Mr Richard P New
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(As amended at the Final Hearing commencing 8 October 2018)
Whilst registered as a Paramedic, and during the course of your employment at South Central Ambulance Service NHS Foundation Trust:
1. On or around 4 October 2016 you were involved in transporting Patient A to a hospice and you:
a) Allowed Person B to suction Patient A, without adequately assessing and / or monitoring Person B's competency to do so.
b) Did not advise Person B on the use of the seatbelt.
c) Did not monitor Patient A's breathing adequately, in that you did not identify that Patient A’s breathing had changed.
d) Conducted conversations of an unprofessional nature, for example:
i) Suggesting you would go to the pub on Friday and "chat up the barmaid" or words to that effect.
ii) Suggesting you would eat something to "inflame your IBS and irritate your colleagues" or words to that effect.
iii) Said that you "will have to keep an eye on the stock of KY Jelly as [Colleague C] wants to make love to me" or words to that effect.
2. On or around 8 October 2016 whilst on shift with Colleague D, you said "How do you get a gay man to sleep with a woman?[...] You shove **** up a ****" or words to that effect.
3. Your comments at particulars 1(d) and 2 were offensive and / or homophobic.
4. The matters described at paragraphs 1-3 constitute misconduct and / or lack of competence.
5. By reason of your misconduct and / or lack of competence your fitness to practise is impaired.
Application to Amend the Allegation
1. At the start of the hearing, the Panel heard an application by Mr Foxsmith on behalf of the HCPC to amend Particular 1(a) of the Allegation in the terms set out in the body of this determination.
2. He submitted that the proposed amendments did not materially alter the Allegation that the Registrant faced and that amendment was in the interests of justice because it ensured that the amended particular better reflected the evidence. He also submitted that the amendments could be made without prejudice to the Registrant, not least because he had been notified of the proposed amendments by a letter dated 1 February 2018.
3. Ms Hewitt did not object to the proposed amendments on behalf of the Registrant.
4. The Panel heard the advice of the Legal Assessor, which it accepted. The Panel applied the test of whether the amendment was in the interests of justice and whether it could be made without prejudice to the Registrant. It decided it could because the amended particular better reflected the evidence and notice of the HCPC’s intention to apply to amend the Allegation had been served on the Registrant on 1 February 2018 with a copy of the proposed amendments giving him ample time to respond if he had any objection. Accordingly, the Panel allowed the amendments.
5. Before the Panel heard any evidence, the Registrant, through Ms Hewitt, admitted Particulars 1(d), 2 and 3.
6. On 4 October 2016, the Registrant was a Band 5 Paramedic employed by South Central Ambulance Service NHS Foundation Trust (the Trust). He joined the Trust on 12 September 2016. He had over 10 years’ experience as a Paramedic and had been working on ambulances continuously since 1997 in various roles. On 4 October 2016, he had recently joined the Trust and was still working out his probationary period.
7. On that day he was assigned to an ambulance driven by Colleague C and also crewed by Colleague D, who was very new in the role of Emergency Care Assistant.
8. In the late afternoon they were called to the home of Patient A, who was a severely disabled young man of 27, who suffered from a number of serious conditions, including, microcephaly, cerebral palsy, profound learning difficulties, scoliosis, hip dysplasia, epilepsy and asthma. On 3 and 4 October 2016 his condition had deteriorated and the ambulance was called to take him to a hospice, where arrangements had been made to care for him.
9. Before the arrival of the Registrant’s ambulance a Paramedic had attended Patient A’s house by car and administered oxygen to Patient A. By the time the Registrant arrived, Patient A was unconscious but breathing with oxygen.
10. Patient A was being cared for at home at that time by a number of carers, including Person B, who had been his Personal Care Assistant since 2013. Person B accompanied Patient A in the back of the ambulance while Patient A’s mother sat in the front, alongside the driver, directing him to the hospice. There is no dispute that the journey, which was expected to take approximately 20 minutes, took 1 hour and 20 minutes because of a traffic accident on the quickest route.
11. Particulars 1 a-d arise from the Registrant’s conduct in the ambulance on the way to the hospice and shortly after his arrival at the hospice. Particulars 1 a-c arise from the care the Registrant provided for Patient A during the journey. Particulars 1(d)(i) and (ii) arise from a conversation between the Registrant and Colleagues C and D during that journey and d(iii) arises from remarks made by the Registrant shortly after his arrival at the hospice.
