Mr Stephen E Meyern

Profession: Paramedic

Registration Number: PA02239

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 04/03/2019 End: 12:00 04/03/2019

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

Panel: Conduct and Competence Committee
Outcome: Voluntary Removal agreed

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Allegation

The following Allegation was considered by a Panel of the Conduct and Competence Committee at a Substantive Hearing on 9-11 March 2019.

During the course of your employment as a Paramedic with East of England Ambulance Service NHS Trust:

1. On 8 September 2013, you were sent to attend an emergency call for a patient who was described as 'fitting', and:

a. You did not take a defibrillator into the emergency scene to assist you in your treatment of the patient.

b. You did not take a bag valve mask (BVM) into the emergency scene which caused a delay in providing assisted ventilation to the patient.

c. You instructed an Emergency Care Assistant (ECA) to act outside of the Trust's protocol and/or gave incorrect instructions in that:

i. You directed an ECA to draw up diazepam which is a controlled drug.

ii. You directed an ECA to draw up diazepam with a saline solution.

iii. You directed an ECA to administer diazepam intravenously.

iv. You directed an ECA to prepare adrenaline.

v. You directed an ECA to administer adrenaline intravenously.

d. [Not Proved].

e. You did not provide an appropriate Patient Care record in that you recorded inadequate details of the drugs given.

2. The matters set out in paragraph 1 constitute misconduct and / or lack of competence.

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

 

Finding

Background

1. Mr Stephen Meyern (the Registrant) is registered with the HCPC as a Paramedic. On 11 March 2016, a Panel of the Conduct and Competence Committee found that the Registrant’s fitness to practise was impaired by reason of misconduct. The Panel made a Conditions of Practice Order to run for 12 months. That initial Order has twice been reviewed and extended. This hearing is for the Panel to consider a Voluntary Removal Agreement.

2. The Registrant was a Duty Locality Officer (DLO) with East of England Ambulance Service (EEAST). He was responsible for the management of emergency care practitioners, paramedics, ambulance technicians and emergency care assistants (ECA).

3. On 8 September 2013, the Trust received an emergency call in relation to a patient who was described as “fitting”. That evening the Registrant was working in a rapid response vehicle (RRV). He was dispatched to the scene and was advised by the emergency responder that the patient had been “fitting” for approximately 20 minutes. The call was categorised as ‘R1’ (life threatening).

4. The Registrant was the first to arrive at the scene. Upon his arrival, he selected equipment from the boot of his vehicle and took it to the location of the patient. However, he was unable to take a defibrillator with him as he had too many other items of equipment to carry. The Registrant was let into the patient’s house by the patient’s wife and shown upstairs to a bedroom where the patient was in bed. An ambulance crew followed, consisting of Witness 1, ECA, and SK, an ECA.

5. The Registrant provided clinical care to the patient with the assistance of both ECAs as follows. The Registrant cannulated the patient and asked Witness 1 to draw up a vial of diazemuls (diazepam) with a saline flush, which was the wrong solution. The preparation of such medication was outside the scope of her practice. Nonetheless, Witness 1 prepared the vials as requested and showed them to the Registrant. He asked her to put the solution through the cannula. Thereafter the Registrant and SK prepared to take the patient to the ambulance. Witness 1 then overheard SK tell the Registrant that the patient was “rasping at 8”, which is a low level of breathing. The Registrant advised SK that the patient’s breathing would return back to normal.

6. The patient then suffered respiratory arrest. Witness 1 heard the Registrant and SK discussing that the patient was not breathing. It was realised that the Registrant had not brought a BVM into the property, and therefore SK had to make a trip to the ambulance to obtain one, after which it was used on the patient. Soon after, the patient suffered cardiac arrest and there was a need for a defibrillator but the Registrant had not brought one to the scene. SK then went to the ambulance a second time to retrieve it.

7. The patient was moved from his bed to the floor. The Registrant asked Witness 1 to prepare adrenaline, which was also outside the scope of her practice. However, she did prepare the adrenaline and then the Registrant asked her to administer it through the cannula, which she did.

8. When the patient began to improve, he was placed on a carry sheet in order to move him downstairs and into the ambulance. SK began packing up the equipment that had been used and whilst he did so, the Registrant and Witness 1 moved the patient from his bedroom and down the stairs. The Registrant led and went backwards down the stairs with the patient’s head facing towards him and pointing down the stairs. Although Witness 1 considered that the patient’s positioning could compromise his airway she did not have time to suggest this to the Registrant as they were moving so quickly (the journey taking in all some 30 seconds). At the bottom of the stairs the patient was transferred to a stretcher located at the front doorway and thence to the ambulance.

9. The patient was taken to hospital in the ambulance by the Registrant and by Witness 1, with SK following in the RRV. The Registrant therefore delegated the task of asking the patient’s wife for relevant details and completing the Patient Care Record (PCR) to SK, who was able to partly complete it, but who omitted the doses of drugs given as he was unaware of these. Upon arrival, the Registrant handed over verbally to the hospital staff but although he was given the partially completed PCR by SK, he did not then complete it as he was called to another job. The evidence from Witness 2, the Trust Investigating Officer, was that the Registrant would have been expected to complete and handover the paperwork to the hospital before accepting another call out. Witness 1 saw that the PCR had been left in the resuscitation cubicle. One of the doctors started asking her questions about the patient which she could not answer as the information requested was not on the PCR. SK attempted to complete the form later but was unable to. The Registrant returned to the hospital about 1 and a half hours later but, although he took the PCR from SK and signed it off, the Registrant did not complete the same with full and adequate details of the medication that had been given to the patient or the amounts thereof.

