Mr Maksym Wojcieszek
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Whilst registered as a Paramedic and working for East Midlands Ambulance Services (“EMAS”):
1. On or around 25 October 2017 during a ‘ride out review’ you:
a. did not have the underpinning knowledge to complete an adequate patient assessment;
b. had poor ECG recognition skills;
c. did not take into account or understand all information given by a patient in relation to the presenting complaint.
2. On or around 20 November 2017 during an assessment day, you failed to:
a. identify and manage a time critical patient effectively;
b. [not proven]
c. consider reversible causes of cardiac arrest / paediatric arrest;
d. use Capnography during a cardiac arrest;
e. conduct adequate pulse checks on a patient;
f. consider the seriousness of a patient not having passed urine for two days;
g. consider the Paramedic pathfinder and/or NEWS Score for a patient with a history of productive cough;
h. consider using a sepsis toolkit for a patient with a history of productive cough;
i. give 5 rescue breaths prior to placing pads on the chest in a paediatric arrest.
3. The matters set out in Paragraph 1 and 2 constitute misconduct and/or lack of competence.
4. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.
1. It was noted that the Decision of the Final Hearing Panel incorrectly records that the substantive order which was imposed on 13 February 2020 and came into effect on the 12 March 2020 would be the subject of review on the 13 May 2020. There had been no such review, and none was appropriate. This Panel has recorded that error.
2. The Registrant was employed as a band 5 Paramedic by East Midlands Ambulance Services (EMAS) from 27 March 2017, until 25 January 2018. During his employment he had regular probation reviews. However, despite this, concerns about his competence were identified.
3. EMAS decided to examine those concerns further by means of a “ride out review” on 25 October 2017 and an assessment day on 20 November 2017. The ride out review was conducted by Witness 1 who gave evidence at the Final Hearing. The assessment day was conducted by Witness 2 who give evidence at the Final Hearing who was supported by Witness 3 who also gave evidence at the Final Hearing. Both events identified continuing concerns regarding the Registrant’s ability to practise safely.
4. During a probation review meeting on 21 November 2017, it was decided that the Registrant’s probationary period would need to be extended and an action plan was given to him. Thereafter, there were continuing concerns regarding the standard of the Registrant’s practise. On 19 January 2018, the Registrant attended a probationary review meeting chaired by Witness 4 who gave evidence at the Final Hearing. At that meeting a decision was taken to terminate the Registrant’s employment with effect from 25 January 2018. However, following the Registrant’s appeal against his dismissal, the Trust decided to offer alternative employment to the Registrant, and he was offered a place on an Ambulance Technician/Associate Ambulance Practitioner course due to start on 23 April 2018. The Registrant accepted that offer of further employment.
5. At the Substantive Hearing which concluded on 13 February 2020, the Registrant was found to be impaired and made the subject of a 12-month Suspension Order.
6. The Final Hearing panel recorded, in relation to its consideration of the statutory ground, the following:
The Panel has taken into account all of the background circumstances. At the time of the Registrant’s appointment by EMAS, EMAS was running a recruitment programme in which their staff would visit Poland to assess and select individual Polish Paramedics who were suitable for paramedic practice in the UK. Persons appointed under that scheme travelled to the UK and undertook an EMAS adaptation process intended to properly familiarise and train those persons in UK paramedic practices.
The Registrant is a citizen of Poland. In approximately 2011 he qualified as a Paramedic in Poland. He worked in that capacity for about 6 months. He then subsequently came to the UK and, whilst in the UK, applied to EMAS for appointment as a Paramedic. That application for employment was made at a time when the Registrant had only about 6 months prior experience as a Paramedic during the previous 6 years. Because the Registrant was not recruited in Poland he was not assessed in Poland by EMAS staff before being invited for employment and admission to the adaptation process.
