HCPTS |

Profession: Paramedic

Registration Number: PA44528

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 09/03/2020 End: 17:00 13/03/2020

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

Allegation (as amended by the Conduct and Competence Committee at the substantive hearing):

During the course of your employment with East of England Ambulance Service, you:

1) Failed to pass your ECG exam to become a Student Paramedic, on:

a) 12 June 2017; and

b) 13 November 2017.

2) Acted in an unprofessional manner, in that you:

a) on 2 August 2017, hit the door of a stationary Trust ambulance whilst driving an ambulance;

b) on 10 August 2017, did not act appropriately on the scene of a deceased patient in that you;
i. swung on a seat near to the deceased;
ii. risked contaminating a scene that was potentially suspicious.

c) on 5 September 2017, you:
i. did not wear the correct Personal Protective Equipment to deal with an incident;
ii. removed a one use neck collar from a bin to send to Ukraine;
iii. went for a cigarette when you were still in charge of looking after Patient A.

d) on or around 26 September 2017, antagonised Patient D, who was a volatile patient, by smiling and waving at him in an antagonistic manner;

e) on or around 20 October 2017, did not treat a patient with care when you dropped her down a flight of stairs in the carry chair despite her having hip problems;

f) on or around 03 November 2017:
i. hit a wing mirror of a car whilst driving an ambulance and did not stop at the scene;
ii. had a near collision with a pedestrian;
iii. drove the wrong way round a roundabout;
iv. slept in the front seat of the ambulance in public view;
v. did not prepare the ambulance for the next call out
vi. were rude to Patient F when giving her an ECG by telling her not to speak.

g) On or around 14 November 2017, did not pre-alert a time critical patient to the receiving hospital;

h) on or around 14 November 2017, did not treat Patient G with respect by rolling your eyes at him, telling him to hurry up and get in the ambulance so you could take them to A&E;

i) on or around 25 November 2017, scraped an ambulance you were driving and did not inform your manager of the incident.

3) On or around 22 September 2017, when attending Patient H, you:

a) did not communicate your observation with Patient H and/or your colleague;

b) assessed Patient H without obtaining their consent;

c) took blood from Patient H without:
i. Patient H's consent;
ii. cleaning Patient H’s finger.

d) did not apply pressure to the wound caused by taking Patient H’s blood.

4) In November 2017, while the Trust was listed as your place of employment on your Facebook profile, you did not use Facebook appropriately in that you:

a) Posted a Facebook Status on your profile, the content of which was offensive;
b) Posted a meme on your profile aimed at your colleagues at the trust.

5) During the time of your employment with East of England Ambulance Service NHS Trust did not demonstrate the necessary level of understanding of the English language.

6) The matters set out in particulars 1 – 5 constitute misconduct and/or a lack of competence.

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

Finding

Preliminary Matters:

Proceeding in Absence

1. The Panel found there had been good service of the Notice of Hearing.

2. The Registrant became a registered Paramedic on 22 February 2018. At the time of the allegations he was a student Paramedic. He was employed by the East of England Ambulance Service NHS Foundation Trust (hereafter “the Trust”) between 27 March 2017 and 28 February 2018.

3. The Registrant did not attend the final hearing. The Panel first considered whether it ought to exercise its discretion to continue with this hearing in the absence of the Registrant. The Panel concluded that it was in the public interest to do so, having considered the HCPC Practice Note on “Proceeding in the Registrant’s Absence”. Having taken the Legal Assessor’s advice, and considered the guidance in R v Jones [2002] UKHL 5 and GMC v Adeogba, R v Hayward [2001] EWCA Crim 168 and GMC v Visvardis [2016] EWCA Civ 162, for the following reasons:

(a) The Panel is satisfied that the Registrant had notice of the hearing dated 28 November 2019. The bundle was sent to him on 08 January 2020 and two signed witness statements, omitted from the first bundle, were sent on 29 January 2020;

(b) The Registrant has not sought an adjournment;

(d) The Panel concluded that, even if these proceedings were adjourned, there was very little likelihood that the Registrant would attend on a subsequent occasion;

(e) The Panel concluded that the Registrant has deliberately chosen not to attend this hearing, and that this amounted to a voluntary waiver of his right to appear.

(f) The Panel determined that it was reasonable and in the public interest to proceed today in the circumstances, given that the relevant events date back to 2017.

Application to Amend the Allegation:

4. There was an initial application to amend the Allegation. The amended Allegation was sent to the Registrant on 08 January 2020. The purpose of the amendment is to ensure that the Allegation better fits the witness evidence and/or sets out with more clarity the specific conduct alleged. The majority of changes are relatively minor and do not alter the substance of the Allegation the Registrant faces. The Registrant has had notice of the proposed amendment since 08 January 2010 and has not raised any objection to the amendment. The effect of the amendment is also to offer no evidence in respect of two particulars (2)(d) and (e). The Panel concluded that there was no prejudice in allowing the amendments and was content that the Allegation was not being expanded in a way which was unfair to the Registrant. The Allegation set out above is the amended Allegation.

5. The Panel heard a further application to amend on Day 3 of the hearing. The application was to amend the date on Particular 3, changing the date from 27 November 2017 to 22 September 2017. It appears that the incorrect date was included in the allegation. This is the date the incident was reported, not the day it took place. The Panel allowed the amendment as there was no prejudice to the Registrant and the amendment did not alter the substance of the allegation which the Registrant has to face.

Preliminary Application for Video Evidence

6. There was an application, in advance of the hearing, by the HCPC on the 24 February 2020 for one of the witnesses (HM) to give evidence by way of a video link. The application was supported by a skeleton argument from Kingsley Napley dated 03 February 2020, along with supporting documentation. In an email dated 28 January 2020 it was confirmed that HM gave birth on 21 January 2020 and it was not practical for her to leave her child or to make arrangements to travel with her child. It was recognised that in an ideal world HM would have given evidence in person. However, in this instance, such a requirement would have resulted in her being unable to attend and the case having to be postponed for an unspecified and potentially lengthy period of time.

7. The Panel Chair granted the application, having regard to Article 32(3) of the Health Professions Order 2001 as part of her broad case management discretion to ensure that proceedings are conducted expeditiously and that cases are heard without undue delay, fairly and justly, including special measures for witnesses. The factual allegations in this case date back to 2017 and any further delay might impact on the recollection of witnesses.

8. Giving evidence by videolink will still allow HM to be cross-examined and for her evidence to be tested and for the Panel and parties to assess her demeanour and overall credibility. In addition, HM’s evidence was limited to Particular 1 and is also dealt with by another witness, who gave live evidence. In these circumstances it was concluded that it was fair and expeditious to grant the application, having balanced the public interest in proceeding, against the rights of the Registrant to have a fair hearing.

Telephone Witness Evidence

9. The Panel also had to deal with an application by the HCPC for ED to give evidence by telephone, on the third day of the hearing. ED was unable to attend in person for unspecified personal reasons, which he declined to explain to the Panel, even when offered the chance to do so in private.

10. The Panel concluded there was no prejudice to the Registrant, in these circumstances, where he had not attended, in hearing evidence from the witness by telephone.

Background:

11. The Registrant was on a student paramedic pathway and was employed through a conditional contract of employment which required that he pass ECG examinations to become a fully qualified Paramedic in the United Kingdom. He had worked as a qualified Paramedic in Poland, since 2010. The Registrant self-referred to the HCPC, on 23 February 2018, when he failed to pass the ECG examination after the second attempt.

12. On 09 March 2018, the Trust notified the HCPC of further issues relating to the Registrant’s conduct and practice. This included allegations of acting in an unprofessional manner, damaging property, poor standards of patient care and inappropriate comments on social media.

13. The Panel has jurisdiction to hear this case, even though the Registrant did not apply for Registration until 22 February 2018, by virtue of Article 22 (3) of the Health Professions Order 2001: This article is not prevented from applying because the allegation is based on a matter alleged to have occurred outside the United Kingdom or at a time when the person against the allegation is made was not registered.

14. The Panel has been provided with a substantive bundle of documents from the HCPC which included exhibits and nine witness statements.

15. The Panel has also seen written submissions from the Registrant dated 11 April 2019, but re-sent to the HCPC on 23 January 2020. The Panel was provided with these written submissions on Day 4 of the hearing, after the conclusion of the evidence. Mr Lloyd, on behalf of the HCPC, had not appreciated until this point in the proceedings that the Registrant had re-submitted, what appears to have been his ICP submissions, with the intention that these should be seen by the Panel at the final hearing. The Panel considered, what effect if any, the late admission of these submissions had to the fairness of the hearing. The Panel first considered its original decision to proceed in the Registrant’s absence. It concluded that even though the Registrant’s last engagement was 23 January 2020 and not April 2019, the Panel would still have exercised its discretion to proceed in the absence of the Registrant as all the reasons for proceeding in absence were unaffected by more recent engagement.

16. The Panel next considered whether witnesses need to be recalled in fairness to the Registrant. The Panel carefully reviewed all the witness evidence in the light of the Registrant’s written submissions. The Panel concluded that there were no additional questions which meant that witnesses had to be recalled to give further evidence.

