Miss Jemma J Taylor

Profession: Paramedic

Registration Number: PA44406

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 06/04/2021 End: 17:00 09/04/2021

Location: This hearing will take place virtually

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Whilst registered as a Paramedic with the Health and Care Professions Council, on or around 12 July 2018, you:

1) Took Patient 1’s codeine tablet(s);

a) for your own personal use
b) without their consent.

2) Consumed Patient 1’s codeine tablet(s) whilst attending to them.

3) Your conduct at particular 1b) above was dishonest.

4) The matters set out in paragraphs 1 – 3 constitute misconduct.

5) By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Matters

Admissibility

1. Mr Tarbert applied to admit in evidence a brief statement made by LS, who had spoken to the patient while she was in hospital. He submitted that the evidence was admissible and created no unfairness in the circumstances. Although the HCPC had not taken steps to secure the attendance of either LS or the Patient as witnesses, the statement was not sole or decisive evidence and any concerns about its admission could be addressed by the weight to be given to it. He referred to the cases of Thorneycroft v NMC [2014] EWHC 1565 (Admin) and El Karout v NMC [2019] EWHC 28 (Admin).

2. Ms McCullough opposed the application and argued that the statement was ‘double hearsay’, the circumstances in which it had been made were unclear, the questions asked had not been recorded, and appeared to have been leading in nature. It went to the heart of the case on dishonesty and admitting the statement into evidence would be unfair.

3. The Legal Assessor referred to the gateways for admitting evidence under Rules 10(1)(b) and (c) of the Health and Care Professions (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules) as amended. He advised that the requirement of fairness applied to the admission of evidence under either subparagraph. He advised that the evidence was admissible under Rule 10(1)(a) but that it would create unfairness to the Registrant as being potentially decisive evidence as between rival versions of events, the issue was central to what was a very serious allegation that threatened her registration, the statement had not been made by the Patient but by another person, and no attempts had been made to secure the attendance of either witness. For these and other reasons, he advised that the statement should not be admitted into evidence, though the decision was one for the Panel.

4. The Panel accepted the advice of the Legal Assessor and the submissions of Ms McCullough and for those reasons decided that admission of the statement would be unfair to the Registrant. In the circumstances the Panel ruled that the statement should not be admitted, nor the derivative references to its content in the relevant pages of the main hearing bundle.

Admissions

5. On behalf of the Registrant, Ms McCullough made admissions as to particulars 1a) and 2 of the Allegation. The admissions in respect of both particulars concerned a single tablet of codeine.

Background

6. At the time to which the Allegation relates, the Registrant was employed by the East of England Ambulance Service NHS Trust (‘the Trust’) as a Newly Qualified Paramedic, based at March Ambulance Station. She began her employment with the Trust on 11 July 2011. The Registrant has been registered with the HCPC since 16 January 2018.

7. In July 2018, an investigation was commissioned for the Trust by LS, the Registrant’s Line Manager and Acting Senior Locality Manager for North Cambridgeshire. The investigation concerned an incident which is alleged to have occurred on 12 July 2018 involving the Registrant. It was alleged that on this date the Registrant had taken orally medication (codeine) belonging to a patient (‘the Patient’) without the permission of the Patient while attending on call in the Patient’s house.

8. The allegations were set out in a letter to the Registrant dated 13 July 2018. On 20 July 2018 CD was appointed to conduct the investigation. She was (and remains) a Leading Operations Manager for the West Norfolk Management Team of the Trust. CD conducted interviews and submitted an investigation report on 4 September 2018.

9. The Registrant had referred herself to the HCPC on 21 July 2018.

Decision on Facts

10. In reaching its decision on each of the factual particulars of the Allegation, the Panel considered all the evidence both oral and documentary and the admissions made on behalf of the Registrant. The Panel took account of the written testimonials and other matters relied on in support of the Registrant’s ‘good character’ in assessing her credibility as a witness and in consideration of propensity, i.e. as to whether it is likely or unlikely that she acted as alleged in particulars 1b) and 3 of the Allegation.

11. The Panel also took into account the submissions of Mr Tarbert and of Ms McCullough. It also received advice from the Legal Assessor, which it accepted.

12. The burden of proof lies with the HCPC, and the Panel considered the particulars of the Allegation against the civil standard of proof; that is to say, the balance of probabilities. In relation to the charge of dishonesty (including the facts alleged at particular 1b)), the Panel directed itself in accordance with the guidance in In re H (Minors) (Sexual Abuse: Standard of Proof) [1996] AC 563 at page 586 and bore in mind that an allegation of dishonesty should only be found proved on solid grounds based on cogent evidence and after a full consideration of the circumstances.

13. The Panel considered each particular of the Allegation separately, although it was convenient to set out together its findings with respect to particulars 1a) and 2.

14. In assessing the oral witness evidence, the Panel followed the guidance set out in the cases referred to by the Legal Assessor, including Suddock v NMC [2015] EWHC 3612 (Admin) at [59].

