Arkadiusz Bodziany
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Allegation
Whilst registered as a Paramedic with the Health and Care Professions Council and employed at East Midlands Ambulance Service NHS Foundation Trust, you:
1. Between May 2017 and January 2018, attended to patients and there were occasions when you did not:
a) undertake a detailed assessment and/or full patient history;
b) recognise signs and symptoms in patients;
c) recognise time critical patients;
d) demonstrate the ability to act as lead clinician;
e) treat patients appropriately;
f) [No evidence offered in relation to this Particular by the HCPC]
g) identify differential diagnosis;
h) [No evidence offered in relation to this Particular by the HCPC]
i) know the different referral pathways for patients.
2. On 13 November 2017, at an assessment day:
a) In relation to an adult ALS scenario:
i. Did not undertake a scene safety assessment;
ii. Did not adequately manage the patient’s airway;
iii. Did not establish the patient was in cardiac arrest;
iv. Did not identify reversible causes;
v. Did not use capnography adequately.
b) In relation to a conscious patient scenario (tension pneumothorax):
i. Did not undertake a scene safety assessment;
ii. Did not identify a time critical patient;
iii. Did not diagnose the patient;
iv. Did not provide adequate treatment to the patient;
v. Did not pre-alert casualty.
c) In relation to a paediatric cardiac arrest scenario:
i. Did not undertake a scene safety assessment;
ii. Stayed present on the scene for too long;
iii. Did not take a BM reading;
iv. Did not adequately consider reversible causes.
d) In relation to a second Advanced Life Support scenario:
i. Did not adequately use capnography;
ii. Moved the patient;
iii. Did not recognise ECG changes;
iv. Did not understand the concept of reciprocal changes;
v. Did not give adrenaline when it was clinically indicated;
vi. Did not provide an adequate handover;
vii. Did not recognise this as a time critical patient;
viii. Did not manage pain adequately.
e) Did not know the answers for:
i. Normal values of a healthy adult;
ii. Oxygen saturations for COPD (Chronic Obstructive Pulmonary Disorders) patient;
iii. A&P (Anatomy and Physiology) of the heart;
iv. Sympathetic or parasympathetic responses
f) Did not know how to label the heart during the assessment.
3. The matters set out in paragraphs 1 to 2 constitute lack of competence.
4. By reason of your lack of competence your fitness to practise is impaired.
The panel at the Substantive Hearing found the following:
Facts proved: 1a), b), c), d), e), g) and i), 2a) i - v, 2b) i - iv, 2c) i - iv, 2d) i - viii, 2e) i – iv and 2f).
Facts not proved: 1f) and 1h)
Grounds: Lack of Competence
The substantive hearing panel found the Registrant’s fitness to practise to be impaired and a Suspension Order for a period of 12 months was imposed as a sanction. This decision was reviewed on 2 February 2022 and that panel imposed a further Suspension Order for a period of 12 months.
Finding
Preliminary Matters
Service
1. The Panel was provided with a Service Bundle which included:
• a copy of the Notice of Hearing dated 20 December 2022;
• confirmation of the Registrant’s registered email address as it appears on the HCPC Register;
• confirmation of delivery to the Registrant’s registered email address.
2. The Panel was satisfied that the Notice of Hearing had been properly served in accordance with Rule 3 (Proof of Service) and Rule 6 (date, time, and venue) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (as amended) (‘the Rules’).
Proceeding in Absence
3. Having determined that service of the Notice of Hearing had been properly effected, the Panel went on to consider whether to proceed in the Registrant’s absence. The Panel took into account the guidance as set out in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.
4. The Panel determined that it was fair, reasonable, and in the public interest to proceed in the Registrant’s absence for the following reasons:
• The Panel noted that the Registrant did not respond to the Notice of Hearing and therefore there was no explanation for his non-attendance. The Panel also noted that the Registrant did not attend the substantive hearing in February 2021, nor did he attend the first review hearing in February 2022. In these circumstances, the Panel was satisfied that it was reasonable to infer that the Registrant has chosen not to engage in these proceedings. In these circumstances, the Panel concluded that his non-attendance was voluntary and demonstrated a deliberate waiver of his right to attend and his right to participate in these proceedings.
• There had been no application to adjourn and no indication from the Registrant that he would be willing or able to attend on an alternative date. Therefore re-listing this review hearing would serve no useful purpose.
• The Panel recognised that there may be a disadvantage to the Registrant in not being able to make submissions or give oral evidence with regard to his current fitness to practise and his current intentions. However, he was given the opportunity to participate in these proceedings and had not taken up that opportunity. Therefore, as this was a mandatory review, the Panel concluded that the Registrant’s interests were outweighed by the strong public interest in ensuring that the hearing proceeds expeditiously.
