Wesley Weathers

Preliminary Matters:

Potential conflict

1. At the outset of the hearing Dr Garratt, the registrant Panel Member, indicated that between 2009 and 2013 he worked with the HCPC’s expert witness, Dr K, at Coventry University. Dr K was a Principal Lecturer and Dr Garratt was a Senior Lecturer. Dr Garratt had not seen or had any contact with Dr K since 2013. Dr Garratt did not consider he was in any way biased one way or the other as a result but considered it appropriate to raise it with the parties.

2. Both Ms Nagesh and Ms Parker took instructions from their respective clients and thereafter asked a number of questions of Dr Garratt to establish the extent of the relationship. Dr Garratt explained that he worked in a small team of 5 or 6 and for some of the time shared an office with Dr K. He said he may have approached Dr K for academic advice, although he could not specifically remember having done so. He said that since 2013 he had not been in contact in any way with Dr K and that included any social media contact.

3. Having heard the answers given by Dr Garratt, Ms Nagesh said that she had some concerns about the appearance of bias, but she made no formal application as a consequence thereof. Ms Parker said that her client did not wish her to make any application for Dr Garratt to recuse himself.

4. Notwithstanding the absence of any application for Dr Garratt to recuse himself, the Panel retired to consider whether there might be a perception of bias and in doing so accepted the advice of the Legal Assessor, who referred the Panel to the case of Magill v. Porter [2001] UKHL 67.

5. Having given the matter careful consideration, the Panel was satisfied that not only was Dr Garratt not biased in an objective sense, but that on an objective view there would not be a perception of bias. Although for a time the two men had been work colleagues, their interaction was minimal and it was a long time ago, with no contact of any kind since 2013. The Panel thus decided there was no issue in Dr Garratt continuing to form part of the tribunal considering this case.

Application to amend the Allegation

6. Ms Nagesh made an application to amend part of the Allegation, to offer no evidence of one Particular and to remove the allegation that the matters alleged amounted to a lack of competence. Ms Nagesh said that, apart from the lack of competence issue, the other amendments had been notified to the Registrant as far back as 2020 and that there was no opposition to the proposals. She said that the applications arose as a result of the evidence obtained from the expert witness, Dr K, and were necessary to ensure the matters alleged more accurately reflected the evidence. Ms Nagesh said that the proposal to offer no evidence on 1(b)(ii) followed the application to amend 1(b)(i) and the removal of any reference to a cervical collar. Since 1(b(ii) had been predicated on the original wording of 1(b)(i), which made mention of a cervical collar, it followed that if the amendment to 1(b)(i) were allowed then there would be no basis upon which to proceed with 1(b)(ii).

7. Ms Nagesh applied to remove references to lack of competence on the basis that this was really a misconduct case and since it related to one patient on one occasion it could not be said to represent a fair sample of the Registrant’s work. It was not, therefore, a lack of competence case.

8. Ms Parker, on behalf of the Registrant, indicated that none of the proposed amendments or changes were opposed.

9. The Panel considered the applications with care and accepted the advice of the Legal Assessor. The Panel considered each proposal separately.

10. The first requested amendment was to Particular 1(a) to add the words “or ensure an appropriate assessment was conducted.” This was based on the fact that, as the lead clinician on the scene it was open to the Registrant to delegate the assessment, should he have chosen to do so. The Panel noted that it did accord with the evidence given by Dr K in his report. The Panel also noted that it was not opposed. In all the circumstances the Panel was satisfied the amendment would not lead to any injustice and decided to allow this amendment.

11. The second requested amendment was to Particular 1(b)(i) to change it from “did not apply a cervical collar” to “did not ensure the transfer of Patient A onto his back was properly planned and/or executed.” Ms Nagesh said that following the report from Dr K this allegation was no longer appropriate and that the changed wording more accurately reflected the alleged failures by the Registrant. The Panel noted the lack of any opposition to this proposed amendment and agreed that it was important that the matters alleged reflected the evidence. No injustice would result in allowing this amendment and accordingly the Panel agreed to it.

12. Having allowed the amendment to Particular 1(b)(i), it followed that the matter alleged at Particular 1(b)(ii) could no longer be sustained, since it was predicated upon there being a need to apply a cervical collar. The Panel therefore allowed the HCPC’s offer of no evidence on this Particular and was satisfied that in so doing it would not amount to the matter being under prosecuted.

13. Ms Nagesh’s final application was to remove the allegation that the Registrant’s conduct as alleged in Particular 1 constituted a lack of competence (as an alternative to misconduct). Ms Nagesh said that the HCPC put its case on the basis of the failures amounting to misconduct and that it would be wrong to argue a lack of competence in a case involving one patient on one occasion. The Panel accepted that this did not represent a fair sample of the Registrant’s work and that this was not, therefore, a lack of competence case. Accordingly, the Panel allowed the application to remove the allegation of lack of competence.

14. Following the amendments the matters alleged were put to the Registrant and Ms Parker, on his behalf, indicated that Particulars 1(a), 1(c)(i), 1(c)(ii), 1(d) and 1(e) were admitted. Particulars 1(b)(i) and 1(b)(iii) were denied.

Background:

15. The Registrant is a registered paramedic with the HCPC. At the relevant time he was employed by the East Midlands Ambulance Service NHS Trust (the Trust), having started on 5 September 2016. At the time of the matters alleged, he was a Band 6 paramedic, having been conditionally progressed to that rank on 18 January 2018.

16. At 22:50 on 30 November 2018, the Trust was requested to attend an address in Belgrave, Leicester.

17. At 22:59 a double crewed ambulance (DCA1) arrived on the scene of the incident. The crew consisted of two Emergency Medical Technicians (EMTs), JM and DF.

18. At the scene they found Patient A, a 76 year old male, lying on his front on the floor at the bottom of a flight of stairs. The family of the male said that they had heard him fall and that he had fallen down the stairs.

19. As a result, the EMTs made a red request for paramedic backup at 23:11. A red request is the highest priority request. This is where the patient is considered time critical or requires time critical hospital intervention and requires immediate additional resources responding as an emergency using blue lights and sirens.

20. At 23:15 the Registrant arrived as the paramedic on a Fast Response Vehicle (FRV). He had with him a trainee.

21. At 23:22 a further Double Crewed ambulance (DCA2) arrived on scene. That crew consisted of an EMT, RL, and an Emergency Care Assistant, KT.

22. As the only paramedic on scene, the Registrant assumed the role of lead clinician.

23. At the scene Patient A was rolled onto his back and placed into an orthopaedic stretcher (scoop). He was then transferred to the DCA2 vehicle. During this time, his responsiveness dropped and he apparently began to snore.

24. At 00:03 DCA2 left the scene with Patient A, en route to Leicester Royal Infirmary (LRI). LRI is not a Major Trauma Centre (MTC). The Registrant did not go with them.

25. At 00:19 DCA2 arrived at the hospital with the patient. Once at hospital, Patient A was taken for a CT scan and identified as being critically unwell. He had multiple injuries, including unstable cervical fractures, an unstable lumbar fracture, a bilateral tension pneumothorax and hypoxic brain injury.

26. That same day RL raised concerns about the Registrants’ conduct on the scene and completed an Incident Report Form (IR1).

27. At a point unknown Patient A was transferred to a MTC. He passed away just under two weeks later on 12 December 2018.

