Samuel Heenan

Preliminary Matters

Service & Proceeding in Absence

1. The Panel was satisfied that notice of today’s hearing had been properly served on 25 February 2021 by email on the Registrant at his email address registered with the HCPC.

2. The Panel considered Mr Bridges’ application to proceed in the Registrant’s absence. He reminded the Panel it has found good service. The Registrant had e-mailed the HCPC on 12 July 2021 to advise that he would not be attending the final hearing and providing a written statement. He submitted that the Registrant had voluntarily absented himself and that it was in the public interest to proceed. There was no application to adjourn.

3. The Panel is aware that its discretion to proceed in absence is one which should be exercised with the care. The Legal Assessor referred the Panel to GMC v Adeogba [2016] EWCA Civ 162 which makes clear that the first question the Panel should ask is whether all reasonable efforts have been taken to serve the Registrant with notice. Thereafter, if the Panel is satisfied about notice, the discretion whether or not to proceed must be exercised having regard to all the circumstances of which the Panel is aware, with fairness to the Registrant being a prime consideration, but with fairness to the HCPC and the interests of the public also taken into account.

4. The Panel determined to proceed in the Registrant’s absence as it is satisfied that it is appropriate to do so. In reaching this decision, the Panel has noted there has been no request for an adjournment and it noted the email from the Registrant where he clearly states that he will not be attending. It balanced fairness to the Registrant with fairness to the HCPC and the public interest and concluded that the Registrant has voluntarily absented himself. In these circumstances the Panel is satisfied that it is fair and appropriate to proceed in the Registrant’s absence.

Application to Amend

5. Mr Bridges for the HCPC applied to amend the Allegation. He submitted that the amendments all seek to better reflect the witness evidence, were minor and did not increase the gravity of the Allegation. The Registrant had been given notice of these proposed amended Allegations in a letter dated 29 July 2020, and he had not objected and had since made a written response to the proposed, amended Allegation.

6. The proposed amendments to the Allegation, Particulars 1, 2, 4, 5, 6 ,8, 11 and 12 are as follows: -

“1. Between 17 and On 18 November 2018, you did not provide adequate clinical management intervention to a non-conveyed patient you attended to, in that with respect to incident:

a. you did not get a peak flow reading from the patient before and/or after treating them with a nebuliser; and/or

b. did not conduct and/or record a second set of observations on the patient.

2. Between On 17 and 18 November 2018, you did not adequately complete Patient Clinical Report Forms with respect to a non-conveyed patient you attended to, in that, with respect to incident 1534, you did not conduct and/or document a second set of observations.

4. On 18 November 2018, you:

a. told Colleague A not to record the first two blood pressure readings for a patient; and/or

b. overwrote a blood pressure reading in primary observations section on a Patient Clinical Record without striking through, initialling the change and/or providing the reason for the change in the free text box.

5. Between 17 and 20 November 2018, you did not communicate professionally, in that:

b. While driving to an incident you said “I bet they’re are a scroates, living here” or words to that effect.

d. You referred to an incident you had attended to jobs as a “pile of crap”, or words to that effect.

e. While attending to a patient, you asked them patient’s mother if it was their car in the drive and why they had not driven to A&E, or words to that effect.

6. On or around 20 November 2018, you accessed confidential information relating to a patient without authorisation and/or clinical reason to do so.

8. You did not communicate appropriately and/or maintain professional boundaries in relation to Colleague A, in that

11. On 17 May 2017, you left the drugs cupboard and/or room where the drugs cupboard is located unsecured.

12. While working as a Paramedic for South East Coast Ambulance Service NHS Trust on dates before December 2016 between 8th September 2014 and 18 April 2019, you posted inappropriate content to your Facebook page, in that:…”

7. The Panel took advice from the Legal Assessor. He advised that the Panel has discretion to allow amendment but must be mindful of the interests of justice and the need to ensure fairness to all parties. It should consider whether the changes proposed are significant and whether they alter the nature or gravity of the Allegation. The Panel should also be mindful of the public interest.

8. The Panel considered all the amendments could be allowed. They did not materially alter the nature or the gravity of the Allegation and were relatively minor changes to better reflect the witness evidence. Further, the Registrant is aware of the proposed changes, receiving notice in July 2020, and he has not objected but has since responded to the Allegation. The Panel decided it was fair and appropriate to allow the application to amend.

