Mr Paul R Hawker

Preliminary Matters

 

Admissions

 

1. At the commencement of the hearing, the Registrant entered formal admissions to Particulars 1(c) and 1(d) of the Allegation.

 

Witnesses

 

2. The Panel heard live evidence from:

 

• Witness 1 – eye witness, service station employee

 

• Colleague 1 – Emergency Care Assistant (ECA) on shift at the material time with the Registrant

 

• CF – Operations Officer for South Western Ambulance Service NHS Foundation Trust

 

• GC – Operational Quality Lead for the Patient Safety (Quality and Clinical Care) Team at the Trust and Investigations Officer

 

• The Registrant.

 

Background

 

3. The Registrant is, and was at the relevant time, a Band 6 Paramedic for the Accident and Emergency Operations Department of South Western Ambulance Services NHS Foundation Trust (“the Trust”).

 

4. On 24 October 2019 the Registrant was partnered with ECA, Colleague 1. At the end of his shift, he drove his ambulance onto the forecourt of Sainsbury’s Service Station, Weymouth, to fill up with fuel before returning to Weymouth Ambulance Station. Colleague 1 filled up the tank whilst the Registrant walked towards the store to pay. At that time, Witness 1 (“W1”) was tending to a member of the public, Service User 1 (“SU1”), who was sitting in her car. W1 was concerned that SU1 was unwell. The Registrant was alerted to this and went over to SU1’s car.

 

5. It is alleged that in light of what had been brought to his attention, and in light of what he saw, the Registrant did not adequately examine or assess SU1 before leaving the scene, and did not recognise that she was experiencing the symptoms of a stroke. It is alleged and is admitted by the Registrant that he did not complete an Electronic Patient Clinical Record (EPCR) or ask SU1 to sign a Refusal of Treatment Form.

 

6. A police officer (PC1), who drove into the service station in need of fuel, attended to SU1 after the Registrant had left the scene. The police eventually transported her to hospital. SU1 was diagnosed with a stroke and later died. It was not the HCPC’s case that the Registrant’s conduct had contributed in any way to SU1’s demise.

 

7. The incident was investigated internally by CF, Operations Officer for the Trust, who produced an Investigation Report. It was separately investigated by GC, Operational Quality Lead for the Patient Safety Team for the Trust, who produced a Review Learn Improve Report based on the incident.

 

Witness evidence

 

Witness 1

 

8. Witness 1 (“W1”) told the Panel that on 24 October 2019 she was working as a sales assistant in Sainsbury’s service station, Weymouth, when a woman, now known to be SU1, entered the store to pay for petrol. SU1 had told W1 in the past that she had suffered from a stroke. However, W1 noticed nothing untoward about SU1’s appearance or demeanour when she came into the store.

 

9. Approximately five minutes later a male customer came into the store and told W1 that there was something wrong with SU1, who was sitting in her car parked at petrol Pump 2, and did not look very well.

 

10. W1 left the store and approached SU1, who was sitting in the driver’s seat, with the driver’s door open, and her legs were positioned outside the driver’s door. W1 said that SU1 now looked “completely different”. She looked “all clammy and grey”.

 

11. W1 asked SU1 if she wanted a drink of water. SU 1 said “no” at first but then changed her mind and so W1 ran back to the store to fetch a glass of water which she then took to SU1. W1 said that by then SU1 could not speak properly and “it looked like the side of her face had drooped”.

 

12. W1 gave SU1 the glass which SU1 took but her hand was shaking badly making it difficult for her to hold it. W1 asked SU1 if she wanted help with the glass, to which SU1 replied “yes” so W1 then assisted SU1 to sip some water.

 

13. W1 asked her colleagues to call 999 for an ambulance.

 

14. In her witness statement, W1 said that SU1’s speech became increasingly slurred and that after a few minutes she could not understand a word SU1 said. SU1 was also breathing quite heavily and touching her chest with one arm while the other arm was down resting on her leg. Her hands felt clammy when W1 held them to reassure her and her face was still drooped on one side. She described that “this was a massive change to how she had been in the store”. W1 thought SU1 was having a stroke.

 

15. After W1 had returned to SU1, the Registrant drove onto the service station forecourt in his ambulance, crewed by Colleague 1, in order to fill up with fuel before returning to their station nearby at the end of their shift. Colleague 1 filled the ambulance with petrol whilst the Registrant started to make his way to the store to pay. W1 said she called the Registrant over, saying “I don’t think the lady is very well. I’m not sure what’s wrong with her but I think she may be having a stroke. My colleagues are inside dealing with a 999 call. Is there anything you can do to help?”.

 

16. W1 said that the Registrant came over to the car and stood the other side of the open door from her, beside the bonnet. He spoke through the open door. W1 said “he turned around and looked at his wrist and said ‘we’ve finished now, we’re clocking off, you’ll have to continue with the 999 call’. I looked at him in amazement and then looked at the patient, he walked to the store and paid for his fuel”.
17. W1 said she was shocked by the Registrant’s response. She continued to speak to SU1. Meanwhile the Registrant went into the store to pay, came out, walked straight back to the ambulance and drove off.

 

18. W1 said that shortly after this a police car drove onto the forecourt for fuel. W1 explained the situation to PC1. In his witness statement, PC1 stated: “I mentioned to W1 that an ambulance had just left the garage forecourt and she informed me that she had spoken to the male paramedic who walked over to the car and looked at SU1 but did not examine her and he then told W1 to call 999 as they were going off duty soon.” Other police officers attending then made their own calls requesting an ambulance and later drove SU1 to hospital.

