Jason M Garnham

: Paramedic

: PA12686

: Final Hearing

Date and Time of hearing:10:00 20/03/2017 End: 17:00 23/03/2017

: Jurys Inn Southampton, Charlotte Place, Southampton, SO14 0TB

: Conduct and Competence Committee
: Suspended

Allegation

Allegation (amended)
While working for The St John Ambulance & Rescue Service as a registered paramedic, on or around 9 July 2014, you:
1. Did not ensure Colleague 1 completed the following documents relevant to an aborted call from Patient A;
a) An Emergency Call Taking Form; and
b) A green Emergency Call Record

2. Did not listen to the recording of the 999 call

3. Instructed Colleague 1 to record the call from Patient A on the Control Log and take no further action

4. Did not follow up the aborted call from Patient A, in that you:
a) did not contact the Police and/or ensure that the Police were contacted; and/or
b) did not ensure that an ambulance was dispatched to Patient A's location

5. The matters set out in 1 – 4 above constitute misconduct and/or lack of competence

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

Finding

Preliminary matters
1. There were various preliminary and procedural matters that had to be dealt with by the Panel during the course of the hearing. On each occasion the Panel heard submissions from Mr Kewley, received advice from the Legal Assessor and considered the appropriate Practice Notes.

Service and proceeding in absence
2. The Panel was satisfied that the Registrant had been properly served with notice of the hearing.  The Notice of Hearing had been sent to his address on the register by letter dated 30 November 2016.  In addition, on 2 March 2017, the Registrant had returned the Response Pro Forma sent to him on 30 January 2017, which detailed the date of hearing, confirming that he was not intending to attend the hearing.

3. Mr Kewley therefore made an application for the Panel to proceed with the hearing in the Registrant’s absence. He submitted that the Registrant had voluntarily absented himself from the hearing and had made no application for an adjournment, it being clear that he knew how to make such an application since he had successfully applied for an adjournment of the hearing initially scheduled on 1 to 4 November 2016. It was in the interests of justice that the case, involving allegations from 2014, be expeditiously dealt with. Finally, he advised that HCPC witnesses (who had travelled from Guernsey) were present and ready to give evidence.  

4. In reaching its decision the Panel took into account the HCPC’s Practice Note on Proceeding in the Absence of a Registrant and accepted the advice of the Legal Assessor.  The Panel noted that the Registrant had engaged with the HCPC but had made no application for an adjournment and had submitted an extensive bundle of documents and submissions amounting to over 200 pages, together with an invitation that it be considered.  The Panel also took account of the fact that the Registrant appeared to have made a considered decision, citing the “massive stress” that had been placed upon him and his family, as well as the financial cost of attending the hearing.  It therefore concluded that the Registrant had voluntarily absented himself from the hearing. The Panel also noted that these were serious allegations which were approaching three years old (it being in the public interest to deal expeditiously with regulatory matters) and that witnesses had travelled some distance to attend. Taking all these factors into account the Panel decided to proceed in the Registrant’s absence.

Amendment of the Particulars of the Allegation
5. Mr Kewley then applied to amend the Particulars of the Allegation in respect of which notice had been given to the Registrant by letter dated 17 May 2016.  He stated that the reason for the application to amend was to better reflect the evidence, and that there was no significant change to the case by way of the proposed amendments. He submitted that there was no prejudice to the Registrant by the application to amend as he had been given notice of this some ten months earlier.  In addition, the Registrant had not made any objection to the proposed amendments.

6. The Panel noted that there had been no response from the Registrant in relation to this application.  The Panel asked itself whether, if the amendment was allowed, it would result in prejudice to the Registrant and whether he had been given a proper opportunity of preparing his defence to the Allegation as amended. The Panel decided to allow these amendments as it could not see any discernible prejudice to the Registrant given that significant notice of the intention to amend had been given; he had made no objections to them; none of the proposed amendments materially affected the nature of the Allegation and that several of the proposed amendments sought to clarify the particular Allegation and were essentially grammatical.

Background
7. In Guernsey, ambulance services are provided by the St John Ambulance and Rescue Service (“the Service”).  The Registrant had a long, and it would seem successful, career with the Service having joined it in 1996 and having worked his way up from the positon of Ambulance Care Assistant, Emergency Technician, Paramedic (from 2003) to Station Officer (in 2012). Station Officers were sometimes rostered to act as a Duty Officer, this included Ambulance Control Management.

8. On 9 July 2014, the Registrant was on duty at the ambulance station in his role as the Duty Officer.  Manning the Control Room was Colleague 1 who was an Ambulance Control Assistant and was not a paramedic.  At 6:13pm, a 999 call was received and was answered by Colleague 1.  At the outset of the call, Colleague 1 said to the caller “Hello caller, where do you want the ambulance to come to please?”  The caller responded “I want it to come to King George V Playing Fields”.  Colleague 1 then asked “yes, actually on the playing fields?”  After that point there was no response from the caller.  Colleague 1’s evidence is that she tried to call back twice.  At the time, the location of the caller and the mobile telephone number of the caller were the only known pieces of information.  No ambulance was sent to the caller.

9. The following day, 10 July 2014, Patient A, a 65 year old man, was found dead at 7:40am in the Groundsman’s Hut at the King George V Playing Fields (“KGV”).  It was subsequently identified that Patient A had made the 999 call at 6:13 on 9 July 2014 which had been received by Colleague 1. The matter was reported to the Police who in turn contacted the Service on 21 July 2014. The Chief Officer of the Service, Witness 1, therefore authorised, on 22 July 2014 an investigation by the Service into the handling of the 999 call on, such being carried out by CC, an Acting Senior Officer. That investigation concluded that a disciplinary hearing should be convened.  However, before any hearing could take place the Registrant resigned from the Service on 19 January 2015.  A referral was made by Witness 1 to the HCPC on 12 February 2015.    

10. An Inquest into the death of Patient A took place on 15 September 2015. This concluded that Patient A died from natural causes.  The Coroner made it clear that “I cannot find as a fact in these proceedings that the failure in the procedures of the Ambulance and Rescue Service contributed to his death”.   

Decision on facts
11. In considering this case the Panel bore in mind that the burden of proving the facts rests upon the HCPC and that the standard of proof is the civil standard of the balance of probabilities. It has taken account of all the evidence presented to it, namely the written and oral evidence of the witnesses listed below, together with the documentary evidence provided by the HCPC. It has also considered the detailed submissions of Mr Kewley, and has accepted the advice of the Legal Assessor.

12. The Panel heard from three witnesses on behalf of the HCPC namely:
• Witness 1, the Chief Officer of the Service;
• Witness 3, a Paramedic at the Service;
• Colleague 1, formerly an Ambulance Control Assistant at the Service.

