Matthew D Holden
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1. On 04 July 2014, attended an emergency call from Service User A, who advised that she felt like causing herself harm, and you:
a. Obtained her personal telephone number;
b. Went to Service’s User A’s house and engaged in sexual intercourse after your shift.
2. Your actions as set out in Paragraph 1 were sexually motivated.
3. The matters set out in Paragraphs 1 and 2 constitute misconduct.
4. By reason of that misconduct, your fitness to practise is impaired.
1. The HCPC had made a Special Measures application, pursuant to Rule 10A of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003, in advance of the hearing to permit the witness, Service User A, to give evidence via videolink from a venue that was closer to her home in Yorkshire. The witness has been assessed as vulnerable by a psychologist. The purpose of the application was to spare her having to travel and having to give evidence in close proximity to the Registrant. This application was not opposed. It was simply a practical means of allowing a witness to be at her ease when giving evidence. The Panel reminded itself that no adverse conclusion should be drawn against the Registrant by reason of the use of this procedure.
2. The Registrant worked as a Band 5 Paramedic at Yorkshire Ambulance Service (YAS) from 3 May 2007 to 28 May 2015. He worked in Accident & Emergency (A&E) Operations in a frontline Rapid Response Vehicle (RRV) attending 999 calls. He worked the 19.00 to 07.00 shift on 3-4 July 2014. In the early hours of 4 July 2014, the Registrant was called to attend Service User A at her home. She is a 22-year-old user of mental health services. The call log shows that he arrived at the scene at 01.24 and left at 01.59. He took Service User A to hospital in his RRV, arriving at 02.18.
3. The Patient Report Form completed by the Registrant states that the Service User A was “feeling stressed + depressed, feels like causing herself harm” and that she had consumed alcohol, including a ¼ bottle of vodka and MCAT (mephedrone), which is a controlled drug. It was also recorded that she had a history of depression and overdoses. When presenting at the hospital at 02.23, she said that she wanted to self-harm and that she was anxious due to her partner’s imminent release from prison.
4. The Registrant said, when interviewed about these matters as part of an investigation by his employer Yorkshire Ambulance Service (YAS) in February 2015, that Service User A had taken his phone from its holder and dialled her number, so that he had her number on his phone. Service User A told the same investigation that they simply exchanged numbers. Notwithstanding this difference, the Registrant accepts that the result was that he obtained her number and that it was on his phone.
5. It was documented that she was under the influence of MCAT at 03.40.
6. Once discharged from hospital, Service User A contacted the Registrant to invite him back to her home. Following completion of his shift, the Registrant attended her address in his own private car. The Registrant and Service User A both admitted that they engaged in unprotected sexual intercourse. The Registrant has never denied this fact during the course of the internal investigation or this hearing.
7. The Registrant’s account is that Service User A subsequently texted him to invite him to her house again, but he made excuses or did not reply. He says he met her again only one more time after she had texted to say that she was pregnant. He asked her what she was going to do, but she became aggressive and he left.
8. The Registrant told the investigators that he was sorry and ashamed. He was experiencing financial and domestic pressures at the time and felt “burnt out”. He acknowledged that he should not have done it.
9. The first disclosure of this incident was made to a social worker on or about 19 January 2015. Service User A alleged that the Registrant was the father of her baby as a consequence of their sexual intercourse on 4 July 2014. The child was the subject to care proceedings in early 2015. The Registrant was suspended by his employer on 12 February 2015. He was interviewed on 24 February 2015 and referred himself to the HCPC in an email dated 2 March 2015.
10. The Panel received undisputed written evidence as to the background facts and the investigation from JW, who works for the Yorkshire Ambulance Service (YAS) Safeguarding Team. She investigated the allegation and interviewed the Registrant in February 2015.
11. JW spoke to Service User A on the telephone on 19 March 2015. Service User A said that they had kissed and swapped telephone numbers in the RRV before she went into A&E. She disputes that she had dialled her number into his phone. She said that the Registrant had visited her about an hour after she arrived back at home and that they had sexual intercourse. She said that he had attended her home on a number of subsequent occasions. Text messages between the parties show that they were engaged in consensual sexual activity.
