Colin Girvan

Profession: Paramedic

Registration Number: PA01689

Interim Order: Imposed on 14 May 2014

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 20/10/2015 End: 16:00 23/10/2015

Location: Thistle, Cambridge Street, Glasgow, G2 3HN

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

Allegation as amended


Whilst registered as a Paramedic:
1. On 4 September 2014 at Inverness Sheriff Court you were convicted of one count of theft.

 

2. Whilst employed by the Scottish Ambulance Service between 5 November 2012 and 2 December 2013 you appropriated morphine sulphate for your personal use in that you:

a) made entries in the Morphine Sulphate register to the effect that:
i) morphine sulphate which was not administered to patients was
disposed of when that was not the case;
ii) a higher dose of morphine sulphate was administered to the patient
than that recorded on the Patient Report Form (PRF);
iii) a dose of morphine sulphate was administered to the patient when it was not, and or
iv) morphine sulphate was administered to patients on 30/9/2013, 28/10/2013 and/or 2/12/2013 when the patients did not exist.

b) the records referred to at 2(a) above were incorrect

c) falsified the signatures of colleagues A, B and/or C, in approximately 26 entries on the Morphine Sulphate Register.

3. Whilst employed by the Scottish Ambulance Service between November and December 2013 you took up to 4 diazmuls from an ambulance for your own personal use.

4. Whilst employed by the Scottish Ambulance Service between 5 December and 6 December 2013 you:

a) took two entonox cylinders from an ambulance to your home address for your personal use;
b) self-administered drugs in the presence of Patients A and/or B whilst in the back of an ambulance.

5. Your actions described in paragraph 2-4 were dishonest.

6. Your actions described in paragraphs 2-5 constitute misconduct.

7. By reason of your conviction and misconduct, your fitness to practise is impaired.

Finding

Preliminary Matters

1. The Registrant was not present or represented. The Case for the Health and Care Professions Council (HCPC) was presented by Ms Melinka Berridge of Kingsley Napley, Solicitors. The Panel considered Ms Berridge’s application to proceed in the Registrant’s absence. The Panel was satisfied that notice of today’s hearing had been properly served on the Registrant under rules 3 and 6 of the Conduct and Competence Committee Procedure Rules. It therefore had a discretion to proceed in the Registrant’s absence under rule 11. The Panel considered the submissions of Ms Berridge, the advice of the Legal Assessor and had regard to the HCPC Practice Note on Proceeding in Absence. The Panel is aware that its discretion to proceed in absence is one which must be exercised with the utmost care and caution.

2. The Panel has had sight of the Registrant’s Pro Forma Response Form, dated 05 October 2015, together with a covering letter in which he confirms that he will not be attending today’s hearing and that he does not wish to be represented. In reaching its decision, the Panel has borne in mind the need to strike a careful balance between the Registrant’s interests and the wider public interest.  There are two witnesses for the HCPC present today. The allegation dates back to 2012 and there is a public interest in the case being heard in a timely manner. The Registrant has not requested an adjournment of today’s hearing. The Panel is of the view that the Registrant has voluntarily absented himself and that an adjournment would be unlikely to secure his attendance at a future date. The Panel has therefore agreed to proceed in the Registrant’s absence as it is satisfied that it is in the public interest to do so. Having reached this decision, the Panel will ensure that the hearing is as fair as the circumstances permit.

3. The Panel thereafter considered Ms Berridge’s application to make the following amendments:-
 Particulars 2, 3 and 4 - inserting “Whilst employed by the Scottish  Ambulance Service” at the start of each of those particulars; by adding  the words “appropriated morphine sulphate for your own personal use  in that you” to the end of the stem of particular 2; deleting particulars  2a), b) and c) and substituting the following:-
a) Made entries in the Morphine Sulphate register to the effect that:
i) Morphine sulphate which was not administered to patients was disposed of when that was not the case;
ii)  a higher dose of morphine sulphate was administered to the patient than that recorded on the Patient Report Form (PRF);
iii) A dose of morphine sulphate was administered to the patient when it was not, and/or
iv) Morphine sulphate was administered to patients on 30/09/2013, 28/10/2013 and/or 2/12/2013 when the patient did not exist.
b) The records referred to at 2a) above were incorrect
c) Falsified the signatures of Colleagues A, B and/ or C in approximately 26 entries on the Morphine Sulphur Register.
 Particular 4a) - adding the words “for your own personal use” to the end of that particular;
 Particular 4b) - adding “A and/or B” after the word “Patients” 

4. Ms Berridge advised that the Registrant had been given notice of the amendments on 02 July 2015 and no response had been received to this notice. Ms Berridge advised that the amendments served to clarify the case against the Registrant and that there was no significant change to the gravamen of the allegation. She also advised that given the nature of the amendments, there would be no prejudice caused to the Registrant in granting the application.