12. Particular 2 arises from a conversation between the Registrant and Colleague D when they were at work together on 8 October 2016.
13. The Panel considered all the evidence in this case, together with the submissions made by Mr Foxsmith on behalf of the HCPC and Ms Hewitt on behalf of the Registrant.
14. The Panel accepted the advice of the Legal Assessor, who reminded the Panel that the burden of proof rests with the HCPC, and that the Registrant need not prove anything. The Legal Assessor also reminded the Panel that the standard of proof is the civil standard, namely the ‘balance of probabilities’.
15. The Panel had regard to the documents set out in the Final Hearing Bundle submitted by the HCPC, including:
a. transcripts of the evidence given by Person B, Colleague D and the Registrant to a Trust investigation carried out by Witness DO between 4 November and 14 December 2016;
b. Electronic Patient Records of Patient A in the ambulance on 4 October 2016;
c. the witness statements of Witness DO, Person B, Colleague D and the Registrant.
16. It also had regard to the documents contained in the Defence Bundle which included:
a. the Statement of the Registrant dated 13/08/2018;
b. testimonial letters;
c. Continuing Professional Development (CPD) Record including reflections;
d. a letter from Listening Post dated 28 August 2018;
e. the Registrant’s CV.
17. The Panel also heard the evidence of the following witnesses:
a. Witness DO (Investigating Officer)
b. Person B,
c. Colleague D,
d. The Registrant.
18. The Panel found DO to be a straightforward, conscientious and helpful witness. She put the material from her investigation before the Panel and assisted the Panel to understand the context of the Allegation, the working of the Patient Electronic Record system and Trust policy. She was fair to the Registrant and reminded the Panel that he was new to the Trust, albeit that he was an experienced Paramedic. She also highlighted the “notorious” difficulties in using the electronic records system and acknowledged that having two members of staff “third manning” on the same ambulance was not ideal.
19. The Panel found Person B to be an honest and caring witness, who had focused her attention in the ambulance on Patient A, for whom she cared deeply. She gave the Panel a compelling account of the atmosphere in Patient A’s house and in the ambulance and was very properly willing to admit when she could no longer remember details. She had also provided a near contemporaneous account to Patient A’s family in October 2016.
20. Colleague D was also an honest and straightforward witness who remembered the salient events of 4 October 2016 and admitted when she could not remember the detail. She nonetheless gave a good account of the atmosphere in the ambulance transporting Patient A and to a large extent corroborated the evidence of Person B. Colleague D also confirmed the details in her statement with regard to 8 October 2016.
21. The Panel noted that the Registrant found it difficult to give evidence. He was awkward, nervous and found it very difficult to speak slowly or loudly. The Panel noted that he had admitted a significant part of the Allegation and accepted that he was genuinely remorseful. Nonetheless, when he came to deal with some aspects of his care in the ambulance, he closed his eyes to his failings and either failed to respond or became somewhat evasive when challenged.
Decision on Facts
22. Before turning to the individual particulars of the Allegation, the Panel noted the following.
23. It is not disputed that when the Registrant and his colleagues arrived at Patient A’s house the Registrant had an appropriate conversation with Person B and others caring for Patient A, about what Patient A would need on what they all expected to be a short 20 minute journey to the hospice.
24. The Registrant found out from the carers that Patient A had experienced difficulties clearing his airway throughout that day and would require ‘suctioning’ during the journey, that is to say the use of an electronic suctioning device used to suck secretions from Patient A’s mouth so that his upper airway could be managed effectively during the journey.
25. There is no dispute that the Registrant established that Person B was experienced in providing suctioning for Patient A (albeit that she had never done so in a moving ambulance) and was, in his view, the best person to do so during the journey to the hospice because of her knowledge of Patient A.
26. The Panel also accepts that the Registrant demonstrated to Person B how to use the suctioning equipment in the ambulance and that it was appropriate to allow Person B to carry out suctioning for a short journey on a motorway.
27. The Panel also noted that there was no dispute about the seating arrangements in the ambulance. The Patient was on a stretcher on the driver’s side of the ambulance with his head towards the front. Person B was sat in the seat behind Patient A’s head, known as the “jump seat”. The Registrant sat on the “passenger” side of the ambulance, facing Patient A’s head and Colleague D sat on the seat next to him facing the direction of travel. Colleague C drove the ambulance and Patient A’s mother sat in the front to guide the driver.
