Mr Piotr Nowakowski

Profession: Paramedic

Registration Number: PA42789

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 18/03/2021 End: 17:00 19/03/2021

Location: Virtual Hearing - Video conference

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

While registered as a Paramedic with the Health and Care Professions Council and employed with the East Midlands Ambulance Service NHS Trust, you:

1. On 11 March 2018:

a. In relation to Patient A, you:

i. Did not properly investigate Patient A’s chest pain and/or document Patient A’s OPQRSTA history within the Patient Report Form.

ii. Did not administer pain medication for Patient A’s chest pain.

iii. Did not pull the curtain closed during the abdominal and respiratory examination.

iv. Used an unrecognised cannulation method.

v. Did not gain informed consent before administering Ondansetron.

vi. Administered Ondansetron incorrectly, in that you administered it over 60-65 seconds.

vii. Did not ensure Patient A was correctly positioned on the stretcher.

viii. Administered 250mL Sodium Chloride incorrectly, in that it was not clinically indicated and/or was not administered correctly.

ix. Provided an incorrect handover to hospital by booking Patient A in with a clinical impression of dehydration.

b. In relation to Patient A, did not correctly complete the Patient Report Form in that you:

i. Did not record the patient’s gender and/or full next of kin contact details.

ii. Did not document the patient’s breathing category, pulse rate and/or if there was external or internal bleeding.

iii. Left the patient capacity section blank.

iv. Did not document your failed cannulation, or the time, location and clinician ID of the second cannulation.

c. In relation to Patient B:

i. Did not provide a clear pre-alert message to hospital.

d. In relation to Patient B, did not correctly complete the Patient Report Form in that you:

i. Did not record the patient’s pulse.

ii. Did not document that the patient was unable to give a pain score.

iii. Noted the patient had no nausea or facial and arm weakness, when they were incapable of expressing this.

iv. Did not record the route of administration of oxygen and/or Clinician ID.

e. In relation to Patient C:

i. Did not offer stronger pain medication to Patient C.

ii. Did not assess distal circulation, and/or sensation and/or movement before and/or after mobilisation and/or at skin level.

iii. Left Patient C’s Patient Report Form on the dashboard of the ambulance.

f. In relation to Patient C, did not correctly complete the Patient Report Form in that you:

i. Did not record patient GP contact details and/or next of kin details and/or if the next of kin had been informed of patient’s admission to hospital.

ii. Did not record the patient’s breathing category.

iii. Did not record the time both sets of observations were taken.

iv. Did not record oxygen saturation levels and/or the patient’s pain score on the second set of observations.

2. You did not reach the required standard in the following three assessments:

a. Paramedic Level ECG recognition test, by scoring 44%.

b. Trauma Life Support scenario.

c. Online drugs paper test, by scoring 78%.

3. The matters described in paragraphs 1-2 constitute misconduct and/or lack of competence.

4. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary Matters

Service of Notice of Hearing

1. The Panel had information before it that the Notice of Hearing was sent to the Registrant by email, dated 4 September 2020, to his email address which is recorded on the HCPC Register. The Notice confirmed that the hearing would take place by video conference. The service was by email according to HCPTS published guidance and protocol as a result of the Covid-19 pandemic.

2. In all the circumstances, the Panel was satisfied that good service had been effected in accordance with Rules 3 and 6 of the Health Professions Conduct and Competence (Procedure) Rules 2003 (the Rules).

Proceeding in Absence

3. Ms Lykourgou, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. Ms Lykourgou submitted that whilst fairness to the Registrant was of prime importance, the overarching duty to protect the public should be borne in mind by the Panel. In addition, the concerns dated from 2017 to 2018 and there were three professional witnesses who were to give live evidence in what has already been listed as a five-day hearing, and which would take time to relist if the matter were to be adjourned. Ms Lykourgou informed the Panel that the Registrant had indicated in correspondence with the HCPC that he did not wish to deal with these events in his past. Ms Lykourgou submitted that an adjournment would not resolve the matter of the Registrant’s absence and that his absence was deliberate.

4. The Panel took into account the HCPTS Practice Note entitled “Proceeding in the Absence of the Registrant” and accepted the advice of the Legal Assessor.

5. The Panel was aware that the discretion to proceed in the absence of a Registrant should be exercised with the utmost care and caution. The Panel considered the matter carefully, noting that the Registrant had agreed on 3 June 2020 to electronic service of the bundle to the email address to which Notice of today’s hearing had been sent. On 5 June 2020 the Registrant indicated that he had lost confidence in the health care institutions in England and that it was difficult for him to revisit the events which led to the Allegation. There had been no response from him since that date. The HCPC bundle was sent to the Registrant via email on 9 June 2020.

6. The Panel was of the view that the Registrant was aware of the proceedings and had voluntarily waived his right to attend. It was apparent from the correspondence between the HCPC and the Registrant that he has now returned to Poland. He had not requested an adjournment and in the circumstances of his limited engagement with the HCPC prior to the hearing, the Panel was of the view that an adjournment was unlikely to secure his attendance in the future. In all the circumstances, the Panel decided that it was fair and in the public interest to proceed today.

Applications to amend the Allegation

7. Ms Lykourgou applied to amend the Allegation in a number of respects. The proposed amendments were as follows:

While registered as a Paramedic with the Health and Care Professions Council and employed with the East Midlands Ambulance Service NHS Trust, you:

1. Consistently did not reach a level enabling you to work as an autonomous paramedic despite being on a capability plan since 30th December 2017, and oOn 11 March 2018, you:

a. In relation to Patient A, (78 Year Old Female, Chest Pains/Vomiting), you:

i. Did not properly investigate Patient A’s chest pain and/or did not document your questioning to determine pPatient A’s OPQRSTA history within the Patient Report Form (as per OPQRSTA method).

ii. You dDid not administer a pain medication for Patient A’s chest pain, despite the patient providing a pain score of 7/10.

iii. You dDid not have due regard for Patient A’s dignity by not pulling the curtain closed during the abdominal and respiratory examination.

iv. Used an unrecognised cannulation method that increased the risk of infection.

v. You dDid not gain informed consent before administering Ondansetron.

vi. You aAdministered Ondansetron incorrectly, in that you administered it over 60-65 seconds, and not within the prescribed 2 minutes in accordance with the Joint Royal Colleges Ambulance Liaison Committee guidelines.

vii. Did not ensure Patient A was correctly positioned on the stretcher to support their breathing and assist if they should vomit.

viii. When you aAdministered 250mL Sodium Chloride incorrectly, in that it was not clinically indicated and/or intravenously for dehydration, you did was not administered correctly do so over a two hour period.

ix. The primary concern of Patient A was chest pain and an adverse reaction to medication, however you pProvided an incorrect handover to hospital by booking Patient A in with a clinical impression forof dehydration.

