Mr Paul D Charlton

Preliminary Matters
Service
1. The Panel noted that there was no attendance by the Registrant or by any representative on his behalf. However, it was satisfied that fair, proper and reasonable notice of today’s hearing had been served on the Registrant. It noted that the notice of hearing, specifying today’s date, 28 November 2022, had been sent to the Registrant at his registered email address with the HCPC on 14 September 2022. Later that day, the HCPC received notification from Microsoft Outlook that “delivery” of the email was “complete”. The Panel accepted the Legal Assessor’s advice that it could conclude that service had been effected in accordance with the Rules.

Proceeding in Private
2. Mr Keating, on behalf of the HCPC, made an application that this hearing should be heard either wholly or partly in private under Rule 10(1)(a) of the Health Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules), which provides that “proceedings shall be held in public unless the Committee is satisfied that, in the interests of justice or for the protection of the private life of the health professional … the public should be excluded from all or part of the hearing”. He submitted that there would be references to the Registrant’s health which formed part of the Registrant’s private life.

3. The Panel heard and accepted the advice of the Legal Assessor who referred the Panel to the HCPTS’ Practice Note entitled “Conducting Hearings in Private” and decided that it would conduct the hearing in public (as was usual) except when reference was made to the Registrant’s health, in order to protect his private life.

Proceeding in absence
4. Mr Keating then applied to proceed in the Registrant’s absence. To assist him in this, he called as a witness TB, another Paramedic who was a colleague and friend of the Registrant’s, who had assisted the HCPC as a “go-between” to enable it to communicate with the Registrant from about December 2021. Initially, the communication with the Registrant had been with regard to the Registrant voluntarily removing himself from the register for health reasons. TB had received documentation about the proposed voluntary removal from the HCPC and had delivered it to the Registrant. Latterly, in August 2022, he had agreed to receive a copy of this current hearing’s bundle from the HCPC and to deliver it to the Registrant.

5. TB gave evidence under oath. He stated that he had known the Registrant for 20 years as they had qualified as Paramedics together. He had also acted as the Registrant’s Unison representative – they were colleagues, both in and out of work. He confirmed that: he had been a “conduit” between the Registrant and the HCPC; he had delivered the hearing bundle that the HCPC had sent him in August to the Registrant and had sat with him while he read it (and the Panel noted his email to the Kingsley Napley of 19 August 2022 confirming that this had occurred on 18 August 2022); the Registrant was “very aware” of the hearing and was “more than happy for me to speak on his behalf”; and he was aware that he might be struck off.

6. TB went on to say that the Registrant had not attended the hearing because he was in “extremely poor health”. Furthermore, he did not have access to any Wi-Fi and had great difficulty using his mobile phone for internet purposes. In his opinion, the Registrant would not currently be able to attend a hearing. TB did not think that the Registrant would be fit to attend a hearing for at least one or two years. Having said that, TB said that if, due to an improvement in his health, it was possible that the Registrant could physically attend a hearing, he would do so, but he had told TB that he would never return to work as a Paramedic because of his health. He had attempted rehabilitation but this had not been successful and since then his physical health had deteriorated.

7. TB confirmed that he did not know the reason why the Registrant had not signed the Voluntary Removal papers. He had taken the papers to him and the Registrant’s former partner had been aware of the situation, but TB did not know why he had not attended to them. He did observe, however, that when he last saw him the Registrant was surrounded by paperwork in relation to these proceedings and several other matters. As for the Registrant’s future intentions with regard to Voluntary Removal, he had wanted to go ahead with such an application since he knew that he “can never go back to being a paramedic”. He now just wanted to be removed from the register “as easily and as quickly as possible”.

8. Finally, TB confirmed that the Registrant knew that he had “made a big mistake”. As for his hopes for today’s hearing, he said that the Registrant: “expects to be removed from the register one way or another”; did not want to return to being a Paramedic (in respect of which career he was “very proud”) because of his health, and was “remorseful”.

9. Mr Keating made the following submissions. He reminded the Panel of TB’s evidence, namely that the Registrant had been handed the hearing bundle and had read it. In relation to any suggested deficiency in the Notice of Hearing (in that it did not specifically refer to the potential sanction of Striking Off) TB had confirmed that the Registrant was aware that it was a possible outcome to today’s proceedings. Furthermore, in the correspondence bundle (at page 7) there was a note of a telephone conversation between the Registrant and Kingsley Napley on 26 October 2021 in which the Registrant is recorded as stating that “he understood what he has done is wrong and believes he will be struck off anyway. He stated he didn’t want to put the HCPC in disrepute.” Finally, in the email dated 14 September 2022 (which sent the Notice of Hearing to the Registrant) and in the letter dated 18 August 2021 (advising the Registrant of the Investigating Committee’s decision that there was a case to answer) there was the following notification:

“If you do not attend, the Committee may proceed with the hearing in your absence as long as it considers that the HCPC has served you with proper notice of the hearing in accordance with the legislation. You do not have to attend the hearing but it is generally in your best interests to do so. The Committee may reach a decision which has serious consequences for you including restricting or removing your right to practise your profession (Mr Keating’s emphasis).”

