Mr Jason E Edwards
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Allegation
As a registered Paramedic (PA37402):
1. On 6 December 2021, whilst attending a call in respect of a child, Patient 1, with Colleague A, an Emergency Care Support Worker, you:
a) allowed Colleague A to act outside his scope of practise, in that you
drove the ambulance vehicle to Darent Valley Emergency Department (the
Hospital) whilst colleague A cared for Patient 1 in the back of the
ambulance;
b) failed to maintain a supply of oxygen to Patient 1 when you transferred
the Patient from the back of the ambulance to Hospital staff, upon arrival
at the Hospital.
2. On 24 December 2021, you contacted Colleague A to discuss the
incident involving Patient 1 on 6 December 2021, despite having been
asked by Line Manager A to not discuss the incident with Colleague A.
3. On 24 December 2021, you suggested to Colleague A in a telephone call
that he should state that it was Colleague A driving the ambulance, in
respect of the incident involving Patient 1 on 6 December 2021, when this
was incorrect.
4. You acted in the way alleged in one or more Particulars 2 to 4 when you
knew or ought to have known that, on or around 4 February 2021, you
were issued with a final written warning for a duration of 12 months, for
failing to delegate work appropriately and supervise two Emergency Care
Support Workers in caring for a 55- year-old male patient with back pain
and for failing to properly assess and treat that patient.
5. On 24 December 2021, when Line Manager A discussed concerns
raised about the care of Patient 1 on 6 December 2021, you used
unprofessional and/or offensive language in that you referred to the nurse
you had handed Patient 1 to at the Hospital as a “fucking stuck up bitch”,
or words to that effect.
6. You breached South East Coast Ambulance Service’s medicines
management policy in respect of controlled drugs in that, on 23 December
2021:
a) You failed to return controlled drugs at the end of your operational shift;
b) You attended a public house with controlled drugs in your possession.
7. Your conduct in respect of allegation 3 was dishonest.
8. The matters set out in particulars 1 to 7 above constitute misconduct.
9. By reason of your misconduct, your fitness to practise is impaired.
Finding
Preliminary Matters
Service
1. The Panel has seen unredacted copies of two notices of hearing sent by the HCPTS to the Registrant. One was sent to the Registrant’s registered email address on 7 August 2024 and the other, which was in identical terms, was sent to the Registrant’s registered postal address on 9 August 2024. The notice of hearing informed the Registrant of the date and time of this hearing, that it was to be the substantive hearing of the allegations brought against him by the HCPC, and that it was to be conducted virtually.
2. The Panel has also seen proof of service statements from the HCPTS scheduling officer confirming that they sent the notice of hearing by email and by first class post.
3. On the basis of these documents, the Panel is satisfied that the Registrant has received proper notice of the hearing in accordance with the relevant Rules.
Proceeding in the absence of the Registrant
4. Ms Kennedy applied to proceed in the absence of the Registrant. She submitted that there was a public interest in cases being conducted expeditiously. Ms Kennedy also referred to there being five witnesses available to give evidence and submitted that any delay might impact on their ability to recall the events about which they are to give evidence, and also might cause them inconvenience. Ms Kennedy also submitted that the Registrant had voluntarily waived his right to attend and referred the Panel to a telephone note of a conversation which a representative of Capsticks LLP had with him on 18 October 2024. In that conversation, the Registrant indicated regarding these proceedings that he “wants nothing to do with it” and commented that this was something that he had been saying for as long as he could remember. The Registrant indicated that he had moved on now and repeated that he wanted nothing to do with the proceedings.
5. The Panel has received and accepted legal advice. It has considered the various factors set out in the HCPTS Practice Notes, “Proceeding in the Absence of the Registrant”.
6. The Panel is satisfied that all reasonable steps have been taken to inform the Registrant of the hearing. The Panel notes that both notices of hearing, dated 7 and 9 August 2024 respectively, set out the date and time of the hearing and that it will be conducted virtually. Importantly, the notices also inform the Registrant that the hearing might proceed in his absence and provide him with a link to the HCPTS Practice Note, “Proceeding in the Absence of the Registrant”.
7. The Panel also notes that the Registrant has not applied for an adjournment, and it has concluded that an adjournment would serve no useful purpose, given the Registrant’s unequivocal views as set out in the telephone call note of 18 October 2024.
8. The Panel has decided that the Registrant has voluntarily absented himself, thereby waiving his right to attend.
9. In reaching its decision, the Panel has balanced fairness to the Registrant with fairness to the HCPC and the wider public interest.
10. The Panel considers that there is a public interest in these proceedings which involve serious allegations, being resolved expeditiously. The Panel is aware that the HCPC’s five witnesses are available to attend the hearing this week and give evidence about matters which allegedly occurred a number of years ago.
11. The Panel accepts that there will be some disadvantage to the Registrant by not being present and participating in the hearing but considers that this is outweighed by the public interest in proceedings being heard when scheduled. The Panel will be careful to consider all matters which are in the Registrant’s favour throughout the proceedings
12. Accordingly, the Panel has decided that it is in the interests of justice to proceed in the absence of the Registrant.
Application to amend the Allegation
13. Ms Kennedy applied to amend Particular 4 of the Allegation in order to correct what appears to be a typographical error by amending the words “alleged in one or more Particulars 2 to 4…” to “alleged in one or more Particulars 2 to 3…”.
14. The Panel has received and accepted legal advice. It has considered whether the proposed amendment prejudices the Registrant or causes any unfairness in the hearing. The Panel notes that the Registrant has not been given prior notice of the proposed amendment. However, as it is a minor amendment to correct a typographical error and as it does not prejudice him or cause any unfairness in the proceedings, the Panel has decided to grant the application.
Background
15. The Registrant was employed as a Band 6 paramedic at the Dartford Ambulance Station, part of South East Coast Ambulance NHS Foundation Trust (“SECAMB”) from 17 March 2014. The Registrant worked as a frontline clinician, attending all manner of patients, responding to 999 calls in the Dartford area.
16. The allegations relate to a number of concerns spanning December 2021.
Allegations regarding 6 December 2021:
17. On 6 December 2021 the Registrant attended an emergency call out to an unwell 16-month-old child (“Patient 1”) with Colleague A, an Emergency Care Support Worker (“ECSW”). The Registrant and Colleague A provided treatment before transferring Patient 1 to Darent Valley Hospital (“the Hospital”). Hospital staff complained that, upon arrival at the Hospital, the Registrant failed to maintain a supply of oxygen to Patient 1 when transferring the patient from the back of the ambulance to Hospital staff.
18. Colleague A later complained about the Registrant’s conduct following their attendance and treatment of Patient 1, alleging that the Registrant left Colleague A to attend to Patient 1 on his own while the Registrant drove the ambulance, causing Colleague A to act outside of his scope of practise. Colleague A alleges that, on 24 December 2021, when SECAMB raised concerns with the Registrant about his conduct on 6 December 2021, he had called Colleague A and suggested that he should state that it was Colleague A driving the ambulance when transferring Patient 1 when this was not the case. It is also suggested that when asked about a complaint received from the Hospital about Patient 1’s treatment, the Registrant was asked not to contact Colleague A but did so. It is also alleged that the Registrant behaved in an unprofessional way and used offensive language about the paediatric nurse from the Hospital who had raised the complaint.
19. At the time of the above alleged incidents, the Registrant had a final written warning in place, which was live until 4 February 2022, following a previous investigation by SECAMB into allegations of a similar nature. It is alleged that the Registrant had contacted Colleague A when asked not to and had suggested to Colleague A to say he was driving on 6 December 2021 when this was incorrect, knowing that the final written warning was in place.
Allegations regarding 23 December 2021:
20. It is further alleged that, on 23 December 2021, the Registrant failed to return controlled drugs, namely morphine sulphate and diazepam, and left work attending a public house with them. A colleague, VB, who noticed the controlled drugs were missing called the Registrant and went to meet him to collect the controlled drugs.
21. On 21 January 2022, following a suspension risk assessment meeting, SECAMB decided to suspend the Registrant whilst an internal investigation into the concerns was conducted.
22. On 31 January 2022, the Registrant made a self-referral to the HCPC indicating that he had been suspended from his work as a paramedic “pending further investigation only”.
23. On 29 February 2024, a panel of the Investigating Committee (“ICP”) found there was a case to answer and referred the Allegation set out above to the Conduct and Competence Committee for final hearing.
Decision on the facts
Evidence
24. The Panel has been provided with an HCPC bundle of documents (totalling 892 pdf pages, including 276 intentionally blank pages) which, in addition to witness statements from the HCPC witnesses, included a number of exhibits:
i) The Registrant’s self-referral form
ii) The SECAMB’s investigation report
iii) SECAMB Scope of Practice and Clinical Standards Policy
iv) Local investigation meeting notes
v) SECAMB Medicines Policy
vi) Text messages from the Registrant
vii) Final written warning letter dated 4 February 2021
viii) SECAMB’s disciplinary hearing pack
ix) DATIX reports and ePCR (electronic Patient Care Record)
x) Dismissal letter dated 20 May 2022
Hearsay evidence
25. The Panel notes that there is hearsay evidence in the HCPC’s bundle. This includes documentary hearsay and statements from colleagues of the Registrant who are not being called as witnesses in these proceedings. The Panel has received and accepted legal advice in relation to hearsay evidence. It notes that this is not a case where the HCPC has made a formal application to admit any of the witness hearsay evidence.
26. When she opened the case, Ms Kennedy referred the Panel to the presence of the hearsay evidence in the HCPC’s bundle, some of which was potentially favourable to the Registrant, such as Colleague P (who is a Critical Care Paramedic who was in attendance during the incident involving Patient 1 on 6 December 2021). Ms Kennedy referred to the principles regarding hearsay evidence set out in the case of Thorneycroft v NMC [2014] EWHC 1565 (Admin).
27. The Panel has considered carefully whether it would be appropriate to rely on hearsay evidence, in particular in relation to Colleague P whose account was in someways supportive of what appears to be the Registrant’s case. The Panel will indicate where appropriate if it has relied on hearsay evidence.
Witness evidence
28. The Panel heard evidence from five witnesses called by the HCPC.
AB
29. AB is a registered Paramedic and is employed by SECAMB as a Professional Standards Manager. In that role, AB is an arbiter of the HCPC’s Standards and SECAMB’s own values and supports its Human Resources (“HR”) department, through disciplinary and capability processes. He also supports operational leaders in competencies and behaviours, provides teaching and education for newly qualified paramedics (“NQP”), and provides consultant paramedics with clinical leadership for his employer. AB undertakes clinical duties when required.
30. AB told the Panel that SECAMB paramedics usually work on a rotating shift pattern of 12-hour shifts but that they were able to choose from a range of eight to ten-hour shifts, rotating between day and night shifts. AB said that while each ambulance station was different, there could be between six or seven emergency vehicles out running every day, with a minimum of four to five such vehicles. He said that the Registrant would typically be part of a double-crewed ambulance, or on a car. The Registrant would sometimes drive the vehicle and, due to his experience, he would usually be the senior clinician on board the ambulance. AB said the Registrant had a responsibility to provide emergency care to any patient he attended.
