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As a registered Paramedic (PA42694) your fitness to practise is impaired by reason of misconduct, in that:
1. Between 08 March 2018 and 30 June 2019, you did not store confidential clinical records securely and/or act in the patient’s best interest, in that you:
a) kept approximately 341 clinical records which contained patient identifiable information for approximately 274 different patients at your home, specifically but not limited to the following types of clinical records:
i. Patient Report Forms (PRFs);
ii. Diagnosis of Death Forms (DOD);
iii. Capacity to Consent and Best Interest Forms (CtoC);
iv. Care Plans; and
v. Nursing notes.
b) retained approximately 27 green copies of the PRFs at your home when it should have been provided to the patients and/or the professionals whom the patients were referred to.
2. The matters set out in allegations 1a and 1b constitute misconduct.
3. By reason of your misconduct your fitness to practise is impaired.
1. The Panel was satisfied that on 27 October 2021 an email was sent to the email address notified by the Registrant for the purposes of the HCPC Register. That email informed the Registrant of the date and time of the hearing, and also the manner in which it was proposed to conduct the hearing. The Panel was satisfied that this email constituted good service of the notice of hearing.
Proceeding in the absence of the Registrant
2. After the Panel announced its decision that there had been good service of a notice of hearing, the Presenting Officer on behalf of the HCPC applied for a direction that the hearing should proceed in the absence of the Registrant. In the context of this application the Panel was provided with the following information:
• The Registrant had not communicated with the HCPC or HCPTS since 18 June 2020.
• After a decision was made on 3 December 2020 that there was case to answer in relation to the Allegation set out above, the HCPC’s Solicitors attempted to contact the Registrant. Between 12 January 2021 and 7 May 2021, they sent four emails to the Registrant using his HCPC Register email address. The Registrant did not respond to those emails. On 24 May 2021 the Solicitors wrote a letter to the Registrant’s postal address as it appears on the Register, and on 27 May 2021, contact was made with the Registrant by telephone. During the telephone conversation the Registrant stated that he had another email address that he disclosed (hereafter “the alternative email address”). It was explained to the Registrant that he had not updated his email address for the purposes of the HCPC Register. The same day, namely 27 May 2021, the Solicitors sent an email to the alternative email address seeking verification, and on 30 May 2021 the Registrant replied from the alternative email address confirming his name and date of birth. These exchanges demonstrated that in late May 2021 that the Registrant was able to receive emails sent to, and send emails from, the alternative email address. However, on 26 November 2021 when the Solicitors sent an email to the alternative email address, it “bounced back” and was not delivered. On the same day the Solicitors sent an email to the registered email address which was confirmed to them by the HCPC Case Manager as still being the email address recorded on the HCPC Register, but that did not result in any response from the Registrant. Finally, on 8 December 2021 the HCPTS sent to the alternative email address a notice of hearing, but that email “bounced back” and was not delivered.
3. The Panel heeded the legal advice it received that care was required in connection with the decision as to whether or not the hearing should proceed in the absence of the Registrant, and the Panel had regard to the terms of the HCPC Practice Note on the topic. The conclusion of the Panel was that the hearing should proceed. The reasons for that decision were as follows:
• There had not only been a valid notice of hearing served on the Registrant as stated in paragraph 1 above, but from the efforts made by the HCPC and its Solicitors to communicate with the Registrant as described in paragraph 2, the Panel was satisfied that all reasonable steps had been taken to inform the Registrant that this hearing was taking place.
• The inference drawn by the Panel from the lack of contact made by the Registrant to the HCPC and its Solicitors is that he has disengaged from these fitness to practise proceedings and made a voluntary decision not to participate in this hearing.
• There was no application for an adjournment, and no explanation why the Registrant was not participating. It followed that there were no grounds on which the Panel could conclude that there would be a greater likelihood of the Registrant participating in a hearing on a future occasion if it did not proceed at the present time.
• The witness whom the HCPC was intending to call as a witness was ready to give evidence.
• The events alleged against the Registrant occurred some years ago, and further delay in the resolution of the matters alleged would be undesirable.
• For all these reasons the public interest in the hearing proceeding outweighed any disadvantages resulting from the Registrant’s absence.