Background
5. The Registrant was a registered Paramedic at all relevant times.
6. The Registrant was employed by the East Midlands Ambulance Service Foundation Trust (‘EMAS’) between 27 March 2017 and January 2018. The Registrant had qualified as a paramedic in Poland some ten years earlier. During the intervening period, he had been a resident of the UK and living in the Merseyside area. He had been working as a driver and had not used his paramedic qualification in the UK or elsewhere in the previous ten years.
7. The Registrant underwent the six-week International Paramedic Course to transfer/convert his Polish qualification in order to obtain registration from the HCPC.
8. Upon commencing employment as a paramedic at EMAS, the Registrant was treated as a fully qualified paramedic but was required to undergo a probationary period. During the course of his employment, it became clear that the Registrant did not have the knowledge or experience to carry out his duties. He also lacked confidence and was unable to take the lead as expected of a paramedic professional when attending incidents. The Registrant spent time with a number of mentors and as a supernumerary with a number of paramedics.
9. Serious concerns were raised as to his competence and his ability to treat patients. The Registrant undertook a performance assessment, from which it became clear that his competence fell considerably below the level required of a registered paramedic.
10. The substantive hearing panel concluded that its factual findings amounted to a lack of competence and, with regard to the issue of impairment, stated:
“34. The Panel determined that the Registrant’s fitness to practice is currently impaired. The Panel agreed that the Registrant was in breach of the standards … The Panel had found a lack of competence based on comprehensive evidence. It has not heard from the Registrant and so had not seen any insight from him into his lack of competence. Whilst the Registrant’s lack of competence may be remediable by retraining, it has not seen any evidence that the registrant has attempted to address the deficits in his competence. Thus, the Registrant continues to present a real risk of unwarranted harm to patients if permitted to practice without restriction. The Panel also agrees that the public interest demands a finding of current impairment in this case. The Registrant was operating as a paramedic whilst woefully underprepared to do so. On any view that it is a serious matter which would cause concern to the public.”
11. The substantive hearing panel went on to consider sanction. It stated that:
“…The Panel reminded themselves that they had found that the Registrant had been operating as a paramedic at a level considerably below that which is safe or acceptable. The Panel noted that the Registrant had not engaged with the hearing and had not provided evidence of insight or of training to mediate the deficits in his practice.
…
The Panel concluded that only a suspension order for 12 months would both protect the public from the unacceptable risk of harm that the Registrant posed and meet the public interest in maintaining confidence both in the profession and the HCPC.”
12. The review hearing panel imposed a 12-month Suspension Order and indicated that a reviewing panel would be assisted by the following:
• the Registrant’s engagement by either attending a future review hearing in person or remotely, or by making written submissions to the reviewing panel;
• An up-to-date indication as to the Registrant’s future intentions and whether he wished to remain in the Paramedic profession;
• a reflective piece by the Registrant setting out what went wrong and any measures he had taken or intended to take to remediate his practice.
13. The first review of the 12-month Suspension Order took place on 02 February 2022. The first review panel concluded that the Registrant’s fitness to practice remained impaired. The reasons provided by the first review panel were as follows:
“12. The Panel … noted that the Registrant has not provided any of the material that the panel at the substantive hearing had indicated would be helpful to put before a reviewing panel. In these circumstances, the Panel was of the view that it could not find that any of the concerns raised in the original finding of impairment have been sufficiently addressed. It was alive to the persuasive burden on the registrant to demonstrate at a review hearing that they have fully acknowledged the deficiencies which led to the original finding and has addressed that sufficiently through insight, application, education, supervision or other achievement, and [was] conscious that this had not been done.
13. Accordingly, given the number of deficiencies that had been found as facts proved in the substantive hearing, without an indication that this lack of competence has improved, the Panel was of the view that the Registrant remained impaired and this was both made out on public protection and public interest grounds.”
14. The first review panel went on to consider sanction and provided the following reasons for imposing a further 12-month period of suspension:
“14. … In the absence of any significant or material change in circumstance since the original order was made, the Panel was of the view that no lesser order would provide patient protection. The extent of lack of competence required a restriction on the Registrant’s practice. However, conditions of practice would not be workable because the Registrant has not engaged or demonstrated insight or remediation.
15. The Panel applied the principle of proportionality striking a fair balance between interfering with the registrant’s ability to practise and the overarching objective of public protection. However, in light of the decision made at the substantive hearing that there was a real risk to the public if the Registrant was permitted to practise, and in the absence of any information to indicate a change in circumstances, it was of the view that no other order was sufficient to meet either the need for public protection or the public interest.