31. AB told the Panel that he had been made aware of concerns regarding the Registrant in January 2022 and on 30 January 2022, he had been appointed to conduct an internal investigation on behalf of SECAMB. AB stated that he had had no direct working relationship with the Registrant prior to this appointment.
32. AB told the Panel that he had approached his investigation by considering three areas of concern: (i) complaints from a colleague (Colleague A), (ii) a concern raised by the Hospital, and (iii) an alleged medicines management violation. He also told the Panel that the notes of his interview with the Registrant on 9 February 2022 were sent by email to the Registrant so that the Registrant could amend and agree them. AB confirmed that the matters in bold in those notes indicated amendments or additions made by the Registrant.
Colleague A
33. Colleague A is an Emergency Care Support Worker (“ECSW”) and has been employed in that role by SECAMB since 1 September 2018 and based at the Dartford Ambulance Station. In that role, Colleague A supports a registered paramedic or ambulance technician/Associate Ambulance Practitioner, assisting them with everything to do with patient care. Colleague A told the Panel that SECAMB has a scope of practice document which outlines the remits of ability to provide care of an ECSW. Within that remit, Colleague A said he was permitted to drive an ambulance on blue lights and assist in day-to-day support of the paramedic with a limited scope of practice.
34. Colleague A explained that on 21 September 2020, he began to train as an Associate Ambulance Practitioner. He had stopped the training course and returned to work as an ECSW on 27 November 2020. In January 2023, Colleague A resumed training as an Associate Ambulance Practitioner.
35. Colleague A told the Panel that he had first met the Registrant when he had joined SECAMB in September 2018. They had worked together until he started the training course. This was in a two-crew ambulance where the Registrant was the lead clinician and Colleague A was his support as the ECSW. After the training course was paused, Colleague A said that he had resumed working with the Registrant.
VB
36. VB is an Institute of Health and Care Development Paramedic and registered with the HCPC. At the relevant time, she was employed by SECAMB as an Operational Team Leader (“OTL”) based at Thameside Ambulance Station, a role she held until 7 August 2023. In that role, VB undertook clinical duties as a paramedic, some office-based duties and the duties of a line manager (including but not limited to, her team’s management appraisals, welfare, sickness management and general management of the team).
37. VB told the Panel that although the Registrant was not in her team and was based at Dartford Ambulance Station, she would see him regularly at the station. VB said that when the Registrant first joined SECAMB as a paramedic he was based at the Thameside station before transferring to the Dartford station in June 2019.
38. VB explained the procedures for the handling of controlled drugs at both the Thameside and Dartford stations. At Thameside, there was a book system whereas at Dartford, there was a system called Omnicell. VB said that SECAMB’s medicine governance included a specific Controlled Drugs Policy and a Medications Policy.
39. VB said that, in order to obtain controlled drugs at Thameside, a paramedic must go into the drugs room via a locked door, which is accessible using a SECAMB identification swipe card which limits access to only those who have permission. There is then another door, which is not locked, which leads to the medicines room. A key must then be taken from the key safe, which is accessible using a 4-digit code. Each key safe has a different combination code. These codes are available only to those with the clinical grade to require access. Paramedics require access to controlled drugs and, as such, have the relevant codes. The key from the first key safe unlocks a metal Bristol Maid cabinet. Inside this cabinet is a second key safe that only paramedics have the code for. The second key unlocks a smaller, metal safe within the metal Bristol Maid cabinet.
40. VB explained that controlled drugs such as intravenous (“IV”) Morphine Sulphate and Diazepam are stored within the smaller cabinet in small glass vials. VB told the Panel that there is a red book for each of the controlled drugs which are stored inside the Bristol Maid cabinet on a shelf below the controlled drugs safe. The red books are used for signing out (issuing) and signing in (returning) controlled drugs to individual paramedics for their shift.
41. VB explained that when a paramedic needs to access controlled drugs at the beginning of their operational shifts, they must update the red book by giving the date, the time, whether they are withdrawing or returning the drug, the number of vials they are withdrawing or returning, the batch numbers of the vials, whether they have used any of the medication, and how much they have used or are disposing of. The paramedic must then sign and print their name and update the correct number of vials in the safe. This must be done in the presence of a witness who must also sign and print their name. The witness is not required to be a paramedic, and there are occasions when a paramedic is solo working and there is no one at the station to witness their controlled drug transaction. On these occasions, the paramedic documents Single Response Vehicle (“SRV”) and No Witness Available (“NWA”). Any transactions of this type are checked during the weekly medicines audit and reported back to the Medicines team. This is so that an audit of the use of controlled drugs can be carried out each week and a check made against the incident for any waste that may be found.
42. VB told the Panel that when a paramedic signs drugs out of the safe, the drugs become their personal responsibility. The paramedic must always carry the controlled drugs on their person in a case on their belt.
43. At the end of a shift, if the paramedic has not used any or all of the drugs, they must undertake the sign out process, in reverse, thereby signing the drugs back in and providing the same type of information as when signing the drugs out.
44. VB told the Panel of the procedure to be followed when controlled drugs have been administered to a patient. In these circumstances, the paramedic must use the controlled drugs book to document the job number, state how much of the drug was administered and how much was wasted. This procedure must be witnessed by another paramedic. The drug container should then be disposed of in the special wastage pot.
45. VB told the Panel that the controlled drug process was done at the start and end of every shift and that all paramedics were familiar with the process used in each station, whether an Omnicell or Non-Omnicell site. She also said that the Registrant would have received training in the process on joining the station and that paramedics would be advised of any updates via Operational Bulletins, Key Skills and access to all relevant policies and procedures through the SECAMB intranet (“the Zone”). VB said that all Ambulance Trusts must meet legal requirements for the storage and use of medicines, which varies depending on the medication in question. VB told the Panel that, at the time of the incident on 23 December 2021, there had been clear instructions displayed on the wall next to the Bristol Maid cabinet, on how to complete the red book and what to do with vials. She said that there was always an OTL on duty who could be contacted through the duty OTL telephone number for anyone who was not sure what to do.
46. VB told the Panel that it can be busy in the drugs room at times, and that it was not unheard of for staff to be confused as to who was being the witness and whether the drugs were being taken or returned.
Line Manager A
47. Line Manager A (“LMA”) is a registered Paramedic who has worked for SECAMB since August 2014. In January 2021, LMA was seconded as an OTL to Dartford and Thameside Operating Unit, becoming a permanent OTL there in January 2022. In that role, LMA manages a team of staff and addresses DATIX complaints, as well as any clinical concerns. She operates as an Operations Commander on the scene at any mass casualties which occur as a result of any incidents. LMA also works as a paramedic, responding to category one calls, which include cardiac arrests and critically unwell patients. She is also dispatched to any potentially challenging calls such as stabbings or shootings, or to assist any crews that may need support.
48. LMA told the Panel that she first met the Registrant when she was a student Paramedic with SECAMB sometime in 2013 or 2014. When LMA became an OTL, the Registrant was an operational member of staff. LMA was not at that time the Registrant’s line manager. As OTL, if the Registrant was on duty, LMA would be the Registrant’s manager for the day for any day-to-day problems.
GS
49. GS is a registered paramedic with the HCPC. He joined SECAMB in June 2018 and is currently the Operations Manager at Gatwick Make Ready Centre. Between November 2020 to June 2022, GS was based at Paddock Wood in Kent where he was responsible for the operational work force in the West Kent locality.
50. GS chaired a disciplinary hearing into concerns raised regarding the Registrant’s conduct in January 2021.
The Registrant
51. As the Registrant has not been present during the hearing the only information the Panel has had as to his position in relation to the various matters alleged against him comes from (i) the statement he wrote on 24 December 2021 in relation to the incident involving Patient 1 on 6 December 2021, and (ii) from his interview on 9 February 2022 with AB as part of the SECAMB internal investigation. On this occasion, the Registrant was supported by a Union Representative, Colleague O. The Panel has considered what the Registrant said in his original statement about the incident on 6 December 2021 and in his interview as part of the internal investigation. In doing so, it has taken note of the fact that it is unsworn evidence which has not been tested by cross examination on behalf of the HCPC and that there has been no opportunity for the Panel to ask the Registrant any questions for the purposes of clarification.
52. In the Registrant’s written statement prepared by him on 24 December 2024, the Registrant had said that due to Patient 1’s distress at having a mask held to his face which was degrading his respiratory function and readings, he, the CCP and Colleague A had all agreed that having the mask near the baby’s face was the best plan. The Registrant said it was agreed that getting Patient 1 to A&E as quickly as possible was the best action and that putting the baby in an upright position in the car seat would help his breathing rather than being strapped flat on the stretcher with a baby harness. The Registrant described Patient 1 being taken to the ambulance by Colleague P and stated that Colleague P had felt he was not required to travel at this time and that other than getting to the Hospital, it was only oxygen therapy that was needed. The Registrant said that Colleague P confirmed that Colleague A was happy and comfortable travelling in the back and said just go. Colleague A had maintained “best O2 on route to hospital”.
53. The Registrant said that on arrival at the Hospital, they were met by a Paediatric Nurse, and that Colleague A had passed Patient 1 out of the vehicle having disconnected the mask from source. The Registrant said “with the short (less than 10 seconds) distance to Paeds Resus and full bag on non-breather this was decided best rather than waiting to reconnect and carry a small cylinder. At this time the mask was still in position near the face and baby was still receiving O2. This was attempted to be explained to the nurse but she decided just to walk off not listening to the crew”.
54. In the interview, the Registrant described what had happened at the house regarding Patient 1 including that when they had got the oxygen out, Patient 1 had “gone ballistic when we tried to put the mask on. All of us thought it better to hold the mask near/over the baby face” [bold corrections made by the Registrant after the interview]. When they left to go to the Hospital, it had been the CCP, Colleague P, who had Patient 1 who was in a car seat. The Registrant stated that Colleague P had said “I don’t think I need to travel with the baby as the baby has O2 just get there”. The Registrant said he had asked if Colleague A was “OK in the back” and that both he and Colleague P had not felt paramedic skills were needed on the journey to the Hospital. The Registrant described looking into the back of the ambulance on a couple of occasions and seeing that Colleague “A was holding the oxygen mask over the baby I did not think it best for that baby to take it out of the car seat and strap it down on the stretcher and [Colleague] P concurred”.
55. In answer to questions from AB, the Registrant said that having got Patient 1 into the ambulance, he had had a discussion with Colleague P at the ambulance. The Registrant said he had asked Colleague P if he was travelling [in the ambulance] and Colleague P had replied, “no and I don’t think you need to, we don’t need a Paramedic in the back, just oxygen, get going”. The Registrant said he had specifically said to Colleague A “are you OK in the back? You just need to hold the oxygen”. The Registrant said that he had worked with Colleague A for a long time and always said “are you alright?”.