17. The Panel has heard oral evidence on behalf of the HCPC from:

(1) JN, General Manager at the Trust; (Day 1)

(2) TR, Paramedic, Leading Operations Manager (from August 2018), (formerly, Duty Locality Officer (DLO)) at the Trust; (Day 1)

(3) CT, Paramedic Practitioner with Cambridge & Peterborough foundation NHS Trust and formerly, Acting Duty Locality Officer (DLO) at the Trust; (Day 2)

(4) MM, Senior Paramedic at the Trust; (Day 2)

(5) RK, Student Paramedic at the Trust; (Day 3)

(6) ED, Paramedic at the Trust; (Day 3) (by telephone).

(7) JG (nee JP) Paramedic at the Trust; (Day 3)

(8) RD, Paramedic at the Trust; (Day 3)

(9) HM (by video link) Education and Training Officer, with the Trust (Day 3).

18. The Panel was also provided with a witness statement from MZ, Trainee Solicitor with Kingsley Napley. Her statement exhibited the Facebook entry and translation which pertained to Particular 4.

19. The Panel’s view on the witnesses was as follows:

(a) The Panel found JN to be credible and doing his best to assist the Panel.

(b) The Panel found TR to be a credible and reliable witness.

(d) The Panel found MM, RK, RD, HM and ED to be honest witnesses who were credible and doing their best to assist the Panel.

20. The Panel heard and accepted the Legal Assessor’s advice and exercised the principle of proportionality at all times. In approaching the task of deciding the facts, the Panel has kept at the forefront of its deliberations, the importance of requiring the HCPC to prove matters against the Registrant. The standard of proof to which the HCPC is required to prove matters is the civil standard – on the balance of probabilities.

21. The Panel was very conscious that when a witness has not given oral evidence, that this is hearsay evidence. When considering hearsay evidence, which is admissible, the Panel has paid due regard to the weight which it can attach to it, bearing in mind that it has not been possible for that evidence to be challenged or probed. The Panel were also guided by the recent decision in El Karout v The Nursing and Midwifery Council [2019] EWHC 29 (Admin). The Panel reminded itself that it should consider carefully the admissibility of any hearsay evidence and not just the subsequent weight to be given to it. A careful balancing act must be performed between fairness to the Registrant and the wider public interest. However, in cases where the hearsay evidence is the “sole or decisive evidence on an allegation” this would tend to point away from its admissibility.

Decision on Facts:

Particular 1(a) and 1(b) Proved

22. The allegation is that the Registrant failed to pass his ECG exam on 2 occasions, namely (a) 12 June 2017, and (b) 13 November 2017.

23. HM’s evidence was that there was a small cohort of 8 Paramedics recruited from Poland or Latvia. A 4 - 6 week long programme was designed by the Trust, to facilitate the Paramedics with the requirements to practice in the NHS and the Trust. It was essentially a conversion course aimed at those who were already in practice outside the UK.

24. As part of the induction training at the Trust, all autonomous clinicians are required to pass an Electrocardiogram Examination (“ECG exam”). The purpose of the exam is to allow the Trust an understanding of how well a clinician can read and understand an ECG. This is an essential skill for providing patients with effective treatment. The ECG exam sets the Trust standard for clinicians who make decisions about leaving patients at home, appropriately referring them to other services or conveying them to hospital. It underpins the knowledge that the clinician needs to make all of those decisions.

25. An ECG shows electrical activity through the heart and is essential for understanding conditions such as heart attacks. The pass mark for the ECG is 75%. It consists of a 2 hour (closed book) written examination. There are three sections which are weighted evenly:

(a) True or false questions,
(b) Multiple choice questions,
(c) Questions that relate to 5 ECG images that are provided in the examination paper.

26. Prior to the first exam, the Trust’s Education and Training team delivered a one day taught session on 26 May 2017, which the Registrant attended, as part of his induction. This covered various topics related to the heart. New recruits are also provided with a Trust ECG recognition book which enables them to practice and revise independently. The training materials were provided in English only.

27. The Registrant first took the ECG exam on 12 June 2017 and failed, scoring 71% with a pass mark set at 75%. The Registrant re-sat the exam, on 13 November 2017 and failed again, scoring 66% out of the required 75%.

28. JN’s evidence was that the Registrant was provided with training presentations, training materials and Trust ECG Handbook between his first sitting on the exam and his subsequent re-sit. These were provided to the Registrant on 07 September 2017.

29. HM describes the Registrant being provided with individual feedback after his first exam, to assist with directed revision to increase the subsequent chances of passing. He was also give access to a resource called “ECG Learning”. HM describes personally recapping the expectations and format of the ECG exam with the Registrant via email. The Panel has seen the chain of 3 emails between 23 and 27 November 2017.

30. The Registrant was informed of his failure to pass the ECG exam on 20 December 2017. The letter also notified him that a formal meeting would be held with him. This was to discuss his failures in the ECG exam and other conduct issues. Passing the ECG exam is a requirement of an individual’s employment contract with the Trust. As a result, the Trust had little confidence in the Registrant’s ability to read and understand an ECG.

31. The Registrants position, as per his written submissions is that he accepts he failed the exams, but makes two points. Firstly that the guidelines used by the Trust differ from the European Society Cardiologists and secondly that some of the answers he gave were later found to be correct.

32. The Panel accepted the evidence submitted by the HCPC shows that the Registrant failed to pass either of the ECG exams.

Particular 2(a) Not Proved

33. The allegation is that the on 02 August 2017 the Registrant acted unprofessionally by hitting the door of a stationary Trust ambulance whilst driving an ambulance.

34. The evidence in support of this allegation came from JN. He did not witness the incident. Rather, the incident was reported to him by the Duty Locality Manager, CT. She reported that during a shift on 02 August 2017, the Registrant was reversing a Trust ambulance out of the ambulance bay. Whilst doing so, the Registrant hit the door of another Trust ambulance which was stationary.

35. The incident was of some concern to JN as there is a financial cost in repairing the ambulance. The cost of a replacement wing mirror is over £150. Paramedics often have to leave the Ambulance Station when responding to urgent call outs. This was an avoidable accident and the Registrant should have driven with more care. However, JN states that the Registrant was not reprimanded as this was the first incident of this nature, He was however, advised that a repeat of such incidents could lead to an escalation and an informal warning.

36. The incident is recorded in the File notes in the HCPC Bundle for 02 August 2017; “Whilst driving out of the ambulance station on a PO Michal hit the side door on NA979.” The Panel has seen the accident form completed by the Registrant: I was turning left and back of my ambulance hit open side door another ambulance.

37. The Registrant admits that he hit a car door with the ambulance, and stopped to check. He maintains that the damage was “small” and that he was told it had to be reported, even if it could be repaired using a screwdriver.

38. The Panel accepted that the Registrant had been involved in a minor accident and that he had reported it. The Panel was not convinced in the circumstances that such an incident amounted to acting in an unprofessional manner as set out in the stem of the allegation. The Particular overall therefore was not proved.

Particular 2(b)(i) Proved & (ii) Not Proved

39. The allegation is that on 10 August 2017 the Registrant acted unprofessionally whilst on the scene of a deceased patient and failed to act appropriately. The specific allegations are that he (i) swung on a seat near to the deceased and (ii) risked contaminating a scene that was potentially suspicious.

40. TR’s evidence was that on 10 August 2017, the Registrant and his crew mates had been called to a patient who had committed suicide. The patient had hung himself from a swing. TR was called to the scene in his capacity as the DLO on shift. When he arrived at the scene, there were 2 ambulance crews and the police already at the scene. By this stage, the patient had already been cut down and was placed on the ground adjacent to the swing.

41. TR was approached by a police officer, who told him that the Registrant was sat on a swing and was swinging on the same, next to the patient’s body. The gist of the conversation was that the police officer regarded the Registrant’s actions as being inappropriate. TR approached the Registrant who was still sitting on the swing, although he was not swinging. He asked him to get off the swing which he did. TR took the Registrant aside and had a private conversation with him, some distance from the scene; he explained that his behaviour was inappropriate, as it (i) showed no consideration for the patient’s dignity; (ii) showed a lack of professionalism to the public, (iii) and could have potentially forensically contaminated the scene.

42. TR’s view was that respecting the dignity of a deceased patient is respecting the dead, the scene and maintaining professionalism in public. This behaviour is not taught, but it is expected that Paramedics will maintain a natural air of dignity around the dead. The scene was in a public park and could be seen by the public and other professionals. TR comments that members of the public could have taken photographs and that the public might get a poor impression of ambulance staff behaviour, if they were to observe the Registrant on the swing.

43. TR’s evidence was that there was some concerns as to the cause of the death of the patient and whether the scene was suspicious. He suggested that a police forensic unit be deployed at the scene. The Registrant was sat in a position which could have potentially contaminated the forensic evidence. The forensic team had not yet been to the scene when the Registrant was observed on the swing. It is alleged that the Registrant should have left the immediate scene at the conclusion of his medical examination of the deceased.

