Mr Daniel Lauder

Profession: Paramedic

Registration Number: PA22185

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 25/07/2019 End: 17:00 02/08/2019

Location: Novotel Glasgow Centre, 181 Pitt Street, Glasgow G2 4DT

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Whilst registered as a Paramedic and employed by the Scottish Ambulance Service:

1. On the 02 June 2016:

A. You left the primary care of a high-speed Road Traffic Collision (RTC) patient (Patient A), to a student technician whilst conveying them to hospital;B. You did not ensure that the following were carried out and/or recorded for Patient A ,

(i) A Full primary trauma survey;
(ii) Adequate clinical observationsC. You did not demonstrate sound clinical reasoning in that:
(i) You advised the Lorn and Islands Hospital that the Patient A was haemodynamically stable, when this was not the case;
(ii) You advised against Patient A receiving high flow oxygen;
(iii) You failed to drive the ambulance in emergency conditions when transporting Patient A to hospital.

2. In or around June 2016 you represented yourself as a mentor when you had been taken
off the mentor list

3. On 22 September 2014 when attending Patient B,:

A. You did not obtain in a timely manner a full set of observations for Patient B and/or
record these on the a Patient Record Form;
B. You did not administer oxygen to Patient B in a timely manner;
C. You advised Patient B's GP Surgery that "Patient B did not want to go to hospital" or
words to that effect, when this was not the case.

4. Your actions at paragraphs 2 and 3C were dishonest

5. The matters set out in paragraphs 1 - 4 constitute misconduct and/or lack of competence.

6. By reason of your misconduct and/or lack of competence your fitness to
practise is impaired.

Finding

Preliminary matters:

1.The case for the Health and Care Professions Council (HCPC) was presented by Mr Lee Bridges of Kingsley Napley Solicitors. The Registrant was present and represented by Ms Karen Osborne of Thompsons Solicitors. The Registrant admitted the facts of particulars 1A, 1B(i), 1B(ii) and 1C. The Registrant denied the remainder of the allegation.

2.Mr Bridges asked the Panel to consider the statement of WK(1) as hearsay evidence. Mr Bridges provided a letter from WK(1)’s General Practitioner which set out the reasons for his inability to attend or to give evidence remotely. Ms Osbourne, on behalf of the Registrant, advised that she had no objection to the statement being submitted as hearsay evidence.  The Panel is aware that WK(1) is a paramedic who attended the call to Patient B with the Registrant on 22 September 2014 and his evidence is therefore relevant. In addition he had been due to attend to give live evidence and the issue preventing his attendance was only brought to the attention of the HCPC on 10 July 2019. The Panel therefore agreed that it was fair to admit the statement of WK(1) as hearsay evidence.
 
Background

3.The Registrant is a paramedic and has been employed by the Scottish Ambulance Service since 1993. Initially as a technician and, in 2006, the Registrant qualified as a paramedic and was employed in this capacity. In November 2014, Patient B complained to the Scottish Ambulance Service in respect of the treatment she received from the Registrant and another paramedic, WK(1), on 22 September 2014. This prompted an internal investigation which was conducted by JM.

4.On 17 June 2016, WH, employed by the Scottish Ambulance Service, became aware that the Registrant was presenting himself as a Paramedic Mentor to others within the service. On the same day, the Registrant informed WH, in the presence of others, that he was a mentor. When challenged on this, the Registrant allegedly acknowledged that he was removed from the National Mentor List in 2014, but that was his own decision. WH then became aware of an incident that Daniel Lauder and CC attended to on 2 June 2016 with regards to Patient A. CC was a Student Technician at the time. WH had some concerns regarding the service that was provided to Patient A and the support that was provided to CC based on what he had heard from her. WH raised his concerns through the Scottish Ambulance Services internal reporting system. An investigation was subsequently conducted by WK(2). CC and SM (a nurse from Lorne and Islands Hospitals), amongst others were interviewed as part of the investigation.

5.On 2 December 2016 the HCPC received an anonymous referral in respect of the Registrant’s treatment of Patient A.
 
