Mr Stuart J Wright

Profession: Paramedic

Registration Number: PA12613

Interim Order: Imposed on 12 Sep 2017

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 05/11/2019 End: 17:00 12/11/2019

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

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

Allegation (as amended)

During the course of your employment as a Paramedic at Scottish Ambulance Service:

1. You delayed in collecting Colleague B for calls and/or conducting inspections on the following dates:

a) On 23 October 2016 for approximately 6 minutes for an emergency call;
b) On 20 December 2016 for approximately 10 minutes to conduct the Vehicle equipment check;
c) On 21 December 2016 for approximately 15 minutes to attend a 999 call;
d) On 04 February 2017 for approximately 13 minutes, to attend a call and/or did not inform Colleague B there was time on the job in a timely manner.

2. You delayed your colleagues on the following dates:

a) On 09 October 2016 Colleague A waited approximately 4 minutes for you to come into the vehicle for a 999 call;
b) On 24 January 2017, Colleague B waited approximately 10 minutes for you to assist him with the Vehicle Daily Inspection.

3. You used your phone whilst attending to calls on the following dates:

a) 19 September 2016;
b) 22 December 2016.

4. You made inappropriate comments to Colleague B, in that on:

a) 23 October 2016, you said to Colleague B “It is only an old woman, what’s the hurry” or words to that effect;
b) 25 November 2016, you said to Colleague B “I am not hurrying for anyone this is a load of ****” or words to that effect;
c) 20 December 2016 you said to Colleague B “that’s how we do it in England and I am here to educate you thick Highlanders” or words to that effect;
d) 22 December 2016 you said to Colleague B “Not another ***** you know” or words to that effect;
e) 22 December 2016 you made a comment to Colleague B stating “another thick Jock that knows nothing” or words to that effect;
f) 25 January 2017 you made comments to Colleague B stating:
i. “I hate using horns, this is **** ****  or words to that effect;
ii. “couple of ignorant old Jocks” or words to that effect.
g) 30 January 2017 you made a comment to Colleague B stating “thick Jocks and their stupid ****** rules” or words to that effect;
h) 03 February 2017 you made a comment to Colleague B stating “why hurry for a fat, lazy Jock” or words to that effect;
i) 04 February 2017, you said to Colleague B “There is 2 hours on the job, I am watching the rugby.”

5. On 22 December 2016, when referring to a patient’s bypass scar as “CABG” or words to that effect, you did not adapt your communication style when that patient responded each time with “what do you mean?” or words to that effect.

6. You did not provide adequate care and/or treatment to the following patients:

a) Patient A, on 09 October 2016, in that you did not take adequate observations of the patient;
b) On 10 October 2016, you attended to a Patient D who had possible neck injuries and you did not immobilise him prior to moving him and entering the ambulance.

7.On 09 October 2016, in respect of Patient A, you:

a) d not obtain and/or record the patient’s full name;
b) did not obtain and/or record the patient’s date of birth;
c) measured the patient’s blood pressure by taking a radial pulse but entered this on the electronic-patient record form (e-Prf) as the systolic blood pressure;
d) did not complete and/or get the patient to complete the refusal section and/or patient consent section on the e-Prf;
e) did not complete the refusal form and/or get the patient to complete this;

8.On 21 December 2016, you attended to Patient C and you:

a) asked Colleague B, an Ambulance Technician to administer the patient with 5mg of Morphine if needed, despite the fact he was not permitted to administer such medication in his role;
b) administered a second dose of Morphine to the patient without checking his pain score and/or conducting further observations;
c) drove the Ambulance, rather than attending to the patient in the back, whilst the patient had a pain score of 9.

9. You did not act in the best interests of the patient on 02 January 2017, in that you delayed the response to the emergency call that came in at 07:49 hours regarding Patient K who was involved in a road traffic accident.

10. You did not use the Ambulance Service's consumables in an appropriate manner in that: on an unknown date you removed a 5 litre canister of engine oil from the vehicle and kept it at your house.

11. You did not use blue lights and/or sirens during the following calls:

a) when transporting Patient E to hospital on 19 September 2016;
b) when travelling to an emergency call on 25 November 2016;
c) when travelling to an emergency call to Patient M on 22 December 2016;
d) when travelling to an emergency call on 25 January 2017;
e) when travelling to an emergency call on 3 February 2017.

12. You spoke to your colleagues in an inappropriate and/or aggressive manner, specifically:

a) Between 01 June and 30 June 2016, you said on one or more occasion "if anyone tries to take you down or gets in your way or says anything “I will stab them in the ******* neck”, or words to that effect to the following colleagues:

i) Colleague A;
ii) Colleague B; and
iii) Colleague C.

b) On 04 February 2017, you:

i) shouted at Colleague B and pointed your finger at him;
ii) on one or more occasion said “what is your ****** problem” or words to that effect to Colleague B;

13. Between August 2016 and September 2016, you:

a) showed Colleague B an explicit picture of Colleague X topless; and/or
b) showed the photo in particular 13a without Colleague X’s consent to do so.

14. The matters set out in paragraphs 1 to 13 constitute misconduct and/or lack of competence.


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

Finding

Preliminary matters:

Service of the notice of hearing

1. As the Registrant did not attend the hearing and was not represented at it, the Panel first considered whether a valid notice of hearing had been sent to him. The Panel concluded that the letter dated 9 August 2019 informing the Registrant of the date, time and location of the hearing, satisfied this requirement.

Proceeding in the absence of the Registrant

2. After the Panel announced its decision that there was good service of the notice of hearing, the Presenting Officer applied for a direction that the hearing should proceed in the Registrant’s absence. The Panel had regard to the HCPTS Practice Note on Proceeding in the Absence of the Registrant and accepted the advice of the Legal Assessor. The Panel was fully aware that care should be taken when making a decision whether to proceed in the Registrant’s absence, and having carefully considered the matter it decided that this hearing should proceed. The reasons for this decision were as follows:

• On two occasions, namely on 7 June 2019 and on 9 August 2019 (the latter being in response to being informed of the hearing dates), the Registrant stated that he would not be attending the hearing.

