Jonathan Murrell

Profession: Paramedic

Registration Number: PA33062

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 11/10/2016 End: 16:00 14/10/2016

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

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

(as amended at the final hearing on 11 October 2016)
During the course of your employment as a Paramedic with the South East Coast Ambulance Service NHS Foundation Trust (“SECAmb”), you:
1. Continually reset the Mobile Data Terminal (“MDT”) in your ambulance to create the impression that you were unavailable to answer emergency calls on the following occasions:
a. 13 January 2014, in relation to incident 22473610, for 8 minutes;
b. 07 February 2014, in relation to incident 22532850, for 10 minutes;
c. 08 February 2014, in relation to incident 22535552, for 18 minutes;
d. 12 February 2014, in relation to incident 22544913, for 9 minutes;
e. 13 February 2014, in relation to incident 22547326, for 7 minutes;
f. 16 February 2014, in relation to incident 22553724, for 13 minutes;
g. 20 February 2014, in relation to incident 22564748, for 10 minutes;
h. 21 February 2014, in relation to incident 22567013, for 6 minutes;
i. 28 February 2014, in relation to incident 22584295, for 11 minutes;
j. 04 March 2014, in relation to incident 22593311, for 13 minutes;
k. 08 March 2014, in relation to incident 22604498, for 9 minutes;
l. 11 March 2014, in relation to incident 22611912, for 10 minutes;
m. 17 March 2014, in relation to incident 22626551, for 11 minutes;
n. 20 March 2014, in relation to incident 22632142; for 11 minutes;
o. 27 March 2014, in relation to incident 22651213, for 12 minutes;
p. 25 June 2014, in relation to incident 22870266, for 9 minutes;
q. 10 July 2014, in relation to incident 22908621, for 9 minutes.
2. On or around 03 March 2014, you:
a. created the impression that your ambulance was unavailable by continually resetting the MDT;
b. as a result of your actions at paragraph 2 (a) you were unavailable to attend incident 22590980 despite being 2 minutes from the scene.
3. Did not submit a Patient Clinical Report (“PCR”) and/or a Non-conveyance form in relation to:
a. incident 22482324;
b. incident 22484629;
c. incident 22518178;
d. incident 22532850;
e. incident 22564748;
f. incident 22632142.
4. The conduct set out in Paragraphs 1 (a) – (q) and 2 (a) is dishonest
5. The matter set out in paragraph 4 constitutes misconduct.
6. The matters set out in paragraphs 1 – 3 constitutes misconduct and /or a lack of competence.
7. By reason of your misconduct and / or lack of competence your fitness to practise is impaired.

