Mr Christopher Smith
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Allegation against the registrant is as follows:
As a registered paramedic (PA39905) your fitness to practise is impaired by reason of misconduct and/or lack of competence. In that:
1. Between 22 May 2020 and 1 June 2020 you did not maintain professional boundaries with Service User A, in that you:
a) Connected with Service User A as friends on Facebook
b) Sent messages to Service User A via Facebook messenger that were sexual in nature
c) Sent messages to Service User A via Facebook messenger commenting that if you had sex with Service User A you would lose your job, or words to that effect
d) Sent messages to Service User A via Facebook messenger containing information about your private life
2. On 19 February 2021, in relation to Service User B you:
a) diagnosed Pericarditis, when the results of the electrocardiogram showed myocardial infarction.
b) Communicated your doubts about the diagnosis of myocardial infarction to the coronary nurse at Royal Manchester Infirmary
c) Argued with medical staff at Royal Bolton Hospital, stating that you believed Service User B was suffering from Pericarditis
3. You failed to disclose a restriction placed on your practice to the Health and Care Professions Council, in that you did not disclose that you had been prohibited from acting as a clinical lead from 28 April 2021.
4. Your conduct in relation to allegation 1(a) –(c) was sexual.
5. Your conduct in relation to allegation 3 was dishonest.
6. The matters set out in paragraphs 1, 3, 4 and 5 constitute misconduct.
7. The matters set out in paragraph 2 constitute misconduct and/or lack of competence.
8. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired
1. The Registrant is a registered Paramedic who, at the relevant time, was employed by North West Ambulance Service NHS Trust (“the Trust”) as a Band 6 paramedic based in the Salford Group Greater Manchester Area.
Service User A
2. On 21 May 2020, the Registrant attended Service User A’s address with a colleague, SW, after it was reported that Service User A had taken an overdose.
3. On 31 May 2020, Witness PK visited Service User A after she called him suggesting that she may take an overdose. Witness PK is a retired police officer and a friend of Service User A. He visited Service User A at her flat and recorded the conversation between them on his telephone without her knowledge. Witness PK alleged that during their conversation Service User A disclosed that the Registrant had contacted her on Facebook and sent her messages, some of which were of a sexually inappropriate nature. A transcript of this covert recording was provided within the hearing bundle. During the covertly recorded conversation, Witness PK can be heard reading out messages said to be from Service User A’s Facebook messenger application on her telephone.
4. On 2 June 2020, Witness PK submitted a complaint to the Trust. An internal investigation was conducted by Witness RT, an Operations Manager at the Trust allocated by Witness AB, a Senior Clinical Services Manager at the Trust. After an internal investigation, the matter was investigated by Kingsley Napley Solicitors on behalf of the HCPC.
Service User B
5. On 19 February 2021, the Registrant attended Service User B who was suffering from chest pains, feeling sick, and had difficulty breathing. The Registrant and his crewmate allegedly made a working diagnosis of pericarditis and transferred Service User B to the Royal Bolton Hospital (RBH). Upon arrival at the hospital, the Registrant and his crewmate were requested to take Service User B to the Manchester Royal Infirmary (MRI) after the consultant doctor identified a myocardial infarction after reviewing the ECG. En route to the MRI the crew spoke with staff at the hospital, notifying them of their opinion that the patient was suffering from pericarditis. As a result of this conversation, the Registrant and his crewmate were advised that the infirmary had refused to accept the patient and they were instructed to head back to the RBH.
6. Upon arrival back at the RBH, Service User B was reassessed and then transferred back to the MRI following confirmation of the myocardial infarction diagnosis. On 25 February 2021, the Bolton NHS Foundation Trust submitted a complaint to the Trust concerning the actions of the Registrant and his crewmate, which it was stated had delayed Service User B obtaining the treatment he required.
7. The Trust conducted an internal investigation into the incident which resulted in the Registrant having restrictions placed on his practice. The investigation was conducted by Witness JS, an Advanced Paramedic at the Trust.
8. On 20 May 2021, the HCPC were contacted by Kingsley Napley to seek confirmation as to whether the Registrant had informed them of the restrictions on his practice. It was confirmed that he had not.
9. On 19 October 2021, the matter was heard before the Investigating Committee Panel which determined that the Registrant had a case to answer. The Investigating Committee Panel referred allegations on to the Conduct and Competence Committee.
