Andrew Gambles

Preliminary Matters
Service
1. Mr Gambles did not attend. The HCPC’s position was that good service had been effected. The Panel was referred to the Notice of Hearing, sent to Mr Gambles by email, to the email address held for him on the Register, on 22 April 2025. There was confirmation that the email had been delivered.

2. The Panel was aware, in view of the legal advice it received, that in order for service to be effective in accordance with Rule 3 of the HCPC’s Conduct and Competence Committee Rules (hereafter ‘the Rules’), the Panel only needs to be satisfied that the document was sent to the Registrant. The Panel accepted the header of email as evidence of address to which the Notice was sent and was satisfied that Mr Gambles had been properly served.

Proceeding in the absence of Mr Gambles
3. After the Panel announced its decision that there had been good service of the Notice of Hearing, Ms Girven on behalf of the HCPC, applied for a direction that the hearing should proceed in the absence of Mr Gambles. Ms Girven submitted that there was a public interest in progressing the matter expeditiously. She said that the proceedings are five years old, Registrant 1 and the HCPC witnesses are in attendance, and that it would not be fair on Registrant 1 who is in attendance for the hearing to be adjourned. Ms Girven submitted that there had been no communication from Mr Gambles since 2024 and that in all the circumstances it would be fair to proceed in the absence of Mr Gambles.

4. The Panel accepted the Legal Assessor’s advice and had due regard to the Practice Note entitled ‘Proceeding in the Absence of the Registrant’ issued by the Health and Care Professions Tribunal Service (hereafter referred to as ‘HCPTS’). The Panel was aware that Rule 11 provides it a discretion to proceed in the absence of a registrant if it is satisfied that all reasonable steps have been taken to serve notice. As to the matters it should take into account in determining whether it is fair to proceed in a registrant’s absence, the Panel took into account the factors set out in R v Jones [2003] UKPC 34, and the guidance given in General Medical Council v Adeogba [2016] EWCA Civ 162.

5. Having carefully considered the matter, the Panel concluded that Mr Gambles had voluntarily waived his right to attend the hearing. The Panel had no reason to suppose that adjourning the hearing would secure Mr Gambles’ attendance at a later date to attend the hearing or be represented. The Panel took into account fairness to Registrant 1, and considered that there would be disadvantage to him, as well as to the HCPC and the public interest, if the matter were delayed further. It was in the interests of all concerned to deal with the matter as expeditiously as possible going forward, given that the events took place in 2020. The Panel determined that in all the circumstances, it was fair to proceed in Mr Gambles’ absence.

HCPC’s first application to amend the Allegation
6. At the outset of the hearing, Ms Girven made an application to amend the Allegations in respect of both Mr Gambles and Registrant 1. Ms Girven submitted that the amendments were typographical in nature and provided clarity. In addition, the amendments sought in respect of Registrant 1 better reflected the HCPC’s evidence and did not heighten the seriousness of the Allegation. Registrant 1 did not oppose the amendments sought by the HCPC.

7. The Legal Assessor advised the Panel that, although the Rules do not make express provision for the Panel to amend the Allegation, case law has recognised that panels have the power to amend an allegation. She advised that the Panel should consider whether the amendments changed the nature or strength of the case against the Registrants and whether they could be made fairly and without prejudice. In undertaking this process the Panel should consider and balance the public interest in ensuring that cases are not under-prosecuted and that the relevant evidence is placed before it.

Panel’s decision on the Application to Amend the Allegations
Mr Gambles
8. In respect of Mr Gambles, the HCPC sought to delete the first sentence of the Allegation. The HCPC further sought to insert the word “or” in Particular 3 of the Allegation.

“As a registered Paramedic, your fitness to practise is impaired by reason of misconduct. In that:”
“3. The matters set out in particulars 1 and/or 2 above constitute misconduct.”

9. The Panel accepted that these amendments were typographical in nature and caused no prejudice to Mr Gambles.

HCPC’s second application to amend the Allegation – Mr Gambles
10. Following the conclusion of the HCPC’s case, Ms Girven made an application to amend Particular 1(b) in respect of Mr Gambles as follows:

1. On 23 December 2020, when attending a call to Patient A, you did not provide adequate treatment in that:
b. You did not recognise and/or act on the fact that an Oropharyngeal airway and/or bag valve mask and/or oxygen rather than an i-gel airway appropriate for unconscious/apnoeic/cardiac arrest cases.

11. Ms Girven submitted that the amendment sought did not heighten the seriousness of the allegation and was a matter of clarification.

12. The Legal Assessor reminded the Panel of the advice previously given, with specific reference to Professional Standards Authority v Health and Care Professions Council and Doree [2107] EWCA Civ 319, which makes clear that it is open to a committee to amend an allegation even at the conclusion of the facts stage so far as it was fair and reasonable to do so, and in doing so, does not cause Mr Gambles any further prejudice. In undertaking this process the Panel should be mindful that the amendment being sought is not tailored to meet the evidence emerging against Mr Gambles.

13. The Panel approved the proposed amendment to Particular 1(b). The Panel noted that the further Particularisation of what is alleged clarified the three distinct aspects of early interventions. The Panel was satisfied that no prejudice to Mr Gambles arose from making the amendment and it was fair to make it.

Application to admit hearsay evidence
14. The HCPC sought to rely on three pieces of written evidence which related to Colleague C. These were:

• Mr Green’s summary of Colleague C’s internal statement dated 29 April 2021;
• Colleague C’s statement dated 8 January 2021;
• Colleague C’s first hand account dated 29 January 2021.

15. Ms Girven referred the Panel to the principles in Thorneycroft v NMC [2014] EWHC 1565 (Admin). She explained that the HCPC made attempts to engage Colleague C, however Colleague C did not respond to the HCPC’s communications. No steps were taken by the HCPC to secure Colleague C’s attendance as Colleague C is not a regulated professional. Ms Girven submitted that Colleague C’s evidence was relevant to both Registrants’ cases. In all the circumstances the Panel ought to exercise its discretion and admit the evidence of Colleague C as it was fair and in the interests of justice to do so.

16. Registrant 1 told the Panel that he had re-read Colleague C’s evidence and did not object to its admission in evidence, however there were minor aspects of Colleague C’s evidence Registrant 1 did not accept.

