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1. Practised as a paramedic whilst unregistered between 8 February and 25 February 2013;
2. Attended a road traffic collision involving Patient A on 1 February 2013 and you:
a) allowed an unauthorised member of the public to accompany you;
b) did not request any form of ambulance back up to convey Patient A to hospital after you had assessed the patient as having sustained a head injury and requiring further assessment in hospital;
c) did not complete a Patient Care Record ('PCR') for Patient A;
d) did not complete a Discharge of Care Form ('DCF') for Patient A;
e) did not provide police with a PCR or a DCF;
f) left Patient A with non-clinically trained police officers in circumstances where you had assessed Patient A as having a head injury;
g) left the incident location prior to completing a full clinical assessment of Patient A.
3. Provided misleading information during the initial complaint investigation stage of the SWAST investigation specifically, in your signed statement of 25 February 2013 you stated that you:
a) requested PI back up following your assessment of Patient A;
b) followed the police towards the hospital;
c) responded to a further emergency as you approached the hospital.
4. Your actions as described in paragraph 3 were dishonest.
5. The matters described in paragraphs 1-2 constitute misconduct and or lack of competence.
6. The matters described in paragraph 3 -4 constitute misconduct.
7. By reason of that misconduct and or lack of competence your fitness to practise is impaired.
Facts Proved: 1, 2(a), 2(b), 2(c), 2(d), 2(e), 2(f), 2(g), 3(a), 3(b), 3(c), 4
Impairment: Currently Impaired
Sanction: Strike Off + Interim Suspension Order
1. At the commencement of the hearing, the Registrant entered formal admissions to Particulars 2(a), 2(b), 2(d), 2(e), and 2(g) of the Allegation.
2. The Registrant also admitted sub-particulars (a), (b), and (c) of Particular 3, but not the stem of Particular 3.
3. The Panel heard from the following live witnesses on behalf of the HCPC:
· NE – Operations Officer, South West Ambulance Council
· AW – Head of Incidents and Complaints, Great Western Ambulance NHS Trust
4. It was also provided with a written statement from:
· CH – Registration Manager, HCPC
5. The Registrant gave evidence and provided the Panel with a bundle of documents numbered 1 – 26.
6. The Registrant commenced employment with the Avon Ambulance Services NHS Trust as an Ambulance Practitioner in 2003. He became a Paramedic in September 2009.
7. On 1 February 2013, he was assigned to attend an incident involving a young male patient, Patient A, who had hit his head and was being held in a police car.
8. At the time of the Registrant’s arrival at the scene, Patient A was handcuffed with his arms behind his back and was placed in the back seat of the police car.
9. Information from the police later revealed that Patient A had jumped out of a moving vehicle, had fallen to the floor and had then attempted to abscond, before being handcuffed and detained.
10. The Panel heard that a police officer who had been present at the scene had stated that the Registrant arrived in the company of a female who helped to remove a bag from the Registrant’s vehicle. It was alleged that this was an unauthorised member of the public who should not have been accompanying the Registrant.
11. The police officer had also stated that he had not been given, nor had sight of, any of the relevant paperwork that should have been compiled by the Registrant in connection with the incident, such as the Patient Care Form (PCF) and the Discharge of Care Form (DCF).
12. AW gave evidence with the assistance of records. He said that the Registrant had not requested the back-up of a double man ambulance and had not followed the police to the hospital. Instead, he had left Patient A in the hands of non-clinically trained police officers without having completed a full clinical assessment of Patient A.
13. After the event the Trust received a verbal complaint from the mother of Patient A about the fact that Patient A had been transferred to the hospital by the police as opposed to by ambulance in circumstances where he had sustained injuries to his head and arm which had required surgery.
14. An enquiry commenced and the Registrant was asked by NE to provide a statement, which he did, on 25 February 2013. This was signed and contained a declaration as to the truth of its contents. In his statement the Registrant stated that after his initial assessment of Patient A, he:
· explained to the police that Patient A required an ambulance to transport him to hospital and called for an ambulance;
· followed the police to the hospital; and
· received a call on his way to the hospital enquiring whether he was able to attend another incident, which he then agreed to do.
15. The inquiry further revealed that the Registrant had worked as a Paramedic on 14, 15, 16 and 17 February 2013, and that he had not been registered with the HCPC to do so, as he had not paid his registration fees. He was spoken to about this on 14 February and claimed that he had telephoned the HCPC who had told him that it was “fine to continue”. NE made further enquiries and spoke to the Registrant further on 19 February 2013, informing him that he should not practise as a Paramedic until further notice.
16. In his defence, the Registrant accepted that he had attended the scene with a female who had not been authorised to accompany him. He explained that he had mentored many trainees in the past and had assumed, when this trainee attended at the beginning of his shift that day, that she had been authorised to accompany him. He accepted that in the event this had not been the case.