9. The Panel noted the Registrant’s written admission to the Allegation and misconduct but was mindful that it was for the Panel to assess all the evidence and decide whether the Allegations are proved on the balance of probabilities, the burden of proof being on the HCPC.

10. The Panel heard from four witnesses for the HCPC:

• Samuel Garman - Investigating Officer (in respect of Particular 12)
• Clive Burvill - Investigating Officer (in respect of Particulars 10 and 11)
• Colleague A - Melissa Wale
• Andrew Paterson - Investigating Officer.

Background

11. The Registrant is a Paramedic who was employed by South East Coast Ambulance Service NHS Foundation Trust (“the Trust”) as a Band 6 Paramedic between 8 September 2014 and 18 April 2019. On 19 November 2016, it came to the Trust’s attention that the Registrant had made a number of inappropriate posts on his Facebook page.

12. Samuel Garman, Acting Clinical Team Leader, subsequently conducted an investigation into this matter and the case proceeded to a disciplinary hearing, which took place on 5 May 2017.

13. On 17 May 2017, it was reported that the drugs cabinet and the room where the drugs cabinet is kept had both been left open at Guildford Station, with the Registrant having been the last person to have accessed the drugs cabinet. An internal investigation conducted by Clive Burvill, an Operations Manager, followed and a disciplinary hearing in respect of this matter took place on 5 September 2017.

14. On 26 November 2018, the Trust received a complaint from Melissa Wale (Colleague A), a student Paramedic regarding the Registrant’s behaviour during shifts on 17 and 18 November 2018. Andrew Pattison, an Operations Manager, was appointed as Investigating Manager and an internal investigation into the Registrant’s conduct followed. During the investigation, it came to a light that there were a number of other issues with the Registrant’s conduct that were not covered by the complaint; these were subsequently added to the remit of the investigation. However, prior to its conclusion, the Registrant resigned from his role at the Trust.

15. The concerns are those as set out in the particulars of the Allegation which essentially allege that the Registrant made errors in his practice, breached confidentiality, made inappropriate comments to Ms Wale, left a drug cabinet unlocked and that he also repeatedly made inappropriate posts on social media about a number of service users.

Witness 1 - Samuel Garman

16. Mr Garman took the affirmation and adopted his witness statement as his evidence. He is a registered Paramedic and operations manager at the South East Coast Ambulance Service NHS Foundation Trust (“the Trust"). He investigated and conducted a fact finding interview with the Registrant regarding Allegation Particular 12, the Facebook posts.

17. In his witness statement Mr Garman states that on 19 November 2016 he had been working with a colleague who had informed him that she had some concerns over recent inappropriate posts she had seen on Facebook by the Registrant. Mr Garman then viewed the Registrant’s Facebook account and had immediate concerns with the posts he saw there. Due to the nature of the posts and amount of posts he had approached his Clinical Operations Manager, Andrew Pattison on 1 December 2016 to seek advice. Andrew Pattison requested that Mr Garman undertake an investigation and conduct a fact finding meeting with the Registrant.

18. On 28 December 2016, Mr Garman and a colleague met with the Registrant and conducted a formal fact finding meeting. Notes of the meeting were made and are produced in the exhibits bundles. During the meeting, the Registrant was shown the screenshots from Facebook and he was asked whether this was his Facebook account and if he was the only person who had access to it. The Registrant confirmed that it was his account and that he was the only person with access to it. Mr Garman stated that the Registrant did not appear to understand the Trust policy and said that he thought the posts would raise morale and were humorous. Mr Garman stated that he felt the Registrant’s response during the meeting demonstrated a lack of awareness of the Trust's values, its policies and procedures, and his responsibilities as a HCPC registered professional. He also lacked an understanding of how the posts may be perceived by the public. The Registrant agreed to remove the posts.

19. Mr Garman told the Panel that the meeting notes that were taken at the two fact finding meetings were taken at the time and they were subsequently agreed by the Registrant although not signed. These notes are exhibited.

20. On 31 January 2017, Mr Garman met with Samuel Heenan for a second fact finding meeting and asked some more questions about the social media posts. Following the fact finding meetings, Mr Garman and a colleague collated an investigation report, which covered both the social media concerns and the other issues raised, and this was submitted to Jo Crerar, the Operational Unit Manager. A copy of the report is exhibited (the conclusions redacted). The case then proceeded to a disciplinary hearing which took place on 5 May 2017.