44. When TR raised these issues with the Registrant he agreed that he had made a mistake and that his conduct was not appropriate. He believed that the Registrant’s “behaviour came from ignorance.” The Registrant explained his actions, on the basis that he was tired, but TR did not regard this as an excuse for his conduct. However, he accepted that different people react differently to death and having witnessed a traumatic scene. For this reason, he did not escalate the matter any further, although he did record the incident as a file note.

45. TR concludes that the Registrant “overstepped an acceptable boundary to another professional, the police officer…could form a negative view of the ambulance profession. I have never been approached on scene by other emergency services asking me to ‘speak’ to my staff to get them to behave appropriately since becoming a manager.”

46. The Registrant’s submissions accept that he was swinging on a seat, but maintains that this was not intentional. He sat on the swing to undertake the paperwork. It had been a long night and “if that is a lack of dignity. I apologize him and everybody around…”

47. The Panel found as a fact that the Registrant had swung on the seat, on the basis of the evidence set out above and the Registrant’s own submissions/admissions. The Panel regarded such behaviour as unprofessional and found the allegation proved.

48. However, the Panel was unable to find 2(b)(ii) proved. The Registrant would not have been aware that the scene was potentially suspicious at the time he was sat on the swing. This only came to light when TR informed him of this and in circumstances where there were other professionals in the vicinity and the police forensic team had not yet visited the site. The Panel were unable to conclude in these circumstances that the Registrant had been acting in an unprofessional manner.

Particular 2(c) (i), (ii) & (iii) Proved

49. The allegation is that on 05 September 2017, the Registrant acted unprofessionally in that he (i) did not wear the correct Personal Protective Equipment (PPE) to deal with an incident; (ii) removed a one use neck collar from a bin to send to Ukraine and (iii) went for a cigarette when he was in charge of looking after Patient A.

50. The Panel accepted the evidence from CT and also saw the file note dated 05 September 2017, compiled by CT. She recounts that she had attended a road traffic collision that morning and that the Registrant was not wearing a high visibility jacket or a helmet. This is so that the Paramedic can be seen when operating on the road and to protect the head from debris or other on scene hazards. The Registrant was wearing safety boots. The requirement to wear PPE is standard practice throughout the profession and PPE should be stored on the ambulance. There is spare PPE kept at the station if an individual forgets his PPE.

51. CT asked the Registrant to put on his PPE, and he replied that he did not have a helmet or a high visibility jacket. As a result, she had to ask him to remain away from the scene and to return to the ambulance for his own safety. She subsequently provided the Registrant with a spare set of PPE to use for the rest of the shift.

52. The Registrant submissions state that this incident occurred on a sunny day. Nobody had informed him that he needed to wear his fluorescent jacket when at the scene of a car accident. He did not own his own helmet and no one had ever informed him what he should do. The Panel found that it was unlikely that he was unaware of the safety requirement.

53. The Panel accepted the evidence from CT and found the particular proven.

Removal of Neck Collar

54. Subsequently, following the road traffic collision, Patient B was taken to hospital. CT followed Patient B in an ambulance and wished to explain in more detail to the Registrant why she had removed him from scene, in a more relaxed environment.

55. CT met the Registrant and his crew mate at the hospital. CT describes being told by the Registrant’s crew mate that the Registrant had removed the cervical collar out of the bin in the ambulance and placed it in his personal bag.

56. CT sat in the rear of the ambulance and explained that the collar was a “once only” item which should be used only once and then disposed of. Her evidence was that the Registrant found this hard to understand as other countries are struggling for equipment. The Registrant replied that: “he had removed it from the bin to send to Ukraine.” Thereafter, the Registrant removed the neck collar and placed it into the bin. The Panel has seen the file note created by CT in respect of this incident.

57. CT’s evidence was that such items are only used once as they might be contaminated with bodily fluids and this is set out in the Trust’s internal compliance procedure.

58. The Registrant’s submissions accept that he removed the collar, because it was “new, clean, unused and sill in cover”. The Panel rejected this submission as the Registrant should have known that “once only” patient equipment should not be reused.

Smoking when tasked with care of Patient A

59. CT has no personal knowledge of this incident. CT’s evidence was that 05 September 2017, she received an email from an Emergency Medical Technician called Georgia (she was unable to recall her surname). Georgia was on a shift, being held at Addenbrookes Hospital. There were two ambulances. The Registrant was working with another Paramedic JWP. Georgia was working with AW. Patient A, was in the care of the Registrant and JWP. However, all of the Paramedic staff were speaking with Patient A as he had been known to the Trust for many years. Georgia’s email explains that the Registrant walked to the far end of the ambulance bay parking area. The Registrant went behind the storage unit, with a cigarette packet in his hand. Georgia approached the Registrant and told him that it was not the time or place to be having a cigarette, as Patient A was still in their care. The Registrant grunted in response but did not take any notice of what was being said. Georgia then had to ask the Registrant to put the cigarette out and to return to the ambulance to support his crew mate. The Registrant declined. Georgia explained her crew mate was unsupported and that Patient A having suffered a seizure earlier, may seize again. Georgia informed the Registrant that she would take the matter further. Her concern was that Patient A was potentially unstable and could have gone into cardiac arrest or seized. Patient A was also confused about what was going on, having just had a seizure, and there was a risk they could lash out.

60. The file note dated 05 September 2017 says: “Informal verbal warning issued to Michal - Present at the time of the discussion TR [name redacted]. Informal verbal warning issues for above concerns. - leaving crew mate in the ambulance whilst waiting on red light to handover and having a cigarette on Adenbrookes site (No smoking site).”

61. CT recounts a meeting with the Registrant on 06 September 2017. Also present was TR. The Registrant was initially quite defensive. However, they explained why they were concerned about his behaviour, and he appeared to understand. During the meeting, the Registrant was provided with an informal verbal warning - this was an initial step to ensure an action plan was put in place to address the Registrant’s behaviour.

62. The Panel has seen a letter dated 07 September 2017 issued to the Registrant by the Trust, giving him an informal verbal warning for his conduct and professionalism, related to: “…reports of yourself leaving a crew mate with a patient and going off to have a cigarette on hospital grounds.”

63. The Registrant’s submissions accept that he smoked a cigarette “behind a container when nobody saw”. The Registrant submitted that the patient was not time critical. He said they were waiting at the Adenbrookes garage. There were four other ambulances with crew and “I know if that was not professional but was not harmful for patient.”

64. The Panel concluded that this incident occurred in the manner alleged and broadly acknowledged by the Registrant. It was unprofessional to leave the patient in these circumstances to have a cigarette on Trust property where smoking is not permitted.

Particular 2(d) Not Proved

65. The allegation is that on 26 September 2017, the Registrant acted unprofessionally by antagonising Patient D, who was a volatile patient, by smiling and waving at him in an antagonistic manner.

66. The Registrant was working with MM on 26 September 2017. They were dropping a patient at Accident and Emergency (A&E), when they saw Patient D. Patient D was a volatile psychiatric patient. He was not in the care of MM and the Registrant and they had no involvement with him.

67. Whilst MM and the Registrant were waiting at A&E, Patient D was observed to be getting upset and shouting at the security guard and nursing staff. MM was concerned for the safety of female nurses and hence positioned himself approximately 10 metres from them, ready to prevent any physical abuse. He wanted to stay within viewing distance of Patient D, without becoming directly involved, in order to intervene if the situation escalated.

68. The Registrant was standing around the corner. He was out of MM’s direct view, but within the view of Patient D. MM noted that Patient D was becoming more agitated, although no physically abusive.

69. When MM and the Registrant returned to the A&E department later in the shift, MM asked one of the nurses what had happened to Patient D. One of the staff members told him that: “…they were furious with Michal Szczytynski as he had made the situation worse by provoking Patient D.” This had apparently been reported to the Trust’s management team. He states: “I believe they said that Michal Szczytynski did something silly such as waving, smiling or winking at the patient which antagonised Patient D.” It was suggested that the Registrant’s actions had “made Patient D’s condition considerably worse.”

70. MM confirms in his statement that he did not witness the incident itself, and his only knowledge derives from the discussion with the unidentified member of the nursing staff. However, he then goes on to assert his belief that the Registrant was “making fun of Patient D” and that his actions were intentional, “knowing he would make Patient D’s condition worse.” In doing so, it is suggested that he “increased the risk of Patient D becoming more verbally or physically abusive towards nurses and security guards.” Patient D was a “time intensive” patient who was taking nurses away from other patients and making the job of nursing staff harder.

71. Upon their return to the Station, MM reported the incident to the Duty Manger RA. This was written up as a file note dated 26 September 2017.

72. The Registrant’s submissions state: When I was referring patient to hospital nurse I hear screaming aggressive person behind door. Logic for me was to check it. I come in, check if everything was ok and I come back to continue I did not make any unprofessional behaviour. Adenbrook’s hospital have cctv, so if something I done wrong that should be recorded.

73. The Panel gave careful consideration to the evidence in support of this Particular and concluded that the facts were not established on the balance of probabilities. MM did not witness directly the Registrant’s alleged behaviour and is reliant on the anonymous hearsay evidence from a nurse that the alleged gestures were made, had the effect on the patient and that there was a causal link between the two. The Panel regarded the evidence overall as too weak to admit as hearsay evidence and hence found the allegation not proved.

