Mrs Joy Lytham

: Operating department practitioner

: ODP32487

: Final Hearing

Date and Time of hearing:10:00 26/06/2017 End: 12:00 26/06/2017

: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Voluntary Removal agreed

Allegation

Allegation (as Found at the Final Hearing on 6 May 2014):

During the course of your practice as an Operating Department Practitioner with Harrogate and District NHS Trust:
 
1. Between 5 and 6 April 2012 you were unable to demonstrate sufficient knowledge of basic procedures relevant to your role in that you:
 
a) did not have suitable laryngoscopes available
 
b) did not have a bougie available despite the Anaesthetists requests
 
c) were unable to set up a capnograph or arterial line

d) did not know how to zero an arterial line
 
e) did not apply cricoid pressure for a rapid sequence induction

f) did not demonstrate independent judgement of what action was required.
 
2. On 12 July 2012 (during assessment of your skills as an Operating Department Practitioner) you were unable to practise at the required level of competence of a band 5 Operating Department Practitioner in that you were unable to:
 
a) check the set-up for the specialist needs of the patient in that you did not:
 
(i) prepare fluids for administration to the patient by running them through the giving set;

(ii) make ready a rapid infuser [ADMITTED];
 
b) correctly prepare airway management equipment for the situation in that you:
 
(i) did not cut the ET tubes;

(ii) did not attach a syringe for rapid sequence induction;

(iii) did not prepare the difficult intubation trolley;
 
c) safely assist the clinician with intubation procedure in that you released cricoid pressure during intubation

d) [NOT PROVED]

e) prepare for CVC monitoring [ADMITTED];
f) demonstrate how to recognise:
 
(i) tension pneumothorax [ADMITTED];

(ii) [NO CASE TO ANSWER]
 
g) adapt to a changing situation in that:
 
(i) you were unable to determine the cause of the patient’s cardiac arrest [ADMITTED];

(ii) you were unable to deliver effective chest compressions [ADMITTED];
 
h) provide a competent handover of care to the PACU team

(i) [NOT PROVED]

(ii) [NO CASE TO ANSWER]
 
3. On 10 August 2012 (during assessment of your skills as an Operating Department Practitioner) you were unable to practise at the required level of competence of a band 5 Operating Department Practitioner in that you were unable to:
 
a) check the anaesthetic machine correctly as part of its set up;

b) check the set-up for specialist needs of the patient in that you did not
 
(i) take account of the patient’s low body temperature [ADMITTED];

(ii) make correct adjustments for intubation where a hard collar was in situation;
 
c) correctly prepare airway management equipment for the situation

d)  safely assist the clinician with intubation procedure in that you:
 
(i) released the syringe during the intubation procedure;

(ii) removed the patient’s hard collar to facilitate intubation;

(iii) rolled the patient onto their side whilst a hard collar was not in situ;
 
e) demonstrate awareness of or discuss alternative techniques for airway management
 
f) prepare for CVC monitoring and/or arterial line insertion [ADMITTED]

g) undertake a collection of arterial blood and provide basic interpretation of gas results;
h) adapt to a changing situation in that you did not notice the patient was in cardiac arrest for seven minutes;

i) assist with cardiac arrest management in that you used an ineffective CPR technique [ADMITTED];

j) [NO CASE TO ANSWER]

k) [NO CASE TO ANSWER]

(i) provide a competent handover of care to the ODP for transfer in that you did not:
 
(ii) explain that the patient had undergone cardiac arrest;

(iii) communicate the treatments and drugs that had been administered to the patient [ADMITTED].
 
4. On 11 October 2012 (during assessment of your skills as an Operating Department Practitioner) you were unable to practise at the required level of competence of a band 5 Operating Department Practitioner in that you:
 
a) [NOT PROVED]

b) did not communicate adequately to the anaesthetist
 
c) were unable to use the pressure infuser device correctly

d) were unable to select the correct drugs for RSI in preparation for the anaesthetist arriving
e) were unable to deliver chest compressions at the correct ratio [ADMITTED].
 
5. [NO CASE TO ANSWER]

6. The third assessment took place on 11 October 2012, which the Registrant also failed to complete satisfactorily.

7. At the end of the Capability Hearing on 23 November 2012 the Trust decided to dismiss the Registrant. The Registrant was referred to the HCPC and the Final Hearing took place on 6 to 14 May 2014.

8. The particulars of allegation set out above were found proved, in part by way of admissions and in part by way of evidence produced by the HCPC.

Finding

Preliminaries

Service

1. The Panel was informed by the Hearings Officer that Notice of this hearing was sent to the Registrant’s registered address by letter dated 7 April 2017, and contained the required particulars. A copy was also sent by email on the same date. The Panel was satisfied that notice had been properly served as required by the Rules.

Proceeding in Absence

2. Mr Thompson, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. The Panel heard and accepted the advice of the Legal Assessor who advised that the Panel’s discretion to proceed in the Registrant’s absence must be exercised with the utmost care and caution.

3. The Panel took into account that this matter has been listed for the Panel to consider whether or not is appropriate to allow this matter to be dealt with by way of Voluntary Removal, and there is a Voluntary Removal Agreement which has been signed by the Registrant and is dated 12 May 2017.

4. The Panel was satisfied that the HCPC had fulfilled its obligations and taken all reasonable steps to serve the notice on the Registrant in accordance with the Rules.

