Mr Stephen G Dean

Profession: Paramedic

Registration Number: PA07485

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 07/10/2020 End: 17:00 08/10/2020

Location: This Hearing took place virtually

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

(as amended on day 1 of the hearing, namely, 7 October 2020)

As a registered Paramedic (PA07485) your fitness to practise is impaired by reason of misconduct and/or a health condition. In that:

1.  On 19 June 2018, you attended to a patient who had breathing problems due to an asthma attack and you did not provide adequate care and treatment, in that:

a) you did not administer Hydrocortisone and/or record on the PRF the reasons for not doing so;

b) you did not administer Adrenaline and/or record on the PRF the reasons for not doing so;

c) you did not recognise the severity of the patient’s condition given the observations you made, specifically:

i) a respiratory rate of 30 breaths per minute;
ii) a heart rate of 152 beats per minute.

d) you did not measure the patient’s Peak Expiratory Flow Rate and/or record on the PRF the reasons for not doing so;

e) you did not maintain primacy of care for the patient, in that you allowed an Emergency Medical Technician, Colleague A to attend to the patient whilst you drove the ambulance.

2.  You have a physical and/or mental health condition as set out in Schedule A.

3. The matters set out in paragraph 1 above constitute misconduct.

4. By reason of your misconduct and/or health your fitness to practise is impaired.

Finding

Preliminary Matters

Service and Proceeding in Absence

1. The papers before the Panel showed that the Notice of Hearing was emailed by the HCPC to the Registrant’s email address on 4 August 2020. In response, the Registrant sent an email on 16 August 2020 to confirm its receipt. The Panel therefore found good service in this case.


2. Within that same email of 16 August 2020, the Registrant informed the HCPC that he would not be attending this hearing because he now lives outside the UK. He added that he would not be represented and would not be calling any witnesses.


3. The Panel accepted the submission of Mr Millin that it was appropriate for this case to proceed in the absence of the Registrant. It was plain that he was voluntarily absenting himself, there had been no application for an adjournment and it was in the public interest that this case should be heard in his absence.


Perception of Bias


4. The only witness to be called by the HCPC in this case is MF who, in addition to other roles he performs, sits sometimes as a panellist on HCPTS hearings. Of today’s three panellists, one of them, Ms Crawley, thinks that it’s possible that she may have sat on the same panel as MF in the past, but has no clear recollection of this. Indeed, none of the panellists have any direct knowledge of MF.


5. The Registrant was informed by an email of 6 October 2020 of these matters and was invited to comment. He has not done so. The Panel took the advice of the Legal Assessor and paid due regard to the test that was applied in Porter v McGil which formulated the following question “would a fair minded and informed observer, having considered all the facts, conclude there is a real possibility of bias?” In the knowledge that the papers reveal no substantive clash with the parties on the principal issues in this case, the Panel decided that there was no real possibility of bias were they to continue to hear this matter as empanelled.


Application to Amend the Allegation


6. On 5 May 2020 an email was sent to the Registrant giving him the details of the Allegation in its original form. On 15 May 2020, MF signed his witness statement, to which was appended a copy of his Investigation Report. On 19 May 2020 the HCPC informed the Registrant by email that an application was to be made to make minor amendments to the Allegation, to better reflect the evidence. The Registrant has made no comment with regard to this application.


7. The Panel determined that the suggested amendments were minor, they would not cause injustice to the Registrant and it would be appropriate to grant this application.

Health Allegation


8. Particular 2 of the Allegation refers to a physical and/or mental health condition apparently affecting the Registrant. Mr Millin invited the Panel to accept that this matter, if ever proceeded with, should be deliberated upon by a Health Committee. It was inappropriate that this Panel should consider this allegation.


9. The Panel agreed with this contention and determined that it was a matter that they would not consider in this case.


Background


10. The Registrant joined the London Ambulance Service (LAS) in 1986 and became a registered Paramedic in 1996. At the material time he was working as a Band 6 Paramedic.


11. On 19 June 2018, the Registrant and his crewmate, Colleague A, an Emergency Medical Technician, were called to attend to a 13 year old patient with a history of asthma. The patient was experiencing shortness of breath which was believed to be caused by an asthma attack. The patient was transported to hospital by Stephen Dean and Colleague A. The ambulance had its blue lights on throughout. Shortly before arrival at hospital, the patient suffered a cardiac arrest and died later that day.


12. Concerns were raised regarding whether the Registrant had maintained primacy of care, as it emerged Colleague A, who held a role junior to the Registrant, had travelled in the back of the ambulance whilst the Registrant drove it to the hospital.


