William Munro

Preliminary Matters:

Service

1. A Notice of Hearing dated 4 October 2021 sent to the Registrant’s e-mail address on the HCPC register, informed him of the date and time of the hearing and that it would be conducted by video conference.

2. The Panel found that there had been good service of the Notice of Hearing in accordance with the Health and Care Professions Council (Conduct and Competence Committee)(Procedure) Rules 2003.

Proceeding in the absence of the Registrant

3. Ms Penfold made an application for the hearing to proceed in the absence of the Registrant. She referred the Panel to an e-mail from the Registrant dated 25 November 2021 sent to the Hearings Officer. This confirmed that the Registrant’s position remained that stated in his e-mail dated 18 October 2021 where he stated:

“I now intend to rely on the combination of the facts in the material I have submitted to you as well as your own fairness. I therefore do not plan to appear at the hearing either in person or remotely.”

4. Ms Penfold informed the Panel that the final hearing had been scheduled to take place beginning on 9 August 2021. The Registrant requested an adjournment, and this request was granted. Ms Penfold submitted that the Registrant understood the option of making an application for an adjournment of the hearing, but he had not done so on this occasion. Ms Penfold further submitted that it was in the public interest for the hearing to proceed.

5. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note “Proceeding in the Absence of the Registrant”. The Panel exercised its discretion with the utmost care and caution.

6. The Panel considered the circumstances of the Registrant’s absence, particularly the content of his e-mail dated 18 October 2021, and concluded that he has waived his right to attend the hearing. The Registrant has not requested an adjournment and the Panel considered that there was little prospect that he would attend a hearing at a later date if the case were to be adjourned for a second time. The Panel noted that the Registrant has provided detailed written representations and this mitigated, to some extent, the disadvantage to him in not attending the hearing.

7. The Panel considered that it was in the public interest for the final hearing to be concluded without delay. This was the second occasion the four HCPC witnesses, three of whom were eyewitnesses to the event, had been warned to attend the hearing to give their evidence. The events in question occurred almost three years ago and it was in the public interest and the Registrant’s interests for the hearing to proceed expeditiously.

8. The Panel therefore decided that it was fair and appropriate to proceed with the hearing in the Registrant’s absence.

Amendment of the Allegation

9. Ms Penfold made an application to amend the Allegation. She submitted that the proposed amendments of particular 1 of the Allegation better particularised the Allegation. The addition of particular 2 was appropriate to ensure that the Allegation reflected the full gravity of the regulatory concern and that there was no undercharging. Ms Penfold referred the Panel to a Notice to the Registrant dated 9 September 2020 which informed him of the proposed amendments.

10. The Panel accepted the advice of the Legal Assessor and considered whether the proposed amendments were appropriate and whether they created any unfairness for the Registrant.

11. The Panel was satisfied that the proposed amendments did not unfairly prejudice the Registrant. He has been aware of the proposed amendments since September 2020, has not objected to them, and provided written submissions based on the amended Allegation. The amendment to particular 1 is appropriate in particularising the nature of the alleged behaviour. The Panel noted that particular 2 is an addition relating to the events in particular 1. The Panel was satisfied that it was appropriate for particular 2 to be included in the Allegation.

Redactions to the bundle

12. Ms Penfold informed the Panel that, in fairness to the Registrant, exhibit 14 at D46-48 of the bundle should not be before the Panel and should be removed. In addition, there should be a redaction to paragraph 18 of the witness statement of SS to remove the reference to exhibit 25 and the description of this exhibit.

13. The Panel confirmed that, as a professional panel, it would make these redactions, and that it would entirely disregard the redacted evidence.

Background:

14. The Registrant was a Paramedic at the time of the alleged incident and had been employed by the Welsh Ambulance Services NHS Trust (WAST) since January 2014.

15. On 28 January 2019, the HCPC received a fitness to practise referral from WAST in respect of the Registrant’s conduct during his attendance to an emergency call on 6 January 2019. On 6 January 2019, two emergency medical technicians, Colleagues A and B (the “first crew”), were attending to Patient A, who was reported to have attempted to end her life by consuming alcohol and medication. When the first crew arrived at the scene Patient A was intoxicated and verbally abusive. Colleagues A and B were unable to persuade Patient A to go to hospital and they contacted ambulance control to request assistance.

