Katarzyna Ciszewska

Preliminary Matters

Proceeding in private

1. Ms Constantine made an application for the proceedings to be heard partly in private. She submitted that specific details should be heard in private in order to protect the Registrant’s private life. Mr Collins agreed to this application.

2. The Panel had regard to the HCPTS Practice Note “Conducting Hearings in Private” and heard advice from the Legal Assessor. It was mindful of the principle of open justice, but that Rule 10(1)(a) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules) permitted departure from this principle if one of the exceptions applied. The Panel determined that any part of the proceedings relating to the details of the Registrant’s private life should be heard in private in order to protect the Registrant’s privacy.

Background

3. On 26 November 2021, the Registrant’s employer, North East Ambulance Service NHS Foundation Trust (the Trust), made a referral to the HCPC. The Trust had been contacted by the press office of the North West Ambulance Service NHS Trust (NWAS). A member of the public had sent in images and photographs and reported to NWAS that the Registrant had been sharing these.

4. The images contained photographs of patients and patient identifiable information, along with photographs of crew members. The Trust conducted a formal investigation.

5. During this, the Registrant made admissions to taking the photographs and sharing them. One of the photographs showed that the Registrant and other ambulance crew had eaten a takeaway meal in the back of an ambulance.

Decision on Facts

6. The Registrant admitted Particulars 1a) and 1b). She further admitted Particulars 2b), 2c), 2d), and 2e).

7. Mr Collins applied to withdraw Particular 2a). The partial discontinuance was requested on the basis that it was no longer in the public interest to proceed with this. The Registrant had said that purchasing the food was not her suggestion, and there was no under-prosecution by withdrawing this element of the Allegation. He drew the Panel’s attention to witness evidence which also suggested that it was a group decision to purchase the food. It was submitted that whether or not Particular 2a) was found proved may not impact on the outcome in any event.

8. The Panel heard and accepted legal advice. It acknowledged that its role is to protect the public and, as such, it has to play a more proactive role than a judge in criminal law proceedings in making sure that evidence is properly presented.

9. The Panel found that the approach taken by the HCPC was consistent with some of the witness statements provided. It found that this specific Particular was unlikely to impact on the overall seriousness or gravamen of the Allegation as a whole. The Panel determined that it would not amount to an under-prosecution if this one element of the Particulars did not proceed. It therefore consented to the withdrawal request in respect of Particular 2a).

10. The Panel then considered whether it could find the facts of the admitted matters proved without hearing oral evidence from the witnesses. It took account of the advice of the Legal Assessor and the HCPTS Practise Note “Admissions” dated October 2024.

11. It was determined by the Panel that the Registrant’s admissions were unequivocal. They were consistent with the admissions she had already made during the Trust disciplinary proceedings. The Registrant had the benefit of legal representation, and the Panel found that there was no unfairness or disadvantage to her in it accepting the admissions made. Accordingly, the Panel determined the admitted facts to be found proved without considering further oral evidence.

Decision on Grounds

Submissions on behalf of the HCPC

12. Mr Collins referred to the case of Roylance and submitted that misconduct must be serious. He explained that the Panel can take into account provisions of the ‘Code’, but breach of the code would not necessarily constitute misconduct. It was submitted that the allegations relating to sharing photographs of patients in the midst of receiving care without their knowledge would reflect a serious departure from the relevant standards. It was submitted that this constituted misconduct, as it was a clear breach of patient confidentiality and privacy. This occurred on multiple occasions and with multiple patients. Mr Collins submitted that, although it may not have been the Registrant’s intention that the photographs were distributed further, this was a clear consequence and risk of disclosing them in the first place.

13. Mr Collins submitted that the Panel should consider various factors when determining whether misconduct was made out in respect of Particular 2 of the Allegation. He submitted that the Registrant was the most senior member on the crew who had eaten the takeaway food in the back of the ambulance. It was submitted that the evidence from the Trust’s investigation highlighted the risk of harm to patients; for example, the potential for a patient to suffer an allergic reaction to a contaminated substance, although there was no actual patient harm.

14. Mr Collins explained that it was clear from the evidence obtained by the HCPC that disciplinary proceedings would not have been brought by the Trust in relation to Particular 2 alone. He referred the Panel to the case of Schodlock and acknowledged that no referrals had been made to the HCPC for the other members of crew involved in the takeaway incident.