10. The next day Witness 1 raised concerns regarding the clinical care provided to the patient (who had nonetheless survived the experience) by the Registrant. A Serious Investigation was initiated, the outcome of which was to initiate a disciplinary process. During the period of the disciplinary process, the Registrant was suspended from front-line duties and given office-based work, although for about six months of this period he was on sick leave.

11. On 31 October 2013, Witness 2 was commissioned as the investigating Officer. His investigation concluded in April 2014. A disciplinary hearing was held on 7 May 2014 at which point a number of the allegations against the Registrant were found proved and he was given a Final Written Warning. He was also required to undertake an Action Plan to cover: clinical knowledge in relation to drug pharmacology; the “fitting” patient and the effects of hypoxia (lack of oxygen); observation of a variety of patients and clinical practice; and reading about the scope of practice for staff.

12. The Registrant appealed against that decision but the decision was upheld at an appeal hearing on 13 January 2015.

13. These events were then the subject of a referral to the HCPC and after investigation the Registrant faced the Allegation as detailed above.

14. At the final hearing the Registrant admitted the factual basis of the matters found proved and the Panel imposed a Conditions of Practice Order.

15. At the first review of that Order, that reviewing panel decided to vary and extend it for 12 months to give the Registrant a further opportunity to demonstrate sufficient incite and remediation and thereby be considered safe to practise without restrictions on his registration. At the second review, in March 2018, that reviewing Panel stated:

“The Panel took into account that a Suspension Order would prevent the Registrant from working which would result in him being unable to demonstrate effective remediation. The Panel also considered that the Registrant had engaged with these proceedings in some way and had successfully managed to gain employment as a Paramedic in May 2017, albeit for a very short period of time.

Taking all matters into consideration, the Panel concluded that by extending the period of the current Conditions of Practice Order for a further 12 months, the Registrant would have one more opportunity to provide evidence of reflection and updated CPD. The Registrant should be in no doubt that, the next reviewing panel may impose a more serious sanction if he has failed to comply fully with the Conditions of Practice Order.”

16. On 9 January 2019, the Registrant spoke with an officer at the HCPC. He said he had retired over 3 years ago, he was now 64 years old and he would like to conclude the matter amicably. Voluntary Removal was discussed and the Registrant indicated he would like to pursue such a course.

17. In a letter to the HCPC dated 7 February 2019, the Registrant confirmed that he admitted the substance of the Allegation and that his fitness to practise was currently impaired. He also confirmed that he did not intend to practice as a Paramedic in the future and that he was aware, and understood, that a Voluntary Removal Agreement has the same effect as a Striking-Off Order.


Decision

18. The Panel considered with care the documentation provided and the submissions made by Ms Dyas and Ms Spencer. The Panel accepted the advice of the Legal Assessor and in reaching its decision referred to the HCPTS Practice Note on “Disposal of Cases by Consent”.

19. The Panel was provided with a Voluntary Removal Agreement dated 22 February 2019 and signed by both the Registrant and a representative of the HCPC.

20. The Panel noted that, before agreeing to a voluntary removal it must be satisfied that the appropriate level of public protection is being secured and that voluntary removal would not be detrimental to the wider public interest. Since voluntary removal is equivalent in its effect to a strike-off, the Panel was satisfied that such a course would provide the appropriate level of public protection because the Registrant would no longer be able to practise as a Paramedic.

21. The Panel was also satisfied that the Registrant’s voluntary removal would not be detrimental to the wider public interest. The incident that led to these proceedings was an isolated occurrence and the Registrant had admitted the facts of the Allegation and that his fitness to practise is currently impaired. The Registrant retired from practice prior to the final hearing, nearly three years ago. Although he attempted to return to practice part-time under the Conditions of Practice Order, it was short-lived and he did not get beyond training before his contract was terminated. The Registrant has confirmed that he now has no desire or intention to return to work in the healthcare service. In such circumstances, the Panel was satisfied that it would not be in the public interest, or indeed the Registrant’s interests, to keep him in a substantive order review cycle when he has no intention of returning to practice and would not, therefore, be able to demonstrate that he had remedied the concerns raised by this case.

22. In all the circumstances, the Panel decided that it was appropriate to dispose of this case by way of a Voluntary Removal Agreement. Accordingly, the Panel revoked the current Conditions of Practice Order with immediate effect.

Order

The Registrar is directed to revoke the current Conditions of Practice Order and to remove the name of Mr Stephen E Meyern from the Register with immediate effect.

Notes

No notes available

Hearing History

History of Hearings for Mr Stephen E Meyern

Date Panel Hearing type Outcomes / Status
04/03/2019 Conduct and Competence Committee Review Hearing Voluntary Removal agreed
09/03/2018 Conduct and Competence Committee Review Hearing Conditions of Practice
09/03/2017 Conduct and Competence Committee Review Hearing Conditions of Practice
09/03/2016 Conduct and Competence Committee Final Hearing Conditions of Practice