Mr Anthony Morris

Profession: Paramedic

Registration Number: PA40198

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 22/09/2020 End: 17:00 24/09/2020

Location: Virtual hearing

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

On 26 August 2016, whilst registered as a Paramedic and employed by the
North West Ambulance Service, you attended Service User A and you:

1. Made the following inappropriate comments:

a) You requested an amber level ambulance backup ‘for my own
sanity’, or words to that effect;

b) Regarding not lifting Service User A, you asked if Service User
A’s family would pay your mortgage if you hurt your back, or
words to that effect;

c) You made comments to the effect that Service User A was not
unwell, or was feigning illness;

d) You told Service User A to ‘come on’ and ‘get up’, or words to
that effect when she collapsed;

e) You made a comment to the effect that it did not matter how
long it took to treat Service User A as you would be paid until the
end of your shift anyway

f) You made a comment to the effect that you could be helping
others and that Service User A was wasting your time

2. Did not communicate appropriately with Service User A and/or her
family, in that:

a) Following Service User A’s collapse, you did not update
Service User A’s family before transporting Service User A to the
hospital.

b) You did not inform Service User A (or her family) of her
potential diagnoses and the risks associated with those.

3. Did not complete and/or record an adequate clinical assessment
and/or examination.

4. Walked Service User A to the ambulance, despite her being
tachypnoeic and/or without offering appropriate assistance.

5. Did not provide a wheelchair to Service User A despite this being
requested by Person B

6. Did not assist Service User A to stand when she collapsed on
multiple occasions

7. Did not provide care to Service User A in a timely manner
following her collapse.

8. Did not transport Service User A to the hospital in a timely
manner despite Service User A hyperventilating

9. Did not provide an adequate treatment plan in response to
Service User A’s hyperventilation

10. Did not complete and/or record regular observations of Service
User A

11. Did not assist Service User A to travel down the stairs,
including by not using a track chair

12. Informed your employer that care was provided to Service User
A in a timely manner following her collapse, when this was not the
case.

13. Your actions as described at paragraph 12 above were
dishonest.

14. Your actions as described at paragraphs 1 – 11 above
amounted to misconduct and/or lack of competence.

15. Your actions as described at paragraphs 12-13 above
amounted to misconduct.

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

Finding

Preliminary Matters

Amendment of Allegation

1. Ms Constantine, on behalf of the HCPC, applied to amend paragraph 2(b) of the Allegation, by inserting the words “or her family” after the words “Service User A”. She submitted that the amendment sought was consistent with the evidence and served to clarify the allegation by giving further and better particulars.

2. The Registrant did not object to the amendment. Ms Hicks indicated that he had been aware that the application was to be made.

3. The Panel accepted the advice of the Legal Assessor, who advised that it was open to the Panel to amend the allegation, provided the Panel was satisfied that no injustice would be caused by the amendments. The Panel considered that the amendment sought did not change the substance of the allegation. The amendment did clarify the allegation and would not cause injustice, as it is always preferable that allegations are as clear as possible so that registrants are clear what is alleged against them in order for them to respond. The Panel therefore allowed the amendment to be made.


Background

4. The Registrant was employed by North West Ambulance Service NHS Trust (“NWAST”) as a Paramedic.

5. On 26 August 2016, he attended to Service User A in response to an emergency 999 call made by Person C. The Registrant subsequently contacted

the Ambulance control room and requested an ambulance crew as backup. Ms Chadwick and Colleague A were dispatched to assist him and arrived in an ambulance. Ms Chadwick was a paramedic also employed by NWAST and Colleague A was an Emergency Medical Technician (“EMT”). Service User A died shortly after her arrival at the hospital.

6. Person B, Service User A’s mother, submitted a written complaint to NWAST on 22 March 2017 with regard to the care that Service User A received from the Registrant and Ms Chadwick. PC, a Patient Experience Manager at NWAST, subsequently completed an investigation. JP, who was an Advanced Paramedic, conducted a clinical review of the incident.

7. A referral was made to the HCPC by NWAST on 25 July 2017 in regard to the Registrant’s fitness to practise.


Decision on Facts

8. The Panel considered all the evidence in this case together with the submissions made by Ms Constantine on behalf of the HCPC, and Ms Hicks on behalf of the Registrant.

9. The Panel accepted the advice of the Legal Assessor who reminded the Panel that the burden of proof rests with the HCPC, and that the Registrant need not prove or disprove anything. The Legal Assessor also reminded the Panel that the standard of proof is the civil standard, namely the balance of probabilities.

10. The Panel heard oral evidence from the following witnesses on behalf of the HCPC:

• PC, the Patient Experience Manager at NWAST who investigated this incident;

• JP, the Advanced Paramedic who carried out the clinical review of this incident;

• Person C, the niece of Service User A who was present at the time of the incident;

• Person B, the mother of Service User A who arrived at the incident shortly before the arrival of the ambulance crew and who was present throughout the incident thereafter;

11. The Panel also heard evidence from the Registrant.


HCPC's evidence

12. The Panel found PC, the Investigations Officer, to be a clear and cogent witness. Her recollection was reasonable. She was clear when she did not agree with matters put to her, and she did not speculate. Her evidence was internally consistent and was also consistent with other evidence in the case. Whilst she did not witness the incident, she was able to give clear and cogent evidence of her investigation and what witnesses had said to her during that investigation. The Panel found her to be a credible witness.

13. The Panel found JP to be a credible witness. His evidence was clear and cogent. His evidence related to a clinical review of the records of the events, and relevant policies. He was not in possession of facts related to the Registrant’s registration dates, and conceded that he had made assumptions about the length of time that Mr Morris had been operational as a paramedic. However, in respect of his evidence related to the clinical review, the Panel found JP’s evidence to be credible and consistent.

14. In relation to Person C, Service User A’s niece, the Panel found her to be a credible witness. Person C was calm and collected in the way she gave evidence and she appeared to have a clear recollection of events. The Panel noted that her evidence on who had accompanied Service User A down the stairs differed from that of Person B, but the Panel concluded that this difference was not material to the allegation and did not detract from the Panel’s view of her evidence overall.

15. The Panel found Person B, Service User A’s mother, to be credible. Her account of what she witnessed was detailed and corroborated by other evidence in this case. The Panel noted that during oral evidence Person B identified the Registrant as making a comment about his mortgage, in contradiction to her statement where she had said she could not recall which paramedic said this. The Panel gave greater weight to her statement dated 15 April 2019 that she could not recollect who had said this as it reflected the content of her complaint letter of 22 March 2017. The Panel considered that this single discrepancy did not detract from the Panel’s view of her evidence overall.

16. The Panel also received evidence from the HCPC which included:

• The Patient Record Form (the “PRF”) completed by the Registrant in relation to Service User A;

• The CAD audio recording of the Registrant requesting a backup ambulance;

• The Bodycam footage taken by the Police Constable who attended the incident;

• The Investigation Report by PC;

• The Clinical Review carried out by JP;

• Various policy and guidance documents of NWAST;

• Guidance issued by the Joint Royal Colleges Ambulance Liaison Committee (“JRCALC”); and

• Photographs taken of the building where this incident took place.


The Registrant’s evidence

17. The Registrant gave oral evidence. He also provided the Panel with a bundle of evidence which included:

• a statement dated 20 October 2018, which he adopted as his evidence for the purpose of these proceedings

• Character references

• A written reflection on the incident dated 20 October 2018

• Continuing Professional Development (“CPD”)

• Video footage of the ramp supplying Service User A’s block of flats and satellite maps of the geography of the relevant area.

18. The Panel did not find the Registrant to be a credible witness. The Panel was satisfied that he broadly remembered what happened but portrayed events in a light favourable to him, which was contradicted by other evidence before the Panel, such as the Bodycam footage. The Panel noted that at times he changed his account under cross-examination after being confronted with evidence by

Ms Constantine. His evidence was internally inconsistent. For example, in respect of his assessment of Service User A’s condition, he began by stating that he took her condition seriously, whereas under cross-examination he conceded that he had viewed her condition as ‘behavioural’ not ‘clinical’, and that she was messing around. A further example relates to his description of Service User A’s reaction to her mother’s presence; in his evidence to the Trust he indicates that Service User A was agitated by her mother’s presence, whereas in his written reflection he states that Service User A began to co- operate upon the mother’s arrival.

