Mr Gary Eves

Profession: Paramedic

Registration Number: PA32268

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 26/04/2021 End: 17:00 06/05/2021

Location: Hearing taking place virtually

Panel: Conduct and Competence Committee
Outcome: Caution

Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via tsteam@hcpts-uk.org or +44 (0)808 164 3084 if you require any further information.

 

Allegation

Whilst registered with the Health and Care Professions Council as a Paramedic, you:
 
1. On 14 July 2018, in relation to your treatment of Patient 1:
 

b) Left Patient 1 unattended after Methoxyflurane (Penthrox) was administered;

c) Advised that Patient 1 be transferred to hospital in their family’s car instead of by ambulance;

d) Advised Paramedic 1 to administer Diazepam when it was not clinically indicated;

e) Did not maintain an appropriate standard of record keeping, in that you recorded Patient 1’s observations on a phone;

f) Did not provide your name and/or HCPC registration number to the Community First Responder and/or South Central Ambulance Service crew on request;

g) Did not provide an adequate handover of Patient 1 to the Community First Responder.

 
2. Did not cooperate with an investigation into the care of Patient 1 carried out by South Central Ambulance Service.
 

3. Did not communicate professionally with staff at South Central Ambulance Service, including in relation to emails sent on:


a) 8 August 2018;
 
b) 10 August 2018.
 

4. The matters set out in paragraphs 1 – 3 constitute misconduct.

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

Finding

Preliminary matters


Amendment of allegation
 
1. Mr Bridges for the HCPC applied to amend particulars 1a) and 2 of the original allegation by removing them from the particulars of the allegation. He offered no evidence, following a review of the report of the expert witness relied on by the HCPC. The HCPC had concluded that there was no evidence for particular 1a) and insufficient evidence in relation to particular 2. The application was not opposed by Mr Harries QC on behalf of the Registrant.
 
2. The Panel accepted the advice of the Legal Assessor that an amendment may be made at any time and that it was good practice for the HCPC to review the particulars of the allegation following evidence received at a later stage. The Panel determined that the amendments could be made without injustice and that they were appropriate on the evidence in this case. Following the deletion of the original particular 2, the subsequent particulars were re-numbered 2-5.
 

Background
 

3. This is a brief outline of the incident. There are more detailed summaries of the evidence of each witness below.
 
4. The Registrant is a Paramedic. He is the director and shareholder of a private company, Community Paramedics Services Bristol Limited. He was contracted to attend a private white collar boxing match in Windsor, Berkshire, on 14 July 2018 as the event Paramedic.
 
5. A young woman who attended the event sustained a fall at approximately 22:45 and complained of severe hip pain. She may have aggravated a pre-existing injury. The Registrant attended to her and administered the pain relief medication, methoxyflurane, also known as Penthrox, in the form of an inhaler. He made a note of his primary observations on his phone at 22:50.
 
6. Someone at the scene called 999 at 22:51 for an ambulance. A Community First Responder (CFR 1) was dispatched and arrived at 23.15. On arrival, CFR 1 observed that the Registrant was not with the patient. He also noted that the patient had been provided with a drug that was unfamiliar to him. CFR 1 therefore contacted the control room for assistance. On the Registrant’s return to the scene, CFR 1 was informed that the drug was the pain relieving medication known as Penthrox. He had further concerns about the speed and content of the Registrant’s handover and the recording of observations on his phone. CFR1 noted the Registrant’s primary observations on the South Central Ambulance Service’s (SCAS) Patient Clinical Record (PCR).
 
7. The ambulance arrived twenty minutes later at 23:35. Paramedic 1 attended the patient and recorded further observations. She was concerned that the Registrant was not supervising the patient at all times. Following the incident, Paramedic 1 submitted a Datix incident electronic report in respect of her concerns regarding the Registrant’s administration of Penthrox to the patient and his recommendations that the patient be taken to hospital by car and that the patient be administered the drug Diazepam.
 
8. Operational Bronze Commander BM commenced an investigation on behalf of the Trust. Further issues arose in relation to the Registrant’s compliance with the investigation and the tone and content of his response to emails. A fitness to practise referral was subsequently submitted by the Trust in respect of the Registrant’s conduct.
 

The Evidence
 
9. The evidence of the witnesses is summarised in more detail below. The summaries combine their written and oral evidence.
 
CFR 1
 
10. CFR1 made a statement dated 24 July 2020 for the HCPC and gave oral evidence to the Panel on 26 April 2021. He had also made a witness statement to the police on 15 July 2018. He was an inexperienced volunteer Community First Responder (CFR1) with relatively limited clinical training at the time. He attended Windsor Leisure Centre at 23:15 on 14 July 2018. The police were already at the scene when he arrived and he was told that an event Paramedic (the Registrant) was at the venue. CFR 1 entered the building and saw a female patient on the floor, holding her arm, screaming, and puffing on an inhaler. It was a tense situation, and he was aware of reports of an earlier unrelated assault, further the people with the patient did not know what drug had been given to her or the whereabouts of the event Paramedic. The event Paramedic was not with the patient, who was in obvious pain, and nobody seemed to know where he was.
 
11. CFR 1 was calling Control when the Registrant appeared a short time later. He could not say exactly how long it was before he appeared. The Registrant then told him that the patient’s primary observations were fine and that he had made notes on his phone at 22:50. CFR 1 copied the primary observation notes into the Patient Clinical Record (PCR). CFR 1 accepted that the observations included a record of the patient’s airway response, respiratory rate, pulse rate, blood pressure level, blood sugar level, Glasgow coma score, pupil size, pain score and temperature. CFR 1 checked and confirmed those observations then performed his own secondary observations at 23:35. The Registrant also related a brief history of the patient’s hip pain and that Penthrox had been administered.
 
12. On reviewing the extent and detail of the primary observations recorded on the PCR at 22:50, CFR 1 accepted that it was “a little bit unfair” to state “I received a better handover from the manager of the leisure centre than I did from Gary Eves”. He characterised the Registrant’s handover as brief. He accepted the description that the handover was focused "to a point". CFR 1 also agreed with the suggestion put to him that it was efficient, he said it did contain all the observation numbers. He added however that he felt that it was "far too quick" at the time and it was unlike other handovers he had experienced.
 
13. CFR 1 asked the Registrant to confirm his name and noted his surname in capitals on the second page of the PCR. CFR 1 could not recall whether the Registrant had given his full name, but he accepted that he might have done. CFR 1 had said in his statement for the HCPC in 2020 that he had asked the Registrant three times for his HCPC registration details, without any response, but he accepted in his oral evidence that this was in fact a request for identification details, rather than a specific request for his HCPC registration number. CFR 1 also acknowledged that he had made no reference to requesting the Registrant’s HCPC registration details in his near contemporaneous police statement on 15 July 2018.
 
14. CFR 1 was unsettled by the way in which the Registrant kept disappearing then returning from the scene. He thought that the Registrant ought to have remained with a young patient who was in obvious pain. He accepted that there were two people with the patient who seemed to know her and agreed that the Registrant might have had other matters to attend to at the event.
 