Particular 2(e) Proved

74. The allegation is that on 20 October 2017, the Registrant acted unprofessionally in that he did not treat a patient with care when he dropped her down a flight of stairs in the carry chair, despite her having hip problems.

75. The Registrant was working with RK on 20 October 2017, on a two person ambulance crew. The first callout was to Patient E, who was suffering with shortness of breath or chest pains. Patient E’s living conditions were poor and unpleasant; the house was dirty and cluttered. RK recollects that there were areas where mould was growing and faeces and urine were present. RK was attending the patient and the Registrant was driving the ambulance. As Patient E advised them that she had ongoing hip problems and poor mobility, the Registrant brought in an ambulance chair, whilst RK was conducting an assessment. The ambulance chair is similar to a sack barrow with two wheels and is used to transport patients to and or from the ambulance. It is also referred to as a carry chair. It requires two people to use it.

76. After the assessment was complete, it was determined that Patient E needed to be conveyed to hospital, although this was not urgent. Patient E was secured in the carry chair by both RK and the Registrant. As RK began to clear up his equipment, the Registrant wheeled Patient E out of the room and towards the front door. He assumed that the Registrant would wait by the door with Patient E as the carry chair is a two person job. This was common practice. As he made his way to the front door to assist, he realised that the Registrant had already started to manoeuvre Patient E down the concrete stairs which led to the front door. The Registrant was walking down the stairs backwards and dragging Patient E backwards with him. As RK arrived at the top of the stairs, Patient E had already been moved down two to three steps. RK observed patient E saying: “ow! You are hurting me.”

77. RK put down his bag and offered to assist. However, by the time he had done so, the Registrant had already reached the bottom of the stairs with Patient E. RK’s evidence was that Patient E was angry and upset. On the way to the hospital, RK apologised to Patient E about what had happened and stated that he would report the incident as “I felt his behaviour was clearly inappropriate.” He comments that the Registrant showed no remorse and did not recall him being apologetic.

78. RK’s evidence was that the Registrant should have waited for him. In the event that Patient E had to be taken down the stairs by the Registrant alone, he should have taken them down facing forwards - this allows the Paramedic to control the weight of the patient. There was no need, in this instance, for the Registrant to have undertaken the task on his own.

79. The Registrant should have known the effect it would have on Patient E by dragging or pulling her down each step as there was a six inch drop each time. The Registrant risked losing balance and dropping patient E, who could have fallen sideways or toppled backwards. On your own, you have no control over the way the carriage is going or the force with which the patient drops from one step to another.

80. RK’s evidence was that Patient E, as well as being in pain, may have believed that she was being rushed and not taken seriously - being dragged away in an uncomfortable fashion. His belief is that the Registrant, due to Patient E’s poor living conditions, did not want to stay in the house and this may have contributed to his decision to move Patient E on his own.

81. RK had received training in how to transport patients safely and recalls receiving carriage training within the first 8 weeks of his placement and at basic training school. RK reported his concerns to CK (in the Bronze Team (now the Mentor Support Team), which is responsible for supporting new or struggling members of staff), via email on 10 October 2017, having already raised his concerns to CK orally. The concerns were recorded in a file note, also dated 10 October 2017.

82. The Registrant’s submissions state: “patient was how heavy job we done by carry her down by stares from second floor, and was happy for helping her. I do not remember any problems with carry her.”

83. The Panel preferred the detailed account of the incident provided by RK and concluded that the Registrant had acted in an unprofessional manner.

Particular 2(f)(i), (iii), (iv), (v) Proved
Particular 2(f) (ii) & (vi) Not Proved

84. The allegation is that on 03 November 2017, the Registrant acted unprofessionally by (i) hitting the wing mirror of a car whilst driving an ambulance and did not stop at the scene; (ii) had a near collision with a pedestrian; (iii) drove the wrong way around a roundabout; (iv) slept in the front seat of the ambulance in public view; (v) did not prepare the ambulance for the next call out; and (vi) was rude to Patient F, when giving her an ECG, by telling her not to speak.

Driving allegations 2(f)(i) -(iii)

85. The Registrant was working with ED on 03 November. They worked an entire shift together which was 10-12 hours. During the shift they switched roles between attending the patient and driving the ambulance. ED was the Paramedic and had clinical seniority.

86. ED’s evidence is that towards the start of the shift the Registrant was driving the ambulance down a narrow street in Cambridge city centre. It was a small side road. When the Registrant exited the narrow T junction onto the road, a pedestrian walked across the road. The ambulance almost came into contact with the pedestrian. The Registrant braked and the pedestrian moved back onto the pavement. ED describes the incident as a “near miss.” He expresses the view that the Registrant was driving too quickly and without due care. He is unsure whether the speed limit is 20mph or 30mph, but notes that this is a blind junction and that the Registrant should have been approaching slowly due to likely hazards. ED’s evidence was that he had been trained to have a driving plan based on what you can see, what you cannot see and what you can reasonably expect. The road is normally pedestrianised and controlled with bollards which limit vehicle access. In these circumstances, the hazard should have been anticipated. The Registrant should have driven more slowly and nudged out onto the main road. ED did not mention this to the Registrant at the time, as it was the start of the shift and he did not want to “get on my crewmates nerves so early on in our first job together…”

87. The Registrant’s submissions state: “I do not remember this situation. If I really hit someone and my partner notice why he didn’t tell me that?”

88. The Panel found this allegation 2(f)(ii) not proved. There is no definition of what constitutes a “near collision” and/or that the Registrant acted unprofessionally. The evidence at its height is that the pedestrian walked into the road, the Registrant braked and the pedestrian moved back onto the pavement.

89. Shortly thereafter, the Resistant, whilst still driving the ambulance, hit the wing mirror of a stationary vehicle. The point of contact was with the wing mirror on the ambulance. The wing mirror on the ambulance was knocked out of place. The Registrant did not stop to assess the damage to either vehicle. In fact, he did not acknowledge the incident at all. The incident took place under normal driving conditions. They were not en route to a patient and there was therefore nothing to prevent the ambulance from stopping to assess the damage. The Registrant did not readjust the ambulance wing mirror or ask ED to do so. This would have affected his visibility. The road was not particularly narrow and the incident, in ED’s view was avoidable.

90. The Panel has seen the accident report for this incident, completed by the Registrant and also contained a diagram: I reversed and hit mirror to container. The Registrant’s submissions state: more details needed.

91. The Panel accepted ED’s evidence on this issue and found the particular proved.

92. At approximately 4.45pm, the Registrant was driving the ambulance on a blue light in rush hour traffic. In doing so, ED states that he drove the ambulance anti-clockwise around the roundabout, against the flow of traffic. The roundabout had trees in the middle and ED states that the effect would have been to blindside other road users, as they drove around the roundabout. In addition, cars would not be expecting an ambulance to approach from the front and not the rear. This can cause other road users to slam on their brakes or cause a collision. This may have resulted in the ambulance being delayed in responding to the emergency call, if a collision had occurred.

93. As the Registrant was carrying out this manoeuvre, ED asked him what he was doing. His response seemed to be that there was not an issue; he did not demonstrate any remorse or acknowledge the danger posed to both themselves and other road users.

94. ED describes the Registrant’s driving as “incredibly dangerous, especially with such poor visibility.” His view was that the Registrant’s actions were a short cut as he said: “it’s fine, it’s ok.” It might have been possible to take a slight anti-clockwise turn whilst driving around stationary vehicles. However, this would only be acceptable in exceptional cases and this was not the case in this instance. There were moving cars on a busy roundabout in rush hour. He assumed that the Registrant had received blue light training, or had an equivalent qualification in Poland.

95. The Panel accepted ED’s evidence on this issue and found this particular proved.

Sleeping in Ambulance Particular 2(f)(iv)-(v) Proved

96. Later on during the 03 November 2017 shift, the Registrant and ED had conveyed a patient to hospital. ED took the patient into the hospital on his own. The Paramedic who stays in the ambulance should get the vehicle ready for the next call. This would include cleaning, tidying the equipment, and changing the bed sheets. When ED left the hospital he noted that the Registrant was asleep in the front passenger seat of the ambulance. ED did not challenge him on this, but simply asked if everything was ready for the next patient. He was unable to recall his response. ED describes the Registrant’s conduct as being “inappropriate as he was in full view of the public,” and this might “diminish their trust in the profession,” particularly if they had made their own way to hospital, instead of waiting for an ambulance.

97. Later the same day there was a second incident. ED had again taken a patient into the hospital and when he returned the Registrant was, once again, asleep in front of the ambulance which was parked in the ambulance bay at the hospital. The ambulance had not been tidied. ED states that sleeping in the ambulance “looks lazy and portrays the service in a bad light…"

98. The main issue however, as far as ED was concerned, was that the Registrant had not prepared the ambulance. Therefore, when they “greened up” they were not ready to see a patient. Going green means that the ambulance is ready to be assigned to a call. If they had been allocated a job straight away, there would have been a delay in responding as the ambulance was not prepared. Every second could count and it is more difficult to scramble into the back of the ambulance and prepare the equipment when the vehicle is moving. The crew will also drive in an increased state of stress and this creates a difficult working environment.

