Mr Christopher J Turner

: Paramedic

: PA02601

: Final Hearing

Date and Time of hearing:10:00 20/02/2017 End: 17:00 23/02/2017

: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Suspended

Allegation

(as amended at final hearing):


During the course of your employment as a Paramedic at South Western Ambulance Service:

1. On 6 May 2015, in relation to Service User A, you:


 a. Did not carry out an adequate assessment on Service User A;


b. Did not complete and/or submit a patient care record (PCR) of the incident.


2. Between approximately 10 June and 15 September 2015, you did not complete and/or submit approximately 14 patient care records.


3.   The matters set out in paragraphs 1-2 constitute misconduct and/or lack of competence.


4.  By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.

Finding

Preliminary matters:

Service

1. The Panel was aware that written notice of these proceedings was posted by first class post to the Registrant at his registered address on 12 October 2016. Notice of these proceedings was also sent to the Registrant by email at his last known email addresses.  The Panel was shown documents which established both the fact of the service and the identity of the Registrant’s registered address. In these circumstances the Panel accepted that proper service of the notice had been effected.
Proceeding in the absence of the Registrant

2. Ms Chaker on behalf of the HCPC submitted that the Panel should consider the case in the absence of the Registrant. In response to questions from the Panel, Ms Chaker informed it that the Registrant had made written representations to the Investigating Committee of the HCPC in January and March 2016 but had not engaged with the HCPC since that time. Ms Chaker also informed the Panel that the bundle of evidence sent to the Registrant’s registered address was returned marked “not collected”.

3. The Panel heard and accepted the advice of the legal assessor.


4. The Panel was aware that a decision to proceed in the absence of the Registrant was one to be taken with great caution.  However the Panel decided to proceed in the absence of the Registrant. Its reasons are as follows;

• Service of the appropriate notice of this hearing has been properly effected.

• There is no reason to suppose that an adjournment would result in the future attendance of the Registrant and the Registrant has not applied for an adjournment.

• There is a public interest in proceeding.

• These allegations relate to matters that occurred in 2015 and the issues should now be disposed of as quickly, as can justly be done.

• In all the circumstances the absence of the Registrant should be treated as voluntary.

5. The Panel noted that the current bundle had not been received by the Registrant, but noted that it did not know the reason for this.  It was the Registrant’s responsibility to keep his registered address up to date.

Application to Amend the Allegation


6. Ms Chaker applied to amend the Allegation. She submitted that the amendments were necessary to give clarity to the Allegation and would cause no injustice to the Registrant.  She further informed the Panel that the Registrant was informed of the intended amendment by a letter dated 10 June 2016 sent to his registered address, as well as by email, and that the Registrant has not made any objection. The Panel heard and accepted the advice of the Legal Assessor and having concluded that the amendments could be made without injustice to the Registrant, the Panel directed that the amendments should be made. The amendments are indicated in bold under the heading “Amended Allegation” at the commencement of this determination.


Procedure


7.  The Panel decided to consider the facts, misconduct, lack of competence, and impairment as a single stage. Sanction if appropriate, would be considered as a separate stage.

Background:

8. The Registrant commenced employment at South Western Ambulance Service [SWAS] NHS Foundation Trust [the Trust] as a Band 5 Paramedic in 1992.  On 27 July 2015 the Trust received an incident report that was completed by a Senior Paediatric Consultant who had treated Service User A, who at the time of the incident was under 2 years old. The complaint outlined concerns raised by the mother of Service User A [Mother A] regarding the standard of care afforded to Service User A by the Registrant, who was the Paramedic sent to attend Service User A on 06 May 2015, following a 111 call made by Mother A.  

9. It was alleged in the complaint that the Registrant did not carry out an adequate assessment of Service User A. Service User A was subsequently admitted to hospital later that evening. Service User A was treated for a number of days before being discharged.

10. The complaint was investigated. The investigation officer Richard Garment [RG] was unable to find the relevant Patient Care Record (PCR). Further investigation revealed that a number of PCRs which should have been completed by the Registrant were missing. It is therefore alleged that the Registrant did not complete these PCRs.

