Mark Dunkerley

Profession: Paramedic

Registration Number: PA00479

Interim Order: Imposed on 27 Nov 2015

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 07/11/2016 End: 17:00 15/11/2016

Location: Novotel Glasgow Centre, 181 Pitt Street, Glasgow, G2 4DT

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

Allegation 1:

 

While working as a registered Paramedic for Blue Star Medical Services:

 

1. In or around March 2014, you transported a patient with cardiac problems to Medway Hospital and did not travel with the patient in the back of the ambulance

 

2. On or around 12 March 2014, whilst talking to Colleague A on shift, you used racist language in that you used the words:

(a) “P**i”

(b) “N*****r”

 

3. On 19 April 2014, whilst attending Service User A, you:

(a) Did not perform an adequate physical assessment of Service User A

(b) Did not record adequate observations on the Patient Report Form (“PRF”)

(c) Recorded contradictory information on the PRF in that you recorded that the patient was unresponsive and was speaking in incomplete sentences.

 

4. On or around 18 or 19 April 2014 whilst on a shift with Colleague B you used the following words, or words to the effect of:

(a) “who cares? He/she is just a n*****r” and/or "if they are not white, then it does not matter''

(b) “p****”

(c) “old c**t, just leave him to die”

(d) “split a***” when referring to a woman and/or women

 

5. On 6 August 2014 you were asked to complete essay responses to two questions and you:

(a) Were unable to complete the essay responses to the standard expected of a registered Paramedic

(b) Submitted work which was not entirely your own work

 

6. Your actions described in paragraphs 2(a), 2(b), 4(a) and/or 4(b) were racially motivated

 

7. Your actions described in paragraph 5(b) were dishonest

 

8. The matters described in paragraphs 2, 4, 5(b), 6 and 7 constitute misconduct

 

9. The matters described in paragraphs 1, 3 and 5(a) constitute misconduct and/or lack of competence

 

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

 

 

Allegation 2:

 

While working as a registered Paramedic for Jigsaw Medical Services, on or around 22 August 2015 you attended a patient with respiratory problems (“Service User B”) and you:

 

1. Spent time preparing the ambulance for transit rather than attending to Service User B

 

2. Did not attempt to cannulate Service User B

 

3. Drove the ambulance and did not travel in the back of the ambulance and attend to Service User B

 

4. In relation to the Patient Clinical Record (“PCR”), you did not ensure the information recorded on the PCR was correct

 

5. The matters described in paragraphs 1-4 constitute misconduct and/or lack of competence

Finding

Preliminary Matters:
1. The Registrant was present and represented by Mr Fraser Bryce. He denied the allegation. The case for the HCPC was presented by Ms Rebecca Turner of Kingsley Napley, Solicitors. Ms Turner made an application to amend the allegation by adding a new paragraph 8, as follows: - “The matters described in paragraphs 1 to 7 constitute misconduct and/or lack of competence”. Ms Turner advised that when the two allegations had been conjoined this wording had been omitted in error. Mr Bryce, on behalf of the Registrant, had no objection to this amendment. The Panel therefore agreed to grant the application as it was satisfied that no prejudice was caused to the Registrant and that this had been a typographical error when two separate allegations had been conjoined.

2. In the course of the evidence of AW, Mr Bryce made an application to admit a document which was an extract from the witness’s Facebook page which, in the Registrant’s view, indicated that the witness did not feel strongly about the type of language the Registrant is alleged to have used. Ms Turner, on behalf of the HCPC, opposed the application on the grounds that the document was not relevant as this was a witness of fact who was being asked about what he had heard and seen. Having considered the submissions of both parties and the advice of the Legal Assessor, the Panel refused the application to admit the evidence on the basis that it was not relevant to the matters which the Panel had to determine. AW was a witness of fact only and the matters referred to in the document were not relevant to the decision the Panel had to make in respect of this witness’s evidence.

Background:

3. The Registrant was employed as a paramedic at Blue Star Medical Services (BSMS) from March 2014 to November 2014.

4. A number of complaints were received about the Registrant's behaviour and conduct in and around March 2014. JA, an Ambulance Technician, reported that she had been in conversation with the Registrant when he used the terms "nigger" and "paki". A further concern was raised by AW, a Trainee Ambulance Technician, about the Registrant’s treatment of Service User A.

