Mr Samuel Heenan
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Allegation
The following Allegation was considered by a panel of the Conduct and Competence Committee at a Substantive Hearing on 26-28 July 2021.
As a registered Paramedic (PA37861) your fitness to practise is impaired by reason of misconduct. In that:
1. On 18 November 2018, you did not provide adequate clinical intervention to a non-conveyed patient you attended to, in that with respect to incident 597:
a. you did not get a peak flow reading from the patient before and/or after treating them with a nebuliser; and/or
b. [not proved]
2. On 17 November 2018, with respect to incident 1534, you did not conduct and/or document a second set of observations.
3. On 18 November 2018, after leaving the scene of an incident, you drove to get breakfast before booking clear from the scene.
4. On 18 November 2018, you:
a. told Colleague A not to record the first two blood pressure readings for a patient; and/or
b. overwrote a blood pressure reading in primary observations section on a Patient Clinical Record without striking through, initialling the change and/or providing the reason for the change in the free text box
5. Between 17 and 20 November 2018, you did not communicate professionally, in that:
a) After departing from an incident, you referred to the patient you had just attended to as a “pansy” or words to that effect;
b) While driving to an incident you said “I bet they’re are scroats living here” or words to that effect;
c) While driving to an incident you said “we should leave our lights and sirens on outside the house to embarrass the patients” or words to that effect;
d) You referred to jobs as a “pile of crap”, or words to that effect;
e) While attending to a patient, you asked the patient’s mother if it was their car in the drive and why they had not driven to A&E, or words to that effect;
f) You referred to a patient as a compulsive liar, or words to that effect.
6. On or around 20 November 2018, you accessed confidential information relating to a patient without authorisation and/or clinical reason to do so
7. Between 19 and 20 November 2018, you disclosed confidential information about a patient to Colleague A.
8. You did not communicate appropriately and/or maintain professional boundaries in relation to Colleague A, in that:
a) On 20 November 2018, you wrote to Colleague A on Facebook Messenger, saying “Shame you weren’t there tbh it would have been hilarious. You could have done a rectal exam on him”, or words to that effect.
9. During the fact-finding interview on 11 January 2019, you admitted to using an automatic blood pressure device on patients without knowing how old it was or when it had last been calibrated.
10. On 17 May 2017, you did not obtain a witness signature in the controlled drugs logbook.
11. On 17 May 2017, you left the drugs cupboard and/or room where the drugs cupboard is located unsecured.
12. While working as a Paramedic for South East Coast Ambulance Service NHS Trust on dates before December 2016, you posted inappropriate content to your Facebook page, in that:
a) You posted an image of yourself parked behind an ambulance, with the caption, “Not only do we stack in A&E, we stack up outside coffee shops” or words to that effect;
b) You posted an image of yourself holding a knitted object, with the caption, “Always appreciative of patients who knit you a very generously oversized willy warmer” or words to that effect;
c) You posted an image of a steering wheel with a Pokémon on it on, with the caption, “Standard shift saving the world and training to become a Pokémon master” or words to that effect;
d) You posted, “When you work with Colleague H and she is asked by a drunk woman how old she thinks she is and Colleague H overestimates and you feel like you should step in before a fight breaks out in the ambulance” or words to that effect;
e) You posted, “First patient of the night took themselves to A and E decided that the 4 hour wait was too long so drove home and called an ambulance thinking we could help so we politely informed them that they should make their way back to the A and E…Please be sensible tonight people” or words to that effect;
f) You posted, “People ask me what I have achieved at work today so I inform them that I have been enforcing traffic law, scaring people driving using their phone and writing fake speeding tickets. All in a day’s work for an undercover paramedic” or words to that effect;
g) You posted an image of yourself pointing at a stop sign, with the caption, “I think it’s about time we stopped taking emergency(ish) calls now as there are no ambulances to send and no beds in A and E” or words to that effect;
h) You posted, “What I learned at work today, “vigorous sex can exacerbate pain caused by kidney stones” (Patient at al. 2016)” or words to that effect;
i) You posted, “Shout out to the woman who dreamt that her husband had forgotten his medication so called an ambulance in the middle of the night” or words to that effect;