During a probation review meeting on 19 January 2017 (D4) the Registrant said that as a Paramedic in Poland he was trained to perform certain skills, but he was usually with a doctor who decided when those skills should be used. During the assessment day he accepted that he had previously said he could not see the point of having “anatomy and physiology knowledge”.
Within 3 months of starting his employment with EMAS on 27 March 2017, there were concerns amongst EMAS staff as to the Registrant’s competence. The Panel is satisfied that the Registrant was a conscientious employee who was trying to do his best to fulfil his duties. His failure to perform, (in the eyes of EMAS), to an adequate standard was, in the Panel’s view, because of his very limited practical experience in Poland when he was working in a paramedic environment which required a much more limited area of expertise and autonomy compared with UK paramedic practice. In addition, the duration of his past paramedic employment in Poland had been very limited.
The Panel is satisfied that the Registrant’s failure to operate at a competent level was not because he was failing to use skills that he already had. It was as a result of the Registrant not having previously been trained to the level required of a UK Paramedic. The adaptation training offered by EMAS did not, for whatever reason, adequately meet the gap in the Registrant’s skill level.
The Panel has concluded that it cannot reasonably be said that the Registrant’s failings amounted to misconduct. The failings clearly amounted to a lack of competence alone.
7. In the Final Hearing panel’s assessment of Sanction, it recorded, as mitigating factors, that:
· The Registrant was always committed to his duties.
· There was a skills gap between the level of skill expected from a Paramedic registered in Poland and a Paramedic registered in the UK. For whatever reason, the training received by the Registrant on his appointment to EMAS did not sufficiently prepare him to operate as a competent UK Paramedic.
Information received since the Final Substantive Hearing
8. The Panel had before it a copy of the Disciplinary Hearing Outcome letter of 15 September 2020, sent by EMAS, relating to the hearing that took place on 2 September 2020.
9. At that hearing the Registrant faced the allegation that:
Whilst completing the Associate Ambulance Practitioner (AAP) apprenticeship, you provided plagiarised elements of your portfolio.
10. The key points presented at that hearing had been:
a. The Registrant had been working for the ambulance service as a Trainee Technician on a Futurequals AAP course since June 2018, when he had moved from his previous position as a Paramedic due to concerns about his professional knowledge and skills.
b. The Registrant submitted his first portfolio in December 2018. In January 2019, during a meeting with his Clinical Practice Tutor, the Registrant had been advised about plagiarism within his academic work, and was given a further opportunity to submit his portfolio in his own words.
c. The Registrant submitted a second portfolio in July 2019. During the Internal Quality Assurance (IQA) process it was noted that the formatting of sections of the Registrant’s portfolio of evidence was inconsistent with the rest. It was noted that the level of language and detail of response was also inconsistent throughout the portfolio. Following further checking, it was found that 4 paragraphs from unit 11 of the portfolio were directly lifted from various international websites.
d. The Registrant had been unable to explain how this had happened, but suggested that these could have been saved and submitted as an earlier version of the portfolio. It was suggested by those presenting on behalf of EMAS that this explanation did not explain how the text does not follow the process the Registrant had described as to way his portfolio had been completed.
e. According to the Registrant, who paid for a review of his work by a plagiarism checking website, a review of 123 paragraphs had identified 12 further examples of work taken directly from the internet. The 123 paragraphs checked did not include Unit 11, which had contained the 4 found during the IQA.
11. The EMAS panel had concluded at the hearing on the 2 September 2020, that the Registrant’s actions could not be considered simple poor academic skill, as the act of copying and pasting is a deliberate act, and although it may have been an error on the Registrant’s part not to change the text, it was the EMAS panel’s view that these actions could be defined as plagiarism.
12. The outcome of that disciplinary hearing was that the allegation had been made out, and the Registrant’s actions had constituted a breach of the Disciplinary Policy. The Registrant received a First Written Warning which would ‘remain live’ for a period of 26 weeks.
