Mr Warren Yates

Profession: Paramedic

Registration Number: PA03540

Hearing Type: Final Hearing

Date and Time of hearing: 12:30 12/08/2016 End: 16:00 12/08/2016

Location: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Voluntary Removal agreed

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Allegation

During the course of your employment as a Paramedic with the North West Ambulance Service NHS Trust, you:
1) On 13 December 2013, attended to two patients at the scene of a road traffic accident, and you:
a) did not identify that Patient A had fractured:
i. his right clavicle;
ii. his right radius;
iii. his right lunate.
b) supervised the completion of the Patient Report Form for Patient B, and you:
i. did not ensure the Patient Report Form was completed thoroughly;
ii. did not countersign the Patient Report Form.
2) On 7 May 2014, you:
a) administered Glucose gel to Patient C, who you assessed as having a Glasgow Coma Score of 6 and so was at risk of choking or aspiration;
b) discharged Patient C from your care but did not follow the Self-Care Pathway for Hypoglycaemia assessment checklist, in that you:
i. did not document whether the Patient had mental capacity or was in a fit state of mind to be discharged.
3) On 17 September 2014, you attended Patient D, who was reported as suffering from chest pains, and you:
a) did not recognise that Patient D was experiencing myocardial infarction;
b) failed to initiate any cardiac-related management of Patient D.
4) The matters set out in paragraphs 1 - 3 constitute misconduct and/or lack of competence.
5) By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary Matters:
Service of Notice and Proceeding in the Registrant’s Absence
1. The HCPC produced evidence that Notice of today’s hearing had been sent by way of letter which contained the full and correct details of today’s hearing. This letter had been sent using the appropriate postal service and posted in sufficient time in advance of the hearing to the address shown on the HCPC’s register.  The Notice sent by post was also sent by way of email.
2. The Panel accepted that the rules relating to service of Notice had been fulfilled.
3. The HCPC made an application to proceed with the hearing in the Registrant’s absence. It submitted that in this instance the public interest in a matter proceeding without delay coincided with the interests of the Registrant. It was argued that it was unlikely that an adjournment would secure the Registrant’s attendance.
4. The Panel accepted the Legal Assessor’s advice on the matters to be considered before reaching the decision that it would proceed with the hearing in the Registrant’s absence. The Panel noted that the Registrant had not attended a hearing this morning to deal with the issue of discontinuance of particulars 1(b) and 2(b). From the documentation it was clear that the Registrant was aware of today’s hearings. There was no application to adjourn. Indeed, it was in his interests, and there was evidence in the paperwork before the Panel, that the Registrant was keen for this matter to be concluded today.
Background:
5. The Registrant was an employee of what has now become the North West Ambulance Service NHS Trust (the Trust) for around 35 years, the last 20 years  as a Paramedic.
6. At its meeting on 26 January 2016, a panel of the Investigating Committee (IC) of the HCPC determined that there was a case to answer in relation to an allegation of impairment of the Registrant’s fitness to practise.  The Panel confirmed the following allegation:
“During the course of your employment as a Paramedic with the North West Ambulance Service NHS Trust, you:
1. On 13 December 2013, attended to two patients at the scene of a road traffic accident, and you:
a) did not identify that Patient A had fractured:
i) his right clavicle;
ii) his right radius;
iii) his right lunate.
b) did not identify that Patient B had suffered a neck injury;
c) supervised the completion of the Patient Report Form for Patient B, and you:
i) did not ensure the Patient Report Form was completed thoroughly;
ii) did not countersign the Patient Report Form.
2. On 7 May 2014, you:
a) administered Glucose gel to Patient C, who you assessed as having a Glasgow Coma Score of 6 and so was at risk of choking or aspiration;
b) did not undertake and/or failed to document any reassessment of Patient C after administering the Glucose gel;
c) discharged Patient C from your care but did not follow the Self-Care Pathway for Hypoglycaemia assessment checklist, in that you:
i) did not document whether the Patient had mental capacity or was in a fit state of mind to be discharged.
3. On 17 September 2014, you attended Patient D, who was reported as suffering from chest pains, and you:
a) did not recognise that Patient D was experiencing myocardial infarction;
b) failed to initiate any cardiac-related management of Patient D.
4. The matters set out in paragraphs 1 - 3 constitute misconduct and/or lack of competence.
5. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.”
Background to the Particulars
7. On 13 December 2013, following a road traffic accident, two individuals, (Patient A and Patient B), were taken by the Registrant to Whitegate Drive Health Centre (Whitegate), a walk-in health centre. Whitegate were concerned that, given these patients’ injuries and presentation, they should have been taken to Accident and Emergency, as opposed to a walk-in health centre. Whitegate referred both patients on to an Accident and Emergency Department. On the basis of their concerns Whitegate referred the matter to the Trust, who investigated it internally.
8. Around May 2014, a complaint was received by the Trust from Patient C regarding the manner in which the Registrant had administered glucose to her following a hypoglycaemic episode due to he diabetes.
9. On 17 September 2014, the Registrant who was working as a solo responder on a fast response unit (FRU), attended Patient D, who had been suffering with chest pains. Around 30 minutes later an ambulance crew arrived to transport Patient D to hospital. The Paramedic crew member of that ambulance became aware of the Registrant’s misdiagnosis and lack of treatment of Patient D. The Paramedic colleague’s concerns were brought to the attention of the Registrant’s manager.
10. Following the incident with Patient D, the Registrant was placed on restricted duties, pending further investigation by his employer.
11. The Registrant self-referred to the HCPC, informing them of the pending investigation. This in turn resulted in the matter being considered by the IC who formulated the above Allegation.