10. Mr Keating therefore maintained that, even though there was no specific reference to the ability of the Panel to strike off the Registrant, he was fully aware that it was a possible outcome.

11. Mr Keating then drew the Panel’s attention to the HCPTS Practice Note on “Proceeding in the Absence of the Registrant” and went through the various factors that the Panel was required to consider in deciding whether to proceed in the Registrant’s absence.

12. In relation to the first two factors, namely (i) the general public interest and, in particular, the interest of any victims or witnesses that a hearing should take place within a reasonable time of the events to which it relates and (ii) the nature and circumstances of the registrant’s absence and, in particular, whether the behaviour may be deliberate and voluntary and thus a waiver of the right to appear, Mr Keating argued that the Registrant had now received and read the hearing bundle following extensive efforts to contact him, including through intermediaries. It was apparent that the Registrant was not a well man and TB’s evidence indicated that he was probably too unwell to attend. As to whether he was willing to attend, TB’s evidence suggested that he might wish to do so were he well enough, but that the Registrant also wanted a conclusion to these proceedings and that he did not wish to remain on the register. Taking everything in the round, Mr Keating suggested that the Registrant had waived his right to attend.

13. In relation to the next factor, namely whether an adjournment was likely to result in the Registrant attending the proceedings at a later date, Mr Keating argued that there was no reliable evidence before the Panel that there was any real likelihood of the Registrant attending the hearing if the matter were adjourned.

14. In relation to the next factor, namely the extent of the disadvantage to the Registrant in not being able to give evidence having regard to the nature of the case, Mr Keating reminded the Panel that this was a Conviction allegation which was not denied and in relation to which the Panel was entitled to take account of incontrovertible evidence, namely the Certification of Conviction. Whilst it was correct that there was no direct evidence from the Registrant of remediation, insight, remorse or apology, the Panel did have TB’s evidence as to the Registrant’s current thoughts so such disadvantage was mitigated.

15. In relation to the next factor, the likely length of any such adjournment, not only was there the issue of whether the Registrant would attend any adjourned hearing but also the suggestion by TB that he believed that it was unlikely that the Registrant would be able to do so for one or two years, which was not a reasonable time.

16. In relation to the next factors, namely whether the Registrant, despite being absent, wished to be represented at the hearing or had waived that right; and the extent to which any representative would be able to receive instructions from, and present the case on behalf of, the absent Registrant, the Panel was to take account of TB’s comments, which confirmed that he was there in a voluntary capacity only and which supported the fact that there was nothing to suggest that the Registrant wanted representation throughout the hearing.

17. In conclusion, Mr Keating maintained that it was apparent that the Registrant wanted to be removed from the register as soon as possible and that there was no application by him for an adjournment. Finally, the Panel was to take note of the Practice Note which stated that:

“Public protection through the effective regulation of registrants is the overriding objective against which all of the other factors have to be balanced. The fair, economical, expeditious and efficient disposal of allegations made against registrants is fundamental to that objective. Hearings should be adjourned only where there is a compelling reason to do so that overrides the key objective of public protection (Mr Keating’s emphasis).”

18. The Panel accepted the advice of the Legal Assessor, who also drew the Panel’s attention to the HCPTS Practice Note on “Proceeding in the Absence of the Registrant”. It noted that it has the power to do so under Rule 11 of the Rules if it is satisfied that all reasonable steps have been taken to serve the Notice of Hearing on the Registrant. The Panel must also consider all the circumstances of the case, balancing fairness to the Registrant with fairness to the HCPC and the interests of the public.

19. In relation to the possible inadequacy of the Notice of Hearing by the omission of the entitlement of a panel to strike off the Registrant, the Legal Assessor confirmed that there was no requirement in the HCPC’s procedure rules that such information was to be provided – the only requirements referred to were that the Notice of Hearing was to contain details as to the date, place and time of the hearing. The Legal Assessor confirmed that, especially since there had been other references in the documents presented to the Registrant to the Panel’s powers to strike off a registrant, together with the evidence that he was aware of such power (and expected it) the Panel was entitled to conclude that the Notice of Hearing was valid.

