Matthew Lee Taylor

Preliminary Matters
Service and Proceeding in Absence
1.     The Panel was satisfied that reasonable efforts had been made to serve the Registrant at his registered email address. The Panel found that notice of today’s hearing had been properly served on 26 January 2023 and 6 April 2023, the latter with the shortened hearing dates, on the Registrant at his registered email address in terms of the rules of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”). The HCPC had also written to the Registrant at this registered postal address on 16 March 2023 asking him to contact the HCPC to confirm his email address. There has been no response.

2.     The Panel noted that the hearing bundles had been served on the Registrant by post and that the post office receipt dated 21 March 2021 shows they have been received and signed for at the Registrant’s registered postal address by someone signing with “Taylor”. The panel was satisfied that service has been carried out in accordance with the rules, which do not require proof of delivery.

3.     The Panel next considered Mr Greany’s application to proceed in the Registrant’s absence. He advised that the email notices sent to the Registrant were sent on 26 January 2023 and 6 April 2023. There has been no response. It is the Registrant’s duty to provide, and keep updated, a registered contact address to the HCPC.

4.     Mr Greany referred to the Rules, the HCPTS Practice Note on “Proceeding in the Absence of the Registrant”. He advised the Panel about the efforts made by the HCPC to serve the Notice of Hearing and that it had been sent to the Registrant’s email address as registered on the HCPC Register. He referred to the service bundle and the efforts made by the HCPC in March and April 2023 to contact and engage with the Registrant. He submitted that the Registrant had not requested an adjournment or indicated that he would attend. There was a public interest in proceeding and witnesses were in attendance. He submitted that it appeared that the Registrant had chosen not to attend.

5.     The Panel was aware that its discretion to proceed in absence is one which should be exercised with care. The Legal Assessor gave advice and referred the Panel to the HCPTS Practice Note and to the case of Adeogba v GMC [2016] EWCA Civ 162. This case makes clear that the first question the Panel should ask is whether all reasonable efforts have been taken to serve the Registrant with notice. The discretion whether to proceed must be exercised having regard to all the circumstances of which the Panel is aware, with fairness to the Registrant being a prime consideration, but balanced with fairness to the HCPC and the interests of the public.

6.     The Panel agreed to proceed in the Registrant’s absence as it is satisfied that it is fair and in the public interest to do so. In reaching this decision, the Panel noted that the Registrant has not responded to the notice and he has not asked for an adjournment. It concluded that he has chosen to absent himself and has waived his right to attend. He is entitled not to attend. The Panel balanced fairness to the Registrant with fairness to the HCPC and the public interest in proceeding. The Panel has taken account of the fact that this is a substantive hearing and that all reasonable efforts have been made by the HCPC to engage with the Registrant. An adjournment would serve no purpose and there are witnesses in attendance. In these circumstances, the Panel was satisfied that it was appropriate and fair to proceed in the Registrant’s absence. The Panel will draw no adverse inference from the Registrant’s absence.  

Amendment
7.     Mr Greany applied to amend the Allegation by adding the words “and/or 8” to particular 10. He submitted that this was a minor amendment that added in a missed reference in particular 10 to particular 8 when referring to the grounds of misconduct and/or lack of competence. This proposed amendment was sent to the Registrant by email on 16 March 2023 and he has not responded, either to agree or to object.

8.     In the circumstances, the Panel having heard and accepted legal advice, was satisfied that it was fair and appropriate to allow the proposed minor amendment. This amendment does not alter the nature or gravity of the allegation, and it does not give rise to prejudice to the Registrant. The application to amend was accordingly granted.
Background

9.     The Registrant is a Registered Paramedic who worked for Care UK as an agency worker in an out of hours General Practice (‘GP’) in a paramedic role in Gloucester.

 

10. On 18 November 2019 a complaint was made by Service User A which related to the level of care provided to her by several different medical practitioners, including the Registrant. The background to the complaint is that Service User A attended Gloucester Royal Hospital as she was pregnant and had been experiencing bleeding and pain. A scan revealed that she had been carrying twins, neither of which had a heartbeat and a decision was taken to manage the termination medically rather than surgically and she was discharged home with the appropriate medication.

 

11. Service User A took the medicines as directed and soon began to feel very unwell. She returned to the sexual health clinic just over a week later where clinicians other than the Registrant conducted another scan and assured her that whilst they had seen a fibroid looking mass there were no retained products of conception (‘RPOC’). Throughout this time Service User A suspected that there were RPOC but relied on the judgement of the
health care professionals. Several days after the second scan she contacted 111 who made an appointment for her at the Care UK GP Out of Hours treatment centre. It was at this point that Service User A encountered the Registrant.

 

12. During this appointment, Service User A alleged that the Registrant was inappropriate with his language and the care provided towards her. Service User A raised her concerns and made a complaint. Person A was the partner of Service User A at the time.

 

13. Further, and separately, on 11 January 2020, the Registrant attended Service User B while staffing the out of hours GP service. Service User B, who provided a witness statement as part of the HCPC investigation, describes the Registrant as behaving unprofessionally towards him as well as misdiagnosing his symptoms. Service User B then raised a complaint about the Registrant.

 

14. As a result of the complaints made, an investigation was commenced by Care UK and an audit of a selection of the Registrant’s consultations were undertaken. As a result of this, further concerns were raised, this time in relation to the Registrant’s treatment of Service Users C, D and E, as set out in the allegation. These allegations are supported by the clinical records and the expert evidence of Dr Clarke who has examined those records.

 

15. The witnesses in the case are:

 

Nicholas Earnshaw - Advanced Nurse Practitioner and Emergency Care Practitioner, who conducted the audit.
Service User A
Service User B
Person A
Dr Vince Clarke, Expert witness

Summary of Evidence
Service User B

16. Service User B (SU B) gave evidence. He is a retired teacher. He referred to and adopted his witness statement. He told the Panel about his attendance at the Out of Hours GP service on 11 January 2020.