Particular 1(a) – Found Proved (in part)
(The Panel found this particular proved, in respect of monitoring alone.)
28. At the end of the HCPC’s evidence, Ms Hewitt submitted that there was no case to answer in respect of Particular 1(a).
29. The Panel acceded to the submission in part. It found that all the evidence pointed to the Registrant having carried out an adequate assessment of Person B’s competence to suction Patient A in the ambulance and he had made a reasonable decision to allow her to carry out this task because of her familiarity with Patient A and her experience of suctioning Patient A.
30. Nevertheless it found there was a case to answer with regard to monitoring Person B’s competency during the journey to the hospice. The Panel found that the nature of the journey changed significantly once it became apparent that the short route on the motorway, estimated to take 20 minutes, was blocked. The journey then changed to one of 80 minutes on winding country roads, which would have challenged the skills of an experienced paramedic.
31. The Panel found that the Registrant did not adapt to the change of circumstances, reassess the situation and provide monitoring that was adequate in what had become a longer and significantly more demanding journey.
32. Person B gave evidence that the Registrant was “chatting the whole journey with Colleague D”, that she had to ask for something with which to wipe secretions from Patient A’s mouth and she did not recall the Registrant “asking me about how I was providing care to Patient A.” She said that the Registrant had simply asked her if she was OK on at most “a couple of occasions”. He did not monitor the situation when she stood to perform suctioning and was at risk of falling. Nor did he take any action to take over when it became clear that the journey was going to take longer than 20 minutes.
33. When assessing the adequacy of the Registrant’s monitoring of Person B’s competence in the changed circumstances, the Panel found it telling that when Person B noticed a change in Patient A’s breathing, she had to interrupt his conversation with Colleague D to tell him about it.
34. This evidence was supported by the evidence of Colleague D that the Registrant was not focused on Patient A but rather was chatting to Colleague D and keeping up, what the Registrant himself described as, “light-hearted banter”.
35. The Registrant gave evidence that he had monitored Person A’s competence, although he could not explain how. He accepted that with the benefit of hindsight he should have taken over suctioning when the route diversion occurred and also agreed when questioned by the Panel that Patient A’s airway had not been effectively managed.
36. The Panel contrasted the evidence of the two witnesses with the Registrant’s bare assertion and his own admission that he had not taken charge, as he should have. The Panel found that his failure to do that was compelling evidence that he had not adequately monitored Person B’s competence in the ambulance because if he had, he would have intervened at the time.
37. Having regard to all the evidence, the Panel is satisfied that such monitoring as the Registrant did carry out was significantly below that required of the paramedic in the back of the ambulance.
Particular 1(b) – Found Proved
38. The Panel accepted the evidence of Person B that she was never told about the seat belt and was unaware if the seat in which she sat even had a seat belt.
39. The Panel gave particular weight to Person B’s evidence on this point because it did not depend only upon her memory of two years ago but was supported by a virtually contemporaneous statement which she made in October 2016 and was included in Patient A’s Family’s formal complaint in the same month. In that statement she wrote, “I wasn’t told to wear a seat belt in the seat, I don’t actually recall if there was a seat belt there.” Her evidence on that point has been consistent in her written and oral evidence, both to the Trust investigation in November 2016 and to the Panel.
40. That evidence is supported to an extent by the evidence of Colleague D who stated that she didn’t recall anyone wearing a seatbelt and she had seen Person B stand to perform suctioning.
41. The Registrant gave evidence that he was adamant that he had advised Person B about wearing a seat belt and that she had been wearing one at the beginning of the journey.
42. The Panel compared the two accounts and bearing in mind the matters set out above, was satisfied that Person B’s account was correct and that the Registrant was simply unable to face up to the fact that he had not done what he should have.
Particular 1(c) – No Case to Answer
43. The Panel approached this particular in two stages. First it looked at the electronic patient records and noted that the Registrant had made (or caused to be made) appropriate entries indicating he had monitored Patient A’s breathing. Person B gave evidence that Patient A was connected to the Lifepack monitoring device and that readings were visible on the screen above Patient A’s head.