15. The Panel heard oral evidence from the following witnesses:

KW – a Senior Emergency Technician employed by the Trust;

DG –  Paramedic Practitioner and registered Paramedic;

CD – Leading Operations Manager employed by the Trust, registered Paramedic.

The Panel considered that KW was a credible and generally reliable witness. On the key matters in dispute her evidence was inherently probable and consistent, both with the evidence of DG and with previous statements she had made for the Trust at the time when the matter was reported and investigated. Although the Registrant did suggest in cross-examination that KW was motivated not to tell the truth in her evidence, the Panel did not accept that KW had been motivated to give her evidence other than honestly and to the best of her recollection. When she did not know the answer to a question, she said so.

16. The Panel considered DG to be a credible witness and her evidence to be reliable on the key points. Her testimony on those matters was in substance consistent with previous statements she had made to the Trust and consistent with the evidence of KW. She had no axe to grind towards the Registrant. In her witness statement she did differ with KW as to who found the medication in the Patient’s kitchen. The Panel considered it likely that it was KW who found the medication, which was the evidence of both KW and the Registrant. Overall, the Panel considered that DG was a careful witness whose evidence was considered and fitted with the inherent probabilities of the circumstances, as explained in more detail in the Panel’s findings.

17. CD gave evidence as to the investigation and produced relevant documents generated during that process. The Panel considered that CD’s evidence was helpful as far as it went.

18. The Panel considered the Registrant to be an unsatisfactory witness. She was articulate, but the Panel did not consider her evidence to be credible on the key points. Her evidence on those points was both improbable and contradicted in important respects contemporaneous statements she had made, which she attempted to explain away by giving unconvincing explanations to the Panel, variously that she had been in pain, acting in haste and in great distress, or had problems concerning predictive text on her phone. In reaching its conclusions on the credibility of the Registrant’s oral evidence, the Panel did take into account the positive written testimonial evidence relied on by her as to her honesty and integrity. However, in all the circumstances, the Panel found the Registrant to be an unreliable witness whose evidence on the key issues lacked credibility.

Particulars 1a) and 2 – Proved

1) Took Patient 1’s codeine tablet(s);

a) for your own personal use

2) Consumed Patient 1’s codeine tablet(s) whilst attending to them.
 
19. The following are the facts as found proved by the Panel. On 12 July 2018, KW was on an ambulance shift with the Registrant. Early that morning, they were called out to back up DG, who was on a call to an elderly lady who had been having difficulties with mobility, being unable to stand up. The premises was a small bungalow, with an ‘L’-shaped living room to the left of the hall giving onto a garden, with a kitchen at the end of the hall and an office and a bedroom to the right of the hall.

20. The visit lasted for between one and two hours. A medical assessment was carried out as to the Patient’s health and also an assessment of her mobility. She was unable to walk or self-care. The Patient was assessed as competent. She was adamant that she did not want to go to hospital. The Registrant carried out observations on the Patient in the living room and performed an ECG, which revealed an abnormality.

21. Enquiries were made as to what support the Patient might receive in the community to address her difficulties with mobility. These included a phone call made by DG to the local Joint Emergency Team (JET) community team from the office and a conversation took place by phone between the Registrant and a member of the Patient’s family, who said that there was no family support available.

22. Food was prepared for the Patient, her soiled clothes were washed in her washing machine and, with her permission, searches were made for her medication and for a previous ECG. These were found by KW in a kitchen cupboard. The crew needed to know what medication the Patient was taking and the whereabouts of any previous ECG in view of the abnormality shown on the ECG that had been carried out. KW called out that she had found what was needed and brought the ECG print-out into the living room and gave it to the Registrant, who was with the Patient. KW went over to the table where DG was writing up notes and told her that the medication that she had found was paracetamol and codeine. The Registrant told the Panel that she did hear KW say this.

23. The Registrant was suffering from bad toothache due to an infected tooth. Towards the end of the visit she went into the kitchen and took a 15 mg codeine tablet from a packet in a cupboard and placed it into her mouth. The Registrant was unaware that DG was standing behind her as she did so. The Registrant’s case is that the Patient had given her permission to do that during a conversation that took place earlier in the visit, not in the presence of either DG or KW. The HCPC’s case is that no such permission was given by the Patient. Shortly after she had taken the tablet, the Registrant went to the ambulance and then returned to the living room. During that time DG told KW what she had seen in the kitchen.

24. Following her return from the ambulance, the Registrant spoke to the Patient in the living room in the presence of DG and KW. She spoke to the Patient about having taken her medication and the Patient expressed her agreement to what the Registrant said. The Panel returns to this conversation later in its findings.

25. The JET team called back later towards the end of the visit, but they could not offer care for the Patient. By this time the Registrant had become concerned about the Patient’s ECG results in view of the readings on the previous ECG and she considered that the Patient required further assessment in hospital. The Patient was persuaded to attend hospital.

