Mr Patrick L Higgins

Profession: Paramedic

Registration Number: PA37179

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 19/11/2018 End: 17:00 21/11/2018

Location: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

Whilst registered as a Paramedic with the Health & Care Professions Council  and employed by South Western Ambulance Service NHS Foundation Trust, you:

1. On 1 April 2017, in relation to Patient A, who had a pain score of 10/10 and a potential sepsis diagnosis:

a. did not record offering and / or considering the use of and / or administering analgesia to Patient A;

b. did not undertake further observations;

c. left Patient A unattended by departing from the scene 15 minutes prior to the arrival of a Priority 2 back up crew.

2. The actions set out at particular 1 constitute misconduct.

3. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Matters

Service

1. The Panel is satisfied that there has been good service of the Notice of Hearing. A letter was sent to the Registrant’s registered address giving notice of these proceedings on the 20 August 2018. The Notice of Hearing was also sent by email.

Proceeding in the Absence of the Registrant

2. The Registrant did not attend at this final hearing, nor was he represented. The Panel considered whether it ought to exercise its discretion to continue with this hearing in the absence of the Registrant.

3. The Panel was provided with a bundle of documents evidencing communications with the Registrant. There has been very limited contact with the Registrant. There is an email dated 11 August 2017 where the Registrant confirms that he has moved back to the Republic of Ireland and asked that the HCPC update him regarding ongoing investigations. There is a second email confirming his email address dated 16 January 2018. There has been no response from the Registrant in relation to any subsequent correspondence.      

4. The Panel concluded that it was in the public interest to proceed in the absence of the Registrant, having considered the HCPC Practice Note on “Proceeding in the Absence of the Registrant“, having taken the Legal Assessor’s advice, and considered the guidance in R v Hayward [2001] EWCA Crim 168; R v Jones [2002] UKHL 5, and GMC v Adeogba and GMC v Visvardis [2016] EWCA Civ 162, for the following reasons:

a. The Registrant has not engaged in these proceedings, despite being aware of them. 

b. The Registrant has not sought an adjournment and there is no evidence that if these proceedings were adjourned, that he would attend on a subsequent occasion.

c. The Panel concluded that the Registrant’s actions, in these circumstances, could be regarded as deliberate or voluntary, and amount to a waiver of his right to appear.

d. Two witnesses attended to give live evidence and any further delay is likely to have an impact on the quality of that evidence. Hearings should take place within a reasonable period of time to the events which they are giving evidence about.

e. There is a general public interest in final hearings proceeding. Public protection through the effective regulation of registrants is the overriding objective against which all of the other factors have to be balanced. The fair, economical, expeditious and efficient disposal of allegations made against registrants is fundamental to that objective. Hearings should be adjourned only where there is a compelling reason to do so that overrides the key objective of public protection. The Panel has not been able to identify any such compelling reason in this case. 


Background

5. The Registrant was employed by SWAST as a Band 5 Paramedic between November 2013 and April 2017. His main responsibility was to attend 999 emergency calls outs to patients in a rapid response vehicle (RRV). He was based in the East Dorset Operations Department.

6. On 2 April 2017, a Datix incident report was completed by KN who attended Patient A in a double crew ambulance. A Datix incident report is a risk identification tool used by the ambulance service to report incidents where patient safety is thought to be compromised. The concerns had initially been raised by telephone to the duty operational officer, who requested that the Datix form be completed if there was a belief that the patient’s safety had been compromised.    

7. In this instance, concerns were raised about the actions of the Registrant on the previous day, 1 April 2017. A decision was made to investigate on 4 April 2017. The investigation was conducted by BM, who was the Registrant’s line manager.

8. The Registrant was invited to attend an investigatory meeting on 20 April 2017, but did not attend, having gone off sick on 3 April 2017. The Registrant had handed in his resignation on 25 February 2017, prior to the incident in question and did not return to work prior to his final day on the 28 April 2017. The only information provided by the Registrant concerning the incident was a witness statement, dated 3 April 2017, which was completed online and never signed.   

9. The Panel was very conscious that when a witness has not given oral evidence, their evidence is determined to be hearsay evidence. When considering hearsay evidence, which is admissible, the Panel has paid due regard to the weight which it can attach to it, bearing in mind that it has not been possible for that evidence to be challenged or probed. The Panel considered the Registrant’s witness statement, despite the fact he did not give evidence and was hence not cross-examined. The Panel did note that the statement was made relatively contemporaneously and felt able to place some, albeit limited weight upon it.      

