Mr John W Williams

Profession: Paramedic

Registration Number: PA39245

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 07/01/2020 End: 17:00 07/01/2020

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

The following Allegation was considered by a Panel of the Conduct and Competence Committee at a Consent Hearing on 05 February 2019.

During the course of your employment as a Paramedic with South Central Ambulance Service between March 2016 and July 2016 you;

1) On or around 26 March 2016, attended patient 1 and;

a. did not complete a primary survey;

b. did not immediately provide them with oxygen following a below normal oxygen saturation reading.

2) On or around 31 May 2016, attended patient 2 and;

a. did not assess the patient’s injury at all, or until prompted to do so, in that you did not:

i. expose their foot and ankle;
ii. assess the colour of their foot;
iii. assess the temperature of their foot;
iv. assess their pedal pulse;

b. did not recognise it was a potentially ‘time critical’ incident.

3) On or around 31 May 2016, attended patient 3 and;

a. discharged the patient on scene without understanding the nature of their condition;

b. did not request any assistance in regards to understanding the patient’s condition.

4) On or around 31 May 2016, attended patient 4 and were unaware of the possible consequences of an Amitriptyline overdose.

5) On or around 31 May 2016, when questioned by a clinical mentor, were unable to confirm the signs and/or symptoms of a Diazepam overdose.

6) On or around 30 May 2016, attended patient 5 and did not question the patient regarding sporadic incontinence at all, or until prompted to do so.

7) On or around 30 May 2016, attended patient 6 and;

a. did not feel for a radial pulse;

b. did not understand the patient’s ECG readings, in that you were unable to confirm if the patient was in normal sinus rhythm or not.

8) On or around 1 July 2016, attended patient 8 and;

a. did not carry out a visual inspection of their airway;

b. did not position the patient correctly in order to undertake an abdominal assessment;

c. did not offer the patient pain relief until prompted to do so;

d. were unable to identify a potential differential diagnosis.

e. did not assess Patient 8’s respiratory rate.

9) On or around 1 July 2016 attended patient 9 and;

a. did not undertake an ECG during the secondary survey;

b. did not offer the patient pain relief until prompted to do so;

c. did not identify an appropriate disposition plan.

10) On or around 2 July 2016, attended patient 10 and;

a. Did not carry out a visual inspection of their airway;

b. did not obtain a respiratory rate;

c. did not question the patient in order to identify red flags relating to back pain, until prompted to do so;

d. did not communicate the side effects of Morphine before administration to the patient;

e. before administering a second dose of Morphine failed to check the following until prompted to do so:

a) Pulse;

b) Respiratory rate;

c) Blood pressure;

f. did not identify air in the syringe which you were about to use to administer Morphine.

11) On or around 2 July 2016, attended patient 11 and;

a. did not complete a primary survey;

b. proposed a plan which would have delayed conveying the patient to hospital had a colleague not intervened;

c. did not provide them with oxygen therapy.

12) On or around 4 July 2016, attended patient 12 and did not take the lead in completing the primary survey.

13) Did not consistently demonstrated effective communication skills when:

a. Communicating your decisions to patients;

b. Delegating tasks to other crew members.

14) The matters as set out in paragraphs 1-13 constitute a lack of competence.

15) By reason of this lack of competence your fitness to practise as a Paramedic is impaired.

Finding

Preliminary Matters:

1. The case for the HCPC was presented by Ms Jenna Oppong.  The Registrant was present and represented by Ms Hewitt, Counsel. The Panel considered Ms Hewitt’s application for any references to the Registrant’s health or private life to be taken in private in terms of Rule 10(1)(a) of the Conduct and Competence Committee Procedure Rules. Ms Oppong did not oppose the application. The Panel accepted the advice of the Legal Assessor and considered the Practice Note on Conducting Hearings in Private. The Panel concluded that the right of the Registrant to protection of his private life and confidentiality of his health issues outweighed the general presumption of hearings being conducted in public and agreed that any references to the Registrant’s health or private life would be taken in private.