 

19. In cross-examination it was put to W1 that she had overheard a member of the public, rather than the Registrant, saying that the Registrant had finished his shift. W1 denied this. She said she couldn’t remember whether the Registrant was wearing a watch. It was put to her that the Registrant spoke directly to SU1 and asked SU1 some questions, which W1 disputed. W1 claimed that the Registrant did not speak to SU1 at all. W1 also said that the first police officer arrived after the ambulance had left. She was adamant that SU1’s condition did not improve in the course of her interaction with the Registrant, or at all.

 

Colleague 1, CF and GC

 

20. Colleague 1 was on the other side of the ambulance, filling up with petrol, at the relevant time. She therefore did not see what happened.

 

21. CF produced stills from CCTV footage which she had viewed. The stills showed SU1 sitting in the driver’s seat of her vehicle with the door open. W1 was standing beside SU1 and leaning in towards her. The Registrant was standing on the other side of the open door, beside the bonnet, so that he was facing both W1 and SU1. The stills indicated that the first police car had arrived just before the ambulance left. The stills showed that the Registrant was standing at SU1’s car for a total of 48 seconds. CF stated that on the CCTV footage, SU1’s limbs could be seen to move.

 

22. CF was a registered Paramedic. She said that the symptoms of a stroke could include facial droop, slurred speech, and weakness of the limbs. However, the type of stroke that SU1 was later discovered to have suffered, would have resulted from a bleed in a specific part of the brain, and that therefore the signs might have been non-specific, such as headache, high blood pressure, nausea and generally feeling unwell. She said that regardless of whether the symptoms had been specific or non-specific, the “average” Paramedic would be aware of this, and expected to conduct a full set of observations, including an ECG to rule out cardiac problems, a “FAST Test” to investigate symptoms associated with a stroke, and a cranial nerve assessment. This would involve direct contact with the patient, rather than merely speaking to or observing the patient. She confirmed that the duties of a Paramedic applied, when in uniform, whether or not the Paramedic had been called to the scene following a 999 call rather than being hailed by a member of the public. CF said that she had not seen the Registrant look at his watch on the CCTV footage, but stated that it would not have been possible to ascertain this due to the angle of the camera.

 

23. GC confirmed that she too had viewed the live CCTV footage. She agreed that it had showed SU1 moving her limbs. She said that it did not show the Registrant looking at his watch although she could not exclude the possibility that he had looked at his watch and that this was not caught on CCTV.

 

24. GC said that she had later spoken to a doctor at the Trust regarding SU1’s condition who had informed her that the symptoms of her stroke could have been intermittent.

 

The Registrant

 

25. The Registrant said he had been a registered Paramedic since 2002. He now worked as operational Paramedic at Dorchester Ambulance Station.

 

26. He said that on 24 October 2019, he got out of the ambulance with the intention of paying for fuel but was approached by a male member of the public who said, “I know you’re off duty but there’s a lady over there in a vehicle who’s not feeling very well”. The Registrant said that he had never been able to find out how this person had known that he was off duty.

 

27. The Registrant said that he approached SU1’s car. The driver’s door was open, SU1 was sitting in the driver’s seat, W1 was standing beside SU1 talking to her and he stood on the other side of the open door by the bonnet. He said he introduced himself to W1 and said, “I gather the lady is not feeling too well”. W1 replied “the lady is not feeling too well I think she might have had a stroke”.

 

28. The Registrant said he then introduced himself to SU1 who looked well. She looked “like any other person you might meet in the street”.

 

29. The Registrant said he asked SU1 if she needed any help. She replied “no”.

 

30. He asked SU1 whether there was any pain anywhere. She said “no”.

 

31. He asked if she needed any further help or to go to the hospital. She said, “no I’m fine”.

 

32. He did not ask any further questions.

 

33. The Registrant said that W1 then interjected by indicating that a phone call had been made to SU1’s relative who was coming to pick SU1 up. SU1 agreed to this by saying “yes”.

 

34. The Registrant stated that he then said “OK that’s fine if you don’t need any help. But if for some reason in the future you need us, call 999”. He said that both SU1 and W1 verbally agreed, and that this was the end of the conversation.

 

35. The Registrant said that there had been nothing about the presentation of SU1 that had caused him concern. He said he could see she was moving and focusing on him and was hearing what he was saying. She was moving her hands. At no stage was SU1’s speech slurring when he was with her. Nor was her face drooping. She was not grey or clammy. She was sitting in the driver’s seat, her head was slightly out of the car so that the three of them could have a conversation, and she was moving reasonably well. He disagreed with W1’s evidence to the contrary.

 

36. The Registrant said that he did not think it prudent to make further enquiries at the time. He had concluded that SU1 did not want more help and that she had decided to refuse help from him.

 

37. He said he would have liked to have done a FAST Test but he did not do so because SU1 was adamant that she did not want more help. He accepted, with the benefit of hindsight, that gaining a history would have been beneficial.

 

38. The Registrant said he was not wearing a wrist-watch stating that he never wore one whilst on duty as it was not allowed.

 

39. The Registrant said there was nothing else said between himself and SU1. He walked to the store to pay for his petrol before returning the ambulance, glancing towards SU1’s car as he did so, to see that she was still talking to W1. He saw a police car on the forecourt and nodded to the police officer who was filling up.

 

40. He then drove off.

 

41. The Registrant accepted that he should have asked SU1 to sign a refusal of treatment form and that he should have completed an EPCR.

