Gary Warwick

Preliminary Matters

Proof of Service

1. The Panel was provided with a copy of the Notice of Hearing that had been sent to the Registrant by post and to his legal representatives by email on 27 March 2025, and a signed certificate confirming that it had been sent to the address shown for the Registrant on the HCPC Register. The Panel was satisfied that Notice had been properly served in accordance with the Rules and that the HCPC had taken all reasonable steps to bring notice of this hearing to the Registrant’s attention.

Proceeding in Absence

2. Having determined that service of the Notice of Hearing had been properly effected, the Panel went on to consider whether to proceed in the Registrant’s absence. The Panel was advised by the Legal Assessor and followed that advice. The Panel also considered the guidance as set out in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.

3. The Panel noted that the Registrant’s legal representative (Keystone Law) acknowledged receipt of the Notice of Hearing and, on 01 May 2025, sent an email which stated (amongst other things):

“Mr Warwick will not be attending the hearing and will not be represented. No discourtesy whatsoever is intended by this, and I should be grateful if this could be relayed to the Committee. However, as [sic] Mr Warwick is entirely supportive of the HCPC’s application for disposal by consent, and he is content for it to be dealt with in his absence.”

4. The Panel determined that it was reasonable and in the public interest to proceed in the Registrant’s absence for the following reasons:

• The Panel noted that the HCPC and the Registrant had reached agreement with regard to a consensual disposal and so, in effect, the hearing had been listed to consider the joint application. The email from the Registrant’s legal representative made it clear that he supported the HCPC’s written submission in its entirety. In these circumstances, the Panel was satisfied that it was fair and reasonable to conclude that the Registrant was content for the hearing to proceed in his absence. Therefore, the Panel concluded that the Registrant’s absence demonstrated a voluntary waiver of his right to be present.

• The Panel was satisfied that there would be no disadvantage to the Registrant given that the application was for disposal by consent.

Background

5. The Registrant is a registered Paramedic who was employed by Bristol Ambulance Emergency Medical Services (‘BAS’) at the relevant time. BAS provided South Western Ambulance Service NHS Foundation Trust (‘the Trust’) with assistance during periods of high demand.

6. The allegations relate to the care provided by the Registrant to two patients during emergency response calls on 12 June 2020 and 29 July 2020.

7. On 12 June 2020, the Registrant attended an emergency call out in relation to an 86-year-old male (Service User A) due to concerns that he was having difficulties breathing, was vomiting, and was hot to touch. The Registrant attended with an Emergency Care Assistant (‘ECA’), Witness A.

8. Following the completion of an assessment, the Registrant reportedly advised that Service User A should be admitted to hospital. However, the Registrant ultimately decided to discharge the patient into the care of nursing home staff following confirmation that the nursing home could not provide an escort to accompany Service User A to hospital. The nursing home staff agreed with the Registrant that they would call an out-of-hours GP.

9. Later that evening, a further 999 call was received which raised concerns that Service User A had deteriorated. A separate crew provided an emergency response. Service User A was subsequently conveyed to hospital under emergency conditions and died the following morning, with the cause of death being noted as aspiration Pneumonia.

10. On the same day, the Lead Clinician of the separate crew raised an incident report regarding the care provided by the Registrant and Witness A. A “Review, Learn, Improve” review (‘RLI’) was undertaken on behalf of the Trust, which identified the areas of concern which relate to Particular 1 (see below).

11. On 29 July 2020, the Registrant attended an emergency call out in relation to an 80-year-old male (Service User B) who had reportedly collapsed in the kitchen for no apparent reason and could no longer move his arms and legs. Following an assessment, the Registrant advised that Service User B required hospital admittance and transferred the patient to Royal Bournemouth Hospital Emergency Department.

12. Service User B was later identified to have sustained significant multiple neck fractures/obvious spinal haematoma and had been paralysed from the waist down. Service User B was transferred to Poole General Hospital for specialised ongoing care and treatment. Service User B was subsequently discharged from hospital and died on 17 November 2020.

13. An incident report was raised by the second ambulance crew who had conveyed Service User B to Poole General Hospital. They raised a number of concerns regarding clinical care and decision-making. A second incident report was raised later by Poole General Hospital for the same reasons. Again, an RLI review was undertaken by the Trust, which identified the areas of concern which relate to Particular 2 (see below).

14. The Registrant was dismissed from his role at BAS and self-referred to the HCPC on 25 January 2021.

15. On 28 October 2021, an Investigating Committee Panel (‘ICP’) considered the matter and found a case to answer.

16. On 23 April 2024, a Conduct and Competence Committee panel granted applications by the HCPC to admit the expert evidence of Dr Vince Clarke, to discontinue various parts of the Allegation, and to make amendments to the Allegation.