Finding

Preliminary matters:
1. Mr Ross, on behalf of the HCPC, applied to make the amendments set out in the HCPC’s letter dated 5 May 2016. Mr Short, on behalf of Mr Murrell, did not object to the amendments. The Panel was satisfied that no injustice would be caused by the amendments and agreed to them being made.
Background:
2. Mr Murrell has been employed by South East Coast Ambulance NHS Foundation Trust (SECAmb) as a paramedic since 2011. He previously worked in the Emergency Operation Centre (EOC) as a despatcher. He faces an allegation that, on a number of occasions, he reset the Mobile Data Terminal to give the impression that his ambulance was unavailable and that this was dishonest. He also faces an allegation that, on a number of occasions, he did not submit the necessary forms following his dealing with a patient.
Mobile Data Terminal
3. All SECAmb ambulances are fitted with a Mobile Data Terminal (MDT). The MDT transmits data about incidents and messages between the ambulance despatch team in the EOC and frontline ambulance staff.
4. The MDT has a Global Positioning System which records the location of the ambulance and the speed at which it is travelling. This information is recorded in an Automatic Vehicle Location (AVL) log which updates at different times depending on the activity of the ambulance vehicle.  If the vehicle is moving the AVL log is updated every 15 seconds unless it is attending an emergency when the log is updated every 5 seconds.
5. The AVL log allows the EOC to locate an ambulance and send the nearest ambulance to an incident.
6. When a 999 call is made to the EOC a despatcher transmits an emergency call to frontline ambulance staff requesting their attendance at an incident. The staff on their vehicle receive this notification via the MDT and they then have to acknowledge the request by touching “acknowledge” on the MDT screen. This information is then transmitted back to the EOC to inform them the call has been accepted.
7. When an ambulance has completed an incident the crew are expected to notify the EOC, using the MDT, that they are “clear”. This will allow the ambulance to be shown on the system as an available ambulance.
8. The MDT is not routinely switched off; however, it does have a reset button. If this button is pressed the MDT automatically restarts and the current location of the ambulance is not transmitted to the EOC whilst the system is restarting. When the MDT is resetting the ambulance would not show to the EOC as available.
9. The only time an ambulance crew would need to reset the MDT is if it “freezes”. If an ambulance crew needs to reset the MDT they need to inform the EOC as the system does not automatically report that it is being reset.
Patient Clinical Report and Non-Conveyance Forms
10. A paramedic has to complete a Patient Clinical Report (PCR) whenever they have direct contact with a patient. The PCR is used to document various matters including clinical observations, treatment and what the plan of action was for the patient.
11. If a paramedic decides not to take a patient to hospital a Non-Conveyance form (NCF) must also be completed. The NCF acts as check sheet for the ambulance staff when making a decision not to take a patient to hospital. The patient is asked to sign the form to confirm that they are happy with the decision not to take them to hospital.  
Decision on Facts:
12. The Panel took account of all the oral and written evidence and reminded itself that the burden is on the HCPC to prove its case on the balance of probabilities.
13. The Panel heard evidence on behalf of the HCPC from:
• AP, Clinical Operations Manager, SECAmb.
• SM, Dispatch Team Leader, SECAmb.
14. The Panel heard evidence from Jonathan Murrell, and the following witnesses called on his behalf:
• AE, Clinical Advice Manager, SECAmb.
• WE, Ambulance Technician, SECAmb.
15. The Panel considered AP to be a credible witness who did his best to help the Panel.
16. The Panel considered SM to be a very helpful witness who gave clear explanations about the processes followed. She was a credible witness.
17. The Panel found Mr Murrell to be a credible witness. 
18. In relation to AE and WE the Panel found them both to be credible witnesses.
19. The Panel has made the following findings of fact:
Particular 1
20. Mr Murrell has admitted this particular and the Panel has found this particular proved in its entirety.
21. AP gave evidence that as a result of an investigation into the actions of another ambulance crew concerns about the AVL data recorded during Mr Murrell’s shifts came to light. As a result SM was asked to carry out an investigation. The period covered by the investigation was 01 January – 31 July 2014. SM found that on 18 occasions during Mr Murrell’s shifts the MDT was continually reset for a period of time. As a consequence of this the EOC was given the impression that the ambulance was not available when it was.