13. In addition, the Panel considered a bundle of documents from the Registrant, which included a number of statements and submissions prepared by him, amounting to some 230 pages.

Evidence of Witness 1
14. Witness 1 confirmed that, as the Chief Officer of the Service, he authorised the investigation into the matter and appointed CC to investigate. In his evidence he confirmed that when Ambulance Control Assistants (Assistants) took emergency 999 calls, they were, at the time, expected to complete an Emergency Call Taking (ECT) form as they were taking the call and then attach it to an Emergency Call Record (ECR).  The colours of the ECR forms were green, amber and red. The red ECR form was for life threatening calls; the amber form was for serious calls and the green form was for everything else. 

15. He also confirmed that these procedures were outlined in the Service's Ambulance Control Guidelines and Procedures for Control Operators (“Guidelines”). He clarified that the Guidelines referred to Control Operators instead of Ambulance Control Assistants, but confirmed that the terms were interchangeable. The ECR was normally part started by the person taking the call and completed by the ambulance crew, if they were asked to attend the incident.

16. He went on to say that Duty Officers were expected to check all of the forms filled in by the Assistants and the Ambulance crew by the end of the Duty Officer’s shift. The Duty Officer should therefore check both the ECR and ECT forms in order to ensure that all the required details have been documented and then sign off the completed package of documents for that incident. If the ambulance crew attended the patient, the package would also include other documents such as a Patient Report Form. If any details were missing from the documents, it was the Duty Officer's responsibility to go back to the individual who recorded the information in order to get the missing details, before signing the form off.  The documents had to be checked and signed off within the duty period in which they were created.

17. Consequently, Witness 1 said that he would therefore have expected the Registrant to have checked whether the ECR and ECT forms for Patient A had been completed properly and, if they had, to have signed the documents off.  The Registrant would have known that both of these forms should be completed for every emergency call, and checked and signed off by the Station Officer because this was part of his responsibility and covered during his training as Station Officer. He confirmed that at the time the Registrant received his training in 2012 it was standard practice to complete a green ECR form for aborted calls. An email, which was in the evidence bundle, was sent to all staff members on 29 January 2013 reminding them that "any emergency call that result in a 'none response' from the Service... must be recorded on a green ECR". The Registrant would therefore have been aware that an aborted call should still be recorded on an ECT form and a green ECR.

18. Witness 1 commented upon the allegation that the Registrant had instructed Colleague 1 to record the call from Patient A in the Control Log.  He confirmed that at the time, the Control Log was used for any unusual circumstances where the information requested by the caller did not fall into a normal 999 call-taking procedure. For example, the Ambulance Service sometimes received calls from elderly people who requested information in relation to chemists. Any advice given during a call of that nature would have been recorded in the Control Log. The information that should be recorded in the Control Log was outlined in section 10 of the Ambulance Control Guidelines and Procedures for Control Operators.

19. He went on to say that aborted calls did not fall into this category of calls because an aborted or incomplete 999 call was an emergency call. It was therefore not appropriate for the Registrant to advise Colleague 1 to record the call in the Control Log and not to take any further action.  The call should have been recorded on both an ECT and a green ECR form and the Registrant should have checked and signed off both forms. No recording should have been made in the Control Log. 

20. In relation to the allegation that the Registrant did not listen to the 999 call, Witness 1 stated that all 999 calls received by the Ambulance Service at the time were recorded on a recording machine and it was very easy to listen back to the recordings. Although Duty Officers were not expected to listen to all 999 calls, he would have expected the Registrant to have listened to the recording of this 999 call because it was not completed and it was aborted.  This was covered as part of the Registrant’s training as Station Officer. 

21. In relation to the allegation that the Registrant did not follow up the aborted call from Patient A, Witness 1 stated that following the aborted call, the Assistant should have made an effort to re-establish contact with Patient A. In this case Colleague 1 had tried to re-establish contact with Patient A but was unable to do so. In those circumstances, Witness 1 would have expected the Registrant to have asked Colleague 1 to either ask the Police to attend Patient A in order to investigate the call further or to immediately dispatch an ambulance resource, as the location of the caller was known. He would have expected the Registrant to have done that even if he believed that the call was a hoax call or the patient had changed his mind and no longer needed an ambulance. It was also important to note that the Ambulance Service does not receive many hoax or inappropriate calls mainly because patients have to pay for an emergency ambulance in Guernsey. It was therefore common practice to initiate a response to every 999 call, even with very limited information.  The Registrant was fully aware of this, as he had regularly followed the correct protocol in the past and had been praised for doing so. On one occasion he had received an award for his persistence in tracing a 999 call from a confused elderly person who had become lost on the cliffs and who did not know her location. 

22. Witness 1 further stated that, in this case, it was clear from the 999 telephone call transcript that the location of Patient A was known, as the patient's location is the first question on the ECT form. He personally had designed the ECT form in that way so that a patient's location was the first thing to be recorded in case the call was disconnected for any reason so that the ambulance service could still attend.

23. He went on to say that the Registrant had stated during the internal investigation that he had given clear instructions to Colleague 1 to call the Police. If such an instruction had been given, it was the Registrant’s responsibility as a manager to ensure that his instructions had been followed. Witness 1 would therefore have expected the Registrant to have followed up his instructions within 10 minutes at the very latest. If a phone call had been made to the Police, the time of the call and the signature of the caller should have been recorded on the ECR, which included a section about contacting the Police directly. If Colleague 1 had failed to follow his instructions, then Witness 1 would have expected the Registrant to have called the Police himself.  He would also have expected him to have taken corrective action against Colleague 1, as failing to follow instructions about a 999 call was very significant.

24. Alternatively, he would have expected the Registrant to have sent an ambulance response or an ambulance car or other resource to check the patient, even though they did not know what they were responding to. The Panel also heard evidence that, at the time the call came through, there were ambulance resources available. Witness 1 confirmed that, during the 30 years that he had been working at the Service, it had never had a policy not to respond to 999 calls. It was common practice for an ambulance or Police response to still be made even if it had not managed to gain sufficient information during a 999 call.

25. Witness 1 further confirmed that at the time of the incident there was no written policy in relation to abandoned 999 calls.  This had now been addressed to the extent that no single person would be able to make a decision about an abandoned 999 call.  However, the written policy essentially formalised existing custom and practice.

Evidence of Colleague 1
26. Colleague 1  stated that on 9 July 2014, she was working on a 4pm to midnight shift. She could not recall how busy it was on that day although she said between 5.30 – 6.00pm was usually the busiest time as people were on their way home.  At around 6:13pm she answered an emergency call from a mobile phone.  She was alone in the Control Room when she received the call. She asked the caller where he wanted the ambulance to go and he responded "I want it to come to King George V Playing Fields".  She then asked whether he wanted the ambulance to go to the playing fields but there was no response. She kept saying hello and if anybody was there but there was no response.  She then put the phone down.  She could not tell whether the line was still active or whether it was cut off. She confirmed that sometimes the Cable and Wireless operator, who monitored the calls, would say that the caller had hung up but on this occasion the operator did not come through.

