Mr Daniel Lauder

Preliminary Matters

Service

1. The Registrant was not present at the hearing and was not represented.

2. The Panel was satisfied that the notice of the review hearing had been sent to the Registrant by post and email dated 21 June 2021.

3. The Panel noted the response from his representative dated 14 July 2021 and referring to the hearing today, in which they confirm that the Registrant “…does not wish to present any evidence or attend the hearing…”

4. The Panel accepted the advice of the Legal Assessor. The Panel was satisfied that notice of today’s hearing had been sent to the Registrant in accordance with the requirements of Rule 13 of the Conduct and Competence Committee (Procedure) Ruled 2003 (the Rules”).

Proceeding in Absence

5. Mr Mullen submitted that the HCPC had made all reasonable efforts to give notice of the hearing, that the Registrant had voluntarily waived his right to attend and that it was in the public interest for this mandatory review of the Suspension Order to proceed today.

6. The Panel considered the submissions on behalf of the HCPC and accepted the advice of the Legal Assessor. The Panel was referred to the HCPTS Practice Note, Proceeding in Absence, which sets out guidance from the cases of R v Jones (Anthony) [2004] 1 AC 1HL and GMC v Adeogba and GMC v Visvardis [2016] EWCA Civ 162. Applying that guidance, the Panel was careful to remember that its discretion to proceed in absence is not unfettered and must be exercised with the utmost caution and with the fairness of the hearing at the forefront of its mind.

7. The Panel was satisfied the HCPC had made all reasonable efforts to give the Registrant notice of the review hearing at the email and postal addresses held for him. The Panel noted that the notice of the hearing offered the Registrant the opportunity to attend the hearing and present his case.

8. Having considered the emails of 8 July and 14 July 2021 from the Registrant’s representative, the Panel was satisfied that the Registrant had voluntarily waived his right to attend the review hearing and did not wish to be present. There was no indication that he was unable to attend for any reason. The Panel considered therefore that an adjournment would serve no useful purpose.

9. The Panel was mindful that this was a mandatory review of the Suspension Order which was due before its expiry on 29 August 2021. The Panel decided that it was in the public interest that the order be reviewed, and it was fair and in the public interest to proceed with the review hearing in the Registrant’s absence.

Background

10. The Conduct and Competence Committee hearing in the Registrant’s case took place on 25-26 July, 29-31 July and 1 August 2019. The Registrant attended and was represented by Thompsons Solicitors.

11. The Registrant is a Paramedic. He was employed by the Scottish Ambulance Service from 1993, initially as a technician. In 2006, he qualified as a Paramedic and thereafter worked in that capacity.

12. In November 2014, Patient B complained to the Scottish Ambulance Service about treatment she had received from the Registrant and another paramedic, WK(1), on 22 September 2014. An investigation was conducted.

13. WH, an employee of the Scottish Ambulance Service, became aware of concerns regarding an occasion when the Registrant and a Student Ambulance Technician, CC, had attended Patient A on 2 June 2016. WH raised his concerns through the internal reporting system and an investigation was conducted.

14. On 2 December 2016, the HCPC received an anonymous referral concerning the Registrant’s treatment of Patient A.

The findings of the Panel at the Conduct and Competence Committee hearing in 2019

15. At the hearing, the Panel heard evidence from a number of witnesses on behalf of the HCPC. It heard oral evidence from the Registrant, who made some admissions and denied a number of matters. In giving its decision, the Panel stated that it found that the Registrant’s evidence was often inconsistent. He changed his position from being able to recall an incident to being unable to recall it. He contradicted himself on occasions and his evidence contradicted the documentary evidence.

Particular 1(a)

16. The Registrant admitted the facts alleged. The Panel heard evidence that the Registrant drove the ambulance to the Lorn and Island Hospital with Patient A and CC, a Student Ambulance Technician, in the back of the ambulance. The Panel received copies of relevant guidance from the Scottish Ambulance Service which made it clear that the senior practitioner was ultimately responsible for the treatment and care of patients.

