Mr David Short

Profession: Paramedic

Registration Number: PA37781

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 13/01/2020 End: 17:00 16/01/2020

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

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

Whilst registered as a Paramedic and employed by East of England Ambulance Service NHS Trust:

1. On 18 October 2018, in response to a C1 emergency call you did not:

a) claim any Road Traffic Exemptions; and/or

b) activate blue lights, or blue lights and sirens, whilst en route to the incident.

2. Your actions at paragraph 1 delayed your response to the C1 emergency

3. On 18 October 2018, you delayed mobilising to an emergency call, in that you queried the categorisation of the call before mobilising and/or did not acknowledge the Mobile Ack button on the MDT until approximately 3 minutes after the call was passed.

4. The matters set out in particulars 1 to 3 constitute misconduct.

5. By reason of your misconduct, your fitness to practise is impaired.

Finding

Preliminary Matters

Application to amend the Allegation

1. At the commencement of the hearing Mr Bridges applied to amend the Particulars of the Allegation, in respect of which notice had been sent to the Registrant on 8 November 2019.

2. He stated that the reason for the application was to better reflect the evidence in the case and to correct and/or amend grammatical errors, which did not result in any significant change to the case as a result. He submitted that there was no prejudice to the Registrant by the application and he had been given notice of it some four months earlier.

3. Ms Lambert indicated that the Registrant had no objection to the proposed amendments and, indeed, she considered they would assist the Panel.

4. The Panel accepted the advice of the Legal Assessor. The Panel decided to accede to the application for the following reasons: reasonable notice of the intention to amend had been given; the Registrant had made no objections to them; the proposed amendments did not materially affect the nature of the Allegation; and they reflected the evidence already disclosed to the Registrant.

Proceeding in Private

5. From time to time during the hearing, both representatives referred to health matters. The Panel decided that the hearing should proceed in private at those junctures due to the fact that reference would be made to the Registrant’s health and personal issues (as disclosed in the papers circulated prior to and during the hearing).

Background

6. The Registrant is a registered Paramedic and, at the relevant times, was employed as a Senior Paramedic Mentor in the North Cambridgeshire Locality of the East of England Ambulance Service NHS Foundation Trust (“the Trust”) from 10 April 2005. He operated out of the Peterborough Ambulance Depot, or “Hub”, in the Emergency Ambulance Response Department.

7. When a person made a 999 emergency call it was picked up by one of three Control Rooms in the area (Bedford, Norwich, or Chelmsford). The call taker asked the person a series of questions, gathering details of what happened prior to the call being made. The answers given by the caller were entered into the Advanced Medical Priority Dispatch System (“AMPDS”).

8. AMPDS then created an algorithm which dictated the category of a call based on the answers given by the caller. The AMPDS system worked like a flow chart; the handler would enter the caller’s answer into the system and this would direct the handler to the next question to ask based on the answer to the previous question. The purpose of the questioning was to assess the condition of the patient and the severity of that condition. At the end of the questions, AMPDS would generate a code based on the answers given. The code was based on the likelihood of serious injury or illness.

9. The Trust Standard Operating Procedure – Deployment Guidelines (Ambulance Response Programme) (“ARP”) dictated how quickly a unit needed to respond to a call based on its categorisation and whether blue lights were required. The response times of the Trust had been set since October 2017. A summary of the ARP was available to all Trust employees on the intranet. Calls were categorised as one of the following:

“Cat 1 – Immediately life-threatening injuries and illnesses. Patients will be responded to in an average (mean) time of seven minutes, and within 15 minutes at least nine out of 10 times (90th percentile).

Cat 2 – Emergency. These will be responded to in an average (mean) time of 18 minutes, and within 40 minutes at least nine out of 10 times (90th percentile).

Cat 3 – Urgent calls and in some instances where patients may be treated in situ (e.g. their own home) or referred to a different pathway of care. These types of calls will be responded to at least nine out of 10 times (90th percentile) within 120 minutes.

