Michelle A Bignall
Profession: Paramedic
Registration Number: PA40597
Hearing Type: Final Hearing
Date and Time of hearing: 10:00 30/03/2026
End:
17:00 13/04/2026
Location:
Virtual
Panel: Conduct and Competence Committee
Outcome: Suspended
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Allegation
As a registered Paramedic (PA40597):
1. Between 24 March and 4 April 2020, you did not ensure and/or record that all necessary observations were undertaken and/or an adequate patient assessment was completed in relation to one or more of the following patients:
a. Patient A in respect of one or more of the following observations and/or assessments:
i. Blood pressure
ii. Blood sugar
iii. The carrying out of an electrocardiogram (ECG)
b. Patient B in respect of one or more of the following observations and/or assessments:
i. Respiration rate
ii. Oxygen saturation levels
iii. Pulse rate
iv. Blood pressure
v. Blood sugar
vi. The carrying out of an ECG
c. Patient C in respect of one or more of the following observations and/or assessments:
i. Blood pressure
ii. The carrying out of an ECG
d. Patient D in respect of one or more of the following observations and/or assessments:
i. Blood pressure
ii. Blood sugar
iii. The carrying out of an ECG
e. Patient E in respect of one or more of the following observations and/or assessments:
i. Blood pressure
ii. The carrying out of an ECG
f. Patient F in respect of one or more of the following observations and/or assessments:
i. Blood pressure
ii. Blood sugar
iii. The carrying out of an ECG
g. Patient G in respect of one or more of the following observations and/or assessments:
i) Blood pressure
ii) The carrying out of an ECG
iii) Pain score
iv) Assessment of character, severity or exacerbation of headache
h. Patient H in respect of one or more of the following observations and/or assessments:
i) Blood pressure
ii) Blood sugar
iii) The carrying out of an ECG
i. Patient I in respect of one or more of the following observations and/or assessments:
i) Blood pressure
ii) The carrying out of an ECG
iii) Review of respiratory system assessment
j. Patient J in respect of one or more of the following observations and/or assessments:
i) Blood pressure
ii) The carrying out of an ECG
k. Patient K in respect of one or more of the following observations and/or assessments:
(i) Blood pressure
(ii) Pulse rate
(iii) Blood sugar
(iv) The carrying out of an ECG
l. Patient L in respect of one or more of the following observations and/or assessments:
(i) Blood pressure
(ii) The carrying out of an ECG
m. Patient M in respect of one or more of the following observations and/or assessments:
i. Pulse rate
ii. Oxygen saturation
iii. Blood pressure
iv. The carrying out of an ECG
v. Heart rate
2. In or around March 2020, you instructed one or more colleagues not to undertake necessary observations on suspected COVID-19 patients.
3. Between 28 March and 4 April 2020 you inappropriately left at home one or more of the patients listed in Schedule A.
4. On 3 April 2020 you did not carry out and/or failed to record the consideration of an alternative care pathway or safeguarding referral for Patient K.
5. The matters set out in Particular 1 and/or 2 and/or 3 and/or 4 constitute misconduct.
6. By reason of your misconduct your fitness to practise is impaired.
Schedule A
Patient A
Patient B
Patient C
Patient E
Patient F
Patient F
Patient G
Patient H
Patient I
Patient J
Patient K
Patient L
Patient M
Finding
Preliminary Matters
Hearing in private
1. On behalf of the Registrant, Mr Hussain-Dupré made an application for part of the hearing to be heard in private to protect the private life of the Registrant and of a witness on behalf of the Registrant.
2. On behalf of the HCPC, Mr Smith did not oppose the application.
3. The Panel accepted the advice of the Legal Assessor. She advised that hearings are heard in public in accordance with the principle of open justice. There are limited exceptions to this principle and one exception is to protect the private life of the Registrant or other individuals as explained within the HCPTS Practice Note “Conducting Hearings in Private”.
4. The Panel carefully balanced the public interest in open justice and the need to protect the private life of the Registrant and the witness. The Panel decided that it was appropriate for the limited matters outlined by Mr Hussain-Dupré to be heard in private.
Background
5. The Registrant is a registered Paramedic. She was employed by the London Ambulance Service (LAS) as a Band 6 Paramedic from April 2016.
6. On 28 March 2020, a family member of Patient A raised a complaint regarding the attending crew’s conduct towards Patient A. The Registrant was the relevant Paramedic regarding Patient A.
7. As a result of the concerns raised by Patient A’s family, LAS investigated the Registrant’s conduct. BE, LAS Director of Operations, conducted the investigation which identified further concerns regarding the Registrant’s assessment and observation of 12 patients (Patients B to M) during the COVID-19 pandemic. It was alleged that the Registrant failed to complete a number of key assessments and observations when attending to patients. LAS also identified concerns regarding the Registrant’s record-keeping and concerns that the Registrant allegedly instructed junior colleagues not to undertake certain observations on patients.
8. On 10 June 2020, the concerns regarding the Registrant’s practice were referred to the HCPC.
9. The HCPC commissioned an expert report from Paramedic Mr David Lee to provide expert opinion to assist the Panel.
Decision on Facts
10. There were no admissions to the Allegations.
11. The Panel reviewed the documentary evidence contained within: the 476-page hearing bundle; the 124-page Registrant’s bundle; the 32-page Registrant’s addendum bundle; the Registrant’s signed witness statement; Person P’s signed statement; and the bundle of documents relating to Person O.
12. The Panel heard evidence from the following witnesses on behalf of the HCPC:
• BE;
• Mr David Lee;
• Person N, who at the time was a newly qualified Paramedic who worked with the Registrant and attended some of the patients referred to in the Allegation.
13. The Panel heard evidence from the following witnesses on behalf of the Registrant:
• Person O, currently a Paramedic, who at the time was an Emergency Medical Technician (EMT) who worked with the Registrant and attended some of the patients referred to in the Allegation;
• The Registrant;
• Person P, currently a Paramedic, who at the time was an EMT who worked with the Registrant and attended some of the patients referred to in the Allegation.
14. The Panel read the written submissions from Mr Smith on behalf of the HCPC, who supplemented those submissions with oral submissions.
15. The Panel read the written submissions from Mr Hussain-Dupré on behalf of the Registrant, who supplemented those submissions with oral submissions.
16. The Panel accepted the advice of the Legal Assessor and was aware that the burden of proof is on the HCPC and that the standard of proof in deciding whether the facts are found proved is ‘on the balance of probabilities’.
17. The Panel was advised to consider each particular of the Allegation separately and consider whether the facts set out in the Allegation are proved, assessing the weight of the documentary and the oral evidence.
18. The advice of the Legal Assessor also included reference to the case of PSA v GMC and Garrard 2025 EWHC 318. She advised that there are two grounds on which evidence may be cross-admitted: propensity to commit that kind of conduct and/or to rebut coincidence. In this case the HCPC relied on both grounds. The Panel must be clear as to which ground it was considering because a different approach applies to each ground.
19. The Panel should consider whether the evidence which was suggested to be cross-admissible was admissible. To be admissible it must be relevant, so the Panel should consider whether there was a sufficient connection and similarity between the facts of the allegations or particulars.
20. If the evidence was admissible, where it was sought to be cross-admitted on the ground of propensity the Panel would need to be satisfied on the balance of probabilities that at least one particular was proved before relying on the evidence in relation to that particular to prove another particular.
21. Where the evidence was sought to be admitted to rebut coincidence, in this case the number of patients who were recorded to have declined a blood pressure reading, the Panel should consider all the relevant particulars together holistically rather than sequentially and consider the Registrant’s explanation that patients were more likely to decline a blood pressure reading during the COVID-19 pandemic. When considering this ground it was not necessary to find one allegation or particular to be proved before relying on the evidence in respect of that allegation in support of the others.
22. The Panel noted that some of the factual witnesses, including the Registrant, Person N, Person P, and BE, gave opinion evidence in addition to their factual evidence. This opinion evidence was based on their experience of Paramedic practice and was admissible. The Panel was satisfied that the Registrant, Person N, Person P, and BE have special expertise as to Paramedic practice and it did not disregard their opinion evidence, but it gave greater weight to the opinion evidence of Mr Lee. The Panel gave greater weight to Mr Lee’s evidence because he was under an obligation to provide independent objective evidence and his overriding duty was to the Panel and not to the HCPC which instructed him. Mr Lee had experience working as a Paramedic during COVID-19. His qualifications and expertise were not challenged by the Registrant. The Panel found that Mr Lee’s evidence was consistent and cogent.
