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Whilst registered as a Paramedic and during the course of your employment with Northern
Ireland Ambulance Service, on around 3 November 2015 you:
1. Failed to adequately complete one or more of the following observations in relation to
a. Blood pressure (“BP”);
b. Heart rate (“HR”); or,
c. Oxygen saturations (“O2 sats”).
2. Recorded the following observations on a Patient Report Form (PRF) for Patient
T when you had not in fact completed one or more of them:
b. HR; or
c. O2 sats.
3. Recorded on a PRF that Patient T had a normal sinus rhythm when in fact you
had not completed an electrocardiogram.
4. Failed to carry out a pre-hospital electrocardiogram in relation to Patient T.
5. Failed to carry out a blood glucose measurement (BM) in relation to Patient T.
6. Failed to adequately assess and / or manage Patient T’s pain.
7. Failed to appropriately record Patient T’s pain score on the PRF.
8. Failed to perform a second pupillary response test in relation to Patient T.
9. Failed to record a Glasgow Coma Scale (“GCS”) score in relation to Patient T.
10. Inappropriately left Patient T in the care of his relatives for approximately 10
11. Failed to adequately complete the Patient Report Form (PRF) pertaining to:
a. Patient A;
b. Patient B;
c. Patient C;
d. Patient E;
e. Patient F;
f. Patient G; and
g. Patient H.
12. Inappropriately left Patient I in the care of his relatives whilst they waited for ambulance
transport to hospital.
13. Your actions at Particulars 2 and / or 3 above were misleading and/or dishonest.
14. The matters set out at Particulars 1 - 13 above constitute misconduct.
Application to amend the Allegation
1. Mr Lloyd made an application to amend the stem of the Allegation to delete reference to the date of 3 November. He submitted that it was appropriate to delete this date because particulars 11 and 12 of the Allegation had no connection to this date.
2. Dr Wright did not oppose the application to amend the Allegation.
3. The Panel accepted the advice of the Legal Assessor and considered whether the proposed amendment created any unfairness for the Registrant. The Panel decided that the amendment did not prejudice the Registrant and that the amendment was appropriate. The Panel therefore agreed to the proposed amendment.
Hearing in private
4. Mr Lloyd made an application for part of the hearing to be heard in private where the evidence related to the Registrant’s private life. Dr Wright supported the application.
5. The Panel accepted the advice of the Legal Assessor and applied the guidance in the HCPC Practice Note “Conducting Hearings in Private”. The Panel decided that parts of the hearing relating to the Registrant’s private life should be heard in private.
6. The Panel also decided that the evidence given by some of the witnesses relating to their family members should be heard in private.
7. The remainder of the hearing was heard in public, having regard to the important principle of open justice.
8. The Registrant was employed by the Northern Ireland Ambulance Service Trust (“the Trust”) as an Operational Paramedic based at Newry Station. The Registrant was employed from 2005 until 24 March 2017 at which point he took leave from work until April 2018. The Registrant remains employed by the Trust. At the time of the relevant events the Registrant worked as a Band 5 lone responder Paramedic on a Rapid Response Vehicle.
9. On 3 November 2016, the Registrant attended a call out to Patient T at their home address. Patient T was referred to the Trust by his General Practitioner who decided that Patient T needed to be taken to hospital as he was exhibiting signs of a stroke. The Registrant began to assess Patient T upon arrival and confirmed a request for an ambulance crew to attend. The Registrant completed a Patient Report Form (“PRF”) in relation to Patient T and arranged onward transportation to hospital. The Registrant then left the scene, leaving Patient T in the care of his wife and daughter before the ambulance crew arrived.
10. On 21 November 2015, the ambulance crew who attended to Patient T on 3 November 2015 emailed their Clinical Support Officer and raised concerns about the Registrant’s conduct. This ambulance crew consisted of AK and SS. In particular, they were concerned that the Registrant had left Patient T at his home address without medical assistance before the arrival of the emergency ambulance crew. They were also concerned that the Registrant had recorded observations of Patient T on the PRF, which had been left with the patient. Patient T told them, and the family confirmed, that the Registrant had failed to carry out any observations.
11. The concerns were escalated to the Divisional Training Officer, FA, on 23 November 2015 and on 2 November 2015, SM was instructed to conduct an investigation into the Registrant’s conduct in relation to Patient T. The Registrant made a fitness to practise self-referral to the HCPC on 6 April 2017 following this investigation.
12. On 15 February 2017, further concerns came to light following a routine review of PRFs completed by the Registrant. Concerns were identified in several PRFs completed by the Registrant. The concerns were identified by FA and escalated to MC, the Southern Division Area Manager and the Trust Medical Director.
Decision on Facts
13. The Panel read the HCPC bundle of documents which included witness statements and exhibits.
14. The Panel read documents provided by the Registrant during the hearing: a reflective statement dated 11 March 2021; Training needs analysis dated 25 May 2018 (included in HCPC bundle), GP letter dated 25 April 2017; occupational health reports dated 12 January 2021 and 3 March 2021, health risk assessment dated 27 July 2017; a training document prepared by Dr Wright; and an e-mail chain between the Registrant and MC dated 4 August 2021.
