Caution was based on an audit undertaken by EO, which revealed that during these dates there were discrepancies for every month in the Registrant’s morphine records. EO said:

“The discrepancies varied. On some occasions, I found that she had signed morphine out twice a day. Morphine should only be signed out once a day, meaning that [the Registrant] had signed out more morphine than she should have. There were also occasions where she had signed out four vials and signed four back in, but the PCRs showed that morphine was administered to a patient. There were also occasions where I found she had signed morphine out at the end of a shift, and signed morphine out when she was supposed to be on a rest day. Wetherby Ambulance Station is very quiet and often there will not be people around so she may have been able to come and go without being noticed.

I also conducted an audit comparing [the Registrant]’s morphine use to other Paramedics at Wetherby Ambulance Station. I compared her with three clinicians that were based at the same station with the same shift pattern during that period of time. I found that one Paramedic had used 12 ampules of morphine, one had used 16 ampules and one had used 27. In comparison, [the Registrant] had used 82 ampules in the same time frame. In total, all of the clinicians at Wetherby Ambulance Station had used 59 ampules of morphine between them.

I also found on the PCRs I looked at that [the Registrant] was recording that she had administered high doses of morphine to patients. The PCRs suggested that she used two vials on the majority of her patients. 10mgs or below is usually suitable for pain relief however, there are occasions when more than 10mgs may be required, for example in cases of extreme pain, trauma, or larger built patients.”

30. EO said the police were informed of her investigation because they were concerned the Registrant was stealing morphine from YAS for her own personal use. The Registrant was interviewed by the police and admitted that she misused morphine while on duty prior to September 2017. She stated that she would administer 0.5 mg of morphine to herself in the toilet in order to help her stay awake at work. The Registrant estimated that June 2017 was her peak of morphine misuse.

31. EO informed the Panel that the police had been told the result of her audit from the relevant period was that there were 67 vials of morphine unaccounted for.

32. The Registrant admitted stealing morphine from YAS between February 2017 and September 2017, although she said she had not taken morphine since August 2017. The Panel noted that the Conditional Caution did not make reference to any specific quantity of morphine.

33. Given the existence of the Conditional Caution, which can only be administered if the accused admits the conduct alleged, the Panel found Particular 1(a) proved.

Particular 2 - found proved

2. Between approximately February 2017 and September 2017, self-administered morphine whilst on duty.

34. This allegation was based on the HCPC’s case that the morphine stolen from YAS was then self-administered by the Registrant, whilst on duty. The HCPC relied on the evidence of EO as referred to above in relation to Particular 1 and, more significantly, the Registrant’s own admissions.

35. As referred to above, in her statement to the police the Registrant admitted that she misused morphine while on duty prior to September 2017.

36. Unsurprisingly there were no eyewitnesses to the Registrant self-administering morphine whilst on duty since, by her own admission, she would do this to herself in private. However, based on her admissions to the police that she had been stealing morphine from YAS and self-administering it whilst at work, the Panel was satisfied, on the balance of probabilities, that this Particular was made out. There was certainly no evidence of her stealing morphine to supply to others and, given her admitted use of morphine, the only logical motive for her stealing it was for her own personal use.

37. This was supported by admissions made by the Registrant in her correspondence, particularly her statement dated 10 August 2018, where she said:

“To address the all-important initial question - I admit to taking small amount of morphine over a short period of time prior to September 2017 though not in the pursuit of any high … but in the pursuit of trying to remain alert and awake during very long shift runs … I’m afraid I cannot supply dates I estimate June last year was its peak.”

38. In that same letter the Registrant added:

“I know that the first time I was really really struggling on shift I had an unduped left over remnant of morphine in my pocket of 0.5 mg and self-administer this in the toilet at hospital which had the desired effect of reducing my drowsiness in the middle of a long set of shifts. I know in retrospect this was wrong but I can only say that at the time I was … struggling … and persuaded myself it was just this once. And although it may be hard for someone outside my circumstances to see I was also concerned about giving patients the best and remaining alert. This was always my primary motivating factor I also felt I could not risk a further episode of sickness without endangering my job.”

39. She also said:

“When it became an overwhelming coping mechanism … I on the odd occasion will have written off the odd vial of morphine on the top copy of the patients PRF which will not marry with the hospital copy (but to also add to this the occasion in April highlighted by work was not such and was a genuine paperwork omission that was rectified verbally and assumed changed by staff) however this is unlikely to be the case with PRF's from last July/August if the two do not marry up then I will be guilty of having accounted for it on paper because of an overwhelming need to take 0.5mg to see me through the shift.”

40. The Registrant made references to several factors that she says led her to self-administer the morphine that she accessed by abusing her position as a Paramedic. She referenced regularly administering 0.5mg of morphine to herself as a coping mechanism. She added, “YAS are right to make allegations about me for summer last year and I am guilty”. She acknowledged committing a crime and breaching HCPC Standards but denied patient care was compromised.

41. Based primarily on the Registrant’s own admissions, the Panel found this Particular proved.

Particular 3 - found proved

3. On 9th and/or 10th May 2018, you attended incident number 5449 and on the copy of the Patient Care Record kept by YAS recorded that 15mg of morphine was administered to the patient but on the carbon copy kept by the hospital recorded that 5mg was administered.