44. The only alleged example of “failure to monitor”, which the HCPC relied upon in Particular 1(c) was that the Registrant “did not identify that Patient A’s breathing had changed”.
45. Person B gave evidence that, shortly before their arrival at the hospice, she noticed a change in Patient A’s breathing which she pointed out to the Registrant. The Panel considered carefully the evidence of Person B that the change was “subtle” and that she was uniquely well placed to notice it both because of her experience of Patient A and her position in the ambulance.
46. In those circumstances the Panel decided there was no evidence that the Registrant was demonstrating inadequate monitoring by not noticing the change before it was pointed out to him.
Particulars 1(d)(i - (iii) – Found Proved
47. The Registrant admitted these particulars at the start of the hearing. The Panel noted that the Registrant made the admissions through his Counsel. He confirmed the admissions in his evidence. The admissions were in accordance with the written evidence (confirmed on oath) of Person B and Colleague D.
48. The Panel noted that there was no dispute about the circumstances in which the words were spoken. The Registrant was on duty caring for an extremely ill young man, Patient A. In the ambulance, Patient A, Person B and Patient A’s mother were all present.
Particular 2 – Found Proved
49. The Registrant admitted this particular at the start of the hearing. The Panel noted that the Registrant made the admission through his Counsel. He confirmed the admission in his evidence. The admissions were in accordance with the written evidence (confirmed on oath) of Colleague D.
50. Again, there is no dispute about the circumstances in which the words were spoken. The Registrant was at work. On this occasion there were no patients, carers or members of the public present but Colleague D, to whom the remarks were addressed, was very junior and made her feel so uncomfortable at work that she never wanted to work with the Registrant again.
Particular 3 – Found Proved
51. The Registrant admitted this particular through his Counsel at the start of the hearing and the Panel was satisfied that there could be no other finding in the light of the words used in the circumstances set out above.
Decision on Grounds
52. The Panel next considered whether the facts, found proved in Particulars 1-3, amounted to lack of competence and / or misconduct.
53. The Panel heard the submissions of Mr Foxsmith and Ms Hewitt who both made submissions based only on misconduct
54. The Panel also accepted the advice of the Legal Assessor. It bore in mind that there is no burden of proof at this stage and it is a matter for the Panel’s professional judgment in reaching its decision on this question.
55. The Panel considered each particular in turn. Nevertheless, the question of lack of competence can be dealt with in the round.
56. The Panel heard no evidence that the Registrant was not competent to do his work, indeed he is a Paramedic of over 10 years’ experience. Accordingly the Panel did not make a finding of lack of competence.
57. It then went on to consider whether the facts found proved amounted to misconduct. It bore in mind that not every failure by a registrant will amount to misconduct. The question is whether the conduct falls sufficiently below what is expected to amount to misconduct.
58. It looked at the circumstances and results in each case and asked whether a fellow practitioner would regard the conduct as reprehensible, blameworthy or “deplorable”.
59. It had regard to the HCPC Standards of Conduct, Performance and Ethics (2016 edition) and in particular 1.1, 1.7. 2.1, 2.3, 4.2, 6.1, 6.2 and 9.1.
1 Promote and protect the interests of service users and carers
Treat service users and carers with respect
1.1 You must treat service users and carers as individuals, respecting their privacy and dignity.
Maintain appropriate boundaries
1.7 You must keep your relationships with service users and carers professional.
2. Communicate appropriately and effectively
Communicate with service users and carers
2.1 You must be polite and considerate.
2.3 You must give service users and carers the information they want or need, in a way they can understand.
4 Delegate appropriately
Delegation, oversight and support
4.2 You must continue to provide appropriate supervision and support to those you delegate work to.
6 Manage risk
Identify and minimise risk
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.
9 Be honest and trustworthy
Personal and professional behaviour
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
60. It also had regard to the Standards of proficiency for Paramedics and in particular 1.4, 2.1, 2.3, 2.4, 4, 8.1, 8.3, 8.4, 8.6, 8.7, 9 and 15.1.
