Mr Richard M Hook

Background

1. The Registrant is, and was at all material times, registered as a Paramedic with the HCPC. At the time these matters came to light he had been employed for 37 years as a Paramedic with the Welsh Ambulance Service Trust.

2. In 2015, the Amman Tawe Partnership (‘The Partnership’) was established following the merging of a number of surgeries in the Amman and Swansea Valley. New staffing possibilities arose and, in May 2015, adverts were placed for Advanced Paramedic Practitioners (APP). The Registrant applied for the role and in doing so provided a copy of his Curriculum Vitae (‘CV’), which stated he was a qualified APP with a Masters Degree (‘MSc’) in Advanced Clinical Practice from the University of South Wales. Following his successful interview the Registrant took up the post at the Gwaun Cae Gurwen Surgery. The starting salary was £40,954. Those employing him made it clear that they would not have offered him the position had they known he was not qualified to the standard he claimed to be.

3. The Registrant’s primary role at the Partnership was seeing patients who had been allocated to him via the surgery’s triage system. The Registrant had said he had the necessary clinical ability and experience to assess patients, make diagnoses and suggest treatment plans. If the treatment plan required a prescription to be issued the Registrant had to seek a General Practitioner’s (‘GP’) professional clinical advice and the GP would then sign the prescription that the Registrant had produced. The Registrant was fully aware that he was not authorised to sign prescriptions.

4. The Registrant remained in this post until 2016, when the Clydach Primary Care Centre, following the lead of others, also advertised for an APP. The Registrant was approached because he had a previous association with that centre. An interview was arranged and the Registrant again relied on the same CV, claiming he had an MSc in Advanced Clinical Practice from the University of South Wales. Based on the accuracy of the CV, the Registrant was offered the position and started on 27 June 2016. His starting salary was £41,373.

5. The Registrant would commence work at 0800 and have scheduled appointments at 15 minute intervals. Although the Registrant would start work before the GPs, who would start appointments at 0830, there would always be a GP present from that time to approve and sign prescriptions.

6. On 3 August 2017 a patient’s prescription had been handed to the receptionist who did not recognise the signature on it. From enquires subsequently made it became apparent that it was the Registrant who had signed the prescription. Following that discovery, a search of the computer records was carried out to ascertain all of the cases where the Registrant had issued and signed prescriptions. Numerous prescriptions were found bearing similar signatures to the first one that had been identified.

7. The Registrant was then spoken to by the Practice Manager and he admitted signing prescriptions, claiming that he had only been doing it for a week. This turned out to be untrue. He was immediately suspended from work.

8. Due to the potential number of falsified prescriptions, together with the need to ensure that there was no risk to patients, the Clydach Health Centre undertook an examination of 14,250 prescriptions in order to locate those issued by the Registrant. The initial exercise identified in excess of 300 prescriptions in July 2017 alone, thereby demonstrating that this practice had been going on for more than the one week claimed by the Registrant.

9. Following this a counter fraud investigation was launched. Examination of CCTV footage showed the Registrant entering a GP’s room when the GP was not present and shortly afterwards going to the reception area. It was clear that he had just stamped a prescription as the patient he had seen shortly before then went up to the reception desk to collect it. The Registrant was later to accept in interview that he had used the stamp to show the prescription was genuine.

10. A further and wider check was then conducted, revealing that many more prescriptions had been issued and signed by the Registrant over a much longer period. In amongst all those examined, it was apparent that the Registrant had issued a small number of prescriptions for Class A, B and C controlled drugs. He had also issued prescriptions for the treatment of very young children. The Registrant was subsequently to accept he had issued and signed about 400 prescriptions.

11. When interviewed by the police, on 27 September 2017, the Registrant admitted that he had been signing prescriptions without authority to do so and agreed that he had behaved dishonesty, although he claimed it had not been his intention to deceive anyone. He denied forging a GP’s signature but could provide no explanation for why the signatures looked like the GP’s and bore little resemblance to his own. The Registrant recognised that he was in a position of trust, which had been abused. He said that he was under a lot of pressure to see patients within 15 minutes so he signed the prescriptions in order to expedite the process.

