Mr Dominic Maddocks

Profession: Paramedic

Registration Number: PA30208

Interim Order: Imposed on 20 Jun 2016

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 04/09/2018 End: 16:00 10/09/2018

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

Panel: Health Committee
Outcome: Conditions of Practice

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Allegation

By reason of your physical and/or mental health your fitness to practise as a Paramedic is impaired.

Finding

Application to conduct hearing in private
1. The Registrant applied for the whole hearing to be heard in private. Ms Ryan supported the application for the hearing to be heard entirely in private pursuant to rule 10(1) of the Rules. Ms Ryan submitted that, this being a health case, there would be continuous reference during the hearing to health matters relating to the Registrant and privacy was required to protect the Registrant’s private life, namely, details of his health.
2. The Panel accepted the Legal Assessor’s advice and took account of the guidance in the HCPTS’s Practice Note “Conducting Hearings in Private”. The Panel determined that it would not be practicable to hold the hearing partly in private and therefore determined that the whole hearing should be heard in private to protect the Registrant’s private life. 

Background:

3. The Registrant is a registered Paramedic who had been employed by Yorkshire Ambulance Service NHS Trust (YAS) as a Paramedic since he qualified in 2009, having initially joined YAS in 2003. He achieved promotion to Emergency Medical Despatcher on the major trauma co-ordinator despatch desk within the Wakefield Emergency Operations Centre (EOC).

4. YAS became concerned when the Registrant failed to report for a shift on 12 October 2015. The operational Clinical Supervisor visited the Registrant’s home address in accordance with normal practice. With Police assistance, he entered the property and found the Registrant in an unfit state. The Registrant did attend for work later in the day, but was considered unfit for duty. The Registrant was then absent from duty for a substantial period due to ill-health. The Registrant made a self-referral to the HCPC about health concerns on 11 December 2015. YAS’s concerns resulted in the Registrant being suspended from duty on 14 October 2016 whilst allegations were investigated. The Registrant was made redundant by YAS in February 2017.

Decision on Facts:

HCPC evidence

5. Witness 1 is a Sector Commander for the South Yorkshire region of YAS and he confirmed the contents of his witness statement dated 30 April 2018. He was appointed as fact finding officer for the YAS investigation and provided a copy of his Fact Finding Investigation Report dated November 2016 with its appendices. He conducted an interview with the Registrant on 29 September 2016. Witness 1 explained that, as was normal in health cases, YAS occupational health was involved with the Registrant during 2016.
6. Witness 2 was engaged by the HCPC to assess the Registrant’s health condition, which he did by reviewing all the Registrant’s available medical records and conducting a consultation with the Registrant on 3 March 2018. Witness 2 provided a Medical Report dated 19 March 2018.
7. The Registrant did not dispute Witness 2’s medical diagnosis.
Registrant’s evidence
8. The Registrant explained that he accepts Witness 2’s medical diagnosis and that he has a health condition. He also accepted that a relapse in his health would give rise to a potential risk to patients.
9. The Registrant said that he is committed to working in healthcare and really enjoys his work for Bevan Healthcare, a social enterprise GP practice based in Bradford. He joined in January 2018 as a driver and subsequently applied for a promotion as Outreach Coordinator, which he successfully began in April 2018. He works on that practice’s street medicine service for the homeless, and, since the Interim Order in July, practises under supervision of an Advanced Nurse Practitioner. He is also on the local Reachout street intervention team which collaborates with other local health providers. The Registrant has monthly appraisals with his workplace supervisor and he provided the Panel with some testimonials and evidence of his CPD activities up until July 2018.
10. In giving his evidence the Registrant demonstrated significant insight and described to the Panel his various coping strategies and the support network that he now has in place. The Registrant acknowledged the impact that his health condition had upon himself, the service and potentially to patients. The Registrant felt that he was fit to return to clinical practice and he accepted the medical expert’s recommendations.
11. Looking forward, the Registrant said that he feels undertaking a four-day refresher course for Paramedics would be beneficial to him. In the longer term he wishes to progress his career and is considering undertaking an Advanced Care Practitioner course, perhaps next year.
Decision
12. Ms Ryan submitted that the HCPC had produced sufficient evidence for the Panel to find the alleged health condition proved on the balance of probabilities. She submitted that the evidence of the two HCPC witnesses was both credible and reliable, and supported by the exhibited documents in the hearing bundle.
 
13. The Registrant submitted that he accepted the medical diagnosis.
14. The Panel accepted the Legal Assessor’s advice that the burden of proof was upon the HCPC to prove the alleged health condition, and the standard of proof required was that it had to be proved on the balance of probabilities.

