Mr Trevor M Walsh

1. For the purposes of this hearing, the HCPC has submitted and the Panel has read, a Skeleton Argument dated 15 September 2022 signed by Ms Rosie Welsh Presenting Officer [the Skeleton Argument]. Ms Welsh adopted the Skeleton Argument as the basis of her submission to the Panel. The Panel has also read all the documents that are annexed to the Skeleton Argument.
Background
2. The Registrant is a registered Paramedic.
3. At the relevant time the Registrant was employed by East Midlands Ambulance Service (“the Trust”). He began working for Lincolnshire Ambulance Service in 1986, which later merged with the Trust. He initially worked as an Ambulance Technician and qualified as a Paramedic in 1992.
4. On 05 July 2018, a 999 call was received in relation to Patient X. He was an 84-year-old patient who had reportedly fallen off a ladder in his garden. The Registrant, along with his crewmate Colleague A attended the scene before transporting Patient X to Boston Pilgrim Hospital Emergency Department. Further tests at the hospital determined that Patient X had a flail chest (an acute chest injury in which two or more ribs become detached from the rest of the ribcage) and a suspected hemopneumothorax (blood in the chest). Patient X passed away at the hospital.
5. This incident was raised to the Patient Advice and Liaison Service. Staff at the hospital had concerns around why Patient X had been transported to Boston Pilgrim hospital rather than a Major Trauma Centre (“MTC”).
6. The Trust commenced a Serious Incident investigation into the care of the patient and concerns were raised in relation to the treatment the Registrant provided to the patient. Amanda Davidson, a Serious Incident Investigator, conducted the investigation on behalf of the Trust.
7. As part of the investigation, Ms Davidson interviewed the Registrant. In her statement, she records his responses as follows:
“I asked Trevor Walsh to give an account of what happened on 05 July 2018. Trevor Walsh told me that the crew received the call in the usual way and he thought it said the patient had fallen from a ladder. However, the patient denied that this is what had occurred. Trevor Walsh described how he and the Colleague A considered contacting control about requesting a helicopter but they decided to wait until they got there to assess the situation. He said that he considered the potential mechanisms of injury and the worst case scenario.
Trevor said he did a “top to toe” of Patient X and found that he had no neck or back pain. He said Patient X was uncomfortable when they moved his arms and legs and it seemed the discomfort was located in his right shoulder. They took Patient X’s pulse which was tachycardic, and he was a little bit clammy. Trevor Walsh said they were in a hot environment so they decided to move him to the ambulance. Trevor Walsh said he remained mindful that the patient could have fallen so they wanted to limit his movement.
When they were in the ambulance Trevor Walsh said that he listened to the right side of Patient X’s chest. He thought there could be diminished sounds however it was a noisy environment because the air-conditioning was on. Trevor Walsh said that Patient X’s oxygen saturation was reduced. Patient X had a score of around 14-15 on the Glasgow coma scale which indicates reduced consciousness. He told me Patient X said he had a history of high blood pressure. Trevor Walsh said that the patients blood pressure was low which may not have been normal for him, however this could have been impacted by working in the bright sunshine.
I asked Trevor Walsh what he would have done if he knew that Patient X had definitely fallen from the tree. He said that he would have formally immobilised the patient and split the scoop stretcher rather than ease him onto it. He also said he would have called control to see if a helicopter was available and probably taken the patient to a MTC. Trevor Walsh identified in interview that he used to be a helicopter paramedic so he should have been well versed in how to deal with traumatic injuries.
8. On 23 January 2022, the matter was referred to the HCPC by the Serious Incident Investigator. The HCPC subsequently completed its own investigation and progressed the concerns to a final substantive hearing.
Substantive Final Hearing decision
9. Between 06–10 June 2022, a Panel of the Conduct and Competence Committee considered the following allegation:
1. On 05 July 2018, you attended to Patient X and you did not provide X with adequate care and treatment, in that you:
(a) Did not immobilise Patient X prior to moving him;
(b) Did not give Patient X pain relief prior to moving him;
(c) Did not place an oxygen mask on Patient X and/or administer a higher amount of oxygen to address his low oxygen saturations;
(d) –
(e) –
(f) Did not convey Patient X to the nearest Major Trauma Centre;
(g) Did not conduct a full assessment of Patient X;
(h) Did not carry out further investigation to rule out tension pneumothorax when you observed diminished chest sounds on Patient X’s right side;
(i) –
(j) Did not conduct a full assessment of PatientX’s injuries before moving him;
(k) Did not consider that Patient X’s reduced alertness level could have impacted his ability to recount accurately what had happened.