23. The Panel was satisfied that there was no change to the expectations of Paramedics in respect of observations and assessments that were required for Paramedics during COVID-19. The LAS bulletins reminded Paramedics that suspected COVID-19 cases should be treated as they would treat any other patient. Between 18 March 2020 and 27 March 2020, LAS Paramedics were advised that they should carry out a ‘doorstep challenge’. This involved asking the person answering the door if the patient had a continuous cough and asking the family member or friend to take the patient’s temperature. The purpose of the ‘doorstep challenge’ was to enable the Paramedics to assess the risk and decide whether they needed to wear personal protective equipment (PPE). The ‘doorstep challenge’ did not apply from 27 March 2020 because a bulletin issued on that date advised that COVID-19 infection should be presumed in all face-to-face attendances and that the ‘doorstep challenge’ was no longer required.
24. Where there were differences between the Registrant’s account of events in her investigation interviews with BE and the evidence set out within her witness statement, the Panel gave more weight to her interviews with BE. The Panel considered that the Registrant’s responses in her interviews on 3 June 2020 and 23 July 2020 were more reliable as they were closer in time to the events. The Registrant attended the interviews with a trade union representative and she signed a copy of the notes of interview to confirm that her responses had been accurately recorded.
25. The Panel was satisfied that the Registrant’s answers in the interviews reflected the way in which she applied, and expected others to apply, the ‘doorstep challenge’. She stated “We were told with COVID19 we would do temperatures and if they had persistent cough, we were telling them to go back into their property”. When asked about physical observations such as heart rate, blood pressure, or blood glucose, the Registrant repeated that the Paramedics would tell the patient to go back in to the house if they showed COVID-19 signs. This was a misunderstanding of the ‘doorstep challenge’.
26. The Registrant was also frank in her interviews about her fear of catching COVID-19, saying that she was “scared out of her life”. She also referred to her concerns for her crewmate, Person P, who was in the early stages of her pregnancy.
27. Person P similarly misunderstood the ‘doorstep challenge’. In her interview with BE she stated, “…at the time I perceived the guidelines as doing the doorstep challenge and if they looked well, we give them the advice and they stay at home”.
28. In a further interview with BE, Person P was asked about her discussions with the Registrant. She stated, “We would do the doorstep challenge. If they looked well and they’ve got a temperature and cough, we would advise that they self-isolate following the NHS guidelines”. Person P was then asked whether in this discussion with the Registrant they decided to limit the amount of observations carried out. Person P replied, “Yes, to try to minimise touching the patients”.
29. The Panel was invited by Mr Hussain-Dupré to take into account evidence that on other occasions the Registrant had carried out herself or had been present when the attendant had carried out full observations. The Panel gave little weight to this evidence. The Panel had no detailed information about the circumstances of the patients where full observations were recorded or the reasons why such observations were carried out. Mr Smith also pointed out that many of the cases where full observations were carried out did not involve suspected COVID-19.
30. The Registrant was a Band 6 Paramedic and senior to all other crew members she worked with when treating Patients A-M. For all patients, other than Patient C, the Registrant was responsible for driving the ambulance and she delegated the responsibility for taking the physical observations and recording those observations to her crewmate, ‘the attendant’. Although the Registrant delegated responsibility to her crewmate, as the Registrant was the most senior clinician with a higher level of knowledge and/or skill, she was ultimately responsible for the care of the patient. This is described as ‘primacy of care’.
31. The Panel accepted the evidence of Mr Lee and BE on ‘primacy of care’, which was consistent with the documentary evidence. The “LAS Policy Statement of Duties to Patients” states at paragraph 5.2:
“Primacy of care is the area where there can be a blurring within the grade(s) and or professions of staff on scene. In general terms two basic principles apply here;
1) The first qualified person on scene will initiate treatment and continue to advise/direct and carry out treatment, until that episode of care is concluded, or until they hand the patient over to another appropriate member of staff of healthcare professional etc…, and:
2) Where there is more than one member of staff on scene it is the more senior member of staff on scene in terms of clinical qualifications who must take responsibility.”
32. The policy also states at paragraph 5.3:
“Other than in the presence of a more qualified clinician … it is an absolute requirement [emphasis added] that the most qualified and competent member of LAS staff assumes overall responsibility for the patient’s clinical management at all times”
33. The Panel was satisfied that the Registrant, as the most senior clinician, had the overall responsibility for the care of Patients A-M. The crewmates who worked alongside the Registrant had a duty to carry out their responsibilities with due care and in accordance with their level of skill, but the Registrant remained responsible for the patients’ care. For Patient A, the care of the patient by the attendant was in the back of the ambulance, but the Registrant told the Panel that from her seat she could see an attempt by the attendant to carry out one of the observations. For Patients B and D-M, the Registrant told the Panel that to avoid the risk of infection, she stood a few feet behind the attendant whilst the physical observations were carried out. The Registrant also had the opportunity to ask the attendant which physical observations they had carried out.
34. In her evidence the Registrant told the Panel that all clinicians attending to a patient have primacy of care. This is a misunderstanding of the written policies and of the principles that underlie primacy of care. All clinicians have a duty of care to the patients, but the Registrant had the primacy of care.
35. The Panel was satisfied that the primacy of care also extended to the completion of the Patient Report Form (PRF), which is part of the care provided to the patient. The Panel found that practice within LAS varied. The Registrant did not routinely check the PRFs completed by the attendant and Person P’s experience was that her PRFs were not routinely checked by the more senior clinician. Person P told the Panel that there was no requirement for PRFs to be checked by the senior clinician either in 2020 or at today’s date. The Panel was not provided with a document setting out a requirement for such checking. Although checking PRFs was not routine, Person O and Person N had some experience of checking PRFs or of their PRFs being checked. The Panel found that the absence of routine checking of PRFs did not negate the principle of primacy of care. The PRF is part of the package of care for a patient to ensure that future clinicians are aware of the steps undertaken by the ambulance crew.
36. The Panel’s findings on the allegations, other than Particular 4, relate to the Registrant’s primacy of care in relation to physical observations or assessments of the patient, rather than to the recording on the PRF.
Particular 1
Between 24 March and 4 April 2020, you did not ensure and/or record that all necessary observations were undertaken and/or an adequate patient assessment was completed in relation to one or more of the following patients:
Particular 1(a)
a. Patient A in respect of one or more of the following observations and/or assessments:
i. Blood pressure (not proved)
ii. Blood sugar (proved)
iii The carrying out of an electrocardiogram (ECG) (proved)
37. The documents before the Panel included a copy of the PRF, which showed that no observations were recorded for blood pressure, blood sugar, or an ECG for Patient A. There was no suggestion by the Registrant that those observations were carried out but were not recorded on the PRF.
38. The Panel was satisfied that Person P made an attempt to take Patient A’s blood pressure, but that she was unable to do so because the blood pressure cuff was not sufficiently large for the patient and “popped off”. The Panel accepted Person P’s evidence that there was no suitable cuff on the ambulance. Person P’s evidence was consistent with her interview with BE. The Panel accepted the evidence of Mr Lee that taking Patient A’s blood pressure measurement was necessary. However, the explanation that Person P was unable to take a blood pressure measurement was consistent with the contemporaneous documents and was plausible.
39. The Panel therefore found Particular 1(a)(i) not proved.
40. The Panel accepted Mr Lee’s evidence that a blood sugar observation was necessary for a patient who was Tachycardic, Pyrexic, and Hypoxic. A failure to perform a full assessment can also result in a misdiagnosis and/or inappropriate treatment. Mr Lee maintained his opinion when challenged in cross-examination. The Panel gave little weight to the assertions of the Registrant in her evidence to the Panel that a blood sugar observation was not necessary because the Registrant is not an independent expert witness and because the Registrant gave a different explanation to BE when he interviewed the Registrant in 2020.
41. Accordingly, the Panel found Particular 1(a)(ii) proved. The Registrant did not ensure that a necessary observation was carried out and therefore she did not ensure that an adequate patient assessment was completed.
42. The Panel accepted the evidence of Mr Lee that an ECG was necessary for a patient who was Tachycardic, Pyrexic, and Hypoxic. In cross-examination Mr Lee was challenged about the difference between cardiac chest pain and pleuritic chest pain and was referred to a table which analysed the differences. Mr Lee acknowledged the differences but his opinion remained that the application of JRCALC (clinical guidance for Paramedics) indicated that an ECG is the appropriate starting point for the assessment of a patient with chest pain.
43. The Panel therefore found Particular 1(a)(iii) proved. The Registrant did not ensure that a necessary observation was carried out and therefore she did not ensure that an adequate patient assessment was completed.
