Margaux Ducker
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Allegation
The following Allegation was considered by a Panel of the Conduct and Competence Committee at a Substantive Hearing on 2-5 November 2021.
- On 30 May 2018:
a) in relation to Patient A, did not appropriately triage the patient in relation to their:
i. presenting condition;
ii. medical history;
iii. allergies.
b) in relation to Patient B:
i. did not appropriately triage the patient in relation to their:
a) presenting condition;
b) medical history;
c) allergies.
d) did not assess whether the patient was able to attend hospital as you advised them to do.
2. On 16 July 2018:
a) in relation to Patient C:
i. said that no appointments were available, which was incorrect;
ii. [Not proved].
b) in relation to Child A:
i. told Child A's mother that no appointments were available, which was incorrect;
ii. did not appropriately triage Child A in relation to their:
a. presenting condition;
b. medical history;
c. allergies.
c) in relation to Patient D:
i. [Not proved];
ii. did not appropriately triage Patient D in relation to their:
a. presenting condition;
b. medical history;
c. allergies.
d) in relation to Patient E:
i. said that no appointments were available, which was incorrect;
ii. did not appropriately triage Patient E in relation to their:
a. presenting condition;
b. medical history;
c. allergies.
e) in relation to Patient F:
i. said that no appointments were available, which was incorrect;
ii. did not appropriately triage Patient F in relation to their:
a. presenting condition;
b. medical history;
c. allergies.
3. The matters set out in particulars 2a, 2b(i), 2c(i), 2d(i) and 2e(i) were misleading and/or dishonest.
4. The matters set out in particulars 1 - 3 constitute misconduct and/or lack of competence.
5. As a result of your misconduct and/or lack of competence, your fitness to practise is impaired
Finding
Skeleton Argument
1. For the purposes of this hearing, the HCPC has submitted and the Panel has read, a Skeleton Argument dated 27 October 2022 signed by Ms Rosie Welsh, Presenting Officer. [the Skeleton Argument]. The Panel has also read all the documents that are annexed to the Skeleton Argument.
Preliminary Matters
Service of the Notice and proceeding in the absence of the Registrant
2. The Panel has seen a notice sent to the Registrant by email and dated 2 November 2022 which informed the Registrant of the date and time of this hearing. The Panel has seen an electronic communication dated 2 November 2022 which confirmed that delivery of the email to the Registrant had been effected.
3. The Panel has seen an email from the Registrant, addressed to the HCPC and dated 2 November 2022 which stated, “Thank you for your email however I will not be participating”. The Registrant’s email was in response to the Notice identified above. This was consistent with a previous email from the Registrant dated 5 October 2022, which the Panel has seen, in which she stated that she would not be attending the hearing. In that email the Registrant also confirmed that she wished her name to be removed from the Register as she was no longer in practice and had not been so for several years.
4. Having regard to the documents identified above, the Panel determined that good service of the notice of this hearing had been effected. Moreover, in view of the emails from the Registrant dated 2 November 2022 and 5 October 2022, the Panel determined, that as the Registrant had decided not to attend this hearing and as the VRA was in accordance with her wishes, it should proceed with this hearing in the Registrant’s absence.
Background (as extracted from the Skeleton Argument)
5. The Registrant is a registered Paramedic (PA30365) and at the time of the fitness to practise concerns, was employed as a Clinical Advisor by iHeart, part of the Barnsley Healthcare Federation (“the Federation”). iHeart is a triage and referral service that provided extended access to General Practitioner (GP) appointments for the population of Barnsley.
6. On 16 July 2018, LJ who was an Advanced Nurse Practitioner, also undertaking the role of Clinical Advisor for the Federation, overheard the Registrant on a call with a service user. LJ was concerned that the Registrant had allegedly told the service user that no appointments were available without undertaking an appropriate triage of the presenting complaint. LJ reported her concerns to the Registrant’s line manager, SC, as she did not consider that the Registrant had safely dealt with the caller.
7. SC undertook a review of the call that LJ had overheard. SC also reviewed a number of other calls that had been taken by the Registrant on 16 July and 2 calls that had been handled by the Registrant on 30 May 2018. It was alleged that the Registrant had incorrectly told callers that appointments were not available and that she had failed to triage patients appropriately.
8. The Registrant was suspended on 24 July 2018, while the Federation conducted an investigation of the concerns, led by SC, the Registrant’s line manager at the relevant time. The Registrant resigned from her role with the Federation on 26 July 2018, before the Federation was able to conclude its investigation.
