Andrew C Dawson

Profession: Paramedic

Registration Number: PA19161

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 16/12/2021 End: 17:00 16/12/2021

Location: Virtual Hearing via Video Conference

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

As a registered Paramedic (PA19161) your fitness to practise is impaired by reason of misconduct, in that:

1) On 8 September 2019, you did not undertake an adequate assessment and/or provide adequate care to Patient A, in that you:

a) Did not perform a thorough observation of Patient A’s physical presentation;

b) Did not record and/or ensure that accurate information of the assessment was recorded on the patient report form (PRF) for Patient A;

c) Inappropriately delegated the Emergency Medical Technician to attend to the patient whilst you drove to the hospital;

d) Retrospectively recorded information about the physical presentation of Patient A on the PRF, namely that the patient was intoxicated, when this was not the case and/or not assessed when attending the patient on scene.

2) Your conduct in relation to particular 1d was dishonest.

3) The matters set out in particulars 1 and 2 amount to misconduct.

4) By reason of that misconduct, your fitness to practise is impaired.

Finding

Preliminary matters
 

1. At the outset of the hearing Mr Short, appearing on behalf of the Registrant, informed the Panel that the Registrant’s bundle, which he submitted had been served in time on the Health and Care Professions Council (‘HCPC’), had not been made available to the Panel prior to the hearing commencing.

 

2. The Panel requested that the Registrant’s bundle be provided to it. The Panel took the time to read the documents contained with the Registrant’s bundle, prior to the hearing commencing. The documents provided to the Panel were as follows:

i.          Registrant’s C.V.;

ii.           Registrant’s statement of fact;

iii.          Continuing Professional Development log;

iv.          Registrant’s reflection; and

v.          5 testimonials.

 

 

Background
 

3.    The Registrant is a Band 6 Paramedic. He has been employed by North West Ambulance Service (‘NWAS’) since 2002, as an Emergency Medical Technician (‘EMT’), qualifying as a Paramedic in 2006. His base is Middleton Ambulance Station.

 

4.    On 08 September 2019, the Registrant and WG (an ‘NWAS’ ‘EMT’), who were working together as a crew, were allocated an emergency call, coded as a potential mental health issue. The crew attended to Patient A and transported her to Royal Oldham Hospital. During this incident, both Patient A’s husband (Person B) and sister were present.

 

 

5.    At the hospital, Patient A’s son (Person A), also a NWAS Paramedic, made a complaint against the Registrant. Whilst Person A had not been present at the incident, he had been informed of the events that took place by family members.

 

6.    The complaint was subsequently investigated by NM (Advanced Paramedic), who interviewed both the Registrant and WG.

 

Summary of evidence

 

7.    The HCPC relied upon the oral evidence of three witnesses who were called to give evidence:

i.        NM – Investigating Officer;

ii.        WG – attending EMT; and

iii.        Person B – Patient A’s husband.

 

 

8.    NM was instructed to carry out NWAS’ investigation into the Registrant’s conduct. He gave evidence regarding the expectations of a Paramedic and how the Registrant responded to NWAS’ internal investigation.

 

9.    WG was the attending EMT alongside the Registrant on the day in question. He gave evidence to the Panel regarding what happened on 08 September 2019.

 

10. Person B is Patient A’s husband and was present at the scene attended by the Registrant and the WG (EMT). He also gave evidence to the Panel regarding the events of 08 September 2019.

 

11. The HCPC also relied upon a bundle of documents consisting of 70 pages.

12. The Registrant gave oral evidence to the Panel, in addition to relying upon the documentary evidence outlined above. The Registrant also called AC, a Senior Paramedic Team Leader for NWAS as a character witness.

 

13. The accounts below are provided as a summary of the witnesses’ evidence and are not a verbatim account.

 

Witness NM

 

14. Witness NM informed the Panel that he has been employed by NWAS as an Advanced Paramedic since 2015. He stated that he currently has clinical responsibility for staff working within the Salford group within the Central Sector of Greater Manchester. NM told the Panel that prior to this he was a Senior Paramedic for NWAS for 2 years and that he has worked for the ambulance service for 13 years and qualified as a Paramedic in 2008.

 

15. NM informed the Panel that the Registrant is a Band 6 Paramedic who has been employed by NWAS since 2002 as an EMT, qualifying as a Paramedic in 2006. NM stated that whilst the Registrant does not hold managerial responsibilities he does mentor new paramedics and acts as the senior clinician when working with staff of lower clinical grades. NM told the Panel that when he first started working for NWAS he worked in the same group as the Registrant but since NM was promoted to a role with a higher band grade, in 2011, he did not believe that he had worked with the Registrant since that time.

 

16. NM informed the Panel that on 08 September 2019, the Senior Paramedic Team Leader made him aware of an incident, as he was the operational Advanced Paramedic on duty on the evening in question. NM told the Panel that due to the nature of the incident, and specifically

that Patient A was the mother of another NWAS Paramedic, he was asked to try and deal with the situation and find out more about what had happened during the call attended by the Registrant and a colleague EMT (WG).

 

17. NM stated that on 18 September 2019, Person A (Patient A’s son) contacted the Senior Paramedic Team Leader with a complaint regarding the care that Patient A had received. NM informed the Panel that Person A was not present at the scene of the incident but had been informed about what had happened by other family members who were.