Particular 1(b)
b. Patient B in respect of one or more of the following observations and/or assessments:
i. Respiration rate (not proved)
ii. Oxygen saturation levels (proved)
iii. Pulse rate (proved)
iv. Blood pressure (proved)
v. Blood sugar (proved)
vi. The carrying out of an ECG (proved)
44. The Panel was provided with a copy of the PRF for Patient B. The respiration rate was recorded on the PRF. The Panel therefore found Particular 1(b)(i) not proved. The remainder of the observations (ii) to (vi) were not recorded on the PRF and the Panel was satisfied that they were not carried out.
45. The PRF for Patient B was completed by Person P. She recorded on the PRF “Unable to do full set of obs due to highly suspected COVID Items will be contaminated”. Although this record partly reflects the reason for the absence of observations, a further underlying reason was the fear of the Registrant and Person P of catching COVID-19 themselves. This was clearly stated by the Registrant when she was interviewed by BE. The Panel was satisfied that the COVID-19 circumstances were the reason the observations were not carried out.
46. The Panel accepted the evidence of Mr Lee that oxygen saturation level, pulse rate, blood pressure, blood sugar, and an ECG were necessary observations for Patient B.
47. Accordingly, the Panel found Particulars 1(b)(ii), (iii), (iv), (v), and (vi) proved. The Registrant did not ensure that a necessary observation was carried out and therefore she did not ensure that an adequate patient assessment was completed.
48. Having found Particulars 1(a)(ii), (iii), and 1(b)(ii)-(vi) proved, the Panel considered whether it should take those findings into account when determining the remainder of the particulars within Particular 1. The Panel was satisfied that there was sufficient similarity between the particulars for its findings to be relevant. The Panel therefore decided to admit its findings on 1(a)(ii), (iii), and 1(b)(ii)-(vi) under the cross-admissibility ground of propensity. The relevance of those findings was that necessary observations for two patients had not been carried out due to COVID-19 circumstances.
Particular 1(c)
c. Patient C in respect of one or more of the following observations and/or assessments:
i) Blood pressure (proved)
ii) The carrying out of an ECG (not proved)
49. The Panel noted that the Registrant was the attendant for Patient C. She described Patient C as being generally non-compliant and having only called the ambulance to request a COVID-19 test.
50. The Panel was provided with a copy of the PRF for Patient C, which did not record observations for blood pressure or the results of an ECG. The Panel was therefore satisfied that those observations were not carried out.
51. The Panel accepted the evidence of Mr Lee that a blood pressure observation was necessary for a patient with Pyrexia.
52. In relation to the need for an ECG for Patient C, Mr Lee described this as falling below the standard for a Paramedic but “to a lesser degree than failing to record a blood pressure”. Mr Lee did not give a reason why an ECG was required.
53. The Panel was not satisfied that not carrying out an ECG for Patient C was a necessary observation or that in not carrying out such an observation the Registrant had failed to ensure that an adequate patient assessment was conducted.
54. The Panel therefore found Particular 1(c)(i) proved and Particular 1(c)(ii) not proved.
Particular 1(d)
d. Patient D in respect of one or more of the following observations and/or assessments:
i. Blood pressure (proved)
ii. Blood sugar (proved)
iii. The carrying out of an ECG (proved)
55. The Panel was provided with a copy of the PRF for Patient D. No observations for blood pressure, blood sugar, or an ECG were recorded and the Panel was satisfied that they were not carried out.
56. The PRF did not record that Patient D refused to be examined by the attending Paramedic. It recorded “did not take obs due to infection risk”.
57. The record on the PRF was not consistent with the Registrant’s description of the attendance to Patient D. She described that Patient D would not let the ambulance crew get close enough to take observations and that Patient D retreated to the top of the stairs and refused to come down. Her account was supported by the evidence of Person P.
58. Although it is possible that there was some reluctance on the part of Patient D to engage with the attendant, Person P, she was able to take some observations, including observations of the patient’s pupils. The Panel was satisfied that the reason the observations were not taken for Patient D was the COVID-19 circumstances, rather than his reluctance. Infection risk was the reason recorded on the PRF, which is the formal and legal record of the treatment of the patient and must be an accurate description of the circumstances. The Registrant told BE that the fear of contracting COVID-19 was the reason for omissions in patient observations. She had discussions with Person P about using the ‘doorstep challenge’, giving advice to suspected COVID-19 patients to isolate, and limiting observations to avoid touching the patients. Patient D was a patient with a high temperature and an infection risk was described in the PRF.
59. The Panel also took into account its findings on Particulars 1(a) and 1(b).
60. Having considered the evidence, the Panel was satisfied that the reason the observations were not carried out was the COVID-19 circumstances and the Registrant’s erroneous interpretation of the ‘doorstep challenge’.
61. The Panel accepted the evidence of Mr Lee that blood pressure, blood sugar, and an ECG were necessary observations for Patient D, who had a past medical history of diabetes and hypertension. Given his medical history and prescribed medication, an ECG was indicated due to the increased risk of cardiovascular disease.
62. The Panel therefore found Particular 1(d) proved in its entirety.
Particular 1(e)
e. Patient E in respect of one or more of the following observations and/or assessments:
i. Blood pressure (proved)
ii. The carrying out of an ECG (proved)
63. The Panel was provided with a copy of the PRF for Patient E. This did not include blood pressure or ECG observations and the Panel was satisfied that they were not carried out.
64. The attendant for Patient E was Person O. He recorded that Patient E declined a blood pressure reading. He made the same recording that the patient declined the blood pressure reading for Patients F, H, and I on the same day. The HCPC invited the Panel to conclude that this was not a coincidence and that it was highly unlikely that four patients declined a blood pressure reading on the same day.
65. The Panel admitted the evidence relating to the other three patients, F, H and I, to rebut coincidence. It was satisfied that the four records of a patient declining a blood pressure reading on the same shift were not due to collusion or contamination of the evidence. The Panel accepted Mr Lee’s evidence that on occasion patients do decline blood pressure readings, but that this is not common. The Panel was not satisfied that the COVID-19 circumstances explained the coincidence. It considered that during COVID-19 a refusal may have been somewhat more common, but that it was highly unlikely that within a single shift four patients declined a blood pressure reading.
66. When he was interviewed by BE, Person O did not confirm that the patients had declined a blood pressure reading. He stated that the Registrant had “told me not to carry out observations on COVID patients, do the ‘doorstep challenge’”.
67. The Panel found that a record made by Person O that a patient declined a blood pressure reading reflected the absence of a recording but could not be relied on as evidence that the patient declined a blood pressure reading.
68. The Panel was satisfied that there was no reason for a blood pressure reading not to be carried out for Patient E.
69. The Panel accepted the evidence of Mr Lee that blood pressure and an ECG were required for Patient E.
70. Accordingly, the Panel found Particular 1(e) proved in its entirety.
Particular 1(f)
f. Patient F in respect of one or more of the following observations and/or assessments:
i. Blood pressure (proved)
ii. Blood sugar (not proved)
iii. The carrying out of an ECG (proved)
71. The Registrant had no recollection of Patient F. For the reasons given above, the Panel did not accept that Patient F had declined a blood pressure measurement.
72. The Panel accepted the evidence of Mr Lee that blood pressure and an ECG were observations required for Patient F. Mr Lee noted that shortness of breath was recorded in the free text box on the PRF. Patient F had no previous medical history which would suggest that the shortness of breath was acute in nature. Patient F also had an elevated respiratory rate. Mr Lee stated that applying JRCALC indicated that an ECG was required. A blood pressure reading was also required, and without it the National Early Warning Score 2 (NEWS2), which assesses the deterioration of an unwell person, particularly someone with suspected sepsis, would be inaccurate.
73. The Panel noted from the evidence of Mr Lee that no clinical reason was provided as to why a blood sugar reading was required. The Panel was therefore unable to conclude that this was a necessary observation as part of an adequate patient assessment.
74. Accordingly, the Panel found Particulars 1(f)(i) and 1(f)(iii) proved. Particular 1(f)(ii) was not proved.
Particular 1(g)
g. Patient G in respect of one or more of the following observations and/or assessments:
i) Blood pressure (proved)
ii) The carrying out of an ECG (proved)
iii) Pain score (proved)
iv) Assessment of character, severity or exacerbation of headache (proved)
75. The Registrant was unable to recollect Patient G. She pointed out that Person O recorded “nil neurological deficit” and other details in respect of Patient G on the PRF.
76. The Panel accepted the evidence of Mr Lee that blood pressure, an ECG, and a pain score were necessary observations for Patient G. Mr Lee’s report included reference to JRCALC and the guidelines for headache. The guidelines indicate that patients with a headache must have their blood pressure and a pain score recorded. An ECG is required for a patient who has difficulty in breathing, hypertension, and hypercholesterolaemia. Mr Lee also referred to JRCALC in stating that an assessment of the character, severity, or exacerbation of the headache is required.