19. The Panel was not satisfied that the Registrant was being truthful about his recollection of events. Where his testimony conflicted with that of Witness 3 and Witness 4, the Panel preferred their evidence.

20. The Panel noted that the Registrant made some admissions at the outset of the hearing and conceded some matters during his oral evidence.

21. The Panel considered each of the factual particulars and made the following findings:


Particular 1(a)

1. Made the following inappropriate comments:

a) You requested an amber level ambulance backup ‘for my own sanity’, or words to that effect;


22. The Registrant accepted that he had made that request whilst saying those words. Furthermore, the Panel heard the CAD audio record of the Registrant’s request and it is clear that he says the words ‘for my own sanity’. The Registrant said that the situation was chaotic with various things happening simultaneously, but accepted that regardless of that, he should not have said what he said.

23. The Panel therefore finds that fact proved. The Panel then considered whether the comment was inappropriate in the circumstances. The Panel took into consideration that the words were heard by Person C who was “shocked” by them.

24. The Panel determined that the comment was inappropriate in the circumstance where they were spoken out loud in the presence of both Service User A and Person C.

25. Therefore the Panel finds Particular 1(a) proved on the balance of probabilities.
Particular 1(b)

1. Made the following inappropriate comments:

b) Regarding not lifting Service User A, you asked if Service User A’s family would pay your mortgage if you hurt your back, or words to that effect;


26. Person C was clear in her evidence that those words were said and that it was “the first Paramedic who arrived at the scene” who had said those words. That person was the Registrant who had arrived first and remained the sole paramedic for almost two hours before the back-up ambulance arrived. It was not likely that Person C could have confused the Registrant with Colleague A in those circumstances. The Panel noted that the words are mentioned in the letter of complaint, and in the investigation notes.

27. The Registrant in his defence stated that he did not say those words and that it was unlikely he would have said those words because he did not, and never did, have a mortgage. He also told the Panel that he did not hear anyone else say those words.

28. The Panel preferred the evidence of Person C and was satisfied that the Registrant did say those words.

29. The Panel then considered whether such a comment was inappropriate in the circumstances. It determined that a paramedic’s duty is to assist a patient if they collapse and therefore such comments are inappropriate, even more so in the presence of service users. Witness 3 said it made her ‘question the paramedic in [her] mind’.

30. Therefore the Panel is satisfied that Particular 1(b) is proved on the balance of probabilities.

Particular 1(c)

1. Made the following inappropriate comments:

c) You made comments to the effect that Service User A was not unwell, or was feigning illness;


31. Person C was clear that it was the first paramedic who said words to the effect that Service User A was behaving in that manner because she was pretending.

32. The Registrant denied making such comments. He told the Panel that he could not say that someone was not well or feigning if he could not undertake an assessment. He said that Service User A would not let him assess or examine her and in those circumstances he would not have made such a comment. He told the Panel that Service User A’s family had told him her history and that the fact they had called for an ambulance indicated to him that there was obviously an underlying condition. He said that in those circumstances, it was his intention to take Service User A to the hospital, as evidenced by his request for an ambulance to convey her to hospital.

33. However, the Registrant told the Panel several times during his oral evidence that he initially thought that Service User A’s actions in the flat “were behavioural and not clinical” and that her actions were “deliberate”.

34. The Panel also noted that, on the Bodycam video footage, the Police Constable is seen to ask the Registrant, with reference to Service User A, if this was a “kid on” and the Registrant replied “Absolutely”.

35. The Panel has direct evidence that even after Service User A collapsed, the Registrant still thought that Service User A was ‘kidding’, and this was confirmed in cross examination. The Registrant then said that when Service User A had collapsed he knew she was ill but not how ill she was.

36. The Panel was satisfied on the balance of probabilities that the Registrant did make comments to the effect that Service User A was not unwell, or was feigning illness, in the flat before she collapsed in the stairwell.

37. The Panel was satisfied that the comments were inappropriate in the circumstances. Such comments should not be made by a Paramedic to a member of Service User A’s family in her presence.

38. Therefore the Panel is satisfied that Particular 1(c) is proved on the balance of probabilities.

Particular 1(d)

1. Made the following inappropriate comments:

d) You told Service User A to ‘come on’ and ‘get up’, or words to that effect when she collapsed;


39. It is the HCPC’s case that the Registrant said the words ‘come on’ and ‘get up’ to Service User A. The HCPC relied upon the Bodycam video footage to prove this sub-particular. The HCPC’s case is that this particular relates to when Service User A had already collapsed at the bottom of the stairwell and not to any time prior to the arrival of the Police Constable.

40. The Panel has viewed the Bodycam video footage and whilst the Registrant is heard to say “come on” to Service User A on three separate occasions. He is not heard to say “get up” to her.

41. The Registrant says that when Service User A had collapsed at the bottom of the stairwell to be block of flats, he was saying, “come on” whilst patting Service User A in order to try and get a response from her.

42. The Panel determined that in the particular circumstances it may not have been inappropriate to use the words, “come on”.

43. Therefore the Panel did not find Particular 1(d) proved.


Particular 1(e) and 1(f)

1. Made the following inappropriate comments:

e) You made a comment to the effect that it did not matter how long it took to treat Service User A as you would be paid until the end of your shift anyway;


f) You made a comment to the effect that you could be helping others and that Service User A was wasting your time.

44. The Panel considered these two sub-Particulars together because they are linked in that they relate to the amount of time that the Registrant was spending with Service User A.

45. Both Person C and Person B stated that they heard the Registrant make those comments.

46. The Registrant does not accept that he made those comments. He said that he would never say such things to any service user. He said that if they were unwell enough to call for paramedic assistance, then he would sit with them regardless of how long it took. He said that he would not consider anyone in that situation to be wasting his time. He said that he joined the ambulance service because he wanted to help people.

47. The Panel accepted the evidence of Person C and Person B. The comments were referred to in the complaint letter, the investigation notes, and in the statements of Witness 3 and Witness 4. The Panel found that the Registrant did make those comments.

48. The Panel then considered whether such comments were inappropriate in the circumstances and determined that they were. The comments indicated that Service User A was wasting the time of the Paramedics who had attended.

49. Therefore the Panel found particulars 1(e) and 1(f) proved on the balance of probabilities.

Particular 2(a)

2. Did not communicate appropriately with Service User A and/or her family, in that:
a) Following Service User A’s collapse, you did not update Service User A’s family before transporting Service User A to the hospital;


50. The Panel was satisfied upon the evidence before it that there was a duty on Paramedics to update a patient’s family, if they are present, before transporting that patient to the hospital.

51. Person C and Person B told the Panel that the paramedics did not give an update to them about Service User A’s condition before they transported her to the hospital.

52. The Registrant denied this Particular. He told the Panel that once Service User A was in the back of the ambulance she suffered a cardiac arrest. He said that the Police Constable was informed of the situation and that the paramedics had reasonably expected him to speak to Person B. The Registrant said that at the time Person B had returned to the flat, on the instructions of the Police Constable, and he did not feel it was appropriate to leave his colleagues in the ambulance to go back up four flights of stairs to tell Person B of the situation, as this would have delayed the conveyance of Service User A to the hospital.

53. The Registrant pointed out that the Police Constable had come to the driver’s side window of the ambulance and had received an update from the EMT who was about to drive the ambulance to the hospital. The Registrant stated that it was appropriate for him to rely on the Police Constable to convey the situation to Person B as the Police Constable was a trusted individual, and he had said that he would inform Person B of what happening and where the paramedics were taking Service User A. The Registrant stated that he did not want to waste any time and that he wanted her to get the help she needed as soon as possible.

54. The Panel saw direct evidence from the Bodycam footage, of Ms Chadwick telling the Police Constable that they were ‘working on’ Service User A. It also saw evidence of the EMT telling the Police Constable of the destination hospital.