• The Registrant did not apply for an adjournment of the hearing or suggest that there would be dates or a period when he would attend.

• It follows from these facts that it was not possible for the Panel to conclude that the Registrant would attend the hearing on a future occasion if it did not proceed at the present time.

• The Registrant had had an opportunity to advance his case in writing to the Panel, and had in fact submitted the material he wished to be considered.

• The case was ready to proceed. One witness had travelled from the Scottish Highlands to London in order to give evidence, and arrangements had been made for three other witnesses to give evidence by video link.

• The issues in the case were already somewhat dated, occurring as they did approximately three years ago. It was clearly disadvantageous, not least from the perspective of the reliability of witness memories, for there to be further delay.
• In these circumstances the clear public interest in the hearing proceeding outweighed any disadvantage arising from the Registrant’s absence.

Hearsay evidence

3. Before the Presenting Officer opened the case, the Legal Assessor informed the Panel that in accordance with the judgement of Spencer J. in El Karout v Nursing and Midwifery Council [2019] EWHC 28 (Admin), it would at some stage be necessary for the Panel to consider whether the hearsay evidence included in the HCPC’s hearing bundle should be admitted. The Panel was invited to consider whether it would be convenient to consider the matter at the outset, rather than to deal with it piecemeal as and when it arose. The Panel agreed that it was appropriate to consider it at the outset.

4. The Panel considered the identified hearsay aspects and concluded that each aspect should be admitted. The hearsay statements were not presented as throwaway remarks made, but were given in the formal context of the Scottish Ambulance Service (“SAS”) investigation in response to structured questions. The hearsay evidence was not the sole or decisive evidence in relation to any issue. Some of the hearsay evidence, for example, the evidence of Ms SA, was potentially helpful to the Registrant.

5. It should be stressed that in deciding that the evidence should be admitted, the Panel was clear that the hearsay nature of the evidence would necessitate careful consideration of what, if any, weight could properly be attributed to it when making its decisions.

Amendment of the factual particulars of the allegations

6. Although it was not an application that was made at the outset of the case, it is nevertheless convenient to explain in this preliminary section of the Panel’s determination that an application was made to amend the factual particulars of the case. The application was made on behalf of HCPC after the HCPC’s evidence had been presented. It was made because when Colleague B gave evidence he corrected the impression created by his witness statement that the matters described in paragraphs 34 to 39 all related to one patient. He informed the Panel that in fact there were two distinct patients involved, and they were on different days, namely, paragraphs 34 to 37 being on 21 December 2016 and paragraphs 38 and 39 the following day. This correction resulted in the Presenting Officer applying to amend particulars 1(c), to change the date from 22 December 2016 to 21 December 2016, and the stem of particular 8 that had previously identified the patient specifically as Patient C. The Panel agreed that these particulars should be amended. This is because no prejudice would be caused to the Registrant. The allegations were not date-reliant. They pertained to the Registrant’s conduct which was well known him through the service of the HCPC’s bundle of evidence. The amendments were minor and did not change the substance of the particulars. Accordingly, the Panel acceded to the application. The allegations as they are set out above are as amended.

Background

7. The Registrant was employed as a Paramedic by the SAS from 28 May 2014. He was based in Kingussie. As he worked in a relatively sparsely populated area of the Highlands, he did not work at or out of an ambulance station. Rather, along with Colleagues A, B and C he worked from home. He and those colleagues lived in very close proximity to one another, journeys between any of them taking mere minutes by vehicle. The ambulance they used was kept by one of them at a time, making a transfer of the vehicle as needed for the shifts they were rostered to work.

8. In opening the case, the Presenting Officer stated that the allegations involved instances that could be grouped into three main categories, namely:

• Delay and time-keeping issues.

• Deficient performance with regard to patients.
• Conduct towards colleagues.
Decision on Facts
9. The HCPC relied upon four witnesses. The witnesses were:
• Mr JQ, a Paramedic employed by SAS who is the Area Service Manager for Inverness-shire. Mr JQ undertook for SAS an investigation into matters related to those being considered by the Panel.

• Colleague A, a Paramedic employed by SAS. Colleague A graduated with a degree in Paramedic Practice in June 2016, but worked as an Ambulance Technician before qualifying as a Paramedic.

• Colleague B, an Ambulance Technician, and in that role a long-standing employee of SAS. He was a member of the Kingussie crew.

• Colleague C. Between July 2015 and November 2017 Colleague C was employed as a Paramedic by SAS and was also a member of the Kingussie crew. Prior to qualifying as a Paramedic he was employed as an Ambulance Technician.

10. Mr JQ attended the hearing in person to give evidence. As a consequence of special measures applications made in advance of the hearing, directions were made that the remaining three witnesses should be permitted to give their evidence by video link. Colleagues A and B were based in the Highlands of Scotland and it would clearly be inconvenient for them to be required to travel to England (where the hearing was required to be held because of the Registrant’s HCPC Register address) in order to give evidence. Colleague C was in Canada. The Registrant did not object to the special measure applications made in respect of Colleagues A to C. The Panel should add that after the video link with Colleague C in Canada was eventually made, the connection dropped out on more than one occasion. The Panel decided that it was thereafter appropriate to continue by receiving Colleague C’s evidence by telephone. The Panel was satisfied that the taking of evidence by video (and, for part of his evidence, by telephone
in the case of Colleague C), allowed a proper and fair opportunity for the evidence to be explored and tested.

11. The Panel’s general assessment of the witnesses was as follows:

• Mr JQ. Although he appeared to be somewhat nervous when giving evidence, the Panel found him to be a measured and fair witness. This was made clear when he did not offer a negative view of the Registrant when he was asked about his demeanour. The evidence of Mr JQ was entirely consistent with his own statement and the other written material. As his role was the investigating officer for the purposes of the SAS investigation, Mr JQ had no direct personal knowledge of the relevant events. He stated matters factually and told the Panel that he formed no opinions or views of the Registrant while undertaking the investigation. The Panel was satisfied that it could rely upon his evidence.

