Mr Srinivasa Veerasamy

Profession: Paramedic

Registration Number: PA16261

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 16/04/2018 End: 16:00 27/04/2018

Location: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

Allegation (as amended at final hearing):


During the course of your employment as a Paramedic with Tascor Medical Services between 2 March 2015 and 28 August 2015, you:

 

 

1. On at least one occasion, advised detained persons that you were a doctor.

 

 

2. On occasion, completed your report on detained persons before examining them.

 

 

3. On occasion, did not record important information on reports which were provided by:

 

a) custody staff;

 

b) detained persons.       

 

 

4. On or around 26 June 2015, in relation to a female detained person, Person A:

 

a) stared at her breasts throughout the examination which made Person A uncomfortable;

 

b) stated to Person A, when she advised you that she was going on holiday, 'Oh, I wish you could take me in your suitcase', or words to that effect; ·

 

c) told Person A, 'I'll get you out of here in no time, don't you worry I'll speed things along for you', or words to that effect.

 

 

5. On or around 13 June 2015, in relation to a female detained person, Person B:

 

a) advised Person B that to get help with her alcoholism she should seek religion and/or go to church, or words to that effect;

 

b) asked Person B for her personal email address in order to contact her on her release from custody;

 

c) provided Person B with your personal email address.

 

 

6. On occasion, were rude and/or abrupt with:

 

a) detained persons;

 

b) custody staff.

 

 

7. On one occasion, refused to issue methadone to a detained person despite that person having a prescription for it.

 

 

8. Your actions, as described in paragraph 4 (a) were sexually motivated.

 

 

9. Your actions, as described in paragraph 1 were dishonest.

 

 

10. The matters set out in paragraphs 1 - 9 constitute misconduct and/or lack of competence.

 

 

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

Finding

Preliminary Matters

Application to amend the particulars

1. At the outset of the hearing, Ms Sheridan, on behalf of the HCPC, applied to amend Particulars 3, 4, 5, 6 and 7. In Particular 3, she sought to add the word ‘important’ to qualify the information allegedly omitted from the Registrant’s reports. In Particular 4, she sought to amend the date from 16 June 2015 to 26 June 2015. In Particulars 4, 5, 6, and 7, she sought to amend the description of Witnesses A and B from ‘Prisoner’ to ‘Person’. Mr Harries, on behalf of the Registrant, did not object to the proposed amendments.

2. Having heard and accepted the advice of the Legal Assessor, the Panel decided to allow the proposed amendments in full. It was of the view that the amendments did not materially change the nature of the Allegation which the Registrant faced. The amendment proposed to change the date in Particular 4 would correct it, and had been apparent in the papers.

Application 2

3. Part of the way through the HCPC evidence, Ms Sheridan further applied to amend Particular 2 to read: ‘On occasion, completed your report on detained persons before conducting any and/or any adequate examination on them’. She submitted that this application was made in light of the evidence which had been received, in particular from SS. Ms Sheridan accepted that the application was made at a late stage in the proceedings, but that it was not an application which could have been made earlier, because it was the developing of SS’ account in oral evidence which raised the issue.

4. Mr Harries, on behalf of the Registrant, objected to the proposed amendment. He submitted that it would be grossly unfair to allow the amendment at such a late stage. He submitted that the notion of the adequacy of the Registrant’s examinations had never arisen as part of the case before. He submitted that the issues raised by SS in her oral evidence, of the Registrant not checking medication or the issue about the length of time taken for an examination were not raised in any exhibit or statement previously provided to the Registrant. He further highlighted that the medical tabs (part of a custody record) were not documents which the Panel had been able to see.

5. The Panel heard further advice from the Legal Assessor, in respect of an application to amend partway through the HCPC case and accepted that advice. The Panel determined not to allow the application to amend Particular 2 on the basis that to do so would be unfair and prejudicial to the Registrant.

6. The Panel observed that there had been delays in the disclosure of the custody records to the defence, which had ultimately been obtained pursuant to a Production Order. The Panel noted that there was one specific example, given by Custody Sergeant KL, of the Registrant completing the Health Care Professional (HCP) tab on the custody record before conducting the examination. The Panel had been provided with a copy of that custody record. It was the computer generated timings within that custody record, which appeared to be inconsistent with KL’s evidence that the record had been completed prior to examination. SS had accepted in cross examination that for a period of time the Registrant had been in with a DP while the HCP tab was open.

7. The Panel was mindful that SS, upon whose evidence the HCPC sought to rely in respect of alleged inadequacy of examinations, was not medically qualified, and had effectively based her opinion on what she considered to be the short length of time taken to conduct the examination(s). Further, given the late stage of the application, Mr Harries had not explored with any of the witnesses previously called by the HCPC the adequacy or otherwise of the Registrant’s examinations of DPs, that not being an allegation that the Registrant had to meet at that time.

8. In light of the above, the Panel was of the view that the proposed amendment would materially alter the nature of that allegation against the Registrant from allegedly completing report(s) before examining a DP to allegedly conducting no or inadequate medical examination(s). The Panel was concerned that no evidence had been adduced before the Panel as to an objective qualitative approach by which it could evaluate, in medical terms, the adequacy or otherwise of the Registrant’s examinations. Further, given the late stage of the proceedings in which the application was sought, the Panel considered that the Registrant would not, fairly, be able to meet that amended allegation against him.