Witness 2 – Clive Burvill

21. Mr Burvill took the affirmation. He is a registered Paramedic employed by South East Coast Ambulance NHS Foundation Trust ("the Trust") as an Operations Manager since 2006. He was referred to and accepted his witness statement was true and accurate. He told the Panel about the Allegation, Particulars 10 and 11 regarding the incident on 17 May 2017, when it is alleged, the Registrant did not obtain a witness signature in the controlled drugs logbook and left the drugs cupboard and room unsecure.

22. Mr Burvill explained the position of the drug cabinet in the Guildford station. He stated that the drug office is through the small office within the station and that the locked drug cupboard contained morphine and other controlled drugs.

23. Mr Burvill stated in his witness statement that the controlled drugs book was on the desk in the drugs room and had been signed by the Registrant, but his signature had not been witnessed. He stated that it is standard procedure at the Trust that when a Paramedic signs out controlled drugs at the start of their shift, they need to have their signature witnessed. The witness should verify that the count of the stock and the drugs being signed out are correct. The witness is normally the Paramedic's crew mate, but Mr Burvill said that it can be anybody who is on the station at the time.

24. Mr Burvill stated that the Registrant and a colleague had started their shift at 10:00 am and the CAD records confirmed that they received an emergency call about 20 minutes after the start of their shift. He stated that the Registrant therefore had plenty of time to remove the controlled drugs without any compromise to procedure, and to have his signature witnessed. He said that all crews are given 15 minutes of protected time at the start of their shift to get their drugs, check the vehicle and to complete other house-keeping tasks.

25. The Registrant later informed Mr Burvill that when they were mobile and en-route to a second call he had remembered that he had left the drugs room open. The Registrant had said that he had tried to contact his team leader, other crews and the control room to ask for someone to go over and secure the room. He could not have turned back at that point because he was on a call.

26. Mr Burvill also referred to the Medicines Management Manual in force at the time of the concerns and the Standard operational procedures (SOP). The policy at the time did not require a witness signature. He stated that, as a result of a subsequent CQC inspection, an SOP was later applied that contained a requirement to have controlled drugs signed out with a witness signature and they had all received training in that process.

Witness 3 - Colleague A / Melissa Wale

27. Ms Wale affirmed and accepted that her witness statement was true to the best of her knowledge and belief. She is a registered Paramedic and at the time of the Allegation she was a student, and the Registrant was her mentor. She referred to her statement and her notes made at the time of the alleged incidents.

28. In November 2018 Ms Wale had been on placement with the Registrant, and her placement had started in October or November 2018, being her second year as a BSc (Hons) paramedic science student. As such she would not be the clinical lead. Ms Wale told the Panel that she had concerns about some of the Registrant’s behaviour and had reported her concerns to Andrew Pattison. She told the Panel about the alleged incident when she had been told by the Registrant not to record the first two blood pressure readings for a patient and she referred to the observations recorded at the time with a systolic blood pressure of 171, she said that she had already written down the initial blood pressure reading by the time the Registrant had said that. However, she recalled that the Registrant had used his own blood pressure cuff to take the reading and had subsequently overwritten the diastolic entry with his later reading, changing a 125 to 105.

29. Ms Wale told the Panel about the comments she heard the Registrant make about “scroats”; calling a patient a “pansy” and the job being “a pile of crap.” Ms Wale also told the Panel about the series of text messages that she had received on 20 November 2016 from the Registrant telling her about the treatment given to a fellow student and she referred to the screenshots in the exhibits bundle. She said she had felt uncomfortable and embarrassed about the manner and tone of the texts from the Registrant.

30. Ms Wale told the Panel about incident 597 on 18 November 2016 when she attended with the Registrant with a patient having an asthma attack. She was a student at the time and said she had concerns that proper observations had not been taken by the Registrant and the job had felt “very rushed” and no peak flow reading was taken. She also told the Panel about the incident when the Registrant had rushed from a call to get breakfast. She said that he seemed to have little patience for less serious calls and to prefer category 1 or 2 calls, the most serious calls.

31. Ms Wale told the Panel about incident 1534 regarding a child with breathing problems. She recalled it was had been a 111 call. The mother had answered the door with the child, who appeared generally well and smiling. She said in her witness statement that the Registrant had been sarcastic and had asked the patient's mother "is that your car in the drive?" and then looked at the child and said "Oh! Well you don't look very unwell!". She said that his conduct had really bothered her. The mother seemed slightly taken aback, then apologised and made a comment about the child having improved slightly since she first called. She said that the Registrant had then thoroughly assessed the child and was fairly patient and reassuring with the mother. She said that he had said to the mother, with reference to the 111 NHS call staff, that “they were a bunch of monkeys”.