15. The Registrant had given the patient pain relief medication, Penthrox, with which CFR 1 was unfamiliar. The Registrant gave CFR 1 some paperwork about Penthrox and explained that it worked like Entonox. CFR 1 could not say where this paperwork was now or whether it had contained the Registrant’s name or HCPC registration number. Having taken instructions from the Clinical Support Desk over the phone, CFR 1 removed the Penthrox inhaler and administered Entonox to relieve the pain. The SCAS crew subsequently arrived, and CFR 1 relayed his concerns about the nature of the handover and the administration of Penthrox. CFR 1 made no reference in his evidence to the Registrant suggesting or advising the administration of Diazepam or taking the patient to hospital in a car.
 

Paramedic 1

16. Paramedic 1 made a statement dated 18 June 2020 and a written statement to the police dated 15 July 2018. She gave oral evidence at the hearing on 27 April 2021.
 
17. The SCAS crew, that included Paramedic 1, were notified of the call at 23:15 and arrived at the scene at 23:35. The Registrant was not with the Patient when Paramedic 1 arrived. Although she accepted he may have been in “line of sight” of the patient. The Registrant returned to the patient shortly after the arrival of Paramedic 1 and provided sufficient information for Paramedic 1 to complete a patient history on both pages of the PCR. He walked away after a short handover. The patient had fallen over and had a history of back problems. There were many people at the scene and the patient was displaying obvious signs of significant pain. She did not herself hear any conversation with the Registrant about his identification.
 
18. Paramedic 1 recalled that there was some discussion that the patient’s family transport her to A&E in their car. She was not herself present when this conversation took place so she had not heard what was said. She was concerned by this idea because the Registrant had administered Penthrox, a drug she was familiar with, having trained in Australia and knew the patient would therefore have required monitoring on the way to the hospital. She was also concerned because the patient could not bear weight, so it would have been difficult or unsafe to get her into a car if she could not stand.
 
19. The Registrant explained to Paramedic 1 that he administered Penthrox. She was aware that her Trust was not licensed to use this medication. She was however concerned for the safety of the patient who was young, intoxicated and incapable of standing. Paramedic 1 was aware through her own experience that Penthrox can produce side effects and that its administration should be monitored, especially after heavy consumption of alcohol. She accepted that an icepack or a device to monitor heart rate or blood pressure might be useful but she had not seen the Registrant with either of those items.
 
20. Paramedic 1 recalled that the Registrant recommended other pain relief in the form of Diazepam. She knew that she could not administer this drug because it was not approved by the Trust. She accepted there was a distinction in principle between clinical advice and a suggestion made in the context of a wider discussion of treatment. She accepted that Diazepam, even though not approved by the Trust, might have reduced the pain.
 
21. Paramedic 1 cannulated the patient and provided paracetamol intravenously then transported the patient to Wexham Park Hospital in Slough. She completed a Datix electronic complaint form at 01:54 on 15 July 2018 primarily because of her concerns about the Registrant’s administration of Penthrox without proper monitoring of an intoxicated patient for side effects.
 
BM
 
22. BM made a written statement dated 4 March 2020 and gave oral evidence to the Panel on 26 April 2021. She adopted her statement as her evidence in chief. BM has been employed as a Team Leader by the Trust since 2002. She acknowledged that the Registrant was not bound by or contracted to follow Trust policies.
 
23. On 14 July 2018, BM was on duty as an Operational Bronze Commander when she received a telephone call from the paramedic crew that had attended the incident at a private boxing match that was organised by Ultra Events at Windsor Leisure Centre. They reported that they had concerns about the event Paramedic at the scene.
 
24. BM commenced an investigation. She had not initially obtained the PCR because the forms were not usually scanned onto the database until some months later. She accepted it would have been preferable to obtain it from the outset. She agreed that it was acceptable to record observations on a phone if notes were recorded on a secure system.
 
25. BM emailed Ultra Events to obtain further information about the Paramedic on 4 August 2018. A representative of the company responded on 8 August 2018 and copied in the Registrant, who then emailed BM at 09:31 on 8 August to say that CFR 1 was given the Paramedic’s PIN number, details of the medication, including patient alert card as part of the handover. He said it was a "negligent misstatement" to assert that the Paramedic had refused to hand over personal details. BM accepted that the Registrant had given his name and details of the medication at the scene, but she was concerned that the Registrant did not identify himself as the event Paramedic in this email.
 
26. BM replied at 08:22 on 10 August 2018 to say that she had been informed that that the Paramedic had no identification and did not give his name. She also asked for more detail about the drug that was administered.
 
27. The Registrant replied at 09:03 as follows: Unfortunately, this demonstrates the incompetence and lack of integrity of your crew, which I have seen time and time again from SCAS, your clinical practice as a service is out of date, your staff are clearly not keeping up to date with new drugs being used by Paramedics, and cannot fill out their EPCR correctly, and then lying to cover their mistakes. To be clear, the Paramedic did have ID but was never asked for it, his PIN number and name were given to the CFR on handover. They don’t even have the ability to google Community Paramedics!  I suggest some reflective practice is in order! I don’t see that I can help your investigation any further, I suggest that if you have concerns you contact the police, who I believe have dropped the investigation. If I have to spend any more of my time on this, I will be considering issuing proceedings against the trust to claim a financial remedy to cover the costs of my time dealing with the fallout of your incompetent staff. The Registrant did not identify himself as the Paramedic concerned.
 
28. BM took legal advice and was advised not to respond in view of the tone of the email and to refer the matter to the HCPC. The Trust investigation does not seem to have progressed further after those emails were exchanged. BM accepted that she did not regard the matter as particularly serious at that stage and that she would not have taken it any further if the event Paramedic’s employer was dealing with it.
 

DR

29. DR is a Specialist Medicines Advisor contracted by the College of Paramedics. He made a statement on 9 March 2020. He has been a qualified Pharmaceutical Chemist since 1995 and is currently an Independent Prescriber as well as a Paramedic registered with the HCPC. He confirmed that Penthrox, known also as methoxyflurane, is a licenced drug (PL 42467/0001) in the UK. It is identified by the Medications and Healthcare Products Agency (MHRA) as a ‘black triangle’ drug that is subject to increased monitoring and vigilance. All side effects, even if minor, should be reported. He accepted that an intoxicated patient may not require constant monitoring if they appeared to be coping well and other observations were stable. A Paramedic would be expected to monitor the patient in accordance with their professional judgment and HCPC standards. The period for monitoring is dictated by the clinical condition of the patient, their presentation, and the potential side effects of the drug, depending on the circumstances of the individual case.
 
AR
 
30. AR is employed by the Medicines and Healthcare products Regulatory Agency (MHRA) as a Senior Policy Manager. She made a statement on 22 May 2020. She was not required to attend the hearing for any questions by the parties or the Panel because her evidence was not contentious. Under the Human Medicines Regulations 2012, registered paramedics have a list (at Part 3 of Schedule 17 of the Regulations) of injectable medicines that they can legally administer. Penthrox is not on that list. It is a prescription only medicine administered via inhalation.
 
