Mr Maksym Wojcieszek

Profession: Paramedic

Registration Number: PA43411

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 11/02/2020 End: 17:00 14/02/2020

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Whilst registered as a Paramedic and working for East Midlands Ambulance Services (“EMAS”):

1.On or around 25 October 2017 during a ‘ride out review’ you:

a. did not have the underpinning knowledge to complete an adequate patient assessment;

b. had poor ECG recognition skills;

c. did not take into account or understand all information given by a patient in relation to the presenting complaint.

2. On or around 20 November 2017 during an assessment day, you failed to:

a. identify and manage a time critical patient effectively;

b. adequately carry out scene safety assessments;

c. consider reversible causes of cardiac arrest / paediatric arrest;

d. use Capnography during a cardiac arrest;

e. conduct adequate pulse checks on a patient;

f. consider the seriousness of a patient not having passed urine for two days;

g. consider the Paramedic pathfinder and/or NEWS Score for a patient with a history of productive cough;

h. consider using a sepsis toolkit for a patient with a history of productive cough;

i. give 5 rescue breaths prior to placing pads on the chest in a paediatric arrest.

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

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

Finding

Preliminary Matters
Service
1. The notice of hearing was sent to the Registrant by post on 28 October 2019 to the address provided by him for the purpose of his HCPC registration. A copy was also sent on the same day to him by email. The Panel took into account that a notice of hearing may properly be served on a Registrant by post in accordance with rule 3 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003. The Panel was satisfied there had been good service of the notice of hearing.

Proceeding in absence
2. There was no attendance by or on behalf of the Registrant. In an email dated 9 September 2019 sent by the Registrant to the HCPC the Registrant said:

“Thank you for the email.

Over the past year, I have not received any support from my employer (EMAS) regarding to my registration. I tried to get some help many times at different levels but without success.

Over last (sic) two years I done a lot of hours as a Paramedic in EMAS and for others, and I finished many of courses and trainings to keep my HCPC number (you have all this info).

But I give up - I feel very bad regarding to this LONG process - On the last month I didn’t pay fee to re-fresh my HCPC.

I don’t have the strength anymore – please make the right decisions without me.

Kind regards
Maksym Wojcieszek”.

3. The Panel took into account the HCPTS Practice Note Proceeding in the Absence of the Registrant. There is a public interest in these proceedings being dealt with by reasonable expedition. Four witnesses had made arrangements to be present to give evidence in support of the HCPC case. The Registrant had chosen not to attend the hearing. There was no indication that he would attend on a future occasion if the hearing were adjourned. The Panel took into account that to proceed in the absence of the Registrant would be to his disadvantage. However, the Panel concluded, after weighing all of the relevant factors, that the fair step was to continue in the absence of the Registrant.

Background
4. The Registrant was employed as a band 5 Paramedic by East Midlands Ambulance Services (“EMAS”) from 27 March 2017 until 25 January 2018. During his employment he had regular probation reviews, however concerns about his competence were identified.

5. EMAS decided to examine those concerns further by means of a “ride out review” on 25 October 2017 and an assessment day on 20 November 2017. The ride out review was conducted by Witness 1. The assessment day was conducted by Witness 2 who was supported by Witness 3. Both events identified continuing concerns regarding the Registrant’s ability to practise safely.

6. During a probation review meeting on 21 November 2017, it was decided that the Registrant’s probationary period would need to be extended and an action plan was given to him. Thereafter, there were continuing concerns regarding the standard of the Registrant’s practice. On 19 January 2018 the Registrant attended a probationary review meeting chaired by Witness 4. At that meeting a decision was taken to terminate the Registrant’s employment with effect from 25 January 2018. However, following the Registrant’s appeal against his dismissal, the Trust decided to offer alternative employment to the Registrant and he was offered a place on an Ambulance Technician Associate Ambulance Practitioner course due to start on 23 April 2018. The Registrant accepted that offer of further employment.

