Mr Stephen E Meyern

: Paramedic

: PA02239

: Review Hearing

Date and Time of hearing:10:00 09/03/2017 End: 12:30 09/03/2017

: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Conditions of Practice

Allegation

As found at the Final Hearing:

During the course of your employment as a Paramedic with East of England Ambulance Service NHS Trust,

1)     On 8 September 2013, you were sent to attend an emergency call for a patient who was described as 'fitting', and:-

 

a)     You did not take a defibrillator into the emergency scene to assist you in your treatment of the patient.

 

b)    You did not take a bag valve mask (BVM) into the emergency scene which caused a delay in providing assisted ventilation to the patient.

 

c)     You instructed an Emergency Care Assistant (ECA) to act outside of the Trust's protocol and/or gave incorrect instructions in that:

 

i)      You directed an ECA to draw up diazepam which is a controlled drug.

ii)     You directed an ECA to draw up diazepam with a saline solution.

iii)    You directed an ECA to administer diazepam intravenously.

iv)    You directed an ECA to prepare adrenaline.

v)     You directed an ECA to administer adrenaline intravenously.

 

d)    Not proved

 

e)     You did not provide an appropriate Patient Care record in that you recorded inadequate details of the drugs given.

 

2)     The matters set out in paragraph 1 constitute misconduct and/or lack of competence.

 

3)     By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding


Preliminary matters

Hearing in private

1. The Panel received an application for a portion of the hearing to be heard in private as there were issues relating to health that were to be explored. The Panel took advice and agreed that given the nature of the questioning it would hear this discrete portion of the Registrant’s evidence in private.
Background (as recorded at the final hearing in March 2016)

2. The Registrant was a Duty Locality Officer (DLO) with East of England Ambulance Service (EEAST). He was responsible for the management of emergency care practitioners, paramedics, ambulance technicians and emergency care assistants (ECA).  

3. On 8 September 2013, the Trust received an emergency call in relation to a patient who was described as “fitting”. That evening the Registrant was working in a rapid response vehicle (RRV). He was dispatched to the scene and was advised by the emergency responder that the patient had been “fitting” for approximately 20 minutes. The call was categorised as ‘R1’ (life threatening). 

4. The Registrant was the first to arrive at the scene. Upon his arrival he selected equipment from the boot of his vehicle and took it to the location of the patient.  However, he was unable to take a defibrillator with him as he had too many other items of equipment to carry.  The Registrant was let into the patient’s house by the patient’s wife and shown upstairs to a bedroom where the patient was in bed.  An ambulance crew followed, consisting of Witness 1, ECA, and SK, ECA.  

5. The Registrant provided clinical care to the patient with the assistance of both ECAs as follows.  The Registrant cannulated the patient and asked Witness 1 to draw up a vial of diazemuls (diazepam) with a saline flush, which was the wrong solution.  The preparation of such medication was outside the scope of her practice.  Nonetheless, Witness 1 prepared the vials as requested and showed them to the Registrant.  He asked her to put the solution through the cannula.  Thereafter the Registrant and SK prepared to take the patient to the ambulance.  Witness 1 then overheard SK tell the Registrant that the patient was “rasping at 8”, which is a low level of breathing.  The Registrant advised SK that the patient’s breathing would return back to normal.    

6. The patient then suffered respiratory arrest.  Witness 1 heard the Registrant and SK discussing that the patient was not breathing. It was realised that the Registrant had not brought a BVM into the property, and therefore SK had to make a trip to the ambulance to obtain one, after which it was used on the patient. Soon after, the patient suffered cardiac arrest and there was a need for a defibrillator but the Registrant had not brought one to the scene.  SK then went to the ambulance a second time to retrieve it.   

7. The patient was moved from his bed to the floor. The Registrant asked Witness 1 to prepare adrenaline, which was also outside the scope of her practice.  However, she did prepare the adrenaline and then the Registrant asked her to administer it through the cannula, which she did.

