Mr Geoffrey Brown

Profession: Paramedic

Registration Number: PA05680

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 19/02/2018 End: 17:00 23/02/2018

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Allegation as amended:

While registered as a Paramedic and during the course of your employment with East Midlands Ambulance Service you:


1. On 21 December 2015 in relation to Patient A:


(a) Physically restrained Patient A for an inappropriate length of time without seeking police assistance;


(b) Did not adequately document details of the restraint on the Patient Record Form and/or Incident Report Form (IR1)


(c) Physically restrained Patient A without completing and/or recording a mental capacity assessment;


(d) Administered IV Diazemuls to the patient outside of clinical practice guidelines;


(e) Did not adequately complete and/or record patient observations in that you did not:


(i) check and/or record blood glucose;


(ii) check and/or record oxygen saturation; and/or


(iii) carry out and/or record a neurological assessment;


(f) Did not utilise and/or document:


(i) The use of the Paramedic Pathfinder tool; and/or

(ii) The National Early Warning Score (NEWS).


(g) Did not ensure adequate “safety netting” was completed and/or recorded.


2. On 31 March 2016, in relation to Patient B:


(a) Did not document:


(i) The use of the sepsis screening tool; and/or


(ii) The use of the Paramedic Pathfinder tool; and/or


(iii) The National Early Warning Score (NEWS).


(b) Did not identify alternative care pathways for the patient.


(c) Did not ensure adequate “safety netting” was completed and/or recorded.


3. The matters set out in paragraphs 1 – 2 constitute misconduct and/or lack of competence.


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

Finding

Preliminary Matters

Service of Notice


1. The notice of this hearing was sent to the Registrant at his address as it appeared in the register on 14 November 2017. The notice contained the date, time and venue of today’s hearing. The Panel accepted the advice of the Legal Assessor and is satisfied that notice of today’s hearing has been served in accordance with Rule 6

(1) of the Conduct and Competence Committee Rules 2003 (the “Rules”).

Proceeding in the absence of the Registrant

2. The Panel then went on to consider whether to proceed in the absence of the Registrant, pursuant to Rule 11 of the Rules. In doing so, it considered the submissions of Mr Paterson on behalf of the HCPC.


3. Mr Paterson submitted that the HCPC has taken all reasonable steps to serve the notice on the Registrant. He further submitted that the Registrant has not engaged with the HCPC since 4 May 2017 when he sent an email with representations that he wished the Panel to take into consideration at the substantive hearing. Mr Paterson reminded the Panel that there was a public interest in this matter being dealt with expeditiously.


4. The Panel accepted the advice of the Legal Assessor. He advised that, if the Panel is satisfied that all reasonable efforts have been made to notify the Registrant of the hearing, then the Panel had the discretion to proceed in the absence of the Registrant. He cautioned the Panel that the discretion was to be exercised with care and caution as set out in the case of R v Jones [2002] UKHL 5.


5. The Legal Assessor also referred the Panel to the case of GMC v Adeogba and Visvardis [2016] EWCA Civ 162 and advised that the Adeogba case reminded the Panel that its primary objective is the protection of the public and the public interest. In that regard, the case of Adeogba was clear that “where there is good reason not to proceed, the case should be adjourned; where there is not, however, it is only right that it should proceed”.


6. It was clear, from the principles derived from case law, that the Panel was required to ensure that fairness and justice were maintained when deciding whether or not to proceed in a Registrant’s absence.

7. The Panel was satisfied that all reasonable efforts had been made by the HCPC to notify the Registrant of the hearing. It was also satisfied that the Registrant was aware of the hearing.


8. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPTS practice note entitled ‘Proceeding in the Absence of a Registrant’. The Panel weighed its responsibility for public protection and the expeditious disposal of the case with the Registrant’s right to a fair hearing.