5. The Panel concluded that the Registrant was aware of the hearing today, had signed an agreement and was recorded in a telephone note as stating that she was content for the hearing to take place in her absence. The Panel took into account that the purpose of this hearing was to decide whether or not to approve a Voluntary Removal Agreement which has been applied for by the Registrant and agreed by the HCPC. The Panel considered that it was in the public interest and the Registrant’s own interests for the hearing regarding whether or not to approve the Agreement to take place.

Background

6. On 26 August 2009, the Registrant was employed at Harrogate and District NHS Trust (the Trust) as an Operating Department Practitioner (ODP). In this role she was based in the Main Theatres as an expert assistant to surgeons and anaesthetists both during surgical procedures and whilst patients were in recovery.

7. On 11 October 2010, informal capability proceedings were started in relation to the Registrant in relation to a number of complaints that had been made by colleagues about her ability to understand or fulfil the requirements of her role. As part of that process, key competencies were outlined as objectives for her to achieve and she worked on a supernumerary basis throughout the capability process. On 2 March 2011, the informal capability process was lifted, allowing the Registrant to work autonomously on standard shifts (excluding nights).

8. On 6 April 2012, a complaint was made regarding the Registrant’s performance during treatment of a patient in a resuscitation bay. The complaint concerned the Registrant’s ability to prepare and set up standard equipment and demonstrate necessary competence during procedures.

9. The Trust initiated a formal capability process and an Action Plan was agreed on 24 July 2012. As part of the ongoing capability process, the Registrant undertook three assessments, which took place on 12 July 2012, 10 August 2012, and 11 October 2012. The Registrant failed to complete each assessment satisfactorily. A Capability Hearing was held on 23 November 2012, which resulted in the Registrant’s dismissal from the Trust, following which it referred the matter to the HCPC.

10. Between 6 and 14 May 2014, a Substantive Hearing was held before a Panel of the Conduct and Competence Committee (CCC), at the end of which the Registrant’s fitness to practise was found to be impaired by reason of lack of competence. She was made the subject of a Conditions of Practice Order for 12 months.

11. On 5 May 2015, shortly before it was due to expire, that Order was reviewed by a Panel of the CCC. In light of reports regarding the Registrant’s practice which had been prepared for the review, and which raised a number of concerns, that review Panel directed that a Suspension Order for a period of 12 months should take effect from the date of expiry of the original Order.

12. On 6 May 2016, shortly before the Suspension Order was due to expire, a Hearing was scheduled to review it. On that date, the Panel adjourned the matter to allow the Registrant to attend, and in so doing, extended the Suspension Order for two months.

13. On 12 July 2016, shortly before the Suspension Order was due to expire, the Order was reviewed. That second reviewing Panel determined that the Registrant’s fitness to practise remained impaired. It extended the Suspension Order for 12 months.

14. On 7 November 2016, the Registrant wrote to the HCPC to inform them that she had not been able to obtain a placement, and so would not be in a position to demonstrate her required competencies and to successfully have her suspension lifted and expressing a wish to bring the proceedings to an end.

15. On 29 November 2016, following telephone discussions regarding the option of Voluntary Removal, the Registrant wrote to the HCPC applying for Voluntary Removal from the Register as an ODP. 

16. A Voluntary Removal Agreement (the Agreement), dated 12 May 2017, was prepared by the parties and drawn up by the HCPC. On 16 June 2017, the HCPC received a signed and witnessed copy of the Agreement from the Registrant. Schedule C of the Agreement contains a signed letter to the Registrar requesting removal from the Registrar, following revocation of the Suspension Order.

Decision

17. Mr Thompson took the Panel through the history of the case and the contents of the Agreement. He invited the Panel to revoke the Suspension Order so that the Registrant could voluntarily remove herself from the Register.

18. The Panel heard and accepted the advice of the Legal Assessor. It had regard to the section on Voluntary Removal in the HCPTS Practice Note entitled Disposing of cases by consent.

19. The Panel decided to approve the Agreement for Voluntary Removal from the Register and revoke the current Suspension Order under Article 30(2). This is on the understanding that the Registrant will act in accordance with the Agreement which she has signed, and remove herself from the Register, having signed a prepared letter to the Registrar, requesting such removal.
20. The Panel was satisfied that the appropriate level of public protection is being secured by allowing Voluntary Removal, as the Registrant would not be permitted to practise as an ODP once her name is removed from the Register. Also, she would not be able to apply for re-admission to the Register, until a period of at least 5 years had elapsed.

21. In relation to the wider public interest, the Panel was satisfied that this had been appropriately addressed as the allegation had previously been determined in public by a CCC Panel and a sanction had been imposed, which was identified at that time to both protect the public and to meet the wider public interest. The sanction had also been reviewed twice.

Order

The Panel directs that the Suspension Order be revoked on the basis that the Registrar will remove the name of Mrs Joy Lytham from the Register with immediate effect.

Notes

If the Registrant seeks to return to the HCPC Register at any time the application would be treated as if the registrant had been struck off as a result of that allegation.

Hearing history

History of Hearings for Mrs Joy Lytham

Date Panel Hearing type Outcomes / Status
26/06/2017 Conduct and Competence Committee Final Hearing Voluntary Removal agreed
12/07/2016 Conduct and Competence Committee Review Hearing Suspended
06/05/2016 Conduct and Competence Committee Review Hearing Suspended
05/05/2015 Conduct and Competence Committee Review Hearing Suspended
06/05/2014 Conduct and Competence Committee Final Hearing Conditions of Practice