Michael J cashman
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During the course of your employment as a Paramedic with the Welsh Ambulance Service on 26 December 2013, when responding to Red 2 call incident P1138687, you:
1. Did not give appropriate and/or adequate care whilst treating Patient A, in that you;
a) did not utilise any of the equipment in the 'response bag' whilst in attendance at the property
b) did not conduct an adequate formal primary assessment
c) did not adequately and/or safely secure Patient A in the ambulance when travelling to the hospital
d) did not conduct thorough and/or regular observations whilst at the property and/or whilst travelling to
f) did not provide Patient A with oxygen or a nebulizer in the ambulance when travelling to the hospital
g) did not adequately ascertain the clinical condition of Patient A
h) did not act upon the 'red flags' noted in the PCR which would indicate that Patient A was at risk
2. In respect of the Patient Clinical Record (PCR) for Patient A, you did not record;
a) an adequate primary assessment and/or observations
b) any on-going and/or timely clinical observations and/or monitoring of the patient
c) any specific medication prescribed to the patient
d) any formal secondary assessment and/or observations
e) any treatment of Patient A
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.
1. The Panel is satisfied that the notice of hearing has been properly served by letter dated 27 March 2015 which was sent to Mr Cashman’s registered address.
2. Mr Cashman was not present at the hearing but was represented by Mr Woloshak a solicitor from Slater and Gordon solicitors.
3. The HCPC applied to amend the allegation in this case. Ms Jones submitted that the amendments served to clarify the allegation faced by Mr Cashman. She submitted that there was no prejudice to Mr Cashman who was made aware of the proposed amendments in advance of this hearing and has consented to them. Ms Jones contended that the amendments did not alter the substance, nature or severity of the case which Mr Cashman was required to meet. On behalf of Mr Cashman, Mr Woloshak did not oppose the application to amend.
4. The Panel noted that the amendment to paragraph 1c was not mentioned in the HCPC letter to Mr Cashman dated 30 January 2015 which contained details of the other proposed amendments. Nonetheless the Panel has granted the application to amend the allegation. It is satisfied that the purpose of the amendments at paragraphs 1h and 2e is to clarify the factual allegations being made in this case. The Panel accedes to the removal of paragraph 1a of allegation and to the amendments to paragraphs 1c, 2a and 2e of the allegation. The Panel notes that the effect of these amendments is to reduce the seriousness of the allegation and it is satisfied that in granting the application there is no prejudice to Mr Cashman.
5. Mr Cashman is employed by the Welsh Ambulance Service NHS Trust (“the Trust”). At the time this incident occurred he was employed as a Band 5 Paramedic and was based at Newport Ambulance Station.
6. On 26 December 2013 at 04.36 the Trust received an emergency call from Patient A’s mother who reported that Patient A, a three year old child, was having an asthma attack and struggling to breathe. At 04.37 Mr Cashman and his emergency ambulance technician, Mr Steve Lippiatt, were allocated to the emergency call.
7. Mr Lippiatt was driving the ambulance. Their vehicle arrived at Patient A’s home address at 04.53. Upon arrival Mr Cashman left the ambulance, collected the response bag and entered the house. Mr Cashman returned to the ambulance with Patient A’s mother who was carrying her child in her arms. Mr Cashman placed Patient A and his mother on the stretcher in the rear of the vehicle. He did not secure them with a safety harness. Mr Cashman then told Mr Lippiatt that they were ready to leave the scene.
8. At 04.55 the ambulance was recorded as having left the incident and travelling to the University Hospital of Wales.
9. The ambulance arrived at the hospital with Patient A at 05.08 and Patient A was transferred into the care of hospital staff and subsequently admitted.
10. Mr Cashman and Mr Lippiatt were recorded as clear of the incident at 05.19.
11. Patient A’s grandmother contacted the Trust by telephone later on 26 December 2013 to express her concern that Mr Cashman had failed to carry out any proper examination of Patient A.
12. Mr Cashman referred himself to the HCPC on 16 January 2015. The Trust initiated a formal investigation and a number of allegations were referred to a Disciplinary Hearing. The Disciplinary hearing took place on 30 April 2014 and Mr Cashman was issued with a Final Written Warning for a period of two years and redeployed into the role of Emergency Ambulance Technician.
13. The Allegation in this case concerns two matters. The first relates to the adequacy of Mr Cashman’s assessment and treatment of Patient A when responding to an emergency call on 26 December 2013. The second concerns Mr Cashman’s recording of his clinical observations and assessments on the Patient Clinical Record (“PCR”) for Patient A.
14. The Trust concluded that Mr Cashman had failed to conduct a full and thorough primary assessment of Patient A and had failed to undertake regular and thorough observations of his condition. It found that Mr Cashman had also failed to conduct a thorough secondary assessment of Patient A which resulted in him failing to focus on Patient A’s medical complaint and vital signs and failing to obtain a thorough patient history.
15. The Trust’s guidance on the completion of the PCR states that the PCR must be fully complete without any omissions. The guidance notes that “good record keeping is an integral part of professional practice and the overall care process”. Within the Trust PCRs also serve the wider purpose of clinical audit and research. The trust concluded that Mr Cashman had failed to fully complete the PCR for Patient A.
16. Notice of a final hearing of the Conduct and Competence Committee on 10-12 June 2015 was sent to Mr Cashman on 27 March 2015. On 21 May 2015 solicitors acting for Mr Cashman contacted the HCPC with a proposal that this matter be disposed of by way of a voluntary removal agreement. Having taken advice, the HCPC consented to that proposal and draft documents were produced and sent to Mr Cashman for his signature on 9 June 2015.
17. On behalf of the HCPC Ms. Jones submitted that removal of Mr. Cashman’s name from the register would provide the level of protection necessary to reassure members of the public. She contended that a voluntary removal agreement was an appropriate and expeditious disposal of this matter. Ms. Jones submitted that Mr. Cashman was no longer employed as a Paramedic nor did he wish to practise as an HCPC registered professional. Mr. Cashman has demonstrated insight by providing an early explanation to his employer for his conduct, by self referring to the HCPC and by making admissions as to the facts, misconduct and impairment. In addition Mr. Cashman has reflected on his conduct and offered an apology to Patient A and his family and to the HCPC.
18. Mr. Wolosak submitted that this was not a case of repeated harmful acts or omissions. He reminded the Panel that Mr. Cashman had served as a Paramedic for twenty four years without incident. He noted that the allegation did not concern Mr. Cashman’s probity or honesty. He contended that a voluntary removal of Mr. Cashman’s name from the register was preferable to a contested final hearing, whatever the outcome of that hearing might be.
19. Before reaching its decision the Panel considered the provisions concerning ‘Voluntary Removal Agreements’ in the HCPC Practice note on ‘Disposal of Cases By Consent and accepted the advice of the Legal Assessor.
20. The Panel considers an essential part of its task to be the assessment of risk. It is satisfied that the removal of Mr. Cashman’s name from the register provides the necessary degree of public protection as he will be unable to work as a registered Paramedic. The Panel has considered whether a voluntary removal agreement would be detrimental to the wider public interest. It has concluded that in the light of Mr. Cashman’s early admissions, demonstrated insight and remorse nothing would be gained by this matter proceeding to a final hearing.
21. Having regard to all the circumstances of this case the Panel is satisfied that the public would be adequately protected if Mr. Cashman is permitted to enter into a voluntary removal agreement and resign from the register.
History of Hearings for Michael J cashman
|Date||Panel||Hearing type||Outcomes / Status|
|10/06/2015||Conduct and Competence Committee||Final Hearing||Voluntary Removal agreed|