Submissions on behalf of the Registrant

15. Ms Constantine submitted that the Registrant accepted that Particular 1 constituted misconduct. The Registrant had made admissions early on in the investigation process and had been consistent throughout. The Registrant was aware of the serious breach of confidentiality, and accepted that sending the photographs was a serious lapse of judgement.

16. Ms Constantine submitted that eating the takeaway meal in the ambulance was not so serious as to be considered deplorable by other members of the profession. She submitted that, were it not for the serious matter of the photographs, the Registrant would not have been subject to Trust disciplinary procedure around the meal, and queried whether the Registrant would have been brought to a HCPC substantive hearing for that matter alone.

Legal Advice

17. The Legal Assessor confirmed to the Panel that there is no specific legislation to define misconduct, and there is no specific standard or burden of proof. Whether the findings amount to misconduct is a matter for the Panel’s judgement. The Legal Assessor summarised some case law to assist the Panel, including the cases of Roylance v GMC (no 2) (2001) A1C 311, Beckwith v SRA (2020) EWHC 3231 (Admin), R (Remedy UK Ltd) v GMC (2010) EWHC 1245 (Admin), Schodlock v GMC (2015) EWCA Civ 769, Khan v Bar Standards Board (108) EWHC 2184 (Admin), and Bolton v The Law Society (1994) WLR 512.

Panel Decision

18. The Panel considered each of the Particulars separately. It firstly considered Particular 1. The Panel found that the misconduct admitted and found proved in respect of this Particular was serious. The Registrant had received training about breach of confidentiality and should have known better than to share confidential photographs of patients with another person. This was not only a serious lapse of judgement but also a breach of the Registrant’s professional responsibilities. It was aggravated by the fact that the photographs had been shared to another Trust, and the Registrant’s conduct had risked a chain reaction of other people sharing the images. Some of the images also contained identifiable patient data.

19. The Panel considered the relevant HCPC “Standards of Conduct, Performance, and Ethics” (2016). It agreed with the written and oral submissions made on behalf of the HCPC that, in sharing with another person photographs in which patients were being assessed or treated, the Registrant had breached the following standards:

1 Promote and protect the interests of service users and carers

Treat service users and carers with respect

1.1 You must treat service users and carers as individuals, respecting their privacy and dignity.

5 Respect confidentiality Using information

5.1 You must treat information about service users as confidential. Disclosing information

5.2 You must only disclose confidential information if: – you have permission; – the law allows this; –it is in the service user’s best interests; or –it is in the public interest, such as if it is necessary to protect public safety or prevent harm to other people.

6 Manage risk Identify and minimise risk

6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.

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.

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

20. The Panel was mindful that breach of a code of conduct alone would not necessarily constitute misconduct. However, in this case there had been multiple instances of sharing photographs, with some of the patients being identifiable, and multiple breaches of the HCPC Standards. The Panel acknowledged what the Registrant had said during the Trust disciplinary investigation about the reasons why this behaviour had come about, but it concluded that this did not serve to excuse or justify the behaviour. The Panel found this conduct constituted serious misconduct, such that it could rightly be characterised as professional misconduct.

21. The Panel then moved on to consider whether the findings of fact at Particular 2 constituted misconduct. The Panel found that sharing a takeaway in the back of an ambulance had risks, including the risk of harm to a patient of coming into contact with contaminated surfaces and potentially suffering from an allergic reaction. It was also accepted by the Panel that there were risks inherent in taking a meal break without permission, as this could have meant the crew was not immediately available on request. The Panel considered that, as the most senior person present, the Registrant should have known better than to participate in this conduct. The conduct was demonstrative of a serious lapse in judgement and it was the Panel’s view that an observer, aware of all the facts of the case, could find it unprofessional, inappropriate, and offensive.

22. It was notable that the Trust did not consider that this conduct would have been subject to standalone disciplinary proceedings, and that the other crew members involved were not formally disciplined for this behaviour. The witness statement of DL, who conducted the Trust investigation, stated, “If the only breach were eating food in the back of the ambulance, we would not have had to take disciplinary action”.

23. The Panel found as a fact that were it not for the more serious matters, it was unlikely that this Particular would have come before it. It is entitled to take a different view from the Trust, and accepted that eating a takeaway in a clinical area of an ambulance had risks. However, the Panel found that although the Registrant’s behaviour was clearly inappropriate and unprofessional, in the Panel’s judgement it could not be said, due to its isolated nature, to be so serious as to amount to professional misconduct. The Panel therefore found that Particular 2 did not amount to misconduct.