 

18. NM told the Panel that, on 19 September 2019, he was asked by the investigations officer to investigate the allegations against the Registrant and another colleague.

 

19. NM stated that, on 04 October 2019, he interviewed the Registrant about the incident concerning Patient A. NM told the Panel that during NM’s interview with the Registrant he produced a statement, which NM exhibited before the Panel. NM also informed the Panel that on the same date, he also interviewed the EMT (witness WG) who responded to the 999 call alongside the Registrant. NM also produced a copy of WG’s statement from his interview with him for the Panel to consider.

 

20. NM also produced a copy of the Patient Record Form (‘PRF’) and a sequence of the events for the Panel to consider.

 

Witness WG:

 

21. Witness WG told the Panel that he is currently an EMT employed by NWAS. He informed the Panel that he has been employed by NWAS since January 2019. Prior to this he was in the infantry of the British Army for 10 years.

22. WG told the Panel that he had previously worked alongside the Registrant, as part of the same crew on an ambulance on previous occasions, but that he could not recall specifically how many times.

 

23. He also told the Panel that on the date of the incident (08 September 2019) he had been with NWAS for approximately 8 months and only had approximately six weeks operational experience. He informed the Panel that on the 08 September 2019, the Registrant was supervising him and as the Paramedic on their crew, the Registrant was considered to be the senior clinician.

 

Person B:

 

 

24. Person B gave evidence to the Panel. He informed the Panel that he was Patient A’s husband and that he had been present, along with Patient A’s sister, for the duration of the Registrant’s and the EMT’s visit to their home address, on 08 September 2019.

 

25. He informed the Panel that at no point was he separated from Patient A’s sister and that he remained in the same room as the Registrant and WG throughout their visit to treat his wife (Patient A). He also told the Panel that Patient A’s sister remained in his field of vision whilst entering the ambulance. Person B stated that neither he, nor Patient A’s sister, informed the Registrant or WG that Patient A had been drinking alcohol or that alcohol consumption may have been a possible contributing factor to her presenting condition.

 

Registrant:

 

26. The Registrant informed the Panel that he attended an emergency call to treat Patient A, on 08 September 2019, with his colleague EMT WG. He outlined the details of his visit to the Panel.

27. He also provided a written statement to the Panel for it to consider, along with the bundle of documents produced at the outset of the hearing.

 

Witness AC:

 

28. Witness AC informed the Panel that he was a Senior Paramedic Team Leader and has been employed by NWAS for 14 years. He told the Panel that he has been the Registrant’s Team Leader for approximately 4 years and that he has known the Registrant for approximately 14 years.

 

29. AC provided testimonial evidence to the Panel. He informed the Panel that he believes the Registrant to be honest and trustworthy and has never found him to be dishonest or untrustworthy. He informed the Panel that the Registrant is a reliable staff member and he has no concerns over his ability to perform his role as a Paramedic.

 

Decision on Facts
 

Panel’s Approach

 

30. The Panel was aware that the burden of proving the facts was on the HCPC. The Registrant did not have to prove anything and the individual particulars of the Allegation could only be found proved if the Panel was satisfied on the balance of probabilities.

 

31. In reaching its decision, the Panel took into account the oral evidence of the HCPC witnesses, the Registrant, the documentary evidence contained within the hearing bundles as well as the oral submissions made by Mr Bridges on behalf of the HCPC and those made by Mr Short on behalf of the Registrant.

 

32. The Panel also had regard to the fact that the Registrant admitted Particular 1c), contained within the Allegation and took his admissions

into account when determining the facts of the case. The Panel also noted the Registrant’s good regulatory character and took this into account when assessing the evidence before it.

 

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

 

Panel’s Decision

Particular 1a)


1. On 8 September 2019, you did not undertake an adequate assessment and/or provide adequate care to Patient A, in that you:

 

a)   Did not perform a thorough observation of Patient A’s physical presentation;

 

34. The Panel noted that there was no dispute between the parties that: the Registrant is a Paramedic registered with the HCPC; and the Registrant attended an incident relating to Patient A on 08 September 2019 along with his colleague WG. The Panel also noted that it was accepted by the Registrant that as the Paramedic attending alongside an EMT, he took overall responsibility for Patient A’s treatment and care.

 

35. The Panel had regard to the evidence before it and noted that witness NM stated that an EMT can lead the diagnosis and assessment of a patient, but that once the patient is assessed, deemed to be unwell, and beyond the EMT’s scope of practice to assess and treat, the Paramedic should take over as the attendant with responsibility for care for the patient.

 

36. NM told the Panel that it was clear from the statements taken as part of his investigation into the incident, that the Registrant had conducted a visual assessment of Patient A and believed Patient A to be having a hypoglycaemic episode (low blood sugar). As a result, blood sugar results were taken. However, the Panel noted that NM also told it that

he was concerned as to why the Registrant did not prompt WG to use the ‘ABCDE’ (airway, breathing, circulation, disability and exposure) assessment approach when assessing Patient A. He explained to the Panel that the ‘ABCDE’ approach is a common assessment strategy that ensures that assessments are made in order of clinical priority.

 

37. NM stated that whilst a leading diagnosis may have led the Registrant to question Patient A’s blood sugar, prioritising this assessment over that of a breathing and circulation assessment could have led to greater harm than a low blood sugar being untreated for a short time.

