Mr Andrew E Vaughan

: Paramedic

: PA04280

: Final Hearing

Date and Time of hearing:10:00 18/09/2017 End: 17:00 21/09/2017

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

: Conduct and Competence Committee
: No further action

Allegation

(As Amended at the Final Hearing):

During the course of your employment as a Paramedic with the Welsh Ambulance Service on 27 December 2013, you:

1. Did not attend to Patient A in a timely manner.

2. Did not take and/or ensure that appropriate equipment was taken to Patient A.

3. Did not provide appropriate care in moving to Patient A, in allowing him to be carried by non-clinical staff towards your ambulance.

4. Struck Patient A whilst they were being carried;
a) Once with a closed fist;
b) And once with an open palm.

5. The matters set out in paragraphs 1 - 4 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

Application to Amend the Allegation as detailed above

1. The Panel heard an application by Ms Shameli, on behalf of the HCPC, to amend Particular 3. No objections were received on behalf of the Registrant. The Panel received and accepted the advice of the Legal Assessor. It was satisfied that the amendments were necessary and desirable as they provided greater clarity and did not substantively change the nature of the Allegation. One typographical error was also amended in paragraph 3. The Panel was satisfied that the amendments were not prejudicial to the Registrant.
Application to Adjourn the Hearing

2. The Panel next heard an application by Ms Shameli, on behalf of the HCPC, to adjourn the hearing to 09.30 hours on Day 2 of the Hearing, in order that efforts could be made to secure the attendance of the HCPC witness known as DJ in these proceedings. She drew the Panel’s attention to the fact that the witness had not attended the hearing despite having been properly notified to do so. The witness had contacted the HCPC during the preceding week to express reservations about giving evidence due to an unrelated anonymous complaint that had been made against him in his professional capacity.  He had been reassured that those matters were not relevant to the current proceedings. The HCPC considered that the reassurances had been effective and, in light of this, the expectation was that the witness would attend the hearing and give evidence.

3. On the morning of day 1 of the hearing, telephone contact had been made on two occasions with the witness.  He had reported to a hearings manager, at the HCPC, that he had continued reservations about attending the hearing due to the anonymous complaint and a further separate investigation now being undertaken against him in his professional capacity, which related to the death of a close colleague.  He had indicated that, due to the associated pressures of these matters, he had sought medical advice and was very concerned about his ability to give evidence.

4. Ms Shameli submitted that, if the application was granted, then she anticipated that further enquiries could be made with the witness to establish whether a potential health condition was precluding him from attending the hearing or alternatively whether he would be willing to attend the following day, failing which, enquiries could be made as to whether he would give evidence by telephone.

5. There were no objections to the application on behalf of the Registrant.

6. The Panel accepted the advice of the Legal Assessor and had regard to the HCPC Practice Note, ‘Postponement and Adjournment of Proceedings’, dated September 2015 and the guidance in the case of CPS v Picton [2006] EWHC 1108.

7. The Panel noted that:

• the witness’s evidence was material  and relevant to the case;

• The HCPC had not been the cause of any delay in seeking to secure his attendance.  This matter had only arisen on day 1 of the hearing and could not have been anticipated;

• There was still a possibility that the witness may attend or engage in the hearing.  Further enquiries would be required in order to ascertain this with any degree of certainty and it was encouraging that the witness had been receptive to contact on the morning of the hearing;

• There were no objections to the application.

8. The Panel was mindful that it is in the public interest to deal with cases expeditiously and it was reassured that all parties in the case envisaged that the case could still be concluded within the time allocated.  In all of these circumstances, and given the serious nature of the Allegation, the Panel was satisfied that it would be in the interests of justice and fairness to both the Regulator and the Registrant to grant the application.  This decision takes account of the public interest in concluding cases expeditiously. The Panel was satisfied that any delay would be minimal and the decision would not be prejudicial to the Registrant. Accordingly, the case was adjourned until 09.30 hours on 19 September 2017.

Background

9. The Registrant is a registered Paramedic.  He was employed by the Welsh Ambulance Service NHS Trust (“the Trust”). At the relevant, time he worked at Swansea Ambulance Station as an operational Paramedic. He was based on an emergency medical service (EMS) rota. 