b. In relation to Patient A, you did not correctly complete your the Patient Record Form notes by in that you:

i. Did Nnot recording the patient’s gender and/or full next of kin contact details.

ii. Did not document the patient’s breathing category, pulse rate and/or if there was external or internal bleeding.

iii. Leftaving the patient capacity section blank.

iv. Did Nnot documenting your failed cannulation, or the time, location and clinician ID of the second cannulation.

c. In relation to Patient B (83 year old female, Hot/unresponsive), you:

i. Did not provide a clear pre-alert message to hospital by not conveying the observations effectively.

d. In relation to Patient B, you did not correctly complete you’re the Patient Record Form in that you notes by:

i. Did Nnot recording the patient’s pulse.

ii. Did Nnot documenting that the patient was unable to give a pain score.

iii. Noteding the patient had no nausea or facial and arm weakness, when they were incapable of expressing this due to being unconscious.

iv. Did not record the route of administration of oxygen and/or Clinician ID not noted.

e. In relation to Patient C (male patient with hip pain), you:

i. Did not offer stronger pain medication to the pPatient C when transferring them from the chair to the Carry Chair, despite them reporting a pain score of 3/10 at rest and 10/10 on movement.

ii. asked for a pelvic splint to be used on the patient;

iii. Did not assess distal circulation, and/or sensation and/or movement before and/or after immobilisation of movement and/or at skin level.

iv. Did not respect patient confidentiality by leaving Left Patient C’s Patient Report Form personal contact details left on the dashboard of the ambulance while in view of the public at hospital.

f. In relation to Patient C, you did not correctly complete your the Patient Record Form in that you notes by:

i. Did Nnot recording patient GP contact details and/or next of kin details and/or if the next of kin had been informed of patient’s admission to hospital.

ii. Did Nnot recording the patient’s breathing category.

iii. Did Nnot recording what the time both sets of observations were taken.

iv. Did Nnot recording SPO2 oxygen saturation levels and/or the patient’s pain score on the second set of observations.

2. You did not reach the required standard in the following three assessments:

a. Paramedic Level ECG recognition test, by scoring 44%.

b. Trauma Life Support scenario, deemed a unanimous fail by the two assessors for safety reasons.

c. Online drugs paper test, by scoring 78% with 80% deemed as the pass rate.

3. The matters described in paragraphs 1-2 constitute misconduct and/or lack of competence.

4. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

8. Ms Lykourgou informed the Panel that the Registrant had been made aware of the proposed amendments in a letter from the HCPC dated 19 March 2020. She submitted that the proposed amendments did not change the scope or substance of the allegations against him.

9. The Panel accepted the advice of the Legal Assessor.

10. The Panel decided to accede to the application except for the proposed addition of Particular 1(e)(ii). The Panel was of the view that the Registrant had been given sufficient advance notice of the HCPC’s intention and noted that the proposed amendments were contained in the bundle which had been sent to him, as noted earlier in this determination. The Panel was of the view that the amendments (with the exception of Particular 1(e)(ii)) were clarificatory and did not add anything substantive to the nature and the extent of the case against the Registrant. Rather, they were more in line with the evidence. In some cases, parts of particulars were deleted to better reflect the evidence. However, Particular 1(e)(ii) was an entirely new allegation and the Panel did not consider that it was fair to the Registrant to allow its introduction on the morning of the hearing without the Registrant having any notice.

11. The Panel therefore allowed the application to amend in part.

12. Ms Lykourgou made two further applications to amend the Allegation during the hearing, and these are set out below.

13. Before her closing submissions, Ms Lykourgou applied to amend the Allegation in respect of particulars 1(b)(ii) (in relation to Patient A) and 1(d)(i) (in relation to Patient B) as a result of the oral evidence of SW.

14. In his oral evidence, SW confirmed that in relation to Patient A, the Registrant had made a record on the Patient Report Form (PRF) as to Patient A’s pulse rate but he had not made a record as to her pulse strength. He confirmed that his witness statement, which stated that the Registrant had not made a record as to Patient A’s pulse rate, was incorrect.

15. Additionally, in his oral evidence SW confirmed that in relation to Patient B, the Registrant had recorded the patient’s pulse but he had not recorded the pulse strength.

16. Ms Lykourgou therefore applied to amend Particular 1(b)(ii) to replace the word “rate” with “strength” in respect of Patient A’s pulse. Ms Lykourgou also applied to amend Particular 1(d)(i) to add the word “strength” after the word “pulse” in respect of Patient B’s pulse. Ms Lykourgou submitted that such amendments were fair and could not have come any earlier, as they arose from the evidence of SW.

17. The Panel accepted the advice of the Legal Assessor.

18. The Panel refused the application on the basis of: the lateness of the application; that the amendments as applied for introduced a new dimension to the allegations; and that the Registrant had not been given notice of the application, and therefore it would not be fair.

19. During her closing submissions, Ms Lykourgou applied to amend the references to the “Patient Record Form” in particulars 1(b), 1(d), and 1(f) because this was incorrect terminology, and that it should have been termed as “Patient Report Form” instead. Ms Lykourgou highlighted that particulars 1(a) and 1(e) correctly referred to “Patient Report Form”.

20. The Panel accepted the advice of the Legal Assessor.

21. The Panel decided to accede to the application. The amendment to “Patient Report Form” was a more accurate name for the document referred to and did not change the nature of the case or the level of its gravity in any way. The Panel decided that the Registrant would not suffer any prejudice as a result of these amendments.

22. The amended Allegation therefore is as follows.

Amended Allegation

While registered as a Paramedic with the Health and Care Professions Council and employed with the East Midlands Ambulance Service NHS Trust, you:

1. On 11 March 2018:

a. In relation to Patient A, you:

i. Did not properly investigate Patient A’s chest pain and/or document Patient A’s OPQRSTA history within the Patient Report Form.

ii. Did not administer pain medication for Patient A’s chest pain.

iii. Did not pull the curtain closed during the abdominal and respiratory examination.

iv. Used an unrecognised cannulation method.

v. Did not gain informed consent before administering Ondansetron.

vi. Administered Ondansetron incorrectly, in that you administered it over 60-65 seconds.

vii. Did not ensure Patient A was correctly positioned on the stretcher.

viii. Administered 250mL Sodium Chloride incorrectly, in that it was not clinically indicated and/or was not administered correctly.

ix. Provided an incorrect handover to hospital by booking Patient A in with a clinical impression of dehydration.

b. In relation to Patient A, did not correctly complete the Patient Report Form in that you:

i. Did not record the patient’s gender and/or full next of kin contact details.

ii. Did not document the patient’s breathing category, pulse rate and/or if there was external or internal bleeding.

iii. Left the patient capacity section blank.

iv. Did not document your failed cannulation, or the time, location and clinician ID of the second cannulation.