16. In response to this request, ambulance control sent a second crew, the Registrant and Colleague C. Colleague C was a Newly Qualified Paramedic undertaking her fourth shift since qualifying. Patient A was transferred from the property to the first crew’s ambulance and taken to hospital.

17. After Patient A had been handed over to hospital staff, Colleagues A and B discussed the events and decided to report the incident to their Clinical Team Leaders. They each completed a DATIX report, a written record of the events. A locality manager, SS was instructed to carry out an investigation into the events reported on the DATIX forms. In SS’s investigation he identified a further concern that the Registrant had not completed a PCR in relation to the incident, but had relied on the PCR completed by Colleague B.

Decision on Facts:

18. The Panel read the HCPC final bundle, exhibit 7A (Datix form), and the addendum bundle which included the Registrant’s written submissions.

19. The Panel heard oral evidence from SS and from Colleagues A, B and C. The HCPC Presenting Officer, the Legal Assessor and the Panel asked the witnesses questions arising from the witness statements and documents, including the Registrant’s written submissions.
20. Ms Penfold’s submissions on behalf of the HCPC were recorded in writing and read to the Panel.

21. In his written submissions the Registrant denied the entirety of the HCPC Allegation.

22. The Panel accepted the advice of the Legal Assessor. In respect of the facts, the Panel understood that the burden of proving each individual particular is on the HCPC and that the standard of proof is the civil standard, that it is more likely than not that the events occurred as alleged.

Particular 1

23. The Panel heard oral evidence from three witnesses who were present at the incident on 6 January 2019, Colleagues A, B and C. The Registrant was the senior clinician on the scene. The witnesses described that the event was unexpected and took place over a very short period of time with minimal opportunity for them to respond or react. This is consistent with records showing that the Registrant was on scene for approximately twelve minutes. This included the time for him to be directed into Patient A’s property by Colleague B, time spent in Patient A’s property, transferring Patient A in a wheelchair out of the property, over a step and down a short slope to the ambulance, and transferring and securing Patient A onto a stretcher in the ambulance.

24. None of the witnesses challenged the Registrant’s behaviour at the time of the event, but Colleagues A and B very promptly expressed their concerns to each other, reported the matter to Clinical Team Leaders and completed Datix forms on 8 January 2019.

25. The relevant events took place in a small room where each witness would have a different view of the events. There were some discrepancies between the witnesses about the location of each individual, but the Panel considered that such discrepancies would be expected, particularly given the unexpected nature of the incident, the short time frame within which it took place, and the passage of time since the events.

26. All three eyewitnesses to the event told the Panel that they had not seen anything similar to the Registrant’s behaviour, in practice, either before or since this incident.

27. The Panel found that the oral evidence of Colleague A was consistent with the Datix form dated 7 January 2019, notes of interview dated 19 March 2019 recorded as part of SS’s investigation, and her HCPC statement. The events on 6 January 2019 had an emotional impact on Colleague A. She was shocked and upset by the events and they have therefore stayed in her memory. She described that for six months after the incident she was anxious at work, didn’t enjoy her work, and was concerned that she might have contact with the Registrant. The Panel found that Colleague A’s description of the impact of the incident on 6 January 2019 was credible.

28. The Panel found that the oral evidence of Colleague B was consistent with the written documents including the Datix form dated 8 January 2019, her statement dated 21 January 2019 made as part of SS’s investigation, and her HCPC statement. Colleague B’s recollection of the events on 6 January 2019 was good and she was able to describe and demonstrate to the Panel the Registrant’s actions. She was very clear in her answers to questions. For example, she agreed that the Registrant has an accent, but explained that she had no difficulty with his accent and could not have misunderstood his words. Although the Registrant described that Colleague B was on the telephone during the incident, the Panel was satisfied that she was an eyewitness to the relevant events as described in the Datix form.

29. Colleague C’s evidence was consistent with her statement dated 13 January 2019 and her HCPC statement. In her oral evidence, due to the passage of time, Colleague C did not have a good recollection of the events. She referred to her statement when answering questions.

