Mr Jeffrey D Hartopp

Profession: Paramedic

Registration Number: PA00709

Hearing Type: Review Hearing

Date and Time of hearing: 09:00 14/07/2016 End: 12:00 14/07/2016

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via tsteam@hcpts-uk.org or +44 (0)808 164 3084 if you require any further information.

 

Allegation

During the course of your employment as a Paramedic at East Midlands

Ambulance Service NHS Trust:

 

1. On 28 November 2013, you attended Patient A* and you:

 

a) Did not adequately complete the Patient Report Form (PRF) in that you did not record the:

 

i. Incident number;

ii. Times of the job;

iii. Call times;

iv. Patient’s age;

v. Patient’s ethnicity;

vi. Patient’s consent to treatment;

vii. Respiratory rate;

viii. Rationale for leaving Patient A* at home with a neighbour when she was suspected of suffering from a neck of femur injury;

ix. Patient’s medications and/or medical history.

 

b) Did not adequately complete the PRF in that you recorded only one set of observations for Patient A*.

 

c) Failed to carry out an adequate assessment of Patient A* in that you:

 

i. Did not carry out a trauma examination to exclude medical causes for the patient’s fall or collapse;

 

ii. Did not carry out a head, neck and back assessment.

 

d) Did not act in Patient A’s best interests, in that you left Patient A* at home with a neighbour instead of waiting until the Double Crewed Ambulance arrived to convey her to the hospital;

 

e) Did not provide Patient A* with adequate care and treatment in that you did not treat Patient A* for her injuries and/or give her pain relief.

 

2. On 28 November 2013, you attended Patient B*, and you:

 

a) Did not adequately complete the Patient Report Form (PRF) in that you did not record:

 

i. The patient’s telephone number;

ii. The patient’s next of kin details;

iii. The contact details of the patient’s next of kin;

iv. The patient’s age;

v. The patient’s gender;

vi. The patient’s ethnicity;

vii. The patient’s consent to treatment;

viii. The patient’s pupil reactivity;

ix. The time of the patient's first symptom;

x. The dosage of the patient’s medication;

xi. The patient’s allergies;

xii. The patient’s state or mind or normal level of communication;

xiii. The patient’s understanding and/or ability to make an informed decision;

xiv. The observations that were taken at 0215 hours;

xv. Your rationale for not transporting the patient to the hospital;

xvi. The clinical impression section of the PRF;

xvii. Whether the Out of Hours GP Service was recommended or declined;

xviii. Your discharge advice;

xix. The signature of the patient or carer;

xx. The patient's results on the AVPU scale.

 

b) Did not provide Patient B* with adequate care and treatment in that you:

 

i. Made a diagnosis of Urinary Tract Infection when the patient’s symptoms suggested possible sepsis;

ii. Did not question the patient’s last oral intake even though she had a blood glucose reading of 10.4;

iii. Did not carry out further investigation when you obtained a GCS (Glasgow Coma Scale) reading of 5;

iv. Did not assess the patient’s breath sounds even though she presented with a respiratory rate outside the normal limits.

 

c) Did not transport Patient B* to the hospital;

 

d) Made inappropriate comments to Patient B* and/or Person C*, in that you said:

 

i. “Don’t worry Patient B*, I’m not touching your tits” or words to that effect;

ii. “Oh well I don’t practice safe sex anyway” or words to that effect.

 

3. The matters described in paragraphs 1 to 2 constitute misconduct and/or lack of competence.

 

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

Finding

Background
1. The Registrant was employed by the East Midlands Ambulance Service (EMAS) as a Bank Paramedic on a zero hours contract in 2013.  He has worked for EMAS for forty years and as a Paramedic in a wide variety of roles from 1993.  Concerns were raised about his clinical practice, record keeping and conduct towards two elderly patients on 28-29 November 2013.  He attended Patient A at her home. Patient A had suffered a fall and was unable to stand. He failed to adequately complete the Patient Report Form (PRF) or to carry out an adequate assessment of her condition (a suspected neck of femur fracture).  He left her in the care of a neighbour for two hours instead of waiting until the ambulance he had requested had arrived to convey her to hospital.  

