Rafal Piotrak

Preliminary Matters

 

Documents

 

1. In advance of the hearing, the Panel has received an 8-page service bundle and a 66-page substantive review hearing bundle, which included the written determinations of the Conduct and Competence Committee following the substantive hearing held between 7-16 June 2021, and the review hearing on 15 June 2022.

 

Service

 

2. The Panel was provided with a copy of a notice of today’s substantive review hearing dated 15 May 2023. The notice of hearing specified the date, time, and purpose of today’s hearing.

 

3. The Panel was satisfied that the notice of hearing was sent by email to the Registrant on 15 May 2023. The Panel was provided with a copy of the HCPC Certificate of Registration, which confirmed the Registrant’s email address registered with the HCPC, and a copy of a Microsoft Outlook confirmation of email report delivery dated 15 May 2023.

 

4. The Panel accepted the advice of the Legal Assessor.

 

5. The Panel was satisfied that good service of the notice of hearing had been effected in accordance with Rule 13 of the (Conduct and Competence Committee) (Procedure) Rules 2003 as amended (“the Rules”).

 

 

Application to proceed in the absence of the Registrant

 

 

6. Ms Welsh submitted that all reasonable steps have been taken to serve the notice of hearing on the Registrant. Therefore, the Panel should exercise its discretion to proceed with the substantive review hearing in the absence of the Registrant. Ms Welsh referred the Panel to the HCPTS Practice Note: Proceeding in the absence of the Registrant. Ms Welsh submitted that the Registrant did not attend the substantive hearing of this matter or the first review hearing. She submitted that there has been no response from the Registrant to the notice of hearing and that there has been no engagement by the Registrant with the HCPC since the imposition of the Suspension Order.

 

7. Ms Welsh submitted that it was clear from the Registrant’s actions that he had voluntarily absented himself from this hearing. Ms Welsh further submitted that this was a mandatory statutory review of a Suspension Order and that it was in the public interest for the review hearing to proceed today. Ms Welsh reminded the Panel that the overriding purpose of fitness to practise proceedings is to ensure public protection.

 

8. The Panel accepted the advice of the Legal Assessor who referred the Panel to Rule 11 of the Rules, the HCPTS Practice Note: Proceeding in the absence of the Registrant, and the relevant guidance from the cases of R v Jones (Anthony) [2004] 1 AC 1HL and GMC v Adeogba [2016] EWCA Civ 162.

 

9. The Panel noted that the Registrant was given the required notice of today’s hearing He was informed of the powers available to the Panel at this hearing. He was also informed of his right to attend the hearing and/or be represented. In the circumstances, the Panel was satisfied that all reasonable efforts have been made by the HCPC to inform the Registrant of this hearing.

 

10. The Panel noted that the Registrant has not responded to the notice of hearing and has not sought an adjournment. The Panel was satisfied that the Registrant has waived his right to attend and/or be represented and has voluntarily absented himself from the hearing. Given the Registrant’s lack of engagement with these proceedings, the Panel was further satisfied that an adjournment was unlikely to result in the Registrant’s attendance on a future occasion.

 

11. The Panel was mindful that there would be some disadvantage to the Registrant if the review hearing proceeds in his absence, however, this must be balanced against the public interest in proceeding with this mandatory, statutory review of an existing Suspension Order.

 

12. The Panel therefore decided that it was fair and in the public interest to proceed with this substantive review hearing in the absence of the Registrant.

 

 

 

Background

13. The Registrant had been a Paramedic in Poland and had moved to the UK to take up employment with East Midlands Ambulance Service NHS Foundation Trust (“EMAS”) at the time of the allegation.

 

14. Upon starting his employment with EMAS the Registrant completed his 6-week development course and progressed to mentored shifts on the road. The Registrant had three mentors during his transition period, all of whom reported concerns regarding his performance. The Registrant’s probation period was extended and an Action Plan was implemented in February 2018.

 

15. In May 2018, the Registrant was placed under an 8-week formal capability plan and was provided with additional On 16 July 2018 the Registrant became registered as a Paramedic with the HCPC.