17. He said that he was unsure whether to categorise the bruising to Patient A’s eye area as a head injury. He was unable to conduct a full assessment because Patient A was aggressive and the police had warned him not to get into the police car to inspect Patient A.
18. He claimed that he had completed a PCF. He said that he had done this on a separate booklet that he had brought to the scene with him in his pocket rather than using the booklet that was available to him in his vehicle. He had started completing the booklet whilst dealing with Patient A standing outside the vehicle and had then got into his own vehicle to complete his notes. He could not explain what had then happened to the PCF that he completed, but presumed that it must have got lost in the system as this had been known to happen before.
19. In relation to his signed statement of 25 February 2013, he accepted that the contents were inaccurate but claimed that he had not done this intentionally. He said that he had complied the statement three weeks after the event and had been forced to rely solely on his memory as he had not been provided with any of the salient facts. He pointed out that, once he had been provided with those facts, he had made a second statement which was accurate; he said that this was because his memory had been triggered.
20. He accepted that he had attended work on 14, 15, 16, and 17 February 2013 at a time when his registration had expired, but he argued that he had not had to make use of his skills as a Paramedic on those dates.
Decision on Facts
21. In reaching its decision, the Panel accepted the advice of the Legal Assessor. It understood that the HCPC bore the burden of proving the case on the balance of probabilities. It gave less weight to any evidence that had been presented to it in the form of hearsay evidence. It took into account the fact that the Registrant was a person of good character and that no previous complaints had been made against him of any sort.
Particular 1 – proved
22. In relation to Particular 1, the Panel concluded that the Registrant had worked as a paramedic on 14, 15, 16, and 17 February 2013. He had been in a position to make use of his skills if required to do so. The fact that he may not in fact have had to make use of those skills in the event was irrelevant. The records showed that he had worked in his role as a Paramedic on those dates at a time when he had not been registered to do so. Accordingly, the Panel found Particular 1 proved.
Particular 2(a) – proved
23. In relation to Particular 2(a), the Panel accepted the admission that the Registrant had entered. The Registrant had accepted that the member of the public who had accompanied him had not in fact been authorised to be there. The Panel concluded that the Registrant should not have been unaware of this at the time and he should have checked the situation. Accordingly, the Panel found Particular 2(a) proved.
Particular 2(b) – proved
24. In relation to Particular 2(b), the Panel accepted the admission entered by the Registrant and found Particular 2(b) proved.
Particular 2(c) – proved
25. In relation to Particular 2(c), the Panel took into account a PCF booklet that the Registrant had used in relation to other incidents that the Registrant had been involved in that day immediately before and immediately after the Registrant’s dealings with Patient A. The forms for these incidents had been numbered sequentially, suggesting that the Registrant could not have used that particular booklet in order to complete a form relating to Patient A. The Panel did not accept the Registrant’s explanation for this, namely that he had used a different booklet brought by him to the scene in his pocket. The Panel concluded that there was no good reason for him not to have used the booklet that he had used for the other incidents that day, which had been present in his vehicle when he had, on his evidence, sat in the vehicle to complete a PCF. Furthermore, no PCF had been found despite the fact that PCFs existed in triplicate form. The Panel found Particular 2(c) proved.
Particular 2(d) – proved
26. In relation to Particular 2(d), the Panel accepted the admission entered by the Registrant and found Particular 2(d) proved.
Particular 2(e) – proved
27. In relation to Particular 2(e), the Panel accepted the admission entered by the Registrant and found Particular 2(e) proved.
Particular 2(f) – proved
28. In relation to Particular 2(f), the Panel found that the injuries sustained to Patient A’s face, as accepted by the Registrant, amounted to a head injury. Accordingly, the Panel found Particular 2(f) proved.
Particular 2(g) – proved
29. In relation to Particular 2(g), the Panel accepted the admission entered by the Registrant and found Particular 2(g) proved.
Sub-Particulars 3(a), 3(b) and 3(c) – proved
30. In relation to sub-particulars (a), (b) and (c) of Particular 3, the Panel accepted the admissions made by the Registrant.
Particular 3 (stem) – proved
31. In considering the stem of the Particular, which was denied by the Registrant, the Panel concluded that the degree of fine detail provided by the Registrant in his signed written statement dated 25 February 2013 was such that it was clear that the Registrant had been inventing the contents of this statement with the intention of misleading the reader. The Panel had in mind in particular a number of very specific features, such as his assertion that he had:
· fetched Patient A a bowl to spit in which Patient A refused to do
· called for an ambulance
· explained to the officers present that Patient A required an ambulance to transport him to hospital which the officers “were fine with”
· followed the police to the hospital
· received another call relating to another incident en route to the hospital
· agreed to attend the other incident
32. The Panel concluded that it was inconceivable that the Registrant could have recalled this degree of detail erroneously, and concluded on the balance of probabilities that the Registrant had fabricated this account in order to cover his tracks. Accordingly, the Panel found Sub-Particulars 3(a), 3(b) and 3(c) proved.