27. Colleague 1 stated that the caller was a male, who sounded as if he was in his early 60s.  He also sounded slightly intoxicated because his speech was slurred.  She did not think he sounded distressed or panicked. She tried to call back straight away but the phone did not ring; it was just silent.  She tried to call back a second time but it was again silent and did not ring. 

28. The Panel noted the evidence presented to the Inquest of Patient A from DS Edwards, who confirmed that an analysis of the telephone records from Patient A’s mobile revealed that on 9 July 2014 at 18.13.23, an initial telephone call was placed from his mobile to the 999 service – the call lasted 37.9 seconds.  At 18.14.39, a telephone call was attempted from the Service to the mobile but did not connect – the attempted call was terminated at 18.14.54.  A second telephone call was placed from the Service at 18.15.08 but again did not connect and was terminated at 18.15.23.  The Panel noted the challenge to this evidence from the Registrant, on the basis that DS Edwards’ source of this information from the mobile telephone company had not been disclosed, but also notes that her evidence was accepted by the Inquest and therefore saw no reason not to rely upon it.

29. Colleague 1 went on to say that the Registrant came into the room as she was calling the caller back for the second time.  She immediately told him that she had a call from someone who said he was calling from King George V but then there was silence and that she had kept saying 'Hello, are you there' but the line had gone dead.

30. Colleague 1 confirmed that whenever she received a 999 call she completed an ECT form as the information was obtained from the caller.  She would normally write the time of the call, the phone number and where the ambulance should go.  The procedure was that the form was then attached to an appropriate ECR and given to the ambulance crew. The colour of the ECR form denoted the seriousness of the call. 

31. Colleague 1 confirmed that, as soon as she received this call, she immediately started filling in an ECT form. She recorded the time of the call, the phone number and where the ambulance should go.  However, when the Registrant came into the Control Room she asked him whether to complete the ECT form but he told her to just record the call in the Control Log and not to complete any other paperwork.  She did so but could not recall what happened to the ECT form she had initially begun to fill in.  As very little information had been provided during this call, a green ECR form would have been the appropriate additional form to fill in. However, as the Registrant told her not to complete any other paperwork other than the Control Log, she did not complete an ECR form. There was no Protocol that she was aware of at the time for aborted calls.  She had never experienced such a call before which was why she asked the Registrant for guidance. She confirmed that if, as the Registrant asserted, she had been instructed to complete “the relevant documentation” she would have filled an ECT and ECR.

32. Colleague 1 confirmed that at the time of the incident, ECT and ECR forms were handwritten. The standard practice was for the Ambulance Control Assistants to complete the ECR form, pass it on to the crew to fill in their part and then would be controlled by the Duty Officer. As no crew was called in this case, the standard practice would have been for her to pass the completed forms to the Duty Officer, namely the Registrant.  However, this did not happen as he told her not to fill in any other paperwork other than the Control Log. 

33. Colleague 1 then asked the Registrant whether she should carry on trying the number but was told to stop panicking and leave it as “they would call back if they needed us”.  She therefore recorded the details of the phone call in the Control Log, as directed, before leaving the Control Room to meet CC, Acting Senior Officer at the time, about an entirely different matter. She was asked why she did not mention any concerns about the aborted 999 call to CC. She explained that she had raised the matter with the Station Officer, the Registrant, and trusted him to do whatever else was required. She also said that she had gone to see CC about something else entirely.

34. She confirmed that at no time did the Registrant ask her to fill in an ECR form, dispatch an ambulance to the caller's location or contact the Police.  She was certain that all he asked her to do was complete the Control Log.  The Registrant was present in the Control Room the whole time from when Colleague 1 was calling the caller back for the second time until she left the Control Room to go speak to CC.

35. Colleague 1 confirmed that Witness 3, a Paramedic, came into the Control Room to check if a crew was required as he had heard a 999 call.  Colleague 1 could not be certain exactly what time he came into the Control Room but she believed it was not very long after the initial call, as he was the Paramedic who was on call at the time. Colleague 1 said that perhaps she should try calling back the number again, but Witness 3 told her to “stop getting so het up about it”.  She believed that he was in the Control Room for about five minutes before she left the Control Room to go speak to CC.  She could not recall exactly what was discussed when he was in the room but recalled that the Registrant said something along the lines of "We've got enough, we don't need more work".

36. Colleague 1 stated that at the time she was not happy that she could not get hold of the caller and felt uneasy about the incident. However, as she had referred the incident to the Registrant who was the Duty Officer at the time, and more senior than her, she thought that he would take on board anything else that needed to be done.

37. During her oral evidence Colleague 1 confirmed that she had been trained for the job by the Registrant, and that in that training he had emphasised that everything had to be properly recorded.

Evidence from Witness 3
38. Witness 3 confirmed that on 9 July 2014, he also was working on the 4pm to midnight shift. He recalled that it was not a very busy evening at the time of the incident. At the time in question one Emergency Medical Technician crew was out attending calls.  He said that at 6:14pm he went to the Control Room to talk to Colleague 1 about any latest developments she knew of regarding the proposed move of the Control Room to the Police Headquarters. He could not recall whether he was aware of a 999 call recently coming in or whether he was on his way to the Control Room anyway.

39. He confirmed that when he walked into the Control Room, Colleague 1 was sitting in the left hand control position at Control 1 with the handset in her hand and the Registrant was sitting in the right hand position at Control 2 - there was nobody else in the room.  On entering the Control Room, he remembered the Registrant laughing and believed that he said to Witness 3, jokingly, that Colleague 1 was touting for business or trying to find them work, or words to that effect. He could not recall the exact words of the conversation. The atmosphere was jovial and Colleague 1 laughed at the Registrant’s comment.  Witness 3 then told Colleague 1 something along the lines of 'That's not good, what are you up to Colleague 1?'.

40. Witness 3 recalled that Colleague 1 then said that she had recently taken a 999 call from King George V Playing Fields, but there was no caller on the end of the telephone.  She also said that she tried to ring back several times. He believed that she said she tried to call back three or four times. However, Colleague 1 was “pensive” and concerned about the call and said she would try calling again. He told Colleague 1 that perhaps the caller was a sportsman and someone else was taking him to hospital or he decided he no longer needed an ambulance.  He also told Colleague 1 that there was probably a limit to how many times she could attempt to call back. He confirmed that Colleague 1 tried to call the caller again whilst he was in the Control Room.