56. The Registrant stated “We got to the hospital there was a Paeds nurse waiting. I got out and opened the door, [Colleague] A was at the door with the baby. The Paeds nurse said, “why isn’t the baby on oxygen”. I said he is on oxygen we just can’t get the mask on. She strolled off. [Colleague] A passed the baby down. I hadn’t noticed that the CD cylinder wasn’t connected. It was 20 yards to where we had to go. We went into resus and [Colleague] A did the handover”. The Registrant also said “I never asked [Colleague] A to do anything outside of his scope. When we took the baby off. I don’t know why the O2 cylinder wasn’t connected”.
57. In answer to questions from AB, the Registrant said that it was about 10 metres from the back door of the ambulance to Paediatric Resus, or about 10 seconds. He said that when asked at the ambulance door about why the oxygen mask was not on, he had said “we have got it dangling”, and the nurse had just walked off.
58. In relation to contact with Colleague A after the incident, the Registrant said that “when I was doing the statement, I texted [Colleague] A and I have copies of those messages, to confirm a few details. I did not coerce him to say anything if I had I wouldn’t be brazed enough to say get the CCTV. It is well within his scope that he can provide oxygen. I did send him a copy of my statement [for reference] [I was under the impression] [Colleague] A was not asked for a statement until weeks later”.
59. AB asked the Registrant what his intention had been in contacting [Colleague] A. The Registrant said that it “was to let him know about it [DATIX]. And to confirm a few details. He was back in Boxing Day. To let him know LMA was going to contact him. He was in the pub, and he phoned me back. We confirmed he had the oxygen in the back and the mask was near the baby at which point I/he said there is CCTV in there that would prove it. We discussed was we going to get in trouble for [Colleague] A being in the back, or was I? No, we didn’t think so”.
60. Asked by AB if, at any point, he had asked Colleague A to say the Registrant was in the back, the Registrant said, “No at no point did I ask him to change his story”.
61. In relation to the matter alleged in Particular 6, the Registrant said that he did not know how his controlled drugs were not replaced. He said he was on relief at Thameside which had a books system whereas at Dartford station, which was his base station, they used Omnicell. He had completed his shift with Colleague J, and this had finished on time. They had taken their equipment off the vehicle as no one was taking over. They had gone to the drugs room, “got rid of the drugs bag, CD drugs, filled it all in. I don’t know how [Colleague] J’s have gone in but mine were not”. The Registrant said when he had phoned his partner to say he was on his way back, she was in the pub with friends at it was her son’s birthday and she had asked if he would join them. The Registrant said he would go but would not stay long as he was back at Thameside on Christmas Eve.
62. The Registrant said that it was about 7.30 pm when VB had phoned him asking if he had the controlled drugs on him. The Registrant said he didn’t know so he had checked in the boot of his car and “to my dismay yes I had them. V said where are you? I said I was having a drink at The Chequers pub. V lives nearby and knows the area and said she would come and get them. I took my plastic container off my belt put it in my pocket and waited for V. V pulled up outside and I went out. V has brought a spare vial container and asked them to be put in, but fearing they may be dropped I said take mine as I’m at Thameside tomorrow I’ll pick up the pot then”. The Registrant said that he was not intoxicated in the 15 minutes he had been in the pub. He had left Thameside at 1900 hours and VB had phoned at 19.30. He said that he had had a drink but did not refuse to return the vials due to intoxication.
63. The Registrant said that VB had not stressed that he needed to bring the vials back to the station, “it was …I know where you are I will come and get them. I thought that was nice being Christmas and everything else but obviously not”. The Registrant said that if he had been asked to bring the vials back, he would have done so. The Registrant reiterated that he did not know why the controlled drugs vials had not been replaced. The Registrant referred to an email that had been sent out on 8 February 2022 regarding the medication protocols at Thameside which would “suggest/highlight that there is an issue with medication returns, distractions and numbers of people in the drugs room”.
The Panel’s approach
64. The Panel has borne in mind throughout that the burden of proving the Allegation is on the HCPC and that to do so, there must be sufficient evidence to satisfy the civil standard of proof. The Panel has considered each of the particulars and sub-particulars of the Allegation separately. Where the Panel has received opinion evidence, the Panel has reached its own conclusions on the matters referred to.
Particular 1(a) and Particular 1(b) are found proved
The stem
65. The Panel first considered the stem of Particular 1 and is satisfied that on 6 December 2021, the Registrant attended a call in respect of a child, Patient 1 with Colleague A, an ECSW. The Panel has seen contemporaneous documentary evidence which shows that on that date, the Registrant attended a call in respect of a child together with Colleague A. It has also heard evidence which it accepts from Colleague A about this particular call which he attended with the Registrant. In addition, it is clear from the Registrant’s statement about the incident and his interviews with both AB and LMA that he accepts that he attended with Colleague A.
66. The documents seen by the Panel included the 999-call log relating to the incident. This shows that Patient 1 was a sixteen-month-old boy. A Critical Care Paramedic (“CCP”), Colleague P, was dispatched at 13:40, arriving at approximately 14:02. A double-crewed ambulance 984 was dispatched at 14:03 and were mobile at 14:04. The Panel has also seen the ePCR (electronic Patient Care Record) relating to Patient 1 which was signed by both Colleague A and the Registrant on 6 December 2021 after Patient 1 had been admitted to the Hospital.
Particular 1a)
67. The Panel heard evidence from Colleague A as to the circumstances of the incident on 6 December 2021 involving Patient 1. The Panel accepts this evidence as being credible and reliable. Colleague A told the Panel that on 6 December 2021, he and the Registrant had been assigned to Patient 1 from a 999 call dispatched from control. The 999-call had initially been marked as a Category 1 call but was then marked as a Category 2 when the Registrant and Colleague A attended. Colleague A said that a CCP, Colleague P, was already seeing paediatric Patient 1 who was quite unwell and was presenting with cyanosis, which meant he was quite blue. The CCP had made a first review assessment prior to their arrival and confirmed, after listening to Patient 1’s chest, that he was hypoxic with low oxygen saturation in the patient’s blood.
68. Colleague A said that when they attended, the CCP made a formal handover of the patient to them. He said that at this time, Patient 1 was already in a child car seat ready to be put in the ambulance for transfer to hospital. The CCP had managed to take a clear SATs (saturation) reading, to measure Patient 1’s blood oxygen saturation levels. These were dangerously low (below 50%) and could have led to a hypoxic brain injury. Colleague A explained that with paediatric patients the monitor for the SATs reading goes round their toe and stays attached when transported into the back of the ambulance, and this had been the case for Patient 1.
69. Colleague A told the Panel that the CCP had placed oxygen therapy to help improve Patient 1’s oxygen levels on Patient 1 prior to their arrival. Colleague A said that he had then put Patient 1 on piped oxygen in the ambulance. Colleague A described the condition of Patient 1 as being critically unwell and that he had never seen a paediatric patient who was alive, looking as unwell as Patient 1 and he had thought that Patient 1 looked so unwell that he had thought the result could have been fatal. Colleague A described Patient 1 as being blue, limp, lifeless and he thought Patient 1 was near cardiac arrest. Colleague A said that it was quite common that where the deterioration of a patient was highly likely, that the paramedic should be in the back of the ambulance with them.
70. Colleague A said that in being in the back of the ambulance with Patient 1, he had felt that the Registrant had asked him to step outside his scope of practice, training and experience as an ECSW. Colleague A explained that oxygen therapy is within his scope of practice as an ECSW. Colleague A said that he did not get time to challenge the Registrant due to being at the “height of my bandwidth” and also because the Registrant had closed the door on him and so he had not even had the chance to ask. In answer to a Panel question, Colleague A said he had been annoyed that the Registrant was driving and had not even checked to see if he was ok in the back. Colleague A said that he had not heard any conversation between the Registrant and Colleague P about if a paramedic was needed in the back of the ambulance. He said that it had been a very quick, high-pressured scenario and he had not been listening to what was going on outside the ambulance. Colleague A said that he had got the Bag-Valve-Mask (“BVM”) out and placed it on the side of the ambulance ready for transporting.
71. The Panel accepts that, as an ECSW, Colleague A is not a clinician and so it has looked for other evidence as to whether his being left in the back of the ambulance to treat Patient 1 was outside Colleague A’s scope of practice. The Panel has heard opinion evidence from both AB and LMA as to the seriousness of Patient 1’s condition, and as to whether the Registrant allowed Colleague A to act outside his scope of practice. The Panel is aware that AB and LMA are not independent expert witnesses, and so it has considered whether each has the necessary experience and specialist knowledge to give an opinion on these matters. The Panel is satisfied that as experienced paramedics they are entitled to express their respective opinions in these regards. The Panel will reach its own conclusions on that evidence.
72. AB told the Panel that in double-crewed ambulances, the staff usually take it in turns to drive the ambulance if their respective scopes of practice allowed it. If not, the paramedic would travel in the back of the ambulance with a patient. AB referred to the SECAMB matrix which sets out what procedures are within e.g., an ECSW’s scope of practice. AB said that an ECSW can undertake most duties at most incidents but there were certain occasions where an ECSW would not be competent to treat a patient. In relation to an unwell 16-month-old child, AB said that it would depend on the circumstances as to whether it was appropriate for an ECSW to travel in the back of an ambulance. AB considered that it was more appropriate for a paramedic to travel with a child of that age as an ECSW was not equipped to deal with the nuances should a situation arise with that child. AB said that a paramedic with more enhanced skills and knowledge was needed. AB said that if a CCP was in attendance, they might travel in the ambulance to undertake monitoring and to respond to any deterioration in the child’s condition. AB said he would not necessarily have expected the CCP on 6 December 2021 to travel in the ambulance with Patient 1 but he would have expected the Registrant as the CCP had handed over care of Patient 1 to him as the lead clinician. AB said that the Registrant could take advice from the CCP but that he should have made his own decision once the duty of caring for Patient 1 had been handed over to him.
73. AB said that Patient 1 should have been taken out of his clothes in the back of the ambulance so that the effectiveness of the oxygen treatment could be monitored at skin level.
74. LMA told the Panel that in her opinion Patient 1 should have been undressed and on a stretcher in the ambulance to observe the respiratory effort being made. LMA said that it appeared Patient 1 could have been peri arrest at any moment and so the Registrant should have been in the back of the ambulance in a position to provide the best treatment. LMA told the Panel that she had looked at the observations taken by the Hospital and by the ambulance crew (Colleague A and the Registrant) and that from these observations, it was her opinion that Patient 1 should have been treated with supplementary high flow oxygen therapy with the potential for assisted ventilations due to the severe respiratory distress. LMA said that the outcome for Patient 1 was that he had a hypoxic-brain injury. LMA said that her knowledge of Hypoxic Brain injuries was that symptoms can vary significantly depending on the amount of time that the brain has been hypoxic for. The symptoms range from an impaired level of consciousness to behavioural changes and the symptoms can develop rapidly causing severe brain damage imitating a stroke or ultimately death if not rectified. LMA said that, in her opinion, the Registrant should have supplied supplementary oxygen in a high flow format through a non-rebreathe mask if effective. Dependent on the observations and respiratory effort the Registrant should have utilised a BVM to administer assisted ventilations to increase oxygenation to the brain. LMA said that Patient 1 had a very high respiratory rate and low oxygen levels, meaning that he was not ventilating efficiently and therefore not oxygenating effectively.