28. The following witnesses were called on behalf of the HCPC:

• RS - Service Delivery Manager and Investigating Officer at the Trust
• RL - EMT on DCA2
• Dr K - expert Paramedic witness

29. In his defence the Registrant provided oral evidence to the Panel.

Decision on Facts:

30. In reaching its decisions on the facts the Panel took into account the evidence provided by the witnesses called by the HCPC, all the documentary evidence and the Registrant’s oral evidence. The Panel also took into account the submissions made by Ms Nagesh on behalf of the HCPC and Ms Parker on behalf of the Registrant. The Panel accepted the advice of the Legal Assessor and bore in mind that it was for the HCPC to prove its case on the balance of probabilities. It was not for the Registrant to disprove the allegations.

Allegation 1(a) – did not undertake an appropriate level of assessment as lead clinician or ensure an appropriate assessment was conducted

31. The Registrant admitted this allegation. He accepted that he was the lead clinician and that whilst he carried out some assessment on his arrival at the scene, sufficient to enable him to decide the appropriate pain relief to be administered and to recognise the need to immobilise the patient, he did not carry out a full primary survey based on the recognised <C>ABCDE approach, namely: Catastrophic haemorrhage, Airway, Breathing, Circulation, Disability, Exposure and environment.

32. Dr K’s opinion was that no competent paramedic would fail to recognise that the mechanism of injury (a fall down the stairs) could result in time critical injury or injuries and they would recognise that a detailed assessment would be necessary to confirm or refute this.

33. In DF’s witness statement for the disciplinary investigation, she was asked about the Registrant’s assessment soon after arriving on scene. She replied:

“[JM] had given him a handover on the way into the house. I can’t remember him doing a massive amount of obs. I had done a BP, he looked at the obs we had got, but no, I don’t remember there being a lot more done at that stage.”

34. When pressed on the issue, DF said she could not remember the Registrant doing an assessment.

35. The other EMT in DCA1, JM gave accounts in his witness statement to the fact finding investigation and the disciplinary investigation and neither indicate that a detailed assessment was done by the Registrant, or ordered by him. In his witness statement dated 1 December 2018 for the fact-finding proceedings he described the Registrant arriving at the scene. He said that he advised the Registrant as to the injuries and that he asked for assistance for pain relief and extracting the patient. The Registrant said that he could not administer morphine due to the low blood pressure but could give IV paracetamol. The Registrant cannulated Patient A and administered paracetamol. They then decided to work out how to get the patient onto the scoop. At that point DCA2 arrived.

36. In the Registrant’s witness statement for the fact-finding investigation, dated 1 December 2018, he said that he assessed Patient A’s pelvis and did a ‘brief assessment’ of the spine. He said “The crew had previously already cleared it”.

37. In his interview for the disciplinary investigation, dated 24 January 2019, the Registrant stated:

“I went over to the patient and started talking to him, asked him if he has got pain anywhere else apart from his arm, had a quick check on his head, quick feel of his c-spine, he is not complaining of any pain at all. I asked him if he feels nauseous or dizzy, he said no so I said don’t worry because he is in quite a lot of pain, I said don’t worry get you some pain relief going in a minute”.

38. When asked about his assessment priorities in the disciplinary investigation, dated 20 May 2019, the Registrant said:

39. The Registrant was asked what his survey entailed and he said “End of bed, so I was talking to the patient and trying to see what had happened in their own terms, then I moved onto ‘have you got pain anywhere?’ and everything else I’ve just described.” When asked whether the secondary survey was all questions, he said “Yes. In terms of his C spine I pressed to see if there was any tenderness there. And his head – I felt for any edges or anything or breaks or bleeding.”

40. There are no recorded clinical observations between 23:08 and 00:05, covering the time that the Registrant was on scene.

41. Dr K’s opinion as to the quality of the assessment was as follows:

“I am of the opinion that Mr Weathers did not undertake, or direct another appropriate ambulance clinician to undertake, an adequate primary survey as soon as Patient A was positioned to allow such assessment. I am of the opinion that this falls far below the standard one might reasonably expect”.

42. Based on Dr K’s evidence that such an assessment should have been conducted by the Registrant and the Registrant’s admission to this allegation, the Panel found 1(a) proved. The Panel accepted that the Registrant had carried out some assessment, but it was not adequate in all the circumstances, as he himself acknowledged

Allegation 1(b)(i) – did not appropriately manage potential for C-spine injury in that the Registrant did not ensure the transfer of Patient A onto his back was properly planned and/or executed

43. The Registrant denied this allegation.

44. Dr K gave his expert opinion as to the way in which the transfer of Patient A onto his back should have been managed. He stated that the following should have happened:

i. The move should have been co-ordinated with an ambulance clinician at the head of the patient supporting the head and neck. The person at the head end would co-ordinate the move and direct others assisting with the move;

ii. In a separate move Patient A should have been log-rolled onto his back. This is a coordinated and controlled activity with the aim of rolling the patient onto their back bringing the spine into neutral alignment, and avoiding rotation or other movement of the spine;

iii. It is essential that in undertaking the procedure that there is space to complete it. This may involve moving furniture.

 

45. In her witness statement for the fact-finding investigation RL stated:

“We have a conversation about rolling him over, but we didn’t want to roll him onto his injured side, and he was cannulated on the other. We were just going to have to be careful. [JM] was on the head, Wez [the Registrant] on the left and I was on the right, with Chris [trainee] on the feet. [JM] suggested rolling direct onto the scoop, to which Wez said no, we will roll him over and then get the scoop in normally. That’s what we did. We rolled him towards Wez, but it wasn’t simply, as there wasn’t enough space, so from lying on his back, facing me, rolled onto the left. We came to a stop as Wez was against him, and Wez was against the sofa. We couldn’t roll any further, so we had to slide him and turn him to put him flat on his back. He was on his left side, and then had to use his belt loops to move him so that he was square.

46. In her oral evidence RL confirmed the evidence she had given in her various statements.

47. In JM’s witness statement for the fact finding investigation he did not describe the roll onto the back in any detail, he simply said that it was decided that they would put Patient A onto his back, separate the scoop and then put him on. In his interview to the disciplinary investigation, JM clarified that after the decision to put Patient A onto the scoop, he, JM, was transferring what electronic data they had and did not seem to have been involved with the roll. This accorded with RL’s evidence that it was just she, Chris (the trainee from whom there was no statement) and the Registrant performing the roll.

48. In his statement for the fact-finding investigation the Registrant did not describe the roll in any detail, he simply said “We popped him on a scoop”.

49. In his disciplinary interview, dated 20 May 2019, the Registrant simply referred to getting Patient A into the room, deciding how they were going to get him on his back, the scoop was collected and set up and they rolled Patient A onto his back.

50. Accordingly, at the time that Dr K gave his opinion on the adequacy of the roll the only detail of what had occurred came from RL. Dr K opined:

“If [RL’s] description is correct it would appear that the transfer of Patient A onto his back was poorly planned and poorly executed.”

51. Dr K concluded that if RL was correct then, on the balance of probabilities, the Registrant did not have an effective plan and the roll was not made in a controlled manner. In that situation, Dr K was of the opinion that this fell below the standard one might reasonably expect.

