Richard C Moxon

Profession: Paramedic

Registration Number: PA07363

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 21/11/2016 End: 17:00 24/11/2016

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

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

(As amended at Final Hearing):

1. On 27 November 2013, you attended to Service User A and

behaved inappropriately towards the service user’s female relatives in that you: -

 

(a) commented that Person B was wearing a ‘Onesie’;

(b) Commented to Person B “you can rub my legs”, or words to that effect, when she described how she had been rubbing Service User A;s leg;

(c) made a comment when referring to Person B’s hair, “bloody hell, haircut 100”, or words to that effect;

(d) placed your hand on Person B’s hair and pressed it down in an attempt to flatten it;

(e) approached Person B from behind and;

(i) swept your hand underneath her armpit near to her breasts;

and/or

(ii) commented “I bet you’re not ticklish are you”? or words to that effect;

(f) asked Person B “Oh do you come with it? You could become my home carer” or words to that effect, in reference to the Property on realizing that it was being advertised for sale;

(g) stated, “I bet you see it all there don’t you coz these young ones all like shagging don’t they” or words to that effect;

(h) made reference to a patient, advising that she had died as she was waiting for an ambulance to arrive and stated that "people often die waiting for an ambulance to arrive" or words to that effect;

(i) disclosed to Person D the street name of two service users that had died whilst waiting for the ambulance to arrive;

(j) informed Person D on more than one occasion that she should complain to Patient Advice and Liaison Service (PALS) about the delayed response and stated “if you don’t, nothing would change” or words to that effect.

 

2. On 27 November 2013 you:

(a) did not record the correct time on the Patient Record Form (PRF)

(i) for the first set of observations;

(ii) for the second set of observations;

(iii) for your departure from the scene;

(b) used the term ‘Tomoz’ on the PRF;

 

3. On 27 November 2013 you:

(a) made a request for a ‘Hot no Divert’ to the Emergency Operational Centre (EOC) when this was not required given Service User A’s condition;

(b ) did not act in the best interests of Service User A in that you:

(i) did not discuss a referral to the Falls service with Service User A as one of the treatment options and/or;

(ii) did not refer Service User A to the GP scheme.

 

4. On 28 November 2013, you caused distress for Person B and her relatives in that you:

(a) returned to the property of Service User A uninvited and without the agreement and consent of Emergency Operational Centre (EOC);

(b) were captured on the North West Ambulance Service (NWAS) mapping system in close proximity to the property on or around 5 occasions during the day;

(c) tried to gain access into the property when Person B was present.

 

5. The matters described in 1b and 1e were sexually motivated.

 

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

 

7. By reason of your misconduct and/or lack of competence your fitness to Practise is impaired.

Finding

Preliminary matters

Proof of service

1. The Panel was informed by the Hearings Officer that notice of this hearing was sent to the Registrant’s registered address by letter dated 20 July 2016. A copy was also sent by email on the same date. The Panel was satisfied that the notice contained the required particulars and had been properly served as required by the Rules.
Proceeding in the absence of the Registrant

2. Ms Mond-Wedd applied for the hearing to proceed in the Registrant’s absence. The Panel received and accepted the advice of the Legal Assessor who advised that the Panel’s discretion to proceed in the Registrant’s absence should only be exercised with the utmost care and caution.

3. The Panel had regard to an email from the Registrant dated 5 April 2016 confirming that he would not be attending the Final Hearing, which was originally fixed to be heard in May 2016, but which could not go ahead for reasons not connected to the Registrant.

4. The Panel also had regard to the completed pro-forma document relating to the re-fixed Final Hearing of 21 to 24 November 2016, which had been signed and dated on 11 October 2016. In answer to the question of whether he intended to attend the Final Hearing in person, the word ‘no’ had been written.

5. The Panel concluded that the communications received from the Registrant indicate that he is not intending to attend the Final Hearing. The Panel has noted that the Registrant has not applied for an adjournment.

6. The Panel was satisfied that the HCPC had fulfilled its obligations and taken all reasonable steps to serve the notice on the Registrant in accordance with the Rules.

7. The Panel concluded that the Registrant had voluntarily waived his right to attend and there was no evidence that he would attend an adjourned hearing. The Panel noted that the allegation dates back to 2013 and was of the view that it was in the interests of justice that the hearing should proceed without any further delay. There were two witnesses waiting to give live evidence on behalf of the HCPC and a further HCPC witness waiting to give telephone evidence. Accordingly, the Panel decided to proceed in the Registrant’s absence.

Amendments to the allegation

8. At the outset of the hearing, Ms Mond-Wedd applied, on behalf of the HCPC, to formally amend the allegation, to change the wording in sub-Particular 1(b) from ‘her father’s’ to ‘Service User A’s’ and to add ‘(a)’ to the sub-Particular intended to be 3(a).