32. Ms Wale said that she would not have wanted the Registrant to treat a member of her family and that she had felt she was not learning from him.

Witness 4 - Andrew Pattison

33. Mr Pattison affirmed and accepted that his witness statement was true to the best of his knowledge and belief. He is a registered Paramedic at the Trust.

34. In his witness statement, Mr Pattison states that he conducted an investigation into the Registrant’s conduct and the Allegations about inappropriate comments, Facebook posts, blood pressure readings, incidents 1534 and 597, breach of confidentiality, and the Allegation about taking breakfast before booking clear with the control room. He had interviewed Ms Wale and the Registrant.

35. Regarding incident 597, Mr Pattison told the Panel that the Registrant had gone for breakfast before “booking clear” with the control room first, meaning that they would conclude that the crew was not available to assist on another call and that had occurred for 12 minutes.

36. Mr Pattison told the Panel about the significance of peak flow readings and the need for a second set of observations for asthma patients. He also explained the role of mentoring and the need to maintain an appropriate relationship with students.

Closing Submissions for the HCPC

37. Mr Bridges closed the case. He summarised the evidence and referred to the time line produced by him to cross reference the evidence to the Allegation. He submitted that all the witnesses were credible and reliable, and he reminded the Panel of the Registrant’s admission to all the Particulars in his email of 8 June 2021. He stated there that the Registrant had apologised and stated, “I do not deny any of the evidence put forward”. The Registrant had also accepted the Allegation amounted to misconduct.

38. Mr Bridges referred to the case law and guidance on misconduct and impairment and to the standards breached by the alleged misconduct. He submitted that if the conduct alleged in any, or all of particulars 1 to 12 are found proved, this established that the Registrant had acted in a way which fell far short of what would be proper in the circumstances and what the public would expect of a HCPC registered Paramedic. In doing so, he submitted that the Registrant has breached Standards 1, 2, 5, 6 and 10 of the HCPC Standards of Conduct, Performance and Ethics (2016).

39. Mr Bridges submitted that the Registrant has shown a level of insight but there was little evidence of remediation. He also reminded the Panel of the need to consider the wider public interest. He invited the Panel to find misconduct and that the Registrant’s fitness to practise was impaired on both the personal and public component.

Decision on Facts

40. The Legal Assessor reminded the Panel of the need to assess and weigh all the evidence carefully on the balance of probabilities. He reminded the Panel that misconduct and impairment were both matters for its own professional judgment. On misconduct, he reminded the Panel of the guidance in Roylance v GMC (No. 2) [2000] 1 AC 311; and on impairment he referred to the HCPTS Practice Note on Impairment and to the guidance in CHRE v NMC and Grant [2011] EWHC 927 (Admin). He referred to the importance of considering the Registrant’s insight, remediation and the risk of repetition. He reminded the Panel of the central importance of considering the wider public interest in maintaining confidence in the profession and upholding proper professional standards.

41. The Panel accepted the legal advice, and it considered all the evidence before it including the exhibit bundles, the written submission from the Registrant and the evidence of the four witnesses. It was mindful that although the Registrant has admitted all the facts and misconduct, both mattes remained a matter for the judgement of the Panel.

42. The Panel found all the witnesses credible and reliable. All of the witnesses were knowledgeable, open, consistent and keen to assist the Panel. In particular, the Panel was impressed by Ms Wale who was candid and was willing to assist the Panel even where that had the potential to reflect poorly on her, although the panel found that it did not, and she sought to accept a level of responsibility that, as a student, the Panel considered was beyond her remit.

43. The Panel found the time line of assistance when considering all the evidence in this lengthy Allegation.

44. The Panel found the following in respect of each particular of the Allegation:

1. On 18 November 2018, you did not provide adequate clinical intervention to a non-conveyed patient you attended to, in that with respect to incident 597:
a) you did not get a peak flow reading from the patient before and/or after treating them with a nebuliser; and/or
b) did not conduct and/or record a second set of observations on the patient.

Particular 1a) Proved; 1b) Not Proved

45. The evidence of both Ms Wale and Mr Pattison was that a peak flow was not obtained from the patient. The incident support forms also confirm that. The Panel, however, found both witnesses stated that there was a second set of observations taken and recorded including a second heart rate, respiratory and oxygen saturations. Both witnesses stated that blood pressure would have been beneficial. The Panel therefore found 1a) proved, but 1b) not proved.