c. In relation to Patient B:

i. Did not provide a clear pre-alert message to hospital.

d. In relation to Patient B, did not correctly complete the Patient Report Form in that you:

i. Did not record the patient’s pulse.

ii. Did not document that the patient was unable to give a pain score.

iii. Noted the patient had no nausea or facial and arm weakness, when they were incapable of expressing this.

iv. Did not record the route of administration of oxygen and/or Clinician ID.

e. In relation to Patient C:

i. Did not offer stronger pain medication to Patient C.

ii. Did not assess distal circulation, and/or sensation and/or movement before and/or after mobilisation and/or at skin level.

iii. Left Patient C’s Patient Report Form on the dashboard of the ambulance.

f. In relation to Patient C, did not correctly complete the Patient Report Form in that you:

i. Did not record patient GP contact details and/or next of kin details and/or if the next of kin had been informed of patient’s admission to hospital.

ii. Did not record the patient’s breathing category.

iii. Did not record the time both sets of observations were taken.

iv. Did not record oxygen saturation levels and/or the patient’s pain score on the second set of observations.

2. You did not reach the required standard in the following three assessments:

a. Paramedic Level ECG recognition test, by scoring 44%.

b. Trauma Life Support scenario.

c. Online drugs paper test, by scoring 78%.

3. The matters described in paragraphs 1-2 constitute misconduct and/or lack of competence.

4. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Application to rely on hearsay evidence

23. Prior to the opening of the HCPC case, Ms Lykourgou applied to rely on hearsay evidence in the form of emails from two individuals from the East Midlands Ambulance Service (EMAS) who mentored the Registrant and who were not being called as live witnesses. In addition, Ms Lykourgou sought to rely on the notes of the Final Case Review held by EMAS on 16 March 2018 to consider the Registrant’s future with EMAS. These notes included the comments of a number of EMAS employees who were not called as witnesses. Ms Lykourgou referred to sections 1 and 4 of the Civil Evidence Act 1995.

24. The Panel accepted the advice of the Legal Assessor, who referred to the cases of NMC v Ogbonna [2010] EWCA Civ 1216, Thorneycroft v NMC [2014] EWHC 1565, and El Karout v NMC [2019] EWHC 28.

25. The Panel decided to accede to the application.

26. The first body of hearsay evidence which was the subject of the application was in the form of emails from EMAS employees to senior colleagues regarding their knowledge of the Registrant while they were his mentors. The Panel was of the view that these two mentors had direct personal knowledge and that they were writing formal letters about the Registrant. Their evidence was not the sole and decisive evidence in respect of any allegation faced by the Registrant. The Panel found that it was fair to admit their evidence and their decision. What weight to be given to the evidence would be a matter to be considered in due course.

27. The second body of hearsay evidence which was the subject of the application was in the form of comments made by a number of senior individuals in EMAS contained in the notes of the Final Case Review of the Registrant carried out on 16 March 2018. Once more, the Panel decided that it would be fair to admit this evidence. These were comments made by senior EMAS employees as part of the Registrant’s capability review. This was a formal process and their comments were documented as part of that formal process, given as part of a review of the Registrant’s future at EMAS. Once more, the Panel took into account in its decision of the fact that such evidence was not the sole and decisive evidence in respect of any allegation. The Panel found that it was fair to admit this evidence. What weight to be given to the evidence would be a matter to be considered in due course.

Background

28. The Registrant is a registered Paramedic. He is a Polish national and was recruited by EMAS as part of an international recruitment scheme. He commenced employment on 16 January 2017 and was made subject to a nine-month probationary period. During the first few months of his employment, concerns were raised about his practice, specifically in relation to his knowledge of the English language as well as his knowledge and skills as a Paramedic. In October 2017, a formal review was undertaken of the Registrant’s probation and it was determined that this would be extended for a period of two months.

29. In or around December 2017, it was decided that the Registrant would undertake a capability development programme, and he was placed on a SMART Action Plan which was intended to run for 12 weeks. On 11 March 2018 the Registrant was assessed on a “ride out” with a SW, a Clinical Support Manager. Further assessments were conducted on 14 and 15 March 2018 which raised further concerns about the Registrant’s skills and knowledge as a Paramedic.

Decision on Facts

30. The Panel heard live evidence from three HCPC witnesses, and read the HCPC bundle. The three witnesses were:

• LS, Clinical Support Manger at EMAS, who undertook observations on the Registrant’s practice;

• SW, Clinical Support Manager at EMAS, who assessed the Registrant on a “ride out” on 11 March 2018;

• SL, Clinical Support Manager at EMAS, who acted as the Registrant’s mentor during the Registrant’s 12-week SMART action plan.

31. The Registrant did not make any admissions to the Allegation and did not submit any written submissions or documents in relation to any particular of the Allegation.

32. The Panel accepted the advice of the Legal Assessor and was aware that the burden of proof in respect of each particular of the Allegation is entirely upon the HCPC to the civil standard, namely on the balance of probabilities.

The Panel’s assessment of the witnesses

33. The Panel was of the view that LS was a reliable and credible witness. He showed compassion for the Registrant, and the Panel’s view was that he was fair and balanced. The Panel considered SW to be credible and clear, and he tried to help the Panel in giving his evidence. With regard to SL, the Panel formed the view that he was credible, fair, balanced, and had got to know the Registrant and his abilities well, having been assigned to be his mentor for the 12-week SMART Action plan.

The Stem of the Allegation

While registered as a Paramedic with the Health and Care Professions Council and employed with the East Midlands Ambulance Service NHS Trust, you:

34. It was clear from the evidence of all three witnesses, as well as the copy of the Registrant’s terms and conditions of employment by EMAS, that the Registrant was employed by EMAS while he was registered as a Paramedic with the HCPC. The Panel therefore found the stem of the Allegation proved.

Particular 1(a)(i) – Proved

1. On 11 March 2018:

a. In relation to Patient A, you:

i. Did not properly investigate Patient A’s chest pain and/or document Patient A’s OPQRSTA history within the Patient Report Form.

35. The Panel took into account the evidence of SW in the form of his witness statement, his oral evidence, and the notes he made of his observations of the Registrant. The Panel also had before it the PRF of Patient A.

36. The Panel concluded that the Registrant did not document Patient A’s history within the PRF using the OPQRSTA method, which is a mnemonic to aid in the taking of a full history within the PRF. OPQRSTA stands for Onset, Provocation, Quality, Radiation, Severity, Timings, and Associated symptoms. The Panel noted the oral evidence of SW that OPQRSTA is one of a number of such mnemonics that could be used; however, there was no evidence of any appropriate mnemonic being used on Patient A’s PRF. The information required either by the OPQRSTA or another such mnemonic was not fully recorded on the PRF. Therefore, the Panel found that the Registrant did not properly investigate the chest pain.

