Lynne Robertson

Profession: Paramedic

Registration Number: PA44416

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 30/11/2021 End: 17:00 03/12/2021

Location: Virtual Hearing via Video Conference

Panel: Conduct and Competence Committee
Outcome: Caution

Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via tsteam@hcpts-uk.org or +44 (0)808 164 3084 if you require any further information.

 

Allegation

As Amended
As a registered Paramedic (PA44416) your fitness to practise is impaired by reason of misconduct. In that:

1. On 16 September 2019, whilst employed as a Paramedic for the Scottish Ambulance Service you:
a) requested that the nightshift ambulance crew attend Patient A when the incident had already been allocated to your crew by the Ambulance Control Centre (ACC).
b) In respect of the nightshift crew, you advised the ACC “they’re booking onto the vehicle at the minute”, or words to that effect, when you were not with the nightshift crew.
c) In respect of the nightshift crew, you stated to the ACC “they’re leaving now” or words to that effect, when this was not the case.
d) You instructed and/or told Colleague 1, who was driving the emergency vehicle to attend Patient A, “let’s go back” or words to that effect.
e) You returned to the ambulance station without authorisation from ACC to do so.
f) You requested that the nightshift crew attend Patient A when they were not ready to do so.
g) Did not inform the ACC that you were returning to the ambulance station.

2. Your actions at paragraph 1 (a) – (g) were not in the best interests of Patient A in that they delayed the emergency response.

3. Your actions at paragraph 1 (b) and 1 (c) were dishonest.

4. Your actions set out at paragraphs 1 to 3 constitute misconduct.

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

Finding

Preliminary Matters
Amendment of the Allegation
1. Mr Bridges made an application to amend the Allegation. He submitted that the amendments were minor and better particularised the Allegation. There was no prejudice to Ms Robertson because she received notification of the proposed amendments on 22 March 2021.

2. Mr Lawson did not oppose the application.

3. The Legal Assessor advised that the Panel may amend the Allegation provided it does not create any unfairness for the Registrant and the amendment is appropriate.

4. The Panel decided that the Registrant has had ample notice of the proposed amendments and that the amendments would not prejudice her. The amendments were minor and appropriate. The Panel therefore agreed to amend the Allegation.

Background
5. The Registrant is a Paramedic working in frontline emergency services within Leven Ambulance Station. The Registrant registered with the HCPC as a Paramedic in or around January 2018 after she obtained her professional qualification. She has been employed by Scottish Ambulance Service (SAS) since February 2005. She worked initially as a patient transport driver, and then as an ambulance technician until she qualified as a Paramedic in 2018.

6. On 17 September 2019, SB (Area Service Manager) received an e-mail from Ambulance Control Centre (ACC) logging a concern about the response time to an incident which had occurred in the evening on 16 September 2019. The incident was categorised as a Code Purple which is the highest category of call, involving an immediate threat to life. The call on 16 September 2019 involved a cardiac arrest. The expectation is that SAS would endeavour to attend this acuity of call within 8 minutes. A single crew rapid response (Leven 3013) had been dispatched to the incident and ACC also allocated vehicle Leven 5040 crewed by the Registrant and Colleague 1, an Ambulance Technician, as the back-up crew. The single responder would not be able to initiate advanced life support until the back-up crew arrived.

7. ACC reported to SB that there had been a significant delay in the response of the Registrant and Colleague 1. On 17 September 2019, SB also received a message from Colleague 1, who wished to speak to someone about the incident. Following informal meetings with the Registrant and Colleague 1 on 17 September 2019, SB was requested to investigate the incident under the SAS Management of Employee Conduct Policy. SB carried out the investigation and conducted interviews with a number of SAS employees. She conducted an interview with Colleague 3 who was a witness of events at Leven Station.

8. The Registrant continued with her duties as a Paramedic during the investigation and she remains employed as a paramedic by SAS.

Decision on Facts
9. The Panel read documentation contained in the HCPC Final Hearing Bundle and the Registrant’s bundle. It heard oral evidence from the HCPC witnesses SB, Colleague 1 and Colleague 3. It heard oral evidence from the Registrant and from a character witness, DH, who is the Registrant’s current shift partner.

