Mr Arkadiusz Bodziany

Preliminary matters:

Service

1. The Panel was provided with evidence that the Notice of Hearing had been sent on 08 October 2020 to the email address shown for the Registrant on the HCPC Register. The Panel accepted the advice of the Legal Assessor and was satisfied that the Notice of Hearing had been served in accordance with all relevant legal and procedural requirements.
Proceeding in Absence

2. The Panel first considered whether to proceed in the absence of the Registrant. Ms Lykourgou, Counsel, instructed on behalf of the HCPC submitted that it should. She pointed out that the Registrant had been served with notice of the proceedings and has not engaged. She submitted that there was no reason to adjourn or delay the proceedings. The Panel heard advice from the Legal Assessor.

3. The Panel noted that the Registrant had been served with the papers and was aware of the hearing. The Panel noted that he had not sought an adjournment and that there was no reason to suppose that he might attend any future hearing if the matter did not proceed. The Panel also noted that four busy paramedics were due to give evidence over the course of the next few days. The Panel had in mind the principles in R v. Jones [2002] UKHL 5.

4. The Panel therefore determined that it was both in the public interest and fair to the Registrant to proceed to hear this matter in his absence.

Application to Amend the Allegation

5. Ms Lykourgou next applied to amend the Allegation. She informed the Panel that the application to make the amendments had been served on the Registrant in February 2020 and so he had had plenty of notice of the application and had not raised any objections. She submitted that the amendments were in the interests of justice and were not unfair to the Registrant.

6. Ms Lykourgou also offered no evidence on Particulars 1f) and 1h) of the Allegation and these Particulars were dismissed.

7. After hearing advice from the Legal Assessor, the Panel concluded that the amendments could properly be made without unfairness to the Registrant.

Background:

8. The Registrant was employed by the East Midlands Ambulance Service Foundation Trust (‘EMAS’) between 27 March 2017 and January 2018. The Registrant had qualified as a paramedic in Poland some ten years earlier. In the intervening period he had been a resident in the UK and living in the Merseyside area. He had been working as a driver and had not used his paramedic qualification in the UK or elsewhere in the previous ten years.

9. The Registrant underwent the six-week International Paramedic Course to transfer/convert his Polish qualification in order to obtain registration from the HCPC.

10. Upon commencing as a paramedic in the EMAS the Registrant was treated as a fully qualified paramedic but was required to undergo a probationary period. During the course of his employment, it became clear that the Registrant did not have the knowledge or experience to carry out his duties. He also lacked confidence and was unable to take the lead, as a paramedical professional should be able to do, when attending incidents. The Registrant spent time with a number of mentors and as a supernumerary with a number of paramedics.

11. Serious concerns were raised as to his competence and his ability to treat patients. The Registrant undertook a performance assessment from which it became clear that his competence fell considerable below what is required of a paramedic.

Witnesses

12. The Panel heard live evidence from CP, Clinical Support Manager and Line Manager at EMAS, KD, Clinical Support Manager, LC a paramedic and LW who is also a paramedic. The Panel also considered the written exhibits.

13. The Panel received submissions from Ms Lykourgou and received advice from the Legal Assessor.

Decision on Facts:

14. The Panel found all of the witnesses to be credible and did their best to assist the Panel. The witnesses each seemed to be being fair to the Registrant but simply found his skill and knowledge set to be so far below the minimum standard required to practise safely that they were unable to contemplate him reaching a safe standard without comprehensive re-training, possibly even at undergraduate level. Such a gulf could not be bridged during preceptorship as a qualified paramedic.

15. CP was the Registrant’s mentor when he commenced at EMAS. The Registrant had told him that the training and expectations of a paramedic in Poland are very different. The Registrant told him that in Poland an ambulance would carry a doctor, a nurse and a paramedic, who would be last in the line of responsibility. The paramedic, in effect, supported the other two. In the UK the paramedic is the lead professional in an ambulance and expected to act on their own initiative and take charge of the situation.

16. CP explained that the Registrant spent the first few weeks of his employment as a supernumerary as his registration at the HCPC had not come through. Once the Registrant was able to act as a paramedic it became clear to CP that the Registrant was not at the required level and it would not be safe for him to go out on his own without a supervising paramedic.

17. CP explained that the Registrant would not talk to patients who he was attending to, which is vital to his role. This seemed to be due to a lack of confidence. He also noticed that the Registrant lacked medical knowledge, clinical skills and his treatment was sub-standard. CP explained these concerns both to the Registrant and to his superiors.

18. These concerns were echoed by the other witnesses KD, LC and LW who also worked alongside the Registrant.

Particular 1a) is found proved.