Cat 4 – Less urgent. In some instances, patients may be given advice over the phone or referred to another service such as a GP or pharmacist. These less urgent calls will be responded at least nine out of 10 times (90th percentile) within 180 minutes.”

10. Once a call was categorised, the category of call could not change unless the case was assessed by a Control Room Clinician who decided that the categorisation should be changed based on a clinical assessment.

11. Mobilisation time is the period between a unit being allocated to a job and the wheels of their ambulance turning to attend that job. All crew members carried a radio. There were a maximum of two personal radios per ambulance. When a crew were allocated a job their radio would make an alert noise. From that moment, the crew was expected to be on their way to that job within 30 seconds (such time period being dictated by the Trust Mobilisation Standard, valid from 24 July 2013).

12. The Mobile Data Terminal (“MDT”) within the vehicle would make a noise notifying the crew that they had been allocated a job. The data terminal in the ambulance would also show the crew the details of the incident they had been assigned to and would record the time that the crew were allocated the job. The MDT displayed a button that read “Mobile Ack”. When the crew was ready to start travelling to the scene they were expected to press the Mobile Ack button, which would indicate that the vehicle was mobile or would be immediately after being pressed. The MDT would then record the time the button was pressed. The Computer Aided Dispatch (“CAD”) system would recognise that the vehicle was moving even if the Mobile Ack button had not been pressed.

13. The Trust endeavoured to attend all C1 calls within seven minutes and if this target was not met, the times were scrutinised. Mobilisation time and response time are important, as seconds count when a crew is responding to a C1 emergency call.

14. Whilst in his role, on 18 October 2018 the Registrant was allocated to a C1 emergency call. The Registrant’s crew mate was AR, another Registered Paramedic. They had never worked together before, she having been transferred from another Trust a few weeks previously. The call was coded as a C1 in relation to a haemorrhage.

15. The Registrant and AR were allocated the job at 15:34:46. It had been agreed between them that the Registrant would be the driver for the afternoon since AR had been driving that morning. The Registrant arrived at the ambulance before AR. He called Control. The recording of the call indicates that he asked, “what exactly is this haemorrhage?” and, when told that it was a small amount of blood in Patient A’s catheter, asked, “is it strictly a C1?”. Control told him that it was, “unfortunately”, and that they did not agree with it but, “there’s not much I can do about the coding, sorry guys,” to which the Registrant said, “yeah, roger that, mate,” and concluded the call. AR confirmed that she arrived at the ambulance part-way through the conversation.

16. A Paramedic could only assess a patient’s condition once they had arrived on the scene, assessed the patient, and drawn their conclusions based on their observations and clinical assessment.

17. The Panel noted that it was agreed between the parties that the actual distance between the Peterborough Hub and Patient A’s village was just over 21 miles and was in another county.

18. The vehicle tracking records indicate that the ambulance began moving (as in, the wheels began to turn) at 15:37:32, some 2m46s after the initial notification at 15:34:46. However, the Mobile Ack button was not pressed until 15:38:02, some 3m16s after the call had been allocated. Accordingly, the vehicle was not mobilised within the 30-second mobilisation time set by the Trust, which gives rise to the allegation that the Registrant delayed mobilising in answer to this C1 emergency call by calling Control and querying the categorisation of the call.

19. Road Traffic Exemptions (outlined in the Trust’s Driving Standards Policy) allowed crew members to, for instance: travel over the speed limit set by the Highways Agency; travel through red traffic lights as if they were a give way; and use audible warning outside of normal hours (this was the use of sirens and the horn at night).

20. Whether it was appropriate to claim Road Traffic Exemptions, in many cases, depended on the personal judgment of the Paramedic driving the vehicle. The Panel heard that Paramedics were trained in such a way that they were expected to be able to make sound judgment calls based on what they thought was right in light of their experience, confidence, and the presenting circumstances.

21. The use of blue lights was required for all C1 and C2 calls and enabled ambulances to exceed speed limits. This enables ambulances to exceed the speed limit by 20mph.

