Service of Notice
1. The notice of today’s hearing was sent to the Registrant at his address as it appeared in the register on 20 October 2015. The notice contained the date, time and venue of today’s hearing; although the venue was later changed, but the Panel was satisfied that the Registrant would have been redirected to the correct HCPC venue which was very close by.
2. The Panel accepted the advice of the Legal Assessor. The Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”) require that a notice of hearing must contain the above information and be sent to the Registrant at his registered address not less than 28 days before the date of the hearing.
3. Accordingly the Panel is satisfied that notice of today’s hearing has been served in accordance with the Rules.
Proceeding in the absence of the Registrant
4. The Panel then went on to consider whether to proceed in the absence of the Registrant. In doing so, it considered the submission of Ms Johnson on behalf of the HCPC.
5. Ms Johnson submitted that the HCPC has taken all reasonable steps to serve the notice on the Registrant. She further submitted that the Registrant has engaged with the process and is aware of today’s proceedings. She drew the Panel ’s attention to the case management form, signed by the Registrant on 30 September 2015 and returned wherein he indicated that he did not intend to attend today’s hearing. Ms Johnson informed the Panel that the Registrant did engage with the process by attending a medical examination on 14 January 2015 when requested to do so by the HCPC, but that there has been no response since December 2015. Ms Johnson submitted in the circumstances, that the Panel can be satisfied that the Registrant’s absence today is voluntary and that he has waived his right to attend and/or to be represented. An adjournment would serve no useful purpose and there was a public interest in this matter being dealt with expeditiously and for this matter not to be further delayed.
6. The Panel accepted the advice of the Legal Assessor. He advised that if the Panel is satisfied that all reasonable efforts have been made to notify the Registrant of the hearing then the Panel has the discretion to proceed in the absence of the Registrant. He reminded the Panel that it should exercise that discretion with the utmost care and caution. He drew the Panel’s attention to the principles to be considered when exercising the discretion to proceed in the absence of the Registrant as outlined in the case of R v Jones  UKHL 5. He further advised that the Panel must consider the nature and circumstances of the Registrant absenting himself, in particular whether the decision was voluntary and if so, whether the he has waived his right to be present and/or represented; and the general public interest that this matter is dealt with expeditiously.
7. The Panel was satisfied that all reasonable efforts had been made by the HCPC to notify the Registrant of today’s hearing. It is also satisfied that the Registrant is aware of today’s hearing.
8. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPC practice note entitled ‘Proceeding in the Absence of a Registrant’. The Panel weighed its responsibilities for public protection and the expeditious disposal of the case with the Registrant’s right to a fair hearing.
9. In reaching its decision the Panel took into account the following:
• The Registrant has not made an application to adjourn today’s hearing;
• The Registrant has engaged with the process, attended a medical assessment in January 2015, returned the case management form on 30 December 2015 wherein he indicated that he would not be attending today’s hearing, nor would he be represented and that he did not intend to call any witnesses on his behalf;
• The HCPC has its witnesses in attendance, one of whom is an expert witness;
• There is a public interest that this matter is dealt with expeditiously.
10. The Panel was satisfied that the Registrant had voluntarily absented himself from the hearing and has waived his right to be represented. It determined that it was unlikely that an adjournment would result in his attendance at a later date. The Panel did not draw any adverse inference from his non-attendance. It determined that there would be no injustice to the Registrant with proceeding in his absence. Having weighed the public interest in the expeditious disposal of this case with the Registrant’s own interest, the Panel decided to proceed in the Registrant’s absence.
Application for proceedings to be heard in private
11. Ms Johnson made an application for today’s hearing to be held in private. She submitted that as this is a hearing which has been convened regarding the Registrant’s health, it is will be considering personal details of the Registrant’s health condition.
12. Ms Johnson submitted that the hearing should be in private in order to protect those details, and that it would not offend the principles of “open justice”.
13. The Panel accepted the advice of the Legal Assessor. The Panel determined that given the health issues present in this case and the detail in which the hearing will be required to enquire into the health issues, it was appropriate to hear the entire hearing in private.
