Mr Alexander McDowell

Preliminary Matters:

Privacy application

1. Ms Rao submitted that the Panel should proceed in private where it was necessary to do so to protect the health information of the Registrant.

2. Mr Tobias agreed with Ms Rao that any reference to the Registrant’s health information should be heard in private.

3. The Panel heard and accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note ‘Conducting Hearings in Private’ dated February 2025.

4. The Panel accepted the submissions made by both parties. The Panel acknowledged that there is a strong public interest in ensuring that hearings are conducted in public for transparency. However, any health issues relating to the Registrant should be kept private, as he has a right to protection of his private life, so far as it relates to his health. The Panel concluded that it was feasible to conduct only part of the hearing in private as matters relating to the Registrant’s health are not intrinsically linked to the Allegation.

Other matters

Witness

5. Prior to the hearing commencing the Hearings Officer informed the Panel and the Legal Assessor that one of the HCPC witnesses, AB, sits for the HCPTS as a Fitness to Practise panel member. The Panel was informed that AB did not recognise any of their names. The Panel was informed that the HCPTS scheduling team had taken steps to mitigate any potential conflict by appointing a Panel who had not sat with AB. The Panel members and Legal Assessor all said that they were not aware of having sat with AB.

6. This information was relayed to the parties and when the hearing started the Legal Assessor confirmed the information for the transcript.

7. In due course AB gave evidence under affirmation. Whilst under affirmation he confirmed that he did not recognise any of the Panel members. In return, and having seen AB on camera, the Panel members and Legal Assessor confirmed that they did not recognise AB.

Hearsay and Amendment of the Allegation

8. The Panel was informed that a preliminary hearing was held in respect of this case. The purpose of the preliminary hearing was to deal with the HCPC’s applications to amend the Allegation and to allow Service User A’s evidence to be admitted as hearsay evidence. The Panel was told that the preliminary hearing was contested by the Registrant.

9. The Panel was informed that the preliminary hearing panel had decided to allow the applications to amend the Allegation and to admit Service User A’s evidence as hearsay. The Panel was not provided with a copy of the preliminary hearing decision. The Panel did receive a copy of the ‘Notice of amended Allegation’ letter sent to the Registrant, dated 11 April 2025, which sets out the amended Allegation.

Steps of the hearing

10. The Panel had regard to the HCPTS Practice Note ‘Fitness to Practise Impairment’ dated February 2025. This gives information on the sequential approach to hearings.

11. The parties proposed that the Panel should retire to consider and hand down on the ‘Facts’ step. If any findings of fact are made, the Panel can then proceed to the next steps.

12. The Panel had regard to the nature of the case and the timetabling and agreed with the parties that it would deal with facts first.

Background:

13. The Registrant was employed at South East Coast Ambulance Service NHS Trust (“the Trust”) from February 2016 to July 2022. The Registrant was first employed as an emergency care support worker. He then worked as an associate ambulance practitioner and later as a Newly Qualified Paramedic once he qualified in July 2021.

14. The Registrant attended an emergency callout on 24 January 2022 to Service User A at her college (“the College”), where she was a residential student at the time. The callout related to Service User A allegedly attempting to take her own life.

15. It is alleged that the Registrant and Service User A began communicating on social media (Instagram) on or around 30 March 2022. It is alleged that the communications between the Registrant and Service User A continued and moved on to Snapchat, including times when the Registrant was at work and on a break.

16. Service User A alleges that there were many conversations with the Registrant where he said she was ‘teasing him’ and that he couldn’t wait to ‘fuck me’. Service User A also alleges that the Registrant complimented her on her body and would tell her the sexual things he couldn’t wait to do to her. Service User A alleges that there was one specific conversation when she told him she had started her period, and the Registrant allegedly told her ‘last night was the one chance before Switzerland to fuck me and you blew it’.

17. Service User A alleges that during the conversations, the Registrant referred to what her college room looked like on the night he attended the emergency callout to her, including details such as her wearing pink crocs and a random bowl of Haribo’s being on the floor.

18. Service User A alleges that she was on the Registrant’s Instagram, and she clicked on his tagged photos to see that he had a girl called Person H on Instagram who tagged him in a picture of a kitten saying “new addition to the family”. Service User A alleges that she recognised the kitten as the Registrant had told her he lived alone with two cats. Service User A states that she then realised the Registrant had a girlfriend. Service User A alleges that when she sent the Registrant screenshots and asked him who Person H was, he got angry and blocked her.

19. Service User A alleges she had shown the messages to Person H who confirmed that the Registrant was her (Person H’s) boyfriend.

20. Service User A alleges that the last contact Service User A had with the Registrant was on 10 April 2022, when she asked him if he told all of his vulnerable patients how special they were and planned futures with them to cheat on his girlfriend.

21. On 22 April 2022, a message was inputted on the College’s safeguarding system in relation to Service User A by a residential staff member. The message relayed that Service User A had informed the staff member that the Registrant had made contact with Service User A over Instagram during the Easter holidays.

22. On 26 April 2022, Service User A spoke to the Student Wellbeing and Safeguarding Manager at the College (SB). Service User A spoke about her alleged contact with the Registrant. The College subsequently raised concerns about the Registrant to the Trust.

23. The Registrant was suspended on 26 April 2022 by the Trust pending the outcome of an internal disciplinary investigation into the concerns surrounding Service User A.

24. Service User A and SB met jointly with the Investigating Manager at the Trust (AB) to provide further information during a meeting on 17 May 2022.

25. On 22 June 2022, the Trust submitted a referral to the HCPC. It is alleged that the Registrant did not self-refer to the HCPC.

26. The Trust’s internal investigation concluded on 13 July 2022, and the Registrant was summarily dismissed on the grounds of gross misconduct. The Registrant appealed the Trust’s decision. The appeal hearing was chaired by AR, on 16 December 2022. The decision to dismiss the Registrant from the Trust was upheld, however the reasons for dismissal were amended.

Witnesses

27. The HCPC called the following witnesses to give live evidence:

• SB – Student Wellbeing and Safeguarding Manager at Service User A’s College. Written statement dated 20 July 2023.

• AB – Professional Standards Manager and Specialist Paramedic at the Trust, who conducted the Trust’s disciplinary investigation into the Registrant. Written statement dated 14 July 2023.

• AR – Associate Director of Operations at the Trust, who conducted the Registrant’s appeal hearing at the Trust. Written statement dated 5 April 2023.

28. The Registrant did not seek to cross examine on the written statements from MR – HCPC Registrations Manager and RM – HCPC Operational Manager, and therefore they were not called to give evidence.

29. The live witnesses all gave evidence under oath or affirmation and adopted their witness statements and exhibits as their evidence in chief. They were all asked supplemental questions by Mr Tobias, they were cross-examined by Ms Rao, and asked questions by the Panel.

30. Prior to the HCPC closing its case, the parties agreed that 74 pages of emails could be provided to the Panel in relation to Service User A’s lack of signed statement and non-attendance at the hearing.

The Registrant

31. The Registrant gave evidence under affirmation and adopted his written documents contained within the bundle as his evidence in chief. He was asked supplemental questions by Ms Rao, was cross examined by Mr Tobias, and asked questions by the Panel.

32. Prior to the close of his case, the Registrant submitted three documentary character references to the Panel.

Legal Advice

33. The Panel heard and accepted the advice of the Legal Assessor in respect of the approach to take in determining findings of facts and the burden and standard of proof. The burden of proof rests on the HCPC and it is for the HCPC to prove the Allegation. The Legal Assessor provided advice on the issues of:

• Credibility and reliability, as per the guidance in R (Dutta) v GMC [2020] EWHC 1974 (Admin), Byrne v GMC [2021] EWHC 2237 (Admin), and Hindle v NMC [2025] EWHC 373 (admin).
• Wording of the Allegation including the word failed.
• Sexual Misconduct including reference to the HCPTS Practice Note on a Registrant’s state of mind.
• Dishonesty, as per the above Practice Note.
• Admissions, as per the HCPTS Practice Note on Admissions.
• Weight of evidence including a direction on hearsay evidence in relation to Service User A.
• Testimonials.
• Good character.
• Drafting decisions, as per the HCPTS Practice Note on Drafting.

Decision on Facts:

1.Between around 30 March 2022 and 10 April 2022, you were in regular contact with Service User A via social media. FOUND PROVED.

34. The HCPC relied on the evidence of SB to explain the background to how the allegations made by Service User A came to light.

35. SB’s statement states that on 22 April 2022, a message was flagged on the College’s safeguarding system, in relation to Service User A. The message was inputted by a residential staff member. It states that Service User A informed the staff member that one of the paramedics (the Registrant) who assisted her to the hospital following the incident on 24 January 2022, had made contact with her through Instagram over the Easter holidays. SB’s statement exhibits a printout of the concern from the safeguarding system.