19. The Panel accepted the evidence of CP that whilst mentoring, the Registrant would miss checking the patient’s airways or other key life-threatening elements of patient assessment. He also recalled that the Registrant would not have a full patient clinical handover when they arrived at the Emergency Department. The Panel also accepted the evidence of KD that on one occasion with a female patient who seemed reluctant to talk to them he seemed to flounder. KD also recalled him performing a FAST test (to test for a stroke) and when he noticed a weakness in the arm became excited and was shouting out that the patient should go to hospital immediately. He should have carried out a full and comprehensive assessment before reaching this conclusion. He should not have been shouting out his conclusion. LC recalled an incident with a cancer patient when the Registrant took an incomplete history which would have led to a different referral route if she had not intervened. LW recalled attending a patient who was presenting with cardiac pain. The Registrant was supposed to take over from a technician already in attendance. The Registrant was asking the same questions over and over again as he attempted the handover and didn’t seem to be paying attention to the technician.

Particular 1b) is found proved.

20. The Panel accepted the evidence of KD that whilst on their way to a patient with an immobile left arm the Registrant, when considering possible diagnosis, did not consider a stroke as possibility but instead focused on trauma or cardiac causes. The Panel also accepted the evidence of LC that whilst attending a patient with breathing difficulties the Registrant did not recognise the possible complication of sepsis. The Panel also accepted the evidence of LW who recalled attending a patient with abdominal pain and when she asked the Registrant for a view and he simply said that he didn’t know. He didn’t attempt to recognise the symptoms and question the patient.

Particular 1c) is found proved.

21. The Panel accepted the evidence of LW who recalled an incident with a cardiac patient who might have been time critical, though it turned out not to be, but whom the Registrant did not seem to understand the urgency. She also noted that he did not realise that the ambulance carried two types of adrenalin on board, one for anaphylactic patients who are very time critical. She did not think that he knew this or how to administer adrenalin in these circumstances. The Panel accepted LC’s evidence that the Registrant did sometimes recognise time critical patients and on occasions understood the urgency of the situation but this did not overbear his failures in respect of other occasions.

Particular 1d) is found proved.

22. The Panel accepted the evidence of CP that during the time he mentored, the Registrant was not able to take the role of lead clinician, which is essential for a paramedic. KD confirmed that the registrant failed to take the lead when he was with her, failing to carry out a stroke test until prompted to do so by her. LC thought that the Registrant did take the lead sometimes. But on one occasion she was forced to take over as the Registrant was not dealing with the situation effectively. LW found that during the shifts with her he shied away from taking the lead.

Particular 1e) is found proved.

23. The Panel accepted the evidence of KD that in respect of a patient who may have been FAST positive, the Registrant did not ask her to move her leg, check for weakness and muscle tone. He did not consider a blood sugar test in order to rule out hypoglycaemia as this may have explained the symptoms. LC recalled the Registrant being unable to canulate a patient. He also failed to take a pain score which meant that once the pain relief had taken effect, he was unable to compare the score to prior to giving the pain relief and was thus unable to assess its efficacy. He was unable to treat patients appropriately without support from her. LW recalled his shying away from patients and not treating them independently of her. He failed to consider pain relief for patients who were plainly in pain.

Particular 1g) is found proved.

24. The Panel accepted the evidence of LW that the Registrant was not able to provide differential diagnosis when he was with her. An example she gave related to a patient with acute abdominal pain. The Registrant had no suggestions. She would have expected him to at least consider appendicitis. He should have conducted an abdominal assessment in order to discover possible causes of the pain. However, he simply accepted from the patient that because she had previously had bowel surgery this must be the cause of her symptoms.

Particular 1i) is found proved.

25. The Panel accepted the evidence of LC that the Registrant had failed to appreciate that a cancer patient did not need to be taken to the Emergency Department but could instead be taken directly to a ward where she would receive appropriate treatment. LW remembered the Registrant thinking that all patient’s being taken to hospital should go to the Emergency Department. He did not appreciate that early pregnancy patients would go to the Emergency Department, but late pregnancy patients would go to the maternity ward. He didn’t realise that he could telephone the hospital for advice as to which pathway to follow and where to take patients.

Particulars 2a) – f) found proved

26. On 13 November 2017, the Registrant attended an assessment day which included and examination paper and a number of practical patient scenarios. The assessment was conducted by independent assessors. The Panel heard evidence from CP and read the results of the assessment. The Registrant performed very poorly across the board. As a result of hearing this evidence and reading the results of the assessments the Panel made the following findings: Particulars 2a) i-v are found proved, Particulars 2b) i-v are found proved, Particulars 2c) i-iv are found proved, Particulars 2d) i-viii are found proved, Particulars 2e) i-iv are found proved and Particular 2f) is also found proved.

Decision on Grounds:

27. The Panel next went on to consider whether or not the facts found proved amounted to a lack of competence.

28. The Panel heard submissions from Ms Lykourgou who said that the Registrant’s practice fell considerably below the standard expected of a reasonably competent paramedic and that the Panel had a fair sample of his work to consider. The Panel also received advice from the legal assessor.