9. The Panel heard and accepted the advice of the Legal Assessor.

10. The Panel was of the view that the amendments sought did not materially change the nature of the allegation, as the object of sub-Particular 1(b) had always been clear and the addition of ‘(a)’ corrected a typographical error and so neither adversely affected the case against the Registrant. The Panel also noted that there had been no response either accepting or challenging the proposed amendment to 1(b) from the Registrant, which had been notified to him by letter dated 15 July 2015.

11. In light of the above, the Panel decided to allow the amendments, as to do so did not result in any unfairness to the Registrant.

Background

12. The Registrant is registered as a Paramedic with the HCPC. He started his Service with the North West Ambulance Service Trust (NWAS) in 1986 and remained there, qualifying as a paramedic in 1993. At the time of the allegations he was employed as a paramedic within the NWAS Greater Manchester Area Paramedic Emergency Service Directorate. He also provided cover for the Rapid Response Vehicle (RRV) from Bury Station.

13. On 27 November 2013 at 16:47, NWAS received an emergency call for Service User A, who had suffered a fall. The call was coded and categorised as requiring a response within 60 minutes, if possible, meaning that a response should have arrived by 17:47. At 17:35 the Urgent Care Desk unsuccessfully attempted to contact Service User A in order to carry out a more detailed assessment.

14. At 18:01 a second call was received in relation to Service User A, advising that he was not completely alert. As a result, the call was upgraded to a ‘Red two’ with a target of 8 minutes response.

15. At 18:03 the Registrant, staffing the RRV, was allocated to attend and he arrived at Service User A’s home address at 18:09. At the address, Service User A’s two daughters (Person D and Person C) and his granddaughter (Person B) were also present in the property. They were the ones who had called for an ambulance. They had been contacted by Service User A’s carers at 16:30, and informed that he had suffered a fall. Service User A had recently returned home from a period in hospital, and they had been unable to get him up.

16. On 28 and 29 November 2013, NWAS received complaints from Person D about the Registrant, alleging that he had behaved inappropriately towards her niece (Person B) on 27 November when he was in Patient A’s property, and had returned to Patient A’s property unannounced the following day (28 November 2013) when Person B was present and caring for her grandfather.

17. Following this complaint, an internal investigation commenced, undertaken by Witness 2 and overseen by Witness 1. During the course of the investigation, witness statements were taken from Persons B, C and D. They alleged that the Registrant had made a number of inappropriate comments, which were mainly directed towards Person B with whom he was alleged to be flirting. Person B alleged that he touched her hair. It is also alleged that he told Person B she could rub his legs and that he touched her underneath her armpit, near her breast, and that these two actions were sexually motivated.

18. The investigation also sought a Clinical Review of the services the Registrant provided to Service User A on 27 November 2013, from Witness 3, an Advanced Paramedic. She ultimately raised some clinical matters in respect of the Patient Report Form (PRF), which the Registrant completed, and the care he had provided.

19. Witnesses 1 and 2 conducted a statement session with the Registrant on 11 December 2013, which resulted in a statement of his account being drawn up.

Decision on Facts


20. The Panel heard and accepted the advice of the Legal Assessor. The Panel understood that the burden of proving each individual fact rests on the HCPC and that the HCPC will only be able to prove a particular if it satisfies the required standard of proof, namely the civil standard whereby it is more likely than not that the alleged incident occurred.

21. The Registrant did not attend but the Panel did not hold his non-attendance against him and scrutinised all of the evidence fairly, including questioning witnesses, to properly test their evidence.

22. The HCPC called the following witnesses:

• Witness 1 – At the relevant time he was the Operations Manager for NWAS and the Registrant’s line manager. He was appointed as Investigation Manager following receipt of the compliant against the Registrant.


• Witness 2 – A non-clinical Investigation Officer in the Making Experiences Count (MEC) Team at NWAS. She was appointed as Investigation Officer in the investigation in respect of the Registrant.


• Witness 3 – Qualified Paramedic since 2002, registered with the HCPC, and Advanced Paramedic from 2010. She was employed at NWAS and was asked by witnesses 1 and 2 to conduct a Clinical Review of the services the Registrant provided to Service User A on 27 November 2013.

23. The HCPC did not call any of Persons B, C or D to give evidence. It sought to rely on their hearsay statements.

24. The Panel found the evidence of Witness 2 to be credible and reliable. She had overseen the investigation and much of her evidence was not controversial. She said she had been surprised to find Person C at the address when she and Witness 1 had gone round to take a statement from Person D. She also acknowledged that, with hindsight, it would have been preferable to see Persons C and D separately, rather than together, although she had not been concerned as she felt they had independent recall of the events. She was not a clinician and she had admitted to the Panel what she had not known in respect of clinical matters.