10. The Panel heard submissions from Mr Bridges on behalf of the HCPC and Mr Lawson on behalf of the Registrant.

11. The Panel accepted the advice of the Legal Assessor. In respect of the facts, the Panel understood that the burden of proving each individual particular is on the HCPC and that the standard of proof is the civil standard, that it is more likely than not that the alleged incident occurred.

12. The Panel accepted the advice of the Legal Assessor in relation to the test for dishonesty as outlined in the cases of Ivey v Genting Casinos (UK) Ltd [2017] UKSC67 and Professional Standards Authority v GDC and Amir [2021] EWHC 3230 and took into account the guidance in the HCPTS Practice Note “Making decisions on a registrant’s state of mind”.

Particular 1(a) – found proved
13. The Panel found particular 1(a) proved by the Registrant’s admission, the evidence of Colleague 1, and the documentary evidence.

14. On 16 September 2019 the Registrant and her shift partner Colleague 1, working ambulance Leven 5040, were due to end their shift at 19:00. There was a custom and practice at Leven Ambulance Station that the night shift crew, who were due to start their shift at 19:00, would arrive at least fifteen minutes early. The nightshift crew would accept calls, including Code Purple calls, which came into the station during the period prior to the start of their shift to enable to early shift to finish on time. On 16 September 2019, the nightshift crew included Colleagues 3 and 4.

15. At 18.47 ACC sent an emergency call notification to Leven 5040 while the Registrant was in the bathroom. This was a Code Purple. Patient A, who was eighty years old, had fallen downstairs and was in cardiac arrest. Colleague 1 accepted this call from ACC and moved the ambulance forward in preparation for leaving the yard when the Registrant returned. Colleague 3 overhead the audible alert and spoke on two occasions to Colleague 1, inviting her to speak to ACC and tell them that the night shift crew would take the job. Colleague 1 replied to Colleague 3 that it was a Code Purple call. Colleague 1 believed that the Registrant would return quickly from the bathroom and, entirely appropriately, she decided not to accept Colleague 3’s offer as she did not consider that they were available and ready to go.

16. The Registrant was alerted to the emergency call by another colleague; she returned from the bathroom and entered Leven 5040. As she did so, Colleague 3 spoke to her and said “contact ACC and tell them that we will take the job”. Leven 5040 then left the ambulance yard driven by Colleague 1, in response to the emergency under blue lights.

17. While Colleague 1 drove Leven 5040 the Registrant contacted ACC on the radio. This (2 wav) call was recorded:

“-5040 from East Amb, pass on your message
-Control, can you send the night shift on this arrest, over
-If the night shift can go, it’s a Code Purple
-Yeah that’s a yes yes, over
-Are they going in this vehicle?
-Er, no they’ll be on the other vehicle, over
-Roger
-Thanks very much,
-Do you know the call sign? We don’t have them on the system..”

18. The call was then cut off. This was a request made by the Registrant for the Code Purple call which had been allocated to Leven 5040 to be allocated to the night shift.

Particular 1(b) – found not proved
19. The Panel found particular 1(b) not proved.

20. ACC made a call back to Leven 5040 which took place after the 2 wav call had been cut off. This 3 wav call was recorded:

“-5040 from EAST Amb, I don’t have the night shift on the vehicle, you’ll just need to attend this one I’m afraid.
-They’re booking on at the vehicle at the minute, over, it’s the one Colleague 5 and Colleague 6 are on, over
-If they want to go on your vehicle, they can go, but we don’t have them on and CPR is ongoing, it’s a purple call and we need you to go out ASAP
-OK, they’re leaving it now, over”

21. The Registrant admits the content of this call and that she said “they’re booking onto the vehicle at the minute”, but she told the Panel that she was with the nightshift crew at the time this conversation took place.

22. In her witness statement and her oral evidence to the Panel, Colleague 1 did not have a good recollection of the timing of the calls between the Registrant and ACC. She stated that she could not remember how many calls were made by the Registrant. Colleague 1 was interviewed by SB on 14 November 2019 approximately two months after the incident. In this interview SB played tapes of the two calls between the Registrant and ACC and asked Colleague 1 where the vehicle was. Colleague 1 was unable to recall but said that the calls happened while Leven 5040 was responding to the incident.

23. Colleague 1’s concern in reporting the incident was that she had been wrongly instructed by the Registrant to return to the Ambulance Station. She did not suggest that the Registrant had lied to ACC in making false statements about the nightshift crew.