11. These matters have led to the allegations that are set out in Particulars 1 and 2 of the Allegation.
Decision on Facts

12. The Panel heard oral evidence from the following witnesses who were called by the HCPC:

• From RG who is the Operations Manager for the Trust, which is a role that he has held since 2015. Prior to that he was a Quality Lead for the Trust for approximately two years. RG is a Paramedic. He qualified in 2011 and is registered by the HCPC. He has made a written statement dated 04 November 2016.

• From Mother A: She has made a written statement which is dated 25 July 2016.

• From ZJ who is an Emergency Care Assistant employed by the Trust. She has made a written statement dated 10 August 2016.


• From NL who is a Clinical Improvement Officer employed by the Trust. She works in the PCR Requests team in the Clinical Records Office, a role she has occupied since 11 August 2008. She has made a written statement dated 26 July 2016.


13. The Panel considered that the evidence given by all these witnesses was credible. In particular:


• The Panel found Mother A to be clear and compelling. Her evidence was measured and consistent. For her it was a very memorable event and she had a clear recollection of it.


• The Panel found RG to be an honest and straightforward witness. He had no prior knowledge of the Registrant, nor of the events. He showed no bias against the Registrant and the Panel thought that he was fair and impartial in his evidence.


• The Panel also regarded both ZJ and NL to be honest witnesses. They were both clear and consistent in their description of the relevant procedures. Where they did not know facts they were happy to acknowledge that. NL was candid in her acceptance that prior to 2013, the procedures were less robust.


14. The Panel considered a bundle of documents comprising 199 pages which was produced by the HCPC. This bundle contained contemporaneous documents relating to the allegations against the Registrant and documents which came into existence as part of the investigation. This bundle includes the record of the meeting between the Registrant and RG on 25 September 2015 and the record of a telephone conversation held on 10 November 2015 between RG and the Registrant. The Panel paid careful attention to what the Registrant is recorded as having said at that meeting and in the telephone conversation.


15. The Panel has also read and taken account of written representations made by the Registrant to the Investigating Committee of the HCPC together with documents that he annexed to those representations which included statements from four potential witnesses.


16. The Panel considered the submissions as to facts, misconduct, lack of competence and impairment made by Ms Chaker on behalf of the HCPC.


17. The Panel heard and accepted the advice of the legal assessor as to facts, misconduct, lack of competence and impairment.


18. The Panel was aware that on matters of fact [as distinct from issues of misconduct, lack of competence and impairment] the burden of proof rested on the HCPC and that the standard of proof was the civil one namely on the balance of probabilities.


Particular 1 (a)


Did not carry out an adequate assessment on Service User A:

Proved


19. The HCPC relied primarily on the oral and written evidence of Mother A and that of RG.


20. In her written statement Mother A described the relevant events and the background facts.  Her child (Service User A) had been severely ill with a respiratory condition and admitted to hospital in March 2015. On 6 May 2015, she and her partner noticed similar symptoms.  Upon calling the 111 service, a 999 response was activated.

 
21. Mother A said that the Registrant attended the scene in a car. He used what she later learned was a Paediatric Assessment Triangle (PAT) to assess her child. She said that he did not touch her child or record any observations.  He said her child was fine and told her and her partner to go to A&E themselves if they were worried.


22. Mother A was concerned that the Registrant’s assessment was inadequate and that he was disregarding her concerns about her child, including the respiratory symptoms and previous medical history.  Later that evening, the parents took Service User A to A&E and the child was admitted.


23. The oral evidence given by Mother A to the Panel and the responses that she made to questions put to her were consistent with the contents of her written statement. The written statement and the oral evidence were consistent with what Mother A had previously said in the course of the investigation conducted by RG. A record of that is contained in the bundle of documents produced by the HCPC.