5. The Panel considered the submissions of Ms Berridge and the advice of the Legal Assessor. The Panel was satisfied that amendments served to clarify the case the Registrant has to answer; better reflected the evidence; and did not alter the nature of the allegation.  The Panel was satisfied that the amendments could be made without causing any injustice to the Registrant and agreed to grant the application.

6. Ms Berridge drew the Panel’s attention to the Registrant’s request in his covering letter for the whole of the proceedings to be conducted in private, in order to avoid any adverse impact on him personally and his family, as a result of any media coverage of the case.  Ms Berridge advised that the HCPC opposed the application to conduct the full hearing in private on these grounds. She directed the Panel to the terms of rule 10(1)(a) of the Conduct and Competence Procedure Rules and the HCPC Practice Note on Conducting Hearings in Private. Ms Berridge advised the Panel that she did not intend to explore the Registrant’s personal issues, but that if the Panel wished to do so, it may consider if it would be appropriate to take these matters in private.  The Panel accepted the advice of the Legal Assessor and considered the relevant HCPC Practice Note. The Panel concluded that the Registrant’s request to conduct the whole of the hearing in private, in order to prevent adverse publicity for himself and his family, was not sufficient reason to conduct the full hearing in private and did not meet any of the exceptions contained within rule 10(1)(a) of the Conduct and Competence Procedure Rules. The application was therefore refused. The Panel agreed that in the event of personal information in relation to the Registrant’s private life being explored with any of the witnesses, these matters could be taken in private.

Background

7. The Registrant was employed by the Scottish Ambulance Service (SAS) as a paramedic for approximately 24 years until he was suspended on 6 December 2013. The Registrant was stationed at Kingussie from approximately July 2012, having transferred from Cumnock Station. In the week commencing 02 December 2013, the Registrant was on shift with Witness 2, an ambulance technician, who identified a number of concerns about the Registrant’s behaviour and practice which he reported to DG, a Team Leader, on 05 December 2013. Witness 2 noticed that the Registrant had been signing the Morphine Sulphate Register for him, when he was expected to sign the document as a witness. Witness 2 also had concerns about the Registrant’s treatment of patients. On 04 December the Registrant went to see Witness 2 at his home and asked to take some spare syringes from the back of the ambulance. When Witness 2 checked to see what the Registrant had taken, he found that a diazemuls was missing from the paramedic response bag.

8. On one occasion during that same week, Witness 2 noticed that the Registrant had an Entonox delivery unit in his jacket and two Entonox cylinders in his personal protective equipment bag (PPE). The Registrant took his PPE bag with the Entonox cylinders into his home. On 06 December 2013, the Registrant and Witness 2 attended to Patient B. They were responsible for transporting Patient B from Raigmore Hospital to Glasgow, a journey of approximately 170 miles. Witness 2 was suspicious of the Registrant’s behaviour and spoke with Patient B. Patient B advised Witness 2 that the Registrant had been sat behind her during the journey and that she had heard clanking sounds and the noise of air escaping. This led Witness 2 to believe that the Registrant had been self-administering Entonox whilst en route to the hospital. Witness 2 also described the Registrant as being “spaced out”.

9. Witness 2 reported these concerns to DG. The Registrant was subsequently suspended from his employment with the SAS and an internal investigation was carried out by DC, Operations Support Manager.  Following a review of the Morphine Sulphate Register, it was identified that the Registrant had been falsifying information relating to the administration of morphine and falsified colleagues’ signatures. The Registrant was dismissed from his employment following a disciplinary hearing. He appealed against that decision and the appeal was unsuccessful.  