12. Service User A had not intended to report the Registrant but her social worker had asked for the name of the father in the course of the care proceedings for the child. The Registrant complied with a court-ordered paternity test, which confirmed that he was the father of the child in April 2015.
13. The HCPC has made the following allegation (as amended) against the Registrant:
During the course of your employment as a Paramedic with Yorkshire Ambulance Service NHS Trust:
1. Between 3-4 July 2014, you attended an emergency call from Service User A, who advised that she felt like causing herself harm, and you:
a. Obtained her personal telephone number:
b. Engaged in sexual intercourse with Service User A after your shift.
2. Your actions set out in Paragraph 1 were sexually motivated
3. The matters set out in Paragraphs 1 and 2 constitute misconduct
4. By reason of that misconduct, your fitness to practise is impaired.
14. The amendment to the allegation was of a technical nature, which it is not necessary to repeat here. It did not change the substance of the case. No objection was made to the amendment. The Panel found that there was no prejudice to the Registrant in allowing the amendment.
15. The Registrant admitted all the particulars of the amended allegation as set out above, including misconduct and impairment. Mr Chalmers for the HCPC then opened the facts of the case.
16. Service User A gave evidence via videolink. She confirmed the content of her witness statement in which she stated that she had sexual intercourse with the Registrant after she had been discharged from hospital and after the Registrant had finished his shift. Answering questions in cross-examination, she maintained that she did not dial her number on his phone and she did not push his sleeve up to see his tattoo. When asked to confirm that they had only had sexual intercourse once, she answered “no comment”. In re-examination, she said that they had had sexual intercourse on two occasions.
17. The Registrant gave evidence. He maintained that Service User A had dialled her number into his phone. He accepted that he should have deleted the number or reported the incident. He insisted that they had only had sexual intercourse once. He said that he disliked what he had done and felt disappointed in himself that he had let it happen. He accepted that he had let his profession down. He gave details of his own personal health issues, which it is not necessary to repeat here. The hearing went into private session briefly to hear that evidence.
18. When cross-examined, the Registrant accepted that his profession often placed him in contact with vulnerable service users that he had duty of care towards. He gave his account of answering a call at her home in the early hours of 4 July 2014. He was aware that she was a vulnerable service user under the influence of drugs and alcohol. He said he did not find her sexually attractive. He was asked by the Panel Chair how he could reconcile his evidence of not finding her sexually attractive with his admission that his actions were sexually motivated, and with the explicit sexual content of the text messages, but he had difficulty in answering that point.
Decision on Facts
19. The Panel heard submissions from the parties and accepted the advice of the Legal Assessor. The essential facts, as set out in the particulars 1(a) and 1(b) of the allegation, were not in dispute and the Panel found them to be proved to the required standard. The Panel also found that the Registrant’s conduct was sexually motivated, as alleged in the second particular of the allegation. In view of those findings, there was no need to determine subsidiary issues of fact, such as how the Registrant obtained Service User A’s number or whether they had sexual intercourse once or twice.
Decision on Grounds
20. The Panel also found that the facts as alleged amount to misconduct. This was a clear and compelling case of breaching professional boundaries that fell well below what was to be expected of a Paramedic in the performance of his professional duties. It was of little or no consequence that the actual sexual intercourse had occurred when he was off-duty, shortly after the Registrant had finished his shift.
21. The Registrant was legally represented by counsel and presumed to be fully and properly advised in making the admission of misconduct at the start of the hearing.
22. The Panel found that the Registrant’s conduct was such as to breach standard 1 (acting in the best interests of service users), standard 3 (keeping high standards of personal conduct) and standard 13 (behaving with honesty and integrity and making sure that your behaviour does not damage the public’s confidence in the profession) of the HCPC Standards of Conduct, Ethics and Performance. The conduct also breached standard 2 (practice within the legal and ethical boundaries of the profession) of the HCPC Standards of Proficiency for Paramedics.
Decision on Impairment
23. The Panel found that the misconduct was such as to impair the Registrant’s fitness to practise as a Paramedic. The Panel reminded itself of the public component in Cohen v GMC  EWHC 581: “the need to protect the individual and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect…and that the public interest includes, amongst other things, the protection of service users and the maintenance of public confidence in the profession.” It was beyond dispute that the Registrant’s conduct breached proper standards of conduct and that it brought his profession into disrepute. Any other finding would damage confidence in the profession and in the regulator.
