1. The Panel received a bundle of documents from the HCPC comprising a Case Summary, the Notice of Hearing and Exhibits. The Registrant submitted a written statement for the purposes of this hearing.
2. The Registrant is registered with the HCPC as a Paramedic.
3. On 30 August 2017 the Registrant was arrested on suspicion of possessing indecent images of children. On 1 November 2017 the Registrant submitted a self-referral to the HCPC.
4. On 10 November 2017, the Registrant notified the HCPC that he was, at that stage, employed as a registered nurse by Worcester Acute Hospitals Trust. He stated, “Last Paramedic Post: Have only been self-employed, taking ad-hoc work predominantly as an “event paramedic” or on scheduled repatriations.”
5. The Registrant was charged with 4 counts of making and distributing indecent images of children. He pleaded not-guilty.
6. On 10 December 2018 the Registrant was convicted at Birmingham Crown Court of 3 counts of making indecent photographs or pseudo-photographs of children and 1 count of distributing such images. He was sentenced to 18 months’ imprisonment, was placed on the Sex Offender Register for 10 years and was made subject to a Sexual Harm Prevention Order for 5 years.
7. From the remarks of the sentencing judge, it is clear that there were a significant number of indecent images: 98 images, either still or moving, were at category A, the most serious level of image; 74 at category B and 738 at category C. The judge described a specifically aggravating factor in the distributing offence to be the fact that a child in one of the category A images was 2 years old and obviously very vulnerable. It is also apparent from the remarks of the sentencing judge that the Registrant had been accessing the material over a period of around 2 years.
Decision on Facts and Ground
8. The Panel accepted the advice of the Legal Assessor.
9. In his statement to the Panel, the Registrant admitted the fact that he has been convicted of the above offences, although he denied the circumstances that led to his conviction. He stated, “My admission related to the fact of the conviction. My response is not an explicit admission nor inference of guilt. I request that this panel documents verbatim that I maintain my innocence.”
10. The Panel had before it the Certificate of Conviction from Birmingham Crown Court setting out that the Registrant was sentenced to a period of imprisonment of 18 months, having been tried and convicted on indictment for the above offences, on 16 January 2019 and that he would be placed on the Sex Offender Register for 10 years and under a Sexual Harm Prevention Order for 5 years. The Panel has also been provided with a certified copy of the transcript of the sentencing hearing on 16 January 2019.
11. The above documents set out clearly the offences for which the Registrant was convicted and the sentence imposed upon him. On the basis of these documents, which the Panel determined to be reliable evidence of the convictions, and in accordance with Rule 10(1)(d) of the Heath and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003, the Panel finds that the HCPC has discharged the burden of proving that the convictions were recorded against the Registrant. Accordingly the Panel finds the fact of the conviction proved.
12. No separate consideration arises in relation to the statutory ground, as it is the fact of the conviction.
Decision on Impairment
13. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of the conviction.
14. The Presenting Officer outlined the background facts of the conviction and submitted that the Registrant has breached Standard 9 of the HCPC Standards of Conduct, Performance and Ethics and that his behaviour fell far below that expected of a regulated healthcare professional. The Presenting Officer submitted that the Registrant’s fitness to practise is currently impaired in that the convictions are for serious criminal offences involving children, and the public interest requires that a finding of impairment be made so as not to undermine public confidence in the profession and the regulatory process. She reminded the Panel that the Registrant is still subject to ancillary orders imposed to protect the public, namely a Sexual Harm Prevention Order and is on the Sex Offenders’ Register. She submitted that the relevant considerations in this case are the seriousness of the conviction, the nature of the sentence, the public perception of such criminal offences and of registrants convicted of such offences. The Presenting Officer submitted that the public would be astounded if the Registrant’s fitness to practise was not found to be impaired.
