Mr Amjid Mahmood
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(as amended at Substantive Hearing):
Whilst employed as a Paramedic for Yorkshire Ambulance Service NHS Trust (YAS) you:
1. Between 1 December 2015 and 12 March 2016, claimed overtime for periods of time you did not work on approximately 35 occasions.
2. Whilst receiving paid sick leave from YAS, undertook paid work with:
a) Regional Medical Services on 18 and 19 June 2016; and
b) KFA Medical on or around 26 June 2016.
3. Your actions as described at paragraphs 1 and 2 were dishonest.
4. The matters described in paragraphs 1 to 3 constitute misconduct.
5. By reason of your misconduct, your fitness to practise is impaired.
Proof of Service
1. The Panel found that there had been good service of the Notice of Hearing by a letter sent on 21 March 2018 to the Registrant at his registered address advising him of the date, time, and venue of the hearing.
Proceeding in the absence of the Registrant
2. Ms Williams made an application for the hearing to proceed in the absence of the Registrant. She referred the Panel to a bundle of documents which showed the chronology of the contact between the Registrant and the HCPC. On 25 February 2017, the Registrant completed and signed a Pro-forma document stating that he admitted the facts alleged against him, that he did not intend to appear in person at the hearing, and did not intend to be represented. On 6 October 2017 a Notice of Hearing was sent to the Registrant advising him of a hearing date in January 2018. The hearing did not proceed in January and was re-scheduled for today’s date. On 9 April 2018 the Registrant confirmed by e-mail that he had received the Hearing Bundle in relation to today’s hearing.
3. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.
4. The Panel carefully considered the circumstances of the Registrant’s absence. The Registrant has engaged with the HCPC to the extent of providing submissions for the Investigating Committee, completing the Pro-forma, and acknowledging receipt of relevant correspondence. However, he has clearly stated that he would not attend the hearing. The Panel was satisfied that the Registrant was aware of the hearing and that his absence was voluntary. The Panel considered that there would be no purpose in adjourning the hearing. The Registrant had not requested an adjournment and there was nothing to indicate that he might attend a hearing if it was adjourned to a later date. Although it might be in the Registrant’s interests to attend the hearing, the Panel decided that his interests were outweighed by the public interest that the hearing should proceed without delay. The HCPC witness was in attendance to give her evidence and there was a strong public interest in the Allegation being determined expeditiously.
Application to admit a further document
5. Ms Williams made an application to admit an additional document that was not included in the HCPC exhibits bundle and had not been served on the Registrant in advance of the hearing. The additional document was the Corporate and Local Induction Policy referred to in paragraph 14 of the witness statement of LS.
6. The Panel accepted the advice of the Legal Assessor and carefully considered whether it was fair to admit a document which had not been served on the Registrant.
7. In its deliberations, the Panel had carefully in mind the requirement that the hearing must be fair for the Registrant. The Panel noted the Registrant’s position that he admitted the facts of the Allegation. The Panel also noted that the document is referred to by its title in the witness statement of LS. The Panel considered that the document did not appear to be contentious. Although it was not clear to the Panel whether the document was required for the determination of the Allegation, on balance, the Panel decided that it was appropriate to admit the document. When considering the weight, if any, to give the document, the Panel would bear in mind the need to ensure that the Registrant was not prejudiced by the late admission of the document.
Application to amend the Allegation
8. At the conclusion of the evidence of LS, Ms Williams made an application to amend particular 2(b) of the Allegation to add the words “or around”. She submitted that this amendment did not prejudice the Registrant. The amendment was appropriate because the evidence of LS indicated an element of uncertainty from the available evidence about whether the day the Registrant worked for KFA Medical was 25 June 2016 or 26 June 2016.
9. The Panel decided that it was appropriate to allow the amendment. Although the Registrant has not had prior knowledge of the amendment, the amendment is minor and makes no substantive change. The Panel took into account the fact that the Registrant has consistently admitted that he worked for KFA Medical on 26 June 2016.
10. The Registrant was employed by Yorkshire Ambulance Service (YAS) as a Paramedic. An anonymous e-mail was received by YAS on 21 June 2016 which raised a concern that the Registrant was due to work as a Paramedic for a private company (KFA Medical), whilst he was absent from YAS by reason of sickness.