2. On 17 November 2018, with respect to incident 1534, you did not conduct and/or document a second set of observations.

Particular 2 Proved

46. The evidence of Ms Wale and Mr Pattison support this Particular. Ms Wale directly observed the position and reported the issue to her lecturer who reported it to Mr Pattison. Ms Wales’s contemporaneous notes were also consistent with her recollection in oral evidence.

3. On 18 November 2018, after leaving the scene of an incident, you drove to get breakfast before booking clear from the scene.

Particular 3 Proved

47. The evidence of Ms Wale and Mr Pattison support this, Ms Wale being on the call with the Registrant, and this is supported by the automatic vehicle location evidence before the Panel.

4. On 18 November 2018, you:
a) told Colleague A not to record the first two blood pressure readings for a patient; and/or
b) overwrote a blood pressure reading in primary observations section on a patient clinical record without striking through, initialling the change and/or providing the reason for the change in the free text box

Particular 4a) and b) Proved

48. Ms Wale’s evidence was that she directly observed the Registrant, and she was told not to record the first two readings and the Registrant then overwrote the entry. She was sure in her oral evidence that the writing was not hers and was likely the Registrants handwriting. Her oral evidence was consistent with her witness statement.

5. Between 17 and 20 November 2018, you did not communicate professionally, in that:
a)After departing from an incident, you referred to the patient you had just attended to as a “pansy” or words to that effect; 
b) While driving to an incident you said “I bet they’re a scrote, living here” or words to that effect;
c) While driving to an incident you said “we should leave our lights and sirens on outside the house to embarrass the patients” or words to that effect;
d) You referred to jobs as a “pile of crap”, or words to that effect; 
e) While attending to a patient, you asked the patient’s mother if it was their car in the drive and why they had not driven to A&E, or words to that effect;
f) You referred to a patient as a compulsive liar, or words to that effect.

Particular 5a) - f) Proved

49. Ms Wale’s witness statement supports a) - f) of this Particular and it is admitted by the Registrant. She also confirmed in her oral evidence her recollection of the “pansy” comments. Particular f) is also referred to in the Facebook messages from the Registrant to Ms Wale seen by the Panel.

6. On or around 20 November 2018, you accessed confidential information relating to a patient without authorisation and/or clinical reason to do so.

7. Between 19 and 20 November 2018, you disclosed confidential information about a patient to Colleague A.

8. You did not communicate appropriately and/or maintain professional boundaries in relation to Colleague A, in that:
a) On 20 November 2018, you wrote to Colleague A on Facebook Messenger, saying “Shame you weren’t there tbh it would have been hilarious. You could have done a rectal exam on him”, or words to that effect.

Particulars 6, 7 & 8 Proved

50. This is supported by Ms Wales in oral evidence, in her witness statement and by the Facebook messages from the Registrant to Ms Wale all support these particulars. There was no evidence of authorisation or evidence of any clinical reason for accessing the information. Disclosure in Particular 7 is supported by the Facebook messages. Ms Wale stated in her oral evidence that she was taken aback and embarrassed by receiving the message at Particular 8a) from the Registrant. The Panel also had sight of the Facebook message sent by the Registrant to Ms Wale in respect of 8a). The Panel found that the message was both inappropriate and breached professional boundaries.

9. During the fact-finding interview on 11 January 2019, you admitted to using an automatic blood pressure device on patients without knowing how old it was or when it had last been calibrated.

Particular 9 Proved

51. The Registrant has admitted this Particular. This Particular is supported by Mr Pattison in his witness statement with reference to the meeting notes, which Mr Pattison confirmed in his oral evidence were accurate.

10. On 17 May 2017, you did not obtain a witness signature in the controlled drugs logbook.

Particular 10 Proved

52. Mr Burvill in his statement said that there was no witness signature in the controlled drugs logbook.

11. On 17 May 2017, you left the drugs cupboard and/or room where the drugs cupboard is located unsecured.

Particular 11 Proved

53. Mr Burvill in his witness statement supports this Particular and he referred to photographic evidence he had seen in that regard. His evidence was that both the cupboard and the room were left unsecured. However, the Panel noted that his evidence was that the control drugs safe was not unsecured, and that the Registrant had later realised and called back to control room to advise. The station itself was secured and only authorised staff had access to the station. The Registrant admitted the Particular.