10. In January 2014, South Wales Police undertook an investigation into an alleged assault of Patient A which was said to have occurred on 27 December 2013 at the Oxygen Club (the Club), Swansea. As a result of the alleged assault, Patient A had sustained a fractured skull, a bleed on the brain and a punctured ear-drum. During the course of the police investigation, witness statements were taken and CCTV recovered from the Club.  From the CCTV footage, it was noted that the Registrant had come into contact with Patient A. Concerns in relation to the incident were highlighted to the Trust by South Wales Police.

11. No criminal charges were brought against the Registrant in this respect.

12. The Registrant was suspended from duties pending an internal investigation by the Trust. Additional concerns were identified during the course of the investigation in relation to the Registrants conduct towards patient A.

13. A referral was made to the HCPC by the Trust on 24 April 2015.

Decision on Facts

14. The Panel carefully considered all of the evidence in this case. It noted the submissions of Ms Shameli, on behalf of the HCPC, and Mr Harris, on behalf of the Registrant.  It accepted the advice of the Legal Assessor. On behalf of the HCPC, the Panel heard oral evidence from Witness DJ, and viewed CCTV footage relating to the activities which form the basis of the Allegation. The Registrant gave evidence on his own behalf and exhibited 7 calls between a member of the public, the emergency services, the ambulance control centre [ACC] and his ambulance in relation to the incident. The timings of these calls could not be established.

15. The Panel received two bundles of documentation from the HCPC, one comprising a case summary, correspondence with the Registrant and the witness statement of DJ, the other comprising 58 pages of exhibits.

16. The Panel disregarded any reference to incidents which do not form part of the Allegation and reminded itself that the burden of proving the facts is on the HCPC alone and that the standard of proof is the ordinary civil standard, namely the balance of probabilities.

17. The Panel noted the case of Enemuwe v Nursing and Midwifery Council [2015] EWHC 2081 and disregarded the findings of the internal investigation conducted by the Trust. Furthermore, the Panel ensured that it was not influenced in its deliberations by its knowledge of those internal processes.

Credibility of the Witnesses and Assessment of the Evidence

18. The Panel first assessed the credibility of the witnesses and the reliability of all of the evidence presented to it.

DJ

19. DJ, was one of the investigating officers in the internal investigation at the Trust. He had identified the further concerns referred to in the background (above) based on his interpretation of what was viewed on the CCTV footage.  However, he had no direct involvement in the incidents upon which the factual particulars of this case were based. He exhibited the CCTV footage and also certain documents and records obtained or produced during the internal investigation.  The Panel found his evidence to be credible and honest.  He spoke favourably about the Registrant both personally and professionally and demonstrated no animosity towards him.  However, the Panel found his evidence to be limited by:

• The delay between the incident occurring in December 2013 and his involvement in the internal investigation commencing in July 2015 approximately 18 months later;

• His inability to secure an interview with NW who was present with the Registrant during the incident;

• The fact that he had not secured copies of the incident log, the log of activity on the Mobile Data Terminal [MDT] screen in the ambulance, and a log of the timing of the 7 calls exhibited by the Registrant.  The HCPC had not obtained this evidence during its investigation either;

• His heavy reliance on hearsay evidence, in particular the witness statements which were obtained during the police investigation.  These were originally given to the police in respect of a different incident to the one before the Panel. The contents of those statements were therefore focused upon that incident. Those witnesses were not interviewed during the internal investigation so as not to prolong the matter further for the Registrant. However, these witnesses were not called by the HCPC to give direct evidence at the final hearing either.

The Registrant

20. The Registrant expressed his pride at having qualified as a Paramedic and having had a successful and unblemished career for over 26 years prior to this incident.  He is now retired but wishes to retain his professional registration, given how hard he worked to achieve it and the fact that he continues to be committed to, and proud of, his profession.

21. The Panel considered that the Registrant gave open, credible and honest evidence.  He gave a helpful account of the fluid nature of dealing with medical incidents in a busy city centre during the Christmas period.  His was the only direct evidence of events that evening. The Panel did not consider his oral evidence to be inconsistent with what was said during the internal investigation as the Registrant has had several years to reflect upon what happened and to elaborate upon his position. For example, the Registrant assisted the Panel in clarifying the setting inside the Club and the situation both inside and outside at the relevant time.