Part of the hearing in private
4. Before opening the case, the Presenting Officer applied for a direction that the hearing should be treated as being conducted partly in private in the event that the evidence given disclosed information concerning the Registrant’s health or private life. Following legal advice the Panel considered and agreed that such a direction should be made.
5. At the time of the events alleged against the Registrant he was working as a Paramedic with North West Ambulance NHS Trust (“the Trust”). He had qualified as a Paramedic in 2017, when he commenced work as a Band 5 Newly Qualified Paramedic. However, the Registrant had worked for the Trust in other capacities, specifically in the Patient Transport Service and later as a Technician, since 1996.
6. On 10 July 2019 the Trust was informed by Greater Manchester Police (“the Police”) that on 5 July 2019 when Police Officers had visited the property where the Registrant was living a large number of patient records were found at various locations in the property. The records discovered were handed to a Senior Paramedic Team Leader and subsequently to DS, whose role at the Trust will be described below. DS analysed the recovered documents and conducted an investigation. His investigation included interviewing the Registrant.
Decision on Facts:
7. In reaching a decision on facts, the Panel took account of the documentary and witness evidence, the submissions of the HCPC and the legal advice it received.
8. The HCPC called a single witness to give evidence before the Panel, DS, the Interim Head of Service for Paramedic Emergency Services in the Greater Manchester Area. In addition to the oral evidence of DS, the Panel was provided with witness statements DS had made for the present proceedings and also to approximately 160 pages of documentary exhibits, many of which were produced or collated by DS for purposes of the internal Trust investigation.
9. The Police evidence that the documents were found at the property where the Registrant was living was hearsay in nature, but the Panel accepted it as accurate because it accepted the evidence of DS that when he interviewed the Registrant on 22 July 2019, the latter confirmed that the documents were in different locations in the property. Although the Registrant acknowledged that the documents were in different locations he stated that they had been put in cupboards and drawers.
10. The Panel also accepted the evidence of DS in relation to the breakdown of the documents as alleged in the Allegation, namely:
• That in total there were 341 clinical records which contained patient identifiable information.
• The 341 clinical records comprised:
o 298 white copies of Patient Report Forms (“PRFs”). White copies of PRFs should have been securely retained in the ambulance until they were returned to the ambulance station where they should be posted into a secure box from which they could not be removed.
o 27 green copies of PRFs. More will be said about the intended purpose of the green copy of a PRF below, but at this stage it is sufficient to record that the green copy should remain with the patient, and in the event of the care of the patient being handed over to another healthcare professional, handed on to them.
o 7 Capacity to Consent and Best Interest and Diagnosis of Death Forms. These documents were also coloured in the same manner as PRFs, and should have been dealt with in the same manner as the PRF copy of the same colour.
o 9 other documents, including care plans and nursing notes. These documents should have been handed to the professional receiving the patient and never retained by the Paramedic or the Trust.
• Records relating to 274 patients were included in the documents recovered.
11. The acceptance by the Panel of the evidence of DS had the consequence that the totality of particular 1 of the Allegation was factually proven by the HCPC.
12. The Panel considered that it is necessary to make some further contextual findings. It was satisfied that the Registrant knew how he should have been dealing with the documents described above. Not only had the Registrant been working for the Trust in various capacities in which he would have had knowledge of the intended purpose of the different copies of the forms, but when he was interviewed by DS on 22 July 2019, he demonstrated a knowledge of the correct procedure. In that interview the Registrant sought to explain the presence of the documents on forgetfulness and he also stated that he had experienced personal difficulties from 2016 until around the time he moved into the property where the documents were found. He said that at the end of a shift when at home he would find documents in his pocket, and that although he knew what he should have done with them he did not return them to the Trust because he feared that he would get into trouble returning out-of-date records. The Panel was not able to accept the explanation of accident or forgetfulness. The time span covering the wrongful retention of documents was approximately 16 months from April 2018 to July 2019 and concerned 341 separate documents. Having examined the number of shifts worked by the Registrant in the relevant period, DS was able to calculate that a PRF was retained, on average, on more than 55% of the shifts worked by the Registrant. In the judgement of the Panel the scale and frequency of the retention of documents is inconsistent with forgetfulness. The Panel is also unable to accept that any personal difficulties experienced by the Registrant either explains or excuses the hoarding of a significant number of documents not least because the commencement date of his actions being considered by the Panel coincides with period when those difficulties were largely behind him. The Panel is not able to discern a reason why he would wish to retain these documents, but it nevertheless finds that the decision to retain the documents was deliberate behaviour on the part of the Registrant.