12. Enquiries with the University of South Wales revealed that whilst the Registrant commenced a Masters Degree in 2012, at the end of Year 3 he failed his Practice Based Dissertation. He was due to repeat that module but did not in fact enrol to do so. Accordingly, the Registrant does not hold a MSc in Advanced Clinical Practice. When interviewed by the Police on 2 July 2018, the Registrant admitted this to be the case and that the CV, that he had submitted for the posts, was false in this respect. He again said he did not intend to deceive, but he did accept his actions were fraudulent.

13. The employer referred the matter to the HCPC on 22 August 2017. The NHS Counter Fraud Department investigated the matter and, on 5 November 2018, confirmed that the Registrant was being prosecuted.

14. On 2 January 2019, the Registrant admitted and was convicted at Cardiff Crown Court of three counts of fraud and one of forgery. He was sentenced to a 6 month custodial sentence, suspended for 12 months and a community order of 120 hours unpaid work, together with 10 day rehabilitation requirement. He was ordered to pay £3,597 in costs and a £140 surcharge.
15. When sentencing the Registrant, the Judge said:

“[Your barrister] has described this as a spectacular fall from grace and that, I have to say, seems to me to fit your particular circumstances. At the age of 61, having had a distinguished career, both in public service and also as a paramedic, it is a sadness to see you standing there in the dock having pleaded guilty to three counts of fraud and one of forgery.

The facts have been outlined at length, so I am not going to repeat them. As I indicated a little earlier, this was a course of conduct starting in 2015 when you represented yourself to have a Master’s degree. As [your barrister] has pointed out, it may well be that you would have obtained that post without it, but it is a serious matter to misrepresent one’s qualifications in that way.

That is compounded, of course, because you repeated that in relation to the second surgery and again, of course, in relation to the issue of the public liability insurance that was required by the practice. That was potentially very serious because it could have had the risk that, had there been any claim, that that somehow would have caused difficulty for the practice in having any pay out from any claim.

But perhaps the most serious of these matters is the forgery, of course. Having been, because of your qualifications, because of your experience, recruited to carry out a high level of responsibility, a high level of trust at the Clydach Primary Care Centre, allowed to judge whether treatment plans would be appropriate and then allowed to draft prescriptions for them. To then proceed, when you fully knew that they had to be countersigned and approved by a medically qualified practitioner, for you to proceed in that way showed a significant lapse in judgment and compounded that, on your own admission, some 400 prescriptions were issued in that way.

Both Prosecution and Defence counsel have commented on the difficulty of applying the guidelines on fraud to your particular situation. I have to have regard to them, but I note, and to my mind, although there was nominally financial loss involved in your fact that you were employed at these two practices, to my mind the really significant damage done if you like, the harm done for these two practices and particularly the Clydach Primary Care Centre, related to its reputation and potential loss of reputation. The fact that they had to then, once they discovered that you had been signing prescriptions, 14,000 prescriptions had to be looked at, 350 patients reviewed, three called in. It is not suggested that anybody came to harm but, of course, that was perhaps more good fortune because you knew that a general practitioner should have looked at each and every one of these prescriptions and some of these patients were young children.

So, there was a potential for serious harm if they were wrongly prescribed. There was a persistence in that once you started issuing these prescriptions, you seem to have carried on. You initially misled the doctors when you were challenged by saying you had only done it for a week. I do accept that later, in interview, you were much more candid and although the pleas were entered at the PTPH, given the admissions in interview, I am minded to give full credit in this case on the basis of plea because I do not think there was any real prevarication about your guilt in this matter.

So, I am allowing full credit. You have no previous convictions. You have lost your good character. You are now currently suspended from working in a medical capacity and no doubt there will be disciplinary proceedings that follows. Fortunately, you have been able to obtain a different kind of post without medical responsibilities and so, the financial hardship is not as great as it would have been in other circumstances.