42. EO provided background information about the process involved in the management of morphine by Paramedics. She said:

“Paramedics must follow a certain procedure for signing morphine out on each shift. Each ambulance station has a locked secure room where morphine is stored. The room is accessed by the Paramedic’s ID badge, and then the safe in the room is accessed via an ID code. At the beginning of each shift Paramedics should sign out four vials of morphine and put two vials each into two different containers. The Paramedic should record this in the station’s controlled drug register. The register is kept in the secure room with the morphine. Paramedics should record their name, the date, their badge ID number, the number of vials that they have signed out and the fleet number they will be working on. They should also update the tally which shows how many vials of morphine are currently being stored in the secure room. For example, if there are 100 vials remaining and a Paramedic signs out four vials, they should update the tally to 96. If they signed four vials back in at the end of their shift then they would update the tally to 100.

After this, Paramedics should go to their vehicle and sign the morphine into the vehicle console drug register. This is kept in a locked safe on the ambulance. The morphine should also be stored here. Paramedics should record the number of vials signed in and their signature. Ideally, a second person should sign the vehicle console drug register as a witness; however this is sometimes difficult at the start of the shift when a crew key on duty and are called immediately to an emergency. If this is not completed at the start of the shift then the Paramedic should obtain a signature at the next available opportunity on the shift.

If morphine is administered during a shift then the Paramedic should record how much was administered, how much was ‘dooped’, the incident number, and time in the vehicle console drug register. A signature and witness signature should also be recorded in the vehicle console register. ‘Dooped’ refers to the amount of morphine left over in a vial after it has been opened and used for patient administration. The dooped morphine goes into a container that absorbs the morphine which is then disposed of. Paramedics should also record the morphine administered on the Patient Care Record (PCR) for that patient. They should record the drug name, amount administered, the batch number, route and expiry date.

When the shift is over the morphine should be signed out of the vehicle console drug register. This should be signed by a colleague who has witnessed it, usually the crewmate. Then the remaining vials should be signed back into the station controlled drug register and the tally updated.”

43. EO also produced YAS’s Medicine Management Policy, which contains guidance on the handling of morphine.

44. This allegation relates to the Registrant’s overnight shift beginning at 7pm on 9 May 2018 to 7am on 10 May 2018. In the vehicle console Controlled Drug register for fleet number 1554, the ambulance being used by the Registrant and Person B, the Registrant recorded that 15mg of morphine was administered and 5mg was dooped for incident 5449. PCRs have a top copy that is kept by YAS and a carbon copy that is given to the hospital during the handover. On the copy of the PCR for incident 5449 kept by YAS, it is recorded that 15mg of morphine was administered. However, on the carbon copy kept by the hospital it is recorded that 5mg was administered to this patient.

45. In her police statement the Registrant said that her patient would have received the exact dosage recorded on the hospital copy of the PCR. She also said in this statement that when she was misusing morphine prior to September 2017, on the odd occasion she wrote off the vial of morphine on the top copy of the PCR, meaning it would not marry up with the hospital copy, although she denied doing that on this occasion.

46. In her undated letter to YAS in response to YAS’s letter dated 30 May [2018], the Registrant said:

“If this is the job I think it is then I believe 15mg was administered to the patient. When filling in the drugs book I realised I hadn’t recorded the second and third doses and added them to the PRF and recorded them accurately in the book. Nursing staff were made verbally aware of the dosage and I was under the assumption this would be amended on the PRF but in hindsight acknowledge I should have ensured this by requesting the physical copy to amend myself. I also believe I got the doop witnessed and signed.”

47. In his oral evidence to the Panel, Person A said in relation to this matter:

“YAS copy of the PCR showed 15mg of morphine administered to a patient.

The entire PCR raised concerns.

15mg is a massive dose and for major trauma and did not fit with the chest pain being complained of here. I would not expect any morphine for these presenting conditions or at most 2.5mg, but not 15mg.

I wanted to see the hospital copy to see if something was amiss.

She gave 5mg to patient, handed the carbon copy into the hospital and then wrote an extra 1 on the top copy.”

48. Person A said he spoke to the hospital and was told that in the verbal handover the Registrant told them that 5mg had been given to the patient, not 15mg. He added that, “The problem is when you just look at the registers if the numbers tally then it all seems ok.”

49. Two vials of morphine were signed back into the morphine safe and the station’s Controlled Drug register. Person B could not recall if morphine was administered on this shift.

50. The Panel noted the inconsistent accounts given by the Registrant, namely that when misusing morphine she would sometimes write off a vial of morphine on the top copy of a PCR, no doubt as a way of concealing its use by her. This was inconsistent with her earlier account that she had given the full 15mg to the patient and filled in the form incorrectly. The Panel also noted the evidence of Person A, who spoke to the hospital and was told the Registrant had informed them that only 5mg was administered to that patient. This seemed to the Panel to be far more likely given the presenting condition of the patient and the evidence of Person A that 15mg would only ever be given in the most extreme cases of trauma.

51. The Panel noted that what was actually alleged in Particular 3 was that the copy of the PCR kept by YAS recorded that 15mg was administered to the patient, but the carbon copy kept by the hospital recorded that 5mg was administered. The Panel had sight of both documents and it was clear this was recorded in the way alleged. The Panel therefore found this allegation proved.