j) You posted, “A call came through on the screen earlier to a 30s year old male 14 weeks pregnant. The first time I’ve questioned my anatomy and physiology knowledge in my 2 years as a paramedic” or words to that effect;
k) You posted, “When your patient calls 999 for “chest pain” and you ask what they have been doing and they respond with “well I was playing boxing on the (Nintendo) Wii”. The doctor understandably confused when I informed him that the patient had been playing with her Wii for most of the day” or words to that effect;
l) You posted, “Got a call to a patient who was complaining of a 3-week history of “having smelly poos”. I’m struggling to see the emergency here as many of us have experienced a lifetime of this issue” or words to that effect;
m) You posted an image of the ambulance’s MDT screen showing the details of a call, with the caption “Good old general public, can’t decide if patient is having a seizure or eating a sandwich but calls the ambulance anyway just to be sure the patient is satisfied with their ham sandwich from the Sainsbury’s meal deal” or words to that effect;
n) You posted an image of the ambulance’s MDT screen showing the details of a call, with the caption “Just want to clarify a few things about this emergency call: i. Firstly a paper cut on your neck does not count as a stab wound. ii. Secondly: A paper cut on the neck does not justify an emergency ambulance iii. Thirdly: How do you even get a paper cut on your neck?! iv. Fourthly: It’s lucky the assailant was not present on scene as I would not want to fight a guy armed with a sheet of A4” or words to that effect.
13. The matter set out in allegations 1-12 above constitutes misconduct.
14. By reason of your misconduct, your fitness to practice is impaired.
The panel at the Substantive Hearing found the following:
Facts proved: All (except Particular 1b)
Grounds: Misconduct (except for Particulars 1a, 4a, 9,10 & 11)
The panel found the Registrant’s fitness to practise to be impaired and a Suspension Order for a period of 12 months was imposed as a sanction.
Finding
Background
1. The Registrant is a Paramedic who was employed by South East Coast Ambulance Service NHS Foundation Trust (“the Trust”) as a Band 6 Paramedic between 8 September 2014 and 18 April 2019.
2. On 19 November 2016, it came to the Trust’s attention that the Registrant had made a number of inappropriate posts on his Facebook page. SG, Acting Clinical Team Leader, subsequently conducted an investigation and a disciplinary hearing took place on 5 May 2017.
3. On 17 May 2017, it was reported that the drugs cabinet, and the room where the drugs cabinet was kept, had both been left open at Guildford Station. The Registrant was the last person to have accessed the drugs cabinet. An internal investigation was conducted by CB, Operations Manager, and a disciplinary hearing took place on 5 September 2017.
4. On 26 November 2018, the Trust received a complaint from MW (Colleague A), a student Paramedic, regarding the Registrant’s behaviour during shifts on 17 and 18 November 2018. AP, Operations Manager, was appointed as Investigating Manager and an internal investigation into the Registrant’s conduct followed. During this investigation it came to a light that there were a number of other issues with the Registrant’s conduct and these were subsequently added to the investigation. The Registrant then resigned from the Trust.
5. Following a self-referral to the HCPC on 14 January 2019, it was alleged that the Registrant made errors in his practice, breached confidentiality, made inappropriate comments to MW, left a drug cabinet unlocked, and repeatedly made inappropriate posts on social media about a number of service users.
6. The Registrant admitted all the Particulars in an email of 8 June 2021, apologised and stated, “I do not deny any of the evidence put forward”. The Registrant also accepted that he was guilty of misconduct.
7. The Registrant e-mailed the HCPC on 12 July 2021 to advise that he would not be attending the substantive hearing and provided a written statement.
8. The substantive hearing panel determined to proceed in the Registrant’s absence as it was satisfied that it was appropriate to do so. The panel granted the HCPC’s amendment applications on the grounds that the changes proposed did not materially alter the nature or the gravity of the Allegation and were relatively minor changes.
The substantive hearing panel’s decision
9. The panel found 1a) proved, but not 1b). Particulars 2, 3, 4a) and 4b), 5a) - f), 6, 7, 8, 9, 10, 11 and 12a) - n) were also proved.
10. The Registrant breached standards 1.1, 1.5, 2.1, 2.5, 2.7, 5.1, 5.2 and 9.1 of the HCPC Standards of Conduct, Performance and Ethics (2016). In respect of particulars 2, 3, 4 b), 5a) - f), 6, 7, 8 and 12a) - n) the panel found his conduct fell far short of what would have been proper and that it amounted to misconduct. Particulars 1a), 4a), 9, 10 and 11 did not amount to misconduct.