Decision on application to admit hearsay evidence
17. The Legal Assessor advised the Panel that Rule 10 (1)(b) provides that the rules on the admissibility of evidence that apply in civil proceedings in the appropriate court in the part of the United Kingdom where the hearing takes place shall apply. In relation to the admissibility of evidence in civil proceedings, the Civil Evidence Act 1995 applies. The Act allows for hearsay evidence to be admissible, subject to certain safeguards. The Rules also make it clear that a panel may hear evidence which would not be admissible in civil proceedings if the Panel is satisfied that admission of that evidence is necessary in order to protect members of the public. The Legal Assessor reminded the Panel that its overriding duty is to ensure that the hearing is fair. She then advised the Panel of the factors it should take into account in considering a hearsay application and referred to the principles derived from the cases of Thorneycroft v Nursing and Midwifery Council [2014] EWHC 1565 (Admin), and Mansaray v Nursing and Midwifery Council [2023] EWHC 730. The Legal Assessor also referred to the case of El Karout v NMC [2019] EWHC 28 (Admin) in that the Panel should first consider admissibility of the evidence. If it admits the evidence, then at the facts stage it can decide what weight to place on it. The Legal Assessor referred the Panel to the HCPTS Practice Note entitled ‘Evidence’ dated October 2024, paragraphs 31 to 36.

18. The Panel carefully considered the submissions of Ms Girven, which were not objected to by Registrant 1, and accepted the advice of the Legal Assessor. The Panel agreed that the evidence in relation to Colleague C is hearsay evidence, in that they are statements made otherwise than by a person while giving oral evidence in the proceedings which is tendered as evidence of the matter stated. The Panel approached the HCPC’s application bearing in mind the overriding duty to protect the public as well as its duty to ensure that hearsay evidence should only be admitted if it is relevant and fair. It bore in mind that at a final hearing, the HCPC bears the burden of proof of the factual allegations and that the civil standard of proof will apply. The Panel was mindful that the allegations in this case were serious and if proved, would have an adverse impact on both Registrants professional careers.

19. The Panel considered the application in accordance with the approach set out in Thorneycroft and the non-exhaustive list set out in the HCPTS Practice Note entitled ‘Evidence’.

20. The Panel decided to admit the hearsay evidence for the following reasons. The hearsay evidence is in respect of both Registrants, rather than of any other witness. The hearsay evidence was served on Registrant 1 and Mr Gambles as part of the HCPC’s final hearing bundle. The hearsay evidence is not the sole and decisive evidence in this case upon which the HCPC sought to rely to prove the facts. The hearsay evidence bore a degree of reliability and credibility in that Colleague C was simply reporting what they had witnessed directly when present with both Registrants at the time of the events. The second and third statements of Colleague C were provided as part of the Welsh Ambulance Service NHS Trust’s internal investigation and were made close to the time of the events. In relation to the extent of challenge to the evidence, the Panel noted that neither Registrant had been made aware of the hearsay application in advance of the hearing. Mr Gambles has therefore not had the opportunity to respond to the hearsay application. However, there was no information before the Panel to suggest that Colleague C was fabricating what they saw. In terms of Registrant 1’s position, he was content with Colleague C’s evidence being admitted but made clear there were minor aspects of Colleague C’s evidence he disputed. The HCPC had made attempts to engage Colleague C but these were not successful. Having considered the relevant principles from the case law and the relevant Practice Note, the Panel was satisfied that it was fair and in the interests of justice that the hearsay evidence of Colleague C should be admitted in its entirety. The Panel understood that it was to decide what weight to place on the hearsay evidence in due course.

CCTV footage
21. At the outset of the hearing, Ms Girven informed the Panel that CCTV footage the HCPC sought to rely upon had not been served on the Registrants and the Panel. Ms Girven explained that the CCTV footage was from the bank where the incident in respect of Patient A occurred and that the footage showed seven camera angles of the incident. Ms Girven also confirmed that Mr Steve Bell, the expert, had only viewed camera angle two at the time he compiled his expert report in March 2023. Registrant 1 informed the Panel he had not received nor viewed the CCTV footage.

22. The Panel, concerned that neither Registrant had been served the CCTV footage in advance of the hearing, allowed Registrant 1 time to view the CCTV footage in private. The Panel also viewed the CCTV footage in private. Mr Bell was provided time to view the CCTV footage in advance of his evidence.

Allegation as Amended
Amended Allegation - Registrant 2 Mr Gambles
1. On 23 December 2020, when attending a call to Patient A, you did not provide adequate treatment in that:
a. You did not maintain continuous cardiopulmonary resuscitation
b. You did not recognise and/or act on the fact that an Oropharyngeal airway and/or bag valve mask and/or oxygen was initially being used rather than an i-gel airway appropriate for unconscious/ apnoeic/cardiac arrest cases.
c. You did not continuously monitor and/or record monitoring of Patient A’s End-tidal CO2
d. You did not follow the correct process for Recognition of Life Extinct (ROLE), in that:
i. You did not ensure that Patient A received at least 20 minutes of continuous Advanced Life Support (ALS) treatment
ii. ROLE was implemented when Patient A was not in asystole for 30 seconds and/or Patient A was not in asystole persistently and consistently.

2. In respect of particular 1:
a. you did not inform and/or ensure that Police were informed of Patient A’s sudden death.
b. You did not assist in the completion of the Patient Care Record, which was incomplete and contained incorrect information.

3. The matters set out in particulars 1 and/or 2 above constitute misconduct.

4. By reason of your misconduct your fitness to practise is impaired.

How the different stages included in the Allegation would be dealt with
23. As the Allegation to be decided was whether both Registrants’ fitness to practise as Paramedics is impaired by reason of misconduct, it followed that there were three distinct stages to be addressed, namely the facts, if relevant facts were proven, whether they amounted to misconduct, and, if misconduct is established, whether that misconduct is currently impairing the Registrants’ fitness to practise as Paramedics.

24. The Panel was clear that these three elements were to be decided not only separately but sequentially. Following the above decisions in the case prior to the Panel’s findings of fact, and having heard submissions from Ms Girven, the Panel was satisfied that it would address the fact finding stage as a separate decision, before hearing any submissions in respect of misconduct and any further evidence and submissions in respect of impairment. Registrant 1 was content with this approach.

Background
25. On 23 December 2020 at 12:09 hours, the Welsh Ambulance Service NHS Trust (the Trust) received a 999 call regarding an 80-year-old female (Patient A) who had collapsed in a bank and was in cardiac arrest. The call was categorised as highest priority. An Emergency Ambulance with Registrant 1 and Colleague C was allocated to the call and arrived at the scene at 12:19 hours, and a Rapid Response Vehicle (RRV) with Mr Gambles was allocated to the call and arrived at the scene at 12:24 hours (these timings were those provided by the Trust). At the time both Registrant 1 and Mr Gambles were working as Band 6 paramedics for the Trust. Mr Gambles had worked for the Trust since 1986 and Registrant 1 since 2003.