9. In reaching its decision the Panel took into account the following:


• The Registrant has not made an application to adjourn today’s hearing;
• The Registrant has shown limited engagement with the process and has submitted written representations he wishes the Panel to take into consideration;
• Witnesses have been warned to give evidence and are in attendance;
• These proceedings relate to matters in late 2015 and early 2016;
• There is a public interest that this substantive hearing proceeds expeditiously.


10. The Panel was satisfied that the Registrant had voluntarily absented himself from the hearing. It determined that it was unlikely that an adjournment would result in the Registrant’s attendance at a later date, in the light of the non-engagement of the Registrant since May 2017. Having weighed the public interest for expedition in cases against the Registrant’s own interest, the Panel decided to proceed in the Registrant’s absence.


Amendment of Allegation


11. Mr Paterson, on behalf of the HCPC, applied to amend the Allegation.  He submitted that the amendments sought were consistent with the evidence before the Investigating Committee and served to clarify the Allegation. Mr Paterson drew the Panel’s attention to the correspondence sent on 30 June 2017 to the Registrant informing him of the proposed amendments.


12. The Panel accepted the advice of the Legal Assessor, who advised that it was open to the Panel to amend the allegation and its particulars, provided no injustice would be caused by the amendments. The Panel considered that the amendments sought did not change the substance of the allegation nor did they increase the severity of the allegation. The Panel considered that the amendments were reasonable and fair. The amendments served to clarify the allegation and would not cause injustice. The Panel therefore allowed the amendments to be made. The amended Allegation is as set out above and the original wording of the Allegation is set out at the end of this decision.

Background

13. East Midlands Ambulance Service NHS Trust (“EMAS”) employed the Registrant as a Band 5 Paramedic in Accident and Emergency operations. He was based in Mablethorpe Ambulance Station and was responsible for responding to patients requiring routine, urgent or emergency ambulance care.


14. This case arises from the actions of the Registrant in relation to two incidents he attended on 21 December 2015 and 31 March 2016. It is alleged that his actions on those nights amount to a lack of competence or misconduct on his part.

Decision on Facts

15. The Panel considered all the evidence in this case together with the submissions made by Mr Paterson on behalf of the HCPC. Mr Brown did not attend the hearing and the Panel did not draw any adverse inference from his non-attendance.


16. The Panel accepted the advice of the Legal Assessor who reminded the Panel that the burden of proof rests with the HCPC, and that the Registrant need not disprove anything. The Legal Assessor also reminded the Panel that the standard of proof is the civil standard, namely the balance of probabilities.


17. The Panel heard oral evidence from the following witnesses on behalf of the HCPC:

• Witness 1, Clinical Team Mentor and Paramedic with EMAS, who investigated the ‘call-out’ on 21 December 2015;


• Witness 2, Emergency Care Assistant with EMAS who was present with the Registrant on 21 December 2015 when he attended to Patient A;

• Witness 3, Team leader with EMAS who investigated the ‘call-out’ on 31 March 2016;


• Witness 4, Ambulance Technician for the East Division Lincolnshire, EMAS, who was present with the Registrant on 31 March 2016 when he attended to Patient B.


18. The Panel received a bundle of evidence from the HCPC consisting of the statements and documents gathered as part of EMAS’ investigation into these matters. The Panel also received the Registrant’s representations that he wished the Panel to take into consideration. These were the representations he made to the Investigating Committee dated 17 March 2017 and also in a further email he sent to the HCPC on 4 May 2017.


19. The Panel firstly considered the two events in turn. The evidence in relation to 21 December 2015 comes from Witness 1 and Witness 2. Witness 1 was a clinically sound paramedic. However, he recognised that he had received very little training in carrying out investigations of this nature. He based his report on the documentation of the ‘call-out’ and an interview with the Registrant conducted earlier by another manager. He did not interview nor speak to the Registrant, Witness 2 or the service users, who were direct witnesses and this limited his awareness of the context of the incident. He told the Panel that he had wanted to interview the Registrant and Witness 2 but had been prevented from doing so by operational pressures. Therefore his report is based on incomplete information, which in turn limited the usefulness and veracity of his evidence.

