Mr William Mitchell

Profession: Paramedic

Registration Number: PA33900

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 08/06/2015 End: 16:00 12/06/2015

Location: Health and Care Professions Council, Park House, 184 Kennington Park Road, London, SE11 4BU

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

During the course of your employment as Paramedic with the North East Ambulance Service, on 18 April 2013 you:
1. Exposed yourself to Patient A by unzipping your trousers and taking out your penis.
2. Pushed Patient A’s head towards your exposed penis.
3. Placed Patient A’s hand on your groin area and rubbed yourself against the patients hand.
4. Rubbed Patient A’s breasts.
5. Your actions at paragraphs 1 – 4 were sexually motivated.
6. The matters set out in paragraphs 1 – 5 constitute misconduct.
7. By reason of that misconduct your fitness to practise is impaired.

Finding

Preliminary Matters:
Service:
1. The Panel is satisfied that there has been good service of the Notice of Hearing. A letter was sent to the Registrant’s registered address giving notice of these proceedings on the 20th January 2015. On the same date, a copy of the letter was sent by email to the Registrant’s personal email address.     
Proceeding in Absence:
2. The Registrant has not attended the hearing today and is not represented.  
3. The Panel first considered whether it ought to exercise its discretion to continue with this hearing in the absence of the Registrant.  The Panel concluded that it was in the public interest to do so, having considered the HCPC Practice Note on Proceeding in the Registrant’s Absence and having taken the Legal Assessor’s advice, for the following reasons:
(a) The Panel is satisfied that the Registrant had notice of the hearing.
(b) The Registrant has not paid any active part in these proceedings, although the Registrant has completed the Response Proforma dated the 21st April 2015, which stated that he was not intending to attend the hearing or to be represented. 
(c) The Panel was of the view that even if these proceedings were adjourned there was very little likelihood that the Registrant would attend on a subsequent occasion and he has not requested an adjournment.
(d) The Panel concluded that the Registrant has deliberately chosen not to take part in these proceedings.          
(e) The Panel determined that it was reasonable and in the public interest to proceed today in the circumstances.
(f) The Panel was also mindful of the fact that witnesses had travelled a significant distance to attend this final hearing.   
Application to amend the allegation:
4. The Panel next considered an application to amend the allegation. The HCPC are offering no evidence in respect of Particular 5. The Registrant was given notice of the proposed amendment in a letter dated the 19th November 2014.  The effect of the amendment is therefore to delete Particular 5 and to renumber the remaining particulars. The Panel regarded the amendment as being in the Registrant’s favour, reducing the number of allegations which he faces. There is no prejudice to the Registrant in allowing the amendment. The allegation set out above is therefore the amended allegation. 
Background:
5. The Registrant is a qualified Paramedic. He was employed by North West Ambulance Trust between 1995 and his resignation on the 6th June 2013.  He was based at the Durham division and at the Stanley Ambulance Station. The allegation arises out of an incident on the 18th April 2013. The Registrant attended at the home of Patient A in the course of his employment along with JS, an Emergency Care Support Worker, who drove the ambulance. The Rapid Response Vehicle driver GR was already in attendance at Patient A’s home address.
6. Patient A was transported to hospital in the ambulance. There was a defect in the ambulance rear view mirror so that JS could not potentially see what was taking place behind him in the rear of the ambulance. The Registrant travelled alone with Patient A in the rear of the ambulance, which was fitted with CCTV equipment.
7. A complaint was made the following day by Patient A when a subsequent ambulance attended her property crewed by PD and MD. The complaint is recorded in the electronic patient record of their attendance. Patient A had called 111 complaining of breathing difficulties. She stated that she did not want an ambulance. An ambulance crew were despatched to her home address, to check on her welfare. Patient A was distressed and said that she did not want to go to hospital. She then informed the ambulance crew that the paramedic from the previous day had touched her breasts and that he had got his “thing out” pointing at one of the crew member’s crotch area and stated that he had put it in her face.  
8. A fact finding investigation was conducted by DM, Head of Emergency Care for the South Division of the North East Ambulance Service NHS Trust (hereafter NEAS).