37. The Panel therefore found this Particular proved.

Particular 1(a)(ii) – Proved

1. On 11 March 2018:

a. In relation to Patient A, you:

ii. Did not administer pain medication for Patient A’s chest pain.

38. The Panel took into account the evidence of SW. The Panel also had before it the PRF of Patient A. The Panel also considered EMAS’ Pain Management Standard Operating Procedure. The Panel also took into account the Joint Royal Colleges Ambulance Liaison Committee Guidelines (JRCALC) Guidelines dated March 2016 and September 2017, which are the nationally recognised guidelines applicable to Paramedics. Both documents were, the Panel heard from SW, applicable at the time of the events which gave rise to the Allegation.

39. Patient A’s PRF recorded a pain score of 7 for her chest pain. According to EMAS’ Pain Management Standard Operating Procedure, a pain score of 7 is classed as “severe pain” and the Procedure provides for the administration of analgesia. According to the PRF, no analgesia was given for Patient’s A chest pain.

40. The Panel therefore found this Particular proved.

Particular 1(a)(iii) – Proved

1. On 11 March 2018:

a. In relation to Patient A, you:

iii. Did not pull the curtain closed during the abdominal and respiratory examination.

41. The Panel took into account the evidence of SW. He was very clear that during the Registrant’s abdominal and respiratory examination, which meant that Patient A was exposed, the curtains of her bedroom were left open by the Registrant. SW recalled that he himself closed the curtains in order to preserve Patient A’s dignity. The window of her room faced onto a public highway where the public could reasonably have seen Patient A while she was being examined.

42. The Panel therefore found this Particular proved.

Particular 1(a)(iv) – Not Proved

1. On 11 March 2018:

a. In relation to Patient A, you:

iv. Used an unrecognised cannulation method.

43. The evidence of SW was that the Registrant penetrated Patient A’s skin with the tip of the needle, and while the tip of the cannula remained inside the skin the Registrant moved the cannula in and out approximately 10-12 times while he sought entry into the vein. SW stated that if the Registrant had failed to locate the vein, SW would expect the Registrant to remove the tourniquet and the cannula and try to insert a new cannula at a different site.

44. The Panel took into account that there was no EMAS procedure on cannulation before it, nor any reference in the JRCALC to “recognised” and “unrecognised” cannulation methods.

45. SW’s oral evidence was that the cannula should not be reinserted into the same site as that would give rise to the risk of infection. However, his evidence was not that the Registrant did not do this. Instead, his evidence was that the Registrant did not completely remove the cannula, and it remained under the skin whilst he attempted to find a vein.

46. There was no clear evidence that the Registrant’s method was “unrecognised”. There was no policy or procedure regarding the maximum times a Paramedic should attempt to find a vein before withdrawing the cannula. It may have been that the Registrant’s attempts were not best practice, but this was not the same as being “unrecognised” as a method.

47. The Panel therefore found this Particular not proved.

Particular 1(a)(v) – Proved

1. On 11 March 2018:

a. In relation to Patient A, you:

v. Did not gain informed consent before administering Ondansetron.

48. The Panel took into account the evidence of SW and Patient A’s PRF. It was clear from the PRF that the Registrant administered the drug Ondansetron to Patient A. However, the box on the PRF which confirmed that Patient A’s informed consent had been obtained by the Registrant were not marked by the Registrant. The evidence of SW was that Patient A did have capacity to consent but that this was not obtained by the Registrant prior to administering Ondansetron.

49. The Panel therefore found this Particular proved.

Particular 1(a)(vi) – Proved

1. On 11 March 2018:

a. In relation to Patient A, you:

vi. Administered Ondansetron incorrectly, in that you administered it over 60-65 seconds.

50. SW’s evidence was very clear that the Ondansetron was administered incorrectly, in that it was administered too quickly over a period of 60-65 seconds. The Panel noted that SW’s contemporaneous notes of the incident also referred to this incorrect administration over 60-65 seconds. The evidence of SW was that the correct administration should have been, according to the JRCALC Guidelines, over a two-minute period. The Panel read that section of the Guidelines. SW was present at the time solely to observe as an assessor of the Registrant’s practice, and the Panel decided that it was credible that he would have noticed the details of the administration of the drug.

51. The Panel therefore found this Particular proved.

Particular 1(a)(vii) – Not Proved

1. On 11 March 2018:

a. In relation to Patient A, you:

vii. Did not ensure Patient A was correctly positioned on the stretcher.

52. SW’s evidence was that when Patient A was transported to hospital on a stretcher she was in a semi-recumbent position, and that this was not a correct position for her to be in. SW said that Patient A should have been upright in order to help with her oxygen levels. SW stated that it was the Registrant’s responsibility, as the lead clinician, to ensure that she was in the most clinically beneficial position.

53. The Panel considered whether the semi-recumbent position was an incorrect position, and concluded that there was insufficient evidence to support this allegation. Neither the EMAS Management of Cardiac Chest Pain Procedure, nor the EMAS Safer Manual Handling Policy, state that either the upright or semi-recumbent position are correct or incorrect for a patient presenting with such symptoms. The Panel took into account an email dated 30 March 2020 from a Clinical Education Development Specialist at EMAS, who expressed the view that:

“most patients experiencing cardiac chest pain would, if conscious, be nursed in a semi-recumbent or upright position on an ambulance trolley”.

54. The Panel therefore found this Particular not proved.

Particular 1(a)(viii) – Proved

1. On 11 March 2018:

a. In relation to Patient A, you:

viii. Administered 250mL Sodium Chloride incorrectly, in that it was not clinically indicated and/or was not administered correctly.

55. SW’s evidence was that the Registrant’s administration of Sodium Chloride to Patient A was not clinically indicated, and SW relied on the JRCALC Guidelines. SW’s evidence was that the Registrant incorrectly considered Patient A to be dehydrated and that this was the reason why the Registrant administered Sodium Chloride (which would be clinically indicated in such circumstances).

56. In addition, SW’s evidence was that Sodium Chloride was incorrectly administered because, according to the JRCALAC Guidelines, it should be administered over a number of hours in the case of a patient presenting with dehydration. SW’s evidence was that the Registrant gave Patient A a bolus of Sodium Chloride which was administered rapidly, which was not appropriate in Patient A’s case.

57. The Panel therefore found this Particular proved.

Particular 1(a)(ix) – Proved

1. On 11 March 2018:

a. In relation to Patient A, you:

ix. Provided an incorrect handover to hospital by booking Patient A in with a clinical impression of dehydration.

58. SW’s evidence was that when the Registrant handed over Patient A at the hospital, he gave the clinical impression of dehydration as the primary concern. SW was clear that he had to step in at that point and inform the hospital that Patient A was being booked in with chest pain. SW made clear that he did this as a matter of patient safety because chest pain is clinically more significant than dehydration.