Admissibility of Evidence

Application 1

9. Three custody records were adduced in evidence as part of the HCPC case. These were the custody records of Person A, Person B and an unknown male. The Registrant had allegedly completed his report on the custody record before examining the unknown male. Following the evidence of Sergeant KL, it became apparent that the three custody records were incomplete, in that they did not include a number of relevant ‘tabs’, which formed part of the custody record, in particular, the ‘HCP tab’ and the ‘medical tab’.

10. Following Sergeant KL’s evidence, Ms Sheridan made inquiries about the missing tabs and was provided with copies of the HCP tabs for each of the three custody records, but not the medical tabs. Consequently Ms Sheridan applied to adduce the HCP tabs in evidence. Although Mr Harries did not challenge their admissibility, he made a number of observations relevant to the weight the Panel should give the evidence in due course.

11. Having heard and accepted the advice of the Legal Assessor, the Panel determined to admit the omitted HCP tabs into evidence. It was satisfied that they were relevant to the case and formed part of the custody records which were already before the Panel. The Panel further considered that they were potentially of assistance to the Registrant, and there would be no prejudice to him in allowing the HCP tabs to be adduced in evidence.

Application 2

12. Included within the Final Hearing statements bundle was a witness statement provided by LA, a Designated Detention Officer (DDO) at Staines Police Station. She had been expected to give evidence in person, but had not attended as required. Ms Sheridan applied to adduce her witness statement as hearsay. Ms Sheridan acknowledged that the last occasion on which LA had communicated with the HCPC was 26 April 2017, when she had provided her dates to avoid in respect of a hearing date in October 2017, which was subsequently changed. The last communication from LA with the HCPC’s solicitors was 10 May 2017, when LA had returned her signed statement to them. There had been no response from LA to the subsequent correspondence sent by the HCPC, including attempts by the Hearings Officer to contact LA during the Substantive Hearing.

13. Ms Sheridan submitted that the statement was admissible as hearsay evidence under Section 1 of the Civil Evidence Act 1995, (the Act) and was not the sole or decisive evidence in respect of any of the particulars. She submitted that once admitted it would be a matter for the Panel as to what weight to give to the statement in accordance with Section 4 of the Act.

14. Mr Harries objected to the admission of the statement. He acknowledged that Section 1 of the Act and the HCPC Rules permit the admission of hearsay evidence. He submitted that the lack of response from LA to either the HCPC or their solicitors must have been apparent. He essentially submitted that it would be unfair to admit the witness statement of LA.

15. Having heard and accepted the advice of the Legal Assessor, the Panel determined to allow the witness statement of LA to be admitted. The Panel noted that it was unsatisfactory that the matter was not pursued once the provisional date of the Substantive Hearing had been changed, and no further communication had been received from LA for nearly a year. The Panel considered that the evidence of LA was relevant, but it was not the sole or decisive evidence in respect of any of the particulars. Therefore, notwithstanding the failures in communication with LA, the Panel considered that her signed witness statement was admissible. The Panel acknowledged that the evidence was not agreed by the defence and there would be no opportunity for it to be tested through cross examination or by Panel questions. The Panel would bear this in mind when assessing what weight will be given to the statement.


Background

16. The Registrant is a Paramedic registered with the HCPC. He had been a forensic Health Care Professional (HCP) at Tascor Medical Services, subsequently Mitie, since 2 March 2015. In this role, he was responsible for providing medical care for detained persons (DP) in custody.

17. The allegations against the Registrant are that during his employment as a Paramedic with Tascor Medical Services between 2 March 2015 and 28 August 2015 he:

• on at least one occasion, the Registrant advised that he was a Doctor, and his actions in so doing were dishonest;

• on occasion, the Registrant would complete his report on detained persons before examining them;

• on occasion he did not record important information on reports which were provided by both custody staff and detained persons;

• on 26 June 2015, in relation to a detained female, Person A, he displayed sexually motivated behaviour, in that he stared at her breasts throughout the examination, and also made comments about wishing to be taken in Person A’s suitcase on holiday and that he would get her out of custody in no time;

• on 13 June 2015, in relation to a detained female, Person B, he advised her regarding seeking religion to get help with her alcoholism and sought to exchange personal email addresses to contact her on her release from custody;

• on occasion he was rude and abrupt with both detained persons and custody staff; and

• on one occasion refused to issue methadone to a detained person with a methadone prescription.


Submission of No Case to Answer

18. Ms Sheridan called evidence on behalf of the HCPC from a number of witnesses, namely:

• Dr JY, who at the time of the allegations, was the Medical Director for Tascor Medical Services;

• Sergeant KL, who at the time of the allegation was the Custody Sergeant at Staines Police Station;

• SS, who was a Designated Detention Officer (DDO) at Staines Police Station;

• TC, who was a DDO at Staines Police Station; and

• Dr MS, who at the time of the allegations was the Clinical Lead in Surrey for Tascor Medical Services.