11. LS, Clinical Duty Manager, was appointed as Investigating Officer to investigate this concern. There were also concerns that the Registrant had fraudulently claimed end of shift overtime that he had not worked. LS conducted a fact-finding interview with the Registrant on 18 July 2016. At a second fact-finding interview on 9 August 2016 LS asked the Registrant for further information as to whether he had worked as a Paramedic at a Motorcross event in Oxfordshire for Regional Medical Services on 18 and 19 June, while he was absent from YAS by reason of sickness.
12. The Registrant self-referred to the HCPC on 26 September 2016. In his self-referral he stated that he fully admitted and accepted the allegations made against him and that he had since resigned as a Paramedic from YAS and wished to rebuild trust as a Paramedic elsewhere.
Decision on Facts
13. The Panel carefully read the documents in the HCPC exhibits bundle.
14. The Panel heard evidence from LS. The Panel found that she was a credible witness. She answered questions to the best of her recollection and knowledge. When she was unable to answer a question she said so. The Panel noted that there were some gaps in the investigation and that certain lines of enquiry might have been pursued in more depth. However, the Panel also recognised that LS prepared her report under her terms of reference as part of a disciplinary process that had not been completed by the time of the Registrant’s resignation.
15. The Panel carefully read and considered the Registrant’s written representations.
16. YAS permitted Paramedics to make a claim for overtime if they worked beyond the end of their shift. For example, the Paramedic might be required to respond to a call at the end of that shift and not be able to return to the ambulance station until after the end of the shift. When they return to the station, they press a button in the ambulance to automatically log the time that the vehicle was back on station.
17. The Paramedics also complete an electronic claim form by entering the time the work on their shift finished. After completing the form a box appears on the computer screen which states “Making a false claim on this form will be considered a serious breach of trust and may lead to disciplinary action. I confirm that the information on this form is a true and accurate statement of hours worked and expenses claimed”. The Paramedic ticks the box to confirm.
18. LS compiled a list of the Registrant’s shift times and overtime claims for the period 1 December 2015 to 31 March 2016. She recorded:
• the date and time of each shift;
• the time which the Registrant recorded that he finished his shift;
• the time the ambulance returned to the ambulance station after the last call of the shift; and
• the length of overtime claimed by the Registrant (except in cases where the ambulance returned to the ambulance station after the end of the shift, the time recorded was the difference in time between the ambulance returning to the station and the claimed finish time)
19. On a regular basis the Registrant was claiming periods of 30-40 minutes overtime. This included claims for shifts when the ambulance returned to the station before the end of his shift. For example on 2 December 2015, the Registrant’s shift was due to end at 2.30 a.m. He claimed that the end of his work on the shift was 3.00 a.m. The ambulance was back on station at 1.51 a.m.
20. At the fact finding interview on 18 July 2016, LS asked the Registrant about the reasons for the overtime claims. The Registrant stated, “I’ve already had a conversation about this with [my line manager]. I was under the impression I could claim up to the next 15 minutes. We did it in North West and I asked [another individual] who said it was right”. The Registrant also stated “[my manager] spoke to me and said I couldn’t do it anymore and I haven’t. It was a misunderstanding”.
21. LS conducted her investigation on the basis that the Registrant’s claims for overtime were acceptable if they were for 15 or 20 minutes either after the end of a shift or after the ambulance returned to the station, if that was later than the end of the shift. However, she identified the claims that were longer than 20 minutes as unacceptable claims because it would not have taken more than 10 minutes for the Registrant to carry out the tasks of restocking the ambulance and locking away the morphine. LS identified thirty five occasions when the claims were more than 20 minutes. LS told the Panel that she gave the Registrant the benefit of the doubt for claims up to 15 minutes.
22. The Registrant did not, either at the time he was questioned by LS or subsequently, explain the overtime claims, other than his belief that he could claim for fifteen minutes at the end of a shift. His explanation does not cover the thirty five occasions when LS identified a claim for more than 20 minutes. There were many occasions when a period of 30 minutes overtime was claimed when the ambulance had returned to the station well before the end of the shift and the only outstanding task at the end of the shift would have been to lock the morphine away.
