Sabrina Anderson
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Allegation
While Registered with the HCPC as a Paramedic, and employed by Yorkshire Ambulance Service NHS Trust between 12 September 2016 and 20 December 2018:
1. In relation to Patient 1, on or around 18 January 2017:
a) You did not:
i. take and / or record Patient 1’s blood pressure or record that this could not be taken;
ii. record Patient 1’s initial oxygen saturation levels;
b) You did not provide or attempt to provide Patient 1 with salbutamol;
c) You used the ‘LifePak’ monitor on ‘Automated External Defibrillator’ (AED) mode instead of ‘Manual’ mode;
d) You did not adequately assist Patient 1’s breathing
e) You did not secure Patient 1’s airway;
f) You used the incorrect size Laryngeal Mask Airway (LMA);
g) You carried out Cardiopulmonary Resuscitation whilst straddling Patient 1 in the ambulance;
2. In relation to Patient 2, on or around 12 November 2017:
a) You used the ‘LifePak’ monitor on ‘Automated External Defibrillator’ (AED) mode instead of ‘Manual’ mode;
b) You did not demonstrate that you were able to turn the ‘LifePak’ monitor into ‘Manual’ mode, and / or did not ask how to do so;
c) You intubated the patient with an endotracheal (‘ET’) tube:
i) without following a stepwise approach to securing their airway; and/or
ii) without adequately securing the ET tube
3. In relation to Patient 3, on or around 6 January 2018, you:
a) did not have the ‘LifePak’ monitor on a mode enabling the patient’s heart rhythm to be monitored
b) did not demonstrate knowledge of how to operate the ‘LifePak’ monitor.
4. In relation to Patient 4, on or around 2 February 2018:
a) You did not take and / or record adequate observations;
b) You did not review the ECG print out
c) You incorrectly recorded Patient 4 was in normal sinus rhythm on the Patient Care Record.
d) You did not identify a second degree atrioventricular (‘AV’) block on Patient 4’s electrocardiogram (‘ECG’);
e) You did not identify and/or record that Patient 4’s ECG demonstrated one or more episodes of bradycardia;
f) You did not consider and/or record a differential diagnosis;
g) You:
i. Did not transfer or attempt to transfer Patient 4 to hospital;
ii. Told Patient 4’s mother that it would be a waste of her time and hospital time to take Patient 4 to hospital;
iii. Recorded that Patient 4 refused to travel to hospital, when this was not the case;
h) You did not complete a safeguarding referral.
5. In relation to Patient 5, on or around 11 April 2018:
a) You were not aware of the distinction between ventricular tachycardia (‘VT’) and supraventricular tachycardia (‘SVT’);
b) You referred to the wrong JRCALC Protocol;
c) You gave Patient 5 medication which was not appropriate.
6. In relation to Patient 6, on or around 12 April 2018:
a) You gave intravenous paracetamol, when it was not clinically appropriate to do so;
b) You did not provide Patient 6 with Morphine and/or GTN and/or aspirin;
c) You did not recognise that Patient 6 was at risk of acute coronary syndrome.
7. In relation to Patient 7, on or around 15 December 2018:
a) You performed Transcutaneous Pacing when:
i. this procedure was outside of your scope of practice
ii. this procedure was not indicated;
iii. you did not have access to the necessary medications to accompany this procedure.
b) You did not perform Transcutaneous Pacing correctly;
c) You advised a colleague that you were ‘Red Arrest Team’ (‘RAT’) trained, when this was not the case;
d) You did not provide Patient 7 with necessary medications alongside delivering Transcutaneous Pacing.
8. Your conduct in particular 7c was dishonest.
9. The matters at paragraphs 1 – 7 above amount to lack of competence and / or misconduct.
10. The matter at paragraph 8 above amounts to misconduct.
11. By reason of your lack of competence and / or misconduct, your fitness to practise as a Paramedic is impaired.
Finding
Preliminary Matters
Service
1. The Panel has seen a copy of an email dated 13 October 2023 sent to the Registrant and copied to her representative, Ms Andrea James of Keystone Law, giving notice of the review hearing today. The notice set out the date, time and purpose of the hearing. The Panel noted that service requires the sending of notice to the proper address and it had been provided with a certificate demonstrating that the notice had been sent to the correct email address.
2. However, the Panel has also been provided with a copy of a letter in response from Ms James, on behalf of the Registrant, dated 1 November 2023. The Panel took this as confirmation that the notice had come to the Registrant’s attention and that she is aware of the hearing today.
