James A Bramwell

Preliminary Matters
Service
1. The Panel was satisfied that a Notice of Hearing had been sent to the Registrant by an email dated 20 April 2022 with an updated Notice of Hearing sent on 26 April 2022 including the Registrant’s full name. The Notice was sent to the Registrant’s email address as held on the Register by the HCPC. This gave notice of the hearing date and informed the Registrant that the hearing was to be a virtual hearing. The Panel had sight of a confirmation of delivery email.

2. The Panel was satisfied that there had been proper service of the Notice of Hearing in accordance with the Health and Care Professions Council (Coronavirus) (Amendment) Rules 2021 Rule 3.

Proceeding in Absence
3. The Registrant was not in attendance at the hearing and had not been in touch with the HCPC prior to the hearing. The Panel were told of a number of emails received from the Registrant in 2021 where he indicated that he did not wish to be further contacted, he did not wish to participate in the proceedings and wished to retire as a Paramedic. Ms Lykourgou on behalf of the HCPC made an application to proceed in the Registrant’s absence.

4. The Panel listened to the submissions of the Presenting Office and considered the advice of the Legal Assessor, and the Practice Note on “Proceeding in Absence”.

5. The Panel considered that the Registrant had not made any contact with the HCPC nor an application for an adjournment. Therefore, the Panel decided that he had voluntarily waived his right to be present at the hearing. The Panel was mindful of the time that had elapsed since the alleged incidents. The Panel felt a further adjournment would neither secure his attendance nor be in the public interest. The Panel was satisfied that any disadvantage to the Registrant by not attending could be mitigated by the Legal Assessor and Panel testing the evidence.

6. Therefore, the Panel decided to proceed with the hearing in the absence of the Registrant and drew no adverse inferences from his non-attendance.

Special Measures
7. An application was made on behalf of Person A to have her cousin in the room with her whilst she gave evidence over the video link. Person A was very nervous and worried about giving evidence and this would calm her and enable her to give evidence effectively.

8. The Panel accepted the legal advice provided by the Legal Assessor and considered the HCPTS’ Practice Note on “Special Measures”.

9. The Panel concluded that as Person A is the alleged victim in a case involving an allegation of a sexual nature she qualified to be treated as a vulnerable witness. The Panel went on to consider whether the quality of her evidence is likely to be adversely affected. Having heard the concerns Person A has about giving evidence the Panel determined that she should be treated as a vulnerable witness who is eligible for special measures.

10. The Panel noted that the examples of special measures listed in the Practice Note are non-exhaustive. The Panel was satisfied that allowing Person A to give evidence from a room where she was accompanied by her cousin was an arrangement that would ensure that the quality of her evidence is not diminished. Fairness to the Registrant could be achieved by ensuring that Person A’s cousin was on screen so there was no communication between them.

Background
11. The Registrant was employed as a Paramedic Team Leader for St John’s (‘the Employer’) from 17 December 2014, until 14 February 2017.

12. On 16 December 2016, the HCPC received a referral from the Registrant’s then employer, St John’s Ambulance (‘SJA’). The referral reported that the Registrant had been arrested and bailed for a criminal offence described as “alleged sexual harassment and possible sexual assault” on a female volunteer staff member. It was alleged that the Registrant and alleged victim (‘Person A’) first met at an event where they were both working. Person A was said to have told the Registrant about some health issues relating to a heart murmur. The Registrant performed two ECGs on Person A. It was alleged that following this, and whilst on duty, the Registrant visited the alleged victim at her place of work and attended at her GP Practice.

13. It is alleged that on 9 December 2016 the Registrant attended at Person A’s home without invitation and took an ECG reading, following which the Registrant is alleged to have touched Person A without her consent, including by kissing her and touching her vagina. It was also alleged that the Registrant said that he wanted to go upstairs to bed and to make love to Person A.

14. On 9 December 2016, the Registrant was arrested and charged with the offence of assault of a female, identified as Person A, by penetration with part of the body or a thing. A trial hearing in relation to this matter was held in October 2019, and the Registrant was subsequently found not guilty by a jury on the Judge’s direction.

15. Following the Registrant’s arrest, further concerns were brought to light during a local investigation by SJA, namely regarding the Registrant’s alleged non-compliance with the Employer’s policies and procedures relating to controlled drugs and medicines management.

16. The Panel received the HCPC hearing bundle of 504 pages, a service bundle of 8 pages, a statement from LZ of Kingsley Napley and a transcript of a criminal trial that was said to be unused material.

Hearsay Evidence
17. Ms Lykourgou made a submission on behalf of the HCPC to admit hearsay evidence in the form of a statement from Person B and statements from the police, Person A’s GP and TM who was tasked with examining the Registrant’s and Person A’s phones. She referred the Panel to the case of El Karout v NMC [2020] EWHC 3079 (QB) and submitted that Person B could no longer attend due to her extreme anxiety, the other witnesses are professionals who provide information about the chain of evidence and the attendance at the GP surgery. It is fair to admit such evidence as the Registrant had been sent a copy of the bundle and had not raised any objection to the evidence. Therefore, it is fair both to admit the evidence and give it a high degree of weight.

18. The Panel accepted the advice of the Legal Assessor who also referred it to the Rule 10(1)(b) and (c) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”), the Civil Evidence Act 1995 and the case of Thorneycroft v. Nursing and Midwifery Council [2014] EWHC 1565 at para.45. The Panel was also invited to consider admissibility first of all but to consider weight to attach to the evidence as a factor that is to be weighed in the balance.

19. Person B’s evidence relates to her first-hand account of the events surrounding the administration of the ECG at the Christmas Fair on or around 26 November 2016. There is a conflict between the accounts given by the Registrant and Person A which needs to be resolved. Person B also gives hearsay evidence as to what she has been told by Person A about the level of her contact with the Registrant and what happened during a meal with GW.

20. Having seen a note from Person B’s therapist, the Panel accepted that there was a cogent reason why Person B was unable to attend the hearing. However, the Panel also took into account the fact that the Registrant had no prior notice that the statement would be read. The Panel considered the statement of Person B and read the statement it had been provided by LZ of the Kingsley Napley dated 31 March 2022. The statement explained that “on 8 December 2021, I corresponded with Person B’s Therapist, [TW] by telephone regarding difficulties Person B is currently experiencing regarding her mental health. During this phone call, [TW] informed me that Person B had difficulties reading and understanding her evidence and had therefore asked Person A to assist by reviewing her witness evidence and confirm the contents of this with Person B in order to assist Person B with her understanding. I informed [TW] that Person A and Person B should not be reviewing each other’s evidence in order to avoid evidence contamination in the case.” This caused the Panel significant reservations as to the extent to which Person B’s evidence had been contaminated. The Panel decided that this issue would be almost impossible to resolve or test without Person B’s attendance and questioning. The Panel also noted that Person B was Person A’s sister and therefore was not an independent witness. The Panel felt this further undermined the objectivity and reliability of Person B’s evidence. The Panel was not satisfied that it had any means to test the reliability of Person B’s statement.

21. The Panel determined that carrying out an assessment as to what weight (if any) to attach to Person B’s statement was insufficient to safeguard the concerns it has about the reliability of the evidence. Therefore, having carried out a careful balancing exercise the Panel decided that fairness requires it not to admit the evidence of Person B.

22. However, the Panel reached a different conclusion as to the remainder of the hearsay evidence. The Panel was satisfied that the evidence came from professionals and as such there was no suggestion that they had any reason to fabricate their evidence.

23. The statements from professionals largely went to peripheral matters and did not form sole or decisive evidence in support of any of the allegations. The Panel was satisfied therefore that the evidence was demonstrably reliable. Therefore, it reached the conclusion that it was fair to admit this hearsay evidence subject to the issue of what weight to attach to it.

Decision on Facts
24. The Panel considered the submissions of Miss Lykourgou on behalf of the HCPC. She provided written submissions to the effect that there was sufficient evidence in support of all the facts alleged, for the Panel to be satisfied that the facts were proved. The Panel accepted the Legal Assessor’s advice and bore in mind that the burden of proof on the facts is upon the HCPC and the standard of proof to be applied is the civil standard, on the balance of probabilities. The Panel’s attention was drawn to the HCPTS Practice Note on “Making decisions on a registrant’s state of mind”.

25. The Panel proceeded to consider all the evidence presented in support of the HCPC’s case and whether it was satisfied that the particulars of the allegation were proved on the balance of probabilities. As the Registrant had not attended the hearing, the Panel took great care to consider the evidence that the Registrant might have drawn their attention to had he been present. In particular the Panel considered the explanations proffered by the Registrant in his police interview and interview for the local investigation.