10. The Panel has seen a bundle of documents provided by the HCPC which runs to 79 pages.

11. In addition to documentary evidence, the Panel has heard oral evidence from the following witnesses on behalf of the HCPC:

a. BM, Deputy County Commander (formerly Acting Operations Manager) with South Western Ambulance Service NHS Foundation Trust (SWAST);

b. KN, Paramedic with SWAST.   

12. The Panel heard and accepted the Legal Assessor’s advice and exercised the principle of proportionality at all times. In approaching the task of deciding the facts, the Panel has kept at the forefront of its deliberations, the importance of requiring the HCPC to prove matters against the Registrant. The standard of proof to which the HCPC is required to prove matters is the civil standard – on the balance of probabilities.

13. The Panel found the evidence given by BM to be open, transparent and honest. He gave considered answers to questions and sought to assist the Panel. The Panel also found KN’s evidence to be credible and reliable, although to a slightly lesser extent than with BM, whose evidence the Panel accepted without reservation. Whilst KN also sought to assist the Panel and made appropriate concessions when she was unable to answer questions, her evidence was to some extent affected by obvious disapproval of the Registrant’s actions. That being said it was to her credit that, for example, she conceded in evidence that her clinical observations could have been influenced by environmental factors, such as heat in Patient A’s home. However, this did not appear to have occurred to her at the time the initial concerns were raised.        


Decision on Facts

Particular 1 (Stem)

On 1 April 2017, in relation to Patient A, who had a pain score of 10/10 and a potential sepsis diagnosis:

14. The Panel found the stem proved on the basis of the first part of the stem of Particular 1, i.e. that Patient A had a pain score of 10/10 on 1 April 2017.

15. The Panel were less convinced regarding the second part of the stem, namely that Patient A had a potential sepsis diagnosis and did not find this proved on the balance of probabilities. The evidence from BM was that the EPCR (Electronic Patient Clinical Record) would automatically flag up that the issue of sepsis should at least be considered, in light of the recorded observations. This is not the same as Patient A’s symptoms having been assessed by a clinician as potentially warranting a sepsis diagnosis, and including this potential diagnosis in the stem could give the erroneous impression that Patient A’s condition was more serious than it actually was.

16. The Panel, having received legal advice from the Legal Assessor, took the view they were entitled to consider these two aspects of the stem disjunctively.

Particular 1(a) – Found Proved (in part)

Did not record offering and / or considering the use of and / or administering analgesia to Patient A;

17. The Panel found Particular 1(a) proved in respect of the Registrant not recording offering and / or not recording considering the use of analgesia. It concluded that Particular 1(a) was not proved in respect of not recording administering analgesia.

18. Patient A was an elderly lady in her 80s who lived at home. She had a fall on 1 April 2017, landing on the floor. She was able to activate her Careline pendant. The Registrant was the first responder who attended upon her. It is recorded in the EPCR document that upon arrival, Patient A was conscious, alert, breathing and had good colour. There were no obvious signs of trauma or injury. Patient A told the Registrant that she had tripped and fallen when moving between rooms. However, she did complain of groin and abdominal pain. Her pain score was recorded as being 10 out of 10, and she reported that she had had a vaginal bleed. A pain score is usually taken directly from a patient’s subjective perspective as part of an initial clinical assessment. The usual wording that a paramedic might use is: “On a sliding scale of zero being no pain and 10 being the worst pain you have ever felt, score your pain between zero and 10.” 

19. There is no record in the EPCR that the Registrant offered or considered the use of analgesic pain relief to Patient A. There is also no suggestion in the Registrant’s witness statement dated 3 April 2017 that he offered or considered the use of analgesia. KN’s evidence was that there were three places in the EPCR where it could be recorded that medication had been considered and not administered, for example, because the patient had previously taken her own medication.

20. The Panel found the factual allegation proved on this basis, in relation to the failure to record offering or considering the use of analgesia.

21. The Panel had more difficulty in relation to the third element of Particular 1(a), namely that the Registrant did not record administering analgesia to Patient A. The allegation is not drafted such that the mischief is the failure to administer analgesia when this was required; rather there is an alleged failure to record administering analgesia.

22. The Panel concluded on the balance of probabilities that the Registrant had not in fact administered analgesia. The Panel considered the following evidence on this issue.    

23. KN’s evidence was that Patient A told her that she had not been given any pain relief. She accepted Patient A’s subjective assessment of pain, but did concede there were other elements which may have influenced the overall picture, including her distress. KN stated that in her opinion the consequence of the Registrant not giving Patient A analgesia was that she remained in pain unnecessarily.   

