Mr Mervyn F Dougan

Profession: Paramedic

Registration Number: PA06547

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 15/02/2021 End: 17:00 19/02/2021

Location: Virtual hearing - Video conference

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

On 26 November 2015, you attended to Patient A during an emergency call, and you:

a) arrived at the address with no equipment;

b) did not carry out an adequate assessment on Patient A in that you:

i. did not carry out and/or record any or adequate observations on Patient A;
ii. did not take and/or record a full history of Patient A;
iii. did not adequately assess and/or record an assessment of Patient A’s capacity.

c) did not provide Patient A with appropriate treatment in that you did not dress their head wound;

d) did not adequately complete the Patient Report Form for Patient A.

2. On 07 June 2016, you attended to Patient B during an emergency call, and you:

a) did not recognise:

i. ST elevation on the electrocardiogram (ECG);
ii. the patient had signs of Acute Myocardial Infarction (AMI) and not cerebrovascular accident (CVA) or transient ischemic attack (TIA);

b) did not complete the Patient Report Form (PRF) for Patient B accurately, in that you:

i. recorded the rhythm as Normal Sinus Rhythm (NSR) when in fact there was ST elevation on the ECG;
ii. did not record that oxygen therapy had been administered;

c) did not complete the PRF for Patient B adequately, in that you did not:
i. complete any area of the ‘FAST’ Test;
ii. complete the sections regarding your management of Patient B;
iii. record the status of Patient B’s airway and/or any airway management administered;

d) did not provide Patient B with adequate care and treatment, in that you:

i. did not consider and/or attempt intraosseous access for Patient B;
ii. did not administer any drugs to Patient B whilst attending to him;
iii. made a decision to carry out Basic Life Support instead of calling for assistance and/or carrying out Advanced Life Support on Patient B whilst on route to the hospital;

3) On 20 November 2016, you attended to Patient C and you:

a) did not you provide Patient C with adequate care and treatment, in that you;

i. did not consider and/or attempt intraosseous access for the Patient;
ii. did not administer any drugs including atropine and/or adrenaline to Patient C whilst attending to him;
iii. did not intubate Patient C;
iv. did not consider and/or undertake early removal of Patient C to hospital or ‘BM’ readings for the patient;
v. did not consider and/or administer early intervention such as: administering Naloxone Hydrochloride;
vi. did not take and or record Patient C’s blood sugar level (‘BM’);
vii. did not arrive on scene with a bag valve mask.

b) did not adequately complete the Patient Report Form (PRF) for Patient C, in that:

i. you did not ensure the rationale for not attempting intraosseous access on Patient C was recorded;
ii. did not ensure the patient’s blood pressure was recorded.

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

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

 

Finding

Preliminary Matters

Service

1. The Hearings Officer provided an unredacted copy of the service bundle to the Panel, comprising a copy of the notice itself and an extract from the HCPC Register. On 3 November 2020, the HCPC sent the notice of this hearing by email to the registered email address recorded for the Registrant. The notice contained the required particulars, and informed him that the hearing would take place electronically via video conference due to the ongoing pandemic.

2. The Panel was satisfied on the documentary evidence provided, that the Registrant had been given proper notice of this hearing in accordance with Rules 3 and 6 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules).

Application to proceed in absence

3. Mr Foxsmith, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence under Rule 11, which states:

Where the registrant is neither present nor represented at a hearing, the committee may nevertheless proceed with the hearing if it is satisfied that all reasonable steps have been taken to serve the notice of the hearing under rule 6(1) on the registrant.

4. Mr Foxsmith informed the panel that the Registrant had never engaged with nor given any signs of wishing to engage with the regulatory process. After he had been referred to the HCPC, the Registrant had indicated that he no longer wished to work; was not in work; and did not intend to engage in the process. In the correspondence, dated 18 February 2020, the Registrant had underscored his intention not to engage, as well as referencing his health. Mr Foxsmith submitted that whilst the correspondence raised the issue of health, that was not the underlying reason for the Registrant’s non-attendance. Mr Foxsmith submitted that there was no adjournment request on the basis of health; the nature and circumstances of the Registrant’s absence were such that he had voluntarily waived his right to attend; and an adjournment was unlikely to secure his attendance. Mr Foxsmith submitted that there was a public interest in proceeding and drew the Panel’s attention to the five witnesses who were lined up to give evidence.

5. The Panel heard and accepted the advice of the Legal Assessor, who advised that the discretion to proceed in a Registrant's absence must be exercised with the utmost care and caution. It also had regard to the HCPTS Practice Note on proceeding in the absence of a Registrant.

6. The Panel was satisfied that the HCPC had fulfilled its obligations and taken all reasonable steps to serve the notice on the Registrant in accordance with the Rules. The Panel considered that there was a settled intention demonstrated by the Registrant that he would not be engaging with the regulatory process. The Panel therefore inferred that the Registrant’s absence was voluntary, thereby waiving his right to attend. Although the Registrant had referenced his health, the Panel did not consider that his health was the reason for his non-attendance. Further, the Panel did not consider that an adjournment would secure his attendance. The Panel noted that witnesses had been arranged to attend, and there had been some considerable delay already, as the allegations related to 2015 and 2016. In all the circumstances, the Panel considered that it was in the public interest for the hearing to proceed notwithstanding the Registrant’s absence.

Application for part of the hearing in private

7. During his application to proceed in absence, Mr Foxsmith applied for those parts of the hearing which related to the Registrant’s health to be heard in private. In particular, the references in the Registrant’s correspondence of 18 February 2020.

8. Having heard and accepted the advice of the Legal Assessor, the Panel considered that it was justified to hear any information relating to the Registrant’s health in private, in order to protect his private life.

Application to amend

9. Mr Foxsmith applied to amend a number of the particulars of the allegation. He informed the Panel that the application was made on notice, in a letter, dated 5 November 2019, informing the Registrant of the HCPC intention to apply for the amendments and setting out the amendments sought. No objection had been received.

10. Mr Foxsmith submitted that the proposed amendments would appropriately capture what the Registrant was alleged to have done and properly reflect the evidence, so that the public and the Registrant would understand what was alleged. He submitted that the allegations reflected three incidents. In relation to the first allegation, the proposed amendments would give a fuller breakdown, reflecting alleged failings in the area of observations, patient history, assessment and treatment. In relation to the second and third allegations, the proposed amendments would remove and replace with a more appropriate description of what was alleged. Mr Foxsmith submitted that the amendments were consistent with the evidence and did not particularly expand the scope of nor add to the gravamen of essentially three occasions of alleged failures in patient care.

11. The Panel, having heard and accepted the advice of the Legal Assessor, decided to allow the proposed amendments. It was not the case that the proposed amendments were significant. They were not substantive, nor would they alter the nature of the case alleged against the Registrant. Consequently, the Panel was satisfied that would be no unfairness to the Registrant in allowing the application.

Admissibility of HCPC witness statement of Colleague B

12. Mr Foxsmith applied to adduce the HCPC witness statement of Colleague B, who was the EMT who attended the emergency call to Patient B with the Registrant on 7 June 2016. Mr Foxsmith explained that Colleague B was scheduled to give evidence at the hearing, and his Trust investigatory interviews of 5 October 2016 and 7 December 2017 had been previously exhibited within the HCPC bundle and disclosed to the Registrant. Mr Foxsmith said that for logistical reasons, there had been delays in obtaining the HCPC statement, which was signed and dated 11 February 2021. He submitted that the statement was primarily a production statement producing Colleague B’s Trust interviews. Mr Foxsmith explained that the statement also touched on the treatment Patient B received, although it did not raise new material not evidenced from other sources within the bundle. Mr Foxsmith made the application because he acknowledged that service of the HCPC witness statement was outside the usual service requirements, but he was able to confirm that it had been served on the Registrant.