2. On 05 July 2018, you used the scoop stretcher to move Patient X in an incorrect manner.
3. On 05 July 2018, you did not maintain adequate records, in that you did not complete the electronic Patient Report Form for Patient X in an adequate manner, specifically you did not:
(a) Record your decision making and why immobilisation was not used;
(b) Record that you gave Patient X fluids;
(c) Record that you had considered Patient X’s low saturations and/or tachycardia and/or low blood pressure and/or the fact that Patient X was cold on a hot day;
(d) Document that you completed a further top to toe survey with equal air entry evident on Patient X;
(e) Document the possibility that Patient X had fallen from a height;
(f) Record the potential for significant chest injury based on the observations;
(g) Record consideration that Patient X’s low blood pressure was an indication of a spinal injury and/or other injuries;
(h) Record consideration of transport to a Major Trauma Centre and/or the use of a helicopter;
(i) Record an assessment of Patient X’s pelvis and/or abdomen and/or chest;
(j) –
4. On 05 July 2018, you did not provide sufficient information during the pre-alert call and/or handover to the hospital in order to ensure a timely treatment for Patient X, specifically you did not:
(a) Include the possibility that Patient X had fallen from a height;
(b) Request for a trauma call.
5. The matters set out in paragraphs 1a to 4b constitute misconduct and/or lack of competence.
6. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
10. The Panel did not find that particulars 1(a), 1(b), 1(f), 1(g), 1(j), 1(k), 2, 4(a) and 4(b) were proven, but did make a finding that all other facts – 1(c), 1(h) and 3 (in its entirety) were proven.
11. The Panel made a finding that there had been a breach of the 2016 Standards of Conduct Performance and Ethics applicable to all HCPC Registrants, namely Standard 2 relating to communication with service users and carers, Standard 6 relating to identifying and minimising risk of harm to service users, carers and colleagues as far as possible, and Standard 10 relating to promptly keeping full clear and accurate records.
12. The Panel also found that the Registrant had breached Standards of Proficiency for Paramedics (2014), namely Standard 4.1, 4.2, 4.3, 4.4 in relation to being able to practise as an autonomous professional, exercising professional judgement; and Standards 10.1 and 10.2 in relation to being able to maintain records appropriately.
13. The Panel considered that the Registrant’s conduct represented a serious failing short of the standard expected of a competent Paramedic, and that identifying chest injuries was fundamental to a Paramedic’s practice. The Panel noted that the Registrant should have known how to conduct an examination and should have done so. The Panel considered that members of the public would be shocked to hear that a Paramedic had failed in this way, and that it was a serious failing in the care and treatment of Patient X. The Panel considered the combination of facts found proven as amounting to serious failures and misconduct.
14. The Panel identified that the failings were capable of remediation but with the information before them, that there was still a real risk of repetition and that a finding of impairment was required for public protection reasons. The Panel also concluded that a finding of impaired was required for public interest grounds in order to maintain confidence in the profession and maintain professional standards. The Panel noted that the Registrant’s failings, whilst isolated, were serious and fundamental to the role of a Paramedic. The Panel subsequently concluded that the Registrant’s fitness to practise was impaired on both public protection and public interest grounds and imposed a Conditions of Practice Order for a period of 12 months.
Post Final Hearing – Consent Background
15. On 25 June 2022, following the substantive hearing, the Registrant contacted the HCPTS:
Following my fitness to practise hearing between 6 -10 of June 2022 taking into consideration the ongoing restrictions which would apply, I have decided I would like to be removed from the register, as I no longer wish to practise as a paramedic...”
16. On 27 June 2022, the HCPC case manager responded to the Registrant to acknowledge receipt of the request and to provide further information about the process. The information included the Practice Note for Disposal by Consent and providing a copy of a pro forma response for the Registrant to complete.
17. On 28 June 2022, the HCPC case manager had a further discussion and provided information to the Registrant about the process via a telephone call. The Registrant confirmed he would consider voluntary removal.