Particular 4 - found proved

4. On 10th and/or 11th May 2018 in relation to incident 8331 you did not complete a Patient Care Record for the patient and/or a full and thorough handover to the maternity unit at St James Hospital.

52. At the end of the shift on 11 May 2018, the Registrant and Person B attended incident 8331. This was a maternity incident, and the patient was transported to the maternity unit at St James Hospital by the Registrant and Person B. The Registrant did not complete a PCR for this patient. Person B said, in her Trust statement taken on 11 May 2018, that the Registrant told her she was not going to complete a PCR for the patient. Person B confirmed at YAS interview that the Registrant did not complete a PCR for this patient. She said the Registrant stated, “I don’t know why you have brought that as I am not doing paperwork for this job”. In her statement for these proceedings, she said that when the Registrant saw her with the PCR, she said words to the effect of, “I don’t know why you’ve brought that, I don’t need it”, so she left it in the ambulance. Person B added:

“I expected the PCR to be filled out which is why I started completing it. [The Registrant] should have recorded our observations, the history and treatment. We have to complete a PCR for every patient. There are no occasions where we do not have to fill out a PCR.”

53. In her letter to CL (YAS Sector Commander) the Registrant wrote that the patient lived five minutes from the hospital and should never have got an ambulance in the first place. She said that the patient had a full set of maternity notes with her. She said that if there had been anything pertinent in the notes, such as an allergy or any intervention undertaken, then she would have filled in a full PCR.

54. The Panel heard from EO how this is not an acceptable reason not to complete a PCR and that Paramedics should fill in a PCR for every patient. This is covered in YAS’s policy for Assessment, Conveyance and Referral of Patients and Transport of Patients, provided to the Panel.

55. In light of this evidence and the Registrant’s own admission that she had not completed a PCR for this patient, the Panel was satisfied that the first part of Particular 4 was made out.

56. EO said that by failing to provide the staff on the labour ward with a PCR, the Registrant may have placed the patient at risk. It meant that the hospital staff did not have a record of any intervention or drugs administered by the Registrant. This could have caused the continuity of patient care to be compromised.

57. In her Trust statement, Person B said that the Registrant handed over to the midwife and stated that there was not a PCR completed. In her oral evidence Person B could not remember any detail of the handover. In her letter to CL, the Registrant wrote that staff on the labour ward were asked if they required a PCR, but the nurse was happy with a verbal handover. EO and Person A were of the view that no midwife would ever be satisfied with such a handover and that they would always expect a written PCR on every handover.

58. The Panel noted that YAS’s policy for Assessment, Conveyance and Referral of Patients and Transport of Patients states that, “A clinical handover should be given to the receiving member of staff followed by a completed patient report form including all relevant clinical and assessment information. YAS staff must ensure that a signature is obtained on the PCR from the healthcare professional taking the handover.”

59. Based on all this evidence the Panel was satisfied, on the balance of probabilities, that the Registrant did not complete a full and thorough handover to the maternity ward in respect of this patient. She may well have provided a verbal handover, but a full and thorough handover would have required the provision of a completed PCR.

60. Accordingly, the Panel found both parts of Particular 4 proved.

Particular 5 - found proved

5. On 10th and/or 11th May 2018 you signed morphine onto call sign 1554 but changed to call sign 1505 part shift and did not re-sign the morphine onto the correct vehicle.

61. Person A informed the Panel that it was YAS policy that Paramedics should carry four vials of morphine on each shift. There is 10mg of morphine in each vial. At the beginning of each shift, they should sign out four vials from the station morphine safe by updating the station morphine register and then sign it into their vehicle safe by updating the vehicle morphine register. On the night shift 10-11 May 2018, the Registrant started the shift on vehicle 1554 and duly signed four vials of morphine into that vehicle’s register. However, part-way through the shift vehicle 1554 went in for a service and was swapped with vehicle 1505. Person A said he checked the vehicle morphine register for 1505 and found that the Registrant had not signed any morphine in or out of the register for that vehicle, as required by YAS’s Medicine Management Policy.

62. In her undated written response to YAS, following receipt of YAS’s letter date 30 May [2018], the Registrant said she:

“Acknowledged the drugs were signed out but not into or out of the new vehicle this would normally have been rectified at the end of the shift had an oversight been made out but I was in no fit state to do anything other than walk away by the end of the shift.”

63. The Panel was satisfied that there was clear evidence the Registrant started the relevant shift in vehicle 1554 and assigned the four vials of morphine to that vehicle. There was also clear evidence that part-way through the shift she transferred to vehicle 1505 but did not record in that vehicle’s morphine register the four vials from vehicle 1554. Furthermore, the Registrant did not appear to dispute this. Accordingly, the Panel found this particular proved.

