Mr Simon Williams
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In or around December 2014, during the course of your employment as a Paramedic by East of England Ambulance Service, you:
1. Posted photographs and comments on Instagram, which breached patient confidentiality, including photographs:
a. of patients;
b. containing patients' medical information;
c. containing patients' personal details.
2. Posted inappropriate photographs and comments on Instagram, which related to your operational duties.
3. The matters set out in paragraph 1 - 2 constitute misconduct.
4. By reason of your misconduct your fitness to practise is impaired
1. The Panel concluded that, in accordance with the HCPC’s procedural Rules the Notice of Hearing letter dated 4 April 2016 had been served in time, to the Registrant’s last known registered address and it stated the date, time and venue of this hearing. Thus, the Panel concluded that there has been good service of this hearing on the Registrant.
Proceeding in private
2. The Panel noted Mr Dilaimi’s submission in relation to proceeding in private when necessary. The Panel accepted the Legal Assessor’s advice and paid regard to the HCPC’s Practice Note on Proceeding in Private. The Panel concluded that the matters relating to the Registrant’s and any witness’ private and family life, for example, relating to health, in any part of this hearing, it would be fair and proportionate to allow those parts of the hearing and any documentation relating to those issues to be in private. The Panel concluded that the default position of all hearings to be held in public should be maintained and that primarily, this hearing should be in public, but should go into private session(s) if confidential and sensitive health matters about the Registrant and the witness and/or their families were to be raised.
Proceeding in Absence
3. The Panel noted the submission of Mr Dilaimi. It accepted the advice of the Legal Assessor and exercised the principle of proportionality. The Panel paid regard to the HCPC’s Practice Note on Proceeding in Absence. The Panel took into consideration that the Registrant has emailed the HCPC twice on 31 March 2016 and on 3 April 2016, both in response to an email, each time from the HCPC. In the Panel’s opinion, the Registrant’s responses were prompt and in articulate terms, stating that he did not wish to attend on health grounds and he expressly asked for the hearing to proceed without him and that he will await the outcome by email/letter. The Registrant did not request an adjournment in either email.
4. In the Panel’s judgement, the Registrant’s emails are concise, clear and were returned promptly. Therefore, the Panel concluded that the Registrant had the ability to make a decision on whether or not to attend this hearing. In the Panel’s judgement the Registrant has decided not to attend and did so of his own free will. Thus, the Panel concluded that the Registrant has decided voluntarily to be absent from this hearing and the Panel concluded that if the hearing was to be adjourned, it would be highly unlikely that the Registrant would attend on any future date. The Panel determined that there was a public interest need to have this case heard promptly as the allegation is over eighteen months old. In the Panel’s judgement, there was adequate and detailed information about the Registrant’s stance on the case from the papers before the Panel. For these reasons, the Panel determined that it would be fair, proportionate and in the interests of justice to proceed in the Registrant’s absence.
Amendment to the allegation
5. The Panel concluded that the amendment sought by the HCPC is entirely fair and proportionate as it reflects the evidence that the Registrant has received and is only a grammatical correction; an apostrophe. The Panel determined that the amendment makes the Allegation less ambiguous and is not prejudicial to the Registrant.
6. The Registrant was employed by East of England NHS Foundation Trust (the Trust) from 2004. He had been an Emergency Medical Technician initially, then became a Paramedic on 28 October 2008. By the end of 2014, when the allegations arose, the Registrant had over 11 years’ service with the Ambulance Service and 6 years as a Paramedic.
7. The Registrant had an Instagram account. This is a social media application for people to share photos and add comments if desired. A post is generally completely public and people do not have to enter another person’s account so as to access any one person’s photographs and comments. The other way to access these is by hashtags and in this case the Registrant has used many of those. The date the post was likely to be made by the Registrant can be referenced by the letter “W” on the individual photographs with a number, indicating the time between when the Trust reviewed these matters and when the photograph was posted by the Registrant, which was generally a period of between two and four weeks.
8. The Registrant had his own company, with its own website. Its purpose was to sell jewellery online. The Allegation related to the Registrant’s inappropriate posting of photographs and comments on his Instagram account. These had a number of “likes” on them, indicating that some members of the public had seen them and formed an opinion of them.
