Mr Lee Parkin

Preliminary matters
Service

1. The Panel was provided with a copy of the Notice sent by first class post to the Registrant’s registered address on 31 July 2019, setting out the time, date and venue for this review and the possibility of the Panel proceeding without the Registrant in the event that he did not attend. The Panel was provided with proof of postage by way of a signed declaration by an HCPC employee. The Panel was thus satisfied that good had been effected.

Proceeding in absence
2. The Registrant did not attend the review hearing. He did not provide any written representations nor did he respond to the Notice of Hearing.

3. Ms Ktisti, on behalf of the HCPC, made an application to proceed in the Registrant’s absence given that good service has been found by the Panel

4. When deciding whether to proceed in the absence of the Registrant, the Panel took into account the submissions made by Ms Ktisti and accepted the advice of the Legal Assessor. It bore in mind that, although it had a discretion to proceed in the absence of the Registrant, this discretion should be exercised with the utmost care and caution. The Panel was cognisant of the fact that this was a statutory review and its purpose was to review a Suspension Order before the date it was due to expire. There was nothing to suggest the Registrant would attend on another occasion. The Registrant had not responded to correspondence about this hearing, that was both posted and emailed to him, and the Panel observed that he had not attended the substantive hearing either. He has not engaged with the HCPC since 16 June 2017, when he indicated by email that “I will not be attending any of the hearings related to this case” and that he was “looking for other employment outside of the health care industry.”

5. The Panel therefore decided that, by his lack of engagement and his indication that he would not be attending any hearings, the Registrant had voluntarily absented himself and thereby waived his right to be present. It decide that any adjournment would be unlikely to result in his attendance at a future hearing given his lack of engagement thus far. The Panel considered there was a public interest in the matter proceeding and it was also in the Registrant’s own interests that the Order be reviewed. In all the circumstances, the Panel decided to proceed in the absence of the Registrant.

Background
6. The Registrant was employed by the East Midlands Ambulance Service NHS Trust (‘EMAS’) as a Paramedic between 1 July 2002 and 8 May 2017. At the time of the events covered by the factual particulars of the allegation the Registrant was working as a solo responder in a “response car” (otherwise known as a fast response vehicle or ‘FRV’) in the Derby area.

7. Patient A was a high volume user of 999 services and was also known to the Police. She was also known to misuse alcohol. She had received a suspended sentence in March 2014 for persistent use of the 999 system and for assaulting a paramedic. She was later, after the events in question, imprisoned for continued persistent use of the 999 system.

8. In the course of his duties, the Registrant attended her at her home address on 27 May 2016 and 30 July 2016 in response to 999 calls made by Patient A.

9. On 30 July 2016 Patient A made multiple 999 calls that resulted in different EMAS staff attending at her address on multiple occasions on that date. Two of those attendances resulted in independent concerns being raised about the relationship between Patient A and the Registrant: one from the attendance of an EMAS crew which included RB (Emergency Medical Technician) and EB (Paramedic) and one from the attendance of CB (Emergency Care Practitioner) who attended in a solo vehicle. RB, EB and CB all gave evidence at the final hearing.

10. The Registrant’s attendance at Patient A’s premises on 30 July 2016 had been as a result of her 999 call placed at 03:05am. RB and EB had also attended on Patient A a few weeks prior to 30 July 2016. On that occasion Patient A had asked whether they knew a paramedic called Lee. She showed them a greeting card which had been signed off as “Lee”. RB recognised the handwriting as belonging to the Registrant.

11. On 30 July 2016, RB’s EMAS crew, including EB and a trainee Technician, again attended on Patient A as a result of a 999 call placed at 13:39. On this occasion Patient A appeared to be under the influence of alcohol. She again had the same greeting card on display, talked about her friendship with the Registrant, showed RB text messages on her phone which she said were from the Registrant, and reported that the Registrant had taken her to Asda in his paramedic car on a previous occasion. After this attendance, RB raised concerns with a Team Leader and, as requested, hand wrote an account of what had occurred that same day. EB also hand wrote a statement on 30 July 2016.