Particular 6 (a) - found proved

6. During your shift on 10th and/or 11th May 2018 you:

a) Signed out four vials of morphine but only signed three back in and did not record where the outstanding one vial of morphine had been used;

64. This allegation related to the Registrant’s overnight shift beginning at 7pm on 10 May 2018 and ending at 7am on 11 May 2018. At the beginning of the shift on 10 May 2018, the Registrant signed out four vials of morphine from Wetherby Ambulance Station and recorded this in the station’s Controlled Drug register. At the end of the shift, the Registrant returned to Leeds Ambulance Station so that Person A could assist her with signing her morphine back in. The Registrant was unable to return the morphine to the safe at Wetherby because her safe card had been deactivated. EO said this was because the Registrant had been on long-term sick leave. Person A, however, said it was because YAS had had suspicions in 2017 about the Registrant’s misuse of drugs and so had deactivated her card for that reason. Person A accepted that a card could be deactivated as a result of a Paramedic being on long-term sick leave, but said that this was extremely rare.

65. Whatever the reason, the fact was the Registrant’s card had been deactivated and hence the need to go to Leeds where a supervisor could access the safe. The Registrant signed three vials of morphine back into the Leeds Central morphine safe. Person A said that he had a genial chat with the Registrant, who made no mention of any issue with a morphine vial. However, because only three had been signed in Person A checked the Registrant’s PCRs from the shift and could not find where the missing vial of morphine had been administered. Person A also spoke to the Registrant’s crew mate, Person B, who said that the Registrant had not administered any morphine to patients during the shift.

66. Person A told EO during YAS interview that when he questioned the Registrant later about where the outstanding vial of morphine had been used, she said that she “kind of” gave it on the second to last job. Person A said that the Registrant told him she disposed of the morphine after she drew it up but could not get IV access.

67. This account, however, was in conflict with what the Registrant told Person B in text messages on 11 May 2018. In the text messages, Person B felt the Registrant was trying to tell her what she would have seen on the shift in terms of morphine use. However, Person B said she had not seen anything, and she did not reply to the texts sent by the Registrant. Person B said:

“These text messages made me feel like [the Registrant] was trying to put words in my mouth as to what I should have seen, for example, a broken morphine vial. She was outlining that she carried morphine in her pocket and had been given conflicting information as to whether this was allowed. However, I had not seen anything because we did not use morphine on this shift.”

68. Also, in the texts to Person B the Registrant wrote that she, “cracked a vial in her pocket”. This was the account the Registrant stated in her resignation letter and in a letter to CL, that the outstanding vial of morphine broke in her pocket but that she did not document it anywhere due to fear of ramifications. The Panel heard how broken vials should be recorded in the vehicle Controlled Drug register, reported to the Clinical Supervisor, and DATIX-reported.

69. In her oral evidence EO conceded that the Registrant’s version of a vial breaking in her pocket was possible; however, she thought it unlikely as they are carried in a protective case.

70. There was, in the Panel’s view, clear evidence that the Registrant had signed out four vials of morphine on this shift, signed three back in, and made no record of what had happened to the fourth vial. The Panel therefore found Particular 6(a) proved.

Particular 6(b) - found proved

b) Provided inconsistent accounts of what happened to the outstanding vial described at particular 6a) in that you told Person A that you had attempted to administer morphine to a patient but disposed of it because you could not get IV access but later stated that the vial broke in your pocket;

71. Person A’s evidence was consistent, namely that the Registrant told him that she had tried to cannulate the post-C-section patient but could not get intravenous access. She had then disposed of the morphine but forgot to record it in the register. In his oral evidence Person A queried this version of events, posing the question, “Why draw up a dose of morphine before attempting to cannulate a patient? The logical order of events is to cannulate and then draw up the morphine once you have established IV access.”

72. In her text messages to Person B, the Registrant said, “Also managed to crack vile [sic] in my pocket … Happy for you to say what is truth that we didn’t give any but attempted to on last but one job pregnant post c section but in the end couldn’t due to access … Please erase this message so you are in no way “aware” of breakage.”

73. Person B’s evidence was that she was not aware of any intention or attempt to administer morphine during that shift.

74. In the Registrant’s letter to the Locality Manager, she mentioned attempting to cannulate a patient but could not gain access. She also said she was carrying two vials in her pocket and that one had been crushed. If this were true, the Panel would have expected the Registrant to have said to Person A that this is what happened. Person A made it clear in his oral evidence that vials do get broken from time to time and that, provided proper process is followed, nothing more arises as a result. It would have required the Registrant to have contacted Person A or another supervisor, who would have advised her to take a photograph of the broken vial and then doop any remaining morphine and fill out a DATIX report. It was clear from the evidence that breakages were not uncommon within the ambulance service.

75. The Panel noted the inconsistent accounts given by the Registrant and contrasted that with the clear evidence given on Affirmation by Person A regarding the account given to him by the Registrant, and was satisfied that the Registrant had given inconsistent accounts about what had happened to the outstanding vial of morphine. The Panel thus found Particular 6(b) proved.

Particular 6(c) - found proved

c) Took the one vial of Morphine described at particular 6a) for your own personal use;

76. The Registrant has never admitted this allegation. The HCPC invited the Panel to infer she took a vial of morphine for her own personal use, based on a well-established pattern of abusing morphine. Reliance was also placed on the frequent admissions made by the Registrant in her correspondence that during these shifts in 2018 she was struggling. Mr Walters said that the Registrant’s previous coping mechanisms when she could not cope at work were self-administering morphine.

77. Mr Walters further submitted that there had never been a reliable explanation from the Registrant as to what happened to the missing vial of morphine. He invited the Panel to prefer the logical explanation that the Registrant had resumed her previous actions of taking morphine for her own personal use.