I indicated earlier I am going to treat this as a course of conduct and, therefore, pass concurrent sentences. I take as the lead sentence that for the forgery, for it seems to me that that is the most serious of these offences. Had this been after trial and this gone to trial with a Jury, it seems to me that the correct sentence would have been in the order of some 36 weeks’ immediate imprisonment. I am going to give you full credit and so, I reduce it from 9 months down to 6 months, which in fact is 26 weeks on the forgery.

In relation to the other three matters, I am going to pass concurrent sentences of 12 weeks. So, it is 26 weeks. But that will be suspended for a period, and since I am suspending it, I am going to be making it for a shorter period of 12 months than 18 months. There will be 10 rehabilitation activity requirement sessions and I am going to ask, given that your health is not at the best, I am going to order 120 hours’ unpaid work.

You will know, you have been a Magistrate, you know exactly what this means. Commit any new offence, which I think is highly unlikely, during the next 12 months, then of course this could be activated. Fail to carry out the rehabilitation activity requirements and the unpaid work, again, you will be brought back to the Crown Court and the custodial term could be imposed.

I am going to order that you pay the costs of bringing the matter of £3,497 and, of course, there has to be a victim surcharge up to, in this case is £140 I believe.”

Decision on Facts

16. In reaching its decisions on the facts the Panel took into account the Certificate of Conviction which, the Legal Assessor advised, is conclusive proof of the conviction. The Registrant had also admitted the facts at the outset of the hearing. Accordingly, the Panel found the facts as set out in Allegations 1 (a) and (b) proved.

Decision on Statutory Ground

17. The Panel next considered the statutory ground. Because this is a conviction case, and the Panel had been provided with the Certificate of Conviction, the Panel found the statutory ground to be made out.

Decision on Impairment

18. Having found the statutory ground of conviction to be well founded, the Panel went on to consider whether the Registrant’s current fitness to practise was impaired as a result of that conviction. In doing so it took into account the submissions made by Ms Hastie, those made by the Registrant and all the documents provided. The Panel accepted the advice of the Legal Assessor. The Registrant accepted that his fitness to practise was currently impaired and although the Panel took this into account, it reached its own independent judgement on the matter.

19. The Panel was of the view that the Registrant had breached the following standards of the 2012 Standards of Conduct, Performance and Ethics:

1 You must act in the best interests of service users.
6 You must act within the limits of your knowledge, skills and experience and, if necessary, refer the matter to another practitioner.
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.

20. When considering current impairment the Panel also took into account the comments made by the sentencing Judge in the Crown Court, in particular when she said:

“… an aggravating feature is that it wasn’t just one practice but two practices that were misled as to his qualifications. And as to the insurance, it seems to me that, potentially, that that is a serious matter. It’s not a question of paying for the insurance and saying it was only £5,000 or whatever, because in fact, it could have invalidated the practice’s, any claim against the practice it seems to me, potentially. So, there’s potential risk of loss there that perhaps could have been considerable had, let’s say, somebody suffered because the wrong prescription was given and there was a claim. But I don’t want to inflate it beyond, but they are serious matters on, it seems to me, the reputation of the practice, the trust of the patients in the integrity of the procedures are, in many ways, more significant than any financial loss in this particular case.”

21. The Panel had been advised by the Legal Assessor that an important factor when considering current impairment is whether the conduct which led to the allegation is remediable, that it has been remedied and that it is highly unlikely to be repeated. The Panel noted that the Registrant’s actions required positive steps on his part and did not rely solely on custom and practice. Although the Registrant had shown some insight by his admissions and expressions of remorse, he continued, notwithstanding his guilty pleas to fraud and forgery, to deny that his actions had been meant to deceive and the Panel could not be satisfied that his conduct was therefore highly unlikely to be repeated. The Registrant had not provided any clear evidence of remediation or a clear understanding of what had motivated him to lie about his qualifications and to create so many forged prescriptions and how he might prevent such behaviour being repeated. In addressing the Panel the Registrant tended to minimise his behaviour and appeared to be more concerned about the impact upon himself and his family than the surgery and the profession as a whole. This all suggested an attitudinal problem which, although not impossible to remediate, is much more difficult to do so.