24. In his written statement, RG addressed the question as to whether the Registrant had carried out an adequate assessment of Service User A. He did so on the undisputed evidence from the Trust’s Vehicle Tracking System that the Registrant was at the scene for approximately 7 minutes.  RG stated as follows:


Seven minutes was not a sufficient amount of time for a paramedic to complete an adequate assessment of a child with symptoms as outlined in the event chronology and by the mother of Service User A.  If a child is thought to have respiratory difficulties a full respiratory assessment should be completed.  This would include taking the child’s top off and seeing if the skin over the ribs is being heavily sucked in when they breathe.  The paramedic should look for an equal rise and fall of the lungs and an equal amount of air in both sides of the chest.  They should also look for any evidence of a blue colour in or around the child’s lips or on their body which can indicate they are not getting enough oxygen.  The paramedic should take the patient history from the child’s parents.  From the assessment you should decide if and what further assessment is required and what, if any treatment is required.  An adequate assessment of a child with a complaint of respiratory problems should take approximately 15 minutes.  This is the amount of time required to decide whether the child is well enough to go home or whether treatment is required.


A paediatric assessment triangle is a tool paramedic’s used to assist with identifying possible problems the child may have.  The tool provides guidance on how quickly a child needs to be dealt with depending on the symptoms they are presenting with, such as the tone of their skin and rate of their breathing.  It should assist the paramedic as to how they should prioritise and assess the child.  This tool gives an indication of what problem a child may have but cannot assess what is actually wrong with the patient.  It is inadequate to only use the paediatric assessment triangle to assess a child.  There was not a policy of how a paediatric assessment triangle should be used at the time of these allegations.  All paramedics receive training on how to use a paediatric assessment triangle during their basic training to qualify as a paramedic.

25. The oral evidence given by RG and his responses to questions was consistent with the contents of his written statement. Both his oral and written evidence was consistent with and corroborated by material in the bundle of documents produced by the HCPC.


26. In the interview conducted with RG on 25 September 2015 the Registrant described the general procedure that he would adopt in circumstances that existed on 06 May 2015. In regard to the actual incident and in summary he stated:


• “I did an assessment and there was nothing clinically wrong”.


• “It is always difficult coming in as an outsider so I said to her [Mother A] that if she thinks that there is something wrong with the child, she knows [the child] better, to go to the ED and see a paediatrician".


• “She [Mother A] wasn't hysterical but she was very stressed”.


• “I told her that the child seemed fine but if you are concerned lets take [the child] to see a doctor. She said that she can’t go to hospital because she has to get home. Her husband would be getting home. She just shut me down and started to walk away”


• “I did offer transportation which was declined by the mother”


• “I did what I normally do. Checked [the child’s] appearance, breathing, circulation to the skin, pulse ox, and temperature. If there was a comment of wheeze I would have listened to the chest”

• “I tried to reassure her [Mother A] but she was up there”


• “There were no red flags and it was not life threatening.


• “Service User A was pink, warm, happy and not wheezing. There was nothing clinically wrong with [the child] but I said that if she was unhappy then lets put [the child] under the nose of a doctor and she was offered transportation. She [Mother A] was already in a state when I arrived. I advised her to go to ED. I offered a backup vehicle but my being there was aggravating the situation.”

• “I did listen to [the] chest. There was no grunting or wheeze”


27. The Panel found this particular proved and its reasons are as follows;


• The Panel accepted the evidence of Mother A which in its opinion was clear, credible and consistent. In the opinion of the Panel, Mother A had a clear and accurate recollection of events which were memorable and had imprinted themselves on her mind. Notwithstanding the account given by the Registrant and which has been summarised above, the Panel had no reason to doubt the evidence of Mother A.


• Further, she has had subsequent interaction with various Health Care Professionals and the interaction with the Registrant stands out as being one of a very poor standard.


• The Panel accepted the evidence of RG, that the Registrant could not have completed an adequate assessment of Service user A within the 7 minutes that he was at the scene. It noted that this included time to leave the vehicle, take in his bag of equipment, take a medical history, undertake a full assessment, complete a PCR, return to his vehicle and leave the scene.