13. It was important that all copies of all categories of documents concerned identified in the Allegation were dealt with in accordance with the Trust’s protocols, not least to prevent patient identifiable information falling into the hands of people who had no entitlement to see it. It was particularly important that the 27 green copies of PRFs reached their intended destination. In the Trust’s guidance it is explained thus: “The [green] copy of the PRF that contains patient identifiable information stays with the patient, any copy that has not been passed on to a healthcare professional providing continued care (ie. A&E, GP etc) because it was not appropriate to do so, are left with the patient for a Required Not Conveyed/Refusal. If it is not appropriate to leave with a patient this copy is disposed of confidentially on station by a member of staff that created the record.” As is clear from this quotation, the green copy could be an important document for the purposes of the ensuring continuity of care and treatment for a patient.
Decision on Misconduct:
14. The Panel began its decision on the statutory ground of misconduct by considering whether the Registrant’s proven behaviour constituted breaches of the HCPC’s Standards of conduct, performance and ethics. The Panel concluded that it had and found that the following standards had been breached.
• Under the heading, “Promote and protect the interests of service users and carers – Treat service users and carers with respect”:
o Standard 1.1, “You must treat service users and carers as individuals, respecting their privacy and dignity.”
• Under the heading, “Respect confidentiality – Using information”:
o Standard 5.1, “You must treat information about service users as confidential.”
• Under the heading, “Manage risk – Identify and manage risk”:
o Standard 6.1, “You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.”
• Under the heading, “Be open when things go wrong – Openness with service users and carers”:
o Standard 8.1, “You must be open and honest when something has gone wrong with ….. services you provide ….”
• Under the heading, “Keep records of your work – Keep records secure”:
o Standard 10.3, “You must keep records secure by protecting them from loss, damage or inappropriate access.”
15. When the Panel turned to consider degree of seriousness of these breaches, the Panel acknowledged that even a diligent and competent Paramedic might occasionally forget to deal with paperwork as required by established protocols, and it is possible to imagine that such a Paramedic might find that they have finished a shift with a document still in their pocket. The substitution test conducted by DS resulted in Paramedics confirming that they had done that. An inadvertent, isolated incident of this nature would be unlikely to be labelled as misconduct. However, in the view of the Panel the present case is in a completely different category.
16. The facts proven against the Registrant demonstrate that there was deliberate behaviour involving a huge number of documents, and it was behaviour that extended and was repeated over a period of 16 months. The fact that the Registrant’s actions did not result in identifiable harm to the patients concerned is purely fortuitous because his actions created a clear and obvious risk of harm, particularly so far as the green copies of the PRFs are concerned. It was necessary for the Trust to write to all the patients concerned and disclose the breach of their personal information, and that inevitably resulted in reputational damage to the Trust and the Paramedic profession as well as creating a cause of anxiety for patients whose documents were improperly retained.
17. The Registrant’s behaviour constituted a serious falling short of the standards expected of him that should properly be described as misconduct.
Decision on Impairment:
18. The Panel accepted legal advice and acknowledged the importance of considering the issue of current impairment of fitness to practise from the point of view of both the personal component and the public component.
19. So far as the personal component was concerned, the Panel first decided whether the Registrant’s shortcomings were remediable, and, if they were, whether they had been remediated. The Panel was of the view that breaches of the sort committed by the Registrant were conceptually capable of being remedied. However, when the Panel then considered whether the Registrant had in fact remediated them, it concluded that he had not. When interviewed by DS on 22 July 2019, the Registrant demonstrated an accurate understanding not only of what should have happened to the documents he retained, but the reasons why they were required to be dealt with in the required manner. However, the Panel has seen no meaningful recognition made by the Registrant of the consequences for the patients and the Trust his actions did have and could have resulted in. Furthermore, in circumstances where the Registrant offered no explanation for his actions other than forgetfulness and personal difficulties, explanations which for reasons already explained the Panel was unable to accept, the Panel finds that there is no meaningful acceptance of the gravity of his actions. Without understanding and acknowledging why something occurred there can be little confidence that it will not reoccur. These factors have led the Panel to conclude that there is a significant risk of repetition, and that risk has the consequence that the Registrant’s fitness to practise is impaired upon consideration of the personal component.