13. The Panel heard and accepted the advice of the Legal Assessor. In order to determine whether it was relevant and fair to admit the HCPC witness statement of Colleague B, the Panel had sight of it. The Panel concluded that although the statement had been served late, it had nevertheless been served on the Registrant in advance of the hearing. The Panel was satisfied that the statement was relevant, as it was from an eyewitness who had attended the incident on 7 June 2016, which was the subject of allegation 2. The Panel did not consider that it would be unfair to admit the statement, as it predominantly produced the Trust investigatory interviews of Colleague B which were within the bundle and which had been previously served. Further, Colleague B was scheduled to attend to give live evidence, so his evidence could be tested. The Panel did not consider that the admission of the statement at this stage of proceedings would amount to an ‘ambush’, as much of the information within the statement was covered in other sources within the bundle. Consequently, the Panel decided to allow the HCPC witness statement of Colleague B to be admitted.

Background

14. The Registrant is a Paramedic registered with the HCPC. The Registrant had been employed as a Paramedic by Northern Ireland Ambulance Service Health and Social Care Trust (the Trust) since December 1988.

15. On 26 November 2015, an emergency call was made regarding Patient A, which the Registrant and Colleague C, an Emergency Medical Technician (EMT) attended, arriving at approximately 01:45. The Registrant, as the qualified Paramedic, was the Clinical Lead, assisted by the EMT, and so the Registrant had overall responsibility for patient care. The emergency call detailed that Patient A, an elderly man with terminal bone cancer, had fallen over in his home sustaining head injury. It is alleged that the Registrant arrived on scene with no equipment, did not carry out an adequate assessment of Patient A, did not provide the patient with appropriate treatment and did not adequately complete the Patient Report Form (‘PRF’) pertaining to the patient.

16. On 7 June 2016, an emergency call was made regarding Patient B, which the Registrant and Colleague B, an EMT, attended. The emergency call detailed that Patient B, a man in his 50s, was suspected of having suffered a stroke. Patient B died shortly after his arrival at hospital. It is alleged that the Registrant did not recognise Patient B’s presenting symptoms of having had a heart attack, did not adequately or accurately complete the PRF pertaining to the patient or provide adequate care and treatment to Patient B.

17. On 20 November 2016, an emergency call was made regarding Patient C, which the Registrant and Colleague A attended at the Students Union of Belfast University. The emergency call detailed that Patient C, a man in his 20s was unconscious from a suspected drug (ecstasy) overdose and alcohol. It is alleged that the Registrant did not provide adequate care and treatment to Patient C or adequately complete the PRF pertaining to the patient.

Decision on Facts

18. On behalf of the HCPC, the Panel heard evidence from Mr MM, FA, Colleague A, PM, and Colleague B.

19. MM was, at the time of the allegations, a Station Officer at the Trust, but based at a different station to the Registrant. MM had been in this role since July 2007 and prior to that had been a Paramedic Supervisor at the Trust between 2004 and 2007. He had qualified as a Paramedic in 1994. In his role as a station officer he conducted an internal Trust investigation into the incident of 26 November 2015, and produced a disciplinary investigation report, dated 29 February 2016. He raised a number of concerns, giving his opinion, regarding the Registrant’s alleged acts and omissions.

20. FA was, at the time of the allegations, a Divisional Training Officer at the Trust, a role he had been in since 2003. Prior to that he had been a Paramedic Supervisor at the Trust for eleven years. He had qualified as a Paramedic in 1990. As part of the internal Trust investigation into the 7 June 2016 incident, FA was asked to perform a clinical review of the Patient Report Form (PRF) completed by the Registrant and the associated Electro-Cardio-Graph (ECG). He raised a number of concerns, giving his opinion, regarding the Registrant’s alleged acts and omissions.

21. Colleague A was, at the time of the 20 November 2016 incident, an EMT at the Trust, and had been employed in that role since 2002. Before that, he had been employed by the Trust as an Ambulance Care Assistant for two years. He was based at a different station to the Registrant, but had been sent to ‘crew up’ with the Registrant at the Registrant’s station at Lagan Valley Ambulance Station.

22. PM was, at the time of the allegations, a Clinical Training Officer at the Trust, and had been since 1990. In that role he was responsible for the provision of education and training for operational divisions within the Trust. He qualified as a Paramedic in 1988. As part of the internal Trust investigation into the 20 November 2016 incident, PM was asked to perform a clinical review of the PRF completed for this incident. He raised a number of concerns, giving his opinion, regarding the Registrant’s alleged acts and omissions.

23. Colleague B was, at the time of the 7 June 2016 incident, an EMT at the Trust, who had been in that role for a few months. Before that he was employed by the Trust as an Ambulance Care Assistant since 2006. He had not worked with the Registrant directly until June 2016, when he worked with him on two or three occasions as part of a double crewed ambulance.

24. The Panel also received documentary evidence, including:
i. the Trust’s internal Investigation Reports for 26 November 2015, 7 June 2016, and 20 November 2016;
ii. correspondence between the Trust and the Registrant;
iii. the patient call logs for each of the three incidents;
iv. the PRFs for each of the three incidents;
v. the ECG print outs for the 7 June 2016 incident;
vi. copies of the internal investigation interviews with the EMTs attending each of the three incidents;
vii. summaries of the internal investigation interviews with the Registrant for each of the three incidents;
viii. the Registrant’s letter of apology for the 26 November 2015 incident; and
ix. the Joint Royal Colleges Ambulances Liaison Committee (JRCalc) Clinical Guidelines effective from March 2016 on Advanced Life Support (ALS), Basic Life Support (BLS), and Traumatic Cardiac Arrest;

25. The Panel heard and accepted the advice of the Legal Assessor. The Panel understood that the burden of proving each individual fact rests on the HCPC and that the HCPC will only be able to prove a fact if it satisfies the required standard of proof, namely the civil standard, whereby it is more likely than not that the alleged incident occurred.

26. The Registrant did not attend the hearing, but the Panel did not draw any adverse inferences against him for his absence at the fact-finding stage. The Panel had regard to the Registrant’s accounts in the internal investigation interviews, but noted that they had not been tested by cross examination.

27. At the outset of its deliberations on the facts, the Panel made an assessment of the credibility of the witnesses who gave evidence before it.

28. The Panel noted that although the HCPC had not formally adduced expert evidence, it was relying on the opinion evidence of MM, FA, and PM based on their knowledge and experience. These witnesses gave opinion evidence regarding the Registrant’s alleged acts and omissions, as well as what would have been adequate care, treatment, and record keeping in the circumstances. Consequently, the Panel particularly evaluated their knowledge, skills and objectivity.

29. In relation to MM, the Panel considered that he was a competent and credible witness whose oral evidence was consistent with the contemporaneous documentation. It acknowledged that he was a very experienced Paramedic, having qualified in 1994, and was in the role of station officer at the time. The Panel was satisfied that he had the necessary skills and experience to give his opinion about the events of 26 November 2015, and had done so objectively. He had interviewed the Registrant as part of his investigation and, in the Panel’s view, had fairly reported the Registrant’s remorse for his actions and the impact on him of his omissions.