24. The Panel found that there was a lack of specificity in Colleague 1’s evidence as to the location of the vehicle at the time of the calls, whereas the Registrant has been consistent in stating that this (3 wav) call took place when the Leven 5040 had returned to station. The Registrant corrected interview notes dated 14 November 2021 describing the sequence of events and she was specific that the 3 wav call back from ACC in which she had said “they’re booking onto the vehicle at the minute” took place when Leven 5040 was in the yard and she had asked Colleague 3 to take the job.

25. Mr Bridges submitted that the Registrant’s account was not credible because of the timeline of events. He referred the Panel to the Sequence of Events document, a contemporaneous document which records ACC’s contact with ambulances and emergency calls. He submitted that the timeline demonstrated by this document established that the Registrant could not have returned to the station by the time she received the call from ACC, which he submitted took place at 18.50.00. The Panel gave careful consideration to the Sequence of Events document, but decided that it could give little weight to it. The document was produced by SB and included in her investigation, but, as she explained and fully acknowledged in her evidence, she does not have expertise in interpreting such documents. Her evidence was that it was unclear exactly what time Leven 5040 returned back to the ambulance station. There was no tracking documentation for Leven 5040 to correlate with the Sequence of Events document and there was no explanation of the Sequence of Events document from an ACC witness. The Sequence of Events document included a large number of calls that appeared to be unrelated to Leven 5040. The Panel found insufficient evidence for it to conclude that the Registrant could not have returned to the station by the time she made the statement to ACC “they’re booking onto the vehicle at the minute”.

26. The Panel considered that the Registrant’s good character supported her credibility in relation to this part of her evidence, particularly because this particular involves a related allegation of dishonesty.

27. The Registrant’s credibility was also supported by the evidence of Colleague 3. While Colleague 3 was not a witness to the relevant call, he confirmed that the Registrant spoke to him when Leven 5040 returned to the yard. He immediately agreed to take the call and made preparations to leave. In that context, the Registrant made an assumption that the nightshift were booking onto their vehicle and ready to leave.

28. There was also some support for the Registrant’s credibility in the content of the call, because ACC concluded the call stating “we need you to go out ASAP”, which appears to indicate that Leven 5040 was at the ambulance station.

29. The Panel concluded that the HCPC has not discharged the burden of proof in relation to particular 1(b).

Particular 1(c) – found not proved
30. The Panel found particular 1(c) not proved. The HCPC has proved that the Registrant stated to ACC “they’re leaving now”, or words to that effect in the wav 3 call, but the HCPC has not proved that the nightshift were not leaving.

31. In his oral evidence Colleague 3 told the Panel that the nightshift crew were ready to accept the call. He explained that the crew does not need to book on to the ambulance before leaving the ambulance station and that the booking on process can take place when the ambulance is on route to the call.

32. This evidence is consistent with the Registrant’s evidence that she saw Colleague 3 enter the driver’s side of the ambulance and that this was why she said to ACC “they’re leaving now”.

33. For the reasons explained above, the Panel gave little weight to the Sequence of Events document, and did not conclude that the Registrant was still on route when she said to ACC “they’re leaving now” or words to that effect.

34. The Panel found that the HCPC has not discharged the burden of proof.

Particular 1(d) – found proved
35. The Panel found particular 1(d) proved by the Registrant’s admission, the evidence of Colleague 1, and the documentary evidence.

36. The Registrant was the more senior crew member. After the 2 wav call she gave an instruction to Colleague 1 to return to the ambulance station.

Particular 1(e) – found proved
37. The Panel found particular 1(e) proved by the evidence of SB, the evidence of Colleague 1, and the documentary evidence. The Registrant does not admit this particular, but she accepts, with the benefit of hindsight, that she did not have clear authorisation.

38. The context of the 2 wav call was that Leven 5040 was responding to a life threatening Code Purple call and was on route to that call. All paramedics responding to such a call would require an unambiguous “stand down” instruction from ACC to cease their response. The conversation with ACC in 2 wav was not a “stand down”. It was an unfinished conversation, cut off before it could be completed. No instruction was given by ACC and the Registrant did not have authorisation from ACC to return to the station.

Particular 1(f) - found proved
39. The Panel found particular 1(f) not proved.