77. Mr Lee had reviewed the PRF in detail and was aware that Person O had recorded “nil neurological deficit” and the other details highlighted by the Registrant. The references and details on the PRF were insufficient because sinister headaches may or may not be accompanied by neurology, and that the “history of the headache was also key”.
78. The Panel therefore found Particular 1(g) proved in its entirety.
Particular 1(h)
h. Patient H in respect of one or more of the following observations and/or assessments:
i) Blood pressure (proved)
ii) Blood sugar (proved)
iii) The carrying out of an ECG (proved)
79. The Panel noted that Person O recorded that Patient H refused a blood pressure reading. For the reasons addressed in relation to Patient E, the Panel did not accept that Patient H had refused a blood pressure reading.
80. The Panel accepted the evidence of Mr Lee that blood pressure, blood sugar, and an ECG were required for Patient H. Patient H was diabetic and therefore a blood sugar reading was required. Patient H was also a patient with asthma and under the JRCALC guidelines, a blood pressure measurement should be obtained. An ECG was required because Patient H had difficulty in breathing.
81. The Panel therefore found Particular 1(h) proved in its entirety.
Particular 1(i)
i. Patient I in respect of one or more of the following observations and/or assessments:
i) Blood pressure (proved)
ii) The carrying out of an ECG (proved)
iii) Review of respiratory system assessment (proved)
82. The Panel noted that Person O recorded that Patient I refused a blood pressure reading. For the reasons addressed in relation to Patient E, the Panel found that this recording was Person O’s description of the approach advised by the Registrant that blood pressure readings should not be taken for suspected COVID-19 patients.
83. The Panel accepted the evidence of Mr Lee. He noted that according to the PRF the patient presented with “fine crackles”, but that there was little or no review of Patient I’s respiratory system and no record of blood pressure or ECG. Mr Lee explained in his supplementary report that “fine crackles” are an important finding that should prompt a thorough assessment to exclude any cardiac or respiratory pathology.
84. The Panel therefore found Particular 1(i) proved in its entirety.
Particular 1(j)
j. Patient J in respect of one or more of the following observations and/or assessments:
i) Blood pressure (proved)
ii) The carrying out of an ECG (proved)
85. The history of Patient J’s reported complaint included a possible myocardial infarction and that Patient J reported central chest pain, radiating, and worsening on exertion. In Mr Lee’s opinion these are symptoms associated with Acute Coronary Syndrome (ACS) that required a prompt and accurate assessment. He referred to JRCALC, which states that “monitoring with a defibrillator” is indicated for patients with suspected ACS.
86. The Registrant’s position, supported by Person N, who was the attendant, was that the observations within the allegation were not required. The Panel gave little weight to Person N’s opinion evidence because she is not an independent expert and at the time of the relevant events she was not a qualified Paramedic. The Panel accepted the evidence of the Registrant that a patient with an initial reported complaint may present differently when physically assessed and that Patient J did so in this case. However, the reported complaint, as relayed to the ambulance crew and recorded in the PRF, should be investigated. The observations carried out should include those set out in the reported complaint unless there is a clear explanation in the PRF as to why the reported complaint was judged as not relevant and not requiring investigation. The possibility of a cardiac problem had been dismissed by the attendant and the Registrant without the baseline observations being carried out.
87. In considering the evidence relating to Patient J, the Panel also took into account the evidence of the attendant, Person N. The Panel accepted her evidence that during her shifts with the Registrant on 3 and 4 April 2020, the Registrant stated that she had decided to do the ‘doorstep challenge’ for patients where COVID-19 was suspected and that minimal observations were taken on the doorstep. She stated that she did not challenge this decision not to take a full set of observations because she felt that the Registrant would not respond well to being challenged.
88. The Panel also took into account its findings on Particulars 1 and 2 and the Registrant’s practice, at that time, of not carrying out full observations because of her fears relating to COVID-19.
89. The Panel was satisfied that the observations of a blood pressure measurement and an ECG were necessary and part of an adequate assessment for Patient J.
90. Accordingly, the Panel found Particular 1(j) proved in its entirety.
Particular 1(k)
k. Patient K in respect of one or more of the following observations and/or assessments:
(i) Blood pressure (proved)
(ii) Pulse rate (proved)
(iii) Blood sugar (proved)
(iv) The carrying out of an ECG (proved)
91. The Registrant described the attendance to Patient K as an “assist only” or a social call. Patient K was reported to be stuck between a chair and a wall, and on arrival the Registrant found Patient K to be unable to get up from a couch which was broken. Patient K had recently been discharged from hospital with a care package and a carer was in attendance when the attendant and the Registrant arrived.
92. The Panel accepted the evidence of Mr Lee and BE that in such circumstances, a Paramedic would be required to carry out baseline observations even where the purpose of the call was to provide assistance rather than a health concern. The Panel accepted the evidence of Mr Lee that blood pressure, blood sugar, and pulse rate observations and an ECG should be performed on a known diabetic patient who is taking anti-coagulant medication.
93. The PRF recorded that the Patient K was “unable to cope”. The Registrant stated that this referred to the patient’s inability to manage her medication following her hospital discharge, as she was awaiting a blister pack which had not yet arrived. This was not explained within the PRF.
94. The Panel was not persuaded that the Registrant’s description of the call to Patient K undermined the evidence of Mr Lee and BE that baseline observations were necessary. Patient K, who was diabetic and recently discharged from a lengthy hospital stay, had been sat on the couch for some time unable to move. It was not possible to exclude the possibility that the hospital discharge was premature or that there was a health concern without carrying out baseline observations. There was insufficient explanation in the PRF to explain why observations were not carried out.
95. The Panel therefore concluded that measurements of blood pressure, pulse rate, blood sugar, and an ECG were necessary and part of an adequate assessment for Patient K.
96. The Panel therefore found Particular 1(k) proved in its entirety.
Particular 1(l)
l. Patient L in respect of one or more of the following observations and/or assessments:
(i) Blood pressure (not proved)
(ii) The carrying out of an ECG (not proved)
97. The Panel accepted the evidence of the Registrant and Person N that Patient L was agitated, combative, and was pulling the oxygen saturation probe from his finger. Person N described Patient L as almost looking as though he was going to punch the ambulance crew.
98. The Panel accepted Mr Lee’s evidence that observations should have been carried out but in the circumstances, the Panel accepted that this was not possible.
99. The Panel therefore found Particular 1(l) not proved.
Particular 1(m)
m. Patient M in respect of one or more of the following observations and/or assessments:
i. Pulse rate (not proved)
ii. Oxygen saturation (not proved)
iii. Blood pressure (not proved)
iv. The carrying out of an ECG (not proved)
v. Heart rate (not proved)
100. Mr Lee agreed in his oral evidence that heart rate is the same as pulse rate. The Panel therefore found Particular 1(m)(v) not proved as it was duplicitous.
101. The Panel accepted the evidence of the Registrant and Person N that it was not possible to carry out the observations for Patient M because he was at a second floor window and declined to come downstairs to speak to the ambulance crew.
102. The Panel accepted the evidence of Mr Lee that the observations were necessary but in this case they were declined by Patient M. Mr Lee confirmed in his oral evidence that the patient’s wishes should be respected and if the patient declines observations, he would not be critical of the Paramedic.
103. The Panel therefore found Particular 1(m) not proved in its entirety.
Particular 2
2. In or around March 2020, you instructed one or more colleagues not to undertake necessary observations on suspected COVID-19 patients. (proved)
104. Person O and Person N were less experienced and junior to the Registrant. As the more senior clinician, she had primacy of care and was able to give instructions to Person O and Person N.
105. The Panel accepted the evidence of Person O. Person O had attended to give evidence on behalf of the Registrant under a witness order. Although he was a reluctant witness who was unable to assist the Panel with any details, he confirmed the content of his brief statement which formed part of BE’s investigation and the record of his interview with BE. In the interview with BE, Person O stated that the Registrant “told me not to obs on COVID patients … if they look well they can stay at home”.
106. Person N described a conversation about the same topic. She did not state that she was told not to carry out observations but said that the Registrant had decided that observations were not required for COVID-19 patients. Person N described noticing that blood pressure had not been taken for one of the patients and saying to the Registrant that they needed to go back. Person N then said that the Registrant refused to go back and had stated that it was not necessary. Although not explicitly phrased as an instruction, the Panel was satisfied that the effect of the conversation was that of an instruction, given that Person N had not worked with the Registrant before, the Registrant was more senior, and that she had primacy of care.
