Mr Kieron M P Galton

Profession: Paramedic

Registration Number: PA38174

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 16/12/2020 End: 17:00 16/12/2020

Location: Hearing taking place virtually

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

Whilst employed at South Western Ambulance Service and registered with the HCPC as a Paramedic, between 1 December 2017 and 7 December 2017, you:

  1. Breached Professional Boundaries, in that you;

a)Asked Patient A for her phone number and/or accepted her phone number.

b) During Patient A's transfer to the hospital spoke to her about your personal life

c) Visited Patient A in the emergency department and brought her chocolate

d) Sent Text Messages to Patient A, on;

i) 1 December 2017

ii) 2 December 2017

iii) 3 December 2017

iv) 4 December 2017

v) 5 December 2017

vi) 7 December 2017

  1. Did not follow the lone worker policy when treating Patient A, in that you did not offer and/or record offering a chaperone when conducting an Electro Cardiogram (ECG).
  1. When conducting an Electro Cardiogram (ECG) left Patient A physically uncovered for an inappropriate length of time.
  1. Did not record taking a pain score before or after administration of Morphine to Patient A.
  1. Administered Morphine to Patient A when it was not clinically indicated.
  1. The matters set out at paragraphs 1-5 amount to misconduct.
  1. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Matters

Application to Amend

1. Ms Lykourgou applied to amend three Particulars of the Allegation, namely:

i) Particular 1(a) – by adding the words “and/or accepted her phone number”.
ii) Particular 2 – by adding the words “in that you did not offer and/or record offering a chaperone when conducting an Electro Cardiogram (ECG)”.
iii) Particular 3 – by substituting the words “Having requested that Patient A remove her top and bra to perform an Electro Cardiogram (ECG)” with the words “When conducting an Electro Cardiogram (ECG)” and by substituting the words “a prolonged period” with the words “an inappropriate length of time”.

2. Mr Galton (“the Registrant”) did not oppose the application.

3. The Panel accepted the advice of the Legal Assessor. The Panel concluded that the proposed amendments did not prejudice the Registrant and did not cause unfairness to either party. The Panel decided to allow the application.

Admissions

4. At the commencement of the hearing, the Registrant entered the following formal admissions:
1(a). Admitted on the basis of his interview/statement
1(b). Admitted on the basis of his interview/statement
1(c). Admitted
1(d). Admitted
2. Admitted on the basis of “did not record”
3. Denied
4. Admitted
5. Denied

Witnesses

5. The Panel heard live evidence from:

• Patient A
• JJ – Acting Deputy County Commander employed by South Western Ambulance Service NHS Foundation Trust (“the Trust”), and Investigating Officer
• The Registrant.

Background

6. The Registrant was employed by the Trust from 23 May 2016 to 24 September 2018. At the time of the Allegation he was working as a Band 5 Paramedic with Dorset Accident & Emergency Department. His role involved responding to 999 calls as a sole responder in a Rapid Response Vehicle (RRV) which is a car.

7. On 1 December 2017 the Registrant responded to a 999 call, at the request of the 111 service, following a 111 call made by Patient A who was complaining of right sided numbness.

8. A summary of the HCPC Allegation is as follows in the paragraphs numbered 9 – 14.

9. It was alleged that when he arrived at Patient A’s home, the Registrant did not follow the Trust’s “Lone Worker Policy”, in that he did not offer or record a chaperone prior to examining Patient A. He then performed an ECG on Patient A whilst she was naked from the waist up, and left her uncovered for an inappropriate length of time. He administered morphine, when this was not clinically indicated, and did not record the fact that he had done so on the Patient Care Record (PCR).

10. It was alleged that the Registrant then transported Patient A to hospital in his vehicle, and discussed his personal life, including his marital status, en route.

11. It was alleged that on arrival at the hospital, the Registrant asked Patient A whether she would be happy for him to take a note of her phone number.

12. It was alleged that after he had taken Patient A into hospital, and after he had departed from the hospital in his RRV, the Registrant returned and gave Patient A a bar of chocolate.

13. It was alleged that later on the evening of 1 December, while Patient A was still in hospital, the Registrant sent her a text message and subsequent to her discharge, sent further messages on 2, 3, 4, 5, and 7 December 2017, in which he referred to her in terms of over familiarity.

14. The event was brought to the attention of the Trust, by Patient A’s boyfriend, on 19 July 2018. An internal investigation was commenced by the Trust. Patient A was interviewed on 27 July 2018, and the Registrant was also interviewed on that day. The Registrant expressed remorse, and accepted that he had made some errors of judgement. He provided a prepared statement dated 20 August 2018 in which he admitted that he had asked for Patient A for her telephone number, had given her for a bar of chocolate and had texted her. On 19 September 2018 the Registrant attended an internal disciplinary hearing and admitted that he had made a series of errors of judgement. He subsequently referred himself to the HCPC.