9. In or before December 2014, the Registrant took and then posted on Instagram 24 photos, which could be fully accessed by the public. He stated that he did so with the intention of getting more visitors to his jewellery website, which had been struggling. Some patients and patients’ medical conditions were identified from the Instagram posts and most of the Registrant’s posts related to his operational duties as a paramedic. The employer did not know of these initially, but became aware of them on or about 11 December 2014. The Trust received a Tweet via Twitter from a member of the public, who stated that they were “not impressed” and provided a link to the Registrant’s Instagram posts.
10. The Trust decided to investigate the matter and on 12 December 2014 the Registrant was asked to engage in the investigatory process.
11. On 1 January 2015 more graphic pictures of patients being attended to were discovered by Colchester Hospital. It felt that the Registrant’s Instagram posts brought the Trust hospital into disrepute and had breached patient confidentiality. It communicated to the Registrant’s employing Trust that the posts had shown their own Trust in a negative light and may have damaged the reputation of that Trust.
12. The Registrant’s employing Trust had a “Use of Digital Media Policy” that included employees not revealing any information about patients or incidents, not bringing the Trust into disrepute, not posting derogatory or offensive comments on the internet and not posting if angry. The Policy also stated that there should be no posting of photographs or imagery on digital media during work time without permission. In the Registrant’s case, the Instagram account was his own private social media account and the name and link related to his own jewellery company. The Trust assumed that the Registrant had been trained on Information Governance at the Trust, but he stated in his disciplinary interview on 30 January 2015 that he had not known of the Digital Media Policy at the time of the events.
13. During the 30 January 2015 interview, when the Registrant was interviewed in depth by the Trust, the Registrant made many admissions relating to his conduct, including that he had taken the photographs, or if not, had downloaded them from elsewhere and had posted them on his Instagram account and did so to promote his jewellery business. He took them all down from his Instagram account shortly after he received notice that the Trust were taking the matter further. The Registrant stated that at the time of the events, his thought processes were that, as these matters related his personal life, it was not something that he acted upon with any diligence and that he had “not thought it through”. He stated at interview that he knew and understood now (at the interview) the consequences of his acts, but not at the time and he stated that he had been “stupid”.
14. The following are examples of the pictures posted by the Registrant on his Instagram account and the subject of the Allegation:
• A photograph of extensive blood on a floor, with a comment about it being a “bloodbath” and reference to the geographic area, and the diagnosis, age and sex of the patient involved;
• Another photograph of extensive blood on a floor relating to, what the Registrant commented underneath it as, a “stabbing”, but by the Registrant’s own admission in his Trust interview, it was not a stabbing and he had “glamourised” the event on the grounds that if the photo was dramatic, it might engender more public interest in his jewellery company.
• A photograph of the ambulance’s Mobile Data Terminal, in which a patient’s address and personal details are visible. He said, at interview, that he did not think it through at the time.
• In another photograph, the Registrant identified the hospital in which he took it. He stated in his Trust interview that he did it to show how busy the unit was and that he hoped it would stop the public dialling 999 so frequently for poor reasons.
• Another photograph showed a patient being stented following a myocardial infarction (a heart attack).
• The Registrant downloaded another photograph of a car collision with the comment “got to laugh sometimes”, which he agreed in his Trust interview was cruel and inappropriate.
• Another photograph was of a patient’s ECG in ventricular fibrillation. He redacted the patient’s name, but posted it on his Instagram account with the word “whoops” and agreed at the Trust interview that it was an inappropriate comment.
• Other photographs showed police officers and the Registrant knew that this might place the officers at risk of identification.
• A photograph showed a patient on the floor of an ambulance and the word “idiot” to describe the patient. The Registrant stated in the Trust interview that he realised at the interview that it could bring his Trust into disrepute. He said his post reflected 18 years of frustration at the public’s misuse of the emergency services and Accident and Emergency Departments.
• A photograph of a street scene had derogatory words about a drunken “idiot” who had damaged his vehicle. He appreciated in interview that this could have offended the public reading it.
• A photograph that had a graphic description of a 95 year old patient’s condition and the Registrant has added “lol”. He justified it at the Trust interview by stating that the patient had been out shopping the week before and that the Registrant was trying to communicate that this patient would live for a long time. He agreed in interview that this would have a different effect to vocalising such a comment in humour.
• A photograph showing a lorry collision that the Registrant was apparently attending and had the words “no one dead on this one” in the comments’ section underneath. He stated in interview that he realised that the victim of the collision would feel bad if they had read the words.