8. When the patient began to improve, he was placed on a carry sheet in order to move him downstairs and into the ambulance. SK began packing up the equipment that had been used and whilst he did so the Registrant and Witness 1 moved the patient from his bedroom and down the stairs.  The Registrant led and went backwards down the stairs with the patient’s head facing towards him and pointing down the stairs.  Although Witness 1 considered that the patient’s positioning could compromise his airway she did not have time to suggest this to the Registrant as they were moving so quickly (the journey taking in all some 30 seconds).  At the bottom of the stairs the patient was transferred to a stretcher located at the front doorway and thence to the ambulance.

9. The patient was taken to hospital in the ambulance by the Registrant and by Witness 1, with SK following in the RRV.  The Registrant therefore delegated the task of asking the patient’s wife for relevant details and completing the Patient Care Record (PCR) to SK, who was able to partly complete it, but who omitted the doses of drugs given as he was unaware of these. Upon arrival the Registrant handed over verbally to the hospital staff but, although he was given the partially completed PCR by SK did not then complete it as he was called to another job.  The evidence from Witness 2, the Trust Investigating Officer, was that the Registrant would have been expected to complete and handover the paperwork to the hospital before accepting another call out. Witness 1 saw that the PCR had been left in the resuscitation cubicle.  One of the doctors started asking her questions about the patient which she could not answer as the information requested was not on the PCR.  SK attempted to complete the form later but was unable to.  The Registrant returned to the hospital about 1½ hours later but although he took the PCR from SK and signed it off the Registrant also did not complete the same with full and adequate details of the medication that had been given to the patient or the amounts thereof.       

10. The next day Witness 1 raised concerns regarding the clinical care provided to the patient (who had nonetheless survived the experience) by the Registrant. A Serious Investigation was initiated, the outcome of which was to initiate a disciplinary process. During the period of the disciplinary process the Registrant was suspended from front-line duties and given office-based work, although for about six months of this period he was on sick leave.  

11. On 31 October 2013 Witness 2 was commissioned as the investigating officer. His investigation concluded in April 2014. A disciplinary hearing was held on 7 May 2014 at which a number of the allegations against the Registrant were found proved and he was given a Final Written Warning and was also required to undertake an Action Plan, such to cover: clinical knowledge in relation to drug pharmacology; the “fitting” patient and the effects of hypoxia (lack of oxygen); observation of a variety of patients and clinical practice; and reading about the scope of practice for staff.

12. The Registrant appealed against that decision but the decision was upheld at an appeal hearing on 13 January 2015.

13. These events were then the subject of a referral to the HCPC and after investigation the Registrant faced the following Allegation (as amended and found proved at the Final Hearing):

14. At the Final Hearing the Registrant admitted the factual basis of the matters found proven and set out above.

15. The Final Hearing Panel considered that the matters found proven were serious and individually and collectively established the ground of misconduct. The Panel noted in particular that the Registrant’s failings were examples of conduct that had fallen far below the standards expected of a registered paramedic. That Panel noted that allowing an ECA to work outside her scope of practice and carry out tasks, such as the administration of controlled drugs under supervision, was in breach of the Trust’s Policy and is the sort of risk which the restriction on ECAs’ scope of practice is intended to avoid. The Panel also noted how vitally important it was to maintain good records of medications given as this information was relied on to inform practitioners’ choices about further subsequent treatment.

16. The Final Hearing Panel at the impairment stage took into account the Registrant’s length of career and the testimonials he had produced. The Final Hearing Panel however noted the variety and nature of the Registrant’s failings and that there had been a disregard of his duties towards not only his patient but also his colleagues. That Panel concluded that the Registrant’s fitness to practise was impaired on the both the public and personal components.

17. At the sanction stage the Final Hearing Panel took into account all mitigating and aggravating factors together with the personal and health issues which the Registrant had placed before the Panel. That Panel concluded that a Conditions of Practice Order was appropriate and proportionate in all the circumstances of the case.