 

38. NM also told the Panel that he had concerns that Patient A’s pupils were not checked as part of the ‘D’ disability step of the assessment and that Patient A’s head was not checked for trauma as part of the ‘E’ step during Patient A’s assessment. NM told the Panel that according to the Registrant’s statement and the account provided to him as part of his investigation into the incident, the Registrant stated that Patient A was fixating on her head, running her hands through her hair and stating that her head was ‘gone’. Accordingly, he would have expected the Registrant to identify this and to investigate it further.

 

39. NM also told the Panel that he was concerned that an electrocardiogram (ECG) had not been performed at the scene of the incident. NM told the Panel that in the Registrant’s statement, provided to him as part of his investigation, the Registrant had stated that Patient A’s husband had informed him that Patient A’s potassium levels were low and that whilst he accepted that the Registrant would not have been able to test this in the pre-hospital setting (Patient A’s home), knowledge of what low potassium is and its effects on the body would suggest that an ECG be performed to rule out any cardiac arrhythmias.

 

40. NM told the Panel that the clinical assessment of Patient A was below

the standard that he would expect of a Paramedic. NM also told the Panel that due to performing an inadequate assessment the clinical diagnosis and decision making flowing from that was flawed.

 

41. NM also informed the Panel that clinically there would have been no treatments performed differently by any other paramedic crew. However, other paramedic crews would have likely assessed differently and changed who remained providing care to Patient A on the journey to hospital.

 

42. The Panel was satisfied, on all of the evidence before it, that the Registrant was under an obligation to perform a thorough assessment of Patient A in order to be able to formulate a working diagnosis of her presentation and to consider the appropriate next steps in terms of her ongoing care.

 

43. The Panel noted the evidence provided by WG, the Registrant and Person B, in respect of how Patient A presented to the Registrant and WG upon their arrival at the scene of the incident. The Panel noted that Patient A was said to be shouting, screaming and rolling around on the floor pulling at her hair and head. The Panel accepted that it would have been obvious to the Registrant and WG that Patient A’s airway was unobstructed given her presentation (screaming and shouting) and that she was breathing, for the same reasons. The Panel therefore determined that WG and the Registrant, upon arrival at the scene of the incident, had performed parts A and B of the ‘ABCDE’ assessment tool.

 

44. The Panel also determined that it was not inappropriate for the Registrant to instruct WG to undertake a blood glucose (sugar) test because his working diagnosis, when presented with Patient A, was that she had low blood glucose level. The Panel also noted that the Registrant undertook a second blood glucose test as he was ‘surprised’

by the result of the test taken by WG showing Patient A’s blood glucose levels as within normal range.

 

45. The Panel considered NM’s evidence that the Registrant should have undertaken assessments on: Patient A’s pupils; her head to check for signs of trauma; and also conducted an ECG, owing to her possible low potassium. The Panel accepted that these steps should have been undertaken as part of the Registrant’s assessment of Patient A and as part of steps ‘CDE’ of the assessment tool.

 

46. The Panel noted that WG, in his oral evidence, accepted that an assessment of Patient A’s pupils could and should have been undertaken at the scene of the incident. The Panel noted that WG also accepted that it would have been possible to perform this assessment, during periods when Patient A was sedate and more compliant.

 

47. The Panel also had regard to WG’s evidence and the Registrant’s evidence that no assessment or examination was undertaken of Patient A’s head and that they did not perform an ECG because the results may have been inconclusive owing to her rolling around on the floor. The Panel noted the Registrant’s evidence where he accepted that, after undertaking additional learning and reflection following NWAS’ investigation into the incident, that the best way to undertake a thorough assessment of Patient A was to utilise the ‘A,B,C,D,E’ assessment method.

 

48. Having regard to all of the above, the Panel was satisfied that the Registrant was under an obligation to perform a thorough observation of Patient A’s physical presentation and because he did not check Patient A’s head for signs of trauma, or her pupils for dilation, the Registrant failed to do so. The Panel also considered whether the Registrant’s failure to perform an ECG also formed part of his failure to

undertake a thorough assessment of Patient A and concluded that it did not. The Panel was satisfied, on the evidence before it, that owing to Patient A’s presentation, performing an ECG may have been difficult and that it also had the potential to further distress Patient A and further, that any results produced may have been inaccurate given Patient A’s movement and inability to remain still for the required period of time.

 

49. The Panel next considered whether the Registrant’s failure to perform a thorough observation of Patient A’s physical presentation meant that he had failed to undertake an adequate assessment and/or provide adequate care for Patient A.

 

50. The Panel determined that in failing to perform a thorough observation of Patient A, (by not checking her head for signs of trauma, or her pupils for dilation) the Registrant did fail to perform an adequate assessment of Patient A. In forming this view, the Panel had regard to NM’s evidence to it that the Registrant’s clinical assessment was below that expected of a qualified Paramedic.

 

51. The Panel next considered whether the Registrant had failed to provide adequate care for Patient A. The Panel determined that the Registrant had failed to provide adequate care to Patient A. In forming this view, the Panel again had regard to NM’s evidence where he stated that clinically there would have been no treatments performed differently by any other paramedic crew and that Patient A did not deteriorate whilst in NWAS care. However, the Registrant’s failure to perform a thorough observation and adequate assessment of Patient A’s amounted to a failure to provide adequate care of a patient with an unknown condition.