99. ED’s evidence was that it would have been more acceptable for a Paramedic to rest in an ambulance during the night shift. However, discretion would be required and this would not extent to sleeping in the front seat. The ambulance would have to have been restocked and parked out of view.

100. The Registrant’s submissions accept that he was asleep in the front of the ambulance but states: “…it was without patient and we was going to “stand by” point.” The Registrant appears not to have considered the issue of whether the ambulance was equipped and ready to depart. The Panel accepted ED’s evidence on this point and found the particular proved.

Particular 2(f)(vi) Patient F: Not Proved

101. ED describes in his evidence, attending upon Patient F. The Registrant referred to Patient F as “Madam”. He thought that this demonstrated a language barrier between him and the patient. He would have expected that the Registrant would have introduced himself and asked Patient F her name and how she would like to be referred to. ED describes Patient F as not looking happy with the manner which she was being addressed by the Registrant.

102. ED also recounts what happened when the Registrant was undertaking an ECG on Patient F. He describes the Registrant speaking to her in an “abrupt tone”. The Registrant asked Patient F not to talk when he was conducting the ECG. When Patient F responded to a question posed by ED, related to a medical condition or medication, the Registrant warned the patient for a second time not to speak. He said words to the effect of: “Madam, I have told you once already, please be quiet.”

103. ED states that he regarded this as “…inappropriate due to the tone and the disrespectful manner in which he spoke to the elderly patient that made this most inappropriate. Michal Szczytynski came across as scolding. It was like he was speaking to a child and telling her off.”

104. ED stated that it is standard practice to ask a patient not to speak or move whilst doing an ECG, as it can affect the reading on the ECG monitor. However, the way to deal with a patient who speaks during the reading, is simply to wait a few seconds and obtain a tracing after they have finished speaking. The Registrant should have explained to Patient F that the ECG was sensitive and it would be best not to speak or move for thirty seconds, speaking nicely and being patient, as any patient might be scared in this situation. The Paramedic may come across as uncaring and it will decrease the rapport between patient and Paramedic. This may result in not all relevant information being obtained, delaying treatment or leading to a condition being overlooked.

105. The Panel was unable to conclude that the Registrant had acted in a manner which was rude. The evidence from ED is that the Registrant called Patient F “Madam” and used the word “please”. The Panel also had regard to the evidence that the patient has to be asked not to speak during an ECG. The Panel was not convinced that the actions of the Registrant were unprofessional in these circumstances.

Particular 2(g) Proved

106. The allegation is that the Registrant on or around 14 November 2017, acted unprofessionally, in that he did not pre-alert a time critical patient to the receiving hospital.

107. The evidence in relation to this incident was given by JG which was accepted by the Panel. She was called to attend a patient on 14 November 2017, whilst working with the Registrant. The patient was complaining of dizziness, having recently had a pacemaker fitted. The patient was sweating and described the room as spinning. As a result, the Patient’s husband had rung 999. On this occasion, JG was responsible for driving the ambulance, leaving the Registrant to take the lead in attending on the patient.

108. Upon arrival, the patient was distressed and saying that they felt like they were going to die. The patient was visibly pale, clammy and had an irregular pulse rate. The patient had also vomited. The patient’s ECG was irregular and abnormal at times. The Registrant and JG carried out a full assessment of the patient. They were unable to rule out a Cerebrovascular Accident (CVA). There were 2 time critical working diagnoses - Cardiac Event or CVA. It was agreed that the patient should be conveyed to hospital.

109. JG’s evidence was that pre-alerting a hospital to a patient’s arrival means notifying the hospital that you are en route with a patient. The pre-alert should take place if the patient will require immediate assistance upon arrival at hospital (for example the cardiac or stroke team can be on standby to directly receive the patient). In the case of a major haemorrhage, blood can be prepared prior to the arrival ready to be administered.

110. The Registrant was travelling in the rear of the ambulance with the patient. Before they left the scene, JG asked the Registrant if he was going to pre-alert the hospital or whether he would like her to undertake this task whilst en route. JG’s view was that the patient was time critical and needed a blue light transfer to the nearest hospital. The Registrant disputed this and demanded that they should travel at normal speed with no pre-alert. JG recounts that a heated argument took place; he was “…abrupt and rude…” He refused the instruction of JG who was the higher grade clinician. JG then instructed the Registrant to drive the ambulance and she called West Suffolk General Hospital to pre-alert them of their arrival. She did this as they were pulling away from the scene, by telephone.

111. The Panel accepted the evidence of JG and has seen the file note dated 21 November 2017 which record this incident.

112. The Registrant’s submissions on this issue, simply state: "More details please.”

Particular 2(h) Proved

113. The allegation is that on or around 14 November 2017, the Registrant acted unprofessionally in that he did not treat Patient G with respect, by rolling his eyes at him and telling him to hurry up and get into the ambulance so that he could be taken to A&E.

114. The evidence for this particular was provided by JG which the Panel accepted. The Registrant and JG were called to attend to Patient G who had suffered a suspected overdose. JG was driving the ambulance. Upon arrival, the Registrant walked over to Patient G and without introducing himself was very abrupt towards them. She describes the Registrant approaching Patient G “begrudgingly” and asking Patient G’s friend: “What has he taken?” or words to that effect. He in turn asked Patient G: “Why did you take it?”

115. JG’s evidence was that Patient G had taken an intentional Paracetamol overdose and would have been considered as potentially having mental health difficulties. He should have been dealt with with compassion, to establish a rapport which would have helped gain the patient’s cooperation.

116. The Registrant told Patient G: “get in the ambulance, we are going to hospital,” or words to that effect. Patient G appeared offended by the Registrant’s attitude as he started rung and refusing care and treatment. The Registrant “rolled his eye at the patient and said ‘hurry up and get in the ambulance’ or words to that effect.” At this point JG stepped in to diffuse the situation. She eventually managed to persuade Patient G to accept transport and admission to hospital. Whilst doing this, the Registrant collected all the equipment up and “stormed” back to the ambulance. JG describes being approached by the University Porter who reported ‘how disgusted she was about how Michal Szczytynski had behaved towards the patient…”

117. After Patient G was no longer in their care, JG raised the issue with the Registrant indicating that in her view his behaviour had been “inappropriate and unprofessional.” The Registrant showed no remorse and stated: “I treated the patient, filled out paperwork and took him to hospital, what more do you expect?”

118. JG’s view was that the Registrant demonstrated “poor patient care and a lack of compassion, empathy and professionalism.” In a worst case scenario, “Patient G could have become too distressed, or absconded from the scene and potentially proceeded to commit suicide.” If she had not been there to diffuse the situation, she does “not know how Michal Szczytynski would have got Patient to be compliant or go to hospital. This suggests that Patient G would not have received the care and treatment they needed.”

119. The Panel has seen the file note dated 21 November 2017 which records this incident.

120. The Registrant’s submissions state: “Drunk patient whom make suicide trial by overdosing paracetamol - Potential time critical.”

Particular 2(i) Not Proved

121. The allegation is that on or round 25 November, the Registrant acted unprofessionally by scraping an ambulance that he was driving and did not inform his manager of this incident.

122. The Panel has seen a file note dated 25 November 2017 but the writers name has been redacted. It states that the Registrant was working with two other Paramedics. Upon their return to the station, another Paramedic (TOB) advised the file note writer that the Registrant had just scraped the ambulance on the last call (this being the only call where he had driven). An accident report was subsequently completed. The incident was not reported directly by the Registrant.

123. This incident resulted in the Registrant receiving a Verbal Warning, as contained in a letter dated 25 November 2017, from RA (who was a DLO at the Trust), as there had been two incidents in a 3 month period.

124. The Registrant’s submissions state: “This day I was working with one of Duty local officer, after I done scratch I inform him about it and bcs that was small should I have to report it. He said yes but I can do it in the morning. In morning I went to another DLO to make paperwork. She asked why I didn’t report it yesterday. I explained why.”

125. The Panel was unable to find this particular proved. There was no direct evidence from any of the witnesses and the Registrant has provided an explanation. The Panel concluded that it would be wrong to rely wholly on the hearsay evidence in the bundle to establish that it amounted to acting in an unprofessional manner.

Particular 3(a),(b), (c) (i), (ii), (iii) Proved

126. The amended allegation is that on 22 September 2017, when the Registrant was attending Patient H, he (a) did not communicate his observation with Patient H and/or his colleague; (b) assessed Patient H without obtaining their consent; and (c) took blood from Patient H without (i) obtaining their consent, (ii) without cleaning Patient H’s finger and (iii) did not apply pressure to the wound caused by taking Patient H’s blood.

127. This incident was witnessed by RD. The Panel accepted his evidence as a true account of the incident.

128. On 22 September 2017, RD was working on a two person crew with the Registrant. This was the second shift they had worked together. They responded to a 111 call for Patient H whose carer had reported symptoms of a swollen left hand and arm. Patient H was bed bound due to a stroke and had some paralysis. The Registrant was responsible for attending on Patient H, as RD had driven the ambulance.