15. The Registrant read a statement to the Panel; the statement of 6 pages was provided to the Panel, which it re-read in the retiring room. He addressed the Panel in relation to his current circumstances and the remaining ancillary orders in place, following his criminal sentence being imposed in January 2019. He told the panel that he self-referred to the HCPC and has engaged fully with both his criminal and regulatory proceedings. The Registrant assured the Panel that he understands the role of the HCPC in relation to public protection and maintaining the integrity of the professions. He said that he accepted that his fitness to practise was “fundamentally impaired” as a result of his criminal conviction.
16. The Registrant stated that he recognised that the safety of children is paramount and that he recognised the ongoing impact of images of abuse. He said that he was “ashamed and embarrassed to have been involved in any way in this matter” and that, “Those that know me well, recognise that this conviction represents such a gross and inexplicable departure from character.” The Registrant told the Panel that, although he understood the role of the Panel today and the fact that it could not go behind the criminal conviction, it was important that he put across his position that he downloaded images of children “inadvertently, without intent, in amongst and whilst downloading other data...I did not commit these offences. My mistake was not reporting such material when encountered. For fear of retribution, I failed my lawful duty.” In terms of ongoing risk that he presents, the Registrant submitted that the ongoing ancillary orders that he is subject to suggest that he is deemed to be “low-risk rather than no risk.”
17. The Legal Assessor reminded the Panel that its role was not to go behind the conviction, nor was it to seek to retry the criminal case. The Legal Assessor advised the Panel that its task was to determine whether the Registrant’s fitness to practise is impaired, based upon the nature, circumstances and gravity of the criminal offences concerned. The Panel should consider whether the Registrant’s actions had brought the Paramedic profession into disrepute or had undermined public confidence in that profession, and if so, whether any sanction needs to be imposed.
18. The Legal Assessor also advised the Panel that it should bear in mind the principle of public protection in its broadest sense. In doing so, the Panel was entitled to adopt a 'retrospective' approach and consider the conviction as if the Registrant were applying for registration with the HCPC.
19. The Panel was advised that it could take into consideration whether the Registrant pleaded guilty to the offences and if he did, at what stage in the criminal proceeding proceedings. A guilty plea entered at the first reasonable opportunity is indicative of greater insight on the part of the Registrant than one entered at the last moment.
20. The Legal Assessor also advised the Panel to have regard to the sentence received, but also to bear in mind that the sentence imposed is not necessarily a good indicator of the seriousness of the offences when considered in a regulatory context. This is because the prime consideration of regulatory tribunals is the protection of the public and of the wider public interest. As Dame Janet Smith noted in the Fifth Shipman Inquiry Report,
“The fact that the court has imposed a very low penalty or even none at all should not lead the [regulator] to the conclusion that the case is not serious in the context of [its own] proceedings The role of the [regulator] in protecting [service users] involves different considerations from those taken into account by the criminal courts when passing sentence. What may well appear relatively trivial in the context of general criminal law may be quite serious in the context of [professional] practice.”
Decision on Impairment
21. The Panel recognised that there is no burden or standard of proof and that this is a matter for its independent judgment. The Panel has taken into account the HCPTS Practice Notes ‘Conviction and Caution Allegations’ and ‘Finding that Fitness to Practise is Impaired.’ It has accepted the advice of the Legal Assessor. In reaching its decision, the Panel had regard to all the evidence before it. It took account of the submissions of both parties.
22. The Panel’s task is to determine whether the Registrant’s fitness to practise is currently impaired, based upon the nature, circumstances and gravity of the offences concerned. The Panel adopted the approach formulated by Dame Janet Smith in her fifth report of the Shipman inquiry by asking itself the following questions:
“Does the Registrant’s conviction, and the facts relating to the conviction show that his fitness to practise is impaired in the sense that he:
a) has in the past acted and/or is liable in the future to act so as to put patient or patients at unwarranted risk of harm; and/or
b) has in the past brought and/or is liable in the future to bring the paramedic profession into disrepute; and/or
c) has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the paramedic profession?
d) has in the past and/or liable in the future to act dishonestly..