• Colleague A was fair and measured and did not seek to embellish or sensationalise. His evidence was consistent with his accounts of events, and he was clear when he could not recall something he was asked about. He displayed no malice towards the Registrant. The Panel was satisfied that his evidence could be relied upon.

• Colleague B was clear, credible and unambiguous in his evidence and was fair and balanced in his description of the Registrant’s behaviour. The fact that he volunteered the error in his witness statement that resulted in the application to amend the factual particulars that has already been described, demonstrated that he had a good recollection of events. Again, the Panel was satisfied that his evidence could be relied upon.

• Colleague C was a credible witness who was not prone to exaggeration. He did not work with the Registrant on a great number of occasions, and regarded the Registrant as a friend. He was clear and willing to say when he could not remember a matter he was asked about. He was also a witness whose evidence the Panel could rely upon.

12. In addition to direct evidence from the witnesses who had personal knowledge of the relevant events, the Panel was also provided by the HCPC with a substantial body of documentary exhibits. These included printed versions of electronic Patient Report Forms (“PRF”) and prints of information recorded on “I CAD” describing the stages of activity in relation to calls to relevant patients.

13. The Panel was provided with an email written by the Registrant and dated 1 July 2018. This email was addressed, “To the FTP Panel”, and continued, “Of the allegations I have been accused of I have nothing to add to these that has not been made previously. When Scottish Ambulance Service investigated originally I answered there (sic) questions both honestly and as accurately as I could ….” The Panel paid close attention to what the Registrant wrote in this email and to the content of the interviews conducted by Mr JQ in the SAS investigation. The Panel also considered the supporting testimonial evidence introduced by the Registrant.

14. Due to the Registrant not being present it was not possible for the Panel to assess the Registrant as a witness in the same way as it was possible to assess those witnesses from whom it heard evidence during the hearing. However, it is necessary for the Panel to make a general comment about the account of the Registrant given to Mr JQ when interviewed for the purposes of the SAS investigation. In those interviews there is a general pattern of the Registrant denying matters initially, but then when challenged on his denial by Mr JQ, and particularly when told that there is some positive assertion made to the contrary of what has been denied, the Registrant then making a further reply acknowledging some acceptance. This fact necessarily puts a question mark over the extent to which the Panel has been able to accept the Registrant’s account. However, when the Panel turns to address the specific factual particulars, if there is no reference to what the Registrant is recorded as having said about the matter, it should be assumed that it is denied. The absence of an explicit statement to that effect in this determination should not be taken as the Panel overlooking that fact, rather the absence of the statement merely reflects a desire to avoid repetition.

15. Particular 1(a) to (d) generally. Each of the four elements included under particular 1 concern occasions when it is alleged that the Registrant kept Colleague B waiting. In relation to each, save for particular 1(d), the Registrant denied that he had been guilty of delay. In relation to particular 1(d), having initially stated that no one had ever questioned him for being late, when asked about “the rugby” he said that he would hold his hands up to that one. The conclusion of the Panel in relation to each of these sub-particulars is that the evidence of Colleague B is to be preferred to that of the Registrant.

16. Particular 1(a). On 23 October 2016, Colleague B and the Registrant were asked to attend an emergency call to an 82 year-old female patient who had fallen on the floor of her home. The call was allocated at 08:42, but the “resource mobilised” time was 08:51. The Registrant took 10 minutes to collect Colleague for the call, something that should have taken only 3 to 4 minutes. Accordingly, there was a delay of approximately 6 minutes. This call will also be relevant to particular 4(a), where the words spoken by the Registrant are in issue. On the issue of delay with regard to the collection of Colleague B, particular 1(a) is proven.

17. Particular 1(b). On 20 December 2016, the Registrant was 10 minutes late to commence the ambulance vehicle test that was required at the commencement of the shift at 08:00, and which was to be undertaken with Colleague B. This incident is also relevant to particular 4(c), when the words spoken by the Registrant are in issue. On the issue of the delay with regard to the commencement of the vehicle check, particular 1(b) is proven.

18. Particular 1(c). On 21 December 2016, the Registrant and Colleague B were called out to a patient, Patient C, who was a patient to whom calls were regularly made. Patient C suffered from Parkinson’s Disease and had limited strength in this legs and was unable to weight bear very well. He was also a heavy drinker and heavy smoker. On this occasion the attendance was in response to a 999 call to the effect that Patient C had slid out of his chair. Colleague B waited for the Registrant out of doors in the snow for approximately for 20 minutes before being collected. The wait should have been no longer than approximately 4 to 5 minutes. Accordingly, the Panel is satisfied that the delay was approximately 15 minutes with the consequence that particular 1(c) is proven.

19. Particular 1(d). On 4 February 2017, Colleague B was alerted to a call he was required to make with the Registrant to a girl who had suffered an injury in a serious fall while skiing. The request for ambulance transport came from an out of hours surgery in Aviemore. Colleague B changed into his uniform and waited outside his home, standing in sleet and snow, for approximately 13 or 14 minutes. He then telephoned the Registrant to ask what the delay was, to be informed by the Registrant that he was watching the rugby and that there was “2 hours on the job” a statement that indicated that when the Registrant had checked with control, he had been informed that the requirement was that the call should be attended within 2 hours. This call is also relevant to particular 4(i) and 12(b)(i)&(ii), but on the issue of delay relevant to the present particular, the Panel finds particular 1(d) proven because there was a delay of approximately 13 minutes and the Registrant did not inform Colleague B that there was
“time on the job” until Colleague B asked the reason for the delay after he had been standing outside for that length of time.