78. The Panel considered this was supported by the Registrant’s own comments in her undated written response to YAS following receipt of YAS’s letter dated 30 May [2018], as referred to above, where the Registrant said that she:

“Acknowledged the drugs were signed out but not into or out of the new vehicle this would normally have been rectified at the end of the shift had an oversight been made out but I was in no fit state to do anything other than walk away by the end of the shift.”

79. The Registrant was required to take a drugs test in May 2018 due to the missing morphine. On 11 May 2018 she agreed to take a drug and alcohol test. The test was positive for buprenorphine and opiates.

80. Notwithstanding the Registrant’s account above, on the evidence and given the Registrant’s history of taking morphine for her own use, the Panel considered it a reasonable inference to draw that the missing vial from the shift of 10-11 May 2018 was taken by the Registrant for her own personal use. Accordingly, the Panel found Particular 6(c) proved.

Particular 7 - found proved

7. On 10th and/or 11th May 2018, in order to conceal your actions you deliberately removed a page from the vehicle morphine register.

81. Directly linked to Particular 6, Particular 7 relates to pages 39 and 40 of the fleet 1505 morphine book, which had been ripped out. It would have been on these pages that the Registrant should have recorded that she had broken a vial, had this been true.

82. In her letter to CL, the Registrant wrote that she, “failed to see what she would gain by removing a page from the drugs book”. She said if she were intent on covering something up, she would have been better writing the morphine vial off as damaged.

83. In her oral evidence, Person B said that she saw the Registrant take the vehicle morphine register out of the vehicle when they arrived at Leeds to return the unused morphine. Person A said there was no reason for a vehicle morphine register to be removed from the vehicle. The Panel questioned why the Registrant would have removed the book from the ambulance unless it was to do something with it.

84. The Panel noted the inconsistent accounts given by the Registrant as to what happened to the fourth vial on that shift and that this tended to suggest she had been trying to hide something. The Panel considered, on the balance of probabilities, that in all the circumstances it was reasonable to draw the inference that she had deliberately removed pages 39 and 40 in order to conceal what she had really done with the missing vial. She could indeed have simply recorded it as damaged, but this appeared to be her later account. Her first account was that given to Person A, namely that she had tried to give it to a patient but could not get IV access so disposed of it. Either account could have represented a legitimate explanation for the missing vial, but it seems the Registrant had been unsure what account she was going to rely on, and this suggested to the Panel that she was fully aware that she had taken it for her own use.

85. EO, after her thorough investigation, could not find anyone else who could have had a motive for removing those specific pages from the vehicle morphine register. Person B said she had never known anyone remove the vehicle morphine register from the ambulance. Person A said he had removed this particular register on 11 May 2018 as soon as he became suspicious and it is known that the pages were missing at that time, which narrowed down the time when they could have been removed to the shift where the Registrant and Person B were crewing the ambulance. All of this pointed to it being the Registrant who had removed those pages.

86. Of further noteworthiness was the evidence of Person G, a manager involved with the drugs test referred to above, who said in a statement dated 12 May 2018 that:

“During the conversation between 1900 and 1930 [the Registrant] told me why she was here for the drug tests, I had advised her I was unaware of all the facts and didn't need to know them, however she told me that this had all occurred due to her stupidly trying to hide the fact that she had smashed a vial of morphine in her right trouser leg pocket.

She advised that she had been in trouble before due to having morphine in her pocket and didn’t want to be again. [The Registrant] then initially said that she tried to hide it by saying that she was going to give it to a patient, but then changed this saying she was going to give it to a patient but couldn’t cannulate them and DOOP'ed the morphine. She states that she wrote this in the morphine book but then ripped the page out of the book were [sic] she had recorded this. [The Registrant] then stated that she knew that she would be sacked for this incident as it involved morphine, I did not reply to any comments in regards to the morphine or her comments on being sacked.”

87. EO, in her statement, for these proceedings said:

“It was found that page 39 and page 40 were missing from the vehicle console drug register for fleet number 1505. This could suggest that [the Registrant] was trying to cover up a discrepancy in her morphine documentation. Person E and Person F had also found a page ripped out of a controlled drug register when they were investigating concerns in 2017 which could suggest a pattern of behaviour.”

88. Accordingly, although no one actually witnessed the page being torn out, the Panel was satisfied, on the balance of probabilities, that the only person with a motive to remove the page, and the means to carry it out, was the Registrant.

89. The Panel therefore found Particular 7 proved.

Particular 8 - found proved in relation to Particulars 3, 5, 6(a), 6(b), 6(c) and 7

8. Your actions described at paragraph 3 and/or 5 and/or 6 and/or 7 were dishonest.

90. Having found Particulars 3, 5, 6(a), 6(b), 6(c), and 7 proved, the Panel had to decide whether the Registrant’s actions as described in those particulars were dishonest.