9. A formal investigatory interview with the Registrant took place on the 29th April 2013. The Registrant insisted that his conduct was professional and denied touching Patient A inappropriately or exposing himself to her. He maintained this stance, even after viewing the CCTV footage which had recorded the incident.
10. There was a second formal interview on the 28th May 2013. The Registrant again denied the allegations. He did however accept that Patient A could be regarded as a vulnerable adult – she had complained of abuse from her husband; had been found to have urinated on her clothes and there was a suggestion that she had consumed alcohol. However, the Panel heard evidence from GR who did not regard Patient A as being vulnerable. He described her as being calm and in control of the situation.  JS described her as being “in a day dream” and felt that her behaviour made him think she had consumed alcohol. She was speaking slower than he would expect, but she did not appear to be confused. In evidence he said he thought that Patient A’s issue was social and not medical - she had had an argument, as opposed to being unwell.     
11. A report was submitted to the Chair of the Disciplinary Panel. The report concluded, in light of the contents of the CCTV, that the allegations made by Patient A were truthful and that the Registrant’s sexual actions were unacceptable and unprofessional.     
12. The Registrant resigned on the 6th June. A letter dated the 5th June 2013 had been sent to him, setting a date for the disciplinary hearing of the 10th June 2013. The disciplinary hearing proceeded in the absence of the Registrant.   The hearing concluded that had the Registrant remained an employee, then he would have been dismissed for gross misconduct.  
13. A police investigation also took place. Patient A gave a formal police interview on the 20th April 2013 which was recorded. A summary of her account is as follows:
“...the Paramedic put his hand up her top and started to rub her breasts....She stated that she was not wearing a bra because she had quickly got changed in her house....She said that he was moving all around her nipples and was rubbing for quite a while. She stated that she’d had a lump taken out of her right breast last year so that was quite sore....
She said that the paramedic then took his penis out, he unzipped his trousers and took it out. At the time it was semi-erect. He was holding it in his right hand and started to rub it around her hip area. It became hard. She stated this didn’t last long before he pushed her head from behind and tried to push it towards his penis. She stated that she said no and he stopped.”      
14. The Registrant subsequently pleaded guilty on the 9th December 2013 to an offence of misconduct in a public office. However, the conviction was subsequently quashed in the Court of Appeal, as the Registrant was not acting as a public officer in the course of his employment as a Paramedic. 
15. The Panel has heard oral evidence from:
i. DM, Investigating Officer;
ii. GR, Rapid Response Vehicle Paramedic,
iii. JS; Emergency Care Support Worker,
16. In addition, the Panel was able to read the witness statements from PD, Paramedic, and MD, Paramedic, although they were not required to give oral evidence at the final hearing. The Panel has not heard any evidence from Patient A, who was unwilling to be a witness in these proceedings. The Panel however had the benefit of her recorded interview with the police, which took place shortly after the incident.  
17. The Panel has been provided with a bundle of documents which runs to 73 pages, submitted by the HCPC and viewed the CCTV footage of the incident. In reaching its decision, the Panel has paid close attention to the entirety of the evidence, written, visual and oral.
18. The Panel has also been provided with a Response Proforma signed by the Registrant dated the 21st April 2015. In answer to question 3, the Registrant has written yes to the question as to whether he admits the facts alleged against him in the notice of allegation.   
19. The Panel has heard and accepted the Legal Assessor’s advice and has exercised the principle of proportionality at all times. In approaching the task of deciding the facts, the Panel has kept at the forefront of its deliberations the importance of requiring the HCPC to prove matters against the Registrant. The standard of proof to which the HCPC is required to prove matters is the civil standard – on the balance of probabilities.
20. The Panel was very conscious that when a witness has not given oral evidence, this is hearsay evidence. When considering hearsay evidence, which is admissible, the Panel has paid due regard to the weight which it can attach to it, bearing in mind that it has not been possible for that evidence to be challenged. The Panel has, in respect of each allegation, sought to corroborate the allegation where possible through documentation and the oral evidence it has heard.