5. These complaints were investigated by CH, the Director of Operations at BSMS.  He instructed JE, the Head of Education at BSMS to review the incident relating to Service User A. JE reviewed the Patient Report Form (PRF) for Service User A and copies of statements obtained from AW and the Registrant. JE identified that the Registrant had not performed a physical assessment of Service User A and his recording on the PRF was incomplete and contradictory. JE recommended that the Registrant would require further training and education.

6. A disciplinary meeting was held on 21 July 2014 to consider the complaints made against the Registrant. At this meeting it was held that the Registrant should undertake a period of training and education to enable him to practise safely.

7. JE was responsible for delivering a training programme to the Registrant commencing in July 2014. As part of the training, he drafted an action plan with four objectives. During the course of the action plan, JE identified that the Registrant had satisfactorily completed objectives two and four. However he also identified concerns with objectives one and three. For these objectives, the Registrant was required to complete essay-style submissions and reflect on his practice.

8. JE identified concerns with the Registrant’s fourth attempt at completing objectives one and three and was of the view that one of his submissions had been plagiarised. JE tested the Registrant’s submissions on WriteCheck software and also asked an independent examiner to review the Registrant’s work.

9. Due to the concerns about the Registrant submitting sub-standard work, he was invited to take part in a Viva Voce. The Registrant declined this offer, disengaged from the process and resigned from his role in November 2014.

10. In 2015 the Registrant was employed by Jigsaw Medical Services Ltd (Jigsaw) as a Paramedic and was responsible for responding to emergencies and transporting routine patients to hospital. He was the lead clinician when working on the ambulance.

11. On 22 August 2015 BB, an Ambulance Technician for South Central Ambulance Service (SCAS) was called to attend, as First Responder, to Service User B who had breathing difficulties. The Registrant and LZ, an Emergency Care Assistant (ECA) subsequently attended.  BB was concerned that on taking Service User B to hospital the Registrant drove the vehicle and LZ was in the back of the ambulance with the patient who was suffering from breathing difficulties. Following the callout BB completed a Datix incident report form outlining his concerns.

12. RM, the Director of Clinical Services at Jigsaw was asked to review the concerns. He asked the Registrant to provide a statement and from this information he was concerned that the Registrant spent time preparing the ambulance for transit and did not attempt to cannulate Service User B. Following a disciplinary hearing at Jigsaw, the Registrant was asked to self-refer to the HCPC.

Decision on Facts:

13. The Panel heard evidence from seven witnesses on behalf of the HCPC: - CH, who had been employed as Head of Operations for Blue Star Medical Services until November 2014; AW, who was employed as a trainee technician by Blue Star Medical Services in 2014; JE, Head of Education at Blue Star Medical Services from 1 July 2103 until 31 October 2015; JA, a Police Officer for the Metropolitan Police Service who worked as an Ambulance Technician for Blue Star Medical Services from August 2013 to September 2014; LZ, who was employed by Jigsaw as an Emergency Care Assistant in 2015; RM, Director of Clinical Services at Jigsaw Medical Services Ltd and BB, Emergency Medical Technician at Southern Central Ambulance Service. Both RM and BB gave evidence by video link. The Registrant elected not to give evidence before the Panel and asked the Panel to rely on his written submissions and supporting documentation.

Matter 1

Particular 1

14   The Panel heard evidence from CH, who it found to be an honest and credible witness, that in or around March 2014 an ambulance technician reported that he and a number of colleagues had witnessed the Registrant arriving at the Accident and Emergency Department of Medway Hospital. His evidence was that the Registrant was driving the ambulance with a patient suffering from cardiac problems being treated by a trainee ambulance technician. He advised the Panel that he did not obtain any details of the patient and that he was expecting the witnesses to this incident to provide statements but he never received them. He also gave evidence that a trainee ambulance technician could attend to a cardiac patient, if the patient was stable.

15 The Registrant has denied the facts of this particular. The HCPC is relying solely on hearsay evidence and there is no documentation to support this particular. The Panel is not satisfied that the HCPC has discharged its burden of proof and therefore finds this particular is not proved to the requisite standard.