11. The Registrant had breached patient confidentiality, which encompasses the fundamental professional tenets of trust and integrity. In addition, his comments and conduct when working with MW, particularly bearing in mind his role as her mentor, as well as his repeated Facebook posts, were deeply inappropriate, disrespectful, and unprofessional. The Registrant’s conduct would be considered deplorable.
12. The Registrant had apologised but had not demonstrated insight into the impact of his conduct on patients, colleagues, and the wider public. His conduct and the comments he made to MW, and his repeated inappropriate posts on Facebook, were crass and profoundly disrespectful of patient dignity, colleagues, his profession, and NHS staff. The Registrant appeared to have given little or no thought to the impact of his behaviour and conduct. This conduct had the potential to place patients at risk of harm.
13. The finding in respect of the breach of patient confidentiality showed a further aspect of the Registrant’s lack of insight and his lack of recognition and understanding of the fundamentals of patient dignity and trust. In breaching patient confidentiality, he abused the trust placed in him as a Paramedic.
14. The panel found that there was no evidence of remediation. Whilst the Registrant had continued to work in a health care setting, he had demonstrated limited insight and no apparent remediation. There was little evidence beyond his apology and admissions that he had meaningfully reflected on his conduct and sought to recognise and take any steps to remedy his misconduct; there was a real risk of repetition of his misconduct and his fitness to practise was impaired on the personal component.
15. On the public aspect of impairment, the panel decided that a reasonable and well-informed member of the public would be concerned by the nature and gravity of the findings of fact and misconduct. If a finding of impairment were not made it would undermine public confidence in the profession and the Regulator and would also fail to uphold and declare proper professional standards.
16. The panel concluded that the Registrant’s fitness to practise was impaired under both the personal and the public components.
17. With regard to sanctions, the mitigating factors identified were:
• The admission of the entire Allegation and misconduct.
• Apology and some evidence of insight.
• Some recognition of the impact off his conduct on the wider profession.
• No evidence of any previous fitness to practise concerns.
• No evidence of any patient harm.
18. The panel found the following aggravating factors:
• Multiple and wide-ranging deficiencies in several aspects of practice, over a significant period of time.
• A number of the incidents of misconduct were in the presence of the student he was mentoring and there was an additional responsibility therefore to model professional conduct.
• Disparaging colleagues and NHS staff in the presence of patients or members of the public.
19. Taking no further action and the sanction of a Caution Order would not, the panel considered, reflect the seriousness of the Allegation found proved and the finding of impairment. Further, these would not be adequate given the wider public interest in maintaining confidence in both the profession and the regulatory process and upholding proper professional standards. Neither order was sufficient, appropriate, or proportionate in the circumstances.
20. The panel next considered a Conditions of Practice Order. The Allegation found proved was serious and there was a risk of repetition. The findings were in large part attitudinal and wide-ranging and included a breach of a fundamental tenet, namely integrity. The competence of the Registrant was not the focus of the Allegation. The Registrant had shown limited insight and no remediation and there had been limited engagement in the regulatory process. He failed to work in partnership with colleagues and the panel could not formulate a Conditions of Practice Order that would be workable, realistic, proportionate, and sufficient to protect the public and the wider public interest.
21. The findings represented a serious breach of the HCPC Standards of Conduct, Performance and Ethics. The Registrant had admitted the Allegation and misconduct and shown some limited insight. The deficiencies found were potentially remediable, and there was nothing to indicate that the Registrant was unable or unlikely to be able to resolve or remedy his failings. The Registrant’s conduct included elements of a failure to work with colleagues (in the sense of making disparaging remarks), failing to act professionally (particularly in his role as a mentor), and a single breach of patient confidentiality.
22. The Registrant had shown some insight and the panel concluded that the findings are not at the level of seriousness or recklessness where no lesser sanction would be sufficient other than a Striking Off Order.
23. The panel concluded that a 12-month Suspension Order was the appropriate and proportionate sanction to protect the public, maintain confidence in the profession, and declare and uphold proper professional standards. It stated that the reviewing panel may be assisted by the Registrant providing the following:
• A reflective piece fully addressing insight into his conduct and the impact on the profession, colleagues, and the public.