17. SU B told the Panel that he had become acutely and suddenly unwell on 10 January 2020 and had contacted the Out of Hours service. He met with the Registrant who introduced himself as a Paramedic. SU B said he thought that he was to see a doctor and so asked the Registrant if he could see a doctor. He said that the Registrant replied that he was greatly offended and then gave him an indignant “diatribe” which SU B said seemed to him to be disproportionate and unprofessional. He described the Registrant as “throwing a hissy fit”.

18. SU B stated that he described his symptoms and that the Registrant did not carry out any physical examination. He said that the Registrant had swiftly diagnosed a urinary tract infection, “a water infection”. SU B said he was not content with that diagnosis given his symptoms and said that he had politely insisted on seeing a doctor. He told the Panel he was concerned that he had required to push so hard to see a doctor. A doctor then examined him and asked for samples. As SU B could not provide them he was asked to return the next day and provide samples.

19. SU B said that he had continued to feel very unwell overnight and visited his GP the next day, 11 January 2020, with samples. He was immediately referred to a gastroenterologist and received various scans. SU B was then urgently admitted to hospital and diagnosed with a suspected bowel obstruction. He said he had received treatment and made a good recovery after several days in hospital. SU B made a complaint about the Registrant on 13 February 2020. He said that his concern was that the potential consequences of a misdiagnosis were catastrophic.

Expert Witness - Dr Vince Clarke
20. Dr Clarke took the affirmation and gave evidence. He referred to his detailed expert report dated 26 February 2023. In that report he expresses his expert opinion in respect of Service Users A to E.

21. In relation to Service User A, in Dr Clarke’s opinion, the Registrant failed to adequately consider Service User A’s recent medical history and to document findings from assessments and observations. He states that, if those were not actually performed by the Registrant, that represented practice which fell significantly below the standards expected of a reasonable paramedic.

22. In relation to Service User B, Dr Clarke’s opinion was that if the Panel were to find the facts as presented by Service User B to be true, then it would be conduct by the Registrant which fell below the standards expected of a Registered Paramedic.

23. In relation to Service User C, Dr Clarke’s opinion was that the Registrant’s conduct was a significant departure from the standards expected of a Registered Paramedic. In his opinion the Registrant was required to check the Patient Group Directions (PGDs) for the patient, which is standard practice, and not to have done so was a significant departure from the standards expected of a paramedic.

24. In relation to Service User D, in Dr Clarke’s opinion, the Registrant’s conduct fell below the standards expected of a paramedic. He states that there appeared to be no clear record of evidence of a urinary tract infection via urinary analysis, although the record notes ‘no urine sample to test’. Further, the clinical records do not document the dosage and/or duration of the medication prescribed. Dr Clarke concludes that there appears to have been a failure by the Registrant to confirm that Service User D, a 4 year old child, met the PGD exclusion/inclusion criteria for the administration of Trimethoprim. Dr Clarke concludes that, in his opinion, in relation to Service User D the Registrant appears to have failed to follow the PGD for Trimethoprim, which, if found, constitutes a significant departure from the standards expected of a paramedic.

25. In relation to Service User E, in Dr Clarke’s opinion, the Registrant appears to have failed to follow the PGD, failed to adequately document the consultation and failed to refer Service User E to pregnancy services following vaginal bleeding at seven weeks of pregnancy. In his opinion, these failures indicate a level of practice which falls below the standards expected of a Registered Paramedic. He states that maintenance of full and thorough clinical records is a reasonable expectation of a paramedic and that a patient who is presenting with vaginal bleeding at seven weeks of pregnancy may have underlying obstetric issues which would benefit from referral to a specialist.

26. Further, in relation to Service User E, Dr Clarke’s opinion is that the Registrant appears to have failed to follow the PGD for Nitrofurantoin, which, if found, constitutes a significant departure from the standard expected of a Registered Paramedic. In his opinion, a failure to appropriately refer a patient presenting with vaginal bleeding at seven weeks of pregnancy constitutes a significant departure from the standards expected of a Registered Paramedic.

27. Dr Clarke explained the need for a paramedic to follow PGD’s when supplying certain medicines, and that paramedics supply but do not “prescribe” medicines, unless they have specific prescribing qualifications. He said he had checked and the Registrant did not have any prescribing qualifications and so he required to follow the PGDs. He said that there is no room for deviation from PGDs and that, if a paramedic was unsure about symptoms, such as abdominal pain, they should take a full history and the patient should be referred on for further tests and assessment.

Witness - Nicholas Earnshaw
28. Mr Nicholas Earnshaw (NE) gave evidence. He is an Advanced Nurse Practitioner (ANP) and Emergency Care Practitioner (ECP) who at the time worked at the GP out of hours service at Gloucestershire. He referred to and adopted his witness statement as his evidence in chief.

29. As NE was the ANP / ECP Lead he dealt with the complaint received from SU A. He then conducted an audit of the Registrant’s work and clinical notes and stated that he had completed this audit using the standard Care UK audit tool with the support of three colleagues. In his statement, NE explained that the audit system was one based on guidelines from the Royal College of GPs, and the purpose was to ensure that a clinician is delivering care of sufficient quality and identify dangerous practice. The clinician receives feedback.

30. NE said that he looked at a sample and found that nine out of 24 cases were compliant with a score of 80% or higher. During this investigation, NE completed an audit in order to identify any other causes for concern and to evaluate the Registrant’s performance. He stated that the audit was able to evaluate the quality of the clinical notes made by the Registrant and the audit scored his overall clinical notes as 64%. 80%, 52% and 40%, suggesting that there was cause for concern. NE said that he had looked at less than 5% of the Registrant’s overall case load.

31. NE stated that after reviewing these results, he conducted three further audits to gain a more detailed review of the Registrant’s performance. These cases were not specifically chosen, but rather one was generated by the software for the routine monthly audit, and the other two were chosen at random from the Registrant’s cases from January 2020. These audits identified three more cases of concern. NE’s audit then led to concerns regarding the Registrant’s treatment of Service Users B, C, D and E which are now set out in the particulars of the allegation.