20. The Panel is aware that its discretion to proceed in absence is one which should be exercised with care and it accepted all the advice of the Legal Assessor, including that relating to the validity of the Notice of Hearing. It noted the guidance in the HCPTS Practice Note on Proceeding in the Absence of the Registrant, that the discretion whether to proceed must be exercised having regard to all the circumstances of which the Panel is aware with fairness to the Registrant being a prime consideration, but balanced with fairness to the HCPC and to the public interest.

21. The Panel decided to proceed in the Registrant’s absence as it is satisfied that it is fair and in the public interest to do so. In reaching this decision, the Panel noted that it has already satisfied itself that service of the notice of hearing has been effected in accordance with the Rules. The Panel took account of the fact that the events which were the basis for the allegation in Particular 1 were now over two years’ old, having occurred in June and July 2020, so it was in the public interest to proceed to ensure that matters were resolved in a timely manner. Moreover, in relation to the nature of the Registrant’s absence, it noted the evidence of TB (whom it found to be a credible witness) that he was currently incapable of attending any hearing and that it was unlikely that he would be in a position to do so for quite some time. The Panel noted that there was no medical report from a treating practitioner before the Panel which provided any detail or prognosis in relation to his current medical condition, only the evidence from TB which, essentially, amounted to what he had been told by the Registrant and himself observed. The Panel therefore questioned whether an adjournment would result in his attendance, or even if it could, whether such attendance would be within a reasonable time.

22. The Panel also noted that the Registrant had had some engagement with the HCPC and that he was aware of the potential outcomes. It was aware that there was a potential disadvantage in him not being able to present his case in person, but the Panel took account of the fact that TB (who had been the Registrant’s Unison representative) had been able to tell it what the Registrant wanted from these proceedings (namely that he wanted them resolved as easily and quickly as possible and that he did not wish to remain on the register) which argued against an adjournment. The Panel also noted that there was some reference to the Registrant’s thoughts about his actions in the papers before it.

23. The Panel also took account of the fact that, although the HCPC had attempted to resolve the matter earlier this year by liaising with the Registrant in an attempt to bring about a Voluntary Removal from the register including listing a hearing for that purpose on 11 July 2022, such an attempt had failed for reasons unknown - TB was unaware of any save that it seemed that the Registrant appeared to be overwhelmed by the significant amount of paperwork generated by these proceedings and by various other matters, due to his current situation. There was therefore no indication that, if the hearing was adjourned, the proposed Voluntary Removal would be achieved.

24. In particular, the Panel noted that: although the Notice of Hearing confirmed that the Registrant could make such an application, there had been no request for an adjournment by the Registrant or by TB on his behalf; the Registrant had indicated that he wished the case to be resolved swiftly; and that he expected a particular outcome. The Panel therefore found itself agreeing with Mr Keating that there was no compelling reason which overrode the key objective of public protection so as to justify adjourning this case.

25. The Panel therefore concluded that the Registrant has voluntarily chosen to absent himself. In these circumstances the Panel is satisfied that it is fair and appropriate to proceed in the Registrant’s absence.

Background
26. The Panel took account of the background in this matter. The Registrant was a Paramedic with South West Ambulance Service Trust (“the Trust”). He was employed by the Trust for 20 years. In late 2018 the Registrant was put under the Trust’s Internal Disciplinary Procedures due to his sickness and absence. The Registrant explained that he had been suffering with the health conditions outlined in Schedule A for a period of 3 years following a series of traumatic events related to both his professional and personal life.

27. On 25 June 2020 the Registrant was stopped by police and was found to be driving under the influence of alcohol. On 21 July 2020, the Registrant advised the HCPC of a “pending court case” against him. On 23 July 2020, at Truro Magistrates’ Court, the Registrant pleaded guilty to driving a motor vehicle after consuming so much alcohol that the proportion of it in his breath, namely 95 microgrammes of alcohol in 100 millilitres of breath, exceeded the prescribed limit. This reading was some 2½ times over the legal limit (which is 35 microgrammes of alcohol in 100 millilitres of breath).

28. In his further email to the HCPC dated 13 August 2020, the Registrant stated that:

“I had a drink and realised I had promised my parents, who are…both very unwell, fish and chips for tea. Without thinking and without rationale I got into the car and proceeded which is when I was stopped by the police. May I stress this is not an excuse but merely an explanation…I have suffered…for the last 3 years following a succession of traumatic events in work and social life. This has been addressed by the ambulance service and I have had a lot of support not only from the ambulance service but also occupational health, red poppy, the well being service... [My] [p]eriods of sickness are as follows - 05/11/2018 till 13/05/2019 and 05/10/2019 until present.”