Decision on Facts:  
Particular 1 Proved
21. The Panel found this particular proved. Having viewed the CCTV evidence, there is evidence of the Registrant unzipping his trousers and exposing his penis. The Panel also had regard to Patient A’s statement to the paramedics the following day, recorded contemporaneously on the electronic patient record, and the contents of her police interview, both of which were consistent with the CCTV footage. The Panel concluded it was reasonable to rely on the hearsay evidence in these circumstances because of the high level of consistency in these accounts.
22. The Panel also took account of the Registrant’s admission in the Response Proforma. In doing so, the Panel rejected the Registrant’s original denial in the initial investigatory interview, where he denied undoing his trousers.
23. In the second investigatory interview, the Registrant denied exposing his penis and trying to place it in Patient A’s mouth. He stated that the patient became floppy and was being thrown about – he was simply trying to hold her in place. The Panel did not regard this as credible and rejected it, in light of the CCTV footage and other evidence noted above. 
Particular 2 Proved
24. The Panel found this particular proved having viewed the CCTV evidence. The Panel concluded that there was no clinical rationale as to why the Registrant would push Patient A’s head towards his groin area. 
25. The Registrant can clearly be seen pushing Patient A’s head towards his exposed penis in the CCTV footage viewed by the Panel. This is corroborated by Patient A’s account to the two paramedics the following day, as recorded by them on the electronic patient record, and her police interview.
26. The Panel rejected the account in the Registrant’s initial interview, wherein he stated he was in fact was simply trying to “sit her up” and that he was “straightening her up, she was being thrashed about and it was hurting her...”  
27. The Panel concluded, on the balance of probabilities, that there was no innocent explanation for the Registrant’s actions, and this is reflected is his subsequent admission in the Proforma provided to the Panel.
Particular 3 Proved
28. The Panel found this particular proved in light of the CCTV evidence which shows Patient A placing her hand out towards the Registrant, whilst he is sitting down completing the paperwork. He can clearly be seen taking Patient A’s hand and placing it on his groin area. The Registrant can clearly be seen rubbing himself against Patient A’s hand.
29. The Panel, as above, also relied on the police interview given by Patient A and her complaint to the paramedics the following day, in which her account was consistent with CCTV footage.   
30. The Panel rejected the Registrant’s account, in his initial interview, where he stated that he was trying to “jam her hand in the rail”. He stated that her “hand was crooked and wouldn’t straighten”. He explained that she was “crying at the time, she reached out to grab my hand, I stood to comfort her and in doing so her hand fell flat against me.”  He further alleged that Patient A was sliding off the stretcher and that he was “easing her back and across,” his hand being used to secure the vomit bowl and to stop it falling.   
31. The Registrant also denied that he had grinded his body towards Patient A, stating that he had 2 false hips which, “made it difficult to stay mobile at times, I needed to get my knees under the stretcher to secure myself, otherwise it tends to ache...”
32. The Panel concluded that these explanations were inconsistent with the CCTV footage and the Registrant’s subsequent admissions. 
Particular 4 Proved
33. The Panel finds this particular proved, having carefully watched the CCTV. The Panels accepts that there is a possible clinical explanation for the Registrant’s initial actions, as detailed in his initial investigatory interview. The Registrant alleged that he was examining Patient A’s ribs, as she had complained of pain in this area, down the left hand side. There is some evidence of possible palpation in the CCTV followed by the Registrant making a note, after which pain relief is provided in the form of entonox gas. This could be a reasonable clinical assessment process.
34. However, thereafter the CCTV footage shows the Registrant placing his hands under her clothing for a significant period of time. This is consistent with Patient A’s subsequent complaint to the paramedics the following day, although the Registrant’s hand is closer to her left breast than her right one. The Panel concluded that there was no clinical explanation as to the Registrant’s actions at this point in the CCTV footage, and rejected the assertion that he was reaching for a rail on the other side of the bed to steady himself. The Panel determined that, in light of their findings in respect of Particulars 1-3 it was a reasonable inference to draw that there was a sexual motivation for placing his hands inside Patient A’s clothing. This inference is corroborated by the Registrant’s subsequent admission.       
Particular 5 Proved
35. The Panel finds Particular 5 proved. The Panel has found as a fact that the Registrant had exposed his penis and rubbed himself against Patient A’s hand, as well as touching her breasts. The Panel, in these circumstances could not ascertain any other possible explanation for the Registrant’s actions, other than there was a sexual motive. The Registrant is clearly demonstrated on the CCTV footage standing over Patient A in an unnecessary and inappropriate manner. The Panel also had regard to the Registrant’s admission in the Proforma.   
Decision on Grounds:   
36. The Panel considered whether the Registrant’s actions amounted to misconduct, falling well below a reasonable professional standard for a Paramedic. The Panel concluded that they did. The actions of the Registrant would be regarded as deplorable by other members of the Paramedic profession.
37. The Panel concluded that the Registrant is in breach of the following Standards of Proficiency for Paramedics:
• 1a.1 be able to practice within the legal and ethical boundaries of their profession,
• 1a.1 understanding the need to act in the best interests of service users at all times,
• 1a.1 understand the need to respect...the rights, dignity, values and autonomy of every service user...
• 1a.5 be able to exercise a professional duty of care
38. The Registrant is also in breach of the following Standards of Conduct, Performance and Ethics:
• 1 – You must act in the best interests of service users,
• 13 – You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.  
Decision on Impairment: 