26. The Panel heard from six witnesses and have set out their roles at the time of the allegations: PDB, Station Manager, Ambulance Operations (East Midlands) for St Johns Ambulance (hereinafter “SJA”); Person A, volunteer first aider at SJA; GW, Volunteer Area Manager for SJA with responsibility for Safeguarding; Colleague A, SJA Paramedic Team Leader for the Falls Team; Colleague B, Advanced Life Support and Professional Lead for Paramedics at SJA; LR, Person A’s Line Manager.

27. PDB accepted that due to the lapse of time since his investigation and the fact that he had only spent 12 months in that employment he had limited knowledge of the policies and procedures in place. He also accepted that the investigation into the issues related to Controlled Medicines was carried out by his colleagues and he simply accepted their conclusions.

Particular 1
On 26 November 2016 conducted two ECGs on Person A and did not:
28. The Panel viewed two ECG print outs dated 26 November 2016 that were contained in the bundle. The Panel noted that the Registrant accepted that he had performed two ECGs on Person A. The Panel was therefore satisfied on the balance of probabilities that two ECGs were conducted on Person A as evidenced by the ECG traces.

Particular 1(a) – Found Proved
Obtain and/or record Person A’s medical history
29. The Panel listened closely to Person A’s evidence as to what occurred during the Christmas Fair on 26 November 2016.

30. Person A explained that on 26 November 2016 she was a SJA volunteer at the Christmas Market working alongside the Registrant who was the events Paramedic. She described being quite out of breath on the day going up and down the hill as she had recently come off her heart medication. She said that she recalled the Registrant being in the first aid room and she began to tell him about her heart condition and how she was feeling.

31. The Registrant explained in the local investigation interview on 19 January 2017 that he performed Person A’s “obs, stats and took her temperature”. PDB explained that the Registrant ought to have “taken a full medical, history, obtain her consent for treatment/assessment and recorded any of the findings that he made during this assessment in the PRF”.

32. As part of his interview the Registrant also accepted that he had not completed a Patient Report Form (hereinafter “PRF”) on that day and should have done so.

33. The Panel considered the St John Ambulance “Management of Patient Report Forms (PRFs)” document dated August 2014. It was satisfied that this was the version that was in place at the time of the alleged incidents. At paragraph 3.2 the document stated that “PRFs should ideally be completed at the time of care delivery.” In oral evidence PBD confirmed that there was a three-day deadline to submit a PRF. He also said that it was his expectation that an episode of patient contact where there was genuine concern about a clinical condition or need for intervention should be recorded and a copy of the PRF provided to the patient to give to their GP. PBD reviewed whether there was a PRF from for this episode of care during the local investigation and found that there was not.

34. At paragraph 3.3 it stated that “Continuation sheets, where used, must be completed with the patient’s details and the PRF number to which they related. These must then be submitted together with the PRF to the scanning centre.”

35. Having considered the evidence carefully the Panel was satisfied that the discussions the Registrant had with Person A were sufficient to conclude that he had taken a medical history.

36. The Panel was satisfied that an undated PRF Continuation Sheet which it was shown did relate to the episode of care on 26 November 2016.

37. The Panel accepted the evidence it heard from PBD, as he was a professional who had carried out his investigation as part of his professional obligations. The evidence that he gave was consistent with the documentation that the Panel had been taken to in the bundle. Therefore, the Panel accepted that PBD had not found a completed PRF form when he was carrying out his investigation in January 2017.

38. The Panel was also satisfied that the continuation sheet ought to have been attached to a PRF, completed contemporaneously and handed in a maximum of 3 days after 26 November 2016. There was no evidence that any of these steps had taken place. Therefore, the Panel reached the conclusion that this form was deficient in a number of ways.

39. Therefore, the Panel was not satisfied that the Registrant had recorded Person A’s medical history.

Particular 1(b) – Found Proved
Obtain and/or record Person A’s consent;
40. PBD explained that prior to performing an ECG the Registrant ought to have obtained Person A’s consent for that investigation. PBD had exhibited to his statement an excerpt from “C004 Management of the legal aspects of care, treatment and support” which stated at 4.6.1.1. “Consent may be given orally or by implication. It shall be freely and voluntarily given. The consent needs to be recorded on the Patient form. It is important for all the evidence supporting the consent to be recorded as well.”

41. Person A explained in her statement which she confirmed to be true at the start of her oral evidence that she had agreed to have the ECG performed on the 26 November 2016 in the presence of her sister. She confirmed that she had been asked by the Registrant if she wanted an ECG, in her local investigation interview, on 13 January 2017. She confirmed that she had agreed to it. The Panel was satisfied that consent had been freely given.

42. However, there was no record of the consent on the continuation sheet and for the reasons set out above the Panel does not accept that that sheet complied with the Registrant’s obligations to record the treatment episode.

Particular 1(c) - Found Proved
Undertake and/or record an assessment of Person A;
43. Person A recalled discussing her medical condition with the Registrant and he confirmed in the local investigation interview that he had conducted an assessment. The Panel saw that there were a number of observations recorded on the PRF Continuation Sheet and Person A did recall a conversation about her condition. The Panel was satisfied that some assessment of Person A had been undertaken by the Registrant. The Panel considered whether the nature of the conversation and assessment that was described by Person A and the Registrant was adequate.

44. The Panel reached the conclusion that the HCPC had failed to satisfy them on the balance of probabilities that the assessment was deficient.

45. However, for the reasons set out above the Panel found that the PRF continuation sheet was inadequate in a number of ways. Therefore, the Registrant had failed to record the assessment.

Particular 1 (d) – Found Proved
Undertake and/or record Person A’s vital signs
46. The Panel reviewed the evidence carefully and was not satisfied that it had ever been explained to the Panel what a check of vital signs entailed. PBD’s witness statement was silent on this point. Therefore, the Panel could not determine that the Registrant had not undertaken Person A’s vital signs.

47. However, the Panel remains satisfied for the reasons set out above that the Registrant’s purported recording of the entire care episode was inadequate and does not amount to a record and so it found as a fact that no vital signs were recorded.

Particular 1(e) – Found Not Proved
Record the findings of the ECG
48. Person A told the Panel that she had been given a copy of her ECG print out to show her GP. The Panel also saw copies of the ECG trace in the bundle as referred to above. The Panel considered SOP 004-05 (1.1) Documenting Care Provision as referred to by PBD. This did not indicate any specific ways in which the ECG ought to have been recorded. PBD said that the findings should have been recorded in the PRF so that Person A could have shown this to her GP.

49. The Panel noted that a copy of the ECG was found by the SJA staff when they carried out the investigation.

50. The Panel was satisfied that a copy of the ECG had been provided to Person A and a copy was available to SJA staff. Therefore, in the absence of any particular SOP containing any specific requirements that recording an ECG entailed, it was satisfied that the ECG trace was sufficient to demonstrate that it had been recorded.

Particular 2 – Found Not Proved
You attended at Person A’s place of work on unauthorised visits and/or attended at Person A’s place of work and used a company vehicle for private purposes whilst on duty, on or around the following dates:
a. 28 November 2016;
b. 29 November 2016;
c. 1 December 2016;
d. 5 December 2016.
51. Person A described what was from her perspective a purely professional relationship with the Registrant. It had started whilst they were both on duty at a Christmas Fair in their respective roles as event first aiders. Person A as a volunteer through SJA and the Registrant as a registered Paramedic. Their paths crossed when Person A began to experience symptoms from a longstanding medical condition that she had, and the Registrant offered to perform an ECG on her. Person A explained that initially she was pleased that he was showing concern about her medical condition. Witnesses that knew Person A namely GW and LR described her as being naïve and lacking in life skills expected of someone her age.

52. Person A was interviewed by PBD as part of his investigation on 13 January 2017. Person A confirmed that on a number of occasions the Registrant had come to her work after the Christmas Fair. In this interview Person A confirmed that the Registrant had visited her work on 28 November 2016 at about 8.30am. She confirmed that he also came in on 29 November 2016 at about 8.30am. Person A also confirmed that he had attended on 5 December 2016 as well. Person A also confirmed that following her GP’s visit on 1 December 2016 the Registrant had attended her place of work. Person A’s evidence as to the Registrant visiting her place of work has been consistent throughout.

53. The Panel also heard from LR, Person A’s manager, who described that she had witnessed a Paramedic in full uniform come to their place of work and ask to see Person A. However, she could not remember the date on which this had happened. LR explained that after the event she was told that this was the Registrant. The Panel accepted this evidence and found that it corroborated the account given by Person A.

54. Person A was unable to confirm the dates in her oral evidence to the Panel as it was over five years after the events complained of. However, the Panel took the view that this did not detract from the reliability of her contemporaneous accounts.

