Mr Andrew Mills
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Whilst registered as a Paramedic, on 26 May 2016 at Northampton Magistrates' Court you were convicted for two counts of:
1. Fraud, in that you dishonestly made a false representation, namely giving false information to obtain a prescription, intending to make a gain, namely obtaining a prescription for medication, for yourself, on the following dates:
a. 11 October 2015 and
b. 21 September 2014
2. By reason of your convictions as set out at paragraph 1 your fitness to practise as a Paramedic is impaired.
1. There were various preliminary and procedural matters that had to be dealt with by the Panel during the course of the hearing. On each occasion the Panel heard submissions from Ms Young, received advice from the Legal Assessor and considered the appropriate Practice Notes.
2. The Panel was satisfied that the Registrant had been properly served with notice of the hearing. The Notice of Hearing had been sent to his address on the register by letter dated 22 November 2016 and had been responded to by him.
Proceeding in Private
3. At the request of Ms Young, prior to considering whether to proceed in the Registrant’s absence, the Panel first considered the question of proceeding in private, on the basis that there would be extensive reference to matters relating to the Registrant’s health and private life. Ms Young indicated that she was not asking for all the hearing to be in private, only those parts which dealt with his health and private life. Ms Young drew the Panel’s attention to one of the Registrant’s e-mails from 16 February 2017 in which he made such a request for privacy. Ms Young reminded the Panel that proceedings should normally be held in public and directed the Panel to Rule 10(1)(a) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules), which states:
“At any hearing—
(a) the proceedings shall be held in public unless the Committee is satisfied that, in the interests of justice or for the protection of the private life of the Registrant, the complainant, any person giving evidence or of any patient or client, the public should be excluded from all or part of the hearing;”
4. The Panel was also referred to the Practice Note entitled “Conducting Hearings in Private”.
5. The Panel was mindful that, under Rule 10(1)(a), it must be satisfied that it is in the interests of justice or for the protection of the private life of a Registrant before a decision can be made to exclude the public from any proceedings. Moreover, its decision must be consistent with Article 6(1) of the European Convention on Human Rights (ECHR), which provides limited exceptions to the need for hearings to be held in public, namely that it is “in the interests of justice or for the protection of the private life of the health professional, the complainant, any person giving evidence or of any patient or client”.
6. The Panel decided to grant the application so as to protect the privacy of the Registrant insofar as to hold the hearing in private whenever matters of the Registrant’s health or his private life, were being discussed. Accordingly, at various times during the hearing the Panel went into private session.
Proceeding in absence
7. Ms Young therefore made an application for the Panel to proceed with the hearing in the Registrant’s absence. She produced copies of various e-mails between the Registrant and the HCPC’s Case Manager in which the Registrant indicated that he would not be attending the hearing due to his health concerns.
8. Ms Young therefore submitted that the Registrant had voluntarily absented himself from the hearing and had made no application for an adjournment. Indeed, he had stated, in a second e-mail from 16 February 2017, that “[I’]m not contesting against anything with [HCPC]”, which Ms Young submitted was a clear indication that he was not disputing the allegations. Finally, it was in the interests of justice that the case, involving allegations going back to 2014, be expeditiously dealt with.
9. In reaching its decision the Panel took into account the HCPC’s Practice Note on Proceeding in the Absence of a Registrant and accepted the advice of the Legal Assessor, who drew the Panel’s attention to the HCPC’s Practice Note on “Proceeding in Absence”. The Panel noted that the Registrant had engaged with the HCPC but had made no application for an adjournment. He had indicated that he was not contesting the allegations. It therefore concluded that the Registrant had voluntarily absented himself from the hearing. The Panel also noted that these were serious allegations which involved matters dating from 2014. It was in the public interest to deal expeditiously with regulatory matters. Taking all these factors into account the Panel decided to proceed in the Registrant’s absence.
10. At all relevant times the Registrant worked as a Paramedic for the Northamptonshire division of East Midlands Ambulance Service. At 11:35 on Wednesday 4 November 2015, he was arrested on suspicion of Fraud by abuse of position under the Fraud Act 2006.
11. On 26 May 2016 at Northampton Magistrates' Court, the Registrant was convicted of two counts of Fraud, in that he dishonestly made a false representation, namely giving false information to obtain a prescription, intending to make a gain, namely obtaining a prescription for medication, for himself, on 11 October 2015 and on 21 September 2014.
12. He was sentenced to 12 weeks’ imprisonment, suspended for 12 months. He was also ordered to carry out unpaid work for 100 hours within 12 months and to pay a Victim Surcharge and Prosecution Costs totalling £280.
