Joanna Cierzniakowska

Preliminary Matters

1. Ms Sampson made an application for any matters relating to the Registrant’s health and private life to be heard in private.

2. The Panel had regard to the HCPTS Practice Note on “Conducting Hearings in Private” and accepted the advice of the Legal Assessor. The Panel granted the application for any matters relating to the Registrant’s health and private life to be heard in private on the grounds advanced by Ms Sampson.

Background

3. The Registrant qualified as a Paramedic in Poland in 2011. She began working in healthcare in the UK in 2012 when she took a role as a healthcare assistant in August 2012 with HMP Thameside. The Registrant worked at Buckinghamshire Healthcare NHS Trust between April and August 2019. She worked in the Emergency Department of Stoke Mandeville Hospital as a Paramedic.

4. The panel at the substantive hearing was provided with a number of witness statements, setting out the concerns raised about the Registrant’s ability to prioritise the care of patients, her knowledge of the sepsis.

5. The panel at the substantive hearing was presented with evidence that the Registrant acknowledged her failures in practice, in particular a signed and dated copy of the consensual disposal request pro-forma dated 5 March 2022. That form confirmed that the Registrant admitted the substance of the allegation made against her and that her fitness to practise was currently impaired by reason of her health and lack of competence.

6. In the appendix to the form, the Registrant stated that she still worked in a healthcare environment as a healthcare assistant and performed ECGs on a daily basis and had been doing online training and reading medical articles to improve her knowledge and skills. She asked that the submissions made to the Investigating Committee would be considered, in particular her explanation of the difficulties that she accepted she had at the time of the allegations. She concluded by stating that she did accept the substance of the allegations and that her fitness to practise was impaired.

7. The Registrant accepted at the outset that the role she held at the relevant time was perhaps not best suited to her. She accepted that her performance was not always to the standard that it should have been and that was to her great regret. This was her first paramedic role since coming to the UK and she accepts that she did find it difficult to adapt to paramedic practise in the UK coming from Poland, where the systems and responsibilities of a paramedic can be very different. The Registrant made it clear that she was open to accepting where errors may have been made and reflecting on her practice.

8. The panel received a reference from Dr Alex Bunn, Lead GP at HMP Wandsworth, dated 20 December 2022. This confirmed that the `Registrant started working in the prison in February 2020 and that, as of December 2022, she had worked in the capacity of a HCA, performing ECGs and overseeing phlebotomy. Dr Bunn stated that he had been very impressed with the standard of her work, including attention to patient safety and that her documentation was excellent.

9. The Registrant provided the panel with evidence of her Continuous Professional Development, including completion of the 12 Lead ECG Recording course, in which she achieved a score of 90%, on 1 November 2022. The panel also received an Activity Report, outlining various training sessions that the Registrant had completed.

10. As at 11 October 2023 the Registrant was working as a Band 3 Health Care Assistant. She was described by Kristen Ross, Head of Healthcare at HMP Wandsworth as an “excellent HCA”.

11. The panel concluded that the agreement for a Consensual Disposal by the imposition of a Conditions of Practice Order should be approved and that an order should be made in the terms set out below:

12. The Panel has determined to approve, with immediate effect, the outcome sought by both the HCPC and the Registrant in the agreement for consensual disposal, namely the imposition of a Conditions of Practice Order for a period of 12 months in the following terms:

1) Before undertaking work that may involve use a sepsis screening tool, you must:

a) satisfactorily complete refresher training and/or supervised practice in relation to use of sepsis screening tools; and
b) forward evidence of your completion of Condition 1a to the HCPC.

2) Before undertaking work that may involve use of oxygen or air masks, you must:
a) satisfactorily complete refresher training and/or supervised practice in relation to use of oxygen and air masks; and
b) forward evidence of your completion of Condition 2a to the HCPC.

3) 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 14 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.
4) You must work with your workplace supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:
5) Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.
6) You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.
7) You must allow your workplace supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

Today’s hearing

13. The Panel was provided by the HCPC with a hearing bundle containing the decision of the panel at the substantive hearing.