• Relevant references and testimonials.
• Evidence of any relevant training and professional development.
• Attendance at the review hearing.
HCPC submissions
24. Mr D’Alton submitted that the previous panel had highlighted the need for the Registrant to develop insight and remediation. There has been some progress made by the Registrant since then, but his fitness to practise is still impaired.
25. The Registrant’s submissions today were focused on his personal issues and the reasoning behind his actions. Mr D’Alton submitted that it was only when he was pressed that more developed insight emerged. The Registrant has begun to acknowledge and address these issues, but they were absent from his written submissions and reflective piece.
26. Mr D’Alton submitted that the Registrant’s insight is at an early stage and therefore a further suspension is required. In respect of his future plans, Mr D’Alton submitted that the Registrant placed emphasis upon the environment he is working in, rather than his responsibility to take actions to prevent a repetition of the issues giving rise to these proceedings. He has shown the beginnings of insight but that was not the primary focus of his submissions today. He has avoided dealing with his past misconduct due to the publicity surrounding the substantive hearing panel’s decision. The Registrant will need to build upon the progress he has made, and he indicated today that he intends to do so.
27. The reviewing panel’s task is to “consider whether all the concerns raised in the original finding of impairment have been sufficiently addressed” (Abrahaem v GMC [2008] EWC 183 (Admin).
The Registrant’s submissions
28. The Registrant provided a reflective piece by email dated 8 July 2022. He also provided a written submission for this review hearing by email dated 21 July 2022, stating:
“I have attached certificates from the courses that I have completed in order to keep up to date with the current resuscitation guidelines. I have also frequently checked for updates on the resus.org.uk website. I regularly listen to the “Resus Room” podcast which covers case studies and the management of complex patients both in and outside of the hospital. This has been core in keeping up to date with new developments in patient management, but unfortunately there is no certificate provided for this which I can pass on to the Panel.
I have also read multiple studies and clinical trials that cover multiple issues, the latest being chest decompression and paramedics not being able to identify the correct landmarks risking piercing the heart of the patient. The trial had some interesting results, though only a small number of paramedics involved in the trial (I believe in the USA), none of them could identify the correct insertion point for the needle even though they could talk through the theory correctly in how they would find the location. This led me to look further into this and although I could not find any reliable figures for the UK, I did come across an article. This highlighted that there have been multiple instances where the procedure was carried out where it was not indicated. Looking at the two articles, it is concerning that the identification of a safe point of insertion is incorrect in many cases with a risk of hitting the heart and that clinicians are also carrying out the procedure when not indicated.
I have learnt a lot from my previous mistakes and have worked hard to develop myself and my situational awareness. I have since studied human factors in aviation which has a large cross over with healthcare, particularly in the emergency setting. It has also helped me understand a lot about how I reacted previously to events and has reinforced the techniques to manage certain situations and closely follow operating procedures.”
29. The Registrant supplied a bundle of documents to the Panel, including a screenshot of an article dated 2 August 2019 and five e-learning certificates dated 14 July 2022. He submitted today that he had fallen short of the HCPC Standards and was sorry for having done so. He is more aware of his actions now. He did not wish to involve his current employer in these proceedings. He enjoyed managing a Covid hub before he was suspended and he could in future provide testimonials from friends and colleagues. He accepts full responsibility for his actions and he failed to see them from the perspective of others at the time. He did not intend to be offensive and would have taken down any offensive posts if he had been asked to do so. He accepts his actions brought the profession into disrepute, but he would not do so again.
Legal Assessor’s advice
30. The Legal Assessor advised the Panel to consider if the Registrant is fit to return to unrestricted practice. The hearing today is not a rehearing of the original Allegation and the Panel cannot go behind the substantive hearing panel’s findings. The Panel has to make an assessment of the Registrant’s fitness to practise as at today’s date.
31. The Panel should take into account the HCPTS Practice Notes on “Review of Article 30 Sanction Orders” and “Fitness to Practise Impairment”. If the Registrant’s fitness to practise remains impaired the Panel will need to consider what restriction, if any, should be imposed.
