Peter Read

Profession: Paramedic

Registration Number: PA00295

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 26/05/2015 End: 16:00 29/05/2015

Location: Jury's Inn, Newcastle-upon-Tyne

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

As amended at the hearing:

During the course of your employment as a Paramedic employed by North East  Ambulance Service, between 6 October 2012 and 10 April 2013, you:  

1. Did not complete or contribute to a Patient Report Form or Electronic Patient Care Record showing your assessment and/or treatment of patients in the following cases:

a) case 3361043
b) case 3371481
c) case 3464486
d) case 3360797
e) case 3439047
f) case 3399634
g) case 3507401
h) case 3360860
i) case 3331749
j) case 3517259

2. Did not carry out initial assessments and/or observations and/or administer treatments in the following cases:

a) case 3399342
b) case 3491364
c) case 3328613
d) case 3328022
e) case 3371213
f) case 3399106
g) case 3399242
h) case 3399709

3. Did not carry out a FAST test in relation to patient for case 3507225

4.  Did  not  take  a  pain  score   in  relation   to  the  patient   for   case  3444422  after administration of Entonox.

5.  The  matters  described  in  paragraphs  1  - 4  constitute misconduct  and/or  lack  of competence.

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

Finding

Preliminary Matters: 

Application to amend

1. Ms Thompson, on behalf of the HCPC, made an application to amend the allegation to reflect better the evidence to be presented.  The amendments sought are set out above.

2. Mr Barber, on behalf of Mr Read, did not object to the proposed amendments.

3. The Panel acceded to the application to amend as it concluded that the amendments could be made without prejudice to Mr Read.

Application to introduce evidence of previous HCPC Decision

4. At the close of the HCPC case Ms Thompson made an application to admit into evidence a previous finding that Mr Read’s fitness to practise was impaired by reason of misconduct. She submitted that although the previous finding was not relevant to the fact finding process or misconduct, it was highly relevant to the issue of impairment. She further submitted that as the Panel had indicated at the outset of the hearing that it would, as appropriate, consider the facts, misconduct and impairment at this stage this was the time for the Panel to receive the information.

5. Mr Barber objected to the introduction of the information as he contended it was not relevant to impairment. He submitted that the wording of the allegation was such that the Panel was confined to receiving evidence about the facts of the case and not previous matters.

6. The Legal Assessor advised that the previous finding was potentially relevant to the impairment stage. He drew the Panel’s attention to Cohen v GMC where Silber J stated “It must be highly relevant in determining if a doctor’s fitness to practice is impaired that first his or her conduct which led to the charge is easily remediable, second that it has been remedied and third that it is highly unlikely to be repeated.” He also referred the Panel to Cheatle v GMC where Cranston J said: “The authorities quoted above make clear that a finding that fitness to practise is impaired is a two step process.  First, there must be a finding of serious misconduct.  Secondly, the Panel must conclude that, as a result, the doctor’s fitness to practise is impaired. In coming to a conclusion on impairment, the authorities make clear that the Panel must look forward.  It must consider whether, in the light of what happened, and of evidence as to the doctor’s conduct and ability demonstrated both before and after the misconduct, fitness to practise is impaired by the particular events.”

7. The Panel determined that the previous finding was potentially relevant to the issue of impairment and decided that it would receive the information. However, in order to be fair, the Panel decided firstly to consider and announce its decision on the facts and misconduct. Only if misconduct were to be found would it need to consider impairment, and at that stage it would receive the information.

Background:

8. At the relevant time Mr Read was employed by the North East Ambulance Service (NEAS) as a Paramedic working in the Hazardous Area Response Team (HART) as a solo responder on a Rapid Response Vehicle. In April 2013 Mr Read was removed from clinical leadership following a Root Cause Analysis into a complaint received by the NEAS in December 2012. It was alleged that Mr Read had been the first to arrive at an incident and that he had not completed either a paper or electronic patient record.

9. As a result of this complaint an audit was conducted into cases that Mr Read had attended, and concerns were identified relating to Mr Read’s practice.