107. The Panel found it was credible and consistent with other evidence that the Registrant had given such an instruction to Person O and to Person N. Her instruction was similar to the approach that she had agreed with her regular crewmate, Person P. It was also consistent with her answers to BE when interviewed, where she explained her understanding of the ‘doorstep challenge’, her approach to observations for COVID-19 patients, and her fear of catching COVID-19. The Registrant told BE that she didn’t want to touch the COVID-19 patients. The Panel was satisfied that the Registrant’s approach involved dispensing with at least some of the baseline observations in order to minimise the risk of being infected by COVID-19.
108. The Panel found that it was also credible that neither Person O nor Person N had challenged the Registrant about her approach. In her interview with BE, Person N described not feeling comfortable challenging the Registrant, feeling less confident when working with her, and said that she would have challenged the Registrant had she felt more confident. The Panel also noted that this was the first time Person N had worked with the Registrant. Similarly, in his interview with BE, Person O described not being a confrontational person and being worried that there would be conflict if he said anything about the lack of observations. Person O suggested that he felt the shift would be very unpleasant had he spoken out. While the Panel noted that there was no evidence the Registrant said or did anything to give Person N and Person O this impression, it did consider that the evidence indicated both Person N and Person O believed their comments would not be received well by the Registrant and so they did not speak up.
109. On behalf of the Registrant, Mr Hussain-Dupré invited the Panel to consider PRFs contained in the Registrant’s bundle, where at least one full set of observations was completed when Person N was working with the Registrant. The Panel did so but it did not consider that this evidence was inconsistent with the evidence of Person N. There might be reasons for taking observations in some cases and the Registrant’s general practice of not taking full observations in COVID-19 cases did not mean that she would never carry out such observations or be present when such observations were carried out.
110. The Panel was satisfied that observations for suspected COVID-19 patients were necessary as explained by Mr Lee and that the Registrant instructed two of her colleagues not to carry out such observations.
111. The Panel therefore found Particular 2 proved.
Particular 3
3. Between 28 March and 4 April 2020 you inappropriately left at home one or more of the patients listed in Schedule A. (not proved)
112. The Panel found that the HCPC had not discharged the burden of proof in respect of any of the patients in Schedule A. In respect of each of the patients, the Panel found that necessary observations were not carried out either because the Registrant failed to ensure that they were carried out or because it was not possible to carry them out.
113. In the absence of at least one set of full observations, Mr Lee had an incomplete picture of the condition of each patient. He acknowledged this within his expert report and his oral evidence to the Panel. One of the purposes of the baseline observations is to enable the Paramedic to gather information which will inform the decision about whether the patient could be left at home.
114. The Panel was invited by Mr Smith to consider Patients A, B, J, and K. The Panel did so, but for each of these patients there were significant gaps in the baseline observations and therefore inadequate assessments of the patients. The Panel bore in mind that it is inappropriate for it to speculate on what the outcome of full baseline observations and an adequate assessment would have been.
115. The Panel therefore found Particular 3 not proved.
Particular 4
4. On 3 April 2020 you did not carry out and/or failed to record the consideration of an alternative care pathway or safeguarding referral for Patient K. (proved (recording only))
116. In her evidence the Registrant provided the Panel with the reasons she did not consider that an alternative pathway or a safeguarding referral were required for Patient K. Patient K had just been discharged from hospital with a new care package in place. A carer was attending four times daily and was to assist Patient K with her medication. Arrangements were already in place for a blister pack to be delivered for Patient K’s medication. A carer was in attendance. Patient K had been assisted from the couch and advised not to sit on it again. Alternative seating was available for Patient K. The reference to Patient K’s inability to cope was limited to her inability to cope with her medication and arrangements were already in place to address this issue.
117. This reasoning was not set out clearly within the PRF but the Panel was satisfied that the Registrant had given consideration to the adequacy of the care for Patient K and whether any further steps were required. The Panel therefore found that the HCPC had not proved that the Registrant failed to consider an alternative pathway or safeguarding referral.
118. The consideration of the adequacy of care and whether a safeguarding referral was required was not sufficiently recorded in the PRF. Although there was reference to the presence of a carer, there was no explanation of the consideration of the adequacy of the care package, the reasons Patient K was unable to cope, how this was to be addressed, and whether there were any issues that were not addressed by the care package. There were insufficient reasons to explain why a safeguarding referral was not required.
119. The Registrant did not write the PRF for Patient K, but she had primacy of care and therefore was responsible for its content. She had a duty to keep full and clear records of the care of Patient K.
120. The Panel therefore found Particular 4 proved in that the Registrant failed to record the consideration of an alternative care pathway or safeguarding referral for Patient K.
Decision on Grounds and Impairment
121. At this stage of the hearing the HCPC provided the Panel with an “Impairment bundle”. This bundle included:
• An extract of the witness statement of BE which had been redacted for the Panel’s decision on the facts. BE described his impression of the Registrant in his meetings with her. He found that she did not show remorse. He described her demeanour as “bravado and bluster”. He stated that following a disciplinary hearing she refused to engage in further conversation in relation to her accountability, competence, or development needs.
• Notice of a decision of a Conduct and Competence Committee panel at a substantive hearing which concluded on 13 December 2024. The panel concluded that on various dates between 28 May 2018 and 6 December 2020, the Registrant had demonstrated bullying and unprofessional conduct towards Colleagues B, D, and E, that the conduct constituted misconduct, and that the Registrant’s fitness to practise was impaired. B and D were EMTs at the relevant time and therefore junior to the Registrant. The panel imposed a Conditions of Practice Order which is due to expire in June 2026.
• A decision of a Conduct and Competence Committee panel at a preliminary hearing on 3 July 2025 which addressed issues in dispute between the parties relating to the admissibility of evidence in the present case.
122. While the Panel was in private session deliberating on its decision on current impairment, the Registrant provided additional documents to Mr Hussain-Dupré. The Registrant had not appreciated the relevance of the documents until she had listened to Mr Smith’s submissions. On behalf of the Registrant, Mr Hussain-Dupré apologised for the late provision of the documents, submitted that they were relevant, and invited the Panel to consider them.
123. On behalf of the HCPC, Mr Smith adopted a neutral position on the admissibility of the additional documents. He noted the extremely late service of the documents. He submitted that the Panel would need to decide whether the documents were relevant and have in mind the principle of fairness to both parties.
124. The Panel decided to admit the additional documents, notwithstanding their late service. The Panel considered that the additional documents were relevant. The Panel considered fairness to both parties and decided that it was fair to admit the documents. The Panel noted that the HCPC did not oppose the admission of the documents and Mr Smith had the opportunity to provide submissions relating to the additional documents. The Panel considered that the exclusion of the documents would be unfair for the Registrant.
125. The Panel read the following additional documents:
• Immediate Life Support course certificate (dated 24 October 2024);
• Conflict Resolution course certificate (dated 15 February 2026);
• Infection Prevention and Control Level 2 course certificate (dated 15 February 2026);
• Bullying and Harassment at Work Level 2 course certificate (dated 29 November 2024);
• Reflective Practice Note on sepsis in the elderly patient (dated 6 November 2025);
• Giving and Receiving Feedback course certificate;
• Identification and Initial Management of Adults with Sepsis course certificate;
• 12 Lead ECG in ACS Part 1 course certificate;
• DNACPR Training for Senior Responsible Clinicians course certificate (dated 25 March 2026);
• Reference from AG, training provider (dated 10 April 2026);
• How to Advocate for Yourself at Work course certificate;
• Manage Conflict within a Team – Level 3 course certificate (dated 29 November 2024);
• Reflection on People Skills course with AG;
• Reflection on December 2024 Conduct and Competence Committee hearing (dated January 2025).
Decision on Grounds
126. The Panel heard submissions from Mr Smith. Mr Smith referred to the HCPC’s case summary and supplemented those submissions with oral submissions. His submissions included reference to aggravating factors. He submitted that the facts in Particulars 1, 2, and 4 amounted to the statutory ground of misconduct. The Panel also had regard to the written submissions of Mr Smith which he provided further to the provision of the extra documentation from the Registrant.
127. The Panel heard submissions from Mr Hussain-Dupré. His submissions included reference to the findings of fact made by the Panel.
128. The Panel first considered whether the facts found proved in Particular 1 amounted to misconduct. It took into account all the evidence together with the submissions made by Mr Smith on behalf of the HCPC and the submissions made by Mr Hussain-Dupré on behalf of the Registrant.
129. The Panel accepted the advice of the Legal Assessor. Her advice included reference to Roylance v General Medical Council (No 2) [2000] 1 A.C. 311 and Nandi v GMC [2004] EWHC 2317 (Admin). In these cases misconduct is described as a falling short of the standards of conduct which are expected of practitioners, and the falling short must be serious.