12.While working as a Paramedic for South East Coast Ambulance Service NHS Trust on dates before December 2016, you posted inappropriate content to your Facebook page, in that:
a) You posted an image of yourself parked behind an ambulance, with the caption, “Not only do we stack in A&E, we stack up outside coffee shops” or words to that effect.
b) You posted an image of yourself holding a knitted object, with the caption, “Always appreciative of patients who knit you a very generously oversized willy warmer” or words to that effect.
c) You posted an image of a steering wheel with a Pokémon on it on, with the caption, “Standard shift saving the world and training to become a Pokémon master” or words to that
d) You posted, “When you work with Colleague H and she is asked by a drunk woman how old she thinks she is and Colleague H overestimates and you feel like you should step in before a fight breaks out in the ambulance” or words to that effect;
e) You posted, “First patient of the night took themselves to A and E decided that the 4 hour wait was too long so drove home and called an ambulance thinking we could help so we politely informed them that they should make their way back to the A and E….Please be sensible tonight people” or words to that effect;
f) You posted, “People ask me what I have achieved at work today so I inform them that I have been enforcing traffic law, scaring people driving using their phone and writing fake speeding tickets. All in a day’s work for an undercover paramedic” or words to that effect;
g) You posted an image of yourself pointing at a stop sign, with the caption, “I think it’s about time we stopped taking emergency(ish) calls now as there are no ambulances to send and no beds in A and E” or words to that effect;
h) You posted, “What I learned at work today, “vigorous sex can exacerbate pain caused by kidney stones” (Patient at al. 2016)” or words to that effect;
i)You posted, “Shout out to the woman who dreamt that her husband had forgotten his medication so called an ambulance in the middle of the night” or words to that effect.
j) You posted, “A call came through on the screen earlier to a 30s-year-old male 14 weeks pregnant. The first time I’ve questioned my anatomy and physiology knowledge in my 2 years as a paramedic” or words to that effect;
k) You posted, “When your patient calls 999 for “chest pain” and you ask what they have been doing and they respond with “well I was playing boxing on the (Nintendo) Wii”. The doctor understandably confused when I informed him that the patient had been playing with her Wii for most of the day” or words to that effect;
l) You posted, “Got a call to a patient who was complaining of a 3 week history of “having smelly poos”. I’m struggling to see the emergency here as many of us have experienced a lifetime of this issue” or words to that effect;
m) You posted an image of the ambulance’s MDT screen showing the details of a call, with the caption “Good old general public, can’t decide if patient is having a seizure or eating a sandwich but calls the ambulance anyway just to be sure the patient is satisfied with their ham sandwich from the Sainsbury’s meal deal” or words to that effect;
n) You posted an image of the ambulance’s MDT screen showing the details of a call, with the caption “Just want to clarify a few things about this emergency call:
  i. Firstly a paper cut on your neck does not count as a stab
  ii. Secondly: A paper cut on the neck does not justify an emergency ambulance
  iii. Thirdly: How do you even get a paper cut on your neck?!
  iv. Fourthly: It’s lucky the assailant was not present on scene as I would not want to fight a guy armed with a sheet of A4” or words to that effect.

Particular 12a) - n) Proved

54. The Registrant has admitted this Particular a) – n). The Panel had sight of all the screenshots for each post for each Particular. In addition, there was evidence from the interview that Mr Garman had with the Registrant when he admitted the posts were sent by the Registrant from his Facebook account to which only he had access.

Decision on Grounds - Misconduct

55. The Panel accepted the legal advice and the guidance in the Roylance case. Misconduct is a word of general effect “involving some act or omission which falls short of what would be proper in the circumstances."

56. With regard to Particular 1a), the Panel considered the oral evidence of Ms Wale and Mr Pattison about peak flow tests not being essential and that it was not always indicated. Although it was indicated in this case, the Panel heard that some clinicians do not conduct this test and there are alternatives. The Panel took the view that its finding on this Particular, taken alone, does not meet the threshold for misconduct and would not be considered deplorable by fellow members of the profession.

Particular 4a)

57. The Panel considered the evidence of Ms Wale and Mr Pattison about the issue of a reading not matching the clinical picture of a patient. It heard that it is acceptable in some circumstances to re-do a blood pressure reading if you consider it may be inaccurate. The Panel therefore concluded that Particular 4a) does not amount to misconduct.