10. The HCPC presented two witnesses:
Mr CK, Clinical Investigation Officer, NEAS
Mr YR, HART and Resilience Manager

11. Mr K had made a statement and he produced as exhibits his investigation file and report.

12. Mr K told the Panel that he was appointed to investigate Mr Read’s patient documentation practices following an incident on 9 December 2012 where it was alleged that Mr Read had not completed either a Patient Report Form (PRF) or and Electronic Patient Care Record (EPCR). EPCRs are filled in on a small handheld computer known as a Toughbook.

13. Mr K selected a six month period to review covering three months before and three months after 9 December 2012. He explained that during the period in question NEAS was in a transitional period whereby paramedics were using both paper PRFs and EPCRs

14. Mr K explained that he obtained his information from the following NEAS recording systems

Qlickview

This was a system by which the paper PRFs were scanned onto a central system. Mr K was able to access the PRFs scanned onto Qlickview by using web – view software called MEDUSA.

CLERIC EMS

This is a system used in the Ambulance Control Centre which logs every call that comes in and gives it a time and date stamp and a unique case number. It is also updated with actions taken by crews whilst dealing with calls.

NICE

This system records and date and time stamps every telephone call and every radio message received or made by the Ambulance Control Centre. Although the system was not working for some of the period with which Mr K was concerned.

15. In his statement Mr K set out the NEAS Policy on Patient Report Forms. The Policy confirms that there must be a PRF completed for every job allocated with a case number, to an Emergency Ambulance or a Rapid Response Unit… Mr K stated that in circumstances where two or more vehicles are allocated to an incident, it is envisaged that there will be one joint PRF or two (or more) separate ones. Mr K said that there was a similar requirement in relation to EPCRs, albeit the information was input on a Toughbook.

16.  In his statement he stated that where a paramedic had been to a patient’s side, even if they had not done any clinical observation or assessment prior to a crew arriving he would expect some record of attendance. However, when questioned, Mr K said he would only expect a record if there had been a “meaningful conversation” with the patient.

17. Mr K told the Panel that his investigation identified a number of occasions where Mr Read had attended incidents but had not completed a PRF or an EPCR. In some cases the only record that Mr Read had attended was on the CLERIC EMS system, in other cases there was a reference, on records completed by other crews, to Mr Read attending but there was no information as to what he had done.

18. When Mr K interviewed Mr Read about the absence of records Mr Read said that it was very common practice amongst his colleagues not to fill in PRFs or EPCR where an ambulance crew back up a Rapid Response Unit. However, he declined to identify any colleagues.

19. Mr R, in his statement, gave background to Mr Read’s case and confirmed that Mr Read had received training on the completion of EPCRs and considered that it was a not a user friendly system. He told the Panel that he considered that you start to assess a patient as soon as you see them, unless you only have a fleeting glimpse of them.

20. When cross examined by Mr Barber, Mr R accepted that it had been suggested that a number of other HART paramedics be subject to the same type of audit as Mr Read had undergone. However, he explained that this was not done for resource reasons. Mr R explained that a type of audit was done for other HART paramedics and he accepted that this showed that there were a number of occasions when they had not completed records. However, he went on to explain that there were no issues with this as a valid explanation for the absence of a record would have been provided.

21. The Panel was provided with a statement from Mr Read in which he provided a detailed response to the allegation. In his oral evidence he explained that he had had difficulty in adapting to the EPCR system and that there was time delay between training and the implementation of the system on the Rapid Response Vehicles.

22. When cross-examined by Ms Thompson regarding occasions where he appeared to be on a scene for a long period after an ambulance crew had attended he explained that he was probably taking a break.

Decision on Facts:

23. The Panel gave consideration to all of the evidence, both written and oral in reaching its decision. It took account of the submissions of Ms Thompson and Mr Barber. It also accepted the advice of the Legal Assessor as to the approach that it should take to determining the factual issues in this case.

Assessment of witnesses

24. The evidence of Mr K and Mr R was not challenged to a great degree and the Panel found them to be credible witnesses.