29. During the Trust’s investigation, the Registrant is recorded as stating the following:

“In Mr Charlton’s [o]wn words he “forgot that he had promised his parents fish & chips” and drove to the fish and chip shop whilst under the influence of alcohol. His van’s insurance had expired…and he had not realized. A police car pulled Mr Charlton’s car over due to the insurance and found him to be 2.5x the legal limit of alcohol.”

Decision on Facts
30. In considering this case the Panel bore in mind that the burden of proving the facts rests upon the HCPC and that the standard of proof is the civil standard of the balance of probabilities. It has taken account of all the evidence presented to it, namely the written evidence from the HCPC, the oral evidence of TB, and the submissions of Mr Keating. It has accepted the advice of the Legal Assessor.

31. In particular, the Panel noted the advice of the Legal Assessor as follows:

“The HCPC’s Procedural Rules indicate, at Rule 10 (1) (d), that where a registrant has been convicted of a criminal offence, a certified copy of the certificate of conviction shall be admissible as proof of that conviction and of the findings of fact upon which it was based. You have that document before you so, consequently, you would be entitled to find Particular 1 proved on the evidence you have considered.”

32. The Panel also notes that the Registrant pleaded guilty to the charge in the Magistrates’ Court, and admitted committing the offence, both in his communications with the HCPC and to the Trust during the investigation. Accordingly, the Panel finds Particular 1 proved.

Decision on Grounds
33. The Panel once again took into consideration the submissions of Mr Keating and accepted the advice of the Legal Assessor, who stated that, generally, in assessing whether the Registrant’s actions satisfied the statutory ground of Conviction, the Panel had to be satisfied that the conviction was sufficiently serious to give rise to concerns about the Registrant’s Fitness to Practise since not all convictions would put his Fitness to Practise in jeopardy, such as very minor Road Traffic Act offences.

34. The Panel took account of the fact that the Conviction was for an offence of drink driving where the Registrant was some 2½ times over the legal limit, thereby potentially endangered the lives of others as well as himself (although the Registrant apparently attracted the attention of the police because of insurance issues). The Panel therefore had little hesitation in concluding that this Conviction was serious enough to engage the statutory ground of Conviction.

35. The Panel also agreed with the HCPC that the Registrant had breached the following Standards of conduct, performance and ethics as a Registrant with the HCPC, namely:
9 – Be honest and trustworthy
9.1 – You must make sure that your conduct justifies the public’s trust and confidence in you and your profession

Decision on Impairment
36. Having found the statutory ground of Conviction was made out, the Panel then moved on to consider the question of impairment. In reaching its decision on impairment, the Panel has again taken account of all the evidence before it, the submissions of Mr Keating and the advice of the Legal Assessor. It has also taken account of the HCPTS Practice Note “Fitness to Practise Impairment”.

37. The Panel is aware that, in determining whether fitness to practise is impaired, it must take account of a range of issues which, in essence, comprise two components, namely the ‘personal’ component (the current competence and behaviour of the individual Registrant) and the ‘public’ component (the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession). It appreciates that not every finding that the ground of Conviction has been made out will automatically result in a panel concluding that fitness to practice is impaired. Moreover, it cannot adopt a simplistic view and conclude that fitness to practise is not impaired simply on the basis that, since the allegation arose, a registrant has corrected matters or “learned his/her lesson”. Although the Panel’s task is not to punish past wrongdoings, it does need to take account of past acts or omissions in determining whether a Registrant’s present fitness to practise is impaired. In addition, when assessing the likelihood of a Registrant causing similar harm in the future, the Panel should take account of both the degree of harm, if any, caused by a registrant and that registrant’s culpability for that harm. Finally, the Panel is to consider whether a registrant has demonstrated insight into his attitude and failings.

38. The Panel noted the submissions of Mr Keating. In relation to the personal component, Mr Keating accepted that this was a “tragic” case. The Registrant had practised for 20 years as a Paramedic without blemish and otherwise had a career of extensive public service. However, his conviction and the other evidence before the Panel indicated that he was not able to practise safely. It was clear from the Trust report that the Registrant chose to drive whilst under the influence of alcohol.