Decision on Facts

6.The Panel heard live evidence from six witnesses on behalf of the HCPC: WK(2), a paramedic employed by the Scottish Ambulance Service appointed as Investigating Officer in respect of the incident relating to Patient A; SM, Advanced Nurse Practitioner at the Lorne and Islands Hospital; CC, an Ambulance Technician employed by the Scottish Ambulance Service; WH, Clinical Training Officer employed by the Scottish Ambulance Service; JM, a paramedic employed by the Scottish Ambulance Service appointed as Investigating Officer for the incident relating to Patient B and Patient B (by telephone). The Panel also considered the written statements of WK(1), a paramedic employed by the Scottish Ambulance Service; EJ, Patient B’s General Practitioner and ER, a Legal Assistant at Kingsley Napley, Solicitors.  The Panel also heard live evidence from the Registrant and considered all of the documentation produced by the HCPC and by the Registrant.

7.The Panel heard live evidence from WK(2) and was provided with a copy of his investigation report and the transcript of the interviews he conducted in the course of his investigation.  The Panel found him to be professional and he assisted the Panel by clarifying facts and providing a clear account of acceptable practice and relevant policy. His evidence was balanced and detailed. The Panel found him to be a reliable witness.

8.The Panel heard live evidence from SM. The Panel was also provided with a copy of a transcript of her interview with WK(2) on 26 July 2016 which was conducted for the purposes of the internal investigation. Although nervous when giving her evidence, she was clearly willing to assist the Panel. The Panel found her to be considered when answering any questions. The Panel also found that her evidence withstood the challenge of cross-examination and there was no evidence of any prejudice towards the Registrant. The Panel therefore found her to be a credible and reliable witness whose recollection was supported by a contemporaneous record of the conversation she had with the Registrant on 2 June 2016.

9.The Panel heard live evidence from CC.  The Panel was also provided with a copy of a transcript of her interview with WK(2) on 26 July 2016 which was conducted for the purposes of the internal investigation. The Panel found her to be professional when giving her evidence, although nervous. Her evidence was considered and detailed and was consistent with the contemporaneous record contained within the Patient Report Form, her interview during the internal investigation and with the written statement she provided to the HCPC. It was clear from her evidence that she was patient-centred and despite being distressed by the incident, such that she reported it to her mentor, she was able to give a clear account of the incident. The Panel found her to be a credible and reliable witness.

10.The Panel heard live evidence from WH. The Panel was also provided with a copy of the email he sent on 1 July 2016 detailing his concerns in respect of the Registrant. He gave evidence of the procedures in a straightforward manner and provided an account of his conversation with the Registrant.  On the whole, the Panel found him to be a credible and reliable witness. 

11.The Panel heard live evidence from Patient B by telephone. The Panel was also provided with a copy of the Registrant’s initial email of complaint dated 30 November 2014. Despite hearing her evidence by telephone and therefore unable to assess her visual demeanour, the Panel found that she was very clear in her evidence, that she had a good recollection of events and her evidence stood up robustly to cross-examination. Patient B had over forty years’ experience as a nurse and therefore had a good understanding of the issues. While the Panel accepts that she was unwell at the time, her recollection is wholly supported by the contemporaneous record contained in the Patient Report Form. In addition her evidence has been consistent since she submitted her email of complaint on 30 November 2014, in her statement to HCPC on 7 June 2018 and in her oral evidence to this Panel. In addition the Panel was of the view that she had no reason to make a false complaint. The Panel found her to be a credible and reliable witness.

12.The Panel heard live evidence from JM and had sight of his investigation report in respect of the incident relating to Patient B. Although his evidence was limited to his investigation, the Panel found that he gave his evidence in a straightforward manner and explained the Registrant's and WK(1)’s position as stated by them in the course of his investigation. The Panel found him to be a credible and reliable witness.

13.The Panel also considered the written statement of WK(1) who attended Patient B with the Registrant. He did not attend and give evidence and his statement was submitted as hearsay. His statement supported the evidence of the Registrant in respect of the treatment of Patient B and her refusal to go to hospital. WK(1)’s evidence was untested by cross examination and questioning and where it differed from that of Patient B, the Panel preferred her tested evidence.

14.The Panel also considered the written statement of EJ, Patient B’s GP,  EJ did not attend and give evidence. His statement was submitted as hearsay. It provided details of Patient B’s medical notes in respect of the call to the surgery on 22 September 2014 and an extract of Patient B’s medical records from 22 September 2014 to 19 November 2014. The Panel only gave weight to his evidence to the extent that it confirms Patient B’s clinical notes and her consultation with EJ on 19 November 2014 when she expressed her feelings of trauma in relation to her treatment on 22 September 2014.