15. The Panel heard evidence from the HCPC witnesses SM, AK, MC and FA.
16. The Panel heard evidence from character witnesses called by the Registrant AM (Paramedic), JW (Paramedic), MH (Paramedic Station Supervisor), RC (retired Detective Superintendent), SM (Paramedic Station Supervisor), BM (Paramedic).
17. The Registrant chose not to give evidence. He answered questions from the Panel.
18. At the start of the hearing the Registrant made full admissions of all the factual particulars and admitted that the facts amounted to misconduct. The Panel noted that the admission of facts does not amount to conclusive proof and that the HCPC must prove its case on the balance of probabilities.
19. The Panel found particular 1(a), (b) and (c) proved by the admission of the Registrant, the documentary evidence, and the evidence of SM and AK.
20. The Registrant recorded on the PRF for Patient T two sets of observations for blood pressure, heart rate, and oxygen saturations, the former two being identical to the observations recorded in the GP letter left at the patient’s address approximately two hours earlier. The second set of observations is recorded on the PRF at the time of 16.05 which is after the time the Registrant left the scene at 15.58. In the PRF completed by AK she first recorded observations at 16.30. Those observations indicated that Patient T had deteriorated from the observations recorded by the GP. The Registrant recorded a pulse of 76, whereas AK, attending in the double crewed ambulance, recorded a pulse of 50.
21. The Panel drew the inference from these PRF documents that the Registrant had not completed observations of Patient T’s blood pressure, heart rate, or oxygen saturations when he recorded those on the PRF.
22. This inference is supported by hearsay evidence in the statement of AK. AK described that the Registrant had left his completed PRF at Patient T’s address. She assumed from the paperwork that the Registrant had conducted observations. She informed Patient T that she would repeat the checks that the Registrant had carried out. Patient T informed her that the Registrant had not carried out checks and this information was confirmed by members of Patient T’s family.
23. The Panel found that AK’s evidence was consistent with the documents, consistent with her earlier statements, and was reliable. Although the cross examination of AK included an attack on AK’s credibility, the Registrant did not challenge any of AK’s evidence relating to the Allegation. The Panel considered that this matter was not relevant to the Panel’s determination of the facts of the Allegation.
24. The Panel found that SM’s evidence was reliable, balanced, and consistent with the documents, including relevant JrCALC guidance and NIAS guidance.
25. The Panel found particular 2(a), (b), and (c) proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM.
26. The Registrant recorded on the PRF two sets of observations for Patient T’s blood pressure, heart rate, and oxygen saturations which he copied from the GP letter. The Registrant’s observations are identical to those in the GP letter and they differ markedly from those recorded by AK, approximately half an hour later. SM told the Panel that the Registrant’s recorded observations were inconsistent with the deterioration in Patient T’s condition.
27. In interview with SM on 10 December 2015 the Registrant suggested that he had used his own probe to take Patient T’s oxygen saturation levels and pulse, but also said that he had “recorded observations the same as the GP had recorded on GP letter”. In this hearing the Registrant has admitted that he failed to adequately complete and record Patient T’s blood pressure, heart rate and oxygen saturation levels.
28. The Panel found particular 3 proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM.
29. The Registrant recorded on the PRF normal sinus rhythm (NSR) for Patient T.
30. In an interview with SM on 10 December 2015 the Registrant stated:
“I didn’t consider taking an ECG because I was out and in speaking with family in kitchen and patient in room. Patient did not have any chest pain….NSR was recorded on PRF and I don’t know why I done this?”
31. The Registrant had not completed a 3- or 12 lead ECG but recorded on the PRF that he had done so and that the result was normal.
32. The Panel found particular 4 proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM.
33. The Registrant did not carry out an electrocardiogram.
34. Patient T had been identified by the GP as a possible stroke patient and the relevant JrCALC Guidance for stroke or transient ischaemic attack indicates that a 12-lead ECG should be considered by the Paramedic.
35. The Panel found particular 5 proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM.
36. The Registrant’s PRF for Patient 5 does not include a blood glucose measurement.
37. In interview with SM the Registrant admitted that he did not take a reading for blood sugar.
38. The relevant JrCALC guidance states that the Paramedic should check blood glucose levels for stroke or transient ischaemic attack patients.
39. The Panel found particular 6 proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM.
40. In her PRF AK identified Patient T’s pain score as 10/10 in her first set of observations. Patient T informed AK that he had a severe headache. AK administered IV paracetamol for Patient T’s pain. Following this treatment Patient T’s pain score reduced to 6/10.
41. The Registrant did not identify that Patient T was suffering headache or any degree of pain. In interview with SM he stated “when I assessed Patient I didn’t note any pain in the head or elsewhere”.