23. The Registrant admitted the facts of the Allegation in his Pro-forma.
24. The Panel concluded that there were approximately thirty five occasions when the Registrant claimed excessive overtime that he did not work.
25. The Panel found particular 1 proved by the evidence of LS, the documentary evidence, and the Registrant’s admission.
26. The Registrant was recorded as absent from work from 2 June 2016. From 14 June 2016, the Registrant’s absence was supported by a statement of fitness for work from his General Practitioner. This statement confirmed that the Registrant was not fit to work for a period of 4 weeks or until 12 July 2016. The GP statement indicated that the Registrant was not fit to undertake any duties as a Paramedic.
27. On 18 and 19 June 2016 the Registrant undertook duties as a Paramedic at a Motorcross event for Regional Medical Services. The status in which the Registrant was contracted to work is confirmed by an e-mail from Regional Medical Services dated 20 August 2016.
28. At the second fact finding interview on 9 August 2016, the Registrant agreed that he worked at the event on 18 and 19 June 2016 and was paid for his services. LS asked why the Registrant stated at the first fact finding interview that he had no secondary employment. He replied: “In hindsight, I should have said I did I was only meant to be a first aider at the Motorcross event so I said I’d come down. In hindsight I can see it was wrong. I couldn’t see that I was doing anything wrong. I need the over time to keep afloat. I have maxed out two credit cards and have financial problems. I can see it was wrong though. When I got there, they said they needed me to work as a Paramedic. Initially I only meant to step in”.
29. The Registrant therefore admitted in the fact finding interview that he undertook paid work with Regional Medical Services on 18 and 19 June 2016. He made similar admissions in his self-referral to the HCPC, written submissions, and Pro-forma.
30. The Panel found particular 2(a) proved by the evidence of LS, the documentary evidence and the Registrant’s admission.
31. On 26 June 2016, the Registrant was certified unfit to work by his GP. This is confirmed by the GP statement of fitness to work.
32. On or about 26 June 2016 the Registrant undertook paid work with KFA Medical at a boxing event. YAS were alerted to the Registrant’s anticipated work at this event by an anonymous e-mail dated 21 June 2016. When the Registrant was asked about this work at the first fact finding interview with LS on 18 July 2016, he agreed that he worked at the event and that he was paid. He suggested in the interview that he did not expect to be paid and that this was a “one-off”.
33. The Registrant has consistently admitted that he was paid for his attendance on 26 June 2016 while he was unfit to work in the fact finding interview, his written submissions, and Pro-forma.
34. The Panel found particular 2(b) proved by the evidence of LS, the documentary evidence and the Registrant’s admission.
35. In its consideration of dishonesty the Panel accepted the advice of the Legal Assessor. Applying the guidance from the Supreme Court decision in Ivey v Genting Casinos, it first considered the Registrant’s state of mind. Having considered the Registrant’s understanding and beliefs, it applied an objective test, and considered whether the Registrant’s conduct was honest or dishonest by the standards of ordinary decent people.
36. The Registrant suggested in the fact finding interview that the excessive overtime claims were due to a misunderstanding on his part because he believed that he was entitled to claim an additional fifteen minutes. The Panel’s review of the overtime claims showed that the Registrant was regularly claiming 30-40 minutes of overtime. This is well over fifteen minutes and cannot be explained by a misunderstanding. The Registrant knew that he was making claims for overtime that he had not worked. The Panel also noted the evidence from the fact finding interviews that the Registrant had financial difficulties at the time he made the excessive claims. An error does not explain the overtime claims because of the pattern of excessive claims on approximately thirty five occasions.
37. The Registrant knew of the importance of accuracy and honesty when he made the overtime claim because on each occasion he completed an overtime claim he ticked a box on the screen which confirmed that he knew that making a false claim was a breach of the trust placed in him and would be regarded as fraud.
38. The Panel concluded that the Registrant knew that he was making fraudulent overtime claims. This conduct is dishonest by the standards of ordinary decent people.