Partly Private Hearing
10. At the outset of the hearing, the Panel was informed that the Registrant has a suspected health condition. The Panel determined that to protect the Registrant’s right to a private life no reference would be made to matters relating to his health whilst in public session. However, if it became necessary to refer to his health in more detail that aspect of the hearing would proceed in private and would not form part of the public record.
11. The Panel also directed that it would take regular breaks at approximately 1 hour intervals to ensure that the Registrant would be able to maintain appropriate concentration levels.
12. During the hearing, the Panel also determined that there should be no mention of Service User A by her name and no reference to private matters relating to a member of the Registrant’s family or other aspects of his private life on the public record to protect their right to a private life.
Amendment of Allegation
13. Mr Foxsmith, on behalf of the HCPC, made an application to amend Allegation 7 by adding the words “and/or misconduct’. He acknowledged that the proposed amendment was late, in that, it could have been made in advance of the hearing. However, he submitted that no injustice would be caused to the Registrant as the proposed amendment does not change the scope of the allegation. He submitted that it is fair and appropriate that the Panel be given the opportunity to consider the alternative statutory ground of misconduct.
14. Ms Shah raised no specific objections to the application to amend and informed the Panel that she would not be arguing that the Registrant would be prejudiced by the proposed amendment. However, she invited the Panel to note that it was a late application to amend, relates to a single clinical error and that the evidence indicates that it was the Registrant’s colleague that spoke to medical staff at the MRI and the RBH. Ms Shah observed that, if it had been known in advance that misconduct in respect of Allegation 7 would be alleged, the Registrant may have prepared further reflections.
15. The Panel accepted the advice of the Legal Assessor.
16. The Panel granted the HCPC’s application to amend for the following reasons:
i. The Panel was satisfied that the proposed amendment did not widen the scope of the allegation and that earlier notification would not have materially altered the way in which the Registrant prepared for this hearing. Therefore, the Panel concluded that the amendment would not cause the Registrant any injustice.
ii. The Panel was also satisfied that, in the interests of the overarching objective to protect the public, the statutory ground of misconduct should be considered by the Panel in the event that Allegations 2(a), (b) or (c) are found proved.
17. Following the amendment of Allegation 7, the Registrant admitted Allegations 2(a) and 3. On Day 2 he admitted Allegation 1(a).
18. The remaining allegations were denied.
19. Prior to closing his case, on behalf of the HCPC, Mr Foxsmith made an application to withdraw Allegations 2(b) and 2(c).
20. Mr Foxsmith informed the Panel that following the oral evidence of Witness JS there was no longer any evidential basis upon which he would be able to submit that Allegations 2(b) and 2(c) are capable of being found proved. He submitted that Witness JS had fairly and appropriately clarified during his oral evidence that it was the Registrant’s colleague that had communicated with the MRI and had argued with medical staff at the RBH.
21. Mr Foxsmith submitted that, in the interests of fairness, the HCPC should withdraw unmeritorious allegations. He further submitted that, in light of the evidence of Witness JS, he anticipated that Ms Shah would make an application of no case to answer, which would take up valuable hearing time to consider and determine. He submitted that, in these circumstances, there were also practical reasons for making the discontinuance application.
22. The Panel accepted the advice of the Legal Assessor.
23. The Panel noted that Witness JS made it clear, during his oral evidence, that it was the Registrant’s crewmate that had communicated directly with MRI, and the crewmate was also the one that had argued with medical staff at the RBH. Witness JS stated, during cross examination, that the Registrant was the driver on 19 February 2021 and therefore he was not the lead attendant. He stated that the driver cannot make telephone calls directly to a hospital.
24. The Panel concluded that there was no realistic prospect of Allegations 2(b) and 2(c) being found proved and there was no public interest in pursuing allegations that are bound to fail. It would also be unfair to the Registrant, to pursue these allegations when it is clear that the HCPC would not be able to prove its case.
25. Accordingly, the Panel determined that Allegations 2(b) and 2(c) should be discontinued.
The Panel’s approach
26. The Panel accepted the advice of the Legal Assessor.
27. The Panel was aware that the burden of proving the facts was on the HCPC at all times. The Registrant did not have to prove anything, and the allegations could only be found proved, if the Panel was satisfied, on the balance of probabilities.