Mr James Brogan (expert witness)
 
31. Mr Brogan is a registered Paramedic and a specialist in paramedicine. He worked as a Paramedic for the West Midlands Ambulance Service from 2010 to 2017 and has since taught paramedic science in various academic posts whilst maintaining his clinical experience whenever possible. He has a BSc in Health Sciences and other vocational qualifications relating to the practice of paramedicine.
 
32. Mr Brogan prepared a report dated 12 February 2020. He concluded that the administration of methoxyflurane (Penthrox) was clinically appropriate to a patient who was complaining of moderate to severe pain. He considered however in his report that the Registrant’s actions in respect of the patient were ‘slightly below the standard of a reasonably competent paramedic’ for the reasons that are set out below.
 
33. Mr Brogan considered in his report that it was neither appropriate nor justified to leave the patient unsupervised following the administration of methoxyflurane because it was a drug which was new to the market (a black triangle drug) so higher levels of vigilance and close supervision of the patient were required for any potentially adverse reactions or side effects. Specifically, Mr Brogan would have expected subsequent close monitoring of the patient’s blood pressure by the Registrant or by a colleague.
 
34. When giving oral evidence, Mr Brogan confirmed that close supervision was not necessarily the same as constant supervision and accepted that the nature of the supervision may depend on the circumstances and the presentation of the patient. He accepted that an automatic device to monitor blood pressure or cardiac issues may be useful in such circumstances. He agreed that a possible serious side effect of Penthrox was a severe allergic reaction. Nausea and vomiting may quickly become apparent when this is the case. Kidney or liver problems will not manifest themselves immediately. He accepted that a person administering Penthrox should provide an explanatory leaflet to the patient.
 
35. In answering further questions, Mr Brogan confirmed that the notes recorded by Paramedic 1 on the PCR showed the patient was severely intoxicated. There was a risk that Penthrox, when combined with alcohol, would have a stronger sedative effect which could lead to lowered blood pressure or reduced consciousness, hence the need for hyper-vigilance as to its administration. Mr Brogan did not therefore consider that such a patient should be left unattended, even if line of sight was maintained, and even allowing for the relative lack of additional assistance on site that is available to an event Paramedic.
 
36. Mr Brogan considered in his report that it was inappropriate to advise that a patient in continuing pain should be transported to hospital by the patient’s family car rather than by an ambulance. Mr Brogan’s view was reinforced when he noted that the patient was unable to bear weight and intoxicated with alcohol. He accepted when giving evidence that there was a distinction between clinical advice to take a certain course and a discussion of a range of possible options between a professional and a patient or colleagues, depending on how a particular situation developed. Mr Brogan added that he might reconsider his view if there were a long delay in the arrival of an ambulance, but he would be reluctant to advise such a course in view of the potential sedative side effects and the risk of aggravating the injury.
 
37. Mr Brogan considered in his report that it was clinically inappropriate to advise the administration of Diazepam in these circumstances, which did not in his view meet the criteria for either the intravenous administration of diazepam on the JRCALC guidelines or the BNF indications for oral administration for treating anxiety. There was no apparent indication as to whether the Registrant had considered these issues. When giving evidence, Mr Brogan accepted again that there was a proper distinction between clinical advice to administer specific medication and discussion of the option amongst colleagues. He agreed that the latter course was often to be encouraged and that it was beneficial to share professional experience. 
 
38. Mr Brogan agreed that paramedics may carry oral Diazepam for treating anxiety and that it could also be used to relieve muscle spasms or a high pulse rate. When invited to review the PCR, he agreed that there was a reference to pre-existing muscle pain and that the relatively high pain score might indicate muscle spasms and/or anxiety. He accepted that if these were the circumstances at the time it was not necessarily clinically inappropriate to administer diazepam in light of the new information he had received.
 
39. When asked about the combined effect of alcohol, the administration of Diazepam and Penthrox, Mr Brogan stated that all three may have a cumulative depressive effect on nervous system, which could lead to lower blood pressure, a lower pulse rate, reduced consciousness with consequent airway obstruction issues. He accepted that Diazepam might also relieve pain and/or anxiety but it carried a risk in these circumstances and its administration ought to be discussed with colleagues at the scene.
 
40. Mr Brogan considered in his report that it was not inappropriate to record observations on a phone but this depended on whether sensitive data was properly stored and disposed of. Recording observations on a phone would be acceptable if it was on secure portal although it would be preferable to note observations directly onto the PCR. He had experience of those with profound dyslexia who preferred to type their observations rather than make a manuscript note for greater clarity and accuracy.
 
41. Mr Brogan concluded in his report that the handover was poor on the evidence provided, including the police statement of CFR 1. He would have expected a handover to include particulars of the history of the complaint, past medical history, physical examination and the treatment and response. When questioned at the hearing, he accepted that he would revise that opinion if he learned that the Community First Responder accepted that the handover was focussed, efficient and of sufficient length to allow a set of observations to be performed and for the present complaint and the history to be recorded. He would also revise his opinion if he learned that the Registrant was at pains to explain the nature of the medication and that he had handed over the paperwork relating to it. Mr Brogan added however that he would expect a better dialogue between the Registrant and the Community First Responder in relation to communicating the circumstances of the incident and the reasons for administering Penthrox.
 
 
Decision on Submission of No Case to Answer
 
42. Mr Harries QC for the Registrant submitted that the HCPC had failed to establish a case to answer on the facts in respect of all the particulars of the allegation, save for 1b). He contended that the evidence was weak and inconsistent that the case should not proceed further. He further submitted that none of the particulars, including 1b), even if capable of being proved and taken at their highest, were such that a reasonable panel could make a finding of misconduct or impairment
 
43. Mr Bridges for the HCPC conceded that there was no longer a case to answer in relation to particular 1f) and acknowledged evidence that might undermine the HCPC’s case in relation to other particulars. He deferred to the decision of the Panel.
 
44. The Panel accepted the advice of the Legal Assessor and had regard to the Galbraith test and the approach set out in the current HCPTS Practice Note on ‘Half-Time Submissions’ dated 22 March 2017.
 

Particular 1b): left Patient 1 unattended after Methoxyflurane (Penthrox) was administered – accepted there is a case to answer on the facts

45. Mr Harries QC for the Registrant accepted that there was a case to answer on particular 1b) in relation to the fact finding stage. The Panel agreed that there was evidence of the Registrant leaving the patient unattended after administering Penthrox and other evidence of the risks associated with that. The issue of whether that evidence was capable of leading to findings of misconduct and impairment is addressed below.
 

Particular 1c): advised that Patient 1 be transferred to hospital in their family’s car instead of by ambulance – no case to answer

 
46. The issue on this particular of the allegation was whether there was evidence of the Registrant giving specific clinical or professional advice, as opposed to a more general discussion or suggestion of options, that the patient should be transferred by car. Mr Harries QC submitted that the evidence of such advice was limited and weak. The original evidence of ‘advice’ derived from Datix extract completed by Paramedic 1 but she was not present when this was originally discussed and referred to this ‘advice’ in terms of a recommendation or suggestion in her statements.
 