25. The Panel found the evidence of Witness 3 to be credible and reliable, but it appeared that her experience and understanding at how to perform a Clinical Review was, at the time, limited, as was demonstrated by the fact that she had sought to revise her initial report. However, she was able to explain some of the alleged clinical shortcomings and to put them into perspective.

26. The Panel found the evidence of Witness 1 to be credible and reliable. He was at the time an experienced and qualified Paramedic who was therefore able to provide a professional view of matters.

27. The Panel was aware that the evidence for Particular 1, primarily came from the hearsay statements of Persons B, C and D. It therefore considered the contents of their statements against the factors set out in section 4 of the Civil Evidence Act 1995, to determine what weight, if any, could be attached to that evidence. Section 4 of the Civil Evidence Act 1995 states:

1) “In estimating the weight (if any) to be given to hearsay evidence in civil proceedings the court shall have regard to any circumstances from which any inference can reasonably be drawn as to the reliability or otherwise of the evidence.
2) Regard may be had, in particular, to the following—

a. whether it would have been reasonable and practicable for the party by whom the evidence was adduced to have produced the maker of the original statement as a witness;
b. whether the original statement was made contemporaneously with the occurrence or existence of the matters stated;
c. whether the evidence involves multiple hearsay;
d. whether any person involved had any motive to conceal or misrepresent matters;
e. whether the original statement was an edited account, or was made in collaboration with another or for a particular purpose;
f. whether the circumstances in which the evidence is adduced as hearsay are such as to suggest an attempt to prevent proper evaluation of its weight.”

28. The Panel considered the efforts that had been made by the HCPC to try to secure the attendance of Persons B, C and D to give live evidence and was of the view that it could not have done anything more, although it had ultimately been unsuccessful.

29. Regarding contemporaneity of the witness statements of Persons B, C and D, the Panel considered each in turn and how they had been created.

30.  Person B had been telephoned by Witness 2 on 2 December 2013, and given her account of events. Witness 2 had then prepared a draft statement which was sent to Person B on 9 December 2013 for approval and signing. Person B amended the statement on 2 January 2014, and her final statement was signed on 8 January 2014. In the Panel’s view, Person B’s evidence was reasonably contemporaneous as the initial account was within 5 days of the alleged events.

31. Persons C and D were visited by Witnesses 1 and 2 on 6 January 2014, for their accounts to be taken. Although this was 5 weeks after the alleged events, and therefore less contemporaneous, the Panel was of the view that it was nevertheless within a reasonable time of the alleged events and the delay had no significant impact on the quality of their respective recollections.

32. On 27 January 2014, Persons C and D edited the statements which had been prepared from their accounts given on 6 January 2014. Person C signed and dated and returned her statement. Person D confirmed the accuracy of her witness statement in a further statement for the HCPC on 13 April 2015.

33. The Panel also noted that a complaint had been made by Person D on 28 November 2013 to the Emergency Control Operation Centre and again on 29 November 2013 to MEC. The record of the complaint received by MEC was consistent with what was then said in Person D’s statement.

34. Therefore, the Panel was satisfied that overall, there was good contemporaneity of the hearsay statements of Persons B, C and D.

35. In relation to whether the hearsay involved multiple hearsay statements, the Panel identified only one item of multiple hearsay, namely that Person C reported that she had been told by one of the neighbours that he had seen the RRV twice outside the property.

36. The Panel considered whether there was any motive on the part of Persons B, C and D to lie. The Registrant had suggested that the relatives had been hostile towards him from the outset, due to the delay of the emergency response. The Panel does not find that this provides a motive for them to lie about his behaviour whilst at the property. In particular, the Registrant had told the relatives how to complain, should they wish to do so.

37. The Panel considered whether there was collaboration between Persons B, C and D. It recognised that they would have discussed between each other what had happened; it would have been unnatural not to have done so. However, there was no evidence to suggest any form of collaboration in terms of constructing an agreed version. In fact the evidence was to the contrary. The Panel noted variations in their respective statements, for example: there were differences in the street names; Person D had said that the Registrant had touched Person B, whereas Person C did not; Persons D and C heard the comment about ‘shagging’, whereas Person B did not mention it; Person D did not see hair touching; although she was told about hair touching by Person B and Person C did not mention any touching. In the Panel’s view, these minor variations gave the accounts in the statements the ‘ring of truth’.

38. The Panel considered that the circumstances were such that the statements were significantly and reliably corroborated in a number of respects by the mapping and ambulance records.

39. The mapping records documented the times that the Registrant was shown at the property and they corresponded with at least two of the occasions mentioned by Persons B and C, of when the Registrant was captured as being at the property the following day, on 28 November 2013.

40. The ambulance records show the Registrant as having attended recent calls in the streets identified by Persons C and D as having been disclosed by him to them. The Panel found that this was very significant corroboration, as Persons C and D could not have known the addresses of the streets. Therefore, the Panel did not consider that they would have made up any parts of their accounts.