 

42. In the course of Panel questioning, the Registrant agreed that during the internal investigation interview he had claimed that it was SU1 not W1 who had told him about the arrangements regarding a family member being on their way. He said that had been a mistake on his part.

 

Submissions

 

43. Mr Foxsmith submitted that the case rested on the evidence of W1, who had provided evidence in a manner that was calm, measured, clear, coherent, compelling and consistent. By contrast the Registrant’s evidence lacked credibility.

 

44. Ms Bracken submitted that W1 was an honest witness, but was not sufficiently reliable to overcome the burden and standard of proof. By contrast the Registrant was a man of good character whose evidence should be believed.

 

Legal Advice

 

45. The Panel accepted the advice of the Legal Assessor, who advised on the burden and standard of proof, the formal admissions entered by the Registrant, the approach to take when considering the credibility of witnesses (Dutta v GMC [2020] EWHC 1974) and the Registrant’s good character.

 

46. In reaching its decision the Panel took into account the evidence of the HCPC witnesses, together with the documentation provided by them, and the evidence of the Registrant, together with testimonials supplied on his behalf. Throughout its decision-making the Panel took into account, to the Registrant’s benefit, the Registrant’s good character, as supported by the testimonials supplied on his behalf.

 

Witness analysis

 

47. The Panel found W1 to be a credible, clear, coherent and reliable witness. There was a high level of consistency between what she said at the time to PC1, as referenced in paragraph 16 above, what she said in her HCPC statement, and what she told the Panel in oral evidence and during cross-examination.

 

48. The Panel concluded that the evidence of Colleague 1 took the matter no further.

 

49. The Panel took account of the evidence provided by CF and GC, and in particular their evidence regarding the CCTV footage. However, the majority of their evidence concerned background material and views that they had themselves formed on the basis of the evidence, which was not a matter for the Panel to consider; the Panel formed its own view of the evidence before it.

 

50. For reasons that will be set out later in this document, the Panel found the Registrant to be inconsistent in giving evidence; much of his evidence was inherently implausible and his evidence lacked credibility.

 

Decision on Facts

 

Sub-Particulars 1(a) and 1(b)

 

51. The Panel accepted the evidence provided by W1, who provided clear reliable evidence. There was no reason to suppose that she had made any of her evidence up, and it had not been suggested that she had done so. It was suggested that she had been mistaken, but the Panel disagreed with that view.

 

52. In answer to the suggestion made on behalf of the Registrant that the CCTV evidence had thrown doubt on W1’s evidence, in that it did not show the Registrant looking at his watch, the Panel took account of the evidence of CT that whilst she had seen no footage of the Registrant looking at his watch, nevertheless it was possible that the Registrant had looked in the direction of a watch and that this had not been caught on CCTV. Further, the Panel noted from the CCTV stills, that for the majority of the time it was the Registrant’s head and shoulders alone that could be seen, and W1 as well as the open car door were obscuring a full view of the Registrant. Whilst W1 had stated to the police that the Registrant had looked at his watch, she had clarified this in her witness statement to the HCPC by stating “he was looking at his wrist whilst he was saying this. I believed he was looking at the time on a watch”. In his investigation interview the Registrant had agreed that he may have looked down, albeit not at his watch, and conceded that there may have been a mannerism that was interpreted as such. The Panel concluded that W1 may have wrongly presumed that the Registrant was looking at his watch at the time when he said that his shift had come to an end and he had to leave. In any event, the Panel found the issue of whether the Registrant looked at his watch to be tangential and did not affect the Panel’s view of the credibility of W1.

 

53. In answer to the suggestion made on behalf of the Registrant that W1 had been incorrect in saying that the police car arrived after the ambulance had left, the Panel noted that the first time that W1 made this point was in her witness statement to the HCPC dated 18 January 2021. In her police statement, made closer in time, on 12 November 2019, she referred to the arrival of PC1, and not to the arrival of the first police car. The Panel concluded that she may have conflated the time of the attendance at SU1’s car by PC1 on foot with the time of the arrival of the first police car. Again, the Panel found this to be a tangential point. W1 had been concentrating on providing care and reassurance to SU1, and it would be understandable if she demonstrated confusion regarding the precise timing of the arrival of the first police car which was situated out of her field of vision when she was focused on attending to SU1.

 

54. By contrast the Panel found the Registrant’s account of events inherently implausible. Even on his own account he had not obtained SU1's history or asked W1 if there had been any reported history other than her belief that SU1 was having a stroke. The CCTV footage showed that he had spent a mere 48 seconds in her presence. In that time, on his own evidence he did not obtain anything other than one word answers from her. In relation to three questions asked by him, she had, according to the Registrant, responded “no”, and in response to a fourth question, she had responded “yes”. This could not be regarded as an examination or assessment.

 

55. In his reflective statement, entitled ‘reflection petrol station incident 2019’, the Registrant had stated that SU1 could complete full sentences. However, his evidence was now that she provided one word answers.

 

56. In oral evidence the Registrant said that W1 told him that SU1 was having a stroke. He had not provided this evidence in any earlier statement, previously only stating that she had been reported as feeling “unwell”.

 

57. In the internal investigatory interview, the Registrant claimed that it was SU1 who informed him that a family member was on their way, whereas in his reflective statement he stated that it was W1 who informed him of this.

 

58. The Panel did not accept the Registrant’s evidence that a member of the public approached him armed with the unlikely knowledge that he was off duty at the time. It preferred the evidence of W1 who stated that it was she who called the Registrant over to assist as soon as he got out of the ambulance, and not another member of the public. The Panel further noted that, although the investigators on behalf of the Trust had viewed the entire CCTV footage, they had made no reference to this alleged member of the public approaching the Registrant. The Panel concluded on the balance of probabilities that the Registrant had invented this encounter to explain how it was that W1 recalled him saying that he was unable to stay to assist as he was off duty.