59. SW was very clear in his evidence about having to step in to correct the handover.

60. The Panel therefore found this Particular proved.

Particular 1(b)(i)

1. On 11 March 2018:

b. In relation to Patient A, did not correctly complete the Patient Report Form in that you:

i. Did not record the patient’s gender and/or full next of kin contact details.

61. The copy of Patient A’s PRF which was in evidence before the Panel was redacted, and part of that redaction covered where the Registrant would have had space to document Patient A’s gender and full next of kin contact details.

62. SW gave evidence that when he wrote the witness statement he had before him an unredacted copy and that when he had looked at it, the Registrant had not recorded Patient A’s gender and full next of kin contact details.

Gender – Not Proved

63. With regard to Patient A’s gender, even if the relevant section which was redacted had not been completed, the Panel noted that the Registrant had documented Patient A’s gender clearly elsewhere on the PRF. The Panel therefore decided that this part of the particular, concerning not recording the patient’s gender on the PRF, was not proved.

64. The Panel therefore found this part of Particular 1(b)(i) not proved.

Full next of kin details – Proved

65. With regard to the full next of kin details, the Panel took account of SW’s clear evidence on this point and was satisfied that the Registrant did not correctly complete the PRF in that he did not record the full next of kin contact details.

66. The Panel therefore found this part of Particular 1(b)(i) proved.

Particular 1(b)(ii)

1. On 11 March 2018:

b. In relation to Patient A, did not correctly complete the Patient Report Form in that you:

ii. Did not document the patient’s breathing category, pulse strength and/or if there was external or internal bleeding.

67. SW’s evidence was that the Registrant did not document Patient A’s breathing category or if there was external or internal bleeding.

Breathing category – Not Proved

68. SW’s evidence was that it was not documented whether Patient A’s breathing was regular or irregular. On examining Patient A’s PRF, the Panel noted that the box which could be marked to denote that breathing was normal was hidden by a black circle, which was a photocopied hole on the PRF made by a hole punch. The Panel was able to see a slight mark under the hole punch which could possibly indicate that the Registrant had marked this box, although it was not clear. The Panel decided that if he had marked this box alone, this would be sufficient to document breathing category. Further, the Panel also noted that the Registrant had clearly recorded Patient A’s breathing character in the summary section of the PRF. Therefore, even if the box was not marked, the Registrant had documented Patient A’s breathing category within the PRF.

69. The Panel was of the view that it was for the HCPC to prove its case, and it was not satisfied on the balance of probabilities that this part of the Particular was proved in light of the mark on the PRF which obscured the box and the Registrant recording Patient A’s breathing character elsewhere on the PRF.

70. The Panel therefore found this part of the Particular not proved.

Pulse Rate – Not Proved

71. SW’s evidence was that the Registrant did in fact document Patient A’s pulse rate. The Panel had seen this on the PRF.

72. The Panel therefore found this part of the Particular not proved.

External/Internal bleeding – Proved

73. The Panel took into account the PRF, which made clear that the Registrant did not tick the box regarding external or internal bleeding.

74. The Panel noted that there was no evidence that Patient A had any internal or external bleeding and therefore it would not have been appropriate to tick that she had either.

75. However, on the basis of the precise wording of the Particular, the Panel found this part of the Particular proved.

Particular 1(b)(iii) – Proved

1. On 11 March 2018:

b. In relation to Patient A, did not correctly complete the Patient Report Form in that you:

iii. Left the patient capacity section blank.

76. SW’s evidence was that the capacity section had been left blank. The relevant section on the PRF was not completed.

77. The Panel therefore found this Particular proved.

Particular 1(b)(iv) – Proved

1. On 11 March 2018:

b. In relation to Patient A, did not correctly complete the Patient Report Form in that you:

iv. Did not document your failed cannulation, or the time, location and clinician ID of the second cannulation.

78. SW’s evidence was that the Registrant did not document his failed cannulation, or the time, location, and clinician ID of the second cannulation.

79. The Panel examined Patient A’s PRF and could not see that these matters were documented on the form.

80. The Panel therefore found this Particular proved.

Particular 1(c)(i) – Not Proved

1. On 11 March 2018:

c. In relation to Patient B:

i. Did not provide a clear pre-alert message to hospital.

81. SW’s evidence was that the Registrant did not provide a clear pre-alert message to the hospital, the reason being, from his evidence, that the Registrant struggled to provide clear observations of Patient B during the call.

82. The Panel was of the view that there was no indication in the evidence of what constituted a “clear” pre-alert message, and decided that simply because the Registrant struggled to give Patient B’s observations did not in itself mean the call was not clear. The Panel also took into account SW’s notes of the incident, which stated that there were no concerns raised during the hospital handover. No other concerns from the hospital were documented regarding the pre-alert message.

83. The Panel therefore found this Particular not proved.

Particular 1(d)(i) – Not Proved

1. On 11 March 2018:

d. In relation to Patient B, did not correctly complete the Patient Report Form in that you:

i. Did not record the patient’s pulse.

84. SW’s evidence was that the Registrant had recorded Patient B’s pulse rate on the PRF as well as noting that it was irregular.

85. The Panel therefore found this Particular not proved.

Particular 1(d)(ii) – Proved

1. On 11 March 2018:

d. In relation to Patient B, did not correctly complete the Patient Report Form in that you:

ii. Did not document that the patient was unable to give a pain score.

86. SW’s evidence was the Registrant had not documented on the PRF that Patient B was unable to give a pain score.

87. The Panel noted that this information was not documented on the PRF.

88. The Panel therefore found this Particular proved.

Particular 1(d)(iii)

1. On 11 March 2018:

d. In relation to Patient B, did not correctly complete the Patient Report Form in that you:

iii. Noted the patient had no nausea or facial and arm weakness, when they were incapable of expressing this.

89. SW’s evidence was that the Registrant had noted that Patient B had no nausea or facial and arm weakness when Patient B was unable to express these things.

90. The Registrant had documented in Patient B’s PRF that this was a patient who was “unresponsive”.

No Nausea – Proved

91. With regard to nausea the Panel found, on the balance of probabilities, that this was a symptom which Patient B herself would need to confirm she was not suffering from in order for the Registrant to conclude that she was not. It was not something that the Registrant would be able to confirm if she were “unresponsive”. The Panel therefore found that the Registrant had not correctly completed the PRF by documenting that Patient B had no nausea.

92. The Panel therefore found this part of the Particular proved.

No facial weakness – Not Proved

93. The Panel noted that Patient B had a reduced level of consciousness; however, the Panel decided that, on the balance of probabilities, the Registrant would be able to assess if she had facial weakness or not by looking at her face and any pain responses she demonstrated.