130. When considering whether the facts found proved amounted to misconduct, the Panel noted that not all breaches of the HCPC’s “Standards of Conduct, Performance and Ethics” need amount to a finding of misconduct.
131. The Panel considered whether the Registrant’s conduct in Particular 1, not ensuring that necessary observations were carried out and not ensuring that adequate assessments took place for 11 patients, was sufficiently serious to amount to misconduct. The Panel considered that this conduct amounted to a breach of the HCPC’s “Standards of Conduct, Performance and Ethics” 2016 as follows:
3.4 You must keep up to date with and follow the law, our guidance and other requirements relevant to your practice.
4.2 You must continue to provide appropriate supervision and support to those you delegate work to.
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.
132. The Panel considered the context and surrounding circumstances. While acknowledging that the COVID-19 circumstances were stressful and that the LAS guidance was changing at frequent intervals, it was the Registrant’s responsibility to ensure that she understood the guidance. It was not open to her to adopt her own interpretation of the ‘doorstep challenge’ to suit her own interests.
133. Although a global pandemic is a unique situation, it is not exceptional for Paramedics to work in circumstances where there are significant infection risks and the role of a Paramedic includes the management of such risks. During COVID-19 PPE (Tyvek suits) was provided by LAS and detailed instructions on their use were contained within the LAS bulletins.
134. The Panel noted Mr Lee’s opinion that the failures to perform a number of the observations fell significantly below the standard reasonably expected from a Paramedic. In his opinion clinical assessments are a basic requirement and essential for safe treatment, and the absence of them placed patients at risk of misdiagnosis and incorrect management.
135. In the Panel’s judgement the approach adopted by the Registrant involved a real risk of harm to patients. A patient making a 999 call and requiring an ambulance during the COVID-19 period might have COVID symptoms but might also require emergency healthcare for other reasons. The Registrant’s approach involved making decisions on the basis of flawed assessments when potentially the patients may have required emergency care or admission to hospital.
136. Having considered the context and the surrounding circumstances, the Panel found that the Registrant’s conduct in Particular 1 was sufficiently serious to amount to misconduct.
137. The Panel next considered whether the Registrant’s conduct in instructing her colleagues not to carry out necessary observations on suspected COVID-19 patients (Particular 2) was sufficiently serious to amount to misconduct. The Registrant’s conduct amounted to a breach of the HCPC’s “Standards of Conduct, Performance and Ethics” 2016:
3.4 You must keep up to date with and follow the law, our guidance and other requirements relevant to your practice.
4.2 You must continue to provide appropriate supervision and support to those you delegate work to.
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 Ensuring that your conduct justifies the public’s trust in you and your profession.
138. The Panel considered the seriousness of the Registrant’s instruction to her colleagues. The Registrant was in a position of seniority to her colleagues, Person O and Person N. She had primacy of care and bore the ultimate responsibility for the care of the patients. Rather than setting standards and acting as a role model, her supervision of her junior colleagues put the safety of patients at risk of serious harm. The Registrant overruled her colleague, Person N, who suggested that the ambulance should return to a patient whose blood pressure had not been taken.
139. The Panel had no hesitation in concluding that the Registrant’s conduct in Particular 2 fell far below the standards for Paramedics and was sufficiently serious to constitute misconduct.
140. The Panel next considered whether the Registrant’s conduct in failing to record the consideration of an alternative care pathway or a safeguarding referral for Patient K (Particular 4) was sufficiently serious to amount to misconduct. The Registrant’s conduct amounted to a breach of the HCPC’s “Standards of Conduct, Performance and Ethics” 2016:
10.1 You must keep full, clear and accurate records for everyone you care for, treat or provide other services to.
141. The Panel considered the context and circumstances relating to the Registrant’s failure to record. This was a single instance of a failure to record. The Panel noted that the PRF did include reference to some of the protective factors for Patient K, such as the presence of a carer and a care package. The Panel does not condone the Registrant’s behaviour in Particular 4, which was below the standards for a Paramedic, but it concluded that the conduct was not sufficiently serious to amount to misconduct.
142. Having considered the context and surrounding circumstances, the Panel found that the Registrant’s behaviour in Particulars 1 and 2 was sufficiently serious to amount to misconduct.
Decision on Impairment
143. The Panel went on to decide whether the Registrant’s fitness to practise is currently impaired by reason of her misconduct. It received no further oral evidence at this stage.
144. In his oral submissions to the Panel, Mr Smith supplemented the written submissions set out within the HCPC statement of case. He submitted that the Registrant’s fitness to practise is impaired. He submitted that there was insufficient evidence to demonstrate that the Registrant has remediated the conduct found proved or that she has insight into the findings of fact made by the Panel. He submitted that while the clinical concerns are remediable, an attitudinal issue is more difficult to remedy. He submitted that there was a significant attitudinal concern as a result of the Panel’s finding in Particular 2 and the previous decision of the Conduct and Competence Committee panel in 2024. Mr Smith submitted that although the concerns arose within the particular context of the COVID-19 pandemic, there was a risk of repetition because of the attitudinal concerns and the Registrant’s disregard of the guidance.
145. Mr Smith also invited the Panel to conclude that the Registrant’s “rejected defence” should be taken into account and referred to the guidance in paragraph 19 of the HCPTS Practice Note “Fitness to Practise Impairment”.
146. Mr Smith submitted that the additional documents provided by the Registrant during the Panel’s deliberations did not demonstrate adequate insight and remediation to establish that the risk of repetition is low or non-existent. He submitted that the training documents did not address the need to undertake full observations when clinically indicated, did not address ensuring that all guidance issued by the employer has been reviewed and understood, and that they did not demonstrate that the Registrant understands or appreciates the impact of her actions on colleagues or service users.
147. Mr Smith further submitted that the Panel may take the view that the late service of so much Continuing Professional Development (CPD) documentation demonstrated the Registrant’s fundamental lack of understanding of her failures in this case, and therefore a lack of insight into the relevant issues. If the Registrant had appreciated the impact of her actions on colleagues and service users, this documentation would have been provided much earlier.
148. Mr Hussain-Dupré referred the Panel to the documents in the Registrant’s 32-page addendum bundle. This included testimonials and references and monthly supervision reports which were prepared as required under the Conditions of Practice Order. Mr Hussain-Dupré submitted that, while under scrutiny, the Registrant has practised under the Conditions of Practice Order without incident or complaint. He submitted that the 2024 decision of the Conduct and Competence Committee panel involved allegations of a wholly different character and that the current case was referred to the HCPC before the allegations in the 2024 case.
149. In relation to patient harm, Mr Hussain-Dupré referred to the Panel’s findings on Particular 3 and he submitted that for Patients B-M there was no evidence of actual harm to those patients.
150. Mr Hussain-Dupré referred to the circumstances of the COVID-19 pandemic and submitted that those circumstances were unlikely to arise again. He submitted that the Registrant’s actions were confined to the circumstances of the COVID-19 pandemic and the consequent fears of the Registrant for her health and the health of family members.
151. The Panel accepted the advice of the Legal Assessor. It also had regard to the guidance in the HCPTS Practice Note “Fitness to Practise Impairment”. The Panel considered the Registrant’s fitness to practise at today’s date. It bore in mind the HCPC’s overarching objective of protecting the public.
152. The Panel carefully considered whether the decision of the Conduct and Competence Committee panel in December 2024 was relevant to its assessment of whether the Registrant is currently fit to practise as a Paramedic. The Panel acknowledged that the findings were of a different character. However, the Panel identified that there was a connection between the decision in December 2024 and the Panel’s finding in Particular 2. The impact of the Registrant’s behaviour in this present case was that the Registrant’s colleagues felt unable to speak up (as set out in paragraph 108 above). The 2024 decision included a description of the evidence of Colleague B that “he had not felt able to challenge [the Registrant] as he felt he would not be listened to and would be talked down to ‘as if he were nothing’”.
153. The connection between Particular 2 and the decision in 2024 was that both involve a failure to work in partnership with colleagues. An element of working in partnership with colleagues involves senior colleagues responsibly supervising their junior colleagues and a reflective response to question or challenge. When Person N suggested that the crew should return to take the missing blood pressure, the Registrant reiterated the instruction rather than reviewing it. The ability of junior colleagues to speak up to challenge or question the judgement of senior colleagues is part of effective working and necessary for ensuring patient safety.
154. The Panel applied the guidance within paragraph 19 of the HCPTS “Fitness to Practise Impairment” Practice Note when considering the Registrant’s defence. The Registrant’s defence presented to the Panel differed from the responses she gave to BE when she was first questioned about her conduct. Before the Panel she presented arguments that the observations were not clinically necessary. While the Panel had not accepted those arguments, the Registrant was entitled to defend herself against the allegations she faced. The Panel has not concluded that the defence put forward by the Registrant was a blatant and manufactured lie.