39. Mr Keating accepted that the Registrant’s situation was remediable but it appeared that, although the Registrant had taken some remediable action, he had not successfully completed such and there was no evidence since the offence took place that he had undertaken any further specific treatment. Accordingly, Mr Keating submitted that there was still a very real risk of the Registrant repeating the “very dangerous” behaviour that resulted in his conviction.

40. As for the Registrant’s insight, Mr Keating accepted that his self-referral email did indicate some level of insight but there was no information before the Panel which demonstrated that, since his rehabilitation in June 2020, he had made any further attempts to deal with his health. Consequently, Mr Keating maintained that the Registrant’s insight was limited and that the Registrant was currently impaired in relation to the personal component.

41. In addition, Mr Keating argued that the Panel ought to find impairment on public interest grounds so as to declare and uphold proper standards of behaviour and maintain public confidence in the profession as well as send a message to fellow practitioners that such behaviour was unacceptable. Paramedics had to deal every day with the consequences of drink driving and accordingly there was a “very real risk of harm” to members of the public and to colleagues if the Registrant continued working without restriction. A finding of impairment in relation to the public component was therefore required.

The Panel’s decision
42. The Panel noted that there were some references in the evidence before it to the Registrant appreciating the seriousness of his offending. In his self-referral email to the HCPC he had accepted that there was no excuse for his actions. In the telephone call with Kingsley Napley on 26 October 2021 he had indicated that he was aware of the concept of bringing the HCPC into disrepute. He had also stated that: he knew that he would not ever be able to be a Paramedic again due to the physical side effects; although it “broke his heart” to admit it as he “loved his job”, he accepted that his actions involved some “very dodgy decisions”, one of them being drink driving; and he did not want “to make the HCPC look bad” but the situation was all his fault and it was “because of him” what had happened. Furthermore, TB had confirmed that the Registrant was “remorseful” and that he was aware that he had made “a big mistake”. The Panel also acknowledged that he had engaged, to some extent, with the HCPC (although his ongoing health issues probably played a part in limiting such engagement). Furthermore, it was apparent that the Registrant had made some attempts to address his health condition by referring himself, or by being referred, to a number of organisations (as set out in the extract from the Trust report above).

43. In relation to the personal component, the Panel agreed with Mr Keating that the Registrant could remediate but that his attempts to do so had ultimately not been successful. One of the difficulties faced by the Panel was the lack of any report from the Registrant’s treating medical practitioner so it did not have any information before it about his current medical conditions (other than what the Registrant told TB). The Panel was therefore unable properly to ascertain what recent steps, if any, the Registrant had taken to or to develop further insight sufficient to reassure the Panel that he now understood the significance of his offending. This, in turn, led the Panel to conclude that, in the absence of any real evidence of remediation or insight, there was a real risk that the Registrant would repeat his offending.

44. Consequently, the Panel was of the view that the Registrant had failed to demonstrate that he had developed any significant insight or had remediated his wrongdoing and that there was a real risk in him repeating his offending. Accordingly, the Panel concluded that the Registrant was currently impaired in respect of the personal component.

45. In relation to the public interest component, the Panel considered that the Registrant’s conviction was in any event sufficiently serious that the need to declare and uphold professional standards and maintain public confidence in the profession would be undermined if a finding of impairment were not made in these circumstances. As Mr Keating submitted, Paramedics daily have to deal with the consequences of drink driving and therefore have a responsibility to set an example. Committing such an offence therefore required a marker to be set down to remind the Registrant and other members of the profession that such behaviour is unacceptable. The Panel therefore concluded that a right-minded member of the public, with full knowledge of all of the circumstances, would be concerned if a finding of current impairment were not made.

46. The Panel therefore concluded that a finding of impairment on public interest grounds was also required.

Decision on Sanction
47. In reaching its decision on sanction the Panel took account of TB’s oral evidence together with the documentation before it; the submissions of Mr Keating; the Sanctions Policy (“SP”) document; and the advice of the Legal Assessor, which it accepted. The Panel was mindful that the purpose of sanctions is not to be punitive, although they may have that effect. It appreciated that the primary purpose of any sanction is to address public safety from the perspective of the risk which the registrant concerned may pose to those who use or need his services. It noted, however, that in reaching its decision, panels must also give appropriate weight to the wider public interest, which includes: the deterrent effect to other registrants; the reputation of the profession concerned; and public confidence in the regulatory process. In addition, the Panel noted that it must act proportionately, which requires it to strike a balance between the interests of the public and those of the Registrant.

48. The Panel reminded itself that it had found impairment of the Registrant’s fitness to practice on both personal and public interest components.