41. He could not say how long after the initial 999 call he went into the Control Room. As Colleague 1 had the handset in her hand, he assumed that he arrived into the Control Room shortly after the call. He did not see Colleague 1 or the Registrant filling in any ECT form or an ECR.  He was familiar with this paperwork as these forms were passed on to the crew once they were completed by the Assistant or the Duty Officer.

42. Witness 3 then confirmed that the conversation changed. Colleague 1 relaxed. He asked her about the proposed move of the Control Room to the Police Headquarters. This reminded her that she wanted to speak to CC about the future of Control.  Witness 3 informed her that CC was still at the station. The Registrant then told Colleague 1 that she could go speak to CC and he would cover Control while she was talking to him.

43. Witness 3 believed that he was in the Control Room for about 10 to 12 minutes before Colleague 1 left. When Colleague 1 left the Control Room, he followed shortly afterwards leaving the Registrant still in the Control Room alone. Other than the conversation already referred to, he did not witness any additional conversation between Colleague 1 and the Registrant. He did however confirm that he did not hear the Registrant ask Colleague 1 to notify the Police or try to call the caller back while he was present. In addition he did not hear the Registrant tell Colleague 1 not to complete the ECT form or the ECR or to just put a note in the Control Log. From the moment he entered the Control Room to the moment Witness 3 left, the Registrant did not leave the Control Room at any point but remained sitting at Control position 2.

44. Witness 3 confirmed that, during his investigatory interview on 12 August 2014 he was informed that there was another 999 call at 6:16pm from the ferry terminal to which KM, a paramedic, responded. Witness 3 could not remember this call until it was mentioned to him during that meeting. With the benefit of hindsight and questions asked, he recalled that he was in the Control Room at 6:16pm when that call was made and that KM came to the Control Room very briefly before responding to the call from the ferry terminal.

Evidence from the Registrant
45. In his statement dated 22 July 2014, the Registrant maintained that shortly after 18.13, when the call from Patient A was received, he attended the Control Room where Colleague 1 was stationed.  At the time she was taking another call from the Coastguard asking for an ambulance attendance at the Harbour Terminal Building.  From his perusal of records he ascertained that a response was despatched at 18.19. 

46. He went on to say that Colleague 1 then informed him about the 999 call that she had received at 18.13.  She explained that she had not been able to obtain any information from the caller other than he was possibly at the KGV.  He asked her if she had tried to call the number back and she said that she had.  He asked if this person had been playing football or if she had any other information to which she replied “No”.  He therefore told her to document the 999 call on an ECR and then pass the information on to the Police who could possibly attend and check things out for them.

47. His statement went on to say that it did not appear that Colleague 1 completed the relevant paperwork but only made an entry into the Control Log.  He would have expected that an ECT Form and a green ECR Form would have been completed recording the series of events from that 999 call.

48. The Registrant then remained in the Control Room for a time until returning to his office.  His statement concludes that he could not confirm that a call was placed to the Police but when he was not updated he assumed that the matter had been dealt with by Colleague 1.

49. In his meeting with CC and others, including the Police, on 26 August 2014, the Registrant maintained the same account save to say that he did not specifically tell Colleague 1 to complete an ECR form but to complete “relevant documentation”.  He also stated that he had not listened to any recording of the call because he had “furnished her with the information” as to what she should do.  He denied that he had told Colleague 1 to stop panicking, to leave it until the caller called back and to record it into the Control Log.

50. The Registrant was asked whether Colleague 1 had left the Control Room whilst he was there and he initially replied that she did not.  When CC put to him that she had left the room to have a 20 minute meeting with CC the Registrant still could not recall this but opined that she could have taken a toilet break and then made a cup of tea.

51. When asked about signing off the forms relating to this 999 call the Registrant accepted that he was responsible for signing off those forms but he had not registered it as a significant incident so when he was checking the ECRs he did not register that it had not been filled in because he was busy with other Station Officer duties.  When asked if he had asked Colleague 1 what had happened to the call he reiterated that as he did not hear anything from her and did not get any update he assumed the matter had been dealt with as she was a competent controller.  He also confirmed that she was not an employee who did not follow orders.  When asked why she would not have telephoned the Police or filled in the ECR Form he opined that maybe she had forgotten.

52. In his most recent (albeit unsigned) statement contained in his bundle, the Registrant states as follows:

“The incident that occurred that resulted in my demise was one that took place whilst I was in my office. I was not made aware of the dropped call and only got knowledge of it because I entered the control room as via my radio I could hear it was becoming busy and could also hear the emergency line going with frequency. It was only when I entered the control room that I was made aware of the call by [Colleague 1], who was the only controller present. We had a conversation in relation to the dropped call and I gave instruction to her, alone, with her, in that room. These instructions were not carried out.

On 9th July 2014 [Colleague 1] was on duty in the control room at the St. John Ambulance and Rescue Service when at 18:13 she received a 999 call from a male asking for an ambulance to attend the King George V sports ground. At this time the line went silent and [Colleague 1] after being unable to get further response from the caller hung up.

THIS CALL WAS RECORDED.

[Colleague 1] states that prior to my entering the control room she attempted to call the caller back on the number supplied, twice but received no response. She alleges that she advised me of the call and at this point she had started to complete a call taking form and I allegedly told her to "STOP PANICKING AND LEAVE IT" as they would call back and that I told her only to record the call on the log.

[Colleague 1] states that at this point [Witness 3] entered the control room to see if he was required to dispatch to an incoming 999 call, and that she then persisted to question me as to whether she should again call the number back, and at this point she further states that [Witness 3] told her to ''STOP GETTING SO HET UP ABOUT IT".

It was at this point she states that she recorded the call on the phone log only and about 5 minutes later she left the control room to go and speak to [CC] returning some 20 minutes later.

[Colleague 1] has maintained that she was highly affected by this call and my direction to her, however she made no mention to this to [CC] the more senior officer and she made no follow up. Even once I left the room she made no follow up. Her comments during interview that she is scared of me or intimidated so did not argue are not evidenced by any previous incident and if that was the case she again should have mentioned her concern to [CC]…

…The course of events from my part was simple, I entered the control room and [Colleague 1] was on the phone to the coastguard. Once this had been dealt with she made me aware of the previous dropped call and I asked a series of questions to try to identify further information as per my report. I was aware we had no crew available to attend and given the location of the call, a sports ground, I asked that she call the caller back which she said she had completed and so to contact Police to attend in our place to identify if there was a patient to attend to. Then to complete the paperwork relevant to that call.