9. On 31 July 2018, the concerns were referred to the HCPC. On 23 October 2019, a Panel of the Investigating Committee found that there was a case to answer in relation to the concerns raised. The HCPC subsequently completed its own investigation and progressed the concerns to a final substantive hearing.
Substantive Final Hearing decision
10. Between 2 and 5 November 2020, a panel of the Conduct and Competence Committee considered the Allegation which is set out above. The panel came to the conclusions which are also set out above.
11. The Registrant did not attend the final hearing, but provided a bundle of documents, including a written statement that she did not contest the factual allegations but pointed to a number of extenuating circumstances and reasons for her actions.
12. The panel made a finding that the Registrant’s behaviour had breached standards 1, 2, 6, 9 and 10 of the HCPC’s Standards of Conduct Performance and Ethics. They also found that the Registrant had breached 1, 2, 4, 8 and 10 of the HCPC’s Standards of Proficiency for Paramedics. The panel considered the misconduct had seriously fallen short of the standards expected and the basic requirement of the Registrant’s role to assess the needs of callers and ensure safety. The panel considered that the Registrant’s failings were serious and wide-ranging. The panel considered that the Registrant’s dishonesty in respect of more than one patient was deplorable and had the potential to place patients at serious risk of harm, as patients were unnecessarily kept waiting to be triaged and this could have resulted in a deterioration in their condition, and potentially placed pressure on colleagues to deal with those patients at a later time.
13. The panel identified that the failings were not deep-seated attitudinal problems and must be viewed in the context of an unusually stressful working environment. The panel considered the Registrant’s behaviour was closely linked to the working environment and the pressure the Registrant was working under.
14. The panel considered that the Registrant had demonstrated developing insight into the seriousness of her misconduct, and the impact upon patients and the profession. The panel noted that the Registrant accepted her behaviour had fallen below the standard expected and had apologised for her conduct. The panel did not consider that the Registrant had demonstrated complete insight and had not taken full responsibility for her actions.
15. The panel identified the principal aggravating and mitigating factors in the case:
Aggravating factors:
• The Registrant’s conduct put patients at risk of harm;
• The Registrant’s conduct involved multiple patients on two separate occasions;
• The Registrant has not demonstrated remediation.
Mitigating factors:
• The Registrant admitted her conduct fell below the standard required;
• The Registrant was working in a particularly difficult environment at the time of the misconduct;
• The Registrant has apologised and expressed genuine remorse;
• The Registrant has developing insight;
• The Registrant had engaged, and cooperated fully, with the HCPC throughout this process.
16. The panel was satisfied that the Registrant had developing insight and conduct capable of being remedied, that there were no deep-seated attitudinal issues or issues to prevent her from Remediating, and that the failings involved a specific aspect of the Registrant’s clinical practice that could be addressed by conditions. The panel subsequently imposed a Conditions of Practice Order for a period of 12 months.
Substantive Review Hearing on 5 November 2021
17. On 05 November 2021, the Conditions Order was reviewed. The Registrant did not attend and provided a statement regarding her wish to be removed from the Register. The panel considered that the Registrant had not completed the suggestions of the previous panel, that there was no evidence of a material change following the final hearing and that the risk of repetition therefore remained. The panel concluded that the Registrant’s fitness to practise remained impaired on both the personal and public grounds, and following the expiry of the Conditions Order, replaced it with a Suspension Order for a period of 12 months.
Background to the Present Application for a Consensual Disposal
18. On 17 October 2021, prior to the first substantive review hearing, the Registrant sent an email to the HCPC which was in the following terms:
“Thank you for the invitation to attend this review hearing. However, I shall not be attending. I wish to submit the below statement to be read to the Panel
“I firstly wish to thank the Panel for their time. I have not practiced as a paramedic since November 2018. Due to health problems, I decided it was within my best interests to step down from this position. I am therefore no longer registered as a I did not renew my PIN recently. I do not intend to return to practice at any stage in the future. I still respect the position of paramedic and what it involves. I enjoyed working with my patients and serving my community. I am aware that my standards were deemed to have fallen below parr on the occasion brought to your attention and can only apologise for this to the Panel, my fellow colleagues and the public...”
19. On 11 November 2021, the HCPC case manager responded by email to the Registrant, to acknowledge receipt of the request and to provide further information about the process. The information included the Practice Note for Disposal by Consent and provided a copy of a pro forma response for the Registrant to complete.