Legal Advice

15. The Panel accepted the advice of the Legal Assessor, who advised on the burden and standard of proof, the relevance of the admissions entered by the Registrant, and the Registrant’s good character.

Panel’s conclusion: Witnesses

16. The Panel found A to be a credible witness. She showed no sign of malice towards the Registrant, and went out of her way to say that “he was not predatory”. She was balanced when giving her evidence. When she did not know the answer to a question, she said so. She accepted that her anxiety at the time, the effects of the Morphine, together with the passage of time, may have affected her memory of events to some extent.

17. The Panel also found JJ to be a helpful and balanced witness. He gave measured evidence and was prepared to adjust the evidence provided in his statement when provided with fresh information, for example in relation to whether Morphine had been clinically indicated in light of the description of the pain provided by Patient A to the Panel.

18. The Panel found the Registrant to be helpful and cooperative; it was clear that he found the proceedings stressful, emotional combined with a sense of frustration with himself for his past actions. He had made admissions and acknowledged his shortcomings. It appeared that he remained unsure of what his motives had been at times.

Decision on Facts

19. In reaching its decisions, the Panel considered all the oral and documentary evidence provided by the HCPC and the Registrant. This included:

  • the witness statement and oral evidence of Patient A, together with a note of the evidence she gave to the Trust’s disciplinary investigation;
  • the witness statement and oral evidence of JJ;
  • the internal Investigation Report
  • notes from the Disciplinary Hearing
  • a copy of the Patient Care Report (PCR)
  • a copy of the Trust’s Lone Worker Policy
  • copies of the text messages sent between Patient A and the Registrant
  • the Registrant’s witness statement entitled ‘Response to Allegation of hearing’ and oral evidence, together with the notes of his internal interview, notes of his evidence at the Disciplinary Hearing, and a statement compiled by him for the internal proceedings
  • Eight references and twelve testimonials written on behalf of the Registrant.
  • Certificates of courses, and written reflective pieces, completed by the Registrant since the event.

20. The Panel understood that it was for the HCPC to prove its case on the balance of probabilities. It took account of the Registrant’s good character when assessing his credibility and his propensity to have acted as alleged.

1. Breached Professional Boundaries, in that you;
a) Asked Patient A for her phone number and/or accepted her phone number.

21. It was alleged by Patient A that after he had examined her at her home, the Registrant drove her to hospital in the RRV. She said that when they arrived, the Registrant gestured towards the screen of the Mobile Data Terminal (MDT) positioned between the passenger and driver’s seat, and asked, since her details were on the system, whether she would be happy for him to make a note of her mobile number and speak to her later to see how she was doing. She said that this felt inappropriate and that she just wanted to get out of the situation.

22. The Registrant admitted this Particular. However, he did not accept that he had obtained Patient A’s number from the MDT. He asserted that he had asked Patient A for her phone number and she had written it down on a pad of paper, using a pen that was kept in the console of the vehicle. He accepted that this was poor judgement on his part. He said that he had felt the need to stay in touch as Patient A was extremely friendly, and because they had established a connection, namely that her ex-husband was in the ambulance service. He said that he had only met Patient A’s ex-husband in passing, but nevertheless he was part of the “green family”.

23. JJ informed the Panel that the Registrant would not have been able to obtain Patient A’s telephone number from the MDT in the RRV. He said that it is not usually acceptable for a paramedic to ask a patient for his or her telephone number, and certainly not in anything other than in a professional capacity.

24. The Panel found this Particular proved on the basis of the account given by the Registrant, which was supported by the evidence of JJ. JJ’s evidence meant that the Registrant could not have obtained Patient A’s number from the Mobile Data Terminal. The Panel had heard that there was no other paperwork or electronic data available to the Registrant which would have provided Patient A’s number. The Panel concluded from this, and from the Registrant’s evidence, that Patient A had provided her number to the Registrant. In considering Patient A’s evidence on this point, the Panel bore in mind that she had recently been given Morphine and had accepted that this might have affected her nuanced recall of events at times.

25. The Panel accepted JJ’s evidence, and concluded that to have asked for, and accepted, Patient A’s phone number, in the circumstances described by the Registrant, was a clear breach of Professional Boundaries.

26. Accordingly the Panel found this Particular proved.

1. Breached Professional Boundaries, in that you;
b) During Patient A's transfer to the hospital spoke to her about your personal life

27. Patient A said that after the Registrant had examined her at her home, he asked whether she would be happy to be transported to hospital in the RRV. She replied that she was. However she asserted that when they were in the car, the Registrant started to chat with her in a way that was “over sharing”, in that he was overfamiliar and disclosed details of his private life, which made her feel uncomfortable. She said that in the course of this conversation she told him that her ex-husband was a trainee paramedic, and it was established that the Registrant had worked with him briefly.