25. The Panel found Mr Read to be generally credible and sufficiently open to admit he could not remember details of several cases.

26. The Panel has made the following findings:

Paragraph 1(a)

The Panel finds this paragraph proved.

27. The Panel finds this paragraph proved on the basis of Mr Read’s admission and the evidence contained in the bundle.

Paragraph 1(b)

The Panel finds this paragraph proved.

28. Mr Read arrived at the scene 37 minutes before an ambulance crew and he accepts that he would have carried out some assessment and/or treatment during this time. His case is that he did complete a record (PRF or EPCR) and that the record must have been lost. The Panel has taken into account Mr K’s evidence concerning the efforts he made to locate relevant records and it has concluded that the reason that no record can be found is that one was not completed.

Paragraph 1(c)

The Panel finds this paragraph proved.

29. Mr Read arrived at the scene 9 minutes after an ambulance crew arrived, and he admits that he did not complete a record. However, the Panel accepts his evidence that the ambulance crew told him that they did not need help and that therefore it was not necessary for him to complete a record.

Paragraph 1(d)

The Panel finds this paragraph proved.

30. Mr Read is recorded arriving at the scene 8 minutes before an ambulance crew and he admits that he did not complete a record. However, the Panel accepts Mr Read’s evidence that when the system recorded him on scene this did not mean that he had reached the patient. It further accepts his evidence that the crew assisted him in locating the address and then told him that they did not require his assistance. It was therefore not necessary for him to complete a record.

Paragraph 1(e)

The Panel finds this paragraph proved.

31. The Panel accept Mr K’s evidence that there was no record completed by Mr Read. However, as Mr Read is recorded as arriving 1 minute 28 seconds before the ambulance crew the Panel has concluded that it would have been unlikely that there was anything for him to record and that it was therefore not necessary for him to complete a record.

Paragraph 1(f)

The Panel finds this paragraph not proved.

32. The Panel noted that Mr Read arrived 7 minutes before the ambulance crew who arrived at 15.56.34.  The recorded time of the vital signs is 15.55.15 and the Panel has concluded that he must have obtained and recorded this information even though his name does not appear on the record probably because Mr Read did not indicate, after entering the data, who the author was.

Paragraph 1(g)

The Panel finds this paragraph proved.

33. Mr Read accepts that he did not complete a record. However, the Panel accepts his evidence that as he only arrived 5 minutes before the ambulance crew he may not have seen the patient in that time as he was still looking for the address.

Paragraph 1(h)

The Panel finds this paragraph proved.

34. The Panel accepts Mr K’s evidence that there was no record of Mr Read’s involvement in this case. As Mr Read arrived on scene 8 minutes before the ambulance crew the Panel considers that Mr Read would have undertaken assessment and/or treatment in this time which should have been recorded.

Paragraph 1(i)

The Panel finds this paragraph proved.

35. The Panel finds this paragraph proved on the basis of Mr Read’s admission and the evidence contained in the bundle.

Paragraph 1(j)

The Panel finds this paragraph not proved.

36. The Panel accepts that during the NEAS disciplinary process it was accepted that there was evidence that Mr Read had completed a record.

Paragraph 2(a)

The Panel finds this paragraph not proved.

37. There is no direct evidence that Mr Read did not carry out initial assessment and/or observations and/or administer treatments. The HCPC have not presented any evidence from which the Panel could safely infer that Mr Read did not carry out these actions.

Paragraph 2(b)

The Panel finds this paragraph not proved.

38. There is no direct evidence that Mr Read did not carry out initial assessment and/or observations and/or administer treatments. The HCPC have not presented any evidence from which the Panel could safely infer that Mr Read did not carry out these actions.

Paragraph 2(c)

The Panel finds this paragraph proved.

39. Mr Read accepts that he did not carry out any actions in relation to this patient. However, the Panel accepts his explanation that the reason for this was that the patient was a volatile drunk female and it was better to wait for the ambulance crew which comprised of a female member.

Paragraph 2(d)

The Panel finds this paragraph not proved.

