Raymond Byron

Preliminary Matters

1. The Panel has been convened to undertake a review of a substantive suspension order imposed in respect of the HCPC registration of the Registrant, Mr Raymond Byron, a Paramedic. The suspension order was for a period of 12 months, and it was imposed on 11 August 2023, at the conclusion of the final hearing that had commenced on 8 August 2023. The suspension order is due to expire on 8 September 2024.
Service of the notice of hearing.

2. The Panel was satisfied that email sent to the Registrant on 29 July 2024, informing him of the date and time of the hearing, together with the information that the hearing would be conducted by Microsoft Teams, constituted a valid notice of hearing.

Application to proceed with the hearing in the absence of the Registrant

3. After the Panel announced its decision that it was satisfied that a valid notice of hearing had been served on the Registrant, the Presenting Officer applied for a direction that the hearing should proceed in his absence.

4. In deciding on the application to proceed in the Registrant’s absence, the Panel accepted the advice of the Legal Assessor. It also had regard to the HCPTS Practice Note on the topic. In deciding whether in all the circumstances it would be fair to proceed in the Registrant’s absence, the Panel had regard to the following factors:

• In addition to the notice of hearing sent on 29 July 2024, a HCPC Case Manager sent the Registrant an email on 30 July 2024. That email included reference to the hearing today and reminded him of the guidance given by the final hearing panel reproduced in paragraph 16 below. On 5 August 2024, the Presenting Officer also sent an email to the Registrant, and she also referred to the hearing date and reminded him of the suggestion made by the final hearing panel. The Hearings Officer sent the Registrant and email on 19 August 2024, in which she introduced herself, referred to this hearing and offered him the opportunity of a test Microsoft Teams call. The Hearings Officer again emailed the Registrant again on 22 August 2024, when she sent the Registrant a Microsoft Teams link to enable him to join the hearing. No response has been made by the Registrant to any of these communications.

• The Panel notes that the final hearing panel recorded in its determination that on 27 July 2023 (less than a fortnight before the commencement of the final hearing), the Registrant sent an email in which he stated, “As i have said many times, i’ve been retired since 13th April 2018, i have no idea what you’re talking about.” The Registrant did not attend the final hearing, which proceeded in his absence.

• The Registrant has not sought an adjournment, nor has he suggested that his absence from the present hearing is because of inconvenience that might not apply on another occasion. It follows that there are no grounds on which the Panel could conclude that the Registrant would be likely to attend on a future occasion if the present hearing did not proceed.

• The inescapable conclusion of the Panel is that the Registrant has entirely disengaged from participation in this fitness to practise process and voluntarily absented himself from this hearing.

• The review of a suspension order is required by the legislation governing this process. The review is required before the expiry of the current suspension order. The suspension order is due to expire on 8 September 2024, and as notice of not less than 28 days would be required to be given to the Registrant, it would not be possible for a valid notice of hearing to be served before expiry of the current order. Jurisdiction to consider whether a further order should be made would be lost.

5. Having carefully considered the matter, the Panel decided that it was appropriate to proceed with the hearing.

Background

6. The Registrant is registered with the HCPC as a Paramedic. At the time of the relevant events he was employed in that capacity at Band 6 by the West Midlands Ambulance Service University NHS Foundation Trust (‘the Trust”). He was employed by the Trust from 13 April 1992, until his retirement on grounds of ill health at some stage in 2018.

7. On 4 January 2018, the Registrant was working the night shift and working on his own. He responded to an emergency call from Patient Z, an elderly gentleman. Patient Z had a fall in the night and had sustained a minor head injury. The Registrant lifted Patient Z up off the floor, put him into bed, and then left the scene. The Registrant was recorded as arriving at 03:17 and leaving at 03:26. The HCPC contended that the attendance was not documented, which was usually done using an Electronic Patient Record (“EPR”).

8. Patient Z was later attended by a further crew of Paramedics, Colleague A and Colleague X. They assessed Patient Z and decided to take him to hospital as they were concerned that he as unable to bear his own weight. Patient Z’s condition deteriorated during the journey to hospital and, as a result, the ambulance pulled over. Back up was requested from another Paramedic, Colleague Y, who arrived in a rapid response vehicle and assisted with the care of Patient Z.