30. The evidence of Colleague C was different in some respects from the evidence of Colleagues A and B. Where there was an important discrepancy, the Panel gave greater weight to the evidence of Colleagues A and B. The statements of Colleagues A and B were supported by the Datix reports, which were written when the events were fresh in their minds. The Panel also noted that Colleague A was closer to Patient A than Colleague C, and that Colleague A was in the best position to describe how Patient A was transferred from the floor to the wheelchair.

31. The Registrant’s account of events is set out in the notes of the interview with SS dated 9 April 2019, with corrections added by the Registrant. The Registrant also provided comments on the statements made by Colleagues A, B and C as part of his written submissions. The Panel gave little weight to this evidence. The Registrant’s description of events has not been tested under cross-examination and it is inconsistent with the Datix reports and the evidence of Colleagues A, B and C.

Particular 1(i)

32. The Panel found particular 1(i) proved by the documentary evidence and the evidence of Colleagues A and B.

33. The events in particular 1(i) took place after the alleged event in particular 1(iii). Patient A had been transferred to the wheelchair and had reacted to that event by trying to get out of the wheelchair and flailing her arms around.

34. The Registrant admitted in his interview with SS that he put his hand over Patient A’s forehead and that he defended himself from Patient A by parrying blows from her. He does not admit that this was unnecessary physical force. On his account Patient A had punched and spat at him.

35. The Panel accepted the accounts of Colleagues A and B that the Registrant was standing behind the wheelchair and that he placed his hand across her face and mouth. Colleagues A and B demonstrated to the Panel how the Registrant had carried out this action. Colleague A described that this action was carried out aggressively and with force. Colleague B demonstrated that Patient’s A’s face was pulled to one side by the Registrant’s action. This description of the use of force to pull back Patient A’s face is consistent with the evidence, including the Registrant’s interview with SS, that Patient A had reacted to being transferred to the wheelchair and was trying to pull forwards and out of the wheelchair.

36. Colleague C did not confirm that the Registrant placed his hand over Patient A’s face at this point, but she was unable to recall the methods used to restrain Patient A. She confirmed that she saw the Registrant’s hand moving towards Patient A’s face. Given that the incident happened very quickly, the Panel considered that Colleague C’s evidence did not undermine the clear evidence of Colleague A and Colleague B.

37. The Panel also accepted the evidence of Colleagues A and B that the Registrant held down the arms of Patient A and used unnecessary force in doing so.

38. Colleagues A and B had taken a patient approach and had been able to establish a good level of communication with Patient A, notwithstanding that she was intoxicated and on occasions verbally aggressive. At one point they had successfully persuaded her that she should go to hospital. Patient A had not behaved in a physically threatening manner and neither Colleague A or B considered that it was necessary to request the support of the police.

39. The Registrant was not simply defensively responding to Patient A; he applied restraint. Colleague C confirmed that the Registrant applied restraint to hold Patient A’s arms. The restraint applied by the Registrant was unnecessary.

Particular 1(ii)

40. The Panel found particular 1(ii) proved by the documentary evidence of Colleague A and B.

41. Both Colleague A and Colleague B confirmed in their oral evidence, consistently with their earlier written statements, that the Registrant said “Do that again and I’ll break your fucking arm” or words to that effect. Colleague B recollected that the swear word was used twice in the threat. Colleague C did not recollect the words used, but did recollect that the Registrant used swear words.

42. The Registrant admits that he used foul language, but he does not admit that he threatened Patient A. In his written submissions he referred to his strong accent and said that the words he used were “Don’t do that, you’ll break your fucking arms”.

43. The Panel did not accept the Registrant’s submission that his accent gave rise to misunderstandings. Both Colleague A and Colleague B were clear that they heard this threat and did not misunderstand the Registrant.

Particular 1(iii)

44. The Panel found particular 1(iii) proved by the documentary evidence and the evidence of Colleague A and Colleague B.

45. Colleagues A and B described that the Registrant did not speak to Patient A, but came quickly into the room, picked up Patient A around her waist and under her arms and placed her in the wheelchair. This account is consistent with the Datix reports.