40. There is no direct evidence that Mr Read did not carry out initial assessment, observations or treatments. The HCPC has not presented any evidence from which the Panel could safely infer that Mr Read did not carry out these actions.

Paragraph 2(e)

The Panel finds this paragraph proved.

41. Mr Read accepts that he did not carry out any of the actions but the Panel accepts his evidence that the reason for this was that he arrived at practically the same time as an ambulance crew and that they told him that they did not require assistance.

Paragraph 2(f)

The Panel finds this paragraph proved.

42. Mr Read accepts that he did not carry out any of the actions but the Panel accepts his evidence that the reason for this was that he arrived at practically the same time as an ambulance crew and that they told him that they did not require assistance.

Paragraph 2(g)

The Panel finds this paragraph not proved.

43. The patient record contains information that when the ambulance crew arrived Mr Read reported to them that the patient was hyperventilating and was very anxious when he arrived.

Paragraph 2(h)

The Panel finds this paragraph proved.

44. Mr Read arrived 15 minutes before the other crew. However, there is no documentation to show that any initial assessment and/or observations and/or treatment was undertaken during this time.
 
Paragraph 3

The Panel finds this paragraph proved.

45. Although it is recorded that Mr Read reported to the ambulance crew that the patient was presenting with left sided hemiplegia, slurred speech and a right sided headache the panel has concluded that this is not evidence that Mr Read had carried out a FAST test. The FAST test has four important elements, time and three observations of the patient’s state. There is no evidence that Mr Read obtained these four data elements. There was opportunity for him to enter FAST data as he made data entries to the EPCR at 23.36 and could have entered FAST data at that time if the test had been done.

Paragraph 4

The Panel finds this paragraph proved.

Mr Read was on scene at 13.27, vital signs and a pain score was recorded at 13.29. In oral evidence Mr Read confirmed that he gave Entonox shortly after 13.29 but only recorded Entonox administration as being commenced at 14.25. Mr Read admits no repeat pain score was taken by him after Entonox administration commenced.

Decision on Grounds:

46. Ms Thompson submitted that this was not a lack of competence case and the Panel agrees. There is no evidence to suggest that Mr Read did not possess the necessary skills to carry out his duties.

47. Of the matters the Panel has found proved only paragraphs 1(a), 1(b), 1(h), 1(i), 2(h), 3 and 4 are capable of amounting to misconduct.

48. The Panel has concluded that paragraphs 1(a), 1(b), 1(h), and 1(i), represent as serious departure from standard 10 of the HCPC’s Standards of conduct, performance and ethics and amount to serious misconduct.

49. Paragraphs 3 and 4 each represent a serious departure from standard 1 of the HCPC’s Standards of conduct, performance and ethics and amount to serious misconduct. Whilst Paragraph 2(h) taken alone would not of itself represent a serious departure from the standards, when considered along with the other elements it contributes to the overall finding of misconduct.

Decision on Impairment:

50. Having announced its decision on the facts and misconduct the Panel received submissions on the issue of impairment.

51. The Panel has accepted the advice of the Legal Assessor in relation to the issue of impairment.

52. The Panel has been provided with the determination of a Conduct and Competence Committee in 2011. The panel on that occasion found that Mr Read’s fitness to practise was impaired by reason of his misconduct and lack of competence. The facts in that case occurred in 2009 and included failing to maintain an adequate record and failing to assess and treat one patient and failing to assess another patient. The panel in April 2011 imposed a caution order for three years.

53. The Panel noted that the panel in 2011 stated that in relation to the personal aspect of impairment “the Registrant’s fitness to practise is not currently impaired as there is no risk of repetition.”  The findings of this Panel mean that the panel in 2011 was over optimistic.

54. Taking into account that the misconduct this Panel is dealing with occurred whilst the previous caution was still extant and also the similarities between this misconduct and the previous misconduct the Panel cannot rule out repetition of similar behaviour.

55. The Panel accepts that there is no evidence that any patients came to harm but there was a risk of harm and that remains.