9. Patient Z was admitted to hospital, and it was later discovered that he had sustained a displaced fracture of his cervical spine. Patient Z sustained permanent paralysis and remained in hospital for some months.

The final hearing of the allegation between 8 and 11 August 2023.

10. The allegation referred by the Investigating Committee included elements that are not included in the allegation as it is set out at the head of this determination. Specifically, it was alleged that the Registrant had failed to disclose to the HCPC the Trust’s investigation into the events concerning Patient Z, and that his failure to do so was dishonest behaviour. However, at the commencement of the final hearing, the Presenting Officer told the panel that the HCPC could not support the contention that the Registrant had been under an obligation to disclose the investigation, and, accordingly, the HCPC wished to offer no evidence in relation to those elements of the referred allegation. The final hearing panel, having considered the matter, agreed to those elements not being pursued. They therefore formed no part fo the decision of the final hearing panel.

11. The final hearing panel heard evidence from four witnesses called on behalf of the HCPC. They were Colleagues A, X and Y, whose involvement with Patient Z is described in paragraphs 7 and 8 above. That panel also heard evidence from Colleague Z, who was the Clinical Standards Manager in the Trust’s Clinical and Corporate Directorship.

12. In relation to the facts, the final hearing panel found that the Trust required records to be kept for all incidents, but that the Registrant had made no record about his attendance upon Patient Z. It followed that both limbs of particular 1 were proven. The panel found that the Registrant, who had accepted in accounts of the incident be had previously given that he did not take any equipment into Patient Z’s home, did not undertake the minimum observations and investigations that were required of him. In relation to Patient Z’s request to simply put back into bed and not taken to hospital, the panel found that, as the
required investigations had not been undertaken by the Registrant, Patient Z was incapable of giving informed consent. Accordingly, particular 2 was determined to be proven.

13. When the final hearing panel turned to consider the issue of misconduct, it found that the Registrant had breached the following standards of the HCPC’s Standards of conduct, performance and ethics: Standards 6.1 and 6.2 (because he had not identified and minimised risk), Standard 9.1 (his conduct did not justify the trust and confidence of the public in him and his profession), and Standards 10.1 and 10.2 (which related to the absence of records). The panel found the Registrant’s conduct to have constituted a serious falling short of what was expected, and that fellow practitioners would consider it to be deplorable. Accordingly, they determined that it amounted to misconduct.

14. When the final hearing panel considered the issue of impairment of fitness to practise, it determined that the Registrant had demonstrated a lack of insight because his reaction at the time, as evidenced by his report and interview, seemed to accept little responsibility or understanding of the seriousness of the concerns. That fact, coupled with the absence of remedial action since the incident, resulted in the panel finding that there was a risk of repetition, and that there was personal component impairment of fitness to practise. When the panel considered public component impairment of fitness to practise, it acknowledged that the HCPC explicitly stated that it was not contended the severe consequences for Patient Z were attributable to the Registrant’s behaviour. Nevertheless, it found that the finding of impairment was required in relation to the public component in order to uphold proper professional standards and to maintain the required degree of confidence of the public in the Paramedic profession.

15. In relation to sanction, the final hearing panel considered the available sanctions in an ascending order of gravity. It decided that a restriction on the Registrant’s ability to practise as a Paramedic was required, but that the imposition of a Conditions of Practice Order was not appropriate in view of the lack of engagement on the part of the Registrant. In determining that a suspension order for a period of 12 months should be imposed, the panel considered it to be a proportionate outcome and also an appropriate one as it would allow the Registrant an opportunity to provide evidence of remediation should he chose to engage in the process.

16. The final paragraph of the written determination of the final hearing panel was in these terms:

“97. A review would take place shortly before the expiry of the Suspension Order. The Panel considered a future reviewing panel may be assisted, but are not bound, by the following:

• A reflective piece from the Registrant, which includes reflections on the incident, on the potential impact on service users and their families and on the Panel’s findings at this hearing;
• Evidence of continuous professional development; and
• Any other information that the Registrant considers would assist the reviewing panel, particularly around the care of elderly patients, specifically around trauma.”

