Mr Robert Bevan

Profession: Paramedic

Registration Number: PA30787

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 30/11/2018 End: 13:00 30/11/2018

Location: Novotel Cardiff Centre, Schooner Way, Atlantic Wharf, Cardiff CF10 4RT

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

 

Whilst registered as a Paramedic and employed by the Welsh Ambulance Services NHS Trust (‘the Trust’):

 

1. On or around 10 January 2016, you did not provide adequate care to Patient A, in that:

 

 

 

a) You did not observe and/or record that the patient’s presenting condition was of a psychiatric nature;

 

 

 

b) You did not obtain Patient A’s medical history from the patient and/or from the patient’s father;

 

 

 

c) You did not question and/or act upon the empty packet of paracetamol found near the patient;

 

 

 

d) You did not complete a Patient Clinical Record on the day of the incident;

 

 

 

e) You did not consider and/or record your consideration of the patient’s capacity to make an informed decision;

 

 

 

f) You did not question and/or record that you questioned the patient’s father regarding any crisis intervention plans and/or the provision of any support from drug or alcohol rehabilitation teams;

 

 

 

g) You did not leave a recall card with the patient’s father

 

 

 

h) You did not seek support from the Trust’s clinical desk and/or other healthcare professionals;

 

 

 

2. Your actions described at particular 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

Background:

1. The Registrant is a Paramedic.

2. Following a hearing on 27 to 30 November 2017, the Registrants fitness to practise was found to be impaired. A Conditions of Practice Order was imposed.

3. The Previous Panel found that at the time of the relevant events, the Registrant was employed by the Welsh Ambulance Service NHS Trust (“the Trust”).  He was employed by the Trust since 1986, initially as a patient transport driver.  In 1991 he progressed to a role that would now be described as an Emergency Medical Technician (“EMT”).  In 2009 he qualified as a Paramedic. In late 2015, a short time before the events to this case, he ceased to work as a Paramedic and had returned to work as an EMT.  When he attended Patient A he was working as an EMT.

4. At 13:46 on 9 January 2016, the Trust received information from the police that a 26 year old female was “having some sort of episode” and was in the middle of the road.  On receipt of the information from the police, the matter was assigned the dispatch code “25B06” which is the coding for “Psychiatric/Abnormal Behaviour/Suicide Attempt”.  The response expectation was reflected in the matter being recorded as “AMBER2”, which should have resulted in attendance upon the patient within 20 minutes.  In the event, there was no response from the Trust within that period. It was not until 00:36 in the early hours of the following morning, approximately 11 hours after the information was initially received, that the call was allocated to the ambulance on which the Registrant was working.  In the meantime, further information had been received, including the information that the patient had not been injured and was waiting with her father.

5. In attending the patient, the Registrant was working alongside another EMT.  They arrived at the patient’s home at 00:59 on 10 January 2016, some 23 minutes after the allocation of the call.  The Registrant took the lead role in that attendance.  At 01:22 it was recorded that the patient had refused treatment.

6. At a later stage, Patient A started a fire at the house with tragic consequences. 

7. At the conclusion of the hearing, the Panel of the Conduct and Competence Committee of the HCPC found 1(a), 1(c), 1(d), 1 (e) [but only in relation to recording], 1 f and 1 h amounted to misconduct. The Panel found that the Registrant’s fitness to practise was impaired.

8. The Panel was satisfied that the shortcomings identified by its findings were of a nature that were potentially capable of being remedied.  It was also satisfied that the Registrant has expressed genuine remorse.  The Panel concluded that, although the Registrant had started to develop insight into his failings, this was very recent and that he still had rather limited insight.  The Panel considered that there remained a risk of a repetition of the Registrant failing to offer a patient an adequate level of care. That conclusion necessitated a finding that the Registrant’s fitness to practise was currently impaired upon consideration of the personal component.

9. The Panel considered that the public component was also made out.  The Panel concluded that there would undoubtedly be concern on the part of members of the public at the prospect of the Registrant returning to work wholly unrestricted.  This is because he still presented a risk of repeating behaviour that would result in an inadequate level of care being offered to patients.

10. For those reasons, the Panel found that there was current impairment of fitness to practise. The panel determined to impose a Conditions of Practice Order for 12 months on the Registrant in the following terms:-

“The Registrar is directed to annotate the Register to show that, for a period of 12 months from the date that this Order comes into effect (“the Operative Date”), you, Mr Robert Bevan, must comply with the following conditions of practice:

1. You must not work as a Paramedic alone.

2. You must only work as a Paramedic when working alongside another Paramedic who does not have current restrictions imposed on his or her HCPC registration.

3. Within three months of the commencement of this Order you must identify a Paramedic who does not have current restrictions imposed on his or her HCPC registration with whom you must work to formulate a Personal Development Plan (“PDP”) to address the following areas of your practice:

1. Accurate and complete record keeping.

2. How you should focus your Continuing Professional Development moving forward.

3. Mental health assessments with particular regard to the link between red flags and formulating a working diagnosis.

4. You must within three months of the commencement of this Order inform the HCPC of the identity of the Paramedic with whom you are proposing to work in compliance with condition 3.