Particulars 2a) and b)

16. The Panel heard evidence from JA who the Panel found to be a credible and reliable witness with no personal interest. This was the first time she had met the Registrant. She gave evidence that whilst on shift with the Registrant on 12 March 2014, he used the words “nigger” and paki” in the course of general conversation in the cab. She reported this to MB, a Team Leader, who then told CH. JA subsequently provided a written statement for CH which the Panel has had sight of together with a copy of the Registrant’s written response provided to CH dated 14 May 2014. The Panel also heard evidence from CH who confirmed that in the course of his meeting with the Registrant, he admitted that he had used the words “nigger” and “paki”.

17. The Registrant has denied the facts of this particular and suggested that JA was not clear in her recollection of the incident during her evidence before this Panel. The Panel accepts that with the passage of time she may not be able to recall the detail.  However she was clear that she was shocked by the language. The Panel has also considered the terms of her statement to CH which was written at a time when her recollection of the incident would have been clear. In addition the Panel accepts the evidence of CH in support of this particular. The Panel has considered the Registrant’s written response to CH, in which he states “I actually said that I would be more politically correct in the future as I realise it’s a far more diverse community down south and I will quickly have to adapt”. Although the Registrant has not made any admissions of fact before this Panel, the Panel is of the view that he accepted he had made these comments in this document dated 14 May 2014.The Panel is therefore satisfied that the facts of particular 2 have been proved on the balance of probabilities.

Particular 3

18. The Panel heard evidence from JE, CH and AW and also had sight of the Patient Report Form (PRF), the Untoward Incident Form completed by CH, AW’s statement dated 22 and 23 April 2014 together with the Registrant’s response dated 27 April 2014. The Panel also had sight of the relevant JRCALC Guidelines.

Particular 3(a)

19. The Panel accepted the evidence of AW who was a credible and straightforward witness who did not try to exaggerate his evidence. The Panel has had sight of the statement he provided to CH two days after the incident and a record of his telephone interview on the 22 and 23 of April 2014. The Panel notes that he has been consistent in his evidence in both accounts and in his evidence before the Panel that the Registrant did not perform a primary assessment on initial contact with Service User A. He said that the Registrant made an assumption that Service User A was drunk. In his written response the Registrant states that he carried out observations in the back of the ambulance on the way to the hospital. However the relevant JRCALC Guidelines provide that a physical examination entails a primary survey to ascertain facts which is then followed by a secondary survey to develop a treatment and transfer/referral plan. Two sets of observations should be taken and recorded as good and safe practice. JE is clear in his evidence that two sets of observations should be recorded. It is also clear from the PRF that the Registrant did not carry out two sets of observations. The Panel is therefore satisfied that the facts of this particular have been proved to the requisite standard.

Particular 3(b)

20. The Panel has accepted the evidence of JE who, in the Panel’s view, was a credible witness with a well-established academic background and also a member of the Working Group on the JRCALC Guidelines. The Panel has had sight of the PRF in which it can be seen that there is only one set of incomplete observations which do not include Service User A’s pupil reaction, blood pressure or pain score. There should have been two full sets of observations. The Panel is therefore satisfied that the Registrant did not record adequate observations on the PRF and finds the facts of this particular proved.

Particular 3(c)

21. The Panel has considered the PRF where Service User A is identified as unconscious with a GCS score of 5 although the verbal element was scored as 2, indicating that the Service User was able to make incomprehensible sounds. The PRF also records a score of 1 in terms of Service User A not responding to pain. In the Registrant’s response to AW’s allegations he states “I could see he was moving and in no danger from the environment we were in.” If this had been the case Service User A would have been responsive to pain.  This is clearly contradictory information and the Panel is therefore satisfied that the facts of this particular have been proved on the balance of probabilities.    

Particular 4

22. The Panel heard evidence from AW which was supported by his statement given over the telephone to CH on 22 and 23 April 2014, a matter of days after the incident and in which he provides detail of the occasions when this language was used. The witness has signed these notes on 25 April 2014 confirming that they are a true record of that interview and this interview is consistent with the evidence he has given to this Panel. The Registrant denies that this incident took place. The Panel accepts the evidence of AW in relation to this matter and finds the facts of this particular proved to the requisite standard.