26. It is alleged that upon attending to Patient A, Registrant 1 and Colleague C continued resuscitation which the bank staff had initiated. It is alleged that chest compressions were paused for approximately two minutes whilst Colleague C provided ventilation to Patient A using a cushion face mask and Registrant 1 inserted a cannula. It is alleged that this was against guidance not to interrupt chest compressions unless a patient starts breathing normally.

27. It is alleged that both Mr Gambles and Registrant 1 did not maintain continuous cardiopulmonary resuscitation (CPR) of Patient A, the Return of Life Extinct (ROLE) guidance was not followed, Patient A’s End-tidal CO2 was not monitored, and that Patient A’s airway was unprotected by an i-gel, which is a type of supraglottic airway. It is further alleged that the patient report form (PCR) completed at the scene by Registrant 1 in respect of Patient A was inaccurate and incorrect and that the Police were not informed of Patient A's sudden death.

28. Registrant 1 and Mr Gambles self-referred to the HCPC following their involvement with the treatment of Patient A. Mr Gambles submitted a self-referral on 14 January 2021. In the referral, Mr Gambles records that he was removed from frontline duties as a Paramedic due to the Trust's ongoing investigation into his treatment of Patient A. Registrant 1 submitted a self-referral on 11 February 2021. In the referral, Registrant 1 also records that he was removed from frontline duties as a paramedic due to the Trust's ongoing investigation into his treatment of Patient A.

29. The Trust appointed Peter Green, Clinical Development Lead at Aneurin Bevan University Health Board, as the investigating officer in respect of the incident. Mr Green was asked to comprehensively investigate the incident and compile a report with his findings.

30. It is alleged that both Registrants were equally responsible for the care delivered to Patient A. The Allegations differ in relation to the patient clinical record (PCR), which reflects that it is alleged that it was Registrant 1 who completed the records, although it is also alleged that Mr Gambles failed to assist with the completion of the records.

31. On 10 January 2024, at a Preliminary Hearing, the Conduct and Competence Committee joined the Registrants’ cases for a final hearing.

Documents and evidence
32. The Panel was provided with the following documentation and evidence:
• The HCPC’s substantive hearing bundle of 376 pages which included, but was not limited to, the Trust’s Investigation Report and Appendices, witness statements of Peter Green and exhibits, expert reports of Mr Steve Bell, and correspondence in relation to Registrant 1’s health.
• A supplemental bundle of 44 pages which included, but was not limited to, correspondence between the HCPC’s solicitors and Registrant 1, and Registrant 1’s CPD certificates, GP tutor report, character references and Basic Life Support Instructor certificate.
• A clear copy of the PCR Form – 2 pages.
• CCTV footage from the bank.
• The HCPC’s Case Summary - 18 pages.

33. The Panel heard live evidence from the following: Peter Green (Health Board Clinical Lead at Aneurin Bevan University Health Board); Steve Bell (Consultant Paramedic for the NHS Ambulance Trust) and Registrant 1 (Registrant 1).

34. The Panel heard oral submissions from the parties on day seven of the hearing in relation to the facts stage.

Decision on Facts
35. In reaching its decisions on the two sets of Allegations, the Panel took into account the oral evidence of the HCPC witnesses and Registrant 1, together with all of the documentary evidence provided to it, including Registrant 1’s written correspondence with the HCPC’s solicitors and supporting documentation submitted by him, the CCTV footage and the oral submissions on facts made by both Ms Girven on behalf of the HCPC and Registrant 1.

36. The Panel accepted the advice of the Legal Assessor, which is a matter of record. When considering each Particular of the Allegation, the Panel bore in mind that the burden of proof rests on the HCPC and that the Registrants did not have to prove anything. The Allegations are found proved based on the balance of probabilities. This meant that particulars will be proved if the Panel was satisfied that what had been alleged was more likely than not to have happened. The Panel was reminded that some of the evidence before it was hearsay and that it must determine what weight to attach to the hearsay evidence.

37. The Panel was referred to the test for dishonesty as set out in Ivey v Genting Casinos [2017] UKSC 67. The Panel was informed that the Registrants were of good character and therefore received the ‘good character direction’ from the Legal Assessor. The Panel did not draw any inferences due to Mr Gambles’ absence. The Panel accepted that any documentation within the HCPC Final Hearing bundle that referred to an outcome, as identified in the case of Enemuwe v Nursing and Midwifery Council [2015] EWHC 2081, was inadmissible.

38. The Panel was also advised that it should consider the expert evidence of Mr Steve Bell as part of the evidence as a whole, taking it into consideration when determining the facts in dispute. The role of the expert was to assist the Panel on specialist or technical matters that are within that expert’s area of expertise and outside of the Panel’s knowledge and experience. The Panel was not bound to accept expert opinion, even when there is no contrary expert, however, there ought to be clear reasons provided to reject it, which ought to be set out in the Panel’s determination if that is the case.

Evidence
39. The Panel considered that Mr Green, who had undertaken the Trust’s investigation, was a careful and clear witness who gave professionally informed detached evidence largely supported by contemporaneous documents.

40. The Panel accepted Mr Bell as an expert witness. His evidence was detailed and helpful, explaining for the Panel the expectations of a Paramedic in the circumstances of this case. Mr Bell was an experienced specialist in paramedic practice with the NHS and Air Ambulance Service and had acted as an expert witness since 2021. The Panel found that his report did not stray beyond his scope of expertise. Mr Bell was fair and conceded where appropriate, identifying practice by the Registrants of which he was not critical.

41. The Panel reviewed the CCTV footage from the bank and deemed it a reliable and ‘real time’ account of the incident. The recording included a visible timestamp, which further supported its accuracy and chronological integrity (albeit that the timestamp was set some minutes different to the Trust’s recorded timings).

42. Registrant 1 (1st Registrant) had given evidence and was subject to cross-examination, as well as direct questioning from the Panel. His evidence was measured and thoughtful. The Panel found no indication of personal grievance or exaggeration in his account, particularly in relation to colleagues who were present at the incident. Registrant 1 appeared to be genuinely committed to offering a truthful and accurate recollection of events to the best of his ability.

43. The Panel considered each of the Allegations in turn.

Guidance
44. Mr Bell referred the Panel to the applicable guidance in respect of the presentation of Patient A and the scope of practice of the Registrants as detailed in their Band 6 Paramedic Job Descriptions. This guidance is referred to in this decision as the ‘JRCALC Guidelines’, the Joint Royal Colleges Ambulance Liaison Committee being the responsible body for their development; and the Resuscitation Council UK (RCUK) Advanced Life Support guidelines. In accordance with the Registrants’ scope of practice and the clinical guidelines, Mr Bell stated that the Registrants’ roles in respect of Patient A were to deliver both BLS and ALS interventions in accordance with the JRCALC and RCUK guidelines.