55. PC gave evidence that it was reasonable in those circumstances to rely on the Police Constable to update the family.

56. The Panel was satisfied that the Registrant did not personally update Service User A’s family. The Panel determined that in the circumstances, it was appropriate for the Registrant to rely upon the Police Constable to update Service User A’s family.

57. Therefore the Panel did not find particular 2(a) proved.


Particular 2(b)

2. Did not communicate appropriately with Service User A and/or her family, in that:
b) You did not inform Service User A or her family of her potential diagnoses and the risks associated with those.

58. The Panel was satisfied that there was a duty on a Paramedic to inform a service user of the potential diagnoses and the risks associated to enable the service use to give valid consent for any proposed treatment or treatment plan, including transport to hospital.

59. The Panel had the PRF of the incident before it, which was produced by PC as an exhibit. JP told the Panel that he had examined the PRF as part of his Clinical Review. He pointed out that the PRF did not contain details of assessments or potential diagnoses.

60. The Registrant accepted that he had not been able to ascertain any potential diagnosis for Service User A. He told the Panel that this was because Service User A would not let him assess her or take observations. He said that he presumed that Service User A had mental capacity, as a result of speaking to her in the flat. He told the Panel that Service User A refused to let him assess her and he said that if he was unable to assess someone, then he could not give a potential diagnosis.

61. When asked by the Panel which differential diagnosis he was considering initially before calling for backup, the Registrant stated that it was more to do with the hyperventilation and whether it was stress related or whether something had happened.

62. The Panel was satisfied that the Registrant did not inform Service User A or her family of her potential diagnoses and the risks associated with such diagnoses because, as the Registrant accepted, he did not consider any potential diagnoses, or causes, of Service User A’s hyperventilation. As a consequence, he was unable to inform Service User A or her family of any potential diagnoses or associated risks.

63. On this basis the Panel finds Particular 2(b) not proved on the balance of probabilities.

Particular 3

3. Did not complete and/or record an adequate clinical assessment and/or examination.


64. There is duty upon a Paramedic to complete an adequate clinical assessment or examination of a service user where possible. If a Paramedic has been able to carry out that duty, then there is a further duty to record accurately their findings.

65. The Panel first considered what clinical assessment and examination would be adequate in the circumstances and then whether such assessments or examinations were carried out.

66. A copy of the Joint Royal Colleges Ambulance Liaison Committee’s (JRCALC) guidance, as to what could be expected of an adequate assessment was produced to the Panel. The JRCALC guidance is standard guidance on good practice to all registered Paramedics.

67. The Panel took into account the guidance contained within the JRCALC document. It gave a non-exhaustive list of assessments that should be carried out. JP pointed out that there was no evidence of clinical assessment and no detail around any examination that was done.

68. The Panel noted that the Registrant had taken some observations. The Panel accepted that he did record some baseline observations on the PRF and therefore accepted that the Registrant did do some assessment.

69. The Panel was satisfied that on the evidence before it, the PRF did not contain sufficiently detailed information to create a proper clinical picture of Service User A’s condition because clinical assessments were not adequately recorded.

70. There were two critical points when adequate clinical assessment should have been carried out – initially when the Registrant attended the scene and subsequently when Service User A had collapsed at the bottom of the stairwell

71. The Registrant accepted that he had not carried out adequate clinical assessment and examination. He explained that when he first attended the scene Service User A would not allow him carry out a clinical assessment or examination of her, that she had mental capacity, that she could make such a refusal and that a Paramedic must abide by it. When the Registrant was asked why he did not carry out a clinical assessment or examination of Service User A at all, he said that he could not get past Service User A’s refusal for him to make baseline observations of her. As such he did not think to go beyond that and ask whether she would consent to him carrying out a clinical assessment or examination of her.

72. In respect of the stairwell, the Panel notes the JRCALC guidance, the direct evidence from the Bodycam footage which demonstrates that very little assessment was carried out for over 6 minutes before Service A was transferred to the stretcher, and that on cross- examination the Registrant accepted that his assessment was inadequate. He identified in evidence the nature of the assessment he should have undertaken. The Registrant said that he did believe Service User A was unwell but he did not know just how unwell she was. The Panel noted that this evidence was inconsistent with his affirmative response to the Police Constable’s question about whether this was ‘kid on?’.

73. Based upon the evidence before it, the Panel was satisfied, on the balance of probabilities, that the Registrant did not complete or record an adequate clinical assessment or examination of Service User A.

74. Therefore the Panel finds Particular 3 proved.


Particular 4

4. Walked Service User A to the ambulance, despite her being tachypnoeic and/or without offering appropriate assistance.


75. The Panel has interpreted this Particular to mean that Service User A was permitted to walk despite her condition and without appropriate assistance from the paramedics. The Panel interpreted it as walking for any part of the journey to the ambulance. Tachypnoea is where a person experiences abnormal and rapid breathing.


76. The Registrant admitted this Particular in that he accepted that he allowed Service User A to walk. Furthermore, the Registrant accepted that he did not offer appropriate assistance and that the family had to ask a neighbour to help.

77. Person B told the Panel that when she and the neighbour were helping Service User A to walk to the ambulance, the Registrant and Ms Chadwick were walking about 6 metres in front of them.

78. There is evidence on the PRF that Service User A was tachypnoeic. The Registrant states that Service User A was intermittently hyperventilating and that was his main concern.

79. Based upon the evidence before it, the Panel finds Particular 4 proved on the balance of probabilities.

Particular 5

5. Did not provide a wheelchair to Service User A despite this being requested by Person B.


80. The evidence before the Panel was clear. Person B had asked the Registrant for a wheel chair for Service User A and he had not provided her with one. The Panel further considered whether the Registrant had been under a duty in the circumstances to provide a wheelchair when asked.

81. Person B told the Panel that when she had asked the Paramedics for a wheelchair the female Paramedic, Ms Chadwick (the other Registrant in these proceedings) said that “there was nothing wrong with her legs, let her walk” and also said “no, we can’t waste our time giving you the wheelchair, she can walk.”

82. Person B told the Panel that she again asked the Paramedics for a wheelchair a short time later to take Service User A to the ambulance and when asked how she would push a wheelchair down the stairs, she had told them of the ramp in the adjoining building. She said that one of the Paramedics, and she could not recall which one, said that they were not going to provide a wheelchair.

83. The Panel heard evidence from PC and JP that a wheelchair is standard equipment on any of NWAST’s ambulances.

84. The Registrant accepts that the conditions being experienced by Service User A were such that she should not have been permitted to walk and that a wheelchair or other means of transportation should have been provided to get her downstairs to the ambulance. In the first instance, a wheelchair should have been provided when Person B asked for one.

85. The Panel is satisfied on the evidence, that Particular 5 is proved on the balance of probabilities.


Particular 6

6. Did not assist Service User A to stand when she collapsed on multiple occasions.


86. The Panel considered the oral evidence it heard, particularly from Person B.

87. The Registrant said that when Service User A went to the floor in the flat, she did not hit the ground hard and that it was more like a controlled lowering. He said that he did try and help her to sit up and get up to sitting position. It is clear that the Registrant did assist Service User A some of the time during the evening.

88. It is also clear from Person B’s testimony that when Service User A collapsed on the way downstairs, it was Person B who assisted Service User A and not the Registrant. Her evidence was that the paramedics were walking ahead of her and Service User A, which the Registrant accepted.

89. The Panel determined that Particular 6 was proved on the evidence before it.


Particular 7

7. Did not provide care to Service User A in a timely manner following her collapse.


90. JP referred the Panel to the guidance set out in the JRCALC. He explained that the guidance is clear that when a patient collapses, a Paramedic dealing with that patient is expected to carry out an immediate re-assessment to ensure that they are breathing. This was corroborated by PC.

91. In his oral evidence, the Registrant admitted that the care administered should have been much quicker than it actually was, and he also accepted that his assessment had not been sufficient in the circumstances.

92. The Panel viewed the Bodycam footage. In the Panel’s opinion, it shows a lack of urgency and significant delay in the actions of both paramedics present. It is direct evidence that the care provided to Service User A following her collapse was not timely.