23. The Panel concluded that limbs (a) – (c) above were engaged in this case.
24. So far as the personal component is concerned, the Panel acknowledged that the devices on which the images were found were personal items and had no connection with the Registrant’s employment. The Panel, however, agreed with the sentencing judge’s comment that the offences were very serious and noted that there were a significant number of abusive images downloaded over a lengthy period. It also considered the proven charge of distribution of an image involving a child of 2 years old to be very serious. The Panel further noted that, according to the sentencing judge’s remarks, the Registrant had used different email addresses throughout the 2 year period, which the Panel considered to demonstrate a level of pre-meditation. The sentencing judge described the Registrant as being remorseful, appreciating the seriousness of his actions. The Panel noted that the Registrant had pleaded not-guilty in his criminal proceedings and heard from the Registrant during this hearing about his position in that regard.
25. The Panel considered the level of insight shown by the Registrant. On the one hand, he accepted the likely effect on the victims and their families; he also accepted the damage caused to his profession. The Registrant further accepted that a jury had found against him at his criminal trial and he had complied with the sentence imposed. He has not, on the other hand, admitted guilt and has said that he disagrees with the factual findings of the criminal court and denies the circumstances of the conviction. In light of all of the evidence presented to it, the Panel determined that this demonstrated insufficient insight on the part of the Registrant, but, given the seriousness of the matter before this Panel, this is of little relevance.
26. The Panel determined that by this conviction, the Registrant had breached a fundamental tenet of the profession, namely that it is incumbent on members of the profession not to behave in this manner and not to transgress the laws of the land. The Panel determined that the conviction of the Registrant related to very serious criminal offences and had clear implications in terms of the wider public interest in maintaining public confidence in the profession. The Panel determined that other practitioners would consider that the Registrant’s actions were abhorrent and would attract public opprobrium.
27. The Panel determined that the conviction was such that the need to uphold professional standards and public confidence in the professions would be undermined if a finding of impairment were not made. Therefore, Panel determined that the Registrant’s fitness to practise is currently impaired by reason of his conviction.
Decision on Sanction
Submissions on Sanction
28. The Presenting Officer reminded the Panel of the wider public interest in the imposition of a sanction. She submitted that any sanction must be proportionate and that it was important to note that the purpose of a sanction is not to punish the Registrant for a second time. She submitted, however, that the offences for which the Registrant has been convicted are not compatible with him remaining on the HCPC register.
29. The Registrant said that he accepted that, following his hearing at the HCPC today, he will no longer be a Paramedic but that “in my heart, I will always wear green.” He stated, “The panel…must issue a striking off instruction to the registrar for the public to maintain confidence in our profession.”
30. The Panel accepted the advice of the Legal Assessor. She advised the Panel that the full range of sanctions is available to the Panel as this was a case involving a criminal conviction, and she reminded the Panel that it was not to go behind the conviction. She also reminded the Panel of its over-arching objective to protect the public in its broadest sense.
31. The Legal Assessor advised that, whilst the Panel was entitled to take into consideration the sentence that the Criminal Court imposed upon the Registrant, the sentence imposed is not necessarily a good indicator of the type of sanction that should be applied in this case.
32. The Legal Assessor advised the Panel that any sanction it imposes must be the least restrictive sanction that is sufficient to protect the public and the public interest. It should take into consideration the aggravating and mitigating factors in the case. She reminded the Panel that the purpose of a sanction is not punitive, although it may have that effect. The purpose of a sanction is to protect members of the public and the wider public interest, weighing the Registrant’s interest against the public interest.