129. RD’s evidence is that throughout the Registrant’s attendance on Patient H, the Registrant did not speak to him. He stood with his back to him prior to and when conducting his first examination. On arrival, the Registrant had spoken to the Patient H’s carer in Polish. The Registrant did not communicate anything which was said to the carer to RD. RD had to ask questions directly to the carer in English to obtain information.

130. RD’s evidence was that prior to assessing a patient, a Paramedic should speak to a patient and gain their consent to the examination. The consent can be direct verbal consent or indirect consent, such as where this can inferred from their body language (i.e. a patient nodding when asked by the Paramedic if they can listen to a patient’s breathing). Having obtained consent for the first observation, the Paramedic should explain prior to each observation what it is they are going to do. This allows the patient to withdraw consent for any subsequent observations.

131. RD states that the Registrant made no attempt to gain Patient H’s consent, either directly or indirectly at the outset of his assessment. RD’s evidence was that the patient had capacity and this was confirmed by the carer. He said that the Registrant did not ask Patient H whether he could conduct an assessment, as he did not speak to Patient H during the call or ask any questions. He could not have obtained implied consent as the Registrant stood with his back to Patient H and hence would not have been in a position to have recognised any non-verbal indicators of consent. RD’s opinion was the Registrant did not seek to obtain consent from Patient H’s carer. In any event, this would not have been appropriate as Patient H had the capacity to make his own decision on whether to consent to being assessed.

132. RD’s evidence is that the Registrant then went on to conduct a number of assessments without the consent of Patient H. Firstly, Patient H’s carer had mentioned that he had not been passing much, or any, urine. Patient H was lying on the bed. The Registrant then carried out a physical assessment as he reached his right hand backwards and felt Patient H’s bladder. The bladder is anatomically located low in the abdomen, just above the genitalia. Assessing a person’s bladder is an intrusive examination, which many would find uncomfortable or undignified.

133. Secondly, the Registrant then went on to assess Patient H’s swollen left arm and hand. The Registrant stated the reason the limb was swollen was because of how Patient H had been lying in the bed. However, he had reached this conclusion prior to conducting a full set of observations. RD’s view was that this was not the correct diagnosis as his right arm was lying in a similar position, but was not swollen. RD told the Registrant that a full set of observations were required.

134. The Registrant then began listening to Patient H’s breathing with a stethoscope. He did not obtain consent for this. It is standard procedure is for the Paramedic conducting the observation, after listening to the Patient’s chest, to feed this back to the other Paramedic, to allow them to complete the Patient Report Form (PRF). The Registrant failed to relay this information and RG had to ask how Patient H’s chest sounded. The Registrant replied: “left side less.” He did not go through each of the four basic sections of the chest. RG did not understand what the Registrant was describing and said something to the effect of: “what? less crackling less wheezes?” The Registrant replied “yes, but like an infection”. RD conceded that hearing a crackle might be evidence of an infection, but this is not decisive.

135. RD states that at this point he gave up asking the Registrant about Patient H, as his communication had been “completely ineffective.” He was unsure whether the Registrant did not understand, or was just unable to articulate a response. RD had to intervene and listen to Patient H’s chest, having obtained consent to do so. The patient had nodded when RD had asked him to consent to the procedure. He identified that he was unable to hear little or no air flow going into the left lung, which should have been easy to pick up, in a quiet environment with no ambient noise. In addition, the patient did not have significant body fat, which meant that it was not more difficult to hear. This is potentially serious as it could mean a patient is only using 50% lung capacity. It is important that the breathing assessment is accurate.

136. The Registrant subsequently undertook further observations without Patient H’s consent. This included attaching equipment to Patient H; and obtaining data readings in relation to blood pressure, body temperature, heart rate and blood glucose level.

137. RD’s evidence was that when conducting a full set of observations, you are required to take a Blood Glucose Level (referred to as a ‘BM’ in the UK). This requires a drop of the patient’s blood, usually taken from the fingertip. The correct sequence of events is: (a) obtain cosent; (b) clean the patient’s finger, (c) break the skin of the fingertip using a spring loaded pin; (d) wipe away the initial drop of blood; (e) test the second drop of blood to obtain the BM level, and (f) use a piece of gauze to apply pressure to the patient’s fingertip to order to stop the bleeding.

138. During the assessment of Patient H, the Registrant measured his BM. Before taking his blood, the Registrant did not speak to Patient H and therefore did not obtain his consent. Breaking a patient’s skin is quite an invasive procedure and it is important that the patient is given an opportunity to object by explaining what is about to happen. RD states: “Not obtaining consent to take someone’s blood is plain wrong.”

139. RD’s evidence was that prior to taking Patient H’s blood, the Registrant did not clean Patient H’s fingertip. This is important from a hygiene perspective as, if there was dirt on the skin, this could have caused a localised infection. It is also important for the accuracy of the result. If there was a substance on the skin which was sugary or sweet, this could have produced a false BM reading. It is important that the BM reading is accurate, as to too low or too high a reading could indicate a number of serious conditions. Finally, if this observation is incorrect, it could affect the overall conclusion about the patient’s condition.

140. Having pricked Patient H’s finger, the Registrant drew blood and did not wipe away the initial spot from his finger. It is important to wipe away the first drop, as this can contain tissue debris and can hence give an inaccurate reading. The Registrant allowed a stream of blood to run down Patient H’s finger and hand. RD regarded this as an issue of patient dignity. Allowing blood to drip down the patient’s hands was very “impolite at the least.” RD was also concerned as to the accuracy of the blood tested, as the blood tested should be capillary blood, found at the edge of the skin. The blood which trickled down the hand may not have been capillary blood.

141. RD’s evidence was that he got up from his seat and obtained a piece of gauze and applied pressure to Patient H’s fingertip to stop it bleeding and cleaned up the blood from Patient H’s hand.

142. RD’s oral evidence was that the patient had overall been treated in an “undignified” manner and that he could not believe that a Paramedic would treat a patient in such a manner.

143. RD’s evidence was that the Registrant was “adamant” that Patient H should be left at home. RD believed that the Patient H should be taken to hospital, given the problem identified on the left hand side of the chest. He required a chest X-ray and given he was bed bound would need the assistance of a stretcher/ambulance to move him. Patient H subsequently consented to being taken to hospital, but RD states that the patient was disappointed, and that the Registrant and Patient H’s carer failed to manage his expectations, by initially indicating that he could stay at home.

144. The Registrant’s account in his submissions is: “Geriatric type of patient after stroke GCS 8 with impaired cognitive processes with aspected hypoglycemia and bad circulation whom was caring by Polish woman. When I income to house I start attending patient in regular ABCDE protocol. We were talking in English, and I took compete interview in English. The woman whom was caring about patient H told me if she had already clean all patient before she spot some alert symptoms. I’m aware protocol of checking patient glucose 1v1. - Later because pressure of blood was very low, or to say clear the was no any pressure I did not apply pressure to the wound. As I said before I am aware protocol of checking patient glucose level. After everything I had small conversation with Polish woman in Polish language, because she recognise if I’m from Poland. That conversation was not about patient condition. Probably that why my “colleague” thought I didn’t tell him everything”.

145. The Registrant’s account does not undermine the evidence from RD. The Registrant admits that he did not clean the patient’s finger and that he failed to apply pressure thereafter to the wound.

Particular 4: Proved

146. The allegation is that during November 2017, whilst the Trust was listed as the Registrant’s place of work on his Facebook profile, he did not use Facebook appropriately, in that he (a) posted a Facebook Status on his profile which was offensive, and (b) posted a meme on his profile aimed at colleagues at the Trust.

147. The Panel accepted the evidence of JN and the documents exhibited in the bundle. JN’s evidence was that around 08 November 2017, he was notified by a member of staff at the Trust that the Registrant had posted an offensive status of Facebook. The Registrant was friends with other employees at the Trust who were able to view his status. The status was posted in Polish. Facebook provided the following translation.

“You Black slut with name and name I in my diary person to crazy, 1 0 £ ticket doesn’t mean I’m supposed to be disability bonding. The Gypsies on the plane, uposledzeni on gate, once every 10 times, will fly away in time, the pilot which pierdola the direction of flight, and the staff who don’t know when Thank you for using ryanair.”

148. Set out below is a second translation, provided by MZ, a trainee solicitor with Kingsley Napley, who is a fluent Polish speaker.

“You black whore I added your name and surname to the list in my diary obtaining people to remove/harm/kill. £10 ticket does not mean that I am to be checked in by disabled people. Gypsies on the plane, disabled people in check ion gates, the plane is on time once 10 times, who fuck up the right direction, and staff who don’t know when they are working. Thank you for using Ryanair.”

MZ added “I have translated one of the words to mean ‘remove/harm/kill off’ this is because the Polish term used by Michal Szczytynski can mean any of these things.”

149. The Registrant’s Facebook profile was linked to the Trust, as the page stated that he worked at the Trust. JN describes the content of the post as “aggressive and racist” and “brought the Registrant’s professionalism into question.” The status brought the Trust into disrepute and could have offended employees of the Trust. The Facebook status breached the Trust’s Social media policy.