30. In relation to FA, the Panel considered that he was a competent and credible witness whose oral evidence was consistent with the contemporaneous documentation. The Panel recognised that he was a very experienced Paramedic and was a Divisional Training Officer tasked with training other members of staff. The Panel was satisfied that he had detailed knowledge and clinical skills, including in the taking and interpreting of ECGs. FA had made clear to the Panel that his evidence was based on his clinical audit of the PRF, rather than any other contextual information, which the Panel considered demonstrated his understanding of his role and the importance of being objective.

31. In relation to Colleague A, the Panel found his evidence to be quite reflective. The Panel found him credible: clear about what he could no longer recall and balanced, giving a factual account of events with no malice towards the Registrant.

32. In relation to PM, the Panel considered that he was a competent and credible witness whose oral evidence was consistent with the contemporaneous documentation. The Panel recognised that he was a long-term qualified Paramedic and was a Clinical Training Officer responsible for the provision of education and training for operational divisions within the Trust. The Panel was satisfied that he had detailed knowledge and clinical skills. He made it clear to the Panel that his witness statement was based on his clinical audit of the PRF, rather than any other contextual information, but had been provided with the HCPC bundle which now gave him some context for the events. He also had direct experience of the location of the incident. The Panel considered he understood his role and the importance of being objective.

33. In relation to Colleague B, the Panel found him to be a credible witness: open about the incident and his relative inexperience at the time. The Panel considered that he was trying to assist the Panel as best as he was able to remember, refreshing his memory from the investigative interviews held closer in time to events.

Particular 1

On 26 November 2015, you attended to Patient A during an emergency call, and you:
a) arrived at the address with no equipment;

34. The Panel finds particular 1(a) proved.

35. The Panel noted the wording of the particular, but considered that when read together with the stem, the phrase ‘arrived at the address’ should be interpreted to mean crossing the threshold into the address rather than limited to simply arriving in an equipped ambulance at the address.

36. MM told the Panel that there was no set list of equipment a crew must bring to every call, however, paramedic initial training and ongoing post proficiency training required that, at a minimum, a crew should attend with a defibrillator, oxygen, and a response bag.

37. The Panel had regard to the disciplinary investigation report prepared by MM, dated 29 February 2016, in which MM had recorded the complaint of Patient A’s spouse, to the effect that the crew arrived at the address at 01:45 with no equipment. MM had interviewed the Registrant about the incident, and told the Panel that he recalled the Registrant admitting in interview that he had not taken any equipment into the address with him, although MM conceded that he had not recorded this answer in the interview notes.

38. Having concluded that MM was a credible witness, the Panel accepted his evidence that the Registrant had admitted to not taking any equipment into the address with him in the investigation interview. Although MM had not recorded the admission, the Panel considered that it was supported by the remorse demonstrated by the Registrant in the interview, and his subsequent letter of apology to the family. Consequently, the Panel concluded that it was more likely than not that the Registrant had entered the address without the required minimum equipment.

Particular 1

b) did not carry out an adequate assessment on Patient A in that you:
i. did not carry out and/or record any or adequate observations on Patient A;

39. The Panel finds particular 1(b)(i) proved.

40. The Panel had regard to the copy of the PRF which had been provided to it and MM’s evidence. MM explained that a full set of observations would consist of blood pressure (BP); a three-lead electrocardiogram (ECG); pulse; breathing levels; blood sugars (BM); temperature; pupil reaction; and Glasgow coma scale (GCS). MM said that without a full set of observations, the Registrant could not be certain that the patient’s condition would not worsen if he were not conveyed to hospital. In light of this, the Panel was satisfied that an adequate assessment of Patient A would require the taking of a full set of observations as described by MM.

41. The Panel, on viewing the PRF, could see that the ‘observations’ section on the PRF was blank. Consequently, it was satisfied that the Registrant had not recorded any observations on the PRF.

42. The Panel had regard to the length of time that the Registrant was at Patient A’s address, which from the call log provided was recorded as 8 minutes, and which MM had said would not be long enough to carry out the full observations. It took account of its finding at 1(a) that the Registrant did not take any equipment into the address, which he would have needed in order to carry out the observations. The Panel also noted the Registrant’s investigation interview during which he admitted to not conducting a full set of observations on Patient A. Accordingly, the Panel was satisfied that the Registrant did not record any observations in respect of Patient A, and did not carry out any observations beyond a cursory visual check, which was not adequate.

ii. did not take and/or record a full history of Patient A;

43. The Panel finds particular 1(b)(ii) proved.

44. The Panel noted that Patient A was a patient with terminal cancer who was suspected of having collapsed and fallen. The Panel had regard to the PRF and MM’s evidence. MM had said that Patient A’s spouse had given some medical history to Colleague C, which was consistent with the hearsay statement of Colleague C and the recorded complaint from Patient A’s spouse. The Panel considered that Patient A presented potentially complex health issues, including his bone cancer and questions raised by his spouse about his capacity. MM described that an adequate assessment of a patient would include collecting a full history of the patient, and that was taught in the Ambulance Service Basic Training. In light of this the Panel was satisfied that the taking of a full history of Patient A was required for an adequate assessment.

45. The Panel, on viewing the PRF, could see that none of the sections on the PRF relevant to the patient’s history had been completed. Consequently, it was satisfied that the Registrant had not recorded a full history for Patient A on the PRF.

46. The Panel considered that evidence demonstrated that the Registrant had not probed into Patient A’s history, either with the patient himself, or with the patient’s spouse. The Panel considered that the time of 8 minutes at the address supported the position that the Registrant had not explored Patient A’s history. Consequently, the Panel was satisfied that it was more likely than not that the Registrant had neither taken nor recorded a full history of Patient A and so had not carried out an adequate assessment.

iii. did not adequately assess and/or record an assessment of Patient A’s capacity.

47. The Panel finds particular 1(b)(iii) proved.

48. While MM accepted that part of the assessment of whether a patient has capacity comes from speaking with the patient, he explained that the Paramedic should also obtain as much information as possible from family members or individuals at the scene. He said that the circumstances of this case were that Patient A was terminally ill with bone cancer, had slumped to the floor, and had not tripped. Patient A’s spouse had told the Registrant and his crew mate that Patient A did not have capacity to know how he had sustained his injuries or what treatment he required. Both crew members had described Patient A as being adamant that he did not want to be taken to hospital. However, the Panel accepted the evidence of MM that it was incumbent on a Paramedic to take into account the views of the family as well as the patient when deciding on a patient’s capacity, particularly if what the patient was saying contradicted the account of the family. Consequently, the Panel was satisfied that an adequate assessment of capacity included taking into account the views of family members present as well as those of the patient.

49. The Panel, on viewing the PRF, could see that the sections on the PRF relating to patient consent and capacity had been left blank. Consequently, it was satisfied that the Registrant had not recorded an assessment of Patient A’s capacity on the PRF.

50. The Panel had regard to the Registrant’s investigation interview whereby although he had considered that the patient had capacity from speaking to the patient, in future he would take a more extensive history from the relatives. In all the circumstances, the Panel was satisfied that it was more likely than not that the Registrant had neither adequately assessed nor recorded an assessment of Patient A’s capacity.