Each section of direction given to her was not completed and [Colleague 1] was dishonest in her duty report and her interview. The statements and interviews and reports recorded from [Witness 3] shed no further light on what had happened between the two of us in that room because we were the only two present. The lack of paperwork submitted by her, the lack of records supporting that she returned the call to the caller or that she contacted the Police or indeed carried out any form of enquiry were quickly laid at my door.  I knew that I had given her instructions and that she had not carried them out and I believed that the truth would come out.  What followed was a one sided and blatantly dishonest enquiry.”

53. The Panel has included such a long extract as it appears to encapsulate and summarise all the issues that the Registrant wishes to raise in relation to the facts of this case. In addition, during the hearing, Mr Ince as the independent Legal Assessor asked all witnesses questions arising out of the Registrant’s representations.

Assessment of witness credibility
54. In assessing the credibility of the witnesses, the Panel took account only of that evidence which had been presented to it, both written and oral.  It did not, for instance, take any account of the outcome of the Employment Tribunal proceedings, some details of which had been introduced by the Registrant in his bundle and upon which there was some elaboration by Witness 1.  Those proceedings considered different issues and heard different evidence.

55. Witness 1 – the Panel found Witness 1 to be credible.  His evidence was clear and consistent.  He was a straightforward and balanced witness who was willing to give the Registrant appropriate credit, such as confirming that there were never any issues with the Registrant’s abilities as a front-line paramedic and that he had, for instance, been praised for persistence in tracing a 999 call from a confused elderly person who had become lost on the cliffs.

56. Witness 3 – the Panel found Witness 3 also to be credible.  Although the Panel formed the impression that he was somewhat confused about the provenance of his initial statement to CC, it found him to be otherwise clear, honest and measured – for instance, he did not recall the Registrant saying some things which were potentially adverse to the Registrant.

57. Colleague 1 – the Panel found Colleague 1 to be very credible.  It was aware that she was experiencing extremely difficult personal circumstances yet she had attended the hearing.  She was clear and concise in her recollections, which were consistent.  She readily indicated when she could not recall something and was not defensive in any way.  She also gave the Registrant credit, for instance indicating that she respected his instructions since he was her senior and the Duty Officer from whom she sought guidance in relation to a situation that she had not encountered before.  The Panel also noted that her evidence was in the main corroborated by Witness 3, and vice versa.

58. The Registrant – although the Registrant did not attend the hearing, the Panel did not hold that against him.  It took particular account of the carefully-prepared and detailed submissions and statements that he submitted in his bundle.  It noted that he appeared to be very clear in his recollections but it also noted that none of his statements contained any statement of truth and were in the main unsigned.  Consequently, the Panel was only able to attach limited weight to those statements.  The Panel was also concerned by the Registrant’s apparent belief that the HCPC’s witnesses, in particular Colleague 1 and Witness 1, were lying and were seeking to make him a scapegoat for the incident.  Having seen both give their evidence the Panel did not form that impression of them. Moreover, the Panel considered that there were examples of the Registrant misunderstanding previous occurrences, such as his interpretation of the letter from Witness 1 to the Registrant as an ultimatum when, upon consideration, it was clear that it was nothing of the sort.  The Panel noted that the Registrant was consistent in his evidence to the service during their investigations and referred to Friday and Saturday night being busy including hoax calls. The aborted 999 call was made on a Wednesday evening and as noted above hoax calls are infrequent in Guernsey. The Panel therefore approached his evidence with some caution.

59. Accordingly, when it came to consider the evidence overall, the Panel on balance preferred the evidence of the three live witnesses to that of the Registrant, having found them to be credible and generally reliable witnesses.  The Panel appreciates the Registrant’s argument, namely that why would he, who knew the procedures and indeed had taught them to Colleague 1, depart from those procedures?  However, this does not outweigh the very favourable impression of the HCPC’s witnesses, especially Colleague 1, who was particularly plausible.  Moreover, the Panel noted that the Registrant accepted during his August 2014 interview that she had no reputation for not following orders.  The Panel considered that she came across as respectful of authority and of the Registrant and that she did what she was told by her superiors.  It was therefore left with the distinct impression that had she been told by the Registrant to contact the Police she would have done so and that she would only have completed the Control Log for this call if she had been instructed to do so.

60. Further, although the Panel appreciates some slight discrepancies in their recollections, both Colleague 1 and Witness 3’s recollections are substantially similar in that both confirm that, so far as they were aware, no instructions were given by the Registrant for Colleague 1 to telephone the Police and that the attitude of the Registrant was to trivialise the call and to dissuade her from becoming concerned about it, to the extent that both witnesses recall that the Registrant was joking that she was creating work for them.  Witness 3 also confirmed that Colleague 1 was expressing some disquiet about the matter.  Moreover, the Panel considered that, if Colleague 1 was, in Witness 3’s presence, expressing a desire to continue contacting the caller, this begs the question why the Registrant was not heard by Witness 3 to respond along the lines of “there’s no need because I’ve told you to call the Police to investigate it”, which the Panel considered would be the automatic reaction to such an expression of concern. 

61. The Panel made the following decisions in respect of the individual allegations:

Decision on facts
62. The Panel made the following decisions in respect of the individual allegations. There is no dispute that the Registrant was working for the Service as a Registered Paramedic on 9 July 2014 – he admits as such:

Particular 1(a), 1(b) – found proved
63.  There is no dispute that Colleague 1 did not complete either an ECT Form or an ECR.  For the reasons cited above the Panel accepts Colleague 1’s evidence that she began to fill in the ECT Form and ceased doing so when the call terminated.  Furthermore, it accepts her evidence that she did not, having been told to only fill in the Control Log by the Registrant, complete the remainder of the ECT Form or a green ECT Form. The issue therefore is whether the Registrant ensured that she completed those forms.

64. The Panel noted and accepted the evidence from Witness 1 that when a 999 call was received both forms had to be completed in accordance with the existing procedures and that entering details of any call into the Control Log was reserved for those calls that were not emergency calls.  Furthermore, Witness 1 confirmed that it was the responsibility of the Duty Officer to sign off the forms in relation to each 999 call by the end of their shift, or to hand over such responsibility to the incoming Duty Officer in relation to calls which were still being dealt with by an ambulance crew.

65. In addition, the Panel noted that in his interview in August 2014, the Registrant accepted that it was the responsibility of the Duty Officer to sign off such forms but that he did not do so in this case because he was busy with other Station Officer duties and had not registered the aborted 999 call as a significant incident.  The Panel did not regard this as an acceptable excuse.

66. The Panel also noted and accepted the evidence of Witness 1 that it was custom and practice in the Service at the time (which has now been formalised by an amendment to the written procedures) that every aborted 999 call had to be recorded in both the ECT and ECR forms then signed off by the Duty Officer. Moreover, the Panel accepted that it was standard practice to complete a green ECR form for aborted calls.  The Panel therefore concluded that the Registrant who was also an experienced Ambulance Controller and trained Control Assistants, would therefore have been aware that an aborted call should still be recorded on an ECT and a green ECR form.
 