40. The Registrant made the request that the night crew attend Patient A after Colleague 3 had offered to take the job and had invited her to contact ACC to make that request. Although the night crew had not completed all their preparations for the shift, Colleague 3 explained that it was not unusual for the night crew to take an emergency call in these circumstances. The night crew may sometimes take a call and complete the booking on process whilst on route to the call, as happened in the case of Patient A.

Particular 1(g) – found proved
41. The Panel found particular 1(g) proved by the Registrant’s admission, and the documentary evidence. The 2 wav call records the Registrant’s conversation with ACC. She did not inform ACC that Leven 5040 was returning to the ambulance station.

Particular 2 – found proved
42. The Panel found particular 2 proved by the evidence of SB, Colleague 1, and the documentary evidence.

43. If the Registrant had accepted the Code Purple call and had not acted as in paragraphs 1(a), 1(d), 1(e), and 1(g), there would have been a timely and appropriate paramedic response to the life threatening emergency. The Registrant’s decision to return to the station while on route to an emergency call delayed the emergency response.

44. Any delay in response to such a serious and life threatening emergency call was not in the best interests of Patient A. SB estimates that the delay was approximately seven minutes, but she agreed that it may have been less than this because time would be needed for the short journey from the ambulance station to Patient A’s address. The length of the delay is not important because any delay could not be in the best interest of Patient A. In such cardiac arrest emergencies, any delay can make a difference to the patient’s outcome. SB explained that a full paramedic back up crew, rather than a single responder, is required to initiate advanced life support. The delivery of advanced life support as early as possible improves the chances of the patient being discharged neurologically intact and with quality of life.

Particular 3 – found not proved
45. Particular 3 depended on proof of particulars 1(b) and/or 1(c) and was therefore not proved.

Decision on Grounds
46. The Panel went on to consider, on the basis of the facts found proved, whether the statutory ground of misconduct was established. The Panel noted that there is no burden or standard of proof at this stage and that the Panel should exercise its own professional judgment.

47. The Panel heard submissions from Mr Bridges on behalf of the HCPC and from Mr Lawson on behalf of the Registrant.

48. The Panel accepted the advice of the Legal Assessor who referred the Panel to the case of Roylance v GMC [2000] 1 AC 311. There must be sufficiently serious misconduct in the exercise of professional practice that it can properly be described as misconduct going to fitness to practise. The Legal Assessor reminded the Panel that a breach of professional standards does not necessarily amount to misconduct.

49. The Panel concluded that the Registrant’s actions breached the following Standards of the HCPC’s Standards of Conduct Performance and Ethics (2016):

Standard 1 Promote and protect the interests of service users and carers
Standard 2 Communicate appropriately and effectively
Standard 6 Manage risk
Standard 6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
Standard 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.

50. The Panel considered that the Registrant’s conduct, which delayed the emergency response to a vulnerable patient was serious. Colleague 3 described the Registrant’s action in returning to the station when she had not received a stand down authorisation from ACC as “unprecedented”.

51. The Panel noted the Registrant’s rationale for handing over this call to the night shift as she considered that the case would benefit from a “fresh pair of hands”. However, the Panel considered that any delay in responding to a Code Purple call was unacceptable. The Panel concluded that the Registrant allowed her anger and frustration about Colleague 1’s actions to cloud her judgment. The Panel considered that on this occasion, the Registrant put her own interests above the best interests of Patient A. Any delay, for whatever reason, puts such patients at risk of harm. Such conduct falls well below the required standards for paramedics and would be regarded as deplorable by fellow professionals.

52. The Registrant’s decision to return to the station and hand over the call to another crew caused delay and consequently exposed Patient A to the risk of serious harm. The response to cardiac arrests is time critical and any delay in paramedic response which cannot be explained is entirely unacceptable. The Registrant is solely responsible for the delay in the emergency response to Patient A irrespective of custom and practice. There would have been no delay if the Registrant had continued her response to the emergency call with Colleague 1 and had not instructed Colleague 1 to return to the ambulance station.

53. The Panel concluded that the Registrant’s conduct in the particulars found proved is sufficiently serious to amount to misconduct.

Decision on Impairment
54. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of her misconduct.