19. The HCPC evidence also comprised the witness statement from LA, DDO at Staines Police Station (not an agreed statement) a witness statement from RR, a Legal Assistant with KN producing the CCTV custody suite disk for 17 May 2015; the CCTV footage; an exhibits bundle and copies of the custody records for Person A, Person B and an unknown male.

20. At the close of the HCPC case, Mr Harries submitted that there was no case to answer on particulars 1, 2, 3, 5(a), 5(b) 6(a), 6(b), 7 or 9. In respect of each particular, he submitted either:

a) on the evidence available taken at its highest, the alleged facts were not made out and/or,

b) the facts if found proved would be incapable of leading a reasonable Panel properly advised, to the conclusion that they establish a statutory ground and/or,

c) in any event, such a finding on the facts of a particular allegation is incapable of leading a Panel, properly advised, to the conclusion that the Registrant’s current fitness to practise is impaired.

21. Ms Sheridan contested the submission of no case, submitting in respect of each particular, that there was evidence which, taken at its highest, was capable of proof, and that each particular could amount to a statutory ground.

22. The Panel heard and accepted the advice of the Legal Assessor, who advised the Panel in respect of the case of R v Galbraith (1981) 73 Cr. App. R. 124. She advised the Panel of the HCPTS Practice Note, which indicates that if, based upon the case which has been put before the Panel, there is no real prospect of the HCPC proving the facts alleged or of the Panel concluding that the facts amount to the statutory ground of the allegation, or in turn, that fitness to practise is impaired, then they should find no case to answer. The Panel had regard to the HCPTS Practice Note and considered each particular in turn.

Particular 1 and 9

1.  On at least one occasion, advised detained persons that you were a doctor.

9. Your actions as described in paragraph 1 were dishonest.

23. At the outset of the hearing, the Registrant had admitted the fact of Particular 1. The Panel also had sight of CCTV footage from Staines Custody Suite from 17 May 2015. On this footage the Registrant, was seen to say to a Detained Person (DP), ‘I’m the doctor here, I have a few questions to ask you’. In light of the Registrant’s admission and the supporting CCTV evidence, Panel considered that there was a case to answer on the facts in respect of Particular 1.

24. The Panel went on to consider whether, there was evidence which, when taken at its highest, was capable of proving that the Registrant had acted dishonestly. The evidence indicated that the Registrant knew he was not a Doctor, and that he was therefore providing incorrect information to a DP in describing himself as a Doctor. Dr MS had given evidence to the Panel that under no circumstances should a Health Care Professional introduce themselves as a Doctor when they were not, and if a detention officer introduced the HCP as a Doctor, the HCP should correct that information if they were not a Doctor.

25. The Panel considered that the nature of the evidence adduced by the HCPC, indicated that there was a culture within the Custody Suite at Staines Police station to refer to all of the Health Care Professionals as ‘the doctor’, regardless of whether they were a Doctor, Nurse or Paramedic. The evidence of Custody Sergeant, KL, was to the effect that ‘doctor’ was a generic term used by all the custody staff, and that the HCP would be introduced to the DP as a doctor. This culture was borne out both by the CCTV and by the documentation adduced by the HCPC. The custody record of Person A contained an entry by a member of staff to the effect that: ‘At time of check DP taken out of cell to medical room to see doctor’. The handwritten custody record notes for Person B contained several references to Person B remaining in the medical room with ‘the doctor’. It was clear from the evidence that these were references to the Registrant.

26. The Panel had regard to the context of this culture of the custody staff referring to any Health Care Professional as doctor, including introducing Health Care Professionals to a DP as ‘Doctor’. The evidence adduced by the HCPC indicated that this was an expedient method of introducing HCPs to DPs, who had, historically, all been doctors. There was no evidence to the effect that the police did not know that the Registrant was not a Doctor.

27. The Panel considered the test to be applied for dishonesty, as set out in the case of Ivey v Genting Casinos [2017] UKSC 67, to the effect that the standards by which the law determines dishonesty is objective. Even taking the evidence at its highest, in the context of the culture at Staines Police Station, and the absence of personal gain for the Registrant, the Panel did not consider that by the objective standards of ordinary and decent people, the Registrant’s conduct would be considered dishonest. Therefore, the Panel found no case to answer in respect of Particular 9.

28. The Panel went on to consider whether Particular 1, absent dishonesty, was capable in itself of establishing the statutory ground of misconduct. The Panel considered that in the context of this police station and the way in which the custody staff referred to HCPs, the term ‘Doctor’ was a neutral term, not used to denote any particular qualification or standing of the HCP. It was clearly an instance of poor practice on the Registrant’s part; however, it did not, in the Panel’s view fall so far below the expected standards of a Paramedic as to be capable of establishing misconduct.