Particular 9

58. Particular 9 concerns the Registrant’s admission of his actions, which were clinically inappropriate. The Panel decided that this admission of an error was in fact an honest statement, and therefore does not amount to misconduct.

Particular 10

59. There was no evidence that a witness signature was a requirement at the time. It may have been in a standard operating procedure, but the Panel did not have sight of the SOP. The Medicines Management manual contains guidance and policy but does not require a witness signature for controlled drugs in these circumstances. That issue is only mentioned in the administration, wastage and return of out of date stocks of morphine. In the circumstances, the Panel concluded that Particular 10 does not amount to misconduct.

Particular 11

60. The Panel heard evidence about the storage room and drug safe. There was no issue or evidence that the Registrant allowed any unauthorised access to the storage room or to the controlled drugs. The Registrant tried to address the issue as soon as he realised later that day, and he contacted the control room. The Panel concluded that in these circumstances Particular 11 does not amount to misconduct.

61. The Panel found the Registrant breached the following HCPC standards: 1.1, 1.5, 2.1, 2.5, 2.7, 5.1, 5.2 and 9.1 of the HCPC Standards of Conduct, Performance and Ethics (2016).

62. The Panel concluded that the remainder of the Allegation found proved is conduct that falls far short of what would have been proper in the circumstances and concluded that it amounts to misconduct. The Registrant breached patient confidentiality, which encompasses the fundamental professional tenets of trust and integrity. In addition, his comments and conduct when working with Ms Wale, particularly bearing in mind his role as her mentor, as well as his repeated Facebook posts were deeply inappropriate, disrespectful and unprofessional. The Registrant’s conduct would be considered deplorable and is conduct which the Panel found amounted to misconduct.

Decision on Impairment of Fitness to Practise

63. The Panel was mindful of the guidance in the Grant case and the HCPTS Practice Note on Impairment. It considered the tests as expressed in Grant and it was mindful of the public interest.

64. The Panel found that whilst the Registrant has apologised, he has not demonstrated insight into the impact of his conduct on patients, colleagues and the wider public. His conduct and the comments he made to Ms Wale, and his repeated inappropriate posts on Facebook were crass and profoundly disrespectful of patient dignity, colleagues, his profession and NHS staff. The Registrant appears to have given little or no thought to his behaviour and conduct its impact. This conduct had the potential to place patients at risk of harm, harm including not just physical harm but emotional harm.

65. The Panel considered the finding in respect of the breach of patient confidentiality showed a further aspect of the Registrant’s lack of insight and his lack of recognition and understanding of the fundamentals of patient dignity and trust. In breaching patient confidentiality, he abused the trust placed in him as a Paramedic.

66. The Panel found that there is no evidence of remediation. Whilst the Registrant continues to work in a health care setting, he has demonstrated limited insight and no apparent remediation. There is little evidence beyond his apology and admissions, that he has meaningfully reflected on his conduct and sought to recognise and take any steps to remedy his misconduct. In all the circumstances, the Panel concluded that there is a real risk of repetition of his misconduct and that the Registrant’s fitness to practise is impaired on the personal component.

67. On the public aspect of impairment the Panel was mindful of the Grant guidance in Grant :-

“However it is essential, when deciding whether fitness to practise is impaired, not to lose sight of the fundamental considerations…. namely the need to protect the public and the need to declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession.”

68. The Panel decided that a reasonable and well informed member of the public would be concerned, in light of the nature and gravity of the findings of fact and misconduct, were a finding of impairment not made. Were that finding not to be made, it would undermine public confidence in the profession and the Regulator and would also fail to uphold and declare proper professional standards.

69. The Panel accordingly concluded, given the lack of developed insight and any evidence of remediation, that the Registrant:-

a) has in the past acted, and is liable in the future, to act so as to put a patient or patients at unwarranted risk of harm;

b) has in the past brought and is liable in the future to bring the profession into disrepute; and

c) has in the past breached and is liable in the future to breach one of the fundamental tenets of the profession, that of trust, respect and the recognition of the dignity of patients and colleagues.

70. The Panel therefore concluded that the Registrant’s current fitness to practise is impaired on both the personal and the public component

Decision on Sanction

71. The Panel heard from Mr Bridges. He referred to the HCPC’s Sanctions Policy and submitted that the HCPC was neutral as to sanction. He referred to paragraphs 10 and 11 of the Policy and reminded the Panel the purpose of sanction was public protection. He referred to the Panel’s finding of a risk of repetition and a lack of insight and remediation by the Registrant. Mr Bridges submitted that a Caution Order or a Conditions of Practice Order required insight.