75. LMA said that from reading the ePCR and the Hospital DATIX complaint report, Patient 1 should have been on the stretcher in an upright position. The thick clothing should have been removed so that the chest could be inspected for respiratory effort and rate alongside auscultation, percussion and palpitation for an enhanced assessment. LMA said that this was within the Registrant’s scope of practice, but it was not within the scope of practice of an ECSW. LMA accepted that an ECSW could monitor a patient but said that it was for the paramedic to interpret those observations.
76. When asked, LMA said that if the CCP had been content for Colleague A to travel in the back of the ambulance with Patient 1 and for the Registrant to drive, it would still be for the Registrant to make his own decision about this as Patient 1’s care was then his responsibility. LMA said that as Patient 1 was a time-critical patient, the Registrant should have travelled in the back of the ambulance.
77. The Panel is satisfied, based on the evidence of Colleague A and on what the Registrant told AB in his interview on 9 February 2021, that the Registrant drove the ambulance on 6 December 2021 to the Hospital, while Colleague A, Patient 1 and Patient 1’s mother travelled in the back.
78. The Panel is also satisfied that the Registrant allowed Colleague A to act outside the scope of his practice in caring for Patient 1. The Panel has seen an email chain between AB and the CCP, Colleague P in February 2022 regarding the incident. Although this is hearsay evidence and therefore has not been tested in any way, the Panel considers that it is appropriate for it to rely on it as regards the condition of Patient 1 taken from his notes. Colleague P, Colleague A and the Registrant all describe Patient 1 as a critically ill child. The ePCR completed and signed by both Colleague A and the Registrant confirms this.
79. The Panel accepts Colleague A’s evidence that he pre-alerted the Hospital because of Patient 1’s condition and that the Registrant drove on blue lights throughout the journey to the Hospital. This suggests that the Registrant was fully aware of the seriousness of the situation.
80. Although the Panel accepts that the only treatment administered by Colleague A in the back of the ambulance was to administer oxygen which was within his scope of practice, it had concluded that his presence in the back of the ambulance in the particular circumstances of Patient 1 was outside his scope of practice. The Panel is satisfied that it is outside Colleague A’s scope of practice to be in a situation where a critically ill child’s condition may rapidly deteriorate. An ECSW would not be in a position to deal with a cardiac arrest. Although an ECSW can use a BVM, they cannot decide when it becomes necessary to use it. That would be a clinical decision for a paramedic. The Panel considers that even if the Registrant is right when he suggests that Colleague P had said that no paramedic skills were needed in the back and they should just get to the Hospital as quickly as possible, this was not an order and it was for the Registrant to make his own autonomous decision about the risk to Patient 1 of travelling with only an ECSW in the back. The Panel is satisfied that the Registrant made the wrong decision and allowed Colleague A, a non-clinician, to travel in the back of the ambulance with a critically ill child, which was outside Colleague A’s scope of practice. The Panel therefore finds Particular 1a) proved.
Particular 1 b)
81. The Panel has seen a DATIX report from the Hospital on 6 December 2021. This states that “Pt came off back of ambulance in car seat and with coat zipped right up. Obvious signs of cyanosis with no o2 being applied to the child – mask in wafting position, but paramedic holding in his hand the end of tubing that would have been connected to oxygen supply, therefore no oxygen being supplemented to Pt. SR questioned this and informed by Paramedic that pt would not tolerate”. The Panel has not heard any evidence from the paediatric nurse (identified as Colleague D in the papers), who met the ambulance and spoke with the Registrant. However, it is clear that the Registrant accepts that it was he who took Patient 1 from the back of the ambulance into the Hospital and that he was asked by a nurse about why Patient 1 was not receiving oxygen.
82. The Panel has also heard evidence from Colleague A as to what happened on arrival at the Hospital. Colleague A said that during Patient 1’s transfer to the Hospital he was in the back of the ambulance and the Registrant drove on blue lights for the entire 20 minute journey. Colleague A said that he pre-alerted the Hospital of their arrival by way of ASHICE (age, sex, history, injuries, condition and expected time of arrival). Colleague A described sitting on the end of the stretcher where Patient 1 was strapped in a baby car seat. Patient 1 had a coat on, and Colleague A said he could see the rise and fall of the baby’s breathing. Colleague A said he had spent his time trying to keep the oxygen on Patient 1, which was a struggle as Patient 1 was distressed, as was Patient 1’s mother who was also in the back of the ambulance.
83. Colleague A told the Panel that when they arrived at the Hospital, there was a paediatric nurse there to meet them because of the pre-alert call. Colleague A said the Registrant opened the back door to the ambulance and took Patient 1 away with no oxygen attached. He said that the Registrant had taken the mask off Patient 1 and removed the tubing from the ambulance supply. Colleague A said that he had turned to get the portable oxygen cylinder out of the primary bag and when he turned back, he realised the Registrant had already taken Patient 1 into the Hospital. In the statement Colleague A made regarding the incident on 18 January 2022, Colleague A had also said that when he turned to get the portable cylinder, the Registrant had told him not to “as its not far and pulled the pipe off the valve”.
84. Colleague A said it might take 2 to 3 minutes to get from the back of the ambulance into the paediatric resus area, and described a number of secure doors which would need to be opened with either a code or a swipe card. Colleague A said that he had then followed them into the Hospital, and he had undertaken the handover with the resuscitation team and filled out the ePCR for Patient 1 whilst the Registrant went to Costa.
85. Colleague A said that he remembered Patient 1 was intubated at the Hospital in a medically induced coma and that later he had been transferred to the specialist children’s hospital in the area, the Evelina.
86. The Panel notes that while the Registrant accepted in his February 2022 interview with AB that Patient 1 was not on oxygen from the back of the ambulance until he was connected to an oxygen supply inside the Hospital, he does not accept that he took a decision to make the transfer without connecting the mask tubing to a portable cylinder. The Registrant’s position is that he had not realised that the oxygen was not connected when he took Patient 1 in his car seat from the back of the ambulance and only realised when told by the paediatric nurse.
87. The Panel has decided that it prefers the evidence of Colleague A and the information in the DATIX report to the account given during the internal investigation by the Registrant. The Panel notes that the Registrant has changed his position on this matter from his initial statement provided to LMA and his later interview with AB.
88. The Panel is satisfied that Patient 1 was transported at all times in a car seat. It is also satisfied that Patient 1 was wearing a coat and that there was a mask with tubing which had been connected to the ambulance supply during the journey and which would have had to be disconnected in order to move Patient 1 in his car seat to the Hospital. The Panel has heard that an oxygen cylinder is a portable cylinder which would need to be connected to the mask tube and then turned on. The Panel considers that, whether or not it was the Registrant who disconnected the mask tubing from the ambulance oxygen supply, the Registrant must have known when he took the child seat that the mask was unconnected to a portable cylinder. The Panel has reached this conclusion because the response recorded in the DATIX implies that the tube was not connected to any oxygen supply because Patient 1 would not tolerate it.
89. The Panel also considers that the Registrant would have known that he was not handed a cylinder and was not carrying a cylinder in one hand and the car seat in the other when he went from the ambulance to the Hospital. The Panel is satisfied that the Registrant did not maintain a supply of oxygen to Patient 1 when he transferred him from the back of the ambulance to the Hospital.
90. The Panel heard evidence from AB that it would have been the Registrant’s duty to ensure that Patient 1 had a supply of oxygen from the back of the ambulance to the Hospital. AB said that the only treatment needed for Patient 1 at that time was the supply of oxygen and so there was no effective treatment being given to Patient 1 at that time. AB referred to the JRCALC (Joint Royal Collages Ambulance Liaison) guidance which was exhibited in the documents and available to all paramedics on ePCR or on their i-pads. This guidance indicates that with sick children who do not tolerate an oxygen face mask or an oxygen face mask held close to their face, oxygen should be wafted direct from the tubing with the face mask detached. The Panel is satisfied that the Registrant should have maintained a supply of oxygen to Patient 1 given his critical condition and that the Registrant knew he should have done. The Panel is satisfied that the Registrant failed to maintain such a supply in not taking the time to ensure that the tubing was connected to a portable cylinder before taking Patient 1 into the Hospital. The Panel therefore finds Particular 1 b) proved.
Particular 2 is found proved
91. The Panel heard evidence from LMA and from Colleague A in relation to Particular 2. LMA told the Panel that on 24 December 2021 she had been approached by her line manager to ask if she could take a complaint and lead a clinical investigation regarding the Registrant and a complaint that had come in from the Hospital in relation to the care provided to Patient 1 on 6 December 2021. LMA said she began by considering the DATIX report received from the Hospital. She said that the DATIX outlined a clinical complaint and also an attitudinal one.
92. LMA said she had spoken to the Registrant on the same date. Before meeting him, LMA had printed a copy of the ePCR for Patient 1 and the Computer Aided Dispatch (“CAD”) notes. She said she had given these to the Registrant when they met, and she said she had invited him to speak through the complaint. LMA said the Registrant had been very disgruntled to hear of the complaint. LMA said that the Registrant’s reaction to the complaint was one of immediate anger and defensiveness and she had felt he was not being open and honest with her. She described him as going very red in the face. His reaction had been unusual.
93. She told the Panel that she was concerned about the Registrant’s response in that whilst he could remember clearly the paediatric nurse who met the ambulance, indicating that “she was stood there with her arms folded waiting in the ambulance bay at the hospital with her usual face on”, he could not remember if he had been in the back with Patient 1, telling her words to the effect “I can’t remember I was probably in the back as the patient was unwell”. LMA was concerned that the Registrant might have been trying to cover up that he had been driving when, as the paramedic and lead clinician, he should have been in the back of the ambulance. LMA said that she did not question the Registrant further because she knew she could check the Hospital’s CCTV to see who was driving.
94. LMA said she had immediately stood the Registrant down from clinical duties and asked him to prepare his statement as to his recollection of the incident. LMA said that she felt the Registrant was being very protective of himself and was asking why she was speaking just to him and not to Colleague A. LMA said she asked the Registrant not to speak to Colleague A to discuss the facts. She said she was not due to speak to Colleague A until after Christmas as he was on leave until 28 December 2021. She had made this request to preserve the integrity of their respective statements so that she would receive two independent accounts.
95. LMA told the Panel that she went to the Hospital and whilst there had received a number of calls from Colleague A asking about the complaint that had been received. She also said that on her return from the Hospital, the Registrant had informed her that he had called Colleague A.