13. The Registrant was reminded in the Outcome letter dated 15 September 2020, that failure to complete the qualification in the set timescale may result in him been referred, under the Trust’s Supporting Capability Policy, and such action may result in dismissal.
14. The Panel also had before it a copy of the Outcome of Disciplinary Appeal Hearing dated 19 November 2020 relating to the Appeal Hearing which was heard via Microsoft Teams on 9 November 2020. The grounds of appeal were recorded numerically as follows:
1. The panel [original disciplinary panel] stated that they would seek advice from Futurequal before applying a sanction. This had not been actioned before the sanction was given.
2. The panel stated in error that the anti-plagiarism report was only 123 questions, however it was obvious that the full portfolio had been checked and there was a less like occurrence of 2%.
3. There were many errors/human mistakes.
4. The required level to pass the course is 40% and that you had made that.
5. The panel failed to account for the loss of portfolio evidence including certificates and bibliography.
6. No action plans being developed during the course.
7. Evidence like tutorship/portfolios was not prepared by NTU to share for the panel after request.
8. NTU checked the portfolio via USB but the evidence was incomplete.
9. Lack of support with English course.
The EMAS Appeal panel concluded that issues 5, 6 and 9 were partially upheld. The following observations were recorded:
1. In respect of point 5 ‘The panel failed to account for the loss of portfolio evidence including certificates and bibliography’ the appeal panel was unable to determine whether the additional evidence, including a bibliography was or was not present in the portfolio or had been lost.
As a bibliography may have provided further context in relation to a plagiarism allegation it was determined that this should be considered to inform the overall outcome.
2. In relation to point 9, ‘Lack of support with English course’ the [EMAS] appeal panel were not assured that consistent and comprehensive support with applied English skills had been provided or monitored during AAP development and on that basis poor English skills could have contributed to the issues within the portfolio.
3. Similarly, in relation to point 6. ‘No action plans being developed during the course’. The [EMAS] appeal panel did find evidence of some action plans, however the effectiveness of the use and review of these is questionable in terms of the effectiveness in supporting you though the course and ensuring that actions, such as support with your English skills were in place, actioned and effectively reviewed.
The EMAS appeal panel then stated:
In relation to the remaining points of appeal, the panel were assured that these points had previously been considered and responses to appropriately as part of the original hearing or were not relevant to the original allegation that was heard.
15. The EMAS appeal panel determined that plagiarism had occurred within the AAP portfolio in keeping with the original hearing, however it concluded that there were influencing factors that would question as to whether it was a wilful act.
16. In relation to the outcome the EMAS appeal panel stated:
Following due consideration of the appeal points and evidence available the [EMAS] appeal panel find that the formal sanction applied. This being a First Written Warning should be changed to an Informal Counselling in accordance with the Trust Disciplinary Policy and Procedure Version 6.1.
17. As part of its wider instruction for future personal development the EMAS appeal panel stated:
‘…You will need to [be] mindful that the AO will require evidence that is less than two years old for assessment. The OA will also require evidence that you are engaged with English development as part of your professional qualification. This should be completed within the next six months from the date of this outcome.’
18. The HCPC reminded today’s Panel that there is a persuasive burden on the Registrant to present information to demonstrate that he has remedied his failings. There is no evidence before the Panel today that demonstrates that the Registrant has remedied his failings. Both parties agree that there is current impairment of the Registrant’s fitness to practise and that it is appropriate in all the circumstances for a further period of suspension to be imposed.
19. Given the fact that there is likely to be 12 months of further delay before the Registrant will be able to give a panel evidence that he has successfully undertaken all that is required of him, it was submitted that no other level of sanction was appropriate.
20. Whilst a Strike off Order is not available to the Panel, even if it were, in view of the information supplied by the Registrant the HCPC would not invite the Panel to take that step in this instance.