14. The Registrant commenced employment with East England Ambulance Service NHS Trust (the Trust) on 25 June 1979.
15. The Registrant held the position of Emergency Care Practitioner (ECP) and was responsible for working as a single responder on a Rapid Response Vehicle (RRV). He worked 12 hour shifts, either during the day or at night. The Registrant was responsible for responding to all types of emergency 999 calls as well as routine non-life threatening calls.
16. The Registrant took a period of sick leave of 30 days in December 2010 and on return his GP noted that the Registrant was fit for sedentary duty only and was unfit for driving duties.
17. The Registrant was later cleared for full duties in February 2011. Unfortunately, during the year, the Registrant suffered other symptoms which required him to take further periods of leave.
18. Following a formal sickness review in August 2011 the Registrant was cleared for all duties as a paramedic and returned to work as of 12 September 2011.
19. On 15 October 2012, the Registrant reported sick for work and has not returned to active duty as a paramedic within the Trust since.
20. Over the period 2010-2013 there were several extended periods of sickness absence. There were several GP notes produced and the Registrant had also attended other departments for examination and diagnosis. The symptoms continued and the Trust held a Trust Capability Hearing on 10 June 2013.
21. The Panel heard from the following witnesses:
a) Witness 1 who was the Duty Operational Manager for the Trust and had been the line manager for the Registrant.
b) Witness 3 is the expert witness who examined the Registrant on 14 January 2015 and produced a medical report regarding the Registrant’s health condition.
22. The Panel found Witness 1 to be credible. He gave evidence as to the Registrant’s employment history and of the change in circumstances of the Registrant from 2010 up until the time of the Trust Capability Hearing that was held on 10 June 2013.
23. Witness 1 told the Panel that there were no issues with the Registrant’s clinical capabilities and that the Registrant was an “excellent clinician”. He told the Panel that efforts had been made to try and retain the Registrant’s clinical skills but there were no viable options open at the time, and it was a “loss” to the profession.
24. The Panel found Witness 3 to be credible.
25. Witness 3 told the Panel that he had examined the Registrant at the request of the HCPC in January 2015 and had prepared his report which is before the Panel today.
Decision on facts and grounds
26. In reaching its decision on the facts, the Panel took into consideration all the oral and documentary evidence before it. The Panel heard the submissions of Ms Johnson on behalf of the HCPC. She further submitted that Witness 3, who was an ENT Consultant Surgeon, gave his expert opinion regarding the Registrant’s health condition.
27. The Panel accepted the advice of the Legal Assessor. He reminded the Panel that the burden of proving the fact was on the HCPC and the standard of proof was the balance of probabilities. He advised that in assessing the cogency of the expert witness’ opinion, they were to take into consideration the expert’s experience in this field and the fact that he personally examined and conducted tests on the Registrant.
28. The Panel determined that the Registrant suffers from a health condition on the balance of probabilities.
Decision on Impairment
29. Ms Johnson submitted that the evidence points to the Registrant’s fitness to practise is impaired on the basis of the debilitating nature of the Registrant’s health condition.
30. The Panel accepted the advice of the Legal Assessor. He advised the Panel that whether the Registrant’s fitness to practise was impaired was a matter for the Panel exercising its professional judgement.
31. The Legal Assessor advised the Panel that impairment meant current impairment and that whilst it was a forward looking exercise, the Panel was entitled to take into consideration past events and the effect the Registrant’s health condition had on his ability to function as a Paramedic. He also advised the Panel that it should take into consideration the nature of the role of a Paramedic and the circumstances a Paramedic would be expected to operate in.
32. The Panel took into consideration the following:
a) The expert witness’ testimony and other evidence before that Panel, that the Registrant’s health condition meant that he could not function as a Paramedic with patient-facing duties or driving under emergency conditions;
b) The nature and function of the role of a Paramedic;
c) There was no current or new information about the Registrant’s health condition since January 2015.
