Mr Jeffrey D Hartopp

: Paramedic

: PA00709

: Review Hearing

Date and Time of hearing:10:00 14/06/2017 End: 12:00 14/06/2017

: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: No further action

Allegation

During the course of your employment as a Paramedic at East Midlands Ambulance Service NHS Trust:

 

1. On 28 November 2013, you attended Patient A* and you:

 

a) Did not adequately complete the Patient Report Form (PRF) in that you did not record the:

i. Incident number;

ii. Times of the job;

iv. Patient’s age;

v. Patient’s ethnicity;

vi. Patient’s consent to treatment;

vii. Respiratory rate;

viii. Rationale for leaving Patient A* at home with a neighbour when she was suspected of suffering from a neck of femur injury;

ix. Patient’s medications and/or medical history.

 

b) Did not adequately complete the PRF in that you recorded only one set of observations for Patient A*.

 

c) Failed to carry out an adequate assessment of Patient A* in that you:

i. Did not carry out a trauma examination to exclude medical causes for the patient’s fall or collapse;

 

d) Did not act in Patient A’s best interests, in that you left Patient A* at home with a neighbour instead of waiting until the Double Crewed Ambulance arrived to convey her to the hospital;

 

2. On or around 28 November 2013, you attended Patient B*, and you:

 

a) Did not adequately complete the Patient Report Form (PRF) in that you did not record:

i. The patient’s telephone number;

 

iv. The patient’s age;

v. The patient’s gender;

vi. The patient’s ethnicity;

vii. The patient’s consent to treatment;

viii. The patient’s pupil reactivity;

ix. The time of the patient’s first symptom;

x. The dosage of the patient’s medication;

xi. The patient’s allergies;

xiii. The patient’s understanding and/or ability to make an informed decision;

xiv. The observations that were taken at 0215 hours;

xvi. The clinical impression section of the PRF;

xviii. Your discharge advice;

xix. The signature of the patient and/or carer;

xx. The patient’s results on the AVPU scale.

 

b) Did not provide Patient B* with adequate care and treatment in that you:

i. Made a diagnosis of Urinary Tract Infection when the patient’s symptoms suggested possible sepsis;

 

c) Did not transport Patient B* to the hospital;

 

d) Made inappropriate comments to Patient B* and/or Person C* in that you said:

i. “Don’t worry Patient B*, I’m not touching your tits” or words to that effect;

ii. “Oh well I don’t practise safe sex anyway” or words to that effect.

 

3. The matters described in paragraphs 1 to 2 constitute misconduct and/or lack of competence.

 

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

Finding

Background:

1.  The Registrant was employed by the East Midlands Ambulance Service (EMAS) as a Bank Paramedic on a zero hours contract in 2013.  He has worked for EMAS for forty years and as a Paramedic in a wide variety of roles from 1993.  Concerns were raised about his clinical practice, record keeping and conduct towards two elderly patients on 28-29 November 2013. He attended Patient A at her home. Patient A had suffered a fall and was unable to stand. He failed to adequately complete the Patient Report Form (PRF) or to carry out an adequate assessment of her condition (a suspected neck of femur injury). He left her in the care of a neighbour for two hours instead of waiting until the ambulance he had requested had arrived to convey her to hospital.

2.   Later in the same shift, he attended Patient B, the resident of a care home, who suffered from advanced dementia. He did not adequately complete the PRF and he made the diagnosis of a urinary tract infection when her condition suggested a possible sepsis, a medical emergency.  He decided not call an ambulance and instead arranged a GP visit. Patient B was subsequently taken to hospital on the morning of 29 November 2013 after an ambulance was requested again.

3.   The matter was heard by the Conduct and Competence Committee of the HCPC on 27-31 July and 14 October 2015.  The full particulars of the Allegation are set out in the Notice of Decision and Order.  The Registrant accepted that his completion of the PRFs was below standard.  The panel found that his decision to leave Patient A unattended on the floor for two hours fell well below the standard to be expected of Paramedics. The panel also found that the Registrant’s failure to identify a possible sepsis fell well below the expected standard in the case of Patient B. He had failed to keep himself up to date with current professional paramedic practice.  The Registrant’s acts and omissions breached standards 1, 5 and 7 of the HCPC Standards of Conduct, Performance and Ethics. The facts were sufficiently serious to constitute misconduct.

4.   The Registrant was also subject to a Caution Order for misconduct in respect of inappropriate comments and contacts with a patient in 2009.The Caution Order expired on 9 November 2016. The panel at the final hearing was extremely concerned that the current matter had arisen when he was under a Caution Order for misconduct, albeit of a different kind.