28. Whilst the Registrant did not agree with the level of detail asserted by Patient A, he did agree that he had discussed aspects of his personal life, which had included details of his marital life. He accepted that he should not have done this. He said that he had merely been trying to put Patient A at ease by chatting.

29. JJ said in evidence that whilst paramedics often chat to patients on their way to hospital to put them at their ease, it is not appropriate for a paramedic to discuss his or her personal life with a patient and this would be unprofessional.

30. The Panel found this Particular proved. It was clear from all the evidence that the Registrant had discussed his personal life with Patient A. The Registrant himself accepted that he had overshared information regarding his marital life. JJ’s evidence was that this was unprofessional, and the Panel agreed with that view. The Panel concluded that the Registrant’s sharing of personal information in the circumstances amounted to a breach of Professional Boundaries.

31. Accordingly the Panel found this Particular proved.

Breached Professional Boundaries, in that you;
c) Visited Patient A in the emergency department and brought her chocolate

32. Patient A said that before the Registrant left her at the hospital, he said “you must be starving”, to which she responded “no its fine”. However he turned up a little later with a bar of chocolate and stayed to chat for a few minutes.

33. The Registrant accepted that after he left Patient A, he visited a nearby garage to fill his vehicle with petrol, and whilst there he bought a bar of chocolate for himself and for Patient A, as part of a “2 for 99p” offer. He then returned to Patient A and gave her the chocolate bar. He said that he had thought this would be a nice gesture, and that he had been influenced by the link they had established in the form of her ex-husband who was in the ambulance service. He also said that he had wanted to see how Patient A was, and that he was treating this return to the hospital as a learning opportunity. He now accepted that his decision to return had been ill advised.

34. JJ said that he could not think of any circumstances in which the giving of chocolate would be acceptable in the context of an adult patient, and that this was unprofessional conduct.

35. The Panel concluded that both Patient A and the Registrant were in agreement that the Registrant had returned to visit Patient A after leaving her at the hospital, and had given her a chocolate bar. The Panel agreed with JJ’s evidence that this was a breach of Professional Boundaries.

36. On that basis the Panel found this Particular proved.

Breached Professional Boundaries, in that you;
d) Sent Text Messages to Patient A, on;


i) 1 December 2017
ii) 2 December 2017
iii) 3 December 2017
iv) 4 December 2017
v) 5 December 2017
vi) 7 December 2017

37. Patient A said that after she left hospital she received a series of texts from the Registrant. She said that she responded to these because she did not want to appear impolite and was grateful for the Registrant’s help. She now felt annoyed with herself for giving the impression that it was acceptable to be over familiar.

38. The texts were produced in evidence for the Panel to see. They were as follows:

1 December 2017
Registrant to Patient A:
“Hi this is my number. I am on till 6 so let me know what they say. Hope you feel better soon. X Kieron”

2 December 2017
Patient A to Registrant
“Hi Kieron, hope you’re sleeping soundly….I’m on ansty now and awaiting an MRI I think. Mum’s on her way with some stuff. Thank you so much for your amazing help last night and of course the chocolate!”

Registrant to Patient A:
“Morning sweet. How you feeling? Any news yet?? Hope you are ok and you got your cup of tea. X”

3 December 2017
Registrant to Patient A:
“How you feeling?? You home yet? X”

Patient A to Registrant
“….outpatient now plus a …consultation. Oh and I got given Oramorph to bring home. So I’m happily off my face….Hope you’ve caught up your sleep x”

Registrant to Patient A
“Floating round the house then lol. At least they are gonna do further tests. Yeah all caught up on sleep now, back in 2moro morning st 6 so early night 2night. How are you feeling now though, do you still have the pain? If you need anything let me know ok xx”

4 December 2017
Patient A to Registrant
“Afternoon! I seem to have lost another day…Feeling.. better today though and back to normality tomorrow hopefully. Think the rest has eased whatever was going on..Hope today’s shift is going well x”

Registrant to Patient A
“Just finished now so off to the gym. Glad your feeling better sweet. Have to catch up for a drink soon. Xx”

5 December 2017
“Hi ya sweet all ok you never text back? Hope you feeling ok. You still pooing the morphine lol.Xx”

Patient A to Registrant
“Yo! Sorry, busy day back in reality. Pooing is something I’m not doing thanks to the friggin morphine!! Definitely got a trapped nerve I reck though because as the day went on (and I was up as opposed to lying flat) the numbness and pain crept back. Off to the chiro/physio/acupuncturist I go! Hope you had a good day x x.”