39. The Panel then had to consider whether the Registrant’s fitness to practice is currently impaired, in light of the HCPC practice note on impairment. The Panel is mindful of the forward looking test for impairment. The question is whether the Registrant’s current fitness to practice is impaired, with a view to protecting service users and the public interest which includes the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.  
40. The Panel, after reviewing all the evidence in this case, and considering the submissions from parties, and the advice from the Legal Assessor, has concluded that the Registrant’s current fitness to practice is currently impaired, for the following reasons:
a) The very serious nature of the misconduct with a sexual motivation,
b) The Registrant has not attended these proceedings and has not adduced any evidence of remorse or insight into his misconduct
c) The Panel noted that such misconduct is not easily remediable and there was no evidence before the Panel upon which they could conclude that there no risk of repetition of such behaviour in the future. 
d) Patient A clearly had a degree of vulnerability, travelling in an ambulance on her own, having had Entonox administered to her, even if the exact circumstances of her condition cannot be ascertained with certainty.
e) Patients must be able to trust paramedics to act in their best interests at all times. In betraying that trust, the Registrant has breached a fundamental tenant of the profession and the reputation of the profession and the regulatory process would be undermined if there was not a finding of impairment.
Decision on Sanction:
41. The Panel has heard submissions on sanction on behalf of the HCPC. It has paid regard to the HCPC’s Indicative Sanction Policy and has listened to the advice of the Legal Assessor. 
42. The Panel, in reaching its conclusion had regard to the following aggravating and mitigating factors:
a) The Registrant pleaded guilty at the Crown Court to the offence he was charged with and has admitted the particulars of the allegation in the HCPC Proforma signed on the 21st April 2015. 
b) On the other hand, the Registrant denied the allegations in the two internal investigatory interviews undertaken by his employer. In doing this, he called into question the integrity of Patient A which may well have compounded her levels of distress.  
c) The misconduct was very serious and of a sexual nature. There was a gross breach of trust which could seriously impact on the confidence that the public have in the profession of being a paramedic.
d) Patient A could be described as a vulnerable person, being alone in the rear of an ambulance, in the sole care of the Registrant, whom she was entitled to trust would act in her best interests.   
e) The Panel has seen no evidence of insight or reflection on the part of the Registrant in relation to his misconduct.
43. The Panel has carefully considered what type of order should be imposed, starting with the least restrictive order. It has taken into account the principle of proportionality, and balanced the rights of the public and the rights of the Registrant to practice in his chosen profession.
44. The Panel determined that given the nature of the Registrant’s misconduct, that to take no action, or to impose a caution order, would not be in the public interest, and would not retain public confidence in the regulatory process. The misconduct could not be described as being of a minor nature, with a low risk of recurrence. A caution order would also not be appropriate as there is no evidence of insight on the part of the Registrant. The Panel further concluded that public confidence in the profession would be undermined by taking no action or imposing a caution order, as the Registrant would remain in unrestricted practise.
45. The Panel next considered whether to make a Conditions of Practice Order, but concluded that this was not practicable, workable or verifiable. The Registrant is not current employed as a paramedic and has provided no information about his current employment status. 
46. In addition, the Panel was not satisfied that there was any commitment on the part of the Registrant to engage with the regulatory process to resolve matters. There is no evidence that the Registrant would adhere to any conditions which were imposed. The Panel also took the view that the Registrant may pose an ongoing risk to service users and that public confidence in the profession would be undermined if the Registrant were allowed to return to work as a paramedic, even on a restricted basis, given the gravity of the offence.    
47. The Panel next considered whether to impose a Suspension Order and concluded that this would not be in the public interest given the severity of the offence and could not be satisfied that there is a realistic prospect that repetition will not occur. It would also not satisfy the wider public interest, given the fundamental breach of trust which occurred and the sexual nature of the misconduct.  
48. Therefore, having carefully considered all of the evidence before it and the powers available to it, the Panel determined that it is in the public interest, that an order be made striking the Registrant from the register. The Panel recognises that this is the sanction of last resort, but it is appropriate for serious cases such as this, involving abuse of trust and sexual abuse. This is the appropriate order where there is no other way to adequately protect the public. Imposing any lesser sanction would lack a deterrent effect and undermine confidence in the profession and the regulatory process.             
 

Order

The Registrar is directed to strike the name of William Mitchell from the register from the date this order comes into effect, namely 07 July 2015. 

Notes

 Right of Appeal:
You may appeal to the appropriate court against the decision of the Panel and the order it has made against you.  In this case the appropriate court is the High Court in England and Wales.
Under Articles 29 and 38 of the Health and Social Work Professions Order 2001, an appeal must be made to the court not more than 28 days after the date when this notice is served on you.  The order made against you will not take effect until that appeal period has expired or, if you appeal during that period, until that appeal is disposed of or withdrawn.

Interim Order:
The Panel makes an Interim Suspension Order under Article 31(2) of the Health and Social Work Professions Order 2001. This order is necessary to protect members of the public and is otherwise in the public interest for the same reasons given by the Panel in its decision on sanction. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made or, if an appeal is made against the Panel’s decision and Order, the final determination of that appeal, subject to a maximum period of 18 months.

 

 

Hearing History

History of Hearings for Mr William Mitchell

Date Panel Hearing type Outcomes / Status
08/06/2015 Conduct and Competence Committee Final Hearing Struck off