26. The Patient was conveyed by KW and the Registrant to Peterborough City Hospital by ambulance. DG attended other patients that day. The Registrant was driving and during the trip, which took between 30 and 45 minutes, she began to become concerned that she might have done something wrong, on her case, that she should not have taken the Patient’s medication, even though the Patient had given her permission to do so. The Registrant said, and the Panel accepted, that whilst the Patient was being admitted to hospital she tried unsuccessfully to call AP, a member of the management team, to discuss her concerns but she could not speak to him.

27. After the Patient had been admitted to the hospital, the Registrant and KW had a heated conversation in the ambulance while it was parked at the hospital. KW expressed her concerns about what the Registrant had done. They were instructed to move to a standby point about 15 minutes away, where the Registrant phoned and was able to speak to AP. She says that she told him that she had accepted a single 15 mg tablet of codeine from the Patient on whom they had just attended and that this was something she had never done before. Just before midday, the Registrant sent a text message to DG to say that she reported herself to the management, and a later one indicating that the Patient had given her permission to take the medication.

28. Messages were exchanged via Facebook between the Registrant and DG at intervals that afternoon. Most of the messages were from the Registrant and DG found them distracting, as she was attending patient visits. One of DG’s messages later that afternoon informed the Registrant that she would probably have to have a chat with the manager as well because she ‘was there’.

29. In one of the subsequent messages, the Registrant stated, ‘I hope you don’t think I was going to take the meds without asking? But you don’t know so I guess you wouldn’t have known. I would never do that.’ Towards the end of the afternoon, nearing the end of her shift, the Registrant received a phone call from Control to attend Peterborough Ambulance Station and was informed of allegations that had been made against her by DG and KW. At the depot the Registrant saw LS, who was angry with her and asked her if she had a drug addiction.

30. In the ambulance on the way back to the March depot, the Registrant prepared a short statement giving her version of events that had occurred in relation to her taking the codeine. The disciplinary enquiry took place soon afterwards, in which DG, KW and the Registrant were interviewed by CD; the Registrant on 31 July 2018 and DG and KW on 5 August 2018.

31. In those circumstances, the Panel found proved particulars 1a) and 2 of the Allegation. The Registrant’s admissions on those particulars accorded both with her own evidence and with that given on behalf of the HCPC.

Particular 1b) – Proved

1) Took Patient 1’s codeine tablet(s);

b) without their consent.
 
32. The evidence of DG was that she followed the Registrant into the kitchen from the living room. As indicated in the Panel’s findings set out above, when she walked into the kitchen DG was standing behind the Registrant. DG’s evidence was that she could see that one of the kitchen cupboards was open and she heard a rustling of what sounded to her like the blister pack of a strip of medication being opened. She then saw the motion of the Registrant’s arm moving up to her mouth. The Registrant still had her back to DG at that point, so DG did not see a tablet in her hand. She asked the Registrant what she was doing and when the Registrant turned around, she appeared surprised to see DG. The Registrant looked very shocked and surprised to see DG, put her finger to her lips, and said, “Shush, don’t tell anyone”. That confirmed to DG that the Registrant had taken and ingested the Patient’s medication.

33. The Registrant accepted that she was surprised by DG’s presence, but she disputed both that she had said those words and that she had put her fingers to her lips.

34. In examining her account of the incident, the Panel first considered the substance of the Registrant’s evidence on how she said she had secured the permission of the Patient before she took the codeine for her personal use. She was suffering from toothache during the visit. While conducting the ECG and other observations on the Patient, she was engaged in a conversation with the Patient. During that conversation, the Registrant was touching the side of her face and the Patient asked if she was okay. The Registrant said she had toothache. She discussed with the Patient the discomfort of toothache and there was also a brief discussion between them about pain relief. The Registrant told the Patient that she had already consumed Paracetamol and Ibuprofen, so could not take another dose for a while. The Patient told her that there was codeine in the kitchen cupboard and invited her to help herself to it. The Registrant’s evidence was that she declined the offer. It was quite some time later, when the toothache had become unbearable, that she went into the kitchen, opened the cupboard in question, and took the tablet.

35. Ms McCollough submitted that the context of the conversation was entirely plausible and that the content of the entire conversation as recalled by the Registrant was inherently plausible and indeed probable.

36. The Panel accepted that in the circumstances of what was quite an extended attendance at the Patient’s home, it was possible that the Registrant could have had a conversation without either DG or KW hearing it. But did she?

37. The Panel returns to the events that took place in the kitchen when the Registrant took the tablet and reacted as DG said she did but which the Registrant denies. The Registrant appeared to suggest that DG might have been mistaken, because her evidence was that she put the tablet straight onto her tooth and showed the Panel in her evidence how she would have done that. The Panel did not consider that this movement could be confused with what DG said she saw the Registrant doing with her fingers, and it does not explain what DG said she heard the Registrant say.