20. Witness 2’s recollection of events, including the restraint of Patient A was poor, which is not surprising in the light of the fact that the incident occurred in 2015. He had limited awareness of the issues relating to the allegations, and was unable to assist even when asked probing questions by the Panel. As part of his oral testimony, he adopted his witness statement that was taken in August 2017. He should have been interviewed and a statement obtained as part of the investigation carried out by EMAS in order to preserve ‘Best Evidence’. Instead he has had to rely upon his recollection in August 2017, which is closer in time to these proceedings than it was to the time of the events, and this has adversely affected the quality of his evidence and the evidence provided by EMAS.


21. The evidence in relation to the events on 31 March 2017 comes from Witness 3 and Witness 4. Witness 3 said that he had no training in how to investigate such matters at the time, and that this matter was the first time he had carried out an investigation. Witness 3 did not interview nor speak to the Registrant or Witness 4 as part of his investigation into these events. He said he was assigned to take over the investigation from Witness 1 who had left the service. He said that he was not provided with any notes of any enquiries carried out by Witness 1 into these matters, nor was he aware of any such enquiries carried out by Witness 1. As a result he was far removed from the events, and relied upon the documentary evidence without probing elements around decision making and/or making a root cause analysis. Such documentary evidence consisted only of copies of the documents relating to the ‘call-‘out’ and an interview of the Registrant carried out by another Investigating Officer. While giving evidence, he was shown a good copy of the Patient Record Form (“PRF”) and he realised that the copy that he used in making his statement in August 2017 had the relevant information recorded by the Registrant either obscured or removed. The flawed copy of the PRF that he used, was the basis of the allegation 2(a)(ii) and 2(a)(iii). As such, Witness 3’s evidence lacked the veracity and cogency for it to be relied upon without hesitation.


22. The Panel found Witness 4’s evidence to be credible and helpful. His recollection of events was clear and lucid. He told the Panel about his experience with the Registrant, both as a service user and as a colleague. He had worked with many other paramedics, and he explained how the paramedics at EMAS worked. He was clear as to what he could and could not recall about the events of that night.

Particular 1(a)

1. On 21 December 2015 in relation to Patient A:
(a) Physically restrained Patient A for an inappropriate length of time without seeking police assistance;


23. Witness 1 told the Panel that in the circumstances that the Registrant faced on 21 December 2015, the initial restraint of Patient A was not improper. However, it would appear that the duration of the restraint was 40 minutes and Witness 1 told the Panel that this length of time was excessive.


24. The Registrant in his statement dated 4 January 2016 taken by EMAS, did not state that he had restrained Patient A, but rather that he had guided her to the ambulance, despite her being violent. He stated that after over 40 minutes, Patient A was still in the same condition as when he arrived. In the IR1, completed by Witness 2, he said that whilst trying to restrain Patient A, she managed to bite the Registrant twice and himself once. He further stated that after approximately 45 minutes, Patient A calmed down enough to be cannulated and given IV Diazemuls. In his live evidence, Witness 2 stated Patient A had been restrained by himself, the Registrant and Patient A’s father for approximately 30 minutes.

25. Witness 1 told the Panel that paramedics at EMAS were not trained in restraint techniques and therefore the Registrant should have called for assistance from the police, using the emergency call button on his radio, when it became clear that initial attempts to restrain Patient A were not working. He said that 40 minutes was not a reasonable time in any circumstances to attempt to restrain a patient like Patient A without assistance from someone properly trained to do so. He said that what the Registrant did was also contrary to the Joint Royal Colleges Ambulance Committee’s (“JRCALC”) guidelines on the use of restraint.

26. The Registrant does not assert that he had any training in restraint techniques for violent patients. The Panel determined that, 30 to 40 minutes was an inappropriate length of time for a paramedic without proper training to physically restrain Patient A without seeking police assistance in these circumstances.


27. Therefore the Panel finds Particular 1(a) proved.

 
Particular 1(b)

1. On 21 December 2015 in relation to Patient A:
(b) Did not adequately document details of the restraint on the Patient Record Form and/or Incident Report Form (IR1).


