Mr Stephen E Meyern

Profession: Paramedic

Registration Number: PA02239

Hearing Type: Review Hearing

Date and Time of hearing: 12:30 09/03/2018 End: 17:00 09/03/2018

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

During the course of your employment as a Paramedic with East of England

Ambulance Service NHS Trust:

 

1. On 8 September 2013, you were sent to attend an emergency call for a patient who was described as 'fitting', and:

 

a. You did not take a defibrillator into the emergency scene to assist you in your treatment of the patient.

 

b. You did not take a bag valve mask (BVM) into the emergency scene which caused a delay in providing assisted ventilation to the patient.

 

c. You instructed an Emergency Care Assistant (ECA) to act outside of the Trust's protocol and/or gave incorrect instructions in that:

i. You directed an ECA to draw up diazepam which is a controlled drug.

ii. You directed an ECA to draw up diazepam with a saline solution.

iii. You directed an ECA to administer diazepam intravenously.

iv. You directed an ECA to prepare adrenaline.

v. You directed an ECA to administer adrenaline intravenously.

 

d. Not proved.

 

e. You did not provide an appropriate Patient Care record in that you recorded inadequate details of the drugs given.

 

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

 

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

Finding

Preliminary Matters

1. The HCPC was represented by Ms Rebecca Senior, Case Manager with the HCPC. The Registrant was not present and was not represented.

Service of Notice

2. The Panel was informed that notice of the hearing was sent by post to the Registrant’s registered address on 9 February 2018. An amended notice of hearing was also sent to the Registrant dated 26 February 2018. The Panel was satisfied that notice of the hearing had been served in accordance with the rules.

Proceeding in the absence of the Registrant

3. Ms Senior applied for the hearing to proceed in the Registrant’s absence. Ms Senior referred to an email dated 5 March 2018, sent by Unison, who represent the Registrant in which they informed the HCPC that neither they nor the Registrant would be attending the hearing. Ms Senior also referred the Panel to an email from the Registrant in which he set out his representations for the Panel to consider when reviewing the conditions of practice order.

4. The Panel was satisfied that the Registrant had voluntarily absented himself from this review hearing. In the absence of any application for an adjournment, the Panel considered that no purpose would be gained by adjourning the hearing. The Panel was also mindful that this is a mandatory review of a substantive order. The Panel considered that it was in the interests of justice and in the Registrant’s interests for the hearing to proceed in his absence.

Background (as recorded at the final hearing in March 2016)

5. The Registrant was a Duty Locality Officer (DLO) with East of England Ambulance Service (EEAST). He was responsible for the management of emergency care practitioners, paramedics, ambulance technicians and emergency care assistants (ECA).

6. On 8 September 2013, the Trust received an emergency call in relation to a patient who was described as “fitting”. That evening the Registrant was working in a rapid response vehicle (RRV). He was dispatched to the scene and was advised by the emergency responder that the patient had been “fitting” for approximately 20 minutes. The call was categorised as ‘R1’ (life threatening).

7. The Registrant was the first to arrive at the scene. Upon his arrival, he selected equipment from the boot of his vehicle and took it to the location of the patient. However, he was unable to take a defibrillator with him as he had too many other items of equipment to carry. The Registrant was let into the patient’s house by the patient’s wife and shown upstairs to a bedroom where the patient was in bed. An ambulance crew followed, consisting of Witness 1, ECA, and SK, ECA.

8. The Registrant provided clinical care to the patient with the assistance of both ECAs as follows. The Registrant cannulated the patient and asked Witness 1 to draw up a vial of diazemuls (diazepam) with a saline flush, which was the wrong solution. The preparation of such medication was outside the scope of her practice. Nonetheless, Witness 1 prepared the vials as requested and showed them to the Registrant. He asked her to put the solution through the cannula. Thereafter the Registrant and SK prepared to take the patient to the ambulance. Witness 1 then overheard SK tell the Registrant that the patient was “rasping at 8”, which is a low level of breathing. The Registrant advised SK that the patient’s breathing would return back to normal.