20. On 16 November 2021, the Registrant responded by email to the HCPC and provided a medical letter from Cardiothoracic Services and a statement explaining her wish to resolve matters by voluntary removal:
“I wish to still go ahead with having my name removed from the register.
If you read my original reply regarding this allegation, I did admit my performance was below standards required by the HCPC and gave reasons why.
Had I still been practicing I would have of course taken any action to address my failures.
As I have not practiced for 3 years and will not be returning, i am unable to do this. I have hopefully attached a picture of a recent letter from my cardiologist which evidences and highlights my current health and a reason for not returning to practice....
As you can imagine I do not need a further stress, so the quicker this HCPC case is closed and my name removed the better”.
21. On 23 November 2021, the HCPC case manager responded by email to the Registrant to acknowledge receipt and request that she complete the response pro forma. The Registrant subsequently provided a completed form dated 28 November 2021. Although the final hearing had made a finding on fact, grounds and impairment, within the form, the Registrant admitted the substance of the allegation, that her fitness to practise is impaired, that she had read the relevant HCPTS Practice Note and that she would like the HCPC to consider Voluntary Removal.
22. Following receipt of the information from the Registrant, the HCPC reviewed the case and considered that voluntary removal was appropriate in the circumstances and upon the information provided. Given the time that had elapsed, the HCPC wrote to the Registrant to re-confirm that she still wished to be voluntarily removed and the Registrant confirmed she still wished to proceed.
23. The Registrant was subsequently sent a Voluntary Removal Agreement. The signed and completed copy of the agreement is contained within the bundle now before the Panel.
Guidance as set out in the Skeleton Argument
24. The HCPC has in the Skeleton Argument set out guidance as to nature and consequence of a VRA, together with the procedure to be followed and the principles to be applied. That guidance is in the terms set out below. For ease of reference the paragraph numbers used in the Skeleton Argument have been retained, but are shown in brackets:
(22) The Health Professions Order 2001 does not explicitly provide for consent arrangements. There is instead an HCPTS Practice Note (“Disposal by Consent”) that has the HCPC has approved as a means of allowing matters, where suitable, to be disposed of by consent.
(23) The Practice Note states that a Panel should not agree to resolve a case in this way unless it is satisfied of two things: firstly, that the appropriate level of public protection is being secured and, secondly, that doing so would not be detrimental to the wider public interest.
(24) Similarly, in Cohen v GMC the High Court stated that there are “critically important public policy issues” which must be taken into account by Panels in fitness to practise proceedings, including the ‘public’ component of impairment. This ‘public’ component requires consideration of the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.
(25) Disposal by consent does not affect the Panel’s powers or the range of orders available to them, it is merely a process by which the HCPC and the Registrant concerned may propose what they regard as an appropriate outcome to the case. If a Panel is content to do so, it may conclude the case on an expedited basis, upon the terms of the Voluntary Removal Agreement. Equally, it may reject that proposal and the case would return to the substantive order review cycle.
(26) The Voluntary Removal Agreement is an agreement to the effect that the HCPC will not take any further action against the Registrant in relation to this matter on the understanding that she will remove herself from the Register, will not practise as a Paramedic and not attempt to re-join the Register.
(27) If the Registrant were to apply to come back on to the Register, her application would be treated in the same way as someone who had been struck off.
Submissions
The Written Submissions of the HCPC
25. The submissions of the HCPC, as set out in the Skeleton Argument and adopted by Ms Welsh as the basis of her submission to the Panel, are set out below. For ease of reference the paragraph numbers used in the Skeleton Argument have been retained but are shown in brackets:
(28) The HCPC submits that, in all the circumstances, voluntary removal from the Register would be an appropriate means of resolving these proceedings.
(29) The Registrant has been provided with detailed information about the consent process and the effect of voluntary removal from the Register, should the application be granted. The Registrant has had time to review this information and query its implications with the HCPC.
(30) The HCPC submits that the allegations were fully explored, tested and ventilated at a substantive final hearing. Following the hearing outcome, the Registrant has made it clear that she has no desire to practise as Paramedic in the future and expressed a wish to be removed from the Register. Further, she has admitted the substance of the allegations and impairment.
Public Protection
(31) Should voluntary removal be permitted in this case, the HCPC submits that public protection would be ensured as the agreement is equivalent, in effect, to a Striking off Order. The Registrant would be prohibited from using the protected Paramedic title for a period of five years.