15.The Panel also considered the written statement of ER, a Legal Assistant employed by Kingsley Napley. ER did not attend and give evidence. Her statement was submitted as hearsay. It exhibited documents provided by the Scottish Ambulance Service in respect of the Registrant’s training records. The Panel only gave weight to her evidence to the extent that it confirms that these documents were produced by the Scottish Ambulance Service.

16.The Panel also heard live evidence from the Registrant. The Panel found that the Registrant’s evidence was often inconsistent. He changed his position from being able to give an account of an incident to then being unable to remember. He also contradicted himself on occasions and his evidence contradicted the documentary evidence. There were times when the Panel did not find him to be truthful, particularly in relation to the incident with Patient B in respect of the taking and timing of observations, Patient B’s alleged refusal to go to hospital, why oxygen was not administered in a timely manner and his contact with Patient B‘s GP.

Particular 1A

17.The Registrant admitted the facts of this particular. The Panel heard evidence from CC that on 2 June 2016, the Registrant drove the ambulance to the Lorne and Islands Hospital while she was in the back of the ambulance with Patient A. The Panel also heard evidence from WK(2) that the Scottish Ambulance Service issue bulletins to paramedics to provide them with guidance in their practice. He produced copies of guidance issued in June 2011, 15 August 2014 and 9 June 2016, all of which make it clear that the senior practitioner is ultimately responsible for the treatment and care of patients.  The Panel is satisfied that the Registrant’s admission is supported by the evidence of CC and WK(2) and finds the facts of particular 1A proved on the balance of probabilities   
      
Particular 1B(i)

18.The Registrant admitted the facts of this particular. The Panel heard evidence from CC that the Registrant did not carry out a full primary trauma survey on Patient A and that he did not direct her to take any action in this regard. The Panel also heard evidence from WK(2) that the Registrant, as a Band 5 paramedic, was ultimately responsible for assessing the Patient’s condition and directing CC accordingly. The Panel has also had sight of the Patient Report Form for Patient A and heard evidence from WK(2) that from his review of the PRF, it was evident that the Registrant failed to conduct a full primary trauma survey. The Panel is satisfied that the Registrant’s admission is supported by the evidence of CC and WK(2) together with  the documentary evidence and finds that the Registrant did not ensure that a full trauma survey was carried out and recorded and finds the facts of particular 1B(i) provide on the balance of probabilities.  

      Particular1B(ii)

19.The Registrant admitted the facts of this particular. The Panel heard evidence from CC that she was not aware of any observations that the Registrant may have taken. The Panel also heard evidence from WK(2) that the Registrant, as a Band 5 paramedic, was ultimately responsible for assessing the Patient’s condition and directing CC accordingly. The Panel has also had sight of the Patient Report Form for Patient A from which it can be seen that a set of observations was undertaken, however, the Panel accepted the evidence of CC that she had carried these out wholly unprompted by the Registrant. The Panel finds that the Registrant abrogated his responsibility and gave evidence that he was not aware of the results, despite CC’s evidence that she told him as these observations demonstrated that Patient A was critically unwell. The Panel is satisfied that the Registrant’s admission is supported by the evidence of CC and WK(2) together with the Patient Report Form and finds that the Registrant did not ensure that adequate clinical observations were carried out and recorded and finds the facts of particular 1B(ii) provide on the balance of probabilities.  

     Particular 1C(i)

20.The Registrant denied the facts of this particular at the outset of the hearing, although in the course of his evidence-in-chief, the Registrant admitted that he had advised the hospital that Patient A’s condition was “stable”. The Panel heard evidence from SM that she received a radio call from the Registrant at 7.05am on 2 June 2016 in which he advised that he was bringing Patient A into the hospital. She explained that when a call is received, the staff member is expected to make a note of the call so that it can be included in the patient’s record. She produced a copy of the notes that she recorded as she took the call. In these it is recorded that the Registrant had advised that the patient had been in a road traffic accident, that she had some injuries but that she was haemodynamically stable, meaning that her circulatory system was intact, such that her blood pressure, heart rate and respiratory rate would be within normal ranges, which was not the case. The Panel prefers the evidence of SM, which is supported by her contemporaneous record of the conversation, to that of the Registrant. In her oral evidence she said she would not have written this if it had not been said. The Panel finds that the Registrant advised the hospital that Patient A was haemodynamically stable, when this was not the case. The Panel also finds that in doing so, the Registrant did not demonstrate sound clinical reasoning.  The Panel therefore finds the facts of this particular proved on the balance of probabilities.