21. The Registrant was currently working in an Emergency Care Assistant’s post. His representative informed the Panel that the employer and colleagues were supportive of the Registrant’s efforts to retrain. The Registrant’s Representative was able to confirm that in the last 2 years the Registrant’s English language skills had improved significantly.
22. The Registrant took the opportunity of providing the Panel with his thoughts on the process which has taken up the last two years of his professional life. He highlighted the impact of the COVID-19 pandemic had on the process stating that the hearing first scheduled for January 2020 eventually took place in September 2020. He fully appreciated that his professional skills had been below that expected of him and he was prepared and willing to undertake appropriate retraining.
23. The Registrant told the Panel that he fully understood why his employers had initially dismissed him and he was appreciative that he had been given the opportunity to retrain. When he had finished his AAP training, he had been accused of wilful misconduct. The loss of some of his portfolio arose from the EMAS training unit transfer to Nottingham Trent University (NTU). The Registrant had passed all of his exams and completed all assignments. He should have qualified in March 2019 had it not been for the loss of material and then the allegation of plagiarism.
24. Following the Registrant’s successful appeal, a support package had been put in place. This had come into effect in January 2021. The Registrant is fully engaged in the process and it is hoped that within the next few weeks he will again be able to submit his portfolio. If he obtains his AAP qualification the Registrant intends taking forward further retraining so that he can attain the requisite level of skill and knowledge to work as a Paramedic.
25. The Registrant’s Representative informed the Panel that EMAS has asked the HCPC Education Department for an extension of time in which to undertake the remaining courses and support package. It was possible it could be done in 6 months, but more realistically it will take 12 months.
Legal Assessor’s advice
26. The Legal Assessor reminded the Panel that its purpose today was to conduct a comprehensive review to determine if the Registrant is fit to return to unrestricted practice. She referred the Panel to the approach to be adopted in relation to this review hearing. She reminded the Panel that its role was not to conduct a rehearing of the allegations nor was it to go behind the previous findings. She advised that in carrying out this assessment, the Panel must exercise its own independent judgment.
27. The Legal Assessor advised the Panel that if it determined that the Registrant’s fitness to practise remaines impaired, then the Panel must go on to consider what restriction, if any, should be imposed. The Panel’s powers under Article 30(1) of the Health Professions Order 2001, are to extend the Suspension Order or make any order it could have made at the time of the original Order being imposed.
28. She also advised the Panel that it should bear in mind the principles of fairness and proportionality and have regard to the Sanctions Policy document issued by the HCPTS. She reminded the Panel that any order that it makes under Article 30 should not be punitive in purpose, and that it should be the least restrictive order that would suffice to protect the public and/or would otherwise be in the public interest.
29. The Legal Assessor drew the Panel’s attention to the terms of Article 29(6) of the Health Professions Order 2001 which states:
“A striking-off order may not be made in respect of an allegation of the kind mentioned in Article 22(1)(a)(ii), 'lack of competence' or (iv), 'health' unless the person concerned has been continuously suspended, or subject to a conditions of practice order, for a period of no less than two years immediately preceding the date of the decision of the Committee to make such an order.”
30. The Legal Assessor reminded this Panel that the Registrant has not been suspended for a continuous period in excess of two years, and so this Panel does not have the option to strike the Registrant’s name from the register.
31. The Panel accepted the advice of the Legal Assessor. The Panel has to make an assessment of the Registrant’s fitness to practise as of today’s date. The Panel has taken into account the HCPTS Practice Note on Finding that Fitness to Practise is Impaired, which emphasises that the fitness to practise process is about public protection. A Panel must take into account the personal component, which includes the current competence and behaviour of the Registrant, and the public component, which includes protecting service users, declaring and upholding proper standards of behaviour and maintaining public confidence in the Paramedic profession.
32. The Panel considered that this review process required a registrant to demonstrate both developed insight and remediation of their failings before being considered suitable for return to unrestricted practice. This type of review process places a persuasive burden on the Registrant to demonstrate that they are safe to return to practice.