39. The Registrant may or may not have known the details of the YAS policies on secondary employment or had them in mind at the time. However, he knew at the time that he was absent from work due to sickness and that he was not fit to work as a Paramedic in any capacity. He knew that KFA and Regional Medical Services who engaged him would expect him to carry out the duties of a Paramedic if required, but it appeared that he did not inform them that he was not fit to work as a Paramedic. He knowingly accepted payment for his services.
40. In the fact finding interviews, the Registrant made contradictory statements about whether he knew at the time that what he was doing was wrong. The Panel decided that he did know that his conduct was wrong.
41. The Panel decided that the conduct in particulars 2(a) and 2(b) was dishonest by the standards of ordinary decent people.
42. The Panel therefore found particular 3 proved.
Decision on Misconduct
43. The question of whether the proven facts constitute misconduct is for the judgment of the Panel and there is no burden or standard of proof.
44. There is no statutory definition of misconduct, but the Panel had regard to the guidance of Lord Clyde in Roylance v GMC (No2)  1 AC 311: “Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a …practitioner in the particular circumstances…”. The conduct must be serious in that it falls well below the required standards.
45. In reaching its conclusions that some of the proven facts constituted misconduct, the Panel considered the HCPC Standards of Conduct, Performance and Ethics (2016). The Panel considered that the Registrant’s actions and failures breached Standard 9, “be honest and trustworthly” particularly point 9.1, “you must make sure that your conduct justifies the public’s trust and confidence in you and your profession” and 9.4, “you must declare issues that might create conflicts of interest and make sure that they do not influence your judgement”.
46. The Registrant’s dishonest conduct in making claims for overtime that he had not worked was repeated conduct over a significant period of time. It was not a one-off isolated event. The Registrant placed his own interests and needs above his professional responsibility to be honest. This conduct is entirely unacceptable and falls well below the standards for Paramedics.
47. Similarly, the Registrant’s dishonest conduct in being paid by another organisation for professional work whilst absent from work due to sickness was entirely unacceptable. The Registrant was being paid for sickness absence by an NHS employer, but at the same time working in a role he was not fit to carry out and being paid by a private organisation.
48. The Panel considered that the Registrant’s conduct in working when absent from work due to sickness had the potential to put patients at risk, although there is no evidence that it did so. The Registrant’s GP had certified that the Registrant was not fit to work and this covered all the duties of a Paramedic. There was a risk that the Registrant’s ill health might affect his professional performance or judgement.
49. The Panel decided that the Registrant’s conduct in particulars 1, 2, and 3 was sufficiently serious to constitute misconduct.
Decision on Impairment
50. The Panel applied the guidance in the HCPTS Practice Note “Finding that Fitness to Practise is Impaired” and accepted the advice of the Legal Assessor. The Panel considered the Registrant’s fitness to practise at today’s date.
51. The Panel first considered the personal component, which is the Registrant’s current behaviour. The Registrant has engaged with the HCPC to the extent that he has made admissions of the facts and provided written submissions. In his written submissions, the Registrant stated:
52. “I would like to take this opportunity to start by apologising profusely for what I have done. In hindsight and in my naivety at the time I can now see what I did was wrong but I did not do it maliciously. Since the allegations I have resigned from my post as a Paramedic with YAS. With mutual agreement with my line manager and Human resources it was agreed I resigned with immediate effect to help try and build some form of trust in the hope of returning in the future. I am currently working as a Personal Independence Payment Assessor for MEDACS. I have learnt my lesson and have since filled in a secondary employment form with MEDACS to ensure this never happens again. Since the initial allegation ….I have no intention of ever having a repeat episode of this process. I have learnt I need to think about my actions more and fully understand now that under no circumstances can I practice if my GP has signed me off.”
53. The Panel carefully considered the level of the Registrant’s insight. The Panel noted that when the Registrant was first interviewed by LS he was asked about secondary employment. He agreed only to the specific example he was asked about (KFA Medical) and did not volunteer the information about Regional Medical Services. He only accepted that he had worked for Regional Medical Services when he was directly asked at the second fact finding interview. The Registrant has made early admissions, but only when directly challenged about his conduct. The Panel did not consider that the Registrant had made a full and frank admission at the first opportunity. In his written submissions, he did not admit dishonesty in relation to the overtime claims.