42. The Panel inferred from this evidence that the Registrant failed to adequately assess and manage Patient T’s pain.
43. The Panel found particular 7 proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM.
44. The Registrant’s PRF for Patient T does not include a pain score. In interview with SM the Registrant described this as a “clerical omission”.
45. The Panel found particular 8 proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM.
46. The Registrant’s PRF includes in the first set of observations a pupillary response test, but there is no second observation of the pupillary response.
47. In interview with SM the Registrant admitted that he had not carried out a second observation.
48. SM explained in his evidence the requirement for a minimum of two sets of observations, including for pupil response. This requirement is confirmed in the Patient Report Form User Guide (July 2015). A minimum of two observations, enables the Paramedic to monitor any change in the patient’s condition.
49. The Panel found particular 9 proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM.
50. The PRF completed by the Registrant does not include a Glasgow Coma Scale (GCS) score for Patient T. In interview with SM the Registrant admitted that he did not record a GCS score.
51. The JrCALC guidance for Stroke or Transient Ischaemic Attack patients states that the Paramedic should make an assessment of the GCS score.
52. The Panel found particular 10 proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM.
53. The Registrant had arranged for an ambulance to attend and convey Patient T to hospital, but he had not updated ambulance control about the current status of Patient T nor informed them that the double crewed ambulance should not be diverted to another call. It was therefore possible that Patient T might have been left in the care of his relatives for longer than ten minutes if the double crewed ambulance had been diverted.
54. The vehicle and call log documents show that the Registrant left Patient T at 15.58. He was then available to take another call. He confirmed this in his interview with SM. AK arrived in a double crewed ambulance at 16.08. There was therefore a period of approximately ten minutes when Patient T was left in the care of his relatives.
55. In his formal interview with SM on 10 December 2015 the Registrant’s explanation for his decision to leave Patient T was that
56. The Panel carefully considered the evidence relating to this matter. While these health circumstances, as described, would not excuse the Registrant’s decision to leave Patient T, they might have some relevance when considering the surrounding circumstances of the conduct or mitigation.
57. The Registrant chose not to give evidence to the Panel. The Panel therefore had no evidence relating to this health explanation, other than the notes of the interview with SM, the Registrant’s self-report to his GP as mentioned in the GP’s letter dated 25 April 2017, and the Registrant’s written reflection.
58. When the Registrant was first informally interviewed by SM on 25 November 2015 the Registrant advised that he “made the decision to leave as he felt the patient was stable and this would also make himself clear from the scene”. There was no mention at that time that the Registrant had any immediate health problem.
59. However, when the Registrant was formally interviewed by SM on 10 December 2015 he stated ‘I needed to complete this call as quickly as possibly as I had that day and whilst responding to this call
60. The Panel considered the Registrant’s behaviour from 15.58 when he cleared the scene and made himself available to take another call. The Registrant could have contacted ambulance control and advised them that he needed to return to the station, but he did not do so as he was embarrassed. SM explained in his evidence that Paramedics may advise control that they need to return to station without stating a reason if they have personal or health reasons. Although the Registrant was not called out to another call and was able to return to the station, he had made himself available, to take a further call immediately on leaving Patient T at 15.58 and remained available for a call until his rest break at 16.43. The Registrant went on to complete further calls that shift after his break including an emergency call-out at 17.09.
61. On the evidence before the Panel, it found that the Registrant decided to leave Patient T because he felt Patient T was stable and to enable him to take another call. At 15.58 on 3 December 2015 there were no health issues or other reasons sufficiently serious to prevent the Registrant engaging in his normal duties which would include remaining with Patient T.
62. The Panel found particular 11 proved by the admission of the Registrant, the documentary evidence and the evidence of FA and MC.
63. The Panel was provided with copies of the PRFs completed by the Registrant for patients B, C, and G. The PRFs for patients A, E, F and H were missing. MC informed the Panel that these PRFs had been destroyed and were no longer available. FA confirmed in his evidence that he had access to all the relevant PRFs at the time he reviewed them and prepared a summary document which details the aspects of criticism of each PRF.
64. The Panel found that FA was a credible and straightforward witness. His evidence detailing the criticism of the PRFs was not challenged by the Registrant. Having reviewed the PRFs that are available for the Panel’s review, the Panel was able to confirm FA’s criticisms. The Panel accepted FA’s evidence in relation to the PRF’s that are no longer available in addition to his evidence on those that are available.
65. In relation to Patient A, who was diabetic, the Registrant did not record completing a second set of observations as was required to decide whether the patient’s condition was improving or deteriorating. The narrative section of the PRF was poor because the Registrant did not record the patient’s history in sufficient detail. The Registrant also failed to record the time drugs were administered to patient A as required in the PRF guidance.
66. The Registrant did not record a second set of observations for Patient B. The narrative section of the PRF is also poor because the Registrant did not record the patient’s history in sufficient detail, including whether there is any neurological deficit relating to the patient’s CVA (cerebrovascular accident). The Registrant failed to record the times for this call on the PRF. Recording the timings accurately for a CVA patient is critically important because it may impact on the treatment a patient receives.