 

59. The Panel did not accept that there were no visible signs and that there were no symptoms present at the time when the Registrant was with SU1. It was accepted on behalf of the Registrant that W1 had not fabricated the signs that she observed. It was postulated, on his behalf, that; those signs had been absent at the time when W1 first saw her, had developed whilst W1 was in contact with her by the car, must then have diminished by the time the Registrant interacted with her, to no signs whatsoever and then escalated by the time of the arrival of the police. The Panel found this to be inherently implausible. The reported symptoms described by W1 as to the appearance of SU1 were profound. From the CCTV stills, the Panel were able to determine that the timescale for the Registrant walking away from SU1 and leaving the service station in his ambulance was 2 minutes and 45 seconds. There are CCTV stills showing that at the time the ambulance departed the first police officer was in the act of refuelling his police car. Once he finished refuelling, he walked directly to SU1 and W1. Within this very short period of time PC1 described the same signs and symptoms of SU1 as reported by W1. The Registrant had been with SU1 for a total of 48 seconds. The Panel concluded on the balance of probabilities that it was inherently implausible that SU1 was of normal appearance and like “any other person you might meet on the street” as the Registrant reported, during the time he was with her.

 

60. On the basis of the evidence provided by the Registrant, the Panel did not accept the suggestion that SU1 had refused treatment such as to render the possibility of further examination and/or assessment impossible. On his own evidence the Registrant offered SU1 no treatment for her to refuse. On his own evidence he had asked very limited closed questions of SU1. It was, on his evidence, little more than a cursory interaction. Furthermore, the Panel preferred the evidence of W1 who stated that the Registrant had not attempted any dialogue with SU1 and, in any event, she described SU1 as barely being able to talk at all at this time.

 

61. It was the Registrant’s evidence that he had been told by W1 that SU1 had had a stroke. The Panel concluded that what he went on to do was wholly insufficient. Even on his own evidence he did not ask about “nausea, problems with her vision and tingling sensations” he had told the Panel he might have expected to be present. He did not question SU1 in any detail or attempt to make any physical contact with her in order to assess her. He concluded that although she had refused involvement from him he agreed that he did not adequately asses her capacity to refuse further involvement.

 

62. The Panel concluded, on the basis of all the evidence, that the Registrant failed to adequately examine and assess SU1.

 

63. Accordingly, the Panel found particular 1(a) proved.

 

64. The Registrant’s failure to examine and or assess SU1 meant that the Registrant did not discover the symptoms of a stroke. It followed that he did not recognise that she was experiencing a stroke.

 

65. The Panel concluded on the basis of all the evidence that the Registrant failed to recognise that SU1 was experiencing the symptoms of a stroke.

 

66. Accordingly, the Panel found particular 1(b) proved.

 

 

 

Sub-Particulars 1(c) and 1(d)

 

67. The Panel found these sub-particulars proved on the basis of the evidence given and the Admissions entered.

 

Submissions on Grounds and Impairment

 

68. The Registrant did not give evidence at the misconduct and impairment stage. He provided a bundle of documentation which comprised:

 

• references, including a reference from his Operations Manager

 

• A reflective piece

 

• An article written by him entitled: “Reflection of attending a 52 year old gentleman with suspected CVE. (October 2021)”.

 

• An article written by him entitled “Stroke Unit Visit – 5/11/21”

 

• A number of e-learning training certificates, including a certificate in Acute Care and Treatment of Strokes.

 

69. Mr Foxsmith submitted that the Registrant had breached Standards 1, 2, 6, 7, and 9 of the HCPC Standards of Conduct, Performance and Ethics 2016. He submitted that the Registrant’s behaviour, in neglecting to undertake an assessment of a vulnerable service user, was a serious failing that fell far below what would be expected of him as a Paramedic. The Registrant had breached fundamental principles of his profession. He had walked away from the scene that day “without a backward glance”. For all these reasons, his behaviour amounted to misconduct.

 

70. Mr Foxsmith accepted that the material now provided by the Registrant was capable of demonstrating regret, remorse and insight. He submitted that although the Registrant’s reflections had come late, after the Panel’s findings of fact, it was never too late. The Registrant had undertaken assessments of patients who had suffered strokes and had proactively visited a hospital stroke unit. He had not been the subject of any other regulatory concerns. Mr Foxsmith therefore questioned whether the Registrant’s fitness to practise is impaired by reason of the personal component. However he submitted that the Registrant’s fitness to practise is impaired by reason of the public component, and that a finding of impairment of fitness to practise is required to declare and uphold standards and to maintain confidence in the

 

71. Ms Bracken accepted that the Registrant had breached the HCPC Standards of Conduct Performance and Ethics listed by Mr Foxsmith. She made no positive submissions in relation to misconduct. She submitted that misconduct is a matter for the judgement of the Panel.

 

72. Ms Bracken submitted that the Registrant’s fitness to practise is not currently impaired. She relied on the character references put forward. She submitted that the Registrant had taken steps to remediate his failings, as set out in the documentation provided by him. Ms Bracken alerted the Panel to the fact that the Registrant had proactively visited a stroke unit as soon as COVID-19 restrictions allowed and provided an article on his experience there. Ms Bracken submitted that a finding of impairment was not required on the public component in the light of the Registrant’s unblemished career, his remediation and his declared commitment to the profession.