22. The Panel was satisfied that, by his actions, the Registrant had put patients at unwarranted risk of harm, he had brought the profession into disrepute, he had breached a fundamental tenet of the profession and had acted dishonestly. Given his limited, albeit it developing, insight, the Panel considered the Registrant was liable to repeat all four. In all the circumstances, the Panel concluded that the Registrant’s fitness to practise as a Paramedic was at the time, and remained, impaired on public protection grounds because there remained a concern that he could behave in this way again and put patients at risk of harm.

23. The Panel went on to consider whether this was the type of case that required a finding of impairment on public interest grounds in order to maintain public confidence in the profession and the Regulator and to uphold professional standards. The Panel was satisfied that a fully informed member of the public, who was aware of all the background to this case, would have their confidence in the profession and the Regulator undermined if a finding of impairment were not made. The Panel considered that a member of the public would be very concerned if the Regulator took no action in a case where a Paramedic had been convicted of serious offences relating to fraud and forgery directly connected to his role as a Paramedic. There was clearly a need to send out the message to the profession that this sort of behaviour is wholly unacceptable and not to be tolerated. The Panel also took into account the fact that the Registrant has yet to complete the sentence handed down by the Crown Court and that, as a matter of general principle, where a registrant had been convicted of a serious criminal offence, he should not be permitted to resume his practice until he had satisfactorily completed his sentence.

24. The Panel therefore determined that the Registrant’s fitness to practise is currently impaired on public protection and public interest grounds and that the allegation of impairment is well founded.

Decision on Sanction

25. In reaching its decision on sanction, the Panel took into account the submissions made by the Registrant and those made by Ms Hastie, together with all the written evidence and all matters of personal mitigation. The Panel was provided with a number of references on behalf of the Registrant and these too were taken into account. The Panel also referred to the guidance issued by the Council in its Indicative Sanctions Policy (“ISP”). The Panel had in mind that the purpose of sanctions was not to punish the Registrant, but to protect the public, maintain public confidence in the profession and maintain proper standards of conduct and performance. The Panel was also cognisant of the need to ensure that any sanction is proportionate. The Panel accepted the advice of the Legal Assessor.

26. The Panel considered the aggravating factors in this case to be: patients put at unwarranted risk of harm; more than one GP practice misled about his qualifications; a gross breach of trust; the number of prescriptions issued and the prolonged timespan over which this was done; some of the prescriptions were for controlled drugs; because he was not qualified to issue the prescriptions the insurance provided to cover him at the practice, which had been paid for by the practice, would not have been valid; over 14,000 prescriptions had to be checked by the practice, with 350 patient files being reviewed and 3 patients asked to return for clinical review.

27. The Panel considered the following mitigating factors; no previous disciplinary or criminal matters over a career spanning 37 years; some, albeit not fully developed, insight as demonstrated by his admissions; positive testimonials; limited remorse, aimed more at the impact his actions had upon himself.

28. In light of the serious nature of the conviction, the Panel did not consider this was an appropriate case to take no further action.

29. The Panel next considered whether a Caution Order would adequately reflect the seriousness of the conviction. The Panel’s role as indicated by the ISP was not to punish the Registrant twice for the same offence, but to protect the public and maintain high standards among registrants and public confidence in the profession. The Panel did not consider that such an Order would adequately mark the seriousness of the behaviour or protect the public.

30. This was not a case where a Conditions of Practice Order would be appropriate because of the nature of the Registrant’s conduct, which was essentially attitudinal. The Panel did not consider it possible to formulate practicable or verifiable conditions that would address those attitudinal concerns and thereby protect the public. Furthermore the Panel considered conditions of practice would not adequately reflect the seriousness of the dishonest behaviour and would allow the Registrant to return to work before he had completed his Crown Court sentence.

