Miss Kathryn Chignell

Profession: Paramedic

Registration Number: PA34348

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 19/07/2021 End: 17:00 19/07/2021

Location: Virtual hearing - Video conference

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

Allegations as proven at the final hearing:

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) Not proven

(c) Not proven

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) Not proven

(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.

Finding

Preliminary Matters

Service
1. The HCPC submitted that service of notice of the Hearing had been effected properly in accordance with the Rules. A Notice of Hearing letter was sent on 18 June 2021 by email to the Registrant's registered email address. The Registrant's email address is that shown on the certificate of information held on the HCPC register. There was also a proof of service document.

2. The Notice set out the date and time of the hearing and confirmed that the matter would be dealt with via video conference.

3. The Panel took legal advice from the Legal Assessor.

4. The Panel was satisfied that Notice of the Hearing was served in accordance with the Rules.

Proceeding in absence

5. The HCPC made an application to proceed in the Registrant's absence.

6. The HCPC submitted that the Registrant had voluntarily absented herself from these proceedings. She referred the Panel to a letter from the Registrant dated 15 July 2021 in which she stated that she would not be attending the hearing today. She said “I won’t be attending the meeting on Monday, as I have previously told the HCPTS, I no longer want my registration as a paramedic but I can’t just get rid of it instead I still have to go through this process.’

7. The Panel was reminded that this is a mandatory review of a Suspension Order which is due to expire on 28 August 2021, and therefore in the public interest should be reviewed prior to its expiry. The HCPC also submitted that an adjournment would be unlikely to secure the Registrant's attendance and no such adjournment had been sought by the Registrant.

8. The Panel heard and accepted the advice of the Legal Assessor.

9. The Panel concluded that the Registrant has voluntarily absented herself and the hearing will proceed in her absence today. Its reasons are as follows:

a. There has been good service of the Notice of Hearing;
b. On 15 July 2021 the Registrant wrote to the HCPC to say she would not be attending the hearing;
c. There had been no application for an adjournment.
d. The Registrant has not meaningfully engaged in this process since the substantive hearing and did not attend the previous review hearings.
e. The Panel considered that the public interest in this matter proceeding outweighed the Registrant's own interests.

Private

10. The HCPC invited the Panel to hear some parts of the hearing in private relating to matters raised by the Registrant in relation to her health.

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

12. The Panel agreed to hear the HCPC submissions in private only where they related to a health issue raised by the Registrant.

Background

13. 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.

14. 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.

15. 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.

16. The Registrant returned to unrestricted practice from the end of March 2016 following a satisfactory review of her performance.

17. 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.

18. 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.

19. 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.

20. 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.

21. A further review took place on 25 January 2021 when the Panel imposed a further period of suspension for 6 months.

 

Today's Hearing


HCPC Submissions

22. The HCPC submitted that the Registrant’s fitness to practise remained impaired. It was submitted that the Registrant had not engaged with the HCPC at all since the last review hearing. In brief it was submitted that nothing had changed since the current order was imposed or last reviewed.
23. Further, the HCPC reminded the Panel of the last reviewing panel’s decision when it stated that:
“the length of the Suspension Order should be sufficient for the Registrant to consider afresh whether she wishes to take what might possibly be the last opportunity to remedy her professional failings.”

24. The Panel was also reminded that the previous panel noted that a future reviewing Panel would be likely to consider a striking off order and that a 6-month suspension order was to allow the Registrant a little more time “to retrain and re-join her profession or leave voluntarily”.

25. The HCPC invited the Panel to make a ‘Striking Off Order’ as the only appropriate and proportionate sanction. It was submitted that the Registrant had not engaged, lacked insight and had failed to make any attempt to complete and return the voluntary removal forms sent to her by the HCPC.

Decision

26. The Panel accepted the advice of the Legal Assessor. The Panel had regard to the HCPTS’s Practice Note on Fitness to Practise, Impairment and the terms of the Sanction Policy.

27. 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.

28. In particular, the Panel noted the Registrant’s email of 15 July 2021 in which the Registrant stated her reasons for no longer wishing to practise:

“I no longer want my registration as a paramedic but I can’t get rid of it, instead I have to go through this process.”