Decision on Facts: Mr Gambles – 2nd Registrant
Particular 1(a) – Found Proved
1. On 23 December 2020, when attending a call to Patient A, you did not provide adequate treatment in that:
a. You did not maintain continuous cardiopulmonary resuscitation.

45. The Panel noted from the CCTV footage that initial bystander CPR was provided to Patient A by members of staff from the bank. Registrant 1 and Colleague C arrived at the scene at 12:19 hours. Mr Gambles arrived at 12:24 hours, and he began to perform chest compressions on Patient A.

46. The Panel observed that CPR was paused and pulse checks carried out on Patient A, during which time there appeared to be a discussion between Mr Gambles and Registrant 1. Mr Bell stated “during these pulse checks and subsequent apparent discussion CPR is ceased for a period of just over a minute. RCUK guidelines state pulse checks should take no longer than ten seconds to avoid the prolonged interruption of CPR provision…I consider the pause of over a minute to be too long for the purpose of a pulse check.”

47. The Panel observed that CPR was stopped again prior to moving Patient A to the Ambulance stretcher. Mr Bell stated that during the internal investigation Mr Gambles referred to the feeling of Patient A’s femoral pulse, but that regardless of whether there was one present, it was his opinion that CPR should have been recommenced before Patient A was moved to the stretcher. Once Patient A was moved to the stretcher and wheeled from the bank, the Panel observed there was no CPR being provided during this time which was a period of approximately four minutes.

48. The Panel concluded that Mr Gambles did not maintain continuous CPR and this was inadequate treatment for Patient A. The Panel accepted Mr Bell’s evidence that the interrupting and pausing of CPR for protracted periods was against guidance from JRCALC and RCUK and was not something he would expect from a paramedic during the management of a cardiac arrest.

49. The Panel was therefore satisfied on the balance of probabilities that Mr Gambles had not provided adequate treatment to Patient A in respect of Particular 1(a). Accordingly, the Panel found Particular 1(a) proved.

Particular 1(b) – Found Proved
1.On 23 December 2020, when attending a call to Patient A, you did not provide adequate treatment in that:
b. You did not recognise and/or act on the fact that an Oropharyngeal airway and/or bag valve mask and/or oxygen was initially being used rather than an i-gel airway appropriate for unconscious/ apnoeic/cardiac arrest cases.

50. The Panel found Particular 1(b) proved. The CCTV footage showed that an i-gel was used on Patient A at approximately 12:27 hours. Mr Gambles had arrived at the scene earlier. Therefore, there was a period of time when Mr Gambles had not recognised or acted on the fact that a bag valve mask and oxygen was initially being used on Patient A rather than an i-gel airway which was appropriate in the circumstances. Although an i-gel was eventually used, it should have been used earlier in the management of Patient A.

51. In Mr Gambles initial statement dated 8 January 2021, he said that “once inside I asked the crew if they needed any more equipment and the took over cardiac compressions rotating between airway and compressions with a crew member. I’m sure that an i-gel was in place at this time, I can’t be sure when it was put in place, but it may have been prior to my arrival. I do recall the i-gel being secured using the correct device.” The Panel also had regard to Colleague C’s statement of 29 January 2021, which it determined it could attach some weight to as the statement was made close to the time of the events in question. Colleague C stated “…I continued doing chest compressions and ventilations using a bag valve mask, my colleague (Registrant 1) prepared the BVM (Bag Valve Mask) and O2 whilst I compressed her chest, Dan looked at the screen, then inserted a cannula and gave drugs. Around this time, we are joined by a paramedic on an RRV, there was a brief conversation around the events that we knew, the RRV paramedic took over chest compressions and I used the BVM to ventilate the patient….The patient had an orange OPA (Oropharyngeal Airway) inserted as far as I remember.”

52. The Panel had regard to Mr Bell’s report in which he stated that as a Band 6 Paramedic, Mr Gambles should have identified that Patient A was being ventilated without the use of an advanced airway and should have prioritised this as being his focus, given the provision of CPR could have been tasked to Colleague C to deliver. Mr Bell goes onto say “The use of an advanced airway, in the form of the supraglottic airway device the igel, is the preferred method of airway management in cardiac arrest within the Registrant’s Ambulance Trust as highlighted within the Airway Management 2017 document…it follows that not preferentially utilising a SGA (supraglottic airway) as the primary airway adjunct is against Trust guidance for the management of cardiac arrest.”

53. The Panel was satisfied on the balance of probabilities that Mr Gambles had not provided adequate treatment to Patient A in respect of Particular 1(b) and therefore it found this particular proved.

Particular 1(c) – Found Proved
1. On 23 December 2020, when attending a call to Patient A, you did not provide adequate treatment in that:
c. You did not continuously monitor and/or record monitoring of Patient A’s End-tidal CO2.

54. The Panel found Particular 1(c) proved. The Panel had regard to the PCR which was ticked demonstrating that the Supraglottic Airway was checked by End-tidal CO2 monitoring, however no value was recorded. There was also no evidence in the Corpuls data that End-tidal CO2 measurements were obtained during the resuscitation of Patient A.

55. In his statement dated 31 March 2021, Mr Gambles was asked whether he considered discussing End tidal carbon dioxide. He replied, “I don’t remember using it or discussing it. I’d have to look at the Corpuls information. I remember the metronome being on, but can’t remember ETCO2, this was a long time ago now. If I didn’t use it that would have been an error.” The Panel noted that Registrant 1 admitted that End-tidal CO2 was not used during the resuscitation attempt of Patient A.

56. Mr Bell stated that the failure to use End-tidal CO2 monitoring was contrary to the guidance within JRCALC and RCUK ALS guidelines. In Mr Bell’s opinion End-tidal CO2 monitoring should have been used during the resuscitation attempt with the placement of the i-gel. He states, “whilst I accept that it was Registrant 1 who placed the SGA, I would expect any paramedic to be cognisant of the requirements made within JRCALC, RCUK and local guidance regarding the use of End tidal carbon dioxide and therefore, in my opinion, the Registrant (Mr Gambles) has a responsibility to ensure its use.”

57. The Panel was satisfied on the balance of probabilities that Mr Gambles did not continuously monitor and/or record the monitoring of Patient A’s End-tidal CO2 and that this was not adequate treatment. It therefore found Particular 1(c) proved.