22. The Registrant’s evidence was potentially limited by the fact of the delay before the internal investigation at the Trust commenced. The Panel noted that the incident in question took place at the end of a busy 12 hour shift for the Registrant and until the matter was raised with him via the internal investigation, 14 months later, nothing particularly unusual had stood out in his memory about Patient A.

Hearsay

23. The Panel exercised caution in considering hearsay evidence.  In respect of the witness statements obtained during the police investigation, the Panel attached no weight to this evidence.  As stated above, these statements were taken in respect of the original assault of Patient A inside the Club, in which, the Registrant had no involvement.  Consequently, the focus of those statements was not on the issues before the Panel.

24. Bouncer A had been present during matters relevant to the Allegation, but had indicated a reluctance to attend the hearing.  He had also failed to respond to a Witness Order properly served by the HCPC.  His evidence, in some respects, corroborated the Registrants evidence and in other respects it conflicted with the Registrant’s evidence. Given that this evidence could not be tested, no reliance would be placed upon it. In respect of the other witness statements which were obtained during the police investigation, the Panel considered that they did little to take the case further and accordingly, no weight was attached thereto.

25. In respect of all other hearsay evidence, which included the documents, CCTV and calls exhibited, the Panel attached weight to the hearsay evidence, only to the extent that it was appropriate, and where this evidence was corroborated or consistent with other evidence received.

Findings in Relation to the Factual Particulars of the Allegation

During the course of your employment as a Paramedic with the Welsh Ambulance Service on 27 December 2013, you:     

26. The Registrant confirmed that he was employed with the Welsh Ambulance Service at the relevant time.  The witness evidence and the documentary evidence corroborated this fact.  Accordingly, the stem of the Allegation was found proved.

1. Did not attend to Patient A in a timely manner.

NOT PROVED   

27. On 27 December 2013, the Registrant and his colleague, NW, were dispatched in an ambulance to attend an incident at the Club. The Registrant was the Operational Paramedic on the crew and he was driving the vehicle. NW was the Emergency Medical Technician [EMT] and was the attendant on the crew. The dispatch code provided by the Ambulance Control Centre [the ACC] was 32D01 which means that there is an unknown problem with a patient where life status is questionable i.e. it is not known whether or not the patient is breathing. DJ told the hearing that this is a ‘Red 2’ call, which is in the category of calls which are in the highest priority and require the quickest response.  The aim is to attend within 8 minutes as it could mean the patient is not breathing. He could not give evidence as to when the code was received by the crew of the ambulance.

28. The dispatch code would ordinarily be displayed in the ambulance to the crew on the MDT screen. The Registrant’s evidence was that the code was not displayed on the MDT before they arrived at the Club. There was a delay in receiving the code and therefore he was not aware what the code was. Consequently, verbal information was obtained from the ACC upon his arrival. This information was that ‘a man had (query) been knocked unconscious’. There had been several calls to the emergency services about this incident and there was confusing information regarding another potential incident close by, at premises known as The Potters Wheel. It was unclear whether all calls related to the incident at the Club or whether there were two incidents, at the time the Registrant attended the scene of the Club. He therefore needed to clarify which potential incident was the priority.

29. The CCTV showed the ambulance arriving at the scene at 06:15:03.  It is approached by a police officer and members of the Club door staff who speak to the Registrant. At 06:16:06 the ambulance is moved across the road to align its doors with the doors of the Club. It is during the period between 06:16:06 and 06:17:06 (approximately 1 minute) that the Registrant asserts that calls were made from the cab to the ACC to clarify which incident they were required to attend.  The potential being that, if there was a separate incident outside the Potters Wheel, then it might be more serious than the one at the Club, and it might therefore be appropriate to prioritise attendance at that other incident (if there was one). The Registrant himself, was also making enquiries regarding the situation with the door staff/police.  At this stage he asserted that he was still not in receipt of the dispatch code. The door staff informed the Registrant that a man had been knocked unconscious inside the club but that he was now ‘kicking off’ inside.