 

52. Consequently, Particular 1a is proved.

 

 
 
Particular 1b)
 
1. On 8 September 2019, you did not undertake an adequate assessment and/or provide adequate care to Patient A, in that you:
 

b)    did not record and/or ensure that accurate information of the assessment was recorded on the patient report form (PRF)  for  Patient A;

 

53. The Panel had regard to the NWAS Operational Bulletin exhibited by witness NM that stated that ‘The PRF [Patient Report Form] needs to be countersigned by a Paramedic, when it has been completed by a person of lower clinical grade’.

 

54. The Panel also had regard to the evidence of witness NM who stated that because WG was of a lower clinical grade, the Registrant should have countersigned the PRF. The Panel also noted that during the course of his oral evidence, the Registrant accepted that he did not countersign the PRF.

 

55. The Panel noted that the PRF documented that Patient A had differently sized pupils and was recorded as being performed at the scene of the incident. The Panel accepted both the documentary evidence before it, namely an email from the Registrant to NWAS, dated 09 September 2019, clarifying the error on WG’s part and also NM’s, WG’s and the Registrant’s evidence that this entry reflected an inaccurate recording on the PRF as Patient A’s pupils had only been assessed by a nurse during Patient A’s triage at hospital.

 

56. Having regard to the evidence before it the Panel was satisfied that the Registrant did not record his signature on the PRF when he was required to do so. The Panel also determined that the Registrant failed to ensure that accurate information regarding both WG’s and his own assessment of Patient A, was recorded on the PRF. By failing to note, that WG had incorrectly recorded the pupil dilation on the PRF, prior to the PRF being handed in to the hospital, the Panel was satisfied that he had failed to ensure accurate information was recorded on the PRF. Further, the Panel also had regard to the PRF which documented Patient A as diabetic and ‘hypo’. Person B’s evidence to the Panel was that Patient A was not diabetic and that this was “completely and utterly wrong”.

 

57. The Panel next considered whether the Registrant’s failure to record and ensure accurate information was recorded on the PRF amounted to a failure to undertake an adequate assessment of Patient A and/or a failure to provide adequate care to Patient A.

 

58. The Panel considered whether completing the PRF formed part of the Registrant’s responsibility to undertake an adequate assessment. The Panel determined that whilst it was imperative that the PRF be completed accurately, the PRF represents a record of the assessment undertaken by the Registrant on Patient A and of itself does not form part of the assessment. Consequently, the Panel determined that the Registrant’s failure to record accurate information of the assessment on the PRF for Patient A was not the same as a failure to undertake an adequate assessment.

 

59. The Registrant’s failure to ensure that the information provided on the PRF was accurate could potentially have impacted on Patient A’s ongoing treatment. The Panel determined that by failing to sign the PRF and by failing to ensure that accurate information was recorded on the PRF when it was handed in to the hospital, when he was under an obligation to do so amounted to a failure to provide adequate care.

 

60.  Consequently, particular 1b) is part-proved.

 

Particular 1c)
 

1. On 8 September 2019, you did not undertake an adequate assessment and/or provide adequate care to Patient A, in that you:

 

c)  inappropriately delegated the Emergency Medical Technician to attend to the patient whilst you drove to the hospital

 

61. The Panel took account of the fact that the Registrant admitted this particular.

 

62. The Panel also had regard to NM’s evidence when he stated that there was a common practice amongst some ambulance staff to take turns to attend to the patient in the rear of the ambulance or to drive the ambulance. NM told the Panel that in this situation, when it is the Paramedics turn to drive they leave the assessment of the patient to the attendee. However, NM also stated that if the Paramedic is the senior clinician and recognises that the patient is unwell, they should also recognise the need to take over the clinical care of the patient and relinquish the role of driver to the EMT. The Panel noted that NM informed it that the Registrant was in charge of driving the ambulance back to the hospital, whilst WG attended to Patient A in the back of the ambulance.

 

63. NM also told the Panel that it was clear from the Registrant’s statement, provided as part of the NWAS investigation, that he recognised that Patient A needed to get to hospital as a matter of urgency. As a result of this, the Registrant told him that he decided to drive the ambulance, given that he knew the short cuts to the hospital. NM told the Panel that no pre-alert was passed or made to the hospital and the ambulance was not driven using audible and visual warnings (blue lights or sirens) to get Patient A to hospital as quickly as possible. NM told the Panel that a pre-alert would have informed the hospital that an un-well patient was attending, and ensured that a clinician was prepared for their arrival to the rapid assessment, rather than a possibly delayed assessment with no pre-alert.

 

64.  The Panel also had regard to NWAS’ Operational Bulletin, exhibited by

NM, which explored the role of Paramedic when ‘driving versus attending’. The Panel noted that the Bulletin stated the following:

 

‘It is also accepted, that there is a long standing practice of Ambulance crews sharing the driving duties and that not all patients require the knowledge or additional skills of a paramedic. It is important however, that due diligence is given to this decision in every instance.

 

However, in delegating the care of a patient, the paramedic must give proper consideration to the potential for deterioration in a patient’s condition, whether a higher level of monitoring is required or whether an additional paramedic intervention may be required.’