The Hearing
7. The Panel heard evidence from four witnesses in support of the HCPC case:
Witness 1 -         Clinical Support Manager
Witness 2 -         Clinical Support Manager
Witness 3 -         Clinical Support Manager
Witness 4 -         Service Delivery Manager

Decision on Facts
8. The Panel has taken into account the advice of the Legal Assessor and all of the documentary material contained in the HCPC bundle together with:

(i) a chronology provided by Mr Bridges
(ii) emails from the Registrant dated 17 April 2018, 19 June 2019, 9 September 2019 and 3 December 2019
(iii) the documentary material provided by the Registrant to the Investigating Committee of the HCPC (“the IC material”).

9. The HCPC has the burden of proving the asserted facts on the balance of probabilities.

10. The Registrant has relied on the IC material as showing that there have been a number of occasions when he has been assessed by various EMAS mentors as carrying out his paramedic duties in an appropriate and acceptable manner. The Panel has examined all of that material but has concluded that whilst the IC material does give examples of the Registrant operating in an acceptable manner on various occasions, that material does not carry the same weight as the assessments carried out by Clinical Support Managers during the ride out and the assessment day. That is because the ride out and the assessment day provided occasions when the Registrant’s practice could be observed by senior paramedic staff over a continuous, extended period of practice during which time practical skills, relevant to safe paramedic practice, were examined and assessed. The ride out and the assessment day both provided a much more in-depth examination of the Registrant’s paramedic abilities than the brief feedback from mentors. They were a more reliable method of assessing the Registrant’s ability to consistently provide autonomous, safe and effective practice.

11. The Panel made findings on each of the asserted facts as set out below.

Particular 1 – found proved
On or around 25 October 2017 during a ‘ride out review’ you:
a. did not have the underpinning knowledge to complete an adequate patient assessment;

b. had poor ECG recognition skills;
c. did not take into account or understand all information given by a patient in
relation to the presenting complaint.

12. The ride out review was conducted by Witness 1. Witness 1 travelled with the Registrant throughout a 12 hour ambulance shift and observed how the Registrant carried out his paramedic duties. Although Witness 1 held overall clinical responsibility, he allowed the Registrant to lead assessments of patients in order to evaluate the Registrant’s knowledge and skills.

13. By the end of the ride out Witness 1 had concerns regarding the Registrant’s clinical ability in:

(i) obtaining a patient’s medical history and making an adequate assessment
(ii) making an accurate clinical decision on the basis of information obtained from a patient
(iii) understanding the basic principles of electro cardiogram recognition.

14. During the ride out day, the Registrant completed a Training Needs Analysis  in which he accepted that his skills or knowledge in connection with the following topic areas needed refreshing:

(i) Cannulation
(ii) External jugular vein cannulation
(iv) Intraosseous cannulation
(v) Intubation
(vi) Needle cricothyroidostomy
(vii) Needle thoracocentesis
(viii) ECG recognition

15. The Registrant has not denied this particular. The evidence from Witness 1 was clear and supported in part by documentation. The Panel finds this particular to be proved in full.

Particular 2 – found proved except Particular 2(b)
2. On or around 20 November 2017 during an assessment day, you failed to:
a.     identify and manage a time critical patient effectively;
b.    adequately carry out scene safety assessments;
c.    consider reversible causes of cardiac arrest / paediatric arrest;
d.    use Capnography during a cardiac arrest;
e.    conduct adequate pulse checks on a patient;
f.     consider the seriousness of a patient not having passed urine for two days;
g.    consider the Paramedic pathfinder and/or NEWS Score for a patient with a history of productive cough;
h.   consider using a sepsis toolkit for a patient with a history of productive cough;
i.     give 5 rescue breaths prior to placing pads on the chest in a paediatric arrest.

16. The assessment day took place on 20 November 2017 and was conducted by Witness 2 who was supported by Witness 3. The assessment required the Registrant to deal with four simulated patient scenarios. In each case he was given a fictional medical background and was required to deal with each patient as a competent Paramedic.