32. NE told the Panel about the meeting with SU A on 10 March 2020 in response to her complaint. He said he had not met the Registrant face to face, nor corresponded with him. NE said that he had been required to go through the Agency to seek a statement from the Registrant and that the only statement the Registrant gave was the email he sent, via the Agency, on 9 December 2019 in response to the complaint by SU A. NE said that, normally, a clinician is expected to provide a reflective statement, but he was not aware that the Registrant had ever been asked for, or provided, such a statement.

33. NE submitted his report on 5 June 2020 and the Registrant was removed from patient facing duties and referred to the HCPC.

Amendment
34. Prior to the Panel rising to consider facts, Mr Greany submitted that it was appropriate to amend the allegation at particular 1 e) to correct a typographical error in the spelling of the drug “Nitrofuratin” to “Nitrofuratoin”. Secondly, in particular 7 b) the word “prescribed” had been used and technically it was a “supply” and not a prescription. He sought to substitute the word “supplied” for “prescribed” and he submitted that these changes did not alter the gravity of the allegation or cause any prejudice to the Registrant. They also reflected Dr Clarke’s evidence.

35. The Panel, having taken legal advice as to the interests of justice and fairness to the Registrant, decided that neither of the suggested amendments altered the nature or gravity of the allegation. The second amendment more properly reflected the evidence of Dr Clarke. The Panel noted that the term “supplied” has been used elsewhere in the allegation and in the evidence. The Panel concluded that no prejudice to the Registrant arises in these circumstances, and it accordingly allowed the amendment as sought.

Service User A
36. Service User A (SU A) gave evidence and adopted her witness statement as her evidence in chief. She told the Panel about her circumstances in November 2019 when she had contacted the out of hours GP service. She was pregnant and had experienced vaginal bleeding and was feeling unwell. She had consulted her GP on 14 October 2019 and found that she had suffered a miscarriage. She had been prescribed a drug by her GP but had continued to feel very unwell.

37. SU A told the Panel that she had called the out of hours GP service and got an appointment with the Registrant on 3 November 2019. She attended the appointment with her then partner, Person A. She said that her appointment lasted only about five minutes. She stated that the Registrant carried out only a urine test and took her temperature and conducted no further examinations and did not refer her on to a specialist. She thought she should have been more thoroughly examined and then referred. She said that the general conduct and behaviour of the Registrant had been very unprofessional. She said that the Registrant had spent a lot of time swearing and referring to unprotected sex. He had asked Person A if he had thought about getting “the fucking snip” and then said that his wife and friends “fucking love it”. He had also said that her temperature may be due to her wearing a “bin bag coat”.

38. SU A said that she did not question him as she was so unwell. She said that her recollection of the Registrant’s conduct and language was still very clear. She said that the Registrant had been very insensitive, dismissive and disinterested, and she was shocked by his behaviour. She felt that she was not taken seriously by the Registrant. He had also supplied her with a 7 day drug course of Nitrofurantoin, which she later learned from Mr Earnshaw should only have been for 3 days. She felt that it was now more difficult to trust the medical profession as a result of the Registrant’s behaviour. She felt that it had been obvious that something was wrong but that the Registrant had simply told her to contact her GP.
39. SU A made a complaint about the Registrant by email on 13 November 2019 and told Mr Earnshaw what had happened and she subsequently meet with him to discuss the complaint.

Person A
40. Person A is the former partner of SU A and he attended the appointment with the Registrant on 3 November 2019. He referred to and adopted his witness statement. He told the Panel about the appointment and stated that he had been present throughout the appointment which lasted about five minutes.

41. Person A told the Panel that the Registrant had been unprofessional and dismissive. The Registrant had only taken SU A’s temperature and done a urine test. Perso A said that the Registrant told him to get “the snip” and also referred to unprotected sex and SU A wearing a “bin bag coat” and he had been shocked as it was so unexpected. He said that SU A had been so unwell and Person A could not believe the Registrant’s comments and behaviour. He said he could not believe what he was hearing from the Registrant, he said he was “speechless.” He said that the Registrant had used the “F” word many times, and it seemed that the Registrant was “having a laugh”.

42. He was aware that SU A had subsequently made a complaint about the Registrant. Person A said he felt that the Registrant’s behaviour had been inappropriate and had undermined the NHS.

Closing Submissions
43. Mr Greany closed the case for the HCPC. He referred to schedule of evidence that he had supplied to the Panel cross referencing the evidence to the particulars of the allegation. He referred to the expert evidence from Dr Clarke which he reminded the Panel was unchallenged evidence and to which the Registrant had never responded.

44. Mr Greany submitted that particulars 1,3, 5, 6 and 7 were supported by the expert evidence. Particulars 1 and 2 and were supported by the evidence of SU A and Person A, both of whom he submitted were honest and reliable witnesses, and some of SU A’s evidence was fully corroborated by Person A. Mr Greany invited the Panel to find the whole allegation proved. He submitted that SU B’s evidence supported particular 4 and was reliable and should be accepted. He asked the Panel to find the whole allegation proved.

45. The Legal Assessor reminded the Panel that the onus of proof rests on the HCPC and that the civil standard applies, namely the balance of probabilities. The Registrant need prove nothing.

Reconvened 3 July 2023
46.   The Panel reconvened on 3 July 2023. Before concluding its deliberations on the facts the Panel was advised by Ms Hollos for the HCPC that the Registrant had on 1 June 2023, after the conclusion of the hearing on facts in April 2023,  contacted the HCPC. He had read the transcripts of the April hearing, which he did not attend, and he had advised the HCPC that his written responses made to earlier hearings at the HCPC had not be made available to the Panel.  On 5 June 2023, the Registrant had asked that the written representations and reflections that he had previously made for the HCPC Investigating Committee in 2020 be made available to the Panel at this stage.  Ms Hollos advised that this material is not normally made available to the Panel at the final hearing unless it is specifically requested by the Registrant, and no such request had been received prior to the April 2023 hearing.