 

65. Further, the Panel also noted that in WG’s evidence he stated that during the course of Patient A’s transportation to the hospital he became very concerned that Patient A was deteriorating and he alerted the Registrant to this fact. The Panel also noted that the Registrant, as part of his reflective learning undertaken for NWAS and his oral evidence to the Panel, stated that he had believed WG to be more confident than perhaps he had first thought and that upon reflection he should have asked probing questions when WG informed him that he had concerns for Patient A’s wellbeing.

 

66. Having regard to the Registrant’s admission and the evidence before it, the Panel was satisfied that the Registrant inappropriately delegated WG to attend to Patient A whilst he drove to the hospital.

 

67. The Panel was also satisfied that the Registrant failed to undertake an adequate assessment of Patient A’s presenting condition when making the decision to drive to the hospital and leave a more junior clinician (WG) in the back of the ambulance attending to the patient. Consequently, the Panel was also satisfied that by doing so, the Registrant did not provide adequate care to Patient A. In forming this view, the Panel had regard to NWAS’ Operational Bulletin, exhibited by

NM, which stated:

 

‘Where a Paramedic is present, they are responsible for the patient and the default position must be that they continue providing care on the journey to hospital. The very fact that they are being transported to hospital indicates that the patient is at risk of deterioration, otherwise they would be receiving a referral to a community service.’

 

68. The Panel also had regard to NM’s evidence where he stated, in his view, the Registrant had inappropriately delegated to WG because Patient A was unwell and needed rapid transport to hospital. However, the Registrant continued to leave a member of staff, with less experience and clinical knowledge with Patient A.

 

69. The Panel also noted that during NM’s evidence he stated that the Registrant and WG left the scene for the hospital in approximately 23 minutes and that this meant that whilst not knowing the exact cause of Patient A’s complaint, her access to definitive care was not overly prolonged.

 

70. Taking all of the aforementioned into account, the Panel determined that by inappropriately delegating WG to attend to Patient A, whilst he drove to hospital, the Registrant had failed to provide appropriate care to Patient A.

 

71. The Panel noted that the Registrant admitted Particular 1c) and the Panel had regard to the wording of the stem and noted that it referenced ‘did not undertake an adequate assessment’. In the Panel’s view, the Registrant’s decision to inappropriately delegate WG’s attendance to the patient whilst the Registrant drove to hospital amounted to a failure to provide adequate care. His failure to perform a thorough observation of Patient A’s physical presentation impacted on his later decision making and derived from him not undertaking an adequate assessment.

72.  Consequently, Particular 1c) is proved.

 

Particular 1d)
 

1. On    8    September    2019,    you   did    not    undertake    an    adequate assessment and/or provide adequate care to Patient A, in that you:

 

d) Retrospectively recorded information about the physical presentation of Patient  A  on  the  PRF,  namely  that  the  patient  was intoxicated, when this was not the case and/or not assessed when attending the patient on scene.

 

73. The Panel had regard to Mr Bridges submission to it that the Panel could amend the Allegation after findings of fact had been made, if the Panel found itself concerned with the word ‘retrospectively’ contained within the wording of particular. The Panel noted that Mr Bridges, on behalf of the HCPC, did not make an application to amend the Allegation but the Panel was cognisant of the fact that it could amend the Allegation of its own accord should it determine it appropriate to do so. The Panel also had regard to Mr Short’s submissions on the meaning of the word ‘retrospectively’ contained within the Particular.

 

74. Having accepted the Legal Assessor’s advice in respect of: the parties submissions; the cases of Professional Standards Authority v Health and Care Professions Council and Doree [2017] EWCA Civ 319 and R (on the application of the Council for the Regulation of Health Care Professions) v Nursing and Midwifery Council and Kingdom [2007] EWHC 1806 (Admin); and that the words in the Particular should be given their ordinary natural meaning, the Panel determined that this was not a case where the Allegation represented an under-prosecution of the matters before it. In the Panel’s view, amending the Allegation was unnecessary as the alleged mischief was clear to it in respect of Particular 1d). In the Panel’s view, it was not that the Registrant had recorded information ‘retrospectively’, but that he had recorded information about the physical presentation of Patient A on the PRF, that she was intoxicated when this was not the case and/or not

assessed at the scene.

 

75. The Panel determined that it was the entry itself that was the mischief when it considered the Particular and not the fact that the entry was made after the event. The Panel formed this view because it accepted that the nature of any and all PRF entries is that they will be made after the event of treating a patient and thereby may be considered to be retrospective in nature. In forming this view, the Panel had regard to NM’s evidence that it was standard practice for PRF documents to be completed once a patient has been handed over to the triage team within the hospital setting. This practice was adopted to ensure that the EMT’s or Paramedic’s focus remains on the patient and not on completing PRF paperwork.

 

76. The Panel noted that the Registrant accepted, during the course of his evidence that he made an entry on the PRF.

 

77. The Panel noted that the entry, made on the PRF by the Registrant, was as follows:

 

‘Person B stated she has drunk 1 can of lager. Her behaviour suggests she is intoxicated as if she has drunk more. Smells of alcohol.’

 

78. The Panel had regard to Person B’s evidence. Person B provided confirmation that there was no mention of alcohol throughout the incident and that he did not smell any alcohol on Patient A. The Panel noted that Person B was very clear in his evidence that he did not inform the Registrant, or WG, that Patient A had consumed 1 can of lager, or indeed any alcohol on the day in question (08 September 2019).