12. Later on 30 July 2016, as a result of a 999 call placed at 23:40, CB, Emergency Care Practitioner, attended Patient A alone. The patient again appeared to be under the influence of alcohol. Patient A told CB that her “boyfriend” was a paramedic called “Lee”, showed her a greeting card that was signed “Lee”, and referred to a text message that she said had come from him. At CB’s request, Patient A read out the majority of the digits of the number from which she claimed the message came, and when CB entered these digits into her phone it came up with the Registrant’s contact details. Patient A showed CB a rug and said that the Registrant had taken her to Ikea to enable its purchase. She also told CB that the previous night the Registrant had taken her to Asda in his “ambulance car”. CB raised concerns with her manager a few days later on 3 August 2016 and, as requested, hand wrote an account of what had occurred.

13. The Registrant made a self-referral to the HCPC on 3 August 2016, advising that he had been suspended from duty that day whilst an investigation into an alleged inappropriate relationship with a patient took place.

14. EMAS subsequently carried out an investigation and a disciplinary hearing was held on 18 April 2017. The Registrant had submitted an “Employee Statement” prior to that hearing. At the hearing and in his “Employee Statement”, the Registrant made admissions over and above those he had already made in his investigation interview. In particular, despite the explanation he had given when previously interviewed for why he travelled to Asda on the 30 July 2016, he admitted he had in fact taken Patient A to Asda in his EMAS vehicle so that she could purchase alcohol.

15. At the final hearing on 8-10 August 2018, the panel found most of the facts proved, as detailed above. The Registrant did not attend that hearing. In finding the facts proved amounted to misconduct that panel said:

“In entering into an inappropriate with a vulnerable patient, in the Panel’s judgement, the Registrant breached the trust of his patient, his employer and the profession. In the Panel’s opinion, the Registrant’s actions have brought the profession into disrepute and fall seriously below the standards expected of a registered paramedic. In so acting, the Panel concluded that the Registrant has breached several of the fundamental tenets of the profession, as follows:

Of the HCPC’s Standards of conduct, performance and ethics 2016:

 1: Promote and protect the interests of service users and carers

•1.7: You must keep your relationships with service users and carers professional;

 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;

9.1: You must make sure that your conduct justifies the public’s trust and confidence in you and your profession;

9.6: You must co-operate with any investigation into your conduct or competence, the conduct or competence of others, or the care, treatment of other services provided to service users.

Of the Standards of Proficiency for Paramedics 2014:

2: be able to practise within the legal and ethical boundaries of their profession.

For these reasons, the Panel has determined that the facts found proved about to misconduct.”

16. In reaching its decision on impairment the panel at the final hearing said:
“The Panel noted that the Registrant had expressed some remorse and regret and had admitted some matters in his interview with EMAS. He has shown insight only insofar as he admitted at the disciplinary hearing that taking Patient A to Asda to purchase alcohol was a bad clinical decision and that he should have asserted his professionalism in resisting her demands. The Panel concluded that, although the misconduct involves the serious matter of the crossing of professional boundaries, it is remediable conduct. However, in light of the very limited insight by the Registrant and the lack of evidence concerning the commencement or successful completion of any remediation process, there remains a risk of repetition.

In those circumstances, the Panel cannot conclude anything other than that the Registrant remains a danger to the health, safety and well-being of patients, including vulnerable patients, and to the public, with the commensurate risk of repetition. Moreover, in the Panel’s judgement, public confidence in the profession, its reputation and in the regulatory process would be undermined if the Panel were to find this Registrant not to be currently impaired.

For these reasons, the Panel determined that the Registrant’s fitness to practise is currently impaired by reason of his misconduct.”

17. When deciding the appropriate sanction the final hearing panel said:

“The Panel took into account that the Registrant had a previous good record before this regulatory body and that he has been under an Interim Suspension Order since 19 June 2017. In relation to the Interim Order, the Panel noted the legal advice that it should not use the Interim Order to perform a mathematical calculation of its duration when determining the type and length of any relevant sanction, but, rather, the Panel should take the fact, the type and the length of it into account, in proportion, within the whole case.

The Panel considered that there were both aggravating and mitigating factors in this case, as follows:

Mitigating factors:
A relatively long and unblemished career before this matter;
A level of respect and friendliness towards him, historically, as evidenced by his two former colleagues;
His early explanations and some admissions at the employer’s investigatory stages;
Some challenging health circumstances;
Some highly challenging personal circumstances;

Aggravating factors:
A breach of the trust of a vulnerable patient;
Abusing the trust of his employer by engaging in a personal relationship with a patient;
Abuse of his professional position as a Paramedic by crossing professional boundaries;
Placing each of his colleagues involved in the matters relating to this case in an invidious position, as evidenced by them;
The misconduct found proved represented a pattern of behaviour.