5. You must allow the Paramedic identified by you to the HCPC in compliance with condition 4 to provide information to the HCPC with regard to your progress towards achieving the aims set out in your Personal Development Plan.

6. You must obtain from the Paramedic with whom you are working in connection with your PDP up-to-date reports on your development, implementation and progress with regard to the PDP and submit them to the HCPC:

(a) No later than 5 months after the commencement of this Order; and,

(b) No later than 28 days before the date scheduled for the review of this Order.

7. You will be responsible for meeting any and all costs associated with complying with these conditions.

8. Any condition requiring you to provide information or reports to the HCPC is to be met by you sending the information to the HCPC identifying your FTP number and marked for the attention of the Fitness to Practise department.

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

10. 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).”
 
11.The current Panel was convened to review the order that was imposed.

Today’s Hearing

HCPC Submissions

12. Ms Simpson stated the HCPC’s position was that condition 6 of the order had not been fulfilled by the Registrant. The HCPC had not received any direct contact from the Registrant’s mentor, Mrs Bigmore, appointed in compliance with condition 3. She accepted that HCPC had not contacted Mrs Bigmore as allowed for by condition 5.

The Registrant’s evidence and submissions

13. The Registrant attended the hearing. He was represented by Mr Reese of counsel.

14. In advance of the hearing, the Registrant provided the HCPC with a bundle of documents. These comprised of:

(i) A personal statement completed the Registrant
(ii) A certificate from Edify Training, dated 23 August 2018, in relation to Mental Health Awareness training undertaken by the Registrant
(iii) A certificate from Edify Training, dated 17 January 2018, in relation to “level 1” training undertaken by the Registrant in relation to the Mental Capacity Act
(iv) A certificate from Edify Training, dated 24 February 2018, in relation to “level 2” training undertaken by the Registrant in relation to the Mental Capacity Act
(v) A certificate from Edify Training, dated 9 May 2018, in relation training undertaken by the Registrant regarding reporting and record keeping. 

15. At the hearing, the Registrant produced the following references from organisations that he had worked for, namely:

(i) A reference from Mr Royston Bentley of Acute Medics dated 6 November 2018
(ii) A reference from Mr Martyn Morgan of Ajuda Events, dated 18 November 2018
(iii) A reference from Mr Richard Sage of Safeguard Medical Services Ltd, dated 24 November 2018

16. All of the references were in positive terms. They demonstrated that the Registrant had worked as a Paramedic under supervision and as an emergency medical technician. The referees were all positive about the Registrant’s technical abilities. Mr Bentley described the Registrant as an exceptional member of staff.

17. The Registrant provided evidence on oath. He provided evidence in relation to the professional development he had undertaken and the courses he had completed in the past 12 months. The Registrant estimated that he had undertaken around 100 hours of CPD. He had undertaken courses in relation to record keeping. He had also undertaken a number of courses that were focused on mental health awareness.

18. The Registrant explained that Mrs Bigmore was appointed by him as a mentor to assist with developing his personal development plan. Mrs Bigmore was a practicing Paramedic. The Registrant had contact with Mrs Bigmore ten or 11 times over the past 12 months. Each meeting would last between 1 hour and 1 hour 30 minutes. These meetings would cover the Registrant’s professional development. The Registrant and Mrs Bigmore would discuss courses the Registrant should complete. She would provide advice to the Registrant. She had also witnessed him working as a Paramedic.

19. The Registrant outlined that had reflected on the incident that resulted in conditions being imposed. He accepted that he had made mistakes. He considered that the courses and training he had undertaken would assist him in dealing with a similar matter in future.

20. The Registrant candidly accepted that he had not complied with condition 6. No reports had been submitted by Mrs Bigmore. The Registrant stated that this was a pure oversight on his behalf. Mrs Bigmore could attest to his compliance with the conditions.

21. Mrs Bigmore was on holiday but was available to provide evidence by telephone. Mr Reese submitted that the Panel may be assisted by hearing telephone evidence from Mrs Bigmore before determining whether the Registrant’s fitness to practise was impaired.

Preliminary Application

22. In relation to Mr Reese’s application, the panel indicated that it had concerns about hearing from Mrs Bigmore by telephone. The order anticipates that a written report would be required. The Panel expressed a provisional view that such a report was likely to be necessary given the findings made by the previous panel. In light of that observations, the application to hear Mrs Bigmore’s evidence by telephone was not insisted upon. The Registrant had worked on four or five occasions with Mrs Bigmore over the course of 12 months and the Panel felt that this did not represent a fair and proportionate sample of his work.