15. The Panel carefully considered all the documentary and oral evidence, and the submissions made.
16. The Panel considered that the evidence of Witness 1 on his fact-finding investigation was both fair and credible.
17. The medical evidence of Witness 2 was also fair and credible. Witness 2 was clearly very experienced in giving evidence to a variety of health care regulators.
18. The Panel’s view of the Registrant was that he was articulate, reflective, insightful and honest in giving his evidence to the Panel.
Particular 1 – found proved
19. The Panel determined that it accepted Witness 2’s expert medical opinion on the diagnosis that the Registrant is suffering from. This diagnosis was accepted as being correct by the Registrant.
Decision on ground:
20. Ms Ryan submitted that the evidence from Witness 1 and Witness 2 demonstrated the likely detrimental effect of a relapse on the Registrant’s ability to attend for work and to perform his paramedic work. The health condition was, therefore, sufficiently serious so as to amount to the statutory ground of impairment of physical or mental health.
21. The Registrant submitted that he accepted that a relapse would affect his ability to carry out his paramedic work.
22. The Panel accepted the Legal Assessor’s advice that whether the Registrant’s health condition was serious enough so as to amount to the statutory ground was a matter for the independent professional judgement of the Panel.
 
23. The Panel carefully considered the proven facts and the evidence. Witness 2 has stated that the health condition had an ongoing risk of relapse.
24. The Panel determined in the light of that evidence that the Registrant’s proven health condition was serious enough to amount to the statutory ground of physical or mental health.
Decision on impairment:
25. Ms Ryan submitted that current impairment was a matter for the independent professional judgement of the Panel.
26. The Registrant submitted that he was not currently impaired.
27. The Panel accepted the Legal Assessor’s advice that the Panel had to consider whether that proven health condition leads to this Registrant’s fitness to practise being impaired now. There are two component parts of the test for impairment. First, there is what may be termed the personal component of this decision. The Panel considers the proven health condition, together with all the other evidence the Panel have in respect of the Registrant, (e.g. insight, any evidence of the treatment or curing of the health condition, the risk of relapse, the risk to the public presented by any relapse). Second, the Panel must also consider what may be termed the public component, namely, what would be the effect of not finding impairment on the wider public interest? That wider public interest includes the maintenance of public confidence in the profession and its regulator, and the declaring and upholding of proper standards of conduct. Those components are dealt with in the HCPTS’s Practice Note ‘Finding that Fitness to Practise is ‘Impaired’‘ (March 2017).

28. With regard to the public component of the test, an informed member of the public would, in the Panel’s view, be concerned if the Registrant were permitted to resume unrestricted practice, with the resulting risk to the maintenance of the public’s confidence in the profession and its regulator.
29. For these reasons, the Panel determined that the Registrant’s fitness to practise is currently impaired. 
Decision on Sanction:
30. Ms Ryan submitted that sanction is entirely a matter for the independent judgement of the Panel applying the HCPC’s Indicative Sanctions Policy. She reminded the Panel that Witness 2 had proposed what he considered to be viable conditions of practice which the Panel could consider in its deliberations.
31. The Registrant submitted that he did not disagree with the conditions proposed by the medical expert, Witness 2, because he recognised that his compliance with such conditions would give confidence to the HCPC and the public that his health condition is being satisfactorily controlled. He submitted that he has a lot to give to the profession, not least because of his particular life experiences arising from his health condition. As he has not practised for two years, the Registrant said that he recognised that he would have to undertake a refresher course comprising 60 taught hours.
32. The Panel accepted the Legal Assessor’s advice that:
a) the appropriate sanction, if any, is a matter for the independent judgement of the Panel;
b) the Panel must at all times bear in mind that the purpose of imposing a sanction is to protect the public in accordance with the over-arching objective of the exercise of the HCPC’s powers set out in Art. 3(4) of the 2001 Order, as amended. This includes promoting and maintaining the public’s confidence in the profession and promoting and maintaining proper standards of conduct. The purpose of a sanction is not to rehabilitate the Registrant, nor to punish the Registrant, although a restriction on the Registrant’s registration may have a punitive effect;
c) The Panel should consider the impact of a particular sanction on the Registrant, but it is not the primary consideration;
d) the Panel must take account of the HCPC’s guidance in its published “Indicative Sanctions Policy” March 2017, which includes the need for the Panel to exercise the principle of proportionality. This means that if a sanction is required, the sanction imposed should be the minimum appropriate sanction to achieve the over-arching objective. If the Panel deviates from the Policy, it should state clear and cogent reasons for so doing.
33. The Panel carefully considered all the evidence and the submissions made, and has applied the HCPC’s Indicative Sanctions Policy.
34. The Panel first determined that no action, mediation and a Caution Order were each inappropriate and insufficient. Each of those would not protect the public from the risk of a relapse in the Registrant’s health condition, nor would any of those outcomes protect and maintain public confidence in the profession.
35. The Panel next considered the suitability and adequacy of a Conditions of Practice Order. The Panel was persuaded by the expert evidence of Witness 2 that workable conditions of practice would provide for the Registrant’s return to practice safely and provide a mechanism for his cessation of practice if he relapsed. The Panel noted the Registrant’s commitment to managing his health condition, together with his stated recognition of the need for appropriate conditions and his willingness to comply with such conditions of practice. Further the Panel was impressed by the Registrant’s openness and engagement with the HCPC proceedings.
36. The Registrant’s present employers clearly value the Registrant and have expressed their support in developing his current role to include clinical aspects if the Registrant is permitted to resume practice. The testimonials from his line manager and the managing director speak of the Registrant in very favourable terms and his empathetic support for patients within the outreach service is particularly noted. He is clearly a valued and integrated member of the team and is regarded as “transparent and honest” and, importantly with regard to his health, as “reflective and shows a remarkable insight into his recovery journey”.
37. The advice from Witness 2 was that there should be another assessment in March 2019, that is 12 months from the first assessment. The Panel determined that the Conditions of Practice Order should be for a period of nine months, so that the further assessment is available to the panel that will review the order before it expires.
38. The Panel determined that there was no need to impose a Suspension Order, because that would be disproportionate in the circumstances of the Registrant’s recognition of the need for, and willingness to comply with, a Conditions of Practice Order that would sufficiently protect the public and the wider public interest.