Particular 1

c) did not provide Patient A with appropriate treatment in that you did not dress their head wound;

51. The Panel finds particular 1(c) not proved.

52. The Panel noted that the only evidence of a head injury to Patient A came in the form of the hearsay complaint of Patient A’s spouse recorded in an internal memorandum. That complaint referred to the cut as bleeding, whereas in their respective investigation interviews, Colleague C referred to Patient A as having an abrasion, and the Registrant did not reference any visible head injury. There was no photograph of any injury. Although the Panel noted that MM had said that he would have expected the Registrant to ‘dress Patient A’s head wound’, the Panel was not satisfied that the HCPC had discharged the burden of proving that Patient A had sustained a head wound of a type which required dressing.

Particular 1

d) did not adequately complete the Patient Report Form for Patient A.

53. The Panel finds particular 1(d) proved.

54. MM told the Panel that the Registrant had not adequately completed the PRF pertaining to Patient A, as it omitted: the primary survey information; at least one full set of observations; the patient history including allergies, medications, medical history; and any further information such as ECG findings, how Patient A was presenting, the outcome of the assessment, and the agreed treatment plan. Having seen a copy of the PRF, the Panel was able to see that this information was missing. It noted that the Registrant himself had admitted in the investigation interview that the paperwork was not adequate and the PRF that had not been completed fully and properly. Accordingly, the Panel was satisfied that the Registrant did not adequately complete the PRF for Patient A.

Particular 2

On 07 June 2016, you attended to Patient B during an emergency call, and you:

a) did not recognise:
i. ST elevation on the electrocardiogram (ECG);

55. The Panel finds particular 2(a)(i) proved.

56. The Panel had regard to the evidence of FA, who had analysed the ECG taken in respect of Patient B. He explained that an ECG shows various types of elevation and depression and each elevation represents activity within particular areas of the heart. He stated that as a Paramedic, if you observed ST elevation on an ECG this would indicate that the patient was having a myocardial infarction, also known as a heart attack. FA described that the ECG taken for Patient B demonstrated a very large ST elevation, which would be clear to a clinician. Having concluded that FA was a credible witness, the Panel accepted his evidence that the ECG showed a very large ST elevation.

57. The Panel went on to consider whether the Registrant had recognised the ST elevation. The Panel had regard to the evidence of Colleague B, the EMT who attended the emergency call with the Registrant. Colleague B said that he had heard the Registrant tell the family that the numbers from the ECG were fine and normal. The Panel took account of the Registrant’s investigation interview in which he was recorded as saying: ‘I carried out a full set of obs in the living room. 12 lead ECG x 2 and all the numbers were good. There were no red flags’. The Panel considered that the Registrant’s account of not having identified any ‘red flags’ was supported by the PRF where he had recorded Patient B as having a Normal Sinus Rhythm (NSR), which describes a cardiac rhythm falling within set parameters.

58. Given that the Registrant had described the ECG as ‘normal’ to the family and had said in interview that ‘all the numbers were good’ and there were no ‘red flags’, the Panel was satisfied that the Registrant had not recognised the ST elevation on the ECG.

ii. the patient had signs of Acute Myocardial Infarction (AMI) and not cerebrovascular accident (CVA) or transient ischemic attack (TIA);

59. The Panel finds particular 2(a)(ii) proved.

60. The Panel noted that the call log for the emergency call recorded that Patient B was suspected as having suffered a cerebrovascular accident (CVA) or transient ischemic attack (TIA), also known as a stroke. Nevertheless, the Registrant had conducted an ECG at the scene, which demonstrated ST elevation. The Panel accepted the evidence of FA that ST elevation is indicative of an acute myocardial infarction. Colleague B had described Patient B as being pale and clammy with no facial palsy, no weakness in his limbs and no speech impediment, all of which FA informed the Panel were signs not suggestive of a stroke. Given that the Panel was satisfied that the Registrant had not recognised ST elevation, which is indicative of an acute myocardial infarction, the Panel was also satisfied that he had not recognised that Patient B had signs of acute myocardial infarction.

Particular 2

b) did not complete the Patient Report Form (PRF) for Patient B accurately, in that you:
i. recorded the rhythm as Normal Sinus Rhythm (NSR) when in fact there was ST elevation on the ECG;

61. The Panel finds particular 2(b)(i) proved.

62. Given its findings at particular 2(a)(i) above, the Panel was satisfied that there was ST elevation on the ECG, and that would mean that it would not be accurate to describe the cardiac rhythm as a normal sinus rhythm. Having looked at the PRF for Patient B, the Panel was satisfied that the Registrant had recorded the cardiac rhythm as ‘NSR’, and so had not completed the PRF accurately.

ii. did not record that oxygen therapy had been administered;

63. The Panel finds particular 2(b)(ii) proved.

64. FA explained that the PRF recorded that Patient B’s oxygen saturation levels were 83% and 77%, which suggested to him that Patient B’s oxygen saturation was taken, however the box on the PRF to indicate the administration of oxygen therapy had not been marked. Colleague B described that a 100% oxygen mask was on the patient’s chest on arrival at hospital and the Registrant, in his interview, said that he had administered oxygen but in recording his administration of oxygen, had filled out the wrong box on the PRF, incorrectly writing ‘100’ in the ‘Peak Flow’ section. Having looked at the PRF, the Panel was satisfied that the Registrant had not accurately completed it regarding his administration of oxygen therapy, as the section for oxygen was blank, which on its face would lead to the conclusion that oxygen therapy had not been administered.

Particular 2

c) did not complete the PRF for Patient B adequately, in that you did not:
i. complete any area of the ‘FAST’ Test;

65. The Panel finds particular 2(c)(i) proved.

66. The Panel had regard to the face of the PRF and could see that there was a section for a ‘FAST assessment’ with boxes to tick ‘Y’ (yes) or ‘N’ (no) for each of ‘facial weakness’, ‘arm weakness’, and ‘speech impaired’ as well as boxes for ‘side affected’ ‘L’ (left) or ‘R’ (right). The Panel could see that none of the boxes had been completed. The Panel noted that the Registrant in his investigation interview had said that he had conducted the FAST test but had not recorded the results on the PRF. FA told the panel that he would expect the FAST test to be conducted in relation to all patients with the results recorded on the PRF, as the purpose of the FAST test was to ensure that the patient was not suffering from a stroke. Given that the initial emergency call had come in as a suspected stroke, the Panel was satisfied that by not completing the FAST assessment section of the PRF, the Registrant had not completed the PRF adequately.

ii. complete the sections regarding your management of Patient B;

67. The Panel finds particular 2(c)(ii) proved.

68. The Panel had regard to the face of the PRF and could see that there were sections for ‘Ventilation’, ‘Cardiac Arrest’, and ‘Drugs’ (‘Time of Admin’, ‘Drug, Dose and Route’, and ‘By (PIN)’), all of which FA said were related to the management of a patient. The Panel could see that none of these sections had been completed, although the Registrant had written in the narrative section, that on the journey to hospital, Patient B had suddenly become ‘asystole’ and CPR had been carried out. FA said that not completing these sections may mean that a patient is not managed appropriately by other health care providers who rely on the information at a later stage. The Panel was satisfied that by leaving these sections blank, the Registrant had not completed the PRF adequately.

iii. record the status of Patient B’s airway and/or any airway management administered;

69. The Panel finds particular 2(c)(iii) proved.

70. The Panel had regard to the face of the PRF and could see that there was a section for ‘Airway Management’, which was blank. FA said that this section related to the management of a patient, and it was important to record whether the patient’s airway was patent, that is unobstructed, or whether airway management had been required. The Panel was satisfied that by not recording the status of Patient B’s airway or whether any airway management had been administered, the Registrant had not completed the PRF adequately.