Particular 1C(ii)

21.The Registrant denied the facts of this particular. The Panel heard evidence from CC that she thought that high flow oxygen should have been administered to Patient A as part of the primary trauma survey.  CC also gave evidence that in terms of the Joint Royal College Ambulance Liaison Committee (“JRCALC”) Guidelines, high flow oxygen should be administered in all trauma incidents to perfuse tissues in trauma situations and that the Registrant was dismissive of her suggestion to administer high flow oxygen as he said it would not be possible to reach the patient in the position she was in.  The Registrant gave evidence that he did not remember CC saying anything about oxygen at the scene of the accident and that he did not recall administering oxygen or when it was administered. He accepted that high flow oxygen was appropriate in the circumstances and that it should be administered at the first available safe point. He stated that he thought it was CC who administered the oxygen.  He also gave evidence that a police officer at the scene was in the vehicle with Patient A and was holding her head to maintain her c-spine in neutral alignment and that it may have been that he did not want the police officer to assist with oxygen as it would mean moving his hands and compromising the c-spine.  The Panel accepts the evidence of CC and finds that the Registrant advised her against administering oxygen while the patient was still in the vehicle. However, the Panel finds that in doing so, the Registrant did demonstrate sound clinical reasoning as the Registrant preferred to maintain the c-spine over giving oxygen at that time. The Panel therefore finds the facts of this particular not proved on the balance of probabilities.

Particular 1C(iii)

22.The Registrant admitted the facts of this particular. The Panel heard evidence from CC that the Registrant drove the ambulance to the hospital while she was in the back with Patient A. The Panel finds the facts of this particular proved on the basis of the evidence of CC which is supported by the Registrant’s admission. The Panel also finds that in leaving the care of Patient A to an inexperienced Student Ambulance Technician, with only a few week’s operational experience, whilst he drove the ambulance, the Registrant did not demonstrate sound clinical reasoning and therefore finds the facts of this particular proved on the balance of probabilities.

Particular 2

23.The Registrant denied the facts of this particular at the outset of the hearing and later admitted the facts in the course of his evidence-in-chief. The Panel heard evidence from WH that on 17 June 2016 when he was at Oban Ambulance Station, the Registrant stated in his presence that he was a mentor. WH challenged him as he knew that he had removed the Registrant from the National Mentor List in 2014. The Panel also heard evidence from CC that she was present during that conversation. WH and JM both gave evidence that if the Registrant had wanted to go back on to the National Mentor List, he would have to go through an interview and assessment process to do so. The Registrant gave evidence that he had had a conversation with AB, his Line Manager, a few weeks before his conversation with WH and asked if he could go back on to the National Mentor List and that AB agreed he could do so.  The Registrant advised that he was not aware that there was a process to be followed to enable him to return to the National Mentors List. The Panel is satisfied that the Registrant’s admission is supported by the evidence of CC and WH and finds the facts of this particular proved on the balance of probabilities.

Particular 3A

24.The Registrant denied the facts of this particular at the outset of the hearing, although made an admission in his evidence-in-chief. However this admission was not consistent with his evidence under cross-examination. The Panel noted the evidence of WK(1) in his statement for the HCPC dated 21/05/2018 and the statement written by him and co-signed by the Registrant dated 10/12/2014, both of which supported the Registrant’s initial position. The Panel did not accept the accuracy of these documents, which Patient B described as “blatant lies”. The joint statement was produced to respond to a complaint of poor practice against both paramedics. The Panel heard evidence from Patient B that neither the Registrant nor WK(1) took any observations until she was in the back of the ambulance. Patient B gave evidence that she had been a nurse for forty years and understood the observations to be taken.  She stated that she was obviously gasping for breath and was clearly very ill, despite the joint statement saying that “all her observations were within normal ranges”. The Panel also had sight of Patient B’s Patient Record Form which fully supports her evidence and which documents that the first observations were undertaken at 10:26 when Patient B was in the back of the ambulance. The Panel is satisfied that the Registrant’s admission is supported by the evidence of Patient B and finds the facts of this particular proved on the balance of probabilities.