36. SB’s statement explains that having seen the safeguarding message (on 25 April 2022), she and a colleague met with Service User A on 26 April 2022, and that Service User A requested that a complaint be made about the Registrant to the Trust. SB states that during this meeting she asked Service User A to email her with a statement and screenshots of messages between herself and the Registrant. SB states that she did not discuss Service User A’s concerns with her in detail during this meeting, as she understood the importance of Service User A setting out her account as to what had happened in statement form as being a priority.

37. SB states that Service User A provided her written account on 26 April 2022. SB’s statement exhibits an email dated 26 April 2022 (12:08) containing the written account from Service User A. SB’s statement also exhibits an email (27 April 2022) containing a message from Service User A confirming responses to some questions of clarity raised by SB. SB’s statement also exhibits some screenshots of messages sent to her from Service User A of social media exchanges with the Registrant.

38. The HCPC relied on this written account (with some supporting screenshots) provided by Service User A, to prove that the Registrant was in regular contact between around 30 March 2022 and 10 April 2022, with Service User A via social media.

39. In cross-examination, the Registrant admitted to Particular 1 of the Allegation. During his evidence, he accepted that he and Service User A had exchanged messages over social media, starting on Instagram, and then moving, at his suggestion, to the Snapchat platform.

40. The Panel took into account that Service User A’s written account states that the Registrant’s first contact with her via social media was on 30 March 2022 and their last contact was 10 April 2022. The Panel noted that these specific dates are not captured in any of the screenshots provided by Service User A.

41. In his oral evidence, the Registrant disputed parts of Service User A’s evidence. However, he did accept that his contact with Service User A had taken place, via social media, over the course of about a week or so, and that the screenshots provided by Service User A were only a small part of their communications. He recalled that his contact with Service User A had ended around the time of his holiday to Switzerland (with his ex-partner), and during this holiday they, he and his ex-partner, had rekindled their relationship.

42. In cross-examination, the Registrant admitted to Particular 1.

43. The Panel had regard to the HCPTS Practice Notes on Admissions. It was satisfied that the Registrant’s admission was unequivocal and was not made for reasons of expediency or on some other inappropriate basis. The Panel therefore treated the Registrant’s admission to Particular 1 as proof of that fact.

2. During your contact with Service User A at particular 1 above, you told Service User A that you were 24 years old when this was incorrect. Found Proved

44. The HCPC relied on the written account provided by Service User A on 26 April 2022. This states:

“I asked him how old he was to which he told me he was 24 and I said how I am turning 19 next month.”

45. The HCPC also relied on the screenshots provided by Service User A which appear to show a message exchange between the Registrant and Service User A. The screenshot messages do not have a date or time stamp.

46. The messages states as follows:

“how old are you” (Sent by Service User A)
“24 (peace emoji) x” (Sent by the Registrant)
“You? X” (Sent by the Registrant)
“19 in a few weeks xx” (Sent by Service User A)

47. During cross-examination, the Registrant admitted that he was 27 when he sent the message. He did not know why he had done this and having reflected that it was not true he was remorseful for his actions. He considered that it was private and personal at the time, and he was unsure of his motivations, but that there was no malice or nastiness about it, but it was wrong.

48. The Panel was satisfied that the Registrant’s admission was unequivocal and was not made for reasons of expediency or on some other inappropriate basis. The Panel therefore treated the Registrant’s admission to Particular 2 as proof of that fact.

3. Your contact with Service User A at particular 1 above included one or more sexual references, as set out in Schedule 1. Found Proved in relation to Schedule 1: a, b, d.

49. The HCPC relied on Service User A’s written account dated 26 April 2022 and the screenshots she provided with that account. The HCPC submitted that reliance can be placed on this account albeit that Service User A has not provided a formal statement or been tested under cross examination. The HCPC submitted that Service User A’s evidence is consistent throughout including that given during the meeting with AB on 17 May 2022. The HCPC submitted that whilst there is no screenshot to support those parts of the allegations, it suggested that doesn’t make them untrue. Further, it was submitted that, given the Registrant admits the messages where there is evidence, that adds weight to the validity and truth of the account of Service User A.

50. During cross-examination, the Registrant accepted that in general the social media message exchanges between him and Service User A were sexually suggestive at times but were more flirty conversation. He accepted that they had spoken about sex, albeit he was not seeking that, and that he did find Service User A attractive.

51. The Registrant accepted that he sent the topless images of himself lying in bed but said that this is how he goes to bed. He accepted that he had sent the message about Switzerland but that this was a bit of a joke, albeit in bad taste. In relation to the messages as a whole, his evidence was that these were only a small part of the exchanges between them which means each screenshot was likely to have been part of a longer conversation. These screenshots are a tiny fragment of a wider conversation which involved teasing on both sides.

52. The Registrant’s evidence was that he did not receive nude images of Service User A from Service User A nor did he make reference to her boobs or figure as is alleged.

53. The Panel first considered whether the Registrant had sent topless images of himself to Service User A and whether it was a sexual reference.

54. The Panel took into account that the Registrant admits sending the two topless images to Service User A, as shown in the screenshots. The Panel also took into account that he admits the message exchanges were sexually suggestive at times.

55. The Panel had regard to the two photographs on the screenshots. The first is time stamped 21:30 and shows the Registrant topless, from a side angle, on his bed, with an upside-down smiley face emoji overlying the photograph. The next photo is time stamped 21:48 and shows the Registrant topless, from a front angle, on his bed, with the following text and emoji’s overlayed:

“What have you done to me (upside down face – spiral eye face – laughing face)”

56. The Panel took into account the circumstances of the relationship between Service User A and the Registrant. Whilst there are points of contention, it is not disputed by the Registrant that he and Service User A were only in contact for less than two weeks and that during that time they built up a friendship, exchanged many messages, and had a teasing relationship which was sexually suggestive at times.

57. The Panel found the topless images to be contrived rather than images created spontaneously. They were sent late in the evening and show the Registrant topless in his bed.

58. The Panel found that given the undisputed circumstances of this whirlwind online friendship, which involved sexually suggestive messages, sending a topless photo, in bed, late in the evening, is a sexual reference, and was intended to be read in that way.

59. The Panel next considered whether the Registrant had received nude images of Service User A and whether it was a sexual reference.

60. The Panel took into account the hearsay evidence contained within the bundle from Service User A. Her written account states that they “sent photos back and forth”. Service User A is asked in email by SB to clarify if they shared nude or semi photos. Service User A replies on 27 April 2022 stating:

“Images received were nude pictures from both of us. He sent pictures of himself in bed with no clothes on, I did the same.”

61. In the interview with AB, the notes record that Service User A said:

“He said send me nude pictures of you I want to see you, I did as I felt guilty, he responded by sending me pictures of him.”

62. The Panel took into account that in his oral evidence the Registrant denies receiving nude images of Service User A.

63. The Panel acknowledged that the evidence provided by Service User A was not given in a formal statement, nor was it tested by cross-examination, but the Panel was satisfied on balance that the Registrant did receive nude images of Service User A.

64. Service User A’s account was given in writing soon after the social media contact came to an end. The account given in relation to the nude images remained consistent when Service User A met with AB in May 2022. The notes of the interview show that the comments Service User A provides in relation to the nude images is given as part of her lengthy response when asked the open question of, “Please can you describe the incident that resulted in an ambulance being called for you?”

65. Given the nature of the relationship, even on the basis accepted by the Registrant, it is inherently probable that nude images could have been shared.

66. The Registrant’s oral evidence, and flat denial was in contrast to the information he gave to the Trust Disciplinary Meeting which was held on 13 July 2022. At this meeting, the Registrant was accompanied by a Union Representative, and there was a note taker present.

67. During the disciplinary, the Registrant was asked by the OUM who was the decision maker, “were there nude pictures sent by A?”. The notes record that the Registrant replied “yes, two”. Later in the disciplinary hearing, he is asked by the OUM whether this was a “potentially sexual relationship?” to which the Registrant replied “no”. He was then asked, “what about the nude pictures?” to which he replied “She sent those. I didn’t ask for them”.

68. The Panel felt confident in placing weight on the evidence contained in the disciplinary hearing notes. They were made closer to the time of the Allegation and are more contemporaneous. Whilst the Registrant states that he never saw these notes to check the accuracy, the Panel did not accept that this impacted on the reliability of the notes.

69. The Panel took into account that the notes were made by a note taker, during a formal meeting, in which the Registrant was supported by a Union Representative. The questions were asked by the OUM, an independent decision maker, as opposed to AB who the Registrant considers showed him bias during the investigation. Further, the mention of nude images is made twice, during separate times, of the meeting. The responses noted are clear and unambiguous.

70. The Panel found that these disciplinary hearing notes undermine the credibility of the Registrant’s evidence in this part, and corroborate the evidence of Service User A. The Panel found on the balance of probabilities that the Registrant did receive nude images of Service User A from Service User A. The Panel found the receiving of a nude image is a sexual reference. Nude images sent within the context of a flirtatious relationship are overtly sexual.