20. Particular 2(a). On 9 October 2016, the Registrant and Colleague A were required to attend a patient, Patient A, who had suffered a head injury as a result of an assault. Patient A is also the subject of particulars 7(a) to (e). The call was categorised as an emergency, yellow call with an expected 19 minute response time from allocation. The allocation was at 08:49. Colleague A was driving the ambulance and he went to collect the Registrant who delayed coming out with the consequence that the recorded “resource mobilised time” was 08:54. It follows that Colleague A was waiting for the Registrant for approximately 4 minutes. Particular 2(a) is proven.

21. Particular 2(b). On 24 January 2017, Colleague B was to be the driver of the ambulance, and the vehicle equipment check was required to be undertaken at the commencement of the shift. Colleague B drove the very short distance to the Registrant’s home, and sat waiting for approximately 10 minutes for the Registrant to come out and start the check. Particular 2(b) is proven.

22. Particular 3 (a). When working with Colleague B on 19 September 2016, the Registrant attended upon a patient who was not expecting an ambulance. A doctor had requested the attendance of the ambulance crew believing that the patient might need to be transferred to hospital. She was asthmatic and a smoker. As the patient was not expecting an ambulance she was unprepared to leave to be taken to hospital to be nebulised. While Colleague B assisted the patient to gather together the items she needed the Registrant did not enter the patient’s home, but rather stood at the door texting on his personal mobile telephone. The Registrant made no attempt to assist Colleague B. The journey was then made to the hospital with the Registrant driving the ambulance and Colleague B in the back of the ambulance with the patient, a transfer that is relevant to particular 11(a). When the ambulance arrived at the hospital, the Registrant got out of the ambulance, but again used his telephone to text before opening the d
oors of the ambulance to enable the patient and Colleague B to get out. The Panel notes that in the SAS investigation, the Registrant said that he only used his telephone to “Google” matters relevant to patient symptoms. However, the Panel rejects the suggestion that the two incidents of texting on this occasion were related to the patient’s treatment. Particular 3(a) is proven.

23. Particular 3(b). On 22 December 2016 a patient was attended whose circumstances will be returned to in relation to particular 8(a) to (c). However, relevant to this particular, after the patient was placed in the ambulance with Colleague B in the back of the vehicle with the patient, before driving off, the Registrant took his mobile telephone out of his pocket and began texting on his personal mobile telephone. Later on the same day, another patient, Patient M was attended (and the attendance on this patient will also be returned to in relation to particulars 4(d) and 5). In the event Patient M was not transferred to hospital. However, when Colleague B and the Registrant got back into the ambulance, the Registrant sat in the driver’s seat outside the patient’s home texting on his personal mobile telephone. The Panel finds particular 3(b) to be proven.

24. Particular 4(a). On 23 October 2016, on the occasion relevant to the delay explained in particular 1(a), when Colleague B asked the Registrant what had kept him, he replied, “It’s only an old woman, what’s the hurry.” Colleague B described this comment as having been made with an arrogant disregard for the patient. Particular 4(a) is proven.

25. Particular 4(b). On 25 November 2016, when travelling along a road described as “the old A9”, rather than on the newer, faster road, and doing so without a blue light or siren (see Particular 11(b)), Colleague B asked if the Registrant could get a shift on. His reply was to say, “I’m not hurrying for anyone this is a load of shit.” When interviewed by Mr JQ, the Registrant admitted that he had said that jobs are shit, although he did not admit the full extent of this comment. The Panel accepted the evidence of Colleague B that it was said, and Particular 4(b) is proven.

26. Particular 4(c). The vehicle inspection on 20 December 2016 has already been referred to in relation to particular 1(b). When Colleague B asked the Registrant why he was attempting to use draw sheets and added that it was not standard practice for the SAS, the Registrant replied, “That’s how we do it in England and I’m here to educate you thick Highlanders.” Colleague B’s evidence was said that it was said in quite an aggressive, dominating manner as if the Registrant was trying to assert his authority. The Panel accepts that these words were spoken, with the consequence that Particular 4(c) is proven.

27. Particular 4(d). On 22 December 2016 when the crew arrived at the home of Patient M (see particulars 3(b) and 5), the patient’s wife addressed Colleague B by name, as they knew one another. She appeared to be happy to see Colleague B. As Patient M’s wife said this the Registrant said words to the effect of, “Not another fucker that you know?” The Panel accepts the evidence of Colleague B in this regard, with the consequence that particular 4(d) is proven.

28. Particular 4(e). After the attendance on Patient M, who, as has already been stated, was not transferred to hospital, and when Colleague B asked the Registrant if he wanted him to complete the PRF, with reference to the conversation that had taken place with the patient about a CABG (which will be further explained in relation to particular 5), the Registrant stated, “Another thick Jock who knows nothing.” The Panel accepts that this was said by the Registrant with the consequence that Particular 4(e) is proven.

29. Particular 4(f). Colleague B recalls the Registrant having been angry on 25 January 2017. Having initially been asked to respond to a 999 call from Aviemore, when travelling to that town, the crew was stood down and instructed to respond to an emergency call from Newtonmore. The call was to an elderly male patient in a care home who had slid out of his chair. While responding to this call, the Registrant said to Colleague B, “I hate using horns, this is fucking shit.” The Panel accepts the evidence of Colleague B that these words were spoken, and particular 4(f)(i) is proven. They then drove back to Kingussie. As the Registrant drove around a corner two elderly ladies were crossing the road. They were approximately half way across and a collision between the ambulance and the ladies was only narrowly avoided. The Registrant glared at the ladies, and said, “couple of ignorant old Jocks”. In fact the ladies were Italian. The Panel accepted Colleague B’s evidence about this incident, and Particular 4(f)(ii) is proven.

30. Particular 4(g). On 30 January 2017, Colleague B and the Registrant went to Inverness. The Registrant was wearing a wristwatch, something that is not permitted by SAS because of the risk that infections might be spread by anything worn below the elbow. At Inverness, Mr SG, the Area Service Manager, politely reminded the Registrant that he should not be wearing a watch. When Colleague B and the Registrant returned to their vehicle, the latter said, “thick Jocks and their stupid fucking rules.” The Panel accepts the evidence of Colleague B that this was said, and Particular 4(g) is proven.