• A “selfie” photograph taken by himself, where in the comments section below the photograph, it stated that the Registrant, who admitted that it was a “selfie”, was about to participate in surgery “on a female appendectomy”. He agreed at interview that it looked “bad”.
15. The Registrant agreed at interview that the Instagram posts he had made were offensive, frightening and highly unprofessional. He stated that he had not thought that at the time of the events, as he had considered, being his own Instagram account and linked to his own jewellery business, that it was unrelated to his professional roles. When asked, he agreed that the patients and relatives depicted in these photographs would be “very annoyed”.
16. The HCPC’s case also highlighted that, although the Registrant had demonstrated some insight into the use of Instagram and the effect on his employer and on the profession, he had not shown any insight into the effect on hospital Trust staff and the hospital. He seems not to have appreciated that, even at the interview. Hospital staff reported their offence at the posts and the hospital raised it with the Registrant’s employing Trust on various occasions.
17. In his Trust interview, the Registrant admitted that he had taken photographs and posted some whilst on duty during his shifts. He assured the Trust that they had been removed from Instagram. The HCPC contended that the Registrant had provided no mitigating circumstances in the interview, or at any time in this process.
18. The Registrant stated in his Trust interview that he had no malicious intent at the time, but he knew then that he had “crossed way too many lines”. He stated that he would never do it again, either taking the photographs on duty and of, or related to, work subject matter or posting them on any social media. He stated that he was genuinely sorry and relieved that the Allegation did not relate to clinical care, as “that would have been awful”.
19. The Trust referred the case to the HCPC.
20. The HCPC’s case is that the facts found proved amount to a serious breach of professional standards as identified in the following paragraphs of the HCPC’s Standards of Conduct, Performance and Ethics (The Standards):
Standard 1, - you must act in the best interests of service users;
Standard 2 - you must not breach confidentiality;
Standard 3 - you must keep high standards of personal conduct;
Standard 13 - you must not damage the public’s confidence in the profession.
21. In addition, the HCPC relied upon the Trust’s Digital Media policy that is a good guide to help understand the approach to digital media and the employee. The HCPC’s case was that the facts found proved amount to misconduct.
22. The HCPC’s case on Impairment was that that there may have been some insight, remediation, remorse and regret on a personal basis by the Registrant, but the public’s confidence in the profession would be seriously undermined if the Registrant would be found not to be impaired. By his misconduct, the Registrant has brought the paramedic profession into disrepute. Therefore, the Registrant’s fitness to practice is impaired on the grounds of misconduct.
Decision on Facts
23. The Panel noted the reason why the HCPC’s one witness was unable to attend and considered it entirely reasonable for him not to be present based upon the legitimate reason that he has given in his email dated 10 March 2016. The Panel gave the evidence in his witness statement the appropriate weight in light of the fact he could not be questioned on it. However, the Panel noted the HCPC’s submission on the comprehensive interview with the Registrant that took place on 30 January 2015, exhibited by Witness 1 in his witness statement.
24. The Panel considered that the interview, in which each photograph was discussed and probed with the Registrant, was excellent evidence of all the Particulars of Allegation. The Panel also took into account that, in the interview, the Registrant admitted all the allegations of inappropriate posting of the photographs and comments on each one about which he was asked in the interview, and upon which the HCPC relies in bringing these Particulars of Allegation.
25. Examples of how that is demonstrated are as follows:
The stem of Particular of Allegation 1:
• The Registrant admitted in his Trust interview that he had posted photographs and comments on Instagram.
• The Registrant admitted that they were inappropriate photographs and comments.
• The Panel made the following findings of fact:
• Particular of Allegation 1a is clearly proved by the photographs and comments on pages 38, 39 and 40 of bundle B - Proved;
• Particular of Allegation 1b is clearly proved by the photographs and comments on pages 42 and 46 of bundle B - Proved;
• Particular of Allegation 1c is clearly proved by the photographs and comments on pages 37, 42 and 46 of bundle B - Proved;
• The Panel noted that the potentially identifiable pictures of patients in various situations and the personal information contained in some of the photographs and comments breached patient confidentiality.
• Therefore, the stem to Particular of Allegation 1 is proved.
Particular of Allegation 2:
This clearly proved by the photographs and comments on pages 33, 34, 39, 42, 43, 44, 45, 46, 49 and 53, which included, for example, images of a great deal of blood and of a child, as well as references to elderly and vulnerable patients - Proved.