18. The terms of the conditions being reviewed at this hearing are:
1. You must promptly inform the HCPC if you take up any employment as a paramedic and must promptly inform the HCPC if you cease to be so employed.
2. You must promptly inform the HCPC of any disciplinary proceedings taken against you by any such employer.
3. 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 professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).
4. You must place yourself and remain under the supervision of a workplace supervisor or paramedic mentor of at least five years qualification as a paramedic and who is regulated by the HCPC and supply details of your supervisor to the HCPC within seven days of his or her appointment. You must attend upon that supervisor as required and follow their advice and recommendations.
5.  Before undertaking autonomous work as a paramedic you must (1) satisfactorily complete a period of supervised practice as a paramedic, such to constitute at least 10 shifts of supervised call-out duty and (2) forward a copy of your supervisor or paramedic mentor’s report on those shifts to the HCPC.    
6.  Once you have completed 10 shifts of supervised call-out duty as a paramedic, if your supervisor or paramedic mentor certifies in writing to both yourself and to the HCPC, that you are safe and competent to undertake autonomous practice as a paramedic then you will be allowed to undertake such autonomous practice and conditions 4 and 5 will cease to have effect. 
7. You must, within 28 days of the operative date of this order, forward to the HCPC a copy of the reflective essay which you prepared in response to EEAST’s Action Plan and to which you referred in evidence.
Evidence and Submissions from the Registrant and the HCPC

19. Prior to today’s hearing the Registrant sent to the HCPC a paper he had drafted  in November 2014 on ‘The effective management of a patient in status epilepticus with combined effects of hypoxia and benzodiazepine administration’ as required by the terms of his Conditions of Practice Order.

20. The Registrant gave testimony and told the Panel that he had retired just prior to November 2015, four months prior to the Final Hearing. He stated he had completed full pensionable service at the age of 60, and was now nearly 62 years old. At the time of retirement he hoped to continue as a Paramedic Bank Worker and be able to use his experience and skills for many more years.

21. Following the substantive hearing the Registrant returned to the East of England Ambulance Service and requested ten ‘ride outs’ as a bank worker so that he could comply with the Conditions. At that time the ambulance service stated that as it was no longer his employer, its responsibilities to him had come to an end.  An Action Plan had been put in place before his retirement for him to undertake three ‘ride outs’ but these had never taken place.  The Registrant stated he had contacted private ambulance services, but they stated that they did not have another Paramedic available to be able to provide him with ten ‘ride outs’ over a short period due to the erratic pattern of their work. The Registrant had offered to undertake the private ambulance service ‘ride outs’ without payment, however this was not possible either as the Registrant stated he was told that he needed to be an employee in order to comply with their insurance requirements. The Registrant had also explored an offer to work for a Doctors’ surgery, which was available at the time of the Final Hearing. That position was still available but it would not be a position where any other Paramedics would be present.  Therefore supervision would have to be undertaken by the doctors and nurses at the surgery, which he told the Panel they were content to offer.

22. The Registrant has been offered work at a motorsport race track providing ambulance services but this would not be in the role of a Paramedic.  It would however be working with another Paramedic when available, who could supervise his work. This position was unlikely to provide a “ride out” opportunity on any regular basis and so it would be difficult to achieve the required ten shifts.

23. In relation to continuing professional knowledge, the Registrant had identified an online course that would provide him with CPD in exchange for a subscription fee. The Registrant stated he had hoped to receive his CPD through continued work within employment with an ambulance service. He confirmed he had not undertaken any CPD in the last 12 months but was willing to enrol with an online service.

24. The Registrant stated that he wished to remain in practice and is happy to do anything to achieve this. He emphasised that the incident in 2014 was the first and only incident in a long career and was a lapse which he regretted and would not be repeated.

25. The Registrant maintained that the possibility of being able to comply with the Conditions as currently drawn is impossible. The Registrant confirmed that he had not brought with him today any evidence of the terms of the two positions that were available to him, namely the motorsport race track and the Doctors’ surgery.


26. It was submitted by the Registrant’s representative that it would be something of a tragedy if his career came to an end in this way when he still had so much to offer. It was argued that it was in the public interest that such an experienced practitioner was retained to give further public service. There was therefore a request that the terms of the Conditions of Practice Order, particularly Conditions 4, 5 and 6 be varied to achieve this objective.

27. Ms Hamilton, on behalf of the HCPC, highlighted the fact that there was a likelihood of repetition and his conduct had fallen far short of that expected.