41. Although this testing of the hearsay statements was second hand, the Panel was of the view that its examination of them was such that they had been thoroughly tested for accuracy and reliability. The Panel considered the hearsay statements to be very reliable, and it did not identify any real weaknesses in them. The Panel therefore concluded that it could give considerable weight to the hearsay statements of Persons B, C and D.

42. As the Registrant had not attended, nor given evidence, his account came from the statement prepared following the statement session with Witnesses 1 and 2 on 11 December 2013 and was essentially a hearsay account.  The Panel found that it was reasonably contemporaneous; it was not multiple hearsay; and there was no collaboration with other witnesses.

43. However, the Panel was of the view that the Registrant had a strong potential motive not to give an entirely truthful account, namely to protect himself against the complaint that had been received of using inappropriate words and behaviour with sexual undertones towards a service user’s family. His statement was unsupported and uncorroborated and was, in the Panel’s view, undermined by the ambulance records.

44. The Panel recognised that the burden of proof was on the HCPC to prove the facts against the Registrant, and it was not for him to prove that he did not act in the ways alleged. However, when it came to assessing the weight to be given to the accounts of Persons B, C and D, the Panel did not find this was reduced by the Registrant’s account.

In relation to Particular 1(a), this is found proved.

45. Person B says that the Registrant commented that she was wearing a ‘Onesie’. Person C said that the Registrant made unexpected comments towards Person B, regarding her clothing. The Registrant also admitted this on the pro forma that he completed on 25 April 2016.

In relation to Particular 1(b), this is found proved.

46. There is a variation in the recollections of Persons B, C and D, which precluded any suspicion of collaboration. Person B says the Registrant said ‘Oh you can come and rub my knees’. Person C says he said ‘You can rub my legs’. Person D says he said ‘Can you rub my legs?’ Each described that this was done in the context of Person B rubbing Service User A’s legs.
In relation to Particular 1(c), this is found proved.

47. Person B said that the Registrant ‘kept looking at her hair and making comments about it’. Person C said that the made ‘unexpected comments regarding…her hair’. The Registrant, in his statement admitted that he had said: ‘Bloody Hell, Haircut 100’.

In relation to Particular 1(d), this is found proved.

48. Person B said that the Registrant ‘put his hand on my hair and pressed down in order to flatten it’. Although the Registrant denied that he had touched person B’s hair, the Panel preferred the evidence of Person B.

In relation to Particular 1(e)(i), this is found proved.

49. Person B said that when she was in the middle of the living room near the mirror, the Registrant ‘approached from behind me, to my left side, and swept his hand under my armpit, near to my breast’. Person D said she turned to see the Registrant ‘prod my niece underneath her arm’. The Registrant himself said that he ‘took hold of [Person B’s] arm and tickled underneath the arm briefly’.

In relation to Particular 1(e)(ii), this is found not proved.

50. The Panel noted that the only source of evidence for this Particular came from the Registrant’s statement. The Panel found that he had effectively been accused of inappropriate touching and could be seeking to put a relatively innocent explanation forward. None of the more reliable sources, that is Persons B, C or D, mention that the Registrant said anything about tickling. Person B said that when the Registrant swept his hand under her armpit, ‘it did not seem like he was trying to tickle me, it was more like a touch or grab’.

In relation to Particular 1(f), this is found proved.

51. Person B said that the Registrant had informed them that he had just bought a house, at which Person D had said that their house was up for sale. Person B said that the Registrant had then turned to her and said ‘Oh, do you come with it? You could be my home carer.’ Person C said that the Registrant had described buying a house and ‘suggested that [Person B] could be his carer’. Person D said that the Registrant had made ‘an inappropriate comment suggesting that [Person B] could be his carer’.

In relation to Particular 1(g), this is found proved.

52. Person D said that the Registrant had asked her what she did in the NHS and she had told him she worked in baby clinics, to which he stated ‘I bet you see it all there don't you cos these young ones all like shagging, don't they’. This was corroborated by Person C who described the Registrant as saying ‘I bet you see it all. These young ones all love shagging, don't they’.

In relation to Particular 1(h), this is found proved.

53. Person C said that when the Registrant was describing incidents he had attended which had been subject to lengthy delays, he said that ‘people often die waiting for an ambulance to arrive’. Person D said the Registrant had informed them that ‘ambulances are always late and that two people had recently died whilst waiting for an ambulance to arrive’.

In relation to Particular 1(i), this is found proved.

54. Both Persons C and D said that the Registrant had told them the addresses of the two patients that he had said had died whilst waiting for an ambulance. The ambulance records themselves corroborated this evidence of Persons C and D, as they show that the addresses that the Registrant had disclosed to them, were in fact addresses at which the Registrant had recently attended.

In relation to Particular 1(j), this is found proved.