 Particular 3B

25.The Registrant denied the facts of this particular. The Panel heard evidence from Patient B that the Registrant did not administer oxygen. She was given it only when in the back of the ambulance. The Panel also had sight of Patient B’s Patient Record Form which supports the evidence of Patient B and records that oxygen was administered at 10:24 when Patient B was in the back of the ambulance. The Registrant gave evidence that initially oxygen was not administered because Patient B allegedly wanted to vomit and was holding a bowl. The Registrant stated he could not place the oxygen mask because Patient B was retching, all of which Patient B strongly denied. The Panel also considered the hearsay evidence of WK(1) which supported the Registrant’s position. As stated above, WK(1)’s evidence was untested. The Panel prefers the evidence of Patient B whose evidence is consistent with the information recorded on the Patient Record Form and therefore finds that Registrant did not administer oxygen in a timely manner and finds the facts of this particular proved on the balance of probabilities.

Particular 3C

26.The Registrant denied the facts of this particular. The Panel heard evidence from Patient B that she was gasping for breath and that she knew that something was very wrong with her.  She gave evidence that at no point did she refuse to go to hospital and that when the paramedics were preparing to leave, she expressed her concern at being left in the condition she was in by saying “if you go out through that door, you are taking me with you”. Patient B stated that the Registrant and WK(1) realised at that point that she did not want to be left at home and accordingly decided to take her to hospital. The Registrant gave evidence that Patient B initially refused to go to hospital and that was why he contacted her GP and advised that Patient A did not want to go to hospital and to arrange a home visit. Patient B denied ever refusing to go to hospital, saying that WK(1) had suggested that she had “a bug” despite her having no vomiting and that the hospital would only send her home if they took her there. Patient B said that they were clearly very reluctant to convey her to hospital. The Panel also considered the hearsay evidence of WK(1) which supported the Registrant’s position. As stated above, WK(1)’s evidence was untested.  The Registrant was very inconsistent in his evidence and the Panel prefers the evidence of Patient B which it accepts in its entirety. The Panel therefore finds that the Registrant advised Patient B’s GP that she did not want to go to hospital when this was not the case and finds the facts of this particular proved on the balance of probabilities.

Particular 4

27.The Panel next considered whether the Registrant’s actions in representing himself as a mentor when he had been taken off the Mentor List and advising Patient B’s GP that Patient B did not want to go to hospital when this was not the case were dishonest. In considering this issue, the Panel has applied the test set out in the case of Ivey v Gentings Casinos Ltd [2017] UKSC 67.
28.The Panel has first considered the Registrant’s actual knowledge or genuinely held belief when he stated that he was a Mentor when he had been taken off the National Mentor List.  The Registrant provided an explanation that he had spoken to his Line Manager a few weeks earlier because the Ambulance Service had asked for volunteer mentors and that he had agreed that the Registrant could go back on to the National Mentor List. The Registrant said that he was not aware that he had to undergo any further process, believing that his initial assessment still held. The Panel notes that the original report by JM states that the Registrant’s removal from the Mentor list was temporary and has concluded that the Registrant’s genuine state of mind was that he had been reinstated as a mentor following the retraining agreed with JM and the discussion with his Line Manager. The Panel has therefore concluded that reasonable and honest people would not consider his behaviour to be dishonest. The Panel finds that the Registrant’s actions in particular 2 do not amount to dishonesty.

29.The Panel then considered the Registrant’s actual knowledge or genuinely held belief when he advised Patient B’s GP that she did not want to go to hospital. The Panel is of the view that the Registrant knew that Patient B had not refused to go to hospital. Patient B was seriously ill, was gasping for breath and knew that she had not been properly assessed. The Registrant himself had told WK(1) that Patient B was agitated, which she believed was to prompt WK(1) who was the attending Paramedic to take her condition more seriously. The Panel is of the view that the Registrant telephoned the GP because both he and his colleague were reluctant to take her to hospital as they had not done a full assessment and assumed that she had a stomach bug. The Panel is of the view that reasonable and honest people would consider the Registrant’s actions in advising the GP that Patient A did not want to go to hospital, when this was not the case, to be dishonest and finds his actions in particular 3C to be dishonest.