3. The Panel was aware that notice of the hearing would normally allow for a period of 28 days from the date of service to the hearing. However, it took into account that in the response letter, Ms James had stated that the Registrant did not object to the hearing proceeding in her absence. The Panel considered this impliedly waived the short notice, and that notice of the hearing had been duly served.
Proceeding in Absence
4. Ms Collins, on behalf of the HCPC, applied for the hearing to proceed in the absence of the Registrant. She referred the Panel to the above letter and that it set out that the Registrant was not in a position to be represented at the hearing and would not be attending. However, the letter also stated that the Registrant did not object to the hearing proceeding in her absence.
5. Ms Collins submitted that it appeared that the Registrant had received legal advice on the matter. She submitted that it was in the interests of justice for the panel to review the order and proceed with the hearing.
6. The Legal Adviser advised the Panel as to the terms of Rule 11 and the Practice Note on Proceeding in Absence. He referred the Panel to the cases of R v Jones/Hayward [2002] UKHL 5 and GMC v Adeogba [2016] EWCA Civ 162.
7. The Panel noted from Ms James’ letter that the Registrant did not object to the hearing proceeding in her absence. It considered that she had voluntarily absented herself from the review. The Panel took into account that the Registrant had nevertheless provided a bundle of material for the review, together with written submissions from her representative.
8. The Panel took into account that this was a mandatory review of an existing order, which was due to expire in a few days. The review had previously been adjourned and the Registrant had not attended the earlier review. The Panel took into account the Registrant’s position and that no adjournment had been requested. It considered that it had representations on behalf of the Registrant, whose position could therefore be considered. The Panel concluded that it was in the interests of justice and public protection for it to proceed with the review, particularly noting that there was no objection from the Registrant.
Application to proceed partly in private
9. Ms Collins made an application under Rule 10 (1) (a) for the hearing to be conducted partly in private. She submitted that she would be referring, though briefly, to some personal family matters relating to the Registrant in her submissions.
10. The Legal Adviser advised the Panel that there was a public interest in hearings being conducted in public, but the Rules provided a derogation where the interests of justice, or the protection of the private life of the Registrant and others required.
11. The Panel decided that it was in the interests of protecting the private life of the Registrant and her family, to sit in private for the relevant parts of the hearing.
Background
12. The Registrant is a Paramedic who was employed by the Yorkshire Ambulance Service NHS Trust (the Trust) between September 2016 and December 2018. The Registrant qualified as a Paramedic under the International Paramedic Programme (IPP) in 2014 and then worked in the United States of America for one year until her visa expired. She obtained HCPC registration in 2016 and her first employment as a Paramedic in the United Kingdom was with the Trust. During her employment with the Trust there were a number of concerns regarding her clinical practice.
13. Following a clinical incident in January 2017 in relation to the management of a cardiac arrest, a Clinical Case Review (‘CCR’) was held on 14 February 2017. The Registrant was subject to a Directed Action Plan (‘DAP’), which included time spent in the ambulance service training centre.
14. During a clinical incident in November 2017, there were again issues raised about the Registrant’s management of a cardiac arrest. These were addressed at the scene by the Clinical Supervisor and a subsequent email was sent to the Registrant’s line manager in respect of this incident.
15. In January 2018, another incident occurred, again around the management of a cardiac arrest, which again had to be addressed by a Clinical Supervisor.
16. On 2 February 2018, another clinical incident occurred involving an intoxicated 14 year-old. Following these incidents, the Registrant was required to work within the Emergency Care Assistant (‘ECA’) scope of practice until a CCR could be held. This was held on 1 March 2018.
17. The Registrant attended the ambulance training centre and focused on areas such as clinical decision making, defibrillator usage, management of initial patient assessment, Cardiopulmonary Resuscitation (‘CPR’) in a multidisciplinary team, documentation of events and Patient Care Report (‘PCR’) completion. The Registrant was informed that her performance would be monitored for a period of six months and if there was no improvement, she would be referred to the final stage of the procedure.
18. During the period of monitoring the Registrant again attended the training centre and after being assessed by a Clinical Tutor she returned back to Paramedic duties.