31. Particular 4(h). On 3 February 2017 Colleague B and the Registrant were requested to attend an emergency call as back-up for a crew from Inverness. The Patient was a bariatric patient who had been leaving his property, but was unable to manage the last flight of stairs it was necessary for him to descend. The initial crew from Inverness were better equipped to lift the heavy patient. The incident will be returned to with regard to particular 11(e), but so far as the comment is concerned, the Panel is satisfied that when Colleague B made a comment about it being an emergency call, yet the Registrant was driving on the slow, “old A9” road, the Registrant said, “why hurry for a fat lazy Jock?” On the basis that the evidence of Colleague B is accepted, the Panel finds that this remark was made, with the consequence that Particular 4(h) is proven.

32. Particular 4(i). This comment was made when the Registrant belatedly explained to Colleague B that he had discovered that the call relevant to particular 1(d) had been given on the basis that it was required to be completed within two hours. After Colleague B had waited in the snow and sleet for approximately 13 to 14 minutes (1(d)), the Registrant said, “there’s two hours on the job I’m watching the rugby.” The Panel accepts the evidence of Colleague C that these words were spoken, and Particular 4(i) is proven.

33. Particular 5. The call to Patient M has already been referred to in the context of particulars 3(a) and 4(d) & (e). Patient M was sitting on his bed bare chested. He had a scar down the length of his sternum due to previous bypass surgery. This procedure is referred to as “Coronary Artery Bypass Graft”, or “CABG”. When professionals discuss this procedure with one another they tend to refer to it as “cabbage”. However, when the Registrant saw the scar he asked Patient M how long he had had his “cabbage”. The patient was confused and started to ask the Registrant what he was talking about. The Registrant then repeated the question, again saying “cabbage” and pointed at the patient’s chest. Colleague B then apologised and explained to the patient what the Registrant had been referring to. This was the incident in relation to which the Registrant spoke the words that have been proved under Particular 4(e). So far as the present particular is concerned, however, the Panel is satisfied on the evidence of Colleague B that the Registrant did not adapt his communication style when Patient M expressed confusion at the use of the term “cabbage”. Particular 5 is proven.

34. Particular 6(a). This particular concerns the call on 9 October 2016 to the patient described under Particular 2(a). It will be necessary to refer to the patient again below in relation to particulars 7(a) to (e). However, this particular is concerned with the taking of adequate observations. On the basis of the evidence of Colleague A, the Panel is satisfied that the observations that were required to be taken by the Registrant, who took the lead. The required observations included respiratory rate, oxygen saturation, pulse rate and blood pressure. However, they were not taken. Particular 6(a) is proven.

35. Particular 6(b). On 10 October 2016 the Registrant and Colleague A attended an emergency call to a 78 year-old male patient, Patient D, who had fallen and suffered possible neck injuries. The Registrant took the lead. It was reported that the patient had fallen down a full flight of stairs. The family had taken him upstairs to a bedroom to be seated in a chair, which was where the Registrant and Colleague A found him when they attended. It is the recollection of Colleague A that the patient had cervical spine tenderness. The Registrant arranged for Patient D to be walked out of the property to the ambulance, something that made Colleague A very uncomfortable as he felt that the patient’s neck should have been immobilised. The Panel accepts that the Patient was not immobilised prior to him being moved to the ambulance, and also accepts that he should have been. When interviewed by Mr JQ the Registrant conceded in what he described as “hindsight” that the immobilisation should have been undertaken but tendered the explanation that the patient had no neck. The Panel does not accept that as a justification for failing to immobilise. Particular 6(b) is proven.

36. Particular 7(a) to (e) inclusive. All sub-particulars under particular 7 relate to the Registrant’s dealings with Patient A on 9 October 2016 (see particulars 2(a) and 6(a)). Save with regard to blood pressure, the Panel finds that the absence of recorded observations reflects that the required steps were neither undertaken nor recorded. So far as blood pressure is concerned, it is possible that the Registrant observed a radial pulse (although Colleague A did not see him do even this). In the PRF the Registrant recorded a “Bp Systolic” of 90. The Panel finds that this was not a true blood pressure recording because by the Registrant’s own admission he did not measure blood pressure by the use of a cuff. All that he would have been able to do was to record that there was a systolic blood pressure of not less than 90 if he had detected a radial pulse. The Panel finds particulars 7(a) to (e) inclusive proven.

37. Particulars 8(a) to (c) inclusive. On 22 December 2016 Colleague B and the Registrant attended upon this patient. The Registrant administered 5mg of morphine to the patient and then wanted the patient to walk to the ambulance. This request to the patient by the Registrant made Colleague B uncomfortable because the Patient suffered from Parkinson’s Disease and it was a cold, snowy night. Accordingly, Colleague B went to the ambulance to fetch a chair. The patient was then put in the back of the ambulance, and as the Registrant had administered morphine, Colleague B expected the Registrant to travel in the back of the ambulance with the patient. However, not only did the Registrant go to the front of the ambulance to drive it, he also told Colleague B to administer the other 5mg of morphine if the patient needed it. As an Ambulance Technician, it was not lawful for Colleague B to administer morphine. At that stage, the Registrant got out of the cab of the ambulance and administered a further dose of morphine, but did so without taking any observations or checking the patient’s pain score. When interviewed by Mr JQ the Registrant accepted that “with hindsight” he should have travelled in the back of the ambulance with the patient. When he was asked whether he would normally ask an Ambulance Technician to administer morphine, he replied, “No, because I shouldn’t. I’m guilty if Colleague B said I did and I shouldn’t have.” The Panel accepted the evidence of Colleague B in relation to this incident with the consequence that particulars 8(a) to (c) inclusive are proven.