52. In his oral evidence, the Registrant said:

“The patient was at the foot of the stairs in a cramped environment. … His body was down with his face turned to the side and his feet on the stairs. His left arm was in an awkward position. I initiated the conversation to move him. I took the lead. It was pre-planned. I said we can’t do anything with him where he is, so we need more space. [RL] then suggested we move him on the carpet into the living room, which seemed like a great idea. I suggested we could then log roll him. I co-ordinated people. I would be at the head end to control his head and I want you to go either side of the body and with my student at the feet end. My main focus was to make sure his head stayed where it is and not bounce around on the floor and that there were no issues with his c-spine by maintaining alignment of the neck with as little movement as possible.”

53. He went on to say:

“There was enough space to long roll him in the living room. We may have moved some furniture and then there was enough space to get the scoop in and do the log roll. I was still at the head end, two people at the sides and one at the lower end. We rolled halfway as I prefer to do it in stages, it was not safe to do it in one go, then all together we rolled him onto his back. We paused half way so people could reposition if they needed to and then I said ‘ready, set, roll’ and we went the full way. It was clear I was taking the lead and others were to follow my lead and they did.”

54. The Registrant denied the use of Patient A’s belt loops to turn him but said that his clothes were grabbed in order to roll him over.

55. It was clear that those attending the scene were met with a difficult situation, whereby an elderly gentleman had fallen down the stairs (it was not known how many stairs and whether it was from the top, but it had been with sufficient force to dislodge a radiator at the bottom of the stairs). Patient A was face down, with his head to the side, one arm awkwardly above him and his feet still on the last stair. There was very little room to manoeuvre and it was a cramped space in which to treat the patient.

56. The first ambulance on scene was manned by two EMTs and they called for paramedic back-up to provide pain relief. The next to attend was the Registrant with his trainee. The Registrant then became the lead clinician notwithstanding his relative inexperience when compared with the two EMTs already on scene, because of his senior position as a paramedic. The second ambulance arrived shortly thereafter with two further personnel, including RL.

57. Although the evidence of the two EMTs was hearsay, the Panel felt able to give it significant weight because Ms Parker had indicated at the outset of the hearing that it was not challenged. However, on the question of the log roll, neither said very much. Thus the only helpful accounts were those given by RL and the Registrant.

58. As stated, the situation they found themselves in was far from ideal, a patient at the bottom of the stairs, face down with a suspected broken arm, his feet still on the bottom stair and little space. The Panel considered the decision to move him into the living room where there was more space made sense and the idea of using the loose piece of carpet he was lying on also made good sense.

59. There was evidence that once in the bigger space, although still quite cramped, Patent A was rolled onto his back in a two-part manoeuvre. There was some suggestion that more effort should have been made to move furniture to give more space, but the Panel did not have the benefit of any pictures or drawings to allow them to understand the precise layout of the room they were now in. However, on the evidence it was apparent that Patient A’s head was controlled as the roll was executed, although there was a difference in evidence about who was holding his head. The Registrant said he was and this was supported by the evidence of JM. RL said it was JM who was holding the head and that she was on one side with the Registrant on the other side. Notwithstanding this contrary evidence, there was no suggestion that Patient A’s head was not cared for during the roll.

60. Given his lack of a full assessment it was not entirely clear what the Registrant suspected at this stage, however he had clearly recognised the need to immobilise Patient A and place him on a scoop with head restraints. He also put a blanket or sheet under his head once Patient A was prone, having noted his head was raised, suggestive of a kyphosis (excessive curvature of the spine). The Panel noted the reference to using belt loops to assist the turn at one stage and whilst this is far from ideal, because they could break, the Panel recognised that in difficult circumstances clinicians would look to find a point of access in order to help control the movement of the patient.

61. In all the circumstances, which as stated were far from ideal, the Panel considered that the Registrant’s actions were suggestive of a planned log roll, he did give instructions and the roll was executed to an acceptable level. It may not have been a perfect transfer of Patient A onto his back, but it was nevertheless adequate in the difficult circumstances faced at the time.

62. The Panel therefore found 1(b)(i) not proved.

Allegation 1(b)(iii) – did not appropriately manage potential for C-spine injury in that the Registrant applied a head tilt chin lift

63. The Registrant denied this Allegation.

64. The Panel recognised that the matters alleged took place some time ago and that inevitably memories would be affected by that delay. However, in this case the Panel had the benefit of some almost contemporaneous accounts, particularly those given by RL and the Registrant on the day after the event. Accordingly, the Panel gave significant weight to those first accounts when matters would have been most fresh in the minds of the authors.

65. The allegation is that at some stage the Registrant performed a head tilt chin lift. This is a two-handed manoeuvre that requires the clinician to place one hand on the patient’s forehead, the other on their chin and to then tilt the head backwards using both hands. The expert witness Dr K’s evidence was that such a manoeuvre should not be used with a patient who has a potential spinal injury as this would apply unwanted extension to the neck.

66. The first statement on this issue was made by RL in the Incident Report form. This was completed at 05:55 on the morning of 1 December 2018, a matter of hours after the event. In that report RL recorded, “The patient was then rolled onto his non injured side and on to his back, the patient sounded like he was snoring to which [JM] checked his airway and the paramedic performed a head tilt chin lift and the snoring sound stopped."

67. In her near contemporaneous statement, made in the evening of 1 December 2018, RL said:

“Once he was flat on his back he started making a snoring noise, to which [JM] was at the head, and said 'oh he's not got trismus has he?' he looked inside hjs mouth, it did open a little and Wez said, just tilt his head back. And Wez tilted his head back and the snoring noise stopped.”

68. In her statement for the investigation, in June 2019, RL discussed the fact that Patient A started snoring and said “Wes suggested performing a head tilt chin lift and then went on to perform it himself.” There followed the following questions and answers:

Q. Prior to what you've just suggested, what was the patient's head position?

A. Neutral alignment.

Q. How was it being maintained in that neutral alignment?

A. [JM] was holding it.

Q. So, you've said the paramedic verbalised to apply a head tilt chin lift, then went onto do that himself. Was that head tilt chin lift in the complete sense you'd expect?

A. Yes.

Q.What position did that leave the neck in?

A. He remained in a head tilt chin lift position. l'm unsure how he remained that way as l’m pretty sure [JM] didn't continue to hold it there.

Q. Did the snoring stop when this was applied?

A.Yes.

Q. And so l"m clear what you're telling me is the paramedic verbalised that a head tilt chin lift should be applied, was it in those words?

A. Yes or "just do a head tilt chin lift" something like that but he did it pretty much as he said it.

Q. I assume that took the head out of natural alignment?

A. Yes

Q. Could what you had seen the paramedic do, could that action/movement be mistaken for anything else other than a head tilt chin lift?

A. No

Q. Did anyone apply a jaw thrust?

A. No

69. In her oral evidence to the Panel, RL was adamant that this is what the Registrant had said and done and she demonstrated what a head tilt chin lift looks like. She refuted any suggestion that she could have been mistaken in what she heard the Registrant say or do, or that it could have been a jaw thrust that she had confused for a head tilt chin lift.

70. The Registrant was equally adamant that he had not performed a head tilt chin lift or mentioned one. He said in evidence that he noted Patient A had a curvature in the upper portion of his spine (kyphosis) and that when on the scoop Patient A’s neck was hovering above the scoop. He said there was resistance there and the head would not go back any further so he packed it with a blanket. He said that at no stage did he apply any force to Patient A’s head or neck and that he did not want Patient A’s head to drop back, hence the need to place the blanket under his head. The Registrant said that he agreed with Dr K that a head tilt chin lift on a patient with curvature of the spine would require some force and he said it would have been “the opposite of what I was trying to achieve by keeping his head in line and putting blankets under his head.”