30. At 06:17:06 the Registrant approaches the entrance to the Club, to ascertain that the scene is safe given the location is a club and it was the early hours of the morning during the Christmas period, and also given the information provided regarding the demeanour of the patient. At 06:17:13, approximately 2 minutes after his arrival, the Registrant enters the Club, with NW, in order to attend to Patient A.

31. The Panel accepted the Registrant’s evidence in this respect.  There was nothing to contradict his assertion that enquiries were being made in order to properly prioritise incidents and that the crew were told by ACC to ‘sit tight’.  This communication took 30 seconds during the 1 minute period when the ambulance was pulled up alongside the Club doors.  The Patient clinical Record (PCR), completed contemporaneously by NW, showed that the original call had indicated the potential patient was outside the Club, whereas the door staff indicated, when the crew arrived on the scene, that the patient was inside.  This adds weight to the Registrants assertion that a call to clarify the priority of the situation was required.

32. In all of these circumstances, the Panel did not consider that there was any undue delay associated with the timeliness of the Registrant attending to Patient A.  Accordingly, particular 1 was found not proved.

2. Did not take and/or ensure that appropriate equipment was taken to Patient A.

PROVED

33. DJ’s evidence was that, the Registrant knew before he entered the Club that he was dealing with a Patient who had potentially: imbibed alcohol; suffered an assault; sustained a head injury and suffered a loss of consciousness.  It was therefore appropriate that the following equipment be taken into the Club by the ambulance crew: the response bag; a suction unit; an oxygen bag and monitoring equipment.  The first three of these items may have been contained within one response bag.

34. The Registrant conceded that neither he nor his colleague took the response bag into the Club, that it was appropriate equipment in the circumstances known to him, and that one of them should have done so. He considered that NW would take the equipment bag into the Club as he was the attendant on the crew and the Registrant was the driver. The usual arrangement was for the attendant to take the bag as it was more easily accessible from the passenger seat where NW was positioned.

35. The Registrant’s evidence was that, immediately upon entering the Club, he noticed that NW had not brought the bag with him and he (the Registrant) therefore asked him to go and get it to ensure appropriate equipment was  taken inside. NW did not do so and the Registrant did not repeat his instructions. No equipment was taken into the Club. Accordingly, particular 2 was found proved.

3. Did not provide appropriate care in moving to Patient A, in that you allowed allowing him to be carried by non-clinical staff towards your ambulance.

NOT PROVED

36. DJ’s evidence was that, in the circumstances known to the Registrant at the relevant time, and, given that neither a head injury nor a spinal injury had been ruled out, a collar should have been placed around Patient A’s neck, he should also have been immobilised and transported to the ambulance on a stretcher. Failing which, at the very least a chair should have been used with a blanket to secure his limbs.

37. At 06:20:28 hours the CCTV shows Patient A being supported and moved by two members of the door staff in an upright position. At first his feet are seen dragging on the floor.  He is then seen walking whilst being supported and leaning towards the ambulance. The Registrant follows behind the Patient.

38. The Registrant submitted that, whilst he agreed the Patient should ideally have been placed upon a stretcher, it was not possible in the circumstances, as the patient was non-compliant and aggressive whilst inside the Club.  Patient A had refused to be transported to hospital and there were indications that he was confused as he thought he was in his own house.  The Registrant had explained to the door staff that it was not permissible for him to take Patient A to hospital against his will.  The Registrant still considered, at this stage, that it was important to get Patient A to hospital due to concerns that he had sustained a head injury. At that point, in order to remove Patient A from the Club which was about to close, the door staff had taken hold of Patient A and moved him in the manner observed on the CCTV.  Whilst inside the Club, Patient A had lifted his feet from the ground to frustrate the efforts to move him by refusing to walk, hence the fact that his feet can be seen dragging on the ground in the CCTV footage.

39. The Panel accepted the Registrant’s evidence that Patient A was aggressive inside the Club and refused to go to hospital.  In these circumstances, if he had attempted to immobilise Patient A he would have been in breach of Standard 9 of the HCPC Standards of Conduct, Performance and Ethics 2012 (which provides for informed consent to care).  Furthermore, in the circumstances described, the Registrant had no power to prevent the door staff from removing the patient from the Club.  He had no authority over them, therefore this was not a situation where he ‘allowed’ them to remove the patient.