10. On 04 September 2014, the Registrant was convicted of one count of theft at Inverness Justice of the Peace Court. On 30 October 2014 he was sentenced to a Community Payback Order of 240 hours of unpaid work/activities to be completed within one year.

11. The Registrant self-referred the matter to the HCPC.   

 Decision on Facts

12. The Panel heard evidence from two witnesses on behalf of the HCPC; DC, Operations Support Manager at the Scottish Ambulance Service North Division who conducted the investigation on behalf of the SAS and Witness 2, an ambulance technician who raised concerns about the Registrant with his Team Leader.  In addition the Panel also considered the written statements of Witness 3, a General Practitioner at Kingussie Medical Practice, to whom Patient A originally reported her concerns, and Harriet Roach of Kingsley Napley, solicitors who exhibits the extract conviction and the Registrant’s self-referral form. The Panel has also had sight of the documentary evidence in relation to the investigation conducted by the Trust. It has also considered the Registrant’s submissions made in the course of that investigation and his written submissions made to the Panel today, in which he confirms that he does not contest the allegations.

13. The Panel found DC to be a credible and reliable witness. His evidence was supported by documentation including contemporaneous notes of conversations and interviews with witnesses and with the Registrant. The Panel found Witness 2 to be a witness who was open and honest and who had made the difficult decision to notify management of his concerns in relation to a colleague, whom he considered to be a friend. He was clearly still affected by the situation. The Panel also considered the statements of Witness 3 and Harriet Roach as hearsay evidence. The matters contained within their statements were not challenged by the Registrant.

Particular 1
14. The Panel has had sight of the extract conviction dated 22 January 2015 from Inverness Justice of the Peace Court. It accepts this as proof of that conviction and of the findings of fact on which it was based in terms of rule 10(1)(d) of the Conduct and Competence Procedure Rules. The Registrant has also admitted the conviction.  The Panel is therefore satisfied on the balance of probabilities that particular 1 has been proved.

Particular 2
15. The Panel has heard clear evidence from DC that his investigation revealed that the Registrant had misused SAS drugs. This evidence is supported by documentation, which included a table produced in the course of the internal investigation recording all of the missing or non-administered vials in the Ambulance Morphine Register from 05 November 2012 to December 2013 and which recorded the difference between the information in the Patient Record Form and Morphine Sulphate Register. The Panel also considered the evidence of Witness 2 who gave evidence of instances when the Registrant had recorded that he had given Morphine to a patient and the PRF indicated that no morphine had been given. The Registrant has also admitted the facts of this particular. The Panel is therefore satisfied on the balance of probabilities that the facts of particulars 2(a) to (c) are proved.

Particular 3
16. The Panel has heard evidence from Witness 2 that on 04 December 2012 the Registrant had come to his house and asked for a syringe from the back of the ambulance. The Panel heard that Witness 2 was suspicious about this and when the Registrant had left, he went to check the ambulance and found that one vial of diazemuls was missing. When interviewed by DC, the Registrant admitted that he had taken diazemuls approximately two or three times towards the end of November to help him sleep. In addition the Registrant has advised in writing that he does not contest the allegations. The Panel therefore finds the facts of particular 3 proved on the balance of probabilities.
Particular 4a)

17. The Panel heard evidence from Witness 2 that he saw two Entonox bottles in the Registrant’s Personal Protective Equipment (PPE) Bag and that this was not normal practice and made him feel uncomfortable. The PPE bag is used to store equipment, such as hard hats, gloves and goggles. The Panel has heard evidence that Entonox Cylinders should be secured in the back of an ambulance and that once a cylinder is empty it is changed for a full one at an ambulance station. The Registrant has admitted this particular. The Panel is therefore satisfied that the facts of particular 4a) are proved on the balance of probabilities. 
Particular 4b)

18. The Panel heard evidence from DC that he interviewed Patient A, as she had reported concerns to her GP, Witness 3, that she had witnessed the Registrant inhaling Entonox in the back of an ambulance when she was being transported to hospital. The Panel also heard evidence from Witness 2 that, whilst he was driving Patient B in an ambulance from Raigmore Hospital to Glasgow, the Registrant remained in the back of the ambulance. Patient B told Witness 2 that the Registrant sat behind her in the ambulance and that she could hear clanging sounds, like metal hitting metal and that she heard a noise like air escaping from a valve. Witness 2 also gave evidence that Patient B did not receive any treatment or medication during the journey and that when he checked the Entonox bottles in the back of the ambulance the following day, they were empty. He confirmed that the bottles were full when they were called to transport Patient B. The Registrant has admitted this particular. The Panel is therefore satisfied that the facts of particular 4b) are proved on the balance of probabilities.