Particular 1(d)(i) and Particular 1(d) (ii) – Found Proved
1. On 23 December 2020, when attending a call to Patient A, you did not provide adequate treatment in that:
d. You did not follow the correct process for Recognition of Life Extinct (ROLE), in that:
i. You did not ensure that Patient A received at least 20 minutes of continuous Advanced Life Support (ALS) treatment.
ii. ROLE was implemented when Patient A was not in asystole for 30 seconds and/or Patient A was not in asystole persistently and consistently.

58. The Panel found Particulars 1(d)(i) and (ii) proved. The investigation report details that ROLE was implemented on the scene at 13:01 hours. It is understood that ROLE was performed once Patient A was in the rear of the ambulance. The ROLE criteria for ambulance clinicians is set out in the JRCALC ROLE Guidance. Mr Bell states that paramedics are expected to ensure decision making is in the best interests of a patient and aligns with policy. Therefore, Mr Gambles had a duty to ensure that the correct decision making around ROLE was undertaken.

59. In respect of Particular 1(d)(i), Mr Bell stated in his report that the duration of ALS provision commences “at the point at which the patient has an advanced airway device situated, venous access obtained and when ALS drugs (adrenaline) are given. Unless these criteria are met, in my opinion, ALS is not being provided. In accordance with the JRCALC ROLE Guidance, this must then be continued from this point for 20 minutes”. Mr Bell concludes “in this case the only two doses of adrenaline were administered to Patient A…. As the guideline interval for adrenaline administration in cardiac arrest is 3-5 minutes, it follows that ALS was not provided for 20 minutes as I would expect at least four doses to have been given.”

60. In his statement of 31 March 2021, Mr Gambles said that he was aware of the requirement of twenty minutes ALS to ROLE a patient once CPR had commenced. However, he was unsure how long treatment had been going on for Patient A prior to his arrival at the scene. Mr Gambles said “as the crew had started prior to my arrival I didn’t question the decision. I still would be unable to tell you how long the resuscitation lasted for, for this reason. I do remember that on my arrival ALS had been started and IV drugs given.”

61. The Panel was satisfied that Mr Gambles did not ensure Patient A had received at least twenty minutes of continuous ALS treatment. Further, by not ensuring that ALS interventions had been provided for at least twenty minutes Mr Gambles did not follow the correct procedure for ROLE in accordance with the JRCALC ROLE Guidance. Accordingly, the Panel was satisfied on the balance of probabilities that Mr Gambles did not provide Patient A adequate treatment and therefore it found Particular 1(d)(i) proved.

62. In respect of Particular 1(d)(ii), Mr Bell stated that the Resuscitation Guidance specifies that if, after ALS interventions, the patient has “been persistently and continuously asystolic for 20 minutes and all reversible causes have been identified and corrected, resuscitation may cease.” Mr Bell goes on to say that in his opinion Patient A was never in asystole at any point during the available data capture. Mr Bell stated that “the predominant rhythm evident, accepting there may be some compromise from the performing of CPR, is pulseless electrical activity (PEA). PEA is a condition in which cardiac contractions are absent in the presence of coordinated electrical activity. It therefore follows that, in my opinion, the JRCALC requirement for 20 minutes of persistent and continuous asystole isn’t met for the termination of resuscitation in this case.”

63. The Panel was satisfied that Mr Gambles did not follow the correct process for ROLE in that he implemented ROLE when Patient A was not persistently and consistently in asystole. Mr Gambles did not adhere to the JRCALC ROLE Guidance. Accordingly, the Panel determined on the balance of probabilities that Mr Gambles did not provide Patient A adequate treatment and it therefore found Particular 1(d)(ii) proved.

Particular 2(a) – Found Proved
2. In respect of particular 1:
a. you did not inform and/or ensure that Police were informed of Patient A’s sudden death.

64. The Panel found Particular 2(a) proved. It was clear from the evidence before the Panel that the Police had not been informed of Patient A’s death. Patient A was reported missing to the Police by their family several hours post the incident. The Police went on social media to ask for public assistance, to which a member of staff from the bank responded with details of the incident. The Police subsequently lodged a complaint as to why they were not notified of a sudden death in the community. The Police should have been informed of the ROLE of Patient A in accordance with “Clinical Notice 19/2020 – Notifying the police of a death in the back of the ambulance.” The Clinical Notice reminds clinicians of the following: “the back of an ambulance is considered a public place and that a death where the ROLE procedure is implemented must still be reported to the police via CC, even if this occurs outside the Emergency Department.”

65. Registrant 1 stated that he “forgot to request notification of the police following ROLE being undertaken.” Mr Bell commented in his report that the expectation is for all paramedics to ensure decision making is in the best interests of a patient and decisions align with policy. Mr Gambles was not expected to inform the police directly of Patient A’s sudden death, but he did have the responsibility and expectation to ensure that Police were informed of Patient A’s sudden death, even if via the CCC. This was a responsibility Mr Gambles shared equally with Registrant 1.

66. The Panel was satisfied on the balance of probabilities that Mr Gambles did not ensure that the Police were informed of Patient A’s sudden death. Accordingly, the Panel found Particular 2(a) proved.

Particular 2(b) – Found Proved
1. In respect of particular 1:
b. You did not assist in the completion of the Patient Care Record, which was incomplete and contained incorrect information.

67. The Panel found Particular 2(b) proved. The PCR was completed by Registrant 1; Registrant 1 admitted the PCR contained inaccurate and incorrect information. The inaccurate and incorrect information was detailed in Mr Green and Mr Bell’s evidence to the Panel. Mr Bell said he expected any paramedic to ensure that clinical records in which they attend and have had clinical input into are complete and accurate, and that by Mr Gambles not ensuring the PCR was complete and accurate amounted to poor practice.

68. In his statement dated 31 March 2021, Mr Gambles said that “In hindsight I should have stayed and assisted with the completion of the PCR, it is incomplete and lacks information. When I’ve been involved with the resuscitation of a patient, the PCR is normally completed following the event. I trusted the crew to complete the documentation, this is something I’ve done previously whilst working on the RRV.”

69. Having considered the evidence, the Panel was satisfied that on the balance of probabilities, Mr Gambles did not assist in the completion of the PCR which was incomplete and contained incorrect information. Accordingly, it found the facts of Particular 2(b) proved.

Decision on Grounds
Submissions on misconduct
70. Ms Girven submitted that Registrant 1’s and Mr Gambles’ conduct found proved individually and cumulatively amounted to misconduct. She referred to Mr Bell’s report and submitted that Registrant 1’s and Mr Gambles’ conduct fell significantly below or far below the standards expected of a registered Paramedic in the circumstances of this case and was therefore serious misconduct. While it was accepted there was no evidence of actual patient harm, the conduct nonetheless placed Patient A at significant risk of serious harm. This constituted a breach of the HCPC Standards of Conduct, Ethics and Performance (2016).