150. Shortly thereafter, it was drawn to JN’s attention that the Registrant had posted a meme on Facebook that employees at the Trust had found offensive. It was posted around 29 November 2017. The meme shows chimpanzees operating computers with the caption: “Meanwhile in dispatch…” JN’s view was that the meme breached the Trust’s Social Media Policy as the content was aimed directly at employees of the Trust and was disrespectful; showed a disregard for teamwork and a failure to care for others. The Panel has seen a copy of the meme contained in the file note for 29 November 2017.

151. JN sought to discuss the Facebook issues with the Registrant and telephoned him twice on 30 November 2017. He was to be stood down from front line duties, for a number of reasons, including his use of Facebook.

152. There was a subsequent meeting with the Registrant and JN, along with AR, Area Clinical Lead. No notes of the meeting were taken. The Registrant was stood down from front line duties on 30 November. The general response to feedback from the Registrant was “generally polite and professional.” JN comments that there was a lack of understanding in regards to professionalism and how things worked at the Trust. The Registrant would often say that “he had made a mistake and that he would learn from it.”

153. The Registrant submissions state: In post was no any information about relation to EEAS or other NHS unit.

Particular 5 Not Proved

154. The allegation is that, during the time of the Registrant’s employment with the Trust, he did not demonstrate the necessary level of understanding of the English language.

155. JN’s evidence was that soon after the Registrant’s employment commenced, staff at the Trust began to raise concerns as to his oral and written communication. The suggestion was that his use of the English language caused him to come across as aggressive with patients. When spoken to about this, the Registrant maintained that he was working the same as he had done in Poland and the issue appears to have been cultural.

156. However, there is evidence that the concerns extended to the Registrant’s grasp of the English language. The Panel has seen a file note, dated 22 August 2017, from Lead Operational Manager TR. The file note is a copy of an email from TR to the Bronze Team.

157. The email states that the Registrant may find it helpful to undertake English as a foreign language course, as “His clinical skills so far are ok, however, he is having lots of difficulty with communication due to his perceived standards in English.” The emails further notes that:

“I have had a number of unofficial feedbacks from Cambridge staff that have crewed with him over his difficulties with Comms and his unfamiliarity with howe we work or local protocols.”

158. TR’s witness evidence was that he was concerned that the Registrant was having difficulty communicating with patients and colleagues due to the standard of his English.

159. On 11 September 2017, CT received an email from a Paramedic JWP. He had been on a shift with the Registrant on 05 September 2017. The email stated that in his opinion, the Registrant’s “Communication skills are lacking, and whilst I understand English is not the staff member’s primary language, it cannot be ignored that poor communication makes for a poor patient history and thus care episode.” The email notes that at several points, the Registrant “made little or no attempt to obtain any form of history beyond “why are we here.”

160. On 03 November 2017, there was an email from a Paramedic ED to GD, who wrote after working on a shift with the Registrant that day. The email raised a number of concerns, including the Registrant’s communication skills. He stated: “I heard a patient ask him if he spoke the same language as them as they were having difficulty understanding him. I don’t think he acknowledges when he does not understand what has been said to him…”

161. In his evidence to the Panel, ED stated that he did not think that the Registrant acknowledges when he does not understand what is being said to him. He recalls the Registrant, on one occasion parking the ambulance in completely the wrong place at Bennet House, whilst on standby, ignoring the guidance she had given as to where they normally park. He expressed the concern that if he had asked about whether the hand brake was on, or if we had drugs on the ambulance, the Registrant might not have understood what she was saying.

162. JN, in his evidence, stated that the Trust wanted to help the Registrant and were concerned about his language skills. The Duty Locality Manager discussed the concerns with him and explained what support was available, including the employee assistance programme, support from management, a mentor and/or a colleague. In order to assist the Registrant, Mentor Support Shifts were put in place, where a third person is crewed onto an ambulance, allowing the student to receive additional mentorship.

163. On 21 November 2017, Paramedic JP emailed TR in relation to the Registrant’s language skills, amongst other concerns. She wrote: “I understand that English is not M. Szczytynski’s first language however throughout our shift together his poor verbal and written communication caused significant problems when obtaining a clear patient history, gaining patient consent, completing documentation and providing a handover of care to nursing staff. M. Sczcytynski’s struggle with communication combined with his lack of empathy, compassion and appropriate bedside manner inventively [sic] poses a massive risk in the delivery of safe patient care.”

164. On 09 October 2017, the Registrant undertook a shift with TR out of Cambridge. This was the subject of a retrospective file note uploaded on 08 January 2018. The email states: “During my shift with Michal on DSA BA 596 I frankly told him that he needed to improve his English as rapidly as he could, in order to maintain professional standards required of him during patient contact. I felt he was struggling with his communication at work, and during that shift, due to his poor English speaking and writing.” TR provided the Registrant with advice as to where he could access an English Tutor.

165. TR’s evidence was that he felt it was appropriate to record his concerns as to the Registrant’s understanding of the English language, as he was concerned that patient’s did not understand him and that clinical errors were more likely to occur, in light of his quality of English. He describes the Registrant’s spoken English and comprehension as “substandard”. However, in response to Panel questions he accepted that the Registrant’s English was adequate but “there was an area for him to improve”.

166. JN met with the Registrant on 08 January 2018, to discuss the concerns regarding his English language skills. He was concerned there might be a breakdown in communication, miscommunication or lack of clarity in the Registrant’s communication. He does not recall what he said to the Registrant, but the gist of his response was that he was learning English and that lessons were not required.

167. The Registrant’s submissions state: Necessary level? Please explain me that. When EEAS was recruiting me before I start job everything was correct and one year late they are saying if I didn’t demonstrate the necessary level of understanding of the English language? In Feb. 2017 “Jamson Norman - Cambridge EES DLO said Michal make progression.”

168. The Panel was not convinced that the evidence at its height was cogent enough for the Panel to find this allegation proved. There were evidently concerns regarding the Registrant’s English language skills, but this is not sufficient to make out the allegation. JN’s oral evidence was that the Registrant’s grasp of English was adequate and this issue did not prevent him from being deployed on an ambulance. In addition, HN’s evidence was that she did not believe there was a language barrier. There is no evidence of an objective and verifiable language test as to the Registrant’s standard of English language either before, during or after his employment ended.

Decision on Grounds: Misconduct/Lack of Competence

169. The Panel then considered, in light of all the evidence it had heard, whether the Registrant’s actions amounted to misconduct and/or a lack of competence.

170. The Panel accepted the Legal Assessor’s advice on the definition of misconduct. In particular, the Panel paid regard to the definition given by Lord Clyde in Roylance v General Medical Council (No.2) [2000] 1 AC 311: “Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances…”

171. The Panel also had regard to the guidance in Nandi v GMC [2004] EWHC 2317, where Collins J suggested that misconduct could be defined as: “conduct which would be regarded as deplorable by fellow practitioners…”

172. The Panel sets out its findings for each of the proven particulars below:

(a) Particulars 1(a) and (b). The Panel formed the view that the Registrant’s actions did not amount to misconduct. He clearly wished to pass the exams and appealed the outcome. The failure to pass the exam on two occasions did not amount to a lack of competence, as it was not demonstrated by reference to a fair sample of the Registrant’s work.

(b) Particular 2(b)(i). The Panel concluded that the Registrant’s actions did not amount to misconduct and/or lack of competence. The Registrant, in his submissions, states that he checked the patient’s condition, cut the line and “put the body gently on the ground.” He sat on the swing, after a long night to complete the paperwork. There was no intention to be unprofessional when sitting on the swing and the Panel concluded overall that the Registrant may have unintentionally breached Standard 1 of the Guidance on Conduct and Ethics for Students - “you should treat service users and carers as individuals, respecting their privacy and dignity.” However, in all the circumstances it was not so serious as to amount to misconduct.

(c) Particular 2(c)(i). The Panel did not find that the Registrant’s actions amounted to either misconduct or a lack of competence. The Guidance on Conduct and Ethics for Students (Standard 6) states “you should make sure that you take all appropriate steps to limit the risk of harm to service users, carers and others.” The Registrant clearly made an error of judgement or assessment in not having the correct PPE available on a sunny day. This could be regarded as simple lack of awareness on his part. There is no evidence that this was a regular occurrence so as to point to a lack of competence by reference to a fair sample of his work.

(d) Particular 2(c)(ii). The Panel formed the view that the proven facts were not so serious as to amount to misconduct and/or lack of competence. This was a deliberate act with an intention to recycle valuable equipment. Although inappropriate it was not so serious as to amount to misconduct. There was no evidence of this being repeated behaviour and could not amount to a lack of competence.

(e) Particular 2(e). The Panel concluded that the Registrant’s actions amounted to misconduct. A patient suffered actual harm - complaining of being hurt as she was manoeuvred down the stairs. The Registrant is in breach of both Standards 1 and 6 of the Guidance on Conduct and Ethics for Students.

(f) Particular 2(f)(i). This incident did not amount to misconduct and/ or lack of competence. The incident was not serious enough for the other Paramedic involved to ask the Registrant to stop, and did not raise it verbally at the time. The Registrant’s actions, even if amounting to a one off incident of negligence, were not serious enough to cross the threshold into misconduct.