17. The Panel found that the Registrant’s actions amounted to misconduct. He had placed Patient A at real risk of harm by leaving her care to a Student Ambulance Technician when he was the lead clinician. He was not in a position to monitor the condition of Patient A, who was critically unwell and deteriorating.

Particulars 1b(i) and (ii)

18. The Registrant admitted the alleged facts of both particulars. The Panel heard evidence from CC that the Registrant did not carry out a full primary trauma survey on Patient A and did not direct CC to take any action in this regard. WK (2) confirmed that the Registrant, as a Band 5 Paramedic, was ultimately responsible for assessing the patient’s condition and directing CC accordingly. The Panel found that the Registrant failed to ensure that a full primary trauma survey was conducted and recorded.

19. The Panel found that the Registrant did not ensure that adequate clinical observations were carried out or recorded. The Panel heard evidence from CC that she was not aware of any observations that the Registrant may have taken. The Patient Report Form showed a set of recorded observations, but the Panel accepted the evidence that these were recorded by CC, wholly unprompted by the Registrant. The Panel found that the Registrant had abrogated his responsibility and that CC had informed him of the results which indicated that Patient A was critically unwell, although the Registrant gave evidence that he was not aware of the result of the observations.

20. The Panel found that the Registrant’s actions in 1(b)(i) and (ii) amounted to misconduct. It concluded that his actions put Patient A at serious risk of harm and led to the failure to provide the hospital with an accurate account of her condition. As the hospital was not fully staffed for emergencies and was relying on on-call staff based at home, this meant that appropriate resources were not waiting at the hospital when the patient arrived. The Panel stated that primary trauma surveys and adequate clinical observations are fundamental tenets of the paramedic profession. The failure to carry these out, or to ensure that they were carried out, meant that the Registrant was unable to assess any deterioration, resulting in a failure to recognise the patient’s serious condition and causing delay to her ongoing treatment.

Particulars 1c(i)

21. The Registrant denied the facts. The Panel found that the Registrant did not demonstrate sound clinical reasoning. The Panel accepted the evidence of SM that she took and made a record of a radio call from the Registrant at 07:05am on 2 June 2016 and that the Registrant advised that the patient had been in a road traffic incident and he was bringing her to hospital. He told SM that the patient had some injuries but was haemodynamically stable (meaning that her circulatory system was intact, and her blood pressure, heart rate and respiratory rate were within normal ranges), when this was not the case.

22. The Panel found that the Registrant’s actions amounted to misconduct. It concluded that the Registrant’s actions resulted from a failure to recognise that the patient was unstable, very badly injured and that her condition was deteriorating. His actions were serious and prevented the hospital from arranging appropriate resources to provide ongoing treatment and management in a timely manner.

Particular 1c(iii)

23. The Registrant admitted the facts. The Panel found proved that he had failed to demonstrate sound clinical reasoning by driving the ambulance himself and leaving the care of Patient A to CC, who was an inexperienced Student Ambulance Technician with only a few weeks’ operational experience.

24. The Panel found that the Registrant’s actions amounted to misconduct. They stemmed from a failure to recognise the patient’s serious condition. The Registrant had a duty to take the patient to hospital as quickly as possible through the use of emergency warning devices and had failed to do so.

Particular 3(a)

25. The Panel found proved that the Registrant did not obtain a full set of observations for Patient B or record them on a Patient Record Form in a timely manner. The evidence of Patient B, a nurse of forty years’ experience, was that she was gasping for breath and clearly very ill, and that neither the Registrant nor his colleague, WK (1), took any observations from her until she was in the back of the ambulance. The Registrant and WK (1) had previously made a joint statement concerning the complaint in which they stated that all her observations were within normal ranges. The Panel had sight of Patient B’s Patient Record Form which documented that the first observations were taken at 10:26am when Patient B was in the back of the ambulance.