28. This particular is dependent on the documentary evidence. There is no dispute by the Registrant that Patient A was restrained and he did not record this on the PRF or on a separate IR1. Witness 1 told the Panel that the EMAS Capacity to Consent Policy required that when service users are restrained, a separate IR1 should be completed, giving details of the nature, duration and purpose of the restraint.
29. Therefore the Panel finds Particular 1(b) proved.

Particular 1(c)

1. On 21 December 2015 in relation to Patient A:
(c) Physically restrained Patient A without completing and/or recording a mental capacity assessment;


30. There is no record of the Registrant having carried out and completed a mental capacity assessment of Patient A before restraining her. The Registrant does not assert that he did and Witness 2’s description of the events was that they were confronted with a violent patient on arrival and they had to immediately take steps to restrain her for her own safety.


31. The Panel were satisfied on the evidence that the Registrant physically restrained Patient A without completing a mental capacity assessment on Patient A.


32. Therefore the Panel finds Particular 1(c) proved.

Particular 1(d)

1. On 21 December 2015 in relation to Patient A:
(d) Administered IV Diazemuls to the patient outside of clinical practice guidelines;


33. There is no dispute that the Registrant administered IV Diazemuls to Patient A. Witness 1 produced the Clinical Practice Guidelines (“CPG”) for the administration of IV Diazemuls for paramedics. The CPG provides the indicated situations where IV Diazemuls can be administered. The Registrant and Witness 2 said that they were not sure Patient A was having seizure activity and that they thought she was having a ‘cerebral event’. Witness 2’s recollection was that when they managed to effectively restrain Patient A and after she had calmed down, the Registrant administered 10mg of IV Diazemuls. He recalled that because of Patient A struggling, it had not been possible to cannulate her before she calmed down.

34. The Panel observed that convulsion was only the first indicator in the guidance and that there were subsequent indicators to consider where IV Diazemuls should be administered. None of those indicators were noted by the Registrant nor recorded in the PRF or the IR1 as being present.

35. The Panel is therefore satisfied that Particular 1(d) is proved.

Particular 1(e)(i) and 1(e)(ii)


1. On 21 December 2015 in relation to Patient A:


 (e) Did not adequately complete and/or record patient observations in that you did not:


(i) check and/or record blood glucose;


(ii) check and/or record oxygen saturation;

36. Witness 2 told the Panel that the Registrant did not check Patient A’s blood glucose level or her oxygen saturation level during the time they were dealing with her. The Registrant does not assert that he carried out those checks.


37. Witness 2 said that the machines to measure blood glucose and oxygen saturation levels were “off the road”, meaning that they were not working at the time. This is recorded on the PRF as “OTR” against the box for oxygen saturation levels.


38. The Panel were satisfied that the Registrant did not check Patient A’s blood glucose levels nor her oxygen saturation levels. Therefore the Panel finds particulars 1(e)(i) and 1(e)(ii) proved.

Particular 1(e)(iii)


1. On 21 December 2015 in relation to Patient A:

 (e) Did not adequately complete and/or record patient observations in that you did not


(iii) carry out and/or record a neurological assessment;


39. The Panel finds Particular 1(e)(iii) not proved. It was satisfied that there was a neurological assessment carried out and it is adequately recorded on the PRF as the Glasgow Coma Score.

Particular 1(f)


1. On 21 December 2015 in relation to Patient A:


 (f) Did not utilise and/or document:


(i) The use of the Paramedic Pathfinder tool; and/or

(ii) The National Early Warning Score (NEWS)


40. Witness 2 said that he could not recall the Registrant using the Paramedic Pathfinder tool (“PPT”) or the NEWS when deciding whether or not to take Patient A to hospital.