67. The Panel was satisfied, on balance, that the Registrant knew he had a duty to ensure that Colleague 1 completed the relevant forms in relation to the aborted call from Patient A and he did not do so.  

Particular 2 - found proved
68. There is no dispute that the Registrant did not listen to the recording of the 999 call – he admits as such.  The Panel further noted the evidence of Witness 1 that doing so would have assisted the Registrant to better evaluate the nature of the call and would have alerted him to the fact that the caller appeared to be elderly and had slurred speech, which in themselves might have pointed to the need for an immediate response.  

Particular 3 - found proved
69. For the reasons detailed above, the Panel preferred the evidence of Colleague 1 in relation to this particular.  The Panel took account of her statement in her oral testimony that she had never come across such a situation and had sought advice from the Registrant.  It was therefore not plausible that, having sought such advice, she ignored it and instead made an entry into the Control Log.  Making a telephone call to the Police would not have been onerous since there was a telephone next to her with a direct line to the Police station.

70. The Panel also noted the evidence of Colleague 1 and Witness 3, both of whom stated that the Registrant said things which gave the impression that he was trivialising the call on the basis that it would create unnecessary work for them.  Consequently, an instruction to Colleague 1 to simply record the call in the Control Log is commensurate with that background.

71. Finally, the Panel took account of the entry into the Control Log which it found to be clear and unequivocal.  The relevant part of the entry stated:

“Time: 18.13; Messages: 999 call from mobile No…Caller hung up.  Tried calling back twice – no answer; Initials: [Colleague 1]; Action: DO (JG) informed”.

72. This entry corroborates more or less everything that Colleague 1 states took place and has the virtue of being contemporaneous.  It also begs the question why she would have noted that the Registrant had been informed if he had not told her to make such an entry. If, as the Registrant contends, Colleague 1 had failed to follow his instructions to complete the ECT and ECR forms and to contact the Police, it did not appear plausible to the Panel that Colleague 1 would then have provided the evidence that she had not done so in such a permanent and obvious way which would have been followed up by anyone checking the call.  On balance it is more plausible that she made the entry because she was told to do so.

Particular 4(a), 4(b) - found proved
73. There is no dispute that the Registrant did not himself contact the Police. The Registrant has also accepted that he did not ask Colleague 1 whether she had contacted them, on the basis that he believed that she had dealt with the matter in another way following his instruction to her, which the Panel has already found he did not do.  Similarly, the Registrant has accepted that he did not sign off the relevant forms, citing pressure of work on that particular shift.  The issue therefore is whether he had a duty to follow up his instructions. 

74. The Panel noted and accepted the evidence of Witness 1 who indicated that, in the circumstances of the aborted call, custom and practice dictated that the Registrant should have caused further action to be taken and that 999 calls were always responded to. Witness 1 gave evidence that this was what the Registrant had himself done on previous occasions and that he was aware of the duty to take such action.  Witness 1 also alluded to the general lack of hoax calls to the Service in Guernsey (especially because of the charges involved for using the Service); to the fact that it was a Wednesday and not a Friday or Saturday evening; to the fact that the location of the caller was not far away (1½ miles) and to the fact that there was an ambulance available. There were also additional Service resources available, including the Registrant himself, as well as the Police, all of whom could have attended.

75. Moreover, even if the Registrant had instructed Colleague 1 to telephone the Police, Witness 1 was clear that he still had a duty to chase up such instruction within 10 minutes.  The Panel reminded itself that, according to the evidence of Witness 3, which it accepted, during his time in the Control Room the subject of the aborted call was raised, which in itself would have provided a prompt to the Registrant, had he given such an instruction. 

76. The Panel therefore concluded that the Registrant had a duty to follow up the aborted call in the way particularised but, for whatever reason, did not do so.   

Decision on grounds
77. Having found the facts proved in this matter, the Panel went on to consider whether the facts found proved, individually or collectively, amounted to misconduct and/or lack of competence. 

78. In relation to misconduct, the Panel noted the advice of the Legal Assessor who referred to the cases of Roylance v General Medical Council [2000] 1 A.C. 311, Cheatle v General Medical Council [2009] EWHC 645 (Admin), Nandi v. General Medical Council [2004] EWHC 2317, Spencer v General Osteopathic Council [2012] EWHC 3147 (Admin), R v. Nursing and Midwifery Council (ex parte Johnson and Maggs) (No 2) [2013] EWHC 2140 (Admin) and Schodlok v GMC [2015] EWCA Civ 769. The Panel noted that misconduct must be serious and amount to a registrant’s conduct falling far below the standards expected of a registered paramedic.

79. In relation to lack of competence, the Panel noted the advice of the Legal Assessor that lack of competence connotes a standard of professional performance which is unacceptably low and which, (save in exceptional circumstances), has been demonstrated by reference to a fair sample of the Registrant’s work.  Moreover, the benchmark by which to gauge impairment is the standard required of a Registered Paramedic. However, the Panel noted the submissions of Mr Kewley to the extent that the HCPC considered this case essentially to be a misconduct case.  He argued that there was no evidence that the Registrant did not know how or what to do in the circumstances.  It further noted that the Registrant was regarded as a good front line paramedic, who also had had training responsibilities and that a fair sample of his work had not been considered; only this particular incident had been examined.  The Panel therefore had little hesitation in concluding that insufficient evidence had been provided to demonstrate that the Registrant lacked competence.

80. The Panel noted Mr Kewley’s submissions that a number of standards in both the HCPC’s Standards of conduct, performance and ethics, and in the Standards of Proficiency for paramedics, had potentially been breached.  The Panel agrees that the following Standards have been breached by the Registrant’s actions or failings:
• Standards of conduct, performance and ethics:
1 – You must act in the best interests of service users
8 – You must effectively supervise tasks you have asked other people to carry out
• Standards of Proficiency: Paramedics
4  – be able to practise as an autonomous professional,
          exercising their own professional judgement
4.1 – be able to assess a professional situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem
4.4 – recognise that they are personally responsible for and must be able to justify their decisions
9 – be able to work appropriately with others
9.1 – be able to work, where appropriate, in partnership with  
   service users, other professionals, support staff and others

81. In relation to misconduct, the Panel considered each particular in turn individually.

Particular 1
82. The Panel noted that, although this was a falling short of the standards expected, the failure to ensure that relevant forms were completed was not so serious as to amount to misconduct – it was a one-off error of supervision.

 Particular 2
83. The Panel noted that, although desirable in the circumstances, the failure to listen to the 999 recording did not fall short of the standards expected, let alone far short. The Registrant had failed to take advantage of a decision-making aid on one occasion.  The Panel therefore concluded that his failure to listen to the recording was not so serious as to amount to misconduct.