47.   Ms Hollos submitted that this material was admissible but that the Panel should bear in mind that it is untested and is not evidence from the Registrant under oath. Further, she submitted that it had not been tested as it had not been put to any of the witnesses the Panel had heard from in April 2023. Ms Hollos invited the Panel to prefer the evidence of the live witnesses to the untested statements from the Registrant.

48.   The Panel accepted the advice of the Legal Assessor. He advised the Panel to approach this material with caution bearing in mind that it is untested and has not been put to any of the witnesses the Panel has heard from. He reminded the Panel that the Registrant, not having attended the April 2023 hearing, had not been questioned to any extent in respect of this material which included his written statements and reflections. Further, he reminded the Panel that it was not clear the extent to which the expert had had sight of this material from the Registrant.

49.   The Panel decided that this material appeared to be relevant and that, despite its lateness, it was fair to admit it at this stage. It is not opposed by the HCPC. It was a matter for the judgment of Panel to decide what, if any, weight it should attach to this untested material. It noted that some of the material related to concerns that no longer appear to be part of the allegation before it, and that any such material will be wholly disregarded by the Panel.
 
Decision on Facts
1.     Between 2 November 2019 and 3 November 2019, in relation to Service User A, you:

 

a) Did not obtain and/or record an adequate clinical history - Not proved

 

b) Did not undertake an adequate physical assessment - Not proved

 

c) Recorded that you had undertaken a physical assessment of Service User A when this was not the case - Not proved

 

 

50.   The Panel had regard to the expert report, the clinical records as well as the evidence of SU A and Person A. The Panel also had regard to the written statements and reflections from the Registrant in the bundle provided in June. SU A said that she considered she had not been assessed or examined as she had expected. Both Person A and SU A said that the appointment took five minutes. SU A was understandably unwell and in distress at the time and she said in her evidence that she was expecting a more thorough examination and a referral.

51.   The Panel acknowledged SU A’s perspective, and it found that she was open and did her best to recall the details of the examinations undertaken. It was, however, mindful that she was unwell and distressed at the time, and the Panel must assess and look objectively at all of the evidence before it, including the contemporaneous clinical records made by the Registrant. The Panel also considered that neither SU A or Person A are clinicians and may not have an awareness of appropriate examinations that should be conducted under these circumstances. The Panel also noted in the Registrant’s submissions from the June 2023 bundle, “I have to become focussed and succinct in my examination to keep from running behind. This could be perceived as not a thorough examination”.

52.   The Panel carefully considered the clinical notes made by the Registrant and noted from the clinical records that the appointment took place between 13.43 and 14.21, some 38 minutes. Given the notes made by the Registrant, which it found were not particularly brief or cursory, the Panel found that an assessment had been undertaken. The notes contain a history of SU A and her recent miscarriage. They also contain details of the symptoms and presentation of SU A, as well as the examinations that the Registrant recorded he had undertaken. The Panel noted that the Registrant refers in the clinical notes to “Murphy’s sign” and “abdo soft and warm to touch”. These assessments require some physical examination. Whilst SU A states in her evidence that no “additional” physical examination took place, it was not clear what she meant by “additional” examination. She appeared to accept that some examination took place, but not to the extent she had expected.

53.   Dr Clarke states in his opinion that not undertaking certain physical assessments/observations would be a reasonable approach in the case of Service User A’s presenting condition, and adds that:- “The above assessments/observations [Murphy’s sign, Obturator Sign, Bowel Sounds] would be of some benefit in raising the index of suspicion in undifferentiated abdominal pain presentations but would not be mandated in every presentation of abdominal pain.”

54.   Dr Clarke’s report states that the clinical notes contain a record that a physical assessment took place, but he notes that SU A states in her evidence that no such examination took place. That, with respect of Dr Clarke, does not fully reflect SU A’s position about a lack of “additional” examination. Further, his conclusions at paragraphs 4.1.3 and 4.1.4 appear to involve an assumption that the examinations recorded by the Registrant were not, in fact, done, and that the Registrant therefore made false clinical records.

55.   The Panel do not agree that such a conclusion can properly be drawn from the evidence before it. It found that there was a lack of sufficient or cogent evidence to reach the conclusion that the Registrant did not conduct the examinations which he recorded in the clinical notes. There was no evidence that those notes were falsified by the Registrant. The Panel also noted that these were examinations that Dr Clarke stated were not, in any event, necessarily “mandated”.

56.   The Panel found, on the balance of probabilities, that the clinical records demonstrate that the Registrant did take a history and conducted an examination of SU A, albeit SU A states that no “additional” examination took place. The Panel found that there was a lack of evidence of the extent to which the Registrant obtained or recorded a clinical history, and the extent to which he conducted physical assessments. That evidence is required in order for the Panel to make a finding as to the “adequacy” of the matters alleged at 1 a), 1 b) and 1 c) which are all closely connected.

57.   On the balance of probabilities, the Panel concluded that there was a lack of sufficient or cogent evidence to prove particulars 1 a), b) and c). Whilst it accepts SU A’s evidence, there remains a significant lack of clarity around the central issues, being the extent and adequacy of the assessments and examinations undertaken by the Registrant. The Panel concluded that particulars 1 a), 1 b) and 1 c) are not proved.
 

Allegation 1 d) - Demonstrated poor clinical reasoning in that you incorrectly diagnosed Service User A with a urinary tract infection when she was suffering from septic miscarriage – Not Proved

 

58.   The Panel next considered particular 1 d). It was mindful of the expert evidence from Dr Clarke where he states at 4.1.2:- “In a female patient who has recently undergone treatment for miscarriage and now presents with abdominal pain and discharge, as well as feeling generally unwell, potential complications associated with the pregnancy must be considered above all other potential causes. In my opinion, it is the history of the complaint that indicates an obstetric, rather than a urinary tract, pathology. In my opinion, there is no particular clinical assessment or examination finding that would have led the reasonable paramedic to suspect a septic miscarriage… The Registrant appears to have been reliant solely on the urine dip to diagnose a urinary tract infection whilst not being cognisant of the presenting complaint or recent history.…NICE guidelines suggest that the examination of the patient with suspected urinary tract infection should include blood pressure and palpation for flank or suprapubic tenderness and pelvic or abdominal masses.”