33. The Panel had close regard to the HCPC’s Sanctions Policy (SP) document in reaching its decision on sanction. It took account of paragraph 79 of the SP which provides, “Sexual abuse of children, whether physical or online, is intolerable, seriously damages public safety and undermines public confidence in the profession. Any professional found to have participated in sexual abuse of children in any capacity should not be allowed to remain in unrestricted practice.” It also paid particular attention to paragraphs 87-89 of the SP, dealing with ‘Offences related to indecent images of children’. Paragraph 89 states, “Any offence relating to indecent images of children involves some degree of exploitation of a child, and so a conviction for such an offence is a very very serious matter. In particular, it undermines the public’s trust in registrants and public confidence in the profession concerned and is likely to lead to a more serious sanction.”
34. The Panel reminded itself that the purpose of a sanction is not to punish. Rather, a sanction should only be imposed to the extent that it is required to protect the public, to maintain a proper degree of confidence in the profession and the regulatory process, and to declare and maintain proper standards among fellow professionals. To ensure this approach the Panel reminded itself to first consider whether its findings require the imposition of any sanction at all. If they do, then the available sanctions must be considered in ascending order of seriousness until one that satisfies the factors already identified is reached. The Panel confirms that it has followed this approach in the present case.
35. The Panel took into account the following aggravating features of this case:
• There was a significant number of images, 910 in total, found in the possession of the Registrant across 3 official categories of such images. A child in one of the category A images was 2 years old and obviously very vulnerable.
• The convictions related to four charges of making/distributing indecent images (still and moving) of children over a two year period.
• Over the course of the offending behaviour, the Registrant used different email addresses in an attempt to conceal the imagery and his actions.
36. The Panel took into account the following as mitigating features of this case:
• Following his conviction and before sentencing, the Registrant reflected upon his conduct and has expressed remorse and regret for his actions, not just for himself and his family but also for his victims.
37. In this case, the aggravating factors significantly outweigh the mitigating factors.
38. In considering the matter of sanction, the Panel started with the least restrictive moving upwards.
39. The Panel first considered taking no action but concluded that, given the seriousness of the criminal offences, this would be wholly inappropriate and insufficient to declare and affirm proper standards of conduct and behaviour, or to maintain public confidence in the profession.
40. The Panel then considered whether to make a Caution Order. The Panel determined that circumstances of the criminal offences are such that a Caution Order is not appropriate for the same reason as set out above.
41. The Panel next considered the imposition of a Conditions of Practice Order. However, this is not a case that is suitable for the imposition of a Conditions of Practice Order. There are no concerns with the Registrant’s clinical practice or competency as a Paramedic. In any case, the serious nature of the criminal offences makes a Conditions of Practice Order inappropriate as a sanction for the same reasons as set out above.
42. The Panel then considered whether a period of suspension would be a sufficient and proportionate response in order to maintain a proper degree of confidence in the profession and the regulatory process, and to declare and maintain proper standards among fellow professionals. The Panel also considered the public interest in allowing a skilled Paramedic to return to practice at the completion of his criminal sentence.
43. Having weighed all the above considerations, the Panel determined that the matter before it was so serious that a Suspension Order, even for the maximum duration, would not be sufficient to maintain and declare proper standards of conduct and behaviour, nor to maintain the reputation of the profession, nor to maintain public confidence in the profession and the regulatory process. This case involves the Registrant possessing and distributing indecent images of children, such that the imposition of a suspension order, even for the maximum duration of one year, would undermine public confidence in the regulatory process as well as in the profession.
44. The Panel therefore went on to consider striking the Registrant’s name off the HCPC Register of Paramedics. The Panel took into account the impact that such an order would have on the Registrant in terms of his finances and his reputation. However, it concluded that this was such a serious departure from the standards of behaviour expected from a Paramedic that only a striking off order would be sufficient to maintain and declare proper standards of conduct and behaviour, to maintain the reputation of the profession, and to maintain public confidence in the profession and the regulatory process. The seriousness of the Registrant’s convictions demands the ultimate sanction of a striking off order.
45. In light of the above, the Panel is satisfied that the appropriate and proportionate response to protect the public and otherwise in the public interest in these circumstances is to make a Striking-Off Order.