46. In his written submissions, the Registrant denied this account, stating that he is not physically capable of lifting Patient A as described. Both Colleague A and B confirmed that the Registrant had the physical ability to transfer Patient A from the floor to the wheelchair. In his interview with SS he described that Patient A agreed to be transferred to the wheelchair and that he lifted Patient A from the floor with Colleague A; he took Patient A’s left arm and Colleague A took the right arm.

47. Colleague C confirmed that the Registrant lifted Patient A, and described that Colleague A assisted lowering Patient A to the wheelchair.

48. The Panel accepted Colleague A’s evidence that she was entirely taken by surprise when the Registrant lifted Patient A. Her understanding, at that point, was that Patient A had changed her mind and did not agree to go to hospital. Colleague C saw Colleague A standing close to the wheelchair, and she may have been under the impression that Colleague A assisted the Registrant, but the Panel found that she did not do so.

49. The Panel accepted the evidence of SS that it is not an acceptable technique for a Paramedic to lift Patient A as described by Colleagues A and B. Paramedics may use equipment or, in some circumstances, colleagues may co-operate together to transfer a patient from the floor to a wheelchair using an appropriate manual handling technique.

Particular 2

50. The Panel found particular 2 proved by the documentary evidence and the evidence of SS, Colleague A and Colleague B.

51. The WAST PCR User Guide states that “a clinical record must be completed by all grades of SMS staff attending all calls where patient contact is established”. The Registrant, as the more senior clinician in the second crew was responsible for ensuring that a record was made of the contact with Patient A. On the account of every witness, there was a significant patient contact event involving the Registrant and Patient A.

52. A PCR record was made by Colleague B, but the Registrant did not complete his own PCR record or make an entry into the PCR written by Colleague B.

Decision on Grounds:

53. The Panel went to consider, on the basis of the facts found proved, whether the statutory ground of misconduct was established. The Panel noted that there is no burden or standard of proof at this stage and that the Panel should exercise its own professional judgment.

54. The Panel heard and read submissions from Ms Penfold on behalf of the HCPC.

55. The Panel accepted the advice of the Legal Assessor who referred the Panel to the case of Roylance v GMC [2000] 1 AC 311. Misconduct must be sufficiently serious misconduct in the exercise of professional practice that it can properly be described as misconduct going to fitness to practise. The Legal Assessor reminded the Panel that a breach of professional standards does not necessarily amount to misconduct.

56. The Panel decided that the Registrant’s actions breached the following paragraphs of the HCPC’s Standards of Conduct Performance and Ethics (2016):

• Standard 1 - Promote and protect the interests of service users and carers
• Standard 2 - Communicate appropriately and effectively
• Standard 6 - Manage risk
• Standard 9 - Professional behaviour
• Standard 10 - Keep accurate records.

57. The Panel also decided that the Registrant’s actions breached the Standards of Proficiency for Paramedics (2014), in particular:

• Standard 1.3, 1.4
• Standard 2.1, 2.2, 2.4, 2.8
• Standard 3.1
• Standard 4.1, 4.2, 4.4, 4.5
• Standard 8.1, 8.3, 8.4, 8.5
• Standard 9.1, 9.6
• Standard 10.1, 10.2
• Standard 14.4
• Standard 15.1, 15.6

58. Although the incident on 6 January 2019 took place over a very short period of time, the Panel considered that it was serious. The Registrant’s treatment of Patient A did not respect her dignity and it placed her at potential risk of harm. It was entirely unacceptable for a Paramedic to swear and to threaten a patient, to use unnecessary physical restraint and to use an inappropriate technique for transferring a patient from the floor to a wheelchair. The Registrant’s behaviour was unacceptable for anyone interacting with members of the public, and as a professional, his conduct fell far below the required standards. Such behaviour would be regarded as deplorable by fellow practitioners.

59. The Registrant’s conduct on 6 January 2019 had a significant impact on Colleagues A and B who were both shocked by the way the Registrant had behaved. Colleague A was particularly upset by the incident, and it caused her some anxiety at work for approximately six months.

60. There is nothing in the context of the events that explains or excuses the Registrant’s behaviour. The Registrant believed that the first crew had not managed Patient A competently and that his attendance was unnecessary. This belief cannot excuse or mitigate the Registrant’s impatient and unnecessarily forceful conduct.