22. Evidence obtained during the SECAmb investigation showed that the MDT was always reset towards the end of a shift, and Mr Murrell candidly accepted that the reason for this was to ensure he finished on time.
23. SM told the Panel that when a crew “clear” from an incident, they are partially protected from receiving further incidents. SECAmb policy states that a crew within the last 30 minutes of their shift can only be automatically used for the most acutely ill patients, or for patients of lower acuity who would not otherwise be reached in a timely manner.
Particular 2
24. Mr Murrell has admitted this particular and the Panel has found this particular proved in its entirety.
25. Mr Murrell was on a night shift which started at 19:00 on 2 March 2014 and finished at 07:00 on 3 March 2014. The MDT was reset for a period of nine minutes between 06:39 and 06:48. As a result of the MDT being reset Mr Murrell’s ambulance was unable to respond to an emergency call which was 2 minutes away from the ambulance’s location. As a result, another ambulance had to be allocated and the response time for that ambulance was 21 minutes.
Particular 3(a)
26. The Panel has found this particular proved.
27. Mr Murrell accepted that he did not complete either a PCR or NCF form. The Panel accept his evidence that by the time he had arrived at the call there was no patient to deal with and therefore no requirement to complete and submit the forms.
Particular 3(b)
28. The Panel has found this particular not proved.
29. The Panel accept Mr Murrell’s evidence that there was no reason for him not to complete a PCR or NCF. AP told the Panel that completed forms are posted by paramedics into a box at the ambulance station from where they are taken to a central location to be scanned and then associated with the electronic patient record. He accepted that sometimes forms cannot be scanned or that errors may be made which result in the forms not being associated with the relevant patient record. The Panel cannot rule out that the forms had been misplaced and it therefore cannot be satisfied that Mr Murrell did not submit the forms.
Particular 3(c)
30. The Panel has found this particular proved.
31. Mr Murrell admitted that he did not complete either a PCR or NCF form. The Panel accept his evidence that as he arrived at the call he was told by the family he was no longer required and therefore he had no direct clinical contact with the patient. Accordingly, there was no requirement to complete and submit the forms.
Particulars 3(d) – 3(f)
32. The Panel has found these particulars not proved.
33. This is for the same reason as 3(b)
Particular 4
34. Mr Murrell has admitted this particular and the Panel has found this particular proved.
Decision on Grounds:
35. The Panel is satisfied that the proved facts do not amount to a lack of competence, as there is no evidence to show that Mr Murrell did not possess the necessary skills to act as a paramedic.
36. As there was no requirement to submit the forms referred to in particulars 3(a) and 3(c) not submitting them does not amount to misconduct.
37. Mr Murrell has admitted that his behaviour in the other proved particulars amounts to misconduct and the Panel is satisfied that his conduct as described in those particulars fell well below the standards expected of a registered paramedic.
38. His behaviour had the potential to put patients at risk and breached the following standard of the HCPC’s Standards of conduct, performance and ethics:
• 1 - You must act in the best interests of service users.
• 3 - You must keep high standards of personal conduct.
• 13 - You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.
39. The Panel is therefore satisfied that the proved facts in particulars 1, 2 and 4 amount to misconduct.
Decision on Impairment
40. The Panel went on to consider whether Mr Murrell’s fitness to practise is impaired by reason of his misconduct and referred to the HCPC Practice Note “Finding that Fitness to Practise is Impaired”.  In coming to its decision on impairment, the Panel has considered, amongst other things, the issues of insight, remediation, and likelihood of repetition.
41. The Panel considered the reasons put forward by Mr Murrell to explain why he acted as he did.
42. Mr Murrell advanced these reasons as explanations for his behaviour but accepted that they did not excuse his actions. He has provided a reflective statement in which he states that he has undergone counselling and is on a stable dose of medication for his condition. He told the Panel that he had reflected on his actions and is ashamed and remorseful. The Panel saw evidence of letters of apology to work colleagues written in March 2015.
43. He told the Panel that in view of all this if faced with a similar set of events he is aware of options open to him to deal with any stress.
44. The Panel considers all this to be positive, however set against this it cannot ignore that on two occasions when questioned by AP in 2014, Mr Murrell denied resetting the MDT.
45. Given his previous experience as a despatcher the Panel were surprised that in his oral evidence he did not appear to fully appreciate the implications of his actions in relation to patients requiring an ambulance.
46. Taking all the above into account the Panel is satisfied that Mr Murrell has considerable, but not yet full, insight into his misconduct.
47. The Panel accepts that dishonesty is difficult to remediate, however having balanced all factors the Panel has concluded that the chance of repetition is remote.  In reaching this decision the Panel had regard to the fact these events occurred at a particularly stressful time in Mr Murrells life and since this time there has been no repetition. Accordingly, the Panel considered that he no longer poses a risk to patients.
48. The Panel has no doubt that a member of the public would be shocked to learn how Mr Murrell behaved and it has decided, and Mr Murrell accepts, that a finding of impairment is required to declare and uphold proper standards of conduct and behaviour and maintain confidence in the profession and the HCPC.