19. Before a formal review could take place, the Trust received two service complaints from Bradford Royal Infirmary. A CCR was arranged and took place on 17 April 2018. Following the CCR the Registrant was again required to work within the ECA scope of practice. A final performance review meeting was conducted in May 2018 where a number of measures were put in place to try and get the Registrant up to the required Trust standards. In August 2018, it was confirmed that the period of development with the clinical development manager had successfully concluded, and he was content for the Registrant to operate as a Paramedic again. A six-month monitoring period of the Registrant’s clinical practice was formally put in place beginning in July 2018.
20. On 15 December 2018, the Registrant was called to provide back up to a non-paramedic crew who were attending a 74 year old gentleman experiencing chest pains, a slow heart rate and low blood pressure. The Registrant elected to utilise a function of the defibrillator in an attempt to increase the patient’s heart rate, known as Transcutaneous Pacing.
21. Within the Trust this is a skill utilised by a small group of paramedics who are part of the Red Arrest Team (‘RAT’). The Registrant was not trained by the Trust to deliver this treatment and has never attended the Trust RAT training course, nor did she have the appropriate medication.
22. The Trust’s standard operating procedure for this intervention specifies that Paramedics without training from the Trust are not authorised to perform this technique.
23. The Registrant self-referred to the HCPC on 17 December 2018 following the incident on 15 December 2018. The Trust referred the Registrant to the HCPC on 20 December 2018 because of the same incident.
24. On 15 April 2020, a panel of the Investigating Committee decided that there was a case for the Registrant to answer and referred the Allegation set out above to the Conduct and Competence Committee.
25. On 29 December 2021, the Registrant’s legal representatives wrote to the HCPC to canvass disposing of the case by way of consent.
26. On 4 February 2022, the HCPC instructed Kingsley Napley LLP that it was happy to explore disposal by consent in this case. It was agreed that a Conditions of Practice Order was an appropriate consensual disposal. On 25 March 2022, Kingsley Napley LLP sent the Registrant’s legal representatives a draft Consent Order. Following correspondence between Kingsley Napley LLP and the Registrant’s legal representatives, an amended draft Consent Order was sent to the Registrant’s legal representatives on 8 April 2022. On 14 April 2022, Kingsley Napley received the Registrant’s completed Consensual Disposal Request Pro-Forma together with confirmation from her representatives that she accepts the conditions in the draft Consent Order.
27. The Registrant has been employed by the Northern Ireland Ambulance Service (NIAS) since 2019 under the supervision of a clinical supervisor. There had been no further referrals regarding the Registrant made known to the Panel in May 2022.
28. On 5 May 2022, a Conduct and Competence Committee panel heard submissions on behalf of both parties. The panel noted the Registrant’s admission to impaired fitness to practise by reason of misconduct and/or lack of competence. It determined to approve the Consent Order in the case and impose a Conditions of Practice Order for a period of 18 months.
29. In respect of the concerns with the Registrant’s Fitness to Practise, the panel stated the following in its determination:
“40. The Panel is satisfied that the proposed Conditions of Practice Order is the likely outcome of the matter if it was to proceed to a full substantive hearing.
41. The Panel has concluded that the information before it shows that the Registrant has made sufficient admissions which she has addressed and acknowledged. The Panel considers that the Registrant has good insight into her shortcomings for which she has apologised, and she has shown genuine and appropriate remorse. The Registrant’s insight has led her to undertake significant reflection and to undertake a large amount of CPD in areas which are, on the whole, specifically targeted to address her shortcomings. The Registrant has taken significant steps towards remedying her misconduct.
42. The Panel notes that the concerns raised in this case took place during the Registrant’s first employment in the NHS and in this country, when she was still at an early stage in her career as a Paramedic. The Panel also considers that there were significant personal mitigating circumstances during the time when concerns about the Registrant’s clinical competence were raised.
43. It is clear from the documentation that the Registrant has worked as a Paramedic for NIAS, albeit under clinical supervision, without further clinical concerns, since 2019. The Panel has seen many testimonials, some of which are recent. Not all the testimonials are glowing or describe the Registrant as perfect. What they do show is that the Registrant cares about being professional in her work and has taken significant steps towards improving the standard of her clinical competence.
44. The Panel has concluded that the proposed Conditions of Practice are appropriate, proportionate, workable, and measurable and that the Registrant will comply with them. She will be under a workplace supervisor for a period of 18 months to address specified areas of her practice which have been identified from her admitted conduct as in need of being monitored and addressed. Her workplace supervisor will provide a report to the HCPC before any review of the Conditions of Practice Order. The Registrant will also be working alongside another suitably qualified Paramedic. The Panel is therefore satisfied that the proposed Consent Order secures the appropriate level of public protection in this case.
