Mr Colin Williams

Profession: Paramedic

Registration Number: PA04128

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 01/02/2016 End: 17:00 03/02/2016

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Allegations (as amended at Final Hearing 01 February 2016):

1. During the course of your employment as a Paramedic with Yorkshire Ambulance NHS Trust on 8th August 2012, you were called to a Red 2 emergency call in relation to Patient A and you:
 
 a. You did not ensure that chest compressions were performed in accordance with guidance in that;
   
  (i) There was undue delay in commencing chest compressions; and/or;
  (ii) There were undue interruptions in chest compressions.
 
 b. You did not ensure that early defibrillation was performed in accordance with the guidance in that;
  
  (i) There was undue delay in commencing defibrillation; and/or
  (ii) You did not ensure that the defibrillator was used in Manual Mode.

2. The matters set out on paragraphs 1a) – b) constitute misconduct and/or lack of competence.

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

Finding

Preliminary Matters

The Registrant was not present or represented. The case for the Health and Care Professions Council (HCPC) was presented by Mr Laith Dilaimi of Kingsley Napley Solicitors. The Panel considered Mr Dilaimi‘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 in terms of rules 3 and 6 of the Conduct and Competence Committee Procedure Rules and it therefore had a discretion to proceed in the Registrant’s absence in terms of rule 11. The Panel considered the submissions of Mr Dilaimi, the advice of the Legal Assessor and had regard to the HCPC Practice Note on Proceeding in the Absence of the Registrant. The Panel was aware that its discretion to proceed in absence is one which must be exercised with the utmost care and caution.  The Panel has had sight of an email dated 5 January 2015 from the Registrant in which he stated that he was no longer resident in the UK, that he had taken early retirement and had no desire or wish to practise as a paramedic. He also advised that he had provided a full statement of events and that he could not engage with the HCPC any further in this matter. There has been no further engagement from the Registrant since this date.

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.  The Panel is aware that there are two witnesses for the HCPC present. Given the response from the Registrant, the Panel is of the view that he 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. The Panel is also mindful of the fact that the Registrant has submitted detailed written representations in response to the allegation and will ensure that the points made by him are raised with the HCPC witnesses. In addition the Panel will not draw any adverse inference from the Registrant’s failure to attend the hearing.

The Panel thereafter considered Mr Dilaimi‘s application to amend the allegation as set out above in bold or struck through text at particulars 1(a),1(b),1(c) and 2.

Mr Dilaimi advised that the Registrant had been given written notice of the amendments by letter and email and no response had been received in relation to the proposed amendments. Mr Dilaimi advised that the amendments further particularised the allegation and served to clarify the allegation.

The Panel considered the advice of the Legal Assessor and agreed to grant the application. The Panel was satisfied that the amendments better reflected the evidence, did not in any way heighten the gravity of the allegation and did not cause injustice to the Registrant.

The Panel also considered Mr Dilaimi’s application to anonymise Person B, given that he was a relative of Patient A. Mr Dilaimi’s application was made on the grounds that it was for the protection of the private life of Person B and that of Patient A who could potentially be identified. Having considered the application and the advice of the Legal Assessor, the Panel agreed to grant the application for the protection of the private life of Person B and that of Patient A.

The Panel also agreed to grant Mr Dilaimi’s application to view the video of the incident involving Patient A in private. Having considered Mr Dilaimi’s submission and the advice of the Legal Assessor, the Panel agreed to take this matter in private in order to protect the private life of Patient A and his family members.  

Background:

The Registrant is a paramedic and at the time of the incident was employed by Yorkshire Ambulance Service NHS Trust (“the Trust”).  On 8 August 2012 the Registrant and his colleague, an Advanced Emergency Medical Technician, were called to a Red 2 emergency call at a domestic property in respect of Patient A, a 79 year old male who had breathing difficulties and was vomiting. Both ambulance crew entered the house bringing with them the defibrillator/monitor only. They encountered Patient A in the living room. Following a patient assessment, Patient A was assisted onto a carry chair in his living room prior to taking him to the ambulance. Patient A went into cardiac and respiratory arrest whilst in the chair before leaving the living room.  Patient A was taken to the ambulance to be treated. The ambulance transported Patient A to hospital where he was later pronounced dead. Immediately following the incident, the Registrant and his colleague requested the attendance of a supervisor for welfare reasons, who subsequently advised they each should prepare statements of the incident, which they did the following day. A complaint was made by the family of Patient A on 19 September 2013 and the Trust commenced an investigation. The Registrant also self-referred the matter to the HCPC on 21 March 2014. The Registrant retired prior to the conclusion of the employer’s investigation.