55. Person B said that the Registrant had told them that they ‘should complain to PALS’. Person C said that the Registrant had ‘kept telling [Person D] that she should complain to PALS’ and that ‘nothing would change unless people complained’. Person D said that the Registrant told her ‘on at least six occasions that I should complain to PALS about the delayed response’ and saying that if she did not ‘nothing would change’.

In relation to Particulars 2(a)(i), (ii) and (iii), these are each found proved.

56. In respect of 2(a)(i), the Registrant in his statement  said that the PRF notes that he carried out the first set of observations at 18:15, but he believed this time was incorrect and that ‘a more realistic time was approximately 18:25 as I had to deal with the relatives first’. In respect of 2(a)(ii), in his statement he said that ‘the PRF states that I undertook the second set of observations at 18:40’ and that he believes ‘that time is incorrect and that a more accurate time would be approximately 19:00, whilst the crew were making their way out of the property’. In respect of 2(a)(iii), in his statement he said that he ‘cleared from the property at 19:27’, whereas the copy of the PRF before the Panel had been completed with 19:20 recorded as the time of being clear.

In relation to Particular 2(b), this is found proved.

57. Witness 3 notes that the PRF has the colloquial language of ‘tomoz’ used for the word ‘tomorrow’. The copy of the PRF itself records ‘Daughter on scene will inform District Nurse tomoz’. The Registrant also admitted this Particular in his pro forma document, signed and dated 25 April 2016.

In relation to Particular 3(a), this is found proved.

58. The evidence of Witnesses 1, 2 and 3 was that the Registrant’s ‘Hot no divert’ request to the Emergency Operational Centre (EOC) for an emergency ambulance to be dispatched to Service User A’s property, which could not be diverted should another emergency arise, was unjustified. Service User A had fallen and could not get up, but the Panel heard from Witness 3 that there were no cardiac or respiratory difficulties which might justify such a request. The Registrant admitted in his statement that he had made the request.

In relation to Particular 3(b)(i), this is found proved.

59. It was clear from the Registrant’s statement and the PRF itself, that no referral to the Falls Service had been made. The NWAS flow chart of the ‘Paramedic Falls Pathway Referral Process’ identifies that where the patient has had an unexplained fall and is aged over 65years, then a referral should be made. Both Witnesses 1 and 3 confirmed that a referral should have been made. As the Falls Service was a service designed to put steps in place to reduce future risk of falling, by not making the referral the Registrant was not acting in the best interests of Service User A.

In relation to Particular 3(b)(ii), this is found proved.

60. It was clear from the Registrant’s statement and the PRF itself that no GP referral had been made. The NWAS flow chart for the ‘Paramedic Pathfinder GP Referral Process November 2013’ effectively identifies the situation where a patient refuses transport to hospital, as being one where a GP referral should be made. Both Witnesses 1 and 3 confirmed that a GP referral should have been made. As the purpose of a GP referral would be for another clinician to assess a service user who had refused to be taken to hospital, by not making the referral the Registrant was not acting in the best interests of Service User A.

Particular 4

61. In relation to the stem of Particular 4: that the Registrant’s alleged actions the next day (28 November 2013) caused distress for Person B and her family, the Panel had regard to the statement of Person B. She said that when the Registrant had returned the next day and asked about Service User A and Person C, she made an excuse to get rid of the Registrant and closed the door and ‘immediately locked it as I was frightened’ and ‘scared he would return’. Of both days, Person B said she was ‘deeply distressed’. She also said that she had been ‘frightened and upset ever since by the second [day]’. Person C said ‘I was concerned for [Person B’s] safety and she was terrified by the experience’. Person D said ‘I was extremely concerned for my niece’s safety and I therefore telephoned the Emergency Operations Centre’. She also telephoned the police. Both Persons C and D noted that their father, Service User A, had also been distressed by these events. The Panel was of the view that, in light of this, Person B and her family were caused distress by the Registrant in relation to events the next day.

In relation to Particular 4(a), this is found proved.

62. The Registrant admitted that he had returned to the property ‘a couple of times in between being allocated to emergencies’ and that he ‘did not inform the Emergency Operations Centre’ of his decision to return to the address the next day. Person B said that that Registrant had returned to the property the next day ‘at approximately 18:50’, which was whilst she was there assisting Service User A. Person D said that her sister had seen the Registrant drive past the property at approximately 13:30. Person C said that soon after 13:15 she had seen the Registrant drive past Service User A’s property. She said she had also been told by her neighbour that he had seen the Registrant on two occasions outside Service User A’s property. Their evidence is corroborated by the mapping evidence described at 4(b).

In relation to Particular 4(b), this is found proved in relation to four occasions.

63. The mapping information taken from the interrogation of the Emergency Centre’s control system indicated that the Registrant’s RRV vehicle had been captured in close proximity to Service User A’s property at 13:01, 16:00, 17:19 and 18:46 on 28 November 2013. This was supported by the fact that the Registrant accepted in his statement that he had visited ‘a couple of times’ and on the last occasion he had knocked at the door and Person B had answered, who he had described as ‘flustered’.