38. Particular 9. On 2 January 2017 Colleague A and the Registrant were rostered to work together until 08:00. At 08:00 the Registrant was due to go off duty, his role to be taken by another Paramedic, Mr TH. Colleague A was due to continue with his shift, working with Mr TH after 08:00. A call came in at 07:50 to attend a road traffic accident. When the call came in Colleague A had just got out of the shower. He telephoned the Registrant who said that he was in a local shop, and that as he had left his personal protective equipment bag at home, he would pop back to collect it. Colleague A waited to be collected, but when he was collected it was by Mr TH rather than the Registrant. When asked by Mr JQ about this incident, and asked why he did not go on the call that was communicated to him at 07:49, the Registrant initially said, “The other crew jumped at it”. When Mr JQ replied, “No they didn’t. You phoned TH who was in the shower. Why?”, the Registrant replied, “I don’t know. I guess I hoped they would jump for us after our spate of shifts.” The Panel is satisfied that the Registrant delayed responding to the call that was communicated to him before the end of his shift so that he could hand over the ambulance to Mr TH at the commencement of his 08:00 shift. The Panel was satisfied that particular 9 was proven.

39. Particular 10. The complaint advanced by the HCPC is that during a vehicle check being undertaken by Colleague A and the Registrant at the latter’s home, there were two 5 litre cannisters of oil. There had been some history of oil leakage from the ambulance and an extra bottle of oil had been mistakenly purchased on a SAS account. In removing one of the bottles from the vehicle the Registrant stated words to the effect of, “I’m having one of those”. The Panel accepts that what occurred was unusual, but in the judgement of the Panel there is insufficient evidence for the conclusion to be arrived at that the removal of the oil from the vehicle was improper, or that the Registrant intended to either use it for his personal purposes or to prevent it being from being used in the SAS vehicle. Further, Mr JQ gave evidence that there were no rules around how the oil was kept or stored. Accordingly, the Panel does not find on a balance of probabilities an “inappropriate manner”, with the consequence that particular 10 is not proven.

40. Particular 11(a) to (e) inclusive. Each of these contentions arose with Colleague B, and each of them involves an incident already described in relation to another complaint. Each occasion required the use of blue lights, and, depending on circumstances, the siren. The Panel finds that in relation to each incident, the evidence of Colleague B is to be accepted. His evidence receives support from the evidence of Colleague A concerning the reluctance of the Registrant to use blue lights and the siren. The evidence of Colleague B also receives some support from the reply made by the Registrant himself. He acknowledged that he knew he was required to use blue lights for all emergency calls, but when Mr JQ asked him whether it would be fair to say that he was selecting which calls to use them on, the Registrant replied, “Yes”. The Panel finds particulars 11(a) to (e) inclusive proven.

41. Particulars 12(a)(i) to (iii). The background to the Registrant uttering these words is a disagreement that took place in a local café, an incident that resulted in the SAS requiring staff not to use those premises. The Panel is satisfied that the Registrant said that if anyone tried to take him down, or got in his way, or says anything, he would, “I will stab them in the fucking neck”, and he spoke these words in the presence of each of the three colleagues identified. He did not say these words in a light-hearted manner. Indeed, although Colleague C was at pains to inform the Panel that he did not feel personally threatened by the words, he nevertheless remarked that it made him feel odd when the Registrant repeated the phrase word for word in the presence of Colleagues A and B, having previously said it to him when they were alone together. When asked about this by Mr JQ, the Registrant replied, “If they say I said it I probably did …..” The Panel finds particulars 12(a)(i) to (iii) inclusive proven.

42. Particulars 12(b)(i) and (ii). This was an incident that was a continuation of the occasion when Colleague B waited out of doors for approximately 13 minutes (particular 1(d)) while the Registrant watched the rugby (particular 4(i)). When Colleague B eventually got into the vehicle, the Registrant asked him, “What is your fucking problem?”. During the course of this incident that phrase was repeated. When Colleague B said that he had been waiting outside for some time, the Registrant stated that he had been trying to get his dogs into the house. When Colleague B pointed out that that was not what the Registrant had said on the telephone, in the words of Colleague B, the Registrant “lost it”. He was angry and pointing his finger almost touching Colleague B’s face. Colleague B got out of his vehicle and went back to his house. The Registrant got out of the vehicle, and followed Colleague B and stood outside the house where he banged on the door a couple of times. Colleague B telephoned the Duty Manager. When interviewed by Mr JQ, the Registrant acknowledged that there had been occasions when he had behaved inappropriately towards colleagues, including Colleague B. He said that he had apologised. The Panel finds that particulars 12(b)(i) and (ii) are proven.

43. Particulars 13(a) and (b). The Registrant showed Colleague B an image on his mobile telephone of a topless woman whom Colleague B recognised to be a colleague. When interviewed by Mr JQ about this incident, the Registrant stated that Colleague X was not naked in the images he had of her, but that she was wearing lingerie. He then stated that he did not recall if one of the images was of her naked from the waist up. He accepted that he had shown Colleague B an image, but could not recall which one. In the judgement of the Panel these replies were consistent with the evidence of Colleague B which the Panel accepted. Accordingly, Particular 13(b) is proven. As to the issue of consent relevant to that particular, the Panel finds on a balance of probabilities that Colleague X did not give her consent to the Registrant showing the image to others. The Panel makes this finding, not only on the basis that it is inherently unlikely that she would have given such consent, but also because of the hearsay statement she made when she was interviewed about the matter (when she said that she had no recollection of sending the image, but that if she had, “It could have been after a lot of drinks.”), but also because the Registrant himself stated that Colleague X would be angry if she knew that he had shown the photographs he had of her to others. For these reasons, Particular 13(b) is proven.

Decision on Grounds

44. Having decided that all of the factual particulars with the exception of Particular 10 are proven, it has been necessary for the Panel to decide if those proven facts amount to misconduct and/or a lack of competence.