Particular 5(a)

23. The Panel heard evidence from JE and CH, both reliable witnesses. The Panel also had sight of the Action Plan and the Registrant’s repeated attempts at objectives one and three on which JE had highlighted the areas of concern. The Panel also took account of the WriteCheck reports. The Panel accepted the evidence of JE who said that he had identified significant plagiarism in part of the Registrant’s submissions. The Panel is also satisfied that the level of the assessment was set at the appropriate level for the Registrant and has seen evidence in the form of emails offering support to the Registrant and notes that he was given four attempts to complete his assessments when the normal practice was only two attempts. In addition he was offered a Viva Voce in case his ability in written academic communication was what was lacking. It is therefore clear to the Panel that the Registrant was given every opportunity to complete the assessments to the standard expected of a registered paramedic and was unable to do so. The Panel is therefore satisfied that the facts of this particular have been proved.

24. The Registrant has taken issue with comments in an email exchange between JE and CH when setting up the training exercise, which the Registrant suggests indicate that he was viewed as a problem and it was judged in advance that he would not pass the training. The Panel does not accept that the Registrant is described as being the problem, rather that there was a problem with the Registrant’s behaviour. The other remarks which the Registrant takes issue with were not directed against the Registrant as it was clear that BSMS were not considering sacking him at the time but were hoping to improve his performance.  The Panel finds that JE made every effort to support the Registrant through the process and wanted to ensure that he met the relevant standard required for the protection of those using or needing his services in the future.

Particular 5(b)

25. The Panel accepts the evidence of JE and the results from the WriteCheck software. It is clear from the evidence that the two pieces of work submitted were of very different standards, one of a standard expected of a second or third year university student and the other was of such a poor standard, it bore no relation to the first piece of work. The Registrant, in his representations to the HCPC initially asserted that it was all his own work but then went on to say that he had “copied bits of it into my report as it gave the answers in a more professional way.” The Panel is therefore satisfied that the Registrant submitted work which was not entirely his own work.  

Particular 6

26. Having found the facts of particulars 2(a), 2(b), 4(a) and 4(b) proved, the Panel next considered whether the Registrant’s comments were racially motivated. The Panel heard from JA that she could not recall the particular context of the comments referred to in particulars 2(a) and 2(b). Having considered the Registrant’s written response to CH, the Panel has concluded that he did not appear to have an understanding that these comments were offensive and inappropriate. In these circumstances, the Panel does not accept that they were racially motivated.

27. The Panel next considered the comments contained in particular 4(a) which suggest that a different standard of treatment would be acceptable for particular groups of Service Users. The Panel has concluded that these comments were racially motivated given that they indicate a view that Service Users from a particular ethnic background should be treated differently by virtue of the colour of their skin.

28. The Panel also considered whether the term “packy” in particular 4(b) was racially motivated. The Panel is aware that this comment was made a month after the same term had been used in the course of conversation with JA. Following that incident on 12 March 2014, the Registrant’s employers commenced an investigation and he was made aware that this term was racist and inappropriate. Having repeated this language, the Panel is satisfied that the Registrant was clearly aware that it was racist and is therefore satisfied that using the term “packy” in those circumstances was racially motivated.

29. In the course of his cross-examination, the Registrant’s representative suggested that AW only made this complaint after JA made her complaint.  In her evidence JA did not appear to know who AW was. The Panel does not accept the suggestion that there may have been collusion between these two witnesses.

Particular 7

30. The Panel has applied the two stage test for dishonesty. The Panel has first considered whether what was done was dishonest by the standards of reasonable and honest paramedics and if the Registrant in fact realised by those standards that what he was doing was dishonest. The Panel has found that a paramedic submitting work which was not entirely his own work would be considered dishonest by the standards of reasonable and honest paramedics. The Panel next considered whether the Registrant in fact realised that what he was doing was dishonest by those standards. The Panel accepts that the assessment was largely cut and pasted and influenced by advice from others. However, the Panel is not satisfied that the Registrant in fact realised that what he was doing was dishonest. Rather, the Panel is of the view that the Registrant had a persistent lack of understanding of what was required of him, despite the continued support and advice given to him by JE throughout his repeated attempts. The Panel has therefore found that the Registrant’s actions in particular 5(b) were not dishonest.