22. There may be occasions on which a driver would not use blue lights on a C1 or C2 call, these being when it was not safe to do so; for example, if there were road works with no safe space for other road users to give way or pull in safely. In scenarios where it was not safe to proceed for the entire journey on blue lights, the driver was expected to notify Control that they had turned off their blue lights and to relight them when it was safe to do so. It was considered that it would be very rare that it would be unsafe to use blue lights. Whether it was appropriate to use blue lights and or sirens, in many cases, depended on the personal judgment of the Paramedic driving the vehicle.

23. On this occasion, the Registrant did not claim any Road Traffic Exemptions and did not activate the blue lights, or blue lights and sirens, whilst en route to the incident. He did not arrive on scene until 16:19:28 and therefore, after allocation, it took the crew 48m51s to travel to Patient A’s home.

24. Following assessment, Patient A was taken and admitted to hospital, where he stayed overnight.

Decision on Facts

25. In considering this case, the Panel bore in mind that the burden of proving the facts rests upon the HCPC and that the standard of proof is the civil standard of the balance of probabilities. The Panel carefully considered all the evidence presented to it, namely the written and oral evidence of the witnesses detailed below, together with the documentary evidence provided by the HCPC and the Registrant. It also considered the detailed submissions of the representatives and accepted the advice of the Legal Assessor.

26. Notwithstanding that the HCPC’s Procedure Rules do not have a specific provision which indicates that a panel can find allegations proved by simply relying upon the Registrant’s admissions of those allegations, there was likewise nothing in the Rules to prevent it from doing so if it was satisfied that the admissions were made with the benefit of competent legal advice, were not made for reasons of expediency or duress, and that they accord with the evidence before the Panel in relation to that particular. Consequently, the Panel noted that it could take admissions of the factual allegations made by the Registrant into account, particularly where those admissions accord with the evidence before the Panel.

27. The Panel heard evidence from RA, a Leading Operations Manager at the Trust at all relevant times and the Investigating Officer; and from AR, who was, at all relevant times, a Registered Paramedic who accompanied the Registrant in the ambulance when responding to Patient A. The Panel also received into evidence a statement and exhibit bundle from the HCPC. The Panel also heard evidence from the Registrant and received a defence bundle.

28. Before the Panel rose to make its decision on facts, it announced that it intended to listen to the recording of the conversation between the Registrant and Ambulance Control. Before it did so, the representatives and the Registrant listened to the recording and produced an agreed revised transcript of the conversation (part of which had appeared to be inaudible) which amended the Registrant’s initial question to: “Yeah, Control 89, about this job in [redacted], what exactly is the haemorrhage? Over”.

Witness assessment

29. The Panel made the following assessments of the witnesses.

30. It found RA to be knowledgeable and matter-of-fact in her presentation; she readily conceded when something was not within her knowledge or experience. She was balanced (for instance, being fair to the Registrant, describing him as honest) and overall credible.

31. It found AR to be clear and credible in relation to the journey with the Registrant in the ambulance, but her recollection of other (albeit peripheral) parts of her evidence appeared to have been affected by the passage of time.

32. The Panel found the Registrant to be honest, albeit at times his evidence was unfocused. It noted that he had self-referred to the HCPC, he had engaged with the processes of both the Trust and the HCPC, had attended the hearing, and had given oral evidence. Whilst the Panel made allowances for the inevitable stresses of giving evidence, it considered that there was an underlying disconnect between his witness statement and reflective piece with his oral evidence. In particular, he was unable to fully articulate what had influenced his actions on the day of the incident or what relevant training and courses he had undertaken following it.

Decisions on the Particulars

“Whilst registered as a Paramedic and employed by East of England Ambulance Service NHS Trust, you:…”

33. There is no dispute that the Registrant was, at all material times, employed as a Paramedic with East of England Ambulance Service NHS Trust.