14. The Panel heard oral evidence from the Registrant. The Registrant stated that she had been unable to find employment as a Paramedic since the date of the substantive hearing and had not undergone any relevant training or undertaken Continuing Professional Development (CPD). She explained that it was difficult for her to find suitable employment as a Paramedic because she suffered from a medical condition which prevented her from passing blue light training required to join the Ambulance Service. She was therefore restricted in the roles which she could undertake as a Paramedic. She further explained that in the last year she had been distracted by pressing family problems from undertaking training or CPD. She told the Panel that she had continued to work as a Health Care Assistant at HMP Wandsworth alongside other clinicians. This work included administering blood tests and ECGs and generally providing support to patients. She said that the prison had a sepsis tool which she had used but that it was quite basic and would not compare with the type of sepsis tool used by Emergency Departments.

15. The Registrant acknowledged that her fitness to practise remained impaired. She asked the Panel to give her a further opportunity to seek employment as a Paramedic and comply with conditions of practice.

16. On behalf of the HCPC, Ms Sampson submitted that, in the absence of any evidence that the Registrant had addressed and successfully remediated the outstanding concerns about her fitness to practise, as identified at the time of the consensual disposal, the Panel today must inevitably conclude that her fitness to practise remained impaired. Ms Sampson invited the Panel to consider extending the current conditions of practice for at least another 12 months.

The Panel’s decision

17. The Panel took into account the HCPTS Practice Notes “Review of Article 30 Orders” and “Fitness to Practise Impairment” and accepted the advice of the Legal Assessor.

18. The Panel first considered whether the Registrant’s fitness to practise remained impaired by reason of the allegations found proved at the substantive hearing.

19. The Panel took into account the decision of the High Court in Abrahaem v GMC [2008] EWHC 183 [Admin] where it was stated that in practical terms there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that he has fully acknowledged the deficiencies which led to the original findings and has addressed his impairment sufficiently “through insight, application, education, supervision or other achievement”.

20. The Panel considered that the original allegations concerning the Registrant’s fitness to practise were serious and that none of them had been addressed, let alone remedied, since the imposition of the Conditions of Practice Order at the substantive hearing on 1 March 2024.

21. The Panel therefore concluded the Registrant’s fitness to practise remained impaired both in respect of the personal and public components of impairment.

22. With regard to sanction, the Panel took into account the HCPC’s Sanctions Policy and accepted the advice of the Legal Assessor.

23. The Panel considered the need to protect the public and gave appropriate weight to the wider public interest, which includes the reputation of the profession and public confidence in the regulatory process. The Panel applied the principle of proportionality and considered the available sanctions in ascending order of seriousness.

24. The Panel considered that the concerns about the Registrant’s fitness to practise were too serious to take no further action or for the imposition of a Caution Order.

25. The Panel considered whether to extend the Conditions of Practice Order to give the Registrant an opportunity to demonstrate that she had taken steps to address the issues underlying her failures in practice. The Panel noted the constraints and difficulties referred to by the Registrant in finding employment as a Registrant. The Panel was disappointed that the Registrant had not taken any steps to undergo professional training to address the shortcomings identified in her practice or to maintain her CPD but understood there had been competing demands on her time and distractions caused by her family problems.

26. In all the circumstances, the Panel decided that the Registrant should be given a further opportunity to obtain employment as a Paramedic and to comply with conditions of practice. The Panel was satisfied that the current conditions of practice remained appropriate and proportionate. The Panel decided to extend the Conditions of Practice Order for a further two years on the expiry of the current order. That period should give the Registrant enough time to obtain suitable employment as a Paramedic and to undertake the necessary training to remediate all outstanding concerns relating to her fitness to practise.

1) Before undertaking work that may involve use a sepsis screening tool, you must:
a) satisfactorily complete refresher training and/or supervised practice in relation to use of sepsis screening tools; and
b) forward evidence of your completion of Condition 1a to the HCPC.

2) Before undertaking work that may involve use of oxygen or air masks, you must:
a) satisfactorily complete refresher training and/or supervised practice in relation to use of oxygen and air masks; and
b) forward evidence of your completion of Condition 2a to the HCPC.
3) 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 14 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

4) You must work with your workplace supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:
a) prioritisation of patient care;
b) use of sepsis screening tools;
c) understanding of the different types of oxygen masks and the difference between using air or oxygen in patient care.

5) Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

6) You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

7) You must allow your workplace supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

The Order imposed today will apply from 1 March 2025.

History of Hearings for Joanna Cierzniakowska