47. The Panel noted that CFR1 did not refer to this issue at all in either his written or oral evidence. There was insufficient detail from other evidence of what the Registrant had actually said to him about calling an ambulance. The Panel therefore found the evidence of such advice to be so weak and vague that no reasonable panel could find a case to answer on this particular.
 

Particular 1d): advised Paramedic 1 to administer Diazepam when it was not clinically indicated – no case to answer

 
48. This particular has two parts, proof of the alleged giving of advice to administer Diazepam and proof that it was not clinically indicated. Mr Harries QC submitted the evidence went no higher than a suggestion or a discussion of the administering of Diazepam as one option amongst others, which is not clinical advice. He further submitted there was no evidence that Diazepam was not clinically indicated and there was some evidence to suggest that it was indicated as an appropriate drug in these circumstances.
 
49. The Panel noted the evidence in the respective statements of Paramedic 1 that the Registrant either suggested or recommended the administration of Diazepam. The Panel found that this fell short of evidence of specific professional or clinical advice to administer Diazepam. The Panel also found that there was no evidence that Diazepam was not clinically indicated in the case of a young woman suffering from acute pain, notwithstanding that she had consumed alcohol. In reaching that finding, the Panel had regard to Mr Brogan’s evidence that Diazepam could be used to treat anxiety and/or muscle spasm and Paramedic 1’s acceptance that it could be used to relieve pain. The Panel therefore found that there was insufficient evidence of advice to administer Diazepam and no evidence that it was not clinically indicated. Accordingly, no reasonable panel could find that there was a case to answer on this particular.
 

Particular 1e): did not maintain an appropriate standard of record keeping, in that you recorded Patient 1’s observations on a phone – no case to answer

50. Mr Harries QC submitted that there was nothing inherently inappropriate about recording notes, a set of primary observations, on a phone. There was no evidence of poor record keeping and no indication of data protection issues and any suggestions of such were entirely speculative.
 
51. The Panel had regard to the oral evidence of BM and Mr Brogan to the effect that notes could be made on a phone or by other means and noted that the observations were transferred to a proper record on the PCR within a relatively short period. There was no evidence at all that the notes were stored or retained insecurely. Accordingly, the Panel determined that no reasonable panel could find that there was a case to answer on this particular.
 

Particular 1f): Did not provide your name and/or HCPC registration number to the Community First Responder and/or South Central Ambulance Service crew on request – no case to answer

52. Mr Harries QC submitted there was no evidence that the Registrant did not provide his name and there was no evidence that he was even asked to provide his HCPC registration number. Mr Bridges for the HCPC conceded both those points. The Panel had regard to the evidence that the Registrant had in fact given his name to CFR 1 and the absence of evidence that he was ever asked for his HCPC registration number. Accordingly, the Panel determined that no reasonable panel could find that there was a case to answer on this particular.
 
Particular 1g): did not provide an adequate handover of Patient 1 to the Community First Responder – there is a case to answer

53. Mr Harries QC submitted that although CFR 1 had felt that the handover was too brief, he had also conceded on reflection that the handover was focused and efficient when those words were put to him after a review of the extent of the observations recorded. Mr Brogan also said that he would revise his view that the handover was poor if a full set of primary observations had been communicated in a focused and efficient way.
 
54. The Panel considered that CFR 1’s concessions in relation to the handover were more guarded and qualified. He remarked for example that the handover was focused only ‘to a point’. The Panel furthermore noted that there was no indication of the Registrant recording times of when Penthrox was administered.  The Panel noted Mr Brogan’s evidence in his report that a handover may vary according to the clinical qualification of the parties and had regard to the fact that CFR 1 was a relatively inexperienced first responder and that the handover could, on one view, have been tailored to that fact particularly in light of the  challenging circumstances they faced. The Panel therefore determined that there was evidence on which a reasonable panel could find this particular to be proved, so there is a case to answer.
 
Particular 2: did not cooperate with an investigation into the care of Patient 1 carried out by South Central Ambulance Service – there is a case to answer

 
55. Mr Harries QC submitted that there was no evidence of non co-operation with the Trust’s investigation and little evidence of a formal investigative process beyond the email sent directly to the Registrant by BM. He accepted that the Registrant’s responses were defensive in their tone and content, but submitted that could not amount to evidence of non co-operation.
 
56. The Panel found that there was evidence in the emails that BM was investigating a complaint, albeit that the investigation was in its preliminary stages and that the Registrant acknowledged the investigation in his email of 10 August 2018. The Panel determined that the Registrant’s responses could be regarded as not merely defensive but also unco-operative in their content and tone. The Panel therefore determined that there was evidence on which a reasonable panel could find this particular to be proved, so there is a case to answer.
 

Particular 3: Did not communicate professionally with staff at South Central Ambulance Service, including in relation to emails sent on:

a)    8 August 2018

b)   10 August 2018.


There is a case to answer
 
57. Mr Harries QC submitted that the content and tone of the emails was defensive and robust, but that was not unreasonable or unprofessional in view of the now accepted fact that he had, for example, given his name at the scene. The Panel determined that the content of the emails could be regarded as unprofessional and that they could indicate an unwillingness to engage with the investigation. The Panel therefore determined that there was evidence on which a reasonable panel could find this particular to be proved, so there is a case to answer.
 
Is there a case to answer in relation to misconduct?
 
58. There being a case to answer on the facts in relation to particulars 1b), 1g), 2 and 3, the Panel proceeded to consider whether the evidence was such that it could lead to a finding of misconduct in relation to each of those particulars.
 
59. The Panel accepted the advice of the Legal Assessor in relation to misconduct and was assisted by the submissions on behalf of the HCPC and the Registrant. The Panel had in mind the definition of misconduct in Roylance v GMC [2011] 1 AC 311. Misconduct is “some act or omission which falls short of what is proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances.”  The Panel also had in mind that misconduct must be serious misconduct of a kind that would be regarded as deplorable by fellow practitioners and that an isolated incident was unlikely to amount to misconduct. 
 
60. The Panel also had regard to the guidance on the meaning of misconduct that was set out in Remedy UK Ltd v General Medical Council [2010] EWHC 1245 (Admin), in which misconduct was defined as “sufficiently serious misconduct in the exercise of professional practice such that it can properly be described as misconduct going to fitness to practise”.
 
61. The Panel furthermore accepted the principle expressed in Schodlok v GMC [2015] EWCA Civ 769 to the effect that various findings of less serious misconduct should not be combined to reach an overall finding of misconduct that is serious.
 
62. Mr Harries QC for the Registrant relied on the opinion of Mr Brogan that the Registrant’s alleged acts and/or omissions on 14 July 2018 fell only slightly below the expected standard of competence for a Paramedic and submitted that a reasonable panel could not in those circumstances make a finding of misconduct or impairment. Mr Bridges for the HCPC acknowledged this evidence but submitted that this was an issue for the Panel.
 