Particular 1 – Found Proved

“1. On 18 October 2018, in response to a C1 emergency call you did not:

a) claim any Road Traffic Exemptions; and/or

b) activate blue lights, or blue lights and sirens, whilst en route to the incident”

34. During the course of his disciplinary interview, the Registrant explained that he was particularly concerned on this occasion about a trunk road in the area, the A47, which was used daily by ambulance crews. He said that on this date there were road works and the area was more difficult to drive in, as other road users could not move out of the way of the ambulance due to temporary concrete barriers.

35. The Panel took into account the Registrant’s admissions in respect of Particulars 1(a) and 1(b), which were consistent with the evidence, both live and documentary, before the Panel. In addition, the Panel noted the Registrant’s statement, which accorded with the written and oral evidence of AR and RA.

Particular 2 – Found Proved

“2. Your actions at paragraph 1 delayed your response to the C1 emergency”

36. The Panel took into account the Registrant’s admission in respect of Particular 2, which was consistent with the evidence, both live and documentary, before the Panel.

37. The Panel noted the Registrant’s evidence, which accorded with the written and oral evidence of AR and RA. In reaching its decision, the Panel noted the oral evidence of AR who, although she agreed that the categorisation of the call should not have been C1, nonetheless said that she would have driven with blue lights and sirens where possible. She also said that there was a lot of “stop and start” traffic and if she had been driving she would have informed Control of the delays. However, she could not estimate how much quicker they would have arrived had they been on blue lights and sirens.

38. The Registrant readily acknowledged that he could have made better progress. He explained that he “went with the flow” of traffic and assessed that, had he activated the blue lights and sirens, they might have arrived ten minutes sooner. He emphasised how difficult it was driving on the A47 because of the roadworks, which inhibited flexibility of movement. He also stated that he was “cheesed off” and “annoyed”, partly because he was having to travel to a job which was in another county and the initial responsibility of another ambulance division, and that this “clouded” his judgement. He accepted that there was “a poor bloke at the other end – it was not his fault.”

Particular 3 – Found Proved (in part)

“3. On 18 October 2018 you delayed mobilising to an emergency call, in that you queried the categorisation of the call before mobilising…”

Found Proved

39. The Panel took into account the Registrant’s admission in respect of the first part of Particular 3, which was consistent with the evidence, both live and documentary, before the Panel.

40. The Panel noted that, for part of the call, AR was not in the vehicle, so the Registrant could not have left without her. Furthermore, the call lasted less than a minute and if AR had arrived whilst it was in progress, the delay caused by the Registrant querying the categorisation would have been minimal (possibly less than 40 seconds). As such, on a strict interpretation of the wording of the Particular, his query about the categorisation did delay mobilisation and the Panel find this part of the particular proved on this basis.

“…and/or acknowledge the Mobile Ack button on the MDT until approximately 3 minutes after the call was passed.”

Found Not Proved

41. Notwithstanding the Registrant’s admission to this part of the Particular, the Panel noted that, although the Registrant accepted that he did not press the Mobile Ack button until about three minutes after the call was passed to him, this did not “delay mobilisation” as he had started to drive the ambulance as soon as he had finished the call to Control, since AR had by then arrived. The evidence from both the Registrant and AR, and from the vehicle tracking records, indicated that the vehicle was in motion well before the Mobile Ack button was pressed.

42. In addition, there was some confusion as to whose responsibility it was to press the Mobile Ack button. Both RA and AR stated that the usual allocation of duties was that the person who was not driving had that responsibility, whereas the Registrant believed that it was his responsibility on this occasion.

Decision on Grounds

43. Having found Particulars 1(a), 1(b), 2, and 3 (in part) proved, the Panel went on to consider whether the facts found proved, individually or collectively, amounted to misconduct.

44. The Panel took account of the submissions of Mr Bridges and Ms Lambert, which covered both grounds and impairment.

45. Mr Bridges submitted that not properly responding to a C1 emergency call was a serious failure on the part of the Registrant. He submitted that the Registrant was currently impaired and that the public would be surprised if the Registrant’s acts and/or omissions were not marked by a finding of impairment.