5. The Registrant submitted evidence that he had maintained his professional skills by working part time for a private ambulance company.  He had also undertaken training courses relating to the diagnosis of sepsis and neck of femur fractures as part of his continuing professional development. The panel accepted that he was willing to address his misconduct.  However, he had limited insight or understanding of the reasons for his failings identified in the substantive hearing.   There was a distinct lack of rigour in his approach. He failed to demonstrate a proper understanding of the professional obligation to keep himself up to date with the guidance and policies relevant to his practice as a Paramedic.  There had been no independent evidence of the quality of his work since November 2013. There were risks to patients from incorrect diagnoses or incorrect treatment. The failure to complete the PRF to the required standard was also found to present a risk in regard to the continuity of patient care.

6. Accordingly, the panel found that the Registrant’s fitness to practise was impaired on both the personal and public components.

7. The panel imposed a Conditions of Practice Order for 9 months.  A Caution Order would not have provided sufficient public protection. The panel felt that the Registrant could work safely under Conditions of Practice. A Suspension Order or Striking-Off Order were neither necessary nor proportionate.  It was considered possible that the Registrant could work safely under conditions in the belief that he understood them.

8.   The terms of the Conditions of Practice Order imposed on 14 October 2015 were as follows:

1. You must place yourself and remain under the direct supervision of a workplace supervisor or supervisors, registered by the HCPC or other appropriate statutory regulator. Direct supervision means you must work alongside a workplace supervisor whenever you are contact with patients.

2. You must attend upon that supervisor as required and follow their advice and recommendations.

3. You must supply details to the HCPC of your workplace supervisor or supervisors within 7 days of the appointment of the workplace supervisor or supervisors.

4. You must work with your workplace supervisor or supervisors to formulate a personal development plan designed to address the deficiencies in the following areas of your practice:

A. Clinical decision making;
B. Risk management and “red flags”;
C. Record keeping;

5. Within one month of the appointment of the workplace supervisor or supervisors you must forward a copy of your personal development plan to the HCPC.

6. You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your personal development plan.

7. You must forward to the HCPC every three months a report from your workplace supervisor about your progress towards achieving the aims set out in your personal development plan.

8. You must promptly inform the HCPC if you cease to be employed/contracted or take up any other or further employment/contracts.

9. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer/anyone contracting with you to undertake professional work.

10. 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 your application);

C. Any prospective employer (at the time of your application).

11. You will be responsible for meeting any and all costs associated with complying with these conditions.

12. Any condition requiring you to provide information to the HCPC is to be met by you sending the information to the offices of the HCPC marked “for the attention of the Director of Fitness to Practise”.

9.  The first mandatory review of the Conditions of Practice Order took place on 14 July 2016.

10. On that occasion the panel heard that the Registrant had been working for “Hearts First” ambulance service as an Ambulance technician undertaking hospital transfers and providing first aid cover as a first responder “paramedic” in a medical team at events. He was employed on a short notice day-to-day basis for up to 20 hours per calendar month, so it had not been possible to arrange a Supervisor. The Registrant gave evidence that he had previously approached “Ambvale”, a private ambulance company that contracts with EMAS, and another similar company that is based in Hertfordshire, but neither company was prepared to employ him either as a Paramedic or as an ambulance technician with the existing Conditions of Practice in place. His job title when he undertook ambulance transfer work was ambulance technician.
11. When working at events, he worked as part of a first aid team, in which he did some work as a first aider and also as an ambulance technician.  He had also worked as a Paramedic but only when working with another Paramedic and under supervision. The work required him to undertake some diagnosis. When working at events, the Registrant was able to, for example, undertake blood sugar testing and administer glucose as an ambulance technician.  When working on transfers, he worked with an ambulance technician.

12. On the date of the first mandatory review, the Registrant had not complied with the conditions of practice imposed. When questioned by the panel, it became clear that the Registrant had thought that he would have to be engaged as Paramedic in order to carry out the previous Conditions of Practice.  However, under questioning, he accepted that he could apply for work as an ambulance technician under the supervision of a Paramedic.    He had not previously realised that he could have done that.