67. The Registrant administered three doses of the drug Atropine to Patient C, but did not record any observations following the administration of the drugs. There was therefore no information on whether the drug was impacting on Patient C’s condition. The narrative section did not record Patient C’s history in sufficient detail.
68. The Registrant administered Morphine to Patient E but did not record the dosage given. FA told the Panel this was extremely serious. The Registrant also failed to record where Patient E was taken and by whom.
69. The Registrant administered Paracetamol to Patient F, but did not record whether the source of the drugs was from the patient’s own supply or the Registrant’s. If the drug was administered by the Registrant his PIN number should be placed on the drugs section against the drug used. The narrative section of the PRF is poor because the Registrant did not record the patient’s history in sufficient detail.
70. The Registrant recorded only one set of observations for Patient G rather than the minimum two sets of observations required in the PRF guidance.
71. The Registrant recorded only one set of observations for Patient H. The narrative section of the PRF was poor, particularly in relation to medical history and management.
72. The Panel found particular 12 proved by the admission of the Registrant, the documentary evidence, and the evidence of FA and MC.
73. The PRF for Patient I was available for the Panel to review. Patient I was an eighty five year old patient receiving warfarin treatment, a treatment that placed Patient I at increased risk of bleeding if they had a fall. On the PRF the Registrant recorded that Patient I had a head and nose injury following a fall. The Registrant booked ambulance transport to take Patient I to hospital and then left the patient in the care of their family.
74. The Panel accepted the evidence of FA that it was inappropriate to leave Patient I without clinical care in those circumstances because of the increased risk of bleeding.
75. The Panel found particular 13 proved by the admission of the Registrant, the documentary evidence, and the evidence of AK and SM. The Panel found that the Registrant’s conduct in particular 2 and 3 was both misleading and dishonest.
76. The Panel found the Registrant’s PRF record of observations for blood pressure, heart rate, oxygen saturations (particular 2) and sinus rhythm (particular 3) were misleading because the Registrant had not carried out those observations. The PRF presented a false impression to any subsequent treating clinician and to the patient. AK was misled by the PRF because she spoke to Patient T on the basis that the Registrant had already conducted the same observations she was about to undertake. This was not correct.
77. The Panel applied the test for dishonesty set out in Ivey v Genting Casinos  UKSC 67. It first considered the Registrant’s state of knowledge of belief as to the facts. It then considered whether the Registrant’s conduct was dishonest by applying the objective standards of ordinary decent people.
78. The Registrant knew that he had not conducted any of the observations himself (blood pressure, heart rate, oxygen saturations) and that he had not conducted an ECG. He knew that he had copied the observations for blood pressure and heart rate from the GP letter and had failed to carry out his assessment of oxygen saturations. He knew that his recording of normal sinus rhythm was not based on an ECG measurement. He did not explain on the PRF that he had not taken the observations himself. The Registrant knew that the PRF gave a false impression.
79. The PRF form is part of Patient T’s medical record. The Registrant’s recording of observations which he knew he did not undertake was dishonest applying the objective standards of ordinary decent people.
Decision on Grounds
80. The Panel accepted the advice of the Legal Assessor that there is no burden of proof and that misconduct is a matter for the judgment of the Panel. There is no definition of misconduct, but the Panel applied the guidance in the case of Roylance v GMC that “misconduct is a word of general effect involving an act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a …practitioner in the particular circumstances”. The misconduct must be serious in that the conduct is well below the standards expected.
81. At the start of the hearing the Registrant admitted that the facts he had admitted amounted to the statutory ground of misconduct.
82. The Panel considered the context and surrounding circumstances. It noted the evidence from the character witnesses called by the Registrant. The witnesses who are Paramedics or Paramedic Supervisors informed the Panel that it is standard practice for a Paramedic attending as the RRV to provide a detailed verbal handover to the double crewed ambulance arriving later at the scene. The witnesses described that they recalled receiving detailed verbal handover from the Registrant. They also described situations where the RRV Paramedic is focussed on providing immediate patient care to the patient when the double crewed ambulance arrives at the scene. The RRV Paramedic would usually hand their PRF to the double crewed ambulance. There would not always be time for the RRV Paramedic to complete and record two sets of observations before the double crewed ambulance arrived.
83. The HCPC witnesses acknowledged that there might be circumstances where the RRV Paramedic is unable to complete and record two sets of observations. In these circumstances the RRV Paramedic should record in the narrative section of the PRF why they were unable to complete two sets of observations. They are also expected to clearly identify on the PRF which double crewed ambulance the care of the patient was transferred to. In his answers to Panel questions the Registrant confirmed that, following training and monitoring he has received, he would now adopt these steps.
84. The circumstances described above are not relevant in the case of Patient T because the Registrant left the scene before the double crewed ambulance arrived and in addition, he recorded two sets of observations.