91. The Panel considered Particulars 3, 5, 6, and 7 individually when deciding whether they amounted to dishonest behaviour on the part of the Registrant and concluded, on an individual basis, that they all did. All related to the Registrant taking morphine from YAS for her own personal use and attempting to conceal that from anyone who might be interested. She did this by: falsifying records (3); not recording the morphine into the second vehicle (5); taking a vial of morphine (6(a)); giving false accounts about what happened to a missing vial of morphine (6(b)); and removing a page from a vehicle morphine register (7). Such deliberate, premeditated behaviour was far from straightforward or honest. In the Panel’s view the Registrant knew what she was doing; she was stealing morphine just as she had been doing in 2017 and then attempting to conceal her actions from others. This formed a pattern of behaviour which the Panel was satisfied that ordinary decent people would find dishonest.

92. The Panel therefore found Particular 8 proved in relation to Particulars 3, 5, 6(a), 6(b), 6(c), and 7.

Decision on Grounds

Panel’s Approach

93. Having determined the facts, the Panel went on to consider the ground of misconduct. The Panel was aware that determining the issue of misconduct is a matter of judgement; there is no burden or standard of proof.

94. The Panel took into account the oral submissions from Mr Walters on behalf of the HCPC and accepted the advice of the Legal Assessor.

95. In considering the issue of misconduct, the Panel bore in mind the observation made by the Privy Council in the case of Roylance v GMC (No.2) [2000] 1 AC 311, where it was stated 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 misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”

96. The Panel was aware that departures from the HCPC Standards of Conduct, Performance and Ethics (the HCPC standards) alone do not necessarily constitute misconduct.

Panel’s Decision

97. The Panel noted that its factual findings demonstrate that the Registrant acted dishonestly on multiple occasions. Such behaviour inevitably falls far below the standards expected of a registered practitioner. The Panel considered the HCPC standards and was satisfied that the Registrant’s conduct breached the following:

6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.

6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.

6.3 You must make changes to how you practise, or stop practising, if your physical or mental health may affect your performance or judgement, or put others at risk for any other reason.

9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

98. The Registrant’s actions represented a significant breach of her employers’ trust and constituted a criminal offence. Her behaviour cannot be described as a momentary failure or a temporary lapse of judgement as it formed part of a pattern of behaviour which took place during a seven-month and one-month period separated by an interval of sickness absence. The Registrant was aware that she did not have permission to take the morphine for her own personal use. The Registrant’s dishonesty and the attempts to cover up her behaviour also demonstrated a failure to act in the best interests of patients and undermined the legitimate expectation of her colleagues and the public that she would conduct herself in a professional manner at all times. On numerous occasions the Registrant’s dishonest behaviour demonstrated a failure to uphold the high standards of professional conduct and behaviour expected of her as a registered Paramedic. The Panel concluded that the Registrant’s fellow professionals would regard her dishonest conduct as deplorable. The Panel noted that, during YAS’s internal investigation and in communication with the HCPC, the Registrant referred to a number of underlying health conditions. The Panel noted these health conditions and the stressors the Registrant stated that she was experiencing during the relevant period. However, the Panel concluded that the Registrant’s dishonesty was sufficiently serious to be characterised as serious misconduct.

99. The Panel considered the failure to complete a PCR and the failure to conduct a full and thorough handover separately. The Panel considered the HCPC standards and was satisfied that Registrant’s conduct breached the following:

10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services.

100. The Panel noted that the Registrant did not follow YAS’s policy and procedures relating to patient records. The record-keeping failure occurred during the Registrant’s first operational shift where she was the lead clinician following her return to work after a period of sickness absence. The Registrant had a professional duty to not only be aware of YAS’s policy, but to ensure that she complied with it. She chose not to do so. It is not for individual practitioners to pick and choose which policies to follow and which aspects of patient safety can be dispensed with. The Panel noted that the absence of a PCR had the potential to compromise patient care. Therefore, the Panel was satisfied that the Registrant’s failure to ensure compliance with the policy and procedures relating to the completion of a PCR was sufficiently serious to be characterised as serious misconduct.

Decision on Impairment

Panel’s Approach

101. The Panel, having found misconduct, went on to consider whether the Registrant’s fitness to practise is currently impaired. The Panel took into account the HCPTS Practice Note “Fitness to Practise Impairment”. The Panel also took into account the oral submissions made by Mr Walters and accepted the advice of the Legal Assessor.

102. The Panel was mindful of the following aspects of the public interest:

• The ‘personal’ component: the current behaviour of the individual Registrant; and

• The ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

Panel’s Decision

103. The Panel took the view that the factual findings raise significant concerns. The Registrant abused her employers’ and her colleagues’ trust and demonstrated a persistent lack of judgment for a significant period of time.

104. The Panel considered the Registrant’s current fitness to practise firstly from the personal perspective and then from the wider public perspective.

105. The Panel recognised that demonstrating remediation following a finding of dishonesty is particularly difficult, as probity issues are reliant on attitude, which can often only be inferred from conduct. The Registrant’s dishonest conduct relates to a discrete set of circumstances which may be capable of remediation. However, the Panel noted that remediation often requires insight. Although the Registrant demonstrated some remorse and acknowledgement of fault during the internal YAS investigation in 2018, due to the Registrant’s non-engagement during these proceedings there was no evidence before the Panel that she has any insight into the nature and gravity of her misconduct. In particular, at no time has the Registrant demonstrated an understanding of the unwarranted risk of harm patients were exposed to when she self-administered morphine whilst on duty, nor has she acknowledged the impact of her conduct on her colleagues and the wider profession. The Registrant’s misconduct breached a fundamental tenet of the Paramedic profession, brought the profession into disrepute, and demonstrated that her honesty and integrity could not be relied upon. The Registrant’s premeditated and persistent theft of morphine and the attempts to cover up her actions suggest a failure to understand and take seriously her professional obligation to be honest and trustworthy at all times. There was also no evidence before the Panel that the Registrant has properly reflected on the impact of her behaviour. As a consequence, there was no indication that the Registrant has even begun the process of taking remedial steps. Therefore, the Panel concluded that the risk of repetition is high.