2. Later in the same shift, he attended Patient B, the resident of a care home who suffered from advanced dementia.  He did not adequately complete the PRF and he made the diagnosis of a urinary tract infection when her condition suggested a possible sepsis, a medical emergency.  He decided not call an ambulance and instead arranged a GP visit. Patient B was subsequently taken to hospital on the morning of 29 November 2013 after an ambulance was requested again.

3. The matter was heard by the Conduct and Competence Committee of the HCPC on 27-31 July and 14 October 2015.  The full particulars of the allegation are set out in the Notice of Decision and Order.  The Registrant accepted that his completion of the PRFs was below standard.  The Panel found that his decision to leave Patient A unattended on the floor for two hours fell well below the standard to be expected of Paramedics. The Panel also found that the Registrant’s failure to identify a possible sepsis fell well below the expected standard in the case of Patient B. He had failed to keep himself up to date with current professional paramedic practice.  The Registrant’s acts and omissions breached standards 1, 5 and 7 of the HCPC Standards of Conduct, Performance and Ethics.  The facts were sufficiently serious to constitute misconduct.

4.  The Registrant is also subject to a Caution Order for misconduct, this is due to expire on 9 November 2016 in respect of inappropriate comments and contacts with a patient in 2009.  The Panel at the final hearing was extremely concerned that the current matter had arisen when he was under a Caution Order for misconduct, albeit of a different kind.

5. The Registrant submitted evidence that he has maintained his professional skills by working part time for a private ambulance company.  He had also undertaken training courses relating to the diagnosis of sepsis and neck of femur fractures as part of his continuing professional development.   The Panel accepted that he was willing to address his misconduct.  However, he had limited insight or understanding of the reasons for his failings identified in the substantive hearing.   There was a distinct lack of rigour in his approach. He failed to demonstrate a proper understanding of the professional obligation to keep himself up to date with the guidance and policies relevant to his practice as a Paramedic.   There was no independent evidence of the quality of his work since November 2013. There are risks to patients from incorrect diagnoses or incorrect treatment. The failure to complete the PRF to the required standard also presents a risk in regard to the continuity of patient care.

6. Accordingly, the Panel found that the Registrant’s fitness to practise was impaired on both the personal and public components.

7. The Panel imposed a Conditions of Practice Order for 9 months.   A Caution Order would not have provided sufficient public protection. The Panel felt that the Registrant could work safety under Conditions of Practice. A Suspension Order or Striking-Off Order were neither necessary nor proportionate.  It was possible that the Registrant could work safely under conditions now that he understands them.

8. The Conditions of Practice were as follows:
1) You must place yourself and remain under the supervision of a workplace supervisor or supervisors, registered by the HCPC or other appropriate statutory regulator.  Direct supervision means you must work alongside a workplace supervisor whenever you are in contact with patients.
2) You must attend upon that supervisor as required and follow their advice and recommendations.
3) You must supply details to the HCPC of your workplace supervisor or supervisors within 7 days of the appointment of the workplace supervisor or supervisors.
4) You must work with your workplace supervisor or supervisors to formulate a personal development plan designed to address the deficiencies in the following areas of your practice:
A. Clinical decision making
B. Risk Management and “red flags”
C. Record keeping.
5) Within one month of the appointment of the workplace supervisor or supervisors, you must forward a copy of your personal development plan to the HCPC
6) You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your personal development plan.
7) You must forward to the HCPC every three months a report from your workplace supervisor about your progress towards achieving the aims set out in your personal development plan.
8) You must promptly inform the HCPC of you cease to be employed / contracted or take up any other or further employment / contracts.
9) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer / anyone contracting with you to undertake professional work.
10) You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application):
C. any prospective employer (at the time of your application).
11) You will be responsible for meeting any and all costs associated with complying with these conditions.
12)  Any condition requiring you to provide information to or obtain the approval of the HCPC is to be met by your sending the information or request for approval to the offices of the HCPC marked for the attention of the Director of Fitness to Practise.

9. The Panel at the first hearing indicated that the Panel reviewing the order would be assisted by up to date reports from the workplace supervisor detailing progress in relation to record keeping and clinical decision making and evidence of reflection on clinical decision making using a recognised reflective model.