26. The Panel found that the Registrant’s actions amounted to misconduct. His failure to obtain a full set of observations in a timely manner when the patient was very unwell left her at real risk of harm. It was clear that the Registrant did not recognise the seriousness of the patient’s condition until observations were taken in the ambulance which was 20-25 minutes after arrival at the patient’s home.

Particular 3(b)

27. The Registrant denied the facts. The Panel accepted the evidence of Patient B, which was consistent with the information on the Patient Record Form. This recorded that the Registrant did not administer oxygen to Patient B in a timely manner, but only at 10:24am, when she was in the back of the ambulance.

28. The Panel found that the Registrant’s actions amounted to misconduct. His failure to obtain observations in a timely manner led to a failure to recognise that Patient B’s saturations were decreased to a dangerous level which would urgently require supplementary oxygen. When Patient B’s first set of observations were recorded in the ambulance, her oxygen saturations were 76%, which was very significantly lower than a normal reading.

Particular 3(c)

29. The Panel found proved that the Registrant advised Patient B’s GP that the patient did not want to go to hospital when this was not the case. The Registrant’s case had been that the patient initially refused to go to hospital, and he had contacted the GP and informed the GP of this. The Panel accepted Patient B’s evidence that she had been gasping for breath and knew something was very wrong with her. Patient B had said that at no point did she refuse to go to hospital. She wanted to go to hospital and did not want to be left at home and that the Registrant and his colleague had been clearly reluctant to convey her to hospital.

30. The Panel found that the Registrant’s actions amounted to misconduct. His actions in contacting the GP as an alternative to transportation to hospital when the patient was willing to go demonstrated a cavalier approach to patient assessment and management.

Particular 4

31. The Panel found the Registrant’s actions as proved in particular 3(c) were dishonest. The Panel stated that honesty was a fundamental tenet of the profession and was paramount to patient protection and public confidence in the paramedic profession.

32. The Panel found that the Registrant’s fitness to practise was currently impaired by his misconduct, in relation to both the personal and public components of impairment.

33. The Panel concluded that the Registrant had limited insight into the seriousness of his behaviour in relation to Patient A and into the effect it had, not just on Patient A, but also on his colleague, CC. Although the Registrant had reflected on his behaviour, he appeared to minimise his culpability and at times to be making excuses for his behaviour or suggesting that he had behaved differently from what had been found proved. He appeared to fail to remember important factors if they were to his detriment.

34. The Panel found that the Registrant showed no insight into his failures in relation to Patient B. The Panel stated that dishonesty is hard to remedy and therefore there was a risk of repetition.

35. The Panel concluded that the information that the Registrant had provided about his attendance at a three-hour trauma course on 5 November 2018 and the CPD he had undertaken (which he admitted was not up to date in the past two years) was not sufficient to remedy his past actions. The Panel noted that the Registrant accepted that he would be required to undergo considerable re-training and develop a portfolio before being able to practise as a paramedic, as he had been practising as an Ambulance Technician since shortly after his disciplinary hearing.

36. The Panel further concluded that there would be a serious impact on public confidence in the profession and in the regulatory process if a finding of current impairment were not made.

37. In relation to sanction, the Panel stated that it had concluded that a suspension order for a period of 12 months would be sufficient to mark the seriousness of the conduct and to allow the Registrant to demonstrate to a future panel that he has developed further insight and undertaken appropriate training.

The First Review

38. The matter was first reviewed on 22 July 2020 where the reviewing Panel noted that “the Registrant has provided no information as to any remedial steps he may have taken during the suspension period. The information provided by his representative suggested that the Registrant remained in employment as an Ambulance Technician, but no testimonials or information about training or maintenance of his CPD had been provided. The Panel was also mindful that there was a finding of dishonesty against the Registrant, in respect of particular 3(c) and that dishonesty is a more difficult issue to remedy. There was no evidence before the Panel that there has been any attempt by the Registrant to do so.”