Decision on Grounds

30.The Panel next considered whether the Registrant’s actions in particulars 1A, 1B(i), 1B(ii), 1C(i), 1C(iii), 2, 3A, 3B, 3C and 4 (in respect of particular 3C only) amount to a lack of competence and/or misconduct.  The Panel is aware that this is a matter for its professional judgement. In reaching its decision, the Panel has considered the submissions of Mr Bridges on behalf of the HCPC, the submissions of Ms Osborne on behalf of the Registrant and has had regard to the HCPTS Practice Note on Finding Fitness to Practice is Impaired. The Panel has also accepted the advice of the Legal Assessor.

31.The Panel has concluded that the Registrant’s conduct found proved breached the following standards which were in force at the relevant time: -

 HCPC’s Standards of Conduct, Performance and Ethics (2012) :

•Standard 1 – You must act in the best interests of service users and you must treat service users with respect and dignity.
•Standard 10 – You must keep accurate records, complete all records promptly and records must be clearly written and easy to read.
•Standard 13 – You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.

HCPC’s Standards of Conduct, Performance and Ethics (2016) :

•Standard 1 – You must promote and protect the interests of service users.
•Standard 2 – You must communicate appropriately and effectively.
•Standard 10 – You must keep accurate records of your work.

32.The Panel is aware that the Registrant is an experienced paramedic who qualified in 2006 and who had previously been employed as an ambulance technician since 1993.  The Panel did not consider that it had sight of a fair sample of the Registrant’s work in order to make a finding that his actions amounted to a lack of competence.

33.The Panel finds that the Registrant’s actions in particular 1A put Patient A at real risk of harm by leaving her care to a student technician when he was the lead clinician. In addition, he was not in a position to monitor Patient A who was critically unwell and whose condition was deteriorating. In these circumstances the Panel finds that his conduct was serious and amounts to misconduct.

34.The Panel finds that the Registrant’s actions in particulars 1B(i) and (ii) put patient A at serious risk of harm and subsequently led to the failure to provide the hospital with an accurate account of her condition. As the hospital was not fully staffed for emergencies, relying on on-call staff based at home, this meant that appropriate resources were not waiting at the hospital when the patient arrived. Primary trauma surveys and adequate clinical observations are fundamental tenets of the paramedic profession when attending a trauma patient. The Registrant’s failure to carry these out, or ensure these were carried out, meant that he was unable to assess any deterioration and also resulted in a failure to recognise her serious condition and caused delay to Patient A's ongoing treatment. In these circumstances the Panel finds that his conduct was serious and amounts to misconduct

35.The Panel finds that the Registrant’s actions found proved in particular 1C(i) resulted from a failure to recognise that the patient was unstable, very badly injured and that her condition was deteriorating. His actions were serious and prevented the hospital from arranging appropriate resources to provide ongoing treatment and management in a timely manner. In these circumstances, the Panel finds that his actions amount to misconduct.

36.The Panel finds that the Registrant’s actions in particular 1C(iii) stemmed from a failure to recognise the patient's serious condition. The Registrant had a duty to take the patient to hospital as quickly as possible through the use of emergency warning devices and failed to do so. In these circumstances the Panel finds that his conduct was serious and amounts to misconduct.

37.The Panel finds that the Registrant’s actions in particular 2 were negligent in not finding out what process was involved in order to be reinstated to the Mentors’ List. However, the Panel is of the view that his actions were not sufficiently serious to amount to misconduct or a lack of competence.

38.The Panel finds that the Registrant’s actions in particular 3A in failing to obtain a full set of observations in a timely manner when the patient was very unwell, left her at real risk of harm. It is clear that the Registrant did not recognise the seriousness of her condition until observations were taken in the ambulance, which was 20-25 minutes after arrival at the patient’s home. In these circumstances the Panel finds that his failure was serious and amounts to misconduct.