59.   The Panel noted that there is no record of blood pressure being taken and no record of the particular physical examinations Dr Clarke describes. However, as stated  above, the Panel has found that an examination and assessment by the Registrant of SU A did take place. 

60.   The Panel noted that the Registrant stated in his written submissions received in the June 2023 bundle that:- “I have neglected to document a blood pressure which I cannot explain as I always carry out full observations on all patients. I can only put this down to the fact the whole consultation was uncomfortable... This is not an excuse, but this happens frequently in OOH…On reflection, at this point I should have consulted with a specialist in Obstetrics and Gynaecology (O&G) or senior primary care clinician. Having reflected on this case at length, I recall that all clinicians were not able to contact the on-call O&G team on that day, which I have also omitted from the documentation. This is by no means an excuse or justification, I most certainly should have attempted to, or sent the patient to the emergency department with a letter to that effect.”

61.   The Panel was mindful that, as Dr Clarke has stated in his expert report, the making of a diagnosis of septic miscarriage or UTI can involve multiple factors and is often challenging in the pre-hospital environment, requiring specialist assessment that often can only be provided in a hospital.

62.   On balance, the Panel decided that it cannot find that the Registrant demonstrated “poor clinical reasoning” as alleged in these particular circumstances. The Panel found that, on balance, there was not sufficient, cogent evidence to prove this particular. The Panel noted that there is a conflict in the evidence which it cannot resolve. This particular is found not proved.
 

Allegation 1 e) - Supplied Service User A with Nitrofurantoin 100mg, twice daily for 7 days when this was not in accordance with the Patient Group Directive (PGD) which specifies a 3-day course – Proved

 

63.   The Panel next considered particular 1 e). The Panel considered the PGD and the clinical notes. The Registrant supplied the drug for a 7-day course, in breach of the 3 day course set out in the PGD. He was required to adhere to the PGD and the clinical records show that he did not do so. The Panel found, on the basis on the facts as stated, that this particular is proved.
 

Allegation 2 - Between 2 November 2019 and 3 November 2019, you did not communicate professionally during a consultation with Service User A, in the presence of Person A, in that:

 

a) You said to Service User A: “do you know what happens when you have unprotected sex” or words to that effect; - Proved

 

b) You said to Person A: have you thought of having “the fucking snip” or words to that effect; - Proved

 

c) In relation to b), you said to Person A: that your wife and friends “fucking love it” or words to that effect; - Proved

 

d) You said to Service User A: “It won’t help wearing a bin bag coat” or words to that effect - Proved

64.   Particular 2 a) - The Panel found that SU A’s evidence regarding these comments was reliable, clear, credible and cogent. SUA and Person A both clearly stated that the Registrant said these words to them, or words to that effect. The Registrant states “I ...felt it was an appropriate question to ask in the interest of sexual health promotion. I can see that, as an intelligent and well-educated patient, this has been perceived with negative connotations and I am sorry, as that was not intended.” The Panel therefore found this particular is proved.

65.   Particular 2 b) - SU A said that these words were used by the Registrant. This evidence is consistent with and is supported by the evidence from Person A, whom the Panel found were credible in this respect. Both Person A and SU A said that the Registrant had used the “F” word repeatedly during the appointment. The Panel decided that this is proved.

66.   Particular 2 c)  - SU A’s evidence was that the Registrant said these words to her and she said she was shocked. Person A could not recall this comment or words to that effect, when asked directly about this. The Registrant denies this comment and the written submission in the June 2023 bundle he states:- “I have not had a vasectomy, so the comments alleged regarding this are misquoted. Even if I had undergone a vasectomy, I would never see that a discussion of this ilk would be professional or appropriate.” Given that the Panel found Person A could not recall the comment being made to him by the Registrant, it concluded that this was not proved.

67.   Particular 2 d) – SU A in her evidence states that the Registrant said to her “my temperature was high but that it won’t help wearing a bin bag coat”. Person A’s evidence was consistent with that. The Registrant in his June 2023 bundle states “The patient was wearing a big black coat and had a hot water bottle underneath it, something many patients do, it was also late November. The patient had a slight fever, which I said may not be helped by wearing a big black coat, trying to comfort the patient that some symptoms may have been due to environmental factors. I have clearly been perceived as insensitive by the patient, for which I am deeply sorry." The Panel preferred the evidence of Person A and SU A and found this proved.
 

Allegation 3 - On or around 5 January 2020, in relation to Service User C, you:

 

a) Supplied a five day course of Ciprofloxacin to Service User C when this was not clinically indicated and/or was not in accordance with the PGDs – Proved

 

b) Did not supply a three-day course of Nitrofurantoin in response to Service User C’s clinical presentation and/or as permitted by the PGDs – Proved

 

68.   Particular 3 a) & b) -  The Panel noted that the Registrant states in the submission in the June 2023 bundle:
“The patient in question had advserse [sic] reactions to Nitrofurantoin and, having consulted her attendance history, the patient had a history of lower urinary tract infections (UTI). The patient stated that Ciprofloxacin was the only antibiotic that relieves the bothersome symptoms. Having reviewed the notes, I can see that I did not document this, and I admit that is an error on my part. This omission is something I admitted to when the issue was first raised. On this, and many other occasions working for this provider, the patient group direction(PGD) suite was not available for contemporaneous review. I believed that the Ciprofloxacin PGD inclusion criteria included UTIs, and in the absence of them for consultation, I looked in the British National Formulary… it does include UTIs as an indication. I was not aware I had given this medication outside of the PGD suite until I received an email from the complainant informing me of this. I reflected on this issue at the time, refreshed my knowledge of the Ciprofloxacin PGD and responded accordingly. I had thought the matter to be settled internally.”