17. The Panel has received direct evidence from Witness 2 and Witness 3 on the Registrant’s performance during the various assessments. This particular has not been disputed by the Registrant. The Panel has accepted the evidence of the two witnesses as reliable.

18. One of the checks during the assessment was whether the Registrant would first “adequately carry out scene safety assessments” as he approached each simulated “scene”. The two witnesses carrying out the assessment formed the view that the Registrant had not carried out such an assessment. They did so on the basis that he made no comment to the effect that he had done so.

19. However, the relevant sub-particular at 2b asserts simply that the Registrant “failed to adequately carry out scene safety”. There is no evidence that either witness asked the Registrant if he had carried out a scene safety assessment. Witness 3 conceded during oral evidence, that it was possible that the Registrant had carried out the necessary scene safety assessments by observation, but that he had not demonstrated that he had done so. The Panel’s conclusion on this point is that the HCPC has not shown, on the balance of probabilities, that the Registrant did not carry out scene safety assessments. Accordingly, the Panel finds that this sub-particular is not proved.

20. However, the conclusion of the Panel is that each of the other sub-particulars within particular 2 is proved. The evidence from both Witness 2 and Witness 3 has been clear. Each of them provided, separately, a written report at the end of the assessment day in which they gave a detailed account of areas of practice in which the Registrant failed to demonstrate that he was a competent Paramedic. Both witnesses recorded that in respect of each of the sub-particulars now being considered by the Panel, the Registrant failed to carry out the task in a proper manner. The Panel treats the evidence of both witnesses on these points as clear and has concluded that all of the sub-particulars other that sub-particular 2(b) are proved.

Decision on Grounds
21. On the basis of the case of Roylance v GMC [2011] 1 AC 311 the Panel has taken misconduct to mean a serious act or omission which falls short of what is proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a registered practitioner in the particular circumstances.

22. On the basis of the case of Calhaem v General Medical Council [2007] EWHC 2606 (Admin) the Panel has taken lack of competence to mean a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the Registrant's work.

23. The Panel has taken into account all of the background circumstances. At the time of the Registrant’s appointment by EMAS, EMAS was running a recruitment programme in which their staff would visit Poland to assess and select individual Polish Paramedics who were suitable for paramedic practice in the UK. Persons appointed under that scheme travelled to the UK and undertook an EMAS adaptation process intended to properly familiarise and train those persons in UK paramedic practices.

24. The Registrant is a citizen of Poland. In approximately 2011 he qualified as a Paramedic in Poland. He worked in that capacity for about 6 months. He then subsequently came to the UK and, whilst in the UK, applied to EMAS for appointment as a Paramedic. That application for employment was made at a time when the Registrant had only about 6 months prior experience as a Paramedic during the previous 6 years. Because the Registrant was not recruited in Poland he was not assessed in Poland by EMAS staff before being invited for employment and admission to the adaptation process.

25. During a probation review meeting on 19 January 2017 (D4) the Registrant said that as a Paramedic in Poland he was trained to perform certain skills, but he was usually with a doctor who decided when those skills should be used. During the assessment day he accepted that he had previously said he could not see the point of having “anatomy and physiology knowledge”.

26. Within 3 months of starting his employment with EMAS on 27 March 2017, there were concerns amongst EMAS staff as to the Registrant’s competence. The Panel is satisfied that the Registrant was a conscientious employee who was trying to do his best to fulfil his duties. His failure to perform, (in the eyes of EMAS), to an adequate standard was, in the Panel’s view, because of his very limited practical experience in Poland when he was working in a paramedic environment which required a much more limited area of expertise and autonomy compared with UK paramedic practice. In addition, the duration of his past paramedic employment in Poland had been very limited.

27. The Panel is satisfied that the Registrant’s failure to operate at a competent level was not because he was failing to use skills that he already had. It was as a result of the Registrant not having previously been trained to the level required of a UK Paramedic. The adaptation training offered by EMAS did not, for whatever reason, adequately meet the gap in the Registrant’s skill level.