71. The Panel next considered whether the Registrant had sent messages to Service User A, as set in Schedule 1 as c) i and ii, which made reference to her body including words to the effect of “nice boobs” and “you are amazing, look at your figure” and whether they were a sexual reference.

72. The Panel noted that in the written account provided by Service User A she states that the Registrant, “would often compliment my body…” During the interview with AB, the notes record that Service User A was asked, “when did the conversation go to a sexual nature?”. Service User A replied, “It started when he was complimenting me, it went to nice boobs, nice figure, he would say you are amazing look at your figure.”

73. The Panel took into account that the description provided by Service User A was not supported by any screenshots of messages.

74. The Registrant denies making these references to Service User A, and unlike with other aspects of Service User A’s evidence, there is nothing to corroborate this Particular of the Allegation.

75. The Panel kept, in mind, that the burden of proof is on the HCPC, it is not for the Registrant to prove or disprove anything. He gave evidence and was cross-examined, maintaining that he did not admit this particular of the Allegation.

76. In contrast, Service User A, did not provide a statement containing a statement of truth, did not provide any screenshots to support her evidence, despite mentioning on several occasions she might be able to do so, and did not make herself available to give oral evidence or be cross-examined. This meant it could not be explored with her as to why she did not provide screenshots of this and why she did not give this detail in her initial account. In the absence of any other corroboration, the Panel was not confident to place weight on the hearsay evidence of Service User A and found this particular of Allegation not proved.

77. Finally, the Panel considered whether the Registrant sent messages to Service User A referencing sexual relations, including a message on Snapchat using words to the effect of “So last night was the one chance before Switzerland to fuck me and you blew it”.

78. The Panel had regard to the screenshots. There is a message sent from Service User A at 22:39 saying:

“yes it would be
Oh guess what
Hahahaah
I’m livid
I just
Literally just
Started my period :)”

79. The screenshots show a response from the Registrant at 22:40 stating:

“Fuck offffffd
So last night was the one chance before Switzerland to fuck me and you blew it (wink emoji, four laughing emoji).”

80. The Registrant admitted in cross-examination that he sent this message. He said in “really bad taste” he made a joke.

81. The Panel found that the Registrant had sent this message to Service User A referencing sexual relations and that by its very wording it was a sexual reference.

82. In conclusion, the Panel found that the Registrant’s contact with Service User A at particular 1 included one or more sexual references, as set out in Schedule 1: a, b and d.

83. It found this Particular not proved in relation to Schedule 1: ci and cii.

4.On or after 26 April 2022, you failed to inform the HCPC as soon as possible that you had been suspended from your role as a Paramedic. Found Proved

84. The HCPC rely on the evidence of RM who sets out Standard 9.5 of the HCPC’s Standards of Conduct, Performance and Ethics (dated 2016). The HCPC submit that the Registrant was required to make a referral to the HCPC as soon as possible after his suspension from the Trust on 26 April 2022.

85. It is not disputed that the Registrant never self-referred to the HCPC. The Registrant states that he did not believe he was required to do so at the point of suspension, and that he had sought advice from his line manager and his union representative. These were both experienced Paramedics whom he trusted. He stated in oral evidence that he was told that if the Trust case was to proceed, then at that point he would get a disciplinary pack and then he would need to submit a referral to the HCPC.

86. The Panel took into account that a “failure” alleges that the Registrant did not do something which he ought to have done.

87. The Panel had regard to the HCPC Standards document included as an exhibit in the bundle. In part this states:

“Important information about your conduct and competence

9.5 You must tell us as soon as possible if:

– you accept a caution from the police or you have been charged with, or found guilty of, a criminal offence;

– another organisation responsible for regulating a health or social-care profession has taken action or made a finding against you; or

– you have had any restriction placed on your practice, or been suspended or dismissed by an employer, because of concerns about your conduct or competence.”

88. The Panel was in no doubt that the Registrant was aware of the obligation to self-refer to the HCPC, as he had email correspondence with AB on 9 June 2022, pertaining to this issue.

89. The Panel had regard to the email included within the bundle sent to the Registrant by AB to say that:

“…as an employee who has been suspended by their employer, you are required to self-refer to the HCPC. This is a requirement not stipulated by the Trust, but by the HCPC themselves. I have attached the HCPC Standards of Conduct, Performance and Ethics and draw your attention to section 9.5.”

90. The email also attached a HCPC webpage link which AB states may be of assistance.

91. The Registrant replies to the email, pasting paragraph 9.5 from the HCPC website, and states that whilst reference made to suspension, it also says because of concerns about your conduct or competence. The Registrant states:

“What are these concerns? What evidence do you have that my conduct as a paramedic and employee of SECAmb, in anyway impacts this private and personal matter? In fact, apart from the allegations you listed in the interview, I'm yet to see any evidence to support that my conduct was impaired, can you provide this?”. He goes on to state that if he made “an allegation regarding another paramedics conduct or competence, I'd expect an investigation to take place and evidence to be gathered, not for them to immediately self-refer to the HCPC without any prior evidence.”

The Registrant then states that he will discuss this with his Union.

92. The Panel took into account the suspension letter that was sent by the Trust to the Registrant on 26 April 2022. In part, this states:

“I am writing to confirm that you have been suspended from work until further notice with immediate effect pending investigation into the following allegation of gross misconduct:

• …sending inappropriate messages through social media platform to a vulnerable patient…

• Breach of the expected standard of conduct for a registrant under the HCPC code of conduct.

…A copy of our Disciplinary Policy and Procedure is available on The Zone.”

93. Given that the suspension letter referred the Registrant to the Trust’s Disciplinary Policy, the Panel had regard to the Policy as it was exhibited in the bundle. The Panel took into account that the Policy contains a section on suspension and it states:

“If the suspension/restriction in practice relates to a registered professional, and where there is a fitness to practice concern, the employee will be required to self-refer to their regulator which whom they are registered (i.e. Health & Care Professions Council, General Medical Council) and the suspending manager will inform the employee to refrain from clinical activity outside the Trust. If any employee fails to self-refer as required, the Trust may make the referral on their behalf.”

94. Based on all the information before it, the Panel was satisfied that Standard 9.5, is a Standard with which registered HCPC professionals must comply. It is clear and unambiguous. It places an obligation on registrants to self-refer in any of those listed situations arising.

95. In this case, on 26 April 2022, the Registrant was suspended by his employer, because of concerns about his conduct. The Panel found that he was therefore under a professional duty as a registered Paramedic to refer himself to the HCPC, as soon as possible, and he failed to do so.

5. In respect of your conduct at any or all of particulars 1 – 3 above:

a. you knew or ought to have known that Service User A was vulnerable or likely to be vulnerable as a result of your attendance on her in a professional capacity on or around 24 January 2022. Found Proved

96. The HCPC relied on the evidence of SB as to Service User A’s vulnerability. SB states that:

“Service User A was a residential student at the College, …at the time that concerns were raised, in April 2022, …she was eighteen years old. Service User A was moved into residential accommodation at the College two years ago through a charity hardship fund, due to safeguarding concerns…

I first met Service User A at the beginning of the academic year in 2019 when we were made aware of safeguarding and child protection concerns in her home. Service User A had to leave her home due to emotional and physical abuse, which begun the process for her move into residential accommodation in the College.

During this process, I attended social worker meetings with Service User A at which her parents were present and coordinated arrangements for her to continue studying at the College. A team of two to three of us would regularly meet with Service User A. My colleague Person C, Deputy DSL for the College, also had regular one to one meetings with Service User A to support her wellbeing.

Service User A is classified as a vulnerable adult due to her child protection background. Service User A experienced childhood trauma in her family home and is now estranged from her family. Service User A was very dependent on the College safeguarding team as a result. Additionally, Service User A had expressed wishes to take her own life and had a history of self-harming in various different ways.”

97. In relation to the events on 24 January 2022, the HCPC relied on the evidence of SB. In relation to the incident on 24 January 2022, SB states:

“On 24 January 2022, at approximately 08:00am, I was informed by my colleagues Person D, Student Experience Manager, and Person C, that Service User A had attempted to take her own life and that paramedics had been called and were on their way. Person D and Person C informed me that Service User A had been under the influence of alcohol in the early hours of the morning and that when Person D went to Service User A’s bedroom to check on her, she found that Service User A appeared to have taken an overdose of anti-depressants and there was blood all around her wrists. I do not know the type or strength of anti-depressants that Service User A took. I am aware from an entry made on our internal ProMonitor systems by [blank], that in March 2022 Service User A was taking the following medications: the contraceptive pill, painkillers, anti-depressants and sleeping tablets. No further details are provided about the specific prescription or dosages of these medications and, as she was an adult, Service User A was not required to provide these details to the College. I believe from memory, although I cannot be certain, that on 24 January 2022, Service User A took four anti-depressants tablets more than the dosage that she was prescribed.