69.   The PGD is clear that this is not clinically indicated for the presentation of SU C. This is supported by Dr Clarke who was clear there is no latitude for clinical judgment by the paramedic and that a PGD must be adhered to. The Registrant did not supply either drug in accordance with or as permitted by the PGD and the Panel found these particulars proved.
 

Allegation 4 - On or around 11 January 2020 you demonstrated poor clinical reasoning in that you incorrectly diagnosed Service User B with a urinary tract infection when they were suffering from a bowel obstruction. - Not proved

 

70.    The Panel was mindful of the words used in this particular – “poor clinical reasoning” and “incorrectly diagnosed”. The Panel heard from SU B and it found that his evidence was open, and that he sought to assist the Panel so far as he could. It heard that SU B insisted on being seen by a GP. He was seen by the Registrant and then by a GP, Rosemary Ginns, who later reported in the email of 4 June 2020 to witness NE that:- “The consultation I had with the patient afterwards led me to think that a diagnosis of gastroenteritis was more likely than a UTI, and I discussed this with the colleague concerned at the time.”

71.   The Panel considered the evidence from Dr Clarke who notes, correctly, that there is an absence of clinical evidence. He states:- “In order to make a preferred diagnosis of urinary tract infection, the Registrant would have needed to gain a full and thorough history from Service User B.” It is not clear from the evidence before the Panel the extent of the history taken, and clinical notes such as they are, were completed, understandably, by the GP who also saw SU B. Dr Clarke appears to reach his view based on an assumption that SU B is correct in stating that a proper history was not taken by the Registrant. The Panel did not find that is a conclusion that it can properly draw from the evidence.

72.   It is not clear to the Panel to what extent the Registrant was able to complete his assessment of SU B before he agreed to his request to be seen by a doctor. SU B was then assessed by the GP. It is not clear from the evidence that, in such circumstances, the Registrant had, at that point, made any “diagnosis” of a UTI.

73.   In these circumstances, the Panel concluded that there was a lack of sufficient evidence to prove, on the balance of probabilities, that the Registrant “demonstrated poor clinical reasoning” or that he “incorrectly diagnosed”. As Dr Clarke states, there is a lack of evidence of clinical records. Indeed, it appears from the evidence that when SU B insisted on seeing a doctor, the Registrant appropriately escalated the matter to a doctor. The Panel found that there was a lack of evidence to prove this particular, which it found is not proved.
 

Allegation  5 - On or around 11 January 2020, in relation to Service User D, you

 

a) Did not record and/or investigate a possible urinary tract infection via urinary analysis – Proved

 

b) Did not maintain adequate records in that you did not record the dosage and/or duration of the medication supplied – Proved

 

c) Did not follow the Trimethoprim PGD in that you did not ensure and/or record that Service User D met the inclusion and/or exclusion criteria for administration – Proved

 

74.   The Panel had regard to the clinical records and accepted the expert evidence of Dr Clarke with regards to Service User D. He states:-
 

“4.1.8 There appears to be no clear record of evidence of a urinary tract infection via urinary analysis, although the record notes ‘no urine sample to test’. The clinical record does not document the dosage and/or duration of the medication prescribed. Service User D is noted as being three years of age. There appears to have been a failure by the Registrant to confirm that Service User D met the PGD inclusion criteria for the administration of Trimethoprim, i.e., that they were aged five years or over. There appears to have been a failure by the Registrant to confirm that Service User D did not meet the exclusion criteria for the administration of Trimethoprim, i.e., that they were a child aged under five, who should have been referred to a GP for further investigation.

 

4.1.9 In relation to Service User D, in my opinion, the Registrant appears to have failed to follow the PGD for Trimethoprim, which, if found, constitutes a significant departure from the standards expected of a Registered Paramedic.

 

75.   Particular 5 a) – This is proved as it is supported by the clinical record which shows that there was “no urine sample to test”. As a matter of fact, this is proved.

76.   Particular 5 b) - The clinical records do not record the dosage or duration, as pointed out by Dr Clarke. The Panel found this proved.

77.   Particular 5 c) - The Panel considered the records and it accepted Dr Clarke’s analysis and his opinion. Although not specifically recorded in the clinical notes that the drug was supplied, the Panel formed the view that the clear implication arising from the clinical notes is that the Registrant supplied this drug to SU D, a 4 year old child. That is contrary to the PGD, which states that the drug must be supplied only to children 5 years and above. The Registrant had not ensured or recorded that the SU D met the criteria. This particular is found proved.

Allegation 6 - On 11 January 2020 you did not refer Service User E to the local early pregnancy advisor services following a presentation of vaginal bleeding at seven weeks pregnant – Proved

78.   The Panel had regard to the clinical notes and the evidence of Dr Clarke who states :-
“4.1.10 In relation to Service User E, in my opinion, the Registrant appears to have failed to follow the PGD, failed to adequately document the consultation and failed to refer Service User E to pregnancy services following vaginal bleeding at seven weeks pregnant.”

79.   This particular is focussed specifically on referring SU E to the local early pregnancy advisor. The records indicate that there was no such referral and therefore, as a matter of fact, this is found proved.
.

Allegation 7 - On or around 11 January 2020, in relation to Service User E, you:

 

a) Did not follow the PGD for Nitrofurantoin in that you did not ensure and/or record that Service User E met the exclusion and/or inclusion criteria for administration - Proved

 

b) Supplied Nitrofurantoin to a pregnant patient when the PGD stated this as an exclusion criteria – Proved

 

c) Did not record the dosage and/or duration of the course of medication – Proved

 

80.  The Panel had regard to the PGD, the clinical notes and Dr Clarke’s expert evidence which states :-

 

“4.1.11 In relation to Service User E, the Registrant appears to have failed to follow the PGD for Nitrofurantoin, which, if found, constitutes a significant departure from the standards expected of a Registered Paramedic. Failure to appropriately refer a patient presenting with vaginal bleeding at seven weeks pregnancy constitutes a significant departure from the standards expected of a Registered Paramedic”.