106. The Panel concluded that for these reasons the Registrant’s fitness to practise is currently impaired based on the personal component.

107. In considering the public component the Panel had regard to the important public policy issues, which include the need to maintain confidence in the profession and to declare and uphold proper standards of conduct and behaviour.

108. The Panel noted that there were systemic failures within YAS which permitted the Registrant’s actions to remain undetected for a significant period of time. Irrespective of the systemic failings, the Registrant had a personal responsibility to uphold high standards of conduct and behaviour. In the Panel’s view, the Registrant’s blatant disregard of YAS’s policies and procedures is serious, and her degree of culpability is high. Members of the public would be concerned by the prospect of a registered professional flouting these policies and procedures for what is perceived to be for their own advantage. It is critically important that health and safety policies and procedures have integrity, and full compliance by clinicians (including Paramedics) is a vital part of that process.

109. A significant aspect of the public component is upholding proper standards of behaviour. The Registrant’s conduct fell far below the standard expected of a registered practitioner. It is not acceptable for a registered professional to take their employers’ property for their own use without permission and to disregard health and safety policies. The Panel concluded that public confidence would be undermined if a finding of fitness to practise impairment were not made, given the seriousness of the Registrant’s conduct and behaviour.

110. The Panel concluded that the Registrant’s current fitness to practise is impaired on the basis of both the personal component and the wider public interest, and therefore the HCPC’s case is well-founded.

Decision on sanction

Panel’s Approach

110. The Panel accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of any sanction is not to punish the Registrant, but to protect the public and the wider public interest. The public interest includes maintaining public confidence in the profession and the HCPC as its regulator and upholding proper standards of conduct and behaviour. The Panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of severity.

111. The Panel had regard to its findings in relation to misconduct and impairment. The Panel also took into account the HCPC Sanctions Policy and the oral submissions made by Mr Walters.

Panel’s Decision

112. In determining the appropriate sanction, if any, the Panel considered and balanced the mitigating and aggravating factors.

113. The Panel determined that the following aggravating factors apply to the Registrant:

• there has been no engagement during the substantive hearing;
• the repeated dishonesty constituted a pattern of behaviour which persisted for a significant period of time;
• the dishonesty amounted to a significant breach of trust and an abuse of her professional position;
• there has been no demonstration of insight, remorse, or remediation, and there is no evidence of an apology for the impact of her behaviour on patients, colleagues, the wider profession, and her employer;
• patients were exposed to an unwarranted risk of harm.

114. The Panel noted that during YAS’s internal investigation and in communication with the HCPC, the Registrant stated that she has a number of health and personal issues. The Panel accepted that the Registrant experienced the difficulties she described. Although the Panel accepted that these were mitigating factors, it noted that it had not been provided with any independent evidence that there was any link between the Registrant’s health and her deliberate and persistent dishonesty. In these circumstances, the Panel determined that the weight to be attached to the Registrant’s underlying health issues is limited. The Panel was unable to identify any other mitigating factors.

No Action

115. The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s misconduct and in the absence of exceptional circumstances, to take no action on her registration would be wholly inappropriate. Furthermore, it would be insufficient to maintain public confidence and uphold the reputation of the profession.

Caution

116. The Panel went on to consider a Caution Order. The Panel noted paragraph 101 of the HCPC Sanctions Policy, which states:

“A caution order is likely to be an appropriate sanction for cases in which:
• the issue is isolated, limited, or relatively minor in nature;
• there is a low risk of repetition;
• the registrant has shown good insight; and
• the registrant has undertaken appropriate remediation.”

117. The Registrant’s dishonesty and the attempt to cover it up cannot be characterised as minor, limited, or an isolated incident as it persisted for several months. Her behaviour demonstrated a pattern which only came to an end when YAS conducted an internal investigation and there is no evidence that the Registrant has taken any remedial action. The Panel also concluded that the Registrant’s failure to follow YAS’s policy and procedures with regard to patient records cannot be characterised as minor as it had the potential to cause harm to patients. In view of the Panel’s findings that the Registrant has demonstrated no insight into her misconduct and whilst there is a high risk of repetition, the Panel concluded that a Caution Order would be inappropriate and insufficient to meet the public interest.

Conditions of Practice

118. The Panel went on to consider a Conditions of Practice Order. The Panel bore in mind that any conditions imposed would need to be appropriate, proportionate, workable, and measurable.