28. In reaching its decision the Panel took into account the documentary evidence including the transcript of the covertly recorded conversation between Service User A and Witness PK. The Panel noted that hearsay evidence, particularly when it is the sole or decisive evidence, has to be carefully scrutinised, given the inherent risk that it may be given undue weight. The Panel was also mindful that in the absence of direct oral or documentary evidence, it would have to consider whether it would be appropriate to draw an inference; it was only entitled to draw inferences if satisfied that the evidence in support of it was reliable.
29. The Panel noted that following the Supreme Court decision in Ivey v Genting Casinos  UKSC 67 the test for dishonesty is an objective test only. The Panel first had to determine the Registrant’s actual knowledge or belief and then determine whether his act or omission was, on the balance of probabilities, dishonest by the ordinary standards of reasonable and honest people.
Decision on Facts
Allegation 1(a) – Found Proved
Between 22 May 2020 and 1 June 2020 you did not maintain professional boundaries with Service User A, in that you:
Connected with Service User A as friends on Facebook;
30. The Registrant admitted Allegation 1(a) on Day 2 of the hearing.
31. The Panel was provided with a screenshot of the Registrant’s list of friends on Facebook and a screenshot of Service User A’s list of friends on Facebook. The screenshots are exhibited to Witness RT’s witness statement dated 10 December 2021. Witness RT stated, in his witness statement, that during the internal investigation the Registrant was specifically asked if he had any contact with Service User A via social media. The Registrant accepted that he was the account holder of two separate Facebook accounts and that on one of these accounts Service User A is listed as a friend and on Service User A's Facebook account the Registrant is listed as a friend.
32. In these circumstances, the Panel was satisfied that the Registrant and Service User A were connected as friends on Facebook.
33. Accordingly, Allegation 1(a) was found proved.
Allegation 1(b) – Found Not Proved
Sent messages to Service User A via Facebook messenger that were sexual in nature;
34. The Panel noted that Witness PK is a retired police officer. The Panel accepted his evidence that his initial reason for covertly recording his conversation with Service User A was for his own protection, as he was entering her home alone. He was entering the flat of a vulnerable female who appeared to be drunk and who had informed him that she was going to take an overdose. Witness PK stated that he did not know what he was going to find in the flat or how Service User A would react. Witness PK explained that he wanted to find out what had happened and during the conversation with Service User A she told him what had taken place when the police and paramedics attended her flat on 21 May 2020. Witness PK acknowledged that he had asked Service User A leading questions during the conversation.
35. The Panel accepted that Witness PK was concerned by Service User A’s account of her interaction with the Registrant and that he subsequently reported his concerns to the Trust for welfare reasons. The Panel also acknowledged that the covert recording of the conversation with Service User A took place almost 2 years ago. Witness PK accepted during cross examination that due to the passage of time there were some aspects of the sequence of events that he could not remember. For example, he stated that he could not recall when Service User A first mentioned the Facebook messages. He stated that it may have been when Service User A called him or when he spoke to her via intercom on 31 May 2020 before she allowed him entry into her flat.
36. Witness PK stated in his witness statement and during his oral evidence that he read aloud all the messages from the Registrant which appeared to be “relevant.” He stated that he read the messages verbatim. He acknowledged that he did not read aloud the messages which appeared to be general “chitchat”. The Panel had no reason to doubt that Witness PK genuinely believed that he was reading messages that had been exchanged between Service User A and the Registrant. However, he stated that when Service User A showed him the Facebook messages on her phone, he was looking for the first contact. He stated that he had difficulty finding the messages and that she had to help him. In his reports to the Trust, his witness statement and during cross examination Witness PK attributed the following unanswered messages to the Registrant:
“…this came up as people I might know.. I’ve been talking to myself on Yr other one x
I need to talk to u
I know I’m a nuisance but I’ve sent you a message on Yr other account – please will you read it”
However, Witness PK subsequently conceded that these messages had been sent from Service User A to the Registrant on 29 May 2020.
37. The Panel was provided with the screenshots of the messages sent by Service User A to the Registrant and therefore it was satisfied that Witness PK had made an error when he attributed the above messages to the Registrant. However, the Panel was not provided with the messages or screenshots of the messages which were read out by Witness PK on the covert recording. These messages included the following:
• Look I'm lonely I've not had sex since October, I get it but you've got to respect yourself'
• "Plus I am blessed, if you had me you'd be really fucked up"
• "I'd be fucked, career ruined, everything ruined”
There was no dispute that these messages were sexual but their attribution to the Registrant was disputed.