• The Panel also noted the statement in the written representations made by the Registrant to the Investigating Committee of the HCPC that “ I also accept that I could have spent more time and completed a more complete assessment” of Service User A. He also stated “ I do regret my conduct in terms of allegation 1 and accept that the short assessment carried out on [Service User A]may have fell [sic] below the standard expected by the trust”


Particular 1 (b)


Did not complete and/or submit a patient care record (PCR) of the incident.


Proved

28. The HCPC case as set out by Ms Chaker is as follows:


• Section 5.1 of the Trust’s Management of Clinical Records mandates that a PCR must be completed and submitted by paramedics for all emergency calls unless a stop message is received before the paramedic arrives at the scene. In this case there was no stop message. Accordingly the Registrant was required to complete a PCR in respect of his attendance on Service User A.


• RG requested the relevant PCR from the PCR Request’s Team. The PCR could not be located. The Daily Record of PCR Completion, commonly known in the Trust as the log sheet, that was completed by the Registrant on 06 May 2015, indicated that a PCR had been completed. However a note made by the member of the record team who examined the documents when they were checked on delivery from the station, recorded that the PCR had not be submitted. 


29. The Panel noted and accepted the evidence in the written statement of RG which was in the following terms;


It can be seen that by [the incident number] that it has been indicated that a PCR was completed and submitted.  However, in the “notes/ comments” section completed by the records team it has been noted as “not submitted.”


In interview, Christopher Turner confirmed that he had completed and submitted a PCR for the incident whilst on the scene and that he recorded it on the log sheet.  I asked Christopher Turner whether 7 minutes was a sufficient amount of time to complete both his assessment and the PCR and when he completed the PCR.  He responded “it was May, but I normally do it as the job is happening or once I have completed.  I can’t remember though.”  Upon being informed that no PCR was found for this incident, Christopher Turner stated that “you see PCR’s all the time fallen in cars.  No one has ever made me aware that it was missing”.

30. The Panel noted and accepted the evidence given by ZG as to the procedure adopted with regard to the management and checking of the PCRs. In her written statement ZJ described that procedure as follows:

At the end of each shift a practitioner should submit their PCRs from that shift by placing them in an envelope with correlating completion sheet and posting the enveloped into a secure bin at their station.

There are seven secure PCR ‘bins’ at the Staverton Ambulance Station and other PCR bins are also placed at other stations within the North Gloucester locality. These secure ‘bins’ are post boxes that are used by ambulance staff to submit PCRs and completion sheets into at the end of their shift.  The bins are secure.  The keys for the bins are kept locked in a cupboard.  The Operations Officer based at the station, the Operations Manager and the members of staff on light duties emptying the bins are the only individuals who have access to the bins.


The seven bins were all emptied at least once a week.  This would be completed by Hannah Pellant or me.  There was not a schedule as to who would empty each bin each week.  Every day we would decide who would empty which bin depending on availability.  I usually emptied the bins and would empty them through the week by going from one end through to the other end. 

In order to empty the bins I would obtain the key from the Operation Officer’s office.  I would then open the bin and take out each envelope one at a time and check the PCRs against their completion sheet.  My role was to check that all the PCRs recorded on the completion sheet were there and check that there was a sufficient amount of information on the PCRs.


I would only know if a PCR was missing if it was recorded on the corresponding completion sheet.  I would therefore know that there should be a PCR and that it was missing because it was not in the bin.  If a PCR was not recorded on the completion sheet I would not know it was missing.  If I came across a missing PCR I would record this on the completion sheet by circling “no” and writing “not submitted” on the sheet where the PCR information was recorded on it.


Once I had been through a completion sheet and the attached PCRs I would place them into a zipped heavy duty plastic bag that was left in the Operations Officer’s office until it was full.  This office was secure.  No one had access to the office other than the Operations Officer or a member of staff more senior than this role.  Once the bag was full it was sealed.  The bag could still be opened after being sealed if it needed to be.  The bags were then collected and taken elsewhere to be processed.  The bags of PCRs were kept securely in the Operation Officer’s office until they were collected. 