28. The Panel has concluded that it cannot reasonably be said that the Registrant’s failings amounted to misconduct. The failings clearly amounted to a lack of competence alone.

29. The Panel finds that the Registrant’s failings amount to breaches of paragraphs 1, 3, 4, 8, 12 and 13 of the HCPC Standards of Proficiency for Paramedics (September 2014):
1. Be able to practise safely and effectively within their scope of practice
3. Be able to maintain fitness to practise
4. Be able to practise as an autonomous professional, exercising their own professional judgement
8. Be able to communicate effectively
12. Be able to assure the quality of their practice
13. Understand the key concepts of the knowledge base relevant to their profession

Decision on Impairment
30. The Panel has to make an assessment of the Registrant’s fitness to practise as at today’s date. The Panel has taken into account the HCPTS Practice Note on Finding that Fitness to Practise is Impaired, which emphasises that the fitness to practise process is about public protection. A Panel must take into account the personal component, which includes the current competence and behaviour of the Registrant, and the public component, which includes protecting service users, declaring and upholding proper standards of behaviour and maintaining public confidence in the paramedic profession.

31. On the day of the assessment, both Witness 2 and Witness 3 separately sent an email to a senior officer giving their separate personal view on the Registrant’s performance during the assessment. They both concluded that the Registrant would not be safe to practise as an autonomous paramedic.

32. On 26 September 2017, Witness 2 conducted a probationary period review meeting with the Registrant. Witness 2 recorded “(the Registrant) identifies and agrees that there are barriers that he still has to overcome and is cautious going forward”. Later in the record, Witness 2 noted “(the Registrant) is six months into his development program and recognises that there are still barriers he has to overcome before he can be signed off as competent. He is working hard and is engaging with colleagues and his mentor. Clinically he is not reaching the standards expected of a paramedic”.

33. The Panel takes into account the guidance given by Dame Janet Smith in her Fifth Shipman Report and, in particular, one of the examples where a decision maker might conclude that a registrant is unfit to practise. That is, where it considers that 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”. The Panel is satisfied that that applies in this case.

34. The Panel has taken into account the IC material but, as previously commented above, that material does not carry as much weight as the witness evidence and supporting documentation provided at this hearing. The Panel is satisfied that the failings on the part of the Registrant, as identified in the particulars, amount to a serious lack of competence. They were wide ranging and included many of the basic and core skills expected of a registered Paramedic. The failings occurred over two years ago. There is no information from the Registrant as to any insight or remediation there has been on his part. There is nothing to show that the Registrant has carried out paramedic duties to an acceptable professional standard since his paramedic post with EMAS was terminated. In the absence of evidence that the Registrant has taken action to improve his paramedic competence to an acceptable standard the Panel has concluded that the Registrant’s fitness to practise as a Paramedic is currently impaired on both the personal and public components.

Decision on Sanction
35. The Panel has taken into account the advice of the Legal Assessor and the HCPC Sanctions Policy. The primary function of any sanction is to protect the public. The considerations in that regard include:
• any risks the Registrant might pose to those who use or need his services
• the deterrent effect on other Registrants
• public confidence in the profession concerned and in this regulatory process.

36. Any sanction should be a proportionate balance between the competing interests of the Registrant to practise as a Paramedic and the HCPC’s overriding objective to protect the public.

37. The Panel has considered the mitigating and aggravating features in in this case as follows:

Mitigating
• The Registrant was always committed to his duties.
• There was a skills gap between the level of skill expected from a Paramedic registered in Poland and a Paramedic registered in the UK. For whatever reason, the training received by the Registrant on his appointment to EMAS did not sufficiently prepare him to operate as a competent UK Paramedic.

Aggravating
• There was a serious risk to patient safety because the Registrant was operating far below standards of competence.
• The Registrant has not demonstrated insight or remediation.