This is the first mandatory review of the current Conditions of Practice Order, which expires on 11 August 2016.

10. In advance of this review hearing, the Registrant had written to the HCPC on 26 January 2016 to ask that his name be removed from the HCPC Register. He had paid some £3500 to attend various professional training courses in the previous 18 months.  However, EMAS had declined to re-engage him on his bank contract as he was subject to Conditions of Practice.   He was continuing to work on a sub-contractual or agency basis.   The view of the HCPC was that this request for voluntary removal from the Register was premature and that the matter could be considered afresh at this review hearing.

11. Ms Brzezina for the HCPC outlined the history of the case as described above. She submitted that there had been no compliance with the order or the previous Panel’s expectations thus far.  She suggested that it was only recently that the Registrant had come to terms with the need to comply with the Order.  She therefore submitted that the Conditions of Practice should continue in the present terms for 12 months.  In the absence of any evidence of compliance, Ms Brzezina submitted that the Registrant must be presumed to present a continuing risk to the public, and that his fitness to practise remained impaired.

12. Mr Smith made clear that the Registrant did not wish to pursue his request for voluntary removal.  He did not oppose the Order continuing in some form, but he asked that the Panel amend the supervision conditions of practice at 1) to 7) so as to enable the Registrant to comply with the order whilst doing agency work.   There was no objection to the conditions in principle, but it was submitted that the conditions were only practicable for a Registrant who was in full-time employment.

13. Mr Smith told the Panel that Mr Hartopp has been working for “Hearts First” ambulance service as an ambulance technician undertaking hospital transfers and providing first aid cover as a first responder “paramedic” in a medical team at events. He was employed on a short notice day-to-day basis for up to 20 hours per calendar month, so it was not possible to arrange a Supervisor. 

14. The Panel asked for evidence of CPD or testimonials, a reflective piece or other evidence as to insight, and for some indication as to whether the Registrant was willing to undertake non-Paramedic employment such as an ambulance technician in order to facilitate a return to practice.  An adjournment was granted for Mr Smith to prepare that information on behalf of the Registrant.  

15. The Registrant gave evidence that he had previously approached “Ambvale”, a private ambulance company that contracts with EMAS, and another similar company that is based in Hertfordshire, but neither company was prepared to employ him either as a Paramedic or as an ambulance technician with the existing Conditions of Practice in place. His job title when he undertakes ambulance transfer work is ambulance technician.  

16. When working at events, he works as part of a first aid team, in which he does some work as a first aider and also as an ambulance technician.  He has also worked as a Paramedic but only when working with another Paramedic and under supervision. The work requires him to undertake some diagnosis.  

17. The Registrant gave evidence [in private session] about his health.   He had been subject to stress and anxiety as a result of this regulatory process and he had suffered a collapse. He underwent various tests and no diagnosis was given, he has no further occurrences of collapse.  His health was now much improved.  He was on medication for type 2 diabetes, high cholesterol and hypertension, but he was confident that he could work as a Paramedic without adversely affecting his health.

18. When working at events, the Registrant was able to e.g. undertake blood sugar testing and administer glucose as an ambulance technician.  When working on transfers, he worked with an ambulance technician. He now accepts that he could develop a working relationship with another employee or former employee who is a registered Paramedic with the HCPC to act as his Supervisor or Mentor.

19. When questioned by the Panel, it became clear that the Registrant had thought that he would have to be engaged as Paramedic in order to carry out the previous Conditions of Practice.  However, under questioning, he accepted that he could apply for work as an Ambulance Technician under the supervision of a Paramedic.   He had not previously realised that he could have done that.

20. The Registrant was asked if he had read paragraphs 90-91 in the determination of the previous hearing (the guidance as to how a future review Panel may be assisted). He said that he had read it only briefly and he had not really absorbed its meaning.  He confirmed that he now understood what was required from a reflective piece. 

21. He was asked if he understood the purpose of the Conditions of Practice Order.  He said it was to make sure that he understood what had happened and what he had done wrong.  He was reminded that patient safety was the prime focus of the Panel’s deliberations.  He accepted that he had not considered that as fully as he should have done.