Particular 2

d) did not provide Patient B with adequate care and treatment, in that you:
i. did not consider and/or attempt intraosseous access for Patient B;

71. The Panel finds particular 2(d)(i) proved.

72. FA told the Panel that the PRF recorded that the Registrant had attempted to gain intravenous (IV) access to the patient but this had been unsuccessful. In his interview, the Registrant said that he had attempted cannulation of Patient B in the house, which had been unsuccessful, but had not made any more attempts. He described Patient B as becoming very agitated on being transferred to the stretcher. FA explained that IV access is the procedure by which a cannula is placed in a vein and drugs are administered to a patient directly into the blood. FA said that if the Registrant was not able to gain IV access then he would expect the Registrant to attempt to administer drugs through intraosseous access (IO), which is the procedure of placing a needle into the bone of the patient and administering the drug therapies through it. FA also identified the Joint Royal Colleges Ambulance Liaison Committee Clinical Practice Guidelines (JRCalc Guidelines) for Advanced Life Support (ALS), which state: ‘IV access should be established as soon as an appropriately trained responder is able to do so. If IV access is not possible after two attempts, intraosseous access should be considered.’ In light of this, the Panel was satisfied that the provision of adequate care and treatment required the Registrant to attempt intraosseous access for Patient B.

73. The Panel noted that the Registrant had not been asked in interview about IO. The Panel did not consider that there was sufficient evidence to assist it in resolving whether or not the Registrant had considered IO access for Patient B, either once the IV attempt at access had been unsuccessful, or in the ambulance once the patient had gone into cardiac arrest. However, the Panel was satisfied that the evidence did demonstrate that it was more likely than not that the Registrant had not attempted intraosseous (IO) access and consequently had not provided adequate care and treatment to Patient B.

ii. did not administer any drugs to Patient B whilst attending to him;

74. The Panel finds particular 2(d)(ii) proved.

75. FA told the Panel that the PRF indicated that the Registrant had not administered any drugs to Patient B whilst he was conscious but also had not done so once Patient B had had gone into cardiac arrest in the back of the ambulance. FA said that appropriate drugs to administer during cardiac arrest were adrenaline and amiodarone, depending on the presentation, which could increase a patient’s chance of survival, and which were part of the Advanced Life Support pathway, so he would expect a Paramedic to administer them. He also referred the Panel to the JRCalc Guidelines, which state that if asystole rhythms are identified: ‘Start CPR 30:2 and give adrenaline 1mg as soon as IV/IO access is achieved’. In light of this, the Panel was satisfied that the provision of adequate care and treatment required the Registrant to administer appropriate drugs to Patient B, in particular adrenaline.

76. FA explained that adrenaline would need to be administered either through IV cannulation or IO, and as the attempt at IV cannulation had been unsuccessful, and IO had not been carried out, no drug therapy could be administered. Consequently, the Panel was satisfied that the Registrant had not provided adequate care to Patient B as he had not administered any drugs to him.

iii. made a decision to carry out Basic Life Support instead of calling for assistance and/or carrying out Advanced Life Support on Patient B whilst on route to the hospital;

77. The Panel finds particular 2(d)(iii) proved.

78. Colleague B told the Panel that he drove the ambulance to hospital, and the Registrant was in the back of the ambulance attending to Patient B. Colleague B said that on route to hospital, when about 15 minutes away, the Registrant had told him to pull over. Colleague B pulled over, got out, opened the side door, and saw that the patient looked unconscious and that the defibrillator registered the patient’s ECG rhythm as ‘asystole’. In his investigation interview of 5 October 2016, Colleague B said he noted that there were ‘no airway, no pads, no interventions started yet and he went to the head of the stretcher to begin securing airway/BVM and commence CPR. This was to allow [the Registrant] to get his kit sorted etc.’ Colleague B said that the Registrant had told him not to and to get Patient B’s spouse in the front of the ambulance and drive on to the hospital. Although Colleague B was unable to see whether the Registrant administered CPR to Patient B, his wife had confirmed seeing the Registrant carry it out.

79. FA explained that there are two types of life support that should be administered to a patient in cardiac arrest. He described these as Basic Life Support (BLS) and Advanced Life Support (ALS). He said that BLS consists of CPR and airway ventilation, whereas ALS, in addition to CPR, consists of advanced airway management, administration of drug therapies, and defibrillation. FA said that in a cardiac arrest situation, he would expect the EMT or Paramedic to commence with BLS but then expect the treatment to move to ALS, which would require both crew members but be the responsibility of the Paramedic.

80. The Panel had regard to the evidence of Colleague B, about stopping on route to the hospital. Colleague B said that at that time, when the patient had gone into cardiac arrest, he had offered assistance to the Registrant. The Panel considered that when the ambulance had stopped on route to the hospital, it had been open to the Registrant to either call for assistance asking for another crew to attend; or to move to ALS with the assistance of Colleague B. Colleague B said that when they had stopped the ambulance, they were around 15 minutes away from hospital. However, the Panel inferred that the Registrant made the decision to continue with BLS.

81. The Panel noted that FA had said in his witness statement that he was unable to say, on the documentation he viewed, whether ALS would have been appropriate on this occasion. The Panel considered that it had had the benefit of the additional evidence of Colleague B, who was able to provide the context of events. Colleague B’s evidence satisfied the Panel that it would have been open to the Registrant to both call for assistance and carry out ALS when on route to the hospital. In light of this, the Panel was satisfied that the Registrant’s decision to carry out basic life support instead meant that he did not provide Patient B with adequate care and treatment.

Particular 3

On 20 November 2016, you attended to Patient C and you:

a) did not you provide Patient C with adequate care and treatment, in that you;
i. did not consider and/or attempt intraosseous access for the Patient;
ii. did not administer any drugs including atropine and/or adrenaline to Patient C whilst attending to him;

82. The Panel finds particulars 3(a)(i) and 3(a)(ii) proved. It considered them together, as they are both components of the ALS pathway, as set out in particular 2.

83. Patient C was a student at the university, in his early 20s, who was suspected of having taken a drug overdose of ecstasy. He was located in the foyer of the student union, conscious, and being attended to by a medical student. Colleague A and the Registrant returned to the ambulance to collect a trolley to transport Patient C from the venue to the ambulance, as well as a defibrillator and an oxygen tank. Colleague A said that by their return, Patient C had taken a turn for the worse: his breathing was labored, he was pale, and he had gone into cardiac arrest. Colleague A said he had been conducting BLS on the patient for a few seconds when the Registrant decided to attempt to administer adrenaline. Colleague A said that the Registrant attempted to gain IV access to the patient three times, but each attempt was unsuccessful. Colleague A said he suggested twice that the Registrant should attempt to gain IO access, but the Registrant dismissed the suggestion, responding that it was not necessary.

84. The Panel had regard to the evidence of PM, to the effect that he would have expected the Registrant to recognise that Patient C required ALS as he had gone into cardiac arrest. Consequently, PM said he would have expected the Registrant to have taken the steps of: (i) attempting to gain intraosseous access to Patient C; and (ii) having gained IO access, to administer the appropriate drug therapy to Patient C.