12. The HCPC’s solicitors, Kingsley Napley LLP, were then instructed to conduct an investigation into the Allegation referred by the IC. On 7 March 2016, Kingsley Napley interviewed Mr Brian Buck, Advanced Paramedic at the Trust, who undertook investigations into the above identified concerns. The Panel has before it a copy of the notes of the interview. 
13. During the interview, Mr Buck highlighted his concerns in respect of two of the particulars of the allegation, namely particulars 1(b) and 2(b).  Following a Preliminary Hearing before a Panel of the Conduct and Competence Committee Particulars 1(b) and 2(b) were discontinued.
Basis of application for Voluntary Removal Agreement (VRA)
14. The Registrant had self-referred the fact that he had become the subject of an internal investigation. The Registrant fully admitted all of the facts. In his letter of 6 December 2015 the Registrant set out the personal and professional reasons why his practice at that time had been deficient. He stated that at the time of the events set out in the Allegation his health was deteriorating and his personal circumstances were affecting his abilities and judgment. He also stated that his health has further deteriorated and he has now retired from the Ambulance Service. The impact of the HCPC proceedings has had a further adverse impact on his health.  In his letter of 10 February 2016, the Registrant indicated that he has no intention of returning to return to practice and wished to have his name removed from the Register.
15. It was accepted by the HCPC that this matter may be considered to be more competency-based, and therefore remediable. Such a case may therefore result in a final sanction of conditions of practice or suspension rather than a strike off. It was therefore appreciated that the VRA may not be a proportionate sanction in such circumstances. However given the Registrant’s current personal and professional circumstances, it was argued that little would be served by taking this matter to a final hearing. Further, the public interest was served by this means of disposal in that there is no longer any potential for service user harm and also the attendant cost of a final hearing was avoided. The HCPC argued that this was a case that was suitable for the adoption of a VRA.
Decision:
16. The process of disposing of a case by way of consent is an extra-statutory means of concluding a matter.  However, before agreeing to such a course the Panel has to remind itself that it has to be certain that by adopting this process there is the appropriate level of public protection and that it would not be detrimental to the wider public interest. 
17. Article 11(3) of the 2001 Order and Rule 12(3) of the Health and Care Professions Council (Registration and Fees) Rules 2003 prevent a registrant from seeking to resign from the register whilst the registrant is the subject of an allegation.
18. The Guidance issued by the HCPC states:
In cases where the HCPC is satisfied that it would be adequately protecting the public if the Registrant was permitted to resign from the Register it may enter into a Voluntary Removal Agreement allowing the Registrant to do so, but on similar terms to those which would apply if the Registrant had been struck off.
19. If the Panel is not satisfied that the above criteria have been met it appreciates that it has the ability to reject the proposal and allow the matter to proceed to a full Final Hearing.
20. The Panel heard from Mr Claughton that in the HCPC’s view this measure will ensure service user protection.  The wider public interest in this matter has been addressed and satisfied by the process of investigation.
21. The Panel noted the points made by the Registrant in his correspondence that he is now retired and does not enjoy good health. He has admitted the factual basis of the allegations and at this stage in his career and life wishes his professional registration to come to an end.
22. The Panel has considered the documentary evidence before it and has been able to confirm that there is sufficient evidence to support a finding to the requisite level on the particulars as they now stand. There is nothing before the Panel to suggest that during his long career there had been any previous concerns about the Registrant’s competence or conduct before these events.  The Panel noted that these events took place over a period of time which coincided with a period when the Registrant was going through health and personal stresses. The Panel considers that this may therefore have been a temporary lack of competence and judgment. In the absence of any steps to address however this and any willingness on the part of the Registrant to do so, the Registrant’s fitness to practise was, and remains, impaired.
23. The Panel noted that a final hearing was unlikely to have concluded with the imposition of a Striking-off Order, in which case the removal of the Registrant’s name from the Register may be considered to be a disproportionate measure in this instance it is clearly the wish of this Registrant to remove himself and for reasons which the Panel fully appreciates and accepts.
24. After careful consideration the Panel has therefore concluded that in all the circumstances of this case the approval of the proposed VRA is the appropriate course of action in this matter.  The VRA will provide continued service user protection in that the Registrant will not be able to practise as a Paramedic. Further, the public interest is served in that there is no unnecessary expenditure of energies and expense by the HCPC proceeding with a full final hearing. The public interest is also served in that the Registrant has made full admissions and his name is now removed from the Register.
25. The Panel has before it a copy of the Voluntary Removal Agreement that has been signed and dated by both parties.  The Panel note the terms of that agreement. 
26. Accordingly, the Chair of the Panel has, on behalf of the Panel, signed and dated the Notice of Discontinuance which consents to the HCPC discontinuing these proceedings with immediate effect.


 

Order

Order:
The Panel approves the Voluntary Removal Agreement signed by the HCPC and by the Registrant, and directs that the Registrar is directed to remove the name of Warren Yates from the Paramedic Part of the Register with immediate effect.

Notes

This Conduct and Competence Committee Voluntary Removal Agreement Hearing took place at HCPC, London on Friday 12 August 2016.

 

If the Registrant seeks to return to the HCPC Register at any time the application would be treated as if the registrant had been struck off as a result of that allegation.

Hearing History

History of Hearings for Mr Warren Yates

Date Panel Hearing type Outcomes / Status
12/08/2016 Conduct and Competence Committee Final Hearing Voluntary Removal agreed