33. In applying the facts of Particular 3 in consideration of Particular 4, the Panel concluded that, on the balance of probabilities, the Registrant had acted dishonestly by the standards of ordinary and reasonable members of his profession, and further, that it was more likely than not that that he realised that what he was doing was, by those standards, dishonest. It was clear that the Registrant’s signed statement of 25 February 2013 contained important inaccuracies, and the Panel concluded that these were the result of deliberate lies invented by the Registrant, with the intention of deceiving the reader, in an attempt to avoid any proceedings from being brought against him in relation to the incident involving Patient A. Accordingly, the Panel found Particular 4 proved.
Decision on Grounds
34. The Panel accepted the advice of the Legal Assessor, who took the Panel to the cases of Roylance v General Medical Council No 2  1 AC and Calhaem v General Medical Council  EWHC. The Panel was aware that a finding of misconduct and/or lack of competence was a matter for the Panel’s professional judgement.
35. The Panel concluded that there was no lack of competence on the Registrant’s part. The evidence did not suggest that the Registrant lacked the requisite skills or that he was incapable of meeting the standards required of him.
36. The Panel considered whether the Particulars amounted to misconduct, both individually and collectively, and concluded that they did.
37. The Registrant’s actions in allowing an unauthorised person to accompany him, in failing to complete documentation that was required for the provision of proper care to Patient A, and in leaving Patient A in the hands of non-clinically trained police officers amounted to a failure in communication and a failure to keep accurate records, and this was not in the best interests of service users. His behaviour in this regard had fallen substantially below the standard expected of a practitioner acting in the circumstances faced by the Registrant at the time.
38. Further, of particular concern to the Panel was the Registrant’s actions in connection with Particulars 3 and 4, in which the Registrant had deliberately fabricated events in the course of his signed written statement in the hope that his actions relating to Patient A would go undetected. Dishonest conduct of this nature was extremely serious, demonstrating a failure to act with integrity and honesty, which had the potential to damage public confidence in the profession.
Decision on Impairment
39. The Panel accepted the advice of the Legal Assessor, who addressed the Panel on the meaning of impairment and referred to the case of Grant ([Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery council (20 Paula Grant  EWHC 927]).
40. The Panel took into account further evidence given by the Registrant at this stage relating to the personal stress that he had been under at the time of the incident. He also told the Panel about his recent and current employment and provided the Panel with a number of references.
41. The first reference was provided by the Registrant’s past supervisor who confirmed that, after the incident, the Registrant had completed over 200 hours of supervised practice and that he had been:
“consistently able to achieve a relevant and comprehensive history from patients and he is able to recognise the appropriateness of probing when clinically required. I have witnessed no points of contention in regard to his ability in this respect. Mr Wilkinson had demonstrated skills that I would describe as excellent. He has demonstrated that he is able to accurately identify the relevance and necessity of any given examination in a variety of circumstances. When appropriate he has demonstrated comprehensive patient assessment and clinical reasoning executed with empathy and professionalism. He is able to form an accurate list of differential diagnoses and is able to use sound clinical judgment to provide a working diagnosis from which to base his treatment. I have been consistently impressed with his practice in this respect and have not witnessed any failings in his ability to assess and examine…..I have seen nothing during his supervisory period that calls his practice into question in regards to his ability to safely and effectively implement emergency treatment.”
42. A further reference provided by a colleague described the Registrant as:
“very knowledgeable and thoughtful….. What is particularly evident to me is his undiminished compassion and respect for each and every patient he attends”.
43. The Registrant’s current employer confirmed that the Registrant had been employed for just under a year and that in that time:
“James has proved to be a trustworthy and professional paramedic…..has demonstrated sound clinical judgment and has conducted himself with the upmost professionalism. James continues to operate within his current scope of practice while learning new skills and has continued to develop his knowledge in his new role….During his time with my company I have received several comments and letters commending James for his work”.
44. In its earlier finding, the Panel had found that the Registrant’s actions in relation to Patient A had placed Patient A at risk of harm. However, the Panel was satisfied that the Registrant had displayed good insight into, and had in fact remediated, his clinical failings. He had admitted the allegations relating to his poor clinical performance on this occasion and had provided some excellent references regarding his current clinical ability. He told the Panel that there had been no concerns about his clinical practice either before or since this incident. The Panel was satisfied that the risk of repeating his past clinical failings was extremely low and that the Registrant no longer posed a risk to the public in that regard.