71. When asked the question did he think putting the blanket under the head could have looked like a head tilt chin lift, the Registrant said he thought it could have done. He also said that he may have done a jaw thrust, although he could not remember having done so.

72. The Panel was thus faced with two diametrically opposed accounts of what happened, with both parties adamant about their positions. On both accounts, however, Patient A had been snoring and something was done to stop that snoring. It was accepted by all that snoring is an indication of an obstructed airway.

73. The Panel looked to see if there was any support for either account from the other witnesses at the scene.

74. JM described the head of Patient A being tilted backwards and he was unaware of any curvature of the spine. He did not, however, describe the Registrant as carrying out a head tilt chin manoeuvre.

75. DF said she did not think she had seen anybody perform a head tilt chin lift, but she had not been there throughout this time and she had not heard any snoring either.

76. The Panel considered the evidence on this allegation to be fairly finely balanced. It had no reason to believe RL was making her account up, indeed the Panel considered her to be a credible witness who gave evidence in a clear way and she was not in any doubt about what she said she saw and heard. In contrast to her account was the account of the Registrant, possibly supported to some extent by JM. The decisive factor for the Panel, however, was the very first account given by RL very shortly after the event in which she explicitly referred to a head tilt chin lift.

77. In all the circumstances the Panel preferred the evidence of RL given the near contemporaneous record and there being no apparent reason why she would have recorded something so specific in that record if she had not witnessed it. In evidence she was able to demonstrate very clearly what a head tilt chin lift looked like and it was difficult to see how it could be confused with putting a blanket under the patient’s head or possibly doing a jaw thrust, which was a very different manoeuvre. RL demonstrated this manoeuvre during her oral evidence. Furthermore, a head tilt chin lift would have stopped the snoring and it was apparent that Patient A did indeed stop snoring.

78. Accordingly, the Panel was satisfied, on the balance of probabilities, that the Registrant did perform a head tilt chin lift and it therefore found 1(b)(iii) proved.

Allegation 1(c)(i) & (ii) – did not recognise the reasons for and/or react appropriately to Patient A’s (i) fall in response; and (ii) snoring

79. The Registrant admitted these allegations.

80. These Allegations are inextricably linked and the Panel thus considered them together.

81. At some point it is accepted that Patient A was making snoring noises. Dr K addresses this by saying: “I am of the opinion that Patient A had episodes and possibly prolonged periods of reduced consciousness which went unrecognised by Mr Weathers. I am of the opinion that to fail to recognise Patient A’s reduced level of consciousness fell far below the standard one might reasonably expect.”

82. Dr K added: “I am of the opinion that on balance of probabilities the snoring was associated with partial airway obstruction.”

83. Dr K noted that Patient A’s Glasgow Coma Scale (GCS) was assessed at 15/15 and fully conscious at 23:08. However, it had changed to 7/15 and unconscious by 00:05. There was no record of the GCS being assessed in the 57 minutes in between.

84. In his evidence during the disciplinary investigation the Registrant was asked about his conclusions about the fact that Patient A was becoming less responsive and he responded by saying: “I think I put it down to the fact I’d given paracetamol and that he was more comfortable … the patient had had a few drinks, was comfortable with the paracetamol and had fallen asleep”.

85. The Panel considered this to be very much at the heart of this case. It was apparent to the Panel that the Registrant had indeed considered Patient A’s reduced responsiveness was as a result of having been given paracetamol and being under the influence of alcohol and this informed many of the decisions the Registrant made. It no doubt impacted upon his decision to perform a head tilt chin lift to stop the snoring of a patient he felt had fallen asleep, rather than one who was potentially suffering from a cervical fracture or other severe injury. It also no doubt impacted on the decision he would go on to make with reference to the appropriate hospital to be taken to and whether to accompany Patient A in the ambulance. These matters are dealt with in more detail below.

86. On the basis of the Registrant’s admissions, as supported by the evidence relied on by the HCPC, the Panel found 1(c)(i) and 1(c)(ii) proved.

Allegation 1(d) – did not ensure that Patient A was conveyed to a Major Trauma Centre; and Allegation 1(e) – did not accompany Patient A to hospital

87. The Panel considered Allegations 1(d) and 1(e) to be inextricably linked and so dealt with them together. The Registrant admitted both these Allegations. However, he provided a basis upon which the admissions were made that required careful consideration by the Panel since, if his account were accepted, it would impact upon the seriousness of the failings alleged.

88. The Panel had in mind its conclusions in relation to Allegations 1(c)(i) and (ii) referred to above, namely that the Registrant’s actions were informed by his conclusion that Patient A’s reduced responsiveness was due to the paracetamol and the alcohol rather than something more severe.

89. Dr K opined that early indications pointed strongly towards the need for urgent transfer to an MTC. He said “At the point when Patient A was positioned on his back and at times when the level of consciousness fell to P on the AVPU scale it was apparent that Patient A met the criteria for transfer to a major trauma centre”.

90. Dr K set out the criteria for a ‘silver trauma safety net’ to be applied to patients aged 65 years or over. Patient A was 76 years of age. These indicate that if the Systolic Blood Pressure (SBP) is below 110mmHg in the presence of significant injury, that there is injury to two or more body regions or an open fracture proximal to wrist/ankles and the mechanism was a fall
91. Dr K’s opinion about whether the Registrant should have travelled in the ambulance was as follows:

“On the basis that it was reasonably foreseeable that en route to hospital Patient A would have deterioration in level of consciousness and associated airway obstruction. Mr Weathers should not have delegated clinical care to an ambulance technician and should have travelled with the patient himself as their senior ambulance clinician.”

92. By his admission to 1(d), the Registrant accepted that Patient A should have been conveyed to an MTC and not to the LRI, which is what in fact happened. By his admission to 1(e), the Registrant accepted that he should have accompanied Patient A to hospital.

93. The Registrant said that once Patient A was placed on the second ambulance, DCA2, he got on the ambulance with RL and carried out some further observations. At that time Patient A’s observations were stable. The Registrant said that Patient A’s responsiveness was a little less than it should be “but you sometimes get that with alcohol.” He said that throughout the process he thought of major trauma, “but it was 50/50.” He then got off the ambulance and went back into the house to get his trainee and also to speak with the family to see if one of them would be accompanying Patient A on the ambulance. He said that he intended going back to the ambulance and taking a final set of observations before determining where the ambulance should go. He was therefore, he said, shocked to exit the house and find the ambulance gone. He said he did not see it go and so did not know if it went on blue lights but he did not see any blue lights. The Registrant said that he should have made the decision about which hospital to go to, but that at that stage he had yet to come to that decision because he was relying on taking a final set of observations.

94. Given his surprise at the ambulance’s sudden departure before he had given his instructions he went and spoke with the crew of the first ambulance, DCA 1. He said, “I asked the other crew why did they leave and how did they know where to go and I was told by [DF] that she had told them to go to LRI. I said it may be major trauma and they should have gone to the Major Trauma Centre. I suggested calling control to radio the ambulance so I could catch up with them but decided not to as they were only four minutes from the hospital and they would have been there before I could get to them.”

95. He added that he was reassured by the more experienced crew that everything would be fine. He therefore decided not to do anything. In summary, he had not made his final decision about where the ambulance should go and he had no chance to accompany Patient A to hospital because the ambulance had already left before he had a chance to return.