13. MF was appointed to investigate the concerns as Investigating Officer on 20 June 2018.


14. On 29 June 2018 the Registrant was suspended from duty and the next day he self-referred to the HCPC.


15. On 14 August 2018 the Registrant was interviewed as part of the preliminary investigation and tendered his resignation on that same day. In what were regarded as helpful and frank answers, the Registrant said, amongst other things, “I’d not say she was critically unwell, but she was unwell enough to be blue’d into hospital”. He added “I wouldn’t think in a million years that she would deteriorate so fast”. He admitted that he should have been in the back of the ambulance during the journey.


16. On 20 September 2018 the Registrant informed the HCPC that he was employed in a non-medical job.


17. On 24 September 2018 a Serious Incident Report concluded that the patient was in a life threatening stage of exacerbation of her asthma, a fact that was not recognised by the ambulance crew. Furthermore, drugs that were available for the condition were not administered in full.


18. On 3 October 2018 the Registrant emailed the HCPC to say that he would be posting a letter to request the removal of his name from the HCPC register with immediate effect.


19. Because of the COVID-19 pandemic the inquest into the death of the patient is yet to be heard.


Decision on Facts


20. The Panel has considered all the documentary evidence placed before it and has had regard to the live testimony of the single witness who was called by the HCPC. The Panel also paid due regard to the submissions of Mr Millin and has accepted the advice of the Legal Assessor.


21. The Panel has reminded itself throughout that the burden of proof rests upon the HCPC. It is not for the Registrant to prove any relevant matter or disprove a contention advanced against him. The standard of proof is the civil standard – the balance of probabilities.


22. The Panel heard live evidence from MF, Clinical Practice Development Manager (Critical Care) for London Ambulance Service (LAS). Some of his evidence came into the category of hearsay and the Panel paid due regard to the warnings given by the Legal Assessor as how to approach this.


23. On 20 June 2018 MF was appointed as the Investigating Officer to investigate the incident that concerns this case.


24. The Panel found him to be a credible, knowledgeable and very helpful witness. This applied both to his live evidence and to his detailed Investigation Report that forms part of the papers in this case.


25. The Registrant gave no evidence, provided no witnesses on his behalf and made no representations in writing for the Panel’s consideration in this case. The Panel, nevertheless, paid appropriate regard to the answers he provided in his interview that formed part of the investigation.


26. Dealing with the Particulars of the Allegation in turn, the Panel’s decisions are as follows:


Particular 1(a)


27. In his interview the Registrant accepted that he did not administer hydrocortisone to the patient, nor did he record this fact on the Patient Report Form (PRF), or his reasons for his failure to do so. MF told the Panel that steroids like hydrocortisone are listed as a potential treatment for asthma under the National Clinical Practice Guidelines. MF added that, in the circumstances of this case, where there were clear indications that the patient met the criteria for an “acute severe asthma attack” hydrocortisone should have been administered. The Panel was in no doubt that these failures amounted to examples of inadequate care and treatment of the patient. This Particular is therefore found proved.


Particular 1 (b)


28. The PRF makes no mention of the Registrant having administered adrenaline to the patient in his interview.  The Registrant said he “did not think it was initially life threatening for adrenaline”. The Panel found, on the evidence, that the same considerations that applied to their reasoning in paragraph 26 above had equal application here. Therefore, this Particular was also found proved.


Particular 1 (c) (i) and (ii)


29. A reading of the PRF shows that the Registrant and Colleague A reached the patient’s side at 16:27 hours. Eight minutes later the readings were taken. The respiratory rate of a healthy patient should have been about 12 - 14 breaths per minute. The rate recorded was 30 breaths per minute, “a marked” increase said witness MF. As far as the heart rate was concerned, the normal reading should have been about 60 – 100 beats per minute. MF regarded the recorded rate of 152 beats per minute, as “a significant” increase. The view of MF was that these readings were abnormally high and that the Registrant should have been aware of the risk of deterioration. The PRF recorded the time of departure of the ambulance at 16:44 hours. This was after an early warning call had been made to the hospital. The Panel accept the contention of MF that the Registrant had not recognised the severity of the patient’s condition. Therefore, the Panel found this Particular proved.


Particular 1 (d)


30. The Registrant admitted in interview that he did not measure the Registrant’s Peak Expiratory Flow Rate. The explanation provided on the PRF was “we were unable to do so”. Given this response, the Panel was of the view that this did not come within the category of a failure to provide adequate care and treatment. On the balance of probabilities, the Panel found this Particular not proved.


Particular 1 (e)


31. The Panel accepted the opinion of MF that the Registrant, as the senior team member, should have ensured that he was providing adequate care to the patient in the back of the ambulance. In his interview the Registrant stated, “I should have been in the back of the ambulance”. This was a grave dereliction of duty, in the view of the Panel, and plainly amounted to a failure to provide adequate care and treatment to this 13 year old patient. This Particular was therefore found proved.