81.   Particular 7 a) & 7 b) – The Panel accepted the analysis of Dr Clarke and it found that the Registrant did not follow the PGD. He supplied the drug to SU E, who was pregnant, and that supply was contrary to the PGD criteria for that drug which is not to be supplied to pregnant women. The Panel found that the Registrant did not follow the PGD, did not ensure or record the exclusion for administration, and that he supplied the drug to SU E. The Panel found these particulars proved.
82.   Particular 7 c) – There is no record in the clinical notes of dosage or duration of the course of medication. This is proved.
 

Allegation 8 - In relation to the matters set out at paragraph 1e), 3a) and 7b) you acted outside of your scope of practice – Proved

 

83.   The Panel found that the Registrant was confined to working within the PGD which must be adhered to. Dr Clarke states that :- “4.4.1 It is a legal requirement for those using PGDs to follow them as written. There is no scope for deviation from a PGD.” The Panel noted that the Registrant has stated in the June 2023 bundle that “Care UK PGD suite was never available onsite, internet access was restricted so there was no means of accessing online versions, so I was frequently using the advice of GP’s onsite or the BNF.” However, by failing to adhere to the PGD, and in the absence of any qualification allowing the Registrant to prescribe, the Panel concluded that in respect of particulars 1 e), 3 a) and 7 b) the Registrant acted outside his scope of practice.

Submissions on Grounds and Impairment of fitness to practise.
84. Ms Hollos submitted that the findings in the allegations were serious and amounted to misconduct. She submitted that the following allegations breached the HCPC Standards conduct, performance and ethics :-

 

·        Particulars 2(a), 2(b) and 2(d)

Standard 1.1. You must treat service users and carers as individuals, respecting their privacy and dignity.
Standard 2.1. You must be polite and considerate.

Standard 2.2. You must listen to service users and carers and take account of their needs and wishes

·        Particulars 1(e), 3(a), 3(b), 5(c), 7(a), 7(b), 8

Standard 3.1 You must keep within your scope of practice by only practising in the areas you have appropriate knowledge, skills and experience for.

·        Particulars 5(a), 5(b), 7(c)

Standard 10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

·        Particular 6

Standard 3.2. You must refer a service user to another practitioner if the care, treatment or other services they need are beyond your scope of practice.

85. Ms Hollos submitted that the particulars amounted to misconduct or a lack of competence, however, it was a matter for the Panel. She submitted that the supply of medication outside the scope of the PGD and his practice was a breach of the HCPC Standards conduct, performance and ethics  3.1.

86. On impairment of fitness to practise, Ms Hollos submitted that the Panel should find impairment on both the personal and public components of impairment of fitness to practice. She submitted that SU A and Person A had suffered harm to their mental health due to the Registrant’s conduct, and he had breached fundamental tenets of the profession. The findings were wide ranging and required a finding of impairment on public interest grounds.

87. Ms Hollos submitted that the Registrant had made some apologies and reflected in respect of SU A.  The Registrant had also provided a number of character references from 2020 which are contained in the June 2023 bundle.

Decision on Grounds and Impairment of fitness to practise.
88. The Legal Assessor referred the Panel to the guidance on misconduct in Roylance v GMC (no 2) [2000] 1 AC 311 where misconduct was defined as:- “a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. On impairment he referred the HCPTS Practice Note in impairment and to the guidance in the case of CHRE v NMC and Grant [2011] EWHC 927 (admin). He advised the Panel to consider the central issues of insight, remorse, risk of repetition, remediation as well as the wider public interest.

89. The Panel considered its findings.  There is no evidential basis for any finding of lack of competence as the Panel does not have evidence of a fair sample of the Registrant’s practice. Indeed, it has in the evidence bundle positive results of audits of the Registrant’s cases from Dr Kelly at Coventry and Rugby GP Alliance Extended Hours service, dated 25th November 2020.

90. The Panel accepted the legal advice and considered misconduct and the guidance in Roylance. It agreed with the submissions from Ms Hollos as to the breaches of the HCPC code of conduct, performance and ethics. In addition, the Panel found further breaches of Standard 1(in its entirety), Standard 2.6, Standards 4.4, 4.6 and 4.8, and  Standards 8.1 and 8.6 of the Standards of Proficiency for Paramedics.

91. The Panel considered the allegations in the round.  The Registrant has been found to have behaved inappropriately in this communication with service users, kept inadequate records, failed to use the PGD appropriately and consequently acted out with the scope of his practice. The Panel found that those deficiencies individually, and taken together, were serious. Each had the potential to cause harm to service users. The Panel found that the conduct, as found proved, fell short of what would have been proper in the circumstances and amounted to misconduct.

92. The Panel found that its findings in respect of particulars 2 a) and 2 d) were not of themselves serious and did not amount to misconduct. These particular incidents were unfortunate and caused some offence to SUA and Person A. However, these incidents appeared to the Panel to be examples of the Registrant poorly handling and misinterpreting the situation, and where he was  possibly misunderstood, but this was not conduct that was so serious as to amount to misconduct.

93. The Panel next considered impairment of fitness to practice.  The conduct although serious, is capable of being remedied. The Panel considered the Registrant’s insight and remorse. The Panel considered the material submitted by the Registrant. He has responded in some detail to the allegations about SU A and he has apologised and demonstrated some insight into his conduct. He has reflected and has stated:- “ I am truly and deeply sorry for any offence, stress and negativity caused to all service users involved. I have had many years to reflect on these allegations, and I do think about them every day.”

94. The Panel found that the Registrant has shown some, but limited insight into his conduct.  He has not fully accepted and acknowledged his conduct and its impact on service users, the profession and the wider public. His reflections at times seek to justify his conduct and to deflect responsibility. He has sought to excuse his conduct in respect of the PGD which he states was not available. The Panel found that the Registrant has not reflected sufficiently on the PGD allegations, which are a significant aspect of the findings, and which had the potential to cause real harm to service users. The Registrant has not provided any reflection on the HCPC Codes and where and why he breached them.