72. The Panel accepted the advice of the Legal Assessor to consider the HCPC Sanctions Policy. He reminded it to act proportionately and to consider sanction in ascending order and apply the least restrictive sanction necessary to protect the public and the public interest. It may consider any aggravating and mitigating factors and should keep in mind the public interest and that the primary purpose of sanction was protection of the public.

Mitigating and Aggravating Factors

73. The Panel accepted the legal advice and considered the Sanctions Policy. It identified what it considered to be the principle mitigating and aggravating factors in this case.

74. The mitigating factors identified were: -

i. The admission of the entire Allegation and misconduct

ii. Apology and some evidence of insight.

iii. Some recognition of the impact off his conduct on the wider profession

iv. No evidence of any previous fitness to practise concerns

v. No evidence of any patient harm

75. The Panel found the following aggravating factors: -

i. Multiple and wide ranging deficiencies in several aspects of practice, over a significant period of time.

ii. A number of the incidents of misconduct were in the presence of the student he was mentoring and there was an additional responsibility therefore to model professional conduct.

iii. Disparaging colleagues and NHS staff in the presence of patients or members of the public.

76. The Panel approached sanction beginning with the least restrictive first, bearing in mind the need for proportionality. Taking no further action and the sanction of a Caution Order would not reflect the seriousness of the Allegation found proved and the finding of impairment. Further, these would not be adequate given the wider public interest in maintaining confidence in both the profession and the regulatory process and upholding proper professional standards. Neither order is sufficient, appropriate or proportionate in the circumstances of this case.

77. The Panel next considered a Conditions of Practice Order. The Panel considered paragraphs 106 -108 of the Sanctions Policy. The Allegation found proved is serious and the Panel has found a risk of repetition. The findings are in large part attitudinal and wide ranging and include a breach of a fundamental tenet, namely integrity. The competence of the Registrant is not the focus of the Allegation. The Panel has found that the Registrant has shown limited insight and no remediation and there has been limited engagement in this regulatory process. He has been found, in his comments and conduct, to have failed to work in partnership with colleagues.

78. The Panel has nothing before it to reassure it that the Registrant would respond positively or that conditions would be workable and realistic and would serve to protect the public and remedy what are essentially serious attitudinal and behavioural deficiencies. In these circumstances, the Panel found that it could not formulate a Conditions of Practice Order that would be workable, realistic, proportionate and sufficient to protect the public and the wider public interest.

79. The Panel next considered a Suspension Order. It has found serious and wide-ranging Allegations proved. The Panel considered paragraph 121 of the Sanctions Guidance. The findings represent a serious breach of the HCPC Standards of conduct, performance and ethics. The Registrant has admitted the Allegation and misconduct and he has shown some albeit, limited insight. The deficiencies found are potentially remediable and there is nothing to indicate that the Registrant is unable or unlikely to be able to resolve or remedy his failings.

80. The Panel considered a Striking Off Order and paragraphs 130 – 132 of the Sanctions Policy. Striking Off is a sanction of last resort for serious, persistent, deliberate or reckless acts. The Panel recognise that the Registrant’s conduct included elements of a failure to work with colleagues, in the sense of making disparaging remarks, failing to act professionally, particularly in his role as a mentor, and a single breach of patient confidentiality.

81. However, the Registrant has shown some insight and the Panel concluded that the findings are not at the level of seriousness or recklessness where no lesser sanction would be sufficient. The Panel decided that to impose a Striking Off Order would go further than was necessary or proportionate in order to protect the public and the wider public interest and would be punitive.

82. In all the circumstances of the case, the Panel concluded that a Suspension Order is the appropriate and proportionate sanction. This will serve to proportionately and sufficiently protect the public, maintain confidence in the profession and will serve to declare and uphold proper professional standards.

83. The Panel decided that a 12 month Suspension Order was appropriate and proportionate to mark the seriousness of the misconduct found.

84. A future reviewing panel may be assisted by the Registrant providing the following: -

i. A reflective piece fully addressing insight into his conduct and the impact on the profession, colleagues and the public

ii. Relevant references and testimonials

iii. Evidence of any relevant training and professional development

iv. Attendance at the review hearing.

ORDER: The Registrar is directed to suspend the name of Samuel Heenan from the Register for a period of 12 months

Interim Order

The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.
This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Samuel Heenan