13. In relation to the incident on 21 September 2014 the Registrant telephoned an out of hours health professional, Highfield Clinical Care Centre. He gave his name as “Mark” and said that that he was a paramedic who was involved in the treatment of a road accident victim. He gave his own partner’s name (but did not indicate that he was his partner) who had actually been involved in a car accident and needed pain relief. He requested that a painkiller, Codeine, was prescribed. He did not log this incident with EMAS or with Control.
14. As for the incident on 11 October 2015, the Registrant again called an out of hours health professional. He again called himself “Mark” and requested some medication for his partner who was having difficulty sleeping owing to the Registrant himself suffering from health issues at the time. He alleged to the Doctor, however, that he was involved in the treatment of a victim of a road accident where a female patient had died and that a prescription was required for something to help the partner of the deceased person to sleep. He had hoped that Zopiclone would be prescribed but the Doctor issued a prescription for Diazepam, which he allegedly discarded.
15. These matters eventually came to light. The Registrant made full admissions at every stage of the various investigations, both by the Police and at Trust level and also pleaded guilty to the charges at the first opportunity at the Northampton Magistrates’ Court on 25 April 2016.
Decision on Facts
16. In considering this case the Panel bore in mind that the burden of proving the facts rests upon the HCPC and that the standard of proof is the civil standard of the balance of probabilities. It has taken account of all the evidence presented to it, namely the documentary evidence provided by the HCPC. It has also considered the detailed submissions of Ms Young, and has accepted the advice of the Legal Assessor.
17. The Panel noted Rule 10 (1) (d) of the HCPC Procedure Rules 2003 which states;
“where the registrant has been convicted of a criminal offence, a certified copy of the certificate of conviction (or, in Scotland, an extract conviction) shall be admissible as proof of that conviction and of the findings of fact upon which it was based;”
18. The Panel further noted that a certified copy of the Memorandum of Conviction from Northampton Magistrates’ Court confirming the conviction of the Registrant on 26 May 2016 for the offences specified in the particulars above had been produced by the HCPC. In light of this, and the Registrant’s indication that he was not disputing the allegations, the Panel found all the Particulars proved.
Decision on Grounds:
19. In reaching its decision of the Statutory Ground, the Panel took account of the submissions of Ms Young and the Advice of the Legal Assessor.
20. The Panel noted that Article 22 (1) (a) (iii) of the Health and Social Work Professions Order 2001 provides that one of the grounds upon which an allegation may be made is that a registrant’s fitness to practise is impaired by reason of:
“a conviction or caution in the [UK] for a criminal offence”.
21. The Panel noted that it had to take account of the nature, circumstances and gravity of the offence(s) in question and that not every criminal conviction would lead to a Registrant’s impairment. A sufficient level of seriousness had to be reached before the statutory ground was made out.
22. In this case the Panel took account of Ms Young’s submissions that the offences involved dishonesty, in that the Registrant misrepresented his identity, the identity of the alleged beneficiary of the drugs requested and the circumstances behind the requests. Furthermore, they involved an abuse of his status as a paramedic and of the privilege accorded to him which enabled him to request prescriptions for medication. The Panel further noted that the gravity of these offences was recognised by the Court which handed down a custodial sentence to the Registrant (albeit suspended). It also took account of the fact that the offences were duplicated over a period spanning a year.
23. The Panel had little hesitation, therefore, in concluding that the conviction was for offences of significant seriousness and that the statutory ground had been made out.
Decision on Impairment
24. In reaching its decision on impairment, the Panel has taken account of the submissions of the parties, the documentary evidence of the Registrant, and the advice of the Legal Assessor. It has also taken account of the HCPC Practice Notes “Finding that Fitness to Practise is “Impaired”, “Fitness to Practise – What does it mean?” and “Conviction and Caution Allegations”
25. The Panel is aware that, in determining whether fitness to practise is impaired, it must take account of a range of issues which, in essence, comprise two components, namely the ‘personal’ component (the current competence and behaviour of the individual Registrant) and the ‘public’ component (the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession). The Panel appreciates that not every finding that a statutory ground has been made out, will automatically result in a Panel concluding that fitness to practise is impaired. Moreover, it cannot adopt a simplistic view and conclude that fitness to practise is not impaired simply on the basis that, since the allegation arose, a Registrant has corrected matters or “learned his lesson”. Although the Panel’s task is not to punish past wrongdoings, it does need to take account of past acts or omissions in determining whether a Registrant’s present fitness to practise is impaired. In addition, when assessing the likelihood of repetition, the Panel should take account of both the degree of harm if any, caused by a Registrant and that Registrant’s culpability for that harm. Finally, the Panel is to consider whether a Registrant has demonstrated insight into his attitude and failings.