Matter 2

Particular 1

31. The Panel heard evidence from BB and LZ in support of this particular. The Panel was of the view that BB was a straightforward witness whose evidence was measured and fair. In relation to LZ, the Panel found his evidence to be at times inconsistent and where his evidence conflicted with that of BB, the Panel preferred the evidence of BB. Both witnesses gave evidence that the Registrant left the scene and went to the ambulance to obtain a chair for Service User B’s removal to the ambulance. In his written submissions dated 2 September 2015 the Registrant states that he decided to go and get the vehicle ready and bring the chair and blanket for removal to the ambulance. BB also gave evidence that it was acceptable for the Registrant to go and fetch the chair from the ambulance. The Panel is therefore not satisfied on this evidence that the Registrant spent time preparing the ambulance rather than attending to Service User B. At this point, Service User B was being cared for by BB, the First Responder. The Panel is not satisfied that this particular has been proved by the HCPC.

Particular 2

32. The Panel accepted the clear evidence of BB that the Registrant did not cannulate Service User B. In his email to the HCPC dated 24 November 2015, the Registrant confirms that he did not cannulate Service User B, stating that it was not a requirement with a service user suffering from Dyspnoea. The Panel is therefore satisfied that as a matter of fact the Registrant did not cannulate Service User B. While the Panel is aware that there are no set guidelines in relation to this matter, the Panel accepts that Service User B’s condition had deteriorated and IV access should have been obtained for the management of possible further deterioration. RM was clear in his opinion as a paramedic that Service User B should have been cannulated. The Panel found RM to be a reliable witness. The Panel accepts that it is a matter of judgement for the paramedic as the senior clinician on the scene whether or not to cannulate the service user. However, it is clear to the Panel that in this case the Registrant, as the lead clinician, was not in a position to make a proper judgement as he himself had not assessed Service User B at any time. 

33. The Panel therefore finds the facts of this particular proved to the requisite standard.

Particular 3

34. The Panel accepted the evidence of both BB and LZ that the Registrant drove the ambulance and did not travel in the back of the ambulance and attend to Service User B. In his interview with RM on 12 September 2015, the Registrant also accepts that he drove the ambulance and appears to accept that it was unacceptable to do so, stating that he had made an error of judgement. The Panel is therefore satisfied that the facts of this particular have been proved.

35. In the course of the evidence there has been some discussion as to the status of LZ and whether he was a trainee technician or an ECA. The Panel is of the view that it was not clinically safe to have LZ travelling in the back of the ambulance as Service User B was having ongoing treatment and receiving assisted ventilation by way of a Bag Value Mask. The Registrant had not conducted any assessment of Service User B and therefore did not know if it was clinically safe for LZ to travel in the back of the ambulance. The Panel’s view in this regard remains the same, regardless of whether LZ was a trainee technician or an ECA.

Particular 4

36. In his interview with RM on 12 September 2015, the Registrant accepted that he did not write the PRF for this Service User and that he did not see the PRF as no treatment or drugs were administered by him. The Panel has heard evidence from LZ that the majority of the writing on the form is his. BB has also confirmed that he completed the primary observation sections on the form and then handed the form to the Registrant when he arrived on scene as he was the lead clinician. The Panel is of the view that as the Registrant had not assessed Service User B himself, he could not know if the information recorded was correct or not. Having had sight of the PRF, the Panel can see that it is incomplete and poorly written, the section relating to the second set of observations has not been completed and other parts of the form have not been ticked or circled. As the lead clinician, the Registrant was responsible for ensuring that the information recorded on the form was correct. The Registrant has failed to do so and the Panel finds the facts of this particular proved on the balance of probabilities.

Decision on Grounds:

37. The Panel next considered whether the Registrant’s actions in particulars 2,3,4,5 and 6 (Matter 1) and particulars 2, 3 and 4 (Matter 2) amount to misconduct and/or lack of competence. The Panel is aware that this is a matter for its professional judgement.

38. The Panel considers that the Registrant’s actions in submitting work that was not entirely his own work as set out in particular 5(b) (Matter 1), does not amount to either lack of competence or misconduct. The Panel has found that the Registrant had a persistent lack of understanding of what was required of him in the written assessments. The Panel is of the view that this lack of understanding is not sufficiently serious to amount to either a lack of competence or misconduct.

39. The Panel is of the view that the Registrant’s inability to complete the essay responses contained within particular 5(a) (Matter 1) amount to a lack of competence as, despite repeated efforts and ongoing support, the Registrant was unable to produce work of a standard expected of a registered paramedic. The Panel is of the view that the Registrant lacked the necessary knowledge and skills to complete these assessments to the required standard and his failure in this regard amounts to a lack of competence.

