Mr Anthony Morris

Background

1. The Registrant was employed by North West Ambulance Service NHS Trust (“NWAST”) as a Paramedic.

2. On 26 August 2016, the Registrant attended to Service User A in response to an emergency 999 call made by Person C. The Registrant subsequently contacted the ambulance control room and requested an ambulance crew as backup. Another Paramedic (LC) and Colleague A, an Emergency Medical Technician (EMT), were dispatched to assist him and arrived in an ambulance. Service User A died shortly after her arrival at the hospital. Person B, Service User A’s mother, submitted a written complaint to NWAST on 22 March 2017 with regard to the care that Service User A received from the Registrant and LC. PC, a Patient Experience Manager at NWAST, subsequently completed an investigation. JP, who was an Advanced Paramedic, conducted a clinical review of the incident.

3. A referral was made to the HCPC by NWAST on 25 July 2017 in regard to the Registrant’s fitness to practice.

4. At the substantive hearing, the panel determined that the matters found proved amounted to misconduct and the Registrant’s fitness to practise was impaired on both the personal and public components.

5. In regard to sanction, the panel imposed a Conditions of Practice Order for a period of 12 months to enable the Registrant to address the deficiencies that were identified in his practice, thereby protecting service users and maintaining public confidence in the profession. The panel at the substantive hearing considered whether to impose a Suspension Order but concluded that this would be disproportionate to the deficiencies identified and would not enable the Registrant to resume practice and to address the matters of concern. It noted that the Registrant had shown improved insight between July and September 2020 and had shown deep remorse, which that panel concluded was both persuasive and heartfelt, having accepted its findings in full, and there was clear evidence that he was taking responsibility for the failings which had resulted in the death of Service User A.

First substantive review

6. At the first substantive review, the panel varied Conditions 1 and 2 and extended the period of the Order for a further 12 months. The Registrant had not started working as a Paramedic and there was no evidence that he had fully remediated his failings. The panel found that both the public and private components of impairment were met.

Second review

7. This was an early review which was listed at the Registrant’s request. The Registrant had been offered employment by a registered nurse, who had written to the HCPC to explain that she runs an intravenous micronutrient supplementation business and that she would be able to employ the Registrant and supervise him. As she is a practicing nurse and not a paramedic, she would not meet the requirement of Condition 2 of the Order regarding supervision by a registered Paramedic. The application by the Registrant was for Condition 2 to be varied.

8. At that hearing Ms Sampson, on behalf of the HCPC, did not object to the Registrant’s application to amend Condition 2 to allow him to accept the offer of employment. Ms Sampson suggested that Condition 2 could be amended to substitute the words “registered Paramedic” for “registered health care professional”.

9. Ms Sampson submitted that there had been no material change since the last review and that, as a result, the Registrant’s fitness to practise remained currently impaired on the basis of the personal and public components. The variation would allow the Registrant to work as a Paramedic and give him the opportunity to demonstrate further insight, remorse, and remediation. The reviewing panel noted that the Registrant had not worked as a Paramedic for a significant period of time.

10. The Registrant accepted that he remained impaired as he had not been working in a registered Paramedic role.

11. The previous reviewing panel had suggested steps that the Registrant could take which might assist a future panel. In addition, the panel indicated to the Registrant that it would be wise for him to contact the HCPC Registration department to clarify whether the employment he had been offered would allow him to obtain the requisite clinical hours to maintain his registration.

Today’s review hearing

12. In reaching a decision in this substantive review, the Panel read the HCPC bundle, which contained the previous decisions (including the substantive hearing decision), and the Registrant’s bundle. It heard oral submissions from Ms Sampson and from the Registrant.

13. In his bundle, the Registrant provided 23 certificates for training which he had completed online. Although all the certificates were dated 13 and 14 August 2022, the Panel understood that these were the dates on which the certificates had been downloaded and the e-learning itself was completed over a period of four to five months. The Registrant also provided eight reflective pieces. The Panel took particular note of the Registrant’s reflection on the incident and what he had learned from it, as well as a reflective piece on the impact of his omissions/actions on Service User A’s family and on the reputation of the profession.

Personal Development Plan

14. The Registrant provided a copy of his Personal Development Plan, which was completed and signed regularly by the Registrant and his supervisor between February and August 2022. This specifically addressed the following aspects of the Registrant’s practice:

• Managing challenging and non-compliant service users.