20. So far as the public component is concerned, the Panel has no doubt but that the 274 patients whose records were improperly retained would have a negative view of the Registrant’s professionalism. However, the Panel considers that issue extends beyond the patients concerned because all fair-minded members of the public would be dismayed at the prospect of the Registrant being permitted to practice without restriction. A failure to find that the Registrant’s fitness to practise is impaired would be to risk diminishing public confidence in the Paramedic profession and the regulation of it. A finding of impairment of fitness to practise is also required to declare and uphold proper professional standards, and a failure to make that finding would not sufficiently reinforce to other members of the Paramedic profession the importance of maintaining patient confidentiality. For these reasons the Panel finds that public component impairment of fitness to practise is established.
21. The findings that there is misconduct that is currently impairing the Registrant’s fitness to practise has the consequence that the Allegation is well founded. The Panel must proceed to consider the issue of sanction.
Decision on Sanction:
22. After the Panel handed down its decision explaining why the Allegation is well founded it allowed the Presenting Officer time to consider the decision before he made his submissions on sanction.
23. When the Presenting Officer made his submissions on sanction, he reminded the Panel of the proper purpose of a sanction and of the HCPC’s Sanctions Policy. Although he did not urge the Panel to apply any particular sanction, he did submit that the factors that had been identified by the Panel in its decision on the Allegation might result in the Panel deciding that a sanction at the higher end of the scale may be appropriate.
24. In reaching its decision the Panel paid close attention to the Sanctions Policy and also heeded the legal advice it received. The Panel therefore accepted that a sanction should not be imposed to punish the Registrant. Rather, no greater sanction should be determined upon than is required to protect the public, to maintain a proper degree of confidence in the Paramedic profession and regulation of it, and to declare and uphold proper professional standards. As the finding that the Allegation does not automatically require the imposition of sanction, the first question to be answered is whether the particular factors presented by this case demand the imposition of a sanction. If they do, the available sanctions needed to be considered in an ascending order of seriousness. As the finding is one of misconduct, the entire sanction range extending to striking off is available.
25. The Panel initially considered whether there were aggravating factors that should be considered when the factors identified in the Sanctions Policy were addressed. The Panel identified the following factors:
• The Registrant’s actions represented a breach of the trust of the patients whose records he improperly retained.
• The Registrant’s actions represented behaviour that was deliberate and repeated. The Panel concluded that his improper actions occurred on over 55% of his work shifts they could fairly be said to represent a pattern of inappropriate behaviour.
• The Registrant had demonstrated little real or meaningful insight because the explanation for his behaviour did not bear examination or explain the persistent nature of his actions.
• The Registrant’s actions had the potential for patient harm, particularly with regard to the retention of the green copies of PRFs that could have impacted on the continuity of patient care.
26. Against these aggravating factors, the Panel concluded that there were very slight considerations to apply in favour of the Registrant. In the context of the Trust investigation, he did not seek to deny that he had retained the documents, he acknowledged that he had acted improperly, and he did offer an apology. The Panel also kept in mind the personal difficulties referred to by the Registrant when he was interviewed by DS on 22 July 2019.
27. With these considerations in mind the Panel first addressed whether any sanction is required. The conclusion of the Panel was that the matter was far too serious not to be marked by the imposition of a sanction.
28. In relation to a caution order, the Panel considered he factors identified in paragraph 101 of the Sanctions Policy. The issue was not isolated, not limited and not relatively minor in nature. The risk of repetition is not low, and the Registrant has not shown good insight. Furthermore, he has not undertaken appropriate remediation. In the judgment of the Panel a caution order would not be appropriate.
29. The Panel next considered the factors set out in paragraph 106 of the Sanctions Policy and whether a conditions of practice order should be made. The conclusion of the Panel was that such an order would not be appropriate in this case, not least because of the very limited insight shown by the Registrant, but also because the lack of engagement in these proceedings meant that the Panel could have no confidence that any conditions imposed would be complied with.