 

Decision on Grounds

 

73. The Panel accepted the advice of the Legal Assessor, who advised it to ask whether, in its judgement, the Registrant’s behaviour had fallen seriously below the standards required of a registered Paramedic in the circumstances, and whether his behaviour would be regarded as deplorable by fellow practitioners. She took the Panel to the cases of Roylance –v- General Medical Council No 2 [2001] 1 AC 311 and Nandi v GMC [2004] EWHC 2317.

 

 

74. The Panel concluded that the Registrant had breached the following Standards of Conduct, Performance and Ethics 2016:

 

1. Promote and protect the interests of services users and carers.

 

2. Communicate appropriately and effectively.

 

6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.

 

7.1 You must report any concerns about the safety or well-being of service users promptly and appropriately.

 

7.6 You must acknowledge and act on concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so.

 

9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

 

10 Keep records of your work.

 

75. The Panel concluded that a member of the profession would regard the Registrant’s behaviour to be deplorable. His behaviour had fallen far below the standards expected of him as a registered Paramedic. He had failed to conduct an assessment of a vulnerable member of the public, despite significant concern expressed to him by another, engaged, member of the public. The Registrant had conceded in evidence that W1 had told him of her concern that SU1 was having a stroke. Despite this, he had stood at SU1’s car with her and W1 for a mere 48 seconds before choosing to walk away. He conducted no assessment of SU1. He did not speak directly to her. His behaviour amounted to a flagrant disregard of the needs of a member of the public in acute need. Instead, he had chosen to leave SU1 in the care of W1 who was sufficiently concerned to then engage the assistance of a passing police officer, PC1. In turn, this officer and his subsequent colleagues were themselves sufficiently concerned about SU1’s welfare that they chose to remain with her at the scene and called for an ambulance. PC1 confirmed W1’s description of SU1’s appearance; that on arrival at SU1’s vehicle “I could see that the left side of her face had dropped. I took hold of her hand and noticed her skin was also very clammy. Her speech was slurred, and I too believed she was having a stroke”. Shortly after his attendance, PC2 decided to administer oxygen to SU1 himself, and the attending police eventually transported SU1 to hospital over 45 minutes later when an ambulance had not arrived.

 

76. The Panel reminded itself that when giving evidence during the fact-finding stage, the Registrant maintained his position that SU1 had not been demonstrating signs of a stroke in the time he spent with her. He defended his decision not to undertake a medical assessment, explaining that, “As a paramedic, we almost have a sixth sense of recognising if a patient is what we call ‘big sick’ and ‘little sick’ within seconds. It’s a kind of intuitive thing that you build up over years.  So, by looking at someone intuitively with the experience that you gain, you can deduce if somebody is really what we would call ‘big sick’ or ‘little sick’.  On further questioning, the Registrant then went on to describe the serious conditions he said he would have been able to discount in SU1 by such “intuition” and “sixth sense” including hypoglycaemia, myocardial infarction and CVE. He was “confident” he had been able to discount such conditions in the case of SU1, although he later conceded when questioned by the Paramedic member of the Panel that this may not have been possible.

 

77. The Panel determined that the Registrant’s approach to his decision-making in relation to SU1 was seriously flawed and fell far short of what would be expected of him. It concluded that other members of the Paramedic profession would consider it deplorable.

 

78. Accordingly, it was the judgement of the Panel that the behaviour found proved amounted to misconduct.

 

Decision on Impairment

 

79. The Panel accepted the advice of the Legal Assessor who advised it to consider the first three of the criteria set out in the case of the Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Paula Grant [2011] EWHC 927, namely whether the Registrant:

 

• Has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

 

• Has in the past and/or is liable in the future to bring the profession into disrepute; and/or

 

• Has in the past breached and//or is liable in the future to breach one of the fundamental tenets of the profession.

 

80. The Legal Assessor advised the Panel, in accordance with the case of Cohen v General Medical Council [2008] EWHC 581, to ask whether the Registrant’s misconduct is easily remediable, whether it has in fact been remedied and whether it is highly unlikely to be repeated. She advised the Panel to ask whether this could be regarded as an isolated event in an otherwise unblemished career, and whether the Registrant had demonstrated genuine insight into his past misconduct. In accordance with the case of the Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Paula Grant [2011] EWHC 927 she advised the Panel to consider not only whether the Registrant presents a risk to members of the public, but also whether proper professional standards and public confidence in the Registrant and in the profession and its regulator, would be undermined if a finding of impairment of fitness to practise were not made in the circumstances of this case. She encouraged the Panel to consult the Practice Note issued by the HCPTS entitled ‘Finding that Fitness to Practise is Impaired’.

 

81. The Panel accepted that the Registrant was of previous good character and had a long unblemished career. He had worked as a Paramedic for many years with no adverse incident. He had provided excellent testimonials in support of his character and his ability as a Paramedic.

 

82. The Panel accepted that the Registrant had not been idle since the incident, in that he had taken steps to demonstrate why he should be allowed to continue in the profession. He had written a reflective statement. He had visited a stroke unit and provided an article on that visit. He had provided a written reflection of his attendance on a service user who had suffered a Cerebral Vascular Event. He had conducted a literary review of Cerebro Vascular Events. He had completed associated e-learning on Acute Care & treatment of

 

83. It was also clear that the Registrant had demonstrated remorse and regret.

 

84. The difficulty faced by the Panel was that there was no evidence that the Registrant’s fundamental attitude to the events on the day in question had altered.