71. The Panel accepted the Legal Assessor’s advice which is a matter of record. The Panel adopted a two-step process in its consideration. Firstly, the Panel considered whether the facts found proved amounted to misconduct. Secondly, and only if the facts proved were found to amount to misconduct, the Panel would go on to consider whether Registrant 1’s and Mr Gambles fitness to practise is currently impaired as a result of that misconduct.

72. The Panel had regard to the context and circumstances in which the misconduct took place. In reaching its decisions the Panel took into account the terms of the HCPTS guidance set out in its Practice Notes and had recourse to the HCPC Standards of Conduct, Ethics and Performance (2016) in force at the relevant time. The Panel took into account that a breach of the standards did not of itself amount to misconduct. The Panel was assisted in its analysis of the Standards by the evidence of Mr Bell.

73. The Panel carefully considered the seriousness of the Registrants’ failings in the context of Patient A who was presenting as a patient in cardiac arrest at the time of the events. The Panel had regard to Mr Bell’s report in which he states, “pre-hospital cardiac arrest in the UK carries a dire prognosis with survival rates below 10%, however the optimum chance of survival is afforded by carrying out timely high quality basic and advanced life support.”

74. The Panel considered that as Band 6 Paramedics, both Registrant 1 and Mr Gambles should have been fully competent in delivering the full range of interventions and skills associated with both BLS and ALS in accordance with JRCALC and RCUK guidelines and had a duty to provide a level of care to Patient A consistent with the guidance. In this regard, the Panel accepted the opinion of Mr Bell that Registrant 1 and Mr Gambles failed to manage the cardiac arrest of Patient A and deliver the necessary range of interventions in accordance with the guidance. The Panel also had regard to the evidence of Mr Green in coming to its conclusions on misconduct.

75. The Panel considered that Registrant 1 and Mr Gambles had breached the following HCPC Standards of Conduct, Ethics and Performance (2016):

Work with colleagues
2.5 You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers.
2.6 You must share relevant information, where appropriate, with colleagues involved in the care, treatment or other services provided to a service user.
Keep within your scope of practice
3.1 You must keep within your scope of practice by only practising in the areas you have appropriate knowledge, skills and experience for.
Delegation, oversight and support
4.2 You must continue to provide appropriate supervision and support to those you delegate work to.
Identify and minimise risk
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
Keep accurate records
10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

76. The Panel considered each finding of fact separately in relation to misconduct in respect of each Registrant.

Decision on misconduct – Mr Gambles (2nd Registrant)
77. In relation to Particular 1(a) the Panel considered that the interruption in the provision of chest compressions for a patient in cardiac arrest was serious as the interruptions reduce the chance of a patient’s survival and must be avoided in accordance with the guidelines. The Panel agreed with Mr Bell’s opinion that the pauses in CPR fell far below the standards of resuscitation expected from a Paramedic.

78. In relation to Particular 1(b), Mr Gambles did not recognise and act on the fact that Patient A’s airway had not been protected initially by the use of an i-gel in accordance with the guidelines. The Panel considered the delay in the use of the i-gel was serious and agreed with Mr Bell’s opinion that the standard of airway management by Mr Gambles fell far below the standard expected of a Paramedic.

79. In relation to Particular 1(c), End-tidal CO2 monitoring is advocated in both the JRCALC and RCUK ALS guidelines. Its monitoring, particularly during a cardiac arrest serves two purposes; firstly, to confirm the patency and adequacy of the placement of an advanced airway device, and as a surrogate measurement of the effectiveness of CPR. Mr Gambles said he did not recall the use of End-tidal CO2. Not monitoring and recording End-tidal CO2 at any stage during the management of a patient in these circumstances was a serious omission by Mr Gambles. The Panel agreed with Mr Bell’s opinion that this omission fell far below the standards expected of a Paramedic.

80. In relation to Particulars 1(d)(i) and 1(d)(ii), the Panel considered Mr Gambles’ non-adherence to the JRCALC ROLE guidelines to be a serious omission in the management of Patient A. It accepted the conclusions of Mr Bell who stated that there was no evidence of the elements of ALS being delivered by Mr Gambles or him ensuring that it had been provided by Registrant 1 and Colleague C for a continuous period of twenty minutes, and this omission fell far below the standard expected of a Paramedic. Further, when the decision was made to implement ROLE, Patient A was not in asystole persistently or consistently. This was also not in accordance with the JRCALC ROLE guidelines. The Panel was satisfied that Mr Gambles’ conduct fell below the standard expected of a Paramedic.

81. In relation to Particular 2(a), the Panel set out at paragraph 137 the steps taken by Patient A’s family and the Police to establish the whereabouts of Patient A. The Panel considered that Patient A’s family would likely have been distressed not knowing where Patient A was, hence, their contact with the Police, and further, that their expectation would have been that a Paramedic would have ensured notification to the Police, as was their duty. Due to Patient A passing away in a public place, Mr Gambles should have contacted the CCC or ensured that the Police were informed of Patient A’s sudden death so that the coroner and Patient A’s family would be notified accordingly. The Panel considered that Mr Gambles’ conduct fell far below the standards expected of a Paramedic.

82. In relation to Particular 2(b) Mr Gambles admitted that he made a mistake in relying on Registrant 1 to complete the PCR. The PCR lacked information relating to the management of Patient A, and the information provided contained inaccuracies. As a registered Paramedic who had clinical input into the management of Patient A, there was a professional obligation on Mr Gambles to ensure that all necessary paperwork was accurately completed. The Panel had regard to the evidence of Mr Bell, which it accepted, and concluded that Mr Gambles’ omission in not ensuring the PCR was accurate was poor practice and fell below the standard expected of a Paramedic.

83. For the reasons set out above, the Panel concluded that the matters found proved and subsequent breaches of the HCPC’s Standards of Conduct, Performance and Ethics (2016), were both individually and collectively sufficiently serious departures from the standards expected of a Paramedic as to amount to misconduct.

84. The Panel therefore found Mr Gambles’ conduct as found proved amounted to misconduct.

Decision on Impairment
85. The Panel went on to consider whether Registrant 1’s and Mr Gambles’ fitness to practise is currently impaired by reason of the misconduct found proved.

Submissions on impairment
86. There were no submissions from Mr Gambles.