(32) The HCPC submits that voluntary removal addresses any remaining public protection concern, as the Registrant would no longer be registered as a Paramedic and she has confirmed that she has no intention to practise again in the future. Further, the public will be adequately protected from any risk posed by the Registrant should seek to re-register and practice in future, as a voluntary removal is equivalent in effect to a strike-off. Therefore, the HCPC submits that the necessary public protection would be secured when disposing of the case by way of voluntary removal.
Public Interest
(33) The HCPC submits that the wider public interest would not be put at risk should this matter be disposed of by way of consent.
(34) The HCPC submits that the public would not be concerned, nor would public confidence in the profession be put at risk, should the Panel grant this Voluntary Removal Agreement in the circumstances identified above.
(35) The HCPC submits that, in all the circumstances, it is appropriate to dispose of this matter in accordance with the terms of the Voluntary Removal Agreement. It is the HCPC’s view that disposal by consent on these terms is a suitable, pragmatic and expeditious way of dealing with this matter.
(36) For the reasons outlined, the HCPC respectfully invites the Panel to revoke the existing Suspension Order and approve the Registrant’s voluntary removal from the register on the terms within the agreement.
Oral Submissions made by Ms Welsh on behalf of the HCPC
26. Ms Welsh adopted the submissions that are set out in the Skeleton Argument. She summarised the background, the principles to be applied and the justification for seeking a consensual outcome by way of a VRA. She reminded the Panel that in the event that the Panel approved the VRA, the existing Suspension Order should be revoked.
The Stated Position of the Registrant
27. The Panel noted the Document entitled Consensual Disposal Request Pro Forma dated 28 November 2021 in which the Registrant admitted the substance of the allegation against her and that her fitness to practise was currently impaired by her health. She stated her desire for the matter to be disposed of by way of Voluntary Removal. The Panel has seen a further draft document signed by the Registrant and dated 9 September 2022 [confirmed by a previous email from the Registrant dated 8 September 2022] in which the Registrant admitted the substance of the Allegation and also her current impairment; she further stated her desire for the matter to be disposed of by way of Voluntary Removal.
28. The Panel has seen the VRA dated 19 October 2022, signed by the Registrant, also on behalf of the HCPC. The Panel has also seen the associated documents. The Panel notes that in Schedule C to the VRA, the Registrant confirms that she has admitted the Allegation. The Panel further notes that in the Agreed Statement, which is Schedule D to the VRA, it is formally recorded that the Registrant “has now admitted the allegation and has undertaken not to practise as Paramedic”
Decision of the Panel made on 9 November 2022.
29. The Panel has considered the submissions of the HCPC as set out in the Skeleton Argument adopted by Ms Welsh and in her oral submissions. The Panel has taken account of the position of the Registrant as stated in the documents identified above. The Panel has further considered all the other documents that have been submitted.
30. The Panel heard and accepted the advice of the Legal Assessor.
31. In deciding whether or not to approve the agreement for Voluntary Removal, the Panel has had regard to the Practice Note published by the HCPTS in March 2018 and entitled Disposal of Cases by Consent [the Practice Note] which is annexed to the Skeleton Argument.
32. The Panel has concluded that the VRA should be approved. Its reasons are as follows:
• The Panel is satisfied that all the criteria set out in the Practice Note has been complied with;
• The Registrant has admitted the substance of the Allegation. She has also admitted that her fitness to practise is thereby impaired;
• The public will be adequately protected by the voluntary removal of the Registrant’s name from the register, which will have the same effect as if she had been struck off;
• Moreover, the Panel has concluded that a well-informed member of the public would conclude that this matter is properly disposed of by the VRA as sought by both the Registrant and the HCPC;
• The Panel has concluded that disposal by consent is a suitable, pragmatic and expeditious way of dealing with this matter. In the opinion of the Panel there was no public interest in requiring the existing order to be the subject of further reviews.
33. For all the reasons that are set out above, the Panel has determined to approve the outcome sought in the VRA with immediate effect. Having approved the VRA, the Panel directs that as a necessary consequence, the Suspension Order imposed on 5 November 2021 should be revoked.
Order
ORDER: The Registrar is directed to remove the name of Ms Margaux Ducker from the Register with immediate effect.
Notes
No notes available
Hearing History
History of Hearings for Margaux Ducker
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 09/11/2022 | Conduct and Competence Committee | Voluntary Removal Agreement | Voluntary Removal agreed |
| 05/11/2021 | Conduct and Competence Committee | Review Hearing | Suspended |
| 02/11/2020 | Conduct and Competence Committee | Final Hearing | Conditions of Practice |