38. Witness PK also wrongly asserted on the audio recording that the paramedic visit took place at 20:26. He was unsure where he had got this information from but acknowledged during cross examination that he may have misread the “papers” that were left by the Registrant.
39. The Panel was provided with the Patient Report Form completed by the Registrant and the Trusts’ Call Details Log which confirm that he attended Service User A flat at 13:15.
40. The Panel noted that Service User A was vulnerable. She had consumed a significant amount of alcohol and within a 10 day period she had taken an overdose and had threatened to take a further overdose. Although Service User A appeared relatively clear and coherent on the covert audio recording, the Panel accepted the evidence of Witness PK (who has known Service User as a friend since 2013) that he perceived her speech to be slurred and that she was “weepy”’. The Panel also noted that Witness PK was reliant on Service User A to refer him to the relevant messages on her phone. In the absence of a screenshot of those messages and in the absence of direct evidence from Service User A the Panel was not satisfied that Witness PK was reading messages via the Facebook messenger, nor was it satisfied that these messages were from the Registrant. In reaching this conclusion, the Panel noted that Witness PK had been mistaken about the authorship of the messages set out in paragraph 32 above and the time of the call out. The Panel concluded that there was considerable scope for further error by Witness PK.
41. The Panel noted that the context of the covertly recorded conversation was the visit by the police and the paramedics on 21 May 2020 and there was reference to the Registrant by name. However, the link between the messages and the Registrant did not follow a formal structure. Witness PK acknowledged that he was not conducting an interview with Service User A; he was having a conversation with her and readily accepted in his witness statement that on occasion he asked her leading questions. The transcript indicates that Service User A was showing Witness PK messages on her phone, but it was not clear which applications they appeared on, and it was also unclear, on at least one occasion, which part was a direct quote from the message and which part was Witness PK’s commentary.
42. The Panel carefully considered the weight that should be attached to the available evidence. The Panel noted that the hearsay evidence of the incriminating messages was decisive. Direct evidence of these messages was not available, and Service User A had refused to cooperate with the HCPC. Service User A had also refused to cooperate with the Trust’s internal investigation and the Panel noted that when Witness RT and Witness AB spoke to her by telephone on 3 June 2020, she stated that what Witness PK had told them was not true. The telephone note also records that she stated that it was “all rubbish.”
43. In these circumstances, the Panel concluded that the hearsay evidence could be afforded only limited weight. The Panel concluded that it would be unsafe to draw the inference that the messages were from the Registrant because, for the reasons stated above, the underlying evidence was not sufficiently reliable. In these circumstances, the Panel concluded that the HCPC had not discharged the burden of proof.
44. Accordingly, Allegation 1(b) was found not proved.
Allegation 1(c) – Found Not Proved
Sent messages to Service User A via Facebook messenger commenting that if you had sex with Service User A you would lose your job, or words to that effect;
45. For the reasons stated in relation to Allegation 1(b), Allegation 1(c) was also found not proved.
Allegation 1(d) – Found Not Proved
Sent messages to Service User A via Facebook messenger containing information about your private life.
46. For the reasons stated in relation to Allegation 1(b), Allegation 1(d) was also found not proved. In addition, the Panel accepted the Registrant’s evidence that he divulged information about his private life in order to gain her trust. However, insufficient evidence had been adduced by the HCPC that this was in a Facebook message as opposed to during face-to-face conversations in Service User A’s flat.
Allegation 2(a) – Found Proved
On 19 February 2021, in relation to Service User B you:
diagnosed Pericarditis, when the results of the electrocardiogram showed myocardial infarction;
47. The Registrant admitted Allegation 2(a).
48. The Panel noted that it was the Registrant’s crewmate was the lead clinician and made the initial diagnosis. However, the Panel accepted the evidence of Witness JS that there is an expectation that a paramedic should challenge the lead clinician if they thought the diagnosis was wrong.
49. Witness JS also stated, during his oral evidence, that the discussions between paramedic colleagues should be resolved so that the communication to the hospital is clear.