24. During the course of the investigation, BM checked the central registration at the ambulance station where the Registrant was based, to see if there was any record of morphine having been administered and there was no evidence of any record. BM did not check the Registrant’s personal morphine book, but described the usual procedure. The Registrant would be expected to record in the central station morphine book at the first opportunity, on his return to the station or at the end of his shift, if he had administered one of his five ampules of morphine and to restock his supply.  

25. The evidence from BM was that with a pain score as high as 10/10, he would have expected that Patient A would have been offered either Entonox, paracetamol, or morphine, whether orally or intravenously. With a pain score of 10/10, Patient A was potentially in the worst pain that she had experienced in her life. By failing to administer analgesia, Patient A was left in pain, when this could have been reduced.

26. If the Registrant had administered analgesia and failed to record this on the EPCR, this would have had implications for the future management of Patient A. The backup crew, when they arrived, having had no verbal handover, may have administered a further dose having read the EPCR. This could have led to an overdose. This was a patient safety issue, as Patient A may not recall whether she had been given medication previously.

27. The Panel concluded on the evidence before it that the Registrant had not administered analgesia. The issue for the Panel was that given the finding that the Registrant did not administer analgesia, whether there was any obligation on him to make any recording. The Panel concluded that the reason why the Registrant did not record administering analgesia was because he did not do so.

28. Although the Panel heard some evidence about whether negatives should be recorded from BM, for example recording that a patient had declined medication, the overall tenor of the evidence was that this was a matter for the clinical discretion of the individual paramedic. There was however, no obligation on the Registrant to record administering analgesia when he had not done so.     

Particular 1(b) – Found Proved

Did not undertake further observations;

29. The EPCR shows the observation recordings made by the Registrant, along with those of the backup crew. They are recorded under the heading: “Vital Signs”. The Registrant recorded only a single set of observations at 16.32, despite being with Patient A until 17.47.

30. The backup crew recorded two further sets of observations of Patient A, both of which are timed at 18.49 on the ECPR. KN confirmed that in fact they had conducted an earlier set of observations, but that she had forgotten to amend the time she had recorded them when entering the data on the ECPR. It is not an unusual practice for a paramedic to take observations and to record them on their glove, or on a piece of paper, before entering the information later on the EPCR. BM’s view was that the backup crew had taken the first set of observations shortly after arriving at Patient A’s home.

31. The initial set of observations recorded by the Registrant were suitable and correctly recorded. The Registrant was with Patient A from 16.15 to 17.47. The Panel heard evidence from BM that although there is no formal policy on this, he would have expected a further set of observations to have been recorded during this time frame. This would have allowed the Registrant to observe the patient’s direction of travel - i.e. whether her health was declining, improving or remaining stable.

32. The observations which should be carried out are:

a. Airway - is the airway clear and a check for any cervical spinal injury would be conducted, depending on the individual situation.

b. Breathing - efficacy of breathing and rate of breathing;

c. Circulation - the patient’s pulse rate and a blood pressure reading may also be taken;

d. Disability - this commonly covers an AVPU score to establish how conscious a patient is (Alert Verbal Pain Unconscious) check to see if the pupils are equal and reactive, possibly measure blood glucose and an option would be to consider a FAST test to check for a Cerebral Vascular Accident (commonly referred to as a stroke);

e. Evaluate - evaluation of anything else.     

33. The Registrant should have worked through each stage of this primary survey. A paramedic would not have been able to move onto the next stage, until a problem had been rectified (i.e. choking under “A” would need to be resolved by clearing any obstruction before breathing could be assessed).

34. Once the primary survey is completed, a paramedic should move onto a secondary survey. This involves taking a comprehensive patient history and a “top to tail” approach to ascertain the nature of the problem. It is during this secondary survey that the pain score is usually taken. BM’s evidence was that he would have expected that both of these surveys would be completed within 10-15 minutes of arrival. The Registrant would have had ample opportunity to undertake another set of observations and record them on the EPCR.

35. There is a distinct difference between the observations recorded by the Registrant and the initial set of observations subsequently recorded by the backup crew. KN recorded her first observations as a NEWS score of seven (NEWS stands for National Early Warning Score). This is an early warning system to identify acutely ill patients including those with sepsis. The Registrant’s NEWS score is recorded as one on the ECPR at 16.32. The second set of observations recorded by KN are closer to those initially recorded by the Registrant.  