155. The Panel was of the view that the Registrant had failed, and continues to fail, to take responsibility for her actions and had blamed others. The Registrant had sought to distance herself from the care provided to the patients, attributing sole responsibility to the attendants. The Panel considered that this aspect of the Registrant’s defence was relevant to the assessment of the Registrant’s insight.
156. In accordance with the guidance at paragraphs 14-20 of the Practice Note, the Panel considered the seriousness of the Registrant’s conduct. The Panel considered that the conduct was very serious and identified the following aggravating features:
• A significant departure from expected professional conduct and standards.
• The conduct undermined public confidence in the profession. In an emergency members of the public expect that Paramedics will carry out the necessary observations and make adequate assessments rather than putting their own interests first.
• There was a significant risk of harm to patients, including a risk of misdiagnosis and incorrect management. In his report Mr Lee highlighted a range of potential risks, including those for Patient J where the symptoms might have indicated ACS.
• The Registrant’s supervision of her junior colleagues was unsafe and she failed to work in partnership.
• The conduct was repeated. It involved multiple patients over a period of time.
• The conduct involved vulnerable service users. Members of the public requiring an ambulance are vulnerable due to their circumstances.
157. The Panel gave careful consideration to the COVID-19 context of the Registrant’s misconduct. The Panel accepted that the Registrant had a genuine fear that she might contract COVID-19 and potentially pass the infection to other members of her family. The Panel also accepted that the Registrant’s fears and anxiety contributed to her decisions. However, the Panel did not consider that this excused the Registrant’s actions or reduced her responsibility. It is an aspect of the role of a Paramedic to manage the risk of infection and to utilise PPE as required. PPE was available and was used by the Registrant. Furthermore, the Registrant could have engaged with LAS management to address her concerns.
158. The Panel considered that the context and circumstances of the COVID-19 pandemic provided some mitigation but that this carried limited weight.
159. The Panel considered whether the misconduct was remediable. The Panel considered that conduct which includes an attitudinal element is more difficult to remedy. The Registrant’s conduct did include an attitudinal element because she put her own interests above the care of her patients, distanced herself from responsibility for the care that was provided to patients, and persisted in her instruction to Person N without reflecting on it when it was suggested to her that a different approach should be taken. The Panel considered that in principle the attitudinal concerns could be remedied but that it would require deep reflection, acceptance of responsibility, a commitment to personal development and learning, and persuasive evidence of a change in attitude or behaviour.
160. The Panel was not satisfied that the Registrant has demonstrated insight into the facts found proved. The additional documents provided to the Panel demonstrate that the Registrant is engaging with the HCPC under the Conditions of Practice Order and that she is willing and able to reflect on her past conduct. However, the Panel was not presented with evidence that the Registrant has demonstrated remorse or has reflected on the Panel’s findings in this case. In the Registrant’s evidence to the Panel she did not accept her accountability for the care of Patients A-M. The Registrant had yet to provide any insight into the facts which this Panel had found proved. She has not taken responsibility for her actions and, other than Patient C, she attributed all responsibility for patient care to her colleague who was the attendant. The additional documents provided by the Registrant do not address many of the issues in the current case, such as primacy of care, the need to undertake necessary observations, ensuring that guidance is understood and appropriately applied, and consideration of the seriousness of her misconduct, including its impact on patients, her colleagues, and the reputation of the profession.
161. The Panel noted that the Registrant has been working under formal supervision as required by the Conditions of Practice Order and while subject to this supervision, no concerns have been raised about the Registrant’s practice. The Registrant has also completed training, some of which is relevant to the findings made by the Conduct and Competence Committee panel in December 2024. Some of the training the Registrant has completed is relevant to one aspect of the current case, which is working in partnership with colleagues.
162. There was no evidence before the Panel of repetition of similar concerns within the Registrant’s day-to-day practice. The Registrant also provided positive testimonials. However, this evidence did not reassure the Panel that there would be no repetition of similar concerns. The testimonials provided did not address the concerns present in this case and it was not clear that those giving the testimonials were aware of those concerns. The Panel was concerned that there is a risk of repetition in circumstances similar to those that arose during COVID-19 if the Registrant did not wish to touch a patient for fear of infection or other reasons, or circumstances where she interpreted guidance issued by the employer to suit her own interests.
163. Given its conclusions that the Registrant has not demonstrated insight and that there is very limited evidence of remediation, the Panel could not be satisfied that there would be no repetition of similar conduct. If similar conduct were to be repeated, there would be a real risk of harm to patients.
164. The Panel therefore found that the Registrant’s fitness to practise is impaired on the basis of the personal component.
165. The Panel considered the test formulated by Dame Janet Smith in the 5th Shipman Report, which was adopted by Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) as follows:
“Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution, or determination show that his/her fitness to practise is impaired in the sense that s/he:
a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or
b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or
c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or
d. has in the past acted dishonesty and/or is liable to act dishonesty in the future”
166. The Panel considered that the first three limbs of this test were engaged. In respect of risks to patients, the Panel did not conclude that actual harm was caused to patients, but the Registrant’s actions placed patients at risk of serious harm, including the risk of misdiagnosis.
167. The Registrant’s misconduct brought the profession into disrepute. Members of the public rightly expect Paramedics providing emergency care to ensure that the necessary observations are carried out and that adequate assessments are performed. They also expect Paramedics to give instructions to their junior colleagues which ensure that safe care is provided to patients. The Registrant acted in breach of fundamental tenets of the profession because she put patients at an unacceptable risk of harm and put her own interests above those of her patients.
168. The Panel referred to its decision on the seriousness of the Registrant’s conduct and the aggravating features. The Panel had also found that the Registrant has not demonstrated insight and she has taken limited remedial steps which are insufficient to mitigate the risk of repetition.
169. Given its findings, the Panel considered that an informed, reasonable member of the public would be very concerned about the Registrant’s misconduct and would not expect the Registrant to be permitted to practise as a Paramedic in the UK without restriction. The Panel considered that public confidence in the profession would be seriously undermined if the Panel did not find that the Registrant’s fitness to practise is currently impaired.
170. The Registrant’s conduct also involved a serious departure from expected professional conduct and standards, as set out within the Panel’s decision on the statutory grounds. The Panel considered that a finding of current impairment was required to emphasise the importance of those standards and that the Registrant’s behaviour was entirely unacceptable for a registered Paramedic.
171. The Panel therefore found that the Registrant’s fitness to practise is impaired on the basis of the public component.
Decision on Sanction
172. The Panel took account of the submissions made by Mr Smith on behalf of the HCPC. Mr Smith did not invite the Panel to impose a particular sanction. He highlighted parts of the HCPC Sanctions Policy and referred to his previous submissions on aggravating features.
173. The Panel also took account of the written submissions made by Mr Bardell on behalf of the Registrant. Those submissions referred to findings made by the Panel and highlighted mitigating and aggravating features. Mr Bardell invited the Panel to consider the imposition of a Conditions of Practice Order and submitted that remediation and development of insight would be better done whilst in clinical practice to enable progress and attainment to be measured by a supervisor. In the alternative, if the Panel was minded to impose a Suspension Order, Mr Bardell submitted that it should be for the shortest possible time.
174. Mr Smith and Mr Bardell reminded the Panel that it should ensure there was no double-counting between the current case and the findings of the 2024 panel of the Conduct and Competence Committee. The Panel was careful to ensure that its decision was limited to the findings in this case.
175. The Panel also noted and agreed with Mr Smith’s submission that in this case the Registrant’s failure to work in partnership was the Registrant’s instruction to her junior colleagues. This case did not involve the most serious aspects of failure to work in partnership such as bullying behaviour or discrimination against colleagues or patients.
176. The Panel accepted the advice of the Legal Assessor and referred to the HCPC Sanctions Policy (March 2026).
177. In considering sanction, the Panel was mindful that a sanction is not intended to be punitive. However, a sanction may be necessary in the public interest and may have a punitive effect. The Panel bore in mind that any sanction must be proportionate; that is, it must only restrict the Registrant’s right to practise to the extent necessary to protect the public and the public interest.
178. The Panel bore in mind that the HCPC’s overriding objective is to protect the public. A panel must consider the risk the Registrant may pose in the future and decide what degree of public protection is required. The Panel must also give appropriate weight to the public interest, which includes the deterrent effect on other registrants, the reputation of the profession, and public confidence in the regulatory process.