29. Accordingly, the Panel found no case to answer in respect of Particular 1.

Particular 2

2.  On occasion, completed your report on detained persons before examining them.

30. The evidence of SS and TC was to the effect that the Registrant would pre-populate the information about a DP onto the HCP tab before examining a DP. The Panel considered that their evidence was inherently vague and weak. In particular, there was no documentary evidence in support of their general assertions. Neither was medically qualified and the effect of their evidence, following cross-examination, was that neither had a clear understanding of the policy requirements for recording medical information on the custody record. The policy document provided to the Panel in respect of clinical documentation indicated that as medical entries on custody records are not confidential, only pertinent but not excessive medical information should be recorded, primarily for documenting instructions to custody staff. Dr JY had told the Panel that it was acceptable to pre-populate information if recording information which did not require an examination.

31. Sergeant KL had given evidence that it was not possible to access and read the HCP tab until the HCP had effectively ‘signed off’ the HCP tab. This evidence was contradicted by DDOs SS and TC, who said that it was possible to access them before that. Sergeant KL evidenced an example on 30 July 2015 to the effect that he had been able to access the ‘signed off’ HCP tab, while the DP was being taken to the medical room which would have been before an examination had taken place. The statement of LA was that the Registrant pre-wrote the HCP tab entry prior to seeing the DPs and they were all pretty generic. She produced documentary evidence in the form of the HCP tab for the DP regarding 30 July 2015. The Panel had a copy of the custody record for the DP for 30 July 2015, including the HCP tab provided by LA. The evidence given by Sergeant KL was not consistent with the computer-generated timings recorded in the custody record. Sergeant KL was unable to explain the anomalies.

32. The Panel considered that the evidence taken at its highest was so inherently vague and weak, and inconsistent with other evidence, that the Panel considered that there was no case to answer on Particular 2.

Particular 3

3. On occasion, did not record important information on reports which were provided by

a) custody staff;

b) Detained persons

33. The evidence of TC was to the effect that medical material was not recorded on the custody record. SS accepted that she did not see the medical records for DPs. The HCPC evidence indicated that there were several components to a custody record, which included the HCP tab and the medical tab. While the Panel had been provided with the HCP tabs, it had not been provided with copies of the medical tabs, so it was not possible to see what information had or had not been recorded within them. Dr JY had also told the Panel that handwritten medical notes were kept on DPs, which were kept in the medical room and remained the property of Tascor Medical Services. Copies of these handwritten notes were not before the Panel.

34. In light of the record keeping policy, indicating that detailed medical information ought not ordinarily be recorded in the custody record itself, and in the absence of the medical tabs, the Panel considered that the evidence was inherently weak. The HCPC evidence taken at its highest would not establish whether or not important information provided by custody staff or DPs was recorded in reports. The Panel, therefore found no case to answer on Particular 3.

Particular 5(a)

5.  On or around 13 June 2015, in relation to a female detained person, Person B:

a) advised Person B that to get help with her alcoholism she should seek religion and/or go to church, or words to that effect;

35. The Panel finds that there is a case to answer on Particular 5(a) in respect of statutory ground and impairment, no submission having been made on the facts.

36. The evidence of Person B, taken at its highest, was that the Registrant had bought up the topic of religion and had recommended that the church may help her with her troubles, and had told her of his church in New Malden. Although she had not been distressed by the conversation about religion, she indicated that she did feel it was unprofessional and inappropriate for him in his medical capacity to try and impinge his views on her, and on leaving the medical room, had described the Registrant as a ‘nut’.

37. The Panel considered that this was conduct which, if proved, was capable of establishing the statutory ground of misconduct, and, in turn, impairment. The Registrant was in the role of an HCP, responsible for the care of a vulnerable detainee who was under the influence of alcohol as well as being suicidal, according to the custody record. In that role the evidence, taken at its highest, indicates that he sought to impinge his religious views on her, not just generally, but personally, in giving her details of his own church.

Particular 5(b)

5.  On or around 13 June 2015, in relation to a female detained person, Person B:

b)  asked Person B for her personal email address in order to contact her on her release from custody;

38. The evidence of Person B was the sole evidence in respect of Particular 5(b). Her evidence, both in her witness statement and in her oral evidence, was that she could not recall the Registrant asking for her personal email address. The Panel considered that that this evidence was so inherently weak that it was not capable of supporting a finding that the Registrant had asked Person B for her personal email address. Accordingly, the Panel found no case to answer on Particular 5(b).

Particular 6(a)

6. On occasion, were rude and/or abrupt with:

a) detained persons;

39. The evidence of SS was that the Registrant was dismissive and reluctant to see DP’s under the influence of alcohol. The hearsay evidence of LA was that when she was chaperoning the Registrant’s visits with female DPs he was was ‘very rude to some and did not listen to them’. In giving details in respect of this, she said: ‘When a detained person told [the Registrant] how they feel he was quick to tell them it was normal or that they would be fine rather than ask any questions’. She was unable to provide detail regarding specific occasions when that had occurred.

40. Although, LA in her witness statement, said that the Registrant was ‘very rude’ to female DPs, in that same witness statement, when expanding on what she meant by that, she described that the Registrant was quick to tell them that what they were feeling was normal and that they would be fine. The Panel considered that the evidence, taken at its highest was not capable of establishing that the Registrant had been either rude or abrupt to DPs. The Panel, therefore, found no case to answer in respect of Particular 6(a).

Particular 6(b)

6. On occasion, were rude and/or abrupt with:

b) custody staff.