29. The Panel determined that the facts found proved did amount to a lack of competence on the Registrant’s part. They found that he was unable to take the lead in an effective way and understood that his previous training in Poland had not prepared him for this role. The Panel had found that the Registrant could not take patient histories or engage in detailed assessments. He was unable to recognise symptoms or appreciate when a patient might be time critical. The Panel agreed that he could not make differential diagnosis or understand different referral pathways.

30. The Panel understood that the Registrant had expressed a view to CP that he might have been happier as a technician. LW expressed a view that the Registrant was not even operating at the level of a technician but instead operating at the level of a Clinical Emergency Assistant. The Panel accepted entirely the view expressed by each of the witnesses in turn, all of whom had worked alongside the Registrant, that he was completely lacking in the skills necessary to function at the lowest acceptable and safe level as a paramedic.

Decision on Impairment:

31. The Panel next went onto consider impairment. They heard submissions from Ms Lykourgou who said the Panel had heard nothing from the Registrant and could not therefore find that he had any insight into his lack of competence. Nor had the panel heard that he had undergone training to mediate his lack of competence. The Panel were invited to consider whether the Registrant had breached standards 1.4, 2.8, 4, 9.6, 13, 14 and 15 of the HCPC Standard of Proficiency for Paramedics.

32. Ms Lykourgou invited the Panel to conclude that the Registrant had in the past and was likely in the future to place patients at unwarranted risk of harm, breach fundamental tenets of the profession and bring the profession into disrepute. She further submitted that the public interest required a finding of current impairment.

33. The Panel received legal advice from the Legal Assessor.

34. The Panel determined that the Registrant’s fitness to practice is currently impaired. The Panel agreed that the Registrant was in breach of the standards cited above. The Panel had found a lack of competence based on comprehensive evidence. It has not heard from the Registrant and so had not seen any insight from him into his lack of competence. Whilst the Registrant’s lack of competence may be remediable by retraining, it has not seen any evidence that the registrant has attempted to address the deficits in his competence. Thus, the Registrant continues to present a real risk of unwarranted harm to patients if permitted to practice without restriction. The Panel also agrees that the public interest demands a finding of current impairment in this case. The Registrant was operating as a paramedic whilst woefully underprepared to do so. On any view that it is a serious matter which would cause concern to the public.

Decision on Sanction:

35. The Panel heard submissions from Ms Lykourgou in respect of sanction. Ms Lykourgou submitted that the Panel must have regard to the HCPC Sanctions Policy. She submitted that the Registrant had shown no insight or remorse, and had not apologised for his lack of competence. Ms Lykourgou submitted that no further action or the sanction, of a caution were not sufficient in this case to meet the public protection or the public interest. She also submitted that conditions of practice were unlikely to be workable as the Registrant had provided no information to indicate that his competence had improved in any way.

36. The Panel received advice from the Legal Assessor, who reminded them that the most restrictive sanction at their disposal today was a suspension order for twelve months because this was a lack of competence case, and so striking off was not available at this stage.

37. The Panel considered the HCPC Sanctions Policy document. The Panel reminded itself of the principle of proportionality balancing the Registrant’s interests again the public interest. The Panel had in mind the purpose of sanctions is not to punish but to protect the public from harm and to maintain public confidence in the profession and its regulator, the HCPC. The Panel recognised that sanctions can be punitive in character and effect.

38. The Panel reminded themselves that they had found that the Registrant had been operating as a paramedic at a level considerably below that which is safe or acceptable. The Panel noted that the Registrant had not engaged with the hearing and had not provided evidence of insight or of training to mediate the deficits in his practice.

39. The Panel did not think that the matter could be concluded with either no order or a caution. The Registrant was not capable of operating safely as a paramedic and so an order was needed which would protect the public from unwarranted harm.

40. The Panel did not consider that conditions of practice would be workable in this case because the Registrant had not engaged with the regulatory process and there was no evidence that he had insight into his failings or had taken any action to mediate them.

41. The Panel concluded that only a suspension order for 12 months would both protect the public from the unacceptable risk of harm that the Registrant posed and meet the public interest in maintaining confidence both in the profession and the HCPC.

42. The Panel considered that a future panel, reviewing this order, may be assisted by:

a) the Registrant’s engagement by either attending a future review hearing in person or remotely or by making written submissions to the reviewing panel;

b) An up-to-date indication as to the Registrant’s future intentions and whether he wishes to remain in the Paramedic profession;

c) a reflective piece by the Registrant setting out what went wrong and any measures he had taken or intends to take to remediate his practice.

That the Registrar is directed to suspend the registration of Mr Arkadiusz Bodziany for a period of 12 months from the date this Order comes into effect.

This order will be reviewed before 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.

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 Mr Arkadiusz Bodziany