Mr Maksym Wojcieszek
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Allegations as proven at the final hearing
Whilst registered as a Paramedic and working for East Midlands Ambulance Services (“EMAS”):
1. On or around 25 October 2017 during a ‘ride out review’ you:
a. did not have the underpinning knowledge to complete an adequate patient assessment;
b. had poor ECG recognition skills;
c. did not take into account or understand all information given by a patient in relation to the presenting complaint.
2. On or around 20 November 2017 during an assessment day, you failed to:
a. identify and manage a time critical patient effectively;
b. [not proven]
c. consider reversible causes of cardiac arrest / paediatric arrest;
d. use Capnography during a cardiac arrest;
e. conduct adequate pulse checks on a patient;
f. consider the seriousness of a patient not having passed urine for two days;
g. consider the Paramedic pathfinder and/or NEWS Score for a patient with a history of productive cough;
h. consider using a sepsis toolkit for a patient with a history of productive cough;
i. give 5 rescue breaths prior to placing pads on the chest in a paediatric arrest.
3. The matters set out in Paragraph 1 and 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.
1. The Panel finds there has been good service of the notice of hearing dated 12 January 2022 sent to the Registrant’s registered email address. The Panel was satisfied that the Registrant has received the notice of hearing and the Rules of service were complied with. The notice of hearing informed the Registrant that this review of the current Order would take place today by video conference.
2. The Registrant has replied stating that he will not be attending the hearing and wishes to be removed from the HCPC register.
Proceeding in the absence of the Registrant
3. The HCPC invited the Panel to proceed in the absence of the Registrant under Rule 11 of the Procedure Rules and to take into account the HCPTS Practice Note on Proceeding in the Absence of the Registrant. The HCPC submits that it is in the public interest for this statutory review hearing to proceed. The Panel must balance the overriding interest of public protection with fairness to the Registrant.
4. The Panel has considered the HCPC Practice Note, and taken the Legal Assessor’s advice. There is a burden on a Registrant to engage with their regulator and the Registrant is aware of the hearing today. There is a statutory requirement for the current Order to be reviewed before it expires.
5. The Registrant has voluntarily chosen not to attend today’s hearing and it is not likely that the Registrant would participate in these proceedings on a future date if this hearing is adjourned. There has been no request for an adjournment and it is appropriate to proceed in the absence of the Registrant.
6. The Registrant was employed as a Band 5 Paramedic by East Midlands Ambulance Service (EMAS) from 27 March 2017 to 25 January 2018. During this employment he had regular probation reviews when concerns about his competence were identified.
7. EMAS decided to examine the concerns further by means of a “ride out review” on 25 October 2017 and an assessment day on 20 November 2017.
8. The “ride out review” was conducted by Witness 1, who gave evidence at the Final Hearing.
9. The assessment day was conducted by Witness 2, who gave evidence at the Final Hearing and was supported by Witness 3.
10. Both events identified continuing concerns regarding the Registrant’s ability to practise safely.
11. During a probation review meeting on 21 November 2017 it was decided that the Registrant’s probationary period would need to be extended and an action plan was provided.
12. Thereafter, there were continuing concerns regarding the standard of the Registrant’s practise.
13. On 19 January 2018, the Registrant attended a probationary review meeting chaired by Witness 4 who also gave evidence at the Final Hearing. At that meeting a decision was taken to terminate the Registrant’s employment, with effect from 25 January 2018.
14. However, following the Registrant’s appeal against his dismissal, the Trust decided to offer alternative employment to the Registrant and he was offered a place on an Ambulance Technician/Associate Ambulance Practitioner course due to start on 23 April 2018. The Registrant accepted that offer of further employment.
15. At the Substantive Hearing on 13 February 2020, the Registrant was found to be impaired and a 12-month Suspension Order was imposed.
The Final Hearing panel
16. The decision of the Final Hearing panel stated that EMAS was running a recruitment programme in which their staff would visit Poland to assess and select individual Polish Paramedics, who were suitable for paramedic practice in the UK. They travelled to the UK and undertook an EMAS adaptation process intended to properly familiarise and train them in UK paramedic practice.
17. The Registrant qualified as a Paramedic in Poland, worked in that capacity for about 6 months and subsequently came to the UK and applied to EMAS for appointment as a Paramedic. At that time the Registrant had about 6 months prior experience as a Paramedic over the previous 6 years. He was not assessed by EMAS staff while he was in Poland, before being invited for employment and admission to the adaptation process.
18. During a probation review meeting on 19 January 2017 the Registrant stated that as a Paramedic in Poland he was trained to perform certain skills, but was usually with a doctor who decided when those skills should be used. During the assessment day, he accepted that he previously said he could not see the point of having “anatomy and physiology knowledge”.