18. The Registrant subsequently provided a completed response pro forma dated 05 July 2022. Although the hearing had made a finding on fact, grounds and impairment, the Registrant admitted the substance of the allegation, that his fitness to practise is impaired, that he has read the relevant HCPTS Practise Note and that he would like the HCPC to consider Voluntary Removal. The form provides further information, as follows:
“.... after much consideration I have decided I would like to apply for voluntary removal from the register. The reasons being I have not practiced as a Paramedic since Oct 2019. I have now reached 60 years of age and feel that the time is right to bring closure on my Paramedic career.”
19. On 18 July 2022, the HCPC case manager discussed the pro forma response with the Registrant via telephone call and it was confirmed that the matter would be progressed.
20. Following receipt of the information from the Registrant, the HCPC reviewed the case and considered that voluntary removal was appropriate in the circumstances and upon the information provided. The HCPC sent a copy of the Voluntary Removal Agreement for the Registrant’s consideration, and if acceptable, signing.
21. The Registrant signed the Voluntary Removal Agreement on 25 August 2022, and returned the completed agreement to the HCPC
Guidance as set out in the Skeleton Argument
22. The HCPC has in the Skeleton Argument set out guidance as to the nature and consequence of a VRA, together with the procedure to be followed and the principles to be applied. That guidance is in the following terms:
The Health Professions Order 2001 does not explicitly provide for consent arrangements. There is instead an HCPTS Practice Note (“Disposal by Consent”) that has the HCPC has approved as a means of allowing matters, where suitable, to be disposed of by consent.
The Practice Note states that a Panel should not agree to resolve a case in this way unless it is satisfied of two things: firstly, that the appropriate level of public protection is being secured and, secondly, that doing so would not be detrimental to the wider public interest.
Similarly, in Cohen v GMC the High Court stated that there are “critically important public policy issues” which must be taken into account by Panels in fitness to practise proceedings, including the ‘public’ component of impairment. This ‘public’ component requires consideration of the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.
Disposal by consent does not affect the Panel’s powers or the range of orders available to them, it is merely a process by which the HCPC and the Registrant concerned may propose what they regard as an appropriate outcome to the case. If a Panel is content to do so, it may conclude the case on an expedited basis, upon the terms of the Voluntary Removal Agreement. Equally, it may reject that proposal and the case would return to the substantive order review cycle.
The Voluntary Removal Agreement is an agreement to the effect that the HCPC will not take any further action against the Registrant in relation to this matter on the understanding that he will remove herself from the Register, cease from practising as a Paramedic and not attempt to re-join the Register.
If the Registrant were to apply to come back on to the Register, their application would be treated in the same way as someone who had been struck off.
The Submissions of the HCPC
23. The submissions of the HCPC, as set out in the Skeleton Argument and adopted by Ms Welsh as the basis of her submission are as follows:
HCPC Submissions
The HCPC submits that, in all the circumstances, voluntary removal from the Register would be an appropriate means of resolving these proceedings.
The Registrant has been provided with detailed information about the consent process and the effect of voluntary removal from the Register, should the application be granted. The Registrant has had time to review this information and query its implications with HCPC.
The HCPC submits that the allegations were fully explored, tested and ventilated at a substantive final hearing. Following the hearing outcome, the Registrant has made it clear that he has no desire to practise as Paramedic in the future, and expressed a wish to be removed from the Register. Further, he has admitted the substance of the allegations and impairment.
Public Protection
Should voluntary removal be permitted in this case, the HCPC submits that public protection would be ensured as the agreement is equivalent, in effect, to a Striking off Order. The Registrant would be prohibited from using the protected Paramedic title for a period of five years.
The HCPC submits that there is a low risk to public protection, as the Registrant would no longer be registered as a Paramedic and he has confirmed that he has no intention to practise again in the future. Further, the public will be adequately protected from any risk posed by the Registrant should he seek to re-register and practice in future, as a voluntary removal is equivalent in effect to a strike-off. Therefore, the HCPC submits that the necessary public protection would be secured when disposing of the case by way of voluntary removal.
Public Interest
The HCPC submits that the wider public interest would not be put at risk should this matter be disposed of by way of consent.
The HCPC submits that the public would not be concerned, nor would public confidence in the profession be put at risk, should the Panel grant this Voluntary Removal Agreement in the circumstances identified above.
The HCPC submits that, in all the circumstances, it is appropriate to dispose of this matter in accordance with the terms of the Voluntary Removal Agreement. It is the HCPC’s view that disposal by consent on these terms is a suitable, pragmatic and expeditious way of dealing with this matter.
For the reasons outlined, the HCPC respectfully invites the Panel to revoke the existing Suspension Order and approve the Registrant’s voluntary removal from the register on the terms within the agreement.