 

16. A capability meeting took place on 25 July 2018, following which the Registrant continued to receive support, but concerns were still raised in respect of his

 

17. On 10 September 2018, the HCPC received a referral from EMAS regarding the Registrant’s fitness to practise.

 

18. The Registrant’s case was the subject of a hearing before a panel of the Conduct and Competence Committee (“the substantive hearing panel”) on 7-16 June Allegations of impairment of fitness to practise by reason of lack of competence were considered. The Registrant did not attend the hearing and was not represented. The only information from the Registrant was a communication to the HCPC in which he stated:

 

“Hello, my Name is Rafal, I Just to work as a student paramedic in Scunthorpe, I like to tell I cannot come to hearing about my pin Number cos I have no money to travel to London, At the moment I working as a Ambulance Care Assistant with Amvale Lt, Medical private company. EMAS not give me a chance to be paramedic I needed more Time to improve my English and clinical skills its difficult to me to do that on short term. I cannot protect myself, emas leave me without any support, even working as a emergency care assistant I did suggest that but they don’t,

 

I like to be paramedic in future in UK but if I Will be well prepared for that. Im not agree for example my canniulation skills was poor, and couple diffrent skills, I expect EMAS send me to education Centre to improve my skills, I ask you to keep my pin Number please, At the moment I study Medical books in my spare Time, I give myself couple of years to improving and come back as a paramedic in UK, give me a chance I can prof my skills by anybody, RAFAL PIOTRAK”

19. At the substantive hearing of this matter, the HCPC called evidence from a number of members of staff from EMAS who had interacted with the Registrant and/or observed his practice, including:

 

• LB, Paramedic, EMAS,
• GO, Duty Operations Manager, EMAS
• MJ, Paramedic, EMAS,
• AD, Clinical Practice Tutor,

 

20. The factual allegations, with the exception of certain particulars (as set out above), were found proved.

 

21. The substantive hearing panel concluded that the statutory ground of lack of competence was established. It gave the following reasons in its written determination:

 

“The Panel considered that in this case it has heard from a number of different witnesses about the Registrant’s performance. The context of this case is important background. The Panel has heard that a number of people who qualified in Poland as paramedics were recruited to EMAS. However, there was no understanding by EMAS of the role of a paramedic in Poland. Information subsequently obtained, after the paramedics had been provided with supernumerary posts, has revealed this role to be very different to its English equivalent. Concerns regarding the Registrant’s competence to act as an autonomous paramedic in England do not single the Registrant out as AD explained that the Registrant was far from being the worst of this intake, and that for the majority of the recruits’ equivalence was not found.

Evidence has been heard that the Registrant was provided with an extended training programme, which lasted well in excess of three months that would normally be offered to new recruits to EMAS. He was provided a number of mentors, each of whom, although adopting different approaches, made clear that they expended effort in trying to help the Registrant reach the required standards of a HCPC registered

 

 

paramedic. The Registrant also received clinical management support from LB and KT.

The measures described indicate that EMAS provided substantial support to the Registrant, and that any shortcomings in his practise cannot be said to have arisen as a result of a lack of support or supervision. Rather it appears that the expected knowledge and skills, of both a language and clinical nature were not demonstrated. More than one witness has described how they found the Registrant’s professional performance to be unacceptably low in respect of a number of his patients.”

22. The substantive hearing panel found that the Registrant’s fitness to practise was currently impaired by reason of his lack of competence. It gave the following reasons in its written determination:

 

“In terms of determining the personal element, the level of insight shown by the Registrant is central to a proper determination of this issue, along with his current competence and whether deficiencies have been remedied. The Panel in exercising its professional judgment to assess the Registrant’s insight have considered his correspondence with the HCPC in 2019. However, it notes that there has not been any meaningful update to that, given that the Registrant has not attended, nor provided any updated information or submitted any statements regarding his current professional practice.

The Panel has not been provided with any evidence of attempts to remediate the deficiencies in his practice. Time has elapsed since the Registrant was referred to HCPC but there has been no corresponding communication in terms of what improvements, if any, have been made in his practise during this intervening period. Accordingly, all the Panel has before it, is the assertion by the Registrant that some of his clinical skills, such as cannulisation, are not sub-standard and the more nuanced position set out by multiple witnesses to the Registrant’s deficiencies concerning how to communicate his ability to act autonomously and take the lead, despite intensive supervision and oversight.