119. The Panel concluded that stealing morphine, attempting to cover it up, and disregarding policies and procedures are not amenable to conditions, as the basis for this type of misconduct is an attitudinal failing. The Panel was unable to formulate conditions which would be workable, measurable, or proportionate, not least because they require a willingness to comply with conditions. Due to the Registrant’s non-engagement there is no indication that the Registrant would be willing or able to comply with conditions in the event that suitable conditions could be formulated. Furthermore, conditions would not adequately address the serious nature of the misconduct and so would undermine rather than uphold the public’s trust and confidence in the profession and the high standards of conduct and behaviour expected of registered professionals.

Suspension

120. The Panel next considered a Suspension Order. A Suspension Order would send a signal to the Registrant, the profession, and the public reaffirming the standards expected of a registered Paramedic. However, the Panel noted that paragraph 121 of the HCPC Sanction Policy states that a Suspension Order may be appropriate in the following circumstances:

• If the concerns represent a serious breach of the Standards of Conduct, Performance and Ethics;
• the registrant has insight;
• the issues are unlikely to be repeated; and
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.

121. The Registrant has demonstrated no insight into her dishonest behaviour and has not taken the opportunity to persuade the Panel that meaningful lessons have been learnt. Furthermore, there is no evidence that the Registrant is either willing or able to resolve the underlying attitudinal failures which culminated in her dishonest conduct and failure to follow YAS’s procedures. In these circumstances, a Suspension Order would not be sufficient to maintain public trust in the profession and the regulatory process.

Strike Off

122. Having determined that a Suspension Order does not meet the wider public interest, the Panel determined that the Registrant’s name should be removed from the Register. A Striking Off Order is a sanction of last resort and should be reserved for those categories of cases where there is no other means of protecting the public and the wider public interest. The Panel decided that the Registrant’s case falls into this category because of the nature and gravity of her dishonest conduct, her persistent lack of insight, and the high risk of repetition. The Panel was also satisfied that any lesser sanction would undermine public confidence. In reaching this conclusion the Panel balanced the wider public interest against the Registrant’s interests. Although the Registrant indicated that she has taken steps to retrain as a plumber, the Panel took into account the consequential personal and professional impact a Striking Off Order may have upon her, but concluded that these considerations were significantly outweighed by the Panel’s duty to give priority to the wider public interest.

123. With regard to the Registrant’s non-engagement with the regulatory process the Panel noted the judgment of Mr Justice Mitting in NMC v Parkinson [2010] EWHC 1898:

“A [practitioner] who has acted dishonestly, who does not appear before the Panel either personally or by solicitors or counsel to demonstrate remorse, a realisation that the conduct criticised was dishonest, and an undertaking that there will be no repetition, effectively forfeits the small chance of persuading the Panel to adopt a lenient or merciful outcome and to suspend for a period rather than to direct [a Striking Off Order].”

124. In this case the Registrant has disengaged from the regulatory process and has chosen not to re-engage. In doing so, she has not provided the Panel with any opportunity to consider exercising a degree of leniency.

125. The Panel decided that the appropriate and proportionate order is a Striking Off Order.

Order

That the Registrar is directed to strike the name of Ms Elisa Stevens from the Register on the date this Order comes into effect.

Notes

Interim Order

Proceeding with the application in the Registrant’s absence

1. Mr Walters made an application for the hearing to continue to proceed in the Registrant’s absence in order to consider an application by the HCPC for an interim order. He submitted that the Registrant had been given notice that the HCPC may make such an application in the Notice of Hearing dated 16 June 2021.

2. The Panel decided that it was appropriate to consider the HCPC’s application for an interim order in the absence of the Registrant because she had been informed in the Notice of Hearing that such an application might be made, and she had not responded with regard to that warning. The Panel was satisfied that the Registrant had voluntarily absented herself from these proceedings. Furthermore, the Panel had made findings which identify clear public interest concerns, including a potential risk of harm to patients and the need to maintain trust and confidence by upholding proper standards of conduct and behaviour.

Application and Response

3. Mr Walters, on behalf of the HCPC, made an application for an Interim Suspension Order to cover the appeal period on the grounds that it is in the interests of public protection and otherwise in the public interest.

Panel’s Decision

4. The Panel accepted the advice of the Legal Assessor.

5. The Panel determined that the public interest outweighed the Registrant’s interests and that an interim order is proportionate. The Panel determined that an Interim Suspension Order is necessary for the protection of the public and is otherwise in the public interest because of the nature and seriousness of the Registrant’s dishonest behaviour, the attempts to cover up, and the failure to follow patient safety procedures. Members of the public would be concerned if the Registrant were able to continue to practise during the appeal period in circumstances where there is an ongoing risk to patients. Furthermore, it would be inconsistent with the Panel’s substantive determination and therefore inappropriate for the Registrant to be permitted to return to practice unrestricted during the appeal period. In reaching this decision the Panel considered that an Interim Conditions of Practice Order would not be appropriate for the same reasons that it was not appropriate to impose a substantive Conditions of Practice Order.

6. The Panel did not make an interim order on the ground that it was in the Registrant’s own interests.

7. The Panel decided that the appropriate length of an interim order is 18 months, to cover the 28-day appeal period and the time it may take for any appeal, if made, to be determined.

Interim Order

The Panel makes an Interim Suspension 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. 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.

Hearing History

History of Hearings for Miss Elisa Stevens

Date Panel Hearing type Outcomes / Status
26/07/2021 Conduct and Competence Committee Final Hearing Struck off