31. In oral evidence, ZJ assured the Panel that no PCRs were ever left unattended. Only small numbers of PCRs were emptied out and processed at any one time.

32. The Panel noted the assertion by the Registrant in the interview conducted with him by RG on 25 September 2015 that he did complete the PCR.


33. The Panel found this Particular proved and its reasons are as follows;


• The Panel considered very carefully the evidence given by RG, ZJ and NL and concluded it was highly unlikely that a submitted PCR could have gone missing.


• There was no time for the Registrant to have done all that he claimed to have done in seven minutes.  It was therefore highly unlikely that he completed a PCR, as he claimed.   


• It has concluded on the balance of probabilities that the Registrant did not complete and / or submit the PCR in question. It regarded it as more likely that the Registrant had either failed to complete and/or to submit that PCR than that it had gone astray.

Particular 2

Between approximately 10 June and 15 September 2015, you did not complete and/or submit approximately 14 patient care records.
Proved


34. The HCPC’s case is that as a result of finding that no PCR had been completed and /or submitted for Service User A, RG had audited the Registrant’s recent work history. RG requested PCRs for a sample of the Registrant’s work. All cases in the previous 3 months for which the Registrant had spent 20 minutes or less were considered. In each of the 14 cases captured in the sample it was found that no PCR had been completed and / or submitted.
35. The HCPC’s case was supported by the oral and written evidence of RG, ZJ and NL. The Panel regarded all of that evidence as credible, mutually consistent and supported by documentation in the bundle of documents produced by the HCPC.

36. The Panel noted and accepted the written evidence of ZJ as set out in her written statement as follows:

During my time on light duties I was never aware of the secure bins ever being so full that no more PCRs could be posted into them.  I never saw a practitioner unable to push a PCR into a secure bin.  On a few occasions I saw a secure bin with one or two PCRs sticking out from the opening of the bin where the PCRs are posted.  When this happened the PCRs had not been pushed in properly all the way in and just needed to be pushed in further.  This is what I did when I saw a bin like this and never found that the PCR could not be pushed in further.

If all seven bins were so full that no more PCRs could be submitted a practitioner should approach the operations Officer and ask them to open the bins to make more space for the PCRs to be submitted.

37. In oral evidence, ZJ was clear that although she did not start working with PCRs until August 2015, the procedures had been no different in the proceeding months.

38. The Panel also noted and accepted the written evidence of NL, who gave a clear account of the attempts to locate the 16 PCRs that had been requested.  She said it was “unprecedented” for so many PCRs to be missing.

The Audit Office received an email from Mary Lenihan (Personal Assistant to Richard Garment) to try and find 16 PCRs.  This was sometime in the week of 3 October 2015.  The 16 PCRs we were requested to find are listed in the email I sent to Mary Lenihan on 15 October 2015 at 13.01.  We looked according to the procedure.  We were provided with the dates of the visit and the PCR numbers.  Firstly we went through CAD to find additional information regarding each PCR and searched for the PCRs by their date.  When he would not find the PCRs we also searched all the PCRs on each relevant date to the PCRs and all the possible patient names from any patient name provided on CAD.

39. The Panel noted the assertion made by the Registrant in the telephone interview conducted on 10 November 2015 that he had completed and submitted all the required PCRs.


40. The Panel further noted the assertion made by the Registrant in his written representations to the Investigating Committee of the HCPC that he had completed and submitted all the relevant PCRs. In that document he stated:


I strongly maintain my position in regard to this allegation and resist the allegation that I failed to fill in a PCR.  It is commonplace that I find filled in PCRs under the seat or on the floor of the ambulances I work in.  I would also be surprised if colleagues’ records were records were any different to mine in terms of amount of completed PCRs.  I also question the robustness of the paper system utilised by the Trust to collect PCRs as the system is disorganised and insufficient to ensure the proper maintenance and protection of PCRs.