36. The Registrant’s statement dated 3 April 2017 appears to question the accuracy of the initial observations carried out by KN. When asked about this however, KN stood by the veracity of her observations, whilst also acknowledging that environmental factors may have played a part. However, there is no suggestion in the Registrant’s statement that a second set of observations were undertaken.    

37. The apparent difference in Patient A’s observations highlights the requirement for more than one set of observations, to ascertain whether she was improving or was declining. Most importantly a second set of observations undertaken by the Registrant would have informed his decision as to whether to leave Patient A unattended. Further it may also have been useful to the backup crew in painting a picture of whether Patient A’s condition was stable or deteriorating. 

Particular 1(c) – Found Proved

Left Patient A unattended by departing from the scene 15 minutes prior to the arrival of a Priority 2 back up crew.

38. The Registrant arrived at Patient A’s home at 16.15. At 16.39 he requested a Priority 2 backup crew to convey Patient A to hospital. At 17.47 the RRV is recorded as leaving Patient A’s home and returning to Bournemouth Ambulance Station for the Registrant’s rest break. The backup crew comprising KN and technician NB arrived at Patient A’s home at 18.01.

39. The Registrant therefore left Patient A unattended for a period of approximately 14 minutes. This is confirmed in the EPCR which confirms that the Registrant left Patient A at 16.46, leaving her alone for approximately 15 minutes. In every RRV there is a MDT (Mobile Data Terminal) button which a paramedic presses to confirm he or she is leaving the scene and this gets recorded in the incident SOE (Sequence of Events).  

40. There is some suggestion, having regard to the EPCR times that the Registrant was sat in the RRV writing up the patient record at 17.46. This was the view expressed by BM; in essence the Registrant had left Patient A to return to the vehicle, even if only for a short period, prior to pressing the MDT button to inform control he was leaving.

41. The Panel’s overall view was that little turned on the precise length of time which Patient A was left alone for. The mischief was that the Registrant left Patient A alone and did not wait for the backup crew to arrive for a Priority 2 patient. 

42. The SOP (Standard Operating Procedure) for a Priority 2 backup crew is that they attend on a patient within 30 minutes. This category is used where the “Patient is not immediately life-threatening, but requires additional resources responding as an emergency using blue lights and sirens.”

43. The Registrant was not able to convey Patient A to hospital in the RRV, as she needed to be monitored on a double crewed ambulance.

44. KN’s evidence was that upon arrival at Patient A’s home, the Registrant had left and that Patient A presented as very distressed and anxious. She was conscious but rolling around on her bed and appeared in pain and was very agitated, groaning and shouting out. She was half on and half off the bed. It is possible she was trying to get out of bed. KN placed her back into bed before conducting the first set of observations. She was unsteady on her feet and it took both KN and the technician to assist her to get to the bathroom. KN’s oral evidence was that Patient A appeared to be suffering from soft tissue injuries, in particular to the lower abdomen. She suspected a urinary tract infection (UTI). BM confirmed that his subsequent investigations ascertained that Patient A was not systemically unwell. He had followed up her case at hospital and noted that she had been discharged fairly quickly with a diagnosis of a UTI. 

45. Patient A was unable to tell KN, or the technician NB, about any care or treatment she had received prior to their arrival, according to KN’s statement. However, in evidence KN confirmed that Patient A was a poor historian, but she did recall a brief discussion about whether she had previously taken paracetamol.   

46. KN’s opinion was that given Patient A’s pain score of 10/10, she should not have been left unattended. One of her concerns was that Patient A may have tried to get out of bed to visit the toilet and had a further fall. KN’s view was that the Registrant should have stayed to comfort her, administer pain relief and to take further observations. In addition, as she had a high temperature, and her flat was very hot, the Registrant could have taken steps to cool her down, for example by turning the heating off or down and/or opening windows and doors. Once KN had done this, Patient A became less agitated and her temperature reduced.

47. BM’s evidence was that he would have expected, given Patient A’s condition that the Registrant would have remained with her until the backup crew arrived. He states: “In my opinion, there is no reasoning within this case whereby [the Registrant] could have justified leaving Patient A unattended.” 

48. By not waiting, the Registrant was unable to provide the backup crew with a verbal handover. This is an important step as it allows the first responder to give an overview account to the backup crew and covers any points which might have been accidentally omitted from the EPCR.  BM described waiting for the arrival of the backup crew as a “fail safe” in these circumstances. 