63. The Panel had regard to Mr Brogan’s opinion but reminded itself that a finding of misconduct is a matter for the judgment of the Panel that has heard the evidence of all the witnesses in the case. The allegation of leaving the patient unattended after electing to administer Penthrox (particular 1b)) gave rise to potential concerns in relation to the safety of a young and intoxicated patient whose condition should, on one possible view of the evidence, have been monitored more closely for side effects or adverse reactions than it was. The Panel therefore found that a reasonable panel could make a finding of misconduct in relation to particular 1b).
 
64. In relation to the allegation that the handover was inadequate (particular 1g)), the Panel had regard to the importance of recording all available information about the timing of medication and the necessity for professional communication and dialogue between clinical professionals and others, especially those who are potentially non-clinicians. The Panel therefore found that a reasonable panel could make a finding of misconduct in relation to particular 1g).
 
65. In relation to the more closely related allegations of non co-operation with the investigation and unprofessional communications with the investigator (respectively particulars 2 and 3), each of those allegations related to an unsatisfactory or poor standard of communication with a professional colleague who was attempting to reasonably ascertain the facts and to conduct a preliminary investigation. The Panel therefore found that a reasonable panel could make a specific finding of misconduct in relation to either particular 2 and 3. The Panel has borne in mind the principle in Schodlok in making this finding and has considered each matter individually, albeit that they concern essentially the same evidence.
 

Is there a case to answer in relation to impairment?
 
66. The Panel reminded itself of the need to protect the service user and the public component in Cohen v GMC [2008] EWHC 581: “the need to protect the individual and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect…and that the public interest includes, amongst other things, the protection of service users and the maintenance of public confidence in the profession.”
 
67. Having found that there was a case to answer in relation to the four factual particulars and having determined that a reasonable panel could make a finding of misconduct in relation to each of those particulars, the Panel considered whether a reasonable panel could then make a finding of current impairment. The Panel accepted that not every finding of misconduct would lead to a finding of impairment, but concluded that the issues of allegedly leaving the patient unattended in these circumstances and allegedly unprofessional communication could lead to findings of both misconduct and impairment. The Panel therefore concluded that a reasonable panel could find fitness to practise to be impaired on personal or public interest grounds.
 
 
68. It should be emphasised that the Panel’s findings at this stage have related only to whether a reasonable panel could make findings of fact, misconduct or impairment. The Panel’s conclusions at this stage are no indication whatsoever as to its final decision.
 
The Registrant’s case
 
69. The Registrant had not submitted a written statement but he gave oral evidence at the hearing. He served in the Army from 1990 to 2006, including responsibilities as a combat medical technician, platoon commander and an operations officer. He became an ambulance technician in 2007 and a Paramedic in 2010.  He established a social enterprise business, Community Medical Services Limited in 2013. Most of their work was at sporting or boxing events. The business supported student paramedics by giving them paid work relevant to their degree. He had often worked for Ultra Events but the amount of work has reduced by the lack of sporting events during the pandemic. He used his own electronic PCR system. He usually wore a green ambulance style shirt with green trousers and black footwear.
 
70. The Registrant attended the boxing event in Windsor on 14 July 2018 with two paramedic students who arrived in their own car. The Registrant travelled from his home in the Bristol area in his company’s ambulance. The event finished at approximately 22:00. The student paramedics were relieved of duties and left the scene before the incident. The Registrant had changed into his shorts and t-shirt to go home when the incident occurred. There was a crowd around the patient in the foyer area. She was experiencing significant pain in her left hip but she was alert and responded well to questions. He assessed the situation in a ‘back-to-basics’ way and excluded more serious conditions. This event was almost three years ago and he could not recall whether he noticed that she was intoxicated or whether it was something that he looked out for at the time. He recorded primary observations on his electronic PCR at 22:50 then subsequently he decided to leave the patient unattended to fetch his Zoll m-series monitor (monitor) from his vehicle.
 

71. The patient’s pain score of 10 out of 10 was such that, in his view, she required Penthrox. He was familiar with Penthrox before this incident and had administered it to patients without being aware of any side effects on up to fifty previous occasions. He regarded Penthrox as a safe and easy drug. It was easier than morphine in that it did not require cannulation and its inherent risks. There were no contra-indications around this administration of Penthrox such as kidney problems, an observation which was noted on the SCAS PCR. He believed he was one of the first paramedics in the country to use Penthrox since it was reintroduced to the UK, and he had undertaken a lot of research on the drug.
 

72. It was likely that the Registrant administered Penthrox either a short time before or after the first observations. The Registrant was well aware of the side effects in relation to kidney problems. There is a check list of side effects on a document that comes with the Penthrox pack so he would have checked for those. He was aware of the need to report any side effects of a black triangle drug. He had no clear memory of leaving the patient unattended. He believed he would have stayed with her for ten minutes after administration of Penthrox. He fetched the monitor because it would have helped the patient and the wait for the ambulance may have been on his mind. It was late on a Saturday night and England had just lost a football match in the World Cup third place play off. He left her with people who seemed sensible and caring and would have been away for little more than 60-90 seconds. He said initially there was no security but later referred to security guards beside the patient when he left her. Later in his evidence he restated there were no security guards at the venue. His own ambulance was only 30-40 yards away. He accepted that it might have been preferable to fetch his equipment before administering Penthrox. He was not sure whether he had explained his absence to the relatives of the patient before he left or to CFR 1 on his return. He could not remember whether he actually used the monitor or the icepack on the patient.
 
73. When CFR 1 arrived, the Registrant said that he would have conveyed the patient’s name, age, presenting complaint and relevant history as part of the handover. He thought it unlikely that CFR 1’s note on the second page of PCR represented the whole of the information that he gave him. He accepted that would be inadequate if that were all that he had said to him. He accepted there was no record of when Penthrox was administered or the dosage but he would have given that information orally or in the document that he handed to CFR 1. He had initially assumed that CFR 1 was a Paramedic and did not ask him about his credentials. He was not aware of CFR 1’s lack of experience so he did not tailor his handover accordingly. When asked about CFR 1’s evidence that the relatives of the patient did not seem to know where he was, he remarked that CFR 1 had not been truthful in his evidence.
 

74. In relation to the email that the Registrant sent on 8 August 2018, he said that the content was accurate. He had used the term, ‘negligent misstatement’, to describe the allegation that he had refused to give his personal details because it was untrue and he knew that was a legal term that was used in civil cases. He told the Panel that an Employment Tribunal Judge had been critical of his failure to use Equality Act language in previous unrelated emails and he believed that using legal language could have an impact on the other party. He accepted that it would have been better to use the word ‘untrue’. He was not sure why there was no signature or footer because his emails normally come with a footer. He accepted that BM was investigating a potential complaint and seeking his assistance.
 