19. Within 3 months of starting employment with EMAS on 27 March 2017, there were concerns amongst EMAS staff as to the Registrant’s competence.
20. The Final Hearing panel was satisfied that the Registrant was a conscientious employee who was trying to do his best to fulfil his duties. His failure to perform, (in the eyes of EMAS), to an adequate standard was, because of his very limited practical experience in Poland. He had been working in a Paramedic environment, which required a much more limited area of expertise and autonomy, compared with UK Paramedic practice. In addition, the duration of his past Paramedic employment in Poland had been very limited.
21. The Registrant’s failure to operate at a competent level was not because he was failing to use skills that he already had, but was as a result of the Registrant not having previously been trained to the level required of a UK Paramedic. The adaptation training offered by EMAS did not adequately meet this gap in the Registrant’s skill level.
22. The Final Hearing panel concluded it could not reasonably be said the Registrant’s failings amounted to misconduct. His failings clearly amounted to a lack of competence.
23. The Final Hearing panel’s assessment of Sanction recorded the Registrant was always committed to his duties. There was a skills gap between the level of skill expected from a Paramedic registered in Poland and a Paramedic registered in the UK.
24. For whatever reason, the training received by the Registrant on his appointment to EMAS did not sufficiently prepare him to operate as a competent UK Paramedic.
The previous Review Hearing
25. At the time of the Review hearing on 29 January 2021 the Registrant was working in an Emergency Care Assistant’s post. His representative informed the panel that his employer and colleagues were supportive of the Registrant’s efforts to retrain and over the last 2 years the Registrant’s English language skills had improved significantly.
26. The Registrant provided the panel with his thoughts on the process which had taken up the last two years of his professional life. He highlighted the impact of the COVID-19 pandemic. He fully appreciated that his professional skills had been below that expected of him and he was prepared and willing to undertake appropriate retraining. He fully understood why his employers had initially dismissed him and he was appreciative that he had been given the opportunity to retrain. The loss of some of his portfolio arose from the EMAS training unit transfer. The Registrant had passed all of his examinations and completed all assignments. He should have qualified in March 2019 had it not been for the loss of material and then the allegation of plagiarism.
27. A support package was put in place. This had come into effect in January 2021. The Registrant was fully engaged in the process and hoped that within the next few weeks he would be able to submit his portfolio. If he obtained the AAP qualification the Registrant intended taking forward further retraining so that he can attain the requisite level of skill and knowledge to work as a Paramedic.
28. The Registrant’s Representative informed the panel that EMAS has asked the HCPC Education Department for an extension of time in which to undertake the remaining courses and support package. It was possible it could be done in 6 months, but more realistically it will take 12 months.
29. The Reviewing panel had before it a copy of a Disciplinary Hearing Outcome letter of 15 September 2020, sent by EMAS, relating to a hearing on 2 September 2020. At that hearing the Registrant faced an allegation that: “Whilst completing the Associate Ambulance Practitioner (AAP) apprenticeship, you provided plagiarised elements of your portfolio”. The Registrant had been working as a Trainee Technician on a course since June 2018, when he had moved from his previous position as a Paramedic, due to the concerns about his professional knowledge and skills.
30. The Registrant had submitted his first portfolio in December 2018. In January 2019 he was advised about plagiarism within his academic work, and was given a further opportunity to submit his portfolio in his own words. The Registrant submitted a second portfolio in July 2019. During the Internal Quality Assurance (IQA) process it was noted that the formatting of sections of the Registrant’s portfolio of evidence was inconsistent with the rest, the level of language and detail of response was also inconsistent throughout the portfolio. Following further checking, it was found that 4 paragraphs from unit 11 of the portfolio were directly lifted from various international websites. The Registrant was unable to explain how this had happened, but suggested that these could have been saved and submitted as an earlier version of the portfolio but this did not explain why the text did not follow the process the Registrant described. A review of 123 paragraphs had identified 12 further examples of work taken directly from the internet.
31. The EMAS panel concluded that the Registrant’s actions could not be considered poor academic skill, as the act of copying and pasting is a deliberate act, and although it may have been an error on the Registrant’s part not to change the text, these actions could be defined as plagiarism, in breach of the Disciplinary Policy. The Registrant received a First Written Warning to ‘remain live’ for a period of 26 weeks.