The Registrant indicated in his e-mail on 30 July 2019, that he may need a ‘couple of years’ before reaching the required standard for a paramedic in this country. However, the panel are without any indication as to what stage the Registrant has now reached, or if any progress has

 

 

been made at all. The role of a paramedic in this country is one where a Registrant would be required to take the lead in respect of communicating, assessing and treating patients. A paramedic may visit a person when they are at their most vulnerable and the potential consequences of his failings, on his patients, the reputation of the profession and the confidence that the public have in its regulator are all considerations that the Panel takes into account in making its decision as to current impairment.

In terms of the likelihood of a repetition of the Registrant’s behaviours, the Panel without evidence of improvement concerning his confidence, ability to act autonomously, and remedy the lack of competence in communicating with patients and making complete and appropriate handovers to hospital staff, cannot assess if these deficiencies have been remedied.

The Panel find both the personal and the public component to be engaged in this case. The Registrant, perhaps through no fault of his own, was unfamiliar with the expectations of the role that EMAS had in mind for him, but has conceded in effect that the standards were not one that he was able to meet in 2018. Further, that without evidence that there has been improvement and that progress has been made in meeting those standards, that the public’s confidence in the profession would be undermined if a finding of impairment were not made.

The Registrant did not have skill-based competencies that were required, such that this affected his ability to communicate effectively with patients in the course of his work as a registered paramedic or make safe handovers of patients to hospital. While some of his failures may have been exacerbated by his natural shyness, the inability to undertake assessment and communicate with patients or professional colleagues in hospital in effecting a handover are deficiencies which do not allow safe practice. Without knowing that these deficiencies have been remedied the Panel has little choice but to find current impairment.”

23. Having found that the Registrant’s fitness to practise was currently impaired, the substantive hearing panel considered what, if any sanction to impose.

 

24. The substantive hearing panel set out the aggravating and mitigating factors it

identified as follows:

 

“The Panel noted that had the Registrant worked without supervision, there was a risk to patient safety on the basis that a complete patient assessment and patient handover would not have been communicated to the hospital

 

 

staff. Further, this is a case in which the Registrant did not ask for help, or admit where he was struggling in relation to clinical findings, until expressly asked.

As mitigating factors, the Panel took into account that the Registrant was offered a post and recruited for a job by EMAS. They conducted a recruitment exercise where the difference between practise from a paramedic in Poland, and in England was not explained. The Registrant has exhibited some insight in acknowledging that the role and standards are different in England and Poland and that it would take him some time to reach those standards. All the witnesses indicated that the Registrant over the course of the year he worked at EMAS, he exhibited a positive attitude which demonstrated his desire to learn. The Panel also took into account that the Registrant has not had any previous fitness to practise concerns found against him”.

25. In its written determination, the substantive hearing panel stated:

 

“The Panel considered that as a professional, the Registrant ought to have sought help when it was appropriate to do so. It took into account that his personality may not have assisted him with this, as he was described as “shy”. It took into account that there were no attitudinal failings and that the issues raised as a lack of competence could be remediated with more learning, experience and confidence gained.

Where the Panel is not helped is a lack of up-to-date information from the Registrant. The Registrant did indicate his desire and willingness to learn in order to reach the standards of a HCPC registered Paramedic which he acknowledged he was not at in 2018/9. However, it has no way of knowing whether the learning, experience and confidence that his Paramedic colleagues recommended has been obtained. It cannot assess his clinical English language vocabulary at this moment in time and whether his communication and confidence have improved so as to allow him to practise safely without restriction.”

26. The sanction imposed by the substantive hearing panel was a Suspension Order for a period of twelve months.

 

27. The substantive hearing panel made recommendations as to information which it considered would assist a future panel at the review hearing, which were:

 

• Written confirmation that the Registrant still wishes to pursue a career as a HCPC registered Paramedic;

 

• Course certificates, showing the completion of training in clinical communication, addressing both patient assessment and effective patient handovers;

 

• Certificates evidencing any other relevant Continuing Professional Development;

 

• Any testimonials from those for whom the Registrants works in a clinical setting; and

 

• Reflections in writing, demonstrating his insight into his lack of competence, its potential effect on his patients and his profession.