1 be able to practise safely and effectively within their scope of practice
1.4 be able to work safely in challenging and unpredictable environments, including being able to take appropriate action to assess and manage risk
2 be able to practise within the legal and ethical boundaries of their profession
2.1 understand the need to act in the best interests of service users at all times
2.3 understand the need to respect and uphold the rights, dignity, values, and autonomy of service users including their role in the diagnostic and therapeutic process and in maintaining health and wellbeing
2.4 recognise that relationships with service users should be based on mutual respect and trust, and be able to maintain high standards of care even in situations of personal incompatibility
4 be able to practise as an autonomous professional, exercising their own professional judgement
8 be able to communicate effectively
8.1 be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, colleagues and others
8.3 understand how communication skills affect assessment of, and engagement with, service users and how the means of communication should be modified to address and take account of factors such as age, capacity, learning ability and physical ability
8.4 be able to identify anxiety and stress in patients, carers and others and recognise the potential impact upon communication
8.6 be aware of the characteristics and consequences of verbal and non-verbal communication and how this can be affected by factors such as age, culture, ethnicity, gender, socio-economic status and spiritual or religious beliefs
8.7 understand the need to provide service users or people acting on their behalf with the information necessary to enable them to make informed decisions
9 be able to work appropriately with others
15 understand the need to establish and maintain a safe practice environment
15.1 understand the need to maintain the safety of both service users and those involved in their care
61. The Panel found that the Registrant’s conduct fell significantly below those standards.
62. In respect of Particular 1(a) and 1(b) the Panel decided that it would be artificial to consider those failings in isolation. The Registrant’s failure to adequately monitor Person B and / or advise her about her seat belt did not occur because he was distracted by other duties or by a set of higher medical priorities. His failures arose because he was distracted throughout the journey by his inappropriate conversation with Colleague D in front of Patient A and Person B. Once the nature of the journey changed, advising Person B about her seat belt became all the more important.
63. In the Panel’s view that is sufficient of itself to make those failings amount to serious misconduct.
64. In any event, by not adequately monitoring Person B’s competence to carry out suctioning as the journey progressed the Registrant put patient safety at unnecessary risk. Not advising Person B about a seat belt was of itself serious because it put at risk the safety of Person B (and those inside the ambulance), who was not an ambulance crew member but rather a member of the public unfamiliar with the dangers of being in a moving ambulance travelling down country roads for over an hour.
65. The Panel is satisfied that the seriousness of the remarks in the ambulance and at the hospice, set out in Particulars 1d(i-iii), in the circumstances set out above, speaks for itself. They represent conduct that was likely to cause significant distress to everyone who heard them, including people entitled to expect the Registrant to do all he could to alleviate the stress of the situation, not increase it.
66. The words set out in Particular 2 were serious of themselves, because they were offensive and homophobic and also because they made a junior colleague of the Registrant, feel very uncomfortable at work. The Registrant’s Counsel properly conceded that this was deplorable.
Decision on Impairment
67. The Panel next considered whether the Registrant’s current fitness to practise is impaired by reason of misconduct. The Panel heard submissions from Mr Foxsmith and Ms Hewitt and the advice of the Legal Assessor, which it accepted. The Panel has also had regard to the HCPTS Practice Note “Finding that Fitness to Practise is Impaired”.
68. The Panel was aware that impairment is a question for its own judgement. In reaching its decision the Panel considered both the personal component and the public component of fitness to practise, which includes the need to protect service users, maintain confidence in the profession and the regulatory process and uphold proper standards of conduct and behaviour.
69. In deciding whether the Registrant’s fitness to practise is currently impaired the Panel had regard to the following examples given by Dame Janet Smith in the 5th Shipman report and subsequently adopted by the High Court in Cheatle v GMC  EWHC 645 Admin and NMC v CHRE v NMC and P Grant  EWHC 927 (Admin),
a. Does the Registrant present a risk to patients
b. Has the Registrant brought the profession into disrepute
c. Has the Registrant breached one of the fundamental tenets of the profession
d. Is it the case that the Registrant’s integrity cannot be relied upon?
70. The Panel has already set out why the misconduct found at 1(a) put patient safety at risk and that at 1(b) put the safety of a carer at risk.
71. The Panel found that the words used by the Registrant, at work, in front of a patient, carers and colleagues and in circumstances where the conversation of which they were part distracted him from patient care, had brought the profession into disrepute.
72. The Panel is satisfied that by allowing patient care to take second place to the inappropriate conversation found at 1d(i-iii), the Registrant breached a fundamental tenet of the profession. He also did so by making the remarks set out in Particular 2 which (whatever the Registrant’s subjective intentions) demonstrated both prejudice and lack of respect.