61. The Registrant’s failure to make any record of the incident is also serious. The Registrant’s contact with Patient A was not of a minor or insignificant nature. Although the Registrant was not making a clinical assessment of Patient A, the events were so significant that the failure to record them is a serious falling short of the required standards.

62. The Panel therefore concluded that the Registrant’s conduct in particulars 1 and 2 is sufficiently serious to amount to misconduct.

Decision on Impairment:

63. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of his misconduct.

64. The Panel heard and read submissions from Ms Penfold on behalf of the HCPC.

65. The Panel accepted the advice of the Legal Assessor and took into account the guidance in the HCPTS Practice Note “Fitness to Practise Impairment” (December 2019). She reminded the Panel that when considering the current risk to members of the public it should consider whether the matters are remediable, any steps to remediate, and any risk of repetition of similar behaviour. The assessment of the risk of repetition will include consideration of the level of insight demonstrated by the Registrant. When assessing fitness to practise impairment the Panel should also consider the nature and gravity of the misconduct and whether a finding of impairment is required to protect the public and the wider public interest.

66. The Panel noted that although the Registrant made no admissions to the HCPC Allegation other than he accepted that he was “out of order”. He stated:

“I reacted badly and allowed my feelings to get the better of me. I was in the wrong. My language was improper, my manner brusque at best, and I was over assertive with the patient and in my use of equipment. I was also clearly unhappy at the conduct of the crew that my colleague and I were sent to assist”.

67. The Panel considered that this statement demonstrated some insight, but the Registrant then continued in his statement of his position to minimise the seriousness of his conduct. He stated:

“I mean no defiance or denial however, when I state that I also do, and always have done, dispute the extent of my wrongdoing…..I believe that my actions at the event were wrong but not as blameworthy as has been proposed…Overall, I do not believe that any further sanction is either required or necessary. I present no danger to the public and I do cherish my professional registration”.

68. The Panel noted that in all statements the Registrant is critical of Colleague A and Colleague B and their management of Patient A. In his initial interview with SS, the Registrant placed significant emphasis on the fact that he had not received conflict resolution training. The absence of such training has no relevance to the Registrant’s use of unnecessary force or to threat and unacceptable language he used to Patient A. In the Panel’s view, the Registrant deflects responsibility from himself and criticises others. The Panel also considered that the Registrant demonstrated little understanding of the role of the regulator and the purpose of professional regulation. He referred to his employer’s disciplinary proceedings and the penalties imposed and submitted that no further sanction is required. There was no evidence before the Panel that the Registrant has reflected on the potential impact of his behaviour on the reputation of the profession.

69. In the Panel’s judgment the Registrant has demonstrated limited insight.

70. The Panel considered that the Registrant’s conduct in particular 1 is behavioural and attitudinal in nature, and the Panel recognised that such matters are more difficult to remedy. However, the Panel considered that the misconduct in this case may be remediable, but that there would only be a prospect of the Registrant demonstrating remediation if he demonstrated a sufficient level of insight and a commitment to engage with the HCPC regulatory process.

71. In his written submissions, the Registrant chose to provide the Panel with information about matters at WAST which did not relate to the HCPC Allegation. It appeared from his submissions that the Registrant is not currently practising as a Paramedic. The Registrant referred in his submissions to a WAST corrective action plan, but he provided no evidence about the content of this plan, or any steps that he had taken as part of that plan.

72. In his lengthy submissions, the Registrant did not provide the Panel with information about what he has learned from the incident, how he might act differently in future, or what he has done to address his past behaviour. The Panel concluded that the Registrant has not demonstrated that he has remedied the misconduct.

73. Having considered the level of the Registrant’s insight and the absence of evidence of remediation the Panel decided that there is a real risk that the Registrant would repeat similar behaviour and put patients at risk of harm.

74. The Panel therefore decided that a finding that the Registrant’s fitness to practise is impaired is required to protect service users from the risk of harm.

