Mr John W Williams

Profession: Paramedic

Registration Number: PA39245

Hearing Type: Consent Order Hearing

Date and Time of hearing: 10:00 05/02/2019 End: 17:00 05/02/2019

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

During the course of your employment as a Paramedic with South Central Ambulance Service between March 2016 and July 2016 you;

1. On or around 26 March 2016, attended patient 1 and;

a. did not complete a primary survey;

b. did not immediately provide them with oxygen following a below normal oxygen saturation reading.

2. On or around 31 May 2016, attended patient 2 and;

a. did not assess the patient’s injury at all, or until prompted to do so, in that you did not:
i. expose their foot and ankle;
ii. assess the colour of their foot;
iii. assess the temperature of their foot;
iv. assess their pedal pulse;

b. did not recognise it was a potentially ‘time critical’ incident.

3. On or around 31 May 2016, attended patient 3 and;

a. discharged the patient on scene without understanding the nature of their condition;

b. did not request any assistance in regards to understanding the patient’s condition.

4. On or around 31 May 2016, attended patient 4 and were unaware of the possible consequences of an Amitriptyline overdose

5. On or around 31 May 2016, when questioned by a clinical mentor, were unable to confirm the signs and/or symptoms of a Diazepam overdose.

6. On or around 30 May 2016, attended patient 5 and did not question the patient regarding sporadic incontinence at all, or until prompted to do so

7. On or around 30 May 2016, attended patient 6 and;

a. did not feel for a radial pulse;

b. did not understand the patient’s ECG readings, in that you were unable to confirm if the patient was in normal sinus rhythm or not.

8. On or around 1 July 2016, attended patient 8 and;

a. did not carry out a visual inspection of their airway;

b. did not position the patient correctly in order to undertake an abdominal assessment;

c. did not offer the patient pain relief until prompted to do so;

d. were unable to identify a potential differential diagnosis.

e. did not assess Patient 8’s respiratory rate.

9. On or around 1 July 2016 attended patient 9 and;

a. did not undertake an ECG during the secondary survey;

b. did not offer the patient pain relief until prompted to do so;

c. did not identify an appropriate disposition plan.

10. On or around 2 July 2016, attended patient 10 and;

a. Did not carry out a visual inspection of their airway;

b. did not obtain a respiratory rate;

c. did not question the patient in order to identify red flags relating to back pain, until prompted to do so;

d. did not communicate the side effects of Morphine before administration to the patient;

e. before administering a second dose of Morphine failed to check the following until prompted to do so:

a) Pulse;

b) Respiratory rate;

c) Blood pressure;

f. did not identify air in the syringe which you were about to use to administer Morphine.

11. On or around 2 July 2016, attended patient 11 and;

a. did not complete a primary survey;

b. proposed a plan which would have delayed conveying the patient to hospital had a colleague not intervened;

c. did not provide them with oxygen therapy.

12. On or around 4 July 2016, attended patient 12 and did not take the lead in completing the primary survey.

13. Did not consistently demonstrated effective communication skills when:

a. Communicating your decisions to patients;

b. Delegating tasks to other crew members.

14. The matters as set out in paragraphs 1-13 constitute a lack of competence.

15. By reason of this lack of competence your fitness to practise as a Paramedic is impaired.

 

Finding

Preliminary Matters

Proof of Service

1. The Panel was satisfied that notice had been served on the Registrant at his registered address in accordance with Rule 3 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”). Notice of the hearing had been sent on 22 January 2019, which was outside the 28 days requirement imposed by Rule 6, however the Registrant’s representative had confirmed by email dated 18 January 2019 that they were content to waive the 28-day notice period. In those circumstances the Panel was content that notice had been served in a manner that was acceptable.

Proceeding in the Absence of the Registrant

2. Ms Simpson, on behalf of the HCPC, applied for the consent hearing to proceed in the absence of the Registrant pursuant to Rule 11 of the Rules.

3. The Panel accepted the advice of the Legal Assessor, who reminded the Panel of the criteria set out in R v Jones [2002] UKHL 5 and the guidance in General Medical Council v Adeogba/ Visvardis [2016] EWCA Civ 162.

4. The Panel took into account the email dated 30 January 2019 from the Registrant’s legal representative, which stated:

“I confirm that Mr Williams does not intend to attend or be represented at the hearing on 5 February, based on the understanding that the purpose of this hearing is solely for the Panel to consider approval of the agreed Consent Order”.

5. The Panel concluded that the Registrant had voluntarily absented himself from the proceedings, and did not desire an adjournment. He was clearly aware of the proceedings and had engaged in the regulatory process in agreeing to the proposed order before the Panel today. There were no remaining issues in dispute. In these circumstances, the Panel determined that it is in the interests of justice to proceed in the absence of the Registrant today.

Background

6. The Registrant is a registered paramedic, who commenced employment as a Band 5 Paramedic at South Coast Ambulance Service (SCAS) in January 2016.

7. The Registrant self-referred to the HCPC by email on 5 August 2016.

8. As a Newly Qualified Paramedic, the Registrant was required to participate in the "Preceptorship Programme" which required a number of shifts to be worked with a clinical mentor. In March 2016, the Registrant's mentor attended a selection of call outs with the Registrant. Concerns were raised which resulted firstly in the implementation of a formal action plan before a formal capability progress was commenced. During this time further concerns were reported regarding the Registrant’s performance.

9. The totality of the existing concerns are now reflected in the Particulars of the Allegation set out above, these primarily relate to clinical assessment skills.