49. Accordingly, the Panel has concluded that Mr Murrell’s fitness to practise is impaired by reason of his misconduct.
Decision on Sanction:
50. In coming to its own, independent, decision as to sanction, the Panel took into account all the evidence and the submissions made.
51. In deciding what sanction to impose, if any, the Panel has reminded itself that the purpose of sanctions is not to be punitive but to protect patients and the public interest, although there may be a punitive effect.  The Panel has also taken into account the principle of proportionality, balancing the interests of the public with those of Mr Murrell. It has also taken into account the HCPC’s Indicative Sanction Policy.
52. The Panel has identified the following aggravating factors:
• Mr Murrell initially lied during the SECAmb investigation
• Dishonesty occurred over a 6 month period
• Mr Murrell had previously worked as a despatcher so he would have been aware of the consequences of his actions
• His actions transferred work to colleagues
• Mr Murrell put his interests above those of patients
53. The Panel has identified the following mitigating factors:
• Low risk of recurrence
• Previous unblemished record
• Admissions made at this hearing
• Dishonesty occurred during a period of personal stress
• Self-referred to HCPC and cooperation with the HCPC process
• Considerable insight and remorse
• No repetition of similar behaviour
• Positive testimonials
• Apology to colleagues
• Currently holds a responsible role at SECAmb
• Mr Murrell is using his misconduct as a learning tool when teaching university students.
54. As the Panel’s finding of impairment was made on public interest grounds alone it has to consider the issue of sanction on this basis: there are no issues of patient safety to address.
55. In view of the nature of the matters that gave rise to the finding of impairment it would not be appropriate to arrange mediation or to conclude the case without taking any action as this would not sufficiently address the public interest.
56. The Panel then considered a caution order. The Indicative Sanctions Policy states:
“A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate remedial action.”
57. Although Mr Murrell has considerable insight it cannot be said that his misconduct is isolated or of a minor nature so on the face of it a caution is inappropriate.
58. As the Panel is considering sanction on the basis of public interest there are no conditions of practice that can be formulated that address the public interest.
59. The Panel then considered what the Indicative Sanctions Policy says about suspension orders and it states at paragraph 33:
“Suspension should be considered where the Panel considers that a caution or conditions of practice would provide insufficient public protection or where the allegation is of a serious nature but unlikely to be repeated and, thus, striking off is not merited.”
60. The Policy goes on to state at paragraph 35:
“Panels need to be aware that suspension for short periods of time (i.e. less than a year) may have long term consequences for the registrant, including being dismissed from his or her current employment. However, short term suspension may be appropriate, in particular:
• where a less restrictive sanction would:
o be unlikely to provide adequate public protection;
o undermine public confidence; or
o be unlikely to have a deterrent effect upon the registrant concerned or the profession at large…”
61. Having considered the guidance set out above the Panel found itself in a difficult position. It considered that in all the circumstances a striking off order would be disproportionate so it was left with a choice between a caution order and a suspension order.
62. The Panel considered the issues of deterrent effect and the need to maintain public confidence in the profession and the regulatory process.
63. In relation to the deterrent effect on the registrant the Panel concluded that the process itself and the finding of impairment provided a sufficient deterrent effect on Mr Murrell.
64. There is no doubt that Mr Murrell’s behaviour was totally unacceptable and he could not complain if he was suspended. However, a suspension order would remove a clearly highly valued paramedic from practice and the Panel has concluded that this would be disproportionate and unnecessary. In reaching this decision the Panel takes in to account that although the dishonesty occurred over a 6 month period this has to be seen in the context of an otherwise unblemished career. Mr Murrell has been open and transparent about his misconduct to colleagues and apologised to them. Since the events in 2014 Mr Murrell has continued to work for SECAmb as a paramedic both in the EOC and on the road. In addition, he lectures at a university where he uses his failings as a learning tool. Furthermore, he volunteers for the St John Ambulance Service where he teaches Community First Responders.
65. The Panel has concluded that a suspension order would be punitive, and serve no useful purpose.
66. The Panel therefore concluded, although with some hesitation given the serious nature of the misconduct, that a caution order is the appropriate sanction. It is clear that such misconduct has to be marked and a caution order for the maximum period of five years is sufficient to deter the profession at large and to maintain public confidence in profession. Anyone checking the HCPC register would be alerted to the existence of the caution and would be able to access this determination.

Order

The Registrar is directed to annotate the register entry of Jonathan Murrell with a caution which is to remain on the register for a period of five years from the date this order comes into effect.

Notes

This Conduct and Competence Committee Final Hearing took place at HCPC, London on Tuesday 11 October 2016 to Thursday 13 October 2016.

Hearing History

History of Hearings for Jonathan Murrell

Date Panel Hearing type Outcomes / Status
11/10/2016 Conduct and Competence Committee Final Hearing Caution