75. The Panel also considered the wider public interest including the need to uphold the required standards of conduct for Paramedics and to uphold public trust and confidence in the profession. Although the Registrant’s misconduct was a single incident which occurred in a very short space of time, it involved multiple breaches of the Standards of Proficiency for Paramedics and the HCPC Standards of Conduct, Performance, and Ethics. The Registrant failed to treat Patient A with dignity and respect, and put Patient A at serious risk of harm, which is entirely unacceptable. The gravity of the incident is indicated by the impact that it had on Colleagues A and B, both of whom were shocked by the Registrant’s behaviour. Informed members of the public would be particularly concerned by the Registrant’s use of unnecessary physical force and by his language. The Panel decided that a finding of current impairment is therefore required in relation to the “public” component of impairment.

76. The Panel therefore concluded that the Registrant’s fitness to practise is currently impaired. He has in the past put a patient at unwarranted risk of harm and is liable to do so in the future, and he has in the past and is liable in the future to bring the profession into disrepute.

Decision on Sanction:

77. The Panel heard submissions from Ms Penfold. She referred the Panel to the HCPC Sanctions Policy dated March 2019 (SP) particularly paragraphs 9, 10, 11, 21, 25, 28, 37-41, 42, 54-55, 93, 94, and 36.

78. The Panel noted the Registrant’s written submission that no sanction is required.

79. The Panel applied the guidance in the SP and accepted the advice of the legal assessor. The legal assessor’s advice included reference to the cases of Bolton v Law Society [1994] WLR 512 and PSA v NMC & Judge [2017] EWHC 817.

80. The primary function of any sanction is to address public safety. The Panel should also give appropriate weight to the wider public interest which includes maintaining confidence in the profession and setting the proper professional standards. The Panel applied the principle of proportionality and balanced the Registrant’s interests against the public interest. The sanction should be the least restrictive which is sufficient to provide the necessary degree of public protection.

81. In its decision, the Panel carefully balanced the interests of the Registrant and the need to protect the public and the wider public interest. The Panel had regard to the Registrant’s financial and reputational interests and his submission that he wished to remain a member of the profession.

82. The Panel identified the following aggravating features:

• Potential harm to Patient A who was a vulnerable person;
• Multiple instances of misconduct in one call out;
• No evidence of remediation;
• Limited insight (as described in the Panel’s decision on impairment);
• Real risk of repetition;
• The Registrant was the most senior clinician.

83. The panel identified the following mitigating features:

• No evidence that the Registrant’s conduct was premeditated;
• Not a pattern of unacceptable behaviour over a stretch of time.

84. The Panel considered the sanctions in ascending order of severity. The Panel decided the Registrant’s misconduct is of a nature and gravity that the option of taking no action would be entirely insufficient to protect the public and to maintain public confidence in the profession. The Registrant’s use of unnecessary force might be described as a form of violent behaviour, where a more serious sanction is likely to be appropriate because such behaviour is likely to affect the public’s confidence in the profession (paragraph 93 of the SP).

85. The Panel considered the option of a Caution Order but decided that it would be insufficient. The guidance in paragraph 101 of the SP was not applicable because the Panel has found that there is a real risk of repetition, the Registrant has demonstrated limited insight, and has not provided evidence of remediation. A Caution Order would not impose a restriction on the Registrant’s practice as a Paramedic and it would not provide a sufficient measure of protection against the risk of repetition of similar misconduct. A Caution Order would also be insufficient to mark the gravity of the Registrant’s breach of multiple professional standards.

86. The Panel next considered the option of a Conditions of Practice Order. The Panel decided that conditions of practice would be insufficient to mitigate the risk of repetition the Panel has identified. The Panel decided that the Registrant has not demonstrated a sufficient level of insight for conditions of practice to be appropriate. The Panel was also of the view that conditions of practice would not currently be workable. Although the Registrant has engaged with the HCPC to some extent, he has not attended the hearing and the Panel has little information about his current circumstances. The Registrant described himself as an “ex-Paramedic”.

87. The Panel also decided that a Conditions of Practice Order would be insufficient to mark the gravity of the Registrant’s departure from the required standards for Paramedics. A more serious sanction was necessary to send a clear message to members of the public and the profession that the Registrant’s behaviour on 6 January 2019 was entirely unacceptable.