Decision
 
23. The Legal Assessor reminded the Panel that it was required to conduct a comprehensive assessment of the Registrant’s fitness to return to unrestricted practise. Its role is not to conduct a rehearing of the allegations or to go behind the previous findings. In carrying out its assessment, the Panel must exercise its own independent judgement. If it determined that the Registrant’s fitness to practise remained impaired, the options under Article 30 of the Health and Social Work Professions Order 2001 would be open to the panel. These are as follows: confirm, extend, replace, or revoke the existing order. The Legal Assessor reminded the Panel that it should consider the HCPC Practice Note on Impairment, the guidance provided by the Courts, and must always keep in mind the principles of fairness and proportionality. If relevant, it should also have regard to the HCPC’s Indicative Sanctions Policy. The Panel was reminded that any order it makes must be the least restrictive order that would suffice to protect the public or is otherwise in the public interest.

24. The Panel accepted the advice of the Legal Assessor.

25. The Panel first considered whether the Registrant has now complied with the conditions imposed at the previous review hearing.

26. The Panel found the Registrant to be a credible witness. On the basis of his evidence, the Panel was satisfied that he had complied with conditions 1 to 4 of the original order.

27. The Panel determined that condition 6 had not been complied with. The Registrant and Mr Reese candidly accepted that this was the case Condition 6 required the individual appointed by the Registrant, pursuant to condition 3, to provide an up to date report to the HCPC. The individual appointed was Mrs Bigmore. No report has been provided by Mrs Bigmore. It is a matter of significant concern to the Panel that this condition has not been complied with. The imposition of a condition for a supervisor to be in place, and to report back on the Registrant’s progress was an important part of the conditions that were set in order that the Registrant could demonstrate that his fitness to practise was no longer impaired. As this condition had not been complied with, the Panel does not have any independent evidence in relation to the Registrant’s compliance with the personal development plan or his current fitness to practise. The previous Panel clearly considered that such independent verification to be important.

28. Having considered all of the available material, the Panel concluded that the Registrant’s fitness to practise is still impaired. The Panel placed significant weight on the Registrant’s failure to comply with condition 6. Given that attention to detail, particularly record keeping, was a central part of the decision of the original Panel, the current Panel was very concerned that the Registrant had failed to comply with condition 6. The only evidence that the Registrant had addressed the previous issues came from the Registrant himself. The Panel considers that independent verification of remediation was important in the present case. As such, the Panel concluded that there remained a risk of a repetition of the Registrant failing to offer a patient an adequate level of care. Accordingly, the Panel finds that the Registrant’s fitness to practise is currently impaired upon consideration of the personal component.

29. The Panel considered that the public component was also made out.  The Panel formed that view that that there would be concern on the part of members of the public at the prospect of the Registrant returning to work wholly unrestricted in circumstances where the orginal conditions had not been fully complied with. In the Panel’s opinion, given that the conditions imposed have not been fully complied with, the Registrant still presents a risk of repeating behaviour that would result in an inadequate level of care being offered to patients.

30. The Panel was satisfied that the shortcomings were of a nature that were potentially capable of being remedied. The Panel would hope that independent verification, in the form of a positive report from Mrs Bigmore and further input from and existing employer, could address the concerns outlined above.

31. The Panel determined to extend the order for a period of three months and determined to modify the conditions imposed on the Registrant. The conditions have been modified so that the Registrant can provide a report by Mrs Bigmore outlining compliance with the personal development plan and a detailed testimonial from an employer addressing the Registrant’s competence in dealing with vulnerable and mentally disordered patients.

32. The order would be extended for a period of three months and shall be modified so that the following conditions are imposed on the Regsitrant:

Order

Order: The Registrar is directed to vary the Conditions of Practice Order against the registration of Mr Robert Bevan for a further period of 3 months on the expiry of the existing Order. The Conditions are:

1. You must not work as a Paramedic alone.

2. You must only work as a Paramedic when working alongside another Paramedic who does not have current restrictions imposed on his or her HCPC registration.

3. Within 28 days of the Order coming into force, you must provide a report from Mrs Bigmore, the individual appointed in compliance with the condition 3 of the original Order, confirming that how frequently she met with you to discuss your personal development. In the report, she should also address her observations on your practise including, in particular,: (i) record keeping; and (ii) interactions with individuals between you and any individuals that are mentally or emotionally vulnerable.

4. Provide within 28 days of the Order coming into force at least one further reference from an employer attesting to the Regsitrant’s record keeping and engagement with people who are emotionally or mentally vulnerable.

5. You will be responsible for meeting any and all costs associated with complying with these conditions.

6. Any condition requiring you to provide information or reports to the HCPC is to be met by you sending the information to the HCPC identifying your FTP number and marked for the attention of the Fitness to Practise department.

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

8. 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).

Notes

The order imposed today will apply from 28 December 2018

This order will be reviewed again before its expiry on 28 March 2019.

Hearing History

History of Hearings for Mr Robert Bevan

Date Panel Hearing type Outcomes / Status
30/11/2018 Conduct and Competence Committee Review Hearing Conditions of Practice
27/11/2017 Conduct and Competence Committee Final Hearing Conditions of Practice