 
41. The Registrant does not assert that he used the PPT or the NEWS when deciding whether or not to take Patient A to hospital. Further there is no note on the PRF that the PPT or the NEWS had been used. The Panel was aware that there is no specific place on the PRF for PPT or NEWS outcomes to be recorded. However, it is also aware that the Registrant had recorded the use of the PPT and NEWS on the PRF for Patient B in the available space for free text (box 12).


42. The Panel determined that it was more probable that the Registrant did not use the PPT or the NEWS on this occasion as is evidenced by the lack of recording on Patient A’s PRF that they were used.


43. Therefore the Panel finds particulars 1(f)(i) and 1(f)(ii) proved.

Particular 1(g)

1. On 21 December 2015 in relation to Patient A:
 (g) Did not ensure adequate “safety netting” was completed and/or recorded.


44. In relation to this particular, there is evidence of “safety netting” on this occasion and that is recorded on the PRF. However, what was recorded was not adequate in the light of the fact that the Registrant had administered IV Diazemuls. There should have been some discussion with another healthcare professional about the onward care of Patient A because she had been given IV Diazemuls. There is no record of such a discussion taking place and Witness 2 said that there was no discussion with another healthcare professional.

45. The Panel is satisfied that the Registrant did not ensure adequate “safety netting” for Patient A and therefore it finds Particular 1(g) proved.


Particular 2(a)(i)


2. On 31 March 2016, in relation to Patient B:


(a) Did not document:


(i) The use of the sepsis screening tool;


46. Witness 4 gave clear evidence that the sepsis screening tool was used on this occasion. However, there is no recording on the PRF of that usage or the outcome of the use of that diagnostic tool.

47. Accordingly the Panel finds particular 2(a)(i) proved on the basis that the Registrant did not document his use of the sepsis screening  tool on this occasion. 

Particulars 2(a)(ii) and 2(a)(iii)


2. On 31 March 2016, in relation to Patient B:


(a) Did not document:


 (ii) The use of the Paramedic Pathfinder tool; and/or


(iii) The National Early Warning Score (NEWS);

48. The Registrant has clearly recorded the use of the Paramedic Pathfinder tool and the use of the NEWS, and the outcomes of these tools. Witness 3, accepted that he was working from a poor copy of the PRF which had the relevant part of the PRF obscured. When he was presented with another copy of the PRF of Patient B, Witness 3 accepted that the Registrant documented the use of the Paramedic Pathfinder tool and also the use of the NEWS.


49. Therefore the Panel finds paragraph 2(a)(ii) and 2(a)(iii) not proved.

Particular 2(b)


2. On 31 March 2016, in relation to Patient B:

 (b) Did not identify alternative care pathways for the patient;


50. The Panel finds Particular 2(b) not proved. The Registrant asserts that he did identify alternative care pathways for Patient B and Witness 4 confirmed this in his evidence to the Panel. Furthermore, this discussion is properly documented in Patient B’s PRF. Witness 4 told the Panel that the patient had refused to attend the emergency department and did not consent to a GP out-of-hours referral.


Particular 2(c)


2. On 31 March 2016, in relation to Patient B:


 (c) Did not ensure adequate “safety netting” was completed and/or recorded.


51. The PRF recorded that Patient B has breathing difficulties and a productive cough. Witness 3 said that these were activating factors on the sepsis screening tool. It was his opinion that Patient B had pneumonia on the data before him and therefore the outcome, according to the sepsis screening tool, should have been that Patient B should have been transferred to the hospital. In that light, Patient B’s refusal to go to hospital should have prompted the Registrant to seek advice from a senior clinician.

52. The Panel did not accept Witness 3’s opinion that Patient B had pneumonia. His basis for that opinion was a review of the paper work and not of actual assessment of Patient A. The Registrant had recorded the outcome of his use of the NEWS tool. However, the outcome of “3” was not clearly written and Witness 3 wrongly assumed that it was the higher reading of “5” without himself using the NEWS tool to check. When the Panel took him through the details recorded on the PRF and asked him to use the NEWS tool, he reached the result of the lower score of “3” which, according to the EMAS On Scene Conveyance and Referral Procedure document, suggests that Patient B represented a lower clinical risk.