93. The Panel determined that Particular 7 is proved.

Particular 8

8. Did not transport Service User A to the hospital in a timely manner despite Service User A hyperventilating.


94. Both PC and JP drew the Panel's attention to the guidance issued by NWAST in relation to hyperventilation syndrome (HVS). They pointed out that when a paramedic encounters such a situation, they are obliged to also consider the possible underlying causes for hyperventilation when carrying out their assessment of the patient. PC and JP also pointed out that a patient should be transported to hospital if there is a lack of response by the patient after 10-15 minutes of coaching to slow down their breathing, and no underlying cause has been identified.

95. The Bodycam footage shows that the paramedic team did not act with any sense of urgency. It culminates in the ambulance leaving the scene with Service User A.

96. The Registrant told the Panel that when he first arrived at the flat, Service User A was hyperventilating intermittently, in that when she did what he told her to do, the hyperventilation stopped but would then start up again after a few minutes. The Registrant stated that Service User A refused transport to hospital on multiple occasions. The Panel accepted that the Registrant found himself in a challenging situation. Service User A had declined to be examined and assessed, and also had declined to be transferred to hospital several times.

97. In respect of Service User A’s collapse at the foot of the stairwell, the Registrant accepted that he should have transported Service User A to hospital sooner than he did.

98. The Bodycam footage shows Service User A collapsed at the bottom of the stairwell, and she was clearly unable to refuse treatment at this point. The Panel has already determined that care during this period was not provided in a timely manner.

99. The Panel determined on the balance of probabilities that Particular 8 is found proved.


Particular 9

9. Did not provide an adequate treatment plan in response to Service User A’s hyperventilation.


100. The HCPC submitted that no treatment plan is recorded on the PRF regarding Service User A’s hyperventilation.

101. The Panel noted that the NWAST instruction on hyperventilation syndrome does not specify a treatment beyond transport to hospital.

102. The Panel accepted the Registrant’s evidence that very soon after he arrived, he made the decision to convey Service User A to the hospital as soon as possible. That was because he was not able to carry out a full assessment of her. He then tried to gain Service User A’s consent to take her to hospital, without success. He called for a back-up ambulance to convey her.

103. The Panel is satisfied that on the evidence before it, there was an adequate treatment plan in response to Service User A's hyperventilation. That plan was to transfer her to hospital as soon as possible, and continued to be the treatment plan after the ambulance had arrived. Any criticism regarding the treatment plan relates not to its adequacy but to its execution.

104. The Panel determined that Particular 9 is not proved.


Particular 10

10. Did not complete and/or record regular observations of Service User A.


105. The Panel was satisfied that the Registrant was under a duty to complete and record regular observations of Service User A whilst she remained under his care.

106. On the evidence before the Panel, there was a set of observations taken at 22:05 hours. However, it was not a full set as Service User A was not cooperating. There was another set of observations taken at 23:10 hours.

107. JP told the Panel that if a patient was stable then observations should be taken every 30 minutes up to an hour apart. He also said that a service user‘s condition was not stable then the observations should be taken in closer proximity in time.

108. It was clear from the evidence that Service User A’s condition was not stable. The Panel determined that in the circumstances there should have been at least one other set of observations taken between the 22:05 and 23:10 hours.

109. Furthermore, the evidence shows that the next set of observations was taken at 00:25, which is an interval of 75 minutes, during which Service User A's condition was unstable. The Panel determined that there should have been at least 2 more sets of observations taken within that 75-minute interval. None was taken.

110. The ambulance crew arrived on scene sometime during the night and the Registrant had a duty to carry out regular observations until the ambulance crew arrived. Once the crew arrived, there was then a joint duty on all of the paramedics present to take regular observations until one or the other took responsibility for carrying out the observations at regular intervals. The failure here was jointly shared by both the paramedics present.

111. The Panel determined that Particular 10 is proved on the balance of probabilities.

Particular 11

11. Did not assist Service User A to travel down the stairs, including by not using a track chair.


112. It was not in dispute that the paramedics who attended Service User A on the night in question had a duty to assist her to travel down the stairs because of her presenting condition. This duty included consideration of any and all alternatives in order to expedite Service User A's transfer from the flat to the ambulance downstairs.

113. JP agreed that the ambulance that arrived on scene was one drawn from the general pool of vehicles. He told the Panel that every ambulance from the pool should have a track chair as part of its standard equipment.

114. JP also told the Panel that the track chair was the appropriate manner in which to bring a patient down a flight of stairs. He said that there were circumstances where a track chair would not be appropriate, for example due to the narrowness of the staircase. In his oral evidence, the Registrant told the Panel that with hindsight, Service User A should have been taken down the stairs on a track chair. He stated that he did not know whether the ambulance had a track chair as part of its inventory but he should have asked if there was one.

115. The evidence before the Panel demonstrated that the paramedics did not consider the use of a track chair in this case.

116. It was the evidence of Person B and Person C, that Person B assisted Service User A down the stairs and that the paramedics did not assist Service User A to travel down the stairs. This is corroborated by the oral evidence of the Registrant.

117. The Panel determined that Particular 11 is proved on the balance of probabilities.

Particular 12

12. Informed your employer that care was provided to Service User A in a timely manner following her collapse, when this was not the case.


118. The Panel has already determined that the care provided to Service User A by the Registrant was not provided in a timely manner (see the Panel’s determination in relation to Particular 7 above).

119. The evidence of what the Registrant told his employer is contained in his statement made pursuant to NWAST’s investigation into these events. The Panel noted paragraphs 44 and 45 of his statement:

“[Colleague A] and Lisa both went for the stretcher; the ambulance was directly at the bottom of the stairwell. The ramp required deploying but they returned with the stretcher in a matter of seconds.

The Plan was to get the patient onto the ambulance as quickly as possible. We lifted the patient onto the stretcher and immediately boarded the ambulance. The police officer present would have witnessed this. I recall the police liaised with the family and think that he may have asked them for the patient medications.”

120. The words used by the Registrant conveyed a sense of urgency and that care had been provided in a timely manner when it was not the case. The Bodycam footage showed that the time taken for Ms Chadwick to go to the ambulance and return with the stretcher was not seconds but minutes. The Registrant told the Panel that the passage of time seemed to go “a lot quicker” when he was there and accepted that the Bodycam footage showed it was much longer than he thought.

121. The Panel was satisfied that Particular 12 was proved on the balance of probabilities.

Particular 13

13. Your actions as described at paragraph 12 above were dishonest.

122. The Panel’s attention was drawn to the case of Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67 which overruled the use of the Ghosh test when determining dishonesty. The Panel noted the change in the test to be applied for dishonesty. The Legal Assessor advised the Panel that the change in the test for dishonesty did not change the fact that dishonesty is an offence of specific intent. He advised that dishonest acts must be committed intentionally and cannot be committed recklessly, negligently or in ignorance.

123. The Legal Assessor also advised the Panel that any allegation of dishonesty is one of the most serious allegations any professional can face and that the Panel should approach that issue on the basis that the more serious the allegation, the less likely it is that the event occurred. Hence, the need for stronger evidence before a panel should conclude that the allegation is established on the balance of probabilities. He advised the Panel that merely because there is some evidence that alleges something happened and there is no evidence to say otherwise, it did not mean that something is proved on the balance of probabilities .

124. The Legal Assessor also drew the Panel’s attention to the case of In re H (Minors)(Sexual Abuse: Standard of Proof) [1996] AC 563, wherein it was stated:
"When assessing the probabilities the court will have in mind as a factor, to whatever extent is appropriate in the particular case, that the more serious the allegation the less likely it is that the event occurred and, hence, the stronger should be the evidence before the court concludes that the allegation is established on the balance of probability. Fraud is usually less likely than negligence. Deliberate physical injury is usually less likely than accidental physical injury. ... Built into the preponderance of probability standard is a generous degree of flexibility in respect of the seriousness of the allegation. … The more improbable the event, the stronger must be the evidence that it did occur before, on the balance of probability, its occurrence will be established.”