32. The Panel must follow the principles of fairness and proportionality and have regard to the HCPC Sanctions Policy.
33. Under Article 30 of the Health Professions Order 2001, all suspension orders must be reviewed before they expire.
34. The Panel has the power under Article 30 to vary, extend, replace, or revoke the existing sanction. All the sanction options, including a Striking Off Order, are available today.
35. The decision in Abrahaem v GMC states that in practical terms there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that he has fully acknowledged the deficiencies which led to the original findings and has addressed his impairment sufficiently “through insight, application, education, supervision or other achievement”.
Decision
36. The Panel accepted the advice of the Legal Assessor. The Panel has taken into account the relevant HCPTS Practice Notes and the HCPC Sanctions Policy.
37. The Panel has considered the personal component, which includes the current competence and behaviour of the Registrant, and the public component, which includes protecting service users, declaring and upholding proper standards of behaviour, and maintaining public confidence in the Paramedic profession.
38. The review process today requires the Registrant to demonstrate both developed insight and remediation, enabling him to safely return to unrestricted practice. There is a persuasive burden on the Registrant to do so.
39. The Panel has considered the evidence, documentation, and submissions made.
40. The Panel finds that there has been some progress since the last hearing as regards the Registrant’s remediation and insight. He has made submissions to the Panel to demonstrate that he has taken some of the steps suggested by the previous panel. The Registrant has therefore made some progress since the substantive hearing. Whilst he has completed some limited Continuing Professional Development (“CPD”) to maintain his clinical skills, there was nothing before the Panel to demonstrate that he has undertaken any learning around the specific areas of misconduct found proved.
41. However, he has not fully remediated his misconduct on the basis of the evidence and submissions before the Panel today. The Panel accepts the submissions of Mr D’Alton that the Registrant’s insight is at an early stage.
42. The Registrant is not currently employed in a healthcare role. He would like to return to professional practice but his fitness to practise remains impaired because he has not fully remediated the concerns under the personal and public components.
43. The Panel concludes that the Registrant’s fitness to practise remains impaired.
44. As regards the appropriate sanction, if any, taking no further action or the sanction of a Caution Order would not reflect the seriousness of the Allegation found proved and the current finding of impairment.
45. The Panel next considered a Conditions of Practice Order, but the competence of the Registrant is not the focus of the Allegation. The Panel could not formulate a Conditions of Practice Order that would be workable, realistic, proportionate, and sufficient to protect the public and not effectively amount to suspension.
46. There was a serious breach of the HCPC Standards of Conduct, Performance and Ethics in this case. The Registrant admitted the Allegation and misconduct and has begun to develop his insight. The deficiencies found were potentially remediable, and there was nothing to indicate that the Registrant is unable or unlikely to be able to resolve or remedy his failings.
47. The Registrant’s conduct included elements of a failure to work with colleagues (in the sense of making disparaging remarks), failing to act professionally (particularly in his role as a mentor), and a single breach of patient confidentiality.
48. The Panel has decided to extend the current Suspension Order for a further six months. The Panel considers that the least restrictive Order it can impose today, consistent with the public interest and fairness to the Registrant, is a further suspension.
49. This is required to reflect the serious misconduct and give the Registrant an opportunity to further develop his insight and remediation. A short further period of suspension should enable him to do so.
50. The Panel considered that the sanction of a Striking Off Order is not appropriate or proportionate today.
51. A further 6-month Suspension Order is the appropriate and proportionate sanction to protect the public, maintain confidence in the profession, and declare and uphold proper professional standards.
52. This Order will be reviewed before it expires and the reviewing panel may be assisted by the Registrant providing the following:
• A further in-depth reflective piece fully addressing the impact of his misconduct on patients, colleagues, and the public.
• Character references or testimonials from persons who are aware of these proceedings.
• Evidence of further training and CPD, including courses relevant to the concerns raised, such as training on equality and diversity, use of social media, and data protection.
• His attendance at the next review hearing.
Order
The Registrar is directed to suspend the registration of Mr Samuel Heenan for a further period of 6 months on the expiry of the existing order.
Notes
The Order imposed today will apply from 25 August 2022.
This Order will be reviewed again before its expiry on 25 February 2023.
Hearing History
History of Hearings for Mr Samuel Heenan
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 28/07/2022 | Conduct and Competence Committee | Review Hearing | Suspended |
| 26/07/2021 | Conduct and Competence Committee | Final Hearing | Suspended |