94. The Panel therefore found this part of the Particular not proved.

No arm weakness – Not Proved

95. Patient B was documented as having two Glasgow Coma Scores of 3, 4, 1, with the 4 referring to motor response according to the Glasgow Coma Scale set out in the JRCALC Guidelines. According to the JRCALC Guidelines, this indicated that Patient B was able to withdraw from pain. With this level of movement the Panel decided that on the balance of probabilities the Registrant could assess arm weakness, as Patient B would likely have been able to move her arm sufficiently for the Registrant to make such an assessment. The Panel also noted the differentiation made by the Registrant on the PRF between speech difficulties, which he clearly marked as “UTR” (unable to record), and facial and arm weakness, which he marked in the negative.

96. The Panel therefore found this part of the Particular not proved.

Particular 1(d)(iv) – Proved

1. On 11 March 2018:

d. In relation to Patient B, did not correctly complete the Patient Report Form in that you:
iv. Did not record the route of administration of oxygen and/or Clinician ID.

97. SW’s evidence was that the Registrant did not record the route of administration of oxygen or his Clinician ID.

98. It was clear that these matters were not documented on Patient B’s PRF.

99. The Panel therefore found this Particular proved.

Particular 1(e)(i) – Not Proved

1. On 11 March 2018:

e. In relation to Patient C:

i. Did not offer stronger pain medication to Patient C.

100. SW’s evidence was that the Registrant did not offer stronger pain medication to Patient C.

101. SW’s evidence was that it was not clear if Patient C declined the analgesia, and that the PRF should document that the Registrant offered it to him and whether Patient C declined.

102. The Panel carefully considered the PRF. The Registrant documented on Patient C’s PRF that Patient C was informed about analgesia in the form of paracetamol tablets or intravenous paracetamol. In the context of a paramedic treating a patient, the Panel concluded that, by informing Patient C that stronger pain medication was available, the Registrant was necessarily offering this to Patient C. Furthermore, it was noted on the PRF that Patient C “did not agree for any analgesia during transport to hospital”. In order to decline pain medication, it follows that Patient C must have been offered it.

103. The Panel decided that, on the balance of probabilities, the entry in the PRF indicated that the Registrant did offer paracetamol. Intravenous paracetamol can be administered as a stronger pain medication than the Entonox which Patient C received, according to the evidence of SW, who confirmed that Entonox can be given in the interim until stronger analgesia can be given to patients who require it. He confirmed that intravenous paracetamol was a reasonable option.

104. The Panel therefore found this Particular not proved.

Particular 1(e)(ii)

1. On 11 March 2018:

e. In relation to Patient C:

ii. Did not assess distal circulation, and/or sensation and/or movement before and/or after mobilisation and/or at skin level.

105. SW’s evidence was that the Registrant did not assess Patient C’s distal circulation, sensation, or movement before or after mobilisation, or at skin level.

Distal circulation – Not Proved

106. On Patient C’s PRF the Registrant documented three times that Patient C’s limb was warm on examination. On the balance of probabilities, the Panel was satisfied that this meant the Registrant had assessed distal circulation on three occasions, with two of the examinations time-recorded. On the balance of probabilities this occurred before and after mobilisation. The two readings that were recorded were an hour apart, the second being 22 minutes prior to handover at the hospital. It would be reasonable to conclude that mobilisation had, at the very least, occurred prior to the second time-recorded observation. On the balance of probabilities, the Panel concluded that the Registrant would only know that the limb was warm by touching at skin level.

107. The Panel therefore found this part of the Particular not proved.

Sensation and movement – Proved

108. The Panel could find no reference on Patient C’s PRF to the Registrant assessing sensation or movement either before or after mobilisation.

109. The Panel therefore found this part of the Particular proved.

Particular 1(e)(iii) – Proved

1. On 11 March 2018:

e. In relation to Patient C:

iii. Left Patient C’s Patient Report Form on the dashboard of the ambulance.

110. SW’s evidence was that the Registrant left Patient C’s PRF on the dashboard of the ambulance in clear view of the passing public. SW referred to this incident very clearly and confirmed that he raised the matter with the Registrant after SW himself removed the PRF from the dashboard in order to preserve Patient C’s confidentiality.

111. On the basis of SW’s evidence, the Panel found this Particular proved.

Particular 1(f)(i) – Proved

1. On 11 March 2018:

f. In relation to Patient C, did not correctly complete the Patient Report Form in that you:

i. Did not record patient GP contact details and/or next of kin details and/or if the next of kin had been informed of patient’s admission to hospital.

112. SW’s evidence was that the Registrant did not correctly complete Patient C’s PRF, in that he did not record the GP contact details or next of kin details or if the next of kin had been informed about the admission to hospital.

113. The section on the PRF which had space for such details was redacted. However, SW’s evidence was that when he prepared his witness statement he had access to an unredacted version of the PRF, which indicated clearly that these matters had been omitted.

114. On the basis of SW’s evidence, the Panel found this Particular proved.

Particular 1(f)(ii) – Not Proved

1. On 11 March 2018:

f. In relation to Patient C, did not correctly complete the Patient Report Form in that you:

ii. Did not record the patient’s breathing category.

115. SW’s evidence was that the Registrant did not record Patient C’s breathing category on the PRF.

116. On examination of the PRF, the Panel noted that the Registrant had recorded Patient C’s breathing as normal by ticking the relevant box on the PRF. The Panel also noted that on the initial assessment the Registrant marked Patient C’s breathing as “normal” and in his first set of observations as “normal” and “regular”. Further, the Registrant had clearly recorded Patient C’s breathing character in the summary section of the PRF. The Panel was satisfied that this record was sufficient to constitute a record of Patient C’s breathing category.

117. The Panel therefore found this Particular not proved.

Particular 1(f)(iii) – Proved

1. On 11 March 2018:

f. In relation to Patient C, did not correctly complete the Patient Report Form in that you:

iii. Did not record the time both sets of observations were taken.

118. SW’s evidence was that the Registrant did not record the time at which both sets of observations were taken.

119. On examination of the PRF, the Panel noted that the box for the time of post-treatment observations was left blank.

120. The Panel therefore found this Particular proved.

Particular 1(f)(iv) – Proved

1. On 11 March 2018:

f. In relation to Patient C, did not correctly complete the Patient Report Form in that you:

iv. Did not record oxygen saturation levels and/or the patient’s pain score on the second set of observations.

121. SW’s evidence was that the Registrant did not record Patient C’s oxygen saturation levels or the pain score on the second set of observations.

122. On examination of the PRF, the Panel noted that the boxes for these observations were left blank.

123. The Panel therefore found this Particular proved.

Particular 2(a) – Proved

2. You did not reach the required standard in the following three assessments:

a. Paramedic Level ECG recognition test, by scoring 44%.

124. The Panel took into account the evidence of LS and SL, as well as the notes of the Final Review Meeting which took place on 16 March 2018.