45. The Panel first considered lack of competence. The Panel came to the clear conclusion that this case does not demonstrate a lack of competence on the part of the Registrant. So far as what might be described as the technical issues are concerned, for example, the administration of morphine and the attendance upon a patient to whom morphine has been administered and the immobilisation of a patient with a suspected neck injury, the Registrant’s failings were of basic, core Paramedic functions. Again, the delay findings represented fundamental defaults. The Registrant was an experienced Paramedic, and the evidence received by the Panel (which includes testimonial evidence by the Registrant himself) has led the Panel to conclude that he knew perfectly well what he should have been doing, and that he had the skills and knowledge to actually do it. What this case involves is the Registrant’s willingness to do that which he could do and knew he should have done. It is therefore concerned with behavioural and attitudinal shortcomings even so far as the technical particulars are concerned. The same is, of course, true of the particulars concerned with disrespectful language and behaviour concerning patients and service users and directed to colleagues.

46. The Panel then considered misconduct. The Registrant’s behaviour breached a number of standards of the HCPC’s Standards of conduct, performance and ethics as they were formulated from January 2016, namely:

• Standard 1.1, “You must treat service users and carers as individuals, respecting their privacy and dignity.”

• Standard 1.4, “You must make sure that you have consent from service users or other appropriate authority before you provide care, treatment or other services.”

• Standard 1.5, “You must not discriminate against service users, carers or colleagues by allowing your personal views to affect your professional relationships or the care, treatment or other services that you provide.”

• Standard 2.1, “You must be polite and considerate.”

• Standard 2.3, “You must give service users the information they want or need, in a way they can understand.”

• Standard 4.1, “You must only delegate work to someone who has the knowledge, skills and experience needed to carry it out safely and effectively.”

• Standard 6.1, “You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues so far as possible.”

• Standard 6.2, “You must not do anything, or allow someone else to do anything, which could put the health or safety or a service user, carer, or colleague at unacceptable risk.”

• Standard 9.1, “You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.”

• Standard 10.1, “You must keep full, clear and accurate records for everyone you care for, treat, or provide other services to.”

• Standard 10.2, “You must complete all records promptly and as soon as possible after providing care, treatment or other services.”
47. In the judgement of the Panel the Registrant’s behaviour was serious and persistent, taking place on multiple occasions over an eight month period. It placed the safety of patients at risk. That risk included time-critical responses to a number of emergencies and an attitude by the Registrant which could have endangered the life of a patient, for example, the failure to immobilise Patient D. The Panel heard from Mr JQ and Colleague A that by not immobilising the neck any head movement can sever the spinal cord and result in death or paralysis. The fact that the Panel has not been provided with evidence that harm actually ensued is purely fortuitous and does not minimise the seriousness of the matters found. Similarly, the absence of evidence that vulnerable patients, many of whom were elderly, heard the utterly disrespectful terms in which the Registrant described them does not minimise the seriousness of the behaviour. Not only are colleagues entitled to be treated in a respectful manner and not su
bjected to aggressive behaviour as a matter of course, but, if they are not, fractured professional relationships create an obvious risk that the care extended to patients might be compromised.

48. The conclusion of the Panel is that the Registrant’s behaviour fell well below the standard that was expected of him, and that the proven facts, when taken both individually and collectively, must be categorised as misconduct.

Decision on Impairment

49. The Panel then considered whether the misconduct arising from the proven factual particulars is currently impairing the Registrant’s fitness to practise. In this regard the Panel heeded the requirement to consider the matter from the perspective of both the personal and public components.

50. In his recorded responses to the issues being considered by the Panel, the Registrant’s acceptance of shortcomings has been limited and there is a substantial element of continuing denial. As has already been mentioned when his SAS interview evidence was introduced, the pattern was of denial followed by acceptance when challenged and presented with evidence. Even then he attempted to minimise his behaviour. In these circumstances it is not possible for the Panel to conclude that the Registrant has any genuine insight into his behaviour. Of particular concern is the fact that there has been no recognition by the Registrant of the risk he created for service users. Against this background, the tenuous apologies extended by the Registrant count for little when assessing whether he presents an on-going risk. The conclusion of the Panel is that he does, and that fact requires a finding of personal component impairment of fitness to practise.

51. The Panel is also satisfied that a finding of public component impairment of fitness to practise is required. This is not only because of the on-going risk the Registrant presents, which carries with it the disquiet that informed members of the public would have at the prospect of the Registrant being permitted to practise unrestricted. The finding is also required to declare and uphold proper professional standards and to send a warning that behaviour of the sort indulged in by the Registrant will not be overlooked.

52. The Panel’s conclusion that the Registrant’s fitness to practise is impaired in respect of the two limbs in relation to which that issue is to be considered has the consequence that the Panel must go on to consider the issue of sanction.

Decision on Sanction

53. After the Panel announced its decision on the allegations, the Presenting Officer addressed the Panel on sanction. The Presenting Officer identified what he submitted were aggravating factors, but as these are included in those that will be identified by the Panel, they will not be repeated here. In submitting that the Panel should heed the guidance in the HCPC’s Sanctions Policy document, the Presenting Officer identified various sections. However, the Presenting Officer made clear that the HCPC was not contending that any particular sanction should be applied, accepting that the decision was one for the Panel’s discretion.

54. The Panel has approached the issue of sanction on the basis that a sanction is not to be imposed to punish a registrant against whom a finding has been made. Rather, any sanction imposed must be the least restrictive order consistent with the need to protect service users from the risk of harm, to maintain a proper degree of public confidence in the registered profession and to declare and uphold proper professional standards. It is accordingly necessary for the Panel first to consider whether the finding on the Allegation requires the imposition of any sanction. If it is decided that a sanction is required, then the available sanctions must be considered in an ascending order of seriousness until reaching one that sufficiently meets the proper sanction goals. As the finding in the present case is one of misconduct, the entire sanction range up to, and including, striking off is available.

55. The Panel first identified the aggravating and mitigating factors.

56. So far as the aggravating factors are concerned, the Panel identified the following:

• The lengthy period covered by the failings, spanning as they did some eight months.