38. If, as the Registrant contended, she had obtained the Patient’s prior consent, the likelihood in the circumstances is that she would have told DG there and then in the kitchen that the Patient had told her to take the medication. However, the Registrant did not say that the Patient had said that.

39. There is no dispute that the Registrant spoke to the Patient soon after she had taken the medication. However, what she said was improbable if, as the Registrant asserts, the Patient had already given her permission to take some of her codeine.

40. The Panel accepted DG’s evidence that the Registrant said, “I hope you don’t mind but I’ve taken some of your codeine for my tooth, that’s okay isn’t it?” and that after a little hesitation, the Patient responded, “Oh, yes”. The Registrant’s explanation was that she was trying to show DG and KW by this conversation that the Patient had already consented. But again, if that had been her concern, the probability is that she would have said so straightaway in the kitchen. Further, the words used do not fit that of ‘reiteration’, to use the word adopted by the Registrant in her evidence. Rather, “I hope you don’t mind…” accords with no previous permission having been given.

41. In the circumstances, the Panel accepted DG’s evidence as to what happened and what was said by the Registrant in the kitchen. It did not accept the Registrant’s account insofar as it differed from DG’s evidence.

42. Another explanation given by the Registrant was in her statement made while driving back to the depot in March, in which she stated, ‘“I hope you don’t mind that I took one of your pain killer [sic] for my toothache” as I was unsure I had stated the reason prior…’. However, on the Registrant’s evidence her conversation with the Patient had been based on her toothache, her disclosure of it, and the Patient’s offer.

43. The Registrant’s account in her evidence also did not fit with the content of messages she sent to DG, in which she stated what she had told AP: ‘I know [sic] understand you thought I didn’t ask before taking it don’t you bless you. You only heard me say I hope you don’t mind me take [sic] it for my tooth ache?’. Again, asking for permission is a very different explanation to that given by the Registrant in evidence (and elsewhere in the documents) that the Patient had offered the medication to her.

44. This inconsistency was also present in the statement the Registrant made later on 12 July 2018 while driving back to the ambulance depot. She stated:

‘… after taking paracetamol and ibuprofen earlier and still being in the allotted time frames and not being able to take more I asked the patient if I could kindly take one of hers.’

45. When cross-examined about the inconsistency arising from that statement and from the messages, the Registrant gave various explanations. Predictive text was apparently a problem, but the Panel could not understand why it would mean she would refer to asking if she could take the medication as opposed to the Patient having offered it to her. The inconsistencies arising from the written statement in particular were said to be the result of preparing the statement in a great hurry, when greatly distressed by how LS had spoken to her and what he had said, asking her if she had a drug addiction and, as she put it in her written reflections, ‘being made to seem like a hardened criminal.’ The Panel found these explanations of the inconsistencies between the two versions to be implausible.

46. In those circumstances, the Panel concluded that the Patient did not give the Registrant her permission to take the tablet, either in the conversation which the Registrant says took place or at any other time before the Registrant took the tablet. It concluded that the Registrant took the Patient’s codeine tablet without her consent and, therefore, the Panel found particular 1b) to be proved.
 
Particular 3

3) Your conduct at particular 1b) above was dishonest.

47. The correct approach to dishonesty in law was authoritatively stated by the Supreme Court in Ivey v Genting [2017] UKSC 67. Lord Hughes, giving the judgment of the court, stated at [74]:

‘…. When dishonesty is in question the fact-finding tribunal must first ascertain (subjectively) the actual state of the individual’s knowledge or belief as to the facts. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held. When once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the (objective) standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he has done is, by those standards, dishonest.’

48. The Registrant’s evidence was to the effect that her state of knowledge or belief as to the facts was that the Patient had consented to her taking the medication before she removed it from the cupboard for her personal use. The Panel rejected her case and evidence that prior consent was given. The Registrant maintained, in various formulations, from shortly after she left the Patient’s home to her evidence to the Panel today, over two and a half years later, that she took the Patient’s codeine medication with the Patient’s consent. The Panel concluded that the Registrant made a deliberate decision to take the tablet which did not belong to her for her personal use, without asking for permission and in the belief that she would not be seen taking the medication.

49. In those circumstances, the Panel concluded that the Registrant did not have the subjective belief she claimed to have had in her evidence to the Panel. Instead, she took and ingested the codeine without the Patient’s consent in the belief that she would not be discovered doing so.

50. In reaching those conclusions, the Panel did also bear in mind that the Registrant was suffering from severe toothache, and also the assertions in her written reflections and evidence that her decision-making on the day was affected by the pain she was experiencing.

51. However, she had the presence of mind to self-report to her management in what the Panel considered to have been an attempt to get her version of events reported first, to make it appear that the Patient had consented before she took the codeine and that the concerns related solely to taking prescription medication while on call, albeit a matter that would still be serious. Therefore, the Panel concluded that the Registrant knew she had not obtained the Patient’s consent before she took the codeine tablet and that she had taken the tablet for her personal use without the Patient’s consent.