…

When I found the ambulance, there were two paramedics, Mr McDowell and a colleague…Once the paramedics were out of the ambulance, I led them through the residential building to Service User A’s room where Person D was supporting her...

When we reached Service User A’s room, I entered the room with the paramedics. This was the first time that I had been to Service User A’s room since I had been made aware of her attempt on her life. Person D and Person C had wrapped some bandages around Service User A’s wrists where the bleeding was whilst waiting for the ambulance.”

98. In relation to the incident on 24 January 2022, the HCPC also relied on ePCR which is exhibited in the bundle. This is the full case summary for the call on 24 January 2022.

99. In his evidence, the Registrant accepted that on that date (24 January 2022) the Service User was in a vulnerable state. But that did not mean that he would describe her as a vulnerable person. Nor that could she explicitly be described as a vulnerable person all of the time. Vulnerability can change depending on a number of factors.

100. The Registrant’s evidence was that when he had message contact with Service User A she spoke about how well she was doing and was positive about her future and described the 24 January as an episode she had recovered from. He said that the level of detail shared by SB to this hearing had not been available to him at the time of the call out. Nonetheless he felt that he should have used better judgement when later engaging in messages with Service User A as she had been in a vulnerable state in January 2022.

101. The Panel had careful regard to the ePCR which is a contemporaneous record. Whilst the Panel acknowledged that the information seen by the Registrant on that day would not have been seen in the same PDF format as it is now presented to the Panel, it was confident that the Registrant had fairly and appropriately been taken through the pages as part of cross-examination, to comment on what he had entered into the document himself.

102. In relation to the presenting complaint and history, the Panel took into account that at the time of the incident the Registrant had entered the following:

“Pt is an 18 year old student at … college …, she has a complex involvement with social services and no current contact with her parents. Also an ongoing sexual assault case of the patient. She is very content and happy at the college, regards the place and the staff as her family home and is very anxious and upset about having to leave in 4+ months as her course comes to an end. She also reports not sleeping a lot in recent days, stating that she keeps waking up and seeing the face of the perpetrator of the sexual assault. Last night she felt very low and anxious regarding her situation coming to a head, drunk alcohol with a friend (vodka) and then took 3 of her Sertraline tablets (a total of 50mg) and used a clean razor to make 2 superficial scratches to her wrists, one on each wrist. She reports immediately regretting it and at the time said that she was fearful of becoming sad once she leaves the college and wanted to "die happy". She alerted staff who are very supportive and appear to care greatly for her, who then called for an ambulance and remained with her to monitor her.”

103. The Registrant had also entered notes under the heading Psychiatric Notes:

“…Family MHhx - Complex, mum previously attempted suicide, has no contact with parents - Diagnosed with - Depression/anxiety. Occupation - Student at…college ...”

104. On the basis of the notes the Registrant entered on 24 January 2022, which in relation to Service User A’s background and health status, are corroborated by the evidence of SB, the Panel found that Service User A was vulnerable. She had a number of vulnerabilities, in terms of her mental health but also, she was vulnerable as she was isolated from her family, having experienced childhood neglect, and had allegedly experienced a sexual assault.

105. The Panel acknowledged that the Particular relates to the alleged vulnerability as of 30 March 2022. As a matter of common sense, the Panel found that the issues identified in the ePCR, and referred to in SB’s statement, are not ones which are likely to disappear overnight. The issues about Service User A’s childhood are long standing, and the notes mention that the sexual assault case is ongoing. Further, the ePCR notes that Service User A, is very anxious and upset about having to leave in 4+ months as her course comes to an end. The messages between the Registrant and Service User A occur only approximately two months after the call out. At that point Service User A would have been two months away from the end of the course. Taking all the information it had before it, the Panel concluded that as of the 30 March – 10 April 2022, Service User A remained a vulnerable young adult.

106. Having found Service User A to be vulnerable, the Panel next considered whether the Registrant knew or ought to have known this, due to his involvement on 24 January 2022.
107. The Panel found that it is clear from the notes that he inputted into the ePCR that he knew that she was a vulnerable person in January 2022. As to whether he knew she was vulnerable by the 30 March 2022, the Panel had regard to the screenshots of the messages provided by Service User A.

108. One of the screenshots shows a partial message from Service User A, which states:

“was just scrolling through who’s seen my insta and ur face popped up. I was like omg it’s uuuu.”

109. The Registrant replies to say:

“Oh god the pink crocs (facepalm emoji – laughing face emoji) And wasn’t there as random bowl of haribos on the floor? (shrugging emoji – laughing face emoji).”

110. Followed by Service User A:

“yeah it wasn’t my finest hour ok (laughing face emoji x 2)”

111. And a reply from the Registrant to say:

“Haha yead I saw your name pop up a couple of times and knew it was familiar x”

112. The Panel did not accept that the HCPC had proved on balance that the Registrant knew on 30 March 2022, that Service User A was vulnerable. The Panel accepted that the role of a Paramedic involves seeing multiple patients on each day, including dealing with a wide and diverse range of people and health issues. Seeing Service User A’s name pop up and seeing her photo, out of context, would not automatically lead the Registrant to remember the level of detail as to vulnerability that he had inputted into the ePCR some months before.

113. However, the Panel did find that the Registrant ought to have known that Service User A was vulnerable as a result of his attendance on her on 24 January 2022. Whilst he might not have initially recalled when he first saw her name, once he started to exchange messages with her and recall specific details such as the “pink crocs” he should have recalled the reason for the call out which of itself related to mental health vulnerabilities and resulted in Service User A been taken to hospital. For the sake of clarity, the Panel found that the Registrant ought to have known that Service User A was vulnerable as a result of his attendance on her in a professional capacity on or around 24 January 2022.

5. In respect of your conduct at any or all of particulars 1 – 3 above:

b. your conduct was sexually motivated. Found Proved

114. The Panel considered the guidance in the Basson and Haris cases. It was aware that it must decide whether the conduct was done either in pursuit of sexual gratification or in pursuit of a future sexual relationship.

115. It was mindful that it is assessing the Registrant’s state of mind, when he was in regular contact with Service User A, sent and received messages with sexual references, and gave an incorrect age, and that is something that the Panel may find inferentially and by deduction from his conduct and the surrounding evidence on the balance of probabilities.

116. The Panel found that by his own admission, the exchanges between him and Service User A were sexually suggestive and flirty. He also acknowledged that it was him who suggested moving the messages to Snapchat as that was a quicker and easier way to exchange messages, rather than Instagram which he found to be slower. Whilst the Panel acknowledged that it only had a limited number of screenshots, it is not disputed that these formed only a small part of a large amount of messages exchanged over the course of less than two weeks. The Registrant describes this as an online friendship, rather than something sexual. The Panel did not accept this as a plausible alternative explanation for his conduct, for a number of reasons.

117. Firstly, because of the nature and content of some of the messages. Some of the messages might be considered not to contain sexual overtones and not be sexually motivated. However, the Panel found these were in the context of the other messages which did contain sexualised language or images, including the one referred to in this decision about Service User A being on her period and the Registrant responding as he did. The Panel found (at Particular 3) that the messages included overtly sexual references, and the sharing and receiving of images. Some messages also include kisses and heart emojis.

118. Secondly, the Registrant accepted in evidence that when he and Service User A were messaging, he was single, and he did find her attractive. The Panel found that the content, tone and nature of the messages, and the fact that it accelerated to this over a very short space of time, made it clear that he was sexually attracted to Service User A.

119. Thirdly, the Registrant knew that Service User A was 18 (albeit having turned 19 by the time of the message exchanges) as he had attended her at her residential College on 24 January 2022. He therefore knew she was younger than him when he gave her the incorrect age, referring to himself as 24 when he was 27 (and 28 by the time of the Trust’s disciplinary hearing on 13 July 2022).

120. In these circumstances, the Panel concluded that the Registrant’s conduct at Particular’s 1 – 3 (as found proved), was sexually motivated. Whilst the Panel found that there was no evidence that the Registrant specifically sought Service User A out, it found that his engaging in messages with her was done in pursuit of a future sexual relationship.

6. Your conduct set out at particulars 2 and/or 4 above was dishonest. Found Proved in relation to Particular 2

121. In relation to Particular 2, the Panel had regard to the evidence and its finding in relation to the Registrant giving an incorrect age.

122. The Panel considered the legal test as established in Ivey v Genting Casinos. It first considered what the actual state of the Registrant’s knowledge or belief was as to the facts. The Panel then went on to consider the question of whether the conduct was honest or dishonest by applying the objective standards of ordinary decent people with full knowledge of the facts of the case.

123. The Panel found that the Registrant knew in his own mind his actual age, that being 27, and yet when asked directly, over message, by Service User A, he lied and replied that he was 24. The Registrant accepted he lied but was unsure why albeit he said that there was no malice intended.

124. The Panel found that taking into account the Registrant’s understanding of the circumstances, an ordinary decent person would find the conduct to be dishonest.