53. A NEWS tool result of “3”, indicated that Patient B represented a lower clinical risk. Under the EMAS On Scene Conveyance and Referral Procedure document, such a result would not have necessitated Patient B being taken to the hospital. Additionally, the Registrant has documented the use of the PPT and that Patient B did not elicit any activating features at stages 1, 2 or 3 of the tool. In that light, the Registrant did not have to seek advice from a senior clinician. Furthermore, the alternative care pathway of referral to an out-of-hours GP service was refused by Patient B, and as a result Patient B was directed to consult his GP later that day and was asked to call 999 if his condition changed. Accordingly, the “safety netting” provided by the Registrant, as recorded in the PRF, was adequate.


54. Therefore the Panel determined that Particular 2

(c) is not proved.


Decision on Grounds

55. The Panel then went on to consider whether the factual particulars found proved amounted to misconduct and/or lack of competence.  The Panel heard the submissions of Mr Paterson.


56. The Panel also considered the Registrant’s previous submissions to the panel of the Investigating Committee on misconduct.


57. Mr Paterson submitted that the Registrant’s actions breached the following paragraphs of the HCPC’s standards of conduct, performance and ethics: 1, 3, 5, 7 and 10.


58. Mr Paterson further submitted that the Registrant had also breached the following paragraphs of the HCPC’s standards of proficiency for Paramedics: 2, 8, 10, 11, 12 and 15.

59. The Panel accepted the advice of the Legal Assessor. He referred the Panel to the decisions in the following cases:


a) Calhaem v GMC [2007] EWHC 2606 (Admin)

b) Roylance v GMC (2000) 1 AC 311


c) Andrew Francis Holton v General Medical Council [2006] EWHC 2960


d) Hindmarsh v NMC [2016] EWHC 2233 (Admin)

60. The Panel was aware that misconduct is “a word of general effect, involving some act or omission, which falls short of what would be proper in the circumstances.” It is also aware that it was stressed that Misconduct is qualified by the word “serious”. It is not just any professional misconduct, which will qualify.


61. The Panel was also aware that not every instance of falling short of what would be proper in the circumstances, and not every breach of the HCPC’s standards would be sufficiently serious so as to amount to misconduct in this context. Therefore, the Panel has had careful regard to the context and circumstances of the matters found proved. The Panel considered each of the factual particulars in the light of the following circumstances demonstrated by the evidence:


(a) The Registrant was a paramedic with over 30 years experience.


(b) There were no issues raised regarding the Registrant’s practice prior to these matters.

(c) These matters involved two incidents that occurred over a period of three months from 21 December 2015 to 31 March 2016.


62. The Panel determined that in the light of the above factors, the competence of the Registrant was not an issue in this case. It was safe to infer that the Registrant was, at the very least, a competent Paramedic with the necessary knowledge, skill and training for his role. The evidence of Witness 2 and Witness 4 would indicate that the Registrant had a “minimalist” approach to filling in the PRFs. Through witness evidence, it was clear to the Panel that he was not alone in this approach at EMAS. The Panel was told that a significant number of paramedics had that approach. The Panel also noted that the PRF did not have specific boxes in which to record the usage of the Paramedic Pathfinder tool, the sepsis screening tool, or of the NEWS tool. This is despite it being the policy of EMAS that it was mandatory for these tools to be used and recorded.

63. The Panel considered each of the factual particulars found proved in turn, and determined that, in the circumstances, particulars 1(e)(i), 1(e)(ii), 1(d) and 1(g) amounted to serious misconduct. The Panel determined that the actions of the Registrant in each of those particulars breached the following paragraphs of the HCPC’s standards of conduct, performance and ethics:


1.  You must act in the best interests of service users.


10. You must keep accurate records.

64. Particulars 1(e)(i) and 1(e)(ii) amounted to serious misconduct because the blood glucose level and the oxygen saturation level should have been taken as part of any assessment of a patient prior to administering IV Diazemuls. Either of those could have been a cause for seizure activity for which the administration of IV Diazemuls would have been clinically inappropriate. The failure of the Registrant to exclude those possible causes before administering IV Diazemuls to Patient A exposed her to unwarranted risk of harm.