52. In the circumstances, ordinary decent people would consider that taking a person’s medication for their personal use and without their consent in the circumstances, as the Panel found them to be, was dishonest. This was particularly so where the person concerned was a Paramedic and the medication had been taken from a patient during a home attendance.
 
Decision on Grounds

53. Mr Tarbert submitted that the facts, if proved, established misconduct. They constituted serious departures from professional standards. The Registrant’s conduct had, he submitted, brought the profession into disrepute. Ms McCullough did not contend that, if proved, dishonesty would not amount to misconduct.

54. The Panel directed itself in accordance with the advice from the Legal Assessor. In summary, the facts proved would amount to the statutory ground of misconduct if they establish conduct which fell short of what would have been proper in the circumstances, including the requirements of rules and standards ordinarily required to be followed and if, in context, the conduct was sufficiently serious: see Roylance v GMC [2000] 1 AC 311 and Nandi v GMC [2004] EWHC 2317 (Admin).

55. The Registrant’s conduct constituted a number of failures to comply with professional standards, as set out below.

The HCPC Standards of Conduct, Performance and Ethics (January 2016)

Standard 1 - Promote and protect the interests of service users.

Standard 1.7 – You must keep your relationships with service users and carers professional.

Standard 6 - Manage risk

Standard 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.

Standard 9 - Be honest and trustworthy

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

The Standards of Proficiency for Paramedics (September 2014)

Standard 2 – Be able to practise within the legal and ethical boundaries of their profession.

2.1 – understand the need to act in the best interests of service users at all times;

2.4 – recognise that relationships with service users should be based on mutual respect and trust, […..].

Standard 3 – be able to maintain fitness to practise.

3.1 – understand the need to maintain high standards of personal and professional conduct.

56. In taking medication belonging to the Patient without her consent, the Registrant broke the trust of an elderly service user with limited physical mobility who permitted the Registrant to enter her home for the purpose of attending to the Patient’s medical needs. In view of those matters, the failures to comply with professional standards as set out above and in all the circumstances, the Registrant’s conduct was deplorable, serious, and constituted misconduct.

Decision on Impairment 

57. Mr Tarbert submitted that the Registrant’s fitness to practise is impaired by reference to both the ‘personal’ element and ‘public’ element set out and explained in the HCPTS Practice Note “Fitness to Practise Impairment”.

58. He submitted that the apparent remorse and insight shown in the Registrant’s evidence and written reflections must be balanced against her repeated claims from the outset that she had obtained the consent of the Patient. He submitted that the Registrant’s attitude to the events in dispute was relevant in assessing impairment: Nicholas-Pillai v. General Medical Council [2009] EWHC 1048 at [19].

59. Mr Tarbert submitted that, by maintaining that she had the consent of the Patient, the Registrant refused to acknowledge fully the extent of her misconduct and attempted to minimise her wrongdoing. In those circumstances, he submitted that the Panel may consider that there remains a risk of repetition of similar conduct in the future.

60. As to the ‘public’ element, Mr Tarbert relied on the need to declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession, in view of the considerations set out in the judgment of Mrs Justice Cox in CHRE v NMC & Grant [2011] EWHC 927 (Admin). He submitted that every patient is entitled to trust that when a Paramedic enters their home, the focus will be on their care and wellbeing. On this occasion, however, the Registrant broke that trust by taking prescribed medication that did not belong to her without the Patient’s consent. Not only did that conduct breach a fundamental tenet of the profession, but it was also dishonest and likely to bring the profession into disrepute.

61. Ms McCullough submitted that the facts, if proved, constituted a single instance in an otherwise unblemished career. She was a dedicated, hard-working, and competent practitioner as shown by the testimonials and the Continuing Professional Development (CPD) she had undertaken. The Registrant had made substantial steps in trying to rebuild her approach to practice and had shown considerable insight and progress, despite very difficult personal circumstances. Her fitness to practise is not currently impaired, she submitted.

62. In making its decision, the Panel took into account its findings of fact and all the evidence so far as relevant at this stage of the hearing. The Panel also took into account all the submissions of Counsel for each party.

63. The Panel also received advice from the Legal Assessor, which it accepted. That advice included reference to the considerations set out in CHRE v NMC & Grant (see citation above), at [65] - [76] and the correct approach to current impairment in the context of dishonesty as explained in the authorities set out in PSA v GMC & Hilton [2019] EWHC 1638 (Admin) at [85] - [86].

64. The Panel’s conclusions on the issue of impairment were as follows. In considering whether or not the Registrant’s fitness to practise is currently impaired, the Panel examined the ‘personal’ element first.