Decision on Grounds


32. Whether or not the facts found proved amount to misconduct is a matter for the professional judgement of the Panel. Although this case concerns the circumstances surrounding the transport to hospital of a single patient, the facts found proved demonstrate that a wide range of expected requirements were ignored by the Registrant. In the judgement of the Panel, these failings amounted to a severe falling short of the standards expected of a professional paramedic.


33. The Registrant’s performance failed to meet the following HCPC Standards of Conduct, Performance and Ethics:


Standard 4.1 - You must only delegate work to someone who has the knowledge, skills and experience needed to carry it out safely and effectively;

Standard 6.1 - You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible;

Standard 10.1 - You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.


34. Accordingly, in the Panel’s judgement, the allegation of misconduct is well founded.


Decision on Impairment 


35. The assessment of the question of current impairment, just like that of misconduct, is a matter for the professional judgment of the Panel.


36. Since his participation in the Trust’s investigation in August 2018, where some insight was shown, there is no material in front of the Panel to suggest that the Registrant has done anything to remediate his shortcomings. Indeed, it seems from the emails that he has sent to the HCPC that he has decided to leave the profession. The Panel can find no evidence that he has expressed a desire to redress his deficiencies.


37. In the judgement of the Panel, the proved facts in this case demonstrate that the Registrant has shown a careless disregard of his duties as a registered Paramedic.


38. The Panel bears in mind its duty to declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession. To fail to find that the misconduct of the Registrant amounts to current impairment would undermine such confidence.


39. Thus, consideration of the public interest and public protection ensure that it is appropriate to find that the Registrant’s fitness to practise is currently impaired.


Decision on Sanction


40. The Panel heard from Mr Millin on this issue. There were no representations from the Registrant. In coming to its own independent view on sanction, the Panel paid careful regard to what was said and reminded itself of the provisions of the HCPC Sanctions Policy [July 2019] (SP).


41. It also accepted the advice of the Legal Assessor that it should apply the principle of proportionality, weighing the interests of the public with those of the practitioner. The public interest includes not only the protection of patients, but also the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour.


42. In coming to its decision on sanction, the Panel took account of the following mitigating and aggravating features:


Mitigating


• The witness MF described the Registrant as being “very open and frank” in interview. The Registrant’s answers demonstrated he possessed an element of insight into his failures of action on 19 June 2018. He also showed some remorse;


• Within his lengthy service as a Paramedic, there have been no previous regulatory findings against him;


Aggravating


• The misconduct involved a serious departure from good practice by an experienced professional;


• Since he tendered his resignation from the Trust, the Registrant has not engaged effectively in the regulatory process and the consequence is that the Panel has heard no evidence from him in relation to remediation, further insight, or whether he has been keeping his professional development up to date;


• The patient involved in this case was a young and very vulnerable teenage girl.


43. In all the circumstances, it would clearly be inappropriate to conclude this case by taking no action or by referring it for remediation. The imposition of a Caution Order would also be equally inappropriate. None of these courses would serve to protect patients, or maintain the standards of the profession, or the regulatory process.


44. The Panel has no information about the Registrant’s current employment, if he has any. Indeed, there is no information as to which country outside the UK he is now living in. In any event, a Conditions of Practice Order would not be sufficient to reflect the seriousness of the Registrant’s shortcomings. There are no conditions available to the Panel which could address the risk of repetition in a case of this nature.


45. The Panel reminded itself of that part of the SP which refers to the imposition of a Suspension Order. This is a sanction which, in the view of the Panel, would be inappropriate because, apart from anything else, there is a risk that the conduct found proved could be repeated. The fact that the Registrant has shown no engagement in the process since August 2018 confirms the Panel in its view that such a sanction would be neither appropriate nor proportionate.


46. Striking Off is a sanction of last resort and should be used only where there is no other way to protect the public. It is the Panel’s view that the nature and gravity of the Registrant’s misconduct in this case are such that any lesser sanction would fail to address unremedied areas of risk, maintain public confidence in the profession, or declare and uphold proper standards and the regulatory process.


47. Accordingly, it is the Panel’s decision that the only appropriate and proportionate sanction to impose in this case is that of a Striking Off Order.

Order

Order: The Registrar is directed to strike the name of Mr Stephen Dean from the register on the date this Order comes into effect.

Notes

Interim Order


1. Mr Millin has made an unopposed application for an Interim Suspension Order to be imposed upon the Registrant for a period of 18 months.

2. The Panel reminded itself that the Notice of Hearing sent to the Registrant on 4 August 2020 warned him that such an application might be made in the event of certain orders being imposed, including that of a Striking Off Order.

3. The Panel considers that, in the light of its findings of misconduct, it is necessary to impose the requested Interim Suspension Order in order to protect the public and also in the wider public interest for a period of 18 months.

4. The Panel makes an Interim Suspension 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. 

5. 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 Stephen G Dean

Date Panel Hearing type Outcomes / Status
07/10/2020 Conduct and Competence Committee Final Hearing Struck off