65. Particular 1(d) amounted to serious misconduct because the Registrant did not follow accepted guidelines for the administering of IV Diazemuls to Patient A and as such exposed Patient A to unwarranted risk of harm. This is further aggravated by the fact the Registrant had not carried out a proper assessment as to the cause of Patient A’s condition.


66. Particular 1(g) amounted to serious misconduct because of the lack of adequate safety netting and the recording thereof. The Panel was aware of the EMAS On Scene Conveyance and Referral Procedure document. This was the procedure that the Registrant was bound to follow as a paramedic staff member of EMAS. It states that, “Paramedic Pathfinder must be used to support and confirm all conveyance, referral or self-care decisions.” It also states, “The Paramedic Pathfinder outcome must be documented each time a patient is assessed … this demonstrates the clinician has used Paramedic Pathfinder to support, confirm and guide their clinical decision making. For all conveyance options, documentation of the Paramedic Pathfinder outcome further justifies the decision made.”


67. In the circumstances, the Registrant’s actions meant that:


(a) there was no opportunity for a second opinion as to the course of action to be taken for Patient A;


(b) the overall lack of documentation of the restraint and lack of justification for the use of IV Diazemuls meant that a future clinician dealing with Patient A would not have important information passed on to them.


68. The Panel further determined that the remaining factual particulars related to the restraining of Patient A. The Panel took the following factors into account:


(a) The situation was volatile and fast moving;


(b) The Registrant and Witness 2 were acting at the request of Patient A’s father, who assisted in restraining her;


(c) Patient A’s father had told the Registrant and Witness 2 that the condition would normally resolve itself in approximately 15 minutes, and therefore the extended duration on this occasion was unexpected;


(d) There was a real risk to the safety and welfare of Patient A if she was not restrained;


(e) It was clear that the Registrant was acting in the best interest of Patient A and doing what he thought was proper in the circumstances.


69. In the light of the above, the Panel determined that the remaining factual particulars did not amount to serious misconduct in the circumstances.

Decision on Impairment 

70. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of his misconduct. The Panel heard the submissions of Mr Paterson, and it accepted the advice of the Legal Assessor.


71. The Legal Assessor drew the Panel’s attention to the approach set out in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin), and reminded the Panel that there was a personal and public component when considering whether the Registrant’s fitness to practise was currently impaired.


72. For this purpose, the Panel adopted the approach formulated by Dame Janet Smith in her fifth report of the Shipman inquiry by asking itself the following questions:


“Do our findings of fact in respect of the Registrant’s misconduct show that his fitness to practise is impaired in the sense that he:


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


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


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


73. The Panel determined that the answers to all the above questions were in the affirmative in relation to past and future possible conduct. In coming to its decision it took into account the following factors:

(a) The direct consequence of the Registrant’s actions in relation to Patient A put her at unwarranted risk of harm;


(b) The Registrant has failed to engage with the process since 4 May 2017 and has not attended today to tell the Panel what, if any, insight he has gained into his actions. His written representations to the Panel did not address this point nor did it provide any evidence of insight on his part.

(c) There is no evidence of any insight on the part of the Registrant. This is a matter of misconduct, and there can only be very limited remediation without insight. There has been no evidence of any action taken by the Registrant to remediate his misconduct.

(d) The Registrant has indicated that he has retired from the profession. However, the Panel has not been able to test the permanence, or otherwise, of the Registrant’s decision.

74. The Panel also determined that the Registrant’s misconduct was such that the need to uphold professional standards and public confidence in the professions would be undermined if a finding of impairment were not made in these circumstances.

75. Therefore, Panel determined that the Registrant’s fitness to practise is currently impaired on both personal and public interest considerations.