(g) Particular 2(f)(iii). The Panel concluded that this incident was so serious that it amounted to misconduct. The Registrant placed other road users at risk of harm, as well as his colleague on the ambulance. His actions were deliberate.

(h) Particular 2(f)(iv). The Panel found that the Registrant sleeping in the front seat of the ambulance was unprofessional. However, it was not deplorable and did not cross the threshold of seriousness so as to amount misconduct. The Panel considered that this could not amount to a lack of competence.

(i) Particular 2(g). The Panel concluded that the Registrant’s actions amounted to misconduct. There was a serious risk of harm to the patient in refusing an instruction to pre-alert the hospital. The Registrant ignored the view of the more senior Paramedic to the point where he had to be swapped to driving the ambulance, to allow the pre-alert to take place. The Registrant is in breach of both Standards 1 and 6 of the Guidance on Conduct and Ethics for Students.

(j) Particular 2(h). The Panel found the Registrant’s actions were unprofessional with Patient G. However, it was not deplorable and did not cross the threshold of seriousness so as to amount to misconduct and/or lack of competence.

(k) Particular 3(a). The Panel found the Registrant’s actions were unprofessional towards his colleague and Patient H. However, it was not deplorable and did not cross the threshold of seriousness so as to amount to misconduct and/or lack of competence. The Panel notes that the Registrant was operating as a Student Paramedic and had a more senior colleague with him to underwrite his practice.

(l) Particular 3(b), (c)(i) and (ii). The Panel concluded that the Registrant’s actions were so serious that they amounted to misconduct; dealing with basic concepts such as consent and infection control. The Registrant must have known or should have known the importance of gaining patient consent, upholding patient dignity and managing the risks of infection.

(m) Particular 4(a) and (b). The Panel concluded that the Registrant’s actions were serious and amounted to misconduct. The Registrant was in breach of Standard 2 of the Guidance on Conduct and Ethics for Students which requires: “you should be polite and considerate to service users, other students and staff at your education provider and practice placement provider” and “you should use all forms of communication appropriately and responsibly including social media and network websites.”

Decision on Impairment:

173. The Panel then had to consider whether the Registrant’s fitness to practise is currently impaired, in light of the Registrant’s misconduct, having regard to the HCPC Practice Note ‘Finding that Fitness to Practise is Impaired’. The Panel’s task is to determine whether the Registrant’s fitness to practise is impaired, based upon the nature, circumstances and gravity of the misconduct.

174. The Panel is mindful of the forward looking test for impairment and the need to take account of public protection in its broadest sense, including whether the Registrant’s actions bring the profession concerned into disrepute or may undermine public confidence in the profession.

175. The Panel heard submissions on the issue of impairment from the HCPC. It was submitted on behalf of the HCPC that the Registrant’s fitness to practise is impaired on both the public and private components of impairment.

176. The Panel reviewed all the evidence in this case. It heard and accepted the advice from the Legal Assessor.

177. The Panel has concluded that the Registrant’s fitness to practise was impaired during the time that the allegations relate to and remains currently impaired, after considering both the personal and public components.

178. In reaching its decision:

(a) The Panel considered the risk of harm to service users as being significant, particularly having regard to Particulars 2(e) and 3(b).
(b) The Registrant has not engaged in these proceedings. As such, the Panel has no significant evidence before it of insight or remediation. The Panel concluded that there remained a risk of repetition.
(c) The Panel’s overall conclusion, in relation to the personal component of impairment, was that the Registrant’s current fitness to practise is impaired, having regard to the seriousness of the misconduct and the lack of evidence of insight and/or remediation.
(d) In relation to the public component, it is clear that the public’s perceptions of the Registrant’s actions would have been negative and may have harmed the reputation of both his employer and the profession as a whole.
(e) The Panel concluded that the Registrant had breached a fundamental tenet of the profession by placing service users at unwarranted risk of harm. Further, his actions have brought the Paramedic profession into disrepute. The Panel had regard to the need to uphold the proper standards of behaviour and concluded that the public component of impairment is clearly established. The Panel concluded that confidence in the profession and the regulatory process would be undermined if there was no finding of impairment, given the seriousness of the conduct.

Decision on Sanction:
179. The Panel has heard submissions on sanction on behalf of the HCPC. It has paid regard to the HCPC’s ‘Sanctions Policy’ and has accepted the advice of the Legal Assessor. The Panel had particular regard to the principal of proportionality and the need to strike a careful balance between the protection of the public and the rights of the Registrant.

180. The Panel has also reminded itself that the purpose of fitness to practise proceedings is not to punish registrants but to protect the public. The primary function of any sanction is to address public safety. However Panels should also have regard to the wider public interest and this includes the deterrent effect to other registrants, the reputation of the profession and public confidence in the regulatory process.

181. The Panel has had regard to the aggravating and mitigating circumstances in this case.

182. The aggravating features are:

(a) The seriousness of the misconduct found proved, having regard to the safety of service users and the offensive and discriminatory nature of the Facebook post.

(b) The failure to work in partnership with other Paramedics, such as RK and JG.

(d) The lack of evidence of reflection, insight or remediation.

183. The mitigating features are:

(a) The Registrant was a Polish Paramedic on a student pathway. He had been in the UK for only a short period and he would have faced a challenging period of cultural adaptation;

(b) The Registrant has provided written submissions, which contain some admissions, and a limited degree of insight;

184. In light of the above factors, the Panel determined that given the nature of the Registrant’s misconduct, that to take no action, make a Caution Order or to impose a Conditions of Practice Order, would not be in the public interest, and would not retain public confidence in the regulatory process or have the necessary deterrent effect on other registrants. The Panel further concluded that public confidence in the profession would be undermined by imposing any of these sanctions, given the seriousness of the proven misconduct.

185. In addition, the Panel was unable to identify any suitable or workable conditions which could be imposed, in light of certain aspects of the Registrant’s misconduct such as the sexism, racism and disability discrimination exhibited on Facebook.

186. The Panel next considered whether to make a Suspension Order, and concluded that this was an appropriate sanction to both protect the public and to address the wider public interest concerns which the Panel identified. The Panel considered that the incident was serious, involving harm and potential harm to vulnerable service users and the aforementioned discriminatory behaviour. The Panel considered that there was a real risk of repetition.

187. The Panel also had regard to the limited insight as set out above, and concluded that the identified failings are potentially capable of being remedied in the future, if the Registrant engages with a future review Panel.

188. The Panel determined that the Suspension Order should be imposed for a period of 12 months to mark the seriousness of the misconduct, to satisfy the public interest and to act as a deterrent to other registrants. This period of time would also give the Registrant the opportunity to reflect on his misconduct. The Panel concluded in these circumstances that the public interest outweighed the Registrant’s own interest.

189. Having arrived at an appropriate and necessary sanction, the Panel concluded that to impose the more restrictive sanction of a Striking Off Order would be unnecessarily punitive and disproportionate. The Panel noted that striking off should be reserved for cases where there is no other way to protect the public. In this case the Panel determined that an adequate level of public protection and public interest could be achieved by the lesser sanction of a Suspension Order.

190. Whilst in no way seeking to bind any future review Panel, this Panel anticipates that the following matters are likely to be of assistance to any future reviewing Panel:

(a) The Registrant’s attendance at the hearing and engagement with the regulatory process;
(b) Evidence of remediation and/or reflection.

Order

That the Registrar is directed to suspend the registration of Mr Michal Szczytynski for a period of 12 months from the date this order comes into effect.

Notes

Right of Appeal:
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

European Alert Mechanism:
In accordance with Regulation 67 of the European Union (Recognition of Professional Qualifications) Regulations 2015, the HCPC will inform the competent authorities in all other EEA States that your right to practise has been prohibited.

You may appeal to the County Court against the HCPC’s decision to do so. Any appeal must be made within 28 days of the date when this notice is served on you. This right of appeal is separate from your right to appeal against the decision and order of the Panel.

Application for an Interim Order:

1. The Panel heard an application on behalf of the HCPC that an Interim Order was necessary in this case to cover the period from today for the 28 day appeal period and for a maximum of 18 months.

2. It was submitted that an order was required for the protection of members of the public and or is otherwise in the public interest. The Panel decided to proceed in the absence of the Registrant to hear the application, for the same reasons, as set out above, as when deciding to proceed with the final hearing in his absence.

3. The Panel concluded that an Interim Order was necessary on both the suggested statutory grounds, having regard to the seriousness of the misconduct found proved and the sanction imposed. It is proportionate to restrict the Registrant’s practice during the appeal period.

4. The Panel considered an Interim Conditions of Practice Order, but given the Registrant’s lack of engagement, conditions were not appropriate for the same reasons as set out in the substantive hearing.

5. In all the circumstances the Panel determined to make an Interim Suspension Order for the maximum period of 18 months. In deciding to impose this length, it took account of the fact that if the Registrant were to appeal, that process may take a considerable period of time.

Interim Suspension Order:
The Panel makes an Interim Suspension 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 Michal Szczytynski

Date	Panel	Hearing type	Outcomes / Status
04/03/2021	Conduct and Competence Committee	Review Hearing	Struck off
09/03/2020	Conduct and Competence Committee	Final Hearing	Suspended