In relation to Particular 4(c), this is found proved.

64. Person B said ‘The knocking wouldn't stop and I heard somebody trying the door handle on two occasions. I saw the door handle being pushed down and the door shook twice. Fortunately the door was locked’. The Panel inferred from this that the Registrant tried to gain access into the property, but was prevented by virtue of the fact that the door was locked.

In relation to Particular 5, in respect of both 1(b) and 1(e)(i), this is found proved.

65. Person B felt that the Registrant was ‘flirting with me in a serious manner’ and she said that he ‘kept winking at me’. Person D thought that the Registrant was ‘leering at [Person B]’. Person C said that the Registrant was ‘flirting with my daughter’ and ‘flirted with [Person B] throughout the wait’.

66. In the Panel’s view, these perceptions of Persons B, C and D indicate the circumstances in which the behaviour in 1(b) and 1(e)(i) occurred. The behaviour in the circumstances described, has clear sexual undertones. Also, in relation to 1(e)(i) (swept hand underneath armpit near to breasts), Person B said ‘It seemed more like a touch or grab’. She also said it was ‘near to my breast’.

67. The Panel also noted that Person B said that she was so uncomfortable with the Registrant’s behaviour, that despite being too hot, she felt she wanted to put her cardigan on as ‘I was conscious that I should keep myself covered in consideration of the [Registrant’s] comments and behaviour’. It is the Panel’s view that both objectively and subjectively, the Registrant’s behaviour was sexual in nature and therefore, sexually motivated.

Decision on Grounds

68. The Panel next considered whether the matters found proved as set out above, amounted to misconduct and/or lack of competence, and if so, whether by reason thereof, the Registrant's fitness to practise is currently impaired.

69. The Panel considered the submissions made by Ms Mond-Wedd on behalf of the HCPC. She submitted that the HCPC was of the view that this case was effectively a misconduct case, although the clinical matters may amount to a lack of competence. She identified a number of Standards that she submitted that the Registrant had breached.

70. The Panel heard and accepted the advice of the legal assessor. The Panel was aware that any findings of lack of competence and/or misconduct and impairment were matters for the independent judgement of the Panel.

71. The Panel was aware that consideration of impairment only arises in the event that the Panel judges that the facts found proved do amount to misconduct and that what has to be determined is current impairment, that is looking forward from today.

72. The Panel considered both individually and cumulatively whether the facts found proved in relation to the behaviour of the Registrant in Particular 1, and in the circumstances found proved in Particular 5, amounted to misconduct.

73. Individually, it considered that although the comments in 1(a) (Onesie), 1(c) (Haircut 100) and 1(j) (complaint to PALS) were personal and inappropriate, looked at in insolation they were not serious enough to amount to misconduct. However, when taken cumulatively with the other behaviour, including the sexually motivated behaviour of 1(b) and 1(e)(i), they amount to misconduct.

74. The Panel considered the sexually motivated comments of 1(b) (asking Person B to rub his legs) and behaviour of 1(e)(i) (swept hand underneath armpit near to breasts), to be individually very serious and each amounts to misconduct. They were both personally invasive and serious breaches of the appropriate boundaries between a Paramedic responding to a 999 call, and the relatives of a service user.

75. The Panel considered that the behaviour of 1(d) (pressing down hair) to be serious and could be categorised, as an assault, as could 1(e)(i) as they were both instances of touching without consent. It concluded that 1(d) amounted to misconduct.

76. The comments of the Registrant in 1(f) (asking if Person B came with the property and saying she could be his home carer), made Person B feel ‘small and dirty’, and in the Panel’s view had a significant impact upon her. The Panel concluded 1(f) amounted to misconduct.

77. The comments of the Registrant in 1(g) (saying ‘I bet you see it all there don't you coz these young ones all like shagging don't they’) were highly inappropriate and insulting of the service users related to Person D’s work. In the Panel’s view it amounted to misconduct.

78. The comments and disclosures made by the Registrant in 1(h) and 1(i) were, in the Panel’s judgement, a breach of confidence and would have undermined confidence in NWAS and would have been upsetting for the relatives of Service User A in the circumstances. In the Panel’s view they individually amounted to misconduct. 

79. In relation to the clinical matters found proved in Particular 2, the Panel concluded that whilst they were instances of poor practice, they were not serious enough to amount to misconduct.

80. Considering Particular 3 in relation to misconduct, the Panel was of the view that these clinical matters were serious enough as to amount to misconduct. Particular 3(a) (Hot no divert) was serious in that it potentially put other service users at risk, because it diverted the use of scarce resources. The Panel agreed with the suggestion by Witness 3 that in view of the long delay in alleviating Service User A’s distress a ‘hot with divert’ would have been an acceptable request. Particular 3(b) was serious because it was a failure on the Registrant’s part to address the best interests of Service User A.