Submissions made to today’s Panel

17. On behalf of the HCPC, the Presenting Officer explained the decision of the final hearing panel in August 2023. She also made submissions as to the proper approach to the making of the decision required to be made by the Panel. The Presenting Officer referred to the fact that the Registrant had not provided any information from which it could be concluded that his fitness to practise is no longer impaired. Accordingly, she submitted that a further sanction is required. As to the nature of that further sanction, she stated that the HCPC considered that, at the present stage, a striking off order would be appropriate. She acknowledged that a further period of suspension could be considered, but submitted that in the light of the Registrant’s disengagement to impose a further suspension order would lead to an unproductive review cycle that would be undesirable.

18. No submissions were made by or on behalf of the Registrant.

Decision

19. The Panel accepted the advice of the Legal Assessor as to the proper approach to the decision it was required to make. The Panel paid close attention to the HCPTS Practice Note entitled, “Review of Article 30 Sanction Orders” published in November 2023. Accordingly, the Panel approached the matter in the following manner:

• It was required to accept the decisions of the final hearing panel in relation to the factual particulars, and that those facts constituted misconduct.

• The present Panel was required to decide if the Registrant’s fitness to practise is still impaired by reason of the findings made in August 2023. In reaching this decision, the Panel was advised as to the decision of the High Court in Abrahaem v G.M.C. [2008] EWHC 183 (Admin.), namely that in relation to a decision on whether a registrant’s fitness remains impaired, there is a persuasive burden on the registrant to demonstrate that he or she has fully acknowledged the identified deficiencies, and that he or she has addressed that impairment through insight, application, education, supervision or other achievement.

• If, having considered the matter, the Panel concluded that the Registrant’s fitness to practise was no longer impaired, then there should be no further order made.

• If, on the other hand, the Panel concluded that the Registrant’s fitness to practise remained impaired, then the Panel should consider whether a further sanction would be required upon the expiry of the present period of suspension. Any decision about a further sanction should be made applying ordinary sanction principles, and by paying close attention to the HCPC’s Sanctions Policy. As the finding of the final hearing panel was one of misconduct, the present Panel would have jurisdiction to impose any sanction, including that of striking off.

20. The Panel followed the approach set out in the preceding paragraph.

21. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The present Panel agreed with the reasons of the final hearing panel (summarised in paragraph 14 above) for finding that in August 2023, his fitness to practise was impaired in respect of both the personal and public components. The Registrant has provided no information that addressed the reasons of the final hearing panel for that finding. Accordingly, the Panel found that, although the deficiencies identified by the final hearing panel were clearly remediable, the Registrant has not remedied them and that his fitness to practise is no less impaired at the present time than it was a year ago.

22. The finding that the Registrant’s fitness to practise is impaired meant that the Panel was required to go on to consider whether a further sanction is required when the present period of suspension ends.

23. There was a fundamental issue that underpinned the Panel’s decision in relation to a further sanction. It was that, without evidence of remediation, the Panel would be failing in its duty to protect the public to permit the Registration to practise without restriction. Had the Registrant engaged in the fitness to practise process, it is possible that that restriction could have been provided by the imposition of conditions of practice. However, the lack of engagement on the part of the Registrant has ruled that out as an option.

24. It therefore followed that no lesser sanction than a further period of suspension would be appropriate. A further period of suspension might have been appropriate had the Registrant engaged in the process, albeit belatedly, to express a desire to address his failings. However, he has neither engaged nor expressed any intention of doing so. It follows that a further period of suspension would be pointless; the position at the end of any further period ordered by the Panel would be exactly as it is at present.

25. It followed from this decision that the Panel concluded that the only proper outcome at present is the making of a striking off order. The Panel considered whether such an order would be a proportionate response. The Panel was of the clear view that this was not a case in which striking off could be the only appropriate outcome. However, what made it appropriate in the present case was the lack of engagement on the part of the Registrant that ruled out any lesser sanction as being sufficient to address the public interest considerations the Panel was obliged to consider. For that reason, the Panel was satisfied that striking off represented a proportionate response.

ORDER: The Registrar is directed to strike the name of Mr Raymond Byron from the Register upon the expiry of the current Suspension Order.

The Strike Off Order imposed today will apply from 8 September 2024.

History of Hearings for Raymond Byron