125. In relation to Particular 4, the Panel had regard to the evidence and its finding in relation to the Registrant failing to inform the HCPC about his suspension.

126. The Panel took into account that it is not disputed that the Registrant never self-referred to the HCPC. The Registrant states that he did not believe he was required to do so at the point of suspension, and that he had sought advice from his line manager and his union representative. These were both experienced Paramedics whom he trusted. He stated in oral evidence that he was told that if the Trust case was to proceed, than at that point he would get a disciplinary pack and then he would need to submit a referral to the HCPC.

127. The Panel found the Registrant’s evidence on this point to be reliable, and it is corroborated by other evidence in the bundle. His oral evidence that he did not believe he was required to do so is supported by his email sent to AB on 9 June 2022. He comments in this that he has looked at the passage from the link sent and he questions what are the concerns? He states towards the end of the email that he will discuss with his Union and get back to AB soon.

128. His evidence is also supported by the email chain between the Registrant’s line manager and AB on 21 June 2022. It states that the Registrant “is prepared to self-refer if [Person F] deems there to be a case to hear but until that time he would not.”

129. Further, an email from Person F to AB, as part of the same email chain, advising that “[blank] said not to.”

130. The Panel accepted that the Registrant did make an incorrect judgement by not self-referring but at the time he was receiving advice from the Union not to, and despite the contrary indication being given by AB, the Registrant gave his reasons, albeit misguided, as to why he did not think he needed to refer at that time, awaiting a decision being made about a Trust case to answer. That potential further opportunity to self-refer did not arise as AB referred to the HCPC before/at a similar time to the Registrant receiving confirmation that there was a Trust case to answer.

131. Having regard to the Registrant’s knowledge and belief of the circumstances, the Panel did not consider the Registrant’s conduct to be dishonest by the standards of an ordinary decent person. The ordinary decent person is likely to see the Registrant’s actions as belligerent and misjudged but not that there was an active deception towards the HCPC.

132. The Panel therefore found that the Registrant’s conduct at Particular 4 was not dishonest.

Statutory Ground:

HCPC written submissions on the statutory ground

133. The Panel may wish to consider the following factors when determining whether the facts found proved, establish the statutory ground of misconduct.

134. In determining misconduct, the Panel may consider whether that conduct constitutes a serious departure from professional standards. In particular Standard 9.1 of the HCPS’s Standards of Conduct, Performance and Ethics which states, ‘You must make sure that your conduct justifies the public’s trust and confidence in you and your profession’.

135. The facts proved will amount to the statutory ground of misconduct if they establish professional conduct that fell short of what was proper in the circumstances and if the conduct was sufficiently serious: see Roylance v GMC [2000] 1 AC 311, Nandi v GMC [2004] EWHC 2317 (Admin) and R (Remedy UK Ltd.) v GMC [2010] EWHC 1245 (Admin) at [37]. The relevant principles were explained by Auld LJ in GMC v Meadow [2007] QB 462, where he stated, - ‘.... As Lord Clyde might have encapsulated his discussion of the matter in Roylance..., it must be linked to the practice of medicine or conduct that otherwise brings the profession into disrepute, and it must be serious’. As to seriousness, Collins J, in Nandi v General Medical Council [2004] EWHC (Admin), rightly emphasised, at paragraph 31 of his judgment, the need to give it proper weight, observing that in other contexts it has been referred to as 'conduct which would be regarded as deplorable by fellow practitioners'".

136. Serious cases, as identified in the HCPC Sanctions Policy, include dishonesty, abuse of professional position and sexual misconduct.

137. In particular, the Panel may wish to consider the following factors:

• the inappropriate relationship between the Registrant and Service User A,

• the predatory behaviour of the Registrant in his desire to establish a sexual or otherwise inappropriate relationship via social media,

• the vulnerability of Service User A, and

• the sexual misconduct.

138. The Panel may also wish to consider whether the facts proved consisted of grossly inappropriate, predatory behaviour and an abuse of the Registrant’s position in relation to Service User A.

139. The Registrant’s conduct included contact via social media; lying about his age to Service User A; sexual references including sending topless images of himself; receiving nude images from Service User A; and making a direct reference to Service User A having sex with him and missing the chance to ‘fuck him’. All conduct which was found by the Panel to be sexually motivated.

140. The Panel may consider that this constituted an abuse of the Registrant’s position as a Paramedic by engaging in an online relationship with Service User A, a person whom he attended when she attempted to take her life, and who he ought to have known was vulnerable. The Panel will also consider the Registrant’s failure to notify the HCPC as soon as possible of his suspension by his employer.

141. In addition to a breach of Standard 9.1 and 9.5, the Panel may also wish to consider whether the conduct found proved constitutes breaches of the following HCPC Standards of Conduct, Performance and Ethics (dated 2016):

• 1.7 - You must keep your relationship with service users and carers professional.

• 2.7 - You must use all forms of communication appropriately and responsibly including social media and networking website.

• 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.

• 7.4 - You must make sure that the safety and wellbeing of service users always comes before any professional or other loyalties.

• 9.1 - You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

• 9.5 - You must tell us [HCPC] as soon as possible if:
- You have any restriction placed on your practice, or been suspended or dismissed by an employer, because of concerns about your conduct or competence.

142. The Presenting Officer, during his supplementary oral submissions to the Panel, took it to specific paragraphs within the Sanctions Policy which he considered relevant at this stage of the Panel’s considerations. Those paragraphs were:

• 45 - relating to breach of trust.
• 54 – relating to service user harm.
• 56 – relating to dishonesty.
• 67 – relating to abuse of professional position.
• 70 – relating to contact with former service users.
• 71 – relating to predatory behaviour.
• 72 – relating to vulnerable service users.
• 76 – relating to sexual misconduct.

Registrant’s submissions on the statutory ground

143. The Registrant’s Representative stated that the Registrant has, through his previous reflection and this Panel’s findings, recognised and accepted that in relation to allegations 2, 3, 4, 5 (as proved) and 6, his actions amount to misconduct. As far as Particular 1, it was submitted that this would not constitute misconduct in itself, but if taken in the wider context, and in conjunction with Particulars 3 and 5, be considered as misconduct and the Registrant accepts that his actions would constitute misconduct.

144. In relation to Particular 2, and the finding of the Panel in relation to Particular 6, that the Registrant’s actions in stating his age as being lower than it was, constituted dishonesty, it was argued that this could be considered to sit at the lowest end of dishonesty. Paragraph 56 of the HCPC Sanctions Policy states that dishonesty would be considered a serious matter, however, the examples given in paragraph 57 are the type which the public would consider serious. Those are examples of incidents which will affect the wider public, such as, falsification of information in medical records; falsification of details in a job application; theft of medication etc. Paragraph 58 of the Sanctions Policy requires the Panel to bear in mind the different degrees and types of dishonesty and that there is a wide range of things that fall within. In this case, the type of dishonesty is an unusual one, where the Registrant has been dishonest by reducing his age by 3 years within one exchanged comment. It was submitted that the Panel has nothing from Service User A about the effect that this piece of information had on her and nothing to indicate the possible impact on the public. Reasonable members of the public would rightly be concerned about the Registrant in terms of his conduct if it related to something which fell within the range of serious dishonesty, however, in this instance it falls within the lowest end of the range of dishonesty. The circumstances are that there was a slight exaggeration of his age. Not one of the most serious types of dishonesty and one that, in the Registrant’s Representative’s view, fairly fell at the lowest end of the range of dishonesty.

145. Taken in the round, this was a relationship with a service user who was vulnerable. In assessing the seriousness, the Panel should take into account that there was no physical contact, and the only contact was by exchange of electronic text messages. The Panel should also consider that the Registrant did not reach out to make contact first, and this is relevant to the seriousness of the conduct alleged. Further, the relationship was not conducted whilst he was engaged within his professional capacity, and not whilst Service User A was receiving treatment, factors that the Panel should take into account.

146. The Panel found in relation to Particular 5(a) that the Registrant should have known that Service User A was vulnerable. However, by the nature of the Registrant’s work he considered that all service users could be considered as vulnerable. There was nothing different here from the situation the Registrant faced each day, therefore, there should not be any double counting of his actions because the Panel has made a finding that Service User A was vulnerable.

147. In relation to the issue of predatory behaviour, this in the Registrant’s Representative’s view, ties in with who made first contact and the behaviour of the Service User A. The Panel should note that the Registrant had not sought to find Service User A’s details, it was contact made because she reached out and he then made a very bad decision to respond to this and this hearing is the result of that bad decision. This is not predatory, but the result of bad judgment and it is not a case of finding someone on the internet and exploiting them, as the HCPC seems to suggest within the allegation.

148. The Registrant accepts misconduct but when taken with all the nuances of this case it was submitted that it was misconduct at a lower level of conduct.