Submissions
49. Mr Keating stated that, although the Panel was dealing only with an appropriate sanction in relation to Particular 1 and thus the criminal conviction, it was to have in mind the Registrant’s health difficulties. These were relevant since they remained unresolved and therefore affected not only the risk of repetition of the Registrant’s offending but also the risk of harm to service users generally.

50. Mr Keating went through the various mitigating and aggravating factors that he identified were relevant in this case (which the Panel have set out below) and drew the Panel’s attention to various parts of the SP. In relation to the section on criminal convictions, he accepted that the examples provided in paragraphs 80 to 92 of the SP did not include offences of drink driving.

51. Mr Keating submitted that this was not a case where it was appropriate to Take No Action as it was too serious and not proportionate. Similarly, he argued that a Caution Order was not appropriate since the Registrant had not shown good insight and had not remediated his wrongdoing. As for a Conditions of Practice Order, he suggested that the issue here was whether the Registrant would be committed enough to abide by any conditions, especially as he had failed to resolve the concerns about his behaviour.

52. This left either a Suspension Order or a Striking Off Order. Mr Keating referred to paragraph 121 of the SP and maintained that the Registrant did not come within at least three of the factors which might justify the sanction of a Suspension Order, namely that: “a registrant has insight; the issues are unlikely to be repeated; and there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings”. However, Mr Keating argued that the Registrant could be said to come within the criteria for striking off, as contained in paragraph 131 of the SP, namely on the basis that he lacked insight and was unwilling to resolve matters.

53. Mr Keating reminded the Panel that it was to act proportionately, as required by paragraphs 20 to 22 of the SP. In relation to the failed Voluntary Removal, he maintained that the Registrant’s wish to be removed from the register should not “unduly sway” the Panel but it was something that could be taken into account.

Legal Assessor’s advice
54. The Legal Assessor confirmed that Mr Keating had accurately and fairly represented the legal requirements that the Panel had to pay heed to in considering sanction. He added that, when considering the issue of seriousness, the Panel, having decided that the conviction was serious enough to amount to the statutory ground of Conviction, still had to go on and place the Registrant’s offending within the wider range of criminality in deciding the overall seriousness of his case.

55. Furthermore, although the Panel could take into account the Registrant’s stated desire to be removed from the register “as easily and quickly as possible“, it was to guard against acting expediently.

Mitigating and Aggravating factors
56. The Panel took account of the various mitigating factors suggested by Mr Keating namely:
• The Registrant’s previous good character and long service (20 years) as a paramedic;
• His full and timely admissions in relation to the allegation against him;
• His comments in the email referring himself to the HCPC, which accepted that there was no excuse for his actions; and
• TB’s evidence regarding the Registrant’s current position and his health.

57. To these the Panel would add the following:
• The fact that the Registrant had at least attempted to address his problems, notwithstanding that those attempts were unsuccessful;
• The expressions of remorse and regret both to the HCPC and the Trust and also through TB.

58. The Panel also noted the following aggravating features suggested by Mr Keating:
• The lack of any significant insight and the lack of any remediation, which in turn led to an increased risk of repetition. The Panel noted that Mr Keating also suggested that there was a lack of remorse, but the Panel disagrees with that submission on the basis that there were (albeit limited) expressions of remorse and awareness (particularly in relation to the impact of his actions upon the HCPC);
• The potential for harm to service users due to the ongoing risks of the Registrant’s unresolved medical condition. The Registrant posed not just a risk to other road users but also to patients on the basis that there was a risk of them being treated by a Paramedic with a medical condition.

59. To these the Panel would add the following:
• The seriousness of the Registrant’s offending. The Panel appreciates that, on the face of it, a charge of drink driving which did not result in an accident may be placed in the lower half of the overall scale of offending. However, there were particularly aggravating features in this instance. In the first place, the Registrant’s actions were deliberate in that, having consumed (by his own admission, a full bottle of wine) he then chose to drive his car. Secondly, his reading was 2½ times over the limit, which is significant. Thirdly, although he felt that he could not let his parents down by not getting fish and chips for them, this did not amount to any significant or emergency reason for driving well over the limit. Finally, although it appears that he came to the attention of the police for reasons unconnected with his driving, the potential for the Registrant causing serious harm to other road users, and himself, was immense.
• The Panel also observed that there is no evidence before the Panel to suggest that the Registrant has specifically reflected upon the circumstances of his driving and the significant potential danger that he became to other road users.