26. The Panel first considered the personal component. It noted that the incidents do not relate to his competence but to the Registrant’s conduct in providing false information. In addition, the Panel took account of the fact that the Registrant appeared to have some insight into his conduct: he admitted his culpability immediately upon being arrested; he was open and frank during the Police interview on 4 November 2015 in that he accepted that he had been dishonest and had abused his position; he was open and frank during the Trust investigation; and he pleaded guilty at the first opportunity to both offences.
27. The Panel also noted that the Registrant was reported to be unwell at the time of the 11 October 2015 incident since he was off sick from work at the time (from 28 September 2015 up until 5 November 2015). Moreover, during his Police interview he had referred to a number of health and personal issues.
28. However, the Panel noted that, notwithstanding that the Registrant indicated during the various investigations that [his health had improved], his latest e- mails indicated that he currently has [significant] health issues, albeit that at no stage has the Registrant provided any medical reports in support of his contentions. Moreover, there was no evidence before the Panel to suggest that the Registrant had taken any steps to either address his behaviour or to reduce the risk of repetition. Accordingly, the Panel concluded that, whilst the Registrant had shown some insight and had health issues at the time of one of the incidents, there was insufficient evidence before it to show that he had adequately, or at all, remediated his actions. The Panel therefore found that there remained a real risk of repetition and consequently that the Registrant was impaired in relation to the personal component.
29. As for the public component, the Panel took account of the fact that the conviction involved the Registrant twice abusing his position as a paramedic in order to obtain prescriptions for his partner and being dishonest in the process. Moreover, the Registrant knew what he was doing was wrong, as evidenced by him using a false name on both occasions and referring to a bogus incident on one occasion.
30. The Panel asked itself how a member of the public, or another paramedic, would feel if no finding of impairment was made in the circumstances where a paramedic had been convicted of making false representations in order to obtain a prescription. It swiftly came to the conclusion that the Registrant’s
actions had brought the profession into disrepute and it was, therefore, satisfied that public confidence in the Paramedic profession would be undermined if it did not make such a finding. It was also of the view that such a finding was required in order to uphold proper standards of conduct and behaviour in the profession. Accordingly, the Panel concluded that the Registrant’s fitness to practise is impaired on public interest grounds.
Decision on Sanction:
31. In reaching its decision on sanction the Panel took account of the Indicative Sanctions Policy (“ISP”) document (appreciating that it is a guide and no more) and the advice of the Legal Assessor, which it accepted. The Panel was mindful that the purpose of sanctions is not to be punitive, although they may have that effect. It appreciated that the primary purpose of any sanction is to address public safety from the perspective of the risk, which the Registrant concerned may pose to those who use or need his services. It noted, however, that in reaching its decision, panels must also give appropriate weight to the wider public interest, which includes: the deterrent effect to other registrants; the reputation of the profession concerned; and public confidence in the regulatory process. In addition, the Panel noted that it must act proportionately, which requires it to strike a balance between the interests of the public and those of the Registrant.
32. The Panel took account of Ms Young’s very fair submissions. She drew the
Panel’s attention to the case of CHRE v GDC and Fleischman  EWHC
87(Admin). It also took account of the various mitigating factors namely:
• What the Panel understands to be the Registrant’s previous good character – there is no indication before the Panel that the Registrant has been involved in disciplinary matters with the HCPC before;
• During the criminal proceedings and the Trust investigation processes he made full and frank admissions and pleaded guilty at the first opportunity at the Magistrates’ Court;
• He was off work sick and reported to be unwell at the time of the second incident;
• He had some insight into his actions.
34. However, the Panel also notes the following aggravating features and in particular:
• There was no evidence of any remediation;
• There was very limited engagement with the HCPC and its processes. The Panel noted that, although the Registrant communicated with the HCPC in the months leading up to the hearing and was advised about his right to submit evidence and any statement, no such evidence was sent in by him. Consequently, the Panel has no information before it in relation to his current practice, whether he has remediated his failings, or whether he is willing to at least attempt to do so;
• The conviction involved not only dishonesty but also an abuse of his status as a paramedic, the seriousness of which was reflected in a suspended custodial sentence;
• The Registrant’s actions were repeated and spanned a significant period of time;
• There were no medical reports nor any testimonials before the Panel, so it was unable to properly assess the Registrant’s current situation and career history;
• There was no evidence before the Panel that the Registrant has reflected upon the effect of his actions on the Paramedic profession generally;
• His actions could have resulted in harm to the alleged recipient of the medication (the Registrant’s partner) since the prescribing Doctor would not have had the opportunity of properly evaluating the patient’s true needs.