56. The Panel considers that Mr Read does have some insight and understands the importance of record keeping and proper assessment. However, it is concerned that in his oral evidence he seemed to focus more on the effect on him of his failings, namely being before a panel again, rather than the potential effect on the public.

57. The keeping of proper records and the carrying out of initial assessment, observation and treatment are fundamental tenets of the paramedic profession and Mr Read has breached these. Accordingly, the Panel has concluded that public confidence in the profession would be undermined if a finding of impairment were not made.

58. For all the above reasons the Panel has concluded that Mr Read’s fitness to practise is impaired by reason of his misconduct.

Decision on Sanction:

59. In coming to its own, independent, decision as to sanction, the Panel took into account all the evidence and the submissions made.

60. In deciding what sanction to impose, if any, the Panel has reminded itself that the purpose of sanctions is not to be punitive but to protect patients and the public interest, although there may be a punitive effect.  The Panel has also taken into account the principle of proportionality, balancing the interests of the public with those of Mr Read. It has also taken into account the HCPC’s Indicative Sanction Policy.

61. The Panel has identified the following aggravating factors:

• Previous finding of impairment for similar matters
• Misconduct committed whilst subject to a caution order

62. The Panel has identified the following mitigating factors:

• Some admissions made
• No actual patient harm
• Cooperation with NEAS and HCPC processes
• Some insight and remorse

63. In view of the nature of the matters that gave rise to the finding of impairment it would not be appropriate to arrange mediation or to conclude the case without taking any action as this would not sufficiently protect the public or the public interest.

64. The Panel then considered a caution order. The Indicative Sanctions Policy states:
“A caution order may be the appropriate sanction for slightly more serious cases, where the lapse is isolated or of a minor nature, there is a low risk of recurrence, the registrant has shown insight and taken remedial action.”

65. Although the Panel has concluded that Mr Read has some insight, the other factors which might suggest a caution order is appropriate are not present in this case. More significantly the misconduct was committed whilst Mr Read was subject to a three year caution order. Accordingly, the Panel has concluded that a caution order is insufficient to protect patients and the public interest.

66. The Panel then considered a conditions of practice order. The Indicative Sanctions Policy states:

“Conditions of practice will be most appropriate where a failure or deficiency is capable of being remedied and where the Panel is satisfied that allowing the registrant to remain in practice, albeit subject to conditions, poses no risk of harm or future harm.”

67. The Panel considers that these factors are present in this case and accordingly, it has concluded that the appropriate and proportionate sanction is a conditions of practice order for a period of 2 years. The order will ensure that before commencing work as a paramedic he will be fully aware of record keeping policy and procedures and that after commencing work the standard of his practice will be monitored.

68. The Panel considers that a suspension order would merely be punitive and disproportionate and serve no useful purpose.

The order will be reviewed shortly before it expires.

Order

The Panel imposed a Conditions of Practice Order for a period of two years as follows:

1. Each time you obtain new employment as a paramedic, before commencing paramedic duties you must undertake training provided by your employer covering record keeping policy, procedure and the IT systems used to record patient contacts.

2. You must obtain evidence that you have satisfactorily completed the training referred to in condition 1 and forward this to the HCPC within 14 days of completing the training

3. Within 3 months of commencing paramedic duties which involve patient contacts and every 3 months thereafter you must arrange for at least 20 of your patient contacts selected at random to be audited by another registered paramedic working at band 6 or above (or equivalent) to ensure they comply with the relevant policy and procedures

4. You must obtain from the paramedic referred to in condition 3 written confirmation that your records of patient contacts are satisfactory and forward this or a statement to the effect that you have no patient contacts to the HCPC within 14 days of each audit.

Notes

The Order will be reviewed on/around 26 June 2017.

This was a Conduct and Competence Final hearing held at Jurys Inn Newcastle between 26 - 29 May 2015.

Hearing History

History of Hearings for Peter Read

Date Panel Hearing type Outcomes / Status
26/05/2017 Conduct and Competence Committee Review Hearing Struck off
26/05/2015 Conduct and Competence Committee Final Hearing Conditions of Practice