125. The Panel took into account the comments of LS, which were recorded at the Final Review Meeting and which stated that the Registrant obtained a score of 44% for the Paramedic-level ECG recognition test. LS confirmed at the Final Review Meeting that this was a fail.

126. The Panel therefore found this Particular proved.

Particular 2(b) – Proved

2. You did not reach the required standard in the following three assessments:

b. Trauma Life Support scenario.

127. The Panel took into account the evidence of LS and SL, as well as the notes of the Final Review Meeting which took place on 16 March 2018.

128. The Panel took into account the comments of LS which were recorded at the Final Review Meeting, where he stated that the Registrant’s Trauma Life Support test was deemed to be a fail by the two assessors.

129. The Panel therefore found this Particular proved.

Particular 2(c) – Proved

2. You did not reach the required standard in the following three assessments:

c. Online drugs paper test, by scoring 78%.

130. The Panel took into account the evidence of LS and SL, as well as the notes of the Final Review Meeting which took place on 16 March 2018.

131. The Panel took into account the comments of LS which were recorded at the Final Review Meeting, where he stated that the Registrant scored 78% for his online drugs test, while the pass mark was 80%.

132. The Panel therefore found this Particular proved.

Decision on Grounds

133. The Panel took into account the oral submissions of Ms Lykourgou with respect to grounds. Ms Lykourgou submitted that some of the matters found proved may properly be considered misconduct rather than lack of competence. Ms Lykourgou referred to a number of cases, such as R (on the application of Calhaem v GMC) [2007] EWHC 2606 and Roylance v GMC (No. 2) [2000] 1 AC 311.

134. In considering whether the facts found proved constituted misconduct or lack of competence, the Panel was aware that there was no burden of proof at this stage and that the decision was a matter for the Panel’s own independent judgment.

135. The Panel accepted the advice of the Legal Assessor. 

136. The Panel considered each of the facts found proved in turn when deciding whether they constituted misconduct or lack of competence.

137. Firstly, the Panel noted that a number of the facts found proved were of such minor consequence that they constituted neither misconduct nor lack of competence. These were as follows:

• in relation to Particular 1(b)(ii), the Panel found that the Registrant did not document on Patient A’s PRF if there was internal or external bleeding. There was no evidence at all that she had any bleeding, and the Panel decided that, as a result, it was not appropriate to tick either because neither applied.

• in relation to Particular 1(d)(ii), the Panel found that the Registrant did not document on Patient B’s PRF that Patient B was unable to give a pain score. However, the Registrant had clearly documented on the PRF that Patient B was unresponsive and therefore the omission which was found proved was of no consequence to the accuracy of the documentation nor to Patient B’s care.

• in relation to Particular 1(d)(iii), the Panel found that the Registrant had recorded that Patient B had no nausea when she was incapable of expressing this. However, the Panel was of the view that this had no impact on patient care due to the management of Patient B’s reduced level of consciousness taking priority.

• in relation to Particular 1(d)(iv), the Panel found that the Registrant did not record the route of administration of oxygen to Patient B. The Panel noted the evidence of SW who himself stated that it was “not a significant detriment not to record this”, although it was “good practice”. The Panel was of the view that this omission had no impact on patient care in the circumstances.

• in relation to Particular 1(e)(iii), the Panel found that the Registrant did not assess Patient C’s sensation or movement. However, Patient C was in severe pain and the Panel concluded, with regard to movement, that it was arguable that the Registrant should not have attempted to mobilise Patient C in such circumstances. In any event, the omissions had no consequence for Patient C’s care.

138. The Panel carefully considered the remaining factual findings, as well as all the evidence which it has heard.

139. The Panel determined that those remaining factual particulars all constituted a lack of competence. The Panel did not consider any of the matters found proved constituted misconduct.

140. The Panel considered that the overwhelming nature of the evidence before it was that the Registrant was failing to reach the standards required of a Newly Qualified Paramedic, and the Panel was of the view these failings were not the result of seriously falling short of the standards as set out in the case of Roylance. There were a number of factors in this case which fortified the Panel in this view, which are set out as follows.

141. The matters found proved related to a wide range of issues, a number of which were repeated in respect of each patient. They related, for example, to documentation, assessment, medication administration, handover, and not meeting the required standards in assessments. All three live witnesses referred to the Registrant’s lack of knowledge, which did not reach the standard expected of a registered Paramedic. SL, who was the Registrant’s mentor for a 12-week period, estimated that 50% of the Registrant’s issues stemmed from poor command of the English language and 50% from lack of clinical knowledge. All of the witnesses agreed that the Registrant was, as a result, not capable of safe, autonomous practice. The Registrant was the subject of a capability review and was unable to pass his examinations. The Panel was satisfied that in respect of each matter, the Registrant had insufficient knowledge, skills, and competence to carry out the tasks.

142. The Registrant’s lack of competence was evidenced by lack of knowledge, skill, and ability and, as a consequence, poor judgement. The Panel was presented with evidence, both live and documentary, of:

• the observational assessment by SW, which related to three patients over a full shift;

• the Registrant's history of failing exams focused on basic Paramedic skills;

• the evidence of the live witnesses, who were all familiar with the Registrant’s practice (including SL, who was his mentor over a 12-week period).

The Panel determined that this was sufficient evidence to constitute a fair sample of the Registrant’s work in this case.

143. The Panel therefore concluded that the acts and omissions found proved constituted an overall lack of competence on the part of the Registrant.

The Reconvened Hearing 18-19 March 2021

Service of Notice of Hearing

144. The Panel had information before it that the Notice of Hearing was sent to the Registrant by email, dated 22 December 2020, to his email address which is recorded on the HCPC Register. The Notice confirmed that the hearing would take place by video conference. The service was by email according to HCPTS published guidance and protocol as a result of the Covid-19 pandemic.

145. In all the circumstances, the Panel was satisfied that good service had been effected in accordance with Rules 3 and 6 of the Rules.

Proceeding in Absence

146. Ms Lykourgou, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. Ms Lykourgou referred to her previous submissions on proceeding in absence and submitted that the Registrant had had sufficient notice of the hearing and there was no indication that he would attend were the hearing to be adjourned, the Registrant having made clear previously that he did not wish to attend.

147. The Panel took into account the HCPTS Practice Note entitled “Proceeding in the Absence of the Registrant” and accepted the advice of the Legal Assessor.

148. The Panel was aware that the discretion to proceed in the absence of a Registrant should be exercised with the utmost care and caution. The Panel considered the matter carefully, noting that there had been no communication from the Registrant since the hearing was adjourned.

149. The Panel was of the view that an adjournment was unlikely to secure his attendance in the future. In all the circumstances, the Panel decided that it was fair and in the public interest to proceed today.

Decision on Impairment

150. The Panel considered whether the Registrant’s fitness to practise is currently impaired. It was aware that impairment is a matter for its own professional judgment.