75. In relation to his email of 10 August 2018 and his reference to ‘incompetence and lack of integrity…lying to cover their mistakes’, the Registrant said that he had witnessed previous incidents of incompetence and victimisation and discriminatory remarks by those working for SCAS. He was assertive in his emails because that can produce better results. He said, “Sometimes I stick my neck above the parapet to help others….to educate people like (BM) and people associated with the complaint.” When asked why he used that tone, he said that he got better results.
 
76. When asked initially by his counsel about the primary effect of his health condition, he said that it affected his spelling and the length of time that he took to write emails. He relied on his health condition as an explanation for the tone and content of his emails and explained that he now has funding for help in writing emails. When asked whether, on reflection, he thought it professional to write in that way, he said he had reflected on the fact that his email had led to the current proceedings. He said that, whilst he did not want to admit liability, he would have changed the words. He accepted that his email communications could have been better and that the ‘style was just awful’.
 
Decision on Facts
 
77. The Panel accepted the advice of the Legal Assessor that the burden of proof was on the HCPC and that they should apply the civil standard of proof. The Registrant was not under any obligation to disprove the HCPC case. The Panel had in mind that they were entitled to accept or reject expert evidence but that there should be good reasons for rejecting such evidence as stated in Lawrence v GMC [2012] EWHC 464 (Admin). 
 
78. In assessing the evidence of the witnesses, including the Registrant, the Panel had regard to the recent case of Dutta v GMC [2020] EWHC 1974 (Admin) to the effect that they should make a rounded assessment of witness credibility by reference to the proven or undisputed facts and the contemporaneous documentary evidence, especially after a long delay between the incident and the hearing, and not place undue emphasis on the demeanour of a witness or the way in which the witness gave their evidence.
 
79. The Panel did not accept the Registrant’s contention that CFR 1 had not told the truth. CFR 1 readily acknowledged that his recollection was better at the time of the incident and conceded on reflection where he had got facts wrong or where he had over-stated the position. He was open about his relative inexperience at the time. The Panel accepted his evidence that the Registrant was not present when he arrived at the scene. The Panel found that Paramedic 1 was a credible witness who was balanced in her responses to questions.
 
80. BM acknowledged the limitations to her knowledge due to not being present at the scene and she did not speculate. She conceded that the content of her emails was not wholly accurate but she was shocked by what she regarded as the unprofessional content of the emails from the Registrant. The Panel accepted that she had felt misled by the Registrant’s failure to state that he was the Paramedic at the scene in his emails to her.
 

81. Mr Brogan assisted the Panel with his expertise. The Panel found his report was helpful and balanced and that he was able to reassess his preliminary views on receiving further information during cross-examination. He gave a clear explanation in relation to his findings, whether preliminary or revised, in relation to each particular of the allegation. He was clear about what information was available to him and what was not and he demonstrated a good understanding of the issues in the case.
 

82. In assessing the evidence given by the Registrant, the Panel made allowance for his understandable difficulty in recalling events that took place almost three years ago but found that his recollection was incorrect in certain respects. He said for example that there was no security at the event but later recalled that security guards were present when explaining why he left the patient unattended before later accepting there were no security guards present. He said that he did not see the earlier email chain between the event manager and BM when it is clear from his emails in response that he must have done. The Panel therefore placed greater reliance on witness accounts that were recorded contemporaneously in police statements than on the current recollection of the Registrant. The Panel noted that he appeared at times to minimise the extent of the patient’s pain when leaving her and the risk of an allergic reaction. When invited by his counsel or the Panel to reflect on his actions with the benefit of hindsight, the Registrant did not take the opportunity to reflect properly on how he might have approached matters differently. He did not appear to appreciate the importance of constructive engagement with BM’s investigation and the need to explain his use of Penthrox which was then a relatively unusual drug to administer in the UK.
 
Findings of fact
 
Particular 1b) Left Patient 1 unattended after Methoxyflurane (Penthrox) was administered;

 
83. Mr Harries QC for the Registrant submitted that the wording of particular 1b) implied that the leaving of the patient unattended had to be proved to be inappropriate. The Panel accepted that submission and proceeded on that basis. He further submitted that the account of the Registrant had placed the earlier evidence in context and that the Registrant had made a reasonable clinical judgment that her pain was diminishing, that there were no side effects from his administration of Penthrox, and that he could safely leave the patient unattended but in the company of her relatives for a minute or a little longer whilst he obtained a monitor and icepack from his vehicle.
 
84. The Panel did not accept the Registrant’s evidence that he was or would have been absent for little more than 90 seconds. In making that finding, the Panel accepted the evidence of CFR 1 in his contemporaneous police statement dated 15 July 2018 to the effect that he arrived to find the patient screaming in pain and puffing on the inhaler and that he was told that by her relatives or friends that nobody knew the whereabouts of the event Paramedic. The Panel noted that CFR 1 had time to make an initial assessment of the patient’s presentation and then to call Control to ask about the drug and to ascertain whether he should administer Entonox. It was only then that the Registrant appeared. The Panel therefore determined that the Registrant must have left the patient unattended for more than 90 seconds.
 
85. The Panel accepted that it was reasonable to leave the patient briefly to fetch the monitor but found that could and should have been done before administering Penthrox. In leaving the patient unattended, the Panel found that the Registrant made a flawed risk assessment in discounting the risk of side effects and that he should not have discounted the effects of alcohol, a feature that Mr Brogan stated required increased vigilance when administering Penthrox. The Panel did not accept that the Registrant had adequately delegated the patient’s care to her friends or relatives because they did not know where he had gone or what medication had been administered to patient 1. Even had he done so, he should have reassessed whether that was appropriate in the circumstances.
 

86. For all the reasons stated above, the Panel found that the Registrant left the patient unattended for a period and that was not appropriate in the circumstances. The Panel therefore determined that particular 1b) was proved to the required standard.
 

Particular 1g) Did not provide an adequate handover of Patient 1 to the Community First Responder.

 
87. Mr Harries QC for the Registrant submitted that CFR 1 conceded that the Registrant had provided the set of primary observations that were noted in the PCR at 22:50 and further particulars of the presenting complaint and history that were noted on the second page of the PCR. He reminded the Panel that Mr Brogan would have revised his view that the handover was poor had he been aware that fuller observations and notes were recorded. He submitted that there was therefore evidence of an adequate handover at the very least.
 
88. The Panel accepted that CFR 1 had made appropriate concessions about the fuller extent of the Registrant’s primary observations but noted that he did not resile from his view that the handover was ‘far too quick’ and unlike other handovers he had experienced. CFR 1 was so troubled by the experience that it caused him to reflect on whether he could continue to do the job. The Panel found that the Registrant failed to provide sufficient reassurance to CFR 1 as to the timing, quantity, and the effect of the Penthrox that was administered.
 

89. The Registrant told the Panel that he believed that he was handing over to an experienced Paramedic rather than a Community First Responder and did not establish CFR 1’s clinical credentials. The Panel found that he should have done so, not least because a Community First Responder will have to then hand over care of the patient to a Paramedic. The Registrant did not therefore ensure that all relevant information, in particular in relation to the administration of Penthrox, was passed to the receiving clinician.
 