49. There is no evidence that the Registrant contacted control to ascertain how long it might take the backup crew to arrive prior to his departure. BM conceded, that although unusual, he could not rule out the possibility that the Registrant had made this enquiry, using his mobile telephone to contact the crew line.    

50. By leaving Patient A unattended, the Registrant could have placed her health and wellbeing at risk. There is a possibility that she may have deteriorated and there would have been no one available to assist and medically intervene. The fact that a Priority 2 backup crew has been called out to a patient demonstrates that the case is an emergency and that the patient is unwell.

51. The Registrant states in his witness statement that it had been his intention to downgrade the status of the backup crew to Priority 3. However, according to BM even in these circumstances, the Registrant would still have been expected to remain on the scene until the backup crew arrived. A Priority 3 back up has a local response target of 40 minutes. The SOP states: “Patient is not immediately life-threatening and stable, but requires an emergency ambulance responding at normal road speed. Although a blue light response is not required, the patient would need Paramedic level skills during transport…”      

52. KN’s evidence was that it would only be appropriate for a paramedic to leave the scene, prior to the arrival of the backup crew, in the event that the case was a Priority 4. This provided that transport would be made available to transfer the patient to hospital within a one to four hour time frame and that the patient was safe to wait during the intervening period.

53. KN expressed surprise that the Registrant had left the scene prior to the arrival of a Priority 2 backup crew. In 17 years she had never experienced this situation before. BM in evidence also confirmed that he had never previously experienced or heard of a situation from colleagues where a paramedic had left a patient alone, having requested a Priority 2 backup crew to attend.            

54. The Registrant’s statement does acknowledge that he may have made an error in this regard: “In retrospect I probably should not have left Patient A alone waiting for the back up vehicle. However, I determined at the scene that there was zero risk to Patient A and I utterly refute any notion to the contrary without supporting evidence.”


Decision on Grounds

55. The Panel considered whether the Registrant’s actions amounted to misconduct, falling well short of what would be proper in the circumstances, in accordance with the test set out by Lord Clyde in Roylance v General Medical Council (No.2) [2000] 1 AC 311. 

56. Although the Panel found as a fact that the Registrant did not record that he offered or considered the use of analgesia, the Panel were not persuaded that this omission was sufficiently serious to constitute misconduct.  The principal reason for this was the evidence of clinical discretion from BM as to whether negatives should be recorded in the free text box on the EPCR. He accepted that not all negatives would be recorded by Paramedics. Although KN’s evidence was that if analgesia had been declined this should be recorded, this is not the same as failing to record offering or considering the use of analgesia. There was no evidence in this instance that Patient A had been offered analgesia by the Registrant and had declined it.      

57. In reaching this decision, the Panel bore in mind Standards 10 of both the HCPC’s “Standards of conduct, performance and ethics” (January 2016) HCPC’s “Standards of proficiency for Paramedics” (2014) in relation to record keeping. Although the Registrant did not maintain some records, such an omission is not so serious a breach as to amount to misconduct - in failing in essence to keep full records of what he did not do.

58. The Panel then considered whether the Registrant’s actions amounted to misconduct in relation to Particulars 1(b) and 1(c) and concluded that they did. The Registrant’s failures were serious given Patient A’s vulnerability; the fact she had fallen when living alone and was expressing significant pain.

59. The Registrant had plenty of time to carry out a second set of observations and had he done so, this may well have affected his decision to leave Patient A alone. He had no up to date clinical information upon which to base his decision to leave, placing Patient A at a risk of harm.  

60. The Panel had regard to:

• Standard 4 of the HCPC’s “Standards of proficiency for Paramedics” (2014) namely, be able to practice as an autonomous professional, exercising their own professional judgment, and concluded that this had been breached.   

• Standard 14 of the HCPC’s “Standards of proficiency for Paramedics” (2014) namely, be able to draw on appropriate knowledge and skills to inform practice.

• Standard 6.1 of the HCPC’s “Standards of Conduct, performance and ethics” (January 2016) namely, you must take all reasonable steps to reduce the risk of harm to service users….as far as possible.

The Panel concluded that these standards had been breached.


Decision on Impairment

61. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired, in light of the Registrant’s misconduct, having regard to the HCPTS Practice Note “Finding that Fitness to Practise is ‘Impaired’” and after receiving advice from the Legal Assessor.

62. The Panel is mindful of the forward looking test for impairment and concluded that the test was made out in respect of both the personal and public components of impairment, including the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession. The Panel thus concluded that the Allegation was “well founded” having regard to Article 29 of the Health and Social Work Professions Order 2001 (as amended).  