Decision on Facts:

The Panel heard live evidence from two witnesses on behalf of the HCPC:  Rachel Simpson, the Locality Manager for Yorkshire Ambulance Service NHS Trust and Person B, Patient A’s son-in-law. The Panel also viewed a video with sound of the incident lasting 4 minutes and 44 seconds which was filmed by Person B on his mobile phone. This showed Patient A in the back of the ambulance and the treatment received during this time, together with the actions of Patient A’s family. The Panel also considered all of the documentation provided which included the Patient Report Form, the Trust Resuscitation Policy and the Resuscitation Council (UK) 2010 Guidelines. The Panel also heard the audio recording of the 999 call made by Patient A’s daughter, Person B’s wife. In addition the Panel considered the Registrant’s written submissions contained within his initial statement made on 9 August 2012, a letter dated 25 October 2013 to his Locality Manager in response to the family’s letter of complaint, his self-referral letter dated 21 March 2014, the record of his interview of 11 April 2014 for the purposes of the Trust investigation and an email dated 5 January 2015 to the HCPC. The Panel also considered the advice of the Legal Assessor in reaching its decisions on facts, grounds and impairment.

The Panel heard evidence from Rachel Simpson in relation to her investigation of the incident. She did not give direct evidence in relation to events on the day but provided evidence of her investigation. The Panel found Rachel Simpson to be a credible and reliable witness whose evidence of her investigation and of the relevant policies and guidelines was clear and concise.  The Panel also considered the evidence of Person B who gave direct evidence in relation to the incident. He was present throughout the incident and exhibited the video recording.  It is clear that he and other family members were concerned and frustrated at the treatment being provided to Patient A. The Panel found him to be a credible witness and accepted the thrust of his evidence which was supported by the video evidence. The Panel has read the Registrant’s submissions in which he states that from the onset the demeanour of the family was one of hostility and aggression towards him and his colleague and that there was a constant stream of invective from the family members and that he and his colleague were distracted by the family’s constant tirade and behaviour.  The evidence of Person B is that they were concerned by the actions of the Registrant and his colleague but that they were not threatening or hostile. The Panel has viewed the family’s behaviour on the video which is not consistent with the Registrant’s description. While the Panel accepts that they were frustrated and concerned, it does not accept the Registrant’s description of “a constant stream of invective” and does not accept that the family were either threatening or hostile so as to put him or his colleague in danger of physical violence. 

In relation to particular 1(a)(i), the Panel has heard evidence from Rachel Simpson in relation to the Trust’s Resuscitation Policy in cases of cardiac arrest and the Resuscitation Council (UK) 2010 Guidelines and European best practice guidelines which are used by all healthcare professionals and on which the Trust Resuscitation Policy is based. The Panel has also had sight of the relevant sections of these documents within the bundle. In terms of these documents it is clear to the Panel that chest compressions should be commenced immediately when cardiac arrest has occurred in accordance with the Advanced Life Support algorithm. In this case, it is clear to the Panel that Patient A should have been removed from the chair and received immediate Cardio Pulmonary Resuscitation (“CPR”). It is not disputed by the Registrant that cardiac arrest occurred in the living room of the house when Patient A was in the carry chair.

While there is a dispute as to whether chest compressions were commenced before or after the start of the filming, it is agreed by the Registrant and Person B that chest compressions were not commenced until Patient A was in the back of the ambulance. This constituted undue delay. The Panel therefore finds that facts of particulars 1(a)(i) are proved on the balance of probabilities.    

In relation to the facts of particular 1(a)(ii), the Panel has heard evidence from Rachel Simpson in relation to the relevant policies and has had sight of the video from which it can be seen that there is a pause after shocking and a further pause to check for a pulse. The Resuscitation Council (UK) 2010 Guidelines – During CPR – states that “The shorter the interval between stopping chest compressions and shock delivery, the more likely it is the shock will be successful. Reduction in the interval from compressions and shock delivery by even a few seconds can increase the probability of shock success.” The Panel therefore finds that these were undue interruptions and finds the facts of particular 1(a)(ii) proved on the balance of probabilities.

In relation to particular 1(b)(i), the Panel has again considered the evidence of Rachel Simpson in relation to the Resuscitation Council (UK) 2010 Guidelines – Airway Management and Ventilation – which states that “In a witnessed cardiac arrest in the vicinity of a defibrillator, attempted defibrillation takes precedence over opening the airway.” It is clear that cardiac arrest occurred in the living room of the house and defibrillation was not commenced until the patient was in the ambulance, despite the fact that the defibrillator was in the living room with them. The Panel therefore finds the facts of this particular proved and that in acting as he did, the Registrant did not ensure early defibrillation was performed in accordance with the relevant guidance, being Resuscitation Council (UK) 2010 Guidelines – The Use of Automated External Defibrillators – which states “The chances of successful defibrillation decline at a rate of about ten per cent with each minute of delay, basic life support will help to maintain a shockable rhythm but is not a definitive treatment.”

In relation to particular 1(b)(ii), the Panel has found as a matter of fact that the defibrillator was not used in Manual Mode. This is accepted by the Registrant. However the Panel has not found that this is a requirement of either the Trust Resuscitation Policy or the Resuscitation Council (UK) 2010 Guidelines. In the absence of a requirement in the policy or guidelines, the Panel has therefore found that this particular is not proved.

Decision on Grounds:

The Panel next considered whether the Registrant’s actions amounted to a lack of competence and/or misconduct. This is a matter for the Panel’s professional judgement. 

The Panel has heard that the Registrant was an experienced paramedic, having qualified in 1993 and that he was the senior practitioner in this incident. The Panel has also seen evidence of training undertaken by the Registrant in relation to Resuscitation Council (UK) 2010 Guidelines.