50. The Panel noted that the Registrant did not challenge the lead clinician’s diagnosis at that time because he agreed with it. During the Trust’s internal investigation, the Registrant was interviewed by Witness JS and, “… was confident with the diagnosis of Pericarditis.”
51. In these circumstances, the Panel concluded that the Registrant and the lead clinician had independently and jointly diagnosed pericarditis.
52. Accordingly, Allegation 2(a) was found proved.
Allegation 3 – Found Proved
You failed to disclose a restriction placed on your practice to the Health and Care Professions Council, in that you did not disclose that you had been prohibited from acting as a clinical lead from 28 April 2021.
53. The Registrant admitted Allegation 3.
54. Following the internal Trust interview, Witness JS stated in his witness statement that he had concerns that the Registrant may attend an incident and would not be able to identify a heart attack. A risk assessment was then undertaken by LC, the Interim Clinical Lead for Greater Manchester who concluded that the Registrant was currently not suitable to act as a clinical lead on an ambulance vehicle and should only work with another paramedic until the areas of concern regarding the Registrant’s practice could be identified and a support plan put in place.
55. There was no dispute that the Registrant had a duty to disclose the restriction of his practice to the HCPC. Nor is there any dispute that he did not do so.
56. Accordingly, Allegation 3 was found proved.
Allegation 4: Sexual Conduct (in relation to Allegation 1(a) – Found Not Proved
57. The Panel, having found Allegation 1(a) proved, went on to consider whether the Registrant’s connection with Service User A on Facebook was sexual.
58. The Panel noted that Service User A made a sexual overture to the Registrant when he attended her flat and described herself as a “nymphomaniac”. The sexual proposition was confirmed by Service User A during the covertly recorded conversation with Witness PK and by the Registrant in the statement he provided to the Trust. The Registrant and the Service User subsequently connected as Facebook friends following a request from Service User A. The transcript indicates that Service User A is adamant that the Registrant made the initial contact with her via Facebook. However, the Registrant informed the Panel that he accepted a friendship request without realising that it was Service User A. She had contacted him on his publicly available Christopher Smith account which he uses to market his music hobby and had used a different surname to the one that she had used during the callout on 21 May 2020. He stated that it was only after the initial fact finding meeting at the Trust that he accessed his defunct “Chris Smith” account and saw the messages that Service User A had sent to him on 29 May 2020. The Registrant subsequently sent screenshots of these messages to Witness RT. He denied that he had sent any messages to Service User A from his defunct account on 25 May 2020 as indicated by the transcript.
59. The Panel concluded that the Registrant’s account of how he came to be Facebook friends with Service User A had not been disproved by the HCPC. The Panel noted that there was no documentary evidence from Facebook with regard to the initial friendship request and concluded that there was no proper basis upon which an inference could be drawn from the transcript of the covertly recorded conversation. Furthermore, for the reasons set out in relation Allegation 1(b) the Panel concluded that in the absence of direct evidence of the Facebook messages and evidence from Service User A the transcript could be afforded only limited weight.
60. In these circumstances, the Panel was not satisfied that the HCPC had discharged the burden of proof.
61. Accordingly, Allegation 4, in relation to Allegation 1(a), was found not proved.
Allegation 5: Dishonesty (in relation to Allegation 3) – Found Not Proved
62. The Panel, having found Allegation 3 proved, went on to consider the issue of dishonesty.
63. The Panel noted that the Registrant was found by the Trust to have failed to diagnose myocardial infarction and was placed on restricted duties, namely that he could not act as a clinical lead, for a period of two weeks. There was no evidence that the Registrant was provided with any written confirmation of the restriction and shortly afterwards he was on sick leave and did not return to work for approximately 5 months.
64. The Panel acknowledged that it is the Registrant’s responsibility to report any restrictions of his practice to the HCPC and there was no obligation on the Trust to remind him of this duty. However, the Panel accepted the Registrant’s evidence that he genuinely believed that the Trust had issued him with a “Learning Development Outcome” and that once he had demonstrated improvement in a specific area of his practice, he would be able to return to his full duties.
65. The Registrant informed the Panel that he was experiencing significant personal issues at this time relating to his family. He also explained that he had had a significant health scare at that time. The Registrant stated that his personal and health issues contributed to his failure to recognise the significance of the restriction on his practice.