Panel decision on the statutory ground:

149. The Panel heard and accepted the advice of the Legal Assessor. In relation to the issue of misconduct, she advised the Panel in respect of a number of cases, including Roylance v GMC (No. 2) [2000] 1 AC 311. The Legal Assessor advised that for conduct to amount to professional misconduct it must fall short of what would be expected in the circumstances, and that such a falling short must be serious and fall far below the expected standards for the particular practitioner in their chosen profession. The Legal Assessor also advised that the question of whether or not the facts found proven, individually or collectively, amounted to misconduct, was a matter for the Panel’s professional judgement and at this stage there was no onus upon the HCPC.

150. The Panel started by noting that there had been admission and acceptance by the Registrant that the matters found proven amounted to misconduct.

151. The Panel considered whether, and to what degree, the Registrant’s conduct as found proven had been a breach of the standards expected of him. In relation to the HCPC Standards of Proficiency for Paramedics (2014) the Panel considered that his conduct was a breach of Standard 2.2, which relates to the Registrant’s responsibility to ensure that he is fully conversant with his responsibilities and duties to his regulator, the HCPC.

152. In relation to the areas of the Registrant’s conduct, as identified at the fact-finding stage, the Panel found that they were a breach of the following provisions of the HCPC Standards of Conduct, Performance and Ethics (2016) in the following ways:

• 1.7, relating to maintaining professional boundaries. The Panel has found that there was a relationship and the Registrant’s actions regarding that relationship had been sexually motivated.

• 2.7, in relation to the Registrant’s use of social media, not only had the Registrant engaged with Service User A through this mode of communication, but he had then initiated the move to another web-based form of communication which was quicker. He then used this platform to communicate with Service User A and to post photos of himself half naked and within a compositionally posed position whilst in bed.

• 6.1, in relation to the Registrant’s failure to accept and acknowledge that Service User A was a vulnerable person, something which the Panel has later in this determination commented upon further.

• 6.2, relating to the Registrant failing to act to minimise any adverse impact upon Service User A. The Registrant’s interaction with Service User A could have had a serious impact on her. Whilst this was a relationship over a relatively short period of time, there were many opportunities for the Registrant to recognise that it should not have started and thereafter desisted.

• 9.1, in relation to the Registrant’s conduct generally, it would be considered by members of the public as concerning.

• 9.5, the Registrant’s duties to his regulator, he was newly qualified at the time of these events, yet he stated that he was unaware of his duties and responsibilities as a registrant. Even at the time of the hearing, three years after those events, the Registrant had not demonstrated that he was fully conversant with those duties and responsibilities in regard to reporting his suspension.

153. The Panel appreciated that breaches of those provisions did not of itself constitute misconduct and therefore may not pass the threshold of seriousness such to support the Panel making a finding of misconduct. Notwithstanding the Registrant’s admission of misconduct, the Panel gave careful consideration to all the elements of the Registrant’s conduct individually and together.

154. The Panel accepted the submission that Particular 1, when taken in conjunction with the findings of Particulars 3 and 5, formed part of the wider sexually motivated relationship and so could be considered together as supporting a finding of misconduct.

155. The fact of such a sexual relationship, with such a vulnerable individual was, in the Panel’s view, inappropriate and unacceptable conduct. Conduct which fell far below that expected of a registered practitioner. Fellow paramedics, aware of the circumstances in which the Registrant had first encountered Service User A in his paramedic role, someone who had attempted to take her own life, would fully appreciate that she was a very vulnerable individual.

156. The evidence that the Registrant had documented in the free text space of his electronic recording of the incident in January 2022, demonstrated that he was aware of the history of Service User A’s unstable mental health. She was, in January 2022, not just having a ‘blip’, as described by the Registrant, but experiencing an episode within a larger, long-standing personal struggle with her mental health and general wellbeing. The fact that the Registrant was not able to initially remember her but as soon as the incident was recalled he was able to identify intricate details of the setting, such as a bowl of sweets on the floor, and the colour of her Crocs, which demonstrated that he did have recall. The Registrant, when he knew who she was, should have retracted from the situation rather than further nurturing the potential relationship.

157. Although the relationship lasted a short period of time, the Panel noted the pace at which a chance exchange had escalated to comments about missed opportunities to have sex and exchange of semi naked or nude photographs. As noted above, the Panel considered the staging of those photographs sent by the Registrant to be contrived and the motivation behind them was primarily to further a sexual relationship. Those photos would have encouraged this vulnerable service user to believe and hope that there was more than a text-based relationship developing.

158. The Panel consider that the conduct identified in Particulars 1, 3 and 5 are serious matters, and ones which a fellow practitioner would find deplorable with any service user, but particularly so being the case, given the fragile state of Service User A’s mental health. The Panel therefore makes a finding of misconduct in relation to Particulars 1, 3 and 5.

159. In relation to Particular 2, and the Panel’s finding on Particular 6, it has established that the Registrant’s understatement of his age was dishonest. The Panel noted that the Registrant had been unable to provide any cogent reasons for his action. His responses to the Panel on this point were vague. The Registrant said he did not know why he did this. The Panel was itself unable to identify any innocent reason for him doing so. It had not, for instance, been an error arising from an accidental pressing of the wrong figures on the keypad. If it had, there would naturally then have been an attempt to correct such an innocent error.

160. The Panel has therefore concluded that there was no explanation for the Registrant’s actions other than his wish to form the impression in Service User A’s mind that they were closer in age than it may appear. The Registrant was aware of Service User A’s relative youth and so to align himself more with her he provided false information. This was dishonest, and whilst the Panel accepts that in isolation it may as an act of dishonesty rest at the lower end of the spectrum of dishonesty, when taken in the context of the wider sexual relationship with someone who was so vulnerable it was serious dishonesty with a personal motivation behind it. The Panel has concluded that this is serious and constitutes misconduct.

161. The Panel finally considered the issue of Particular 4, not alerting the HCPC to the fact that the Registrant had been suspended. The Panel noted that the Registrant’s position on this was twofold. First, that he had been given conflicting guidance and information. This conflicting information had been supplied on the one hand, by his line manager and union representative, and, on the other, the investigating officer, a person who the Registrant disliked and did not trust. Secondly, the Registrant considered that until the finding of the investigation into the complaint had concluded, and he knew the detail of the complaint, he was not required to report himself to the HCPC.

162. The Panel noted that at the time of the complaint he was only recently qualified. The Registrant maintained that he was not treated by the Trust as newly qualified, and due to his previous employment by the Trust had not been given transitional training nor induction. The Panel took the opportunity to question the Registrant closely on this issue of what was included within his university course in relation to his duties and responsibilities toward his regulator, the HCPC. The Registrant’s answers were unclear and vague and demonstrated poor and selective recall. The Panel also explored with the Registrant why he had ignored the clear instruction by the investigating officer to self-report to the HCPC and why he had chosen to seek further guidance elsewhere rather than spend a few moments checking the correct position on the HCPC website or directly with the HCPC.

163. The Panel remained unclear as to what the reason was for the Registrant’s chosen course of action of relying on the advice of others. It would have been far safer to report than not, a course of action that risked raising concerns over his conduct and his registration. Whilst accepting that the Registrant had intentionally taken this option, the Panel remained unconvinced as to the motivation. In not reporting himself the Registrant has, in the Panel’s view, abrogated his responsibilities as a registered paramedic. The Panel consider that this twofold failure to report, when advised to do so, and then when the investigation had concluded, was serious and constituted misconduct.

164. The Panel has therefore made findings of misconduct on all matters found proven.

Impairment:

HCPC’s submissions on impairment

165. The Panel will have regard to HCPC Practice Note, Fitness to Practise Impairment, and in particular, the ‘personal component’ and the ‘public component’.

166. In relation to the personal component, the Panel will need to answer the following:

• are the acts or omissions which led to the allegation remediable?
• has the Registrant taken remedial action?
• are those acts or omissions likely to be repeated?

167. The Panel will wish to consider whether the misconduct, including the elements of dishonesty and sexual behaviour, have been remediated, with reference to the Registrant’s reflective document in May 22, and his subsequent ‘Novel’.

168. The Registrant’s sexually motivated behaviour occurred over an 11 to 12 day period. It moved quickly from friendly and flirty to sexually suggestive, and from Instagram to Snapchat (a quicker platform to communicate and to share images) where topless and nude images were sent and received and were overtly sexual.

169. During the course of the communications with the vulnerable service user, the Registrant was less than truthful when he lied about his age. He admitted during his evidence that he did not know why he had done this but there was no malice or nastiness about it, but it was wrong.

170. In relation to the public component, the Panel will need to consider the need to maintain public confidence in the profession and to declare and uphold the standards of conduct among members of the profession.

171. The key question being, given the nature of the allegations and facts proved, would public confidence in the profession be undermined if there were to be no finding of impairment?

172. When the Panel considers the circumstances before it, including the Registrant’s otherwise unblemished fitness to practise record and the steps he has taken in his reflective pieces, they should have regard to the nature and seriousness of the misconduct. Further, whether public confidence in the profession would be undermined if no finding of impairment was made, and as such whether a finding of impairment is necessary to maintain public confidence in the profession and to declare and uphold proper professional standards of conduct.