85. The Registrant was provided with training and support on the completion of PRFs by a Paramedic Supervisor JO’H in January to 10 February 2016. The Registrant was provided with a copy of the PRF completion guidelines and assisted to make improvements in his PRF recording. The PRFs for Patients A (13 February 2017), B (12 February 2017), C (23 February 2016?), E (30 December 2017), G (6 January 2017), and H (30 December 2016) were completed after the Registrant had completed the training and monitoring period with JO’H. The PRF for Patient F was completed on the day JO’H reported that the training was completed (10 February 2016). The Registrant knew the requirements for satisfactory PRFs and how to record in the narrative section if he was not able to carry out two sets of observations, but he was not consistently complying with those requirements.
86. The Panel considered the potential impact of the Registrant’s conduct. The misleading and dishonest recording in Patient T’s PRF created a false medical record. The record misled the subsequent treating clinician, AK. It potentially impacted on the continuity of care provided to the patient. The Registrant’s failure to assess and record blood pressure, heart rate, oxygen saturations, blood glucose levels, a second pupillary response test, GCS score, and to carry out an electrocardiogram had the consequence that there was insufficient information for the Registrant to make clinical judgments on the appropriate care for Patient T. The Registrant’s failure to assess and record Patient T’s level of pain had the consequence that Patient T did not receive the benefit of pain-relieving medication until it was administered by AK.
87. The Registrant’s dishonesty occurred in the performance of the Registrant’s duties as a Paramedic and it involved patient clinical records.
88. The Registrant’s decision to leave Patient T in the care of his relatives did not harm Patient T because the double crewed ambulance arrived ten minutes after the Registrant left the scene. However, the double crewed ambulance could have been diverted to attend another call and this involved a potential risk of harm for Patient T. The Registrant left Patient T when he could not know that it was safe to do so because he had not carried out the necessary observations.
89. In his evidence FA outlined the potential impact of the Registrant’s failures to adequately complete the PRFs for patients A, B, C, E, F, G, and H. FA decided that the concerns about the Registrant’s PRFs were more serious and should be escalated to MC.
90. The Registrant’s failure to record the dose of morphine for Patient E was particularly serious because of the nature of the controlled drug. Subsequent treating clinicians would not know whether it was safe to administer further medication. Patient B was a CVA patient where timing of events may be critical to whether certain treatments can be undertaken. The Registrant’s failure to record times for the call therefore had the potential to impact on the care of the patient. The failure to record two sets of observations for Patients A, B, G, and H was significant for patient care because the Registrant and subsequent treating clinicians would be unable to assess whether the patient’s condition was improving or deteriorating and to make the appropriate clinical judgments. The failure to record a set of observations following his administration of the third dose of Atropine to Patient C had the consequence that the Registrant was unable to monitor the impact of the doses on the patient. The incomplete recordings indicated incomplete assessments which placed the patients at risk of harm.
91. The Registrant’s decision to leave Patient I in the care of relatives exposed Patient I to the risk that she might suffer a bleed as a result of the injury and require immediate medical intervention.
92. The Panel noted that the Registrant’s conduct in relation to Patients T and F was covered by the HCPC Standards of Conduct, Performance and Ethics (2012) whereas his conduct in relation to Patients A, B, C, E, F, G, H, and I was covered by the HCPC Standards of Conduct, Performance and Ethics (2016).
93. In relation to the 2012 Standards of Conduct, Performance and Ethics the Registrant acted in breach of:
Standard 1: You must act in the best interests of service users
Standard 10: You must keep accurate records
Standard 13: You must act with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.
94. In relation to the 2016 Standards of Conduct, Performance and Ethics the Registrant acted in breach of:
Standard 6.2 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
Standard 6.3 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.
Standard 9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
Standard 10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.
Standard 10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services.
95. Having considered all the circumstances the Panel decided that the Registrant’s conduct, considered both individually and collectively, fell well below the required standards and was sufficiently serious to amount to misconduct. The Panel considered that fellow practitioners would consider the Registrant’s conduct to be deplorable.
Decision on Impairment
96. The panel accepted the advice of the legal adviser and applied the guidance in the HCPC Practice Note “Fitness to Practise Impairment”. It bore in mind the purpose of fitness to practise procedures, which is not to punish the practitioner for past actions, but to protect the public against the actions of professionals who are not fit to practise. It considered the Registrant’s fitness to practise as at today’s date.
97. In her submissions Dr Wright invited the Panel to consider the Registrant’s case sympathetically. Dr Wright expressed her concerns about the Registrant’s health and well-being at the time the Registrant was answering questions from the Panel.
99. The Registrant has been working as a Paramedic since his return to duties in 2018 (with the exception of periods of absence due to ill health related to an injury).
100. The Registrant’s current position is that he remains employed by NIAS and is temporarily working on an RRV alongside another Paramedic. (Redacted).