Particular 3
84. The Panel considered that instructing a junior colleague to record the call from Patient A in the Control Log and take no further action was tantamount to ignoring it. The Panel considered that one of the fundamental duties of an ambulance service is to respond to emergency calls. Treating an aborted call, especially when an experienced colleague was expressing concerns about it, in an apparently dismissive fashion, which trivialised Colleague 1’s concerns, does represent a far falling short of the standards expected of a paramedic.  In addition, the Panel noted the aggravating factor that this involved directing a junior colleague, who had asked for guidance on a situation which she had not come across before, to act in a way which was unacceptable.  The Panel therefore concluded that the Registrant’s actions were so serious as to amount to misconduct.

Particular 4
85. For reasons similar to those given in relation to Particular 3, the Panel concluded that the Registrant’s actions in not following up the aborted call from Patient A also amounted to a far falling short of the standards expected of a Registered Paramedic. Such actions go against what the public expect of an ambulance service. Responding appropriately to emergency calls is a significant part of what an ambulance service is there to do. The Panel therefore concluded that the Registrant’s failures were so serious as to amount to misconduct.

86. In finding that Particulars 3 and 4 do amount to misconduct, the Panel was mindful that the Coroner concluded that there was no evidence that the inaction of the Service contributed to the death of Patient A and that the HCPC has not made such an allegation against the Registrant nor has it put its case on that basis.  It may be that the Panel will take account of the wider context of the event at a later stage but it has evaluated whether there is a statutory ground independent of that. 

87. Having considered all the evidence, the Panel formed the view that on this particular evening the Registrant made a bad error of judgement.  For whatever reason, the Registrant appeared not to take the information he received seriously and even joked that it potentially was creating unwelcome work. The Panel was satisfied that this was an isolated event which appeared to be out of character, given the Registrant’s previous unblemished record.  However, that does not excuse the fact that, on this one occasion, his failings were so serious as to amount to misconduct.

Decision on impairment 
87. In reaching its decision on impairment, the Panel took account of the submissions of Mr Kewley, the documentary and oral evidence given during the hearing, and the advice of the Legal Assessor.  It also took account of the HCPC Practice Notes “Finding that Fitness to Practise is “Impaired” and “Fitness to Practise – What does it Mean”. 

88. The Panel was aware that, in determining whether fitness to practise is impaired, it must take account of a range of issues which, in essence, comprise two components, namely the ‘personal’ component (the current competence and behaviour of the individual Registrant) and the ‘public’ component (the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession).   The Panel was aware that not every finding of misconduct would result in a finding that fitness to practise is impaired.

89. The Panel has concluded that the Registrant’s fitness to practise is impaired on both the personal and public component grounds.  

90. The Panel noted that the Registrant had a previously unblemished record and was thought of as a good front-line paramedic.  It further took account of the fact that this incident occurred when he was exercising management skills, albeit from a paramedic’s perspective in that an evaluation of the potential medical situation still had to be made in order to carry out those management functions effectively.

91. The Panel also noted that the Registrant has stated that he has not practised as an operational paramedic for some two years and was concerned about becoming de-skilled.  The Panel acknowledged that this concern was evidence of some insight on his part. The Panel otherwise had no information before it as to what the Registrant had been doing to keep his paramedic skills up to date or whether he had undertaken any training, or continuing professional development (“CPD”) in respect of his practice. 

92. The Panel also took account of the fact that this was an isolated incident. The difficulty the Panel had was the fact that the Registrant has apparently refused to acknowledge any error on his part in relation to this incident. He has blamed others for failing to follow his instructions, but the Panel has found that he had not given any instructions other than to log the call in the Control Log. The Panel considered this was a particularly inappropriate response to the situation.  The Registrant has also alleged that he was being made the scapegoat for this incident and that there was, essentially, a conspiracy against him to that effect. The Panel was of the view that, having heard the witnesses in this case and having found them to be credible, there was no evidence to support such an allegation.

93. The point to be made is that, notwithstanding his acknowledgement that he may have become de-skilled as a paramedic, the Registrant has otherwise displayed little or no insight into his actions in this matter.  He has failed to take due responsibility and does not appear to have reflected properly about what he could have done differently nor how his actions may have affected service users or the public’s view of his profession.  Whilst it may be argued that, having undergone this experience, it is unlikely that he would act in this way again, the fact remains that, without any acknowledgement of his part in this incident, the Panel could not be satisfied on the evidence before it that he would not act in this way again.  Although the Panel took the view that the misconduct in this case was capable of being remedied it had to conclude that there was no evidence before it that the Registrant’s failings have yet been remedied.

94. In all these circumstances, the Panel concluded that the Registrant’s fitness to practise is impaired on the personal component grounds.  

95. In relation to the public component, the Panel concluded that a reasonable member of the public aware that the Registrant had not responded appropriately to a 999 call, albeit on only one occasion, would expect a Panel considering these matters to find that fitness to practise is impaired. The public has a right to expect paramedics to respond appropriately to emergency calls and to ensure that their actions do not fall far below acceptable and professional standards such that the public’s confidence in the profession is damaged.  Responding to such calls from vulnerable members of the public is a fundamental expectation of the Paramedic profession. The Registrant’s failure to comply with this brings the profession into disrepute.  The public also has a right to expect that proper standards of behaviour and conduct expected of Paramedics are upheld on behalf of all members of that profession. 

96. The Panel was, therefore, satisfied that public confidence in the Paramedic profession would be undermined if it did not make such a finding. It was also of the view that such a finding was required in order to uphold proper standards of conduct and behaviour in the profession.  Accordingly, the Panel concluded that the Registrant’s fitness to practise is impaired on public interest grounds. 

Decision on sanction
97. In reaching its decision on sanction the Panel took account of the Indicative Sanctions Policy (“ISP”) document and the advice of the Legal Assessor, which it accepted. The Panel was mindful that the purpose of sanctions is not to be punitive, although they may have that effect.  It appreciated that the primary purpose of any sanction is to address public safety from the perspective of the risk which the Registrant concerned may pose to those who use or need his services.  It noted, however, that in reaching its decision, panels must also give appropriate weight to the wider public interest, which includes: the deterrent effect to other registrants; the reputation of the profession concerned; and public confidence in the regulatory process.  In addition, the Panel noted that it must act proportionately, which requires it to strike a balance between the interests of the public and those of the Registrant.

98. The Panel took account of Mr Kewley’s submissions. It also took account of the various mitigating factors namely:
• The Registrant’s previous good character;
• He was regarded as a good front line operational paramedic;
• He had received various Commendations from the Service;
• He had engaged with these proceedings, up to a point;
• He had demonstrated some insight in relation to his de-skilling;
• He had expressed a desire to use his paramedic skills.