96. The Panel also heard from Colleague A who said that on 24 December 2021, he had received multiple phone calls from the Registrant which he had not answered as he was in the pub at the time. He said it was only after the third or fourth call, that he returned the Registrant’s calls. Colleague A said the Registrant told him that he had been pulled off the road by LMA whilst he was working, and that he needed to make a statement in respect of a job with the paediatric patient, Patient 1, which they had attended on 6 December 2021. Colleague A said that during the telephone call, they had discussed the incident involving Patient 1 on 6 December 2021.
97. In his internal investigation interview with AB on 9 February 2022, the Registrant admitted contacting Colleague A on 24 December 2021. He stated that when he was preparing his statement on 24 December 2021, he had texted Colleague A to confirm a few details, and later sent him a copy of his statement. The Registrant agreed that he had queried with LMA why Colleague A and Colleague P had not been asked for statements. AB asked the Registrant what his specific intention had been in contacting Colleague A. The Registrant had said that it was to let him know about the DATIX and to confirm a few details. The Registrant said that Colleague A had been in the pub and had phoned him back. He said they had “confirmed that he had oxygen in the back and the mask was near the baby at which point I/he said there is CCTV in there that would prove it. We discussed was we going to get in trouble for [Colleague] A being in the back, or was I? No, we didn’t think so”.
98. The Panel accepts LMA’s evidence that, on 24 December 2021, she asked the Registrant not to contact Colleague A about the incident involving Patient 1 on 6 December 2021. LMA was clear that her rationale for doing so was so that she could get two independent accounts of what had happened. The Panel also accepts Colleague A’s evidence that the Registrant did contact him on that date and that they did discuss the incident regarding Patient 1 on 6 December 2021. The Panel notes that the Registrant admitted to AB that he had contacted Colleague A on that date about the incident regarding Patient 1 on 6 December 2021.
99. The Panel is therefore satisfied, on the balance of probabilities, that the Registrant did contact Colleague A to discuss the incident regarding Patient 1 on 6 December 2021, despite having been asked by LMA to not discuss the incident with Colleague A.
100. Accordingly, the Panel finds Particular 2 proved.
Particular 3 is found proved
101. The Panel has already found proved that there was a telephone call between the Registrant and Colleague A on 24 December 2021 in which the incident involving Patient 1 on 6 December 2021 was discussed. The Panel is satisfied on the evidence of Colleague A, and from the Registrant’s eventual position on the matter, that it was the Registrant who drove the ambulance and Colleague A who was in the back with Patient 1 on the transfer to Hospital on 6 December 2021.
102. Colleague A told the Panel that during the conversation, the Registrant had said words to the effect, “I need you to say you were attending”. Colleague A understood that the Registrant to be asking him to lie and say that he was driving, and that the Registrant was in the back of the ambulance with Patient 1 during the transfer to Hospital. Colleague A conceded that he had been a little drunk at the time of this conversation, but his response had been to contest what the Registrant had suggested and that he had said words to the effect, “no, I remember the job quite well. I was in the back, I did it all”. Colleague A said he told the Registrant that SECAMB would check the CCTV and realise that he had been in the back. The Registrant had hung up on him.
103. In his statement for LMA dated 18 January 2022, regarding the incident with Patient 1 on 6 December 2021, and the phone call with the Registrant on 24 December 2021, Colleague A said that he had told the Registrant that it was his paper work, he had passed the pre alert to the Hospital, and he had struggled to keep oxygen on the child all the way to the Hospital. Colleague A said he had told the Registrant that he was not going to lie for him and that as there was CCTV in the ambulance, SECAMB would find out if he wanted to say he was in the rear. Colleague A said he had been very upset by the call. He said he had known nothing about the complaint until then and had tried to call LMA about it. Colleague A said that the Registrant had sent him a copy of his statement on 26 December 2021. Colleague A said he considered that it was not an accurate account of the incident, and he was not prepared to put his name to it. He believed the Registrant had sent him his statement so that Colleague A would write the same account. It was after this that Colleague A had put in a complaint about the Registrant.
104. The Panel notes that the Registrant told AB in his interview on 9 February 2022 that, “I did not coerce him to say anything if I had I wouldn’t be brazen enough to say get the CCTV.” The Registrant was asked by AB, “At no point did you ask [Colleague] A to say you were in the back?” to which the Registrant responded, “No at no point did I ask him to change his story”.
105. The Panel has decided that it prefers Colleague A’s account of the conversation. In reaching this conclusion, the Panel has taken note of Colleague A’s admission that he was a little drunk at the time. The Panel rejects the Registrant’s account and considers that the Registrant asked Colleague A to lie for him because he knew he should have been in the back of the ambulance with Patient 1 who was a critically ill child. The Panel also considers that at least part of the reason the Registrant asked Colleague A to lie for him was because of the final written warning he was still subject to which is the allegation in Particular 4.
106. The Panel is satisfied on the balance of probabilities, that on 24 December 2021, the Registrant suggested to Colleague A in a telephone call that he should state it was Colleague A driving the ambulance, in respect of the incident involving Patient 1 on 6 December, when this was incorrect.
107. Accordingly, the Panel finds Particular 3 proved.
Particular 4 is found proved (in relation to Particulars 2 and 3)
108. The Panel has heard and accepted evidence from GS regarding the Registrant being issued with a final written warning on 4 February 2021. GS said he was the hearing manager at a disciplinary hearing on 27 January 2021 in relation to the Registrant’s failure to delegate work appropriately or supervise two ECSW’s in caring for a 55-year-old male patient with back pain, and his failure to properly assess or treat that patient. GS told the Panel that the investigation report had been prepared by Colleague G, an Operations Manager. GS said during the hearing the Registrant had admitted that, in hindsight, he had not delegated properly to his junior colleagues. The Registrant had accepted that he had remained in the ambulance while an ECSW had treated the patient at the scene and that this was not appropriate supervision or delegation. The Registrant had also accepted that he had not treated the patient himself, leaving this to the ECSW. GS told the Panel that he had decided that the matter could be dealt with by a final written warning for 12 months and that the Registrant was notified of this by letter on 4 February 2021. The final written warning was effective from that date. GS said that he was not aware that the Registrant had appealed the decision.
109. GS explained that the consequences of a final written warning were that if further misconduct was alleged against the Registrant during the 12 month ‘live’ period of the final written warning, the final written warning would be taken into account in considering the further misconduct. GS also said that if the warning and the further allegations were progressed to a disciplinary hearing, the likely outcome would be dismissal.
110. The Panel notes that GS did not have any direct knowledge of the matters that led to the disciplinary hearing that he chaired. It has seen the investigation report prepared by Colleague G but has not heard from Colleague G or from any other witness regarding the details of the incident that led to the final written warning. However, it accepts GS’s direct evidence that the Registrant made the admissions referred to in paragraph 108 above at the disciplinary hearing. It also accepts GS’s evidence that he did not announce the outcome at the end of the disciplinary hearing at which the Registrant had been present. GS told the Panel that he had decided to take time to reflect on the matter and that the Registrant was notified of the outcome of the hearing by a letter dated 4 February 2021. This was sent to the Registrant’s known postal address and by email to his known email address. GS told the Panel that he had also notified the Registrant’s line manager of the outcome.
111. The Panel has seen a redacted copy of the outcome letter dated 4 February 2021 addressed to the Registrant from which it is clear that he was issued with a final written warning and why. The outcome letter also refers to support measures which were to be put in place to assist the Registrant. These measures included the requirement for the Registrant to have six shifts with an Operational Team Manager (“OTM”) and to attend review meetings with his own OTM after 3, 6 and 9 months of the 12-month period of the final written warning. Although the Panel has not seen an unredacted copy of the letter and cannot check that it was sent to the address held on record by SECAMB for the Registrant, nor check that the letter was emailed to the Registrant’s known email address, it is satisfied, on the balance of probabilities, that the Registrant would have received the outcome letter and would have been made aware of it in discussions with his line manager who had the responsibility of putting in place the support suggested by GS. The Panel is also of the view that it is very unlikely that the Registrant, aware that GS was taking time to consider what to do in his case and having made admissions regarding the 55-year-old patient with back pain, would not have made enquiries as to the outcome.
112. The Panel has concluded therefore, that it is more likely than not that the Registrant knew he was subject to a 12-month written final warning from 4 February 2021 in respect of his failure to delegate work appropriately and supervise two ECSWs in caring for a 55-year-old male patient with back pain and for his failure to properly assess and treat that patient. Having reached this conclusion, the Panel has not had to consider the alternative allegation that the Registrant “ought to have known”.
113. The Panel then considered whether the Registrant acted as the Panel has found that he did in Particulars 2 and/or 3 when he knew that he was subject to the 12-month written final warning. By 24 December 2021, the Registrant had just over a month until the end of the 12-month “live” period of the warning. The Panel takes the view that the Registrant was aware that the concerns arising out of the incident involving Patient 1 on 6 December 2021, were similar to those which had led to the written final warning. It considers that the Registrant was also aware of the likely consequences for him if he was subject to a further disciplinary hearing for similar concerns. The Panel has already accepted LMA’s evidence that the Registrant was unusually concerned and angry about the complaint when she had first raised the DATIX from the Hospital with him. LMA said that the Registrant had appeared to be angry and had been defensive and very protective of himself.
114. The Panel has concluded that it is more likely than not the Registrant acted as it has found he did in Particulars 2 (in calling Colleague A when told not to), and in Particular 3 (in asking Colleague A to lie about who was in the back of the ambulance), because he knew at that time (24 December 2021), that he was still subject to the final written warning dated 4 February 2021 and he was aware that if the complaint led to an investigation and a disciplinary hearing, he would very likely be dismissed.
115. Accordingly, the Panel finds Particular 4 proved in relation to both Particular 2 and Particular 3.
Particular 5 is found proved
116. The Panel heard evidence from LMA which it accepts that on 24 December 2021, she raised a DATIX which SECAMB had received from Colleague D, a nurse at the Hospital relating to 6 December 2021 and to Patient 1. The Panel has seen the DATIX although it has not heard from Colleague D. LMA told the Panel that she spoke on 24 December 2021 with the Registrant about the DATIX. Before meeting him, LMA had printed a copy of the ePCR for Patient 1 and CAD notes. She said she had given these to the Registrant when they met, and she said she had invited him to speak through the complaint. LMA told the Panel that the Registrant was very disgruntled to hear of the complaint and he was also angry. She described the Registrant as being red in the face and told the Panel that she had dealt with other registrants in relation to complaints, but none had had the extreme reaction that she witnessed in the Registrant. LMA said that the Registrant had referred to the complainant, nurse (Colleague D), as “that fucking stuck up bitch at the hospital”, or words to that effect.
117. The Panel is satisfied it is more likely than not that the Registrant did refer to the nurse, Colleague D, using those words, or words to that effect, as stated by LMA. The Panel does not consider that there is any reason for LMA to lie about this. LMA accepted that the Registrant might from time to time use such language, but she did not expect such language to be used in the context of a meeting between a registrant and an OTL when discussing a formal complaint. The Panel has no doubt that the language used by the Registrant about a fellow healthcare professional during the course of such a meeting was unprofessional and offensive.