 

79. The Panel also had regard to WG’s statement, which it noted was a document prepared at a time when matters were relatively fresh in his

mind and was provided to NM as part of the NWAS investigation where he stated the following:

 

‘I do not recall any conversation regarding Patient A having had alcohol and there no evidence that I could see of alcohol in the house. I do not agree with what was written regarding Patient A smelling of alcohol, I couldn’t smell any. I generally do not have a problem smelling alcohol on pt [patient].’

 

80. Further, the Panel also noted that WG, during the course of his oral evidence to the Panel stated that he didn’t recall smelling alcohol on Patient A.

 

81. The Panel also had regard to the fact that the Registrant, during his oral evidence, accepted that he did not see any signs of alcohol at the scene of the incident and that WG spent the majority of his time in closer proximity to Patient A whilst treating her.

 

82. Having considered all of the evidence before it, the Panel was satisfied that the Registrant made the aforementioned entry on the PRF. The Panel also determined that the Registrant made his entry, on the PRF, prior to the document being handed into the hospital and in doing so that he acted in accordance with accepted NWAS policies with the entry being made on the same day as the incident.

 

83. However, when the Panel considered the contents of the PRF entry, which in the Panel’s view led the reader of the Registrant’s entry to conclude that Patient A was intoxicated, the Panel was satisfied, based on all of the evidence before it, that there was no evidence before the Registrant, on the day in question, to draw this conclusion. Further, the Panel was also satisfied to the required standard that neither the Registrant, nor WG, had assessed Patient A as being intoxicated at the scene.

84. The Panel determined that the Registrant recorded information about the physical presentation of Patient A on the PRF, namely that she was intoxicated when this was not the case and that his entry was made when this was not assessed when attending to the patient on the scene.

 

85. The Panel next considered whether, in making an entry on the PRF, the Registrant did not undertake an adequate assessment of Patient A and/or did not provide adequate care to Patient A.

 

86. The Panel considered whether completing the PRF formed part of the Registrant’s responsibility to undertake an adequate assessment. The Panel determined that whilst it was imperative that the PRF be completed accurately, the PRF represents a record of the assessment undertaken by the Registrant on Patient A and of itself does not form part of the assessment. Consequently, the Panel determined that the Registrant’s inaccurate entry on the PRF did not amount to a failure to undertake an adequate assessment.

 

 

87. In the Panel’s view, the Registrant’s entry on the PRF was inaccurate and could potentially have impacted on Patient A’s ongoing treatment. Accordingly, the Panel determined that the Registrant’s inaccurate entry amounted to a failure to provide adequate care.

 

88.  Consequently, Particular 1d) is part-proved.

 

Particular 2
 

2.  Your conduct in relation to particular 1d was dishonest.

 

89. The Panel had regard to the test, as set out in the case of Ivey v Genting Casinos [2017] 3 WLR 1212.

90. In the Panel’s view, there was no innocent explanation for the Registrant’s entry, on the PRF, that Patient A was intoxicated. In forming this view, the Panel had regard to the fact that the Registrant accepted that he did not raise Patient A’s intoxication with the Triage nurse, at the point at which Patient A was handed over to the hospital and that he accepted that he only made the PRF entry after he had reviewed WG’s earlier PRF entries. At this point, the Panel noted that it would have been very clear to the Registrant that both he and WG, in failing to a undertake pupil dilation test at the scene of the incident, had missed something in their assessment of Patient A. Given that it was also known to the Registrant that Patient A was the mother of a colleague Paramedic at the hospital, the Panel determined that the Registrant’s entry on the PRF was made in an effort to conceal his inadequate assessment of Patient A. The Panel also determined that reasonable and honest people would consider the Registrant’s actions to be dishonest.

 

91.  Consequently, Particular 2 is proved.

 

Decision on Grounds

 

92. Having found Particulars proved, the Panel went on to consider whether the Registrant’s conduct amounted to misconduct.

 

Panel’s Approach

 

93. The Panel took into account all of the material before it and had regard to the oral submissions of the parties.

 

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

 

Panel’s Decision
 

95. In considering the issue of misconduct, the Panel bore in mind the

explanation of that term given by the Privy Council in the case of

Roylance v GMC (No.2) [2000] 1 AC 311 where it was stated that:

 

“Misconduct is a word of general effect, involving some act or omission which falls short of what would be 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 … practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession

... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”

 

96. The Panel considered whether any of the facts found proved amounted to misconduct.

 

97. The Panel considered the HCPC’s Standards of Conduct, Performance and Ethics (dated January 2016) and was satisfied that the Registrant’s conduct had breached the following Standards:

4 - Delegate appropriately;

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

o 4.2 – You must continue to provide appropriate supervision and support to those you delegate work to;

6 - Manage 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;

9.1 – You must make sure that your conduct justifies the public’s trust and confidence in you and your profession; and

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

 

98. The Panel was aware that breach of the standards alone does not necessarily constitute misconduct. Having carefully considered Particulars 1a), 1b) and 1c) the Panel was of the view that each of these Particulars considered alone, or cumulatively, did not amount to misconduct. Whilst the Panel considered that each of Particulars 1a), 1b) and 1c) did amount to a falling short of the standards expected of a Registered Paramedic, the Panel did not consider that a fellow practitioner or member of the public would consider the Registrant’s conduct to be so serious or deplorable. This amounted to an isolated incident in an otherwise unblemished career of 13 years. Further, there was clear evidence before the Panel, that the Registrant’s failings did not result in any deterioration of Patient A whilst in NWAS’ care.

