Mr David A Prideaux

: Paramedic

: PA04711

: Final Hearing

Date and Time of hearing:10:00 13/11/2017 End: 17:00 15/11/2017

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

: Conduct and Competence Committee
: Struck off

Allegation

During the course of your employment as a Paramedic with Yorkshire Ambulance  Service;
1.  On the 25 January 2016 you attended an incident, and you;
a)  Did not take a defribrillator to the patient;
b)  Did not initially give the patient Oxygen;
c)  Did not make substantial efforts to resuscitate the patient; and/or
d)  Were unfit for duty and withheld this information from your line manager.

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

3. By reason of your misconduct and/or lack of competence, your fitness to practise as a Paramedic is impaired.

Finding

Preliminary matters   
Service
1. The Panel is satisfied that there has been good service of the Notice of Hearing. A letter was sent to the Registrant’s registered address giving notice of these proceedings on the 14 July 2017.

2. The Registrant did not attend the final hearing.

Proceeding in absence
3. The Panel first considered whether it ought to exercise its discretion to continue with the hearing, in the absence of the Registrant. The Panel concluded that it was in the public interest to do so, having considered the HCPC Practice Note on ‘Proceeding in the Registrant’s Absence‘, having taken the Legal Assessor’s advice, and considered the guidance in R v Hayward [2001] EWCA Crim 168; R v Jones [2002] UKHL 5, GMC v Adeogba and GMC v Visvardis [2016] EWCA Civ 162, for the following reasons:
(a) The Panel was satisfied that the Registrant had notice of the hearing.
(b) The Registrant indicated that he did not intend to attend the hearing in the Response Proforma: Service of Papers document. This Panel has also seen correspondence dated the 26 July 2017, 10 August 2017 and the 30 September 2017 in which the Registrant makes it clear that he will not be attending the final hearing.   
(c) The Panel was of the view that, even if these proceedings were adjourned, there is very little likelihood that the Registrant would attend on a subsequent occasion, noting that he had not requested an adjournment.
(d) The Panel concluded that the Registrant has deliberately chosen not to take part in these proceedings and voluntarily absented himself.      
(e) There are witnesses who have attended these proceedings and the Panel are mindful of the effect of delay on the memory of the witnesses, if the case were to be adjourned.    
(f) The Panel determined that it was reasonable and in the public interest to proceed today in the circumstances, given the time lapse since the allegation, the seriousness of the allegation and the fact that witnesses have attended today to give oral evidence.

4. The Panel has been provided with a substantive bundle of documents which runs to 198 pages from the HCPC. The Panel has also been provided with a small bundle of representations by the Registrant, consisting of a letter dated 02 December 2016.     

Background
5. The Panel has heard oral evidence from the following witnesses on behalf of the HCPC:
(a) Witness 2, Clinical Supervisor, in the A&E Operations Department at Yorkshire Ambulance Services NHS Trust (hereafter ‘the Trust’),
(b) Witness 3, Interim Locality Manager at Hull & East Riding Area (A&E Operations) at the Trust. 

6. Witness 1, Locality Manager, in the A&E Operations South Clinical Business Unit at the Trust, was unable to give oral evidence before the Panel for reasons concerned with both her husband’s, and her own health. This was evidenced by an Occupational Health report dated the 08 November 2017. The Panel has seen a signed witness statement from Witness 1.

7. The Panel was very conscious that when a witness has not given oral evidence, their evidence is hearsay. When considering hearsay evidence, which is admissible in these proceedings, the Panel has paid due regard to the weight which can be attached to it, bearing in mind that it has not been possible for that evidence to be challenged or probed, in cross-examination. The Panel has, in respect of each of the Particulars, sought to corroborate the Allegation where possible through documentation, and the oral evidence it has heard.

8. The Panel heard and accepted the Legal Assessor’s advice and exercised the principle of proportionality at all times. In approaching the task of deciding the facts, the Panel has kept at the forefront of its deliberations, the importance of requiring the HCPC to prove matters against the Registrant. The standard of proof to which the HCPC is required to prove matters is the civil standard – on the balance of probabilities.

9. The Registrant was employed by the Trust as a Band 6 Paramedic Practitioner, although only qualified as a Band 5 Paramedic. He worked on a Rapid Response Vehicle (RRV), which is a single crewed vehicle designed to reach a patient as soon as possible. He was based at Hull East Ambulance Station and was responsible for providing emergency care to all patients who contacted the Trust, using the 999 emergency contact line. 

10. The Registrant self-referred to the HCPC on the 02 February 2016. 

11. The Allegation arises out of an emergency call which took place on 25 January 2016. The Registrant was asked to attend a call out to a patient who was having a cardiac arrest. The call out was also attended by Witness 2, who later raised concerns with his line manager, about the actions of the Registrant during the call out. A subsequent internal investigation was undertaken by Witness 1.  Witness 3 was an Interim Locality Manager who gave evidence concerning her management of the Registrant’s ill health absence and discussions around his condition.   

12. The Panel was impressed with the evidence it heard from Witness 3 on behalf of the HCPC. Her evidence was of high quality. She was both considered and candid in the responses she gave to the Panel.

13. Witness 2’s evidence was of slightly less assistance to the Panel. Although he was able to corroborate other witnesses on key matters pertaining to the factual Particulars of the Allegation, the Panel found his evidence in certain key regards to be vague and imprecise, such as in relation to the timings of his attendance at the patient’s address, and on details pertaining to the training (and annual refresher training) provided to Paramedics by the Trust.  