Decision on Impairment

24. The Registrant submitted a 3-page reflective piece and 15 pages of references and appreciation letters. These included a reference from her current line manager and character references from other Paramedics who had worked with her. The Registrant chose to give evidence under Affirmation.

25. The Registrant acknowledged the risks of disclosing information about patients: somebody could recognise them; it would take dignity from them; it was a breach of their trust. She acknowledged the patients in the photographs were vulnerable, as they had called for an ambulance.

26. It was explained by the Registrant that her new employer is extremely supportive. She described her current work and practice, and that she has now been promoted to be a leader for health promotion in her workplace. She had disclosed that she was facing HCPC proceedings at interview, and has since instituted changes in her work environment to ensure confidentiality is maintained, receiving positive feedback in her appraisals at work.

27. The Registrant described how she lost her job with the Trust and her world fell apart. She said she had let down the patients and her whole community. She now focuses a lot on procedure at work to prevent mistakes and ensures all paperwork is secured correctly. She has suggested enhanced procedures to ensure infection control.

28. It was acknowledged by the Registrant that she knew about the duty of confidentiality and had regular training prior to the Allegation, and indeed had taken part in the training two or three months before this. When asked why she did not report problems to her manager, the Registrant explained that she had asked for support from managers at the Trust before for unrelated matters and was declined support, so did not feel able to approach her managers. The Registrant clarified that the sharing of photographs occurred over three to four weeks when she had approximately ten shifts.

29. When questioned by the Panel, the Registrant was able to explain the consequences for the patients involved and that they would feel betrayed, devastated, insecure, and unsafe. She recognised that her action might make members of the public feel betrayed and that some Paramedics are people who cannot be trusted. The Registrant expressed empathy for the patients in the photographs, explaining that she would feel devastated if her personal information had entered the public domain. She also explained the negative impact that this behaviour would have on members of the profession and the public.

Submissions on behalf of the HCPC

30. Mr Collins submitted that some remedial action had occurred and there had been no repetition. He submitted that patient confidentiality was a fundamental tenet of the profession. The Registrant had carried out training around this two months prior to 2021 on a number of occasions.

31. Mr Collins questioned whether the misconduct would have occurred if the Registrant had placed greater and appropriate emphasis on the need to maintain confidentiality. He submitted that the Registrant, having heard ‘no’ on a previous occasion from management, and choosing not to raise issues, demonstrated a lack of understanding of the different circumstances of this from her previous requests.

32. Mr Collins submitted that there had been positive steps taken, but the misconduct at the time was so egregious that the Panel would be entitled to find the Registrant remained impaired on the personal component. The lack of understanding exhibited by the Registrant at the time was such that the Panel would require considerable evidence and assurance that this had changed.

33. Further, it was submitted that the public component included the necessity to maintain standards and public confidence in the profession. Mr Collins said that confidentiality underpins a patient’s ability to speak openly, and the need to maintain standards is of utmost importance. Photographs of individuals in vulnerable situations, receiving treatment, and some photographs taken without consent, was antithetical to standards.

34. Mr Collins submitted that this was not a single incident but multiple breaches. The disclosures went further, which was highly possible in the interconnected digital world. Mr Collins submitted that there were inherently greater risks in disclosing sensitive material to an individual, and a very real risk of ongoing harm. He submitted that the public component of the Registrant’s fitness to practise was engaged.

Submissions on behalf of the Registrant

35. Ms Constantine submitted that the Registrant’s bundle of references went to her current competency and behaviour. She submitted that the Registrant had been open and honest with the HCPC investigation, and was well-respected and highly competent in her role. The Registrant’s colleagues had addressed the specific competencies around infection control and patient confidentiality. These references spoke to the Registrant’s current fitness to practise.

36. Ms Constantine submitted that the Registrant chose to give evidence and did so candidly, explaining the details of how she was not thinking straight. The Registrant had been a registered Paramedic in Poland and then the UK for 20 years, and was remorseful from the outset.

37. It was submitted that from the outset, the Registrant had shown remorse and been apologetic and open. She had also changed practices at her workplace to ensure all patients felt safe and dignified, and was mindful of patient confidentiality in doing so.

38. Ms Constantine submitted that this was an isolated incident taking place over a four-week period, and since then she had done everything to work as an exemplary Paramedic. It was submitted that a well-informed member of the public would look at what had occurred and the specific steps that the Registrant had taken in order not to repeat the behaviour. Ms Constantine submitted that the Panel should look forward and not back. The Registrant had not sought to justify her behaviour, and acknowledged that it did constitute misconduct, but there was no risk of repetition as she would never find herself in that position again.