66. The Panel concluded that the Registrant’s failure to disclose the restriction on his practice was not dishonest. The Panel was not satisfied that the non-disclosure was a deliberate and conscious attempt by the Registrant to avoid the possible adverse repercussions of a self-referral to the HCPC. The Registrant knew that his practice had been restricted and would not be lifted until appropriate steps had been taken to demonstrate his competence. However, the Panel concluded that it was more likely, given the circumstances and overall context, that the failure to report the restriction to the HCPC was a genuine mistake during a period of time when the Registrant was subject to a number of stressors.
67. Accordingly, the Panel found Allegation 5 not proved.
68. Having found paragraphs 1(a), 2(a) and 3 of the Allegation proved, the Panel went on to consider whether:
(i) 1(a), 2(a) and 3 amounts to misconduct; and/or
(ii) 2(a) amounts to lack of competence.
69. No further consideration was given to the paragraphs of the Allegation that were found not proved.
The Panel’s Approach
70. The Panel was aware that determining the issue of misconduct and/or lack of competence is a matter of judgement; there is no standard of proof.
71. The Panel took into account the submissions of both parties and accepted the Legal Assessor’s advice.
72. The Panel was aware that lack of competence can be distinguished from misconduct in that it indicates an inability to work at the required level and connotes a standard of professional performance which is unacceptably low and which has usually been demonstrated by reference to a fair sample of the registrant’s work. Unless it is particularly serious, a single clinical incident would not usually indicate a general lack of competence.
73. The Panel was aware that breach of the HCPC’s Standards of Conduct, Performance and Ethics  (‘the Standards’) alone does not necessarily constitute misconduct. A departure from the Standards is a starting point and is relevant; but it is not determinative of misconduct and does not create a presumption of misconduct.
74. The Panel also bore in mind the explanation of the term ‘misconduct’ given by the Privy Council in the case of Roylance v GMC (No.2)  1 AC 311 where it was stated that:
“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a … practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”
75. In Nandi v GMC  EWHC 2317 (Admin) Collins J observed:
“The adjective ‘serious’ must be given its proper weight and in other contexts there has been reference to conduct which would be regarded as deplorable by fellow practitioners.”
76. The Panel was mindful that negligence may amount to misconduct if it is sufficiently serious. In Calhaem v GMC  EWHC 2606 (Admin), Jackson J identified a number of principles relating to clinical failings. These include:
1. Mere negligence does not constitute "misconduct"… . Nevertheless, and depending upon the circumstances, negligent acts or omissions which are particularly serious may amount to "misconduct".
2. A single negligent act or omission is less likely to cross the threshold of "misconduct" than multiple acts or omissions. Nevertheless, and depending upon the circumstances, a single negligent act or omission, if particularly grave, could be characterised as "misconduct".
Connecting with Service User A on Facebook
77. The Panel noted that paragraph 1(a) of the Allegation relates to the Registrant’s failure to maintain appropriate professional boundaries between himself and Service User A.
78. Although a breach of professional boundaries is usually inherently serious, there were particular features of this case which led the Panel to conclude that the Registrant’s behaviour did not amount to misconduct. These features were as follows:
(i) The Panel accepted at the fact finding stage that the Registrant received a friendship request from Service User A, without realising that she was a service user, because she had a different surname to the one that she had used during the callout on 21 May 2020.
(ii) Service User A had contacted the Registrant on his publicly available Christopher Smith account which he used to market his music hobby. Therefore, acceptance of a friendship request did not necessarily indicate that there would be ongoing social interaction either via Facebook or through attendance at music venues.
(iii) The connection between the Registrant and Service User A on Facebook was brief.
79. In these circumstances, the Panel concluded that the Registrant’s behaviour in connecting with Service User A was inadvertent and therefore did not amount to misconduct.
Diagnosing Pericarditis when the results of the electrocardiogram showed myocardial infarction;
80. The Panel went on to consider the misdiagnosis of pericarditis.
81. The Panel noted that, at the outset of the hearing, paragraph 7 of the allegation in relation to paragraph 2, had been amended to include ‘and/or misconduct’ in addition to lack of competence. Paragraph 2 was sub-divided into (a), (b), and (c)., Whilst (a) related to a misdiagnosis which clearly raised a competency issue, (b) and (c) related to communication with the RBH and the MRI which Mr Foxsmith, on behalf of the HCPC, submitted could only amount to misconduct if found proved. It was on this basis that the application to amend was made. It was further submitted, on behalf of the HCPC, that even if the evidence of Mr Strivens in respect of (a) potentially raises a competency issue, the Panel may have concerns that it could not amount to lack of competence because of the expectation that such a finding is usually based on a fair sample of work.