125. The evidence before the Panel shows that the PRF was completed by the Registrant shortly after the incident and that he signed it. The Registrant was requested to write a statement some eight months after the event. He stated that he relied upon his recollection and the information recorded within the PRF. Therefore, it could be reasonably inferred that the Registrant relied upon the PRF for the timing of events. However, the Panel has noted that the PRF has inaccuracies – for example, regarding the time that the 00:25 hours’ observations were taken as it is clear from the Bodycam footage that Service User A was in the ambulance at that time.

126. In the circumstances, the Panel could not be satisfied that the Registrant was aware that, at the time he made his statement, that the timings were wrong. There was insufficient evidence for the Panel to conclude that he knew the timings were wrong, or that he knew that the impression given in the statement about the care provided was inaccurate. The Registrant wrote his statement before the Bodycam footage was available. He has told the Panel that in his recollection, things seemed to move faster than they really did, as was shown on the Bodycam footage. The Panel could not be satisfied that the Registrant knew that the care provided by the paramedics to Service User A proceeded slower than his recollection.

127. The Panel concluded that, in the light of the evidence, a reasonable and honest person would not consider the Registrant’s actions and reasons to be dishonest in circumstances where they could not be certain that the Registrant was aware of the inaccuracies in his statement. A reasonable and honest person would take into account that matters of dishonesty cannot be committed recklessly, negligently or ignorantly.

128. Therefore the Panel determined that Particular 13 is not proved.

 

Application to adjourn – 22 June 2020


The Registrant’s Application

129. The Registrant did not attend the Hearing today. There have been three communications from the Registrant:


• Initially, he had indicated through an email dated 15 June 2020 sent by his peer support, Ms Hicks, that he and Ms Hicks would not be able to attend today. The email indicated that he was unable to take time off work to participate in the proceedings because he had just started a new job. Ms Hicks attached a further four references.


• The Registrant sent an email dated 18 June 2020 in which he explained difficulties he had had with mobile phones and working away from home all week. He said that he was unable to attend the Hearing and that he had ‘tried to get time off but I am unable to due to several members of staff still being furloughed.’


• A further email from Mr Morris arrived at 11.50 during the Hearing. He apologised for his inability to communicate with the HCPC caused by his work situation of being ‘on the road’, without access to wifi, all day for long periods and away from home. He did wish to submit some documents to the Panel and was trying to do so.


130. As a consequence of the above the Registrant was contacted by the Hearings Officer and subsequently spoke to the Legal Assessor and Ms Hastie, the case presenter for the HCPC.


131. The Registrant said that he did not know that he could have asked for an adjournment and that, if that was possible, he would like to have an adjournment in order for him to participate in these proceedings. He indicated that even if he had to take unpaid leave, he did want to participate in these proceedings. He also indicated that he did want to submit documents to the Panel but he did not know that they had to be submitted before the Hearing this week. It was his understanding that he was to submit those documents after the Hearing this week. He confirmed to Ms Hastie and the Legal Assessor that the documents he intended to supply to the Panel related to the issues of misconduct and impairment of fitness to practise.


132. The Registrant confirmed that he is currently working in Scotland and that his job entails driving an articulated lorry making deliveries. As such, he is working away from home during the working week, does not have a Wi-Fi signal that is constant and reliable, and does not have his laptop with him.


133. The Registrant indicated that Ms Hicks, who had previously assisted him in the Hearing, had been unable to help him prepare for this Hearing due to her personal circumstances. However, she will be able to so in the future and the Registrant wished to benefit from her assistance again.


The HCPC’s Response


134. Ms Hastie, on behalf of the HCPC, objected to an adjournment. She submitted that the Registrant did not provide dates to avoid when the HCPTS was canvassing possible dates to reconvene this hearing. She submitted that the Registrant had ample time to prepare a written response on the issues of misconduct and impairment of fitness to practise as he had received the Panel’s written determination on facts since 20 April 2020, when it was sent to him. She pointed out that the Registrant had been notified that the Hearing would reconvene on today’s date when the notice was sent to him on 22 May 2020. She submitted that the Registrant should have prepared his submissions and any other documents that he wishes to be placed before the Panel in good time.


The Panel’s decision


135. The Panel accepted the advice of the Legal Assessor and took into account the representations made by the Registrant and by Ms Hastie. The Panel also reminded itself of its overarching objective and the necessity to be fair and proportionate. It was aware of the general need for expedition in the conduct the proceedings of this nature.


136. In coming to its decision, the Panel took into account the following factors:


(a) this is the first adjournment sought by the Registrant;


(b) the Registrant attended the last Hearing either in person or by telephone and had indicated at that time an intention to attend the resumed Hearing by telephone.


(c) there are no witnesses waiting to give evidence, and the factual stage of proceedings has concluded. What matters at this stage onwards is whether any insight and remediation has been demonstrated by the Registrant;


(d) the difficulty encountered by the Registrant in getting four consecutive days off work to participate in these proceedings is in part due to the fact that these proceedings have been joined to those against Ms Chadwick. As a result of these matters being joined, more time has been needed for the hearing than would have been required if the proceedings had been against the Registrant alone.


(e) The Panel also took into account the current Covid-19 situation, which has affected the Registrant's ability to take time off due to colleagues being on furlough;


(f) if this matter were adjourned, the Panel would still be able to proceed with the case against Ms Chadwick and, by doing so, the time required for any reconvened proceedings would be reduced. This would make rescheduling easier;


(g) the Panel would be assisted in reaching a fair and just decision on misconduct and impairment of fitness to practise, and potentially sanction, by hearing oral evidence from the Registrant. As such, if this matter were not adjourned, then the Panel would almost have no alternative but to proceed in the Registrant's absence and the Registrant's ability to present his case would be compromised.


137. Taking all of the above factors into consideration, the Panel determined that it was fair and just to adjourn the matter against the Registrant to afford him an opportunity to attend and give evidence to the Panel, something that he has done in the past in relation to the ‘facts stage’ of these proceedings and which he has indicated he wishes to do in relation to misconduct and impairment of fitness to practice.

22-24 September 2020


Decision on Grounds


138. The Hearing reconvened virtually by video link due to the Covid19 pandemic, and the Panel went on to consider whether the factual particulars found proved amounted to misconduct and/or lack of competence.


139. The Registrant attended and gave oral evidence in relation to his conduct and impairment.


140. The Panel heard the submissions of Ms Hastie on behalf of the HCPC. Ms Hastie submitted that the Registrant’s actions fell substantially below the standard expected of him by reference to the following paragraphs of the HCPC’s standards of conduct, performance and ethics (2016): 1.1, 1.2, 2.1, 2.2, 2.5, 6.1 and 6.2 and also fell substantially below the standard expected of him as a Paramedic by reference to the following paragraphs of the HCPC’s standards of proficiency for Paramedics (2014) that applied at the time: 1, 2, 3, 4, 5, 8, 9, 10, 12 , 13, 14 and 15.


141. Ms Hastie submitted that the matters found proved represented misconduct on the part of the Registrant rather than a lack of competence.


142. The Registrant accepted that his conduct as set out in Particulars 1, 4, 5, 6 7, 8 and 11 amounted to misconduct. The Registrant submitted that particulars 3 and 10 amounted to a lack of competence on his part. He told the Panel that in respect of Particular 12 the information was based upon the best of his knowledge and affected by the passage of time.


143. The Panel accepted the advice of the Legal Assessor.


144. The Panel was aware that misconduct is “a word of general effect, involving some act or omission, which falls short of what would be proper in the circumstances.” It is also aware that it was stressed that Misconduct is qualified by the word “serious”. It is not just any professional misconduct, which will qualify.


145. The Panel was also aware that not every instance of falling short of what would be proper in the circumstances, and not every breach of the HCPC standards would be sufficiently serious as to amount to misconduct in this context. Therefore, the Panel had careful regard to the context and circumstances of the matters found proved. The Panel considered each of the factual particulars in the light of the circumstances demonstrated by the evidence. It noted there were no issues raised regarding the Registrant’s fitness to practise prior to these matters.