• Treating service users and their families/others with respect and dignity.

• Clinical assessment and examination.

• Baseline observations.

• Communicating with service users and carers.

• Appropriate extrication and conveyance of service users.

• Timeliness of interventions.

The Panel was satisfied that this showed the Registrant had complied with the previously imposed Conditions of Practice Order.

Reflective pieces

15. The Registrant provided eight reflective pieces, some of which covered the issues outlined in his Personal Development Plan. In these reflective pieces he emphasized the importance of public confidence and trust in the Paramedic profession. He wrote that his actions on the day in question had “impacted negatively on the entire profession of paramedics”. He referenced this back to reports in the press which stated that Patient A was “wrongly treated” and which had identified NWAST, the Trust where he was working at the time of the incident. He went on to state, “The family members of patient A have reported that they no longer have faith in the ambulance service and that they have ongoing trauma; they become upset even at the sound of a siren. My involvement has impacted negatively on the entire profession of paramedics for which I am deeply apologetic”. He acknowledged that his conduct had brought the profession into disrepute and wrote that he had, “replayed the incident over repeatedly in my mind from every possible angle and have full knowledge that I would never allow the same situation to happen again. If I was ever faced with a similar high pressure situation I would never make such unprofessional comments or say things that could be deemed inappropriate”. He acknowledged that he had said multiple inappropriate things and that this had impacted on his ability to take a patient history. He wrote that it saddened him that he had caused “patient suffering”.

Supervision and appraisal

16. The Registrant also provided informal ‘supervision notes’ from JH, the nurse who is supervising him. These were dated: 26 February 2022; 29 April 2022; 4, 13, and 30 May 2022; and 3 July 2022. She also provided an appraisal of the Registrant’s progress. There were two positive feedback forms from patients whom the Registrant had treated.

17. In her appraisal and summary of the Registrant’s performance, JH praised the Registrant’s commitment, his clinical strengths, and his patient care. She stated that the Registrant had fitted in at Positive IV and described him as a valuable team member. She stated that he had contributed to updating policies and procedures and that, in her opinion, he was on the right path to independent practice. She wrote in the appraisal, “one of your strengths is to show empathy for our patients and their health … Your team player attitude to the service has been noted”.

Submissions

18. Ms Sampson submitted that the HCPC’s position was that the Conditions of Practice Order should continue. She submitted that although the Registrant had taken significant positive steps, he had indicated to her in pre-hearing discussions that he wanted the Conditions of Practice Order to remain in place. She reminded the Panel of the background facts. Service User A’s mother had called an ambulance because Service User A was having difficulty breathing, was unable to sit up, and was struggling to stay awake. The Registrant did not appear to take Service User A’s condition seriously, implying openly that she was feigning illness. Ms Sampson also submitted that the Registrant had made other inappropriate comments throughout his treatment of Service User A, including requesting an ambulance “for my own sanity”.

19. The Coroner’s Inquest highlighted that there had been gross failures in providing basic medical care to Service User A. Ms Sampson identified the multiple inappropriate comments and the attitudinal failures which resulted in a failure to carry out observations and care in a timely manner and which contributed to the death of Service User A.

20. Ms Sampson took the Panel to the decision of the substantive hearing panel and reminded it that the Registrant bore the persuasive burden at today’s hearing. Ms Sampson acknowledged that the Registrant was developing and was progressing. She noted that the feedback from the Registrant’s clinical lead was positive and that in his current role he had been commended for his kind, considerate, and friendly dealings with patients. She acknowledged his Continuing Professional Development (CPD) in terms of e-learning, but noted that there was no evidence from the HCPC Registration department as to whether this was sufficient as part of his Return to Practice. She also referred the Panel to the reflective pieces, which she stated showed good insight. However, she questioned whether the use of the ‘third person’ was an indicator that the Registrant was not taking full responsibility for his failings. She invited the Panel to extend the Conditions of Practice Order for a further 6-12 months.

The Registrant’s submissions

21. The Registrant made submissions to the Panel. He told the Panel that he believed that this was just a six-monthly review and that he had only been working for five months. He had believed that the Conditions of Practice Order would last for 12 months from the commencement of his employment. He stated that he did not feel confident to return to unrestricted practice. At that stage he had not worked in a role requiring Paramedic registration for over four years.