96. In answer to a question about the account he had given on 1 December 2018 to RL when she asked if he was going to travel on the ambulance she said he replied, “No, I don’t think so”. The Registrant said that what he actually said was that he was not sure yet. He emphatically denied ever saying “No”.

97. The Registrant's account had to be compared with that given by RL and also the evidence of JM and DF.

98. In her statement provided on 1 December 2018, and confirmed in her oral evidence to the Panel, RL said “I said to Wez, ‘I assume your travelling with us?' He said, no, I don 't think I need to he will be fine. He picked his stuff up including the rubbish and went back to his car. Me and [KT] got the family member sat in the ambulance (in the back) and we set off.”

99. In his statement provided the day after the event, the Registrant said:

“Once the patient was on the ambulance, the crew asked me if I was travelling with them. I said no I don’t think so. This was because I had not considered silver trauma at this point. By the time I had considered it, the patient had already left scene. His observations were also back to being stable at this point. His blood pressure had returned to normal and his heart rate was within normal ranges. I assessed his pupils and they were equal and reacting to light.”

100. The Panel noted the similarity between these two almost contemporaneous accounts and the clear indication that the Registrant had decided not to travel on the ambulance and indeed considered Patient A to be stable. This was contrary to the account now being given by the Registrant in evidence to this Panel.

101. RL added:

“During the trip in I felt like it was the first chance I had to assess the patient, this was because I thought that the Paramedic who was on scene would be travelling into hospital with us. Honestly, I thought that I probably wouldn’t even be with the patient, that I would be driving his [the Registrant’s] car in. This wasn’t me not interested, but I normally formulate a view of what happened and plan ready for my handover, I didn’t think I would be handing over, so I didn’t need that plan. When I was sat with the patient travelling in, I recognised that his condition was deteriorating, I wasn’t convinced that his presentation was down to alcohol, like I feel was portrayed to me, I was concerned about him. That’s why we went to resus. I was trying to write the report form, I realised that there were no assessments recorded, I wasn’t able to write my normal standard of PRF. There was no recorded story form first crew on scene or paramedic on scene. I didn’t do on scene assessment as we were third crew. I didn’t know what had happened prior to us arriving and wasn’t able to confirm capacity or consent.”

102. RL clearly thought that the Registrant would be going in the ambulance and that she would be driving his car.

103. The Panel thus preferred the account given by RL, not least because it was supported by her near contemporaneous statement and furthermore the Registrant’s own, near contemporaneous, statement.

104. JM and DF in their unchallenged hearsay statements provide accounts which did not support the current stance taken by the Registrant. JM was seemingly as surprised as RL at the Registrant’s decision not to go on the ambulance. He was surprised that the Registrant did not seem to know where the ambulance was going. He also described the Registrant as unconcerned. This supports the conclusion that when the ambulance left the Registrant had not considered the possible seriousness of Patient A’s condition.

105. The following is an extract of the question and answer session conducted with JM on 3 June 2019:

“Q. Finally, can we discuss the crew leaving scene. Your SI statement details that you were surprised Wes didn't travel and you explored that in some detail. How soon after the crew leaving did that conversation occur with Wes?
 
A. As they were leaving, because they were still outside the property. [DF] had moved our vehicle away so they could load up and go. We had taken equipment back to the vehicle and I saw the vehicle going on blues, and Wes walking towards me. I waited for Wes to walk towards me rather than shout, and I said "I'm surprised, I thought you would have travelled". I asked if he knew where they were, for example were they going to queens, and he didn't know.

Q. Would he have seen the ambulance leave?

A. No, he was walking towards me so it would have been behind him. So, I had vision of the ambulance and Wes was walking towards me. But I was surprised he was walking towards me

Q. Did you see Wes step off the ambulance?

A. No, that's when I was sorting bags out. I was at the side of our ambulance and I looked up and saw the ambulance leaving

Q. Where was Wes walking from?

A. His car. *[JM] provided a visual demonstration of this* Wes' car was 2/3 properties away from the patients', he was walking from that distance towards us, and that's when I noticed the ambulance going. I think it was quite late at night, so I didn't shout.

Q. You expressed your surprise that he hadn't travelled. Did Wes appear concerned'?

A. No, that was again a surprise of mine. I'm sure he said, "I think there's not much more that I can do” So, I'm surprised he wasn't aware which hospital they were going to as I would have assumed there would have been a conversation between them.

Q. So, Wes didn't express any concern, which equally surprised you, and didn't have any awareness of where the ambulance was going, which again surprised you. And during that conversation Wes provided a view that he didn't believe he needed to go with the crew?

A. Yes, I don't remember his exact words, but I picked up from this that he wasn't overly concerned.

Q.At this point who mentioned whether or not the patient should have gone to an MTC?

A. I think it might have been me. I had already discussed it on scene as I said in my statements, as we were at the end of our shift, so I asked if the other crew [RL] would mind travelling. I remember saying as a sweetener that there was a Costa at Queens. So, I had already approached that subject.

Q. So, if memory serves me, that conversation around an MTC was specifically with the second crew and now with Wes?

A. Yes, I spoke to [RL]. I asked what time she was finishing and whether she was happy to transport.

Q. So, the ambulance moves away, Wes didn't appear concerned, my understanding from the Sl report is that there is then a conversation about what would have been the appropriate hospital to go to? You've stated that it may have been you that raised this?

A. I’m visualising it; I think I was looking out the side door talking to Wes, I asked if the ambulance was going to Queens, he said he wasn't sure. I asked if they were going to the LRI, he didn't know. I don't think l said, "they should have gone to an MTC'', I think I said “I’d have bene looking at going to Queens" or words to that affect. When the job came through me and [DF] had already discussed this. So initially it was our first thought based on the story of the patient falling from the top of the stairs that he may need to go to an MTC. But I don't know what the conversation was on the back of the ambulance between Wes and [RL], I was just surprised he had’t travelled and didn’t know where they were going.

Q. At any point after the ambulance left scene, was there an acknowledgement by Wes that maybe this patient should have gone to a trauma centre.

A. No

Q. During that conversation after the ambulance had left scene, was there any agreement between those left that it was probably best for the crew to continue onto the LRI?

A. No because we didn't know where they were going. I assumed they were going to Queens as that’s where I would be going, which is when I asked, "where is she going" and Wes didn't know. As I’ve said I was surprised she had gone to the LRI and hadn't travelled on blues.”

 

106. The following is an extract of the question and answer session conducted with DF on 12 June 2019:

“Q. Finally, the crew leaving scene and the decision that the second crew will transport the patient. What do you recall about that and the general build up to that?

A. There was no urgency, we got the patient on board, I don't remember there being any urgency at all. I think that crew ... I can't remember if they discussed it with the paramedic, as to whether they were going to Leicester, I think they did, and then they left

Q. Were you surprised the Paramedic didn't travel?

A. Yes, I was, I did think he would do and then because he didn't I just thought he obviously wasn’t concerned about the patient and he was quite happy.

Q. Can you recall a conversation with the Paramedic after the ambulance had left'?

A. I think [JM] had a conversation with him to say .... "I thought they'd have gone to Nottingham" but I can't remember what Wes said back.

Q. Were you a part of that conversation?

A. I can't remember that I was or whether I just heard them talking

Q. Was there any concern at that point that the crew had left scene without that paramedic?

A. Wes didn't show any no, there was no comments from him.

Q. Can you recall in that conversation after the ambulance left whether there was a realisation that the patient should have gone to a major trauma centre; and was that verbalised?