16. Given the number of deficiencies and no evidence of engagement, insight and remediation. The Panel was of the view that the current order should be extended for a further period of 12 months so as to allow the Registrant with sufficient opportunity to provide the following:
a) the Registrant’s engagement by either attending a future review hearing in person or remotely or by making written submissions to the reviewing panel;
b) An up-to-date indication as to the Registrant’s future intentions and whether he wishes to remain in the Paramedic profession;
c) a reflective piece by the Registrant setting out what went wrong and any measures he had taken or intends to take to remediate his practice.”
Today’s review
HCPC Submissions
15. Ms Welsh, on behalf of the HCPC, outlined the background circumstances and the history of this case. She referred the Panel to the information which the previous panel had suggested the Registrant may wish to provide to assist this reviewing panel. She reminded the Panel that the Registrant was found by the panel at the substantive hearing to have inadequate competence to be able to practice safely. She submitted that the Registrant’s lack of competence is extensive and fundamental to safe and effective practice. She further submitted that in the absence of any information from the Registrant, there is nothing to indicate that the position has changed since the substantive Suspension Order was imposed.
16. Ms Welsh submitted that had the Registrant been suspended for two years, it would have been open to the Panel to impose a Striking Off Order. However, as the Registrant has not been suspended for a continuous period of two years, she invited the Panel to impose a short period of suspension for three months with a further review.
The Panel’s Approach
17. In undertaking this review, the Panel took into account the documentary evidence and the submissions made on behalf of the HCPC.
18. The Panel accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt, in particular that:
• The purpose of the review is to consider the issue of impairment based on the substantive hearing panel’s findings of fact, the extent to which the Registrant has engaged with the regulatory process, the scope and level of his insight, and the risk of repetition.
• In terms of whether his previous lack of competence has been sufficiently and appropriately remedied, relevant factors include whether the Registrant:
o fully appreciates the gravity of the previous panel’s finding of impairment;
o has updated his skills and knowledge;
o is likely to place service users or colleagues at risk if he were to return to unrestricted practice.
• The Panel should have regard to the HCPTS Practice Note “Fitness to Practise Impairment” and must take account of a range of issues which, in essence, comprise two components:
o the ‘personal’ component: the current competence, behaviour, etc. of the individual registrant; and
o the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.
• It is only if the Panel determines that the Registrant’s fitness to practise remains impaired that the Panel should go on to consider sanction, by applying the guidance as set out in the HCPC “Sanctions Policy” (SP) (March 2019), and the principles of proportionality which require the Registrant’s interests to be balanced against the interests of the public.
Impairment
19. The Registrant was found by the substantive hearing panel to have performed his role as a paramedic at a level which was considerably lower than the standard expected. The shortcomings in his practice included wide-ranging acts and omissions which placed service users at risk of harm. The Panel acknowledged that the Registrant’s lack of competence is, in theory, capable of being remedied. However, the Panel noted that the Registrant did not attend the substantive hearing and did not attend the previous review hearing, nor has he attended today’s review hearing, and no reason for his absence has been provided. Therefore, there is only limited information before the Panel. The Panel was particularly concerned that the Registrant has not responded to the indication from the previous panels as to the information that was likely to be of assistance at the next review hearing.
20. The Panel noted that given the Registrant’s non-engagement with the substantive hearing and subsequent reviews (including today’s hearing), there was no evidence before the Panel that he has made any progress towards recognising the seriousness of his lack of competence, or the impact on his colleagues and service users, nor has the Registrant taken the opportunity to demonstrate that he has adequately remedied his lack of competence or taken appropriate steps towards remediation. In particular, there was no evidence that he understands the level and extent of the deficiencies in his practice and the measures he would need to take to ensure that he is able to meet the required standard. In the absence of any positive evidence of insight and remediation, the Panel was satisfied that there has been no material change in circumstances since the substantive hearing. Therefore, there remains a risk of harm to the health, safety, and well-being of the public, and a significant risk of repetition.
21. The Panel noted that a significant aspect of the public component is upholding proper standards of behaviour. Members of the public would be extremely concerned to learn that a paramedic who is impaired has subsequently demonstrated an unwillingness or an inability to take appropriate steps to acknowledge his lack of competence or take the opportunity to persuade the Panel that he is committed to upholding the high standards expected of registered practitioners. The Panel concluded that, in these circumstances, a finding of no impairment would undermine, rather than uphold and maintain, public trust and confidence in the profession and the HCPC as a professional regulator.