41. The Panel found this allegation proved. Its reasons are as follows;

• The Panel preferred the evidence of RG, ZJ and NL over the previous accounts given by the Registrant.

•  The Panel carefully considered the evidence as to procedure given by both ZJ and NL. The Panel noted in particular that NL told the Panel that in her lengthy experience it was unprecedented to discover that the alleged number of PCRs had gone astray.

• The Panel accepted that the PCRs were not left unattended. 

• The Panel accepted RG and ZJ’s evidence that any PCRs left in vehicles would (eventually) be picked up and submitted so would not be “missing.”

• The Panel also noted that it was in anyway the responsibility of a Paramedic, such as the Registrant, to submit all required PCRs.

• The Panel concluded that it was more likely that the Registrant had failed to complete and / or submit the PCRs, than that they had gone astray.

Decision on Grounds:

42. The Panel proceeded to consider whether the matters found proved amount to misconduct and/or lack of competence. And, if so, whether the Registrant’s fitness to practise is currently impaired.

43. The Panel considered the submissions made by Ms Chaker on behalf of the HCPC.   She submitted that that in respect of the matters alleged in particulars 1 and 2, they were sufficiently serious as to amount to misconduct and that the Registrant’s fitness to practise was impaired. She relied in particular on the guidance given by the Court in the case of Roylance v General Medical Council No 2 [2000] 1 AC 311. She submitted that whilst it was a matter for the Panel this was essentially a misconduct case rather than one of lack of competence. In relation to current impairment Ms Chaker referred to and relied on the guidance given in the case of Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council and Grant [2011] EWHC 927 [Admin].

44. Ms Chaker further submitted that the Registrant was in breach of the standards set out in Standards 1 and 10 of the HCPC Standards of Conduct, Performance and Ethics [The Standards]. She further submitted that the Registrant was in breach of Standards 1, 2, 3, 4, 8, 10, 12, and 13 of the HCPC Standards of Proficiency for Paramedics [The Paramedic Standards].

45. The Panel heard and accepted the advice of the Legal Assessor. He advised the Panel that for misconduct to be established there had to be serious departure from the appropriate standards of clinical performance.

46. The Panel was aware that any findings of misconduct, lack of competence and impairment were matters for the independent judgement of the Panel.

47. The Panel was aware that consideration of impairment only arises in the event that the Panel judges that the proven facts do amount to misconduct or lack of competence and that what has then to be determined is current impairment.

48. The Panel concluded that in respect of the matters that are set out above the Registrant was in breach of Standards 1 and 10 of the Standards.

Standard 1 provides
To be able to practice safely and effectively within their scope of practice.

Standard 10 provides
Be able to maintain records appropriately.

49. The Panel concluded that the facts as found above are sufficiently serous as to amount to misconduct. Its reasons are as follows:

• As regards Particular 1 (a) the Registrant’s failure to conduct an adequate assessment of a child under the age of 2 was especially serious as the clinical condition of a child of that age can deteriorate very rapidly.

• Moreover, the Registrant ignored the “red flag” that should have been clear to him from the history given to him by Mother A.

• Furthermore 7 minutes was a wholly inadequate time in which to fully assess and document the condition of a potentially sick child under the age of

2. The Panel found that the Registrant had failed in his duty of care to Service User A and that his actions fell below the standards expected by fellow Registrants.

50. In respect of the failure by the Registrant to complete the PCR as alleged in Particular 1 (b) and in Particular 2, the Registrant’s actions were a disregard of the Trust’s policy. As a result there was no record of Service Users’ conditions and any interventions undertaken by the Registrant. This had the potential to put service users at risk of harm in that there was no record of the nature of the care administered to the service users involved. In coming to these conclusions the Panel did keep in mind that in respect of a minority of the cases identified in Particular 2, a PCR might not have been required.  The Registrant was an experienced Paramedic with additional clinical training, especially in paediatric care.  He was well aware of his duty to submit PCRs.