90. For all the reasons stated above, the Panel determined that the handover was inadequate and that particular 1g) was proved to the required standard.
 

Particular 2: Did not cooperate with an investigation into the care of Patient 1 carried out by South Central Ambulance Service.

 
91. Mr Harries QC for the Registrant submitted that the content of the emails of 8 August 2018 and 10 August 2018 showed there was co-operation with the investigation in that the Registrant answered and rebutted the questions about his alleged failure to provide his name and other identification details, although he did not specifically respond to a query about the drug that was administered. It was submitted that he had co-operated to that extent and there no further inquiries were made of him.
 
92. The Panel found that the Registrant was well aware that BM was investigating his conduct because he acknowledged the fact of an investigation in his email of 10 August 2018. Whilst he was entitled to defend himself against allegations that proved to be inaccurate in relation to not giving his name or identification details, the Panel noted that he did not answer BM’s reasonable query about the drug that he administered at the scene. The Panel found there was a lack of transparency about his personal role. He referred only to ‘the Paramedic’ and did not acknowledge that he was the professional concerned. The Panel noted in his evidence that he responded in this robust way because it had an impact on the other party and that he ‘stuck his head above the parapet to get better results’. The Panel was concerned by the hostile tone and content of the 10 August 2018 email in which he suggested that BM’s staff were incompetent and dishonest then declined to assist the investigation further, advised her to contact the police and raised the prospect of issuing proceedings for wasting his time. BM was shocked by this email. The Panel therefore determined that the Registrant’s intention was not to co-operate, but to shut down the investigation.
 
93. For all the reasons stated above, the Panel determined that the Registrant did not co-operate with the investigation and that particular 2 was proved to the required standard.
 
Particular 3: Did not communicate professionally with staff at South Central Ambulance Service, including in relation to emails sent on:

a.    8 August 2018;

b.    10 August 2018.

94. Mr Harries QC for the Registrant submitted that the Registrant was accurate in his description of the allegation as a ‘negligent misstatement’ in his email of 8 August 2018. He accepted that the tone of the email of 10 August 2018 was open to possible criticism, but he invited the Panel to have regard to the fact that the Registrant was responding to false allegations in relation to giving his name and other particulars. He conceded that the tone of the 10 August 2018 email was defensive and robust but it was not offensive or insulting.
 
95. The Panel considered each email separately. In relation to 3a) (8 August 2018), the Panel noted that the Registrant answered the questions about the Paramedic giving his identification details, but he did not identify himself as that Paramedic. There was therefore a lack of transparency about his own role in the incident. The Registrant acknowledged that the term, ‘negligent misstatement’ was legal language and that he might have used a simpler word such as ‘untrue’.
 

96. In relation to particular 3b) (the email of 10 August 2018), the Panel repeats its observations and its findings in relation to particular 2, namely that this email was offensive and aggressive in its content and tone in relation to the integrity of BM’s staff and that it was designed to close the investigation by referring to issuing civil proceedings. In making that finding, the Panel also had regard to the Registrant’s own evidence that the words were intended by him to have an effect on the other party and to get better results which the Panel considers to be unprofessional. The Panel did not therefore accept the Registrant’s contention that the tone and content was affected by his health condition which he said primarily affected spelling and the time it took to write an email.
 

97. For all the reasons stated above, the Panel determined that the emails were unprofessional communications and that particulars 3a and 3b were proved to the required standard.
 

98. Mr Bridges for the HCPC reminded the Panel that misconduct must be found to be serious and invited the Panel to have regard to the relevant applicable standards in the HCPC Standards of Conduct, Performance and Ethics (January 2016).
 

99. Mr Harries QC for the Registrant submitted that none of the alleged acts or omissions, if proved, fell so far below the appropriate standards as to merit a finding of misconduct. In making that submission, he placed emphasis on Mr Brogan’s conclusion that the Registrant’s combined actions at the scene of the incident were no more than slightly below the expected standard of competence. He submitted that the Panel should reject that evidence only if there were compelling reasons to do so.
 

100. The Panel accepted the advice of the Legal Assessor and had regard to the legal principles in relation to misconduct that are set out above in its decision in relation to whether there was a case to answer on the issue of misconduct. The Panel had in mind that misconduct must be sufficiently serious to be regarded as conduct going to fitness to practise and that fellow practitioners would regard such conduct as deplorable in the circumstances.
 
Misconduct: 1b) and 1g)

101. The Panel had regard to its findings that the patient was left unattended for longer than was appropriate and that the handover was inadequate. There were however some mitigating features. The circumstances were difficult. The Registrant had conducted a set of primary observations and noted the presenting complaint and the previous medical history, all of which were reflected on the SCAS PCR, and had remained with the patient for a period before fetching items from the ambulance. The Panel took account of Mr Brogan’s assessment that the Registrant’s combined actions at the scene fell below the standard to be expected of competent Paramedic but only slightly below that standard. The Panel was mindful that there must be compelling reasons to take a more serious view than the expert and could find insufficient grounds for doing so in this case. The Panel therefore found that the Registrant’s acts and omissions were below the required standard for a Paramedic but determined that this did not amount to misconduct that was sufficiently serious as to merit a finding of misconduct in relation to either particular 1b) or particular 1g).
 
Misconduct: 2 and 3
 

102. Having found that the Registrant’s emails were unco-operative in relation to the investigation and unprofessional in their content and tone, the Panel considered the standards of communication to be expected of health professionals. The Panel considered the importance of open and co-operative communications between Paramedics and found that the Registrant’s conduct in relation to particulars 2 and 3 breached the following HCPC Standards of Conduct, Performance and Ethics (January 2016)
 

  • You must give a helpful and honest response to anyone who complains about the care, treatment or other services they have received (8.3)
  • You must co-operate with any investigation into your conduct or competence, the conduct or competence of others, or the care, treatment or other services provided to service users (9.6)
     

103. The Panel noted that Mr Brogan had referred in his oral evidence to similar standards of communication in the applicable Standards of Proficiency for Paramedics (August 2014) and found that the Registrant’s also conduct breached those standards in relation to particulars 2 and 3:
 

  • Be able to work, where appropriate, in partnership with service users, other professionals, support staff and others (9.1)

  • Understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team (9.2)
     

104. In considering the issue of misconduct in relation to particulars 2 and 3, the Panel had in mind the principle in Schodlok that findings of misconduct should not be aggregated together to make a finding of serious misconduct, although each particular of the allegation concerns the same subject matter, namely the emails of 8 and 10 August 2018.
 
105. The Panel having found that the content of the emails, in particular that of 10 August 2018, was intended by the Registrant to shut down the investigation for the reasons stated above, and that his conduct breached the standards cited above, the Panel concluded that this was misconduct that other practitioners would find to be deplorable and that it was sufficiently serious to require a finding of misconduct in relation to particular 2.
 