73. The Panel considered carefully and accepted the Registrant’s evidence that his remarks stemmed from thoughtlessness and did not reflect prejudice or lack of respect on his part.
74. The Panel found that the Registrant’s misconduct was capable of remediation and that he had taken some steps in that direction by engaging in the CPD and reflection which the Panel has seen evidenced in writing.
75. The Panel read the Registrant’s reflection and heard his oral evidence with care. He demonstrated that he understood why his remarks were wrong and brought shame on him and the profession as well as causing considerable distress. He was clearly remorseful for the distress he had caused. However, he still found it difficult to accept how they also impacted on his care for Patient A. Nor was he clear how he would approach situations differently in the future, although he did explain that he understood he must not speak unthinkingly to fill the silence.
76. For those reasons, the Panel accepted that the Registrant had developed some insight, demonstrated of course by his admissions to the Panel, but found that his insight was limited.
77. Looking to the future, the Panel derived some reassurance from the Registrant’s admission in evidence that he was not yet “in the right place” to recommence work as a full time Paramedic.
78. The Panel accepted that the Registrant had made efforts to remediate. Nonetheless, he still struggled to demonstrate how would deal with the pressures of work and act differently in the future. The Panel was satisfied that the Registrant had further work to do to complete his remediation.
79. Accordingly the Panel could not be confident that there was no significant risk of repetition.
80. The Panel then looked at the critically important objectives of the regulator to protect the public by pursuing the following objectives:
a. to protect, promote and maintain the health, safety and wellbeing of the public
b. to maintain public confidence in the profession
c. to promote and maintain proper professional standards and conduct for members of that profession
81. There can be no doubt that public confidence in the profession would be undermined if the Registrant’s behaviour did not result in a finding of impairment. That is particularly clear where there remains a risk of repetition. Nevertheless, the Panel is also satisfied that a finding of impairment would be required, in any event to maintain public confidence by demonstrating that misconduct such as this is not acceptable to the profession.
82. The Panel is also satisfied that a finding of impairment is necessary to uphold proper professional standards and conduct and send a clear message that this conduct is not acceptable.
83. For these reasons the Panel finds that the Registrant’s fitness to practise is currently impaired on both the personal and public components.
Decision on Sanction
84. Having found that that the Registrant’s fitness to practise is impaired by reason of misconduct, the Panel considered what, if any, sanction to impose on the Registrant.
85. The Panel heard submissions from Mr Foxsmith and Ms Hewitt on the issue of sanction. The Panel also accepted the advice of the Legal Assessor and had regard to the HCPC’s Indicative Sanctions Policy (ISP).
86. Mr Foxsmith reminded the Panel of the correct approach to sanction and did not advocate any particular sanction.
87. Ms Hewitt made the following submissions on behalf of the Registrant:
a. The Panel should bear in mind that it does not have to impose a sanction. The finding of impairment alone can be sufficient to mark the gravity of a case and protect the public;
b. The Registrant’s misconduct is relatively isolated. It occurred over a 4 day period after many years of practice without any adverse disciplinary findings;
c. The ambulance journey, during which the large part of his misconduct occurred, presented the Registrant with an unusual and unexpected situation;
d. Notwithstanding the Panel’s finding that it could not be satisfied that there was no significant risk of repetition, realistically, the likelihood of repetition was low;
e. The Registrant was clearly a deeply chastened man who had shown signs of real decency by his personal apology through his Counsel to Colleague D and Person B and his decision to remain outside the hearing room during Person B’s evidence, so as not to distress her;
f. The offensive things said by the Registrant had been said without malice much less an intention to denigrate anyone;
g. The Registrant has demonstrated for the past 2 years that he can work without any repetition of his misconduct;
h. The Registrant has demonstrated that he recognised he still had work to do but he had started that work and needed to be able to work to complete it;
i. Having regard to all the circumstances, the Registrant’s misconduct was not so serious as to require even temporary exclusion from the profession.
88. The Panel is aware that the purpose of sanction is not to be punitive but to protect the public and the wider public interest, which includes the deterrent effect on other registrants, the reputation of the profession, and public confidence in the profession and the regulatory process.