40. The Panel is of the view that the Registrant’s conduct in particular 5(a) breached the following standards of the HCPC’s Standards of Proficiency for Paramedics:-

Standard 1a.8
- You must understand the obligation to maintain fitness to practise
- You must understand both the need to keep skills and knowledge up to date and the importance of career-long learning.

41. The Panel next considered the Registrant’s conduct in relation to the use of racist and inappropriate language as found proved in particulars 2, 4 and 6 (Matter 1). The Panel is of the view that such language is inappropriate in any setting and particularly so in a health care setting, albeit not in the presence of service users. The Panel therefore finds that particulars 2, 4 and 6 (Matter 1) amount to misconduct.

42. The Panel considers that the Registrant’s failures in relation to the assessment and treatment of patients and the completion of patient records as set out in particular 3 (Matter 1) and particulars 2, 3 and 4 of (Matter 2) did not arise as a result of a lack of knowledge or skills on the part of the Registrant, given his many years’ experience in these areas. The Panel is of the view that the Registrant had the necessary skills, knowledge and experience in these areas and his conduct does not therefore amount to a lack of competence as opposed to misconduct.

43. In the Panel’s view, the conduct found proved in particulars 3 (Matter 1) and particulars 2, 3, and 4 (Matter 2) are serious breaches of basic and fundamental responses to patients and in the duty of care to junior colleagues. Taking all of these matters into account, the Panel is satisfied that the Registrant’s conduct in these particulars amounts to misconduct.

44. The Panel is of the view that the Registrant’s conduct in these particulars fell well short of what would be proper in the circumstances and breached the following standards of the HCPC’s Standards of Conduct, Performance and Ethics:-
  Standard 1 - You must act in the best interests of service users.
 Standard 3 - You must keep high standards of personal conduct.
 Standard 5 - You must keep your professional skills up to date.
  Standard 7 - You must communicate properly and effectively with service users and other practitioners.
  Standard 8 - You must effectively supervise tasks you have asked other people to carry out.

Decision on Impairment:

45. The Panel next considered whether the Registrant’s current fitness to practise is impaired by that misconduct and lack of competence. In reaching its decision the Panel has considered both the personal component and the public component.

46. In terms of the personal component, the Panel is the view that the Registrant wholly lacks insight. While initially the Registrant made some concessions to his employers, those have since been withdrawn and the Registrant has denied the allegation in full before this Panel. Indeed in a CPD Paper submitted to the HCPC for the purposes of these proceedings, the Registrant states “I am aware you feel I have made an error of judgement.” It is clear to the Panel that the Registrant does not have insight and does not take responsibility for his actions. 

47. The Panel is of the view that the Registrant’s failings are capable of remediation. However, it finds that the Registrant has not remedied his deficiencies. The Panel has had sight of his CPD folder which does not contain any evidence of reflection or critical appraisal in relation to his practice. The majority of the submitted work appears to be cut and pasted with no context and no proof of knowledge absorption or understanding. In addition, very few of the courses he has completed seem to be tailored to the allegations in this matter. The Panel has also considered the Registrant’s CPD which post-dates the allegations and is of the view that there is a similar lack of quality to the CPD which pre-dates the allegation. Given the lack of evidence to demonstrate that these issues have been addressed, the Panel cannot be satisfied that there is no risk of repetition. 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.

48. The Panel has found a series of clinical failings and a use of language which is completely unacceptable and particularly so for a professional within his work environment. The Panel has concluded that there is a serious risk of an adverse impact on public confidence in the profession of paramedics and in the regulatory process, if a finding of impairment were not made in these circumstances. In addition, given the lack of remediation, the Panel is also of the view that there is a risk of patient harm, given the risk of repetition identified.

49. The Panel has also considered the helpful and comprehensive approach of Dame Janet Smith in her 5th Report from Shipman as set out in the case of the NMC and Grant. The Panel is satisfied that our findings in fact in respect of the Registrant’s misconduct and lack of competence show that his fitness to practise is impaired in the sense that he:

a/ has in the past acted or is liable to act in the future so as to put a patient at unwarranted risk of harm; and

b/ has in the past brought and/or is liable in the future to bring the profession into disrepute ;and

c/ has in the past and/or is liable in the future to breach one of the fundamental    tenets of the profession

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

Sanction:

51. The Panel has heard further submissions from Ms Turner and Mr Bryce on the issue of sanction. The Panel is aware that the function of fitness to practise panels is not punitive, and that the primary function of any sanction is to address public safety from the perspective of the risk the Registrant may pose to those using or needing his services in the future. In reaching its decision, the Panel must also give appropriate weight to the wider public interest considerations, which include the deterrent effect on other registrants, the reputation of the profession and public confidence in the regulatory process. The Panel has considered the sanctions available to it in ascending order of severity and has had regard to the HCPC’s Indicative Sanctions Policy and considered the advice of the Legal Assessor. The Panel has also considered the submissions of the HCPC and the Registrant’s submissions.