55. The Registrant accepted in his local investigation interview that he had turned up at Person A’s place of work two or three times. He said that on each occasion he had been invited by Person A. He denied any personal relationship with Person A and reiterated that he was merely concerned about her health. The Registrant explained that the visits lasted only 30 seconds to one minute and had not been recorded in his log.

56. The Panel formed the view that the Registrant was minimising his involvement and level of contact with Person A during both his police interview and local investigation. The Panel also formed the view that he was disguising his motivation for persistent contact with Person A. The Registrant also failed to provide the dates he attended Person A’s place of work. Therefore, the Panel had no difficulty preferring the evidence of Person A and accepted that on each of the occasions listed the Registrant attended Person A’s place of work.

57. The HCPC’s position is that as the Registrant was seen in uniform he was therefore on duty and that there was no evidence that he was “in the area”, for any other reason, on each date. Furthermore, as Person A was described to have been surprised and uncomfortable to see him this suggests that the visits were not welcome or planned.

58. The Panel having considered the evidence from Person A and LR had no difficulty in accepting that Person A found the visits unwelcome as they occurred about the time that she was expressing concerns to GW about the nature and frequency of the contact the Registrant had made. Furthermore, there is no evidential burden on the Registrant to show that he was working in the area at the time.

59. The Panel therefore considered the evidence that it heard on these points. The Panel had heard conflicting evidence as to whether the Registrant ought to have been attending Person A’s place of work in uniform. PBD said that personal visit could be made during a break or lunchtime. PBD said that he would have expected permission to be sought for any private use of a work vehicle. The Panel note that they were not taken to any specific policies to outline these expectations. PBD did accept that it was not uncommon to take breaks for lunch etc within a Paramedic’s operational areas as long as they remained available as needed. PBD could not recall the Registrant’s operational area.

60. Colleague A who was the Registrant’s Line Manager explained that it was not unusual for Paramedics to go to cafes in between their designated jobs. Furthermore, if the Paramedic was on a break, it is for them to take the break where they wish within their operational area. The Panel heard evidence that the Registrant may have had a break of up to 40 minutes although given the passage of time the HCPC witnesses had difficulty recalling the Registrant’s working pattern. The Panel had no evidence as to whether Person A’s place of work, which was a café was outside of the Registrant’s geographical remit.

61. The Panel accepted that the visits had occurred and that they made Person A uncomfortable. However, although the Panel had serious concerns about the frequency of the visits and their ultimate purpose it was not satisfied that the HCPC had established that the visits were unauthorised. Neither was it satisfied that the Registrant used a company vehicle for private purposes whilst on duty in circumstances where the Panel found it was common practice for Paramedics to make stops, particularly to cafes, between their designated visits.

Particular 3 – Found Proved
On or around 1 December 2016 you:
a. attended at Person A’s General Practitioner on an unauthorised visit
62. The Panel had been provided with a statement prepared by Person A’s GP, although she did not give evidence. The Panel noted the warnings that the Legal Assessor had provided regarding hearsay but considered that as this was provided by a Professional, she had no axe to grind against the Registrant, it was provided as part of a police investigation and it contained a statement of truth, this was reliable evidence that the Panel could give significant weight to.

63. Person A’s GP explained that a Paramedic was seen, in the waiting room, on 1 December 2016 asking for Person A. It was reported to the Registrant that she had left the surgery.

64. In her local investigation interview Person A described how the Registrant said he would pop into see her doctor. Person A’s appointment was on 1 December 2016, and she did not see the Registrant when she attended just before 8am. However, her GP confirmed to her later that the Registrant had been seen at the premises by reception staff after about 8.15am that same morning in full uniform.

65. The Registrant in his local investigation interview described receiving a text from Person A to say she was going to her GP and would he go with her for moral support. The Panel has not seen this text. The Registrant explained that he went to the GP surgery, but that Person A was not there. He said that he then went to her place of work and she told him that she had a letter from her cardiologist. The Registrant confirmed that he was in an SJA vehicle, in uniform and on duty at the time he made the visit.

66. PBD explained that he did not think it necessary for a Paramedic to support a friend at a GP appointment whilst on duty. In this instance PBD explained that Person A said she had been upset and surprised that the Registrant had attended. He also confirmed that the Registrant had in fact missed the appointment. PBD said that this visit raised suspicions for him which is why he investigated whether there was an official reason for it and found that there was not.
67. The Panel concluded that visits to a GP practice in uniform, in circumstances where the Registrant had not been invited to accompany Person A, are to be regarded as of an entirely different nature to unsolicited visits to Person A’s place of work.

68. Despite the Registrant’s protestations during interviews that he thought he was friends with Person A the Panel does not accept this. The Panel has considered the fact that he had only known Person A for less than two weeks and that their interactions arose within a professional context due to concerns about Person A’s health. The Panel prefers and accepts Person A’s description that she was pleased the Registrant was showing concern about her health condition. The Panel find the Registrant’s explanation for his attendance at the GP implausible, particularly in circumstances where Person A had not told him the time of the appointment and he ultimately missed it. This is not consistent with his account that Person A invited him to attend with her. The Panel was given some examples of when a Paramedic might be expected to liaise with or visit a GP.

69. The Panel found that this visit did not fall within the circumstances described to it as situations where it was legitimate for a Paramedic to attend a GP in his professional capacity.

70. In the circumstances the Panel found that the Registrant’s visit occurred and was unauthorised.

Particular 3(b) - Found Proved
attended at Person A’s General Practitioner using a company vehicle for private purposes whilst on duty
71. The Panel has already accepted that the Registrant attended the GP Surgery in full Paramedic uniform. The Panel accepted that the Registrant had attended the surgery on or around 8.15am.

72. The Panel had been given evidence about an ambulance vehicle log and for the day in question one visit had been recorded to a GP’s Practice, but it was not Person A’s registered Practice. The investigation report noted that there was no record in the vehicle log that documented an ‘official’ journey to the GP practice for this visit.

73. The Registrant in his local interview accepted that when he made the visit, he was in an SJA vehicle, in a uniform and on duty. The Panel has already found that this visit did not fall within the circumstances described to it as situations where it was legitimate for a Paramedic to attend a GP in his professional capacity.

74. There was no evidence provided to indicate that the Registrant’s vehicle had been seen at the GP Surgery. However, the Panel accepted that on the balance of probabilities, as he was dressed in full uniform and confirmed this in his investigation, he had used his vehicle to visit the surgery. The Panel was also satisfied that he was on duty at the time of the visit.

75. Therefore, given the fact that there was no legitimate official reason for his visit to the GP the Panel concluded that this was a private visit whilst on duty.

Particular 4 - Found Proved
On or around 9 December 2016 you:
a. Attended at Person A’s home on an unauthorised visit;
b. Attended at Person A’s home using a company vehicle for private purposes whilst on duty;
c. Conducted an ECG on Person A and did not complete a Patient Record Form and/or did not submit any Patient Record Form at the conclusion of your shift that day;
d. Put your hands underneath Person A’s clothing and placed your hands on her breasts;
e. Put your arms around Person A’s neck and kissed her;
f. Undid Person A’s belt and lowered her jeans and underwear below her waist;
g. Put your hand and/or finger(s) inside Person A’s vagina;
h. Grabbed Person A’s hand and moved it towards your groin area so that she touched your penis;
i. Said to Person A on numerous occasions that you wanted to “go upstairs to bed” and/or that you wanted to make love to her or words to that effect.
76. On that day Person A had received two texts from the Registrant which the Panel have seen. The first said “are you in xx” and the second said he had done further research and wanted to know when she would be home. Person A responded to neither.

77. Person A told the local investigation that the Registrant arrived at her house in a work estate type vehicle with a logo.

78. She described to them that seeing the Registrant at her house was “complete shock”. She was asked how he knew her address at the time she said it was from “general conversation on duty”. However, she was clear that she had never given him her house number and she confirmed this in oral evidence before the Panel.

79. Person A’s GP noted in her statement that on 9 December 2016 Person A visited the surgery and reported to the receptionist that she had been sexually assaulted by a Paramedic within the Falls Team whose name was James. The staff at the GP Practice advised police intervention and they escorted Person A from the surgery.

80. The Registrant explained, in his police interview, that Person A contacted him via text to say she was short of breath, and he replied to say that he was in her area so he could pop in and examine her. The Registrant said that Person A told him she would be around on Friday. Again, the Panel have not seen the texts described and they do not accord with the texts that have been shown to the Panel. The Registrant accepted that he phoned her, and she did not answer.

81. The Registrant explained in his police interview that he performed a number of investigations including peak flow, SATS and temperature. Having concluded those investigations, the Registrant told her to go to see her GP. He described that as he was packing away Person A put her arms around him.