 

First substantive review hearing on 15 June 2022

 

28. A substantive review hearing took place on 15 June 2022.

 

29. The Registrant did not attend the hearing and was not represented.

 

30. On 13 June 2022 he sent an email to the HCPC in which he stated:

 

            “Hi I’m sorry I cannot attend meeting I’m working. English health system cross              me already, not give me chance”

 

31. The first substantive review hearing panel found that the Registrant’s fitness to practice remained currently impaired by reason of his lack of competence. It provided the following reasons for its decision:

 

            “35. At the original hearing the Registrant did not participate. The original Panel           commented in its determination about the position it faced in the absence of         evidence or up to date information from the Registrant. At this review hearing,                    the Registrant’s non-engagement has continued. The only change in                      circumstances is that the Registrant has now been suspended from practice for                twelve months and his email dated 13 June 2022, as referred to above.

 

36. The Panel regretted that the Registrant has not attended the hearing today or provided up to date information to this Panel. He has not engaged   substantively with the HCPC in the period since the substantive hearing in                 June 2021. This Panel has no new or up to date information from the              Registrant, for example about his current circumstances or any action he                    may have taken towards remedying his lack of competence.

 

37. The Panel considered that the information which the original Panel recommended the Registrant should provide to assist this Panel was               comprehensive and detailed. However, the Registrant has not provided any              of the suggested information, including not providing confirmation that he                        still wishes to pursue a career as an HCPC registered Paramedic.

 

38. The Panel is not able to assess whether the deficiencies in the Registrant’s clinical competencies which were identified by the original                        Panel, such as the inability to undertake assessment and communicate with patients or professional colleagues in hospital in effecting a handover, have   been addressed, but has no evidence to confirm that they have. As the                      original Panel stated, such deficiencies do not allow safe practice and the                            Panel agrees that the Registrant would present a risk if permitted to practise without restriction.

 

39. This Panel is not able to assess whether there has been any change or development in the Registrant’s level of insight, but concluded that the terms             of the Registrant’s recent email of 13 June 2022 suggest that there has not.

 

40. The Panel noted in particular the following findings of the original Panel with which it agrees:

 

“The Registrant indicated in his e-mail on 30 July 2019 that he may need a ‘couple of years’ before reaching the required standard for a paramedic in this country. However, the panel are without any indication as to what stage the Registrant has now reached, or if any progress has been made at all. The role of a paramedic in this country is one where a Registrant would be required to take the lead in respect of communicating, assessing and treating patients. A paramedic may visit a person when they are at their most vulnerable and the potential consequences of his failings, on his patients, the reputation of the profession and the confidence that the public have in its regulator are all considerations that the Panel takes into account in making its decision as to current impairment”.

41. Given these circumstances, this Panel agrees with the findings of the         original Panel in concluding that there remains a risk to service users and                          that the Registrant’s fitness to practise is currently impaired in respect of the         personal component of impairment.

 

42. The Panel is further satisfied that to permit a Paramedic with the     level of deficiencies in competence identified in the findings of the original                                    Panel would undermine public confidence in the Paramedic profession and            its regulation. The Panel therefore also finds impairment of fitness to practise                    in respect of the public component of impairment.”

 

32. The first reviewing panel determined that the appropriate order was a further 12-month period of suspension. It provided the following reasons for its decision:

 

    “43. Having concluded that the Registrant’s fitness to practise is impaired,             the Panel next considered its powers at this review hearing. The Panel                 considered the available sanctions in ascending order of seriousness. Its                   starting point was that the issues found proved at the original hearing put                   patients at risk. The risk of repetition identified by the original Panel remains unaddressed.