31. The Panel next considered whether to make a Suspension Order. The ISP states that, “Suspension should be considered where the allegation is of a serious nature but unlikely to be repeated and, thus, striking off is not merited.”  The Panel reminded itself of the nature of the conviction, namely the lying in his CV about his qualifications, enabling him to obtain employment at two separate locations, informing his insurers he had a qualification he never had and the subsequent forgery of hundreds of prescriptions. This amounted to a gross breach of trust for a Paramedic, particularly one in a senior role, to behave in this harmful way and the Panel was concerned about the real risk of repetition. This was particularly so given the Registrant’s continued insistence that he had made a mistake and he never intended to deceive anyone, in direct contrast to his admitted offences of fraud and forgery in the criminal proceedings.

32. Although a Suspension Order would provide protection to the public for its duration, having identified a risk of repetition of this behaviour and given the limited insight and absence of clear remediation, the Panel decided that suspension was not appropriate. In addition, and in particular, the Panel was not satisfied that it would be sufficient to maintain public confidence in the profession or the regulatory process, or to send a clear message to the profession at large that such behaviour would not be tolerated. The Panel determined that a Suspension Order would not be a sufficient sanction in the circumstances of this case.

33. The Panel therefore looked at the guidance in the ISP on making a Striking Off Order in order to decide whether such an Order would be appropriate. The guidance states that, “Striking off is a sanction of last resort for serious, deliberate or reckless acts involving abuse of trust such as, sexual abuse, dishonesty or persistent failure.” It goes on to observe that “Striking off should be used where there is no other way to protect the public.” The Panel finds that this case is characterised by a gross abuse of trust, and dishonesty directly related to the Registrant’s role as a Paramedic that spanned a significant period and occurred at two different places of employment.

34. The ISP goes on to suggest that a Striking Off Order may be appropriate where the nature and gravity of the allegation are such that any lesser sanction would lack deterrent effect or undermine confidence in the profession. The Panel’s earlier finding in relation to the consideration of a Suspension Order identified that a lesser sanction would indeed be insufficient to represent these wider public interest issues in the specific circumstances of this case.

35. The Panel concluded that the only appropriate sanction in this case, therefore, was to make a Striking-Off Order. The Panel considered that the Registrant’s offending behaviour was fundamentally incompatible with being a registered Paramedic with the HCPC. The Panel took into account the impact this might have upon the Registrant, but concluded that the need to protect the public outweighed his interests and that no other sanction would adequately protect the public and the public interest.

36. Accordingly, the Panel makes a Striking-Off Order and directs the Registrar to strike Richard Hook’s name from the Register.

That the Registrar is directed to strike the name of Mr Richard M Hook from the Register on the date this order comes into effect.

Interim Order:

37. Following the Panel’s decision on sanction, Ms Hastie made an application for an Interim Order to cover the period during which an appeal may be made and, if one is made, whilst that appeal is in progress. The Panel heard and accepted the advice of the Legal Assessor.

38. The Panel has found that the Registrant committed fraud and forgery directly related to his role as a Paramedic. The Panel has already concluded that the Registrant represents a continuing risk to the public because there remains a concern that he would repeat the behaviour, particularly given his limited insight and remediation. The Panel therefore concluded that an Interim Order was necessary to protect the public, from the risks it had identified, during the 28 day appeal period or the time taken to conduct any appeal, in the event that one is made.

39. The Panel is also of the view that, given the nature and seriousness of the conviction in this case, public confidence in the regulatory process would be undermined if the Registrant were allowed to remain in practice on an unrestricted basis during any appeal period. The Panel therefore determined that an Interim Order is otherwise in the public interest.

40. The Panel first considered whether a Conditions of Practice Order would be sufficient. However, for the same reasons as dealt with at the sanction stage, the Panel concluded that conditions would not be appropriate or proportionate in this case.

41. The Panel therefore decided 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.

42. That concludes this hearing for today.

History of Hearings for Mr Richard M Hook