Consideration of Sanction
60. The Panel first considered Taking No Action. However, given the nature and seriousness of the Registrant’s failings the Panel took the view that this was not a case that could be appropriately dealt with without a sanction. The Panel therefore went on to consider the various sanctions, beginning with the least onerous.
61. The Panel noted the sanction of Mediation but concluded that it was not appropriate since this case concerned matters which arose outside the scope of the Registrant’s employment. In any event, the Panel considered that the matter was too serious to be resolved in this way.

62. The Panel next considered a Caution Order. It took account of paragraphs 101 and 102, which state:

“101. A caution order is likely to be an appropriate sanction for cases in which:
• the issue is isolated, limited, or relatively minor in nature;
• there is a low risk of repetition;
• the registrant has shown good insight; and
• the registrant has undertaken appropriate remediation.

102. A caution order should be considered in cases where the nature of the allegations mean that meaningful practice restrictions cannot be imposed, but a suspension of practice order would be disproportionate. In these cases, panels should provide a clear explanation of why it has chosen a non-restrictive sanction, even though the panel may have found there to be a risk of repetition (albeit low).”

63. The Panel considered that none of these criteria applied to the Registrant. Accordingly, it considered that a Caution Order would be inappropriate and disproportionate to the seriousness of the Registrant’s offending.

64. The Panel considered whether it would be appropriate to impose the next most onerous sanction, that of a Conditions of Practice Order, and noted that this is appropriate where a failure or deficiency is capable of being remedied and where the Panel is satisfied that allowing the Registrant to remain in, or return to, practice, while subject to conditions, minimises the risk of future harm to service users. However, the Panel noted that the Registrant had expressly stated that he was unable to return to practice due to his health issues and essentially wanted to come off the register as soon as possible. On that basis the Panel concluded that the Registrant would fail to abide by any such conditions and therefore that it would not be possible to formulate any relevant, meaningful or workable conditions of practice.

65. The Panel therefore considered imposing the next most onerous sanction, that of an order of Suspension. It noted paragraph 121 of the SP:

“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; and
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings”.

66. The Panel considered each of these criteria in turn. It noted its previous observations that, although the Registrant’s offending would not ordinarily amount to the most serious, there were elements which raised significant concerns, particularly in relation to the deliberate nature of his offending.

67. In relation to insight, the Panel relies upon its previous conclusions, namely that there is no evidence before it of any significant insight into all aspects of the Registrant’s offending.
68. In relation to the likelihood of repetition, the Panel took account of the lack of evidence regarding remediation and therefore was led to the conclusion that there was a real risk of repetition of such offending.

69. Finally, the Panel noted that there was no significant evidence to suggest that the Registrant was able to resolve his failings. It appreciated that he had made attempts but these have not succeeded or he has not persisted with them. Also, the Registrant was offered the opportunity of resolving these proceedings by agreeing to a Voluntary Removal but, notwithstanding every effort by the HCPC and TB, he nonetheless did not manage to sign and return the necessary documents.

70. Accordingly, the Panel concluded that, as virtually none of the criteria to justify making a Suspension Order applied to the Registrant, a Suspension Order was not the appropriate or proportionate sanction in this case.

71. This left the sanction of a Striking Off Order. The Panel noted paragraphs 130 and 131 of the SP:

“130. A striking off order is a sanction of last resort for serious, persistent, deliberate or reckless acts involving (this list is not exhaustive):
• …criminal convictions for serious offences

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 a registrant has been suspended for two years continuously, fails to address a lack of competence; or
• is unwilling to resolve matters.”

72. Once again, the Panel considered each of these criteria in turn. It appreciated that the Registrant’s offending might not automatically be seen as the most serious but it was “deliberate” and/or “reckless”. Moreover, the Panel had found that the Registrant “lacks insight”. It is, of course, correct that he has not repeated his behaviour. As for his unwillingness to resolve matters, the Panel noted that he has made attempts to address his addiction but these have been unsuccessful. Accordingly, the Panel considered that, whilst it would not be fair to the Registrant to conclude that he was “unwilling” to resolve matters, it would be appropriate to say that he was “unable” to do so.

73. The Panel therefore considered that, although the Registrant’s case did not neatly fit into all the criteria to justify a Striking Off Order, in the circumstances of his case definitely not meeting the criteria of a Suspension Order, the Panel reached an initial conclusion, not without some regret, that a Striking Off Order was the only viable option open to it.