The Panel first considered imposing no order, mediation and a Caution Order and rejected these outcomes. The matters found proved are sufficiently serious to merit being met by a commensurately serious sanction and one that enables the regulator to oversee the Registrant’s practice. The matters found proved are not at the lower end of the scale of failings within the profession and include a breach of trust relating to a vulnerable patient and the Registrant’s former employer, as well as the crossing of professional boundaries by the Registrant in relation to that patient. In the Panel’s opinion, imposing any of these outcomes would not provide any safeguards over the Registrant’s practice so as to be able to monitor any efforts he might make in the future at remediation and if those efforts had been sufficiently successful to allow a finding of no impairment in the future. In the Panel’s judgement, allowing the Registrant to return to practice now, without a more stringent sanction, would continue to put the public at risk and would undermine public confidence in the profession and in the regulatory process.

The Panel next considered imposing a Conditions of Practice Order. The Registrant has not engaged in the HCPC process and the matters found proved are a serious breach of trust of a patient, where the Registrant appears to have only limited insight into his actions. The Panel has no information about his practice since these events and no information about any further insight he might have gained into the consequences of his failings, as well as any remediation, if he has commenced that. Without this information, the Panel has determined that it would put the public at continuing risk of harm if the Registrant were to be permitted to return to an as yet unknown practice setting without any conditions or a known supervisor/mentor in place to monitor his progress. The Panel concluded that it would be extremely difficult and risky to attempt to put conditions in place, with the identified lack of knowledge about his circumstances and his attitude to the case. Therefore, without any knowledge of the Registrant’s whereabouts, his intentions towards his identified failings and/or towards his profession or any plans for the future that he might have, the Panel has determined that a Conditions of Practice Order at this time would be unworkable and unrealistic and would therefore be wholly inappropriate. In the Panel’s judgement, imposing this sanction at this time would put the public at risk, would undermine public confidence in the profession and in the regulatory process and would not be proportionate to the risks identified.

The Panel next considered imposing a Suspension Order and determined that the level of seriousness of the matters found proved could be adequately met with this sanction. In the Panel’s judgement the aggravating factors outweigh the mitigating factors. The aggravating factors demonstrated the level of disquiet and anger engendered in the two witnesses involved in the case by the Registrant’s reckless and misplaced actions with Patient A, a vulnerable patient with a predisposition to alcohol misuse and violence, the latter of which represented a risk to ambulance staff.

A Suspension Order will prevent the Registrant from working as a paramedic on a temporary basis for its duration, but falls short of a permanent removal from the registrar. It has the effect, both of marking the gravity of the misconduct found proved, whilst also allowing the Registrant, before the Review of this Order, to engage with the HCPC and to commence remediation, if he so chooses. In the Panel’s judgement, imposing the higher sanction of Striking Off, for the reasons given, would be punitive and disproportionate at this time. The Panel considered that a Suspension Order of 12 months would be the most appropriate and proportionate period so as to allow the Registrant time to reflect upon the misconduct, engage with the HCPC and to commence remediation, if he so chooses.”

Submissions
18. Ms Ktisti submitted that since the Suspension Order was imposed there had been no engagement by the Registrant and that therefore the concerns raised by the panel at the final hearing continue to exist. She submitted that there was nothing to suggest that the Registrant was now fit to practise. Ms Ktisti submitted that, following the lack of engagement, absence of insight and remediation, it was the HCPC’s view that the Panel should consider a Striking Off Order.

19. The Registrant had not attended, nor had he provided any written representations.

Decision
20. This Panel took into account all the documentation placed before it, together with the submissions made by Ms Ktisti. The Registrant had not engaged and had not provided any material for the Panel to consider. The Panel accepted the advice of the Legal Assessor and in reaching its decisions referred to the HCPTS’s Practice Note on ‘Finding Fitness to Practise is Impaired’.