85. The Panel was satisfied that provision of adequate care and treatment, as set out in the JRCalc Guidelines, required the Registrant to carry out ALS, the components of which included IO access and administration of drugs including atropine or adrenaline. Colleague A had suggested IO access to the Registrant. Consequently, although the Registrant had considered IO access, it having been suggested by Colleague A, the Panel was satisfied that the Registrant had not attempted IO access because he had dismissed Colleague A’s suggestion rather than carry it out. As neither IV nor IO access had been achieved, the Panel was also satisfied that the Registrant had not administered any drugs, including atropine and adrenaline, to Patient C while attending to him.

iii. did not intubate Patient C;

86. The Panel finds particular 3(a)(iii) proved.

87. PM told the Panel that all Paramedics at the Trust are taught that if they are engaging in a prolonged resuscitation of a patient, the patient’s airway should be intubated using an intubation tube. He said that a prolonged resuscitation is a process which lasts more than five minutes, and an airway is intubated by passing a tube down the patient’s windpipe which ensures the airway is secure during the attempts at resuscitation. He also said that intubation would be appropriate in circumstances where the patient was to be transported down steps. The Panel was satisfied that the provision of adequate care and treatment required Patient C to be intubated.

88. The Panel noted that the PRF recorded that an I-gel had been used, rather than an ET intubation tube, and that there was a reference to the patient having aspirated (vomited) on route to hospital. It had regard to the call log which recorded that the resuscitation at the scene had lasted around 15 minutes, and the evidence of Colleague A, to the effect that the patient had to be transported down steps from the foyer and into the ambulance. The Panel was satisfied that the circumstances of the emergency were such that the Registrant should have used an ET intubation tube, and his failure to do so meant that he had not provided adequate care and treatment to Patient C.

iv. did not consider and/or undertake early removal of Patient C to hospital or ‘BM’ readings for the patient;

89. The Panel finds particular 3(a)(iv) proved respect of both undertaking early removal to hospital and undertaking BM readings.

90. In relation to early removal, the Panel considered the evidence of Colleague A, to the effect that he and the Registrant had collected a stretcher from the ambulance. From this the Panel inferred that the Registrant had initially considered the early removal of Patient C. However, by their return, Patient C was in cardiac arrest, at which point, the Registrant attempted IV access, a component of ALS.

91. PM told the Panel that the location where Patient C was being treated was approximately four minutes from a major trauma hospital. He said that at the Trust, Paramedics are taught that when attending to a potentially life-threatening situation, if attempts at ALS are unsuccessful or unable to be carried out, then the patient should be conveyed to hospital as soon as possible. This was set out in the JRCalc Guidelines and was because the best chance of successfully resuscitating a patient in cardiac arrest was through ALS. Given these circumstances, PM said that he was concerned that the Registrant had stayed on the scene for so long doing BLS, without having succeeded in moving to ALS. The Panel was satisfied that the Registrant if deciding not to proceed with ALS should have undertaken the early removal of Patient C to hospital, once he had gone into cardiac arrest, and his failure to do so had resulted in inadequate care and treatment for Patient C.

92. In relation to BM readings, which are blood sugar levels, the Panel had regard to the evidence of PM. He told the Panel that the PRF indicated that the Registrant had not recorded testing Patient C’s blood sugar level (BM). PM said that at the Trust, Paramedics are taught to consider what may have caused cardiac arrest and, particularly, what the reversible causes may have been. He drew the Panel’s attention to the JRCalc Guidelines which state that ‘hyperkalaemia’ is one of the potential reversible causes of a cardiac arrest, an indicator of which is low BM. PM said that testing BM would not be his top priority for a patient in cardiac arrest, in these circumstances but given the length of time that the Registrant was on the scene with the patient, PM would have expected the Registrant to have tested BM. The Panel was satisfied that the Registrant should have undertaken the testing of Patient C’s BM, given the length of time that he was at the scene, and that it was an indicator of a potential reversable cause. The Panel was further satisfied that the Registrant’s failure to do so had resulted in inadequate care and treatment for Patient C.

v. did not consider and/or administer early intervention such as: administering Naloxone Hydrochloride;

93. The Panel finds particular 3(a)(v) proved.

94. The Panel had regard to the evidence of PM to the effect that the PRF indicated that the Registrant did not administer Naloxone Hydrochloride (Narcan) to Patient C, intramuscularly or at all. He explained that the purpose of Narcan was to reverse the effects of an opiate overdose, a potential reversible cause of a cardiac arrest. PM said that Narcan would not have been an effective treatment for an ecstasy overdose, but taking it would not have had any contraindications for Patient C. PM told the Panel that given that the patient was suffering a cardiac arrest due to a suspected drug or alcohol overdose, he would have expected Narcan to be administered where opiate overdose was a possibility. Consequently, the Panel was satisfied that the provision of adequate care and treatment required Narcan to be administered, as it was a potential reversible cause of cardiac arrest which had no adverse effect if the cardiac arrest was not due to an opiate overdose.

95. Colleague A told the Panel that he had suggested the use of Narcan to the Registrant twice, but his suggestion had been dismissed, albeit the Registrant had not given a reason why. Consequently, although the Registrant had considered Narcan, the Panel was satisfied that he had not administered it because he had dismissed Colleague A’s suggestion.

vi. did not take and or record Patient C’s blood sugar level (‘BM’);

96. The Panel finds particular 3(a)(vi) proved.

97. For the same reasons as given in particular 3(a)(iv), the Panel was satisfied that the Registrant had neither taken nor recorded Patient C’s blood sugar level (BM), and this amounted to inadequate provision care and treatment to Patient C.

vii. did not arrive on scene with a bag valve mask.

98. The Panel finds particular 3(a)(vii) proved.

99. The Panel accepted the evidence of Colleague A to the effect that he and the Registrant did not arrive at the scene with a bag valve mask and had to send a medical student back to the ambulance to retrieve it. PM told the Panel that Paramedics are taught that if they receive an emergency call to attend a young person, then on arrival at the scene, they should take three basic pieces of equipment with them, namely a response bag, an oxygen unit, and a defibrillator. PM said that the response bag should contain a bag valve mask. The Panel was satisfied that the Registrant had not provided adequate care and treatment to Patient C in not arriving on the scene with a bag valve mask.

Particular 3

b) did not adequately complete the Patient Report Form (PRF) for Patient C, in that:
i. you did not ensure the rationale for not attempting intraosseous access on Patient C was recorded;

100.The Panel finds particular 3(b)(i) not proved.

101.The Panel had regard to the PRF itself and the evidence of PM, to the effect that the PRFs were essentially a tick box record of information obtained, decisions made, and care and treatment administered. PM accepted that there was not really anywhere on the PRF to justify or record the rationale for decisions made. He said that the justification or rationale for decisions would normally been telephoned through to Control. Whilst the Panel noted that there was no rationale recorded on the PRF for not attempting IO access, it was not satisfied that the HCPC had discharged the burden of proving that such information was expected on the PRF or that its omission signified the inadequate completion of a PRF.

ii. did not ensure the patient’s blood pressure was recorded.

102.The Panel finds particular 3(b)(ii) proved.