54. The Registrant self-referred to the HCPC. However, the Panel noted that in this referral he did not refer to the fraudulent overtime claims.
55. The Panel considered that the Registrant’s insight, at the time he prepared his written submissions, was limited. His written submissions include an apology, and an assertion that the conduct will not be repeated. However, the statement contains little reflection on the reasons for the Registrant’s dishonest behaviour or the seriousness and impact of his behaviour. The Registrant does not refer to the importance of honesty within the Paramedic profession or the impact of dishonest behaviour on public confidence in the profession. He does not consider the safety aspects of working as a Paramedic when he was certified unfit for all duties by his GP. There is no evidence that the Registrant has developed further insight since he prepared the undated written submissions.
56. The Panel considered that the dishonesty in the circumstances of this case is difficult to remedy. The dishonesty in this case was not a one-off incident, but was repeated over a sustained period of time. The Panel considered there was little evidence that the Registrant has attempted to remedy his past misconduct. There is no evidence of the Registrant’s current employment or circumstances. There is no evidence that the Registrant has changed his attitude and would no longer act unprofessionally because of his own financial needs or interests.
57. Taking into account the Registrant’s limited insight and the absence of evidence of remediation, the Panel decided that there is a risk of repetition of dishonest conduct.
58. The Panel next considered the wider public interest considerations including the need to maintain confidence in the profession and to uphold standards of conduct and behaviour. The Panel considered that in the circumstances of this case a finding that the Registrant’s fitness to practise is impaired is required. The Panel took into account the expectation of members of the public and the profession that Paramedics are honest and trustworthy. The Registrant’s repeated dishonesty involved the loss of trust in himself and the profession. The Panel also took the view that members of the public would be particularly concerned about the potential risk to patients arising from the Registrant’s dishonest decision to work as a Paramedic when he knew that he was certified unfit to carry out any duties.
59. The Panel therefore concluded that the Registrant’s fitness to practise is impaired on the basis of the personal component and the public component.
Decision on Sanction
60. In considering which, if any, sanction to impose the Panel had regard to the HCPC Indicative Sanctions Policy (ISP) and the advice of the Legal Assessor.
61. The Panel reminded itself that the purpose of imposing a sanction is not to punish the practitioner, but to protect the public and the wider public interest. The Panel ensured that it acted proportionately, and in particular it sought to balance the interests of the public with those of the Registrant, and imposed the sanction which was the least restrictive in the circumstances commensurate with its duty of protection.
62. The Panel decided that the aggravating features were:
• the repeated, sustained nature of the Registrant’s dishonesty;
• dishonesty involving two different areas (overtime claims and being paid for work whilst on sick leave);
• dishonesty in the performance of the Registrant’s professional duties;
• the dishonesty involved a breach of trust placed in the Registrant by YAS;
• the potential risk to patients arising from working when deemed not fit to undertake any of the duties of a Paramedic.
63. The Panel decided that the mitigating features were:
• the Registrant’s admissions and apology;
• the Registrant self-referred to the HCPC;
• limited insight.
64. The Panel considered the degree of seriousness of the Registrant’s misconduct. The Panel considered that the dishonesty is towards the top end of the spectrum of gravity of dishonest conduct because of its sustained and repeated nature. The conduct indicated that the Registrant’s integrity cannot be relied on.
65. The seriousness of this case meant that taking no action or mediation would not provide adequate protection for the public nor the required degree of public reassurance.
66. The Panel considered a Caution Order, but decided that it would not be sufficient or appropriate. The misconduct was not minor or isolated, the Registrant’s insight is limited and there is a risk of repetition. A Caution Order would also not be sufficient to maintain confidence in the profession and the regulatory process, given the seriousness of the misconduct.
67. The Panel next considered a Conditions of Practice Order. The Registrant’s misconduct involves dishonesty and a breach of trust. The Panel was not able to formulate conditions which would address the nature of the Registrant’s dishonest conduct and provide adequate protection for the public against the risk of repetition. Conditions would also not send a sufficiently robust message to the public and to the profession in respect of the Registrant’s dishonest conduct.