 

99. However, the Panel was satisfied that the Registrant’s conduct, in respect of his conduct in relation to Particular 1d) and Particular 2 did fall far below the standards expected of a registered Paramedic and would be considered to be conduct which would be regarded as serious by colleagues and members of the public.

 

100. The Panel considered that public trust and confidence in the Paramedic profession is paramount to be able to ensure effective treatment of patients and the public. In the Panel’s view, the public should be able to place its trust and confidence in Paramedics and by being dishonest in his entry on Patient A’s record, the Registrant had undermined the trust and confidence placed in him.

 

101. Whilst the Panel acknowledged that there was no evidence before it that the Registrant’s conduct had an adverse impact on Patient A’s ongoing hospital care, the Panel was concerned that the Registrant’s medical colleagues would expect to be able to rely upon and trust the integrity of the information placed on a patients records by the Registrant. By placing an entry on a Patient’s records, which the Registrant knew to be false, it had the effect of potentially impacting Patient A’s ongoing care.

102. Consequently, the Panel considered that Particulars 1d) and 2 each represented serious breaches of professional standards, falling far below the behaviour expected of a registered Paramedic and amounted to misconduct.

 

Decision on Impairment

 

103. Having found misconduct, the Panel went on to consider whether, as a result of that misconduct the Registrant's fitness to practise is currently impaired.

 

104. The Panel took into account all of the evidence, the submissions made by Mr Bridges and Mr Short, the oral and written submissions provided by the Registrant and the written testimonials provided by the Registrant.

 

105. The Panel took into account the HCPTS Practice Note: “Finding that Fitness to Practise is Impaired”. The Panel also accepted the advice of the Legal Assessor. The Legal Assessor advised that in determining current impairment the Panel should have regard to the following aspects of the public interest:

 

i) The ‘personal’ component: the current behaviour of the individual Registrant; and

 

ii) The ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

 

 

106. Notwithstanding the fact that the Registrant’s conduct relates to dishonesty, the Panel was of the view that it could be remediated. However, the Panel noted that all of the Registrant’s reflections and

additional training, undertaken as part of the NWAS internal investigation process and which placed before the Panel, centred around matters relating to Particulars 1a), b) and c). Noting that the Registrant denied the dishonest aspect of the case brought by the HCPC, the Panel was not satisfied that the Registrant has demonstrated any insight into his dishonest behaviour and the effect that it may have had on Patient A, her family, colleagues and the wider Paramedic profession.

 

107. Further, given the lack of insight demonstrated in respect of his dishonest conduct, the Panel believes that there is a risk of repetition of the Registrant’s failings and was unable to rule out the possibility that his conduct may recur.

 

108. The Panel went on to consider whether this was a case that required a finding of impairment on public interest grounds in order to maintain public confidence in the profession and the Regulator. The Panel was satisfied that a fully informed member of the public, who was aware of all the background to this case, would have their confidence in the profession and the Regulator undermined if a finding of impairment were not made given the failings and lack of insight shown by the Registrant. The Panel was also satisfied that there was a need to uphold proper standards of conduct and behaviour in the Paramedic profession and to maintain confidence in the profession and that an informed member of the public would expect there to be a finding of impairment in respect of the misconduct found in this case. Accordingly, the Panel also found the Registrant’s current fitness to practise impaired on public interest grounds, as well as for public protection.

 

109. The Panel therefore concluded that the Registrant’s fitness to practise is currently impaired on both the personal and public components.

 

Adjourned part-heard

 

110. The Panel handed down its decision on facts, grounds and impairment and allowed the parties time to consider its decision.

 

111. The Panel reconvened after the parties had time to consider its determination. The Panel outlined to the parties its concern regarding the remaining time available to it. The Panel noted that it would need to hear submissions from the parties, legal advice from the Legal Assessor and would also require sufficient time to decide and draft its decision on sanction. Taking all of this into account, the Panel determined that it was in the interests of justice to adjourn proceedings.

 

112. Consequently, the hearing was adjourned part–heard.

 

Decision on Sanction (at the resuming hearing of 16 December 2021)

 

113. Having determined that the Registrant’s fitness to practise is currently impaired by reason of his misconduct, the Panel next went on to consider whether it was impaired to a degree which required action to be taken on his registration.

 

114. The Panel took account of the submissions of Mr Bridges on behalf of the HCPC and of Mr Short on behalf of the Registrant.

 

115. The Panel accepted the advice of the Legal Assessor and it exercised its independent judgement. It had regard to the Sanctions Policy (the Policy) and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive but to protect members of the public and to safeguard the public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.

 

116. Before considering the individual options open to the Panel, it considered what the aggravating and mitigating factors were in this case.

 

117. The Panel considered that, aside from the finding of dishonesty itself, which had the potential to undermine the reputation of the profession and may damage the trust the public have in its paramedics, there were no other aggravating factors.

 

118. The Panel considered the following to be mitigating factors:

 

  • This was a single, isolated incident in an otherwise unblemished career;

  • Having regard to the testimonials, the Panel was satisfied that the dishonesty was out of character;

  • The Registrant had subsequently worked for the same employer for two years without incident and to a high level; and

  • There had been no resultant patient harm.