46. Ms Lambert submitted that the Registrant had demonstrated candour and had not sought to deny what was a “huge error of judgement”. She submitted that his emotions clouded his judgement and that he did not act out of spite or vindictiveness. She further submitted that, set within context and given the nature of the allegations and the Registrant’s response, whilst not appropriate it did not cause harm and was at the “lower level of matters”. She said that the Registrant had demonstrated insight, acknowledged his wrongdoing, and reviewed the Trust’s policies, and that he is not impaired.

47. In reaching its decision the Panel exercised its own independent judgement. It accepted the advice of the Legal Assessor.

48. In relation to the remaining part of Particular 3, namely the Registrant delaying mobilising to an emergency call by querying the categorisation of the call before mobilising, the Panel noted that the delay was minimal, since part of the time spent on the call was accounted for by waiting for his colleague AR to arrive. She arrived as the call was concluding, and as soon as the call finished the Registrant began driving. In the Panel’s estimation, the delay was less than 40 seconds. In addition, it was clear from the recording and transcript of the call that, having been advised about the nature of the haemorrhage and, further, having been assured that it was categorised as a C1, the Registrant did not prevaricate or seek to argue the point but immediately concluded the call. The Panel therefore concluded that, by itself, the Registrant’s actions of querying the categorisation did not fall so far below the standards expected of a registered Paramedic as to amount to misconduct.

49. However, in relation to the facts relating to Particulars 1 and 2 (namely failing to activate blue lights, or blue lights and sirens, whilst en route to the incident (or subsequently claim any Road Traffic Exemptions) and thereby delaying his response to the C1 emergency), the Panel considered these failures to be more serious.

50. In reaching a decision, the Panel noted that: this was a one-off and isolated incident; the Registrant was not alone in believing that the condition had been mistakenly categorised as a C1; he had concerns about driving on the A47 at speed, especially due to the roadworks impeding swift progress and easy evasion of the ambulance by other road users; it was impossible for him to have arrived at Patient A’s home within the seven minutes allocated for C1 incidents due to the distance (some 21 miles); and he had some appreciation of the patient.

51. However, the Panel also noted the following: by his own candid admission during his oral evidence, the Registrant was what he variously described as “cheesed off” and “annoyed”, and he “allowed anger to cloud my judgement”; there was no extra urgency in his driving en route since he “went with the flow of the traffic” and “went as slow as the traffic went”; his colleague AR was of the view that there were opportunities for them to make swifter progress; and the Registrant volunteered that he could have shaved 10 minutes off their travel time had he activated the blue lights and sirens in what was a potentially time-critical situation. More importantly, the Panel considered that although this could be seen as a one-off and isolated incident, it nonetheless lasted for a prolonged period, namely around 48m51s from first notification to arrival.

52. Throughout that time the Registrant had the opportunity to constantly reassess the situation and reflect on what he now accepts was his “big error” of judgement. At no point during the journey did he seek to, either directly or via his colleague AR, call Control to inform them blue lights and sirens were not being used, nor did he request the call to be recategorised. The Registrant was well aware of the appropriate procedures to follow for a C1 emergency call and he deliberately flouted them. Moreover, despite saying that he was aware that he was responding to a C1 call and that “it wasn’t [Patient A’s] fault”, he acted in a way which put his interests and irritation before the interests of the patient. In all the circumstances, he was not patient-focused.

53. Taking all these factors into account, the Panel therefore concluded that the Registrant’s actions and/or omissions in this case as set out in Particulars 1 and 2 were sufficiently serious to amount to misconduct.

Decision on Impairment

54. In reaching its decision on impairment, the Panel took account of the submissions of the parties and the advice of the Legal Assessor. It also took account of the December 2019 HCPTS Practice Note “Finding that Fitness to Practise is ‘Impaired’”.

55. The Registrant had asked himself whether he had lived up to the standards expected, had reviewed the Trust’s policies, and had looked at the HCPC’s Standards. He said that now, if he found himself in a similar situation to that on 18 October 2018, he would “just press the button and go”.