118. Accordingly, the Panel has found Particular 5 proved.
Particular 6a) and 6b) are found proved
119. The Panel heard evidence from VB that on 23 December 2021, she had been the OTL during the shift worked by the Registrant at the Thameside station. VB said she had been alerted to a discrepancy with the controlled drug count in one of the red books. A member of staff had counted the vials as they were signing their drugs out and had noticed that there were fewer vials than there should have been.
120. VB told the Panel that she had gone to the drugs room with the member of staff at about 19.10 and could see from the red book that the Registrant had signed in some drugs at 19.00 that evening. VB could also see from the red book that the Registrant had been working with another paramedic, Colleague J on shift and that they had signed their drugs in together. Colleague J had signed as witnessing the Registrant signing the drugs back in, and the Registrant had signed as witnessing Colleague J signing her drugs in. VB could see that there were only two vials unaccounted for in the red book which meant that one paramedic had placed their drugs back in the safe and the other had not.
121. VB told the Panel that she had called the Registrant about the missing drugs, and he had told her that he did still have them. VB said she had told the Registrant that he would have to return the drugs to the station immediately. She said that the Registrant had asked if he could return them the next day as he would be returning to Thameside for his next shift. VB said she had told him that he had to return them straightaway. She said the Registrant had said that he could not do that as he was in a pub. VB said she told him that she would come and collect the drugs from him. She said she was not sure if the Registrant had had a drink but that she had taken his comment as an indication that he had, and she had not wanted him to drive if that was the case. VB said that the Registrant had informed her that the drugs were in his car and that this had concerned her as they should have been on his person.
122. VB said she drove to the pub and the Registrant had come out to meet her as she pulled up. He had handed her the drugs in his drug case, removing them from his belt. VB said that this suggested to her that the Registrant had not left the drugs in his car. She said the Registrant had told her to take the drugs in the drug case which he could collect the next morning at the beginning of his shift. VB said the Registrant had appeared to be in a good mood and that he did not appear to have a bad attitude about returning them. However, VB said that the Registrant did not appear to recognise his responsibility towards them.
123. VB said that she had signed the drugs in on her return to the station having already informed her line manager for that shift of the situation. VB said she had also completed a DATIX recording the incident.
124. VB explained that this was not the first time that someone had not put controlled drugs back into the safe. She said that she had tried to find a way to prevent it happening again but that it had happened again since this incident.
125. The Panel has seen the SECAMB Medicines Policy and is satisfied that the procedures relating to controlled drugs referred to by VB in her evidence are reflected in that policy document. The Panel has seen the relevant entry in the red drugs book signed by the Registrant at 19:00 hours on 23 December 2021 and witnessed by Colleague J who was a NQP at the relevant time. The Panel has not heard any evidence from Colleague J as she was not a witness in the case. The Panel has also seen the DATIX Incident form submitted by VB at 21:14 the same evening.
126. The Panel does not consider that the Registrant deliberately took the two vials containing controlled drugs from Thameside station at the end of his shift. However, the Panel has accepted the evidence of VB that at the time the Registrant and Colleague J returned controlled drugs to the drugs safe on 23 December 2021, they were the only people in the drugs room. There should therefore have been nothing to distract the Registrant from replacing his controlled drugs according to the relevant procedure. The Panel considers that it is proper to draw an inference from the fact that there was a discrepancy of two vials which was discovered only 10 minutes after the Registrant and Colleague J had completed the entries in the red book, that the Registrant did not carry out the full replacing procedure. If he had, he would have counted all the vials in the drug safe and discovered that two were missing. This would have alerted him to the fact that he had not replaced two vials in his possession. The Panel considers that the Registrant’s behaviour on this occasion suggests a degree of laziness or sloppiness in relation to the return of controlled drugs.
127. The Panel is satisfied that the Registrant failed to return controlled drugs at the end of his operational shift. He was under a duty to do so and, as an experienced paramedic, he would know the importance of doing so. The Panel does not consider that the fact the procedure at Thameside was different to the Registrant’s base station is an excuse. The Registrant was previously based there. The Panel prefers VB’s evidence to that of the Registrant regarding when it was that he became aware that he still had the two vials in his possession. According to VB, the Registrant accepted almost immediately she called him that he had the drugs in his possession. He told her they were in his car. She was not aware that he had gone from the public house to his car to check and said that his response that he had the drugs had been immediate. The Panel considers the Registrant would have understood the significance of VB’s call and considers his almost immediate response to VB as an implicit admission that he had failed to return the controlled drugs at the end of his operational shift. Accordingly, the Panel finds Particular 6 a) proved.
128. The Panel is also satisfied that it is more likely than not that the Registrant attended a public house with controlled drugs in his possession. The Registrant does not dispute this. The Panel does not accept the Registrant’s account of going to his car and finding then that he had the drugs. VB told the Panel that the Registrant had almost immediately told her that he had the drugs and that they were safe in his car. The Panel takes the view that whether the controlled drugs were in the Registrant’s car or on his person when VB called, they were in the Registrant’s possession when he attended the public house. The Panel considers that attending a public house to include being inside a public house and/or in its car park. If the controlled drugs were in his car in the public house car park, this would only be because the Registrant must have taken his belt off to enter the public house. The Panel considers that they would still be in the Registrant’s possession as they were under his control in his car. If they were still on his belt when he entered the public house, then he was in physical possession of them.
129. The Panel has decided that it is more likely than not that when the Registrant attended the public house he was in possession of controlled drugs. Accordingly, the Panel finds Particular 6 b) proved.
Particular 7 is found proved (in relation to Particular 3)
130. The Panel has had regard to the submissions of Ms Kennedy regarding dishonesty. It has received and accepted legal advice as to how it should approach the issue of dishonesty. It has had regard to the HCPTS Practice Note on “Making decisions on a registrant’s state of mind”. The Panel has applied the test for dishonesty as set out in the case of Ivey v Genting Casinos [2017] UKSC 67 (at para 74) [the Ivey test]. In applying the Ivey test, the Panel first decided the Registrant’s knowledge or belief as to the factual circumstances of his conduct in relation to Particular 3. The Panel understands that the Registrant’s belief does not have to be a reasonable one, so long as it is genuinely held. The Panel has then considered whether, based on the factual circumstances as it has found the Registrant believed them to be, his conduct was dishonest by the (objective) standards of ordinary, decent people. The Panel understands there is no requirement that the Registrant must appreciate that what he has done is, by those standards, dishonest.
131. In relation to the first part of the Ivey test, the Panel has concluded that the Registrant’s state of knowledge and belief on 24 December 2021 when he asked Colleague A to say that he had been driving on 6 December 2021, was that:
- he knew of the complaint from the Hospital about Patient 1’s care and had seen the DATIX report;
- he knew he was still subject to a 12- month final written warning in respect of similar concerns regarding his delegating to an ECSW and not treating a patient himself;
- he knew from the outcome letter imposing the 12-month final written warning that if he was subject to any further complaint of a similar nature, the likely outcome would be his dismissal.
132. On the basis of these factual circumstances, and applying the second part of the Ivey test, the Panel has no hesitation in concluding that the Registrant was dishonest when he asked Colleague A to lie for him, as found in Particular 3.
133. Accordingly, the Panel finds Particular 7 proved as it relates to Particular 3.
Decision on Grounds
134. In reaching its decision on the statutory ground of misconduct, the Panel has taken account of Ms Kennedy’s submissions. The Panel has received and accepted legal advice.
Submissions
135. Ms Kennedy submitted that if any or all of the particulars are found proved against the Registrant, this proves that the Registrant acted in a way which fell far short of what would be proper in the circumstances and what the public would expect of a registered paramedic. Ms Kennedy referred the Panel to the definition of “misconduct” as set out in the case of Roylance v GMC [2001] 1 AC 311 which states,
“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a [medical] practitioner in the particular circumstances”.
136. Ms Kennedy also referred the Panel to the HCPC’s Standards of Conduct, Performance and Ethics (2016) and submitted that, as set out in the Case Summary, the Registrant had breached the following Standards:
Standard 2 - Work with colleagues
2.6 You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers.
2.8 You must treat your colleagues in a professional manner showing them respect and consideration.
Standard 4 - Delegation, oversight and support
4.1 You must only delegate work to someone who has the knowledge, skills and experience needed to carry it out safely and effectively.
4.2 You must continue to provide appropriate supervision and support to those you delegate work to.
Standard 6 - Identify and minimise risk
6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.
Standard 7 – Report concerns
7.2 You must support and encourage others to report concerns and not prevent anyone from raising concerns.
Standard 9 - Personal and professional behaviour
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
Decision
137. The Panel has considered the conduct found proved in each of the particulars of the Allegation to judge whether it involves a serious departure from the standards to be expected of a Paramedic and therefore amounts to the statutory ground of misconduct.
138. In reaching its decision on the statutory ground, the Panel has considered the impact of the Registrant’s conduct on the Service Users, the Registrant’s colleagues, on the reputation of SECAMB and on the Paramedic profession, and the wider public interest.
139. In relation to Particular 1a) and 1 b), the Panel has no doubt that the Registrant’s conduct on 6 December 2021 in relation to Patient 1 amounts to a serious departure from the standards to be expected of a Paramedic and that it therefore amounts to misconduct. Patient 1 was a critically ill child and it was incumbent on the Registrant as the lead clinician to treat Patient 1 during the transfer to Hospital. He should not have delegated that role to Colleague A thereby allowing Colleague A to act outside his scope of practice. The Registrant should have ensured that in the transfer from the back of the ambulance to the Hospital, a supply of oxygen was maintained to Patient 1.
140. In acting as he did, the Registrant put Patient 1 at risk of serious harm by not having paramedic support in the ambulance should his condition suddenly deteriorate as it could so easily have done. The Registrant also put Patient 1 at risk of serious harm by removing the supply of oxygen when Patient 1 was already struggling to breathe when transferring him on the short journey into the Hospital.
141. In relation to Particulars 2 and 3, the Panel has considered its findings of fact on these matters separately before then considering them together with its findings in relation to Particular 4. The Panel has done this due to the obvious factual links between them. The Panel has concluded that the facts found proved in Particular 2 taken in isolation, would amount to misconduct but would not reach the level of seriousness required for a finding of the statutory ground of misconduct. Whilst it would be misconduct for a registrant to disobey an instruction given by a senior colleague in the context of an inquiry into a complaint made in a DATIX, the Panel does not consider that, on its own, it was serious misconduct.
142. The Panel has no hesitation in concluding that to ask a colleague to lie about a matter that is subject to a formal complaint from another healthcare professional is a serious departure from the standards to be expected of a Paramedic and that it therefore amounts to misconduct.
143. In relation to Particular 4, the Panel has found that the Registrant acted as he did in Particulars 2 and 3 knowing that he was still subject to a 12-month written final warning for matters that were similar to the complaints raised by Colleague A and in the DATIX regarding Patient 1 on 6 December 2021. The Registrant disobeyed LMA’s instructions not to contact Colleague A and then asked Colleague A to lie about who had driven the ambulance and who had treated Patient 1 on the short journey to the Hospital. The Panel has no doubt that taken together the Registrant’s conduct in Particulars 2, 3 and 4 amount to serious misconduct.