146. As the Registrant was a newly qualified Paramedic at the time his training should have been fresh in his mind. The Panel noted the Registrant’s previous long career in the ambulance service. In the Panel’s view it was safe to infer that he was, at the very least, a competent newly qualified paramedic.


147. Furthermore, this single incident did not represent a fair sample of the Registrant’s work from which the Panel could assess the Registrant’s competence or lack thereof.


148. The Panel determined that in the light of the above, the ground of lack of competence does not fall to be considered in this case.


149. The Panel then went on to consider whether the particulars found proved amounted to misconduct.


Particular 1


Made the following inappropriate comments:


a) You requested an amber level ambulance backup ‘for my own sanity’, or words to that effect;


b) Regarding not lifting Service User A, you asked if Service User A’s family would pay your mortgage if you hurt your back, or words to that effect;


c) You made comments to the effect that Service User A was not unwell, or was feigning illness;


d) [Not Proved]


e) You made a comment to the effect that it did not matter how long it took to treat Service User A as you would be paid until the end of your shift anyway;


f) You made a comment to the effect that you could be helping others and that Service User A was wasting your time.


150. The Panel determined that making such comments to a service user was inexcusable regardless of the circumstances prevailing at the time. A Paramedic is expected to work in a professional manner with service users. The Registrant told the Panel that he had reflected on his behaviour and he accepted that the comments he made were extremely inappropriate. He recognised that it was so serious that it amounted to misconduct.


151. The Panel noted the evidence of Service User A’s family about the impact of the comments and how their confidence in the ambulance service had been undermined.


152. The Panel determined that the conduct outlined in the sub-particulars of Particular 1 was so serious as to amount to misconduct individually and as a whole.


Particulars 3 and 10


3. Did not complete and/or record an adequate clinical assessment and/or examination.


10. Did not complete and/or record regular observations of Service User A.


153. The Panel considered these two particulars together because they relate to adequate clinical assessment, examination and observations during the same incident. The Panel has determined that the Registrant did not complete an adequate clinical assessment or complete regular observations and therefore he did not have information to record.


154. The Panel took into account that the inadequate clinical assessments carried out by the Registrant formed the basis of the subsequent care of Service User A. This was compounded by the Registrant not carrying out regular observations.


155. Adequate clinical assessment is fundamental to the role of a Paramedic. The failure of the Registrant to carry this out in these circumstances falls far below the standard expected of a registered Paramedic and is so serious that it reaches the threshold of misconduct.


156. Accordingly the Panel determined that Particulars 3 and 10 individually amount to misconduct.


Particular 4, 5, 6 and 11


4. Walked Service User A to the ambulance, despite her being tachypneic and/or without offering appropriate assistance.


5. Did not provide a wheelchair to Service User A despite this being requested by Person B.


6. Did not assist Service User A to stand when she collapsed on multiple occasions.


11. Did not assist Service User A to travel down the stairs, including by not using a track chair.


157. The Panel considered these four particulars together because they relate to Service User A’s mobility and the Registrant’s responsibility to assist and support Service User A when transporting her to the ambulance.


158. Service User A’s mother had requested a wheelchair on several occasions and Service User A had collapsed on several occasions.


159. The Panel took into account that throughout the incident the Registrant believed that Service User A was feigning illness and this informed his attitude and behaviour. Furthermore, the Registrant ignored requests for assistance from the Service User’s relatives.


160. The role of the Paramedic in these circumstances was to safely and comfortably transport the critically ill Service User to the ambulance. His failings in each regard fell far below the standard expected of a registered paramedic.


161. Accordingly the Panel determined that Particulars 4, 5, 6, and 11 amounted to misconduct individually.


Particulars 7 and 8


7. Did not provide care to Service User A in a timely manner following her collapse.


8. Did not transport Service User A to the hospital in a timely manner despite Service User A hyperventilating.


162. These two particulars relate the Registrant not providing care in a timely manner to Service User A.


163. Particular 7 relates to the time when Service User A had collapsed at the bottom of the stairwell. As the Panel has stated in its findings of fact, the bodycam footage shows a distressing scene, where Service User A’s condition was deteriorating but the Registrant did not act because he believed that Service User A was feigning illness. The Panel noted how the bodycam footage demonstrated the lack of urgency in the Registrant’s actions.


164. The time frame for this particular runs from the arrival of the ambulance to when Service User A was actually transported to the hospital. It was incumbent upon the Registrant to ensure that Service User A was transported to the hospital in a timely manner. In the Panel’s view this should have been achieved once the ambulance arrived with the appropriate equipment. The Registrant consistently acknowledged that he should have transported the Service User to hospital much sooner than he did.


165. To have failed to provide care in a timely manner and to have not transported Service User A to hospital in a timely manner are serious failings that fall far below the standards expected.


166. The Panel determined that Particulars 7 and 8 amounted to misconduct individually.


Particular 12


12. Informed your employer that care was provided to Service User A in a timely manner following her collapse, when this was not the case.


167. The Panel took into account the circumstances of this particular. It reminded itself that this particular was based upon the statement that the Registrant had written some eight months after the events and based upon the PRF that he had completed at the time. The Registrant told the Panel that the content of his statement reflected his mistaken perception of the passage of time during the incident, which the Panel accepted as genuine. The Panel also noted that the Registrant had not seen the bodycam footage at this point.


168. The Panel accepted that the Registrant had made a reasonable and genuine mistake. The Panel was aware that a mistake does not necessarily amount to misconduct, just as mere negligence does not amount to misconduct. In these particular circumstances, in the Panel’s view, this does not meet the threshold of misconduct.


169. The Panel considered that on the facts found proved the Registrant had breached the following paragraphs of the HCPC’s standards of conduct, performance and ethics (January 2016):


Treat service users and carers with respect

1.1 You must treat service users and carers as individuals, respecting their privacy and dignity.


1.2 You must work in partnership with service users and carers, involving them, where appropriate, in decisions about the care, treatment or other services to be provided.


1.3 You must encourage and help service users, where appropriate, to maintain their own health and well-being, and support them so they can make informed decisions.

Communicate with service users and carers


2.1 You must be polite and considerate.


2.2 You must listen to service users and carers and take account of their needs and wishes.
Work with colleagues


2.5 You must work in partnership with colleagues, showing your skills, knowledge and experience where appropriate, for the benefit of service users and carers.


Identify and minimise risk


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


6.2 You must not do anything, or allow someone else to do anything, which would put the health or safety of a service user, carer or colleague at acceptable risk.

170. As the Panel found that this was not a case involving lack of competence, it did not consider the HCPC’s standards of proficiency for Paramedics (2014) to be relevant.

Determination on Impairment


171. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of his misconduct. The Panel received oral evidence from the Registrant.


172. The Panel was mindful of its previous assessment of the credibility of the Registrant. The Registrant had not fully accepted responsibility for his behaviour or failings at the beginning of the Hearing in February 2020. However, in his evidence at this stage of the Hearing the Registrant accepted in full the findings of fact of the Panel. The Registrant accepted culpability, including his inappropriate attitude on the night of the incident, and now accepted full responsibility. He accepted that his behaviour on the night amounted to misconduct.


173. The Panel had a fresh opportunity at this stage to assess the Registrant’s credibility. During cross-examination and Panel questions, the Registrant demonstrated a significant change in attitude. He exhibited deep remorse, apologised profusely, expressed disgust in his past behaviour and recognised that he had let down the service user, her family, the profession and the public. He spoke in a way that the Panel found persuasive, genuine and heartfelt. This was in stark contrast to the way in which the Registrant came across to the Panel in February 2020. The Panel recognised that the Registrant found it difficult to articulate his emotions, insight and reflections until further questions from the Panel facilitated his responses.


174. The Panel was satisfied that in the intervening period since the receipt of the Panel’s determination on Facts in April 2020 the Registrant has reflected upon the Panel’s findings and developed significant insight. He told the Panel at this hearing that he was disgusted by his behaviour on the night and that his reflection had caused him to question his ability and suitability as a Paramedic. He said that his confidence as a Paramedic had been shattered. He demonstrated significant remorse and shame at the consequences of his actions on the night for the service user and her family.