82. The Registrant confirmed that at the time he made the visit to Person A’s home on 9 December 2016 he was on duty. The Registrant agreed during his local interview that it was not recorded in the ambulance job log. The explanation he gave for not doing so was because “it was a colleague asking for help”. He said that he had not thought to record it as he thought the log was for referral by a GP.

83. The Panel accept that there was no official or legitimate professional reason for this visit.

84. It was put to the Registrant that there was no PRF from 9 December 2016 and nor had it been entered or recorded in the ambulance job log. The Registrant explained that he had a PRF with him when he had been taken away by Buxton police in the evening and did not have time to hand it in. He said that he had tried to give it to Colleagues A and B but “they did not want it. They could have had it anytime”. The explanation for not handing it in given by the Registrant was that he was unsure whether to do a report or not. The Registrant could not explain why he was unsure.

85. The Panel have not seen a PRF, dated 9 December 2016, but merely a Patient Continuation Sheet.

86. The Panel was not satisfied by the Registrant’s answers in the local interview and regarded the fact of him being arrested sometime after the examination as having no bearing upon whether a PRF could have been completed at the time. The Panel have not seen one.

87. The Registrant accepts that it was not submitted at the conclusion of his shift and the Panel accept his evidence on this point as it is consistent with PBD’s account that no PRF was provided at the time.

88. Person A explained that after the Registrant had left on 9 December 2016, she telephoned GW. This was confirmed by GW. GW invited Person A to her place of work and then took her to a colleague’s house and recorded what Person A described had occurred. These notes form the first account that Person A gave about the incident they were provided to the police. The Panel noted that GW was a safeguarding lead and had been trained in how to respond in circumstances such as these. The Panel therefore regarded these notes as reliable. In them it was recorded that Person A said “he put his two hands under your shirt and grabbed my boobs” [sic].

89. Thereafter Person A went to her GP’s surgery and reported that she had been sexually assaulted by the Registrant. The police were called, and she was interviewed by an officer on 10 December 2016 the day after the visit.

90. Person A described how the Registrant has asked to perform an ECG and asked to check her oxygen levels. Thereafter he checked her chest with a stethoscope. At this point Person A recalled that the Registrant asked to go into the kitchen as it was more private. It was as he was using the stethoscope that he moved his hands up and around and moved round to the front of Person A. As he did this Person A describes that he put his arms round her neck and started to kiss her. Person A recalled in her police interview that she made excuses that she had jobs to do. Then she described events happening quickly in that the Registrant got hold of her belt, managed to undo it and pull her trousers down. Then he took her hand and made her hold his penis while he said, “lets go to bed, let me make love to you”. Person A also described how the Registrant put his hand up her vagina. Person A then says she asked the Registrant to leave and reluctantly agreed that he could return at 3pm as a way of getting him out of the house.

91. The Panel considered the Registrant’s account of what had happened which conflicted with what Person A had said. The Registrant suggested that during their initial meeting on 26 November 2016 at the Christmas Fair Person A had kissed him full on the mouth after he had performed an ECG and then hugged him. He said that he felt something was not quite right and that he felt uncomfortable. Person A denies that this is what happened. The Panel noted that the Registrant had not reported this to his employer. Then after this date he continued to pursue contact with Person A in the form of texts, calls and visits to her workplace. The Panel did not find the Registrant’s account plausible. The Panel considered that as a professional, if a patient behaved that way toward him he was not likely to have continued to have unchaperoned contact as this could potentially place him in a difficult and compromising situation. If the Registrant genuinely had these concerns about Person A the Panel would have expected him to have been circumspect about any future contact with her.

92. The Registrant explained that Person A had invited him to her house on the Friday and waved him in when he arrived and offered him a coffee. As they were chatting Person A mentioned that she was short of breath, and it is that which prompted him to perform a Peak Flow test. The Registrant also performed an oxygen saturation test and an ECG. The Registrant suggested that it was Person A’s idea to go into the kitchen. Then as he was using the stethoscope to listen to her chest Person A “out of the blue” put her arms round him and started kissing him intensely. It was at that point that he said Person A said that she wanted to make love to him and said I love you. The Registrant said that Person A undid her jeans, grabbed his right hand and placed it on her vagina until the Registrant said he could not do this as he had to be somewhere. Therefore, he left but as he did so Person A invited him back at 3pm for a drink.

93. The Panel rejects the Registrant’s account of what occurred. The Panel found that the account put forward by the Registrant was inconsistent with his actions. Had the encounter occurred as he said it did the Panel find it inconceivable that he would have returned to Person A’s house at 3pm that same day. The Panel find it inconceivable that had the incident occurred as he described, given how serious it was, that he would not have reported it to his employers for no other reason than to protect himself.

94. The Panel went on to consider carefully the allegation that the Registrant had placed his hand or fingers in Person A’s vagina. The Panel noted that this was not in the original account she gave to GW. However, the Panel did not consider that this detracted from the reliability of her evidence. The Panel took the view that there were many reasons why she might feel uncomfortable discussing this with GW and she had made the disclosure to the police who needed to know this level of detail. It was also consistent with Person A’s visit to her GP later that day to acquire a prescription.

95. The Panel was struck by the similarities between Person A and the Registrant’s accounts save for the description as to who had initiated the sexual contact.

96. The Panel therefore prefer Person A’s evidence as it was consistent, straightforward and could be reconciled with her actions. The Registrant’s account was inherently unreliable and implausible.
97. Therefore, the Panel accepted Person A’s account in full and found all subsections of Particular 4 proven.

Particular 5 – Found Proved
Your actions at particular 4(d) and/or (e) and/or (f) and/or (g) and/or (h) were without the consent of Person A
98. The Panel have accepted Person A’s account of the events of 9 December 2016. The Panel has already explained the reasons it has rejected the Registrant’s account of what occurred.

99. Therefore, the Panel is satisfied on the balance of probabilities that Person A did not consent to any of the conduct described.

Particular 6 – Found Proved
Subsequent to attending at Person A’s house on or around 9 December 2016 you told your employer during their local investigation that you had attempted to hand the PRF to Colleague A and/or Colleague B, when this was not the case.
100. The Registrant was asked in the local interview why he had not provided a PRF prior to the interview. He was asked “Colleague A is your liaison support, why did you not give it to him?” He responded “I tried and to Colleague B, but they did not want it. They could have had it any time.” The Panel is satisfied that this is an accurate record of what was said. It is also satisfied therefore that the Registrant said he had tried to hand a PRF to both colleague A and B.

101. In the record of the investigation, it was noted that the Registrant had “attempted to hand it to Colleague A and the Colleague B”.

102. Emails were sent to both Colleague A and B to ask them whether the Registrant had tried to hand them a PRF. Colleague B responded that there was no discussion, reference or attempt to pass any such documents. Colleague A confirmed in email that “this is the first I have hear if it. [Sic] James has never mentioned an incident occurring on an event let alone show or try and give me a PRF”. Both colleagues were clear at the time and in their evidence before the Panel that on no occasion had the Registrant tried to hand them a PRF.

103. Both Colleague A and B were giving evidence in a professional capacity, and there has been no suggestion that they have any animosity towards the Registrant or a reason not to give honest evidence. Both Colleagues have given consistent evidence.

104. The Panel contrasted this with the evidence provided by the Registrant. He had every reason why this evidence may be beneficial to him in the context of an investigation into allegations which he had to appreciate were very serious.

105. Therefore, the Panel is satisfied that the Registrant did not try to hand a PRF to either Colleague A or Colleague B.

Particular 7 – Found Not Proved
You dated a PRF for Person A for 9 December 2016, yet completed this at a later date without noting it had been completed retrospectively
106. The Panel has seen a copy of a Patient Continuation Sheet dated 9 December 2016. There is no suggestion on the face of this document that it was completed retrospectively.

107. In his local interview the Registrant said in relation to 9 December 2016 “I have a PRF with me here. I got taken off to Buxton by the police in the evening and I did not have time to hand it in”.

108. The Registrant further said “I was considering doing a report over the weekend but then I did not get a chance because of what I was accused”

109. The Panel have not been provided with any evidence that documentation from this date was completed retrospectively. The only clear evidence the Panel has is from the Registrant himself given during the investigation. To find this particular proved the Panel would need to draw an inference from the fact that because the documentation was not handed in on the day it was not completed on the day.

110. The Panel has reached the conclusion on the balance of probabilities that there is insufficient evidence before it to enable it to safely draw this inference.

Particular 8 – Found Not Proved
On unknown dates you sent text messages to Person A in which you:
a. Told her that you wanted to spend your days off with her, or words to that effect;
b. Told her that she was lovely, or words to that effect;
c. Signed off text messages by saying “love you” or words to that effect.