Registrant’s submissions on impairment

173. The Registrant’s Representative stated that the Panel could properly be satisfied that the Registrant is not currently impaired.

174. Unusually the Panel have full acceptance of what happened and two Panel findings on the giving of an inaccurate age and vulnerability of Service User A. The Registrant has always accepted and acknowledged his actions and that is set out in the internal investigation meetings.

175. The Registrant has acknowledged that his actions were wrong and within his lengthy reflective piece of writing he has identified how he fell into those areas of misconduct that flow from his misjudgement. The incident lasted only ten or twelve days and there has been no further subsequent area of concern. The Registrant has identified ways to make sure something like this does not occur again. He has applied himself to another calling and those references before the Panel show there is no current concern about his conduct.

176. It was submitted that there is no risk at all to the public, and that members of the public would not have any concerns about the Registrant continuing to practice as a paramedic. This was a special species of dishonesty which fell into the lowest aspect of dishonesty and does not reflect a wider spread trait of dishonesty. All the evidence before the Panel shows that the Registrant is a good paramedic and well respected. There is evidence that he had been competent and professional over his career and this is the only occasion of misjudgement and failure to act as he should have done.

177. The Registrant did not self-refer to the HCPC, and he is feeling the consequences of that misjudgement. There is nothing to suggest that the Registrant cannot work successfully as a paramedic. The public will feel assured that there is no risk arising from a repetition of his conduct having undertaken the degree of reflection that he has.

178. In response to a request from the Panel for confirmation of the basis on which it was to assess evidence of the Registrant’s current ability to practice without restriction, the Registrant’s Representative confirmed, that in terms of the risk of repetition the Panel was to take the Registrant’s extensive piece of reflective writing as his insight into his former conduct. That has remained his state of mind since concluding his writing at the end of December 2023. Further, in relation to the last three years during this HCPC process, the fact that there had been no repetition of the conduct complained of, and his recent testimony plus the references before the Panel supported the Panel in concluding that there is no risk of repetition.

Panel decision on Impairment:

179. The Panel heard and accepted the advice of the Legal Assessor. As advised the Panel had regard to the HCPTS Practice Note on Impairment, and in particular to the two elements of impairment; namely the personal component and the public component. The Legal Assessor reminded the Panel that it is assessing the Registrant’s fitness to practise as of today as to whether he possesses the ability to work without concerns about his conduct now, or in the future. In this regard the Panel should pay particular attention to the nature of the Registrant’s insight to the former matters which the Panel has decided constitute misconduct. In other words, has the Registrant gained full insight into his former failings and so a repetition is unlikely.

180. At this stage the Panel had from the Registrant the following evidence of current fitness to practise:

• the Registrant’s testimonial evidence at the fact-finding stage, for which the Panel has its own notes and full transcripts.

• The Registrant’s Representative’s submissions, which it took the opportunity of clarifying with her.

• The ‘Novel’, which is the Registrant’s piece of reflective writing, the majority of which was written prior to the Trust appeal hearing in December 2022. The remainder of this reflective diary was then written after that hearing had concluded. The last entry is at the end of December 2023.

• References from one former colleague at the Trust and two from his current place of work.

181. The Panel gave careful consideration of the degree to which that evidence supports the submission of no current impairment. In other words, what weight and reliance could the Panel place upon each.

182. The Panel noted that at the fact-finding stage the Registrant had at some distance from the events, still resisted accepting that Service User A was vulnerable. In this regard he had given some confusing responses relating to all service users as being vulnerable individuals. This service user was described by him as someone who was ‘a well functioning individual who was at the time having a blip’. The evidence is that this service user had a long-term mental health issue and a complex social history. As noted above, the Registrant had recorded her medical history and had total recall of the situation and circumstance when he attended her in January 2022.

183. The Registrant’s testimony provided the Panel with little insight into his current state of mind, relying as he did, upon his presentation of his Novel as being the totality of his evidence of remediation.

184. In his evidence to the Panel the Registrant had described a picture in which professional boundaries had become blurred and moved to suit his recollection or position on the issue. When the Registrant had stated that he knew that he could not take steps to seek out this service user, he had accepted that there was that restriction upon him. However, conversely, when he realised who she was he had taken no steps to stop the interaction. From the evidence, hindsight and further training relating to professional boundaries had not provided the Registrant with a clear and unequivocal understanding where those boundaries started and finished.

185. The Registrant is recorded as being remorseful, but in his testimony to this Panel there was nothing to indicate that this was the case, nor that he had identified the need for an apology or regret for his conduct. It was clear to the Panel that he was still very concerned and angry about the Trust investigation process and the impact it had had upon him.

186. Turning to the ‘Novel’, the Panel noted that there was within it evidence of the training which the Registrant had undertaken during the period December 2022 to December 2023. A limited amount of this training had relevance to the issues engaged in this hearing. Those mentioned, and which the Panel considered where relevant to this matter, were:

• Safeguarding.
• Unconscious bias.
• Professional boundaries (September 2022).

187. There is nothing before the Panel relating to training undertaken since the end of December 2023, and nothing to demonstrate how that relevant training identified above has been applied in practice. Beyond the date of the ‘Novel’ there is nothing to show further development of insight nor anything to support the position that the Registrant’s state of insight remains as it was at the end of 2023.

188. In relation to the insight recorded within the ‘Novel’ the Panel noted that it was heavily focused on the impact of this incident upon the Registrant and relatively little about the service user and the impact it had on her. In those sections which did relate to the incident involving the service user, the Registrant does express some remorse, however, he again returns to the theme of how disappointed he was in himself, rather taking the opportunity to explore the wider picture.

189. It appeared to the Panel that the Registrant had written the reflective part of the ‘Novel’ as a cathartic vehicle to record his frustration and anger at the incident and the internal investigation processes that flowed from it rather than specifically addressing the Panel in relation to the Allegation and its fact finding. The Registrant’s writing shows a generic approach relating to courses undertaken rather than a subjective approach to the value of that training.

190. In relation to the professional references supplied by the Registrant, the Panel noted that they attest to the Registrant being hard working and trustworthy. They confirm the Registrant’s abilities as a paramedic and that he is honest. These references are again generic in nature. There is nothing said by the referees about how the impact of this interaction with Service User A had changed the Registrant’s practice nor how reflection had resulted in changed behaviour. One colleague stated that he had numerous conversations with the Registrant about the impact the complaint and the internal and appeal processes has had upon the Registrant. Again, this is focused on the Registrant rather than the incident and the service user.

191. Having considered this evidence, the Panel moved on to consider the personal component of the Panel’s decision. The Panel referenced the steps identified in the case of ‘Cohen’, in other words, was the conduct capable of being remediated; has it been remediated; and, going forward is there little or no likelihood of repetition of that misconduct.

192. The Panel was of the view that the Registrant’s former conduct which, as the Registrant stated, was based upon poor judgement, could, over time, be successfully remediated. However, before that remediation could be undertaken the Registrant needed to more fully understand the nature of his conduct. There was nothing to support the position that he had fully understood the seriousness of his actions, and without that understanding remediation would be limited. Further, there is nothing before this Panel to support the position that he had successfully remediated. As mentioned above, courses appear to have had little impact on his learning and established the fact that there are immutable professional boundaries.

193. The Panel considered in relation to the sending of semi-nude images, that the explanation given by the Registrant did not provide the Panel with any confidence that he would not act the same way again. There has been no evidence to demonstrate that the Registrant has changed his approach to social media or will do so in the future.

194. In addition, the Panel had grave concerns about the Registrant’s judgement, not only in relation to the historic matters but more recently. For instance, his decision to not provide anything more current than the ‘Novel’ to support his case of no current impairment was ill-judged. The Registrant had understood value of reflection in his ‘Novel’, but had not provided any recent evidence of insight at this hearing. Further, his testimony showed that there had been little or no change in his attitude towards those past events, events where he still considered that he had been the victim of the investigatory process.

195. In relation to the discrete issue of the Registrant’s failure to report to the HCPC, the Panel considered that the likelihood of the Registrant repeating his failure to report to the HCPC has, it believes, been addressed and fully explored in this hearing. The degree of questioning by the Panel was such that it felt confidence that should a similar situation arise in the future the Registrant would not act in the same way again.

196. The Panel has therefore concluded that in relation to the personal component there is no evidence of successful remediation of any of the matters on which this Panel has found misconduct. In terms of insight the Panel remains concerned that it is limited in nature and that in relation to the issue of repetition there remained, except in relation to the issue of non-reporting to the HCPC, a concern that there would be a repetition of the misconduct. The Panel therefore make a finding of current impairment on the personal component.