89. The Panel also bore in mind the principle of proportionality and balanced the Panel’s duty to protect the public against the rights of the Registrant.
90. The Panel had regard to the following aggravating factor:
a. The Registrant’s misconduct on 4 October 2016 occurred during the end of life care of a young patient.
91. The Panel had regard to the following mitigating factors:
a. The Registrant’s misconduct was relatively isolated in the context of a long career;
b. There have been no other disciplinary findings against the Registrant in over 10 years as a paramedic;
c. There has been no repetition of misconduct in the 2 years since the misconduct in this case;
d. The risk of repetition is now low and the Panel is persuaded, having watched the Registrant give evidence and read the CPD, reflections and testimonials that he put before the Panel, that he is committed to ensuring that risk continues to diminish;
e. The Registrant has engaged with the disciplinary process throughout and recognised why what he did was wrong in a way that gives the Panel confidence that he will continue to reflect and remediate in the future;
f. The circumstances which gave rise to the Registrant’s misconduct were out of the ordinary and placed him under unexpected stress in a new work environment;
g. The Registrant has demonstrated a developing empathy to those around him by his personal apology and the steps he took to reduce the stress for Person B by absenting himself from the room. The Panel accepts Ms Hewitt’s submission that he displayed a perhaps unexpected and developing, “decency”;
92. In order to ensure that it imposed a sanction that was no more restrictive than was necessary to protect the public and the public interest, the Panel considered the sanctions available to it in ascending order of severity.
93. The Panel considered that it would not be appropriate to take no further action given the relatively serious nature of the Registrant’s misconduct.
94. The Panel considered carefully a Caution Order and had regard to paragraph 28 of ISP:
“A caution order must be for a specified period of between one year and five years. Cautions appear on the register but do not restrict a registrant’s ability to practise. However, a caution may be taken into account if a further allegation is made against the registrant concerned.
28. A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate remedial action.”
95. After careful consideration the Panel decided that because of the efforts the Registrant has made, the progress he has made and the Panel’s finding that the Registrant is committed to continuing with the remediation he has already started, it is right to impose a Caution Order.
96. The Panel recognised that the Registrant’s misconduct was at the upper end of misconduct for which a Caution would be appropriate. Nonetheless, all the other factors to which the Panel has alluded above, in particular the remedial action he has undertaken, tipped the balance in favour of a Caution Order.
97. When considering the appropriateness of a Caution Order the Panel had particular regard to these words in ISP: “Cautions appear on the register but do not restrict a registrant’s ability to practise. However, a caution may be taken into account if a further allegation is made against the registrant concerned.”
98. The Panel was satisfied that the public would be protected by a Caution Order both because any future employer would be aware of the Order and the Order itself would serve as a reminder to the Registrant that he must continue to remediate because any future breach would result in this matter being taken into account.
99. The Panel considered carefully, the remaining limbs of the Overarching Objective, namely
a. to maintain public confidence in the profession
b. to promote and maintain proper professional standards and conduct for members of that profession."
100. The public record of a Caution along with the public finding of misconduct and impairment would be sufficient to send a message to the profession and the wider public that the Registrant’s misconduct is unacceptable and must never be repeated.
101. In order to be satisfied that a more restrictive sanction was not necessary to protect the public or the public interest, the Panel considered whether it should impose either a Conditions of Practice Order or a Suspension Order.
102. The Panel concluded that there were no workable conditions it could impose in this case.
103. The Panel considered a period of suspension but came to the conclusion that suspension was unnecessary to protect the public in view of the progress the Registrant has made and is determined to continue to make. It would serve the wider public interest in the short term. However it would harm it in the longer term by depriving the public of a competent Paramedic and delaying the remediation which the Registrant has started, and which it is in the public interest for him to complete as soon as possible.
104. Finally the Panel considered the correct length of the Order. Balancing the progress the Registrant has already made, the length of time he is likely to need to complete his remediation, and the need to mark this misconduct in the wider public interest, the Panel decided that 3 years is the correct length of the Order.
That the Registrar is directed to annotate the Register entry of Mr Richard New with a caution which is to remain on the Register for a period of 3 year(s) from the date this Order comes into effect.
No notes available
History of Hearings for Mr Richard P New
|Date||Panel||Hearing type||Outcomes / Status|
|08/10/2018||Conduct and Competence Committee||Final Hearing||Caution|