111. Person A explained that to the best of her recollection the Registrant would send text messages saying that he was concerned about her. She said in her statement that he sent messages saying he wanted to be “friends” and he thought she had a “lovely smile” and would often end the messages writing “love you”. She also said on one occasion the Registrant said he was going away for the weekend and said, “think you are lovely” and “want to spend my days off with you”.

112. In her police interview Person A also described text messages from the Registrant saying things such as “Oh I think you’re lovely” and “You are such a lovely person I want to spend my days off with you”. She also said that every time she received a message, she would show GW.

113. It was GW’s evidence that Person A had mentioned receiving text messages from the Registrant. Although she had been told about text messages, she had not been shown any of them. During the local investigation it was noted that whilst messages were mentioned they were not seen by PBD.

114. As part of the police investigation the mobile telephones of Person A and the Registrant were interrogated. No messages were recovered from the Registrant’s telephone, but a number of messages were recovered from Person A. The text messages recovered date from 6 December 2016 to 9 December 2016. It was Person A’s evidence that she dropped her telephone in the bath and there is a text message to this effect dated 6 December 2016 and the Panel accept this evidence.

115. None of the messages recovered contain any of the details that are contained in this particular. When this was put to Person A she was surprised as she said that she thought all her messages had been saved to her sim.

116. The Panel notes that the texts messages that are available are of a different type and nature than those that form part of this Particular. The Panel notes that the messages it has seen contain a clinical element and are not solely of a personal nature. The Panel is concerned about the number and frequency of the messages in circumstances where the Registrant and Person A were not friends, and the Registrant had no professional reason to be involved in her ongoing medical care.

117. Given the vague description of the messages, the fact that they are not available, the different nature of the messages it has seen, the substantial passage of time since the messages were sent the Panel is not satisfied on the balance of probabilities that messages containing these phrases were sent.

Particular 9 – Found Proved
9. On or around 20 July 2016 you recorded two broken ampoules in the Controlled Drugs Register and did not:
a. complete an Incident Report Form
b. request another colleague witness this;
c. request a restock.
118. A Clinical Investigation Meeting was held with the Registrant on 18 January 2017. Following the Registrant’s suspension Colleague A had collected the Controlled Drugs Pouch, HCP Bag and Register from his home address. Upon a check of those items a number of discrepancies were discovered.

119. It was put to the Registrant that the Controlled Drugs Register dated 20 July 2016 recorded “2 broken amps in case” and after which no Incident Report Form (hereinafter “IRF”) was submitted, that there was no evidence of the breakages and no restock request.

120. The Registrant accepted that he had broken two ampoules of morphine in circumstances where he had simply opened his case and found them broken. He explained that he had put them in the sharps bin then totally forgotten about them.

121. The Registrant explained in his local investigation interview that he had not completed an Incident Report Form (IRF) because he forgot.

122. In light of the documentation contained in the bundle and the Registrant’s admissions the Panel found that he had broken the ampoules, not completed an IRF, therefore not had anyone witness the IRF and not sought a restock. Therefore, the entire particular is proven.

Particular 10 – Found Proved
On unknown dates you altered an entry in the Controlled Drug Register dated 26 June 2016 without explanation, having a witness and/or initialling the alteration.
123. Colleague B stated that he was also concerned because there was an entry on 26 June 2016 where it appeared that the Registrant had altered the book without signature or explanation. It initially appeared that the quantity of Morphine Sulphate administered to Person C was 10mg and later changed to 20mg. The 'balance' column of this drug also appeared to have been changed from 3 to 2.

124. It was Colleague B’s evidence that if the Registrant had administered one 10mg ampoule of morphine to Person C first, and then decided it was clinically justified to give her a second dose, these should have been recorded as two separate entries in the drug book, and the balance should have reduced by one each time.

125. The Panel reviewed the Controlled Drug Register that was contained in the bundle and accepted that there was an alteration on 26 June 2016 with no explanation recorded on the form, no initial and not witnessed.

126. When this concern was put to the Registrant during the local investigation interview, he explained that he had written the wrong figure in the box. He said “I initially gave her 10mg then gave her another 10mg. I just altered the book”. It was put to him that he had not altered this Register in a way that meets the HCPC requirements, and the Registrant responded that he had never read the standards.

127. The Panel, however, could not see any space or box on the form where it might be expected an alteration would be required.

128. Nonetheless based on the evidence before it the Panel found this particular proven.

Particular 11 – Found Proved
On 26 June 2016 you administered Morphine to an on-duty Colleague and you:
a. Recorded 20mg had been administered instead of recording two doses of 10mg with the timing of each dose;
b. Did not accurately record and/or ensure that it was accurately recorded whether the Colleague was given advice to seek further medical assistance.
129. The Panel had sight of the relevant PRF dated 26 June 2016 in the bundle. It was clear that the doses of morphine had not been recorded as separate doses. Instead, the Panel found on the balance of probabilities that 20mg had been written over 10mg.

130. Colleague B in his evidence explained that if one dose of morphine had been given and it was necessary to give second dose this was a second treatment episode and therefore it should be recorded as a separate entry.

131. The PRF also recorded that the patient was left in the care of her husband. The Registrant explained in his local investigation interview that this was the original intention however, the plan changed, and he did not document it.

132. There is an additional entry by someone other than the Registrant that states that the patient was “taken to QMC Nottingham”. The outcome box does have a cross in the Hospital box.

133. There is a space for a signature of the person that the patient was handed over to and this is illegible. The Registrant could give no explanation for this.

134. The Panel was satisfied that the morphine doses were only recorded as a single entry. The Panel was also satisfied that the form did not make clear whether the patient was required to seek any further medical attention. Therefore, the Panel was satisfied that this allegation was proven.

Particular 12 (a)– Found Not Proved
Particular 12 (b) - 12(h)– Found Proved
On the following dates, you recorded stock levels of drugs that were inconsistent with the stock contained in your medicines pack:
a. 14 October 2015 (2 instances);
b. 24 October 2015 ;
c. 28 December 2015;
d. 7 May 2016;
e. 28 June 2016;
f. 2 July 2016;
g. 21 August 2016;
h. September 2016.
135. Colleague A gave evidence that he had performed an audit of the Registrant’s medicines pack having collected it from his house following the Registrant’s suspension.

136. Colleague A listed all the discrepancies in his witness statement prepared for these proceedings. However, despite signing a statement of truth and confirming at the beginning of his evidence that the statement was accurate he confirmed that he had not actually checked whether the discrepancies listed were accurate. He explained that he had not had access to his notes and that when he came to sign his statement this paragraph had been completed for him and he simply assumed it was true.

137. Therefore, the Panel found that it could not place any reliance on the information provided on this point by Colleague B. Instead, the Panel went back to the Prescription Only Medicines Record Book which had been contained in the bundle and had been annotated on 10 January 2017 when the stock check was undertaken.

138. When carrying out this reconciliation the Panel could not find any entries that corresponded with 14 October 2015 (see Particular 12(a)), however, it could see three entries dated 24 October 2015 when only one discrepancy was alleged on that date (see Particular 12(b)). Therefore, the Panel reached the conclusion that Particular 12(a) had not been proven.

139. The Panel was satisfied that there were the following discrepancies during the audit on 10 January 2017:
a. There were no GTN (Glyceryl Trinitrate) in the bag, but the Registrant had recorded that there was one on 24 October 2015;
b. There were no Diazemuls 10mg in the bag, but There were no Diazemuls 10mg in the bag, but the Registrant had recorded that there were eight on 24 October 2015 ;
c. There was one 100mg Hydrocortisone in the bag, but the Registrant had recorded there were two on 24 October 2015;
d. There were 15 300mg Aspirin in the bag, but the Registrant had recorded that there were 14 on 28 December 2015;
e. There were 26 Loratadine 10mg in the bag, but the Registrant had recorded that there were 28 on 7 May 2016;
f. There was no Oramorph suspension in the bag, but the Registrant had recorded that there was 100ml on 28 June 2016;
g. There were six Amiodarone ampoules in the bag, but the Registrant had recorded that there were two on 2 July 2016;
h. There were 12 ldratrodium 20mg in the bag, but the Registrant had recorded that there were 14 on 21 August 2016; and,
i. There were two ibuprofen 400mg in the bag, but the Registrant had recorded that there were six on 10 September 2016.

140. Accordingly, the Panel found Particulars 12(b) – 12(h) proven on the balance of probabilities.

Particular 13 – Found Proved
You did not undertake and/or record a monthly audit of your medicine pack
141. The Panel during its review of the Registrant’s Prescription Only Medicines Record Book could see that monthly audits had not been documented. Therefore, on balance of probabilities they had not been carried out.