52. The Panel has paid careful regard to the following mitigating factors:-
o There have been no previous regulatory findings against him.
o The Registrant has engaged in the process. 

53. The Panel has also considered the aggravating factors as follows:
o The Registrant’s comments, which occurred within the context of his professional life, have been found to be racially motivated.
o These were not isolated incidents.
o There is a continued lack of insight.
o The Registrant disengaged from the action plan designed to help him achieve proper paramedic standards.
o The Registrant accepts little responsibility for his own behaviour and has a tendency to blame others.
o The Registrant has not produced any references or testimonials particularly in relation to his work as a technician over the past year.
o There is a lack of any remediation focussed on the deficient practice raised in the allegations.
o There is a lack of any written or verbal reflection.
o The Registrant appears, in his submission on sanction, to lack any understanding of the value of current paramedic education and the necessity to reach proper standards.

54. The Panel first considered whether to take no further action. It is of the view that this would not be sufficient to protect the public or to address the wider public interest considerations given the lack of evidence of remediation and the seriousness of the Registrant’s conduct.

55.  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. The Registrant has not demonstrated insight and in the absence of evidence of remediation, there is a risk of repetition. In addition the Panel is of the view that a Caution would be insufficient to address the critically important public policy issues or to protect the public.  In these circumstances, the Panel is of the view that a caution would not be an appropriate or proportionate sanction.

56   The Panel next considered a conditions of practice order. The Panel is aware that the Registrant was offered a full action plan and, despite repeated attempts and having declined offers of support, did not pass two of the four objectives and ultimately disengaged from that process. In addition, the Panel is of the view that the failings in his clinical practice are such that any conditions would be so restrictive as to be unworkable. Taking these matters into account, the Panel has concluded that a Conditions of Practice Order would not be an appropriate sanction as it would not be sufficient to address the conduct found proved.

57   The Panel next considered a suspension order. In terms of the Indicative Sanctions Policy, this would be appropriate where the allegation is of a serious nature but there is a realistic prospect that repetition will not occur. In the absence of any insight, remorse and remediation, there is a risk of repetition. Although the Panel has found that the Registrant’s failings are, in theory, remediable, it is concerned that at even at this late stage, the Registrant’s submissions continue to demonstrate a lack of insight and lack of understanding as to how his actions fell short of what would be appropriate in the circumstances. This leads the Panel to conclude that there remains an unwillingness or inability to resolve the failings identified. The Panel is also of the view that suspension would not be sufficient to mark the seriousness of his conduct, to adequately protect the public or to address the wider public interest considerations.

58.  The Panel considers that a striking off order would be an appropriate and proportionate sanction in this case, given the nature and gravity of the allegation and the Registrant’s continued lack of insight and denial. The Registrant’s conduct involved serious and persistent failings in his clinical practice and making comments which were racially motivated and made approximately one month after receiving a warning for making similar comments. On both occasions this occurred within a professional setting. The Panel finds that any lesser sanction would lack deterrent effect and would undermine confidence in the profession and in the regulatory process.

 

Order

Order: The Panel directs the Registrar to strike the name of Mark Dunkerley from the Register from the date that this order takes effect i.e. “the Operative Date.”

The Order will come into effect on 12 December 2016.

Notes

This is a Conduct and Competence Committee Final Hearing which took place on Monday 07 November 2016 at Novotel Glasgow Centre at 10:00am, Tuesday 08 November 2016 to Wednesday 09 November 2016 at Regus Glasgow at 09:30am and Thursday 10 November, Friday 11 and Monday 14 November 2016 at Novotel Glasgow Centre at 09:30am.

Hearing History

History of Hearings for Mark Dunkerley

Date Panel Hearing type Outcomes / Status
07/11/2016 Conduct and Competence Committee Final Hearing Struck off