51. The Panel concluded that lack of competence was not an appropriate finding. The Panel has found that the Registrant knew what he ought to have done but had failed to do it. In the opinion of the Panel this conduct amounted to misconduct rather than lack of competence.

Decision on Impairment 

52. Having regard to its findings on the facts and to its determination on misconduct the Panel has concluded that a finding of current impairment is necessary to maintain proper standards and public confidence in the profession and also to protect the reputation of the regulatory process. Consequently a finding of impairment is in the public interest as described by Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council, Paula Grant [2011] EWHC 927 [Admin].

53. Its reasons are as follows;

• The Registrant had clearly failed in his duty of care to Service User A and as a result the child had been put at risk of unwarranted harm.

• As a consequence of the Registrant’s conduct, Mother A’s confidence in the ambulance service had been undermined; she had described her subsequent fear of having to call the ambulance service. The Registrant’s failure to complete PCRs flouted Trust policy and had the potential to put service users at risk of serious harm.

54. The Panel further considered that the Registrant has shown only limited insight in relation to his actions and as to the potential consequences of his failings. He has not been explicit as to how his assessment of Service User A was deficient. Nor has he reflected on the impact on the child, the family, or on the potential wider implications of his failings. There is no evidence of remediation and in respect of the matters set out in Particular 1b and Particular 2 a total denial of the facts.

55. Whilst the Registrant’s failings are in theory capable of remediation, there is no evidence before the Panel that they have been remedied. Therefore, the Panel considers that there is a real risk of repetition and that a finding of current impairment was also justified for that reason. 

56. For the reasons set out above the Panel finds that by reason of the Registrant’s misconduct his fitness to practise is currently impaired.

Decision on Sanction:

57. Ms Chaker made submissions on behalf of the HCPC.

58. The Panel heard and accepted the advice of the Legal Assessor. He advised the Panel of the need to have regard to the Indicative Sanctions Policy [ISP] published by the HCPC, the importance of applying the principle of proportionality, the need to consider available sanctions in ascending order of severity, the need to consider relevant mitigating and aggravating circumstances and when considering a Conditions of Practice Order, the need to consider whether possible conditions were relevant, proportionate, workable and enforceable.

59. The Panel kept in mind that the purpose of a sanction is not punitive but is designed to protect the public interest which includes protecting members of the public from possible harm, maintaining proper standards within the profession, the reputation of the profession itself and public confidence in the regulatory functions of the HCPC.

60. The Panel took into account the ISP.

61. In considering whether to make an order and the nature and duration of any order to be made, the Panel applied the principle of proportionality weighing the Registrant’s interests in the balance with the need to protect the public interest.

62. The Panel took into account both mitigating and aggravating circumstances.

63. Mitigating factors included the following:

• The fact that apart from the matters that are the subject of the amended Allegation the Registrant appears to have an unblemished professional record.

• The Registrant did carry out a partial assessment of Service User A.

• The Registrant has shown some limited insight.

64. The Panel noted the Registrant’s contention in his written submissions to the Investigating Committee of the HCPC, that the atmosphere between himself and Mother A was somewhat tense. The Panel also noted that the Registrant had in those submissions stated that he was not enjoying his role with the Trust and the shift based nature of the work, together with the inherent stress of the role, was not compatible with an increasingly dependent family. The Panel did not regard these as mitigating factors, as the Registrant should not have allowed either factor to undermine his professional conduct and duty of care to Service User A or other service users. 

65. The Panel considered the following aggravating factors:

• The Registrant’s assessment of Service User A, who was a vulnerable patient, was wholly inadequate.

• The clinical condition of a sick child under the age of 2 is liable to deteriorate rapidly.

• The Registrant has not demonstrated a proper understanding of the consequences of his actions on the health of Service User A, potentially on other service users by his failure to complete PCRs, or on the reputation of the Ambulance Service.

• The Registrant’s failures to complete and/or submit PCRs were numerous, occurred over a number of months and were in direct contravention of Trust policy.