• The fact that the failings occurred in a number of different areas; deficient clinical performance, disregard demonstrated towards patients and colleagues, discriminatory language and aggressive behaviour included in the findings. This in turn has resulted in the Panel finding that the root cause of the problem was behavioural and attitudinal.

• The pattern of repetition, which in turn gives rise to a significantly increased risk of repetition.

• The risk of harm that was created by the Registrant’s identified failings.

• The very real risk of harm that would be created were there to be a repetition of behaviour of the sort found against the Registrant.

• The very limited insight demonstrated by the Registrant, and the failure to acknowledge the risk of harm to which he exposed service users.

• The discriminatory nature of the Registrant’s remarks.

57. The only factors identified by the Panel that could be put against the aggravating factors were that there had been limited acceptance and apology tendered by the Registrant at the time of the investigation and the fact that he said that, at the time of the events, there had been difficult circumstances occurring in his personal life. There is a reference by an email dated 1 July 2018 acknowledging his “shortcomings”, but this in the Panel’s view is vague and, being unspecific, did not convince the Panel.

58. With these findings in mind, the Panel first considered whether a sanction was required. The seriousness of the findings and the risk of repetition with the attendant risk of repetition meant that a sanction was required. The same factors also resulted in the Panel rejecting a Caution Order as an appropriate disposal as none of the features identified in paragraph 101 of the Sanctions Policy as being suggestive of a caution order being appropriate is present.

59. The Panel next considered a Conditions of Practice Order. Now that the full extent of the Registrant’s failings has been determined by a consideration of the totality of the evidence, the Panel has come to the clear conclusion that the issue cannot be addressed by the imposition of conditions. The Panel has very little information about the Registrant’s professional activities. So far as the factors identified in paragraph 106 of the Sanctions Policy are concerned, the Registrant lacks insight and there are persistent and general failings. Furthermore, the Panel has concluded that when the fundamental problem has a behavioural and attitudinal cause, there are no conditions of practice that could be imposed while allowing the Registrant to practise as an autonomous practitioner.

60. Accordingly, the Panel next considered whether a Suspension Order would be appropriate. In this regard the Panel heeded the guidance in paragraph 121 of the Sanctions Policy. So far as the factors identified in that paragraph are concerned, the Panel found that the Registrant does not have insight and there is a real risk of repetition. Having carefully considered the matter, the Panel concluded that for a Suspension Order to be appropriate in a case where the established shortcomings are as serious as those found in this case, it would be necessary to have cogent information which would enable the Panel to conclude that there would be a realistic prospect of a registrant addressing issues during the period of suspension. For the reasons already identified, but particularly the fact that the root cause being behavioural and attitudinal, the absence of remediation and a failure to acknowledge the risk to which patients were exposed, the Panel simply does not have information from which it can reach that conclusion in the present case. For these reasons the Panel rejected a Suspension Order as an appropriate sanction.

61. It follows from these findings that the Panel arrived at the conclusion that a Striking Off Order should be made. The Panel is satisfied that this is a necessary sanction given the seriousness of the findings, the risk of repetition with the consequential risk of harm to service users and the absence of confidence that matters will be satisfactorily addressed by the Registrant. For these reasons the Panel is satisfied that it is a proportionate response.

Order

Order: The Registrar is directed to strike the name of Stuart J Wright from the Register on the date this order comes into effect.

Notes

Interim Order:

The Panel makes 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.

Reasons for making the interim order:

1. The Panel first considered whether it had jurisdiction to make an interim order. The notice of hearing letter dated 9 August 2019 alerted the Registrant to that fact that, if the Panel determined the case to be well-founded and imposed a sanction that removed, suspended or restricted his right to practise, then the Panel might also impose an interim order. This statement had the consequence that the Registrant was afforded the opportunity to make representations on the issue of the interim order, and that fact extended jurisdiction to consider the application for an interim order.

2. The Panel approached the application on the basis that an interim order should not be considered to be an automatic response to the making of a substantive sanction. Rather, an interim order is only to be made if the circumstances require such a response while the registrant’s appeal rights remain extant because it is necessary for the protection of members of the public, is otherwise in the public interest or in the interests of the registrant’s rights himself or herself. Furthermore, even if one or more of these three grounds is met, the Panel must then consider whether the circumstances that resulted in it or them being met can be satisfactorily addressed by the imposition of conditions on an interim basis.

3. For the reasons explained by the Panel in relation to its decision on the substantive sanction, the Registrant presents a substantial risk of repeating unacceptable behaviour, and the repetition of that behaviour creates an unacceptable risk of harm to service users. In the judgement of the Panel this fact has the consequence that an interim order is necessary for protection of members of the public, and it is also required in the wider public interest. For the avoidance of doubt, the Panel does not consider that an interim order is required in the Registrant’s own interests.

4. In the judgement of the Panel there are no interim conditions of practice that could be formulated that at one and the same time would enable the Registrant to practise autonomously as a Paramedic and remove the risk of repetition and consequential harm just referred to.

5. The consequence of these findings is that there must be an Interim Suspension Order. It is necessary to make this order for the maximum period of 18 months because although the order will fall away if the Registrant does not appeal with the period during which he can bring an appeal, if he does appeal it could be 18 months before the appeal would be finally determined.

Hearing History

History of Hearings for Mr Stuart J Wright

Date Panel Hearing type Outcomes / Status
05/11/2019 Conduct and Competence Committee Final Hearing Struck off
14/08/2019 Conduct and Competence Committee Interim Order Review Interim Conditions of Practice
05/06/2019 Conduct and Competence Committee Interim Order Review Interim Conditions of Practice
28/08/2018 Investigating committee Interim Order Review Interim Conditions of Practice
30/05/2018 Investigating committee Interim Order Review Interim Conditions of Practice
06/03/2018 Investigating committee Interim Order Review Interim Conditions of Practice
12/09/2017 Investigating committee Interim Order Application Interim Conditions of Practice