175. The Panel is satisfied that the Registrant’s evidence today is credible. His demeanour and attitude is consistent with the many positive testimonials from professional colleagues including paramedics, a senior nurse and a medical consultant.


176. The Panel was impressed by the Registrant’s professional integrity. The Panel heard that whilst working as a Paramedic under Conditions of Practice, he immediately informed the HCPC when his employer wanted him to operate in a manner which, in the Registrant’s opinion, contradicted those conditions. He did this despite the fact that he expected it would result in the suspension of his registration and an inability to practise as a Paramedic.


177. The Panel considered the submissions of Ms Hastie on behalf of the HCPC. Ms Hastie submitted that the Registrant’s fitness to practise was impaired on both the personal and public components.


178. The Panel considered the submissions of the Registrant. The Registrant appeared to accept that his fitness to practise was currently impaired by way of his submission that were he to return to practice he would need support and supervision.


179. The Panel accepted the advice of the Legal Assessor. The Legal Assessor drew the Panel’s attention to the approach set out in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin) and reminded the Panel that there was a personal and public component when considering whether the Registrant’s fitness to practise was currently impaired.


180. For this purpose, the Panel adopted the approach formulated by Dame Janet Smith in her fifth report of the Shipman inquiry by asking itself the following questions:


“Do our findings of fact in respect of the Registrant’s misconduct show that his fitness to practise is impaired in the sense that he:


a) has in the past acted and/or is liable in the future to act so as to put service users at unwarranted risk of harm; and/or


b) has in the past brought and/or is liable in the future to bring the Paramedic profession into disrepute; and/or


c) has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the Paramedic profession?”


181. The Panel determined that the answers to all the above questions were in the affirmative in relation to the past effect of the Registrant’s conduct. In coming to its decision, the Panel took into account the following factors:


(a) the consequences of the Registrant’s actions for Service User A and her family;


(b) the impact of the Registrant’s actions upon the confidence of the public in the profession, particularly that of Service User A’s family; and


(c) the nature of the Registrant’s misconduct and the breaches of the above-mentioned paragraphs of the HCPC’s standards of conduct, performance and ethics (January 2016).


182. The Panel determined that the answers to all the above questions were in the affirmative in relation to the Registrant’s possible future conduct. In coming to its decision the Panel recognised and took into account the following:


(d) the Registrant has demonstrated considerable insight into his misconduct;


(e) the Registrant’s misconduct is capable of remediation. Whilst is it often said that misconduct arising from attitudinal issues is difficult to remediate, in the Panel’s view this is not a case of deep-seated attitudinal issues. The Registrant has demonstrated considerable insight into his misconduct and expressed a desire to change and improve his attitude where lacking;


(f) the Registrant has started the process of remediation by recognising the shortcomings in his practice and undergoing some courses to address them, such as the course ‘Clinical Decision Making for Paramedics’; and a course in law & ethics.


(g) the Registrant has engaged with the process throughout, but in the Panel’s view did not have a full understanding of the fitness to practise process and what is meant by remediation;


(h) the Registrant had been an EMT for a significant number of years. He stated that his 1-year higher education course to qualify as a paramedic did not include communication styles and professionalism because they were presumed;


(i) the Registrant recognised that his communication style had been ‘old school’ and unprofessional. He stated that he would be assisted in the future by supervision and further training to improve his communication skills.


183. The Panel determined that whilst the Registrant has demonstrated significant insight, he has not yet been able to fully remediate his conduct. It is to his credit that he recognises this and accepts that his fitness to practise is impaired. In the Panel’s view, until the Registrant has demonstrated remediation of his conduct, a risk of repetition remains. The Panel recognises that the Registrant would only be able to demonstrate full remediation by practising in an appropriate healthcare context.


184. The Panel also determined that the Registrant’s misconduct was such that the need to uphold professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in these circumstances. The Panel determined that the facts of this case were such that a member of the public would be concerned if no finding of impairment were made.


185. Therefore, the Panel determined that the Registrant’s fitness to practise is currently impaired on both personal and public interest considerations.


Proceeding in the absence of the Registrant


186. The Registrant was unable to attend the hearing today as he had indicated on Monday 22 September 2020, the first day of this resumed Hearing. The Panel considered whether to proceed in the absence of the Registrant pursuant to Rule 11 of the Rules. In doing so, it considered the submissions of Ms Hastie on behalf of the HCPC.


187. Ms Hastie submitted that the Panel should proceed in the absence of the Registrant. She referred to the letter sent to the HCPC by the Registrant after he had read and received the Panel's determination on impairment.


188. The Panel accepted the advice of the Legal Assessor.


189. The Panel was satisfied that it should proceed in the absence of the Registrant. It was clear from his letter received today that he consents to and expects the Hearing to proceed in his absence. Furthermore, he has made written submissions pertinent to the next stage of proceedings. The Panel also noted that these proceedings have been protracted due, in part to the current COVID situation and to the Registrant’s employment commitments. Having weighed the public interest for expedition in cases and the Registrant’s own interest, the Panel decided to proceed in the Registrant’s absence.


Decision on Sanction:


Submissions


190. Having determined that the Registrant’s fitness to practise is currently impaired, the Panel then considered what sanction should be imposed. It heard the submissions of Ms Hastie on behalf of the Council and considered the written submissions of the Registrant.


191. Ms Hastie indicated that the Council was not seeking any particular sanction and reminded the Panel of the approach that it should take and that it should have regard to the Indicative Sanctions Policy.


192. Ms Hastie submitted that the following were factors that the Panel should take into consideration when determining the appropriate sanction, if any:


• the Registrant has a clean fitness to practise history;


• the facts found proven relate to fundamental aspects of the role of a Paramedic;


• the devastating impact on Service User A's family and the impact on public confidence and the reputation of the profession.


193. Ms Hastie also reminded the Panel that it had found that the Registrant has demonstrated significant insight but that the Registrant has not been able to fully remediate, because he would only be able to demonstrate full remediation by practising in an appropriate healthcare setting.

Legal Advice


194. The Panel accepted the advice of the Legal Assessor. He advised the Panel that it should bear in mind that its over-arching duty is:


(a) to protect, promote and maintain the health, safety and wellbeing of the public;


(b) to promote and maintain public confidence in the professions regulated by the HCPC;


(c) to promote and maintain proper professional standards and conduct for members of those professions.


196. The Legal Assessor advised the Panel that any sanction it imposes must be the least restrictive sanction that is sufficient to protect the public and the public interest. It should take into consideration the aggravating and mitigating factors in the case. He reminded the Panel that the purpose of a sanction is not to be punitive, although it may have that effect. The purpose of a sanction is to protect members of the public and the wider public interest. The Legal Assessor advised that the Panel should consider the least restrictive sanction first and move up the scale of severity only if the sanction being considered is inappropriate. He also reminded the Panel that it must apply the principle of proportionality, weighing the Registrant’s interest against the public interest.


197. The Legal Assessor drew the Panel’s attention to the following cases in relation to proportionality when considering any sanction to be imposed:


a) Kamberova v NMC [2016] EWHC 2955 (Admin); and


b) Bijl v General Medical Council [2001] UKPC 42


198. The Legal Assessor reminded the Panel of the principle of proportionality and advised the Panel that it should take into account the fact that the Registrant's practice has been suspended for almost three years in the interim, when considering the proportionality of any sanction. He advised that whilst an interim order is in no way binding upon a Panel, a Registrant's compliance with the interim order is a relevant part of the context.