41. The evidence of Sergeant KL was that he had received complaints from DDOs, LA, SS and TC, that the Registrant was rude or abrupt to them. He had no first-hand knowledge of the Registrant behaving that way and said that the Registrant was always polite to him. The evidence of SS was that the Registrant’s behaviour was ‘almost bordering on rude’ towards custody staff. She said that the Registrant was difficult, not approachable and dismissive. When asked to provide specific examples, she described an occasion in which she had requested the Registrant attend a cell to provide a second opinion on a DP’s wellbeing. SS said that the Registrant was reluctant to attend and snapped at her declaring that that the DP was drunk. The Panel considered that there was evidence, which taken at its highest, was capable of proving that the Registrant was abrupt with custody staff.

42. The Panel went on to consider whether Particular 6(b), was capable of establishing the statutory ground of misconduct. The Panel considered that the Registrant’s conduct was clearly capable of being an instance of poor practice on the Registrant’s part, however, it did not, in the Panel’s view fall so far below the expected standards of a Paramedic as to be capable of establishing misconduct. The Panel, therefore, found no case to answer in respect of Particular 6(b).

Particular 7

7. On one occasion, refused to issue methadone to a detained person despite that person having a prescription for it.

43. The sole evidence in respect of this particular came from Sergeant KL. In his witness statement, he referred to a complaint he had made in his email dated 31 July 2015, which recorded ‘He recently refused to issue methadone to a DP even when this was a ‘scrip’ [sic] issued by the local chemist for the DP’. Of that email he said: ‘I do not know the date of this incident and cannot recall a lot of detail’ and ‘I recall that I saw no reason why [the Registrant] had not issued methadone although I cannot recall the details now’.

44. The Panel had heard evidence from both Dr JY and Dr MS as to instances when a HCP may properly decline to issue prescribed methadone to a DP, including when a DP may present as intoxicated or provide inconsistent answers to the HCP. In addition, Dr JY had confirmed in evidence that she, as Medical Director of Tascor Medical Services, (later, Mitie) had always allowed an HCP who did not feel adequately competent or confident to administer methadone, even if it had been prescribed and even if the HCP had had training, to ask another colleague on duty to assist.

45. Dr MS had given evidence to the effect that it was the role of the HCP to give prescribed methadone in the same way as any other prescribed medication, as long as it was clinically safe to do so.

46. The Panel had no documentary information before it in respect of this allegation, to identify the occasion to which the allegation related. This meant that there was no evidence before the Panel in respect of what the specific circumstances were, and whether there had been a refusal to issue prescribed methadone, whether it had been clinically safe to issue it, or whether there had been a good reason not to issue it.

47. The Panel considered that the evidence taken at its highest was unsatisfactory, in that it was inherently weak and vague.

48. In any event, even if the evidence, taken at its highest was capable of proving the fact of a refusal to issue prescribed methadone by the Registrant, the Panel was not satisfied that this was capable of establishing the statutory ground of either misconduct or lack of competence. Beyond the fact of the referral to the HCPC made by Dr MS, which included the methadone allegation, the Panel had no evidence before it to indicate that there was any failure on the part of the Registrant to carry out his clinical obligation. There was no evidence to demonstrate that the Registrant had been clinically wrong to refuse to issue prescribed methadone, and there was evidence to indicate that the employer would not require an HCP to administer prescribed methadone in circumstances where he did not feel competent or confident to do so. Accordingly, the Panel finds no case to answer on Particular 7.

Decision on Facts

49. Following the close of the HCPC case and the defence submission of no case to answer, the Panel went on to consider the remaining factual particulars, namely Particulars 4(a), 4(b), 4(c), 5(a) and 5(c).

50. The Registrant gave evidence before the Panel, and the Panel was provided with a Registrant’s bundle, which included the Registrant’s signed witness statement, dated 13 April 2018 and his Investigating Committee submissions and enclosures sent to the HCPC by letter dated 14 April 2016.

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

52. In respect of Particular 4, the Panel recognised that the evidence came from Person A on behalf of the HCPC and the Registrant.

53. Person A had been arrested at 6:54am on 26 June 2015. The custody record showed that her detention had been authorised at Staines Police Station at 8:04am, there was a booking in process and she was taken to a cell at 8:29am. At 9:25am Person A asked to see a doctor.

54. Person A had asked to see the doctor as there was a drilling noise which had brought on a migraine. Initially she had been incorrectly taken to the medical room to see the Registrant who was expecting a different DP. She was returned to her cell and brought back to see the Registrant some time later. The allegations against the Registrant are said to have occurred on the second occasion that she saw the Registrant.

55. The Panel found Person A to be a very credible witness. They considered her evidence to be compelling and consistent. The Panel did not consider that she had exaggerated her evidence, and noted that she conceded that she may have been wearing a blanket as a shawl when she saw the Registrant. The Panel was satisfied that it could rely on her evidence.

Particular 4(a)

4.  On or around 26 June 2015, in relation to a female detained person, Person A:

a) stared at her breasts throughout the examination which made Person A uncomfortable;

56. The Panel finds Particular 4(a) proved.

57. Person A told the Panel that she had been wearing a black mesh top. She described that it was a normal T-shirt material from the bottom of the breast down and from the breast upwards it was a mesh material. The whole of the top area was mesh and the shoulder area was T-shirt material. She thought that she was wearing a bra.