68. The Panel next considered the more restrictive options of a Suspension Order or a Striking-Off Order. The Panel carefully evaluated the mitigating circumstances when considering the proportionality of a Suspension Order. The Panel considered that the mitigating circumstances in this case were of limited weight. The Panel noted that the Registrant’s admissions were made only when he was directly challenged about his conduct. He did not volunteer information to his employer, despite being given a clear opportunity to do so. He was not open and frank in his answers in the fact finding interviews. He was similarly not open and frank in his self-referral to the HCPC because he omitted any reference to the dishonest overtime claims. The Panel considered that the Registrant’s limited insight and his apology were also of limited weight because the overall assessment of the Panel is that there remains a risk of repetition of dishonest behaviour.
69. The Panel also considered that this was a case where the Registrant’s dishonest conduct was so serious that a Suspension Order was not sufficient to mark the seriousness of the conduct, and maintain confidence in the profession and the regulatory process. In situations where the Registrant’s own interests were inconsistent with his professional responsibilities he could not be relied on to act with integrity. This is incompatible with continued registration. The Registrant repeatedly broke the trust placed in him by his employer and in his written submissions he does not appear to recognise or appreciate the seriousness of his dishonest conduct. The conduct was a fraud on the NHS and would be regarded as particularly serious by members of the public.
70. The Panel therefore considered that the only sufficient sanction was a Striking-Off Order. The Panel considered that the guidance in paragraph 47-49 of the ISP applied:
71. “Striking off is a sanction of last resort for serious, deliberate or reckless acts involving abuse of trust such as sexual abuse, dishonesty or persistent failure. Striking off should be used where there is no other way to protect the public, for example, where there is a lack of insight, continuing problems or denial. A registrant’s inability or unwillingness to resolve matters will suggest that a lower sanction may not be appropriate. Striking off may also be appropriate where the nature and gravity of the allegation are such that any lesser sanction would lack deterrent effect or undermine confidence in the profession concerned or the regulatory process.”
72. The Panel has no information about the Registrant’s current employment or circumstances. Nevertheless, the Panel was aware that the sanction of a Striking Off Order might have extremely serious consequences for the Registrant financially and professionally. The Panel decided that the need to protect the public and the wider public interest outweighed the Registrant’s interests in the circumstances of this case.
73. The Panel therefore decided that the appropriate and proportionate sanction was a Striking Off Order.
ORDER: The Registrar is directed to strike the name of Mr Amjid Mahmood from the Register.
Interim Order Application
1. Ms Williams made an application for an Interim Order to cover the 28 day appeal period and, if an appeal is lodged, for a period of eighteen months to cover the period until the appeal has been determined or withdrawn. Ms Williams made the application on the ground that it was necessary for the protection of the public and otherwise in the public interest.
2. The Panel accepted the advice of the Legal Assessor.
3. The Panel considered the application carefully. An interim order on the ground of public protection should only be made if it is necessary. The Panel has found that there is a risk of repetition of dishonest conduct in the context of the Registrant’s professional work. If the conduct were to be repeated, there is the potential for patient harm and harm to the public indirectly because of fraud on the NHS. The Panel decided that the risk of repetition is sufficiently high that an interim order is necessary for the protection of the public. An immediate order may have a serious impact on the Registrant, but his interests are outweighed by the need to protect the public.
4. The Panel also considered that an interim order was otherwise in the public interest. The high threshold for making an interim order is satisfied because of the ongoing risk of repetition of dishonesty.
5. The Panel considered the option of an Interim Conditions of Practice Order, but could not identify any conditions which would address the risks it has identified. The Panel therefore decided that the appropriate and proportionate order is an Interim Suspension Order.
The Panel makes an Interim Suspension Order under Article 31(2) of the Health and Social Work Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.
History of Hearings for Mr Amjid Mahmood
|Date||Panel||Hearing type||Outcomes / Status|
|29/05/2018||Conduct and Competence Committee||Final Hearing||Struck off|