101. The Panel considered whether the testimonial evidence on behalf of the Registrant is relevant to the issues the Panel consider relating to current impairment. The witnesses described their experiences of the Registrant’s professionalism and care for his patients, but none of them carried out any review of the Registrant’s PRFs or his decisions to leave patients in the care of relatives. None of the testimonial witnesses had discussed with the Registrant the detail of the Allegation, including dishonesty, and the Registrant’s reflection on the Allegation. The testimonial witnesses, other than JW were not aware of the Allegation. This included MH, the Registrant’s line manager. MH’s limited role in relation to PRFs was to scan and send a selection of PRFs for review. He did not carry out any review himself. The witnesses were therefore unable to comment on the Registrant’s level of insight or remediation.
102. The Panel considered whether the misconduct in this case is remediable. The Panel considered that the misconduct is remediable, although dishonesty is more difficult to remediate.
103. The Panel considered the Registrant’s remediation. In relation to dishonesty there was little evidence provided to the Panel. In his reflective statement of three pages the Registrant expresses his remorse and regret for his actions. He apologises and states that there will be no recurrence of his actions. He addresses dishonesty only briefly and states that he should have documented which observations had been taken from the GP letter and why. He asks it to be noted that “this was not an attempt to be dishonest”.
104. In its questions the Panel gave the Registrant a further opportunity to reflect on the significance of dishonesty for paramedics and allow him to explain in his own words the seriousness of dishonesty for paramedics and its impact on colleagues, patients, and public confidence in the profession. Dr Wright intervened because she was concerned about this line of questioning and the Registrant did not provide an answer.
105. The Panel considered that the Registrant has not fully engaged with the reasons he acted dishonestly on 3 November 2015 and the reasons for any change in his attitude so that he would now act differently and not take a dishonest short cut to avoid the need to carry out his own observations.
106. The Panel found that there was insufficient evidence that the Registrant has remedied his past dishonesty.
107. The Panel was provided in the HCPC bundle with evidence that on the Registrant’s return to work in April 2018 a training needs analysis was carried out by the Divisional Training Team. This training needs analysis with reference to the unsatisfactory PRFs, communications skills and the development of appropriate care packages for his patients. The training should include a written reflection demonstrating developments in these areas, attendance of 2017 and 2018 post-proficiency training days, two super-numerary observational shifts and two monitoring visits by the divisional CSO at three-month intervals to ensure consolidation of skills.
108. The Panel received no evidence relating to the Registrant’s satisfactory completion of this training programme other than an exchange of e-mails with MC. MC confirmed that the Registrant “finished with the CSO team on 22 June 2018 with your first operational shift on 25th June 2018”. The Registrant told the Panel that he would not have been able to return to work if this had not been completed.
109. The Panel received no evidence or information on the scope and content of the training programme. There was no information on whether it covered the entirety of the issues covered by the Allegation including the Registrant’s decision to leave patients at home in the care of their relatives. The Panel received no evidence or information relating to any review or monitoring of the quality of the Registrant’s completion of PRFs and his decision making relating to leaving patients at home after 25 June 2018. There was no evidence as to whether the learning from the training has been embedded in the Registrant’s practice.
110. The Panel did not infer from the fact that the Registrant has continued to work as a Paramedic that he has remediated all the deficiencies in his practice.
111. The Panel considered that that the Registrant has demonstrated limited insight. In his full admissions, and his expression of remorse in his reflective statement the Registrant has demonstrated some insight. The Registrant also made some admissions, including an admission that he had copied information from the GP letter, when he was interviewed by SM. However, he has not demonstrated to the Panel full insight into the seriousness of his misconduct and its impact on colleagues, patients, and public confidence in the profession. If the Registrant takes responsibility for his actions the Panel would expect him to be open with his colleagues and management about the Allegation and these proceedings. The Panel would also expect him to take a pro-active approach in preparing and presenting evidence to the Panel to demonstrate that he no longer presents a risk to the public.
112. The Panel considered the risk of repetition. It noted that there was a repetition of the similar errors in the completion of PRFs. Similar errors were repeated after the Registrant had completed training with Paramedic Supervisor JO’H in February 2016. The Registrant has remained employed by NIAS for a considerable period of time since the time of the Allegation and the Panel has no evidence that there has been a repetition of similar misconduct. While this may reduce the risk of repetition, it does not exclude it. The Panel decided that there remains a risk of repetition of misconduct, taking into account the Registrant’s limited insight and insufficient evidence that the Registrant has remedied the misconduct. The Panel was unable to exclude the risk of repetition of dishonesty because the Registrant has demonstrated limited insight.
113. The Panel therefore found that the Registrant’s fitness to practise is currently impaired on the basis of the personal component.
114. The Panel next considered the wider public interest considerations including the need to maintain public confidence in the profession and to uphold the required standards of conduct.
115. The Registrant’s misconduct includes dishonesty which occurred in relation to the Registrant’s professional duties and involved patient record. Dishonesty is a breach of a fundamental tenet of the profession. The misconduct also involves the potential risk of harm to patients. Informed members of the public would expect the Regulator to mark the Registrant’s departure from the required standards by a finding of current impairment.