30. The Panel next considered a suspension order and paragraph 121 of the Sanctions Policy. The case is certainly one where the concerns represent a serious breach of the Standards of conduct, performance and ethics, but that apart the circumstances as presented to the Panel do not meet the criteria suggested in that paragraph. For the reasons already explained the Registrant has very limited insight. It cannot be said that the issues are unlikely to be repeated and there is no evidence to suggest that the Registrant is likely to be willing or able to resolve or remedy his failings. The Panel acknowledged that a suspension order would protect the public for the duration of the order but given the Registrant’s non-engagement in this process there was no information available to the Panel on which it could base a finding that there was any likelihood of the position being any different at the end of a period of suspension to the position it is at the present time. In other words, a suspension order would not achieve any positive purpose.
31. The Panel next considered a striking off order and paragraphs 130 and 131 of the Sanctions Policy. The Panel was satisfied that this is indeed a case of serious, persistent and deliberate behaviour and that there is a lack of true insight. Furthermore, the Panel is driven to conclude from the absence of positive engagement by the Registrant that he is unwilling to resolve matters. Having carefully considered the matter and acknowledging the seriousness of making a such an order, the Panel concluded that a striking off is the appropriate sanction in the particular circumstances of this case.
32. Before confirming its provisional view that striking off is the appropriate outcome, the Panel satisfied itself that it is a proportionate response. It is important to note that the Panel’s decision is not that in every case of large-scale misapplication of patient information that a striking off order would be inevitable. Had there been engagement such that there could be confidence on the part of the Panel that conditions would be adhered to, a conditions of practice order would have merited serious consideration. Further, if there had been information from which the Panel could have concluded that there was a genuine intention to address the shortcomings identified by the findings in this case, a suspension order might have been considered appropriate. What made the striking off order the only appropriate, and therefore proportionate, outcome in the present case was the absence of those factors that could have resulted in a lesser sanction being applied.
The Registrar is directed to strike the name of Ian Hitchen from the Register on the date this Order comes into effect.
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.
Application for an interim order
1. After the Panel announced its decision on sanction, the Presenting Officer applied for an interim order to cover the period before the striking off order will come into effect (that is to say, initially 28 days or the final determination of the appeal if the Registrant appeals the Panel’s decision within the initial period of 28 days).
2. To decide if the Panel should consider the merits of this application, it was necessary to decide two preliminary matters, first, whether the Registrant had been put on notice that such an issue might be considered, and secondly, whether it was appropriate to deal with the matter in his absence.
3. The Panel was satisfied that the Registrant had been informed by the notice of hearing email dated 27 October 2021 that in the event of a substantive sanction of the sort that the Panel has decided is appropriate, an interim order might be applied for. As to considering the issue in the Registrant’s absence, by the nature of the application there is a degree of urgency in deciding the matter because if an interim order is required there should be no delay in imposing it. Furthermore, as the Registrant has not engaged in the substantive issues there are no grounds for believing that he would wish to be heard on the issue of the interim order. For these reasons the Panel decided to consider the merits of the application.
4. For the reasons already explained in the determination relating to the substantive issues, the Panel has concluded that the Registrant presents a risk of harm to patients. It follows from this that an interim order is necessary for the protection of members of the public. That same risk coupled with the scale and period over which the Registrant’s proven activities continued also means that there would be an understandable loss of public confidence in the Paramedic profession were there to be no protection. That factor requires an interim order in the wider public interest.
5. Having decided that an interim order is required, the Panel next considered whether an interim conditions of practice order would offer sufficient protection during the period while the Registrant’s appeal rights remain extant. The Panel concluded that they would not for the same reasons that it rejected substantive conditions of practice as an appropriate sanction.
6. It followed from this decision that an interim suspension order is required, and the Panel makes that order.
7. As to the length of this interim order, the Panel determined that it should be for the maximum period of 18 months. If the Registrant does not appeal the Panel’s substantive decision the interim order will simply fall away after 28 days, and therefore the maximum length of the order will not prejudice him. If, however, he does appeal the final determination of the appeal could well take 18 months from the present time, and it is appropriate that there should be the full degree of public protection until that final determination.
Interim Suspension Order:
The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.
This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.
History of Hearings for Ian Hitchen
|Outcomes / Status
|Conduct and Competence Committee