17. The Registrant has not been and is not currently subject to an interim order.

18. The updated Allegation was as follows:

As a registered Paramedic (PA38912) your fitness to practise is impaired by reason of misconduct. In that:

1. On 12 June 2020 when attending Service User A at Potteries Nursing Home, you did not provide adequate care, in that you:

a. did not transport Service User A to hospital when it was clinically indicated to do so.

b. did not administer low flow oxygen to Service User A when it was clinically indicated to do so.

c. did not record adequately or at all:

i. the worsening advice given to care home staff.

ii. Service User A’s capillary refill time.

iii. why clinical observations of Service User A were considered erroneous.

iv. the clinical justification for diagnosing that Service User A had an “impacted bowel”.

v. the clinical need for admitting Service User A to hospital.

d. diagnosed Service User A with “impacted bowel” without sufficient clinical evidence.

2. On 29 July 2020, whilst attending to Service User B at their home address, you did not provide adequate care in that you:

a. did not measure and/or record adequately or at all Service User B’s capillary refill time in the Patient Clinical Record.

b. did not re-assess Service User B’s core body temperature adequately or at all, when it was clinically indicated to do so.

c. did not administer low flow oxgyen when it was clinically indicated to do so.

d. did not fully immobilise Service User B, when it was clinically indicated to do so.

e. did not use head blocks when transporting Service User B on the scoop stretcher.

f. told Service User B’s daughter that Service User B had not sustained any spinal injuries.

g. did not record adequately or at all:

i. the method of extrication for Service User B, namely the use of a scoop stretcher.

ii. that manual immobilisation of Service User B took place.

iii. the reason for administering analgesia to Service User B.

h. In relation to Service User B’s pain, you did not record, adequately or at all:

i. a pain score.

ii. the nature of the pain.

iii. the exact location of pain.

iv. the duration of the pain.

v. Did not consider that Service User B had a potential spinal injury when it was clinically indicated to do so

i. administered analgesia to Service User B without clinical justification.

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

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

The Registrant’s Evidence

19. A consensual disposal was proposed by the Registrant’s legal representatives in a letter dated 13 March 2025. The letter confirmed that the Registrant admitted the substance and severity of the Allegation. A 12-month caution was initially proposed. However, a two-year caution was subsequently agreed.

20. The Registrant also provided:

• A copy of his CV detailing his employment history since 2008. This included working as an ECA from 2008-2015, as a frontline Paramedic from 2015-2020, and as a Paramedic in various ‘non-frontline’ roles from 2020 onwards.

• Written reflections which included his feelings, analysis, evaluation, conclusions, action plans, and learning points in relation to the incidents.

• A further written reflection in respect of the incident on 29 July 2020, written after attendance on the ‘Silver Trauma’ course. This reflection detailed what the Registrant learned from the course, its relevance to the incident, and explained how he would approach the situation differently in future.

• A document entitled ‘CPD log’ which set out the title and dates of Continuing Professional Development (‘CPD’) courses undertaken.

• Various CPD certificates, including the following courses which were relevant to the misconduct:

 “RCNI learning group - Maintaining best practice in record-keeping and documentation”

 “Document and Record Keeping – level 2 - Mandatory Training Group”

 “Identification And Initial Management Of Adults With Sepsis”

 “Defensible Decision Making And How To Do It”

 “Decision Making & Complex Incident Management”

 “How Should We Improve The Use And Communication Of Pre-Hospital Pre-Alerts?”

 “Managing Falls In 24 Hours Care Settings”

• Character references from a previous colleague and a previous line manager.

21. The Panel also received the Consent Order as agreed between the parties, for the Panel’s approval.

HCPC Submissions

22. Ms Mitchell, on behalf of the HCPC, relied on her written submissions and invited the Panel to conclude that this matter was suitable for disposal by way of caution order.

23. Ms Mitchell submitted that the proposed Consent Order would maintain public confidence in the profession and would not be detrimental to the wider public interest. It was submitted that the Registrant had engaged with the regulatory investigation, had admitted the substance of the Allegation, and accepted that his fitness to practise is impaired by reason of his misconduct. It was also submitted that the Registrant had undertaken significant remediation since 2020 and had demonstrated insight. He recognised the concerns raised, acknowledged the wrongdoing, and had apologised for his actions. He had also demonstrated an understanding of the impact of his actions on others and had expressed remorse and empathy towards the service users involved. It was submitted that the risk of repetition is low.

24. Ms Mitchell submitted that it would not be in the public interest to proceed to a full substantive hearing in respect of those matters disputed by the Registrant because the substance and severity of the Allegation against him was accepted. It was submitted that the case squarely met the criteria for a caution order and would be a proportionate outcome. It was stated that a 2-year period adequately reflected the seriousness of the Registrant’s misconduct and the necessity to maintain public confidence in the profession.