Decision on Grounds
26. The Panel considered the facts found proved to be serious and undermined the trust and respect that the public is entitled to have in the paramedic profession. The Registrant took images of patients and their details when they had not given permission to do so and abused that information for his own motives. The panel considered this to be an extremely serious failing in the Registrant’s professional duties to respect patients’ confidentiality and dignity, and which took place over a period of time on more than one occasion. The acts of the Registrant were a serious departure of acceptable paramedic practice. The Registrant, by his actions, has brought the paramedic profession into disrepute and has undermined public confidence in it. The Panel concluded that the Registrant has, by his actions, breached the following Standards:
Standard 1, - you must act in the best interests of service users;
Standard 2 - you must not breach confidentiality;
Standard 3 - you must keep high standards of personal conduct;
Standard 13 - you must not damage the public’s confidence in the profession.
27. For these reasons, the Panel has concluded that the facts found proved amount to misconduct.
Decision on Impairment
28. The Panel was of the view that it was clear from his own interview with the Trust that the Registrant had not fully understood this aspect of his responsibilities as a paramedic at the time of the events. He did not think about the risks and consequences of his actions and considered anything he did as a private individual, as he saw it, to be immune from criticism. This was clearly conduct that was misguided, rash, immature and highly unprofessional and obviously not what would have been expected of a professional. In the Panel’s opinion, the Registrant’s fitness to practise was impaired at the time of the events.
29. The Panel accepted that there was some evidence of insight and remediation in the intervening period and remorse by the Registrant, as shown by his responses in the Trust interview. He had become aware of the Trust’s Digital Media policy by that time, he had expressed his own contrition at the suffering he would have caused the subjects of his posts, had they seen and read them, he had reflected upon the tasteless and offensive nature of his posts and their contexts and he assured the Trust that he would never do this again. He stated that he would not take photographs of service users/patients/the public whilst on duty and/or post inappropriately whilst on duty, or at any time, even whilst off duty. Therefore, on the personal element of impairment, the Panel concluded that it would be unlikely that the Registrant would commit this type of seriously unprofessional behaviour again.
30. However, these were acts that took place within the trusting environment of the Registrant’s employment and whilst he held the trust and confidence of service users and patients and they were actions that were repeated by him on numerous occasions, for his own motives. These were, and remain, extremely serious matters. In the Panel’s judgement, the actions of the Registrant created enduring and repeated images of patients and events of a deeply unpleasant and offensive nature. In addition, the misguided and unintelligent comments made by him combine to create a picture of this Registrant as a highly unprofessional and naïve individual.
31. By reason of his misconduct, the Panel considered that the Registrant has brought the profession into disrepute, and has breached several of the fundamental tenets of the profession. In the Panel’s judgement, the public would be appalled and highly offended if the Registrant were to be declared fit to practise forthwith, when he had covertly taken offensive and graphic photographs of, and relating to, patients/service users and their private and confidential details and posted them on a public social media platform, often with highly inappropriate comments, also without their consent. The misfortune and ill health of the service users was there for all to see, read, and, if so inclined, to ridicule. The Panel considered this conduct to be profoundly unacceptable in any person, and especially so in a Registrant of his seniority and experience.
32. Furthermore, the Panel considered that the serious breaches of confidentiality in this case potentially put the public at risk.
33. For these reasons, the Panel has determined that the Registrant’s fitness to practise was impaired at the time and remains impaired today on the ground of public interest.
Decision on Sanction
34. The Panel noted the submission from Mr Dilaimi and has accepted the Legal Assessor’s advice. It exercised the principle of proportionality at all times. In reaching its decision the Panel was guided by the HCPC’s Indicative Sanctions Guidance.