22. The Registrant stated that he was enjoying his new role and had a lot to learn. He is currently directly supervised in everything that he does. He stated that he now needs to start working autonomously with the safety net of indirect supervision so that he can build his confidence. He said he would like the Conditions of Practice Order to remain in place with some variation.

23. The Registrant was asked by the Panel about his reflective piece and what he would do differently if faced with the same situation again. He stated that, looking back on the incident, his behavior had been “completely out of line”. He said obtaining trust would be a priority. Had he approached the situation differently, recognising as a starting point why the public call an ambulance and the importance of understanding their stress, he might have been able to take a history and do the necessary observations. He said that this was a very stressful situation but that he is now a completely different person. He continually reflects on how his reaction to the situation impacted on the events as they unfolded.

24. The Registrant said that he has no intention of returning to frontline work. He has not practised emergency medicine for a long time and would need a lot of re-training to go back to this type of work.

25. The Registrant stressed that he wanted to be allowed to carry on developing. He stated that his supervisor was available to speak to the Panel if it wanted to hear from her as to how he was doing in his current role.

Decision

26. In reaching its decision, the Panel considered all the information before it together with the submissions of Ms Sampson and the Registrant. It had regard to the HCPTS Practice Notes on ‘Fitness to Practise Impairment’ and ‘Review of Article 30 Sanction Orders’.

27. The Panel accepted the advice of the Legal Assessor. She reminded the Panel that it was required to conduct a full assessment of the Registrant’s fitness to return to unrestricted practice.

28. A substantive review is a two-stage process. The first task of the Panel is to decide whether the Registrant’s fitness to practice is currently impaired and if so, to then consider what sanction, if any, to impose.

29. The Panel must determine whether the Registrant’s fitness to practice is impaired today, taking into account the Registrant’s conduct at the time of the events and any relevant factors since then, such as whether the Registrant has developed insight, whether the matters are remediable or have been remedied, and any likelihood of repetition.

30. The Panel’s task is not to punish the Registrant for past acts. However, the Panel is required to take account of past acts and omissions in order to make an informed assessment as to whether the Registrant’s fitness to practise is currently impaired. The persuasive burden would rest with the Registrant to show that he is no longer impaired.

31. The Panel’s role is not to conduct a rehearing of the Allegation, nor is it to go behind the previous findings. In carrying out its assessment, the Panel has exercised its own independent judgement.

Impairment

32. In considering the question of impairment, the Panel determined that the Registrant’s fitness to practise remains impaired on both the personal and public components.

33. In terms of the personal component, this was a single incident with fatal consequences. However, the Panel was impressed by the work that the Registrant has done since the last review hearing. He has completed a significant amount of robust personal development. The e-learning that he has undertaken is extensive and his appraisal is excellent. Following its questions of the Registrant, the Panel was of the view that the Registrant has developed significant insight and remorse. It accepted that the Registrant understands his behaviour fell far below basic acceptable standards on the night in question.

34. The Panel noted that the Registrant does not intend to return to work as a frontline paramedic. He told the Panel that he would need to do significant re-training to work in an emergency setting and that he is fully aware of the HCPC Standards of Conduct, Performance and Ethics, particularly Standard 3.1, which requires him to ensure that he works within his scope of practice by only practising in the areas where he has the appropriate knowledge, skills, and experience.

35. The Panel noted that the Registrant was clear he wanted the Conditions of Practice Order to continue. The Panel found that the Registrant’s position at today’s hearing was a clear indication of remorse and insight and of his understanding of the limits of his current capability. This position provides an insight into his humility and his understanding of the serious nature of his failings. The Registrant is to be commended for his honesty in this regard. The Registrant is not working independently at the moment. He is directly supervised at all times. The Registrant identified that he needs to build confidence both in taking a patient’s history and in intravenously administering vitamins as part of his current role. The Panel therefore found that whilst the Registrant has developed greater insight and remorse, he has not fully remediated his actions. Accordingly, the Panel found that the Registrant needs to continue to build knowledge and confidence. It noted that the Coroner identified a failure to take a proper history and that, going forward, the Registrant needs to continue to work on this aspect of his practice. In short, for all of the reasons outlined above, the Panel found that the Registrant remains impaired on the personal component.

36. The Panel next considered the public component of impairment. The Panel considered that the public interest requirement in this case is significant. The Registrant’s failures contributed to a fatality. Paramedics occupy a position of trust and vulnerable members of the community depend on them in times of crisis. The Panel considered that a reasonable member of the public would be concerned at the prospect of the Registrant working at the moment without restriction. This is because he has still not shown to the public that it can be reassured he would always offer an adequate level of care to service users. The Registrant himself is not confident because of his lengthy period away from Paramedic practice. The Panel therefore found that the public component of impairment is also found in this case.