197. In relation to the public component, the Panel considers that any practitioner, but especially a fellow paramedic, would be horrified at hearing the details of this Registrant’s conduct. His actions would bring the profession into disrepute and would undermine the public confidence in the profession, and its regulator. As noted in her advice, the Legal Adviser emphasised the relevance and importance of this limb of the Panel’s decision, one which, notwithstanding any evidence of full remediation would warrant a finding in the wider public interest.

198. Further, the Panel was concerned about the potential harm that could have been caused to Service User A; the light touch which the Registrant has applied to his involvement and the potential for significant public interest and adverse reaction. These would quite rightly severely impact upon the profession’s reputation and undermine the public confidence in that profession and the regulatory process if a finding of impairment were not made on the public component. The Panel accordingly make a finding of impairment on the public component.

Sanction:

HCPC submissions

199. The HCPC submitted that at this stage it was a matter for the Panel to consider the appropriate and proportionate sanction having taken into account the guidance set out in the Sanctions Policy.

Registrant’s submissions

200. The Registrant’s Representative stated, that based upon the helpful and clear reasoning provided by the Panel in its decision on current impairment, it is the Registrant’s position that a sanction less than suspension would not be appropriate in this case. It was submitted that a period of suspension would be a proportionate measure

201. The Registrant’s Representative drew a distinction between the process and outcome of an internal investigatory and disciplinary process from those involving a registrant’s regulator. The impact of those was different. The Registrant now fully understands, from the Panel’s findings, the seriousness of the matters involved. Through this regulatory process he will now be aware of what is required of him going forward. The guidance within the Panel’s determination would provide the Registrant with the knowledge of how to focus his efforts and give him the impetus to address his past failings. This Panel can give him the opportunity to do that.

202. Suspension protects the public as the Registrant would not be able to practice and such an order would provide the Registrant with a further opportunity to review his practice with any guidance this Panel provides of evidence that a future reviewing panel may find helpful.

203. The Registrant’s Representative submitted that to impose a striking off was disproportionate in this case where there have been some indications that the Registrant has the ability to address his failings. Whilst it involves serious issues it is not the most serious case, there being no evidence that this is for instance a pattern of behaviour.
Legal Advice

204. The Legal Assessor reminded the Panel that it should take into account the terms of the Sanctions Policy however this guidance was a matter to consider and it remains for the Panel to decide on the appropriate and proportionate level of sanction. The Legal Assessor emphasised that any restriction imposed should be the least onerous possible taking into account all facets of this case and after balancing the interests of the Registrant with those of service users and the wider public interest.

Panel decision on Sanction:

205. The Panel started as advised by considering the elements of this case which would be considered as being mitigating and aggravating factors. Those identified were:

Mitigating

• No previous or subsequent concerns raised with, or reported to, the HCPC in relation to the Registrant’s conduct.

• An expression of remorse.

• Evidence of some, but limited, insight.

• Some relevant training has been undertaken during 2023.

• The Registrant and his representatives have engaged with the HCPC process.

Aggravating

• Potential for serious harm to the Service User A.

• Breach of trust.

• Evidence of an escalating pattern of unacceptable behaviour over a period of 10 to 12 days.

• The evidence before this Panel is only a snapshot of the communications that exchanged between the Registrant and this vulnerable service user and not a full representation of everything that occurred during this period.

• The Registrant had been proactive in progressing this relationship, for instance, initiating the move to Snapchat.

• The extreme vulnerability of the particular service user who was a recent former service user.

• Contact with the former service user was sexually motivated.

• Whilst not predatory behaviour, the Registrant did not resist the opportunity to pursue and then continue the relationship.

206. The Panel then turned to consider the terms of the Sanctions Policy. The Panel had previously been taken by the HCPC Presenting Officer to the relevant sections of the Policy dealing with serious matters. The Panel returned to those and to the later text of the Policy relating to when a certain level of sanction may be appropriate.

207. Starting as advised at the bottom of the range of sanctions the Panel concluded that mediation was not applicable and therefore not appropriate. Taking no further action or the imposition of a Caution Order would not provide any level of public protection and so also not appropriate in this case.

208. The Panel considered that Conditions of Practice would not be an appropriate measure in this case where it involves the Registrant’s behaviour and conduct outside of the workplace. In any event, such a level of sanction would not provide the requisite level of deterrent to other practitioners not to act in the same way nor would it be sufficient to serve the wider public interest.

209. The Panel gave very careful consideration to paragraphs 118 to 131 of the Sanctions Policy. The Panel noted that there were elements of this case which both supported and warranted a period of suspension and a striking off order. In this case there have been serious breach of the standards; limited insight; dishonesty; sexual motivation and the involvement of a vulnerable service user.

210. The Panel also noted that there were elements which did not apply, most importantly there has been no evidence of repetition, this being a single incident, nor had there been a demonstration of unwillingness by the Registrant to address former failings.

211. The Panel has no basis on which to assume that the Registrant would not have the focus and determination to address his failings if given further guidance. The Panel considered that the limited insight shown could be developed and further training may address the issues of poor judgment and any likelihood of repetition in the future.

212. The Panel acknowledged that there are public protection and public interest considerations in the Registrant being removed from practice. In the Panel’s view the Registrant’s level of engagement and level of understanding and insight are just sufficient to support the imposition of a period of suspension rather than a Striking-Off order.

213. The Panel has therefore concluded that it will impose a Suspension Order. The Panel considers that anything less than twelve months would not be appropriate nor proportionate. Further, in the interest of the wider public interest the Panel has decided to exercise its discretion and place a restriction upon the Registrant being able to make an application for an early review. This period of restriction is for the maximum permitted of ten months.

214. The Registrant should be aware that whilst this Panel has provided him with the opportunity and impetus to show he truly is committed to remediating his former misconduct a future reviewing panel will have the same range of powers as this one. Any failure on his part to engage and demonstrate commitment may result in him being permanently removed from the Register.

215. In making this order for a period of suspension of twelve months the Panel did take into account any impact this may have upon the Registrant personally, professionally and financially but considered that this interest was outweighed by the need to ensure public protection and the wider public interest.

216. To assist a future reviewing panel, the Registrant may wish to consider:

• Attending the review hearing.

• Providing evidence of meaningful and comprehensive reflection upon his former misconduct and its impact on the service user; his colleagues; his profession; his regulator; and the reputational impact his actions have had upon all those parties.

• Supplying up to date references relating to his professional and personal conduct.

• Supplying details of recent relevant training and any personal development measures he has employed.

The Registrar is directed to suspend the registration of Mr Alexander McDowell for a period of 12 months, from the date this Order comes into effect.

Right of Appeal:
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

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 on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Interim Order:

The HCPC Application

217. The HCPC made an application for an Interim Suspension Order for a period of eighteen months. This application is made to ensure that the Registrant would be prohibited from practising during the twenty-eight-day appeal period, and should there be an appeal, the order would be sufficiently long to cover the time within which such appeal would be determined.

Registrant’s Representative’s submissions

218. The Registrant’s Representative stated that her position is neutral on this matter but would remind the Panel that an interim suspension order does not automatically apply.

Panel Decision:

219. The Panel sought and accepted the advice of the Legal Assessor. She advised that under Article 31(1)(c) the Panel has a discretionary power to impose an Interim Conditions of Practice Order or Interim Suspension Order where there has been a determination under Article 29(5)(b), the imposition of a Suspension Order.
220. The Panel noted that an Interim Order can be imposed on one of three grounds of being necessary for public protection, or in the Registrant’s interest, or the wider public interest. The application by the HCPC is on the basis of public protection and the wider public interest.

221. Within the guidance in the HCPTS Sanctions Policy a situation that would support the imposition of an Interim Order included that where:

‘the allegation is so serious that public confidence in the profession would be seriously harmed if the registrant was allowed to remain in unrestricted practice.’

222. In the Panel’s view, this is the situation in this case, where the basis for the Panel decision to impose a Suspension Order was that the public would be rightly concerned if the Registrant were allowed to practice after findings of serious sexually motivated misconduct with a vulnerable female service user.

223. The Panel had concluded that in this case there was a risk of repetition of the behaviour complained of, in the absence of any evidence of steps taken to remediate that conduct. This displayed to a degree an attitudinal concern. The Panel therefore considered that an interim order was necessary in such a situation.

224. The Panel considered that the imposition of an Interim Conditions of Practice Order would not be appropriate nor proportionate for all the reasons set out in the Panel’s final determination.

225. The Panel has therefore concluded that it would grant the HCPC’s application for an Interim Suspension Order. The Panel also concluded that the period of that notice should be the maximum that can be imposed as there is no certainty as to how long any appeal process will take. The Panel therefore imposed an Interim Suspension Order for a period of eighteen months.

226. In imposing an Interim Suspension Order the Panel considered the impact upon the Registrant but the Panel concluded that the professional and financial impact was outweighed by the public interest.

Interim Suspension Order:
The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.

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.

History of Hearings for Mr Alexander McDowell

Date	Panel	Hearing type	Outcomes / Status
16/04/2025	Conduct and Competence Committee	Final Hearing	Suspended