35. The Panel identified the following aggravating and mitigating factors:
• The Registrant’s Instagram posting was motivated by the promotion of the Registrant’s own jewellery business;
• Use by the Registrant of deeply personal, distressing photographs, including those of vulnerable service users, and offensive, callous, provocative, inaccurate and disrespectful comments of, and about, service users;
• The public nature of the misconduct, where the service users/colleagues/the Registrant’s employer/associated Trusts were exposed to serious breaches of confidentiality;
• The failure of the Registrant to understand the risks and consequences of his acts at the time of the events;
• The Registrant’s lack of insight, even at interview, of the effects of his acts on the hospital Trust;
• The misconduct took place on more than one occasion;
• It took place over several weeks;
• The taking of the photographs and the posting of them took place whilst the Registrant was on duty on many occasions;
• It concerned a breach of trust of the Registrant’s employer;
• It concerned a breach of trust of the service users in, and associated with, the photographs and comments;
• There has been no engagement in this process by the Registrant to explain his current position and/or future plans;
• The Registrant accepted his actions almost as soon as he was challenged by his employer;
• He accepted to his employer that his actions were inappropriate and wrong;
• He expressed regret and remorse;
• He demonstrated some insight and remediation;
• His actions, whilst deliberate, were not malicious;
• His career was relatively long and, until this matter, without problems;
• He admitted most of his actions relatively promptly and acted to rectify the situation quickly.
36. The Panel noted there have been no testimonials or references on his behalf.
37. The Panel considered taking no action, mediation and a Caution Order and rejected these outcomes. The Panel has determined that this case is extremely serious. The Panel has concluded that a Caution Order would not adequately and effectively reflect the inevitable public disapproval of the Registrant’s unacceptable, unprofessional and inappropriate behaviour. For this reason, any of these outcomes would be disproportionate, as not sufficiently marking the Registrant’s significant breaches of the fundamental tenets of the profession found proved.
38. The Panel next considered imposing a Conditions of Practice Order. The Panel noted that there were no findings in this case that related to the Registrant’s clinical practice. The misconduct concerned the behaviour of the Registrant that fell so far below the standards expected of him as a paramedic as to be virtually un-remediable at this stage by any realistic, proportionate and workable conditions. Furthermore, whilst not conclusive to its decision on conditions, the Panel has no information on the Registrant’s present working arrangements, if any. The issues raised by this case require a proportionate and robust marking so as to uphold public confidence in the profession and to protect the public from any further breaches of confidentiality. The Panel has determined that, at this time, a Conditions of Practice Order would not achieve these important aims.
39. The Panel next considered imposing a Suspension Order. The Panel concluded that the aggravating factors heavily outweigh the mitigating factors. The purpose of a Suspension Order is to achieve a sanction in a case where the misconduct falls short of requiring that the practitioner should be permanently removed from the Register, but where a mark of the seriousness of the misconduct must be made. In the Panel’s judgement, this is just that type of case. The Panel considered that where the public has put its trust and confidence in a paramedic and that trust has been violated, as in this case, such a cynical action must be marked by an appropriate sanction in the public interest. The Panel is of the view that the public must have confidence in a vigorous regulatory system that can protect the public when, as in this case, a paramedic has taken advantage of them, when they are in a vulnerable state. In the Panel’s judgement, a Suspension Order achieves this. A Suspension Order will achieve the need to uphold and maintain the public’s confidence in the profession and in the regulatory process and to protect the public from the identified breaches of confidentiality and the commensurate risks of those. It also has the effect of ensuring that the public and the profession understands the profound unacceptability of the Registrant’s behaviour.
40. In addition, the Panel concluded that a Suspension Order would allow the Registrant, if he so choses, to submit to the HCPC, on the Review, evidence of his insight and as to how he has fully reflected on his management of information, information governance, and its applicability to his practice, that he has fully remediated and that he can demonstrate safe and effective practice, so as to be able to return to practice, whether restricted or not, if he so choses.
41. The Panel considered that a Striking off Order would be disproportionate and punitive at this time, as, although the Registrant has been extremely unprofessional, unintelligent and reckless, he had been in safe and effective clinical practice for a number of years prior to these events and he could become again a valuable member of the paramedic profession in the future, should he so chose.
42. The Panel considered that 12 months is a proportionate and appropriate period for the duration of the Suspension Order, as it properly reflects the serious nature of this case, as set out in the reasons above.
43. This must be reviewed before its expiry.
44. Therefore, the Panel has determined that the only proportionate and appropriate sanction is one of a 12 month Suspension Order.
That the Registrar is directed to suspend the registration of Mr Simon Williams for a period of 12 months from the date this order comes into effect.
The order imposed today will apply from 15 July 2016 (the operative date)
This order will be reviewed again before its expiry on 15 July 2017
History of Hearings for Mr Simon Williams
|Date||Panel||Hearing type||Outcomes / Status|
|14/06/2017||Conduct and Competence Committee||Review Hearing||Struck off|
|16/06/2016||Conduct and Competence Committee||Final Hearing||Suspended|