40. The Panel considered that the CCTV footage supports the Registrant’s evidence that patient A was not compliant.  He can be seen dragging his feet and then walking to the ambulance.  This is consistent with the description given by the Registrant that Patent A lifted his feet inside the club to frustrate attempts to move him.  The Registrant was balancing a number of issues whilst inside the Club and the Panel accepted that his priority was to get him to hospital due to the head injury, which is what he did.  From exiting the Club there was minimal distance to the ambulance.  The Registrant ensured that the presence of Patient A was secured in the ambulance (a safe, quiet, clinical environment) in order to obtain his agreement to being transported to hospital. In the view of the Panel, this was appropriate care of Patient A in the circumstances described.  Accordingly, particular 3 was found not proved.

4. Struck Patient A whilst they were being carried; 
  
a) Once with a closed fist;
b) And once with an open palm.

PROVED

41. The Registrant admitted both limbs of this particular at the outset of the hearing. He accepted that he had come into improper contact with Patient A once with a closed fist and once with an open palm.  However, he did not think that that either incident amounted to ‘striking’ Patient A, given the lack of any force or malice involved.  He was unable to explain his conduct in this respect and was very remorseful thereof.  He thought he was just trying to move the patient forward towards to ambulance.

42. The Panel took judicial notice of the definition of ‘striking’ contained in the Oxford English Dictionary which states that it is ‘ to hit forcibly  and deliberately with one’s hand…’.

43. The CCTV showed two incidents of contact between the Registrant’s hand and Patient A’s back.  They were clearly a punch and a push delivered deliberately with limited force and no clear provocation. Patient A did not respond in any way to this contact. Accordingly, Particulars 4(a) and 4 (b) are found proved.

Decision on Grounds

Misconduct - Proved in respect of Particular 4

44. The Panel next determined whether the facts found proved amounted to misconduct. The Panel accepted the advice of the Legal Assessor. It bore in mind that there is no standard of proof to be applied at this stage; consideration as to whether the threshold for misconduct has been reached is a matter for its own judgment. In considering the ground, the Panel first considered the individual particulars found proved and then the behaviour in the round.

45. The Panel had specific regard to the helpful guidance provided in Roylance -v- GMC (No 2) [2000] 1 AC 311, Meadows v GMC [2007] QB 462 and Shaw v GOsC [2015] EWHC 2721. It noted that misconduct involves an act or omission which falls short of what would be proper in the circumstances and that in order to amount to misconduct, the act or omission needs to be serious and one which would attract a degree of strong public disapproval.

46. The Panel then considered whether the proven facts amounted to breaches of the HCPC Standards of Conduct, Performance and Ethics 2012 (“the HCPC Standards”), and/or breaches of the HCPC Standards of Proficiency applicable to Paramedics 2012, which were relevant at the time. It bore in mind that breaches of any of these Standards did not, in themselves, necessarily constitute misconduct. 

47. The Panel determined that the following HCPC Standards had been breached:

 1. You must act in the best interests of service users

 13. You must … make sure that your behaviour does not damage the  public’s confidence in you or your profession.

48. The Panel also determined that the following HCPC Standards of Proficiency applicable to Paramedics had been breached:

Registrant paramedics must:

1a.1 be able to practise within the legal and ethical boundaries of  their profession
 - understand the need to act in the best interests of service users at all  times
 1a.8 understand their obligation to maintain fitness to practise
 - understand the need to maintain high standards of personal conduct

Particular 2

49. The Panel accepted the Registrant’s description that the scene inside the club was as follows:
When the Registrant entered the Club, Patient A was conscious and seated on the stage which was approximately 10 metres away from the doors through which he and his colleague had entered. This is corroborated by the PCR. They could immediately see the patient was conscious. Upon seeing the ambulance crew, Patient A rose to his feet and behaved aggressively towards them, including spitting at them and trying to kick them.  The Registrant did not therefore reiterate his instructions to NW to retrieve the response bag, as he had assessed the scene and determined that the patient was breathing, standing, displaying aggression and refusing to allow the crew near him.  In these circumstances, there was no reason to use any equipment other than possibly oxygen therapy, and no capacity for using any equipment in any event, given the demeanour of the patient.  The priority was to focus on getting him to hospital as he had a head injury and the patient was refusing to be taken. In these circumstances, the Panel did not consider that the Registrant’s failure to ensure equipment was taken to Patient A amounted to a serious lapse or misconduct.