39.The Panel is of the view that the Registrant’s actions found proved in particular 3B resulted from the failure to obtain observations in a timely manner. This led to a failure to recognise that Patient B's saturations were decreased to a dangerous level, which would urgently require supplemental oxygen. Indeed, when the first set of observations were recorded in the ambulance, Patient B's oxygen saturations were 76% which are very significantly lower than a normal reading. The Panel therefore finds that his failure was serious and as such, amounts to misconduct.

40.In respect of particular 3C, the Panel has found that Patient B did not refuse to go to hospital. Patient B's condition was such that she required immediate transport to hospital and contacting the GP as an alternative to transportation to the hospital, when the patient was willing to go, demonstrated a cavalier approach to patient assessment and management. The Panel finds that the Registrant’s actions were serious and amount to misconduct.

41.In respect of particular 4, the Panel has found that the Registrant acted dishonestly in advising Patient B’s GP that she did not want to go to hospital, when this was not the case. Honesty is a fundamental tenet of the profession and is paramount to patient protection and public confidence in the paramedic profession. The Panel finds that the Registrant’s dishonesty is serious and amounts to misconduct.

Impairment

42.The Panel next considered whether the Registrant’s current fitness to practise is impaired by that misconduct. In reaching its decision the Panel has considered both the personal component and the public component. In addition, the Panel has considered the submissions of Mr Bridges on behalf of the HCPC and the submissions of Ms Osbourne on behalf of the Registrant. The Panel has also had regard to the HCPTS Practice Note on Finding Fitness to Practice is Impaired and has accepted the advice of the Legal Assessor.

43.In terms of the personal component, the Registrant has submitted evidence of a three-hour trauma course which he attended on 5 November 2018 and has submitted two positive testimonials from colleagues. However, the Panel is of the view that the Registrant has demonstrated limited insight into his treatment of Patient A. While the Panel accepts that the Registrant has admitted a number of the particulars in relation to his treatment of Patient A, it was clear from his evidence that he had little insight into the seriousness of his behaviour and the effect it had, not just on Patient A, but also on his colleague CC. Although the Registrant said he had reflected on his behaviour, in the course of his evidence he appeared to minimise his culpability and at times appeared to be making excuses for his behaviour or suggesting that he had behaved differently from what was found proved. It appeared to the Panel that the Registrant had selective memory, maintaining that he had been more involved in assessing the patient in contrast to the evidence of CC, whose evidence was accepted by the Panel. The Panel is of the view that the Registrant failed to remember important factors if they were to his detriment.

44.The Panel is of the view that, other than accepting that both he and WK(1) were jointly responsible for patient care despite WK(1) being the attending paramedic, the Registrant showed no insight into his failures in relation to Patient B. The Panel believes the Registrant was not truthful in his evidence surrounding this matter. Such dishonesty is very hard to remedy and the Panel finds, therefore, there remains a risk of repetition.

45.Whilst the Panel is of the view that theoretically the Registrant’s failures are capable of remediation, the Panel is not satisfied that they have been remedied. The Registrant has produced one certificate of attendance at a three hour, trauma course on the 5th of November 2018. The Panel notes that despite the incident with Patient A occurring in 2016, it was not until 2018 that he attended the course whilst employed as an Ambulance Technician, although still registered as a paramedic. The Registrant admitted that he had completed some CPD but that he was not up to date in the past two years, accepting that there were a number of courses that he had missed due to his shift pattern. The Registrant also accepted that he would be required to undergo considerable retraining and develop a portfolio before being able to practice as a paramedic as he is currently practicing as an Ambulance Technician and has been since shortly after the disciplinary hearing.

46.The Panel has also considered the critically important public policy issues which include the collective need to maintain public confidence in the profession and in the regulatory process, the protection of service users and the declaring and upholding of proper standards of behaviour.  The Panel is of the view that the Registrant’s misconduct would impact on public confidence in the profession. The Panel has found that there is lack of remediation, limited insight and proven dishonesty. The Panel has concluded that there would be a serious risk of an adverse impact on public confidence in the profession and in the regulatory process, if a finding of impairment were not made in these circumstances.
 
47.The Panel therefore finds that the Registrant’s current fitness to practise is impaired by his misconduct in terms of both the personal component and the wider public component and the allegation is well founded.

Decision on Sanction:

48.The Panel has heard further evidence from the Registrant and has heard submissions from Mr Bridges and Ms Osborne on the issue of sanction. The Panel has considered the sanctions available to it in ascending order of severity and has had regard to the HCPC Sanctions Policy. The Panel also accepted the advice of the Legal Assessor.