Background:

2. On 5 February 2019, a panel of the Conduct and Competence Committee agreed to dispose of the case by means of a Consent Order, having found that the Registrant’s fitness to practise was impaired by reason of his lack of competence. The Registrant admitted the Allegation in full and accepted that he had not been practising at the level of a newly qualified paramedic when initially employed by the South Coast Ambulance Service SCAS. He also confirmed that he had voluntarily stepped down from his role as a Paramedic to work as an Emergency Care Assistant.  The Registrant was employed as a Band 5 Paramedic at SCAS in January 2016. As a newly qualified paramedic, he was required to participate in the “Preceptorship Programme” which required a number of shifts to be worked with a clinical mentor. In March 2016, the Registrant’s mentor attended a number of call outs with the Registrant, following which concerns were raised regarding the Registrant’s performance which led to a formal capability process. The concerns primarily related to clinical assessment skills and are set out in the Allegation above. 

3. The panel agreed that a twelve month Conditions of Practice Order would adequately protect the public and would be a proportionate sanction, given that the Registrant had demonstrated insight into the matters which led to the making of the Allegation.

The Review Hearing Today:

4. The Panel today is conducting a review of that Conditions of Practice Order in terms of Article 30(1) of the Health and Social Work Professions Order 2001.

5. The Panel heard from Ms Oppong who referred to the background of the case and the circumstances which led to the imposition of the Conditions of Practice Order.  Ms Oppong also drew the Panel’s attention to an email dated 19 December 2019 submitted by Mr Phil Barr, Leading Operations Manager at East of England Ambulance Service, in which he advised that he had received feedback from a colleague that in the course of a recruitment day, the Registrant had indicated that he had been working as a Paramedic with a private ambulance service since the restriction to practice order was put into effect.  Ms Oppong submitted that the HCPC was of the view that the Registrant’s fitness to practise remained impaired as he had not produced evidence that he had addressed the failings identified. Ms Oppong also advised that the HCPC was of the view that conditions were no longer appropriate as the Registrant had failed to comply with the conditions by working as a Paramedic on 26 October 2019. Ms Oppong submitted that the HCPC considered a Suspension Order would be the appropriate sanction as it would allow the Registrant to demonstrate insight and to undertake further training and development.

6. The Panel also heard submissions from Ms Hewitt and heard evidence from the Registrant. The Registrant confirmed that he had undertaken one shift with Outreach Rescue Medic Skills Ltd on 26 October 2019. He advised the Panel that he had notified Outreach Rescue Medic Skills of his Conditions of Practice Order at the time they were imposed. The Panel also had sight of an email from the Director of Outreach Rescue Medic Skills confirming that on 26 October 2019,  the Registrant’s scope of practice was limited to that of “Technician”, although, if paramedic intervention was necessary, then it was understood that he would be required to call for paramedic assistance from other personnel attending the event, at which point he would be under supervision and would be empowered to utilise his paramedic skills, working with the other paramedic.

7. The Registrant advised the Panel that he had been unable to gain full time employment as a Paramedic and was still working as a Technician. He also advised that he had not yet been notified of the outcome of his application for a paramedic post with East of England Ambulance Service and that he was committed to returning to the profession, although accepted that he would need a further Conditions of Practice Order to support him to do so.

8. The Registrant also advised the Panel of the impact the process had on his health. The Registrant will be aware that he is under an obligation to notify the HCPC at any time if he is of the view that his health is impacting on his practice.

9. Ms Hewitt submitted that it would be disproportionate to impose a suspension order  on the basis of the one shift undertaken by the Registrant and that this had been a misunderstanding on the part of the Registrant. She asked that the Panel continue or vary the existing Conditions of Practice Order to allow the Registrant to return to practice.

Decision:

10. The Panel is mindful that its task today is not to go behind the decision of the previous panel but to determine whether or not the Registrant’s fitness to practise remains impaired and if there is current impairment, what, if any, order should be made when the current order expires. The Panel has considered the submissions of Ms Oppong and Ms Hewitt together with the advice of the Legal Assessor.