 

119. The Panel was satisfied that, given its finding of dishonesty, some form of sanction was required in this case. In reaching this decision, it had regard to the Policy which identifies that dishonesty cases fall into the category of “serious cases”. 

 

120. The Panel bore in mind paragraph 58 of the Policy, in particular the recognition within the Policy that “there are different forms, and different degrees of dishonesty, that need to be considered in an appropriately nuanced way”. In the circumstances of this case, the Panel had regard to the factors which it considered were relevant to the dishonesty, which included that this was a single, isolated incident which occurred within a lengthy and otherwise unblemished career.

 

121. The Panel then considered whether to make a Caution Order. Having regard to the Policy, it was of the view that paragraph 101 was relevant. It states:

 

“A caution order is likely to be an appropriate sanction for cases in which:

  • the issue is isolated, limited or relatively minor in nature;

  • there is a low risk of repetition;

  • the registrant has shown good insight; and

  • the registrant has undertaken appropriate remediation.”

 

122. The Panel was of the view that the actions of the Registrant could properly be described as isolated and limited in nature, as they related to writing in the PRF that the patient was intoxicated when this was not the case and was not what had been assessed. However, the Panel did not find that the issue was relatively minor, given that it related to dishonesty.

123. Further, the Panel also bore in mind its earlier findings at the impairment stage, that: “given the lack of insight demonstrated in respect of his dishonest conduct, the Panel believes that there is a risk of repetition of the Registrant’s failings and was unable to rule out the possibility that his conduct may recur”.

124. The Panel asked itself whether its earlier findings of lack of insight in respect of the dishonesty, and the consequent conclusion that it was unable to rule out the possibility that the conduct may recur, meant that a caution order was not appropriate or proportionate. The Panel considered that it may be difficult for a Registrant who denied dishonesty at the fact finding stage to be able to satisfy a Panel that he does, in fact, have insight.

125. The Panel therefore considered what information it had to reassure it that the Registrant had the necessary level of understanding of the potential impact that dishonesty has on public confidence in the profession. It noted that Mr Short, on the Registrant’s behalf, had confirmed that the Registrant held the truth as sacred. The Panel acknowledged that the Registrant had continued to work for the two years following his dishonest conduct and was well regarded by professional colleagues. The Panel also had the benefit of testimonials, written with the knowledge of these proceedings, which had attested to his usual high standards of honesty and integrity. For example, one senior colleague, with whom the Registrant works stated:

“[The Registrant] is a long-serving colleague, who I have always found to be trustworthy, honest and reliable. Whenever [the Registrant] and I have worked together on a shift, he has always been a supportive, helpful colleague, who has a very calm, caring approach with the patients we have attended to. 

More recently, in my capacity as a developing senior paramedic, and as part of the routine clinical governance arrangements to continually improve care, I have to audit the written patient records of paramedic and technician colleagues and provide those colleagues with feedback. It is always a pleasure to provide feedback to [the Registrant], as he receives the feedback positively and uses it constructively, seemingly eager to take on board comments and continually improve his practice”.

 

126. Whilst the Panel recognised at the impairment stage that it had been unable to rule out the risk of recurrence, in light of all the information, the panel assessed that the risk was, in reality, low.

127.   The Panel also had regard to paragraph 102 of the Policy, which states:

‘A caution order should be considered in cases 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)’.

 

128. The Panel was of the view that this was not a case in which education or training were required. The Registrant was described as a valued practitioner who was continually striving to improve his practice, and so there were no meaningful practice restrictions which could be imposed on the Registrant’s practice. In such circumstances, a Conditions of Practice Order was not appropriate in his case.

 

129. The reality was, therefore, that the next applicable sanction to consider in the hierarchy of sanctions, if a Caution Order was not appropriate, was that of a Suspension Order.

 

130. The Panel concluded that a Suspension Order would be disproportionate and unduly punitive in the particular circumstances of this case. In reaching this view, it had regard to its findings that this was an isolated incident in an otherwise unblemished career, which was out of character and it had assessed the risk of repetition at low. The Panel noted that he had continued to work in the profession for two years whilst the HCPC proceedings were progressing.

 

131. In all the circumstances, therefore, the Panel determined that the appropriate and proportionate sanction in this case is that of a Caution Order. It considered that a Caution Order, whilst not in itself restricting a Registrant’s practice, nevertheless carried a cautionary effect, ensuring that a Registrant is more careful and diligent moving forward. The Panel was satisfied that any risk of repetition, albeit assessed at low, would nevertheless be addressed and managed by a Caution Order.

 

132. The duration of the Caution Order will be for the three years. A shorter period would not, in the Panel’s view, be sufficient to mark the fact of the dishonesty and its reputational damage on the profession. The Panel did not view a caution order as a lenient sanction. It would appear on the register for three years and affect the Registrant’s employability and reputation. The panel was satisfied that it would serve to appropriately mark the seriousness of the case given the detrimental impact that dishonesty can have on public confidence in the profession.

Order

ORDER: The Registrar is directed to annotate the register entry of Andrew C Dawson with a caution which is to remain on the register for a period of three years from the date this order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Andrew C Dawson

Date Panel Hearing type Outcomes / Status
16/12/2021 Conduct and Competence Committee Final Hearing Caution
08/11/2021 Conduct and Competence Committee Final Hearing Adjourned part heard
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