7 December 2017
“Hi beautiful. Sorry to hear you don’t feel great again. If you need me for anything drop me a text. You need a nice hot bath, and a pamper. I would make an appointment at your GO to arrange further tests. Hear if you need me”.

39. The Registrant accepted that he had sent these texts and that this had been an error of judgement on his part. He said that he often ended his texts with an “x” and that there was nothing unusual about that in his case. It was also his style to address people as “sweet” and “beautiful”. He said the mention of catching up for a drink was intended to refer to having a coffee in the local park, with their children.

40. JJ said that there had been no need for the Registrant to contact Patient A after he had treated her. He said that although a paramedic will sometimes enquire about a patient after the completion of their role, this would be for the benefit of personal learning, and should be achieved by contacting colleagues rather than by making direct contact with the patient, to avoid crossing professional boundaries. JJ expressed the view that the type of language used by the Registrant in the texts was unprofessional and should not have been used.

41. The Panel accepted that the Registrant had sent the texts, as evidenced by the evidence of Patient A, the Registrant and the texts themselves. The Panel was also satisfied that the Registrant had breached Professional Boundaries in doing so.

42. Accordingly the Panel found this Particular proved.

2. Did not follow the lone worker policy when treating Patient A, in that you did not offer and/or record offering a chaperone when conducting an Electro Cardiogram (ECG).

43. Patient A said that when the Registrant arrived at her home, her mother and daughter were present. Patient A said that she did not want to be examined in the presence of her daughter and therefore suggested to the Registrant that they go to another room. She said that the Registrant asked her whether she wanted her mother to be present, but she declined that offer, as her mother was shielding her daughter. Patient A was concerned about her daughter’s feelings as Patient A was not well and a paramedic had just arrived.

44. JJ took the Panel to Appendix D of the Trust’s “Lone Working Policy” which states that lone paramedics should offer patients a chaperone or invite the patient to have a friend or relative present before carrying out an intimate examination. The policy also states that if a patient does not want a chaperone present then the paramedic should record that the offer was made and declined.

45. JJ said that when Patient A declined the offer of her mother as chaperone, the Registrant should have called for a crew member to attend. Further, the Registrant should have documented the fact that a chaperone had been offered.

46. The Registrant said that he asked Patient A if she would like to have her mother present as a chaperone, but Patient A declined the offer. He said that the suggestion of calling for further assistance was unrealistic in that he had been informed at the beginning of the shift that the demand that night was high and that it would have delayed her treatment.

47. The Registrant accepted that he had not made a record of the fact that he had offered a chaperone. He put this down to being busy at the time, and the fact that he was not familiar with the new electrical form of documentation, and in particular the tick and drop down system. However he accepted that this was an error on his part.

48. The PCR revealed no record made by the Registrant to evidence the offering of any form of chaperone.

49. The Panel accepted the evidence of both Patient A and the Registrant that the Registrant had offered Patient A’s mother as chaperone. The Panel accepted that whilst best policy may have been to call for further assistance, this may not have been practical. In those circumstances the Panel found the allegation that the Registrant did not offer a chaperone not proved.

50. However it was clear from the documentation, and from the Registrant’s evidence, that the Registrant did not record offering a chaperone when conducting the ECG.

51. Accordingly the Panel found this Particular proved on the basis that the Registrant did not record offering a chaperone when conducting an ECG.

3. When conducting an Electro Cardiogram (ECG) left her Patient A physically uncovered for an inappropriate length of time.

52. Patient A said that after she and the Registrant had moved into her daughter’s bedroom, the Registrant explained that he would need to examine her. She said she removed her upper clothing and then asked the Registrant if she needed to take her vest top off. He said yes. She then claimed that she asked whether she needed to take her bra off and that the Registrant replied “yeah why not”, or words to that effect. She said that the Registrant then knelt beside her to conduct his examination, which made her feel self-conscious as his face was parallel with her breast area. She said that the Registrant then conducted the ECG which lasted a couple of minutes. It was put to her, and she accepted, that she was left on the bed, with her upper body entirely uncovered, for approximately a further eight minutes or so whilst he chatted. She acknowledged that her memory of events might not be totally accurate due to the passage of time and the fact that she had been in pain. She said she felt cold and awkward, and eventually asked if she could get dressed again.

53. The Registrant claimed that Patient A had not been wearing a bra at the time of his arrival, and that he asked her if she wanted to put one on, which she declined. He said that he carried out an ECG, then conducted a respiratory and abdominal assessment on Patient A. He accepted that he had not thought to offer anything to cover Patient A’s upper body after he had attached the ECG. He accepted that it would have been possible to do this. He said that with hindsight he wished that he had, but at the time Patient A appeared to him to be comfortable and relaxed. He accepted in his oral evidence that he could have covered Patient A, and should have preserved her dignity in that way, for which he was at fault.