63. In reaching its decision the Panel had regard to the following factors:

a. The Panel regarded the Registrant’s actions as serious, given the implications for the care of Patient A and the potential risk of harm. However, as a one off incident, the Panel concluded that the Registrant’s failings are potentially remediable,

b. The Registrant has demonstrated some limited insight, having regard to his admission that, in hindsight, he should probably not have left Patient A on her own. However, there is no evidence that he has reflected upon the risk of harm to Patient A and / or the effect of his actions upon his colleagues. It is not clear that the Registrant has demonstrated any understanding of why he should not have left Patient A on her own.  

c. The Registrant has not attended the final hearing to give evidence. There is no evidence available as to the Registrant’s current employment or practice since the events in question although the Panel noted that the Registrant informed the HCPC in August 2017 that at that time he working as a Disability Analysis in the Republic of Ireland.

d. Given the Registrant’s non-engagement with the regulatory process, there is no evidence of remorse or remediation. The Panel could therefore not be satisfied that there would not be a repeat of such misconduct, despite the fact that this appears to be a one-off incident.   

e. In relation to the public component, the Panel had regard to the need to uphold proper standards of behaviour, in particular the need to take all reasonable steps to reduce the risk of harm to service users as far as possible. It concluded that the public component of impairment is established. The Panel further concluded that confidence in the paramedic profession would also be undermined, if there was no finding of impairment, given the nature of the misconduct.   


Decision on Sanction

64. The Panel has heard submissions on sanction on behalf of the HCPC. It has paid regard to the HCPC’s “Indicative Sanctions Policy” and has accepted the advice of the Legal Assessor. The Panel had particular regard to the principal of proportionality and the need to strike a careful balance between the protection of the public and the rights of the Registrant. 

65. The Panel has also reminded itself that the purpose of fitness to practise proceedings is not to punish registrants but to protect the public. The primary function of any sanction is to address public safety. However, panels should also have regard to wider public interest and this includes the deterrent effect to other registrants, the reputation of the profession concerned and public confidence in the regulatory process.  

66. The Panel has had regard to the aggravating and mitigating circumstances in this case.

67. The aggravating features are:

a. The Registrant’s actions placed Patient A at a risk of harm and potentially serious harm;

b. There is no evidence that the Registrant has reflected suitably on the effect of leaving Patient A alone and / or the effect of his actions on his colleagues; and

c. The Registrant has not demonstrated that he understands why he should not have left Patient A alone.  

68. The mitigating features are:   

a. This is a one-off incident;

b. The Panel concluded that the misconduct is potentially remediable;

c. The Registrant has shown some limited insight into his misconduct, accepting that “In retrospect I probably should not have left Patient A alone, waiting for the back up vehicle.”; and

d. There has been some, albeit limited, engagement from the Registrant in the form of a contemporaneous statement, which the Panel found to be factual, direct and consistent with other evidence.

69. In light of the above factors, the Panel determined that given the nature of the Registrant’s misconduct, to take no action would not be sufficient to protect the public, and would not maintain public confidence in the regulatory process or have the necessary deterrent effect on other registrants.

70. The Panel next considered whether to make a Caution Order, and concluded that this was an appropriate sanction to both protect the public and to address the wider public interest concerns which the Panel identified. The Panel considered that the incident was isolated, limited and relatively minor in nature and the Registrant has demonstrated some insight. Although there was some risk of repetition, the Panel concluded that this risk was not significant.

71. The Panel further determined that the Caution Order should be imposed for a period of three years, in light of the Registrant’s limited insight and the extent to which he had fallen short of appropriate professional standards.

72. Having arrived at an appropriate and necessary sanction, the Panel concluded that to impose the more restrictive sanction of a Conditions of Practice Order would be unnecessarily punitive and disproportionate. Whilst the Panel was able to formulate meaningful practice restrictions, it concluded that a suitable level of public protection could be obtained from a less restrictive sanction, whilst maintaining public confidence in the profession and the regulatory process and having the necessary deterrent effect on the profession.

Order

The Registrar is directed to annotate the Register entry of Mr Patrick L Higgins with a caution which is to remain on the Register for a period of 3 years from the date this order comes into effect.

Notes

 

 

 

 

Hearing History

History of Hearings for Mr Patrick L Higgins

Date Panel Hearing type Outcomes / Status
19/11/2018 Conduct and Competence Committee Final Hearing Caution