45. The Panel is also satisfied that the proposed Consent Order is not detrimental to the wider public interest. The proposed Consent Order maintains public confidence in the Paramedic profession and in its regulator. The Panel considers that a reasonable and informed person would be reassured to know that the clinical concerns raised in this case were being monitored and addressed by the proposed conditions of practice. The Panel also considers that the proposed Consent Order sends out a message to the profession that such conduct is not condoned and, in this way, standards of behaviour in the Paramedic profession are declared and upheld.”
Review 3 October 2023
30. The panel on 3 October 2023 decided to adjourn the review with directions, as it had been provided with information that further concerns with regard to the Registrant had been referred for investigation.
Review 3 November 2023
31. The Panel today was provided with an amended Chronology concerning the case, a review bundle and a Registrant’s bundle. The review bundle contained, at the direction of the Panel on 10 October 2023, outlining information concerning the two other concerns currently the subject of investigation.
32. Ms Collins relied on her Skeleton Argument, which had been provided to the Registrant and to the Panel in advance of the commencement of the review hearing. She submitted that the HCPC’s position is that the Registrant’s fitness to practise remains impaired and the Panel should exercise its powers to extend the current Conditions of Practice Order for 12 months. Ms Collins submitted that the Registrant had only returned to practice in September 2023 and there had been little time for the conditions to have real effect.
33. Ms Collins made clear that the HCPC did not rely on the matters which are currently under investigation in making its submissions.
34. The Panel noted that the written submissions from the Registrant supported the HCPC position and that it would be wholly unfair for the two other matters under investigation to be taken into account. The Registrant included certificates of CPD recently undertaken, to demonstrate how she was maintaining her knowledge and skills.
35. The Legal Adviser advised the Panel that, at a review there is an evidential burden on the Registrant to demonstrate that past concerns had been dealt with and that she is safe to return to unrestricted practice. He referred the Panel to the Practice Note on Reviews, dated June 2018.
36. He advised that, whilst the Panel was aware that there had been further concerns referred and under investigation, the due process in relation to these had not been undertaken and the Panel should take care not to place weight on matters which were still under investigation. The Panel had to consider whether the concerns in the previous determination had been addressed.
37. The Legal Adviser advised the Panel that, at a review the issue of current impairment was ‘at large’ and referred it to the cases of Khan v GMC [2009] EWHC 535 (Admin) and Dhoorah v NMC [2020] 3356 (Admin). He advised that, although there was reference to a notice concerning the Professional Standards Authority expressing an intention to appeal the decision of the Committee in May 2022, at present no appeal had been heard and the Panel was obliged to deal with the current order on its own terms.
38. The Legal Adviser advised the Panel to determine whether it regarded the Registrant’s fitness to practise as currently impaired, on the information known up to date. If so, he advised the Panel should consider exercising its powers under Article 30(1) of the Order.
Decision
39. The Panel considered that the failings in relation to which a Conditions of Practice Order had been imposed in May 2022 were wide-ranging and went to fundamental areas of paramedic practice. As a result of other reasons, the Registrant had subsequently been away from practice for a significant period, only having resumed in September 2023.
40. The Panel considered that the areas of concern were summarised in condition 3 of the current conditions as “(a) Clinical Decision Making; (b) Communicating effectively with colleagues and patients; (c) Record keeping; (d) Safeguarding”. The conditions also required that the Registrant only practise alongside another, experienced paramedic and that she should have a workplace supervisor.
41. The Panel considered that the concerns relating to misconduct, which led to the Conditions of Practice Order are potentially remediable. The Panel accepted that the Registrant has approached her return to work positively and has provided some reflections. It accepted that the Registrant has engaged in appropriate courses and training.
42. The Panel considered that some, essential training remains outstanding, possibly not due to the Registrant’s fault, notably in the areas of record keeping and safeguarding. However, in the Panel’s view, the central issue was the need to demonstrate the embedding of the Registrant’s learning and reflections into actual practice.
43. The Panel took into account that the Registrant had only relatively recently returned to practice, in September 2023. It considered that this had not been enough time for the Registrant to be in a position to demonstrate remediation in practice.