22. In closing submissions, Ms Brzezina maintained that the current Conditions of Practice Order should remain in place for a further 12 months.   Mr Smith invited the Panel to have regard to the fact that the Registrant had engaged in the process and asked the Panel to impose conditions that were practicable.

Decision
23. Before reaching its decision, the present Panel considered the advice of the Legal Assessor.  The Panel reminded itself that its task was not to rehear the facts of the case, nor to go behind previous findings, but to conduct a thorough appraisal of whether the Registrant was fit to return to unrestricted practice.

24. The Panel considered that there was no significant change in the circumstances since the last hearing in terms of the assessment of risk.   There was positive evidence of the Registrant attending CPD courses, but the Registrant had not been able to find work that would enable him to comply with the Conditions of Practice Order.  The Panel was therefore not in a position to assess whether he had gained any further insight or whether he was ready to return to the strains of full-time practice.  In the absence of any such information, the Panel’s view was that the Registrant posed a continuing risk to patients and that his fitness to practise remained impaired.
Sanction

25. In deciding the appropriate sanction at this stage, the Panel had regard to the advice of the Legal Assessor and the Indicative Sanctions Policy of the HCPC. The matter was too serious for the Panel to take no action or to consider a Caution Order.

26. The Panel considered that the Registrant should be given a further opportunity to demonstrate his commitment to a return to practice in the light of his now realisation that he could have sought employment as an Ambulance Technician under the supervision of a registered Paramedic.   It was not necessary to consider any more restrictive order at this stage, because a Conditions of Practice Order should provide the necessary protection to the public in this case.

27. A Conditions of Practice Order for a further 12 months was necessary to ensure a safe return to practice by the Registrant.  The Order is in similar terms to the previous Order, subject to amendments.

28. A future reviewing Panel may be assisted by the following:
a. Up to date report from your workplace supervisor or mentor detailing progress in relation to record keeping and clinical decision making;
b. The submission to the HCPC of a reflective piece on clinical decision making using a recognised reflective model such as that by Gibbs or Kobh;
c. Evidence of progress in relation to record keeping and clinical decision making.

Order

Order: A Conditions of Practice Order for a period of 12 months
The order imposed today will apply with immediate effect.

1. You must place yourself and remain under the supervision of a workplace supervisor or supervisors, registered by the HCPC or other appropriate statutory regulator.  Direct supervision means you must work alongside a workplace supervisor whenever you are in contact with patients.

2. You must attend upon that supervisor or supervisors as required and follow their advice and recommendations.

3. You must supply details to the HCPC of your workplace supervisor or supervisors within 7 days of the appointment of the workplace supervisor or supervisors.

4. You must work with your workplace supervisor or a mentor, who must be registered with the HCPC as a Paramedic, to formulate a personal development plan designed to address the deficiencies in the following areas of your practice namely:
A. Clinical decision making
B. Risk Management and “red flags”
C. Record keeping.

5. Within one month of the appointment of the workplace supervisor or mentor, who must be registered with the HCPC as a Paramedic, you must forward a copy of your personal development plan to the HCPC

6. You must meet with your workplace supervisors or a mentor, who must be registered with the HCPC as a Paramedic, every two months after their appointment to review your progress towards achieving the aims set out in your personal development plan.

7. You must forward to the HCPC every three months a report from your workplace supervisor or mentor, who must be registered with the HCPC as a Paramedic, about your progress towards achieving the aims set out in your personal development plan.

8. You must promptly inform the HCPC if you cease to be employed / contracted or take up any other or further employment / contracts.

9. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer / anyone contracting with you to undertake professional work.

10. You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application)
C. any prospective employer (at the time of your application).

11. You will be responsible for meeting any and all costs associated with complying with these conditions.

12.  Any condition requiring you to provide information to or obtain the approval of the HCPC is to be met by your sending the information or request for approval to the offices of the HCPC marked for the attention of the Director of Fitness to Practise.

Notes

The order imposed will apply with immediate effect.

Hearing History

History of Hearings for Mr Jeffrey D Hartopp

Date Panel Hearing type Outcomes / Status
14/06/2017 Conduct and Competence Committee Review Hearing No further action
14/07/2016 Conduct and Competence Committee Review Hearing Conditions of Practice
14/10/2015 Conduct and Competence Committee Final Hearing Conditions of Practice