39. Miss Constantine submitted that the Registrant’s integrity could be relied upon going forwards. She submitted that a finding that the Registrant was not impaired would not undermine public confidence in the profession.

Legal Advice

40. The Legal Assessor referred the Panel to the HCPTS Practice Note “Fitness to Practise Impairment” dated November 2023. The separate private and public components were set out, as were the questions to be asked as formulated by Dame Janet Smith in the Fifth Shipman report. Information from the cases of CHRE V NMC (and Grant) (2011) EWHC 97 (Admin) and Cohen v GMC (2008) EWHC 158 (Admin) was summarised.

Panel Decision

41. The Panel took account of the Registrant’s reflective statement, her oral evidence, and the references and testimonials provided. It acknowledged her reflections and noted her expressions of insight and remorse. The Registrant had also given oral evidence as to how a member of the public might feel in the position of having their confidentiality breached.

42. The Panel found the Registrant to be open and honest, and was mindful that her competence as a Paramedic had never been brought into question. It found that it was unlikely the Registrant would repeat the misconduct, given the consequences for this on her own life and her oral evidence as to how it could impact on others.

43. It was accepted by the Panel that there were human factors involved, and that the misconduct had occurred for a short period of time. The Registrant had been open with her current line manager and now understood that there are resources available for support. The Panel considered that the Registrant’s expressions of remorse and regret were genuine; she had insight into the risks of her behaviour; and she had remediated as far as was possible in the circumstances of this case. The Panel therefore found that, as far as the personal component was concerned, the Registrant’s fitness to practise was not currently impaired.

44. The Panel then moved on to consider the public component. It took the view that confidentiality is a fundamental tenet of the Paramedic profession, and that the principle of confidentiality underpins the work of every healthcare professional. It was mindful that the role of the Regulator is not to punish for past misdeeds, but it was also mindful of the necessity of regulation to uphold proper standards of conduct and behaviour within the profession.

45. It was the finding of the Panel that the Registrant had taken photographs over a period of a month of very vulnerable and unwell patients, at least one of which showed confidential identifiable patient information. The Panel considered that at the time that she did this, the Registrant was fully aware it was wrong. The Panel took the view that a registered professional always knows what their responsibilities are.

46. The Panel had already found a serious breach of Standard 1 of the HCPC Standards, which states:

1 Promote and protect the interests of service users and carers

Treat service users and carers with respect

1.1 You must treat service users and carers as individuals, respecting their privacy and dignity.

47. The Panel determined that what the Registrant had done was fundamentally wrong, and that she had other options available to her at the time. She had chosen not to seek support and instead had breached a fundamental tenet of the profession and allowed vulnerable patients to have their images and confidential personal information exposed to strangers. In these circumstances, the Panel took the view that this was a grave breach of professional standards, and that not to make a finding of impairment in such circumstances would bring both the profession and the Regulator into disrepute. This conduct would seriously undermine confidence in the profession. A member of the public, aware of all the circumstances of the case, would expect such a finding to be made. The Panel therefore found that the public component was engaged, and that the Registrant’s fitness to practise was impaired on this basis.

Decision on Sanction

Submissions on behalf of the HCPC

48. The HCPC made no specific submissions as to the sanction the Panel should impose. Mr Collins explained that this was a matter for the Panel’s judgement, but reminded the Panel that its role was not to be punitive but to protect the public. He commended the HCPC Sanctions Policy to the Panel and invited it to consider the aggravating and mitigating features.

49. Mr Collins submitted that the following features could be considered aggravating: the Registrant knew that what she was doing was wrong; the conduct was repeated; it involved multiple patients as well as multiple dates; patients were vulnerable; and confidential identifiable information had been shared.

50. By way of mitigating features, Mr Collins identified that: there had been no previous fitness to practise proceedings; there was no evidence of repetition; the Registrant had made early admissions at a local level and within these proceedings; the Registrant had shown insight, remorse, and had remediated as far as possible; and the Registrant’s personal circumstances in 2021 were a factor.

Submissions on behalf of the Registrant

51. Ms Constantine acknowledged the aggravating and mitigating factors set out by Mr Collins. She submitted that the Panel should consider the least restrictive sanction first, and that the starting point was to take no action. She submitted that there were no concerns about the Registrant’s ability to practise safely and competently.