Legal advice
87. The Panel had regard to all of the evidence presented in this case, including the submissions of Ms Girven and Registrant 1, the evidence it had heard and the documentation before it. The Panel also heard and accepted the advice of the Legal Assessor and took into account the HCPTS Practice Note entitled ‘Fitness to Practise Impairment’ and the over-arching objective of the HCPC. It was conscious that the test of impairment is expressed in the present tense in relation to the need to protect the public against the acts and omissions of those who are not fit to practise, and that this cannot be achieved without taking account of the way a person has acted or failed to act in the past. It also recognised that the purpose of the regulatory proceedings is not to punish a Registrant but to protect the public.

88. The Panel was mindful that a finding of impairment does not automatically follow a finding that a particular has been found proved and amounts to the statutory ground of misconduct. It could properly conclude the misconduct was an isolated incident and that the chance of repetition in the future was remote. The Panel also noted the guidance in the case of Cohen v General Medical Council [2008] EWHC 581 (Admin) that it must be highly relevant when determining impairment that the conduct leading to the allegation is remediable, has been remedied, and is highly unlikely to be repeated, as well as the “critically important public policy issues” identified in that case. In accordance with the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Paula Grant [2011] EWHC 927 the Panel considered not only whether a Registrant presents a risk to members of the public, but also whether the need to uphold proper professional standards, and whether public confidence in a Registrant and in the profession and its regulator, would be undermined if a finding of impairment of fitness to practise were not made in the circumstances of this case.

89. In determining whether the Registrants’ fitness to practise is currently impaired, the Panel took into account both the personal and public components. The personal component relates to a Registrant’s own practice as a Paramedic, including any evidence of remorse, insight and efforts towards remediation. The public component includes the need to protect the public, including work colleagues and patients, to declare and uphold proper standards of behaviour and maintain public confidence in the profession and the Regulator.

Decision on Impairment – Mr Gambles (2nd Registrant)
90. In addressing the personal component of impairment, the Panel asked itself whether Mr Gambles is liable, now and in the future, to repeat misconduct of the kind found proved. In reaching its decision, the Panel had particular regard to the issues of insight and remediation.

91. The Panel noted that Mr Gambles is a long serving Paramedic. Mr Gambles had not attended the hearing and he had not submitted any material for this Panel to consider. There was no evidence of any meaningful insight into the nature and gravity of the conduct. Although there was some recognition during the Trust’s investigation from Mr Gambles as to the steps he should have taken; for example, in respect of ensuring the PCR was accurate and complete, there was no information from Mr Gambles to explain any steps he has taken since the incident to remedy his misconduct. There was no evidence of any training or any other professional development undertaken by Mr Gambles.

92. The Panel had careful regard to Justice Silber’s guidance in Cohen v. GMC [2008] EWHC 581 (Admin) and concluded that although Mr Gambles’ misconduct was remediable, in the absence of information demonstrating steps taken to remedy the misconduct, the misconduct was highly likely to be repeated. Further, the Panel had no references or testimonials and no information that would enable it to conclude that Mr Gambles had learned from these events.

93. The Panel concluded that Mr Gambles had not developed insight and had not provided evidence of any remediation and there remained a risk that he would repeat matters of the kind found proved. For these reasons, the Panel determined that a finding of impairment was required on the personal component.
94. The Panel went on to consider the public component. In addressing this component of impairment, the Panel had careful regard to the critically important public interest issues identified by Justice Silber in the case of Cohen when he said: “Any approach to the issue of whether .... fitness to practise should be regarded as ‘impaired’ must take account of…the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour.”

95. The Panel considered that there had been a number of serious failings by Mr Gambles in relation to the management of Patient A. The Panel considered that the public would be very concerned to learn of Mr Gambles’ conduct in this matter. The Panel was of the view that public confidence in the profession and the regulatory process would be undermined if Mr Gambles was permitted to continue to hold unrestricted registration in circumstances where there was an appreciable risk of continuing patient harm and where distress had been caused to Patient A's family. Further, members of the public and the profession would be concerned that Mr Gambles had breached the standards set by the HCPC and national guidelines (JRCALC and RCUK). Therefore, the Panel concluded that it was otherwise in the public interest to make a finding of impaired fitness to practise.

96. For all the reasons set out above, the Panel determined that Mr Gambles’ fitness to practise is currently impaired on both the personal and public components.

Decision on Sanction
97. The Panel heard submissions from Mr Walker on behalf of the HCPC in respect of Mr Gambles. Mr Walker did not suggest a particular sanction but he referred the Panel to the guidance issued by the HCPC in its Sanctions Policy (‘SP’), and the principle of proportionality, as well as its own findings on impairment which underscored the seriousness of Mr Gambles’ misconduct. Mr Walker submitted that Mr Gambles has not displayed insight and remorse, despite having ample opportunity to address these concerns, and has made no attempt at remediation. Although there is no direct evidence that Patient A suffered actual harm, she was clearly placed at significant risk of harm by Mr Gambles’ misconduct. Mr Walker informed the Panel that Mr Gambles has no prior regulatory history and there was no interim order in place. In conclusion, Mr Walker reminded the Panel that in considering what sanction to impose, it will have regard to the purpose of sanction to protect the public, uphold confidence in the profession and enforce that standards should not be breached.

The Panel’s decision
98. The Panel accepted the advice of the Legal Assessor. In reaching its decision on sanction, the Panel took into account the submissions made by Mr Walker on behalf of the HCPC. There were no submissions by or on behalf of Mr Gambles. However, the Panel reconsidered all of the documentation in the bundle in order to ensure that anything relevant to sanction was fully taken into account.

99. The Panel also referred to the SP and held in mind that the purpose of sanctions was not to punish Mr Gambles, but to protect the public, maintain public confidence in the profession and to maintain proper standards of conduct and performance. The Panel was also aware of the need to ensure that any sanction is proportionate.

100. The Panel found the following aggravating factors:
• These were serious departures from the standards expected of a Registered Paramedic;
• Mr Gambles has displayed no insight into the potential significant risk of his conduct on Patient A and no remorse;
• There was no recognition from Mr Gambles of the impact his conduct had on public confidence in the profession and the associated risks for patients;
• There was no evidence of attempted remediation.
101. The Panel found the following mitigating factors:
• Prior to this matter Mr Gambles had no previous disciplinary history with the HCPC;
• Mr Gambles has been a long serving Paramedic;
• Mr Gambles’ misconduct was in relation to a single patient.

102. The Panel concluded it could give limited weight to the mitigating factors and was mindful that mitigation is of considerably less significance in regulatory proceedings where protection of the public is the overarching consideration. The Panel concluded that the gravity of the aggravating factors in this case far outweighed the mitigating factors.

103. The Panel considered the sanctions in ascending level of severity in order to ensure that its approach was proportionate.

104. The Panel decided that neither mediation nor taking no action would be appropriate. The Panel decided that due to the gravity of its findings in this case a sanction was necessary.