58. The Registrant had denied that he had stared at Person A’s breasts. His evidence was that her breast area had been covered up by a blanket and he had been alternately looking down to write and looking up at Person A, trying to make eye contact.

59. The Panel was satisfied to the requisite standard that Person A was wearing a mesh top which could be seen by the Registrant and that he had stared at her breasts repeatedly throughout the consultation in a way that had made Person A feel very uncomfortable. The Panel was satisfied that her discomfort had led her to ask to go back to her cell and make the complaint.

Particular 4(b)

4.  On or around 26 June 2015, in relation to a female detained person, Person A:

b)  stated to Person A, when she advised you that she was going on holiday, ‘Oh I wish you could take me in your suitcase’, or words to that effect;

60. The Panel finds Particular 4(b) proved.

61. The Panel accepted the account of Patient A, that when the conversation had moved to discussing her holiday, the Registrant had said words to the effect of he wished she could taken him in her suitcase.

Particular 4(c)

4.  On or around 26 June 2015, in relation to a female detained person, Person A:

c)  told Person A, ‘I’ll get you out of here in no time, don’t you worry I’ll speed things along for you’, or words to that effect;

62. The Panel finds Particular 4(c) proved.

63. The Panel accepted the account of Patient A, that there was a point during the consultation with the Registrant that he had said to her words to the effect that he would her get her out of there in no time and that she should not worry as he would speed things along for her.

Particular 5(a) and (c) 

5.  On or around 13 June 2015, in relation to a female detained person, Person B:

a)  advised Person B that to get help with her alcoholism she should seek religion and/or go to church, or words to that effect;

c)   provided Person B with your personal email address.

64. In respect of Particular 5 the Panel recognised that the evidence came from Person B on behalf of the HCPC and the Registrant.

65. Person B had been arrested at 7:18pm on 13 June 2015. The custody record showed that her detention had been authorised at Staines Police Station at 8:08pm and followed by the booking - in process. The custody records show that Person A was in the medical room at the time of detainee checks at 8:34pm and 8:45pm. From around 10:40pm she was placed on constant supervision. Between 11:02pm and 11:26pm she was in the medical room. From 3:56am, Person B was vomiting and unwell. At 4:18am the Registrant entered the cell and was recorded as providing treatment to Person B. An ambulance was called, which arrived at 4:42am and Person B was taken to hospital.

66. Person B described herself as an alcoholic, who at the time of her arrest was at the very lowest ebb of her life, and would have been intoxicated.

67. The Panel found her to be a very honest witness, who was clearly trying her best to assist the Panel, and who recognised the importance of giving accurate evidence. She confirmed that the Registrant had been sympathetic towards her and had treated her with nothing but consideration and care, and had treated her like a patient and not a criminal.

68. The Panel considered that Person B was very open about the difficulties in her personal life at that time, her mental health, and her issues with alcohol, in particular the extent to which she had been drinking at the time. She had clearly turned her life around since her arrest. She was entirely candid when cross-examined by Mr Harries that her intoxication at the time may have impacted on her memory and that it was entirely possible that she may have misinterpreted matters. Person B herself expressed concerns about her confidence in the reliability of her evidence. The difficulty for the Panel was that Person B, was not able to assist with which parts of her evidence may be accurate, or which parts may be inaccurate. The Panel considered that although Person B was an honest witness, her evidence was unreliable.

69. The Panel finds Particulars 5(a) and 5(c) not proved.

70. In light of the Panel’s evaluation of the reliability of Person B, the Panel did not feel able to place great weight on the accuracy of her recollection of the events of 13 June 2015.

71. The Panel considered the Registrant’s evidence to be plausible and credible in respect of his interactions with Person B. He accepted that there had been a discussion about religion. He said that there had been cards in the medical room containing the telephone numbers and email addresses of a number of organisations offering support, including the Salvation Army, Alcoholics Anonymous and Social Services. He said that he had provided one of these cards to Person B, describing the Salvation Army as a good organisation with Christian principles. He said that her reaction to this was to say that Christians were ‘weird’. At that, although he said that he went to Church, the conversation stopped. He denied that the conversation had extended to him advising her to seek religion or go to Church, or giving his personal email address to her.

72. The Panel was not satisfied that it was more likely than not that the Registrant had advised Person B that to get help with her alcoholism she should seek religion or go to Church, or words to that effect, or that he had provided Person B with his personal email address.

Particular 8

8.  Your actions, as described in particular 4(a) were sexually motivated.

73. The Panel finds Particular 8 not proved.

74. The Panel considered the facts of Particular 4(a) and what inferences could properly be drawn from the surrounding circumstances as to the Registrant’s state of mind and therefore his motivation at the time. The Panel acknowledged that Person A had clearly felt uncomfortable at the Registrant’s staring, and was already angry at being arrested and taken to the police station. Her perception was that he was ‘flirty’ and had prolonged the consultation. However, the Panel did not consider that this assisted it in determining the Registrant’s state of mind.