Oral Submissions made by Ms Welsh on behalf of the HCPC.
24. Ms Welsh adopted the submissions that are set out in the Skeleton Argument. She summarised the background, the principles to be applied and the justification for seeking a consensual outcome by way of a VRA.
The stated position of the Registrant
25. The Panel has seen the document entitled Consensual Disposal Request Pro- Forma signed by the Registrant and dated 5 July 2022. In that document the Registrant admitted the substance of the allegation against him. He also admitted that his fitness to practise is currently impaired by reason of his misconduct. He also stated that he would like the HCPC to consider Voluntary removal.
26. The Panel has read the VRA dated 25 August and signed by the Registrant.
27. The Panel has also read a letter dated 25 August 2022 signed by the Registrant and addressed to the Registrar of the HCPC. That letter was in the following terms:
Registration PA00065
With effect from 27 September 2022 please remove my name from the HCPC Register.
Prior to that date I was the subject of an Order made by the Conduct and Competence Committee in respect of an allegation which I have admitted. That Order was revoked by the Committee to enable me to remove my name from the HCPC Register.
I declare that, other than the circumstances giving rise to that allegation, I am not aware of any matter which could give rise to any other allegation against me under the Health Professions Order 2001.
Yours faithfully,
28. The Panel has further read an agreed statement signed by the Registrant, also dated 25 August 2022. That agreed statement is in the following terms:
Agreed Statement
Mr Trevor M Walsh (the Registrant) was the subject of an allegation to the effect that his fitness to practise was impaired due to misconduct and/or lack of competence regarding the inaccurate assessment and treatment of Patient X and failure to maintain accurate records.
That allegation was held to be well founded by a panel of the HCPC’s Conduct and Competence Committee and a Conditions of Practice Order was imposed for a period of twelve months on 10 June 2022.
The Committee revoked that Order on 27 September 2022 on the basis that the Registrant wished to be removed from the HCPC Register voluntarily. The Registrant admitted the allegation and has undertaken not to practise as a Paramedic or use any title associated with that profession. 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.
29. The two documents signed by the Registrant and dated 25 August 2022 were executed by the Registrant pursuant to the terms of the VRA.
30. The Registrant made no submissions to the Panel. He is to be commended for attending today’s hearing and for the realistic approach that he has taken with regard to this matter, following the imposition of the Conditions of Practice Order in June 2022.
Decision of the Panel made on 27 September 2022.
31. The Panel has considered the submissions of the HCPC as set out in the Skeleton Argument adopted by Ms Welsh and in her oral submissions. The Panel has taken account of the position of the Registrant as stated in the documents identified above. The Panel has further considered all the other documents that have been submitted.
32. The Panel heard and accepted the advice of the Legal Assessor.
33. In deciding whether or not to approve the agreement for the VRA, the Panel has had regard to the Practice Note published by the HCPTS in March 2018 and entitled Disposal of Cases by Consent [the Practice Note] which is annexed to the Skeleton Argument.
34. The Panel has concluded that the VRA should be approved and that an order should be made in the terms set out below. Its reasons are as follows;
• The Panel is satisfied that all the criteria set out in the Practice Note have been complied with.
• The Registrant has admitted the substance of the Allegation. He has also admitted that his fitness to practise is thereby impaired.
• The public will be adequately protected by the voluntary removal of the Registrant’s name from the register, which will have the same effect as if he had been struck off. Such an outcome is also in the interests of the Registrant. Moreover, it addresses and safeguards the public interest.
• The Panel has concluded that a well-informed member of the public would conclude that this matter is properly disposed of by the consensual outcome sought by both the Registrant and the HCPC.
• The Panel has concluded that disposal by consent is a suitable, pragmatic and expeditious way of dealing with this matter. As a consequence, this matter will not be the subject of further review hearings.
35. For all the reasons that are set out above, the Panel has determined to approve the outcome sought in the VRA with immediate effect: In particular, the Panel agrees that the existing Conditions of Practice Order should be revoked and the Registrant’s name should be removed from the register in accordance with the VRA and the letter signed by the Registrant dated 25 August 2022.

ORDER: That the existing Conditions of Practice Order be revoked and the name of Trevor M Walsh should be removed from the Register.

This is a Voluntary Removal Agreement hearing, taking place on Tuesday 27 September 2022.

History of Hearings for Mr Trevor M Walsh