44. The Panel noted that, since the decision in May 2022, there have been two other matters referred to the HCPC concerning the Registrant which have now gone under investigation, in respect of one of which the Panel had been informed the employer had issued a warning. However, the Panel took into account that both of these matters are in the early stage of investigation and no case to answer has been established at present in either case. The Panel noted that one of the concerns related to the issue of effective communication with a patient and about a colleague, which was a concern in relation to the determination in May 2022. However, bearing in mind the stage of the new concerns and that the HCPC expressly stated that it did not rely on them, the Panel did not give these weight in determining current impairment.
45. Bearing in mind, however, the Registrant’s obligation to demonstrate that she has addressed the past concerns, the Panel was not satisfied that it had sufficient demonstration of the Registrant’s remediation in practice, to persuade it that a risk of repetition was now, as put in the case of Cohen v GMC [2008] EWHC 581 (Admin) was “highly unlikely”.
46. The Panel concluded that there was a remaining risk of repetition of past clinical failings and this involved a risk of harm being caused to patients.
47. The Panel therefore determined that the Registrant’s fitness to practise remains currently impaired. The Panel therefore went on to consider which, if any, of its powers to exercise under Article 30(1).
48. The Panel bore in mind the Sanctions Guidance issued by the HCPC. It started by considering the appropriate direction starting with the least restrictive, in order to be proportionate.
49. The Panel considered, in light of its finding of a risk of repetition leading to a risk of harm, that allowing the existing order to lapse by taking no action or referring to mediation would not be sufficient to protect the public. Neither would imposing a Caution Order, as there would be no continuing oversight in practice.
50. The Panel therefore considered the next sanction, of keeping a Conditions of Practice Order in place. The Panel considered that the current conditions of practice were appropriate to the concerns in the case and provided for an appropriate level of supervision of the Registrant’s practice, which afforded protection to the public.
51. The Panel took into account that both parties had submitted that the current order be extended and subject to the same conditions of practice, but it satisfied itself that it was the correct course to take. The Panel therefore decided to extend the Conditions of Practice Order.
52. The Panel considered that a period of 12 months was the length of time over which the Registrant’s practice should be monitored by conditions of practice. Since the order will be reviewed again shortly before expiry, it was also the appropriate period to set, in order to allow the Registrant time to demonstrate the necessary remediation of her practice.
53. The Panel weighed the Registrant’s interests with the need for public protection. However, it determined that, since the Registrant had been able to secure a position subject to the conditions, the conditions were proportionate.
54. The Panel considered whether it was necessary to go further in its powers. However, it concluded that since the conditions provided sufficient oversight to protect the public, it would be disproportionate to go further than extending the conditions of practice.
Order
ORDER: The Registrar is directed to extend the Conditions of Practice Order against the registration of Ms Sabrina Anderson for a further period of 12 months upon the expiry of the existing Order. The Conditions are:
1. You must only practise as a Paramedic whilst working alongside another qualified Paramedic of not less than two years’ post registration experience.
2. You must place yourself and remain under the supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator, and supply details of your supervisor to the HCPC within one month of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.
3. You must meet with your workplace supervisor on at least a monthly basis to monitor and address the following areas of your practice, and any other areas of your practice as deemed necessary by your workplace supervisor:
a. Clinical Decision Making:
b. Communicating effectively with colleagues and patients;
c. Record Keeping;
d. Safeguarding.
4. You must provide to the HCPC within 14 days of each meeting records of the meetings with your workplace supervisor.
5. You must request that your workplace supervisor provides a report to the HCPC at least 14 days before any review of this Conditions of Practice Order.
6. You must promptly inform the HCPC if you cease to be employed by your current employer and/or take up any other or further employment.
7. You must promptly inform the HCPC of any capability or disciplinary proceedings taken against you by your employer.
8. You must inform the following parties that your registration is subject to these conditions:
a. Any organisation or person employing or contracting with you to undertake professional work;
b. Any agency you are registered with or apply to be registered with (at the time of application); and
c. Any prospective employer (at the time of your application).
Notes
The Order imposed today will apply from 5 November 2023.
This Order will be reviewed again before its expiry on 5 November 2024.
Hearing History
History of Hearings for Sabrina Anderson
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 03/11/2023 | Conduct and Competence Committee | Review Hearing | Conditions of Practice |
| 03/10/2023 | Conduct and Competence Committee | Review Hearing | Adjourned |
| 05/05/2022 | Conduct and Competence Committee | Consent Order Hearing | Conditions of Practice |