Particular 14 – Found Proved
You did not ensure that the medicine and/or equipment contained in your medicine pack was in date.
142. The Panel was shown a document called “Current stock list for all ALS response bags” which had been annotated. Colleague B explained that where it had been annotated with OOD this meant that the equipment was out of date.

143. Colleague B further explained that all sterile medical equipment has a use by date recorded on its packaging by the manufacturer. This is because the item is sealed in a sterile environment, and it can only be guaranteed as sterile until this date and providing that the packaging is intact. When a piece of equipment goes out of date it should be handed in at SJA HQ and a replacement sought.

144. Colleague B explained some out of date equipment could have caused harm to the patient. For example, the Bone Injection Gun (hereinafter “BIG”) used when the Paramedic cannot get a cannula into a vein to administer a drug. If the device is out of date, it could not have been guaranteed to be sterile, and so could have introduced an infection directly into the patient's bone which in a worst case scenario could have led to a limb threatening situation due to Osteomyelitis.

145. The Panel was satisfied that the following items were out of date:
a. Endotracheal tube (adult 7mm);
b. Endotracheal tube (adult 5mm);
c. Laryngoscope (MAC 4);
d. I-gel supraglottic airway (size 4.0);
e. Big valve Mask (Adult 1600ml);
f. Bag valve mask (Paed 550ml);
g. Bone injection gun (adult); and,
h. Sphygmomanometer.

146. A number of items had both OOD and a tick overlayed. In these circumstances the Panel could not be satisfied that the equipment was out of date.

147. The Panel found this particular proved on the balance of probabilities.

Particular 15 in relation to sexual motivation
148. The Panel applied the test in Basson v GMC [2018] EWHC 505 (Admin) and Haris v GMC [2021] EWCA Civ 763.
149. The Panel found particulars 4(a) – 4(i) proved and therefore these are the matters they have taken into account as to whether the conduct was sexually motivated.

150. The Panel considered all the surrounding circumstances and the totality of the relationship that existed between the Registrant and Person A. The Panel noted that the best evidence of the Registrant’s motivation was his behaviour. The Panel has already reached the conclusion that Person A gave credible and reliable evidence whilst the Registrant’s account was inherently implausible.

151. The Panel had significant concerns about the manner in which the Registrant had initiated and then prolonged his relationship with Person A. The Panel concluded that the Registrant’s behaviour on 9 December 2016 was overtly sexual in nature due to the fact that it included touching of sexual organs. The Panel found that there was no clinical justification for the Registrant’s attendance at Person A’s home nor performance of an ECG. Attending and treating Person A was not part of the Registrant’s role as a Falls Paramedic.

152. No plausible innocent explanation for the conduct was offered by the Registrant. The Registrant suggested during both the police investigation and local investigation interview that whilst the behaviour was sexual it was instigated by Person A and he was the victim. The Panel having already rejected this explanation on the balance of probabilities, therefore went on to conclude that the Registrant’s behaviour was sexually motivated.

Particular 16 in relation to dishonesty
153. When determining whether the Registrant’s behaviour was dishonest the Panel took into account the test in Ivey v Genting Casinos (UK) Ltd [2017] UKSC 6. The Panel asked itself two questions, firstly, what did the Registrant know or believe as to the facts and circumstances in which the alleged dishonesty arose? Secondly, in the context of the Registrant’s knowledge and belief of the circumstances they were in, was the Registrant’s conduct dishonest by the standards of an “ordinary decent person”?

Particular 6 in relation to dishonesty
154. The Panel considered the circumstances in which this conduct arose. The Registrant was being investigated for potentially very serious allegations. The Registrant was aware of the gravity of the situation and also aware of the inferences that could be drawn had he not completed a PRF form. The Registrant has not attended the hearing to answer questions but the only alternative explanation he could advance was that he was mistaken. The Panel formed the view that there were good reasons why the Registrant would want to mislead his colleagues into thinking that he had tried to submit a PRF at the time. Even taking into account the Registrant’s otherwise good character the Panel did not think that it was plausible that this could have been a mistake. The Panel reached the conclusion that in light of this the Registrant’s behaviour would be seen as dishonest by the standards of an ordinary decent person and that he had misled his employers over a key piece of information.

155. Therefore, the Panel has reached the conclusion that the Registrant was dishonest.

Particular 10 in relation to dishonesty
156. The Panel took into account the Registrant’s explanation for the alternation on the Controlled Drugs Record he said that he had forgotten and that he had simply recorded the change over the top.

157. This is not a case where it has been suggested that the drug was not given to the Patient at the time it is merely a recording error. The Panel took the view that the Registrant’s account was plausible. There was limited space on the form for this explanation to be recorded. The Panel could not determine what motivation the Registrant would have to behave dishonestly in this regard. There was nothing that the Registrant was covering up as it was not said that the drugs were not administered.

158. Therefore, it reached the conclusion that by the standards of an ordinary decent person this behaviour was not dishonest rather it was a lapse in the Registrants recording practices.

Particular 12 in relation to dishonesty
159. The Panel considered particular 12 which related to the discrepancies in the mis-recording of drugs. The Panel took into account that there was both under reporting and over reporting of the drugs in question. The Panel considered the Registrant’s account and did not find that he thought at the time that anything he was doing was dishonest. The Registrant said when interviewed that he had probably miscounted, that some of the drugs may have been out of date, that the drugs had been given to a patient and not recorded. The Panel considered what view an ordinary and decent person would take. As a Paramedic the Registrant was responsible for a large number of drugs. In absolute terms the missing amounts over a period of over 12 months were small in nature and objectively did not demonstrate a pattern of deceptive conduct. The Panel noted that the Registrant had willingly handed over his drug pack. The Panel considered that no one could possibly think that the under recording of one aspirin was dishonest. Aspirin is a drug that is readily available to purchase, the Panel took the view that an ordinary decent person would accept that this is a simple error. Similarly, the Panel came to the view that the under reporting of 4 ibuprofen, a readily available drug, would not have been viewed to be dishonest.

160. The only matter that gave the Panel some hesitation was the missing 100ml of Oramorph which is an opiate and the Registrant explained that he had given it to a patient but failed to record the PRF number.

161. The Panel determined that in the context of the Registrant’s knowledge and belief of the circumstances his conduct was not dishonest by the standards of an ordinary decent person. The discrepancies are explicable as recording errors and carelessness. There is no evidence to suggest that there was any dishonest motivation behind the Registrant’s conduct.

Decision on Grounds
162. The HCPC submitted that the Registrant’s conduct was such that the Panel could be satisfied that the statutory grounds of lack of competence/and or misconduct are made out on the particulars found proven.

163. The Panel accepted the advice given by the Legal Assessor. The Panel also took note of the cases of Holton and Calhaem. The Panel considered the definition of misconduct as given in Roylance v GMC (No 2) [1999] UKPC 16.
65. ‘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.’

164. The Panel considered that the HCPC must show that the Registrant’s care fell below the standard of a reasonably competent practitioner of the Registrant’s experience. It noted that a lack of competence is conceptually separate from both negligence and misconduct. It denotes a standard of professional performance which is unacceptably low, and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the practitioner’s work. The Panel recognised that a single instance of negligent treatment, unless very serious indeed, would be unlikely to constitute lack of competence.

165. In reaching its decision on the statutory grounds, the Panel had in mind the HCPC Standards of Conduct, Performance and Ethics (2016) and concluded that the following standards were engaged and had been breached:
1.7 You must keep your relationships with service users and carers professional.
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.
10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services.

166. The Panel also took into account the Standards of Proficiency for Paramedics and considered the following had not been met:
2.1 understand the need to act in the best interests of service users at all times
2.4 recognise that relationships with service users should be based on mutual respect and trust, and be able to maintain high standards of care even in situations of personal incompatibility
10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines
10.2 recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines

167. In relation to particular 1 the Panel found that this was not a lack of competence. The Registrant knew what was expected of him in terms of completing a PRF. The Panel concluded that this was where the Registrant began to blur the professional boundaries and he chose not to make a record of Person A’s care when he had full knowledge of his professional obligations. Therefore, the Panel concluded that this amounted to misconduct.

168. In relation to particulars 3, 4, 5 and 15 the Panel considered the Registrant’s conduct and, in relation to Person A, this represented an egregious breach of trust. The Panel accepted Person A’s evidence that she respected the Registrant’s profession and was pleased he was helping her with a troubling health issue. The Panel has also accepted that Person A was naïve and lacking in the life skills for someone of her age and clearly trusted the Registrant as a healthcare professional. Whilst the Panel is not satisfied that Person A was targeted for this reason it aided the Registrant in inveigling himself into her life. The Panel concluded that the Registrant’s behaviour was both deliberate and predatory in relation to the assault and demonstrated a serious abuse of his position. The frequency, nature, and intensity of his contact with Person A over such a short period of time, culminating in a sexual assault carried out in her own home under the guise of providing medical treatment can only be seen as deplorable and reprehensible behaviour falling far short of what would be expected from a registered Paramedic. Accordingly, the Panel concluded that this amounted to misconduct.