65. Dishonesty is difficult to remediate, though not impossible. However, more than two and a half years after her dishonest conduct the Registrant has persisted with her position that she obtained the prior consent of the Patient before she took the Patient’s medication, which she must know is untrue. The question of whether or not the Patient had given her consent was in issue on and from the date of the incident, on 12 July 2018. The Registrant’s evidence to this Panel was itself dishonest in all the circumstances, and designed to mislead the Panel.

66. The Registrant has shown insight into the aspect of the misconduct that related to her working whilst unwell and in circumstances where difficulties in her personal life might affect her professional decision-making and performance as a Newly Qualified Paramedic.

67. However, the Registrant’s written reflections and evidence displayed an attempt to downplay what she had done by framing much of her reflections as an exercise in understanding the effects of pain on decision-making and the effect which her actions had or may have had on others and on public confidence in the profession, but not on the basis that she had in fact acted dishonestly.

68. Her evidence as a whole displayed a failure to accept responsibility for her misconduct, with an unwarranted shifting of blame onto others, particularly KW. Her reflections were overly self-focused and did not recognise the breach of trust which she committed by taking the Patient’s medication without her consent.

69. Although the Registrant asserted that she would never take a Patient’s medication again, the Panel was not convinced by that assurance. In sum, her attitude of continuing to dismiss the gravest of the allegations against her when she knew they were true, and her attempts to downplay her misconduct by reflecting on only the less serious aspects of her misconduct on the day, led the Panel to conclude that she has shown a serious lack of insight and has not sufficiently remediated her misconduct, with the result that there remains a risk of repetition of the misconduct.

70. The ‘public’ element requires proper consideration and due weight to be given to the need to maintain public confidence in the profession and to declare and uphold standards among members of the profession.

71. The Panel took into account the difficult circumstances in which the Registrant found herself on the day, and her otherwise unblemished practice record, albeit she was only first registered as a Paramedic in January 2018. It took into account that she is a hard-working, dedicated, and otherwise competent Paramedic. In sum, the Panel bore in mind all the matters advanced on the Registrant’s behalf both by her and by Ms McCullough.

72. However, members of the public aware of the circumstances of this case, including the matters advanced by the Registrant and Ms McCullough, would be concerned if a finding of impaired fitness to practise were not made in view of both the circumstances and gravity of the Registrant’s misconduct.

73. The Panel also bore in mind the considerations identified by Dame Janet Smith from paragraph 25.67 of her Fifth Shipman Report in relation to the question of impaired fitness to practise and set out in CHRE v NMC & Grant at [76].

‘Do our findings of fact in respect of the doctor's misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he

a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or

d. has in the past acted dishonestly and/or is liable to act dishonestly in the future.’

72. In the circumstances and in view of the risk of repetition of her misconduct, the Panel considered that by her actions the Registrant has brought the Paramedic profession into disrepute and is liable to do so again. She has breached fundamental tenets of the profession (Standard 2 of the Standards of Proficiency for Paramedics and paragraphs 1 and 9.1 of the HCPC’s Standards of Conduct, Performance and Ethics) and is liable to do so in the future. She also acted dishonestly and is liable to act dishonestly again.

73. For all those reasons, the Panel decided that the Registrant’s fitness to practise is impaired.

Decision on Sanction

74. Ms Sheridan represented the HCPC at this final stage of the hearing. She referred to the HCPC Sanctions Policy (‘SP’) and to the purpose of sanctions. She invited the Panel to consider each available sanction in ascending order of seriousness. She informed the Panel that there were no previous fitness to practise findings against the Registrant but pointed to a number of what she submitted to be aggravating factors and to paragraphs 45 and 46 of the SP (breach of trust). She invited the Panel to give full consideration to the dishonesty found proved, with reference to paragraphs 57 and 58 of the SP in particular.

75. Ms Sheridan stated that it was not the role of the HCPC to bid for a particular sanction, but she referred to paragraphs of the SP that she submitted may be relevant to the available sanctions.

76. Ms McCullough stated that the Registrant was devastated by the Panel’s findings. Ms McCullough relied on all the mitigating factors that were placed in evidence at the first stage of the proceedings and pointed out the present stresses and difficulties faced by the Registrant. However, Ms McCullough accepted that the Panel’s findings are serious and acknowledged its conclusions as to limited insight and lack of remediation on the part of the Registrant.

77. Ms McCullough stated that the fitness to practise process had been a salutary experience for the Registrant. There have been no previous adverse findings made in respect of the Registrant’s fitness to practise, either in the last two and a half years or at all. The character references attested to the quality of the Registrant’s work as a Paramedic. A sanction of suspension or Striking Off would result in her losing her job. However, the Registrant presented a sufficiently low risk of repeating the misconduct that in all the circumstances a sanction less than suspension would suffice.

78. The Panel took into account the relevant parts of the SP in reaching its decision, its earlier findings, and the evidence before it. No further oral or documentary evidence was relied on at this stage. The Panel also took into account the submissions of Ms Sheridan and Ms McCullough and accepted the advice given by the Legal Assessor.