Particular 5
19. The Panel has applied the two stage test for dishonesty. The Panel has first considered whether what was done was dishonest by the standards of reasonable and honest people and if the Registrant in fact realised by those standards that what he was doing was dishonest. The Panel has found that a paramedic appropriating morphine for his own personal use; making false entries in the Morphine Sulphate Register; falsifying colleagues’ signatures; taking diazmuls from an ambulance for his own personal use; taking two entonox cylinders from an ambulance to his home for his own personal use; and self-administering drugs would be considered dishonest by the standards of reasonable and honest people. The Panel is also satisfied that the Registrant in fact realised that what he was doing was dishonest by those standards, given that his conduct was clearly designed to conceal his actions from his colleagues and employers. The Panel has therefore found that the Registrant’s actions in particulars 2, 3, 4a and 4b were dishonest.

Decision on Grounds

20. The Panel next considered whether the Registrant’s actions as set out in particulars 2 to 4 of the allegation amount to misconduct. The Panel is of the view that the Registrant’s conduct fell well short of what would be proper in the circumstances and breached the following standards of the HCPC’s Standards of Conduct, Performance and Ethics:-

Standard 1 – You must act in the best interests of service users.
Standard 3 – You must keep high standards of personal conduct.
Standard 12 – You must limit your work or stop practising if your  performance or judgement is affected by your health. 
Standard 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.

21. As a paramedic, the Registrant is in a position of trust and is expected to exercise good judgement and act responsibly in all circumstances. The Registrant has been found to have acted dishonestly over a prolonged period of time in the course of his practice as a paramedic. In the Panel’s view, the Registrant’s actions were serious and amount to misconduct.

Decision on Impairment

22. The Panel next considered whether the Registrant’s current fitness to practise is impaired by that misconduct and by his conviction. In reaching its decision the Panel has considered both the personal component and the public component.

23. In terms of the personal component, there is limited evidence of insight and little evidence of meaningful remorse. While the Registrant has admitted his conduct from the outset of the SAS investigation and in these proceedings, he has not engaged in this process. While he has stated in his covering letter that at the time of the allegations he had personal problems which have since been addressed, there is very limited information from the Registrant. Given the lack of evidence to demonstrate that these issues have been addressed, the Panel cannot be satisfied that there is no risk of repetition. 

24. The Panel has also considered the critically important public policy issues which include the collective need to maintain public confidence in the profession and in the regulatory process, the protection of service users and the declaring and upholding of proper standards of behaviour. The Panel is of the view there is a serious risk of an adverse impact on public confidence in the profession of paramedics as a result of the Registrant’s conduct. In addition the Panel finds that there is a serious risk of a loss of public trust in the behaviour, judgement and professionalism in healthcare professionals generally by this conduct. The Panel has also had regard to the impact of the Registrant’s actions on colleagues, patients and on the Scottish Ambulance Service. The Panel has heard evidence from Witness 2 of the adverse effect on him and on the small team who worked in Kingussie. The Panel has heard evidence of a patient, who advised that she would not call an ambulance again as a result of the Registrant’s actions.   The Panel has concluded that as a result of the Registrant’s actions, there is a significant risk of undermining public confidence in the Scottish Ambulance Service and the profession of paramedics. Taking all of these matters into account, the Panel is satisfied that the Registrant’s fitness to practise is impaired by his misconduct. 

25. The Panel has also considered whether the Registrant’s fitness to practise is impaired by his conviction. In reaching its decision, the Panel has had regard to the conduct of the Registrant, the nature, circumstances and gravity of the offence and the public interest, in particular the need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect.

26. The Registrant has been convicted of theft of drugs in the course of his employment as a paramedic. His behaviour has seriously departed from the values and standards expected of a healthcare professional. In the Panel’s view his behaviour is such that the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in these circumstances. The Panel therefore finds that his fitness to practise is impaired by the conviction.