 

    The Panel was satisfied that, given the Registrant’s lack of engagement in                   this review process, that to take no action, to mediate or to issue a caution                 to the Registrant would not provide the necessary public protection or                  address the public interest. The Panel concluded that a conditional order                   would not be appropriate in circumstances where there has been no contact from the Registrant and where there is no evidence before this Panel that                  the Registrant’s lack of competence has been addressed. Further, given the lack of engagement from the Registrant, the Panel could not have                                confidence that the Registrant would engage or comply with conditions of                   practice.

 

    The Panel considered carefully whether a further period of suspension                   would be appropriate. The Panel was mindful that it is not able at this review   hearing to consider making a striking off order under Article 29(5) of the                      Health Professions Order because the Registrant has not been continuously suspended for a period of two years.

 

    The Panel determined that the appropriate order is that a further period of              suspension be imposed from the date when the current order expires. The    Panel concluded that 12 months is the appropriate period. This will allow the Registrant a further opportunity to address the issues relating to his                 professional competence and to re-engage with the HCPC process. The                              Panel strongly urges the Registrant to do so.

 

    This Panel considered the information which is likely to assist a future review        Panel remains the same as recommended by the original Panel, namely:

 

• Written confirmation that the Registrant still wishes to pursue a career as a HCPC registered Paramedic;

 

 

• Course certificates, showing the completion of training in clinical communication, addressing both patient assessment and effective patient handovers;

 

• Certificates evidencing any other relevant Continuing Professional Development;

 

• Any testimonials from those for whom the Registrants works in a clinical setting;

 

• Reflections in writing, demonstrating his insight into his lack of competence, its potential effect on his patients and his profession.”

 

Submissions

 

33. Ms Welsh referred the Panel to the substantive review hearing bundle and set out the background and chronology of this matter.

 

34. Ms Welsh also referred the Panel to the HCPTS Practice Note: Review of Article 30 Sanction Orders. She submitted that the guidance makes clear that in practical terms, there is a persuasive burden on the Registrant to demonstrate that he has addressed the concerns identified by the previous panels.

 

35. In short, Ms Welsh submitted that since the Registrant’s email of 13 June 2022, nothing has changed. She submitted that there is no new information available to this Panel. In particular, the Registrant has failed to demonstrate insight into his failings and has not provided any evidence of steps take to remediate the deficiencies in his practice. Ms Welsh submitted that the Registrant’s fitness to practise remains currently impaired in relation to the personal component of impairment.

 

36. Ms Welsh further submitted that a finding of current impairment was also required in relation to the public component of impairment in order to maintain public confidence in the paramedic profession.

 

37. Ms Welsh submitted that the appropriate and proportionate order was a further period of suspension. Ms Welsh invited the Panel to consider a further period of three months. She submitted that this would provide the Registrant with the opportunity of engaging and addressing the recommendations of the two previous panels. She submitted that it would also mean that at the next substantive review hearing, the Registrant would have been subject to a period of suspension of at least two years and therefore the next reviewing panel would also have the option of imposing a Striking Off order if deemed appropriate.

 

 

 

Decision

 

 

38. The Panel received and accepted the advice of the Legal

 

39. The Panel was mindful of its powers upon a review of a Suspension Order under Article 30(1) of the Health Professions Order 2001 and had regard to the guidance contained in the HCPTS Practice Note: Review of Article 30 Sanctions Orders, the HCPTS Practice Note: Impairment and the HCPC Sanctions Policy

 

40. The Panel noted that its task is to conduct a comprehensive review of the current order on the basis of the information available today. It must not seek to go behind the findings of the previous panels.

 

41. The Panel must first decide whether it finds the Registrant’s fitness to practise to be currently impaired by reason of lack of competence.

 

42. The Panel noted that in accordance with the guidance in the case of Abrahaem v GMC [2008] EWHC 183 (Admin), the persuasive burden to satisfy the Panel of fitness to practise at a review hearing is upon the Registrant.

 

43. The Panel further noted that if it found the Registrant’s fitness to practise to be currently impaired, then it should consider what steps to take in respect of the current order in accordance with its powers under Article 30(1) of the Health Professions

 

44. The Panel was reminded that as this is a lack of competence case, the power in Article 29(6) to make a Striking Off Order is not available to the Panel at this review hearing because the Registrant has not been continuously suspended for a period of two years.