9. The patient then suffered respiratory arrest. Witness 1 heard the Registrant and SK discussing that the patient was not breathing. It was realised that the Registrant had not brought a BVM into the property, and therefore SK had to make a trip to the ambulance to obtain one, after which it was used on the patient. Soon after, the patient suffered cardiac arrest and there was a need for a defibrillator but the Registrant had not brought one to the scene. SK then went to the ambulance a second time to retrieve it.

10. The patient was moved from his bed to the floor. The Registrant asked Witness 1 to prepare adrenaline, which was also outside the scope of her practice. However, she did prepare the adrenaline and then the Registrant asked her to administer it through the cannula, which she did.

11. When the patient began to improve, he was placed on a carry sheet in order to move him downstairs and into the ambulance. SK began packing up the equipment that had been used and whilst he did so, the Registrant and Witness 1 moved the patient from his bedroom and down the stairs. The Registrant led and went backwards down the stairs with the patient’s head facing towards him and pointing down the stairs. Although Witness 1 considered that the patient’s positioning could compromise his airway she did not have time to suggest this to the Registrant as they were moving so quickly (the journey taking in all some 30 seconds). At the bottom of the stairs the patient was transferred to a stretcher located at the front doorway and thence to the ambulance.

12. The patient was taken to hospital in the ambulance by the Registrant and by Witness 1, with SK following in the RRV. The Registrant therefore delegated the task of asking the patient’s wife for relevant details and completing the Patient Care Record (PCR) to SK, who was able to partly complete it, but who omitted the doses of drugs given as he was unaware of these. Upon arrival, the Registrant handed over verbally to the hospital staff but although he was given the partially completed PCR by SK did not then complete it as he was called to another job. The evidence from Witness 2, the Trust Investigating Officer, was that the Registrant would have been expected to complete and handover the paperwork to the hospital before accepting another call out. Witness 1 saw that the PCR had been left in the resuscitation cubicle. One of the doctors started asking her questions about the patient which she could not answer as the information requested was not on the PCR. SK attempted to complete the form later but was unable to. The Registrant returned to the hospital about 1½ hours later but although he took the PCR from SK and signed, it off the Registrant also did not complete the same with full and adequate details of the medication that had been given to the patient or the amounts thereof.

13. The next day Witness 1 raised concerns regarding the clinical care provided to the patient (who had nonetheless survived the experience) by the Registrant. A Serious Investigation was initiated, the outcome of which was to initiate a disciplinary process. During the period of the disciplinary process, the Registrant was suspended from front-line duties and given office-based work, although for about six months of this period he was on sick leave.

14. On 31 October 2013, Witness 2 was commissioned as the investigating officer. His investigation concluded in April 2014. A disciplinary hearing was held on 7 May 2014 at which a number of the allegations against the Registrant were found proved and he was given a Final Written Warning and was also required to undertake an Action Plan, such to cover: clinical knowledge in relation to drug pharmacology; the “fitting” patient and the effects of hypoxia (lack of oxygen); observation of a variety of patients and clinical practice; and reading about the scope of practice for staff.

15. The Registrant appealed against that decision but the decision was upheld at an appeal hearing on 13 January 2015.

16. These events were then the subject of a referral to the HCPC and after investigation the Registrant faced the following Allegation (as amended and found proved at the Final Hearing):

17. At the Final Hearing the Registrant admitted the factual basis of the matters found proven and set out above

Decision

18. Ms Senior outlined the chronology of the matter and drew the Panel’s attention to the reasons why the Substantive Hearing panel had found misconduct and that the Registrant’s fitness to practice was impaired.

19. Ms Senior referred to the Registrant’s statement provided for this hearing. She also referred to a job offer from South Central Ambulance Service dated 12 April 2017. According to his statement, the Registrant commenced employment in May 2017 and completed two weeks of training. The Registrant then resigned from that job after being re-designated as an Emergency Care Assistant.

20. Ms Senior submitted that whilst the Registrant had been able to comply with some of the Conditions of Practice, he had failed to provide a reflective essay or his CPD record as required by Condition 8 of the amended Conditions of Practice Order.