13. On 14 July 2016, the panel considered that there had been no significant change in circumstances since the substantive hearing in terms of the assessment of risk. There was positive evidence of the Registrant attending CPD courses, but the Registrant had not been able to find work that would enable him to comply with the Conditions of Practice Order. The panel was therefore not in a position to assess whether he had gained any further insight or whether he was ready to return to the strains of full-time practice. In the absence of any such information, the panel’s view was that the Registrant posed a continuing risk to patients and that his fitness to practice remained impaired.  The panel considered that the Registrant should be given a further opportunity to demonstrate his commitment to a return to practice in the light of his realisation that he could have sought employment as an ambulance technician under the supervision of a registered Paramedic.

14. A further Conditions of Practice Order for 12 months was imposed in similar terms to the original order, subject to amendments, as follows:

1. You must place yourself and remain under the supervision of a workplace supervisor or supervisors, registered by the HCPC or other appropriate statutory regulator. Direct supervision means you must work alongside a workplace supervisor whenever you are in contact with patients.

2. You must attend upon that supervisor or supervisors as required and follow their advice and recommendations.

3. You must supply details to the HCPC of your workplace supervisor or supervisors within 7 days of the appointment of the workplace supervisor or supervisors.

4. You must work with your workplace supervisor or a mentor, who must be registered with the HCPC as a Paramedic, to formulate a personal development plan designed to address the deficiencies in the following areas of your practice namely:

A. Clinical decision making
B. Risk Management and “red flags”
C. Record keeping.

5. Within one month of the appointment of the workplace supervisor or mentor, who must be registered with the HCPC as a Paramedic, you must forward a copy of your personal development plan to the HCPC.

6. You must meet with your workplace supervisors or a mentor, who must be registered with the HCPC as a Paramedic, every two months after their appointment to review your progress towards achieving the aims set out in your personal development plan.

7. You must forward to the HCPC every three months a report from your workplace supervisor or mentor, who must be registered with the HCPC as a Paramedic, about your progress towards achieving the aims set out in your personal development plan.

8. You must promptly inform the HCPC if you cease to be employed / contracted or take up any other or further employment / contracts.

9. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer / anyone contracting with you to undertake professional work.

10. 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)

C. any prospective employer (at the time of your application).

11. You will be responsible for meeting any and all costs associated with complying with these conditions.

12. Any condition requiring you to provide information to or obtain the approval of the HCPC is to be met by your sending the information or request for approval to the offices of the HCPC marked for the attention of the Director of Fitness to Practise.

15. The first reviewing panel considered that the next panel to review the order would be assisted by: an up to date report from the workplace supervisor or mentor detailing progress in relation to record keeping and clinical decision making; the submission of a reflective piece on clinical decision making using a recognised reflective model such as that by Gibbs or Kobh [sic]; evidence of progress in relation to record keeping and clinical decision making.

Decision

16.  This is the second review of the substantive Conditions of Practice Order, imposed on 14 October 2015 for 9 months.  It came into effect, following the appeal period, on 11 November 2015.  It was extended on 14 July 2016, subject to amended terms, for a period of 12 months.  It will therefore expire on 11 August 2017.

17. The Panel heard representations from Ms Brzezina on behalf of the HCPC. She highlighted that the Registrant had engaged regularly with the HCPC in his endeavours to remediate the situation.  He had regularly provided considerable amounts of information over the course of the last 12 months detailing his actions in dealing with patients, training courses attended, personal reflections, case studies and documents relating to record keeping. She acknowledged that he had made extensive efforts, but had been unable to obtain work which would have facilitated his compliance with the conditions imposed which required him to be supervised by a Registered Paramedic in the workplace. Whilst no formal personal development plan had been produced, she submitted that it is a matter in the Panel’s judgement as to whether the documentation produced and the activities undertaken by the Registrant amount effectively to a personal development plan which has adequately addressed the issues identified.

18. The Panel considered the evidence of the Registrant and the submissions of Ms Sharma on his behalf. 

19. The Registrant submitted documentary evidence in relation to his attendance on a wide variety of CPD courses, many of which were relevant to the complaint and failings identified. These included attendance on training courses related to sepsis, clinical record keeping and falls in older people. The Registrant was able to describe the learning outcomes of these courses and the practical application of his learning. The Registrant also produced  certificates of the training attended, testimonials in respect of patients treated since the last review, evidence of up to date completed PRF’s from First Aid Ltd regarding his management of incidents and reflective piece’s on clinical decision making (albeit these latter documents were in the Registrants own style).   Three references were produced, two of which were from the directors of First Aid Cover Ltd, namely Mr Guy Crofts and Mr Simon Nash who the Panel are told are both Registered Paramedics.