24. The Panel was also concerned about the Registrant’s lack of insight. It was apparent from the history of the investigation that he was at one stage blaming Service User A, at least in part. He had not reported his misconduct to his employer or his regulator at the time. It would probably have remained undiscovered, but for the fact that Service User A became pregnant with his child and had to report the matter when she was subject to family care proceedings some six months later in January 2015. When giving evidence, the Panel noted that the Registrant had to be prompted to recognise the impact upon Service User A and their child. For all those reasons, the Panel finds that there remains a risk of repetition of this conduct, with consequent risk of harm to other service users, and finds that his fitness to practise is impaired on both personal and public grounds.
Decision on Sanction
25. The Panel heard submissions from the parties and accepted the advice of the Legal Assessor. The Panel also considered the helpful guidance in the HCPC Indicative Sanctions Policy. This case concerned a serious breach of professional boundaries for which a Caution Order was wholly inappropriate. Public confidence in the regulator would be damaged if such a sanction were imposed.
26. A Conditions of Practice Order was not workable or verifiable because the Registrant had been dismissed from his employment and he no longer worked as a Paramedic. The issues in this case concern the attitude and insight of the Registrant, rather than his clinical competence or performance. The Panel also considered that such an order would not meet the gravity of the case or protect the public.
27. Counsel for the Registrant had conceded in her submissions that this was a case in which the Panel was presented with a difficult choice between suspension and striking off. The Panel agrees that that was a fair and realistic assessment of the position.
28. The Panel therefore considered the aggravating and mitigating features of this case. On any view, this was a grave breach of professional boundaries and trust. The magnitude of the consequences for Service User A and Child A was a significant aggravating factor. The Panel also found that the lack of insight and the consequent risk of repetition was so serious that public confidence in the profession would be severely undermined if the Registrant were allowed to continue in practice.
29. The Panel noted the particular vulnerability of Service User A and the age gap between her and the Registrant. Service User A presented as young and immature when she gave evidence. She was also potentially suicidal and under the influence of drugs and alcohol at the time of the event.
30. The Registrant had many opportunities to have acted differently. He could have deleted or blocked Service User A’s phone number. He had time and space to reconsider his actions before he went to Service User A’s house. This was a premeditated act on his part.
31. The Registrant met Service User A whilst he was performing his professional duties as a Paramedic. He made no declaration of what he had done until he was compelled to do so by the start of the family proceedings in respect of Child A.
32. The Panel was troubled by the conflict between the Registrant’s expressions of immediate remorse and regret for what he had done and the fact that he had continued to actively engage in intimate text message contacts with Service User A after having had sexual intercourse with her.
33. The Panel gave due weight to the personal mitigating factors in this case. The Registrant had an unblemished career until this episode. This was a one-off incident and he had shown some remorse since the incident. The Panel noted the references and testimonials that were presented on his behalf. The Panel was also mindful that the public should not be permanently deprived of the benefit of a trained and experienced Paramedic unless it was necessary for reasons of public protection. The Panel did not regard the financial and domestic pressures upon the Registrant as amounting to any mitigation in the circumstances.
34. The Panel finds that the Registrant has shown insufficient understanding and insight. He was unable to say why he behaved as he did, and he failed to convince the Panel that he has the strength of will to resist repetition if similar circumstances were to arise again. An order of suspension would not protect the public in the circumstances.
35. The Registrant made a decision that amounted to a serious and deliberate breach of trust, with reckless disregard for the consequences. This was a major transgression of professional boundaries with a vulnerable service user. An order that the Registrant be struck off the Register of Paramedics provides the only protection for the public in such circumstances. The Panel is mindful that striking off is a sanction of last resort, but it is a necessary measure to protect other service users. Public confidence in the profession and in the regulator would be undermined if any lesser sanction were imposed.
That the Registrar is directed to strike the name of Matthew Holden from the Register on the date this order comes into effect.
History of Hearings for Matthew D Holden
|Date||Panel||Hearing type||Outcomes / Status|
|24/05/2016||Conduct and Competence Committee||Final Hearing||Struck off|