55. The Panel heard submissions from Mr Bridges on behalf of the HCPC and from Mr Lawson on behalf of the Registrant.

56. The Panel accepted the advice of the Legal Assessor and took into account the guidance in the HCPTS Practice Note “Fitness to Practise Impairment” (December 2019). She reminded the Panel that when considering the current risk to members of the public it should consider whether the matters are remediable, any steps to remediate, and any risk of repetition of similar behaviour. The assessment of the risk of repetition will include consideration of the level of insight demonstrated by the Registrant. When assessing fitness to practise impairment the Panel should also consider the nature and gravity of the misconduct and whether a finding of impairment is required to protect the public and the wider public interest.

57. The Panel considered that it was relevant that the Registrant has continued to work as a Paramedic from November 2019 with no repetition of similar behaviour. The Panel was provided with testimonials which confirm the high quality of the Registrant’s work as a Paramedic and that there have been no concerns about her fitness to practice. The Registrant provided the Panel with seven excellent testimonials from her line manager and from colleagues. The Registrant’s line manager is aware of the events of 16 September 2019 and the HCPC investigation. He stated:

“I have known [the Registrant] as a colleague and as a clinical team leader for 6 years. In the time before and following the incident to which her forthcoming HCPC hearing relates I have found her to be a competent and capable paramedic. Having recently been her shift partner and witnessed her practice first hand I would consider her to be a capable, knowledgeable and professional practitioner. [the Registrant] is always ready to partake in learning discourse with colleagues on station to both impart knowledge and actively reflect on her own experiences whilst learning from the experience of others. [the Registrant] actively engages students and junior colleagues to ensure their effective professional development. I currently have no reservations around [the Registrant’s] fitness to practise as a Paramedic.”

58. The Panel heard oral evidence from DH, the Registrant’s current shift partners. He recently qualified as a Paramedic with the support and encouragement of the Registrant. He was positive about the Registrant and gave detailed evidence about the quality of her clinical work, her communication with and care for patients, and the support she had provided to him as his mentor.

59. The Registrant provided evidence that she has undertaken training courses to maintain and improve her paramedic skills. This included training in pre-hospital cardiac arrest.

60. The Panel considered the level of the Registrant’s insight. The Registrant provided a reflective statement that she completed in September 2019, soon after the incident, and a reflective statement completed in or around April 2020. In these statements and in her evidence to the Panel the Registrant expresses her regret for her past behaviour, she recognises her failures as a paramedic, and she is clear in stating that in the future she would attend any job allocated to her and ensure “that the patient is at the centre of my care”. Within the Registrant’s reflection she considers some of the reasons why she acted as she did on 16 September 2019. She states that she “allowed feelings of anger and frustration directed toward my colleague for not handing over the job to the nightshift to cloud my judgment and therefore return to base without a clear instruction from ACC”.

61. The Panel recognised that the Registrant has made a genuine attempt to reflect on the past events. However, the Panel was concerned that in her oral evidence the Registrant was very slow to accept that her actions were not in the best interests of Patient A. She referred to the fact that the single paramedic responder was at the scene, rather than focussing on the potential consequences of the delay in the arrival of the backup crew to provide advanced life support for Patient A. The Panel was also concerned that the Registrant’s reflections, and in her evidence, did not include sufficient consideration of the impact or potential impact of her actions on Patient A, her colleagues, or on the reputation of the profession.
62. In the Registrant’s reflective piece and in her evidence to the Panel she stated that in a similar situation she would attend the job, but that she would also “consult with my crew mate after the event of how station protocol was not followed”. The Panel was concerned by this continuing emphasis on custom and practice, whereas the Panel would expect a full reflection to focus more on the dangers of rigid adherence to custom and practice, as the misconduct in this case exemplifies. Although the Registrant stated that she does not blame others, the Panel considered that the Registrant had a tendency to be defensive, deflect responsibility for the delay to others and to minimise her own role.

63. In the Panel’s assessment the Registrant’s insight is developing. She has demonstrated some understanding that her actions were wrong, and that is reflected in her admission of some of the factual particulars, but there remain areas of concern.

64. In its assessment of the risk of repetition the Panel carefully balanced the fact that the incident on 16 September 2019 is a single incident, the positive testimonials, and there has been no repetition of similar behaviour, alongside the Panel’s concerns that the Registrant has demonstrated limited insight. The Panel concluded that there remains a residual risk of repetition. That risk is low, but it is not so low that the Panel can discount it. The Panel therefore decided that the Registrant’s fitness to practise is impaired on the basis of the ongoing risk of harm to the public.