Panel’s consideration and decision


199. The Panel has had regard to all the evidence presented, and to the Council’s Indicative Sanctions Policy.


200. The Panel carefully considered the aggravating and mitigating factors in this case. Whilst the aggravating factors were serious, they were balanced against the many mitigating factors. It took the following factors into account:


• the harm caused to Service User A;


• the psychological harm to the family of Service User A;


• the impact of the Registrant’s conduct on the family’s confidence in the profession, and by inference the public’s confidence in the reputation of the profession;


• the Registrant’s clean fitness to practise history;


• the Registrant’s considerable insight into his misconduct;


• the Registrant’s remorse and apology;


• the Registrant has taken steps to remediate his failings and is willing to improve and progress to demonstrate full remediation;


• the Registrant was a newly qualified Paramedic at the time;


• this was a single episode of care;


• in the Panel’s view the circumstances were such that even experienced Paramedics would have found them challenging;


• there are no persistent or general failings in the Registrant’s practice;


• the significant number of positive professional and personal testimonials from colleagues including an Emergency Department consultant, a senior sister and numerous paramedic colleagues. These attest to the Registrant’s clinical ability and good demeanour prior to and since the events in question;


• there is no evidence of deep-seated attitudinal issues and this is supported by the above-mentioned testimonials;


• the Registrant’s integrity in complying with previous conditions imposed on his practice;


201. The Panel first considered taking no action but concluded that, given the Panel's finding that there remains a risk of repetition and the seriousness of the Registrant’s misconduct, this would be wholly inappropriate.


202. The Panel then considered whether to make a caution order. The Panel was mindful of its finding, and the Registrant's recognition, that there is a risk of repetition as he has not been able to remediate by being in practice. The Panel bore in mind that a caution order would not restrict the Registrant's right to practise. In these circumstances, the Panel concluded that a caution order would not be sufficient to protect the public from the risk posed by the Registrant and as such it would also not be in the public interest for the imposition of a caution order, even for the maximum period.


203. The Panel next considered the imposition of a conditions of practice order.


204. The Registrant has expressed a desire to remain in practice as a Paramedic. The Registrant has also said that he is willing to abide by any conditions the Panel might impose. He has requested that conditions be placed upon his practice to assist him in practising at the level expected of a qualified Paramedic. The Panel noted the Registrant's integrity in complying with the previous interim conditions imposed upon his practice.


205. The Panel noted the nature of the misconduct found. It related to an episode of care involving both clinical and attitudinal failings. The Panel was confident that a set of robust conditions designed to address the fundamental clinical failings and attitudinal and communication shortcomings would be an appropriate framework to return the Registrant to safe practice, whilst protecting the public. The conditions would provide monitoring and supervision of the Registrant while he remediated his practice and would also provide support to enable him to regain his confidence as a Paramedic.


206. The testimonials dated October 2018-January 2020 provided the Panel with evidence that the Registrant’s behaviour on the night in question was inconsistent with his previous and subsequent clinical practice and interactions with service users. This information reassured the Panel that the Registrant has previously been held in high regard by fellow professionals.


207. Taking into account all of the above, the Panel concluded that conditions could be formulated which would adequately address the risk posed by the Registrant, and in doing so protect service users and the public during the period they are in force.


208. The Panel was also of the view that a conditions of practice order would satisfy the wider public interest, and that it was both fair and reasonable to afford the Registrant the opportunity to safely return to practise as a Paramedic. The Panel bore in mind that the wider public interest also includes the safe return of a Paramedic to unrestricted practice so as not to deprive the public of his services.


209. The Panel also considered the HCPC's Sanctions Policy in respect of the criteria for the imposition of a suspension order. The Panel determined that this case did not meet that criteria as although it raised serious concerns, they could be reasonably addressed in the circumstances by a conditions of practice order. The Panel considered carefully the public interest. It considered that a reasonable and fully informed member of the public, in possession of all the facts of this case and knowing that the Registrant had been suspended already for a period of almost three years, would be satisfied that suspension would not be required in these circumstances. In the Panel’s view a suspension order would be disproportionate in the circumstances and would not provide the Registrant any opportunity to remediate his shortcomings and return to practise as a Paramedic.


210. The Panel decided that a Conditions of Practice Order for a period of 12 months would be appropriate. In deciding on the period of the order, the Panel took into account that this was a single episode of care, and that the Registrant shows evidence of considerable insight into his misconduct. The Panel notes that the Registrant has taken initial steps towards remediation, but this was some two years ago and he has not practised as a Paramedic since. In the Panel’s view, a period of 12 months is needed to enable the Registrant to develop further insight, remediate his failings and return to unrestricted practice with confidence. Further, a period of 12 months is required to satisfy the public interest in the circumstances of this case.


211. The Panel has determined that a Conditions of Practice Order for a period of 12 months is the appropriate and proportionate sanction.

 

Order

ORDER: The Registrar is directed to annotate the Register to show that, for a period of twelve months from the date that this Order comes into effect (“the Operative Date”), you Mr Anthony Morris must comply with the following conditions of practice:


  1. You must work as a registered Paramedic only where you are directly working with another registered Paramedic.
    2. You must place yourself and remain under the supervision of a workplace supervisor who is a registered Paramedic.
    3. You must supply details of your supervisor to the HCPC within 14 days of the commencement of your employment under these conditions.
    4. You must attend upon that supervisor as required and follow their advice and recommendations.
    5. Informing the HCPC and others:
    i) You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
    ii) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
    iii) You must inform the following parties that your registration is subject to these conditions:
    A. any organisation or person employing or contracting with you to undertake professional work;
    B. any agency you are registered with or apply to be registered with (at the time of application); and
    C. any prospective employer (at the time of your application).
    6. You must work with your workplace supervisor to formulate a personal development plan designed to address the deficiencies in the following areas:
    • Managing challenging and non-compliant service users;
    • Treating service users and their families/others with respect and dignity;
    • Clinical assessment and examination;
    • Baseline observations;
    • Communicating with service users and carers;
    • Appropriate extrication and conveyance of service users;
    • Timeliness of interventions;
    7. Within two months of commencing employment as a Registered Paramedic you must forward a copy of your Personal Development Plan to the HCPC.
    8. You must meet with your workplace supervisor fortnightly for the first two months, and on a monthly basis thereafter to consider your progress towards achieving the aims set out in your Personal Development Plan.
    9. You must allow your workplace supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan every three months and prior to any review of this order.
    10. You will be responsible for meeting any and all costs associated with complying with these conditions. Any condition requiring you to provide information to the HCPC is to be met by you and sent to the offices of the HCPC, marked for the attention of the relevant Case Manager.
    212. The Order will be reviewed before its expiry on 22 October 2021 and any reviewing panel may be assisted by the following:
    • Your attendance at the review;
    • Evidence of relevant and up-to-date CPD;
    • Recent professional testimonials;

Notes

Interim Conditions of Practice Order:

213. The Panel decided that it was appropriate to consider the Interim Order application in the absence of the Registrant. In reaching this conclusion the Panel took into account that the content of the Notice of Hearing sent to the Registrant on 5 August 2020 included the following words, under the heading Interim Orders: “Please note that if the Panel finds the case against you is well founded and imposes a sanction which removes, suspends or restricts your right to practise, it may also impose an interim order on you (under Article 31 of the Health and Social Work Professions Order 2001). An interim order suspends or restricts a registrant’s right to practise with immediate effect.”

214. The Panel was satisfied that the Registrant is aware that an interim order application was a possible outcome at this hearing. The Panel remained satisfied that the Registrant had voluntarily absented himself from the Hearing today. The Panel could see no reason to adjourn the Hearing. The Panel took into account the fact that it had identified a continuing risk to the public if the Registrant were allowed to practise without restriction and decided it was clearly in the public interest to consider the Interim Order application in the absence of the Registrant.

215. Having heard submissions from Ms Hastie on behalf of the HCPC and having taken advice from the Legal Assessor, the Panel makes an interim Conditions of Practice Order in the same terms as set out above, for a period of 18 months 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.

216. 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 Anthony Morris

Date Panel Hearing type Outcomes / Status
22/09/2020 Conduct and Competence Committee Final Hearing Conditions of Practice
22/06/2020 Conduct and Competence Committee Final Hearing Adjourned part heard
03/02/2020 Conduct and Competence Committee Final Hearing Adjourned part heard
09/12/2019 Conduct and Competence Committee Interim Order Review Interim Suspension
10/09/2019 Conduct and Competence Committee Interim Order Review Interim Suspension
24/10/2018 Investigating committee Interim Order Review Interim Conditions of Practice