56. The Registrant explained what he had learned from his review of the HCPC’s Standards and accepted that he could have communicated better with AR on the day. In relation to managing risk, his initial responses were that he thought the risk on the day was about high-speed driving, but he should have made as much progress as possible. At the heart of his response was that he was “cheesed off”. The Panel considered that the Registrant had little understanding of why the procedures are in place beyond the fact that he must follow them. His responses revealed that he does not fully understand the level of potential harm which could been caused to Patient A by his decision deliberately not to follow the C1 emergency procedures. He accepted that he concentrated on doing what he enjoyed at work (particularly the technical side) and “not on what I should”.

57. The Registrant was asked about the risk of repetition and replied that he had “got it out of my system”. He now had a new crewmate “at last”. He was the senior person in that team and had realised that he had to act in a different way. Beforehand he did not tend to lead, but now he had to set an example and “look out” for those junior to him, particularly as he was a mentor (having been appointed as such well before the incident). This new responsibility “put the brakes on my ungovernable actions” and enabled him to “step back”. Furthermore, the situation at the station was better as there were more clinicians and this enabled him to relax more.

58. The Registrant was asked if he considered whether he had made an error of judgement and replied that he had made a “big error of judgement”. As it was a C1 call, “the lights should have gone on – I allowed my anger to cloud my judgement”. The Registrant agreed that he had driven at the speed he had because he thought that by going quicker and activating the lights and siren he was putting other road users at risk. This was, however, a “decision made in error because I was not happy”. He accepted that he could have speeded up at times.

59. In addition, although he had expressed apologies to a number of people and organisations in his reflective piece, he had not in fact apologised in person to anyone, including Patient A.

60. The Registrant also provided two positive references from work colleagues, including his line manager, both of whom attested to his technical abilities and communication skills.

61. The Panel first considered the ‘personal’ component and the question of whether the acts or omissions which led to the allegation were remediable. It found that the Registrant’s actions were remediable. The Panel took into account that this was an isolated incident (albeit one which lasted almost 50 minutes) in a career spanning some 15 years or more, and the Registrant is of good character. In addition, the Panel concluded that his failings are capable of being addressed by additional training and reflection, particularly since he had, from the start, admitted that he had acted incorrectly and had cooperated with all investigations, thereby demonstrating his willingness to remediate.

62. The Panel next considered whether the Registrant had taken sufficient remedial action. It found that he had taken some remedial action: he stated that he had carried out research to remind himself about the Trust’s policies and the HCPC Standards; he had prepared a written reflective piece; and he had made full admissions and given candid evidence about what he perceived to be his failings. However, in his oral evidence he was unable to expand on how his Action Plan had addressed his failings.

63. In relation to training/Continuing Professional Development (“CPD”) as a result of the incident, the Registrant described various activities which did not have any direct bearing on the issues raised by the incident on 18 October 2018. He had not taken any further training on driving nor on any call categorisation, communication, risk decision-making, and emotional response management. It was clear to the Panel from the Registrant’s responses that his misconduct arose as a result of an emotional reaction by him, and yet he has not undertaken any research or exploration to develop insight in this area.

64. When asked what CPD he thought he needed as a result of this incident, the Registrant said that it would be helpful if he could spend a day in the Operations room to gain an appreciation of what they had to endure so as to better understand their difficulties. However, the Registrant said he would have to do this on his day off and this would be some distance to drive. When asked about relevant development, the Registrant listed two clinical cases of interest to him and routine statutory and mandatory training required by the Trust. All of this, in the Panel’s view, has limited relevance to remediating the Registrant’s misconduct.