38. The failings on the part of the Registrant are too serious to allow the Panel to make no order or a Caution Order. This is not a case where Mediation would be appropriate.

39. The Panel has considered whether a Conditions of Practice order would be appropriate. Such an order is likely to be appropriate where a Registrant has insight, the failure or deficiency is capable of being remedied, there are no persistent or general failures, appropriate, proportionate, realistic and verifiable conditions can be formulated and the Panel is confident the Registrant will comply with the conditions.

40. The Panel cannot be confident that any of those factors are present in this case. Even if Conditions of Practice could be formulated they would be restrictive of the Registrant’s practice as to amount to a Suspension Order.

41. Because the Panel has made a finding of lack of competence rather than misconduct, a Striking off Order is not available in this case.

42. The failings on the part of the Registrant represent a serious breach of HCPC Standards of Conduct. The failings were apparent over an extended period of time. Given the lack of demonstrated insight and remediation on the part of the Registrant and the serious nature of the Registrant’s failings, the Panel has concluded that the only realistic and proportionate order is a Suspension Order to run for 12 months. The Panel is satisfied that a Suspension Order of 12 months is necessary to give the Registrant an adequate opportunity to undertake suitable remediation in respect of the failings found by the Panel.

43. The order will be reviewed by a different Panel before it expires. That review will take place within a hearing. It will assist a future Panel dealing with the review if the Registrant were to attend that hearing.

44. This Panel considers that any future reviewing panel would be assisted if the Registrant were to provide that Reviewing Panel with:

• written testimonials or references from a registered Paramedic line manager or supervisor of the Registrant which comment on the Registrant’s standard of work and his ability to meet the practice requirements of a Paramedic, so far as he can whilst being suspended.

• written detail of any training undertaken by the Registrant in relation to paramedic practice with particular regard to the Registrant’s practice failings identified in this decision.

Order

The Registrar is directed to suspend the registration of Maksym   Wojcieszek for a period of 12 months from the date this Order comes into effect.

Notes

Interim Order
Proceeding in absence
1. The Panel was satisfied that the Registrant had been given adequate notice in the notice of hearing dated 28 October 2019 that if the Panel were to find the case well founded and went on to make a sanction which removes, suspends or restricts the right to practice the Panel may consider an interim order.

2. The Panel considered whether it was fair to proceed in the absence of the Registrant. The Panel was satisfied that the considerations taken into account when deciding to proceed with the substantive hearing applied equally when considering this application. The Panel decided to proceed in the absence of the Registrant.

Application
3. Mr Bridges applied for an interim suspension order. He submitted that such an order was necessary in order to provide adequate public protection during the period of any appeal against the Panel’s decision and was otherwise in the public interest.

Decision
4. The Panel has power to make an interim order only where the Panel is satisfied that one or more of the following conditions is satisfied:
• it is necessary for the protection of members of the public
• it is otherwise in the public interest, and
• it is in the interest of the registrant concerned


5. The Panel has taken into account its findings as recorded above. There would be a clear risk of harm to members of the public if the Registrant were permitted to continue in unrestricted practice during any appeal period. It is also in the public interest that the Registrant’s practice be restricted during the appeal period in order to maintain confidence in the Paramedic profession and this regulatory process.

6. To make an Interim Conditions of Practice Order would not provide adequate public protection for the reasons given above.

7. The Panel takes into account that to suspend the Registrant from practice will have significant adverse consequences to the Registrant. However, the Panel has to take into account all relevant factors including public protection. The Panel has concluded that the justified and proportionate outcome is to make an Interim Suspension Order to run for 18 months, so that it covers the period of any appeal process should the Registrant appeal the decision of the panel.

The Panel makes an Interim Suspension/Interim Conditions of Practice Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.

This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

 

Hearing History

History of Hearings for Mr Maksym Wojcieszek

Date Panel Hearing type Outcomes / Status
11/02/2020 Conduct and Competence Committee Final Hearing Suspended