Particular 4

50. The inappropriate contact between the Registrant and Patient A described in sub particulars 4(a) and 4 (b) forms part of the same action in which the Registrant punched and pushed the patient.  The blows were of limited force, Patient A did not react in any way to them and there was no suggestion that he was injured by them.  Nevertheless, in striking Patient A, the Registrant committed an inexcusable act and breached a fundamental tenet of the Paramedic profession. The Panel was satisfied that the Registrant’s action was a serious lapse which would inevitably attract a degree of strong public disapproval.  Accordingly, misconduct was found proved in respect of this particular.

Lack of Competence - Not Proved

51. Having determined that one of the proven facts in particular 4 amounted to misconduct, the Panel next considered whether the proven facts amounted to the alternate statutory ground of lack of competence. The Panel noted the submissions of the advocates in this respect and accepted the advice of the Legal Assessor.  It considered the guidance in the case of R (on the application of Calhaem) v GMC [2007] EWHC 2606 (Admin).

52. The Panel noted that, the incident which forms the basis of the particulars found proved, comprises one incident in an otherwise unblemished career spanning over a quarter of a century. This does not represent a fair sample of the Registrant’s work and accordingly, lack of competence is not proved.

Decision on Impairment 

53. The Panel next determined whether, by reason of his misconduct, the Registrant’s fitness to practise is impaired. The Panel accepted the advice of the Legal Assessor and had regard to the HCPC Practice Note “Finding that Fitness to Practise is Impaired”, dated March 2017. It bore in mind that not every finding of misconduct will automatically result in a conclusion that fitness to practise is impaired and noted that impairment is ‘forward looking’.  The Panel had specific regard to 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.

54. The starting point for the Panel was that the misconduct identified was serious. The Registrant breached a fundamental tenet of his profession. The standard of the Registrant’s professional practice fell far short of what would be expected of a registered Paramedic on 27 December 2013.

55. The Panel first considered whether the Registrant’s fitness to practise is currently impaired on a personal basis. It determined that the failing identified was remediable.  Whilst the failing was serious, it related to one patient, no actual harm could be identified and no other concerns had been raised in relation to the Registrant’s conduct or performance in a career which spanned over 26 years. Specifically, there had been no repetition of the misconduct between 2013 when the incident happened and 2015 when the internal investigation began.  During this period the Registrant continued to practise without incident until his retirement.

56. The Registrant expressed a significant degree of remorse throughout his testimony.  He described the incident as ‘regrettable’, ‘dreadful’ and the ‘worst incident of [his] life’. He demonstrated insight and also recognised the damaging impact his misconduct would inevitably have upon on the profession.  The Panel also had regard to two references, submitted on behalf of the Registrant, which attested to the high standards of his professional abilities and to positive personal qualities. In these circumstances, the Panel was satisfied that the misconduct had been remedied and that there was no risk of repetition of the failing identified. Accordingly, the Panel did not consider that the Registrant’s fitness to practise was currently impaired on a personal level.

57. The Panel then went on to consider whether the wider public interest dictated that a finding of impairment was required in this case. The Panel is satisfied that the public interest is engaged. The public are entitled to have confidence that they will not be assaulted when attended to by a Paramedic. The Registrant’s misconduct was such that it presented a risk to the reputation of the department within which he worked and the Paramedic profession as a whole. The wider public interest in upholding proper professional standards and public confidence in the profession and the regulatory process would be undermined if a finding of impairment was not made in these circumstances.

58. Accordingly, the Panel finds that the Registrant’s fitness to practise is currently impaired in the wider public interest.

Decision on Sanction

59. The Panel considered the submissions made on behalf of the HCPC and the Registrant.  It accepted the advice of the Legal Assessor.

60. The Panel is aware that the purpose of any sanction is not to be punitive, though it may have a punitive effect. The Panel has borne in mind that its primary function at this stage is to protect the public, while reaching a proportionate sanction, taking into account the wider public interest and the interests of the Registrant. The Panel has taken into account the HCPC Indicative Sanctions Policy (the’ISP’) and applied it to the Registrant’s case on its own facts and circumstances.