65. However, notwithstanding that the Registrant has undertaken some remedial action, the Panel nevertheless found there to be a significant disconnect between what he had written in his written statement and reflective piece with his oral evidence. Although the Registrant accepted that his irritation “clouded his judgement”, he had failed to take this analysis further so as to explain how his judgement was clouded and why he apparently acted with complete disregard to Patient A’s wellbeing and what was a potentially very serious situation (the Registrant having accepted that he would not have been able properly to assess the patient’s health until examining him). The Panel considered that the Registrant’s responses were not patient-focused and did not demonstrate full understanding of the risk of harm to Patient A on that day, which his decision not to follow procedures brought about. The Panel concluded, in these circumstances, that his remediation is wholly inadequate given the seriousness of its findings.

66. In the course of its deliberations, the Panel considered the Registrant’s insight. The Panel noted that the Registrant accepts his behaviour fell below professional standards. However, by virtue of its concerns set out above, the Panel was not persuaded that he fully understands how and why he acted as he did and the consequences, potential or otherwise, for those affected, particularly Patient A. Accordingly, the Panel was led to the conclusion that, until the Registrant is able to show that he has a full understanding of why he acted as he did, there is a risk of repetition. The Panel accepted that the Registrant has stated that in a similar situation in the future he would “put on the lights and go”, but it considered that he has failed to properly articulate why he should act in this fashion or for whose benefit.

67. The Panel asked itself whether the Registrant’s acts or omissions are likely to be repeated. It appreciates that: he has never acted like this in the past and has not acted in this fashion since the incident; he is of good character; there are no concerns about his clinical skills; and he has undertaken some remediation. Taking all these factors into account, the Panel concluded that the Registrant has failed to adequately remediate his failings and therefore there is a likelihood that the misconduct could be repeated. The Panel therefore concluded that the Registrant is still impaired in relation to the personal component.

68. The Panel then moved on to consider the ‘public’ component. Not responding on blue lights and/or blue lights and sirens to a C1 emergency call had the potential for significant patient harm. In the absence of full insight and given that there is a likelihood that the misconduct could be repeated, the Panel considered that the need to declare and uphold professional standards and maintain public confidence in the profession and confidence in the system of regulation would be undermined if a finding of impairment were not made in these circumstances. It considered that an informed member of the public, with full knowledge of all of the circumstances, would be concerned if a finding of current impairment were not made.

69. Accordingly, the Panel concluded that the Registrant is impaired in relation to both the personal and the public components.

Decision on Sanction

70. In reaching its decision on sanction the Panel took account of the submissions of the representatives, the HCPC Sanctions Policy (“SP”) document (bearing in mind that it is a guide and no more), and the advice of the Legal Assessor, which it accepted.

71. Mr Bridges indicated that sanction was a decision for the Panel and that the HCPC did not seek to make any recommendation.

72. Ms Lambert confirmed that the Registrant accepted the findings of the Panel. He recognised that he had fallen short of the standards expected and that on 18 October 2018 he had not been patient-focused. He accepted that further training was needed and in that regard Ms Lambert confirmed that she had, overnight, contacted the Trust, who had agreed to place the Registrant onto a Refresher Emergency Driving course and to have him observe the Control room for a day so that he could better appreciate their difficulties. In addition, the Registrant was willing to provide a written letter of apology to Patient A.

73. Furthermore, the Registrant intended to discuss with his line manager on his next appraisal (known as a “compassionate conversation”) the formulation of a revised Action Plan which would seek to address the issues raised by the Panel in its determination on impairment, namely: (i) the management of emotional responses; (ii) risk decision management: (iii) communication; and (iv) patient-centred care. Ms Lambert submitted that the role of a Paramedic was complex and demanding but that the Registrant had the full support of the Trust. Finally, she confirmed that she was, in essence, leaving the question of sanction to the Panel.

74. The Panel was mindful that what, if any, sanction should be imposed was a matter for its independent judgement. It bore in mind that the purpose of sanctions is not to be punitive, although they may have that effect. It appreciated that the primary purpose of any sanction is to protect the public. It noted that, in reaching a decision, panels must also give appropriate weight to the wider public interest, which includes: the deterrent effect to other registrants; the reputation of the profession concerned; and public confidence not only in the profession but also in the regulatory process. In addition, the Panel noted that it must act proportionately, which requires it to strike a balance between the HCPC’s overriding objective to protect the public and the interests of the Registrant.