75. There was no suggestion that the Registrant had touched Person A. The nature of the top worn by Person A was such that the Panel considered that attention may be drawn to it initially out of, for example curiosity or surprise. The Panel did not consider that Person A’s description of the Registrant’s behaviour as “flirty”, although distressing to her, amounted to his behaviour been sexually motivated. In all the circumstances, the Panel was not satisfied to the required standard that the Registrant’s actions as described in Particular 4(a) were sexually motivated.


Decision on Grounds

76. The Panel gave careful consideration to all the evidence and to the submissions made by Ms Sheridan on behalf of the HCPC and Mr Harries on behalf of the Registrant. The Panel heard and accepted the advice of the Legal Assessor.

77. Both advocates invited the Panel to proceed on the basis that Particular 4 was a misconduct case rather than a lack of competence case, although both statutory grounds had been alleged in the alternative. The Panel was of the view that Particular 4 involved a single consultation in respect of the Registrant's behaviour towards Patient A, and so did not represent a fair sample of his work. In the Panel’s judgement this was not a case of lack of competence on the Registrant’s part.

78. The Panel went on to consider whether the facts found proved in Particular 4 amounted to misconduct on the part of the Registrant.

79. In respect of Particular 4(a), the Panel considered that Person A was in a very vulnerable position. She had been brought into the police station under arrest and early in the morning, was placed in a cell and was not free to leave. She had asked to see a doctor because she was suffering from a migraine. The Registrant was in the role of the HCP with the responsibility for treating her, and the expectation on him was that he would do so professionally, according her both respect and dignity. The Panel had found that the Registrant had stared at Person A’s breasts repeatedly throughout the consultation, which lasted some 20 to 25 minutes, and had made her feel very uncomfortable. She had felt so uncomfortable that she had asked a number of times to be returned to her cell, and shortly after the consultation ended, she reported the Registrant’s behaviour and also made a police statement about it the same day.

80. Although the Panel had not found that the Registrant’s actions had been sexually motivated, the Panel considered that his behaviour was both highly unprofessional and wholly inappropriate. The Registrant was a professional who had been registered with the HCPC as a Paramedic since 2003. The Panel considered that he should know not to stare repeatedly at a patient’s breasts, and should recognise that such behaviour may cause a patient to feel very embarrassed, upset and vulnerable. In the Panel’s judgement, his behaviour in that consultation had fallen far below the standards to be expected of a Paramedic.

81. In respect of Particulars 4(a) and 4(b), the Panel was of the view that these comments in and of themselves were not necessarily inappropriate. However, when judged in the context of a prolonged consultation in which the Registrant repeatedly stared at Person A’s breasts, they were clearly inappropriate and added to the discomfort that she was feeling.

82. The Panel was of the view that the Registrant’s failures had breached the following HCPC Standards of conduct, performance and ethics (2012):

• Standard 3 – you must keep high standards of personal conduct; and

• Standard 13 – you must behave with integrity and make sure your behaviour does not damage the public’s confidence in you or your profession.

83. In the Panel’s judgement, the Registrant’s behaviour in respect of Person A was serious enough to amount to misconduct.


Decision on Impairment

84. In considering whether the Registrant’s fitness to practise is currently impaired, the Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note on Impairment and in particular the two elements of impairment, namely the ‘personal component’ and the ‘public component’.

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

86. The Panel acknowledged that this was a single consultation in respect of a single patient which occurred some three years earlier. However, the behaviour had been sufficiently serious as to cause the patient great discomfort.

87. The Panel considered the level of the Registrant’s insight. It noted that the Registrant had maintained his denials of the allegation against him. The Panel did not consider that this, of itself, necessarily meant that the Registrant lacked insight. In light of the submissions of Mr Harries, the Panel carefully considered the reflection document provided by the Registrant in March 2016, as well as the Registrant’s evidence. The Panel considered that there had been no acknowledgement by the Registrant at any stage of the potential or theoretical impact of such behaviour on a patient, or how it may affect public confidence in the profession. The Panel considered that the reflective document and the Registrant’s evidence had been limited to the impact on himself and how he would protect himself against allegations of that type in future. While the Panel did not doubt it had been difficult for the Registrant since the allegation had been made, the Panel did not consider that the Registrant had demonstrated sufficient insight into the potential impact such behaviour may have on others, and on public confidence in the profession.

88. The Panel considered that the Registrant’s behaviour, in the absence of having been found to be sexually motivated, was capable of remediation. However, in the absence of sufficient insight was not satisfied that that the Registrant had demonstrated remediation.

89. In the absence of both sufficient insight or remedy, the Panel did not feel able to rule out the risk of recurrence, namely that the Registrant would behave in a manner during a consultation which would leave a patient feeling very uncomfortable.

90. Accordingly, the Panel found that the Registrant’s fitness to practise is currently impaired in respect of the ‘personal component’.

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

92. The Panel was of the view that, as a Paramedic, the Registrant was entrusted to look after vulnerable individuals. In the Panel’s view, the nature of the Registrant’s behaviour towards Person A was such that it would undermine public confidence and call into question the high standards of conduct and behaviour that the profession requires of its Paramedics. In these circumstances, the Panel was of the view that public confidence in the reputation of the profession would be undermined if a finding of impairment were not made.