79. The primary function of any sanction is to protect the public and the wider public interest. Sanctions are not intended to punish registrants, but instead to ensure that the public is protected. Inevitably, a sanction may be punitive in effect, but should not be imposed simply for that purpose. In deciding what, if any, sanction to impose, a panel is required to apply the principle of proportionality.

80. In assessing the seriousness of the misconduct, the Panel took into account the following as aggravating factors. The dishonesty involved a breach of trust towards an elderly and vulnerable patient in her own home. The Registrant also placed a colleague in a difficult professional position by inviting DG not to tell anyone that she had taken codeine belonging to the Patient.

81. The Registrant has not shown remorse and made no apology for her misconduct. She failed to accept responsibility for the misconduct, blaming others in the evidence she gave. In her reflections, she attempted to downplay the seriousness of her actions by reflecting on only the less serious aspects of her misconduct. She was overly self-focused in her reflections and persisted in what she must have known to be an untrue version of events and attempted to mislead the Panel in giving her evidence. The Panel also considered the Registrant’s serious lack of insight to be an aggravating factor. Further, although dishonesty is difficult to remediate, the Registrant has taken few steps towards remediation of the misconduct.

82. The Panel took into account the following mitigating factors:

• The dishonest conduct concerned a single incident;

• The Registrant did admit some of the facts alleged and self-referred both to her employer and to the HCPC;

• The difficult personal circumstances in which the Registrant found herself at the time of the misconduct;

• The Registrant has been working hard as a Paramedic, and is dedicated and competent in her work, as shown by the character references;

• She did show some insight into aspects of her misconduct, with reference to the importance of not working while unwell, for example.

83. In making an overall assessment of the seriousness of the misconduct, the Panel bore in mind that dishonesty undermines the public’s confidence in the profession. The Registrant has brought the profession into disrepute by her misconduct (see paragraph 72 above). Although the misconduct did not endanger patient safety and concerned a single incident, the Registrant’s dishonesty was serious, particularly as it was accompanied by a breach of trust towards a vulnerable patient.

84. The Panel bore in mind that the protection of the public includes protection against any risks the Registrant might pose to those who use or need her services, the need to maintain public confidence in the profession and its regulation, and the importance of a deterrent effect on other registrants.

85. The Panel considered the available sanctions in ascending order of seriousness. In view of the nature and seriousness of the Panel’s findings, this was clearly not a case where ‘no action’ would be appropriate.

86. The SP states the following in relation to the sanction of a Caution:

‘99. A caution order can be imposed for any period between one and five years. It will appear on the Register, but will not restrict a registrant’s ability to practise. …

100. Where a panel finds that a registrant’s fitness to practise is impaired, the least restrictive sanction that can be applied is a caution order.

101. 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.

102. A caution order should be considered in cases where the nature of the allegations mean that meaningful practice restrictions cannot be imposed, but a suspension of practice order would be disproportionate. In these cases, panels should provide a clear explanation of why it has chosen a non-restrictive sanction, even though the panel may have found there to be a risk of repetition (albeit low).’

87. The Panel referred to the considerations in paragraph 101 of the SP. Although the dishonesty concerned a single incident, it was serious and not ‘relatively minor in nature’. The Panel referred again to the Registrant’s serious lack of insight and insufficient remediation of her misconduct.

88.  The Panel also decided that there is a risk of repetition of the misconduct. It referred in particular to the Registrant’s continued dismissal of the gravest of the allegations against her when she knew them to be true, her attempts to downplay the misconduct by reflecting on only its less serious aspects, and her attempts to mislead the Panel: see paragraphs 65 and 69 above.

89. Ms McCullough’s submission that the risk of repetition is low was not accepted by the Panel. In all the circumstances, there is a real and significant risk of repetition in view of all the considerations set out in paragraphs 65-69 above.

90. The sanction of a Caution would not protect the public from that risk of repetition of the misconduct. A Caution would also not meet the seriousness of the case. The Registrant brought the profession into disrepute by her actions, having acted dishonestly and betraying the trust of a vulnerable patient. Therefore, a Caution Order would not be sufficient either to maintain public confidence in the profession or to provide a sufficient deterrent effect.

91. The Panel did also bear in mind at this stage of its decision-making that Conditions of Practice would not be appropriate, for the reasons given below. Therefore, it also considered whether or not a sanction of suspension would be disproportionate. As set out in more detail later in this decision, despite all the points advanced in favour of the Registrant and the effect of a Suspension Order on her, the Panel concluded that a Suspension Order is necessary to guard against the risk of repetition of the misconduct and to meet the demands of the wider public interest. Hence, a Suspension Order would not be disproportionate in the circumstances.