33. The Panel determined that the nature and role of a Paramedic having clinical decision-making and clinical care responsibilities as well as driving under emergency conditions would mean that anything other than a minimal risk of relapse would render the Registrant’s fitness to practise impaired. A relapse in the above circumstances would have serious consequences for both members of the public and also for the Registrant himself.
34. In light of the fact that there has been no new information about the Registrant’s health condition since January 2015 as to whether there has been any change, the Panel cannot be satisfied the risk has been minimised. The Panel therefore determined that the Registrant’s fitness to practise is currently impaired by reason of his health condition and also by reason of the public interest.
Decision on Sanction:
35. After announcing the decision that the fitness to practise of the Registrant is impaired by reason of his health condition the Panel heard submissions on sanction. On behalf of the HCPC Ms Johnson reminded the Panel of the proper approach to the imposition of a sanction and urged the Panel to have regard to the HCPC’s Indicative Sanctions Policy. Ms Johnson did not, however, urge the Panel to impose any particular sanction.
36. The Panel accepted the advice of the Legal Assessor who reminded the Panel to bear in mind the twin principles of fairness and proportionality along with its duty to protect the public and the public interest. The Legal Assessor also reminded them to have regard to the Indicative Sanctions Policy issued by the HCPC.
37. The Legal Assessor reminded the Panel that the purpose of imposing a sanction is not to punish. Rather, a sanction is only to be imposed to the extent that it is required to protect the public and to provide a proper degree of confidence in the registered profession and the regulatory process. The Panel has to consider the available sanctions in an ascending order of seriousness until a sanction that meets the needs of public protection is reached. The Legal Assessor reminded the Panel that as this case is a Health Case, the ultimate sanction of a striking-off order is not available.
38. The Panel decided that to take no action or mediation was not appropriate bearing in mind the Panels’ concerns as outlined in its decision on impairment.
39. A caution is not appropriate because it would not address the risk to the public or the public interest.
40. The Panel next considered whether a conditions of practice order is appropriate in this case. The Panel determined that conditions of practice could be imposed which would be sufficient, appropriate and workable and would protect the public and the public interest.
41. The Panel considered a suspension order would be disproportionate bearing in mind evidence heard that the Registrant was an “excellent clinician” and could still work as a non-patient facing paramedic. The Panel considered his knowledge and experience could still be applied to the benefit of the service and the public.
42. The Panel determined that the appropriate and proportionate duration of the Conditions of Practice order is 12 months. This will allow for a significant period of time to demonstrate that he has not suffered a relapse.
43. This order will be reviewed before it expires and the reviewing Panel on the next occasion may be assisted by the attendance of the Registrant in person with ‘up to date’ medical evidence or information on his health condition and information as to current relevant activities.
Order: The Registrar is directed to impose conditions of practice upon the registration of Mr David S Mee, for a period of 12 months from the date this Order comes into effect.
Terms of the Conditions of Practice Order:
1. You must not undertake any patient facing work in your role as a paramedic.
2. You must not drive any vehicle which has the capability to respond to an emergency.
3. You must register with and remain under the care of a general practitioner or other relevant health specialist and inform him or her that you are subject to these conditions.
4. You must inform your general practitioner or other relevant health specialist about these conditions of practice and authorise that person to provide the HCPC with information about your health and any treatment you are receiving.
5. You must keep your professional commitments under review and limit your professional practice in accordance with the advice of your general practitioner or other relevant health specialist.
6. You must cease practising immediately if you are advised to do so by your general practitioner or other relevant health specialist.
7. You must promptly inform the HCPC if you take up employment as a paramedic.
8. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
9. You must inform the following parties that your registration is subject to these conditions:
a) any organisation or person employing or contracting with you to undertake paramedic work
b) any agency you are registered with or apply to be registered as a paramedic with (at the time of application)
c) any prospective employer seeking to employ you as a paramedic ( at the time of application)
The Order will be reviewed before its expiry on 08 March 2017.
This was a Health Committee hearing that took place at the HCPC between 08 - 09 February 2016.