144. In relation to Particular 7 (which relates to Particular 3), the Panel has no hesitation in concluding that the Registrant’s dishonesty in trying to get Colleague A to lie in what appears to have been an attempt by the Registrant to try to cover up his conduct as regards Patient 1 when he was already subject to a final written warning for similar concerns, amounts to the statutory ground of misconduct.
145. In relation to the matters in Particulars, 2, 3 4 and 7, the Panel considers that where a registrant acts as it has found the Registrant did, this has a detrimental impact on the public trust in the Paramedic profession. It is important for the public to be able to trust paramedics who treat them at their most vulnerable.
146. In relation to Particular 5, the Panel does not consider that the Registrant’s conduct fell far below the standards to be expected of a Paramedic when he used unprofessional and offensive language during his meeting with LMA on 24 December 2021 to describe Colleague D, the nurse who filed the DATIX complaint. The Panel considers that the Registrant’s inappropriate choice of language arose in the heat of the moment when he was first being told about the complaint Colleague D had made. In the context of that meeting, while the words the Registrant used were unprofessional and offensive, the Panel does not consider that this was so serious as to amount to the statutory ground of misconduct.
147. In relation to Particular 6a) and 6b), the Panel considers that the Registrant’s conduct fell far below the standards expected of a Paramedic in the handling of controlled drugs. The Panel has found that the Registrant and the NQP, Colleague J were alone in the drugs room and that the Registrant was carrying out a procedure that he had to do at the end of each shift no matter what process was in place at the relevant ambulance station. The Panel considers that it is a serious failing in carrying out a process not only required by his employer but also by law. Once the Registrant is no longer on duty, he is not permitted in law to be in possession of controlled drugs. The Panel takes the view that it would appear the Registrant had a lazy or sloppy approach to the procedure regarding the returning of controlled drugs. The Panel accepts that it be considered less serious if the drugs room had been crowded and the Registrant had been distracted into thinking he had returned the vials when he had not done so. However, where there are only two people in the room, and where he is the senior of the two and the other is a NQP, it is particularly important for the Registrant to carry out the procedure properly. It is clear that he cannot have done so, as had he done so he would have counted all the vials after replacing his own and after Colleague J had replaced hers and realised that two vials were missing. The Panel considers that as the Registrant does not appear to have carried out the full procedure required under the relevant protocol, and because of the seriousness of controlled drugs going missing, that his conduct amounts to serious misconduct.
148. The Panel also considers it a serious failing to be in possession of controlled drugs when attending a public house. The Panel does not consider that it is an appropriate response to suggest bringing the controlled drugs back the next day. He is not legally permitted to have them in his possession when not on duty. On his own account, he had arrived at the public house at around 7:00 pm and VB rang him at about 7.30 pm. The Panel has found that at some point after he arrived at the public house, the Registrant realised he still had the controlled drugs in vials. It appears he may have secured them in the car and carried on with his drink rather than doing as he should have done which was to return them to Thameside. The Registrant was clear that he was not intoxicated and had not refused to return them but said that VB appeared happy to collect them from him. The Panel considers that the Registrant was in possession of controlled drugs, taking them into the public house to await VB’s arrival, to be a serious departure from the standards expected of a Paramedic and amounts to misconduct.
149. In reaching its decision on misconduct, the Panel has also considered the HCPC’s Standards of Conduct, Performance and Ethics (2016) and has concluded that a number of Standards are engaged and have been breached.
Standard 4 - Delegation, oversight and support
4.1 You must only delegate work to someone who has the knowledge, skills and experience needed to carry it out safely and effectively.
4.2 You must continue to provide appropriate supervision and support to those you delegate work to.
Standard 6 - Identify and minimise risk
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.
Standard 9 - Personal and professional behaviour
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession
150. The Panel considers that in allowing Colleague A to work outside of his scope of practise as an ECSW the Registrant did not delegate work to someone who has the knowledge, skill and experience needed to carry it out safely and effectively (Standard 4.1). It also considers that the Registrant was not in a position from the driving seat of the ambulance to provide appropriate supervision and support to Colleague A to whom he had delegated the care of Patient 1 to during the journey to the Hospital (Standard 4.2). The Panel also considers that in acting as he did, the Registrant did not take all reasonable steps to minimise the risk of harm to Patient 1 (Standard 6.1) and he had allowed Colleague A to treat Patient 1 in the back of the ambulance which put the health of Patient 1 at unacceptable risk as Colleague A did not have the skills and expertise to provide appropriate treatment in the event Patient 1’s condition suddenly deteriorated (Standard 6.2). The Panel is satisfied that in acting as he did in relation to Patient 1, the Registrant did not make sure that his professional behaviour justified the public’s trust and confidence in him and in his profession (Standard 9.1).
151. The Panel also considers that in calling Colleague A on 24 December 2021 despite having been told not to by LMA and then dishonestly asking Colleague A to lie about who was driving the ambulance and who was treating Patient 1 in effect to safe his own career because he was still subject to a final written warning for similar concerns, the Registrant did not make sure that his professional behaviour justified the public’s trust and confidence in him and in his profession (Standard 9.1).
152. The Panel is satisfied that in failing to return controlled drugs at the end of his operational shift and then to attend a public house in possession of those drugs, the Registrant did not make sure that his professional behaviour justified the public’s trust and confidence in him and in his profession (Standard 9.1).
153. Accordingly, the Panel finds misconduct in this case.
Decision on Impairment
Submissions
154. Ms Kennedy submitted that the Registrant’s fitness to practise is impaired on both the personal and public component.
155. In relation to the personal component, Ms Kennedy submitted that the misconduct was difficult to remedy because of the Registrant’s attitudinal issues and his dishonesty. Ms Kennedy submitted that the Registrant’s actions had put Patient 1 at risk of serious harm. He had also put Colleague A at risk of harm by asking Colleague A to lie for him at a time when the Registrant was subject to a final written warning for similar conduct. Ms Kennedy referred to the Panel’s findings in respect of the controlled drugs and its conclusion that the Registrant had been lazy and sloppy in his approach to the process for their return to the drugs safe. Ms Kennedy submitted that the concerns in the case were not clinical but rather related to the Registrant’s attitude. She submitted that it was therefore difficult for him to remedy the significant departures from the standards expected of a Paramedic found by the Panel. Ms Kennedy referred to the Registrant’s lack of acceptance of the concerns at the local level and his lack of remorse. She referred to the Registrant’s lack of engagement with the proceedings and his indication in the telephone call on 18 October 2024, that he had “moved on”. Ms Kennedy submitted that the Registrant had shown no insight and had taken no steps to remedy his misconduct, and that there was a risk of repetition.
156. In relation to the public component, Ms Kennedy submitted that the Registrant’s conduct had brought the Paramedic profession into disrepute. She submitted that the public expected paramedics to provide appropriate and competent treatment of their patients, and to act with honesty and integrity. Ms Kennedy submitted that the Registrant had put Patient 1 at risk of harm, and he had put his junior colleague in a difficult situation when asking him to lie. Ms Kennedy submitted that in doing so, the Registrant had also breached fundamental tenets of the profession.
157. In expanding on her submissions regarding harm, Ms Kennedy submitted that the Registrant’s failings had put Patient 1 at risk of serious harm. She also submitted that the Registrant’s inappropriate behaviour towards Colleague A could have impacted on his safe and effective delivery of care due to a breakdown of trust between them.
Decision
158. In reaching its decision on impairment, the Panel has had regard to the HCPTS Practice Note on “Fitness to Practise Impairment”. The Panel has taken account of Ms Kennedy’s submissions. It has received and accepted legal advice. The Panel has borne in mind that the purpose of this hearing is not to punish the Registrant for past misdoings but is to protect the public against the acts and omissions of those who are not fit to practise.
Personal component
159. In relation to the personal component, the Panel has concluded that the misconduct found in this case, should ordinarily be capable of being remedied. It acknowledges that it is more difficult, but not impossible, for a registrant to remedy misconduct which involves dishonesty, particularly where, as here, that dishonesty is at the higher end of the scale. It was a deliberate act by the Registrant in an attempt to avoid being dismissed at a time when he knew he was still subject to a final written warning for similar concerns. The Panel takes the view that the Registrant has attitudinal issues which would make it more difficult for him to remedy his misconduct. The Panel considers the Registrant knows how he should have behaved in caring for Patient 1, in his handling of controlled drugs and knew that in asking a colleague to lie on his behalf, this was dishonest. Despite this, the Registrant chose not to act as he knows he should have done.
160. The Panel has no evidence that the Registrant has any insight into his misconduct. He has not produced any evidence that he has taken steps to remedy the misconduct by, for example, attending relevant courses on ethics, the handling of controlled drugs, or on appropriate delegation to colleagues. The Panel has seen no evidence that the Registrant has reflected on his misconduct. The Panel notes that the Registrant has not engaged with these proceedings, and it has no information about the Registrant’s current employment situation other than, as set out in the telephone note of 18 October 2024, that he has “moved on”.
161. In these circumstances, the Panel has concluded that there is a high risk of repetition.
162. The Panel has considered the risk of harm. The Panel is in no doubt that the Registrant’s actions caused risk of harm to Patient 1. Patient 1 was a critically ill child who had to be placed into an induced coma and transferred to a specialist hospital where it was found that he had suffered a hypoxic brain injury. The Panel takes the view that the Registrant knew that he should have travelled in the back of the ambulance and knew that he should have maintained a supply of oxygen to Patient 1 when transferring him from the back of the ambulance to the Hospital. This was not a situation which was brought about as a result of the Registrant lacking competence. The Panel is satisfied that in the absence of any insight, reflection and remediation, that there is a high risk that the Registrant is liable to put service users at risk of unwarranted harm in the future.
163. The Panel also considers that the Registrant’s inappropriate conduct towards Colleague A both in leaving him to treat Patient 1 outside his scope of practice, and in asking him to lie for him, put at risk the trust that paramedics and ECSWs need to have in order to work safely and effectively together within their respective scopes of practice.
164. The Panel is satisfied therefore, that the Registrant’s fitness to practise is impaired on the personal component.
Public component
165. In relation to the public component, the Panel has no doubt that public confidence in the Paramedic profession would be seriously undermined if there was no finding of impairment in this case. The Panel is satisfied that a reasonable and informed member of the public would be shocked, concerned and worried if there was no finding of impairment where the Registrant had (i) allowed an ECSW to work outside their scope of practice in respect of a critically ill 16-month-old child, (ii) had failed to maintain a supply of oxygen to that child when transferring him from the back of the ambulance to the Hospital, (iii) where, when asked about the matter, had asked a colleague to lie on his behalf because he was subject to a final written warning for similar concerns and would likely be dismissed if the new concerns were investigated, and (iv) where he failed to handle controlled drugs in accordance with his employer’s procedures.