28. The HCPC acknowledged that the Registrant has engaged with the HCPC disciplinary and regulatory process. The HCPC confirmed that the Conditions had been complied with in respect of Condition 7. In relation to Conditions 4, 5 and 6 the Registrant has not been in practice therefore these remain outstanding. In relation to the issue of a variation of the Conditions, as sought by the Registrant, the HCPC accepted that this may be achieved, but maintained that the prime consideration today was the protection of the public and it was, of course, a matter for the Panel’s judgment.
Decision

29. In undertaking its task today, the Panel is conducting a comprehensive appraisal of the Registrant’s current abilities with a view to establishing whether he is now fit to return to unrestricted practice.  The Panel is not undertaking the task of rehearing the matters that had been brought against the Registrant nor going behind the previous Panel’s findings or decisions. 

30. This Panel has considered all documentation placed before it and has heard and given appropriate weight to the fresh evidence of compliance with the Conditions supplied by the Registrant.  It has heard the Registrant’s testimony and the parties’ submissions; taken and accepted the advice of the Legal Assessor and it has reminded itself of the terms of the HCPC’s Practice Notes.

31. The Panel noted that during the last twelve months the Registrant had not taken any steps to maintain and update his knowledge and as he has been out of practice he has not been able to maintain his skills. His lack of remediation by not complying with the Conditions means that the Registrant remains a risk to the public and his Fitness to Practise remains impaired.  Indeed neither party submitted otherwise. The Panel decided that there had been insufficient compliance with the terms of the Conditions of Practice Order such that it was not able to allow the current order to lapse.  Some form of sanction is still therefore required.

32. In reaching its decision as to what further sanction should be placed on the Registrant the Panel has considered and balanced the interests of the Registrant, service users and the wider public interest. In applying the principle of proportionality, the Panel has imposed the minimum level of restriction that will still maintain service user safety and public confidence in the profession.

33. Taking no further action and the offer of mediation remain inappropriate. The Panel did not consider that a Caution Order would offer sufficient service user protection as it would allow the Registrant to practise unsupervised without undertaking any further steps of remediation.

34. The Panel considered whether a Conditions of Practice Order in terms different from those imposed by the Final Hearing Panel, remained the appropriate and proportionate measure.  In undertaking this task of formulating workable conditions the Panel noted from the evidence before it the following:
• The reflective piece of writing which the Registrant had prepared as part of his Action Plan for the Trust, and which had been submitted to the HCPC by the Registrant in compliance with the terms of Condition 7, concentrated on procedures and correct courses of action rather than provide a demonstration of an understanding of risk and appropriate assessment. This piece of writing did not demonstrate an understanding of why the Registrant’s actions had been at fault and, further, there was limited indication of how the Registrant himself would do things differently if faced with a similar situation.
• The Registrant has not provided the Panel with any supporting independent evidence of the extent and nature of the two roles the Registrant has identified as possible places for supervision, namely the Doctors’ surgery and the motorsport race track.
• The Registrant has stated that he has not sought any positions with any other NHS Ambulance Service.
• The Registrant has also not provided evidence of his seeking any honorary contract, such as one provided to students and professionals on placement.  These honorary positions benefit from insurance and supervision.
• The Registrant has not provided supporting documentation that he had contacted and been unsuccessful in securing work with ‘a dozen or so’ private ambulance services, to which he referred in his evidence.
• The Panel has serious concerns as to whether the employment position with the GP practice, as described by the Registrant, would expose the Registrant to the full range of work he would undertake as a Paramedic. Given that a GP practice does not usually deal with life threatening conditions, and if one arose the GP practice would summon an ambulance unit, it is likely that the Registrant would not be exposed to a rapid response situation such as the one which led to these proceedings. Further, there were concerns as to what degree a GP practice was going to be able to supervise and comment upon his Paramedic practice: it would only be able to verify that there had been no identifiable issues.
• The work at the motorsport race track would be limited to dealing with the immediate impact of an incident. It appeared that it would not involve the Registrant in the continuing care of the injured, who would be entrusted into the care of an attending ambulance crew, nor would he be responsible for the care of a wider range of individuals other than the participants in the sport. This role would therefore not offer the range of situations the Registrant would encounter within normal Paramedic duties.