11. In reaching its decision, the Panel has exercised its own independent judgement.

12. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. In reaching this decision, the Panel has considered both the personal component and the public component. The previous panel acknowledged that the Registrant had demonstrated insight into the matters which led to the making of the allegations and considered that the conditions would be sufficient to allow the Registrant to work as a newly qualified paramedic. However the Registrant has not been able to obtain employment as a paramedic and has not therefore had an opportunity to demonstrate that he can practice safely as a paramedic. The Registrant himself also accepts that he would need to be subject to conditions on his return to practice.  This Panel has therefore concluded that the Registrant’s fitness to practice remains impaired. 

13. The Panel has also considered the wider public interest considerations which include the need to protect patients, to declare and uphold proper standards of behaviour and to maintain public confidence in the profession.  In the absence of evidence of remediation, the Panel has concluded that public confidence in the profession would be undermined if a finding of impairment were not made in these circumstances.

14. The Panel has therefore concluded that the Registrant’s fitness to practise remains impaired on both the personal and public components.

15. The Panel has considered the information before it in relation to the shift of 26 October 2019. It is clear to the Panel from the correspondence with Outreach Rescue Medic Skills that they were aware of the conditions on the Registrant’s practice. The Panel is also of the view that as the Registrant was already registered with them prior to the imposition of the Conditions of Practice Order, the Registrant was not therefore taking up further employment, although it would have been advisable to notify the HCPC of this shift.

16. The Panel next considered the sanctions available to it in ascending order of severity. The Panel is aware that the primary function of any sanction is to address public safety from the perspective of the risk the Registrant may pose to those using or needing his services in the future and determine what degree of public protection is required. The Panel must also give appropriate weight to the wider public interest which includes the deterrent effect on other registrants, the reputation of the profession and public confidence in the regulatory process.

17. The Panel considered that to impose a Caution would not be sufficient to address the wider public interest considerations or to protect the public. The Panel then considered whether a Conditions of Practice Order would be appropriate and sufficient. The Panel considers that the current Conditions of Practice Order remains an appropriate and proportionate sanction in that it adequately protects the public, addresses the public interest considerations and will allow the Registrant to return to practice as a paramedic under supervision. The Panel considers that a further period of twelve months would afford the Registrant the opportunity to obtain employment as a paramedic and demonstrate compliance with the conditions.

18. The Panel did consider whether a Suspension Order would be appropriate. However, the Panel determined that this would be disproportionate at this time in circumstances where the conduct found proved is remediable and the Registrant is committed to returning to practice, having demonstrated insight into the matters which brought him before the HCPC.

19. This Order will be reviewed prior to its expiry. The Panel considers that a reviewing panel would be greatly assisted by the Registrant actively engaging with the HCPC and attending the hearing. In addition the Panel may be assisted by:

• References from any employment in a health care setting;

• Evidence of any steps to maintain your skills, including evidence of any training and Continuing Professional Development (CPD).

Order

Order: The Panel directs the Registrar to extend the current Conditions of Practice Order against the registration of Mr John W Williams for a further period of 12 months on the expiry of the existing Order. The Conditions remain as follows:

1. You must place yourself and remain under the supervision of a workplace supervisor, registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within one month of recommencing work as a Paramedic. You must attend upon that supervisor as required and follow their advice and recommendations.

2. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

3. You must promptly inform the HCPC of any capability or disciplinary proceedings taken against you by your employer.

4. You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;

B. any agency you are registered with or apply to be registered with (at the time of application); and

C. any prospective employer (at the time of your application).

5. You must work with your supervisor to formulate a Personal Development Plan designed to monitor and address any deficiencies in the following areas of your practice:

a) Undertaking assessments

b) Communicating effectively with colleagues and patients

6. Within three months of starting work as a Paramedic you must forward a copy of your Personal Development Plan to the HCPC.

7. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

8. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

Notes

The Order imposed today will apply from the expiry of the current Order, namely 5 February 2020.

This Order will be reviewed again before its expiry.

Hearing History

History of Hearings for Mr John W Williams

Date Panel Hearing type Outcomes / Status
07/01/2020 Conduct and Competence Committee Review Hearing Conditions of Practice
05/02/2019 Conduct and Competence Committee Consent Order Hearing Conditions of Practice
21/12/2018 Conduct and Competence Committee Final Hearing Adjourned
16/07/2018 Conduct and Competence Committee Final Hearing Adjourned