166. The Panel has concluded that the Registrant’s conduct has brought the Paramedic profession into disrepute, and given the high risk of repetition, is liable to do so in the future. The Panel is also satisfied that it would be failing in its duty to declare and uphold proper standards of conduct and behaviour in the Paramedic profession if it did not find impairment in this case. Paramedics should be in no doubt that this sort of behaviour is unacceptable. Patient safety and honesty and probity are fundamental tenets of the profession. The Panel is satisfied that the Registrant’s conduct breached those fundamental tenets and given the high risk of repetition, it has concluded that he is liable to breach these fundamental tenets in the future.
167. The Panel has therefore found that the Registrant’s fitness to practise is impaired on both the personal and public component. Accordingly, the Panel finds the Allegation is well founded.
Decision on Sanction
168. In considering the appropriate and proportionate sanction the Panel was referred to, and has taken account of, the guidance set out in the HCPC’s Sanctions Policy. The Panel has received and accepted legal advice. The Panel is aware that the purpose of any sanction it imposes is not to punish the Registrant, although it may have that effect, but it is to protect the public, to maintain confidence in the Paramedic profession and to uphold its standards of conduct and behaviour. The Panel has also had in mind that any sanction it imposes must be appropriate and proportionate bearing in mind the nature and circumstances of the misconduct involved.
Submissions
169. Ms Kennedy set out the relevant principles regarding the imposition of a sanction but, as is the HCPC’s usual approach at the sanction stage, did not advance any particular sanction.
Decision
170. The Panel has considered mitigating and aggravating factors. The Panel first looked at the mitigating factors. The mitigating factors are:
- there are no previous regulatory findings against the Registrant;
- the Registrant made a limited admission at a local level to his employer, namely that he had failed to return controlled drugs at the end of his operational shift, and that the controlled drugs were with him at a public house.
171. The Panel has considered whether there is any personal mitigation and has found there is none.
172. The Panel considers the following to be aggravating factors:
- the risk of significant harm to Patient 1;
- the Registrant’s lack of insight into his misconduct and its impact on Patient 1, Colleague A, his profession and the wider public interest;
- his failure to express any remorse;
- the Registrant’s failure to take any steps towards remedying his misconduct;
- the pattern of concerns regarding the Registrant’s failure to work in partnership with colleagues, namely his inappropriate delegation to ECSWs which in turn led to his failing to properly assess and treat those patients appropriately;
- the level of dishonesty which is at the higher end of the scale.
173. The Panel has considered the available sanctions in ascending order of seriousness. It has decided that to take no action or impose a Caution Order in this case would not be appropriate or proportionate given that the misconduct was not isolated or limited, and nor could it be described as relatively minor in nature. The Panel cannot conclude that there is a low risk of repetition because the Registrant has not shown any insight into the causes of his misconduct or its impact on Patient 1, Colleague A, his profession and the wider public. The Panel is satisfied that to ensure public confidence in the profession is not undermined, it must consider a more severe sanction.
174. The Panel then considered a Conditions of Practice Order and in particular the matters set out in paragraph 106 of the Sanctions Policy which states:
“A conditions of practice order is likely to be appropriate in cases where:
• the registrant has insight;
• the failure or deficiency is capable of being remedied;
• there are no persistent or general failures which would prevent the registrant from remediating;
• appropriate, proportionate, realistic and verifiable conditions can be formulated;
• the panel is confident the registrant will comply with the conditions;
• a reviewing panel will be able to determine whether or not those conditions have or are being met;
• the registrant does not pose a risk of harm by being in restricted practice”.
175. The Panel has also had in mind paragraphs 107 and 108, which state:
107 “Conditions will only be effective in cases where the registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the registrant has failed to engage with the fitness to practise process or where there are serious and persistent failings”.
108 “Conditions are also less likely to be appropriate in more serious cases, for example those involving:…..dishonesty….failure to work in partnership”.
176. The Panel has considered paragraph 109 which states in relation to serious cases and the imposition of a Conditions of Practice Order:
“However, it should only do so when it is satisfied that the registrant’s conduct was minor, out of character, capable of remediation and unlikely to be repeated.”
177. The Panel has found that the misconduct in this case is capable of being remedied although it acknowledges that it may be difficult for this Registrant to achieve. It does not consider that the Registrant’s conduct was “minor” or “unlikely to be repeated”. The Panel considers that the Registrant has shown no insight into his misconduct. There remains therefore, a high risk of repetition of the misconduct.
178. The Panel has also concluded that it is not possible to devise appropriate, proportionate, realistic, and verifiable conditions which would address the serious concerns regarding the Registrant’s behaviour in this case. Where dishonesty is involved, appropriate conditions of practice are rarely appropriate, and they are particularly difficult to formulate. The Registrant is not engaging with the regulatory process and so the Panel has no confidence that he would comply with a Conditions of Practice Order. The Panel also takes the view that given the nature and gravity of the misconduct, the imposition of a Conditions of Practice Order would not be sufficient to maintain public confidence in the Paramedic profession and in the regulatory process.
179. The Panel next considered whether to impose a Suspension Order. It has had in mind the following guidance from the HCPC’s Sanctions Policy:
“121 A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:
• the concerns represent a serious breach of the Standards of conduct, performance and ethics;
• the registrant has insight;
• the issues are unlikely to be repeated;
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.”
180. The Panel has considered very carefully whether the Registrant’s misconduct and the level of the risk of repetition rules this sanction out. The Panel has already expressed its view that while the concerns in this case are capable of being remedied, it considers that it would be difficult for this Registrant due to his attitudinal issues. The Panel has seen no evidence to suggest that the Registrant is capable of remedying his misconduct, or that he wishes to do so. The Registrant has not engaged with the process. In the note of a telephone call dated 18 October 2024, the Registrant made it clear so far as these proceedings are concerned, he “wants nothing to do with it” and he commented that this was something that he had been saying for as long as he could remember. In these circumstances, the Panel has concluded that a Suspension Order is not the appropriate and proportionate sanction in this case.
181. The Panel has also concluded that a Suspension Order even for a period of 12 months would not be appropriate or proportionate to maintain public confidence in the Paramedic profession or its regulatory body. Such an Order would not send out an appropriate message to the profession about this type of misconduct. The Panel considers that a reasonable and informed member of the public would expect a more severe sanction in circumstances where the Registrant put patients at risk of harm despite having the clinical knowledge and experience to know better, and where the Registrant allowed a colleague to work outside his scope of practice and then dishonestly asked him to cover this up in order to prevent his own potential dismissal.
182. The Panel has therefore concluded that the only appropriate and proportionate sanction is an order striking the Registrant off the Register. The Panel has considered the Sanctions Policy where, in paragraph 130, it is stated that such a sanction is one of “last resort for serious, persistent, deliberate or reckless acts involving” e.g., for “dishonesty, …...failure to work in partnership”. In this case, the Panel has found the Registrant’s dishonesty to have been at the higher end of seriousness. It was a deliberate act by the Registrant in an attempt to avoid almost certain dismissal. It has also found that the Registrant failed to work in partnership with Colleague A at a time when he knew he was subject to a final written warning for what was in effect the same concern, namely, a failure to work in partnership with the ECSWs who were attending the 55-year-old male patient.
183. The Panel has also had in mind paragraph 131 which states:
“A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory profession. In particular where the registrant:
• lacks insight
• continues to repeat the misconduct
• is unwilling to resolve matters.
184. The Panel is satisfied that in order to maintain public confidence in the Paramedic profession and in its regulatory process, and to uphold proper standards of conduct in the profession, it is appropriate and proportionate to order that the Registrant’s name be struck off the register, (i) in light of his lack of insight and his lack of engagement with these proceedings, and (ii) because of the nature and gravity of the misconduct, involving as it does dishonesty and failure to work in partnership with colleagues.
Order
ORDER: The Registrar is directed to strike the name of Mr Jason Edwards from the Register on the date that this order comes into effect.
Notes
Right of Appeal
An appeal may be made to the High Court in England and Wales against the Panel’s decision and the order it has made.
Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served. The Panel’s order will not take effect until the appeal period has expired or, if appealed, until that appeal is disposed of or withdrawn.
Interim Order
Proceeding in the absence of the Registrant
1. Ms Kennedy applied for an Interim Suspension Order. She submitted that the Panel should proceed in the absence of the Registrant for all the same reasons that she had advanced at the start of the hearing. Ms Kennedy submitted that the Registrant had not engaged with the proceedings, and he had made his position clear in the telephone call of 18 October 2024. Ms Kennedy submitted that given the Panel’s findings in relation to impairment and its reasons for imposing a Strike off Order, an Interim Suspension Order for 18 months was necessary to protect the public from an ongoing risk of harm. Ms Kennedy referred specifically to the Panel’s finding regarding the risk of repetition of harm to the public and submitted that an Interim Suspension Order would be consistent with the Panel’s findings.
2. The Panel has decided to proceed in the Registrant’s absence for the same reasons as set out in its determination above. The Registrant has been served with proper notice that this application might be made, in the email and in the letter sent to him by the HCPTS on 7 and 9 August 2024 respectively. The Registrant has made his position clear, as recorded in the telephone note dated 18 October 2024, that he wants nothing to do with these proceedings. The Panel considers that the Registrant has voluntarily waived his right to attend and that it is in the public interest that the application for an immediate Interim Order is considered.
Decision
3. The Panel has decided to make an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001. It is satisfied that for all the reasons set out in its determination above, that an Interim Order is necessary to protect members of the public in light of the high risk of repetition. The Panel is also satisfied that an Interim Order is otherwise in the public interest to maintain confidence in the Paramedic profession and to uphold its standards of conduct and behaviour. The Panel has considered if it is appropriate to impose an Interim Conditions of Practice Order but, for the reasons set out in its determination above, it has concluded that such an Interim Order would be inconsistent with its findings that conditions of practice would not sufficiently address the risk posed by the Registrant, or the wider public interest. The Panel has therefore decided that an Interim Suspension Order for 18 months to cover the period of any appeal, is the appropriate and proportionate Order.
4. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.
Hearing History
History of Hearings for Mr Jason E Edwards
Date | Panel | Hearing type | Outcomes / Status |
---|---|---|---|
21/10/2024 | Conduct and Competence Committee | Final Hearing | Struck off |
26/07/2024 | Conduct and Competence Committee | Interim Order Review | Interim Suspension |
18/06/2024 | Investigating Committee | Interim Order Review | Adjourned |
13/03/2024 | Investigating Committee | Interim Order Review | Interim Suspension |
05/09/2023 | Investigating Committee | Interim Order Review | Interim Suspension |
05/06/2023 | Investigating Committee | Interim Order Review | Interim Suspension |
03/03/2023 | Investigating Committee | Interim Order Review | Interim Suspension |
06/12/2022 | Investigating Committee | Interim Order Review | Interim Suspension |
08/06/2022 | Investigating Committee | Interim Order Application | Interim Suspension |