21. The Panel received and accepted the advice of the Legal Assessor. The Panel was satisfied that the Registrant had not complied with numerous particulars of the Conditions of Practice Order including Particular 8. The Panel was not satisfied that the Registrant had demonstrated sufficient insight into the matters found proved. In the absence of any CPD record, the Panel could also not be satisfied that the Registrant’s misconduct had been remedied and would not be repeated. Accordingly, the Panel found that the Registrant’s fitness to practice is still impaired.

22. In considering the appropriate and proportionate sanction, the Panel was mindful that two years have now passed since the Registrant’s fitness to practice was found to be impaired. The Panel was also mindful that at the Registrant had been given a further opportunity to demonstrate sufficient insight and remediation when the Order was first reviewed on 9 March 2016.

23. The Panel took into account that a Suspension Order would prevent the Registrant from working which would result in him being unable to demonstrate effective remediation. The Panel also considered that the Registrant had engaged with these proceedings in some way and had successfully managed to gain employment as a Paramedic in May 2017, albeit for a very short period of time.

24. Taking all matters into consideration, the Panel concluded that by extending the period of the current Conditions of Practice Order for a further 12 months, the Registrant would have one more opportunity to provide evidence of reflection and updated CPD. The Registrant should be in no doubt that, the next reviewing panel may impose a more serious sanction if he has failed to comply fully with the Conditions of Practice Order.

Order

ORDER: The Registrar is directed to extend the Conditions of Practice Order against the registration of Stephen Meyern for a further period of 12 months on the expiry of the existing order.

1. You must promptly inform the HCPC if you take up any employment as a Paramedic and must promptly inform the HCPC if you cease to be so employed.

2. You must promptly inform the HCPC of any disciplinary proceedings taken against you by any such employer.

3. You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).
4. You must place yourself and remain under the supervision of a workplace supervisor or paramedic mentor of at least five years’ qualification as a  paramedic and who is regulated by the HCPC and supply details of your supervisor to the HCPC within seven days of his or her appointment. You must attend upon that supervisor as required and follow their advice and recommendations.

5. You must undertake appropriate Continuing Professional Development during your supervised practice as identified in 4 above and you must provide  evidence to your supervisor of such study which is to be approved and signed off by your supervisor as completed in accordance with the HCPC standards.

6. Before undertaking autonomous work as a paramedic you must:

(1) satisfactorily complete a period of supervised practice as a paramedic, such to constitute 5 shifts consisting of at least a minimum total of 50 hours of supervised call-out duty and

(2) forward a copy of your supervisor or paramedic mentor’s report on those shifts (to include confirmation of CPD undertaken and completed as set out in Condition 5 above) to the HCPC.

7. Once you have completed the 5 shifts consisting of at least a minimum of 50 hours of supervised call-out duty as a Paramedic, if your supervisor or paramedic mentor certifies in writing to both yourself and to the HCPC, that you are safe and competent to undertake autonomous practice as a paramedic then you will be allowed to undertake such autonomous practice and Conditions 4, 5 and 6 will cease to have effect.

8. You must provide a future reviewing Panel with:

(1) A reflective essay in which you identify the professional considerations which existed within a range of situations which you attended during supervision. and explain how your practice was informed by your previous experience.

(2) If there is difficulty in securing supervision, to provide the HCPC with evidence of the steps taken to attempt to secure employment and supervision in your role as paramedic.

(3) Evidence of your ongoing CPD record.

Notes

This Order will be reviewed again before its expiry on 08 April 2019.

Hearing History

History of Hearings for Mr Stephen E Meyern

Date Panel Hearing type Outcomes / Status
04/03/2019 Conduct and Competence Committee Review Hearing Voluntary Removal agreed
09/03/2018 Conduct and Competence Committee Review Hearing Conditions of Practice
09/03/2017 Conduct and Competence Committee Review Hearing Conditions of Practice
09/03/2016 Conduct and Competence Committee Final Hearing Conditions of Practice