35. The Panel also notes that in his e-mail dated 7 February 2017 the Registrant indicated that he wished to remove himself from the register. [ ]
36. The Panel first considered taking no action but concluded that this was inappropriate given the seriousness of these matters. For similar reasons, the Panel concluded that the sanction of mediation was not appropriate.
37. The Panel next considered a Caution Order, which is deemed to be appropriate “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. A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practice would be disproportionate. A caution order is unlikely to be appropriate in cases where the registrant lacks insight.” The Panel noted that this was not an isolated lapse and that the allegations found proved were particularly serious. Moreover, as the Registrant had ceased to engage with the HCPC to any significant degree the Panel concluded that, in the absence of any current or reliable information about his practice, personal circumstances and health there remains a significant risk of repetition. Consequently, the Panel concluded that, especially given that it believed that there remained issues in relation to the Registrant’s insight, such a sanction would be insufficient to address the Panel’s concerns in relation to public interest grounds or to provide adequate protection to the public.
38. The Panel then considered the next most onerous sanction, that of a Conditions of Practice Order, and noted that this is appropriate where a failure or deficiency is capable of being remedied and where the Panel is satisfied that allowing the Registrant to remain in, or return to, practice, albeit subject to conditions, minimises the risk of future harm to service users.
39. The Panel determined that the breaches in this matter involved matters outside the Registrant’s clinical practice and therefore a Conditions of Practice Order was not appropriate. Moreover, the absence of the Registrant and his limited engagement in these proceedings makes it impossible for the Panel to conclude that, even if it was to make a Conditions of Practice Order, he would comply with it. Accordingly, the Panel concluded that no workable, appropriate, realistic or verifiable conditions could be formulated.
40. The Panel next considered imposing the next most onerous sanction, namely that of a Suspension Order. The Panel noted from the ISP that Suspension should be considered where a Panel considers that a caution or Conditions Of Practice Order 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. However, if the evidence suggests that a Registrant will be unable to resolve or remedy his or her failings then striking off may be the more appropriate option. Where there are no psychological or other difficulties preventing the Registrant from understanding and seeking to remedy the failings then suspension may be appropriate.
41. The Panel decided that it would be appropriate to consider the alternatives of Suspension and Striking Off together since, in reality, these were the only two options open to it.
42. The Panel noted that the ISP indicates that Striking Off is not only a sanction of last resort for serious, deliberate or reckless acts involving abuse of trust such as sexual abuse, dishonesty or persistent failure but also that it 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.
43. Once again, the Panel reminds itself that it has no information before it as to the Registrant’s current situation or whether he has any intention of remediating his practice. The Panel considers that it would be perfectly entitled to come to the conclusion that, in not taking a further opportunity to demonstrate that he has, or is willing to, remedy his practice and address his failings, he is in fact unwilling or unable to resolve them.
44. However, the Panel appreciates that there may have been perfectly understandable reasons why the Registrant has not engaged in these proceedings (for instance his health issues, although the Registrant has not submitted any evidence whatsoever at any time to show the full extent of those health issues) although it also notes that he has indicated that he wishes to remove himself from the register. Consequently, the Panel did consider giving him a final opportunity to demonstrate that he is willing to remedy his failings by imposing a Suspension Order for a period to enable him to demonstrate that he has gained full insight into his failings and wishes to remedy them.
45. Having weighed these matters the Panel has decided that, in the circumstances, to make a Striking Off Order. Despite having been reminded by the HCPC as far back as 16 February 2017 that he could submit further evidence, including a statement, and despite the Registrant indicating that he was minded to do so, nothing further has been received from him in the intervening five weeks. The Panel has no evidence before it of remediation or reflection; it does not know if the Registrant has completed the 100 hours of community work; it has no medical evidence before it about the Registrant’s current health; and it does not know if the Registrant intends to remedy his failings in this matter.
46. In addition, the Panel noted that the offences committed by the Registrant were serious and involved a breach of trust and dishonesty. The Panel could
not be satisfied that there was no likelihood of repetition (especially given the repetition of his offending over a year after the first incident). His actions were deliberate and reckless and could have caused harm to his partner.
47. The Panel is therefore led to the inevitable conclusion that the Registrant appears to be unwilling or unable to remedy his failings in relation to this very serious matter. Accordingly, that Panel considers that the proportionate response is to make a Striking Off Order.
History of Hearings for Mr Andrew Mills
|Date||Panel||Hearing type||Outcomes / Status|
|24/03/2017||Conduct and Competence Committee||Final Hearing||Struck off|
|03/02/2017||Conduct and Competence Committee||Interim Order Review||Interim Suspension|
|11/08/2016||Investigating committee||Interim Order Application||Interim Conditions of Practice|