169. In relation to particulars 6 and 16 for the reasons highlighted above the Panel determined that the Registrant had dishonestly sought to mislead his employer as to the provision of the PRF. The Panel was also satisfied that the Registrant was fully aware of the misleading impression he had planned to create. The Panel was satisfied that this behaviour fell well short of the rules and standards required to be followed by a Paramedic such that it amounted to misconduct.

170. In relation to particular 9 the Panel considered that this related to a Controlled Drug and there was mis-accounting. The Panel took into account the fact that the restrictions are so stringent because of the consequences of misusing the drug. The Panel concluded that recording the use of drugs was integral to a Paramedics practice. There was no suggestion that the Registrant did not know what he was supposed to do, therefore, the only conclusion the Panel could reach was that this was misconduct.

171. In relation to particulars 10 and 11 the Panel took the view that this conduct was not at the same level as the other mis-recording. The Panel determined that there was a lack of clarity in the forms provided which was accepted by Colleague B. In relation to the PRF the Panel took the view that this was sloppy recording as the total amount of the drugs administered was contained on the form and the fact that the Patient went to hospital was recorded. Whilst the Panel found that the Registrant was careless this conduct did not fall so far short of what was expected of a Paramedic that it amounted to misconduct. As this was a limited occasion neither was the Panel satisfied that it amounted to a lack of competence.

172. In relation to particular 12 the Panel considered the concerns around the Registrant’s record keeping. The Panel heard and accepted that the Registrant was an experienced Paramedic having spent significant time in the NHS. No concerns were ever expressed about his competence. However, the Registrant was responsible for keeping proper records of the drugs he held. These were errors that had been maintained over a long period of time. There was no suggestion that the Registrant did not know what was required of him nor that he was unable to keep such records. Therefore, the Panel found that this amounted to misconduct.

173. In relation to particulars 13, whilst the Panel found this factual particular proven it was not satisfied that it had been demonstrated on the balance of probabilities that the Respondent was expected to carry out these audits nor that he knew of the expectation to carry out audits of this frequency. The Panel would have expected to see documents from the Registrant’s induction to evidence that he had been given this information. Therefore, this did not amount to misconduct or lack of competence.

174. In relation to particular 14, the HCPC did not provide evidence to demonstrate that the Registrant knew of the requirement to keep the equipment up to date. In these circumstances the Panel concluded that this failure did not amount to a lack of competence or misconduct.

175. Therefore, the Panel determined that the Registrant had fallen well short of the standard expected of him to the extent that the failings were so serious they could be considered deplorable. For these reasons the Panel found that the failings went beyond lack of competence. The Panel was satisfied that his conduct and standards fell well short of the rules and standards ordinarily required to be followed by a Paramedic such that the matters set out above individually and collectively amounted to misconduct.

176. Therefore, particular 17 is found proven.

Decision on Impairment
177. Having determined that the Registrant's actions amounted to misconduct in respect of the facts found proved, the Panel went on to consider whether his fitness to practise was currently impaired as a consequence of that misconduct.

178. The Panel heard submissions from Miss Lykourgou on behalf of the HCPC and considered her written submissions. Miss Lykourgou submitted that the Registrant was impaired on both the personal and public component. She invited the Panel to consider questions outlined in the case of Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council and Grant [2011] EWHC 927 (Admin).

179. The Panel heard and accepted the advice of the Legal Assessor. It had regard to the HCPC's Practice Note on impairment, and in particular the two aspects of impairment, namely the ‘personal component’ and the ‘public component’, based on the case of Cohen v GMC [2008] EWHC 581 (Admin). The Panel understood that what has to be determined is current impairment, that is looking forward from today.

180. The Panel also had regard to the criteria that were set out by Dame Janet Smith in the Fifth Shipman Report, namely whether the findings of fact in respect of the Registrant’s misconduct show that his fitness to practise is impaired in the sense that he has put service users at risk, or is liable to do so in the future, whether he has brought his profession into disrepute or may do so in the future, and whether he has breached the fundamental tenets of his profession or may do so in the future.

181. The Panel firstly considered whether the Registrant’s misconduct was capable of remediation. The Panel has identified failings of the most egregious and serious nature in relation to the Registrant’s conduct and professional behaviour. The Panel formed the view that the Registrant’s actions in relation to the serious sexual assault and dishonesty are not easily remediable. The Panel viewed the attempts by the Registrant to deceive his employer in the middle of an investigation as serious misconduct. The Panel considered that the Registrant’s clinical failings were potentially remediable. However, the Panel saw no evidence during the local investigation interview that the Registrant has made any attempt to reflect upon his behaviour, his clinical errors or accept any culpability for his actions. Instead, he offered very limited and unsatisfactory responses as to why the deficiencies in his clinical practice had occurred. The Registrant’s conduct was devoid of any attempt to act with honesty, decency, and integrity.

182. The Panel next considered whether the Registrant had taken remedial action to address his misconduct. As the Registrant was not in attendance no further evidence was submitted on his behalf. This meant that the Panel only had the Registrant’s accounts provided during the police and local investigations. The Panel did take account of the fact that the Registrant had no other professional proceedings during the course of his career.

183. The Panel has no evidence of insight or personal reflection from the Registrant nor any evidence of any remedial action that may have been undertaken. The Panel has read Person A’s victim impact statement and notes the serious physical, emotional and psychological harm that the Registrant’s actions have caused. The Panel has found that the Registrant sought to minimise his failings and there is no indication that the Registrant has developed insight into the effect of his actions on Person A or other professionals.

184. In the absence of any evidence of insight or remediation, the Panel concluded that there remained a high risk of repetition, which in turn exposed patients to a risk of harm.

185. In all the circumstances, the Panel concluded that the Registrant’s fitness to practise is currently impaired in respect of the personal component.

186. The Panel noted that the sexual assault had taken place whilst he was in uniform and on duty or purporting to be on duty. He had invaded the privacy of Person A by attending her place of work, her GP, and her home. He used his role to cultivate a relationship and manufacture an opportunity to carry out a sexual assault. The Panel therefore concluded that the Registrant’s fitness to practise as a Paramedic was at the time, and remained, impaired on public protection grounds.

187. The Panel went on to consider whether this was the type of case that required a finding of impairment on public interest grounds in order to maintain public confidence in the profession and the Regulator and to uphold professional standards. The Panel found that these were the most serious of allegations. The Panel was satisfied that a fully informed member of the public, who was aware of all the background to this case, would have their confidence in the profession and the Regulator undermined if a finding of impairment were not made. The Panel considered that a member of the public would be extremely concerned if the Regulator took no action in a case where a Paramedic had initiated and sought to develop a relationship with a patient for sexual purposes, which culminated in a sexual assault and attempted to deceive his employer during their investigation into it. The Registrant had breached some of the fundamental tenets of the profession and therefore not to make such a finding would be wholly inconsistent with the gravity of the offences. There was clearly a need to send out the message to the profession that this sort of behaviour is wholly unacceptable and not to be tolerated.

188. Accordingly, the Panel concluded that the Registrant’s fitness to practise is currently impaired in respect of the public component.

189. In all the circumstances, the Panel concluded that the Registrant’s fitness to practise is currently impaired on the personal as well as the public protection and public interest grounds and that the allegation of impairment is well founded.

Decision on Sanction
Submissions
190. Miss Lykourgou for the HCPC reminded the Panel of the relevant principles regarding the imposition of a sanction but, as is the HCPC’s usual approach at the sanction stage, did not advance any particular sanction. Miss Lykourgou submitted that the Panel should consider the following to be aggravating factors of the Registrant’s misconduct:
a. breach of trust – including the use of his paramedic status to obtain Person A’s contact details, to contact her and try to meet with her ostensibly to speak to her about her health, and to touch her- ostensibly on the basis he was conducting a medical examination;
b. attending Person A’s GP surgery when he was meant to be on duty;
c. the invasion of Person A’s privacy when he attended her GP surgery ;
d. that the sexual assault happened at Person A’s home when she was isolated and alone;
e. that the sexual assault involved the touching of Person A’s naked breasts and genitalia;
f. that the sexual assault involved penetration;
g. that the Registrant breached patient record management protocols in respect of Person A and Person C;
h. that the Registrant extensively breached drugs management protocols in respect of his drugs bag.

