Ms Jemma Pratt

: Paramedic

: PA39180

: Final Hearing

Date and Time of hearing:10:00 24/10/2017 End: 17:00 27/10/2017

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

: Conduct and Competence Committee
: Caution

Allegation

During the course of your employment as a Paramedic for London Ambulance Service NHS Trust (‘the Trust’):

 

1. On 25 March 2016, during your day shift time of 06:00hrs – 18:00hrs, you:

 

a. did not attend an emergency call which had been allocated to you (CAD 3393), to a patient who you knew was in cardiac arrest

b. delayed the response to the emergency call, CAD 3393;

 

2. On 25 March 2016, you told the Trust Emergency Operations Centre that the delay in responding to the emergency call CAD 3393 was caused by an issue with the garage doors, which was not the case;

 

3. You actions described in particular 2 were dishonest;

 

4. Your actions described in particular 1 constitute misconduct and/or lack of competence;

 

5. Your actions described in particulars 2 and 3 constitute misconduct;

 

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

Finding

Preliminary matters

1. The Registrant, Ms Jemma Pratt, has attended this hearing at which she has been represented by Ms Clare Hennessey.

2. When invited to respond to the allegations at the commencement of the hearing, it was indicated on behalf of the Registrant that she admitted factual particulars 1(b), 2 and 3.  She denied factual particular 1(a) on the basis that she was unaware that the patient was in cardiac arrest when she handed over to a colleague.  The Registrant further admitted the misconduct alleged by particulars 4 and 5, and also that her fitness to practise was impaired upon consideration of the public component relevant to that issue.

3. Throughout its decision making the Panel has accepted the advice of the Legal Assessor.

Background

4. The Registrant qualified as a Paramedic in 2015.  Prior to qualification, she worked as a level two student Paramedic and undertook placements at a number of London Ambulance Service (“LAS”) ambulance stations.  Having qualified, the Registrant initially worked for LAS on a Bank contract, but subsequently became a full-time member of staff.

5. The matters being considered by the Panel occurred on 25 March 2016. On that day the Registrant was rostered to work on a Fast Response Unit (“FRU”) with the call sign “H550” on a shift that started at 06:00 and was due to end at 18:00.  The following shift on the FRU, starting at 18:00 was due to be undertaken by Colleague A.  Colleague A attended work some time before his shift was due to commence and was present in the ambulance station dressed in his uniform before any of the events relevant to the allegations occurred.

6. The Registrant returned to the ambulance station at approximately 17:40, having attended an earlier call.  A call came through to her vehicle at 17:46, a time before the end of the Registrant’s shift.  It is accepted by all that she did not attend that call, and that it was Colleague A who attended after some delay.  The circumstances surrounding the Registrant’s failure to attend the call will be explained by the Panel when it turns to its decision on the facts.

7. The issue relating to particular 2 of the allegations is that at 18:00 there was a conversation between the Registrant and the controller concerning the call-out.  The record of the exchanges is as follows: “CALLED RT AND ADVISED THAT SHE IS STILL ON STATION AS NIGHT TURN HAS ARRIVED AND HE WILL TAKE VEH. I ASKED IF VCS IS STILL ON STATION – H550 THEN SAID THEY ARE ABOUT TO LEAVE – ? ISSUE WITH GARAGE DOORS.”  It is the HCPC’s case that the suggestion that the delay was caused by, or contributed to, an issue with the garage doors was untruthful, and, at particular 3, it is contended that it was dishonest for the Registrant to make that suggestion.

Decision on Facts

8. The Panel has approached its decision on the facts, on the basis that the burden of proof rests on the HCPC, the standard of that burden being the balance of probabilities.  In applying this burden it is appropriate for the Panel to consider the Registrant’s admissions as matters capable of proving the relevant facts.

9. The HCPC called two witnesses to give evidence before the Panel.  They were:

• Mr AE, a Paramedic employed by LAS as a Quality, Governance and Assurance Manager.  Mr AE undertook an investigation on behalf of LAS into the matters being considered by the Panel.

• Colleague A, a Paramedic employed by LAS.
10. The HCPC also relied upon the written witness statement of Ms LB, a Paramedic employed as a Clinical Team Leader by the LAS.  Ms LB was in the ambulance station at the time relevant to the Panel’s enquiry and her involvement with the Registrant during the afternoon of 25 March 2016.  The witness statement made by Ms LB for the present proceedings confirmed the statement she had made to Mr AE when he had undertaken his investigation, a statement to which Ms LB said there was nothing she wished to add.

11. In addition to the oral and written witness evidence, the HCPC produced a bundle of documentary exhibits, including statements obtained by Mr AE and others on behalf of LAS, as well as documents reflecting the Computer Aided Dispatch (“CAD”) communications that related to the incident not attended by the Registrant.

12. The Registrant gave sworn evidence and produced a written witness statement as well as a document extending to six pages entitled “Reflection”.  In addition the Panel was provided with a number of written character references submitted on behalf of the Registrant.

13. Before turning to state its decisions on the factual particulars, the Panel will explain its general assessments of the witnesses who gave oral evidence at the hearing:

• Mr AE. The Panel was satisfied that, in giving his evidence, Mr AE sought to help the Panel to reach a just decision.  The Panel did not find that any element of his evidence was given with the desire to damage the Registrant, and the Panel was satisfied that the evidence gathered from his investigation could be relied upon.  However, Mr AE had no direct personal knowledge of the relevant events, and therefore the Panel was careful to exclude from its consideration, the views that he had formed based upon the evidence he gathered.

• Colleague A.  He was clearly nervous when giving evidence.  The Panel is satisfied that in giving his evidence, Colleague A described matters as he believed them to have occurred.  However, by his own admission there were aspects of his evidence which were confused and that he had guessed some of the timings given.  The Panel found that on occasions his recall was poor.  There were also inconsistencies between accounts given by him at different times.  These reservations meant that it was difficult to rely on the evidence of Colleague A save to the extent that it was corroborated by other evidence.

• The Registrant.  The Panel found the Registrant to be credible.  Her recall was generally clearer than that of Colleague A, although even for her there was some confusion around timings and there were elements of her oral evidence that were inconsistent with statements previously made.

The Panel would wish to qualify the observations it has made concerning the confusion and inconsistencies in the evidence of both the Registrant and Colleague A.  The Panel accepted that it was difficult for both the Registrant and Colleague A to be precise about specific timings and the sequence of events over a very short time frame.

14. Before turning to the specific particulars to the allegations, the Panel should state its findings as to a contextual matter.  The Panel accepts that on the day in question the Registrant was in a highly emotional state.  She described herself as stressed and sleep deprived. Information contained in the statement Ms LB made for the purposes of the LAS investigation would tend to support the Registrant’s evidence in this respect.  In addition, Colleague A described the Registrant as being “a bit stressed out”.  The Panel accepts the Registrant’s own description that she was in a “fog of emotion” at the time. 

15. Particular 1(a).  It is accepted by the Registrant that she did not attend the emergency call allocated to her with the reference CAD 3393, but she denied that her failure to attend was with the knowledge that the patient was in cardiac arrest.  The HCPC’s contention that the patient was in cardiac arrest is based upon the information that was reported by the CAD system that police officers were performing CPR on the patient.  The Panel accepts that this information is a sufficient basis for it to be inferred that the patient was in cardiac arrest.  The CAD message about CPR being administered was timed at 2 seconds before 17:49, and the Panel accepts that it was sent to the MDT in the FRU at that time.  Both the Registrant and Colleague A accept that there was, in effect, a handover before 18:00.  The Panel accepts the oral evidence of the Registrant that she was unaware of the suggestion that CPR was being undertaken before the handover was effected, and her evidence in this regard was consistent with the evidence of Colleague A to the effect that he was unaware that the patient was in cardiac arrest until he had arrived at the scene of the incident.  The conclusion arrived at is that it is possible that the message had been displayed on the MDT along with other messages before the handover took place.  The Panel finds that that the HCPC has not discharged the burden of proving that the Registrant had actual knowledge of the information that would have led to her concluding that the patient was in cardiac arrest before that handover took place.  Accordingly, particular 1(a) is not proved.

16. Particular 1(b).  Emergency call CAD 3393 was relayed to the Registrant’s vehicle before the end of her shift, and she did not attend.  She has, from the outset, admitted that she delayed responding to it.  The Panel finds that the root cause of the problem was the poor communication between the Registrant and Colleague A.  Both accept the lack of clear communications between them concerning the emergency call and when the handover took place.  There was no clarity between them as to who was responsible at any particular time.  Instead, assumptions were made based on the exchange of the radio, keys and other equipment on the vehicle.  However, as already stated, the call was received during the Registrant’s shift, and at no time did she explicitly check with Colleague A as to his readiness to respond to the call. Particular 1(b) is proved.

17. Particular 2.  The Registrant has consistently admitted that she made the statement about the garage door which was recorded on the Emergency Operation Centre log, and that there was in fact no issue with it.  Particular 2 is proved.

18. Particular 3.  The Panel accepted the advice of the Legal Assessor given on 25 October 2017 that as a result of a Supreme Court decision given that same day, it was appropriate to consider only the objective test of dishonesty.  Accordingly, the Panel had to decide whether the Registrant’s actual knowledge and belief about the garage door would be considered to be dishonest by the standards of ordinary and honest people.  The Panel concluded that it would be thought to be dishonest, a conclusion consistent with the Registrant’s admission of this particular.  Particular 3 is proved.

Decision on Grounds

19. The Panel determined that the facts of the case do not amount to lack of competence.  There is only one particular found proved (particular 1(b)), representing a single incident that is alleged by the HCPC as being capable of amounting to a lack of competence.  However, the Panel believes that the Registrant knew at the time what she should do, but did not do it.

20. In considering misconduct, the Panel considered particulars 1(b), 2 and 3 together. As to particular 1(b), the Panel is satisfied that the Registrant could and should have done more to accelerate the response to the call, not least by finding Colleague A and retrieving the vehicle keys.  Despite the fact that the HCPC does not advance the case on the basis that the delay in responding resulted in any harm to the patient, the Panel nevertheless regards the matter as serious.  Lying about the garage door was dishonest and a very serious matter.  The Registrant’s actions breached the following standards of the HCPC’s Standards of conduct, performance and ethics in force at the relevant time:

Standard 2.6, “You must share relevant information, where appropriate, with colleagues involved in the care, treatment or other services provided to service users.”

Standards 6.1, 6.2 and 6.3, “You must take all reasonable steps to reduce the risk of harm to service users …. as far as possible”; “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”; and, “You must make changes to how you practise, or stop practising, if your physical or mental health may affect your performance or judgment, or put others at risk for any other reason.”

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

The Panel is satisfied that the Registrant’s actions and behaviour fell significantly below the standard expected of a Paramedic, and that this conduct was sufficiently serious to be categorised as misconduct.

Decision on Impairment 

21. When the Panel considered the issue of current impairment of fitness to practise, as required, it considered both the personal and public components relevant to that enquiry.

22. In reaching its decision on current impairment of fitness to practise, the Panel has not only had regard to the Registrant’s evidence, but also had regard to the testimonial evidence she produced.  Included in the testimonial evidence was a letter from Lt. JM, the Registrant’s Platoon Commander, while she was undergoing Army Basic Training (Phase 1).  The Panel was struck by the statements that having had close involvement with the Registrant, at no point had the Registrant given Lt JM reason to doubt her integrity or judgement, and that despite the stresses that Army basic training can create, the Registrant had dealt with stresses as they have arisen by using the correct chain of command.

23. So far as the personal component, the Panel is satisfied that the Registrant’s actions were out of character.  Her actions occurred on a day when she was in a heightened emotional state due to being exhausted, unsettled and unhappy.  This was compounded by finding herself in an unfamiliar situation in which a colleague had offered her the opportunity to finish her shift early.  This led to the poor communication between herself and Colleague A.  This was further compounded when she panicked on the spur of the moment and was untruthful.  The Panel is satisfied that the Registrant did not deliberately decide to delay responding to the emergency call, and it is equally satisfied that the untruth was told without premeditation.  Since making those errors of judgment on 25 March 2016 the Registrant has been consistently open about what she did and did not do, and has taken full responsibility in acknowledging that her behaviour was unacceptable.  The Panel is satisfied that she has fully accepted her responsibility for her actions, demonstrated comprehensive insight into her actions and expressed genuine remorse.  The Panel is confident that the Registrant has now recognised that it is necessary for her to take the lead when appropriate, understands the importance of communicating effectively and has mechanisms in place for dealing with stress.  Whilst the Panel accepts that it is very likely to be unusual to say that a registrant against whom dishonesty has been proved has fully remediated their shortcomings, the Panel finds that this is a case in which it is appropriate to make that finding.  In short, the Panel finds that there is no appreciable risk that the Registrant will behave in a similar manner in the future, and, therefore, a finding of impairment of fitness to practise is not required to reflect the risk of harm to patients in the future.   For these reasons, the Panel does not consider that the Registrant’s fitness to practise is impaired upon consideration of the personal component.

24. When it considered the public component relevant to current impairment of fitness to practise, however, the Panel concluded that a finding of current impairment of fitness to practise is required.  It is required to declare and uphold proper professional standards, so that other Paramedics will understand that they cannot act as the Registrant has been found to have acted without being held to account.  It is also necessary to maintain public confidence, because even if a fair minded and fully informed member of the public accepted that the Registrant’s actions were out of character and were unlikely to be repeated, so serious would they be considered to be that it would be necessary for the matter to be marked by the regulator.

25. It follows from the fact that the Panel has found that there was misconduct currently impairing the Registrant’s fitness to practise, that the issue of sanction must be considered.

Decision on Sanction

26. After the Panel announced its decisions on the allegations and handed down the written determination explaining them, the parties made submissions on sanction.

27. On behalf of the HCPC, the Presenting Officer reminded the Panel of the proper purpose of sanctions and urged the Panel to have regard to the HCPC’s Indicative Sanctions Policy when reaching its decision.  She identified the proved dishonesty as an aggravating factor, but submitted the fact that the Registrant had made admissions from the outset, was experiencing personal difficulties at the time of the incident and had shown a keenness to learn from the matter as all being mitigating factors.  The Presenting Officer submitted that it would not be appropriate to take no further action or to direct that there should be mediation.  She questioned whether the imposition of a Conditions of Practice Order would be appropriate given the Panel’s findings, but did not submit that the Panel should apply any particular sanction.

28. On behalf of the Registrant, Ms Hennessey made oral submissions that reflected the written submissions on sanction she presented to the Panel.  She also identified dishonesty as an aggravating factor and that the Registrant’s actions resulted in a delay in attending the patient.  Ms Hennessey identified a number of mitigating factors, including the fact that the Registrant is of good character and her actions were out of character, the fact that the Registrant was young both in service and age, as well as the personal stress she was experiencing.  Ms Hennessey invited the Panel to impose a caution order, although she also submitted that if the Panel did not consider that such an order would be appropriate, a Conditions of Practice Order with workable conditions could be made as the Registrant is soon to commence training with the army’s medical corp and could work under the supervision of a Paramedic.

29. The Panel has approached its deliberations on sanction by accepting that a sanction should not be imposed with the intention of punishing a registrant against whom findings have been made.  Rather, the proper aims are the protection of the public and the maintenance of a proper level of confidence in the Paramedic profession and in the regulation of that profession.  The fact that an allegation is well founded, does not of itself require the imposition of a sanction.  Were no sanction to be imposed, public confidence in the Paramedic profession would be diminished and there would not be a sufficient declaration of proper professional standards to operate as a deterrent effect.  Therefore, the Panel determined that a sanction is necessary.  The Panel concluded that a sanction on the grounds of public protection alone is not necessary as the Panel has not found that there is a significant risk of repetition with the consequential risk of harm. The Panel reviewed all the sanctions available to it, starting with the least restrictive.

30. The Panel agrees with the parties that the dishonesty found by the Panel is an aggravating factor, as that finding would attract public disapproval.  The Panel finds the relevant events occurred over a short period of time, when the Registrant was experiencing difficult personal circumstances, was relatively newly qualified and she made clear and early admissions.  These are all mitigating factors.

31. The Panel decided that this is not a case where mediation would be appropriate.  The Panel decided that a Caution Order would address the issues of public confidence, would uphold proper professional standards and act as a deterrent to members of the Paramedic profession.  The conclusion of the Panel is that a Caution Order is appropriate in this case.  When considering the appropriate length of a Caution Order, the Panel considered that it should be for a period of three years to reflect the serious view that would be taken by members of the public of the finding of dishonesty.

32. The Panel tested its view that a Caution Order would sufficiently address the factors a sanction is required to address in the present case by assessing whether the Registrant’s practice should be restricted or even prevented.  Having considered the other sanctions available, the Panel concluded that a more restrictive sanction would be disproportionate, as it would not be required to protect the public.  The Panel is satisfied that the imposition of a 3 year Caution Order would reassure the public that the Registrant’s conduct was viewed as serious by the regulator.

Order

That the Registrar is directed to annotate the register entry of Jemma Pratt with a caution which is to remain on the register for a period of 3 years from the date this order comes into effect.

Notes

No notes available

Hearing history

History of Hearings for Ms Jemma Pratt

Date Panel Hearing type Outcomes / Status
24/10/2017 Conduct and Competence Committee Final Hearing Caution