32. The first HCPTS Reviewing panel also had before it a copy of the Outcome of Disciplinary Appeal Hearing dated 19 November 2020 relating to the Registrant’s Appeal Hearing heard via Microsoft Teams on 9 November 2020. The EMAS appeal panel determined that plagiarism had occurred within the AAP portfolio in keeping with the original hearing, however it concluded that there were influencing factors that would question as to whether it was a wilful act. In relation to the outcome the EMAS appeal panel stated: The First Written Warning should be changed to an Informal Counselling.
33. The first Reviewing panel noted that whilst there had not been any formal delivery of the evidence the Final Hearing panel indicated may be of use to a reviewing panel; what had been conveyed, through two letters and statements made by the Registrant and his Representative, covered the information which was required. The panel noted that the Registrant had not attended the Final Hearing and so had not at that time taken the opportunity to express to that panel his views on his failings.
34. At the review hearing the Registrant had been candid and open about his lack of knowledge and skills. He had also demonstrated and expressed full insight into his former failings. His level of engagement with his retraining and his commitment and energy for self-improvement was obvious.
35. The panel appreciated that the pragmatic position adopted by the Registrant of taking an alternative role which does not require his registration, and working and retraining his way back to his chosen profession was a brave and sensible one. The panel noted that various setbacks had allowed the Registrant the opportunity to show his resilience and determination. In the absence of evidence to demonstrate full remediation, the panel concluded that there remained an ongoing need for a restriction on the Registrant’s practice. Also public confidence in the profession and in the regulatory process would be undermined if the Registrant were able to practise without restriction. The Registrant’s fitness to practise remained impaired on the personal and the public components.
36. The panel then went on to consider the appropriate and proportionate sanction. The panel concluded that the Registrant’s failings were widespread and related to an inability to reach the required standard of performance expected in the UK. The periods of practice review had identified widespread failings in the Registrant’s practice which have not been remedied. The panel was satisfied that a Suspension Order for 12 months was necessary to give the Registrant a further opportunity to undertake suitable remediation.
37. The panel stated a future reviewing panel would be assisted by receiving from Registrant in advance of the hearing:
a) testimonials and/or references from colleagues;
b) a report from a clinical supervisor which comments on the Registrant’s standard of work and his ability to meet the practice requirements of a Paramedic;
c) details of any training undertaken by the Registrant in relation to Paramedic practice, with particular regard to the Registrant’s practice failings identified by the panel.
Submissions at the second Review Hearing
38. Ms Sampson submitted on behalf of the HCPC that the question for the Panel to consider today is what, if anything, has changed since the current Order was last reviewed. The factors to consider include:
a) the steps which the Registrant has taken to address any specific failings or other issues identified in the previous decision;
b) the degree of insight shown and whether this has changed;
c) the steps which the Registrant has taken to maintain or improve his professional knowledge and skills;
d) whether any other fitness to practise issues have arisen;
e) whether the Registrant has complied with the existing order.
The reviewing Panel’s task is to “consider whether all the concerns raised in the original finding of impairment have been sufficiently addressed.” (Abrahaem v GMC  EWC 183 (Admin). As the decision in Abrahaem v GMC indicates, in practical terms there is a “persuasive burden” on the Registrant, to demonstrate at a review hearing that he has fully acknowledged the deficiencies which led to the original finding, and addressed that impairment sufficiently “through insight, application, education, supervision or other achievement”.
39. The Registrant’s submission is that he “is no longer impaired.” However the Registrant has not provided the Panel with any evidence to demonstrate that this is the case, including the information suggested by the previous panel. Additionally, there is no information about the Registrant’s current circumstances or his future plans, other than a request to remove him from the HCPC register. Therefore, the HCPC submits that nothing has changed since the last review and a further order is required. The HCPC submits the Panel has two options: the first is a striking off order which is available to the Panel today as the Registrant has now been continuously suspended for a period of two years. The Panel may think that this would reflect the Registrant’s wishes as he has twice asked to be removed from the HCPC register. Alternatively, the Panel will note that, on 11 February 2022, the HCPC wrote to the Registrant offering him the option of voluntary removal. Considering that, the Panel may wish to consider extending the Suspension Order for a shorter 6-month period to enable the Registrant to consider whether he wishes to pursue this option or to provide a future panel with evidence that he is no longer impaired.
Legal Assessor’s advice
40. The Legal Assessor reminded the Panel that its purpose today was to conduct a comprehensive review to determine if the Registrant is fit to return to unrestricted practice and referred the Panel to the approach to be adopted. The Panel’s role is not to conduct a rehearing of the allegations or go behind the previous findings. The Legal Assessor advised the Panel to take into account the HCPTS Practice Notes on Article 30 Reviews and Finding that Fitness to Practise is Impaired. If it determined that the Registrant’s fitness to practise remains impaired, then the Panel must go on to consider what restriction, if any, should be imposed.