Decision
191. In reaching its decision, the Panel has considered with care the submissions of Miss Lykourgou and has taken the HCPC’s Sanctions Policy into account. It has received and accepted legal advice.

192. The Panel has considered mitigating and aggravating factors. The Panel first looked at the mitigating factors. The Panel considers the fact that there are no previous disciplinary proceedings against the Registrant to be the sole mitigating factor.

193. The Panel considered the list of aggravating factors referred to by Miss Lykourgou in her submissions and finds the following to be aggravating factors:
• the Registrant’s breach of trust in relation to his use of his professional position as a paramedic to obtain confidential information such as Person A’s contact details, which he then used to contact her, and to meet with her on the pretext of speaking to her about her health, and to touch her, again on the pretext that he was conducting a medical examination;

• the Registrant’s attendance at Person A’s GP surgery when he was meant to be on duty which involved an invasion of Person A’s privacy;

• that predatory nature of the Registrant’s sexual assault on Person A’s which took place in her home when she was isolated and alone and particularly vulnerable due to her naivety and lack of life skills;

• that the sexual assault was without Person A’s consent and involved touching her naked breasts and genitalia and involved penetration;

• that the Registrant’s misconduct towards Person A has harmed her both psychologically and physically;

• that the Registrant sought to blame Person A by asserting that she had instigated contact and had consented to the sexual conduct and cast himself in the role of “victim”.

• that the Registrant breached patient record management protocols in respect of Person A;

• that the Registrant extensively breached drugs management protocols in respect of his drugs bag;

• that the Registrant lacks insight, has shown no remorse, and has not apologised for his misconduct or taken any steps to remedy it which led the Panel to conclude that there is a high risk of repetition in this case.

194. In finding the Registrant’s sexual misconduct to be an aggravating factor, the Panel has had in mind paragraphs 71 and 72 of the HCPC Sanctions Policy which state:
“71. A registrant’s behaviour should be considered predatory where they are seen to take advantage of others, motivated by a desire to establish a sexual or otherwise inappropriate relationship with a service user or carer. The Panel should take predatory behaviour particularly seriously, as there will often be a significant risk to the targeted service user or carer.

72. Predatory behaviour might include attempts to contact service users or carers using information accessed through confidential records (for example visiting a service user’s home address without authority or good reason to do so) …..Any evidence of predatory behaviour is likely to lead to more serious sanctions.”

195. In finding the Registrant’s dishonest account to the local investigation to be an aggravating factor, it has had in mind the following paragraphs from the HCPC Sanctions Policy:
“57 Dishonesty, both in and outside the workplace, can have a significant impact on the trust placed in those who have been dishonest… It is likely to lead to more serious sanctions”
58 Given the seriousness of dishonesty, cases are likely to result in more serious sanctions. However, panels should bear in mind that there are different forms, and different degrees, of dishonesty, that need to be considered in an appropriately nuanced way. Factors that panels should take into account in this regard include:
• whether the relevant behaviour took the form of a single act, or occurred on multiple occasions;
• the duration of the dishonesty;
• whether the registrant took a passive or active role in it;
• any early admission of dishonesty on the registrant’s behalf; and
• any other relevant mitigating factors”.

196. The Panel has concluded that the Registrant was actively dishonest when he chose to deliberately mislead the local investigation into Person A’s complaint about him. The Panel notes that the dishonest conduct was motivated by the potential for personal gain in that the Registrant advanced a dishonest account in an attempt to escape the consequences of his sexually motivated conduct.

197. The Panel has considered the available sanctions in ascending order of seriousness. The case is not one which would be amenable to mediation. The Panel has decided that to take no action or to impose a Caution Order in this case would not be appropriate or proportionate, given the nature and gravity of the misconduct concerned, which involved a serious sexual assault on a vulnerable individual, who the Registrant then sought to blame when the matter was under investigation by his employers. The findings of misconduct in this case could not be described as isolated or limited, and the Panel is wholly satisfied that the misconduct could not be described as being “relatively minor in nature”. The Panel has found that there is a lack of insight in this case and a high risk of repetition. In these circumstances, the Panel considers that to protect the public from that risk and to ensure public confidence in the profession is not undermined, it must consider a more severe sanction.

198. The Panel has considered a Conditions of Practice Order. The Panel notes that the Registrant has not engaged with the regulatory process since some time in 2021. The Panel has no information as to the Registrant’s current circumstances and has seen no evidence of any Continuing Professional Development (CPD) which the Registrant has undertaken to maintain his skills and the knowledge necessary for a Paramedic. The Panel notes that in his contact with the HCPC in 2021, the Registrant indicated that he wished to retire as a Paramedic. The Panel notes that whilst this might have been the Registrant’s intention at that time, he could have changed his mind about retiring in the meantime. The Panel has concluded that because of the Registrant’s lack of engagement with these proceedings, it has no confidence that were it to impose a Conditions of Practice Order, the Registrant would comply with it.

199. The Panel has also concluded that it cannot formulate any conditions of practice which would be appropriate, workable, and measurable, and which would address the issues relating to the Registrant’s sexual misconduct or his dishonesty in this case. It is firmly of the view, given the nature and gravity of the misconduct, that even if it had been able to formulate such conditions of practice, these would not be sufficient or appropriate to protect the public and public confidence in the Paramedic profession, or in its regulatory body. Nor would a Conditions of Practice Order send out an appropriate message to the Paramedic profession that misconduct such as the Registrant’s, will not be tolerated.

200. The Panel next considered whether to impose a Suspension Order. It has had in mind the following guidance from the HCPC’s Sanctions Policy:
“121 A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. 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 their failings.”

201. The Panel has found the misconduct in this case to be serious. The Panel has already stated that it considers that the more serious aspects of the misconduct, namely the sexual misconduct and the Registrant’s dishonesty are not easily remediable. The Panel accepts that if the misconduct had been limited to the clinical concerns, that they are potentially remediable. However, the Panel notes that there is no evidence (i) that the Registrant has taken any steps to remedy any aspects of his misconduct, (ii) that he has developed any insight at all into his misconduct, or reflected properly upon it, and (iii) that he has either apologised or expressed any genuine remorse for it. The Panel has found that there is a high risk that the Registrant will repeat his misconduct. The Panel has therefore decided that a Suspension Order is not the appropriate proportionate sanction in this case.

202. The Panel has therefore concluded that the only appropriate and proportionate sanction is an order striking the Registrant off the Register. In reaching its conclusion, the Panel has had regard to paragraphs 130 and 131 of the Sanctions Policy:
“130 Striking off is a sanction of last resort for serious, persistent or reckless acts involving: (there then follows a non- exhaustive list which includes):
• Dishonesty
• Abuse of professional position including vulnerability
• Sexual misconduct.

131 A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant:
• lacks insight;
• continues to repeat the misconduct or, where (n/a); or
• is unwilling to resolve matters.
203. The Panel is satisfied, based on the Registrant’s lack of insight and the nature and gravity of the allegation, involving as it does a serious sexual assault on Person A who was vulnerable and who has suffered harm as a result, and dishonesty in an attempt to escape the consequences of his actions, that to ensure the public’s confidence in the Paramedic profession and in its regulatory process that the Registrant’s name should be struck from the Register. The Panel also decided that in order to uphold proper standards of conduct in the profession, it is appropriate and proportionate to order that the Registrant’s name be struck off the register.

That the Registrar is directed to strike the name of Mr James A Bramwell from the Register on the date that this order comes into effect.

 

Right of Appeal
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Interim Order
The Panel has considered whether to make an Interim Order in this case under Article 31(2) of the Health and Social Work Professions Order 2001. It is satisfied that the Registrant has been given proper notice of this application in the emails dated 20 April 2022 and 26 April 2022 when notice of this hearing was sent to him. It is also satisfied that the Registrant has had the opportunity to make representations regarding an interim order for this hearing which he has chosen not to do.

The Panel has decided that because of the serious nature of the findings in this case in relation to the Registrant’s sexual and dishonest misconduct, an Interim Suspension Order is necessary as it considers that the Registrant represents a serious and on-going risk to members of the public. The Panel notes that were the Registrant to seek employment as a Paramedic, despite his stated intention in 2021 that he wished to retire, his practice would be unrestricted if an Interim Suspension Order was not in place before the Order comes into effect or any appeal is concluded. It is also satisfied that it is otherwise in the public interest as it would seriously undermine public confidence in this regulatory process if the Registrant was permitted to be in unrestricted practice before the Order comes into effect or any appeal is concluded. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for James A Bramwell

Date	Panel	Hearing type	Outcomes / Status
23/05/2022	Conduct and Competence Committee	Final Hearing	Struck off