35. The Panel concluded due to the above reasons that it was not appropriate to vary the Conditions, as requested by the Registrant, to allow the supervision by a Doctor or a Nurse.

36. The Panel has noted the difficulties that the Registrant has encountered in securing supervision having retired from front line duty and being the subject of Conditions which required 10 shifts to be supervised. The Panel has therefore decided that it will reduce the number of hours which the registrant is required to undertake when being supervised to a minimum of 50 hours.

37. The Panel, whilst reducing the number of hours which will be required to fulfil Condition 5, has considered the degree to which the Registrant has adequately demonstrated his insight into his actions. The Panel has decided that the Registrant should use these shifts totalling 50 hours to demonstrate, through a reflective piece of writing (using a recognised tool such as The Gibbs Cycle), the ways in which he has identified the risks and professional considerations which existed within a range of situations arising during his supervision and the ways in which his Paramedic practice was informed by his previous experience.

38. The Registrant has acknowledged that he has not kept his knowledge and skills up to date and so the Panel has considered how the Registrant could demonstrate to a future Panel that he has fulfilled the requirement to maintain his Continuing Professional Development. The Registrant must provide evidence to his supervisor that he has undertaken appropriate CPD to bring his CPD record up to date before he is allowed to practice alone as a Paramedic.

39. The Conditions set out below, will, in the Panel’s view, allow the Registrant the opportunity to demonstrate that he has understood and addressed his previous failings and will provide assurance to the wider public that there will not be any repetition of the Registrant’s previous misconduct.

Order

Order: The Registrar is directed to vary the Conditions of Practice Order against the registration of Mr Stephen Meyern for a further period of 12 months on the expiry of the existing order. The terms of the conditions are:

1. You must promptly inform the HCPC if you take up any employment as a Paramedic and must promptly inform the HCPC if you cease to be so employed.

2. You must promptly inform the HCPC of any disciplinary proceedings taken against you by any such employer.

3. 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 professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).

4. You must place yourself and remain under the supervision of a workplace supervisor or paramedic mentor of at least five years’ qualification as a paramedic and who is regulated by the HCPC and supply details of your supervisor to the HCPC within seven days of his or her appointment. You must attend upon that supervisor as required and follow their advice and recommendations.

5. You must undertake appropriate Continuing Professional Development during your supervised practice as identified in 4 above and you must provide evidence to your supervisor of such study which is to be approved and signed off by your supervisor as completed in accordance with the HCPC standards.

6. Before undertaking autonomous work as a paramedic you must:
  (1) satisfactorily complete a period of supervised practice as a paramedic, such to constitute 5 shifts consisting of at least a minimum total of 50 hours of supervised call-out duty and
  (2) forward a copy of your supervisor or paramedic mentor’s report on those shifts (to include confirmation of CPD undertaken and completed as set out in Condition 5 above) to the HCPC.    

7. Once you have completed the 5 shifts consisting of at least a minimum of 50 hours of supervised call-out duty as a Paramedic, if your supervisor or paramedic mentor certifies in writing to both yourself and to the HCPC, that you are safe and competent to undertake autonomous practice as a paramedic then you will be allowed to undertake such autonomous practice and Conditions 4, 5 and 6 will cease to have effect. 

8. You must provide a future reviewing Panel with:
  (1) A reflective essay in which you identify the professional considerations which existed within a range of situations which you attended during supervision. and explain how your practice was informed by your previous experience.
  (2) If there is difficulty in securing supervision, to provide the HCPC with evidence of the steps taken to attempt to secure employment and supervision in your role as paramedic.
  (3) Evidence of your ongoing CPD record.

The order imposed today will apply from 9 April 2017.

Notes

This is a Substantive Review hearing of the Conduct and Competence Committee convened to hear the case of Mr Stephen E Meyern at 405 Kennington Road, London on the 9 March 2017 at 10am.

Hearing history

History of Hearings for Mr Stephen E Meyern

Date Panel Hearing type Outcomes / Status
09/03/2018 Conduct and Competence Committee Review Hearing Conditions of Practice
09/03/2017 Conduct and Competence Committee Review Hearing Conditions of Practice
09/03/2016 Conduct and Competence Committee Final Hearing Conditions of Practice