82. Mr Foxsmith, in his submissions on grounds, invited the Panel to conclude that the paragraph 2(a) amounts to lack of competence. This was his primary submission. In the alternative, he submitted that the Panel could make a finding that 2(a) amounts to misconduct.
83. The Panel was mindful that from the outset the HCPC had put its case on the basis that paragraph 2(a) amounts to lack of competence and that the application to amend was made solely in relation to the potential impact on 2(b) and 2(c). The Panel took the view that it would be unfair to change the grounds after the findings of fact had been determined. In any event, the Panel concluded that the Registrant’s misdiagnosis was a single isolated error involving the misinterpretation of the ECG and the patient’s history. The Panel noted that the ECG evidence available was a single snapshot rather than a full history of what the Registrant and his colleague would have observed at the scene. It was clear that more than one ECG was undertaken. The Panel noted that the error occurred in circumstances where the Registrant was not the lead clinician; his colleague who made the diagnosis was of equal seniority and had primacy of care for this patient. The Panel also noted that all paramedics are capable of making mistakes. The Panel concluded that the Registrant’s joint diagnosis although serious because it had the potential to have an impact on patient care, was not so serious that it amounted to misconduct.
84. The Panel went on to consider whether paragraph 2(a) amounts to a lack of competence. As the isolated error does not form part of a fair sample of the Registrant’s work the Panel was not satisfied that it indicates a general lack of competence.
85. The Panel separately considered whether the misdiagnosis is particularly serious and for this reason amounts to a lack of competence. The Panel took into account Standard 3.3 which states:
“You must keep your knowledge and skills up to date and relevant to your scope of practice through continuing professional development.”
86. The Panel concluded that the Registrant had breached this standard as the ability to accurately diagnose a range of cardiac conditions is fundamental to safe and effective practise as a paramedic. However, the Panel was mindful that a breach of the Standards alone is not sufficient.
87. The Panel noted that the ECG (provided to the Panel within the hearing bundle) clearly shows a myocardial infarction, and not pericarditis. Furthermore, the patient history taken by the paramedic who called the patient before the crew arrived indicates typical symptoms of myocardial infarction. However, the patient history that had been obtained and documented at the scene was atypical for myocardial infarction. It was within this context that the overall clinical picture was misinterpreted. However, the Panel noted the Trust’s investigation which concluded that “… given the patient had no central chest pain at the time of the crew arrival, even with ST elevation PPCI protocol dictates that the patient should be taken to the local ED for further assessment” and the Registrant and his colleague conveyed the patient to Royal Bolton Hospital. In these circumstances, the Panel concluded that the single clinical error was not sufficiently serious, in and of itself, to lead to the conclusion that the Registrant generally lacks competence.
Failure to disclose the prohibition from acting as a clinical lead
88. The Panel took into account its factual findings in respect of paragraph 3 of the Allegation.
89. The Panel has already determined that the Registrant genuinely believed that the Trust had issued him with a “Learning Development Outcome” and that once he had demonstrated improvement in a specific area of his practice, he would be able to return to his full duties. The Panel has also determined that it was more likely, given the circumstances and overall context, that the failure to report the restriction to the HCPC was a genuine mistake during a period of time when the Registrant was subject to a number of stressors.
90. The Panel noted that it was the Registrant’s duty to disclose the restriction of his practice to the HCPC. However, the Panel concluded that there was no basis upon which it could conclude that the Registrant’s genuine error amounts to misconduct.
91. In these circumstances, the Panel concluded that the Registrant’s omission does not amount to misconduct.
92. As the Panel concluded that none of its factual findings amount to misconduct or lack of competence it determined that the HCPC’s case is not well-founded.
No information currently available
No notes available
History of Hearings for Mr Christopher Smith
|Date||Panel||Hearing type||Outcomes / Status|
|25/07/2022||Conduct and Competence Committee||Final Hearing||Not well founded|
|25/04/2022||Conduct and Competence Committee||Final Hearing||Adjourned part heard|