151. The Panel heard the submissions of Ms Lykourgou, who submitted that the Registrant’s fitness to practise is impaired on the basis of the personal and public components. The Panel also had regard to the HCPTS Practice Note entitled “Finding that Fitness to Practise is ‘Impaired’”. The Panel accepted the advice of the Legal Assessor.

152. In determining whether fitness to practise is impaired, panels must take account of a range of issues which, in essence, comprise two components:

i. the personal component, which includes insight, the risk of repetition, whether the matters raised are remediable, and whether there has been remediation by the Registrant.

ii. the public component, which includes the need to protect service users, maintain confidence in the profession, and declare and uphold proper standards of conduct and behaviour.

153. The Panel considered the personal component. The Panel took into account that the Registrant has not submitted any material to the Panel for its consideration. There is thus no evidence of insight, no reflection into what occurred, and no evidence to address the lack of competence or steps taken to resolve or remedy the lack of competence.

154. The Panel considered the questions formulated by Dame Janet Smith in the Fifth Shipman Report as set out in the case of CHRE v NMC and Grant [2011] EWHC 927.

155. The Panel concluded that due to the matters found proved, the Registrant put patients at unwarranted risk of harm. Due to the lack of any evidence of insight or remediation, the Panel was of the view that the risk of repetition of the lack of competence is high.

156. The Panel considered that the Registrant did not meet the following standards:

HCPC Standards of Proficiency for Paramedics (2014)

1 be able to practice safely and effectively within their scope of practice.

3 be able to maintain fitness to practise.

3.1 understand the need to maintain high standards of personal and professional conduct

4 be able to practise as an autonomous professional, exercising their own professional judgment.

8 be able to communicate effectively

10 be able to maintain records appropriately

13 understand the key concepts of the knowledge base relevant to their profession

14 be able to draw on appropriate knowledge and skills to inform practice

157. Taking into account the matters found proved, the Panel was also of the view that the Registrant brought the profession into disrepute and breached fundamental tenets as set out above. Once again, in the absence of any evidence of remediation or insight the Panel was of the view that there is high risk of bringing the profession into disrepute and breaching fundamental tenets in the future.

158. The Panel took into account the wider public interest. The Panel was satisfied that the Registrant’s wide-ranging lack of competence struck at the heart of the trust placed in Paramedics to carry out their role, often in difficult and testing circumstances, while being able to safeguard the safety and wellbeing of their patients at all times and being able to work autonomously with the requisite skill and competence. The Panel had no doubt that a member of the public, in possession of all the facts and information about this case, would be concerned if no restriction were applied to the Registrant’s practice in light of the wide-ranging and sustained lack of competence despite the support and supervision provided to the Registrant. As such, the Panel was satisfied that the need to uphold proper professional standards and maintain public confidence in the profession would be undermined if a finding of impairment were not made in the circumstances of the case.

159. For the reasons set out above, the Panel decided that the Registrant’s fitness to practise is currently impaired on both the personal and public components.

Decision on Sanction

160. Ms Lykourgou reminded the Panel of the general principles of sanction and referred the Panel to the Sanctions Policy (SP), updated March 2019. Ms Lykourgou submitted that due to the consistent lack of insight and lack of remediation from the Registrant there was still a risk of repetition and a risk to patients. Ms Lykourgou submitted that a Conditions of Practice Order may not be appropriate in the circumstances.

161. The Panel took into account the SP and accepted the advice of the Legal Assessor. The Panel bore in mind that sanction is a matter for its own independent judgment and that the purpose of a sanction is not to punish the Registrant but to protect the public and the wider public interest. Further, any sanction must be proportionate, so that any order it makes is the least restrictive order that would protect the public interest, including public protection.

162. The Panel was of the view that the following were aggravating factors:

• lack of evidence of current insight and remediation;
• limited engagement with the regulatory process and an active decision to disengage with the substantive hearing.

163. The Panel could not think of any mitigating factors other than there being no previous fitness to practice history relating to the Registrant declared to the Panel and that, at the time, he demonstrated some limited insight.

164. The Panel bore in mind that as its findings only speak to lack of competence, a Striking Off Order is not available to it at this present time.

165. The Panel first considered taking no action. The Panel concluded that, in view of the wide-ranging and serious nature of the Registrant’s lack of competence and the ongoing risk to public protection, it would be inappropriate to take no action. It would be insufficient to protect the public, maintain public confidence, and uphold the reputation of the profession.

166. The Panel then considered a Caution Order. The Registrant’s lack of competence was not minor in nature, it was wide-ranging and sustained and, therefore, there is a high risk of repetition. Furthermore, there is no evidence before the Panel to demonstrate that the Registrant has taken any of the steps required to address that lack of competence, nor indeed the current situation with regards to his professional practice. There was no evidence of any training or Continuing Professional Development (CPD) since 2018, no evidence that the Registrant is still practising his profession, and no testimonials or references from any colleagues, former or current. Therefore, the Panel concluded that a Caution Order would be inappropriate and insufficient to protect the public and meet the public interest.

167. The Panel next considered a Conditions of Practice Order. The lack of competence found proved by the Panel is, in principle, remediable. However, on the basis of the Registrant’s lack of engagement and the lack of evidence before the Panel to demonstrate any insight, there is no indication that he would be willing to comply with conditions. The Panel has information that the Registrant currently resides in Poland, but it has no information about his current work arrangements or hopes for future practice. The Panel therefore decided that conditions would be unworkable.

168. The Panel therefore decided that a Suspension Order is the only appropriate and proportionate sanction. The lack of competence is wide-ranging and sustained despite significant support and supervision, and there is a high risk of repetition given the lack of any evidence of insight or remediation. To reflect these circumstances, the Panel decided that a Suspension Order of 12 months’ duration would be appropriate and proportionate. Such an order will also give the Registrant the opportunity to reflect, to obtain and demonstrate insight and remediation, and provide evidence of his current practice, including testimonials, in order to engage with the regulatory process.

169. In coming to its decision, the Panel took into account the principle of proportionality and the impact that such a sanction will have on the Registrant’s right to practise his profession, as well as the likely reputational and financial impact. However, the Panel decided that the need to protect the public and uphold the public interest outweighed the Registrant’s interests in this regard.

170. The Panel therefore decided to impose a Suspension Order for a period of 12 months.

Order

That the Registrar is directed to suspend the registration of Mr Piotr Nowakowski for a period of 12 months from the date this order comes into effect.

Notes

This order will be reviewed before its expiry.

Hearing History

History of Hearings for Mr Piotr Nowakowski

Date Panel Hearing type Outcomes / Status
18/03/2021 Conduct and Competence Committee Final Hearing Suspended
07/12/2020 Conduct and Competence Committee Final Hearing Adjourned part heard