 

85. At its highest the Registrant had said, in his personal reflection, that: “It was never my intention, to not discharge my duties fully. My priority was to help if I was needed. I recognise that I have failed service user 1, by not spending a long enough period of time with her and this contributed to my lack of recognition of her developing signs and symptoms of a CVE…….I recognise now that I did not fully assess the service user as I should have done and was too quick to accept what I interpreted as her refusal for further help”.

 

86. It appeared from this passage, and from the flavour of his reflective statement as a whole, that whilst the Registrant now accepted that he did not spend long enough with SU1, he maintained the stance that he adopted in the course of the fact finding stage of these proceedings; that he had conducted some assessment of SU1, although did not “fully assess” her; and the reason for his lack of engagement was his “interpretation” that SU1 had refused his help, despite the contrary evidence from W1 that there had been no dialogue between them. Furthermore, the Registrant’s reflections did not demonstrate any acceptance on his part that the signs described by W1 at the time would have been clearly visible to him, just as they had been clearly visible to W1 and the police officers. The Registrant had left SU1 in the hands of W1, without conducting any assessment whatsoever. Whilst doing so, the Registrant would have been fully aware that preserving the welfare of any patient thought to be suffering a stroke would be time critical. He had refused to engage with W1, a significantly concerned and engaged member of the public, and SU1, a potentially seriously ill patient.

 

87. In the course of the hearing the Registrant had been provided with ample opportunity during Panel questioning to explore whether the reality was that he had acted as he had done because he was at the end of a long shift. Rather he told the Panel in the course of giving evidence that this was not a factor and would have made no difference to his decision-making. The Panel noted that the Registrant introduced in his most recent reflective piece that he had been suffering from health issues and “by the end of a shift I was exhausted but thought that I did not let it affect how I respond to a call for help. I would like to be clear, that I am not using any of these issues as an excuse for my behaviour and lack of action on that day, but it does demonstrate some of the underlying strains I was facing during that time”. This would appear to be the start of some indication by the Registrant that he might have been fatigued at the time of the incident. However he does not suggest that he failed SU1 because of fatigue or ill health.

 

88. In his most recent reflection the Registrant continued to assert that it was SU1 who had refused help from him, and that this was the reason for him leaving the scene. In his statement he does concede that he had been “too quick to accept what I interpreted as her refusal for further help”. However, his continued assertion of SU1’s refusal is not supported by any assessment by the Registrant of SU1’s capacity to refuse treatment at the time, nor was an EPCR undertaken. A completed EPCR would have documented any refusal of care and ensured proper safety provision (“safety netting”) was in place in the event of leaving a patient unattended or unreferred to an appropriate care pathway. In addition, the Registrant’s suggestion of SU1’s “refusal” was refuted by W1 who was adamant from the very first instance (in her communication with PC1) that the Registrant had failed to attempt any dialogue with SU1, and that in any event SU1 was by then barely able to speak. Rather, W1’s evidence was that the Registrant’s response to her request for help was “we are late as it is, we are clocking off now. You will have to continue with the 999 call”. The Registrant’s reflections indicate no recognition of his responsibility to listen properly to the concerns put to him by W1 (that SU1 was having a stroke), and act on those concerns appropriately.

 

89. Although the Registrant now accepted that he should have spent more time with SU1 and should have fully assessed her, he was unable to give the Panel a credible explanation for why he had chosen not to engage with SU1 or W1 as he should have done. He provided no explanation for his decision to treat SU1 differently to how he would treat any other service user from a 999 emergency call, despite the signs that, on the findings of this Panel, must have been apparent to him at the

 

90. In this regard, there was nothing before the Panel to suggest that the Registrant now accepted his wrong-doing in walking away from SU1 and W1. Neither was there anything from the Registrant to demonstrate that he had addressed any factors that may have contributed towards him being unwilling to engage with SU1 and W1.

 

91. Furthermore, there is no mention of the Registrant’s reliance on intuition and sixth sense as an alternative to an appropriate medical assessment, or any revision of this approach in his written submissions. At the Misconduct and Impairment stages, the Panel was unable to question the Registrant as to whether he had now reviewed this practice. Consequently, the Panel could only conclude that the Registrant’s approach had not changed in this regard.

 

92. Therefore in asking whether the Registrant had developed genuine insight into his misconduct, the Panel was driven to conclude that the attitude demonstrated by him in choosing not to engage with SU1 and W1, and voluntarily leave the scene, had not demonstrably altered.

 

93. It was the judgement of the Panel that without these critical insights into his behaviour in relation to a patient presenting with potential serious ill health, there remains a risk of repetition of the Registrant’s conduct. He therefore presents a risk to the public if permitted to practise

 

94. The Panel therefore finds the Registrant’s fitness to practise to be currently impaired on the personal component.

 

95. The Panel concluded that the Registrant’s misconduct amounted to a breach of a fundamental tenet of the profession and had brought the profession into disrepute. It was the judgment of the Panel that public confidence in the Registrant and his Regulator and his profession would be undermined if a finding of impairment were not made in the circumstances of the case. The Registrant had been presented with a vulnerable member of the public who was demonstrating signs of a stroke, as witnessed by a concerned bystander who drew the matter to his attention. His decision to walk away from the scene without taking any action would cause a member of the public to lose confidence in the profession.

 

96. The Panel therefore also finds the Registrant’s fitness to practise to be currently impaired on the public component.

 

97. Accordingly, the Panel concluded that the Registrant’s fitness to practise is impaired by reason of both the personal and public components.

 

Submissions on Sanction

 

 

98. Mr Foxsmith reminded the Panel of the criteria that the Panel should apply when reaching its decision. He submitted that Sanction was a matter for the judgement of the Panel.