A. No. I don't remember there being a concern

Q. What did you make of the paramedics' communication throughout that incident?

A. He was very relaxed I thought, but not necessarily relaxed as in . ., how do I put it., he wasn't relaxed as in he was relaxed and confident, he seemed very confident, but a bit like ;'he's (the patient) fine"

Q. Blase?

A. Yes. But I took that as he wasn’t concerned about the patient at all and he was quite happy and that was that.”

107. As with JM’s unchallenged account, the unchallenged account given by DF supports the conclusion that the Registrant was unconcerned at the time the ambulance left. It does not support the account given by the Registrant in evidence about his surprise at the ambulance leaving without him and his subsequent discussion with JM and DF about what to do.

108. The Panel considered the Registrant’s account given in evidence had been contradictory and unconvincing. For example why was he going back to the house to see if there was a family member to accompany Patient A in the ambulance when Patient A’s nephew was already in the ambulance. Furthermore, it was not supported by the crew of DCA 1 and it was contrary to the evidence given by RL. In addition, the Panel noted that his own first account was much closer to the account given by RL, which led the Panel to believe he was now trying to avoid full responsibility for his actions, notwithstanding his admission to these Allegations.

109. The Panel thus found 1(d) and 1(e) proved, but on the basis that he had decided Patient A’s condition did not require him to go to an MTC and there was, consequently, no need for him to travel on the ambulance.

Decision on Grounds and Impairment:

110. The Panel, having found allegations 1(a), 1(b)(iii), 1(c), 1(d) and 1(e) proved, went on to consider whether these facts amount to misconduct. No further consideration was given to allegation 1(b)(i).

Submissions

111. Ms Nagesh, on behalf of the HCPC, submitted that the Registrant’s actions breached a number of the Standards of Conduct, Performance and Ethics (effective from January 2016) and the Standards of Proficiency for Paramedics (effective from September 2014) (‘the Standards’). She further submitted that his actions fell far below the standards expected of a paramedic and amount to misconduct.

112. Ms Nagesh submitted that there is nothing within the Registrant’s oral evidence to the Panel or his impairment stage bundle that can provide sufficient assurance that he has demonstrated insight and remediated his misconduct. She further submitted that without significant evidence of remediation public confidence would be undermined if the Panel were to make no finding of impairment. Ms Nagesh invited the Panel to conclude that the Registrant is currently impaired on the basis of the personal and public components of public protection.

113. Ms Parker, on behalf of the Registrant, submitted that no top banded paramedic will get to that level without having committed technical breaches of the Standards. She further submitted that these mistakes become lessons, and these lessons enable healthcare professionals to provide a better standard of care going forwards. She invited the Panel to conclude that the Registrant’s conduct does not amount to misconduct.

114. Ms Parker went on to submit that even if misconduct is found it does not necessarily follow that the Registrant’s fitness to practise is impaired. She stated that this is a case of lack of foresight of harm, rather than any intentional or reckless act. As a result of the Registrant’s insight and the extensive further work he has done since the incident, she submitted that he does not present a risk of harm to patients, and service users do not require protection from him. She further submitted that public confidence in the profession would not be undermined by a finding of no impairment. She invited the Panel to conclude that the Registrant’s fitness to practise is not currently impaired.

The Panel’s Approach

115. The Panel was aware that at this stage of proceedings, there is no burden or standard of proof and the decision on misconduct and impairment is a matter of judgement alone.

116. The Panel took into account the written and oral submissions of both parties and the Registrant’s impairment stage bundle consisting of character references, compliments, and training that he had undertaken.

117. The Panel accepted the advice of the Legal Adviser and bore in mind the overarching objective:

• Protecting, promoting and maintaining the health, safety and well-being of the public;
• Promoting and maintaining public confidence in the professions it regulates;
• Promoting and maintaining proper professional standards and conduct for members of those professions

118. The Panel was aware that public protection includes:

• The ‘personal’ component – the current competence, behaviour etc. of the registrant concerned;
• The ‘public’ component – those critically important public policy issues including maintain trust and confidence in the profession and maintaining professional standards.

119. In reaching its decision, the Panel took a holistic view of the nature of the Registrant’s conduct, the scope and level of his insight and remediation, and the risk of repetition. The Panel was mindful that the Registrant was entitled to dispute the allegations and that his denial of some of the allegations is not a bar to insight. However, the Panel had regard to the case of Sayer v General Osteopathic Council [2021] EWHC 370 (Admin) which states:
‘attitude to the underlying allegation is properly to be taken into account when weighing up insight’

Decision on Misconduct:

120. The Panel in considering the Standards concluded that the Registrant’s conduct breached the following:

Standards of Conduct, Performance and Ethics

• Standard 1 – to promote and protect the interests of service users and carers;
• Standard 6 – to manage risk;

Standards of Proficiency for Paramedics

• Standard 1 – to be able to practise safely and effectively within their scope of practice;
• Standard 4 – to be able to practise as an autonomous professional, exercising their own professional judgment;
• Standard 8 – to be able to communicate effectively;
• Standard 15 – to understand the need to establish and maintain a safe practice environment.

121. The Panel was aware that breach of the Standards alone does not necessarily constitute misconduct. However, the Panel was satisfied that the Registrant’s acts and omissions fell far below the standards expected of a registered paramedic.

122. The Registrant did not provide Patient A with adequate treatment when he attended Patient’s A’s address on 30 November 2018. Although he was the lead clinician, he did not undertake an appropriate level of assessment of Patient A, nor did he ensure that an appropriate assessment was conducted. He did not appropriately manage the potential risk of a C-spine injury and either did not recognise the reasons for Patient A’s drop in level of consciousness and snoring or did not react appropriately to these factors. Furthermore, the Registrant did not ensure that Patient A was conveyed to a MTC and did not accompany Patient A to hospital.

123. The Panel acknowledged that all professionals make mistakes. It also recognised that the factual findings relate to one patient on a single occasion. However, the Panel took the view that the Registrant’s shortcomings went beyond professional misjudgement. They involve multiple acts and omissions each of which are serious and each of which represent significant departures from the standards expected of registered paramedics at all times.

124. The Panel noted that as the lead clinician the Registrant was the primary decision maker. He was expected to lead and direct others and in consultation with others manage the scene and patient care. As Dr K stated, in his expert report, the Registrant was not required to undertake all interventions himself but was required to satisfy himself that any delegation of tasks was appropriate.

125. The Panel concluded that the Registrant’s actions demonstrated poor clinical management in relation to a vulnerable patient. Appropriate clinical assessments of patients is a core paramedic skill. In the absence of such an assessment, patients are likely to be exposed to unwarranted risk of harm. The Registrant did not ensure that Patient A was treated in a way that appropriately managed the risk of harm or protected his interests. The Panel accepted the expert opinion of Dr K, that by not undertaking or directing another clinician to undertake an adequate assessment of Patient A the Registrant fell far below the standard expected of a reasonably competent paramedic.

126. The Registarnt’s clinical shortcomings included not managing the potential for C-spine injury in that he inappropriately applied a head tilt chin lift manoeuvre. The particular circumstances in this case should have caused the Registrant to suspect a spinal or spinal cord injury and treat Patient A appropriately based on that suspicion. The Registrant was unable or unwilling to react appropriately to key clinical factors which indicated that an intervention was required. He did not report any concerns he had about the condition and treatment of Patient A promptly and appropriately to his colleagues at the scene. Nor did he communicate effectively, as evidenced by the lack of proper and clear interaction with his colleagues before allowing them to leave the scene without him. The Registrant’s shortcomings did not demonstrate safe and effective practice. On the contrary, his conduct had the potential to cause significant harm to Patient A.