103.The Panel had regard to the PRF and saw that the section for recording blood pressure was blank and so was satisfied that Patient C’s blood pressure was not recorded on the PRF. Although Colleague A, the EMT, had predominantly completed the PRF, the Panel was satisfied from the evidence of PM, that overall responsibility for the accuracy and adequacy of the PRF lay with the Paramedic. Consequently, the Panel was satisfied that the Registrant did not ensure that Patient C’s blood pressure was recorded, and as such it amounted to the inadequate completion of the PRF.
Statutory Ground and Impairment

104.The Panel next considered whether the facts found proved as set out above, amounted to misconduct, and if so, whether by reason thereof, the Registrant’s fitness to practise is currently impaired.

105.The Panel considered the submissions made by Mr Foxsmith on behalf of the HCPC. The Panel heard and accepted the advice of the Legal Assessor. The Panel had regard to the HCPTS Practice Note on Impairment. The Panel was aware that any findings of misconduct and impairment were matters for the independent judgement of the Panel. It understood that consideration of impairment only arises in the event that the Panel judges that the facts found proved do amount to misconduct, and that in respect of impairment, that is an assessment of whether a Registrant’s fitness to practise is currently impaired, as at today and looking forward from today.

Decision on Grounds

106.The Panel noted that the facts found proved relate to three patient incidents over a 30 year career, and the Panel had been informed that the Registrant had no previous fitness to practise history. The Panel decided to approach the evaluation of whether the facts found proved amount to misconduct patient by patient. In relation to particular 1, the Panel noted that the 2012 version of the HCPC Standards of conduct, performance and ethics applied. In relation to particulars 2 and 3, the Panel noted that the 2016 version of the HCPC Standards of conduct, performance and ethics applied.

107.In relation to Patient A (particular 1), which occurred on 26 November 2015, the Panel considered that this incident related to a series of acts and omissions on the part of the Registrant. The Panel was of the view that taking the necessary equipment into the address was a basic requirement for a Paramedic responsible for the care and treatment of a patient. Further, the Panel considered that the Registrant’s failings stemmed from him treating Patient A’s injury as minor, without having taken proper observations or a full patient history. The Panel considered that these failures meant that the Registrant was not in a position to assess whether there was a risk to the patient in leaving him at the address rather than seeking to persuade the patient to go to hospital. In addition, the Panel considered that the Registrant had not completed the relevant sections of the PRF, so it contained very little information.

108.In the Panel’s view, the Registrant had not acted in the best interests of the patient, who had fallen and hit his head. In the absence of taking proper observations and a full history, the Panel did not consider that the Registrant had explored the potential risk of harm to the patient resulting from a suspected head trauma. In addition, the Panel did not consider that the Registrant had communicated effectively with the patient’s spouse, who expressed her concern that the patient was confused and lacked capacity to decide whether or not to go to hospital. Further, and as a consequence of not carrying out an adequate assessment, the Registrant had not recorded what would have been relevant information on the PRF.

109.The Panel considered that the Registrant had breached the following Standards (2012):

1 - You must act in the best interests of service users;
2 - You must communicate properly and effectively with service users and other practitioners;
10 - You must keep accurate records.

110.In the Panel’s judgement, the Registrant’s care and treatment of Patient A fell far below the standards expected of a Paramedic and amounted to misconduct.

111.In relation to Patient B (particular 2), which occurred on 7 June 2016, the Panel considered that this incident related to a series of acts and omissions on the part of the Registrant, which stemmed initially from not recognising the ‘red flag’ of ST elevation on the ECG. In the Panel’s judgement, this evident clinical emergency needed to be properly assessed, so that the appropriate treatment pathway could be followed. Subsequently, once the patient had gone into cardiac arrest in the ambulance, the Registrant failed to move into ALS, notwithstanding the JRCalc Guidance, and the clear opportunity to do so when Colleague B stopped the ambulance and offered assistance. The Panel considered that the Registrant’s failure to take the necessary steps to enable the administration of adrenaline and move into ALS created a significant risk of harm to Patient B. In the Panel’s judgement, fellow professionals would consider the Registrant’s acts and omissions to be deplorable. It was satisfied that the facts found proved in relation to Patient B were so serious as to amount to misconduct.

112.In relation to Patient C (particular 3), which occurred on 20 November 2016, the Panel considered that this incident related to a series of acts and omissions on the part of the Registrant, which were similar to those of 7 June 2016, and occurred around five months later. In the Panel’s judgement, once Patient C had gone into cardiac arrest, the Registrant, as on 7 June 2016, failed to move into ALS, notwithstanding the JRCalc Guidance. The Panel considered that the Registrant’s failure again to take the necessary steps to enable the administration of adrenaline or atropine and move into ALS created a significant risk of harm to Patient C. In the Panel’s judgement, fellow professionals would consider the Registrant’s acts and omissions to be deplorable. It was satisfied that the facts found proved in respect of Patient C were a serious departure from the standards and amounted to misconduct.

113.In respect of particulars 2 and 3, the Panel considered that the Registrant had breached the following Standards (2016):

1 – Promote and protect the interests of service users and carers;
2 – Communicate appropriately and effectively;
2.5 – You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers;
2.6 – You must share relevant information, where appropriate, with colleagues involved in the care, treatment or services provided to a service user;
10.1 – You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

114.The Panel considered that the Registrant had breached the following Standards of Proficiency for Paramedics (2014):

1 – be able to practise safely and effectively within their scope of practice;
4 – be able to practise as an autonomous professional, exercising their own professional judgement;
9 – be able to work appropriately with others;
10 – be able to maintain records appropriately.

Decision on Impairment

115.The Panel had regard to the HCPTS Practice Note on Impairment and in particular to the two elements of impairment, namely the ‘personal component ‘and the ‘public component’.

116.In relation to the ‘personal component’, the Panel was mindful that the Registrant had not engaged with the HCPC investigation or these proceedings. Whilst the Panel did not hold this against the Registrant, the inevitable consequences of his non-engagement were that there was no information before the Panel of his current level of insight or of any steps taken towards remediation.

117.In relation to particular 1, the Panel had regard to the evidence of MM, to the effect that the Registrant had reflected on his actions recognising that they had not been adequate, was remorseful and had written letters of apology to the Trust, Patient A and Patient A’s spouse. However, this was not the case for the subsequent incidents in June and November 2016. Similar failures to those in November 2015, which the Registrant had reflected upon, had recurred. The Panel identified a pattern of failures in providing adequate care and treatment in emergency situations and in ensuring the completion of accurate and adequate PRFs.

118.The Panel was of the view that the Registrant’s failings are capable of remediation, as they relate to clinical acts and omissions. However, in light of the Registrant’s non-engagement, the Panel had no up to date information from him. Consequently, the Panel did not consider that it had any material before it to demonstrate that the Registrant had developed meaningful insight into his actions, or had remedied his practice. In all the circumstances, in the absence of insight and remediation, the Panel concluded that there was a significant risk of repetition.

119.Accordingly, the Panel concluded that in respect of the ‘personal component’ the Registrant’s fitness to practise is currently impaired.

120.In relation to the ‘public component’, the Panel had regard to the collective need to protect patients; to uphold public confidence in the profession and to uphold the standards expected of a Paramedic. The Panel was mindful that a Paramedic who had not developed sufficient insight into his actions is likely to present an ongoing and future risk to the public. In the Panel’s judgement, members of the public would be very concerned to hear that a Paramedic was not using his skills, such as in Advanced Life Support, to increase the chances of recovery for patients in cardiac arrest. The Panel considered that the public expects that professionals responsible for the emergency care of patients will carry out the necessary observations; recognise serious clinical matters; administer the appropriate drugs; call for assistance where necessary; and carry out Advanced Life Support.