52. Ms Constantine submitted that no action in terms of sanction was the right approach in a case like this. There were no ongoing concerns about patient safety and there was no risk of repetition. The Panel had found the Registrant had insight when answering questions and giving evidence.

53. It was submitted on behalf of the Registrant that she had shown remorse and clear insight within her written reflective piece, as well as in answering questions. Ms Constantine submitted that there could be no risk of repetition when the conduct was related directly to the Registrant’s difficult personal circumstances at the time. The Registrant had demonstrated how she would now behave differently.

54. Ms Constantine submitted that the Registrant’s bundle of documents made it clear that she is held in high regard in her work and is an exemplary Paramedic who is highly respected and is no risk to her patients. She submitted that if the Panel was not agreeable to taking no action, the next sanction to consider should be a caution order. Ms Constantine submitted that the Panel could find a caution order at the lower end of the one-to-five year spectrum to be appropriate, with 12 months being proportionate. She submitted that public confidence would be satisfied by the finding of impairment such that a caution order was not necessary.

Legal Advice

55. Legal advice was provided and accepted by the Panel as to the relevant HCPC Sanctions Policy and the role of the Panel in determining sanction, and proportionality.

Decision

56. The Panel was mindful that its role was not to punish the Registrant for past misconduct. It started by considering the aggravating and mitigating features of the misconduct found proved.

57. It was the conclusion of the Panel that the aggravating features included that the Registrant knew the behaviour was wrong at the time, as well as that it was repeated on multiple occasion and across multiple patients. Further, the patients concerned were all vulnerable, in need of care, and/or receiving care at that time. Personal information about at least one patient had been disclosed and this was shared beyond the Trust, which was a foreseeable consequence of the Registrant’s actions.

58. By way of mitigating features, the Panel found that the misconduct was isolated and limited. It was isolated to a brief period of time. Over the course of her 20-year career as a Paramedic, the Panel noted that the misconduct was limited to this one period of around four weeks. The Panel also found that the Registrant had shown good insight, there was a low risk of repetition, and the Registrant had undertaken appropriate remediation.

59. The Panel concluded that the Registrant’s misconduct could not be said to be minor. She had breached patient confidentiality, which is a fundamental tenet of the profession. The Panel determined that as the public component of impairment of fitness to practise was engaged, it was not appropriate to take no action. This would not be in the public interest given the seriousness of the Panel’s findings.

60. The Panel then moved on to consider a caution order. It noted the remediation, the evidence of the excellent work in her current role as a Paramedic which the Registrant had provided, and the remorse, apology, and regret, along with insight, that she had demonstrated. The Panel noted that the Registrant works in a supportive environment and accepted that she would reach out for support if she experienced personal difficulties of the nature that had led to the misconduct. For this reason, the Panel determined that a caution order was likely to be an appropriate sanction in the specific circumstances of this case.

61. The Panel then moved on to consider conditions of practice, the next most severe sanction, but determined that conditions of practice would not be appropriate due to the nature of the misconduct found. The Panel found that there were no clinical issues and that the Registrant’s past conduct was behavioural. The behaviour and attitude of the Registrant was not something that conditions of practice could address.

62. This meant that the next available sanction was a suspension order. The Panel had found that breaching patient confidentiality was a serious breach of the HCPC Standards and could not be categorised as minor. However, given the Panel’s findings as to the low risk of repetition and the Registrant’s insight and remediation, as well as the fact that the Registrant’s conduct was limited to a brief period, the Panel found that a suspension order would be disproportionate.

63. The Panel also considered that depriving the public of a well-respected, competent Paramedic would not be in the public interest.

64. The Panel does not condone what the Registrant has done. However, its role is not to be punitive. The Panel determined that the public interest requires some form of sanction. It concluded that an ordinary person, aware of all the circumstances of the case, would not consider that a Caution Order was unduly lenient to the extent that it could be said to undermine public confidence in the Regulatory process.

65. The Panel determined that a Caution Order of two years was the appropriate and proportionate sanction. This reflects the seriousness of the behaviour and the breach of professional standards. The Panel considered that a caution order for any less time than this would be insufficient to protect the public interest, and that a longer period of time would be disproportionate given the extremely difficult circumstances of the Registrant at the time of the misconduct.

66. Accordingly, the Panel made a Caution Order of two years.

The Registrar is directed to annotate the register entry of Miss Katarzyna Ciszewska with a Caution which is to remain on the Register for a period of 2 years from the date this Order comes into effect.

No notes available

History of Hearings for Katarzyna Ciszewska