54. JJ said that it was acceptable to conduct an ECG on a patient who is not wearing a bra, but that he would not expect a patient to be totally topless throughout. He said that after the Registrant had placed the ECG leads on Patient A’s chest, the Registrant could have pulled her clothing down again in order to minimise the amount of time she was exposed, or provided her with a blanket to cover her upper body. JJ agreed that the Registrant had recorded evidence of a respiratory and abdominal assessment on the PCR.

55. The Panel concluded that it was clear from the evidence of both Patient A and the Registrant, that the Registrant had conducted an ECG whilst Patient A was physically uncovered. On the basis the evidence of Patient A, the evidence of JJ, and on the basis of the Registrant’s oral evidence, the panel concluded that this had continued for an inappropriate length of time in that he could have provided covering for Patient A after attaching the electrodes. In reaching its conclusion the Panel took into account the last bullet point of Annex D of the Lone Worker Policy which states:

“Give the patient privacy to undress and dress and use drapes to maintain the patient’s dignity”.

56. On the basis of all the evidence the Panel found this Particular proved.

4. Did not record taking a pain score before or after administration of Morphine to Patient A.

57. Patient A said that she had been in considerable pain. In her oral evidence she described the level of pain as being the upper end of moderate, to the lower end of severe. She said that the Registrant took her pain score and then asked her whether she was happy to be administered Morphine. She said she was relieved to be given some proper pain killers.

58. JJ said that the Registrant did not record a pain score on the PCR before or after he administered Morphine, whereas this should have been done. He accepted that the way in which the pain score is recorded on the electronic system was new, and that a number of practitioners had had difficulty locating where to enter the pain score on the electronic PCR.

59. The Registrant accepted that he should have recorded Patient A’s pain score both before and after the administration of Morphine, and that he had not done so. He again said that he had been unfamiliar with the new electronic system of recording.

60. The Panel concluded on the basis of the PCR and the Registrant’s admission, that the Registrant did not record taking a pain score before or after administering Morphine to Patient A.

61. Accordingly the Panel found this Particular proved.

5. Administered Morphine to Patient A when it was not clinically indicated

62. JJ said that it was apparent from the PCR that the Registrant had administered 1.5 mg of Morphine to patient at 19.38, and a further 1.5 mg at 20.30. In his witness statement he said that he was unsure whether Morphine had been clinically indicated for Patient A because, without a pain score, he could not determine how severe her pain was. However he said that two 1.5 mg doses, given 50 minutes apart, indicated to him that the pain had not been severe and therefore intravenous paracetamol may have been a more appropriate option.

63. However JJ amended his view when supplied with the further information provided by Patient A in her oral evidence. Having heard that Patient A had described her level of pain as the higher end of moderate, or lower end of severe, JJ accepted that Morphine would have been clinically indicated in the circumstances.

64. The Registrant said that Patient A had been in pain and that Morphine was justified in his view. He argued that intravenous paracetamol was not an option available in the context of a home visit, for practical reasons. He explained that he administered a lower dose of Morphine than he might otherwise have done, because he was aware of the dangers of transporting Patient A alone in the RRV if he had given too large a dose.

65. The Panel noted that the objection that had once been advocated by JJ had now been withdrawn, on being provided with the additional evidence relating to Patient A’s pain score. The Panel also took account of the evidence given by the Registrant and Patient A that she had been in a lot of pain.

66. On that basis the Panel found this Particular not proved.


Decision on Grounds

67. Ms Lykourgou took the Panel to the relevant legal authorities on the meaning of misconduct and submitted that the Registrant’s actions had fallen seriously below the standards required of him at the time and amounted to misconduct.

68. The Registrant made no specific submissions, and left the issue of misconduct to the judgment of the Panel.

69. The Panel accepted the advice of the Legal Assessor, who advised the Panel to ask whether, in its judgement, the Registrant’s behaviour had fallen seriously below the standards required of a registered paramedic in the circumstances, and whether his behaviour would be regarded as deplorable by fellow practitioners. She took the Panel to the cases of Roylance –v- General Medical Council No 2 [2001] 1 AC 311, Nandi v GMC [2004] EWHC 2317 and Schodlok v GMC [2015] EWCA Civ 769. The Panel was aware that misconduct was a matter for the Panel’s professional judgement.

70. The Panel found that the Registrant’s actions, as found proved, breached the following HCPC Standards of Conduct, Performance and Ethics 2016:

1.1 You must treat service users and carers as individuals, respecting their privacy and dignity
1.7 You must keep your relationships with service users and carers professional

71. The Panel found that the Registrant’s actions, as found proved, breached the following HCPC Standards of Proficiency for Paramedics (September 2014):

10. Be able to maintain records appropriately.

72. The Panel reminded itself that breaches of the relevant Standards, whilst relevant, do not of themselves equate to a finding of misconduct

73. The Panel considered each Particular separately.

74. In relation to Particular 1(a), the Panel concluded that in asking Patient A, a patient he had only just met, for her phone number, the Registrant’s actions had fallen far below the standards expected of a registered paramedic in the circumstances, and that this amounted to misconduct.