33. The Panel considered first whether the Registrant’s fitness to practise is currently impaired. The Panel took into consideration all the documentation before it, and the submissions made by the parties. The Panel noted that whilst there had not been any formal delivery of the evidence which the last panel indicated may be of use to a reviewing panel, it appreciated that what had been conveyed, through the two letters and the statements made by the Registrant and his Representative, covered the information which was required.
34. The Panel noted that the Registrant had not attended the Final Hearing and so had not at that time taken the opportunity to express to that panel his views on his failings. At this hearing the Registrant had been candid and open about his lack of knowledge and skills. He had also demonstrated and expressed full insight into his former failings. His level of engagement with his retraining and his commitment and energy for self-improvement was obvious.
35. The Panel appreciated that the pragmatic position adopted by the Registrant of taking an alternative role which does not require his registration, and working and retraining his way back to his chosen profession was a brave and sensible one. The Panel noted that various setbacks had allowed the Registrant the opportunity to show his resilience and determination.
36. In the absence of evidence to demonstrate full remediation, the Panel has concluded that there remains an ongoing need for a restriction on the Registrant’s practice. In these circumstances, it has concluded that public confidence in the profession and in the regulatory process would be undermined if the Registrant were able to practise without restriction. The Panel has therefore determined that the Registrant’s fitness to practise remains impaired on the personal and also the public components of its decision.
37. The Panel then went on to consider what the appropriate and proportionate sanction should be, starting with the least restrictive. The Panel bore in mind that the purpose of a sanction was not to be punitive, although a sanction may have that effect.
38. The Panel also bore in mind that its over-arching objective is:
· to protect, promote and maintain the health, safety and wellbeing of the public;
· to promote and maintain public confidence in the profession; and
· to promote and maintain proper professional standards and conduct for members of the profession.
39. The Panel first considered taking no action or offering mediation and came to the conclusion that neither of those measures were appropriate in this instance.
40. The Panel next considered whether to impose a Caution Order. In this respect it took into consideration the guidance within the Sanctions Policy as to when such an order was appropriate. The Panel concluded that such an order would not be sufficient to protect the public, nor would it be in the public interest given that the Registrant’s failings were wide spread and related to an inability to reach the required standard of performance expected in the UK. A Caution Order would not restrict the Registrant’s practice and therefore would not adequately protect the public or safeguard the public interest.
41. The Panel next considered whether to impose a Conditions of Practice Order. It concluded that such a measure would neither be appropriate nor proportionate given the nature of the lack of competence found proved and the evidence that periods of practice review had identified wide-spread failings in the Registrant’s practise, neither of which have been so far remedied. In those circumstances, the Panel concluded that it could not formulate appropriate conditions to address the Registrant’s failings other than those which would in practice be a suspension by another means.
42. In these circumstances the Panel has concluded that only a further period of suspension is appropriate and proportionate. The Panel is satisfied that a Suspension Order of 12 months is necessary to give the Registrant further opportunity to undertake suitable remediation in respect of the failings found by the Panel.
43. The order will be reviewed by a different Panel before it expires. That review will take place within a hearing. Whilst this Panel may not restrict the powers of a future reviewing panel it considers that any such future reviewing panel would be assisted by receiving from Registrant in advance of the hearing the following:
· Written testimonials and/or references from colleagues.
· Written report from a clinical supervisor of the Registrant, which comments on the Registrant’s standard of work and his ability to meet the practice requirements of a Paramedic, so far as he can whilst being suspended.
· Written detail of any training undertaken by the Registrant in relation to Paramedic practice with particular regard to the Registrant’s practice failings identified in this decision.
ORDER: The Registrar is directed to suspend the registration of Maksym Wojcieszek for a further period of 12 months on the expiry of the existing Order.
The Order imposed today will apply from 12 March 2021
This Order will be reviewed again before its expiry on 12 March 2022