81. Each of the instances of the Registrant’s behaviour in Particular 4 (his behaviour in returning to Service User A’s property the next day), was, in the Panel’s judgement, individually serious enough to amount to misconduct. This behaviour had a significant impact on the family of Service User A, and in the Panel’s view, gave rise to concerns about his motives.

82. As noted at paragraphs 73 and 74 above, the sexual motivation found at Particular 5 was a serious aggravating feature and amounts to misconduct.

83. The Panel found that the above misconduct amounted to breaches of the following Standards:

• 1 – You must act in the best interests of service users
• 2 – You must respect the confidentiality of service users
• 3 – You must keep high standards of personal conduct
• 7 – You must communicate appropriately and effectively with service users and other practitioners
• 13 - You must behave with…integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.

84. The Panel then went on to consider whether any of the Particulars it had found proved amounted to a lack of confidence. However, there was no indication in respect of any of the Particulars, including the clinical matters, that the Registrant did not know what he ought to have done or how he ought to behave. Furthermore, in relation to the clinical issues at Particulars 2 and 3, this incident represented a single shift in the Registrant’s 23 years as a Paramedic, and so could not properly be described as a ‘fair sample’ of his work. Accordingly, the Panel did not consider that any of the Particulars found proved amounted to a lack of competence. 

Decision on Impairment

85. Having determined that the Registrant’s conduct and behaviour, as described above, amounted to misconduct, the Panel next went on to consider whether his fitness to practise is currently impaired as a consequence of that misconduct. What has to be determined is whether there is current impairment, that is looking forward from today

86. Ms Mond-Wedd submitted that the Registrant’s fitness to practise is currently impaired. She identified the case of Grant and submitted that the following limbs were engaged:

• – has in the past acted and/or is liable in the future to act so as to  put a patient or patients at unwarranted risk of harm; and/or
•  – has in the past brought and or is liable in the future to bring the profession into disrepute; and/or
•  – has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession.

87. The Panel accepted the advice of the Legal Assessor. It had regard to the Practice Note on Impairment, and in particular the two elements of impairment, namely the ‘personal component’ and the ‘public component’

88. The Panel first considered the ‘personal component’.

89. The Panel was of the view that, in the absence of any meaningful engagement with the HCPC during the course of these proceedings, it had little evidence of any insight or understanding on the part of the Registrant. The information it had was limited to the Registrant’s statement taken on 11 December 2013, in which he accepted that on reflection, he probably should not have returned to the property, and he would not have done so if he had felt uncomfortable with the events of the previous evening.

90. The Registrant had also described his interaction with Person B as ‘exchanging banter throughout’, and that all individuals had seemed much happier. The Panel therefore had no evidence in respect of whether or not he now acknowledged that his behaviour towards the family of Service User A was inappropriate or recognised the adverse reputational effect such behaviour would have on the public’s trust and confidence in the profession. It also had no evidence of any remorse by him for his behaviour.

91. As the Registrant has not engaged in these proceedings, the Panel also had no information about the Registrant and his current personal circumstances. As a consequence, the Panel had no information as to whether or not the Registrant had reflected upon his misconduct and therefore whether he had developed any regret, remorse or insight into his actions on 27 and 28 November 2013.  In the circumstances, and in the absence of any evidence to the contrary, the Panel concluded that there must be a risk of repetition in the future.

92. In light of the above, in respect of the ‘personal component’, the Panel concluded that the Registrant’s fitness to practise is currently impaired.

93. The Panel went on to consider the ‘public component’.

94. The Panel took into account its earlier findings that the Registrant had behaved in a manner which had caused distress to the family of Service User A and that some of that behaviour was sexually motivated.

95. The Panel was of the view that the public expects those responsible for responding to emergency calls and attending to Service Users in their own homes, to do so with professionalism, and to be able to trust them.

96. It therefore concluded that public confidence in the reputation of the profession would be undermined if a finding of impairment were not made in this case. Accordingly, in respect of the ‘public component’ the Panel concluded that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction

97. Having concluded that the Registrant’s current fitness to practise is impaired, the Panel went on to consider what would be the appropriate, proportionate and sufficient sanction or other outcome in this case.

98. The Panel accepted the advice of the Legal Assessor. It had regard to the Indicative Sanctions Policy (ISP) and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive, but to protect the public and to safeguard the wider public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.

99. The Panel considered that there were no mitigating factors in this case.

100.   The Panel considered that the following were aggravating factors:

 

a.  The misconduct included matters of a sexual nature.

 

b.  The Registrant’s misconduct had caused distress to Service User A and his relatives,  and fear to Person B

 

c.   The Registrant’s lack of engagement with the HCPC and these proceedings.