74. Notwithstanding this conclusion, the Panel went back and revisited the sanction of a Suspension Order on the basis that such would give the Registrant a “last chance” to resolve matters. It therefore considered whether making a Suspension Order for, say, a period of one year would be appropriate. If such an order was made, given the Registrant’s lack of insight and remediation, it would have to be reviewed so that the Registrant could demonstrate progress in these areas. However, on the evidence before it, the Panel had little or no confidence that the Registrant would engage positively, or at all, given that he has failed to respond to these current proceedings other than to indicate that he wants to be removed from the register as “easily and quickly as possible”. Accordingly, the Panel concluded that taking such a course of action would be fruitless and would most likely cause additional stress to the Registrant.

75. The Panel therefore was led to the conclusion that the most appropriate and proportionate sanction would be a Striking Off Order.

The Registrar is directed to strike the name of Mr Paul D Charlton from the Register on the date 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.

Application for Interim Order
1. Having determined to conclude this case by imposing a Striking Off Order on the Registrant, the Panel heard an application by Mr Keating for an Interim Suspension Order for 18 months (to cover any appeal period).

Application to proceed in absence
2. However, before asking the Panel to consider such an application Mr Keating once again applied to proceed in the Registrant’s absence. He submitted that, although the Notice of Hearing made it clear that if a Registrant did not attend the hearing a panel had powers not only to proceed in their absence but also to impose a sanction which could restrict their practice, paragraph 7 of the HCPTS’ Practice Note entitled “Interim Orders” required such an application to be made. Mr Keating indicated that he relied upon his previous submissions on the issue made the day before. The Panel indicated that it recalled those earlier submissions and that it did not require them to be repeated.

3. The Panel heard advice from the Legal Assessor who relied upon his previous advice on the issue. He reminded the Panel that the only changes in the situation since the last application were that the allegation had been found to be proved and the Panel had imposed the sanction of Striking Off. Accordingly, the Legal Assessor advised that the Panel would be entitled to find that there was now greater urgency in proceeding and therefore that it would be entitled to consider that it would be perverse not to come to the same decision.

4. The Panel considered the matter and concluded, for the reasons previously relied upon, that it was appropriate to proceed in the Registrant’s absence.

Application for Interim Suspension Order
5. Mr Keating submitted that such an order was necessary on both public protection and public interest grounds on the basis that the Panel had found that the Registrant was currently impaired due to his Conviction and had considered that he should be made subject to a Striking Off Order.

6. The Panel accepted the advice of the Legal Assessor, who referred it to paragraphs 133 to 135 of the SP, which state:

“What is an interim order?

133. If a panel imposes a conditions of practice order, suspension order, or striking off order, Article 31 of the Order provides the panel with the discretionary power to also impose an interim conditions of practice order or an interim suspension order. This will apply from the imposition of the substantive order, until the end of the appeal period, or where an appeal is made, the end of the appeal process.

When is an interim order appropriate?

134. The power to impose an interim order is discretionary, and so panels should not consider it to be an automatic outcome. The panel should carefully consider whether or not an interim order is necessary and should provide the parties with an opportunity to address the panel on whether an interim order is required.

135. An interim order is likely to be required in cases where:
• there is a serious and ongoing risk to service users or the public from the registrant’s lack of professional knowledge or skills, conduct, or unmanaged health problems; or
• the allegation is so serious that public confidence in the profession would be seriously harmed if the registrant was allowed to remain in unrestricted practice.”

Decision
7. The Panel also took account of the Practice Note on Interim Orders and first considered whether an interim order was necessary. It noted that the information before it indicated that the Registrant had not practised as a Paramedic for more than two years, mainly due to health issues. It reminded itself that it had found that the Registrant was currently impaired due to his Conviction and that there was a real risk of repetition of the Registrant’s offending due to his lack of insight, his lack of remediation and his continuing health condition. The Panel was therefore satisfied that there was a serious and on-going risk to service users or the public and that, for the same reasons, public confidence in the profession or the regulatory process would be seriously harmed if the Registrant was allowed to remain in unrestricted practice.

8. Having determined that an interim order was necessary, the Panel then considered the appropriate form of that order, beginning with the least restrictive. It first considered whether an Interim Conditions of Practice Order would be sufficient to protect the public, or meet the wider public interest. For the same reasons as given when deciding not to impose a substantive Conditions of Practice Order on the Registrant (which included the Panel’s concerns about his current willingness or ability to comply with such an order) the Panel decided that such an Interim Order would not be appropriate to manage the risks identified by the Panel and that it would be perverse to impose an order inconsistent with the substantive order of Striking Off.

9. The Panel therefore concluded that an Interim Suspension Order was the appropriate and proportionate order. It also determined that it should be for a period of 18 months since, if there was an appeal, the substantive order would not come into effect.

10. The Panel makes an Interim Suspension under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.

11. 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 Mr Paul D Charlton