22. Therefore, the Panel was led to the conclusion that the Registrant’s fitness to practise remains impaired based on the personal and public components.
Sanction
23. Having determined that the Registrant’s fitness to practise remains impaired the Panel went on to consider what sanction, if any, to impose.
24. The Panel first considered taking no action. The Panel concluded that, given the nature and seriousness of the Registrant’s lack of competence, which has not been remedied, to take no action on his registration would be inappropriate. Furthermore, it would be insufficient to protect the public, maintain public confidence, and uphold the reputation of the profession.
25. The Panel went on to consider a Caution Order. The Panel noted that a Caution Order will not restrict the Registrant’s ability to practice. As the Registrant has demonstrated no insight into his lack of competence and provided no evidence of remediation, the risk of harm to the public and the risk of repetition remains. Therefore, the Panel concluded that a Caution Order would be inappropriate and insufficient to protect the public and meet the wider public interest.
26. In considering conditions of practice the Panel took into account paragraph 107 of the SP, which states:
“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.”
27. The Panel took the view that the Registrant is either unwilling or unable to provide the information and evidence that was suggested by the previous panels. Although the Panel acknowledged that the Registrant’s failings are capable of being remedied, in the absence of engagement from the Registrant, there was no indication that the Registrant is committed to addressing the issues which led to the previous findings of impairment. In these circumstances, the Panel could have no confidence that he would comply with a Conditions of Practice Order, even if suitable conditions could be formulated. The Panel was aware that the suggestions made by the previous panel are only indicative and do not have any binding authority, unlike conditions which require compliance. However, both involve willingness on the part of the Registrant and a determined effort. In the absence of any evidence that the Registrant is willing and able to remediate his previous misconduct, the Panel concluded that there were no conditions it could devise which would be appropriate, workable, and measurable.
28. The Panel next considered extending the current Suspension Order for a further period. The Panel noted that a Suspension Order would prevent the Registrant from practising during the extended suspension period, which would therefore protect the public and the wider public interest. The Panel also noted that the Registrant has not been suspended continuously for a period of two years and therefore a Striking Off Order is not an available option. Therefore, the Panel concluded that the current Suspension Order should be extended.
29. In determining the length of the Suspension Order, the Panel noted that the Registrant will have been suspended for a period of two years when the current order expires on 03 March 2023. The Panel cannot bind a future reviewing panel, but it took the view that once the Registrant has been suspended for a continuous period of two years it is likely that a Striking Off Order will be imposed unless the Registrant engages with the regulatory process and takes sufficient steps to demonstrate that he is committed to addressing his lack of competence. Therefore, the Panel concluded that this may be the Registrant’s last chance to avoid being struck off the HCPC Register. In reaching this conclusion, the Panel noted that there can be no public interest in subjecting the Registrant and the HCPC to further review hearings after the two-year period has expired when there is no indication that the Registrant has any intention of returning to practice or engaging with the fitness to practise procedures.
30. The Panel took the view that if the Registrant does not take the opportunity to engage with the regulatory process within the next few weeks, it is highly unlikely that he will ever do so. Therefore, the Panel concluded that the extended Suspension Order should be for a short period. The Panel determined that a period of three months will provide the Registrant with sufficient time to read this determination (and the previous determinations) very carefully and decide whether he is willing and able to work towards a return to unrestricted practice, and if so, the steps that he will need to take to remedy his lack of competence. In the event that the Registrant takes positive steps toward remediation, the next review panel may be willing to impose a sanction short of a Striking Off Order.
31. In these circumstances, the Panel concluded that the current Suspension Order should be extended for a period of three months. The Suspension Order will be reviewed shortly before expiry and it is likely that the next review panel will be assisted by:
• The Registrant’s attendance in person or remotely;
• An up-to-date indication as to the Registrant’s future intentions and whether he wishes to remain in the Paramedic profession;
• A reflective statement setting out what went wrong and any measures the Registrant has taken or intends to take to remediate his practice.
Order
The Registrar is directed to suspend the registration of Mr Arkadiusz Bodziany for a further period of 3 months upon the expiry of the existing Order.
Notes
The Order imposed today will apply from 03 March 2023.
This Order will be reviewed again before its expiry on 03 June 2023.
Hearing History
History of Hearings for Arkadiusz Bodziany
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 26/05/2023 | Conduct and Competence Committee | Review Hearing | Struck off |
| 27/01/2023 | Conduct and Competence Committee | Review Hearing | Suspended |
| 02/02/2022 | Conduct and Competence Committee | Review Hearing | Suspended |
| 01/02/2021 | Conduct and Competence Committee | Final Hearing | Suspended |