• The Panel did not think that the account that the Registrant gave in the interview conducted on 25 September 2015 was wholly honest. The Panel believed that Mother A had given the Registrant a full account of Service User A’s medical history as relevant to the child’s then condition. The Panel did not think that Mother A had declined transport to hospital as suggested by the Registrant.

• The Panel further noted that in his representations of 21 March 2016, the Registrant persisted in his assertion that he had completed and submitted the PCRs referred to in Particular 2. He still blamed poor Trust practices for the fact that his PCRs were missing. 

66. The Panel considered the sanctions available to it in ascending order of severity. In arriving at its decision the Panel applied the principles that are set out in the ISP.

No action.

67. The Panel concluded that having regard to the facts that have been found proven, to take no further action would be wholly inappropriate. The Registrant’s failures are too serious to permit such an outcome, which would provide no protection to the public, would undermine confidence in the profession and in the regulatory functions of the HCPC and would not serve to uphold proper standards of conduct and performance within the profession.

Mediation.

68. The Panel concluded that mediation was not appropriate to a case of this kind.

Caution.

69. For the same reasons as those just expressed with regard to taking no action, the Panel concluded that a Caution Order would also be inappropriate.

Conditions of Practice Order.

70. The Panel considered making a Conditions of Practice order. The Panel was aware that the conditions imposed by such an order must be relevant, workable, enforceable and proportionate. The Panel concluded that in the circumstances of this case, appropriate Conditions of Practice cannot be formulated and in any event would not sufficiently safeguard the public interest or uphold appropriate standards of conduct within the profession. In coming to this conclusion the Panel took into account the following:

• The Registrant has shown little insight or remorse.

• The Registrant’s engagement with these proceedings has been limited.

• The Panel had not received any evidence as to what the Registrant is presently doing or as to his willingness to comply with a Conditions of Practice Order.

Suspension.

71. The Panel concluded that having regard to the Registrant’s conduct, a Suspension Order was the only appropriate and proportionate sanction. Such an order would provide proper and sufficient protection to the public and help to sustain public confidence in the profession. The Suspension Order will be for a period of 12 months. This will provide sufficient time for the Registrant to reflect on and acknowledge his failings and to seek ways to demonstrate that he has addressed them.  The Registrant’s own representations suggest that he may have started on a journey towards full remorse, reflection and insight, but the Panel believes that he needs sufficient time to enable him to make much more significant progress along this road.

Striking off.

72. The Panel did consider a Striking Off Order. It was aware that such an order is a sanction of “last resort”. The Panel did not consider that at this stage such an order was either necessary or proportionate, as it does regard the failings as potentially remediable. 

Review

73. This order will be reviewed prior to its expiration.

74. A reviewing panel may be assisted by the presence of the Registrant.

75. A reviewing panel may also be assisted by a reflective piece from the Registrant indicating:

• A recognition of his failings.

• What he has learnt from these events.

• His understanding of the impact an inadequate assessment could have on the clinical condition of a child under 2 and on the reputation of his profession.

• His understanding of the importance of completing and submitting PCRs, and the potential implications of failing to do so.


76. A reviewing panel may also be assisted by evidence from the Registrant as to his plans for the future. If the Registrant wishes to remain in a profession that requires registration as a paramedic, a reviewing panel may be assisted by evidence of the steps that he has taken to maintain his professional skills. A reviewing panel may further be assisted by evidence as to what the Registrant has been doing by way of work, whether paid or unpaid, since he left the employment of the Trust, together with testimonials from his employers and colleagues at work.

Order

No information currently available

Notes

Order: That the Registrar is directed to suspend the registration of Mr Christopher J Turner for a period of 12 months from the date this order comes into effect. 


The order imposed today will apply from 22 March (the operative date). This order will be reviewed again before its expiry on 22 March 2018.

 

Hearing history

History of Hearings for Mr Christopher J Turner

Date Panel Hearing type Outcomes / Status
01/03/2018 Conduct and Competence Committee Review Hearing Suspended
20/02/2017 Conduct and Competence Committee Final Hearing Suspended