27. The Panel therefore finds that the Registrant’s current fitness to practise is impaired both by his misconduct and by his conviction and the allegation is well founded.

Decision on sanction

28. The Panel has heard further submissions from Ms Berridge on the issue of sanction. The Panel is aware that the function of fitness to practise panels is not punitive, and that the primary function of any sanction is to address public safety from the perspective of the risk the Registrant may pose to those using or needing his services in the future. In reaching its decision, the Panel must also give appropriate weight to the wider public interest considerations, which include the deterrent effect on other registrants, the reputation of the profession and public confidence in the regulatory process.  The Panel has considered the sanctions available to it in ascending order of severity and has had regard to the HCPC’s Indicative Sanctions Policy and considered the advice of the Legal Assessor. The Panel has also considered the submissions of the HCPC and the Registrant’s submissions in the course of the internals disciplinary process.

29. The Panel has paid careful regard to the following mitigating factors: the Registrant was going through difficult personal circumstances at the time he has acknowledged his conduct at the earliest opportunity and has made full admissions in writing to the Panel today. In doing so, he demonstrates a degree of insight. He has had a previously unblemished career spanning 24 years and once confronted by his employers, he accepted the situation and took steps to obtain support to deal with his personal issues. 

30. The Panel has also considered the aggravating factors as follows: the Registrant’s actions involved a serious abuse of trust; there was significant upset caused to individual colleagues; his actions had an adverse impact on the reputation of the SAS and a direct impact on patients. This was not an isolated incident but rather a prolonged course of conduct involving serious dishonesty, which occurred within the context of his professional life.

31. The Panel first considered whether to take no further action. It is of the view that this would not be sufficient to protect the public or to address the wider public interest considerations, given the lack of evidence of remediation and the seriousness of the Registrant’s conduct.

32. The Panel next considered a caution order. In terms of the Indicative Sanctions Policy, a caution may be appropriate where the lapse is isolated or of a minor nature, there is a low risk of recurrence and the Registrant has shown insight and taken remedial action. The Registrant has demonstrated some insight but in the absence of evidence of remediation, there is a risk of repetition that cannot be mitigated. In addition the Panel is of the view that a caution would be insufficient to address the critically important public policy issues.  In these circumstances, the Panel is of the view that a caution would not be an appropriate or proportionate sanction.

33. The Panel next considered a conditions of practice order. However given the nature of the Registrant’s conduct involving dishonesty and given the lack of engagement by the Registrant, the Panel is of the view that no meaningful practice restrictions could be imposed to address such conduct.

34. The Panel next considered a suspension order. In terms of the Indicative Sanctions Policy, this would be appropriate where the allegation is of a serious nature but there is a realistic prospect that repetition will not occur.  In the absence of evidence of full insight, remorse and remediation, there is a risk of repetition. The Panel is also of the view that suspension would not be sufficient to mark the seriousness of his conduct, to adequately protect the public or to address the wider public interest considerations. In reaching this decision the Panel has had regard to the case of Oluyemi v NMC (2015 QBD Admin) which re-states the position set out by Mr Justice Mitting in the case of Parkinson v NMC as follows - “A nurse who has acted dishonestly who does not appear before the panel to demonstrate remorse, a realisation that the conduct criticised was dishonest, and an undertaking that there will be no repetition, effectively forfeits the small chance of persuading the Panel to adopt a lenient or merciful outcome and to suspend for a period rather than direct erasure.”

35. The Panel considers that a striking off order would be an appropriate and proportionate sanction in this case, given the nature and gravity of the allegation. The Registrant’s conduct in this case was serious, and reckless and involved an abuse of trust. The Panel finds that any lesser sanction would lack deterrent effect and would undermine confidence in the profession and in the regulatory process.

 

Order

The Panel directs the Registrar to strike the name of Mr Colin Girvan from the Register from the date that this order takes effect.

Notes

An interim suspension order was imposed to cover the 28 day appeal period.

Hearing History

History of Hearings for Colin Girvan

Date Panel Hearing type Outcomes / Status
20/10/2015 Conduct and Competence Committee Final Hearing Struck off