45. However, in relation to the Panel’s finding that the Registrant had worked whilst unregistered, the Panel concluded that the Registrant had not demonstrated insight into the seriousness of his actions and its consequences. In the absence of demonstrable insight, the Panel concluded that, should the Registrant find himself in similar circumstances in the future, there was an ongoing risk that the misconduct found proved might be repeated. Working as a Paramedic whilst unregistered poses a risk to public protection because members of the public are not in a position to benefit from the safeguards that compliance with professional standards provides.
46. Furthermore, the Panel has found that the Registrant had acted dishonestly in the past. He has continued to deny his dishonesty. In those circumstances it was not possible for the Panel to conclude that he has developed any insight into this aspect of his misconduct. The Panel was concerned that, were he to be placed in the same position again, he might repeat his behaviour. The Panel also concluded that confidence in the reputation of the profession and the HCPC would be undermined if a finding of impairment were not made in light of the seriousness of his behaviour.
47. The Panel therefore found the Registrant’s fitness to practise to be impaired.
Decision on Sanction
48. The Panel bore in mind that its purpose was not to be punitive, but to protect the public interest. It understood that it must act proportionately, balancing the interests of the Registrant with those of the public. It considered the range of available sanctions in ascending order of seriousness, starting with the option of taking no action.
49. The Panel found, by way of mitigation, that the Registrant had:
· no previous findings against his name and that there had been no complaints about his practice since the incidents in question;
· provided positive references;
· suffered stressful personal circumstances at the time of the misconduct;
· engaged in the regulatory process; and
· admitted the allegations that related to his clinical failings.
50. The Panel found, by way of aggravating factors, that:
· the Registrant’s dishonesty had involved a deliberate attempt to conceal his failings in the course of a formal investigation in to his actions by his employer; and
· in excess of two years had passed since the dishonest behaviour, in the course of which the Registrant’s personal circumstances had normalised, yet the Registrant had failed to develop any insight into his dishonest behaviour.
51. In view of the seriousness of the case, to take no further action or to impose a Caution Order would not be sufficient to protect the public, maintain confidence in the profession and maintain confidence in the regulatory process.
52. In considering a Conditions of Practice Order, the Panel concluded that this would be inappropriate. In relation to clinical failings, there were no identifiable areas of practice that required retraining. In relation to the findings of dishonesty there were no workable Conditions of Practice in light of the nature of dishonesty and the Registrant’s lack of insight. In any event, the Registrant’s dishonesty could not be described as minor or unlikely to be repeated, and a Conditions of Practice Order would therefore be insufficient to protect the public interest.
53. The Panel gave careful consideration to a Suspension Order. The difficulty was that the Registrant’s dishonesty had centred around his intention to mislead investigators who had been tasked to look into the Registrant’s own clinical misconduct; he had acted dishonestly in order to avoid disciplinary action being taken against him. This was a serious level of dishonesty. The public would not expect a paramedic to behave with such lack of candour.
54. Further, in considering whether a period of suspension would provide a period of reflection in which the Registrant might develop an appropriate level of insight, the Panel reminded itself that over two years had passed since the time of the Registrant’s dishonest behaviour, giving ample time in which to reflect. His personal circumstances were now less stressful than those in existence at the time of the dishonest behaviour. However, despite the passage of time, the Registrant still denies that he acted dishonestly and he has developed no insight into his dishonest behaviour.
55. In light of the Registrant’s continued denial of dishonesty, there was a risk that he would act dishonestly again. In those circumstances, the Panel concluded that a Suspension Order would not provide adequate protection for the public. In addition the dishonesty had been deliberate and was serious and the Panel concluded that the wider public interest would not be satisfied by such an Order.
56. The Panel understood that a Striking Off Order was the most serious of all sanctions. The Panel understood that to prevent the Registrant from working as a Paramedic would be likely to cause him real financial hardship. However, it was the judgment of the Panel that a Striking Off Order was both the appropriate and proportionate order in the circumstances due to the seriousness of the dishonesty, accompanied by the Registrant’s decision to work as a Paramedic at a time when he knew that he had not been registered. He had demonstrated a lack of insight in relation to the issue of dishonesty, and there was a consequential risk of repetition. Further, the seriousness of the dishonesty was such that a Striking Off Order was required in order to declare and uphold proper standards of behaviour and maintain public confidence in the profession and in the regulatory process.
57. The Panel concluded that a Striking Off Order was the appropriate sanction in the circumstances of this case.
That the Registrar is directed to strike the name of James Wilkinson from the Register on the date this order comes into effect
No notes available
History of Hearings for James Wilkinson
|Date||Panel||Hearing type||Outcomes / Status|
|28/09/2015||Conduct and Competence Committee||Final Hearing||Struck off|