Mr Terence King

Profession: Paramedic

Registration Number: PA34386

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 29/01/2021 End: 17:00 29/01/2021

Location: This hearing is being held virtually.

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Whilst registered with the Health and Care Professions Council as a Paramedic and employed by East of England Ambulance Service between approximately 2016 and May 2018, you:

  1. Deliberately recorded incorrect details relating to Morphine usage in:
  2. Your controlled drugs records book; and/or
  3. Patient Care Records.
  4. Hid ampoules of Morphine during Morphine checks.
  5. Used Morphine from the same ampoule on two separate patients on two or more separate occasions.
  6. Used a single use only syringe on more than one patient on approximately three occasions.
  7. Your actions set out in particulars 1(a) and/or 1(b) and/or 2 were dishonest.
  8. The matters set out in paragraphs 1-5 constitute misconduct
  9. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Matters


1. The Legal Assessor confirmed that she had spoken to the Registrant about the legal process in the presence of the Presenting Officer and the Hearing Officer.


Background

2. The Registrant is a Paramedic registered with the HCPC. At the relevant time, he
was employed in this capacity at East of England Ambulance Service (“the Trust”) as a
Senior Paramedic at Thetford Station. Concerns came to light when, on 3 May 2018, CH, the Thetford Station Supervisor, found a pouch containing 3 x 10 mg ampoules of Morphine Sulphate and 7.5 mg of Morphine Sulphate, drawn up in a syringe with saline, inside the bag on the filing cabinet in the supervisor’s office at Thetford Ambulance Station. The bag was
labelled as belonging to the Registrant.

3. As the Morphine was not recorded in the Registrant’s controlled drugs book, CH submitted a DATIX, a clinical incident reporting tool, recording his concerns. This led to a further investigation which was conducted by LS, an interim Senior Locality Manager for the Trust. The Registrant said words to the effect that, “he had been found out” and made admissions
that he had acted outside the Trust policies.

4. The Registrant indicated that he had done this for positive reasons to try and save the Trust money by using left-over morphine from previous patients; he admitted that he had hidden the morphine and made a number of associated errors, such as re-using a single-use syringe for more than one patient. He acknowledged that these matters occurred during 2016-2018 and only ceased when his actions were discovered. Subsequently, the HCPC received a self-referral from the Registrant.

5. Following a substantive hearing on 29 January 2020, the Registrant was found to be impaired by reason of misconduct. A sanction of 12 months suspension on his registration was imposed. The panel that imposed this sanction indicated that a future reviewing panel is likely to be assisted by evidence of further reflection by the Registrant on the dishonesty issues admitted and found proved, and by character references from any employer for whom he works in any capacity during the suspension period. 

Decision

6. The Panel heard from the Registrant who gave evidence under affirmation. The Panel guided him through the areas of his case that he could helpfully address for it. The Registrant clearly found it more difficult to address some aspects of this case than others, such as what had motivated his dishonest behaviour.

7. Since having his registration suspended, he had continued to work as an emergency medical technician for the Trust, working in a double crewed ambulance. He has realised the
necessity to follow the rules exactly and, although he said it is difficult to provide evidence of honesty, he had endeavoured to show that he can be trusted.

8. He said that in the two and a half years since the incident, no other issues have arisen.
He explained that the index events had initially come about as a mistake, when he used a
leftover part-used ampoule from one patient for another who needed pain-relief. He said that he carried on doing this because it had worked, and justified this behaviour to himself as a “new normal” but has no other justification for his actions. Further, he admitted that he hid the morphine because he knew it was wrong and contrary to the Trust policies.

9. He frankly admitted that he stopped only because he was stopped. He experienced fear when he was found out in terms of possible consequences as he knew he was acting outside
Trust policy. However, he could not convincingly explain why he had decided to act in the manner he did. The Registrant indicated that he is now hyper-aware that every action must be justified because he could not rationalise why he acted as he had previously. Further, he stated that he recognised that he needs to be honest and accurate in any records kept, in case issues later arise, e.g. a contaminated batch of morphine is discovered. He emphasised that his purpose had never involved trying to harm a patient, but said that he recognised now that he was potentially putting patients at risk. This causes him angst, as he had not considered that issue previously.

10. The Registrant spent time detailing the impact that his behaviour has had on him. He said that in addition to being demoted, his supervisors “look at him differently”, and he has had to
undergo this regulatory process. He indicated that he would never repeat this mistake because the, “price is too high”; he acknowledged a degree of embarrassment and fear about the hearing today and not preparing for it fully as he had been unsure “what to do or say”.

11. The HCPC submitted that the Registrant has developed insight in sharing his thoughts
about his behaviour. He has attempted to provide some explanation for his on-going deliberate behaviour following the initial mistake, in reflecting that he attempted to justify a “new normal” of what had proved to work. However, while there is evidence of a growth of insight, this is so far incomplete.