127. For these reasons, the Panel concluded that the Registrant’s acts and omissions amount to misconduct.

Decision on Impairment:

128. The Panel considered the Registrant’s current fitness to practise first from the perspective of his ability to work safely and effectively as a paramedic and then from the perspective of the wider public interest.

129. The Panel noted that the Registrant accepted the majority of the allegations at the outset of the hearing. The Panel also noted that included within the main hearing bundle was the reflective statement of the Registrant, prepared 2019, and in advance of this stage of the proceedings it was provided with a voluminous bundle of character references and evidence of courses that he has undertaken. Therefore, the Panel acknowledged that the Registrant has demonstrated some insight, in that he has some appreciation of the nature and gravity of his shortcomings. However, the Panel concluded that his insight is limited for the following reasons.

130. The Panel recognised that following an adverse clinical event, attending courses can be very useful, but it is the learning that has been achieved and how that learning will be imbedded into clinical practise which is of paramount importance. The Panel noted that a number of the courses had been taken in 2018 or earlier and some are not relevant to the Panel’s factual findings; for example, Business Continuity, Conflict Resolution, Countering Fraud, Bribery and Corruption. The Panel acknowledged that the courses entitled “EPRR – Major Incident Initial Response” and “Manual Handling Level 2” are relevant courses. The Panel also acknowledged that the Registrant has not worked as a paramedic since 2018 and his current role as an Emergency Care Assistant does not provide the same opportunities to demonstrate the ability to work safely and effectively as a paramedic in complex situations. However, it also means that there was no evidence before the Panel that attendance on any of these courses had improved his paramedic practice.

131. The Registrant did not give oral evidence at this stage of the proceedings and did not provide an up-to-date reflective statement. Therefore, the Panel was reliant on the Registrant’s oral evidence at the fact finding stage and the reflective statement within the hearing bundle to assess the level and scope of his insight. The Panel took the view that the Registrant, during his oral evidence, tried to minimise the extent of his wrongdoing. For example, by giving both contradictory and unconvincing evidence in relation to not ensuring that Patient A was taken to a MTC and not accompanying Patient A to hospital. This indicates that at the fact finding stage he was unable or unwilling to accept the extent of his shortcomings. There was no evidence before the Panel that his insight had developed during the intervening period between the fact finding stage and this stage of the proceedings. Furthermore, his reflective statement appears to be primarily an academic evaluation of the issues in the case rather than a deep and meaningful critique of his own behaviour and the steps he has taken to avoid repetition. There were no expressions of genuine regret or remorse. Nor was there any indication that the Registrant had reflected on the impact of his behaviour on Patient A and their family. The Panel was also concerned that the impact on his more junior colleagues could have been considerable.

132. For these reasons, the Panel concluded that the Registrant’s insight was limited.

133. The Panel acknowledged that the Registrant’s misconduct is remediable, as it relates to clinical skills which can be acquired or developed over time, provided there is a willingness to learn from what went wrong. However, the Panel concluded that the Registrant had provided insufficient evidence of remediation. The Panel acknowledged that the Registrant had provided three positive character references. However, the Panel afforded these references only limited weight as they attested to his professionalism and good nature rather than clinical skills directly relevant to the Panel’s factual findings. For the reasons stated above, the Panel took the view that the courses the Registrant has undertaken, and his reflections did not demonstrate that he is able to clinically manage complex situations autonomously. Therefore, in the absence of full insight and remediation, the Panel concluded that there is an ongoing risk of repetition.

134. In these circumstances, the Panel concluded that the Registrant’s fitness to practise is impaired based on the personal component.

135. In considering the wider public interest the Panel had regard to the important public policy issues which include the need to maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour.

136. The Panel noted that paramedics occupy a position of privilege and trust. They are expected to act in a manner which maintains public confidence in them and in the profession. In the Panel’s view the Registrant’s conduct demonstrated a disregard of his professional obligations. Reasonable and well-informed members of the public would be extremely concerned to learn that a lead clinician had not undertaken an adequate assessment of a patient, had exposed the patient to further risk of harm and had not communicated effectively with colleagues or accompanied the patient to hospital. The Panel concluded that the Registrant’s conduct undermined public trust and confidence in the paramedic profession.

137. A significant aspect of the wider public interest is upholding proper standards of behaviour. The Registrant’s conduct fell far below the standard expected and the Panel concluded that public confidence would be undermined if a finding of impairment was not made, given the seriousness of his conduct and behaviour.

138. In these circumstances, the Panel concluded that the Registrant’s fitness to practice is also impaired based on the public component.

Decision on Sanction:

139. The Panel, having determined that the Registrant’s fitness to practice is impaired went on to consider what, if any, sanction should be imposed.

The Registrant’s Further Oral Evidence

140. Following receipt of the Panel’s determination on grounds and impairment the Registrant chose to give further oral evidence.

141. The Registrant, in response to questions from Ms Parker, outlined what he had learnt from the case study which formed part of a course that he undertook in 2019. He stated that if he was presented with the same circumstances that occurred on 30 November 2018, he would act differently. He informed the Panel that he would follow a structured ‘ABC approach’ when assessing the patient to avoid missing injuries, would ensure that the patient’s airway was kept open and would communicate much more clearly with his colleagues. He also stated that he would take the patient to a MTC as this would provide the patient with quicker and more appropriate care and would travel in the ambulance with the patient. The Registrant acknowledged that some of the e-learning he has undertaken is not relevant to the Panel’s fact findings. However, he stated that he tried to do as many courses as he could, subject to limitations such as funding.

142. The Registrant outlined the structure of the first class degree in Professional Clinical Practice that he obtained at De Montford University in 2021. He stated that, save for the Covid lockdowns, he attended the university for face to face learning once a week. He explained that approximately half the modules involved practical assessments as opposed to essay writing.

143. The Registrant informed the Panel that he is currently working as a multi-drop delivery driver and has not worked as an ECA since January 2022. In response to a question from the Panel he stated that he would like to return to practise as paramedic and work towards becoming an Advanced Clinical Practitioner. He stated that he has considered re-training as a doctor at some point in the future.

Submissions

144. Ms Nagesh outlined the relevant paragraphs within the HCPC Sanctions Policy and referred the Panel to the various sanction options.

145. Ms Nagesh submitted that taking no action or imposing a Caution Order would not be appropriate in this case. She acknowledged that Conditions of Practice may address the practise concerns but invited the Panel to also consider whether a suspension order would most appropriately meet its public interest objectives.

146. Ms Parker’s primary submission was no action should be taken by the Panel. She submitted that the public do not need to be protected from the Registrant as this was an isolated incident relating to a single patient on one occasion. She also submitted that he has repeatedly demonstrated that he is a safe practitioner and has shown insight and remorse.

147. As an alternative to no action Ms Parker invited the Panel to impose a Caution Order on the basis that the risk of repetition is low and the Registrant has shown good insight. Ms Parker submitted that if the Panel conclude that a caution would not be appropriate it should impose a conditions of practice order. She further submitted that both a suspension order and a striking off order would be disproportionate.