92. As indicated, Conditions of Practice would not be an appropriate sanction in this case given the nature of the misconduct. Conditions must be appropriate to remedy the concerns raised (paragraph 111 of the SP). Conditions of Practice are not appropriate to the risk of repetition presented by the misconduct in this case, which included dishonesty.

93. Further, the Panel was not satisfied that the Registrant would be likely to comply with any conditions had they been capable of being formulated. Therefore, a Conditions of Practice Order would not be an adequate response to the impairment.

94. In considering whether a Suspension Order would meet the demands of the case, the Panel weighed the aggravating and mitigating factors and also the potential effects of such an order on the Registrant. The Panel had regard to the present difficulties faced by the Registrant but its conclusion was that suspension is the appropriate means of protecting the public from the real and substantial risk of a repetition of the misconduct by the Registrant.

95. A Suspension Order is also sufficient to meet the demands of the wider public interest. Though serious for all the reasons set out above, the misconduct did not endanger patient safety and the Registrant’s dishonesty was not at the most serious end of the scale. An appropriate period of suspension would maintain public confidence in the profession and its regulation and provide a deterrent to other registrants who might engage in similar conduct.

96. While providing the necessary protection to the public, a Suspension Order will also give the Registrant a potential opportunity to remedy the misconduct. In reaching that conclusion the Panel took into account all the mitigating factors in the case and the principle of proportionality. The Panel had in mind the potential effect on the Registrant of a Suspension Order, but it is the appropriate sanction to provide the requisite protection of the public and the wider public interest.

97.  In reaching that conclusion, the Panel gave serious consideration as to whether or not a Striking Off Order would be the appropriate response and paid regard to the considerations set out in paragraphs 121, 130 and 131 of the SP in particular.

98. Although the misconduct involved dishonesty and was serious and the Registrant has shown a serious lack of insight and her remediation is far from complete, the Panel was unable to conclude at this stage that she is unwilling to resolve matters.

99. For the reasons already given, the Panel concluded that the nature and gravity of the circumstances are such that a Suspension Order would be a sufficient sanction and therefore, in all the circumstances, a Striking Off Order would be unnecessary and disproportionate.

100. The Panel decided that a period of 9 months would suffice as the appropriate period of suspension. A substantial period of suspension is required to reflect the seriousness of the misconduct. A longer period is not necessary. 9 months will provide the Registrant time to reflect further on her misconduct and give her an opportunity to demonstrate at a future review hearing that she is fit to practise.

101. For those reasons, the Panel decided that a Suspension Order for a period of 9 months is the appropriate sanction.

Order

That the Registrar is directed to suspend the registration of Miss Jemma J Taylor for a period of 9 months from the date this Order comes into effect.

This Order will be reviewed before its expiry.

Notes

Interim Order

1. Ms Sheridan applied for an Interim Suspension Order. She submitted that in view of the Panel’s decision, such an order was necessary for the protection of the public and was otherwise in the public interest. Ms McCullough opposed the application. She submitted that an Interim Order would be disproportionate in all the circumstances. The Panel accepted the advice given by the Legal Assessor.

2. The legislation has been drafted so that a Suspension Order does not take effect immediately but 28 days after service of the Order and, if the Registrant were to appeal, until after disposal of the appeal.

3. In this case, the only realistic possibility is an Interim Suspension Order because an Interim Conditions of Practice Order by its nature could not address any risk that might justify an Interim Order.

4. The Panel was satisfied that an Interim Order is necessary for the protection of the public, to protect patients from the risk of an abuse of the trust placed by them in the Registrant as a Paramedic.

5. The Panel considered that an Interim Order was also required in the wider public interest. Public confidence in the profession and its regulation is likely to be seriously damaged if the Registrant were to continue to hold unrestricted registration in the interim period. A reasonable member of the public informed of the circumstances of this case and having considered the Panel’s decision would be concerned if an Interim Order were not made in view of the Registrant’s impaired fitness to practise, the seriousness of the misconduct, and the Panel’s decision on the issue of sanction.

6. In deciding whether or not an order should be made in this case, the Panel balanced the need to protect the public and the public interest against the consequences of an order for the Registrant. It also considered whether the consequences of making the order would be proportionate to the risks to the public and the public interest.

7. The Panel also took into account that an Interim Suspension Order may last significantly longer than the substantive order in view of the time it would probably take for an appeal to be heard in the current circumstances, affected by Covid-19.

8. Despite the consequences for the Registrant of an Interim Order and its potential duration, the Panel decided that an Interim Suspension Order would not be disproportionate in the circumstances of this case.

9. Therefore, the Panel decided that an Interim Suspension Order is required. A period of 18 months is the appropriate period for the Interim Order, particularly in view of the likely time for an appeal to be heard and disposed of in the current circumstances.

10. The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest. 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 Jemma J Taylor

Date Panel Hearing type Outcomes / Status
06/04/2021 Conduct and Competence Committee Final Hearing Suspended
01/03/2021 Conduct and Competence Committee Final Hearing Adjourned part heard