 

99. Ms Bracken submitted that a Conditions of Practice Order was the appropriate sanction. She reminded the Panel that the Registrant had a long unblemished career and that he had continued to practise for two years since the incident without there being further concern.

 

100. Ms Bracken informed the Panel that the Registrant accepted every word of the Panel’s determination. She said that he agreed that what had happened was deplorable, and that he was disappointed that he had not better expressed his view of this incident and in the way that the Panel had articulated. Ms Bracken submitted that the Registrant accepts that no assessment was conducted and therefore SU1 was not in a position to accept or refuse treatment.

 

101. Ms Bracken submitted that the Registrant does not seek to go behind the findings of the Panel regarding the presentation of SU1. He does not assert that SU1 was showing no relevant signs; he accepts that he did not put himself in a position to enable him to recognise those signs. The Registrant’s failure to examine or assess SU1 meant that he did not discover the relevant symptoms. It followed that he did not recognise that SU1 was having a stroke.

 

102. Ms Bracken submitted that the Registrant was not seeking to explain his poor decision making by relying on fatigue or other personal matters. She submitted that his candour was to his credit. She submitted that conditions would give him the opportunity of proving to a panel that he had reflected on the incident in the way that was required, and would give him time to express himself in the way he needed to do.

 

Decision on Sanction

 

103. In reaching its decision on sanction, the Panel accepted the advice of the Legal Assessor and took into account the HCPC Sanctions Policy.

 

104. The Panel kept in mind that the purpose of sanction is not to be punitive, but is to protect members of the public, to maintain proper standards within the profession, and to uphold the reputation of the profession and its regulator.

 

105. In considering whether to make an order, and the nature and duration of any order to be made, the Panel applied the principle of proportionality, weighing the Registrant’s interests against the need to protect the public and the wider public interest.

 

106. The Panel took into account both mitigating and aggravating factors.

 

107. The Panel concluded that the following were mitigating factors:

 

• The Registrant’s previous good character and unblemished career, as supported by testimonials, which included his continued work in practice since 2019 without further incident

 

• The Registrant had shown regret and some remorse.

 

108. The Panel concluded that the following were aggravating factors:

 

• The seriousness of the incident
• The risk of harm to a highly vulnerable, elderly and acutely ill service user
• The Registrant’s failure to heed the concerns expressed by W1
• The Registrant’s recklessness and lack of compassion in leaving SU1 without having carried out any clinical assessment of her
• The Registrant’s failure to raise concerns
• The Registrant’s failure to work in partnership with his crewmate, Colleague 1, attending police officer or his colleagues in the Trust’s control room.
• The lack of relevant remediation or insight

 

109. The Panel considered the sanctions available to it in ascending order of severity.

 

110. The Sanctions Policy indicates that a Caution Order is likely to be appropriate for cases in which:

 

• the issue is isolated, limited or relatively minor in nature,
• there is a low risk of recurrence,
• the registrant has shown good insight and
• the registrant taken appropriate remedial action.

 

 

111. The Panel concluded that to take No Further Action or to impose a Caution Order would not be sufficient to protect the public, maintain confidence in the profession and maintain confidence in the regulatory process. Whilst the Panel accepted that this was an isolated event in the Registrant’s unblemished career, none of the factors set out in the Sanctions Policy indicating the suitability of a Caution Order were present.

 

112. The Sanctions Policy indicates that a Conditions of Practice Order is likely to be appropriate for cases in which:

 

1. the registrant has insight
2. the failure or deficiency is capable of being remedied
3. there are no persistent or general failures which would prevent the registrant from remediating
4. appropriate proportionate realistic and verifiable conditions can be formulated
5. a reviewing panel will be able to determine whether or not the conditions have or are being met
6. the registrant does not pose a risk of harm by being in restricted practice
7. the registrant is genuinely committed to resolving the issues and the panel is confident that the registrant will do so
8. the panel is confident the registrant will comply with the conditions.

 

 

113. The Panel concluded that a Conditions of Practice Order would be insufficient in the light of the seriousness of the misconduct. The Panel had concluded that the Registrant lacked insight into his misconduct. Whilst the Panel had been informed that the Registrant now accepted the findings of the Panel, the Registrant had not evidenced any genuine understanding into the effect of his actions on SU1. Nor had he evidenced any understanding into the reputational damage to his profession with regard to his fellow professionals or the wider public. The material that he had put forward by way of suggested remediation had been misguided in that it focused on the competencies required to recognise the symptoms of a stroke when assessing a patient, rather than concentrating on his misconduct which the Panel had found proved. In relation to this remediation, relating to competencies, submitted by the Registrant, the Panel reminded itself of the evidence of Witness CF who had stated that, in any event the “average” Paramedic would be aware of the varied symptomology of strokes, and expected to conduct a full set of observations.

 

114. Notwithstanding the above, the Panel noted that the Registrant’s competency in relation to his ability to recognise symptoms of a stroke had never been part of the allegations against him, rather it was his misconduct. This misconduct was attitudinal in nature in that the Registrant had deliberately and recklessly chosen to walk away from SU1 when he should have stayed to assess her. He had failed to examine or assess SU1 in order to form a view of her condition, or assist her in any way.

 

115. The Sanctions Policy indicates that a Suspension Order is likely to be appropriate where there are serious concerns that cannot be reasonably addressed by a Conditions of Practice Order, but that do not require the Registrant to be struck off the register. The Sanctions Policy states that 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
• There is evidence to suggest the registrant is likely to be able to resolve or remedy the failings.