49.The Panel is aware that the function of fitness to practise panels is not punitive and that the primary function of any sanction is to address public safety from the perspective of the risk the Registrant may pose to those using or needing his services in the future. In reaching its decision, the Panel must also give appropriate weight to the wider public interest considerations, which include the deterrent effect on other registrants, the reputation of the profession and public confidence in the regulatory process.

 
50.The Panel has also considered the mitigating and aggravating factors. The aggravating factors are the potential harm caused to Patients A and B, the limited insight, lack of remediation and proven dishonesty. The mitigating factors are that at the time of the incident with Patient A, the Registrant had personal difficulties which are now being resolved, the Registrant has expressed remorse for his actions, it was a single act of dishonesty as opposed to a pattern of dishonest conduct, the Registrant has produced positive testimonials from colleagues attesting to his character and standard of work, the Registrant has fully engaged with these proceedings, the Registrant has demonstrated full acceptance of the Panel’s findings in the course of his evidence in relation to sanction and appreciates the gravity of his behaviour and how it impacted on patients and the profession thereby demonstrating developing insight, the Registrant has a supportive employer, prior to 2014 the Registrant had a lengthy unblemished career and there have been no further issues since 2016, the Registrant had a passive role in the treatment of Patient B as WK(1) was the lead clinician.

51.The Panel first considered whether to take no further action and was of the view that this would not be sufficient to protect the public where it had identified a risk of repetition and a lack of remediation.

52.The Panel next considered a caution order. In terms of the Sanctions Policy, a caution may be appropriate where the lapse is isolated or of a minor nature, there is a low risk of recurrence and the Registrant has shown insight and taken remedial action. The Panel is of the view that a caution would not be an appropriate sanction as the lapse was not of a minor nature. In addition, it would not address the need for remediation, nor would it address the risk of repetition.


53.The Panel next considered a conditions of practice order. While the Panel is of the view that the majority of the Registrant’s failings are capable of remediation, the issue of dishonesty is difficult to remedy. The Panel has therefore concluded that a conditions of practice order would not be an appropriate or proportionate sanction where there has been a finding of dishonesty.

54.The Panel next considered a suspension order. In terms of the Sanctions Policy, a suspension order may be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. The Panel is of the view that a suspension order is appropriate where there has been a finding of a single act dishonesty. This will protect the public and uphold confidence in the profession and in the regulatory process.


55.The Panel considers that a suspension order for a period of 12 months would be appropriate.  The Panel is of the view that this period would be sufficient to mark the seriousness of the conduct and to allow the Registrant to demonstrate to a future panel that he has developed further insight and undertaken appropriate training.  
              
56.The Panel considered that a Striking Off Order would be punitive and disproportionate where the Registrant has fully engaged with these proceedings, where there was a single lapse of judgement over five years ago, there is no pattern of dishonesty and where the Registrant has the support of his current employers where he remains employed.


57.This Order will be reviewed prior to its expiry. It may assist a future reviewing panel if the Registrant were to: -

•Produce a detailed reflective account of the impact of his failings on Patient B and the profession and how this could be prevented in future
•Undertake training on the duty of candour, professionalism and ethics
•Produce testimonials from his current employer
•Produce copies of any appraisals undertaken during the period of suspension

Order

The Panel directs the Registrar to suspend the registration of Daniel Lauder for a period of twelve months from the date that this order takes effect.

Notes


Interim Order:

1.The Panel thereafter considered Mr Bridges application for an Interim Suspension Order for a period of eighteen months in terms of Article 31 of the health and Social Work Professions Order 2001. The application was made on the grounds that it was necessary for the protection of the public and was otherwise in the public interest. Ms Osbourne did not oppose the application.

2.Having considered Mr Bridges application and accepted the advice of the Legal Assessor, The Panel agreed to make an Interim Suspension Order under Article 31(2) of the Health and Social Work Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.  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) the final determination of that appeal, subject to a maximum period of 18 months.

Hearing History

History of Hearings for Mr Daniel Lauder

Date Panel Hearing type Outcomes / Status
25/07/2019 Conduct and Competence Committee Final Hearing Suspended