179. The Panel referred to its decision on impairment, which addressed the seriousness of the Registrant’s misconduct and the risk that similar behaviour would be repeated. Within that decision the Panel also concluded that the Registrant had not demonstrated insight and that the training she had completed was largely directed towards the findings made by the 2024 Conduct and Competence Committee panel.
180. The Panel considered whether there were any mitigating features other than those identified within its decision on current impairment. The Panel gave little weight to the testimonials provided by the Registrant as to her character and practice. It also gave little weight to the Registrant’s practice in the six years since the index events, as there was no evidence of circumstances similar to those that arose during COVID-19 where the Registrant was able to demonstrate that she put her patients’ interests above her own interests. The Panel considered that the evidence of CPD undertaken by the Registrant was relevant to the extent that it showed she was capable of reflecting on the findings made by the 2024 Conduct and Competence Committee panel and engaging in relevant learning, but none of the CPD was directed towards the findings of this Panel.
181. The Panel did not consider that the Registrant’s lack of understanding of key policies and principles such as primacy of care was a mitigating factor. It is the responsibility of a Paramedic to ensure that they understand such policies.
182. The Panel considered the sanctions in ascending level of severity in order to ensure that its approach was proportionate.
183. The Panel decided that taking no action would not be appropriate. The Panel decided that due to the gravity of its findings and the identified risk of repetition in this case, a sanction was necessary.
184. The Panel considered the factors in the Sanctions Policy in relation to a Caution Order. It concluded that the issues in this case were not minor in nature. There was no evidence of insight and the Panel had concluded that there remains a risk of repetition and a risk of harm to patients.
185. The Panel concluded that a Caution Order was not sufficient or appropriate in the circumstances.
186. The Panel next considered a Conditions of Practice Order. It considered the guidance in paragraph 153 of the Sanctions Policy. This advised that a Conditions of Practice Order may be appropriate in cases where:
“• The registrant has insight;
• The concerns are capable of being remedied or managed;
• There are no persistent or general concerns which would prevent the registrant from remediating;
• Appropriate, proportionate, realistic and verifiable conditions can be formulated;
• The panel is confidence that the registrant will comply with the conditions;
• A reviewing Panel will be able to determine whether or not those conditions have or are being met; and
• A panel is satisfied that a registrant may continue to practise with conditions without exposing the public to risk of harm”
187. The Panel was of the view that many of these criteria applied but that the Registrant had not demonstrated insight. The Panel considered that the absence of evidence of insight was significant because it involves a higher level of risk. This is explained within paragraphs 78-79 of the Sanctions Policy. The policy states at paragraph 79:
“Registrants who lack a genuine recognition of the concerns raised about their fitness to practise and failed to understand or take responsibility for the impact or potential impact of their actions, are unlikely to take the steps necessary to safeguard service users to address the concerns raised. For this reason, in these cases, panels are likely to impose a more serious sanction in order to protect the public”
188. The evidence provided to the Panel in the Registrant’s “Additional documents”, containing the CPD and reflective pieces, indicated that she is capable of reflection, but this did not sufficiently reassure the Panel that the Registrant understands the findings made by this Panel or that she takes responsibility for the impact of her misconduct in this case. The concerns found proved include attitudinal issues, which are more difficult to address by conditions of practice and where the demonstration of insight is particularly important to the assessment of the level of risk.
189. The Panel therefore concluded that at the current time a Conditions of Practice Order would be insufficient to mitigate the risk of repetition and would therefore not provide a sufficient measure of public protection.
190. The Panel was also of the view that a Conditions of Practice Order would not reflect the gravity of its findings in this case, nor would such an order address the concerns regarding the wider public interest.
191. The Panel carefully considered whether an order of suspension would be sufficient to protect the public and address the public interest concerns in this case. The Panel had regard to paragraphs 169-170 of the Sanctions Policy. The Panel noted that a Suspension Order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a Conditions of Practice Order but which do not require the Registrant to be struck off the Register.
192. The Panel was of the view that a Suspension Order could be considered in this case. Although the Panel had concluded that there are attitudinal issues, it had also concluded that those issues are potentially remediable. The Panel also took into account the evidence that the Registrant has been engaging with the HCPC and complying with the Conditions of Practice Order imposed in 2024. The documents provided to the Panel indicated that the Registrant is capable of reflection and of engaging in relevant learning.
193. The Panel noted that the Registrant is supported by her current manager, who is her supervisor for the Conditions of Practice Order. In an email dated 13 April 2026, he stated that he had read and understood the Panel’s determination and that he wished to place on record his full support for the Registrant.
194. The Panel was of the view that the case did not involve the most serious attitudinal issues where only a Striking Off Order would be sufficient to maintain public confidence in the profession and uphold professional standards. The Registrant has had little time to absorb the findings made by the Panel and it was of the view that it would be in the public interest to afford her the opportunity to reflect and to demonstrate insight.
195. For reasons above, together with the mitigating circumstance of the COVID-19 pandemic, the Panel concluded that a Striking Off Order would be unnecessary and disproportionate.
196. The Panel was not provided with information about the Registrant’s circumstances or the impact of a Suspension Order, but it acknowledged that the imposition of such an order would be likely to have a detrimental impact on the Registrant. The Panel decided that the Registrant’s interests were outweighed by the need to protect the public and the wider public interest.
197. The Panel concluded that the appropriate and proportionate sanction in this case was a Suspension Order.
198. The Panel considered the length of the Suspension Order and had regard to paragraphs 171-175 of the Sanctions Policy. The Panel had in mind that the primary consideration was what was necessary and proportionate in order to ensure that the public was protected. The Panel considered that the Registrant would be able to engage in reflection and prepare evidence for a review panel within a relatively short period of time. It was also of the view that a period of suspension is a serious sanction which sends a clear message to members of the profession and members of the public that it is not permissible for Paramedics to put their own interests above those of their patients and not carry out the necessary observations and that it is not permissible for Paramedics to give unsafe instructions to their junior colleagues. The Panel decided that a Suspension Order for a period of four months was sufficient to protect the public, to uphold public confidence in the profession, and to uphold professional standards.
199. The Panel concluded that the appropriate and proportionate order was a Suspension Order for a period of four months.
200. The Suspension Order will be reviewed before it expires. This Panel cannot bind a future reviewing panel, but the Panel considered that the review panel may be assisted by the following:
(i) A reflective statement including reference to the Registrant’s responsibilities as a Paramedic when attending with junior colleagues (sometimes described as primacy of care), the responsibilities of Paramedics to ensure that they understand guidance issued by their employer, the requirement to carry out necessary observations for patients, the responsibilities of a Paramedic when giving instruction to junior colleagues, and the impact or potential impact of the behaviour found proved on patients, colleagues, and the reputation of the profession.
(ii) Any steps towards remediation of the misconduct, such as relevant training.
(iii) The Registrant’s continuing engagement with the Regulator and her attendance at the review hearing.
Order
That the Registrar is directed to suspend the registration of Mrs Michelle A Bignall for a period of 4 months from the date this order comes into effect.
Notes
Interim Order
1. Mr Smith made an application for an Interim Suspension Order for up to 18 months to cover the appeal period before the Suspension Order becomes operative and the time that any appeal might take to be concluded.
2. Mr Bardell informed the Panel that the Registrant adopted a neutral position in relation to the imposition of an interim order.
3. The Panel next considered whether an order was necessary for the protection of the public, otherwise in the public interest, or was in the Registrant’s own interests. It applied the principle of proportionality, balancing the Registrant’s interests against the need to protect the public.
4. The Panel considered whether to impose an interim order. In its findings on impairment the Panel concluded that there is a need to protect the public from the risk of harm. The Panel decided that it would be wholly incompatible with those earlier findings and the imposition of a Suspension Order to conclude that an Interim Suspension Order was not necessary for the protection of the public and to maintain public confidence in the profession.
5. The Panel took into account the Registrant’s interests, but decided that her interests were outweighed by the need to protect the public and the wider public interest. The Panel concluded that an Interim Suspension Order should be imposed on public protection and public interest grounds.
6. The Panel decided that it was appropriate to impose the Interim Suspension Order for a period of 18 months to cover the appeal period and any appeal which may be made. When the appeal period expires, this Interim Order will come to an end unless there has been an application to appeal. If there is no appeal, the substantive Suspension Order shall apply when the appeal period expires.
7. The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.
8. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.
Hearing History
History of Hearings for Michelle A Bignall
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 30/03/2026 | Conduct and Competence Committee | Final Hearing | Suspended |
| 03/07/2025 | Conduct and Competence Committee | Final Hearing | Adjourned |
| 12/12/2024 | Conduct and Competence Committee | Final Hearing | Conditions of Practice |
| 28/05/2024 | Conduct and Competence Committee | Final Hearing | Adjourned part heard |