65. The Panel next considered the nature and gravity of the Registrant’s misconduct and whether a finding of current impairment is required to uphold the required standards of conduct and to maintain public confidence in the profession.

66. The Panel considered that the nature of the Registrant’s conduct would be concerning for an informed member of the public. The Registrant was responsible for a delay in the emergency response to an elderly Patient who had fallen downstairs and was in cardiac arrest. That delay had the potential to harm Patient A. The Registrant put her own concerns and interests above those of the patient, and she allowed her judgment to be clouded by her anger and frustration with her colleague. The breach of professional standards found by the Panel is serious.

67. The Panel therefore decided that a finding of the Registrant’s fitness to practise is currently impaired is required to uphold the required standards for paramedics and to maintain public confidence in the profession.

68. The Panel decided that the Registrant’s fitness to practise is impaired on the basis of the personal component and the public component.

Decision on Sanction
69. The Panel heard submissions from Mr Bridges. He referred the Panel to the HCPC Sanctions Policy (SP), dated March 2019, particularly paragraphs 51-52 and 54-55.

70. The Panel heard submissions from Mr Lawson. He identified mitigating features and invited the Panel to consider the imposition of a Caution Order for a period of one year.

71. The Panel applied the guidance in the SP and the advice of the Legal Assessor. The Legal Assessor’s advice included reference to the cases of Bolton v Law Society and PSA v NMC & Judge [2017] EWHC 817.

72. The primary function of any sanction is to address public safety. The Panel should also give appropriate weight to the wider public interest which includes maintaining public confidence in the profession and setting the proper professional standards. The Panel applied the principle of proportionality and balanced the Registrant’s interests against the public interest. The sanction should be the least restrictive which is sufficient to provide the necessary degree of public protection. The Panel therefore considered the sanctions in ascending order of severity.

73. The Panel first identified the following aggravating features:
• the seriousness of the incident in which the Registrant was responsible for a response delay in a life threatening emergency;
• the potential harm to Patient A from this delayed response.

74. The Panel then identified the following mitigating features:
• the Registrant’s previous good character;
• a single incident;
• the excellent testimonials;
• remedial action in undertaking relevant training courses;
• the Registrant’s work as a Paramedic from November 2019 with no repetition of similar behaviour.

75. In relation to the Registrant’s remorse and insight, the Panel referred to its decision on impairment where the Panel acknowledged that the Registrant expressed her regret for her conduct and demonstrated some insight. As explained in its decision on impairment, the Panel had some concerns about the level of the Registrant’s insight. Overall, the Panel took the view that the risk of repetition of similar misconduct was low, given that the Registrant has practised as a Paramedic with no repetition for more than two years and her evidence that this would never happen again.

76. The Panel considered the guidance in the SP on Caution Orders:

“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. An order of this sort may be taken into account if a further allegation is made against the registrant…
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.

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

101. A caution order should be considered in cases where the nature of the allegations means 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)”

77. The Panel considered that some of the features highlighted in paragraph 100 of the SP applied. In particular, the incident on 16 September 2019 was an isolated incident, there is a low risk of repetition, and the Registrant has undertaken relevant training courses. She has also demonstrated, by objective evidence, the high quality of her work as a Paramedic both before and since the incident with no repetition of similar behaviour. The Panel has described the Registrant’s insight as developing, rather than as good insight.

78. The Panel considered that paragraph 101 of the guidance is relevant in the circumstances of this case. The Panel was of the view that meaningful conditions of practice could not be formulated to address the Registrant’s level of insight and the residual low risk of repetition. The Panel took this view because the incident on 16 September 2019 was behavioural in nature and not clinical, it was not able to formulate meaningful and workable conditions of practice.

79. The Panel considered the more restrictive option of a Suspension Order, but considered that such an order would be disproportionate, given that the risk of repetition is low. A Suspension Order would prevent the Registrant practising as a Paramedic, and it would have a serious detrimental impact on her. The Panel was also of the view that there is a public interest in the Registrant continuing to practise as a Paramedic because she is providing services to the public as a skilled and experienced Paramedic. She is also undertaking valuable work as a mentor to students, as described in the testimonials.