20. The Panel heard that due to the imposition of the conditions, the Registrant lost his position as a Paramedic for ‘Hearts First’ and they were unable to offer him work as an ambulance technician for the same reasons.  Since the last review the Registrant has continued his work for First Aid Cover Ltd, providing treatment  as a technician approximately 3 times per month, at events such as athletics, motorcycle, boxing, motorbike scrambling, equestrian events etc. This has allowed him to utilise his paramedic skills. However, he submitted that whilst the directors of this company were content to continue providing him with work, the Registrant had been advised that there would be limited opportunity to work with a Paramedic and they do not have any in-house training facilities. 

21. Nevertheless, the Panel noted that, on occasion the Registrant did work directly under their supervision at the events, all of his PRF and patient records are retained under their control and he had opportunities to discuss his patients with them and follow their instructions even when he was not working directly with them.  On the occasions when he did work with them, they allowed him to take the clinical lead as a Paramedic in order to demonstrate his clinical decision making,  risk management and identification of ‘red flags’ and record keeping. Evidence in respect of each of these areas of practice was produced in the Registrant’s bundle of documentation and he gave oral evidence in respect of his current insight into the failings identified, the learning from the training courses and his approach to clinical decision making. He gave specific examples of incidents when he has identified sepsis in patients and when he has effectively treated the elderly.

22. The Registrant also detailed his extensive efforts to secure alternative employment in order to fully comply with the conditions and access a formal training environment as follows:

• An application to Ambvale Ambulance Service for part-time work

• An application to two agencies, namely Medicas Ltd and Medic Now

• An application to Human Touch Ambulance Service in Stamford

• An application to Surrey Ambulance Service

• An application to Leicester Event Medical Ltd

• An application to EMAS

• An application to Central Medical Services

23. All applications seeking either Paramedic work or work as an ambulance technician have resulted in rejection due to the restriction on the Registrant’s practice.  Thus he submitted that has been unable to comply with the Conditions of Practice Order. He did not  recognise that Mr Croft and Mr Nash as Registered Paramedics,  had effectively been supervising his work for First Aid Cover Ltd, albeit on an informal basis, but he agreed that this was the situation when it was put to him.

24. The Panel received and accepted the advice of the Legal Assessor. 

25. The Panel noted the findings of the previous panels, namely that the Registrant’s fitness to practise was impaired by reason of his misconduct.

26. In undertaking its task today, the Panel is not undertaking a rehearing of the matters which were brought against the Registrant, nor going behind previous findings. The Panel reminded itself that its role is to conduct a thorough appraisal of whether the Registrant is fit to return to unrestricted practice. The decision as to what is the appropriate and proportionate disposal at this review hearing is a matter for its judgment alone. 

Impairment

27. The Panel accepted the advice of the Legal Assessor, had regard to the HCPC Practice Note “Finding that Fitness to Practise is Impaired”, dated July 2013 and noted the guidance in the case of Meadows v GMC [2007]1 All ER 1, and Council for Healthcare Regulatory Excellence (CHRE) v NMC and Grant [2011] EWHC 927.

28. It had previously been determined that the failings identified were remediable and that the Registrant had showed a willingness to address his misconduct, although previously, remediation was incomplete and the Registrant had failed to demonstrate sufficient insight.

29. The Panel noted that the Registrant has engaged extensively in the fitness to practise process both at the final hearing and in the ongoing period during which he was subject to the order. The Registrant was clearly nervous when giving his oral evidence and struggled with some of the language used in the conditions imposed previously, (for example, he was unfamiliar with formal Personal Development Plans and the Kohb Reflective Model). Nevertheless, on the basis of the evidence given the Panel was entirely satisfied that the Registrant had adequately addressed the areas of concern, such that the risk of repetition of the failings is now low.  He demonstrated insight into his failings when giving evidence and there was no longer any evidence of the minimisation of responsibility which had been identified previously. He had provided extensive evidence to demonstrate that he has developed professionally. In all of these circumstances, the Panel was satisfied that the Registrant had remedied the situation such that his fitness to practise is no longer impaired.

Order

ORDER: The Conditions of Practice Order against the registration of Mr Jeffrey D Hartop will lapse on its expiry on 11 August 2017.

Notes

 

Hearing history

History of Hearings for Mr Jeffrey D Hartopp

Date Panel Hearing type Outcomes / Status
14/06/2017 Conduct and Competence Committee Review Hearing No further action
14/07/2016 Conduct and Competence Committee Review Hearing Conditions of Practice
14/10/2015 Conduct and Competence Committee Final Hearing Conditions of Practice