14. The Panel noted the allegation, in the Registrant’s letter, dated 10 August 2017 that Witness 2 had: “been targeting me for a few months”. In giving evidence, Witness 2, stated that he had not made any previous complaints about the Registrant, nor did he have any other concerns about the Registrant. They were based at different ambulance stations and worked together only infrequently. Witness 2 denied that he had targeted the Registrant. The Panel found no evidence that Witness 2 was targeting the Registrant. The Panel did exercise some caution where his evidence was not corroborated either by other documents or witnesses.  

15. The letter from the Registrant, dated 02 December 2016, states that he has now taken early retirement, commencing on 30 April 2016. The only information available regarding his current employment, is that he says he has a part time contract with a local company, teaching first aid. He adds: “I have no desire, nor am I fit enough, to perform any Ambulance related duties, NHS or private.” The Panel has not seen any documentation to confirm this employment or a reference from his current employer. In addition, there is no up to date medical evidence regarding the Registrant’s health condition.            

Decision on facts
Particular 1(a) - found proved 
16. The Panel finds this Particular proved. It is not in dispute that the Registrant did not take the defibrillator from the RRV into the patient’s home.

17. A defibrillator is used to monitor a patient’s heart rhythm. Where a patient has a heart rhythm that is deemed “shockable”, the defibrillator is used to provide shocks to the patient, with the aim of returning the heart to a normal rhythm.  A defibrillator is part of the first line of treatment for a patient presenting with a cardiac arrest. Witness 2’s evidence was that early defibrillation is an intervention that is understood to unequivocally improve survival. 

18. The Panel has seen the Joint Royal Colleges Liaison Committee (JRCALC [2013]) Advanced Life Support (ALS hereafter) algorithm. ALS is the management of a cardiac arrest that utilises defibrillation, the use of drugs, advanced airway techniques and addresses reversible causes. The guidance on ALS, provides that, in cases of cardiac arrest: “The interventions that unequivocally improve survival are early defibrillation and effective basic life support”. Attendance at a cardiac arrest should focus on these issues. Table 2.4 sets out the guidance on the assessment and management of adult ALS. It provides that in the case of cardiac arrest, Cardiopulmonary Resuscitation (CPR) with chest compressions must be commenced while ventilating with high concentration oxygen and a defibrillator should be used to diagnose the heart rhythm following the application of self-adhesive pads to the chest.

19. There is also a Yorkshire Ambulance Service Resuscitation Policy, which sets out the procedures for clinical staff in the management of cardiac arrest. This sets out the protocol for ALS. Appendix E outlines that CPR must be commenced at a ratio of 30 chest compressions to 2 ventilations and a defibrillator/monitor must be attached the patient.

20. Although the Trust had no specific policy which sets out what equipment must be taken to an incident, the Yorkshire Ambulance Service Clinical Catch Up (Issue 65) provides: “Solo responders must take a minimum of the Green bag and a Lifepak 1000 defibrillator when attending a patient”. The required contents of the green bag are set out in the Yorkshire Ambulance Service Equipment Packing Lists.   

21. The Registrant was the first responder to arrive at the scene. The Registrant would have been aware from his training and the above documentation of the importance of the early use of a defibrillator in a cardiac arrest. There was a defibrillator (Lifepak 1000) on the RRV, which the Registrant should have taken from the vehicle and into the patient’s home.

22. During the internal investigation, the Registrant made the following statement: “On attending I took in the big green bag that contained the oxygen and bag and mask and most of my drugs, I did not take anything else because the fire brigade First responders were following me down the path I assumed they had the defib[rillator]. I find it almost impossible to carry the green bag the resuscitation bag and the defib[rillator] such a long distance due to a long term [health condition] that I am still receiving treatment.” 

23. The Registrant’s letter dated 10 August 2017 admits that he did not take the defibrillator “…into the job…but this was due to the worsening of my [health] condition I was only just able to take in the green bag, and that was with a great deal of pain and discomfort.”

24. The Registrant’s letter dated 02 December 2016 states that on the day of the incident he was experiencing a health condition and that he struggled even to take the green bag into the property.  The room was very tight and he ventilated the patient whilst the Fire Community Responders commenced chest compressions.

25. Other professionals also attended the home of the patient. These included Fire Community Responders, Witness 2 in his role as Clinical Supervisor, and a Double Crewed Ambulance. The Sequence of Events document, appears to shows that the Fire Community Responders arrived on the scene 54 seconds after the Registrant.

26. As the first Trust responder onto the scene, the Registrant should have taken the defibrillator with him. There may be circumstances, where a responder arrives after other responders, where they are aware that other responders have taken the necessary equipment onto the scene, where it might be acceptable not to take their equipment. If a responder is not certain what equipment is available, then all necessary equipment should be taken with them. Until a responder is with the patient he or she would be unaware what equipment was in situ or required, hence it is imperative that the responder takes his or her own equipment to the patient. This would allow the responder to commence advanced life support.

27. The evidence from Witness 2 was that when he arrived there was no  defibrillator on scene. The defibrillator, which was subsequently used on the patient, was brought into the house by Witness 2. There is no evidence that the Fire Community Responders took a defibrillator into the patient’s home.  

28. Witness 2 describes that when he arrived on the scene, he found the patient was in the bathroom. The Registrant was at his head with a bag valve mask, doing ventilations. A Fire Community Responder was doing chest compressions. