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Not wanting to reignite some of the debates (they can be continued in the above previous threads), the purpose of this thread (which I will stick) is to report on HPC hearings (with out naming the people involved, even though its in the public domain).
The purpose is to educate the community on just what action can be takeb by the HPC against registered health professionals (thaks to William for the idea)
The Registrant’s fitness to practice was found to be impaired on the grounds of lack of competence on the 7th February 2007. A suspension order of 12 months was imposed and this was extended on the 27th September 2007 for a period of six months. The 27th September 2007 review was at the Registrant’s request. Today’s hearing is the second review.
The Registrant was employed as a basic grade Occupational Therapist and at the date of the allegations she was in her first post qualification job. Despite support from her employer, the Registrant demonstrated low levels of competence in communication, team work, prioritising and clinical reasoning. She failed to demonstrate even a basic level of competence. After a capability hearing, she was dismissed from her employer in April 2006. She was working by then on restricted duties from November 2005 as an Occupational Therapy Assistant.
The Panel had regard to the documentation, including the Registrant’s bundle and it has heard the submission of Ms. Nahar, for the HPC. The Panel has heard and accepted the Legal Assessor’s advice and it has exercised the principle of proportionality at all times.
The Registrant did not appear and was not represented. The Panel determined to proceed in her absence, and it took note that she had responded to the Notice of Hearing.
The Panel noted that the Registrant has not addressed the concerns of the previous Panels about her lack of insight into her shortcomings and the serious and extensive nature of her deficiencies. It had been suggested to the Registrant that she should provide focussed submissions addressing these concerns. Although the Registrant has produced two references from an employer dated July 2008 in relation to her work as a Clinical Support Worker in 2007 and 2008, the employment does not relate to, or have the level of skill required for Occupational Therapy. Furthermore, one referee was unable to comment on the Registrant’s clinical skills and had expressed a small concern regarding her prioritisation.
Therefore, the Panel has determined from the information before it that there has been no change to the Registrant’s position. The Panel is of the view that public protection and public confidence in the profession and in the regulatory process can only be upheld by extending the Suspension Order on its expiry for a period of twelve months.
1. At all material times until the 28th July 2006 you were employed as a Radiographer at East Sussex Hospitals NHS Trust
2. During that employment you:
a) failed to obey reasonable instructions
b) failed to observe trust policy
c) harassed members of staff
3. Made a false statement to your line manager when requesting annual leave for the 27th and 28th April 2006.
4. In relation to the incident on the 1st December 2005 you :
a) advised a patient to sit upright to perform x-ray despite being advised not to.
b) failed to knowingly carry out duties satisfactorily
c) failed to provide an efficient, safe and high quality service.
1. Mrs Nottage was employed by East Sussex Hospitals NHS Trust (“the Trust”) at Conquest Hospital St Leonards on Sea as a Radiographer from 1990 until she resigned her employment with effect on 28th July 2006.
2. The Health Professions Council has pursued the following allegations:
2.1 At all material times until the 28th of July 2006 you were employed as a radiographer at East Sussex Hospitals NHS Trust.
2.2 Made a false statement to your line manager when requesting annual leave for the 27th and 28 April 2006.
2.3 In relation to the incident on the 1 December 2005 you:
(i) advised a patient to sit upright to perform x-ray despite being advised not to
(ii) failed to knowingly carry out duties satisfactorily
(iii) failed to provide an efficient, safe and high quality service.
3. So far as the charge concerning annual leave is concerned the substance of the allegation is that Mrs Nottage asked a colleague, Vicky Dickinson, to be ready to support her in putting forward an incorrect assertion that Mrs Nottage needed annual leave for 27th and 28 April 2006 because she had theatre tickets in respect of the evening of 27 April 2006 which had been obtained in December 2005.
4. So far as the charge concerning an x-ray procedure on 1 December 2005 is concerned the substance of the allegation is that Mrs Nottage was asked to carry out an x-ray of a patient in the accident and emergency department of the hospital. It is said that Mrs Nottage was specifically requested by nursing staff not to move the patient to a sitting position. The allegation is that Mrs Nottage ignored that request and did move the patient to a sitting position for the purposes of taking an x-ray. Very shortly thereafter the patient experienced a collapse.
5. Mrs Nottage did not attend the hearing. We were satisfied that she had been served with details of the time date and place of the hearing. We heard evidence from Sue Snelgrove, Physiotherapist, Andrew Hopkins, Radiographer, Angela Coshell-Evans, Senior Staff Nurse, Lynne Bradford, Radiographer, Vicki Dickenson, Radiographer and Anne Cowley, Radiographer.
6. We made the following findings of fact:
In respect of allegation 3
6.1 On 1 December 2005 Mrs Nottage was on duty in the hospital x-ray department accompanied by a student radiographer, Andrew Hopkins. A request was made that an x-ray be taken of patient, DC, who was being treated within the accident and emergency department. Mrs Nottage asked Andrew Hopkins to go to the accident and emergency department to ask if the patient could be brought to the x-ray department. Mr Hopkins was told by nursing staff that the patient could not be removed. Mrs Nottage and Mr Hopkins then went to the accident and emergency department. There has been dispute as to the nature of a request put by nursing staff concerning whether or not the patient should or should not be moved into a sitting position for the purposes of an x-ray.
6.2 We are satisfied that the evidence from Mr Hopkins and Angela Coshell Evans is reliable in respect of this incident and indeed in all other parts of their evidence. Their evidence has been consistent throughout and corroborated by each. We find that Mrs Nottage was requested by nursing staff to ensure the x-ray was taken without moving the patient into an upright position. She was told that the patient was likely to collapse and so should not be sat upright. We are satisfied that Mrs Nottage ignored that request. Whilst the nursing staff were still present Mr Hopkins said to the nursing staff that he proposed to move the patient to a 60° angle in order to take the x-ray and the nursing staff were content with that proposal. Mrs Nottage then asked the nursing staff to leave the area. She then told the patient that he would sit up for the purposes of the x-ray and she quickly, to quote Mr Hopkins, yanked the bed so that the patient moved to a 90 degree sitting position. Mrs Nottage without warning or explanation put a cold
x ray cassette against the bare skin of the patient which caused him discomfort. Proper practice, for patient comfort and infection control, would be to cover a cassette.
6.3 Mrs Nottage failed to have the machine properly prepared and she attempted to irradiate the patient whilst Mr Hopkins was unprotected. Fortunately for him the machine was not sufficiently warmed and did not expose which gave him time to insist that he be allowed to be protected by a lead apron which he used before she took the x ray.
6.3 Mrs Nottage and Mr Hopkins left the accident and emergency department after taking the x-ray and left the patient in an upright position. Almost immediately after their departure the patient experienced some kind of collapse and the nursing staff had to administer oxygen and fluids.
6.4 The Trust initiated a disciplinary action against Mrs Nottage. At a hearing on 3 April 2006 a finding was made that Mrs Nottage had failed to carry out her duties satisfactorily, had acted in a way which amounted to a breach of good conduct and/or was likely to bring the trust into disrepute and she had failed to provide an efficient, safe and high quality service. The Trust took into account that Mrs Nottage was then currently the subject of a first written warning which had been given at a previous disciplinary hearing. The Trust determined that a final written warning would be issued.
In respect of allegation 2
6.5 Mrs Nottage attended a hearing on 3 April 2006 and she was accompanied by Vicky Dickinson as a representative of the Society of radiographers. During the hearing Mrs Nottage told Mrs Dickinson that the previous day Mrs Nottage's husband had booked theatre tickets for the two of them to go to the theatre in London at the end of April.
6.6 On 4 April 2006 Mrs Nottage (while she was absent from work due to illness) telephoned Mrs Dickinson at work to ask her to check whether she would be able to take annual leave on 27th and 28 April 2006. Mrs Dickinson indicated that it was unlikely those dates would be available because other staff probably would have booked annual leave for that time. Mrs Nottage asked Mrs Dickinson to put her request to Mrs Cowley, acting lead radiographer. She commented that Mrs Dickinson could say to Mrs Cowley that the theatre tickets had been booked back in December 2005.
6.7 On 11th April 2006 Mrs Nottage spoke direct by telephone to her line manager Mrs Cowley and she put her request that she be allowed annual leave on 27 and 28 April 2006. Mrs Nottage told Mrs Cowley that the theatre tickets had been booked in December 2005.
6.8 Mrs Dickinson felt very uncomfortable, as she saw it, at being asked by Mrs Nottage to put forward an account which she knew to be untrue. Mrs Dickinson told Mr Baker, general manager, of the circumstances and an investigation was initiated. A disciplinary hearing was fixed for 2 August 2006 but before that took place Mrs Nottage resigned her employment with effect on 28 July 2006.
6.9 We have found both Mrs Dickinson and Mrs Cowley to be reliable and credible witnesses. We find that Mrs Nottage asked Mrs Dickinson to lie regarding when the tickets were booked and further that Mrs Nottage lied to Mrs Cowley.
7. On the basis of the above findings of fact we reached the following conclusions.
Mrs Nottage was in Breach of Standards of Conduct Performance and Ethics:
1 Standard 1 - act in the best interests of patients
2 Standard 7 – maintain proper and effective communication with patients and professionals
3 Standard 13 – carry out duties in a professional and ethical way
4 Standard 14 – behave with integrity and honesty
5 Standard 16 – make sure your behaviour does not damage your profession’s reputation.
She was also in breach of Standards of Proficiency for Radiographers in that she did not exercise a professional duty of care.
We are satisfied that the above amount to both misconduct, in respect of ignoring the advice of the health professionals and telling lies, and lack of competence in respect of patient care and maintaining safety standards.
We have to consider fitness to practice. We have to make that judgment as at today. We are satisfied on the basis of our above conclusions that Mrs Nottage demonstrated a serious shortfall in her patient care and professional standards. There is no evidence to suggest that anything has changed since her departure from the Trust and we therefore find that her fitness to practice is impaired.
Our function is not intended to be punitive. The sanction must be proportionate to the seriousness of the findings of misconduct and lack of competence. We have considered no order, mediation and caution but are satisfied that the misconduct and lack of competence is too serious. So far as conditions of practice are concerned there is no evidence on the part of Mrs Nottage that she recognises her lack of professional competence and has not recognised her culpability. We cannot imagine any conditions of practice conditions that would deal with the conduct and competence issues identified. We have no reason to think that Mrs Nottage would cooperate with conditions. We therefore considered suspension order is an appropriate and proportionate sanction. That will run for twelve months.
Order: That the Registrar be directed to suspend the registration of June Helen Nottage for a period of one year.
At the substantive hearing on the 13 September 2005, a Panel found the allegation against the Registrant well
founded, namely that her fitness to practice was impaired by reason for lack of competence. The allegation arose from the Registrant’s employment as a physiotherapist with the North West Wales NHS Trust in Bangor. On that date the Panel imposed a suspension order of 1 year duration. This was reviewed on 7 September 2006 and a further suspension of 1 year was imposed. A second review was conducted on 29 August 2007 when a Panel imposed a further
suspension order of 1 year.
Today’s Panel is undertaking a third review under Article 30 of the Health Professions Order 2001. The Registrant was neither present nor represented; however the Panel was satisfied that all reasonable steps had been taken to serve the notice of hearing under Rule 6 on the Registrant. The Panel has decided, in the exercise of its discretion, to proceed in the absence of the Registrant. The Panel wishes to stress that it’s not its task to revisit the earlier decision as to the finding of impairment of fitness to practice. The task of the Panel is to decide what, if any order should be made with effect from the expiration of the current order on the 10 October 2008.
In reaching its decision, the Panel has carefully considered the submissions made on behalf of the Health Professions Council’s Presenting Officer and the bundle of documents which include the additional documentation provided by the Registrant for the first review hearing.
At the first review hearing on the 07 September 2006, the Panel noted certain improvements in her competency, but concerns regarding her overall competency remained. On that date, the Panel extended the suspension order for a further period of 12 months from the date of expiry of the existing Order on the 11 October 2006.
A second review was conducted on the 29 August 2007. On that date, the Panel noted that the Registrant had not provided any documentation or letters for consideration by the Panel and further that the Panel had no information as to the Registrant’s then current situation. The Panel extended the Suspension Order for a further period of 12 months, from the 10 October 2007.
At today’s hearing, this Panel was advised that no further documentary evidence has been furnished by the Registrant for considering at today’s review hearing. Consequently the Panel has no information regarding any steps the Registrant may have taken to improve her competency and the Panel is unaware of her current employment situation.
Having carefully considered all the evidence contained in the bundle of documents, the Panel has decided that if the Registrant were permitted to return to practice after 10 October 2008, the Registrant would still be a risk to the public by reason of lack of competence. The Panel has had regard of a duty to protect the public as well as maintaining public confidence in the profession and upholding and maintaining standards of the profession. The Panel Has also had regard to the registrant’s own interest and her desire to return to practice.
Balancing these factors, the Panel has decided that it is necessary to further extend the Suspension Order for a
further period of 12 months from the 10 October 2008. This is necessary to adequately protect the public and as a proportionate sanction in the circumstances.
The Panel directs the Registrar to suspend the registration of Miss Magno for a further period of 12 months from the date of expiry of the existing order on the 10 October 2008. This Order is made under Article 30 (1)(a) of the Health Professions Order 2001.
1. At all material times you were employed as a paramedic by the Yorkshire Ambulance Service NHS Trust;
2. During the course of that employment, on 11 December 2007, you responded to a call to attend a male patient complaining of chest pains;
3. You attended the scene as the senior officer, with an Emergency Medical Technician (EMT);
4. Upon arrival at the scene, you failed to:
i. adequately attach monitoring equipment to the patient; and
ii. monitor the patient’s rhythms and note that the patient went into ventrical fibrillation (VF) during the 13
minutes that the patient was attached to the monitor;
5. In failing to recognise VF rhythms, you failed to provide the patient with appropriate treatment;
6. You misdiagnosed the patient as suffering from a fit rather than entering into cardiac arrest;
7. As a result, you left the EMT to treat the patient while you drove the ambulance to the hospital;
8. You did not take ultimate responsibility for the patient’s care;
9. After arriving at the hospital, the patient subsequently died.
The registrant was neither present nor represented at the hearing. The panel heard an application for Ms Jung on behalf of the Health Professions Council to proceed in the absence of the registrant in terms of Rule 11 of the Health Professions Council (Conduct and Competence) Procedure Rules 2003. The Panel was satisfied that notice of the proceedings was properly served on the registrant in terms of rule 6(1) of the 2003 Rules. Having considered the submission and having balanced the right of the registrant to a fair hearing with the interests of the Health Professions Council and the general public interest, the panel agreed to exercise its discretion to proceed with the hearing in the absence of the registrant.
The panel heard evidence from Mr Paul Webster who was employed as a manager by the Yorkshire Ambulance Trust and who conducted an investigation into the incident of 11th December 2006. Mr Webster’s investigation involved interviews
with the registrant and the Emergency Medical Technician who attended the incident with her and records of the emergency call and clinical incident log from the Life Pack 12 defibrillator and medical records.
Mr Webster explained that at 18.52 hours on 11th December 2006, a category “C” call was received by the communications centre to attend a 28 year old male complaining of chest pains. He advised that at 18.57hours, the call was changed to a category “A” call. He advised that the ambulance arrived at 19.01hours when the patient, who did not speak English, was in his car and complaining of chest pains, sweating and frightened. The crew walked him to the ambulance, gave him oxygen and checked his blood sugars. An attempt was made by the registrant to find a vein and to apply the ECG electrodes. The registrant and the technician had advised in the course of the investigation that as the patient was sweaty, they could not attach the electrodes. However, from the defibrillator printout, it was apparent that leads one, two and three were attached and an adequate reading was obtained and produced in evidence. Mr Webster advised that the patient became rigid shortly after being on the trolley and then became limp. The registrant described this as looking like a fit. The patient’s
breathing decreased and the technician placed an airway into the patient’s mouth and began to ventilate with a bag and mask. At this point the patient had no pulse. He was given a precordial thump by the technician who then began chest compressions. Neither of the crew saw a rhythm on the defibrillator monitor and were adamant that the electrodes were not attached to the patient. The registrant then drove the ambulance to the hospital under emergency conditions with the technician treating the patient in the back of the ambulance. The patient subsequently died.
The Panel noted that Mr Webster was an experienced paramedic who had also worked as a paramedic assessor. The panel found him to be a credible and reliable witness and accepted his evidence in relation to the incident.
The panel are satisfied that the registrant was employed as a paramedic by the Yorkshire Ambulance Trust and that during the course of that employment on 11th December 2006, the registrant responded to a call to attend a male patient complaining of chest pains and attended the scene as the senior officer with an Emergency Medical Technician. The panel note that these facts were not disputed by the registrant in the course of the trust’s investigation and find that particulars 1, 2 and 3 are proved.
In relation to particulars 4.i, 4.ii and 5, the panel note from the defibrillator printout that only three of
the twelve leads were attached to the patient. However the panel is of the view that there was sufficient time to
properly attach all twelve leads and to comprehensively monitor the patient’s vital signs and as a result of
failing to do so, the registrant did not monitor the patient’s cardiac rhythm and failed to note that the patient went into ventricular fibrillation. Having failed to recognise the VF rhythms, the registrant failed to provide the appropriate treatment which would have been the instigation of a Full Advanced Life Support Protocol. The Panel also note that the defibrillator sounded audible warnings which should have alerted the crew to the deterioration in the patient’s condition. The panel is satisfied that the facts of particulars 4.i, 4.ii and 5 are proved on the balance of probabilities.
In relation to Particular 6, the registrant stated in her interview with the trust that she thought the patient was
suffering from a fit and the panel find that this was a misdiagnosis as all the symptoms indicated a cardiac arrest which was recognised by the technician. The panel also note that it is recorded in the hospital pre alert notes that the patient was in cardiac arrest. The panel is therefore satisfied that this particular is proved.
The panel find that the registrant left the EMT ventilating the patient and doing chest compressions while she drove to hospital and did not take ultimate responsibility for the patient’s care as the senior clinician. The panel also note that on arrival at hospital, the patient subsequently died. The panel note that the registrant did not deny these facts in the course of the trust investigation. The panel therefore find that the facts of particulars 7, 8 and 9 are proved on the balance of probabilities.
The panel considered that the registrant failed to follow the recognised protocols in relation to the treatment of a cardiac arrest presenting in VF, in particular she failed to defibrillate, intubate, cannulate and provide any drug
therapy, all of which are standard procedures. The panel note that the registrant has 21 years experience with the ambulance service, and has been a registered paramedic for 8 years. The Panel finds that her actions amount to a serious clinical failure and amount to misconduct.
The panel find that the registrant’s conduct breaches standards 1,5, 8, 14 and 16 of the Health Professions Council Standards of Conduct Performance and Ethics. As the registrant has not engaged in the process, the panel have no information to demonstrate that she has addressed her failings and the panel therefore finds that her current fitness to practice is impaired.
The panel therefore find that the allegation is well founded.
The panel heard further submissions in relation to sanction and considered the sanctions available to it in
ascending order of severity. The Panel also considered the letter which the registrant submitted to the investigating Panel on 24th September 2007. The Panel note that there has been no contact from the Registrant since that date. The panel also had regard to the wider public interest considerations which include the
deterrent effect to other health professionals; the reputation of the profession concerned and public confidence in the regulatory process. The panel considered that to take no further action or impose a caution would not adequately protect the public or mark the severity of the registrant’s conduct. The panel is of the view that conditions of practice would not be appropriate as there is no evidence of a commitment on the part of the registrant to resolve matters. The panel next considered a suspension and in the absence of the registrant, were not satisfied that there was a realistic prospect that there would be no repetition of the conduct.
The Panel has reached the view that the only appropriate sanction would be a striking off order, given the serious failures and lack of insight by the registrant. The panel is of the view that this is a proportionate sanction and affords the necessary degree of public protection.
Order: The Panel directs the Registrar to strike Pamela Jameson off the Register.
During the course of your practise as a physiotherapist at BridgeHouse Clinic:
1. On 14 March 2008, you advised SL the owner of the BridgeHouse Clinic that you were leaving the BridgeHouse Clinic to set up your own business;
2. You accessed confidential patient information from the BridgeHouse Clinic and used that information on or around 17 March 2008 to contact existing BridgeHouse Clinic patients to advise them that you were setting up your own business;
3. Your actions outlined in Particular 2 amount to misconduct; and
4. By reason of that misconduct, your fitness to practise is impaired.
During the course of your practise as a registered podiatrist with the XXXXX Community Podiatry Service:
1. For the period January 1994 to August 2008, your patient notes did not meet the standards required of registered podiatrists in that:
i. of the 28 cases that were reviewed, all were found to be incomplete, contain errors, and/or omissions. Specifically, 23 sets of notes:
a. had minimal details of medical and surgical history;
b. had no evidence of vascular, neurological or structural assessment to determine risk to the lower limb;
c. had no diagnosis and/or care plan; and
d. had minimal details relating to patients’ subjective concerns, observations, treatment interventions and secondary referrals;
ii. two sets of notes (Cases 6 and 7) contained little or no evidence of initial assessment documentation;
iii. eight sets of notes (Original Record, Cases 1, 2, 3,5, 7, 14 and 27) contained little or no information in respect of the patients’ medical updates;
iv. in respect of Case 20:
a. evidence that local anaesthetic was administered on 12 February 1997 but no evidence of patient consent;
b. on 04 April 1997 consent was sought for a partial nail avulsion, however, there is no evidence in the notes that this was informed consent and that the patient was made aware of other treatment options, the risks of the procedure and post-operative complications;
v. in respect of Case 21:
a. on 28 February 2007 consent forms for administering local anaesthetic were completed, which were used again for a second procedure that was performed on 28 August 2007, leading to confusion as the patient notes do not state which toe was operated on in August 2007
2. On 12 February 1997, you administered local anaesthetic to a patient without obtaining written consent;
3. On 04 April 1997, you performed a nail avulsion procedure on a patient without the patient’s informed consent;
4. On 28 August 2007 you performed surgery on a patient using consent forms that patient had signed for a separate procedure you performed on 28 February 2007; and
5. On 12 July 2004 you performed nail surgery on a patient using the consent documentation that patient had signed for a separate procedure you performed on that patient on 13 August 2003;
6. The matters set out at 1-5 amount to lack of competence and/or misconduct; and
7. By virtue of that lack of competence and/or misconduct, your fitness to practise is impaired.