75. In relation to Particular 1(b), the Panel accepted the Registrant’s evidence that he had spoken about his personal life in an attempt to reduce Patient A’s anxiety and to put her at her ease. In those circumstances, whilst this was a breach of Professional Boundaries, it was not, in the judgement of the Panel, so serious as to amount to misconduct in the circumstances.

76. In relation to Particular 1(c), the Panel concluded that the purchase of chocolate for a patient amounted to a serious crossing of Professional Boundaries. JJ had said that he had never come across this before. It was the judgement of the Panel that this behaviour was serious and amounted to misconduct.

77. In relation to Particular 1(d), the Panel concluded that the sending of the texts clearly fell far below the standards expected of a registered paramedic in the circumstances, particularly bearing mind the personal and unprofessional tone of the texts concerned. The Panel concluded that this behaviour amounted to misconduct.

78. In relation to Particular 2, the Panel concluded that it was clear that there was scope for difficulty encountered by the practitioner in supplying these details. The Panel noted that there was no specific dropdown box for the recording of the offering of a chaperone on the relevant form. It had been left to the Registrant to make a record in free text. In those circumstances the Panel concluded that whilst the Registrant’s failure to record the offering of a chaperone had not been best practice, this was not so serious as to amount to misconduct.

79. In relation to Particular 3, the Panel concluded that leaving Patient A exposed from the waist up, without offering her the opportunity of covering herself, for a period of time that was inappropriately long, was serious and amounted to misconduct.

80. In relation to Particular 4, the Registrant had given evidence that he had disliked the new electronic method of recording, and that he had struggled with it, preferring instead the old paper system. The Panel took account of this, together with JJ’s evidence that there had been teething problems with the new electronic method of recording, and that others had also omitted the pain score on the form. In these specific circumstances the Panel concluded that the Registrant’s lack of recording was not so serious as to amount to misconduct.

81. In conclusion therefore, the Panel found that the Registrant’s behaviour as found proved in Particulars 1(a), 1(c), 1(d) and 3 amounted to misconduct, but that 1(b), 2 and 4 did not.

Impairment

The Registrant’s evidence and submissions

82. The Panel was provided with a bundle of documentation in support of the Registrant, which included:

  • 10 letters of thanks from members of the public
  • Positive testimonials from 6 fellow paramedics, describing the Registrant in such terms as “very professional competent and hard-working”; “an excellent paramedic”; “always….acting in the best interests of the patient”; and “kind and compassionate attitude”
  • A Learning and Development Review conducted by the Trust, dated 26 July 2018, describing the Registrant as a “knowledgeable and highly dedicated paramedic who carries out his duties to a very high standard”
  • A Certificate in Introduction to Coronavirus disease dated 13 May 2020
  • An undated Certificate in Covid 19 Clinical Readiness Course.
  • A Certificate for a Minor Surgery Distance Course dated 8 September 2020
  • A Certificate in Nursing Studies dated 2 July 2020 and a further Certificate in Nursing Studies dated 3 July 2020
  • A Certificate in Professional Boundaries in Health and Social Care Level 2 dated 23 September 2020
  • A document written by the Registrant entitled “Reflective Essay on Professional Boundaries and Patient Care” in which the Registrant accepted that he had crossed professional boundaries in relation to Service User A. That document included the following:

“During the incident …I …allowed myself to become too involved with my patient, yes the patient was pleasant to me and was happy to talk but as a professional I should have steered the relationship in a manner that remains professional. I failed in this on the night in question and by crossing the zone of helpfulness have caused distress to my patient and myself.”
“It is only through the growth of reflective practise that I fully understand that as a health care professional who interacted with a member of the public, I did indeed cross those boundaries”.
“Regardless of the patients actions I crossed a line from professional to friendship, I became over involved in someone’s care and wellbeing in turn becoming too involved. This is not affective care, and it should not have happened. In reality it is hard to maintain such boundaries all the time however this is what makes us professional and allows us to work in an environment that is safe for us as clinicians and for the patients we serve”.
“After two years of reflection both heart felt and academically, I fully understand that my action surrounding this patient where [sic] not of the high standard set out by my local ambulance service or the Health & Care Professions Council.”
“I fully except [sic] that I crossed a professional boundary with this patient and have learnt from this experience in order to re-assure myself that I will never put myself or anybody that I may care for in the future in this situation”
“I have learnt from this incident on so many levels, I have replayed this situation on a thousand different occasions remarking to myself about all the things I would do differently, this being said I cannot change the circumstances of these events but I can learn from them”.
“I have learnt from these mistakes and will continue to every day so I can grow”.
“I am accountable for my actions and I as a clinician need to learn from them. I will never put myself or any member of the public in this situation again”.