 

 

116. The Panel concluded that the Registrant’s misconduct represented a serious breach of the standards. He had not demonstrated insight and had not provided material to suggest that he was likely to be able to resolve or remedy his failings. It could not therefore be said that the misconduct was unlikely to be repeated.

 

117. The Panel accepted that the Registrant had a long and unblemished career. He had continued in practice since the time of his misconduct some two years ago without further concern. He had provided good testimonials.

 

118. However, the Registrant had chosen to walk away from a highly vulnerable and elderly member of the public in circumstances that he would have been aware were time critical and where there was considerable risk of serious harm. He had not provided evidence of relevant remediation. He had not shown insight into his misconduct. His decision to leave SU1 without professional assistance of any kind had been deliberate and reckless.

 

119. The Panel concluded that the Registrant had failed to respond to or raise any concerns about SU1, both at the scene and subsequently, when he had every opportunity to do so. The Panel took account of the Sanctions Policy which states:

 

“Registrants must report any concerns about the safety or wellbeing of service users promptly and appropriately and ensure that the safety and wellbeing of service users comes before any professional or other loyalties. In particular, the standards outline an explicit requirement to take appropriate action if the concern is about a child or vulnerable adult”.

 

120. The Panel also concluded that the Registrant had failed to work in partnership with his crewmate, Colleague 1, an Emergency Care Assistant, who had been waiting in the ambulance during the Registrant’s interaction with W1. Neither did he choose to work in partnership with PC1 who had arrived at the scene before the Registrant had left; nor his colleagues in the Trust’s control room, who could have been informed of the incident.

 

121. The Panel had been asked to provide the Registrant with more time in which to reflect upon his actions. However, he has had some two years since the incident in which to do so, and two months since the findings of fact made by this Panel. In this time the Registrant has not provided evidence of insight into his misconduct or any relevant remediation to address his attitudinal failings. At the Sanction stage the Registrant provided no further information as to whether he had now begun to review his practice or the attitude he had displayed in relation to SU1. Given the passage of time and the ample opportunity the Registrant has had to address his failings and provide evidence of such, the Panel could only conclude that the Registrant is unable to resolve or remedy his failings.

 

122. The Panel concluded that without insight the Registrant continues to pose a risk to the public. The Panel also concluded that the Registrant’s actions adversely affected public confidence in him, in his Regulator and in his profession.

 

123. In those circumstances the Panel determined that a Striking Off Order is the only appropriate order. Such an order is necessary due to the seriousness of the misconduct and the lack of adequate remediation and insight, as set out in this determination. The Panel has received no reassurance that the Registrant would not repeat his misconduct. The Panel understands that a Striking Off Order is the most serious of all sanctions. However, the Panel has concluded that any lesser sanction would pose a risk to public safety and would undermine confidence in the profession and the regulatory process.

ORDER: The Registrar is directed to strike the name of Paul R Hawker from the Register on the date this Order comes into effect

Interim Order

1. Mr Foxsmith applied for an Interim Suspension Order under Article 31(2) of the Health and Social Work Professions Order 2001. He submitted that there remains a serious and ongoing risk to members of the public and that public confidence would be undermined if an Interim Order were not made. He further submitted that given the Panel’s decision to impose the ultimate sanction of Strike Off, it would be perverse for the Registrant to be allowed to remain in practice over the appeal period. He requested an Interim Order for the maximum time available of 18 months.
   
   
2. Ms Bracken opposed the order on the basis that the misconduct occurred over two years ago, and no Interim Order had been in place in the interim period. She submitted that the Registrant had been trusted by his employer, who had permitted him to continue in employment, and by the HCPC, who had not requested an Interim Order until now.
   
   
3. In the circumstances, and for the reasons set out by the Panel in its substantive decision, which includes a finding that the Registrant lacks insight into his misconduct, the Panel concludes there is a real risk that the Registrant will repeat his misconduct if permitted to practise unrestricted. Accordingly, an Interim Order is necessary to protect the public pending any potential appeal.
   
   
4. In the circumstances, and for the reasons set out by the Panel in its substantive decision, the Panel is also satisfied that the misconduct is so serious that public confidence in the profession would be seriously harmed if the Registrant were to be allowed to remain in unrestricted practice pending any appeal, and that an Interim Order is needed to maintain proper standards within the profession, and to uphold the reputation of the profession and its regulator. The Panel concluded that a reasonable member of the public, in possession of all the facts, would be shocked if no order were to be put in place during the appeal period.
   
   
5. The Panel concluded that an Interim Conditions of Practice Order would not be appropriate for the same reasons as those set out in its determination on Sanction dealing with the suitability of a substantive Conditions of Practice Order, which included attitudinal concerns regarding the Registrant.
   
   
6. Accordingly, the Panel concluded that the appropriate order in the circumstances is an Interim Suspension Order.
   
   
7. The Panel determined that the appropriate length for such an Interim Order is 18 months to cover the appeal period.
   
   
8. The Panel therefore makes an Interim Suspension Order for 18 months. If no appeal is brought, the Interim Order will expire at the end of the appeal period. If an appeal is brought, the Interim Order will expire at the time of the final determination of the appeal, subject to a maximum period of 18 months.

History of Hearings for Mr Paul R Hawker

Date	Panel	Hearing type	Outcomes / Status
06/01/2022	Conduct and Competence Committee	Final Hearing	Struck off
06/12/2021	Conduct and Competence Committee	Final Hearing	Adjourned part heard
18/10/2021	Conduct and Competence Committee	Final Hearing	Adjourned part heard