39. The reviewing Panel concluded that the Registrant’s fitness to practice remained impaired on both the private and public component and determined to impose a further period of suspension of 12 months. The Panel noted that it “carefully considered whether, given the absence of engagement by the Registrant to date, a striking off order would be appropriate. However, it concluded that a further period of suspension would allow the Registrant a further opportunity to address the issues in this case and to provide evidence to the future reviewing panel.”

Decision

40. The Panel took into account the submissions on behalf of the HCPC and accepted the advice of the Legal Assessor. Mr Mullen submitted that the Registrant was plainly afforded the opportunity to provide evidence of any meaningful remediation which he has failed to do. In addition, Mr Mullen reminded the Panel of the finding in respect of the Registrant’s dishonesty and the serious impact on the profession and public confidence in the profession if a finding of impairment was not made. Mr Mulllen submitted that the Registrant had failed to engage with the review process and that a further period of suspension would serve no purpose and that the only course of action would be a striking off order. The Panel was referred to the HCPTS Practice Notes, Finding That Fitness to Practise is Impaired and Reviews of Article 30 Sanction Orders (June 2018), and to the HCPC Indicative Sanctions Policy.

41. The Legal Assessor reminded the Panel that it should consider the submissions but should reach its own decision having conducted a comprehensive review of the current order.

42. The Panel should first consider whether the Registrant’s fitness to practise remained currently impaired.

43. The Panel observed that the substantive hearing panel of 2019 was of the view that the issues found proved were potentially capable of being remedied. However, both for the first review and this review, the Registrant has provided no information as to any remedial steps he may have taken during the suspension period. The information provided by his representative suggested that the Registrant remained in employment as an Ambulance Technician, but no testimonials or information about training or maintenance of his CPD had been provided. The Panel was also mindful that there was a finding of dishonesty against the Registrant, in respect of particular 3(c) and that dishonesty is a more difficult issue to remedy. There was no evidence before the Panel that there has been any attempt by the Registrant to do so.

44. The Registrant had also not provided the information suggested by the previous Panels in their decisions. The Panel noted that the Registrant has not engaged with the Regulator. In short, therefore, the Panel had no other up to date information as the Registrant’s current fitness to practice. In these circumstances, the Panel concluded that the Registrant’s fitness to practise remained currently impaired in respect of the personal component.

45. The Panel also found impairment in respect of the public component. It concluded that members of the public would be concerned if the Registrant, whose identified failings had not been addressed and who posed a potential risk to the public, were found not to be impaired. Public confidence in the profession and the regulatory process would be undermined.

46. The Panel therefore concluded that the Registrant’s fitness to practise remains currently impaired on the grounds of public protection and the wider public interest.

47. 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.

48. 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.

49. The Panel concluded that a Conditions of Practice Order would not be appropriate or workable, as the Registrant had not provided any evidence that he has developed insight and, given his lack of engagement with the reviews, the Panel could not have confidence that he would comply with conditions. The Panel considered that conditions would not be workable or appropriate until the issues have been addressed.

50. The Panel next considered a further period of suspension. It noted the contents of the email from the Registrant’s representatives dated 14 July 2021 in which they state that the Registrant has advised them he will be “retiring permanently in a few months.” The Panel noted that the Registrant had indicated he would not be engaging in the process of remediation and that his intention was to retire. The Panel determined that a further period of suspension and would serve no useful function in light of the Registrant’s declared intention not to engage.

51. The Panel determined that in all the circumstances the only appropriate and proportionate order would be a striking off order. The Registrant does not wish to engage with the remedial work expected of him to address the nature and gravity of the concerns; he has not engaged with the review process and any other outcome would not be proportionate weighing up his interests with that of the public interest which includes that of service users.

ORDER: The Registrar is directed to strike the name of Mr Daniel Lauder from the Register on the date this Order comes into effect

The Order imposed today will apply from 29 August 2021.

History of Hearings for Mr Daniel Lauder