83. The Registrant gave further evidence. He explained that he moved to Malta in 2018. After a brief period of unemployment he worked at a Covid-19 testing drive through centre, and then secured employment in the emergency care unit of a private hospital in a health care assistant’s capacity. He said that he had been given the opportunity to work as a clinician but had declined that offer as he felt it would be inappropriate whilst this hearing was pending. He said that if permitted to remain on the Register, he would continue to reside in Malta for another 5 years due to family commitments, although he would aim to return to the UK during this time on an ad hoc basis to work as a paramedic which would help to keep his practice up to date.


84. The Registrant said that he fully understood that parts of the Allegation had been proved. He said he “had no objection to that”. He accepted that he had made a mistake. He said he had felt a connection with Patient A because she had a member of her family in the Service. He accepted that he had crossed a boundary. He submitted that he was not a risk to the public. He assured the Panel that he would not repeat his actions. He said that there was nothing more important to him than being a paramedic and caring for people in their time of need. He said that if he made Patient A feel uncomfortable then he was “massively sorry” and felt “devastated”. He said that this was something that he would have to live with for the rest of his life. He said that he had given up a full time job to pursue his career as a paramedic and he just wanted to look after his fellow man. He asked to be given the opportunity to make a difference to people’s lives. He said that he was sorry that he let himself, his profession and his regulator down on the day of the incident.

HCPC Submissions

85. Ms Lykourgou submitted that the Registrant’s fitness to practise was currently impaired by reason of his misconduct. She submitted that the Registrant’s conduct, in leaving Patient A exposed for an inappropriate length of time, had placed Patient A at risk of distress. She submitted that the Registrant had failed to behave in a professional manner and had brought the profession into disrepute. She submitted that he lacked insight. She also submitted that public confidence in the profession would be undermined if there were to be no finding of impairment in the circumstances.

Legal Advice on Impairment

86. The Panel accepted the advice of the Legal Assessor who advised the Panel to consider the criteria set out in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Paula Grant [2011] EWHC 927, namely whether the Registrant:

  • Has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or
  • Has in the past and/or is liable in the future to bring the profession into disrepute; and/or
  • Has in the past breached and//or is liable in the future to breach one of the fundamental tenets of the profession
  • Has in the past acted dishonestly and/or is liable in the future to act dishonestly.

87. The Legal Assessor advised the Panel, in accordance with the case of Cohen v General Medical Council [2008] EWHC 581, to ask whether the Registrant’s misconduct is easily remediable, whether it has in fact been remedied and whether it is highly unlikely to be repeated. She advised the panel to examine whether the Registrant had demonstrated adequate insight into his past misconduct. In accordance with the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Paula Grant [2011] EWHC 927 she advised the panel to consider not only whether the Registrant presents a risk to members of the public, but also whether the need to uphold proper professional standards, and whether public confidence in the Registrant and in the profession and its regulator, would be undermined if a finding of impairment of fitness to practise were not made in the circumstances of this case. She encouraged the Panel to consult the Practice Note issued by the HCPTS entitled “Finding that Fitness to Practise is Impaired”.


Decision on Impairment

88. The Panel accepted the advice of the Legal Assessor

89. The Panel concluded that the Registrant had breached a fundamental tenet of his profession. However the panel concluded that the Registrant’s misconduct was capable of remediation. It also concluded that the Registrant had remediated his misconduct, through the completion of relevant online courses, together with his work in the healthcare sector.

90. In considering the issue of insight, the Panel reminded itself that the Registrant had entered formal Admissions to Particulars 1(a), 1(c) and 1(d) at the outset of the hearing, and that whilst he had denied Particular 3 when the Allegation had been put to him, he went on to make full admissions to this Particular in his oral evidence (see paragraph 53 of this decision). On the basis of the Registrant’s evidence, both at the fact finding stage and at this impairment stage, the Panel was satisfied that the Registrant had developed adequate insight into his past misconduct. It was clear that he had developed a genuine understanding of how he had crossed professional boundaries, and why his behaviour had been inappropriate in the circumstances of the case.

91. The Panel concluded that the Registrant’s misconduct amounted to an isolated episode in an otherwise unblemished career, from which the Registrant had learnt his lesson.

92. In those circumstances the Panel concluded that the risk that the Registrant would repeat his misconduct was low.

93. The Panel concluded that the Registrant’s fitness to fitness to practise was not currently impaired on the personal component.