106. The Panel determined that the content of the email of 8 August (particular 3a)) was unco-operative, but that it was not sufficient on its own to merit a finding of misconduct that was serious. The Panel however reached a different conclusion in relation to 3b) which was offensive in its comments about professional colleagues and designed to terminate further communications which was a breach of the professional standards cited above. The Panel therefore concluded that this was misconduct that other practitioners would find to be deplorable and that it was sufficiently serious to require a finding of misconduct in relation to particular 3b).
 
Decision on Impairment


107. Mr Bridges for the HCPC submitted that impairment was a matter for the Panel’s judgment in light of their findings of misconduct. He reminded the Panel that a finding of impairment may be required in order to uphold professional standards and to maintain public confidence in the profession and the regulator.
 
108. Mr Harries QC for the Registrant submitted that the Panel’s findings of misconduct related to the Registrant’s attitude to the investigation and not to public safety. He relied on testimonials from colleagues who praised the Registrant’s support for students and his positive engagement and communications with staff and the public at events. He submitted that the Registrant’s email exchanges with BM were out of character, that his misconduct was isolated and limited and that his failings were remediable. He contended that the Registrant had shown some insight when giving evidence.  In relation to the public component, he submitted that the Panel’s finding of misconduct was by itself sufficient to uphold standards and maintain public confidence in the profession and the regulator.
 
109. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note on Impairment. The Panel read and took account of a bundle of testimonials from professional colleagues and other evidence of the Registrant’s practice as a Paramedic. The Panel reminded itself that not every finding of misconduct will lead to a finding of current impairment.
 
110. The Panel considered the personal component, namely whether the Registrant presented a risk to patients and whether he had demonstrated insight and remedied his misconduct. The Panel accepted that the Registrant had shown some insight when he acknowledged that the ‘style’ of the email of 10 August 2018 was ‘just awful’ and said that he had secured funding for others to write or review his emails. He had demonstrated sufficient insight to persuade the Panel that he was unlikely to repeat the misconduct. The episode was isolated in its nature and related only to his unco-operative and unprofessional response to a complaint. The Panel’s finding of misconduct did not relate to his clinical practice or the safety of patients. The Panel accepted that the experience of this hearing and the finding of misconduct should have a corrective effect on the Registrant.
 
111. The Panel therefore determined that there was no risk to the public and that the risk of repetition of unprofessional communications of this nature was low. The Registrant was not therefore impaired in relation to the personal component.
 
112. The Panel then turned to consider the public interest component in relation to impairment and had regard to Cohen v GMC [2008] EWHC 581: “the need to protect the individual and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect…and that the public interest includes, amongst other things, the protection of service users and the maintenance of public confidence in the profession.”
 
113. The Panel’s finding of misconduct related to the Registrant’s lack of transparency and the unprofessional nature of his communications with a professional colleague in the course of an investigation. The Panel determined that he had therefore breached a fundamental tenet of his profession which was that Paramedics are expected to maintain transparent and co-operative communications with colleagues when complaints, whether justified or not, are under investigation. The Panel therefore determined that public confidence in the profession and the regulatory process would be damaged if no finding of current impairment were made in relation to this Registrant. The Panel considered that a reasonably informed member of the public with knowledge of the facts of this case and the Panel’s findings would expect a finding of current impairment to be made on public interest grounds. A finding of impairment was also necessary to uphold professional standards in this case.
 

Decision on Sanction


114. Mr Bridges for the HCPC reminded the Panel of the principles to be applied when deciding on the appropriate sanction. Mr Harries QC for the Registrant submitted that this was a case in which no sanction was necessary because the risk of repetition was low and the incident was isolated and out of character.
 
115. The Panel had regard to the Sanctions Policy (as revised in March 2019) of the HCPC and accepted the advice of the Legal Assessor. The Panel had in mind that the purpose of a sanction is to protect the public and not to punish the Registrant.
 
116. The Panel determined that there were no aggravating factors and then identified the following mitigating factors:
 

  • This was a single incident that was limited and isolated in its nature;

  • The misconduct has not been repeated;

  • There was testimonial evidence that the Registrant acted professionally in his usual dealings with colleagues and with the public at events;

  • There was no risk to public safety;

  • The findings of misconduct did not relate to clinical issues;

  • The Registrant had demonstrated some insight in conceding that the style of his email was awful;

  • The risk of repetition was low.

117. The Panel then considered the available sanctions and the principles in the Sanctions Policy. The Panel had regard to the principle of proportionality in determining the appropriate sanction and its duty to impose the least sanction that was necessary.

118. The Panel determined that the nature of the misconduct was too significant to make no order and that taking no action to mark its findings of misconduct and impairment was not in the public interest. The Panel further noted paragraph 97 of the Sanctions Policy to the effect that making no order would be an exceptional course following a finding of impairment. The circumstances and the mitigation were not so exceptional as to consider taking this course.

119. The Panel then considered whether to impose a Caution Order and noted the guidance that is set out at paragraph 101 of the Sanctions Policy. The incident of unprofessional and un-co-operative communications was isolated and limited in its nature and the risk of repetition was low. The Registrant had shown some insight and had remedied his misconduct to the extent that there had been no repetition since the incident in 2018.

120. The Panel had regard to paragraph 102 of the Sanctions Policy which states: A caution order should be considered where the nature of the allegations mean that meaningful practice restrictions cannot be imposed, but a suspension of practice order would be disproportionate. In these cases, panels should provide a clear explanation of why it has chosen a non-restrictive sanction, even though the panel may have found there to be a risk of repetition (albeit low).

121. The Panel determined that the mitigating factors were such that a Caution Order was the appropriate and proportionate sanction. In deciding not to apply a more restrictive sanction, the Panel considered whether a Conditions of Practice Order was appropriate or workable but concluded that conditions could not remedy an isolated instance of misconduct that occurred three years ago and which was unlikely to be repeated.

122. The Panel considered whether a Suspension Order was appropriate after considering the guidance at paragraph 121 of the Sanctions Policy. The Panel determined that a restrictive sanction of that nature was disproportionate where there was no finding of a risk to the public and all the mitigating factors were present. It followed in those circumstances that a Striking Off Order would also be wholly disproportionate and unnecessary.

123. The Panel therefore determined that a Caution Order of 12 months’ duration was the sufficient and proportionate sanction to reflect the nature of the misconduct and the finding of impairment on public interest grounds. There were no features of this case that required the duration of the order to exceed the minimum period. The Panel concluded that this order would uphold professional standards and maintain the confidence of the public in the regulator and the profession.

Order

ORDER: The Registrar is directed to annotate the Register entry of Mr Gary Eves with a caution which is to remain on the Register for a period of 1 year (12 months) from the date this Order comes into effect.

Notes

Right of Appeal


You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.


Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you.  The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Hearing History

History of Hearings for Mr Gary Eves

Date Panel Hearing type Outcomes / Status
25/08/2021 Investigating Committee Interim Order Application Interim Suspension
26/04/2021 Conduct and Competence Committee Final Hearing Caution