 

101.   As previously set out, the Panel had no evidence of any remorse on the part of the Registrant. Also, in the absence of any engagement by the Registrant with the HCPC in these proceedings, it followed that the Panel has no information as to his current level of insight in respect of his behaviour, and specifically whether he now recognised the potential impact of his behaviour on Service User A and his family, and public confidence in the profession, or how he might avoid a recurrence of such behaviour in the future.

 

102.   The Panel does not consider the options of taking no further action or mediation to be appropriate or proportionate in the circumstances of this case. Neither would address the identified risks, including the risk of repetition, nor meet the wider public interest as the case is too serious.

 

103.   The Panel does not consider that a Caution Order would meet the criteria as set out in paragraph 22 of the ISP. As previously found, there was little or no evidence of insight, regret, or remorse and there was a risk of recurrence. The case was also too serious.

 

104.   The Panel next considered a Conditions of Practice Order. The Panel took account of paragraph 27 of the ISP, which indicates that the imposition of conditions requires a commitment on the part of the Registrant to resolve matters and so conditions of practice are unlikely to be suitable in cases where the Registrant ‘lacks insight or denies wrongdoing’, as is the case here.

 

105.   The Panel also had regard to the nature of the misconduct which included matters of a sexually motivated and inappropriate nature. In the Panel’s view, this type of misconduct was very serious in nature and demonstrated attitudinal issues on the part of the Registrant. As such, the Panel concluded that it would not be possible to formulate appropriate or workable conditions to address this type of misconduct. The misconduct was also too serious for a Conditions of Practice Order, as such an Order would not maintain public confidence in the profession.

 

106.   The Panel next considered a Suspension Order. Although the Panel recognised that a Suspension Order would provide short term protection to the public, it considered that the public needed longer term protection. In reaching this view, the Panel had regard to paragraph 32 of the ISP, which states: ‘Suspension should be considered (…) where the allegation is of a serious nature but unlikely to be repeated and, thus, striking off is not merited’. In this case, the Panel is satisfied that the allegation was of a serious nature and, for the reasons stated above, the Panel had not concluded that the behaviour was ‘unlikely to be repeated’.

 

107.   The Panel also had regard to paragraph 34 of the ISP, which states: ‘If the evidence suggests that the registrant will be unable to resolve or remedy his or her failings then striking off may be the more appropriate option’. As the Registrant has not engaged with the HCPC, the Panel had no information before it as to his current situation. In the circumstances, the Panel concluded that there was no evidence to reassure it that the Registrant had sought to address his behaviour or would do so during any period of suspension. The Panel therefore considered that a Suspension Order was not the appropriate and proportionate response.

 

108.   The Panel next went on to consider a Striking Off Order and concluded that this was the only appropriate and proportionate sanction in this case. The Panel had regard to paragraph 41 of the ISP, which states: ‘Striking off should be used where there is no other way to protect the public, for example, where there is a lack of insight, continuing problems or denial. A registrant’s inability or unwillingness to resolve matters will suggest that a lower sanction may not be appropriate’. In this case, the misconduct occurred three years ago and there is no indication that the Registrant has since reflected, or has a better understanding of how his behaviour impacted on Service User A or his family, and public confidence in the profession.

 

109.   The Panel also had regard to paragraph 42 which states: ‘Striking off may also be appropriate where the nature and gravity of the allegation are such that (…) any lesser sanction would (…) undermine public confidence in the profession concerned…’ In this respect, the Panel had regard to the nature of the misconduct, including as it did, matters of sexual impropriety. In light of the Panel’s view at the impairment stage, that the public expects those responsible for responding to emergency calls and attending to Service Users in their own homes, to do so with professionalism, and to be able to trust them. It did not consider that it could impose any lesser sanction than striking off without further undermining public confidence.

 

110.   For all these reasons, including the risk of repetition; little or no evidence of insight and remorse; and the non-engagement with these proceedings, the Panel concluded that there was no other way both to protect the public and to meet the wider public interest, than to impose a Striking Off Order. The Panel therefore determined that a Striking Off Order was the only appropriate and proportionate sanction.

 

111.   Although the Panel had no information as to the Registrant’s current situation, it acknowledged that such an Order would be likely to have a serious impact upon him as he will be unable to practise as a Paramedic. However, the Panel determined that the interests of protecting the public and upholding confidence in the profession outweighed the interests of the Registrant.

 

 

Order

ORDER: The Registrar is directed to strike the name of Richard C Moxon from the Register on the date this order comes into effect.

 

The order imposed today will apply from 21 December 2016 (the Operative Date).

Notes

No notes available

Hearing History

History of Hearings for Richard C Moxon

Date Panel Hearing type Outcomes / Status
21/11/2016 Conduct and Competence Committee Final Hearing Struck off
09/05/2016 Conduct and Competence Committee Final Hearing Adjourned