37. In short, the Panel concluded that the Registrant’s fitness to practise remains impaired on both the personal and public components.

Sanction

38. The Panel approached the question of sanction from the least restrictive upwards. It exercised the principle of proportionality. It took into account that the purpose of sanction is to protect the public and uphold the public interest. The Panel accepted the advice of the Legal Assessor.

39. The Panel first considered whether to revoke the existing Order. It concluded that this would be inappropriate as it would provide no restriction on the Registrant’s practice. It would not be sufficient to address the public interest concerns in the case. A Caution Order would be insufficient for the same reasons.

40. With regard to Conditions of Practice, the Panel took into account that the Registrant is making good progress, noting the evidence of insight, remorse, and remediation he has provided for this review hearing. He has abided by each of the conditions set out by the previous panels. He has expressed to this Panel a clear wish to be supervised for the time being. In the circumstances, the Panel concluded that extending the Conditions of Practice Order for 6 months is necessary and proportionate to protect the public against the risk posed by the Registrant. This would also address the wider public interest concerns.

41. The Panel carefully considered the Registrant’s request to vary the conditions to allow him to work more independently. It noted that whilst the HCPC submissions were that the Registrant was allowed to work under the indirect supervision of a registered health care professional, the Registrant had interpreted the Conditions of Practice Order as requiring direct supervision. The Panel accepted that the Conditions of Practice Order as originally drafted had the potential to be interpreted in this way. The Panel decided to amend the conditions to clarify them and to reflect the evidence which it had heard and the progress which the Registrant has made.

42. The Panel noted that the HCPC Registration department has acknowledged the Registrant’s request for information but has not yet responded with advice as to the CPD required for Return to Practice. The Panel would hope that the necessary information will be before a future panel.

43. The Conditions of Practice Order will be extended for a further 6 months, with variations to the conditions as set out below.

44. A reviewing panel may be assisted by the following:

• The Registrant’s attendance at the review hearing.

• His supervisor’s attendance to give evidence as to the Registrant’s progress.

• Copies of the reflective pieces seen by this Panel and any further reflective pieces relating to the Registrant’s recent practice, particularly addressing his confidence in the history-taking process and autonomous working.

• Evidence of relevant and up-to-date CPD and appropriate training.

• Recent testimonials attesting to the Registrant’s character and skills.

The Registrar is directed to vary the Conditions of Practice Order against the registration of Mr Anthony Morris for a further period of 6 months on the expiry of the existing Order. The Conditions are:

1. Whilst working as a registered Paramedic, you must place yourself and remain under the indirect supervision of a supervisor who is a registered healthcare professional and:

a. You must attend upon that supervisor as required and follow any advice and recommendations.

b. You must work with your supervisor to keep your Personal Development Plan up-to-date. Your updated plan must be designed to address deficiencies in your scope of practice, including:

i. working autonomously and independently.

ii. taking full and accurate patient histories.

iii. formulating appropriate treatment plans.

c. You must meet with your supervisor on a fortnightly basis for the first two months, to consider your progress towards achieving the aims set out in your updated Personal Development Plan, and monthly thereafter.

d. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan every three months and prior to any review of this Order.

2. You must supply details of any change to your current supervisor to the HCPC within 14 days.

3. Informing the HCPC and others:

i. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

ii. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

iii. You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;

B. any agency you are registered with or apply to be registered with (at the time of application); and

C. any prospective employer (at the time of your application).

4. Within two months of the commencement of this Order you must forward a copy of your updated Personal Development Plan to the HCPC.

5. You must continue to undertake the process of, and meet the requirements for, Return to Practice as set out by the HCPC and provide details of any correspondence between yourself and the HCPC regarding this matter to your HCPC Case Manager at least 14 days before any review hearing.

6. You will be responsible for meeting any and all costs associated with complying with these conditions. Any condition requiring you to provide information to the HCPC is to be met by you sending this via email to both the relevant HCPC Case Manager and ftp@hcpc-uk.org.

The Order imposed today will apply from 16 September 2022.

This Order will be reviewed again before its expiry on 16 March 2023.

History of Hearings for Mr Anthony Morris