121.In light of this, and its conclusion that there remained a significant risk of repetition, the Panel was of the view that public confidence in the profession would be undermined if a finding of current impairment were not made in this case. It was also of the view that a finding of impairment was required to declare and uphold standards of conduct and behaviour.

122.Accordingly, the Panel concluded that in respect of the ‘public component’ the Registrant’s fitness to practise is currently impaired.
Decision on Sanction

123.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. The Panel took account of the submissions of Mr Foxsmith on behalf of the HCPC. It also had regard to all the evidence it had heard, and all of the material previously before it.

124.The Panel heard and accepted the advice of the Legal Assessor and it exercised its independent judgement. It bore in mind 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 punish a Registrant 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. The Panel understood that it must impose the least restrictive sanction to address those risks which it had identified.

125.Having regard to the Policy, the Panel identified the mitigating and aggravating factors as follows:

Mitigating factors:

  • The Registrant had been a Paramedic for 30 years with no other fitness to practise history; and
  • After the first incident in November 2015, the Registrant had reflected, demonstrated remorse and some insight, and had written letters of apology to the Trust, Patient A, and Patient A’s spouse.

Aggravating factors:

  • There had been a repetition of similar concerns, occurring in June and November 2016;
  • There had been a potential risk of harm to three patients as a result of the Registrant’s failings;
  • Lack of evidence of insight and remorse; and
  • A lack of evidence of remediation.

126.The Panel was of the view that the case was too serious to take no action, and that such a course would send the wrong message to the public. It also did not consider that this was an appropriate case for mediation. The Panel concluded that some form of sanction was necessary to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour.

127.The Panel considered a Caution Order. Having regard to the Policy, the Panel did not consider that the misconduct was isolated, as it related to three occasions in respect of three patients, nor that it could properly be described as limited or relatively minor in nature. Further, the Panel did not consider that the other factors relevant for a Caution Order were present in this case. The Panel’s conclusions at the impairment stage were that there was no evidence of insight or remediation in this case in relation to the 2016 incidents, and consequently there was a significant risk of repetition. In all the circumstances, the Panel did not consider a Caution Order to be the appropriate or proportionate response in this case, as it would neither protect the public nor address the public interest.

128.The Panel next considered whether the imposition of a Conditions of Practice Order was the appropriate and proportionate response. The Panel noted that it had identified that the Registrant’s failings were, in principle, capable of remediation. However, there was no evidence before it of any steps the Registrant had either taken or was taking to remedy his misconduct. The Panel had no evidence of insight or remorse into the 2016 incidents and there had been no engagement from him in this regulatory process. Having regard to the Policy, the Panel considered that the Registrant’s failings were serious and repeated, and it had no information to reassure it that the Registrant was genuinely committed to resolving matters. In light of this, the Panel did not consider that conditions would adequately protect the public or the wider public interest, in circumstances where it could not be confident that the Registrant would be either willing or able to comply with conditions. Consequently, the Panel concluded that conditions were neither appropriate nor proportionate in this case.

129.The Panel next considered whether a Suspension Order was the appropriate and proportionate sanction. Having regard to the Policy, it was satisfied that the nature of the misconduct constituted a serious breach of the Standards of conduct, performance and ethics, one of the factors relevant for a Suspension Order. However, the other relevant factors identified by the Policy as typically exhibited when a Suspension Order may be appropriate, namely insight, unlikelihood of repetition, and evidence to suggest the Registrant is likely to be able to resolve or remedy their failings, were not present in this case. Accordingly, the Panel did not consider that a Suspension Order was the appropriate or proportionate response.

130.The Panel understood that a Striking-Off Order was a sanction of last resort. In the Panel’s view, this was misconduct which had created a potential risk of harm to three patients, and the Panel had concluded that there was a significant risk of repetition. In terms of public confidence, the Panel was of the view that the public would expect a Paramedic who had been called to an emergency, to use the appropriate skills and knowledge in which he had been trained, particularly in order to increase the chances of recovery for patients in cardiac arrest. As identified at the impairment stage, the Panel considered that the public expects that professionals responsible for the emergency care of patients will carry out the necessary observations; recognise serious clinical matters; administer the appropriate drugs; call for assistance where necessary; and move appropriately to Advanced Life Support.

131.The Panel considered that any lesser sanction than a Strike-Off in these circumstances, would be insufficient to protect the public and maintain public confidence in the profession and regulatory process. In reaching this decision, the Panel bore in mind the lack of evidence of insight into his failings in respect of Patient B and Patient C; and that there was no evidence before it to indicate a willingness on the Registrant’s part to resolve matters.

132.The Panel recognised that a Strike-Off Order may have a significant impact on the livelihood, finances and reputation of the Registrant. However, the Panel considered that the public interest outweighed the Registrant’s interest given its responsibility to protect the public, maintain public confidence and uphold public standards.

Order

ORDER: The Registrar is directed to strike the name of Mervyn F Dougan from the Register on the date this order comes into effect. 

Notes

Right of Appeal

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

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

Interim Order

Proceeding with the Interim Order application in the Registrant’s absence

1. Having heard the advice of the Legal Assessor, the Panel decided that it was appropriate to proceed to consider Mr Foxsmith’s application for an 18 month Interim Suspension Order in the Registrant’s absence. The Panel was satisfied that the Registrant had been given notice in the notice of hearing, dated 3 November 2020, that the HCPC may make such an application in the event that a sanction which removed, suspended or restricted his right to practise was imposed.

2. The Panel considered that the same factors applied as for its decision to proceed with the resumed hearing, namely that the Registrant had voluntarily waived his right to attend and it was unlikely that an adjournment would be unlikely to secure his attendance.

Interim Order Application

3. Having heard and accepted the advice of the Legal Assessor and having had regard to the Practice Note on Interim Orders, the Panel decided to impose an Interim Order of Suspension for 18 months.

4. The Panel was satisfied that an Interim Order was necessary to protect the public. The Panel has found misconduct and current impaired fitness to practise on both the personal and public components, as it had no evidence of insight for the 2016 incidents, the Registrant had not remedied his failings, and the Panel had identified a significant risk of repetition, placing patients at risk of harm.

5. The Panel was also satisfied that an Interim Order was required in the wider public interest in order to maintain public confidence in the profession and to uphold proper standards of conduct and behaviour. Having found that the Registrant’s fitness to practise is currently impaired, and that the only appropriate and proportionate sanction is a Strike-Off, the Panel was of the view that the public would be very concerned if the Registrant were permitted to practise during the appeal period.

6. The Panel considered an Interim Conditions of Practice Order, but given the Registrant’s lack of engagement, it concluded that conditions were not appropriate for the same reasons as set out in the substantive decision.

7. In all the circumstances the Panel determined to make an Interim Suspension Order for a period of 18 months. In deciding to impose this length, it took account of the fact that if the Registrant were to appeal, that process may take a considerable period of time, particularly given the current circumstances of the Covid-19 pandemic.

This Interim 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.

 

Hearing History

History of Hearings for Mr Mervyn F Dougan

Date Panel Hearing type Outcomes / Status
15/02/2021 Conduct and Competence Committee Final Hearing Struck off