29. The Panel noted that despite her stated wish to be voluntarily removed from the Register the Registrant had failed to complete and send the required documents to the HCPC.

30. The Panel noted that there had been no material change of circumstances since the first substantive order and following the review hearings.

31. The Panel noted the earlier decisions. Following the substantive hearing, a conditions of practice order was imposed but the Registrant had not worked as a paramedic during that period. Later a Suspension Order was made for 12 months with no real change in the Registrant’s position, following which a further period of suspension was imposed for 6 months.

32. The Panel noted that the Registrant wished to give up her registration by entering into a Voluntary Removal Agreement. At the last review hearing the Panel imposed a further 6-month Suspension Order to provide the Registrant with a final opportunity to remediate her failings or to pursue her desire to voluntarily remove herself from the Register. The Panel noted that the Registrant had not availed herself of either option.

33. The Panel determined that the Registrant's fitness to practise remains impaired on both the personal and public components.

34. In relation to the personal component, there was no evidence of engagement with the HCPC, insight or remediation, and therefore the Panel concluded there was a real risk of repetition.

35. The Panel also considered that the public component was engaged in this case. In view of the history of the case and the continued lack of engagement and remediation, the public’s trust would be undermined in the profession and the regulatory process if a finding of impairment was not made.

36. The Panel then went on to consider what the appropriate and proportionate sanction should be, starting with the least restrictive sanction. It bore in mind that the purpose of a sanction was not to be punitive, although a sanction may have that effect.

37. The Panel also bore in mind that its over-arching objective is:

a. to protect, promote and maintain the health, safety and wellbeing of the public;
b. to promote and maintain public confidence in the profession; and
c. to promote and maintain proper professional standards and conduct for members of the profession.

38. 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.

39. The Panel next considered whether to impose a Caution Order. 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.

40. The Panel next considered whether to impose a Conditions of Practice Order. It concluded that it would neither be appropriate nor proportionate given the Registrant’s lack of engagement and lack of evidence of insight. There was no evidence to suggest that the Registrant would be willing to comply with any such conditions.

41. The Panel next considered a Suspension Order. The Panel did not consider that this would serve any useful purpose since the Registrant had not shown any material change in her circumstances despite the imposition of two periods of suspension. Nor did the Panel consider it would serve the public interest as the Registrant had not engaged with this process since the substantive hearing and was unlikely to engage in the future. The Panel noted that had the Registrant heeded the advice of the previous panel she could have addressed her failings or implemented a process of voluntary removal and thus avoided a further sanction.

42. The Panel concluded that the imposition of a further period of suspension was unlikely to result in the Registrant resolving or remedying her failings given her lack of insight and engagement.

43. The Panel next considered a Striking Off Order. The Panel was reminded of Article 29(6) which states as follows:

“A striking-off order may not be made in respect of an allegation of the kind mentioned in article 22(1)(a)(ii) or (iv) 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.”

44. The Panel also considered carefully the Sanctions Policy and its guidance in relation to strike off.

45. The Panel was particularly mindful of the principle of proportionality. The Panel noted the findings made by the last reviewing panel. The Registrant was given ample opportunity to remedy her failings or come off the register voluntarily. She did neither. Instead, she wrote a letter recently on 15 July 2021 which showed little insight into this process or her failings.

46. The Panel considered whether a Striking Off order was the only sanction sufficient to protect the public, and to maintain public confidence in the profession and the regulatory process. The Panel reminded itself that the Registrant had provided no evidence of insight, had not meaningfully engaged in this process since the substantive hearing and appeared unwilling to resolve matters. The Panel concluded that a Striking Off Order was the most appropriate sanction in the circumstances.

Order

ORDER: The Registrar is directed to strike the name of Miss Kathryn Chignell from the Register on the date this Order comes into effect

Notes

The Order imposed today will apply from 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
28/01/2019 Conduct and Competence Committee Final Hearing Conditions of Practice
10/09/2018 Conduct and Competence Committee Final Hearing Adjourned part heard