The Panel is of the view that the Registrant’s conduct fell short of what would be proper in the circumstances and breached the following standard of the HCPC’s Standards of Conduct, Performance and Ethics:-
 

Standard 1 – you must act in the best interests of service users

The Panel is of the view that the Registrant had the necessary skills, knowledge and experience and was therefore aware of what was required of him in relation to the appropriate steps to take when cardiac arrest had been recognised. In these circumstances the Panel has concluded that his actions amount to misconduct as opposed to a lack of competence.

Decision on Impairment:

The Panel next considered whether the Registrant’s current fitness to practise is impaired by that misconduct. In reaching its decision, the Panel has referred to the HCPC Practice Note “Finding Fitness to Practise is Impaired” and considered both the personal component and the public component.

In terms of the personal component the Panel is satisfied that the Registrant has demonstrated limited insight into his failings by acknowledging in the course of the Trust investigation. The Registrant stated to Rachel Simpson in interview that “I was preoccupied in trying to get an airway and time just ran away.” However he has not at any point shown remorse for his actions and indeed attempts to blame the family, claiming in his interview that his actions were modified for his own safety due to the behaviour of the patient’s family. As stated above the Panel does not accept that the Registrant and colleague were under physical threat from the family. In addition the Registrant has advised that he is no longer practising as a paramedic and has provided no evidence of his current practice and no evidence of remediation. In these circumstances, the Panel cannot be satisfied that there is no risk of repetition. The Panel is not therefore satisfied that the personal component of his conduct has been addressed.

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 that the public would rightly expect an experienced paramedic to act in accordance with the relevant guidelines and to be able to respond appropriately in cases of cardiac arrest.  In the circumstances of this case, the Panel has concluded that the Registrant still presents a risk to the safety of service users, and that public confidence in the profession and in the regulatory process would be undermined if a finding of impairment was not made.

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

Decision on Sanction:

The Panel has heard from Mr Dilaimi on the issue of sanction and heard and accepted the Legal Assessor’s advice and had regard to the HCPC’s Indicative Sanctions Policy.

The Panel is aware that the purpose of sanction is not punitive and that it should consider the risk the Registrant may pose to those using or needing his services in the future and determine what degree of public protection is required. The Panel has also given appropriate weight to the wider public interest which includes the deterrent effect on other Registrants, the reputation of the profession concerned and public confidence in the regulatory process.

The Panel first considered whether to take no further action and was of the view that this would not be sufficient to mark the seriousness of the incident or to address the risk of repetition, and would therefore be inappropriate.

The Panel has considered the mitigating factors in this case. The Panel heard evidence that the Registrant was an experienced paramedic and this appears to be an isolated incident in the course of a long career.

The Panel has considered the aggravating factors in this case which are that the Registrant has shown no remorse for his actions and limited insight and there is no evidence of remediation.

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. However the Panel does not find that the lapse was of a minor nature. The Registrant was an experienced paramedic who failed to follow Trust Policy and Resuscitation Council (UK) 2010 Guidelines when responding to a cardiac arrest. In addition the Panel has found limited insight and a lack of evidence of remediation resulting in a risk of repetition. In these circumstances a caution would not be appropriate as it would not place any restriction on the Registrant’s practice.

The Panel next considered a conditions of practice order. The Panel has no information in relation to the Registrant’s current circumstances other than his email of 5 January 2015 in which he states that he has no desire or wish to practise as a paramedic at any time in the future. In these circumstances it would be difficult to frame realistic, workable and verifiable conditions.

The Panel next considered a suspension order. In terms of the Indicative Sanctions Policy a suspension order would be appropriate where the allegation is of a serious nature but there is a realistic prospect that repetition will not occur.

While the Panel is of the view that this is a serious allegation and there is currently a risk of repetition, the Panel considers that the Registrant’s failings are remediable. The Registrant is an experienced paramedic and could take steps to address his failings. In these circumstances the Panel has concluded that a Suspension Order would be an appropriate and proportionate sanction which would both protect the public and satisfy the wider public interest considerations. The Panel has determined that a period of one year would be sufficient time to mark the seriousness of the incident and to afford the Registrant an opportunity to remediate his failings and provide evidence of this to a future reviewing Panel, should he choose to do so.

Having determined that a suspension order would be the appropriate sanction in the circumstances of this case, the Panel then considered the sanction of striking off, which is the sanction of last resort for serious, deliberate or reckless acts involving abuse of trust such as sexual abuse, dishonesty or persistent failure. Given that the allegation relates to a single incident in a long career, the Panel has concluded that this would be disproportionate.

Order

The Panel directs the Registrar to suspend the Registration of Mr Colin Williams for a period of one year from the operative date.

Notes

The order imposed today will apply from 2 March 2016.

 

This order will be reviewed again before its expiry on 2 March 2017.

 

 

Hearing History

History of Hearings for Mr Colin Williams

Date Panel Hearing type Outcomes / Status
03/02/2017 Conduct and Competence Committee Review Hearing Struck off
01/02/2016 Conduct and Competence Committee Final Hearing Suspended