105. The Panel considered the factors in the SP in relation to a Caution Order. It concluded that the issues in this case were not minor in nature. Although the events occurred in relation to a single patient, the misconduct involved several omissions that fell significantly below the standards expected of a Paramedic. There was no insight and the Panel had concluded that there remained a risk of repetition and a risk of harm to service users. Therefore, a Caution Order was not sufficient or appropriate in the circumstances.

106. The Panel next considered a Conditions of Practice Order. The Panel noted that in the determination of the Preliminary Hearing held on 10 January 2024, Mr Gambles had suggested in written comments to that panel he did not wish to continue to be registered with the HCPC and had decided not to return to a role as a paramedic. In view of this and given that Mr Gambles has not engaged with this process, the Panel does not have the required confidence in his willingness to comply with conditions of practice. Further the Panel, having regard to paragraph 109 of the SP, was not satisfied that Mr Gambles’ misconduct was minor and unlikely to be repeated. These factors indicated that a Conditions of Practice Order was not appropriate in this case.

107. The Panel carefully considered whether an order of suspension would be sufficient to protect the public and address the public interest concerns in this case.

108. The Panel referred to paragraph 121 of the SP. The concerns represent serious breaches of the HCPC’s Standards of Conduct, Performance and Ethics (2016). The Panel has found that Mr Gambles has demonstrated no insight, there was no remorse, and there was a risk of repetition. There was no evidence that Mr Gambles had attempted to remedy the misconduct and was unlikely to be able to resolve or remedy the misconduct going forward. The Panel had regard to all the aggravating factors and concluded that, in the circumstances of this case, a Suspension Order would not be sufficient to protect the public and wider public interest.

109. The Panel concluded that the only appropriate and proportionate sanction in this case was a Striking Off Order. The Panel had regard to paragraph 131 of the SP. Mr Gambles has demonstrated no insight into his conduct for these proceedings. The Panel had regard to the evidence of Mr Green who stated that during the Trust’s investigation, Mr Gambles “showed very little insight into his responsibility on 23 December. He seemed to rely on the fact that Registrant 1 and Colleague C had arrived on the scene earlier than him which resulted in them essentially leading on providing the care and treatment to the patient and him undertaking basic life support”. Mr Gambles’ lack of insight and remediation has therefore continued since the incident with Patient A in 2020 which, in the Panel’s view, provided a considerable and sufficient time period for a Registrant to not only engage with their regulator but to demonstrate insight and provide evidence of their attempts in remedying the misconduct. There was no evidence before the Panel to suggest that Mr Gambles was likely to be willing or able to resolve or remedy the misconduct going forward. He had suggested to the Preliminary Hearing Panel that he did not wish to continue in his role of a Paramedic.

110. The Panel bore in mind the requirement that the sanction it imposes must be proportionate. The Panel was provided with no information about Mr Gambles’ interests, but it acknowledged that a Striking Off Order is likely to have a negative impact on him. However, the Panel concluded that in the circumstances any lesser sanction would be insufficient to uphold and maintain public confidence in the Paramedic profession and the regulatory process. The Panel therefore decided that the public interest outweighed Mr Gambles’ interests.

111. The Panel concluded that the appropriate and proportionate order was a Striking Off Order.

That the Registrar is directed to strike the name of Mr Andrew Gambles from the Register on 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
Application to proceed in Mr Gambles’ absence
1. Mr Walker informed the Panel that he intended to make an application for an Interim Order to cover the appeal period, however he was required to first make an application to proceed in Mr Gambles’ absence.

2. Mr Walker invited the Panel to proceed in the absence of Mr Gambles, submitting that the Panel had already made a decision to proceed in Mr Gambles’ absence at the start of the hearing and would have considered the relevant factors at that time. He referred the Panel to the Notice of Hearing issued to Mr Gambles, which clearly indicated that an application for an Interim Order might be made, thereby placing Mr Gambles on notice and affording him the opportunity to consider and respond to such a scenario and adequate opportunity to engage with the process.

Panel’s decision on proceeding in absence
3. The Panel accepted the Legal Assessor’s advice and had due regard to the Practice Note entitled ‘Proceeding in the Absence of the Registrant’.

4. Having carefully considered the matter, the Panel concluded, as it did at the start of the hearing that Mr Gambles had voluntarily waived his right to attend the hearing and there was no reason to suppose that adjourning the hearing would secure Mr Gambles’ attendance at a later date to attend the hearing or be represented. It was in the public interest to deal with the matter of an Interim Order as expeditiously as possible, given the Panel’s findings. The Panel determined that in all the circumstances, it was fair to proceed in Mr Gambles’ absence.

Application for Interim Order
5. The Panel heard an application from Mr Walker for an 18 month Interim Suspension Order to cover the appeal period. He submitted that such an order is necessary for the protection of the public and is in the public interest.

6. The Panel considered the HCPTS Practice Note entitled ‘Interim Orders’ as well as Paragraphs 133-135 of the Sanctions Policy. The Panel accepted the advice of the Legal Assessor.

7. The Panel took into account its previous findings, and adopting its reasons, the Panel came to the conclusion that an interim order is necessary for the protection of the public and is in the wider public interest in order to maintain public confidence in the profession and to uphold proper standards. The high threshold for such an interim order was met on the basis of Mr Gambles’ conduct having fallen significantly far below the required national and local standards for Paramedics and the serious breaches of the HCPC Standards of Conduct, Ethics and Performance (2016) which had the potential to place Patient A at significant risk of harm. The Panel also took into account the aggravating features referred to in its decision on sanction. In the circumstances, there remained a risk of repetition towards service users and therefore a risk to public protection. Public confidence in the profession and the regulatory process would be seriously harmed if Mr Gambles was not made subject to an interim order during the appeal period.

8. The Panel was mindful of its decision at the sanction stage that Conditions were not appropriate. The Panel considered that not to impose an Interim Suspension Order would be inconsistent with its finding that a substantive sanction of Striking Off is required.

9. The Panel recognised that the Panel must take into consideration the impact of such an interim order on Mr Gambles as part of the principle of proportionality and must balance the impact on Mr Gambles with the need to uphold the public interest. The Panel considered those matters; in the circumstances of the case, the Panel was satisfied that the need to uphold the public interest outweighed Mr Gambles’ interests in this regard.

10. The Panel decided to impose an Interim Suspension Order for a period of 18 months, a duration which is appropriate and proportionate in light of the Panel’s previous decisions, in order to allow any appeal which Mr Gambles may bring, to be concluded.

11. The Panel makes an Interim Suspension Order under Article 31(2) of the Health and Social Work Professions Order 2001, the same being 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 Andrew Gambles