95. The Registrant has not attended this hearing and has not given evidence.  The Panel has no evidence before it about any steps the Registrant has taken to remedy his conduct, including his communication towards service users, his deficient record keeping, and his approach to the PGD within the scope of his practice. In all these circumstances, given the limited insight demonstrated and the lack of any evidence of remediation, the Panel concluded that there is a real risk of repetition of the misconduct.

96. The Panel was mindful of the analysis of impairment in the Grant case.  It found that the Registrant has in the past acted, and is likely  in the future to act in a way so as to put service users at unwarranted risk of harm; that he has  in the past brought, and is likely in the future to bring, the profession into disrepute; and that he has in the past breached, and is likely in the future, to breach fundamental tenets of the profession, namely respecting service users and keeping within the scope of his professional practice. The Panel concluded that the Registrant’s fitness to practice is therefore currently impaired.

97. The Panel considered the wider public interest. It decided that the conduct proved is wide ranging covering conduct with service users, deficient record keeping and failing to adhere to the PGDs.  These are all matters which a reasonable member of the public would be most concerned about, each placing service users at real risk of harm. The Panel decided that not to find impairment in these circumstances would undermine public confidence in the profession and the regulator, and would fail to uphold and declare proper professional standards.

Submissions and Decision on Sanction
98. Ms Hollos remained neutral as to sanction and referred the Panel to the HCPC Sanctions Guidance.  She submitted that insight by the Registrant was an important consideration as well as an acknowledgement of failings.

99. The Legal Assessor referred the Panel to the HCPC Sanctions Guidance and reminded it that it must act proportionately, applying the least restrictive sanction that is sufficient and appropriate to protect the public and the wider public interest. 

100.             The Panel found the following mitigating factors :-
·       No evidence of concerns before or since this allegation
·       Expressions of apology, remorse and some reflection
·       Limited, developing insight into the impact of his communication skills
·       An audit of his record keeping showing satisfactory compliance
·       Positive testimonials, albeit some years old and not dealing directly with the allegations

101.              The Panel found the following aggravating factors :-
·       Potential to cause serious harm to patients including children by not following PGDs
·       Evidence of behaviour that brought the profession into disrepute
·       Lack of evidence of remediation

102.       The Panel decided that the misconduct was too serious to take no action or to impose a Caution Order. The Registrant’s actions had the potential to cause serious harm to service users. Both of these would fail to protect the public and would undermine public confidence in the profession by failing to appropriately mark the misconduct as wholly unacceptable.

103.       The Panel next considered imposing a Conditions of Practice Order.  It was mindful of the guidance in paragraphs 106 and 107 of the HCPC Sanctions Guidance.  These are serious and wide-ranging findings that placed the public at risk of harm and damaged the reputation of the profession.  The Registrant has not engaged in this hearing and the Panel has found there is limited, albeit developing, insight. There is no evidence of any remediation. Given the lack of engagement in this hearing, the Panel could not be satisfied that the Registrant is genuinely committed to resolving the concerns raised and the panel cannot be confident that he would do so. In these circumstances, the Panel decided that conditions of practice would not be proportionate, realistic or workable and not be sufficient to protect the public.

104.   The Panel next considered imposing a Suspension Order. It considered that in light of the seriousness of the misconduct and the lack of remediation that this sanction would proportionately and appropriately mark the conduct as wholly unacceptable. The Registrant has some insight and the misconduct is serious, although the findings are not at the most serious end of the spectrum of misconduct.

105.   The Panel decided that a nine month Suspension Order was appropriate and proportionate to mark the seriousness of the Panel’s findings but short enough to encourage the Registrant to further develop his  insight and remediation. That will serve to protect the public, uphold proper standards and maintain confidence in the profession. The Panel concluded that a Striking Off Order would go further than was necessary and would be disproportionate in light of its findings, and would be punitive

106.   The Panel considered that a future reviewing panel may be assisted by the following:-
·       The Registrant’s attendance at any subsequent review
·       Submissions on reflections regarding the Panel’s findings
·       Evidence of remediation particularly regarding interpersonal skills
·       Up to date references and testimonials

The Registrar is directed to suspend the registration of Matthew Lee Taylor for a period of nine months from the date this Order comes into effect.

Interim Order

1. In light of its findings on Sanction, the Panel next considered an application by Ms Hollos for an Interim Suspension Order to cover the appeal period before the Sanction becomes operative.

 

2. The Panel accepted the advice of the Legal Assessor who referred it to the HCPTS Practice Note on Interim Orders. He reminded the Panel that an Interim Order must be necessary to protect the public, or be otherwise in the public interest. The Panel must act proportionately and balance the interests of the Registrant with the need to protect the public.  The Panel may also want to consider whether it remained appropriate and fair to proceed in the absence of the Registrant.

 

3. The Panel was mindful of its earlier findings and concluded that it was fair to proceed in the absence of the Registrant as there has been no material change in circumstances. It decided that an Interim Order is necessary to protect the public during the appeal period. The Panel decided that that it would be wholly incompatible with its earlier findings and with the Suspension Order Order imposed to conclude that an Interim Suspension is not meantime necessary for the protection of the public or otherwise in the public interest. Accordingly, the Panel concluded that an Interim Suspension Order should be imposed on both public protection and public interest grounds.

 

4. The Panel decided that it appropriate for that Interim Order to be imposed for a period of 18 months to cover the appeal period. When the appeal period expires this Interim Order will come to an end unless there has been an application to appeal.  If there is no appeal the Suspension Order will apply when the appeal period expires.

History of Hearings for Matthew Lee Taylor

Date	Panel	Hearing type	Outcomes / Status
29/04/2024	Conduct and Competence Committee	Review Hearing	Suspended
04/04/2024	Conduct and Competence Committee	Review Hearing	Adjourned
03/07/2023	Conduct and Competence Committee	Final Hearing	Suspended
18/04/2023	Conduct and Competence Committee	Final Hearing	Adjourned part heard