Decision

Panel’s Approach

25. Prior to reaching a decision on the proposed Consent Order, the Panel carefully considered all of the information and evidence within the hearing bundle, including:

• the Registrant’s self-referral;

• the HCPC’s written submissions; and

• the documents referred to in paragraph 20 above.

26. The Panel took into account the guidance contained within the HCPTS Practice Note “Disposal of Cases By Consent”, which states that a panel should not agree to resolve a case in this way unless it is satisfied of two things: firstly, that the appropriate level of public protection is being secured; and secondly, that doing so would not be detrimental to the wider public interest.

27. Annex A (“HCPC Policy on Consensual Disposal”) of the Practice Note states that the HCPC will consider disposing of a case by consent where (amongst other things):

“…the registrant is willing to admit both the substance of the allegation and that his or her fitness to practise is impaired ... [and] …any remedial action proposed by the registrant and to be embodied in the Consent Order is consistent with the expected outcome if the case was to proceed to a contested hearing.”

28. In assessing the appropriateness of the proposed Consent Order, the Panel carefully considered the balance between its duty to protect the public and the interests of the Registrant. The Panel also had regard to the HCPC Sanctions Policy, in particular paragraphs 101 and 102, which state:

“101. A caution order is likely to be an appropriate sanction for cases in which:

• the issue is isolated, limited, or relatively minor in nature;
• there is a low risk of repetition;
• the registrant has shown good insight; and
• the registrant has undertaken appropriate remediation.

102. A caution order should be considered in cases where the nature of the allegations mean that meaningful practice restrictions cannot be imposed, but a suspension of practice order would be disproportionate. In these cases, panels should provide a clear explanation of why it has chosen a non-restrictive sanction, even though the panel may have found there to be a risk of repetition (albeit low).”

29. The Panel noted that it could conclude the case on an expedited basis based on the terms of the draft Consent Order. Alternatively, the Panel could reject the proposal and set the case down for a full substantive hearing.

Panel’s Decision

30. The Panel was provided with a draft copy of the proposed Consent Order. The Panel noted that the substance of the Allegation had been admitted by the Registrant and it was satisfied that, based on the documentary evidence, the particulars of the Allegation were capable of being found proved on the balance of probabilities.

31. The Panel acknowledged that the Registrant’s written reflections demonstrated that he had given careful thought to the incidents relating to Service User A and Service User B. The Panel concluded that he fully recognised the serious nature of his admitted misconduct, had taken the opportunity to reflect on his past behaviour, and had taken steps to ensure that misconduct would not be repeated. In particular, the Panel identified the following mitigating factors:

• the Registrant’s misconduct occurred within the context of an otherwise unblemished career;

• the Registrant made admissions at an early stage;

• the Registrant had expressed genuine remorse;

• the Registrant had developed significant insight.

32. The Panel was mindful that the Registrant’s misconduct caused harm. However, the incidents occurred five years ago, and during the intervening period the Registrant had done all that could be reasonably asked of him in terms of remedial steps. He had reflected on his behaviour in a meaningful way and had demonstrated a willingness to continue to learn and develop. The Panel noted that further training was unlikely to serve a useful purpose given the level of remediation and training already undertaken by the Registrant, and therefore a Conditions of Practice Order was not necessary and, for the same reasons, a Suspension Order was likely to be punitive. The Panel accepted the submission made by the HCPC that the risk of repetition is low.

33. The Panel went on to consider the wider public interest and the need to uphold trust and confidence in the Paramedic profession. The Panel was satisfied that well-informed members of the public would not be concerned by the proposed outcome given that although the Registrant’s acts and omissions were serious, the incidents were isolated and he had taken significant steps to ensure that they are not repeated. Furthermore, the Panel determined that there is a legitimate public interest in avoiding a substantive hearing in circumstances where substantial admissions have been made to allegations which have the potential to undermine public confidence in the profession and where the Registrant has consented to being made subject to a Caution Order for a period of two years.

34. In all the circumstances, the Panel concluded that approval of the proposed Consent Order was both proportionate and appropriate. The Panel was satisfied that it would strike the appropriate balance between sending a message of deterrence to the Registrant and the wider profession, and also upholding trust and confidence in the profession and the regulatory process whilst not depriving the public of the service of an otherwise competent and committed Paramedic.

35. Therefore, the Panel approved the Consent Order.

That the Registrar is directed to annotate the Register entry of Gary Warwick with a Caution which is to remain on the Register for a period of 2 years from the date this Order comes into effect.

No notes available

History of Hearings for Gary Warwick