21. The Panel first considered the issue of current impairment. The Panel took account of the principle set out in Abrahaem v GMC [2008] EWHC 183 (Admin) that there is a persuasive burden at a review hearing for the Registrant to demonstrate that he has “fully acknowledged why past performance was deficient and through insight, application, education, supervision or other achievement sufficiently addressed the past impairments.”

22. The Panel at the final hearing found the Registrant’s fitness to practise impaired on both public protection and public interest grounds for the reasons stated above. That Panel indicated that a reviewing Panel would be assisted by:

• his attendance on the next occasion;
• a reflective piece which addresses the misconduct found;
• any training, including any CPD - related activity, in which he was able to partake that relates specifically to professional boundaries;
• any references and/or testimonials about his character and working practices, obtained in any employment environment, paid or unpaid;
• any future plans and aspirations he might have about his future practice within the profession;
• any training in which he was able to partake that relates specifically to professional boundaries.

23. The Registrant has not heeded that advice and thus the Panel could not be satisfied that the risks identified at the final hearing were not still present. The Registrant has provided no evidence acknowledging why his past behaviour was inappropriate. He has not provided any new evidence of insight, remediation and remorse to demonstrate that he had addressed the past impairment. The Panel therefore decided that his fitness to practise remained impaired on public protection grounds.

24. The Panel went on to consider whether a finding of impairment on public interest grounds was needed in order to maintain public confidence in the profession and the Regulator. The Panel was satisfied that a fully informed member of the public, who was aware of all the circumstances to this case, would have their confidence in the profession and the Regulator undermined if a finding of current impairment were not made. This was because of the nature and seriousness of the Registrant’s misconduct in an area fundamental to his professional practice and in circumstances whereby he had not demonstrated proper insight or remediation of his behaviour.

25. Accordingly, the Panel found the Registrant’s fitness to practise remained impaired on public interest grounds also.

26. The Panel then considered what sanction was both appropriate and proportionate in all the circumstances and in doing so considering the HCPC’s Sanctions Guidance. The Panel noted that the Registrant had now been suspended for almost a year, but had taken no steps to remediate his failings or to demonstrate insight into them. He had not engaged with his Regulator at the final hearing or at any stage thereafter. There was, therefore, no indication that he was in any way committed to resolving his failings. In such circumstances to take no action or make a Caution Order would not be appropriate. Furthermore,  a Conditions of Practice Order would not be appropriate or workable. In addition, without some engagement from the Registrant, the Panel could not be satisfied that he had addressed the issue of professional boundaries and thus a Conditions of Practice Order would not adequately reflect the seriousness of the misconduct.

27. The Panel thus had little choice but either to further suspend the Registrant or to remove him from the Register. The Panel noted the observation of the final hearing panel that at that stage it considered a Striking Off Order would have been punitive and disproportionate and that by suspending the Registrant it would allow him time to reflect, engage with the HCPC and commence remediation, if he chose to do so.  The Registrant had failed to take advantage of that opportunity to demonstrate insight and remediation and had chosen instead to persist with his non-engagement with his regulatory body. The Panel also noted the comments of the Registrant on the last occasion that he had engaged with the HCPC, in June 2017, namely that he would not be attending any hearings and was seeking alternative employment “outside of the health care industry.”

28. The Panel considered that it was not sensible to continue the review process where it appeared that the Registrant was unwilling or unable to remediate his failings. In the absence of any remediation or insight, or any evidence that the Registrant was prepared to engage with his Regulator, the Panel decided the only appropriate and proportionate sanction was to make a Striking Off Order. The Panel took into account the impact this may have on the Registrant, however this was outweighed by the public interest in appropriately dealing with cases where a Registrant had chosen not to engage.

Order: The Registrar is directed to strike Mr Lee Parkin from the Register upon expiry of the current order.

The Order imposed today will apply from 7 September 2019.

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 Articles 30(10) and 38 of the Health and Social Work Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

European Alert Mechanism
In accordance with Regulation 67 of the European Union (Recognition of Professional Qualifications) Regulations 2015, the HCPC will inform the competent authorities in all other EEA States that your right to practise has been prohibited.
You may appeal to the County Court against the HCPC’s decision to do so.  Any appeal must be made within 28 days of the date when this notice is served on you. This right of appeal is separate from your right to appeal against the decision and order of the Panel.

History of Hearings for Mr Lee Parkin