Decision on Sanction

76. The Panel heard the submission of Mr Paterson in regard to sanction.

77. The Panel accepted the advice of the Legal Assessor.  The Panel had regard to all the evidence presented, and to the HCPC’s Indicative Sanctions Policy. The Panel reminded itself that a sanction is not to be punitive although it may have a punitive effect. The Panel bore in mind the principles of fairness and proportionality when determining what the appropriate sanction in this case should be.

78. In coming to its decision, the Panel took into account the considerations it did in determining statutory grounds and impairment, and additionally the following:

a) The Registrant has not demonstrated any insight or remorse;


b) The Registrant is of good character;


c) This is a single incident (21 December 2015) in an otherwise unblemished career;


d) There have not been any further incidents since March 2016;


e) There was no serious cause for concern about the Registrant’s practice previously;


f) The poor supervisory support provided to the Registrant by EMAS, as was clear from the evidence of Witness 1;


g) Witness 4 was positive about the Registrant’s skill; prior to joining EMAS, Witness 4 had experience of the Registrant from the perspective of a service user, and then as a colleague.


79. In considering the matter of sanction, the Panel started with the least restrictive moving upwards.


80. The Panel first considered taking no action but concluded that, given the seriousness of the Registrant’s misconduct, this would be wholly inappropriate.


81. The Panel then considered whether to make a caution order. The Panel was mindful of its finding that the Registrant was likely to repeat his misconduct because of the lack of evidence of insight on the part of the Registrant. In view of this, a Caution Order is not appropriate even if for the maximum period.

82. The Panel next considered the imposition of a Conditions of Practice Order. Conditions of practice would most likely have been appropriate had the Registrant attended this hearing as the misconduct is easily remediable. The Panel would have had an opportunity to ascertain his level of insight and remorse, matters of which he made no mention of in his written representations. As such, the Registrant has not demonstrated insight into his misconduct. Furthermore, the Registrant has indicated that he has left the profession. The Panel determined that conditions of practice would not be suitable as a sanction in this case.

83. The Panel then considered imposing a period of suspension. The Panel determined that in the circumstances of this case, suspension for a period of 12 months would be a sufficient and proportionate response. The period would allow the Registrant sufficient time to reflect and gather evidence of insight and remorse. If he is able to do so earlier, it is open to him to seek an early review of the sanction. The Panel also determined that the period of suspension would suffice to maintain a proper degree of confidence in the profession and the regulatory process, and to declare and maintain proper standards among fellow professionals.


84. The Panel did consider the sanction of striking-off and determined that such a sanction would be disproportionate at this stage.


85. It is important that the Registrant understands that in common with all Suspension Orders, the order made today will be reviewed before it expires. The panel undertaking the review will have all the sanction options available to the Panel today, including the power to make a Striking-Off Order. If the Registrant chooses to take advantage of the opportunity that has been extended to him by the making of a Suspension Order to seek to persuade the reviewing panel that he should be permitted to return to practice, then the present Panel suggests that he consider taking the following steps, which are not to be taken as an exhaustive list:


(a) Engage with the fitness to practise process and attend the review hearing;


(b) Prepare a reflective piece in writing explaining what insight he has developed into the matters that have been considered by the Panel and how he would seek to prevent a recurrence of similar failings.


(c) Provide evidence of any training undertaken to maintain his professional standards and CPD.

(d) Provide up-to-date testimonials from people able to comment on any activities he has undertaken during the period of suspension, including any employment paid or unpaid.

Order

Order:
The Registrar is directed to suspend the registration of Mr Geoffrey Brown for a period of 12 months from the date this order comes into effect.

Notes

A hearing took place in London at 405 Kennington Park Road, London SE11.

Hearing History

History of Hearings for Mr Geoffrey Brown

Date Panel Hearing type Outcomes / Status
22/02/2019 Conduct and Competence Committee Review Hearing Struck off
22/02/2019 Conduct and Competence Committee Review Hearing Hearing has not yet been held
19/02/2018 Conduct and Competence Committee Final Hearing Suspended