75. The Panel was reassured that the Registrant had clearly reflected overnight on the Panel’s earlier determination and is committed to fully remediate and address his failings, with the Trust’s assistance and support.

Mitigating and Aggravating factors

76. The Panel carefully evaluated both the mitigating and aggravating features in this case.

77. The mitigating factors are as follows:

• The Registrant is an experienced Paramedic with a 15-year long career which had resulted in promotion (he is a Mentor);

• The Registrant is of previous good character;

• There has been no repetition of his actions and he has worked without any further incident since October 2018;

• He has made full admissions from the start, both with the Trust and with the HCPC, and has been found by the Panel to be honest and open;

• He is willing to take further remedial action to address the Panel’s concerns, in respect of which he had the Trust’s full support which in turn reduces the risk of repetition;

• He has made a commitment to develop further insight into his failings;

• He intends to apologise to Patient A. Such direct acknowledgment not only would assist the Registrant in developing an understanding of the potential impact of his actions but is, in itself, evidence of a realisation by the Registrant of the risk of potential harm in which he had put Patient A;

• He produced two positive testimonials, including one from his line manager;

• There are no concerns about his technical skills.
 
78. The Panel also noted the following aggravating features and, in particular:
 
• The seriousness of the incident and the potential harm that could have resulted to Patient A by the delay in treating him;

• The failure by the Registrant to fully appreciate the severity of his actions, which resulted in his remediation being incomplete.

79. Given the seriousness of the misconduct and its findings on impairment, the Panel took the view that this was not a case that could be appropriately or adequately concluded without a sanction, particularly since this would not address the public interest component. The Panel therefore went on to consider the various sanctions in ascending order of seriousness, beginning with the least onerous.

80. The Panel first considered the sanction of mediation and concluded that it was not appropriate given that mediation is designed to resolve conflicts between the Registrant and a third party (usually an employer), which clearly did not apply in this case.
81. The Panel next considered a Caution Order.

82. The Panel repeats its observations above, namely that it was reassured that the Registrant had clearly reflected overnight and had made a commitment, through his representative, to engage in further remedial activity with the full approval and support of the Trust, which will directly address the specific concerns of the Panel (namely additional training/observations and the adoption of a revised and focused Action Plan).

83. From the outset, the Registrant has fully engaged (both with the HCPC and the Trust) and he has been candid and honest throughout. The Panel noted that the Registrant attended the hearing having already commenced the remediation process, such as by preparing a reflective piece. He then subsequently liaised with the Trust with regard to his further proposed remediation and they approved his suggestions. Accordingly, the Panel was satisfied that the Registrant is genuinely committed to the process of developing further insight and of fully remediating his failings, and he has sought the Trust’s support. As such, the Panel concluded that the risk of repetition of the Registrant’s misconduct is low.

84. The Panel concluded that a Caution Order would be proportionate and fair and would strike the appropriate balance between the interests of the Registrant and the wider public interest. It therefore decided to impose a Caution Order for a period of one year, which it considered would be sufficient time for the Registrant to complete his additional training, activities, and further reflection and to achieve the goals set out in his intended Action Plan.

85. The Panel did go on to consider a Conditions of Practice Order. It appreciated that such a sanction would enable the HCPC to monitor the Registrant’s progress but, in the unusual circumstances outlined above, where the Panel was satisfied that the Registrant, with the support of the Trust, is sufficiently motivated to ensure that he becomes fully remediated, it considered that such monitoring was unnecessary. In all the circumstances, therefore, the Panel was not satisfied that a Conditions of Practice Order was necessary in the public interest, nor was it proportionate.

Order

That the Registrar is directed to annotate the register entry of Mr David Short with a caution which is to remain on the register for a period of one year from the date this order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Mr David Short

Date Panel Hearing type Outcomes / Status
13/01/2020 Conduct and Competence Committee Final Hearing Caution