 

45. In reaching its decision, the Panel carefully considered all of the documents provided to it in the substantive review hearing bundle and the submissions made on behalf of the HCPC by Ms Welsh. The Panel noted that no submissions or evidence had been provided on behalf of the The Panel further noted that the last contact from the Registrant appears to be his email of 13 June 2022.

 

46. The Panel first considered whether the Registrant’s fitness to practise remains currently impaired.

 

 

 

 

 

47. The Panel carefully considered the reasoning set out in the written determinations of the substantive hearing panel and the first reviewing panel. The Panel noted that the Registrant did not participate in either of those hearings. The Registrant’s non-engagement with these proceedings has continued.

 

48. The Registrant has not followed the recommendations of either the substantive hearing panel or the first reviewing panel. He has not provided any information to this Panel in relation to his current circumstances and has not confirmed that he still wishes to pursue a career as an HCPC registered paramedic. Nor has he provided any evidence of insight or steps taken to remediate his lack of competence.

 

49. In the Panel’s view, it was regrettable that the Registrant has not engaged in this process. In the absence of any new information, the Panel is not able to assess whether the deficiencies in the Registrant’s clinical practice, which were identified by the substantive hearing panel, have been addressed. Similarly, the Panel is not in a position to assess whether there has been any development in the Registrant’s level of insight.

 

50. In the circumstances, the Panel agrees with, and adopts, the findings of both the substantive hearing panel and the first reviewing panel concluding that there remains a risk of harm to service users. The Panel was therefore satisfied that the Registrant’s fitness to practise remains currently impaired in respect of the personal component of impairment.

 

51. The Panel next considered the public component of impairment. Having regard to the level of deficiencies in the Registrant’s competence identified in the findings of the substantive hearing panel, this Panel concluded that a finding of current impairment was required to maintain public confidence in the Paramedic profession.

 

52. Having found that the Registrant’s fitness to practise remains currently impaired by reason of his lack of competence, the Panel next considered its powers as set out in Article 30(1) of the Health Professions Order.

 

53. The Panel considered the available sanctions in ascending order of restrictiveness.

 

54. The Panel was satisfied that to take no action or to impose a Caution Order would not provide the necessary level of public protection given that the risk of harm identified by the Panel remained unaddressed. The Panel was further satisfied that neither course of action would meet the wider public interest considerations.

 

 

 

 

 

 

55. The Panel next considered whether it would be appropriate to replace the Suspension Order with a Conditions of Practice Order. The Panel concluded that such an order would not be appropriate where there has been no engagement from the Registrant and no indication of his willingness to comply with conditions of practice.

 

56. The Panel therefore considered whether a further period of suspension would be appropriate. The Panel determined that a further short period of suspension would allow the Registrant an opportunity to engage in this process and demonstrate that he has addressed the issues relating to his lack of competence.

 

57. The Panel concluded that a further period of three months’ suspension, to take effect from the date on which the current order expires, would be the appropriate and proportionate order. In reaching this decision, the Panel was mindful that it is not able at this review hearing to consider making a Striking Off Order under Article 29(5) of the Health Professions Order because the Registrant has not been continuously suspended for a period of two years. However, at the next review hearing, all options, including a Striking Off Order, will be available to the reviewing panel.

 

58. The Panel therefore encourages the Registrant to engage in this process, and in particular to provide the information suggested in the recommendations of the first review hearing panel (as set out above at paragraph 32 of this determination).

ORDER:

The Registrar is directed to suspend the registration of Rafal Piotrak for a period of 3 months.

The Order imposed today will apply from 14 July 2023

This Order will be reviewed again before its expiry on 14 October 2023.

No notes available

History of Hearings for Rafal Piotrak

Date	Panel	Hearing type	Outcomes / Status
04/09/2023	Conduct and Competence Committee	Review Hearing	Struck off
14/06/2023	Conduct and Competence Committee	Review Hearing	Suspended
15/06/2022	Conduct and Competence Committee	Review Hearing	Suspended
07/06/2021	Conduct and Competence Committee	Final Hearing	Suspended