94. In considering the public component, the Panel concluded that the Registrant’s misconduct had brought the profession into disrepute. The Panel concluded that a reasonable member of the public, on hearing that the Registrant had left the top half of a female patient’s body entirely uncovered for an inappropriate length of time, and had then gone on to ask for her telephone number, purchase chocolate for her, and contact her on more than one occasions by text, would expect a finding of impairment to be made. The Panel concluded that a finding of current impairment was required to maintain standards and confidence in the profession and in the HCPC.

95. Accordingly, the Panel concluded that the Registrant’s fitness to practise is currently impaired on the public component.

Sanction

Submissions

96. Ms Lykourgou urged the Panel to consult the Sanctions Policy. She submitted that sanction is a matter for the judgement of the Panel. The Panel noted from the oral and written submissions of the HCPC as follows: “If the Panel find that the Registrant demonstrates a genuine commitment to resolving the concerns raised and the Panel has confidence they will do so, a conditions of practice order may be appropriate in this case (para 107), if not, then a more serious sanction such as suspension or strike-off may be appropriate”.

97. The Registrant left the issue of sanction to the judgement of the Panel. He said that if the Panel wished to impose Conditions of Practice, he would be willing to abide by them.

Legal Advice

98. The Legal Assessor encouraged the Panel to consult the Sanctions Policy issued by the HCPC. She advised the Panel to consider any mitigating or aggravating features of the misconduct. She reminded the Panel to act proportionately, and to remember that the purpose of sanction is not to be punitive, but is to protect the public and to maintain and uphold standards and confidence in the profession and its regulator.

Decision on Sanction

99. The Panel began by identifying the aggravating and mitigating factors in the case.

100. The Panel found, by way of aggravating factors, that

  • the Registrant had abused his professional position and breached professional boundaries by seeking a friendship with Patient A; and
  • Patient A was a vulnerable patient by virtue of the fact that she was anxious and in pain at the time when the Registrant first had contact with her (1 December 2017).

101. The Panel took into account, by way of mitigation:

  • the Registrant’s previously unblemished record
  • the positive testimonials submitted on his behalf
  • the remorse expressed by the Registrant from an early stage of the Trust’s internal disciplinary proceedings
  • the Registrant’s admission to the allegations
  • the Registrant’s heartfelt apology
  • the Registrant’s remediation in the form of online courses and his reflective statement
  • the Registrant’s insight, as demonstrated in his reflective statement and his oral evidence before the panel.

102. The Panel considered the issue of sanction, beginning with the least restrictive.

103. The Panel concluded that to take no further action would be neither appropriate nor proportionate as it would fail to maintain and uphold confidence in the profession and proper standards of conduct and behaviour.

104. The Panel considered a Caution Order. In examining the suggested factors set out in the Sanctions Policy, the Panel was mindful that sexual motivation was not alleged in this case. That said, the Registrant had breached professional boundaries by seeking the friendship of a patient, and it was the judgment of the Panel that this behaviour could not be described as relatively minor in nature. However the Panel concluded that all the other factors listed in the Sanctions Policy suggestive of a Caution Order were present. The Panel had already concluded that the misconduct amounted to an isolated episode, and had been limited to one patient. The Panel had concluded that the risk of recurrence was low. The Registrant had demonstrated remorse, and had undertaken appropriate remediation by undertaking relevant online courses and providing a detailed reflective statement. The Panel was satisfied that he had demonstrated genuine insight into his misconduct.

105. In those circumstances the Panel concluded that a Caution Order was the appropriate and proportionate sanction.

106. The Panel gave consideration to a Conditions of Practice Order but concluded that meaningful Conditions could not be drafted in light of the nature of the concerns in this case and the role of a Paramedic.

107. The Panel concluded that a period of Suspension would be disproportionately harsh in light of the mitigating features in the case.

108. In considering the length of the order, the Panel concluded that a 1 year Caution Order would be insufficient to mark the seriousness of the misconduct. The Registrant had breached a fundamental tenet of his profession. The public had a right to expect that paramedics will respect professional boundaries when carrying out their duties, particularly whilst working work alone and in a domestic setting. The Panel concluded that the public interest demands a 2 year Caution Order in the circumstances of this case.

109. Accordingly, the Panel decided to impose a Caution Order for a duration of 2 years.

Order

ORDER: That the Registrar is directed to place a Caution Order against the name of Mr Kieron Galton on the Register for a period of 2 years, commencing on the date this order comes into effect.

Notes

Right of Appeal

You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

Under Article 29(10) of the Health and Social Work Professions Order 2001, any appeal must be made within 28 days of the date  when this notice is served on you.  The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Hearing History

History of Hearings for Mr Kieron M P Galton

Date Panel Hearing type Outcomes / Status
16/12/2020 Conduct and Competence Committee Final Hearing Caution
09/11/2020 Conduct and Competence Committee Final Hearing Adjourned part heard