The Panel’s Approach

148. The Panel considered the oral evidence of the Registrant and the oral submissions made by both parties.

149. The Panel accepted the advice of the Legal Adviser and took into account the HCPC’s Sanctions Policy.

150. The Panel was mindful that the purpose of any sanction is not to punish the registrant, but to protect the public and the wider public interest. The panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of severity.

Decision:

151. The Panel acknowledged that the Registrant, in response to questions from Ms Parker, said that if the events which took place on 30 November 2018 happened again, he would act very differently.

152. The Panel accepted that during the Registrant’s responses he expressed regret and remorse. However, the Panel was not persuaded that they demonstrated that the Registrant had undertaken deep and meaningful reflection during the last 4 years. The Panel made allowances for the stress of giving evidence and the different ways in which individuals express themselves but was left with the impression that the Registrant gave what he considered to be the ‘right’ answers rather than a free flowing account of what he had learnt from the events that took place in 2018. Furthermore, the Registrant spoke in quite high level general terms which gave the impression that his personal reflections on this case were superficial. For example: “I am more structured”; “I take more care”; I am more clear about how I communicate.”

153. Although the Panel was not persuaded that the Registrant has full insight it did recognise that he has engaged with these proceedings and has demonstrated a commitment to paramedic practise by completing a degree in Professional Clinical Practice and by undertaking numerous courses. The Panel also noted that the Registrant has taken considerable steps towards demonstrating remediation. Whilst the Panel concluded that these positive features did not amount to mitigation, it was mindful that they do form part of the background circumstances which the Panel took into account.

154. The only mitigating factor that the Panel was able to identify was the admissions made at the outset of the hearing.

155. The Panel identified the following as aggravating factors:

• The absence of a genuine demonstration of regret and remorse until prompted by his representative;
• The lack of deep and meaningful insight.

No Action

156. The Panel first considered taking no further action. The Panel noted that if it were to take no action the Registrant would be permitted to practise unrestricted. The Panel concluded that, in view of the nature and seriousness of the Registrant’s misconduct, and in the absence of exceptional circumstances, it would be inappropriate to take no action on his registration. Furthermore, it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

Caution Order

157. The Panel went on to consider a Caution Order. The Panel noted paragraph 101 of the Sanctions Policy which states:

“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.”

158. The Panel took the view that the Registrant’s misconduct could not be properly described as limited or minor in nature as it had the potential to cause significant harm to Patient A. The Panel also noted that a Caution Order would impose no restriction on the Registrant’s practice and therefore concluded that it would not provide any protection to the public. The Panel concluded that a Caution Order would also undermine public trust and confidence in the profession. In these circumstances, the Panel concluded that it would be neither appropriate nor proportionate to impose a Caution Order.

Conditions of Practice Order

159. The Panel went on to consider a Conditions of Practice Order. The Panel noted that the Sanctions Policy states at paragraph 107:

“Conditions will only be effective in cases where the registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the registrant has failed to engage with the fitness to practise process or where there are serious or persistent failings.”

160. As the Panel stated in its impairment determination, the Registrant’s misconduct is capable of being remedied provided that there is meaningful reflection and a willingness to learn from what went wrong. The Panel noted that a Conditions of Practice Order requires a willingness on the part of the registrant to comply with them and a determination to learn from serious clinical errors and misjudgements. The Panel concluded that the Registrant has indicated, through his engagement with the regulatory process, that he is committed to returning to practise and is willing to address the concerns regarding his practice. Although the Panel has concluded that the Registrant does not have full insight it was satisfied that he has some insight and there is no indication that he is incapable of developing an appropriate level of insight. The Panel also noted that the Registrant has taken steps towards remediation which in the right clinical setting he will be able to develop further.

161. The Panel concluded that in these circumstances there are conditions that could be imposed which would protect patients and uphold public trust and confidence in the profession whilst providing the Registrant with the opportunity to work towards a return to safe and effective practise as a paramedic. The Panel was satisfied that the Conditions of Practice would be appropriate, workable and measurable.

162. The Panel considered a Suspension Order as an alternative to a Conditions of Practice Order. However, as the concerns raised by the Registrant’s misconduct can adequately be addressed by conditional registration, the Panel concluded that preventing the Registrant from practising on a temporary basis would be unduly punitive.

The Registrar is directed to annotate the HCPC Register to show that, for a period of 2 years, from the date that this Order takes effect (“the Operative Date”), you, Mr Wesley Weathers, must comply with the following conditions of practice:

1. You must promptly inform the HCPC if you take up employment as a registered paramedic.

2. You must place yourself and remain under the supervision of an approved paramedic workplace mentor registered by the HCPC and supply details of your supervisor to the HCPC within 14 days of undertaking employment.

3. You must work with your approved paramedic workplace mentor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:

• communication with colleagues and appropriate delegation of responsibility
• clinical assessment and decision making
• identifying areas of clinical risk and signs of patient deterioration
• taking and recording of pertinent patient observations at appropriate intervals
• appropriate transportation and safe discharge of patients for ongoing care

4. Within a month of you undertaking work as a paramedic you must forward a copy of your Personal Development Plan to the HCPC.

5. You must meet with your approved paramedic workplace mentor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

6. You must allow your approved paramedic workplace mentor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

7. You must maintain a reflective practice profile in relation to the points identified above, in condition 3, in your Personal Development Plan and must provide a copy of that profile, outlining your progress, to the HCPC on a three-monthly basis.

8. You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work as a paramedic;

B. any agency you are registered with or apply to be registered with as a paramedic (at the time of application); and

C. any prospective employer you approach to undertake work as a paramedic (at the time of your application).

9. You must promptly inform the HCPC if you cease to be employed as a paramedic or take up any other employment as a paramedic.

10. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

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 Application:

1. Ms Nagesh made an application for an 18 month Interim Conditions of Practice Order to cover the 28 day appeal period and, if necessary, any appeal on the grounds that is in the interests of the public protection and the wider public interest.

2. Ms Parker did not oppose the application.

3. The Panel accepted the advice of the Legal Assessor that an interim order will only be justified, if it is necessary for the protection of members of the public, is otherwise in the public interest or is in the interests of the Registrant himself.

4. The Panel determined that an Interim Conditions of Practice Order is necessary for the same reasons that the substantive order was imposed. The Registrant’s fitness to practise is impaired and therefore an Interim Conditions of Practice Order is necessary to protect the public from the ongoing risk of harm. The Panel was also satisfied that an Interim Conditions of Practice Order is in the wider public interest. A reasonable and fully informed member of the public would be concerned if there was no interim order in place given that there are ongoing patient safety concerns.

5. The Panel concluded that there was no basis for imposing an interim order in the Registrant’s interests.

6. The Panel determined that the Registrant’s registration should be made subject to an Interim Conditions of Practice Order on the same terms as the substantive order. The Interim Conditions of Practice Order is necessary to protect the public and to maintain and uphold trust and confidence in the profession.

7. The Panel concluded that the Interim Conditions of Practice Order should be imposed for a period of 18 months, as the interim order would continue to be required pending the resolution of an appeal in the event that the Registrant submits a Notice of Appeal within the 28-day period.

Interim Conditions of Practice Order:

The Panel makes an Interim Conditions of Practice Order, that mirrors the conditions contained in the Order above, 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.

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) upon the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Wesley Weathers

Date	Panel	Hearing type	Outcomes / Status
18/10/2022	Conduct and Competence Committee	Final Hearing	Conditions of Practice
25/04/2022	Conduct and Competence Committee	Final Hearing	Adjourned part heard