99. However, the Panel also notes the following aggravating features and in particular:
• The Registrant breached a fundamental expectation of paramedics which is that they will respond to calls from vulnerable members of the public such as Patient A;
• He had sought to place blame for the incident onto his junior colleague;
• He directed a junior colleague, who sought his advice, to act in a way which was unacceptable;
• There has been no real expression of genuine remorse;
• There has been no evidence of reflection about this incident nor any indication that he would change his practice because of it;
• The Registrant has not supplied any evidence of CPD nor any relevant testimonials;
• The Registrant still appears to regard himself as the victim in this matter.

100. The Panel has treated the death of Patient A as neither an aggravating nor a mitigating factor. The Inquest made it clear that there was no evidence that the lack of response by the Service had contributed to Patient A’s death, but it is part of the context of this matter which serves as a timely reminder to paramedics that their actions or omissions might have serious consequences.

101. Given the seriousness of the misconduct and the aggravating factors the Panel took the view that this wasn’t a case that could be appropriately dealt with without a sanction.

102. The Panel first considered the sanction of mediation and concluded that it was not appropriate.  There was no evidence before it that the Service or the Registrant would co-operate in such a process, and in any event the matter was too serious to be resolved in this way.

103. The Panel next considered a Caution Order, which is deemed to be appropriate “where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate remedial action.  A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practice would be disproportionate.  A caution order is unlikely to be appropriate in cases where the registrant lacks insight.”  The Panel noted that, although this was an isolated lapse, the Particulars found proved were serious.  Moreover, the Panel had found that there remained a real risk of repetition.  Consequently, the Panel concluded that, especially given that the Panel believed that there remained significant issues in relation to the Registrant’s insight, such a sanction would be insufficient to address the Panel’s concerns in relation to public interest grounds or to provide adequate protection to the public.

104. The Panel then considered the next most onerous sanction, that of a Conditions of Practice Order, and noted that this is appropriate where a failure or deficiency is capable of being remedied and where the Panel is satisfied that allowing the Registrant to remain in, or return to, practice, while subject to conditions, minimises the risk of future harm to service users.

105. The Panel determined that, despite the breaches being serious, the Registrant’s failings were capable of being remedied.  However, the Panel noted paragraph 13 of the ISP which states: “A key factor in many cases will be the extent to which a registrant recognises his or her failings and is willing to address them.”  Furthermore, paragraph 27 states that “The imposition of conditions requires a commitment on the part of the registrant to resolve matters” and states that conditions may be inappropriate where the “registrant lacks insight or denies any wrongdoing”.

106. The Panel noted Mr Kewley’s submissions that, the Registrant had refused to acknowledge any error on his part in relation to this incident; that he had displayed little or no insight into his actions in this matter; and that he had failed to take due responsibility or to have reflected properly about what he could have done differently and how his actions might have affected service users or the public’s view of his profession. Without any acknowledgement of his part in this incident, the Panel could not be satisfied on the evidence before it that he would not act in this way again.  Mr Kewley went on to say that, consequently, there was no available evidence to reassure the Panel that there was the required level of insight and understanding to indicate that a Conditions of Practice Order was an appropriate and proportionate response. The Registrant was still at a stage where his written submissions sought to show the Service in a bad light and blame the absence of a written policy and a colleague for his failings.

107. Given the Registrant’s desire to retain his registration to enable him to take up a job offer, the Panel gave serious consideration to making a Conditions of Practice Order. However, based on the information before it, the Panel felt unable to draft workable, appropriate, realistic or verifiable Conditions of Practice. It concluded that there was little evidence before it that the registrant would comply with such an order.

108. The Panel next considered imposing the next most onerous sanctions.  It decided that it would be appropriate to consider the alternative orders of Suspension and Striking Off together since these remained the only two options open to it.

109. The Panel noted that the ISP indicated that a Suspension Order should be considered where a Panel considers that a caution or conditions of practice would provide insufficient public protection or where the allegation is of a serious nature but unlikely to be repeated and, thus, striking off is not merited.  Where there were no psychological or other difficulties preventing a registrant from understanding and seeking to remedy the failings then suspension might be appropriate. The ISP states, however, if the evidence suggests that a registrant would be unable to resolve or remedy his or her failings then striking off might be the more appropriate option.

110. The Panel noted that the ISP indicates that a Striking Off Order was not only a sanction of last resort for serious, deliberate or reckless acts involving abuse of trust such as sexual abuse, dishonesty or persistent failure but also that it should be used where there was no other way to protect the public. A registrant’s inability or unwillingness to resolve matters would suggest that a lower sanction may not be appropriate.

111. Once again, the Panel reminded itself that it had little information before it as to the Registrant’s current situation or whether he has any real intention of remediating his practice.  The Panel considered that it would be perfectly entitled to come to the conclusion that, by continuing to deny his own part in the matter, by failing to take responsibility for his own actions and by continuing to blame others, the Registrant is not prepared to remedy his practice or address his failings, and is in fact unwilling or unable to resolve them.

112. However, the Panel appreciated that the Registrant may, for whatever reason, have found it difficult to accept responsibility for his actions in this matter and noted that he has indicated that he wishes to remain a Registered Paramedic and to utilise his skills in that regard. Consequently, the Panel has decided to give him an opportunity to show that he is willing to remedy his failings by imposing a Suspension Order for a period of 12 months to enable him to demonstrate that he has gained insight into his failings and wishes to remedy them.

113. It follows that the Panel considered that, at this stage, a Striking Off Order would be disproportionate.  Accordingly, the Panel concluded that the proportionate response is to make a Suspension Order for a period of 12 months, which would give him sufficient time to remedy his failings.

114. That Order will be reviewed towards the end of that period and the HCPC will arrange for a Review hearing to take place.  At that hearing, which of course the Registrant would be entitled to attend, the reviewing Panel may be assisted by:
• Evidence of reflection about this matter together with evidence of insight and remorse;
• Evidence that the Registrant has kept his skills and knowledge up to date, together with evidence of CPD;
• Evidence of the Registrant’s future intentions about practising as a paramedic and details of his plans, if any, for such a return;
• Up to date and relevant testimonials;
• The Registrant’s continued engagement with the HCPC.

Order

That the Registrar is directed to suspend the registration of Mr Jason M Garnham for a period of 12 months from the date this order comes into effect.

Notes

The order imposed today will apply from 20 April 2017 (the operative date).
This order will be reviewed again before its expiry on 20 April 2018.

Hearing history

History of Hearings for Jason M Garnham

Date Panel Hearing type Outcomes / Status
20/03/2017 Conduct and Competence Committee Final Hearing Suspended