61. The starting point for the Panel was that the misconduct was serious. It constituted breaches of the HCPC Standards of Conduct, Performance and Ethics and the Standards of Proficiency applicable to Paramedics.  The failing identified also amounted to a breach of a fundamental tenet of the profession.

62. The Panel identified the following aggravating factors in this case:

• The Registrant has damaged the reputation of the profession such that a finding of impairment was necessary on public interest grounds. In particular the public must have confidence that they will not be assaulted when attended to by a Paramedic.

• This was an unprovoked assault on a vulnerable patient by a professional who had primacy of care.

63. To balance against those issues, the Panel identified the following mitigating factors in this case:

• This was an isolated incident which was out of character for the Registrant.

• The Registrant had practised without any other incident, or concerns being raised as to his conduct or competence, for over 26 years. Notably, the Registrant worked for 14 months after this incident without concern before the matter was drawn to his attention.

• No harm was caused to Patient A, and the Panel accepts that the Registrant did not intend to cause harm. Patient A appeared to be entirely unaware of being struck.

• The Registrant provided two references which attested to his professional expertise, excellent interpersonal skills and positive personal attributes.  In particular the Registrant’s kindness to patients was noted.

• The Registrant was found not to be impaired in relation to the personal component and thus is a safe and competent practitioner who does not pose a risk to patients or the public.

• He admitted to his misconduct at the outset of the proceedings.

• He expressed significant remorse into the failing identified.  He described it as being the worst incident of his life.  He said he was disgusted with it. No risk of repetition has been identified.

• The Registrant recognised the impact of his behaviour upon the reputation of the profession. Furthermore, the Panel was satisfied that the internal investigation at the Trust and the HCPC’s proceedings, in themselves, have had a significant effect upon the Registrant.  The Panel had little doubt that they would have caused him to reflect even further on his conduct; he thus had insight into his failings;  In light of all of these matters, the Panel has considered what sanction, if any, should be applied, in ascending order of seriousness.

No Further Action

64. The Panel took the view that this was a case that could be appropriately dealt with without a sanction. For the reasons already stated in its determination on Misconduct and Impairment, the Panel is satisfied that this is one of those exceptional cases where a finding of impairment on public policy grounds is sufficient to mark the seriousness of the matter and will be a constant reminder to this Registrant that his actions towards Patient A were unacceptable. The Panel noted the significant mitigation put forward on behalf of the Registrant and accepted that this incident constituted a ‘moment of madness’ which caused no harm to Patient A and will not be repeated.  The Panel is satisfied that knowledge of the internal disciplinary and HCPC regulatory processes will have had a sufficiently deterrent effect on other professionals in the circumstances described.  Notably, the matter has been outstanding and hanging over the Registrant for in excess of two and a half years.

Caution

65. The Panel did consider whether a minimal sanction, such as the imposition of a caution, might be an appropriate alternative and noted from the ISP that a caution was considered 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.”

66. However, although the Registrant’s case mirrored some of the factors mentioned above, the Panel concluded that the imposition of a caution was unnecessary; it would serve no useful purpose which had not already been addressed in the reasons at paragraph 64. In those circumstances, the Panel did not see any additional advantage in imposing any formal sanction over and above its finding of impairment, which it considered was sufficient in the particular circumstances of this case, to mark the seriousness of the matter, to remind the Registrant of the unacceptability of his actions and to deter others.

Conditions of Practice/Suspension/Strike Off

67. The Panel is satisfied that taking no action is an appropriate and proportionate outcome in the circumstances. The responsibility to protect the public and maintain confidence in the profession and the regulatory process has been satisfied.  The Panel considers that to impose any sanction at this stage would be unduly punitive and serve no useful purpose given that both the public interest and the interests of the Registrant are satisfied by this outcome.

Order

No information currently available

Notes

No notes available

Hearing history

History of Hearings for Mr Andrew E Vaughan

Date Panel Hearing type Outcomes / Status
18/09/2017 Conduct and Competence Committee Final Hearing No further action