116. The Panel considered the test proposed by Dame Janet Smith in the fifth Shipman report and considered that all four limbs of the test were engaged.
- The Registrant has in the past acted and is liable in the future so as to put a patient or patients at unwarranted risk of harm;
- The Registrant has in the past and is liable in the future to bring the paramedic profession into disrepute;
- The Registrant has in the past and is liable in the future to breach one of the fundamental tenets of the profession;
- The Registrant has in the past acted dishonestly and is liable to act dishonestly in the future.
117. The Panel therefore decided that a finding of impairment is required on the basis of the public component.
Decision on Sanction
118. The Panel accepted the advice of the Legal Assessor. It had regard to and applied the guidance in the HCPC Sanctions Policy. The purpose of any sanction is not to punish the Registrant, but to protect the public and the wider public interest. The Panel applied the principle of proportionality balancing the Registrant’s interests against the need to protect the public and the wider public interest.
119. The hearing had been adjourned part heard after the Panel’s decision on current impairment at a hearing held 2-6 August 2021. At this reconvened hearing the HCPC was represented by Ms Sheridan. The Panel was informed by Ms Sheridan that the Registrant is currently subject to an Interim Conditions of Practice Order which was imposed on 31 August 2021. This Interim Order includes certain practice restrictions in addition to standard reporting requirements. The Panel was informed that the Registrant remains employed by the Trust, but has not returned to undertake duties as a paramedic since the panel’s decision on facts, grounds and impairment dated 6 August 2021.
120. The panel was not provided with new evidence in advance of the reconvened hearing.
121. Dr Wright informed the Panel that the Registrant chose not to give evidence to the Panel, but was willing to answer questions from the Panel. The Registrant answered questions about his current circumstances. In the course of its questions the Panel requested documentation and was provided with:
- An occupational health assessment dated 30 September 2021. The assessment was limited to an assessment of the Registrant’s health. The recommendation was that Mr McDermott is fit to work as an RRV paramedic, but unfit to work as part of a two person crew;
122. The position remained the same as at the hearing 2-6 August 2021 that there was no medical evidence to suggest that the Registrant was impeded by health reasons from providing the Panel with evidence or information in relation to remedial action or his current level of insight.
123. Dr Wright also provided the Panel with an e-mail from MC (a witness for the HCPC). He advised “Following a clinical review, I can confirm that I met with Patrick McDermott on 8 June 2021 to commence an informal capability process”. There was no further documentation relating to this meeting, the nature of the incident identified, or any remedial steps taken under the capability process.
124. Until it received this e-mail the Panel was not aware that the Registrant was under a capability process commencing in June 2021; it had been given the impression by the Registrant and his representative at the 2-6 August 2021 hearing that the Registrant had successfully completed training in June 2018 and that there were no outstanding issues. When the Panel was exploring the issues of training and remediation with the Registrant at the hearing 2-6 August 2021 it would have expected the Registrant to have been candid about the recent capability process, and to provide details about its progress.
125. The Panel identified the following aggravating features:
- Dishonesty relating to completion of patient records;
- Breach of the trust placed in the Registrant by his employer, colleagues, and the patients;
- Potential risk of harm to patients;
- A pattern of repeated behaviour in failures to complete PRFs;
- Absence of evidence of remediation.
126. The Panel identified the following mitigating features:
- the absence of any previous regulatory findings;
- the Registrant’s admissions of the facts and his written statement expressing remorse.
127. The Panel did not give weight to the positive testimonial witnesses because those witnesses were not able to comment on the issues of dishonesty or completion of PRFs, and (other than one witness) they were not aware of the HCPC Allegation.
128. The Registrant had the opportunity to consider and reflect on the Panel’s decision on misconduct and impairment while the hearing was adjourned between 6 August 2021 and 4 October 2021. In its decision the Panel explained that it expected the Registrant, as a professional, to take a pro-active approach in preparing and presenting evidence for the Panel. The Panel was disappointed that the Registrant did not take the opportunity presented to him to prepare evidence for the reconvened hearing to demonstrate that he has begun a process of reflection and that he is motivated to remedy his past misconduct. The Registrant presented no new evidence to the Panel, no reflective statement, and no evidence, either in writing or oral evidence, that he understood and recognised the seriousness of the Panel’s findings. When asked by the Panel the Registrant had no plan for how he might begin to address the finding of current impairment. The Panel detected no signs that the limited insight that the Registrant demonstrated at the hearing in August 2-6 was developing or that the Registrant had made any effort to progress in a journey towards remediation.
129. The Panel considered the seriousness of the dishonesty. The dishonesty related to patient records which is a particularly serious form of dishonesty. It involved one patient, but multiple recordings for that patient. The dishonesty was an active form, it included deliberate copying from the GP letter. Although the dishonest act took place on a single day, the Registrant maintained to his colleague AK days later that he had carried out all the observations he had recorded. He made admissions only when the matter was reported to management and subject to an investigation. The Panel considered that there was no significant mitigation in relation to the dishonesty.