80. The Panel was aware that a Caution Order does not restrict the Registrant’s practice as a Paramedic, but it considered that a Caution Order would provide a sufficient measure of protection for the public. The Caution Order and the Panel’s public decision sends a very clear message to the Registrant that her behaviour on 16 September 2019 was unacceptable and it acts as a deterrent against any repetition. The content of the Panel’s decision also enhances the Registrant’s understanding of the potential impact of her behaviour on member of the public and the profession and why it was unacceptable. The public decision and Caution Order would also inform any potential future employer of the fitness to practise concern and the serious nature of the incident on 16 September 2019. The Panel therefore considered that a Caution Order would further reduce the risk of repetition from its currently low level.

81. The Panel considered whether a Caution Order would be sufficient to mark the gravity of the Registrant’s misconduct and her departure from the required standards. In considering this question, the Panel carefully balanced the seriousness of the incident and the potential harm to Patient A, against the mitigating factors. The Panel considered that weight should be given to the mitigating factors, particularly the fact that the incident was isolated and there has been no repetition of similar behaviour. The Panel also considered that informed members of the public would be reassured by the excellent testimonials and the Registrant’s line manager’s view that he has no concerns about her fitness to practise. The incident on 16 September 2019 was serious, and the Panel considered that this could be marked by the imposition of a Caution Order, which would send a clear message to members of the public and to the profession that the Registrant’s behaviour is entirely unacceptable for Paramedics. For these reasons, the Panel decided that a Caution Order would be sufficient to maintain public confidence in the profession and to uphold the required standards of conduct for Paramedics.

82. The Panel next considered the length of the Caution Order. It considered the guidance in the SP:

“The panel can impose a caution order for any period between one and five years. As discussed earlier, the panel should take the minimum action required to protect the public and public confidence in the profession, so should begin by considering whether or not a caution order of one year would be sufficient to achieve this. It should only consider imposing the caution order for a longer period where one year is insufficient.
Each case should be considered on an individual basis, and the panel’s decision should clearly state the length of sanction it considers to be appropriate and proportionate, and the reasons for that decision”

83. In considering the length of the Caution Order, the Panel considered that the most important factor was the seriousness of the incident on 16 September 2019 and the risk of harm to Patient A. In its decision, the Panel identified these aggravating features. This case therefore falls under paragraph 101 of the SP rather than paragraph 100. Given these circumstances, the Panel considered that a one year Caution Order would be insufficient to mark the seriousness of the Registrant’s misconduct. The Panel considered the option of a two year Caution Order, but decided that it would be insufficient for the same reasons. The Panel concluded that a three year Caution Order was the appropriate and proportionate sanction. This lengthy period is a serious sanction which marks the gravity of the Registrant’s misconduct, acts as a deterrent against the repetition of similar behaviour, and is sufficient to maintain public confidence in the profession.

84. The Panel therefore decided to impose a three year Caution Order as the appropriate and proportionate sanction.

considers to be appropriate and proportionate, and the reasons for that decision”

83. In considering the length of the Caution Order, the Panel considered that the most important factor was the seriousness of the incident on 16 September 2019 and the risk of harm to Patient A. In its decision, the Panel identified these aggravating features. This case therefore falls under paragraph 101 of the SP rather than paragraph 100. Given these circumstances, the Panel considered that a one year Caution Order would be insufficient to mark the seriousness of the Registrant’s misconduct. The Panel considered the option of a two year Caution Order, but decided that it would be insufficient for the same reasons. The Panel concluded that a three year Caution Order was the appropriate and proportionate sanction. This lengthy period is a serious sanction which marks the gravity of the Registrant’s misconduct, acts as a deterrent against the repetition of similar behaviour, and is sufficient to maintain public confidence in the profession.

84. The Panel therefore decided to impose a three year Caution Order as the appropriate and proportionate sanction.

Order

The Registrar is directed to annotate the Register entry of Ms Lynne Robertson with a caution which is to remain on the Register for a period of three years from the date this Order comes into effect.

Notes

Right of Appeal
You may appeal to the Court of Session against the Panel’s decision and the order it has made against you.

Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Hearing History

History of Hearings for Lynne Robertson

Date Panel Hearing type Outcomes / Status
30/11/2021 Conduct and Competence Committee Final Hearing Caution