12. Mr D’Alton submitted that the Registrant’s mistake led to a spiralling of the actions, and that he was brought out of this pattern of behaviour by his supervisor’s discovery. While the
Registrant’s evidence indicates improvement in his insight, he has not provided the material the previous panel indicated would be helpful to a reviewing panel. A reflective statement or diary would indicate that the Registrant had carefully spent time reflecting on the matters rather than avoiding dealing with them head on. The HCPC position is that there are ways that could demonstrate that the Registrant has attempted to remediate in his actions, e.g. by providing written reflections in relation to dishonesty, the reasons for it and the wider impact it has. Further, character references would be independent verification of what the Registrant has said about his insight and subsequent conduct.

13. The Registrant indicated that he would like to return to being a paramedic but acknowledged that he had not provided the references that he had been told would assist a reviewing panel. He indicated that he would be prepared to do this if given a future opportunity to do so. He acknowledged that whilst he could indicate that his employers had confidence in him, this was his own impression and he had no objective evidence to place before the Panel at this time.

14. It was not clear if the Registrant was asking for a conditional decision on impairment to be
made, or for an adjournment. Mr D’Alton indicated that if an adjournment was being sought at this late stage, the HCPC would object to this, on the basis that the Registrant has had 12 months to prepare for this case, and has had a reminder by way of letter more recently that should have been adequate. That he failed to read it does not support a valid reason for an adjournment.

15. The Panel received legal advice from the Legal Assessor on the matter of an adjournment which it accepted. It considered that it was not in the interests of justice for an adjournment to be granted at this time. The Registrant had been provided with ample time to prepare for
this hearing, and it could not be satisfied that a short adjournment would serve any useful
purpose, in circumstances when the Registrant had already had 12 months to prepare.

16. Insofar as making a decision regarding impairment, the Panel accepted the advice of the Legal Assessor. The Panel was referred to the HCPTS Practice Notes “Finding That Fitness to Practise is ‘Impaired’” and to the HCPC Sanctions Policy. The Legal Assessor reminded the Panel that it should first consider whether the Registrant’s fitness to practise remains currently impaired. She reminded the Panel of its powers at a mandatory review under Article 30(1) of the Health Professions Order if current impairment is found, and that it should impose the least restrictive order which appropriately protects the public and the public interest.

17. The Panel carefully considered the evidence of the Registrant. They recognised his
developing insight, but were concerned that a combination of embarrassment about what
he had done and fear of the consequences had led to him not preparing more fully for this hearing. The Registrant had admitted that he knew what he was doing was wrong, and that is why he attempted to hide his actions. However, he had not fully addressed his wrongdoing which involved the potential of a serious risk to patients and mishandling of a controlled drug along with the dishonesty.

18. While the Panel was heartened at the progress that the Registrant had made, it does not have any documentation to support his oral evidence. In these circumstances, the Panel cannot be satisfied today that the Registrant has understood the full implications of his behaviour, and could accordingly guard against the same. In light of the lack of evidence that can stand as independent verification of what the Registrant had said, the Panel found that the Registrant had failed to discharge the persuasive burden to indicate that he was no longer impaired.

19. Having taken into account all the information before it, the Panel considered that there remains a risk to the public. It concluded that members of the public would be concerned if the Registrant, who has admitted not being able to fully address all aspects of his wrongdoing, were found not to be impaired. Public confidence in the profession and the regulatory process would be undermined. The Panel therefore concluded that the Registrant’s fitness to practise is impaired on the grounds of public protection and the wider public interest.

20. The Panel considered the available sanctions and referred to the HCPC Sanctions Policy. It
applied the principle of proportionality and carefully considered the sanctions in ascending order of seriousness.

21. The Panel considered that it would not be appropriate to impose no order or a Caution
Order because the public would not thereby be protected and the wider public interest would not be adequately addressed.

22. The Panel considered whether it could formulate a Conditions of Practice Order. However, the Panel concluded that no conditions could be formulated which address dishonesty.

23. The Panel evaluated whether further period of suspension would be appropriate and
proportionate to address public protection and the wider public interest issues. They
considered this to be the case, given the Registrant’s developing insight and the progress he has made in frankly addressing some issues of his misconduct.

24. The Panel considered that a relatively short period of further suspension should be
sufficient for the Registrant to be able to make further progress on developing his insight. Accordingly, the Panel determined that a further three months of suspension should be imposed. The Panel did indicate that the following would be likely to assist a future
reviewing Panel:

a) evidence of further reflection by the Registrant on the dishonesty, in terms of why it arose,
and its consequences;

b) character references from his current employer;

c) evidence of any Continuing Professional Development and Training undertaken to support work as a paramedic;

d) evidence of any arrangements and plans made to facilitate a return to work as a paramedic, e.g. records or reports detailing conversations and agreement between his employer and him.

Order

ORDER: The Registrar is directed to suspend the registration of Mr Terence King for a
further period of 3 months on the expiry of the existing order.

Notes

The Order imposed today will apply from 26 February 2021.


The Order will be reviewed again before its expiry.

Hearing History

History of Hearings for Mr Terence King

Date Panel Hearing type Outcomes / Status
21/04/2021 Conduct and Competence Committee Review Hearing Hearing has not yet been held
29/01/2021 Conduct and Competence Committee Review Hearing Suspended
27/01/2020 Conduct and Competence Committee Final Hearing Suspended