130. The Panel recognised the seriousness of dishonesty as outlined in paragraphs 58 and 59 of the Sanctions Policy. The dishonesty in this case had a direct impact on the Registrant’s colleague AK and it potentially had an impact on patient safety.
131. The panel considered the sanctions in ascending order of seriousness. The option of taking no action would be entirely inappropriate and insufficient because the Panel has concluded that there is a risk of repetition.
132. The option of a Caution Order is insufficient because of the seriousness of the misconduct, involving a breach of a fundamental tenet of the profession, the Registrant’s limited insight and the absence of evidence of remediation.
133. The Panel considered a Conditions of Practice Order. The Sanctions Policy at paragraph 108 provides guidance that conditions of practice are less likely to be appropriate in more serious cases such as those involving dishonesty. The Panel did not consider that this is an exceptional case where conditions of practice would be appropriate, particularly because the Panel has concluded that there is a risk of repetition of dishonesty as well as incomplete completion of PRFs. The Panel also decided that conditions of practice would be insufficient to maintain public confidence in the profession, given the gravity of the misconduct in this case.
134. The Panel next considered the option of a Suspension Order. Paragraph 121 of the Sanctions Policy provides guidance that:
“A Suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:
- The concerns represent a serious breach of the Standards of conduct, performance and ethics;
- The registrant has insight;
- The issues are unlikely to be repeated; and
- There is evidence to suggest that the registrant is likely to be able to resolve or remedy their failings”
135. The Panel considered that the application of these considerations did not indicate that a Suspension Order was appropriate. In particular the Panel has no evidence before it that the Registrant is likely to be able to resolve or remedy the misconduct, the Registrant’s insight is limited, and there is a risk of repetition. The risk of repetition is not always a conclusive factor against the imposition of a Suspension Order because a Panel may be persuaded that there is a prospect that the Registrant will be able to remedy the misconduct and thus mitigate against the risk of repetition, enabling a return to safe practice. In this case the Panel was not persuaded that there is a realistic prospect that the Registrant will be able to remedy the misconduct. Despite having the opportunity to reflect on the Panel’s decision, the Registrant did not present evidence and the Panel did not detect any progression or change in his attitude.
136. In circumstances where the Registrant has not demonstrated his understanding of the Panel’s decision and the seriousness of his misconduct, the Panel considered that a Suspension Order would not be sufficient to uphold public confidence in the profession and the regulatory process.
137. The Sanctions Policy at paragraph 130 advises that a Striking Off Order is a sanction of last resort for serious acts including dishonesty. Guidance is given at paragraph 130:
“A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant:
- Lacks insight;
- Continues to repeat the misconduct …
- Is unwilling to resolve matters.”
138. The Panel decided that this guidance applies and that the appropriate sanction is a Striking Off Order.
139. In the entirety of its deliberations the Panel bore in mind that any sanction must be proportionate. The Registrant remains employed by the Trust and the Panel was aware that the sanction of a Striking Off Order will have a significant negative impact on the Registrant’s financial interests and reputational interests. Nevertheless, the Panel decided the Registrant’s interests were outweighed by the need to protect the public and to maintain public confidence in the profession and the regulatory process. The Panel decided that a Striking Off Order is the appropriate order.
ORDER: The Registrar is directed to strike the name of Patrick McDermott from the Registrant from the date this order takes effect.
Right of Appeal
You may appeal to the High Court in Northern Ireland against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.
Ms Sheridan made an application for an interim suspension order for a period of eighteen months on the ground that it was necessary for the protection of the public and was otherwise in the public interest. She submitted that if the Registrant were to lodge an appeal there would be no protection for the public if the Registrant was to return to practice.
Dr Wright adopted a neutral position on the application.
The Panel accepted the advice of the Legal Assessor.
The Panel decided that an interim order is necessary for the protection of the public. The Panel has identified an ongoing risk to the public arising from the risk of repetition. It would not be appropriate and contrary to the Panel’s decision on impairment and sanction for there to be no public protection during the twenty-eight days before the Suspension Order takes effect and for the duration of any appeal. An interim order is also otherwise in the public interest because informed members of the public would be shocked or troubled to learn that the Registrant had continued to practise as a Paramedic during the appeal period.
An Interim Conditions of Practice Order would not be sufficient because it would not adequately protect the public against the risk of repetition of dishonest conduct. Therefore, an Interim Suspension Order is the appropriate order. The Panel decided to make the order for a period of eighteen months, the maximum duration, to allow sufficient time for any appeal to be disposed of.
The Panel therefore made an Interim Suspension Order for a period of eighteen months.
The registrant has appealed this decision and therefore the interim suspension order will remain in place until the outcome of the appeal.
History of Hearings for Patrick McDermott
|Date||Panel||Hearing type||Outcomes / Status|
|04/10/2021||Conduct and Competence Committee||Final Hearing||Struck off|
|02/08/2021||Conduct and Competence Committee||Final Hearing||Adjourned part heard|