93. Accordingly, the Panel concluded that the Registrant’s fitness to practise is currently impaired in respect of the ‘public component’.


Decision on Sanction

94. Having determined that the Registrant’s fitness to practise is currently impaired by reason of his misconduct, the Panel next went on to consider whether it was impaired to a degree which required action to be taken on his registration by way of the imposition of a sanction.

95. The Panel took account of the submissions of Ms Sheridan on behalf of the HCPC. Ms Sheridan informed the Panel that the Registrant had a previous HCPC finding against him for unrelated, dissimilar clinical matters in 2012, which had been satisfactorily dealt with by way of a 6 months Condition of Practice Order in March 2014. The Panel took account of the submissions Mr Harries on behalf of the Registrant. It also had regard to all of the material previously before it, as well as the additional material submitted on behalf of the Registrant for this sanction stage, namely testimonials from fellow professionals including his current employer.

96. The Panel heard and accepted the advice of the Legal Assessor and it exercised its independent judgement. 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 members of the public and to safeguard the public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.

97. The Panel considered the positive testimonials which had been submitted on the Registrant’s behalf at this sanction stage. The Panel noted its earlier finding at the impairment stage that it had been unable to rule out the risk of repetition. In light of the testimonials received, the Panel considered whether it was possible to assess the level of risk of repetition. The Panel noted that a number of them were very recent and provided with the full knowledge of the allegations the Registrant was facing. Given the testimonials, it appeared to the Panel that the Registrant’s misconduct appeared to be out of character, and that the risk of repetition was low.

98. Before considering the individual options open to the Panel, it identified what it considered to be the relevant aggravating and mitigating features in the case.

99. The Panel considered the following to be aggravating factors:

• Person A was in a vulnerable position and had been made to feel very uncomfortable by the Registrant;

• the Registrant had a lack of understanding of how his actions may be perceived by others, and how they may leave others feeling uncomfortable, embarrassed or upset.

100. The Panel considered the following to be mitigating factors:

• This was a single, isolated incident in respect of a single patient;

• The Panel had been provided with positive testimonials which indicated that the Registrant’s misconduct appeared to be out of character;

• In light of the testimonials, the Panel was able to conclude that the risk of repetition was low.

101. The Panel first considered whether to take no action. Given the Panel’s findings at the misconduct stage that the Registrant’s behaviour had been highly unprofessional and wholly inappropriate, it concluded that to take no action would send out the wrong message to the public and to the profession. It concluded that some form of sanction was necessary to maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour. Given that the Panel had ruled out that this was an appropriate case for no further action, it concluded that mediation was also not an appropriate outcome in this case.

102. The Panel then considered whether to make a Caution Order. The Panel noted that a number of the factors identified in the ISP of when a Caution Order may be appropriate were present in this case. The misconduct related to a single, isolated incident, in respect of a single patient, which had occurred three years ago. The testimonials indicated that his behaviour appeared to have been out of character and the risk of repetition was low. Although there had been a previous HCPC finding, the Panel noted that this was for dissimilar clinical matters in 2012, which had been addressed through the successful completion of a 6 month Conditions of Practice Order in 2014. The Panel did not consider that this affected its conclusion that the misconduct in this case appeared to be out of character or the risk of repetition was low.

103. The Panel was mindful that it had identified at the Impairment stage that the Registrant had not demonstrated sufficient insight into his behaviour, nor had he remedied his misconduct. The Panel therefore considered carefully whether this precluded a Caution Order from being the appropriate and proportionate sanction in the circumstances of this case. The Panel concluded that the Registrant would be able to remedy his failings in the period of time that the Caution Order was in place, and it would serve as a constant reminder to him as to the profound unacceptability of his behaviour. Given the low risk of repetition, the Panel was satisfied that such a sanction would not place the public at risk.

104. The Panel considered that a Conditions of Practice Order would be disproportionate in the circumstances of this case. Beyond requiring the Registrant to attend relevant professional boundaries or communication courses, the Panel considered that there were no meaningful practice restrictions which could be imposed on the Registrant’s practice and so a Conditions of Practice Order was not appropriate in his case.

105. The reality was, therefore, that the next applicable sanction to consider in the hierarchy of sanctions, if a Caution Order was not appropriate, was that of a Suspension Order, which the Panel concluded would be wholly disproportionate and unduly punitive in the particular circumstances of this case.

106. In all the circumstances, therefore, the Panel determined that the appropriate and proportionate sanction in this case is a Caution Order for the period of three years. The Panel considered that a three year Caution Order would be sufficient to demonstrate to the public and the profession that the Registrant’s behaviour on 26 March 2015 had been unacceptable and had led to disciplinary proceedings by his regulator, and ultimately a sanction

Order

The Registrar is directed to annotate the Registration of Mr Srinivasan Veerasamay with a Caution Order for the period of three years from the date on which this Order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Mr Srinivasa Veerasamy

Date Panel Hearing type Outcomes / Status
16/04/2018 Conduct and Competence Committee Final Hearing Caution