41. The Legal Assessor advised the Panel that it should bear in mind the principles of fairness and proportionality and have regard to the Sanctions Policy. Any Order under Article 30 should be the least restrictive order that would suffice to protect the public and/or would otherwise be in the public interest.
42. The Legal Assessor drew the Panel’s attention to the terms of Article 29(6) of the Health Professions Order 2001 which states: A striking-off order may not be made in respect of an allegation of the kind mentioned in Article 22(1)(a)(ii), 'lack of competence' or (iv), 'health' unless the person concerned has been continuously suspended, or subject to a conditions of practice order, for a period of no less than two years immediately preceding the date of the decision of the Committee to make such an order.
43. The Legal Assessor reminded this Panel that the Registrant will have been suspended for a continuous period in excess of two years, and so this Panel does have the option to strike the Registrant’s name from the register on the expiry of the current order.
44. The Panel’s powers under Article 30(1) of the Health Professions Order 2001 include all the sanction options including a Striking-off Order.
45. The Panel accepted the advice of the Legal Assessor. The Panel has to make an assessment of the Registrant’s fitness to practise as of today’s date. The Panel has taken into account the HCPTS Practice Note on Finding that Fitness to Practise is Impaired, which emphasises that the fitness to practise process is about public protection. A Panel must take into account the personal component, which includes the current competence and behaviour of the Registrant, and the public component, which includes protecting service users, declaring and upholding proper standards of behaviour and maintaining public confidence in the Paramedic profession.
46. This review process requires a Registrant to demonstrate both developed insight and remediation before returning to unrestricted practice. There is a persuasive burden on the Registrant to demonstrate that he is safe to return to practice. The Panel took into consideration all the documentation before it, and the submissions made. The Panel finds that there has been no change in the Registrant’s circumstances since the last Review hearing, as regards remediation or insight. He gave evidence to the previous Reviewing panel but he has provided no evidence that he has taken the steps suggested by that panel. His fitness to practise is still impaired because he has not remediated the concerns with regard to his Paramedic skills, and the public protection issues remain unresolved. He is still impaired on the personal and public components.
47. The Panel considered whether to impose a Caution Order and took into consideration the guidance within the Sanctions Policy as to when such an order was appropriate. The Panel concluded that such an order would not be sufficient to protect the public, nor would it be in the public interest given that the Registrant’s failings were wide-spread and related to an inability to reach the required standard of performance expected in the UK. The Panel next considered whether to impose a Conditions of Practice Order and concluded that such a measure would neither be appropriate nor workable given the nature of the lack of competence found proved and the evidence that periods of practice reviewed had identified wide-spread failings in the Registrant’s practice. The Registrant has also recently stated in his email correspondence with the HCPC that he is not currently impaired. The Panel has determined that this demonstrates a lack of insight into his failings. He has not attended the hearing today.
48. The HCPC submitted that the Panel should consider either a short further suspension or a Striking-off Order. The Panel was advised to consider imposing the least restrictive Order today, consistent with the public interest and fairness to the Registrant. The Panel took into account that the Registrant fully engaged and cooperated with the previous Review hearing and indicated his clear intention to undertake remediation. He has responded to the Notice of Hearing for today’s hearing, albeit only to state that he will not be attending and is not currently impaired. In these circumstances, the Panel has concluded that a further period of suspension for 6 months is appropriate and proportionate.
49. The Panel is satisfied that a Suspension Order of 6 months will give the Registrant an opportunity to either request a voluntary removal from the HCPC register, or to demonstrate he has undertaken suitable remediation in respect of the failings identified by the previous Reviewing panel. The next Reviewing panel will be assisted by the Registrant providing:
a) testimonials and/or references from colleagues;
b) a report from a clinical supervisor which comments on the Registrant’s standard of work and his ability to meet the practice requirements of a Paramedic;
c) details of any training undertaken by the Registrant in relation to Paramedic practice, with particular regard to the Registrant’s practice failings identified by the last Reviewing panel.
50. If no further steps are taken by the Registrant to engage with the HCPC, the next Reviewing panel will still have the available sanction of a Striking-off Order. The Panel today considered imposing a Striking-off Order but decided that the Registrant should be given a final opportunity to engage with the HCPC and demonstrate remediation, or seek a voluntary removal.
The Registrar is directed to suspend the registration of Maksym Wojcieszek for a further period of 6 months on the expiry of the existing Order.
The order imposed today will apply from 12 March 2022.
This order will be reviewed again before its expiry on 12 September 2022.