88. The Panel then considered guidance in the SP on a Suspension Order. The Panel considered that this case did not involve all the factors highlighted in paragraph 121 of the SP. The Panel considered the Registrant’s submissions to the HCPC and was of the view that it was uncertain whether he may be able to resolve or remedy the misconduct. The Registrant’s recognition that his behaviour on 6 January 2019 was wrong was positive, but for the reasons explained in the Panel’s decision on impairment he has demonstrated limited insight. In its decision on impairment the Panel was of the view that the Registrant’s conduct might be remediable. Therefore, in these circumstances, given the uncertainty described, the Panel decided that it would be disproportionate to impose a Striking Off Order.

89. In reaching its decision that a Striking Off Order would be disproportionate, the Panel had regard to the SP. A Striking Off Order is a sanction of last resort. It is the appropriate sanction for serious misconduct where the Registrant lacks insight and is unwilling to resolve matters. The Panel considered that at this stage it is uncertain whether or not the Registrant is willing to resolve matters.

90. Having decided that a Striking Off Order would be disproportionate, the Panel decided that a Suspension Order was the appropriate sanction. The Panel considered that a Suspension Order was sufficient to protect the public because the Registrant would not be permitted to practise as a Paramedic, and this protects against the risk of repetition. A Suspension Order was sufficient to maintain public confidence in the profession and to uphold the required standards for Paramedics. A Suspension Order is a serious sanction which sends a very clear message to members of the public and the profession that the misconduct in this case is entirely unacceptable.

91. The Panel decided that the Suspension Order should be for the maximum period of twelve months. The Panel considered that any lesser period would not be sufficient to mark the gravity of the Registrant’s misconduct. A twelve month period would also allow sufficient time for the Registrant to read and reflect on the Panel’s decision, begin the process of remediation, and prepare evidence for a review panel.

92. The Panel therefore decided that the appropriate and proportionate sanction is a twelve month Suspension Order. The Panel took into account the Registrant’s interests but decided that they were outweighed by the need to protect the public and the wider public interest.

93. The Suspension Order will be reviewed before it expires. A future review panel may be assisted by the following evidence:

• A written reflective piece including the Registrant’s learning from the incident on 6 January 2019 and consideration of the impact or potential impact of his conduct on the patient, colleagues and the reputation of the profession;
• Evidence of any remediation (e.g. relevant training courses, personal development plan);
• Evidence that the Registrant has kept his knowledge and skills up to date;
• Testimonials/references from employment paid/unpaid

The Registrar is directed to suspend the registration of William Munro for a period of 12 months from the date this order takes effect.

This order will be reviewed prior to its expiry.

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 / Proceeding in Absence

1. Ms Penfold made an application for an interim suspension order for a period of eighteen months on the grounds that it was necessary for the protection of the public and was otherwise in the public interest. She submitted that if the Registrant were to lodge an appeal there would be no protection for the public if the Registrant was to return to practice.

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

3. The Panel first considered whether it was appropriate to consider this application in the absence of the Registrant. The Notice of Hearing dated 4 October 2021 informed the Registrant that if the Panel imposed a sanction which removed, suspended or restricted his right to practise, it may also impose an interim order which would have immediate effect. The Panel decided that the Registrant had received appropriate notice of the application and that he has waived his right to attend the hearing. The Panel decided that public protection and public interest required that the Panel should proceed and consider whether an interim order was necessary for the protection of members of the public.

4. The Panel decided that an interim order is necessary for the protection of the public. The Panel has identified an ongoing risk to the public arising from the risk of repetition. It would be entirely contrary to the Panel’s decision on impairment and sanction for there to be no public protection during the twenty-eight days before the Suspension Order takes effect and for the duration of any appeal. An interim order is also otherwise in the public interest because informed members of the public would be shocked or troubled to learn that the Registrant had continued to practise as a Paramedic without restriction during the appeal period.

5. An Interim Conditions of Practice Order would not be sufficient because it would not adequately protect the public against the risk of repetition of misconduct. Therefore, an Interim Suspension Order is the appropriate and proportionate order. The Panel decided to make the order for a period of eighteen months, the maximum duration, to allow sufficient time for any appeal to be disposed of.

6. The Panel therefore made an Interim Suspension Order for a period of eighteen months.

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 William Munro