Order

The Registrar is directed to annotate the HCPC Register to show that, for a period of nine months from the date that this Order takes effect (“the Operative Date”), you, Dominic Maddocks, must comply with the following conditions of practice:
1) You must register with and remain under the care of a general practitioner and inform him or her that you are subject to these conditions and authorise that person to provide the HCPC with information about your health and any treatment you are receiving.
2) You must keep your professional commitments under review and limit your professional practice in accordance with the advice of your general practitioner.
3) You must cease practising immediately if you are advised to do so by your general practitioner.
4) You must provide to the HCPC details of the management arrangements and forward copies of the management results to the HCPC within 14 days prior to the review hearing.
5) [Redacted]
6) [Redacted]
7) You must make yourself available for a further assessment prior to the review hearing of this Order.
8) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
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) You must have monthly meetings with your line manager to discuss your attendance, punctuality and engagement at work and obtain a report from your line manager to be provided to the HCPC at least 14 days prior to the review hearing of this Order.
12) You must maintain a reflective diary detailing your continuing journey in managing your health issues.
13) You will be responsible for meeting any and all costs associated with complying with condition 4 of these conditions.

This order will be reviewed again before its expiry.

Notes

Right of Appeal:
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health and Social Work Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you.  The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

 

Interim Order Application:
1. Ms Ryan applied for an interim Order on the grounds that it was necessary for the protection of the public and/or was otherwise in the public interest upon the Panel’s findings in its determination on facts, grounds, impairment and sanction. This was a serious health matter that the Panel had determined could put service users at risk of harm.
2. The Registrant said that he understood the application and had no submissions.
3. The Panel accepted the advice of the Legal Assessor that the Panel should take into account the HCPTS Practice Note “Interim Orders” and could only make an Interim Order if it was of the view that an Interim Order was:
(i) necessary for the protection of members of the public;
(ii) is otherwise in the public interest; and/or
(iii) is in the interests of the Registrant.
Decision:
4. The Panel took all the circumstances of this case into account, the submissions of Ms Ryan and the Registrant, and the contents of the HCPTS Practice Note “Interim Orders”.

Interim Conditions of Practice Order:
5. The Panel determined to make an Interim Conditions of Practice Order in the same terms as the substantive Order, the same being necessary to protect members of the public and is otherwise in the public interest, for the same reasons as it determined to make the substantive Order of Conditions of Practice. The Interim Order will be for 18 months to allow for the period of time required by the Courts to deal with an appeal, if an appeal is made.
This order will expire:
(if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made;
(if an appeal is made against the Panel’s decision and Order) upon the final determination of that appeal, subject to a maximum period of 18 months.

 

 


Hearing History

History of Hearings for Mr Dominic Maddocks

Date Panel Hearing type Outcomes / Status
04/09/2018 Health Committee Final Hearing Conditions of Practice