10. The matter was first referred to the Investigating Committee Panel ("ICP") on 17 February 2017 who determined that there was a case to answer. Following this decision, the investigation continued and the matter was returned to the ICP on 22 September 2017 which determined that there was a case to answer in relation to the further particulars which had been put forward. On 17 July 2018, a preliminary hearing was held in which a Panel of the Conduct and Competence Committee allowed proposed amendments to the Allegation.

11. On 29 June 2018, the Registrant's representative wrote to the HCPC, suggesting that the matter could be resolved by means of a Consent Order. The letter set out the case that the Registrant did not deny the HCPC allegations and accepted that he was not practising at the level required of a Newly Qualified Paramedic when initially employed by SCAS. The letter also indicated that the Registrant had voluntarily stepped down from his role as a paramedic to work as an Emergency Care Assistant (ECA) with SCAS. He had been in this role for 20 months and had gained sufficient patient exposure and practical experience to commence independent practice as a Newly Qualified Paramedic. Conditions of Practice involving supervision were suggested as the appropriate outcome. This was confirmed by the Registrant’s representative in an email dated 18 July 2018.The HCPC determined that disposal by consent by way of Conditions of Practice was suitable. A proposal for a Conditions of Practice Order was offered by email on 12
September 2018.

12. The Registrant's representative confirmed on 18 September 2018 that the Registrant consented to the proposed Conditions of Practice Order.

13. The Registrant was sent a copy of the consent order on 03 October 2018 and returned this signed on 15 October 2018

Submissions

14. Ms Simpson drew the Panel’s attention to the Practice Note on Disposal of Cases by Consent. She submitted that the Registrant had engaged with the HCPC throughout. She submitted that correspondence dated 29 June 2018 and 30 January 2019 sent to the HCPC on behalf of the Registrant suggested that the Registrant had insight into the Allegation and that he was stepping down from his former position and taking steps to improve his knowledge and skill base. The Registrant was supported by his employer and had engaged in further training and professional development since the referral. Ms Simpson submitted that the Conditions of Practice Order put forward was the appropriate and proportionate sanction in the circumstances and invited the Panel to approve the proposed order.

Decision

15. The Panel considered the public protection and public interest tests as set out in the HCPC Practice Note on the Disposal of Cases by Consent. It also carefully considered the HCPC Indicative Sanctions Policy. It accepted the advice of the Legal Assessor.

16. The Panel took account of the content of the e-mails sent by the Registrant’s legal representative, including an email dated 29 June 2018 which confirmed that the Registrant had voluntarily stepped down from his role as a Paramedic to work as an Emergency Care Assistant and had been successfully working in that role for the past 20 months. The email confirmed that his work had gone very well and he had now gained the correct level of patient exposure and practical experience required to commence independent practice as a Newly Qualified Paramedic. His supervisors in the Ambulance Trust now considered that he is fit to recommence work as a paramedic.

17. The Panel also took into account an undated letter from the South Central Ambulance Service NHS Foundation Trust which confirmed that the Registrant’s job offer was subject to normal standard conditions and that all Newly Qualified Paramedics would be given front loaded shifts with more senior clinically trained staff along with advice lines in accordance with the national Newly Qualified Paramedic standards. The letter confirmed that the concerns which had been raised with the HCPC had been addressed to their satisfaction and that the Registrant now meets the standard that is required to work as a Newly Qualified Paramedic.

18. In signing the Consent Order the Panel noted that the Registrant had accepted the Allegation in full. Furthermore, he had confirmed that he consented to the making of a Conditions of Practice Order in the terms set out below.

19. The Panel was satisfied that there was potential for a finding of impairment in this case on both public protection and public interest grounds as a result of the Registrant’s lack of competence.

20. Nevertheless, the Panel was satisfied that the Registrant had demonstrated insight into the matters which led to the making of allegations, and had engaged in the fitness to practice process. The Panel was satisfied that the public would be adequately protected by such an order and that such an order was proportionate in the circumstances. The Panel was also satisfied that public confidence in the profession and the regulator would be maintained by the making of such an order. The order was proportionate in the circumstances, and the conditions of practice were workable, as confirmed by correspondence with the Registrant's employer, South Central Ambulance Service NHS Foundation Trust.

21. Accordingly, the Panel approves a Consent Order imposing a Conditions of Practice Order of one year’s duration in the terms set out below.

Order

Order: That the Registrar be directed to annotate the Register to show that for a period of 1 year from the date that this Order comes into effect (the Operative Date), you, John W Williams, must comply with the following conditions of practice:


1. You must place yourself and remain under the supervision of a workplace supervisor, registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within one month of recommencing work as a Paramedic. You must attend upon that supervisor as required and follow their advice and recommendations.
2. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
3. You must promptly inform the HCPC of any capability or disciplinary proceedings taken against you by your employer.
4. 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).
5. You must work with your supervisor to formulate a Personal Development Plan designed to monitor and address any deficiencies in the following areas of your practice:
a) Undertaking assessments
b) Communicating effectively with colleagues and patients
6. Within three months of starting work as a Paramedic you must forward a copy of your Personal Development Plan to the HCPC.
7. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.
8. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

Notes

No notes available

Hearing History

History of Hearings for Mr John W Williams

Date Panel Hearing type Outcomes / Status
05/02/2019 Conduct and Competence Committee Consent Order Hearing Conditions of Practice
21/12/2018 Conduct and Competence Committee Final Hearing Adjourned
16/07/2018 Conduct and Competence Committee Final Hearing Adjourned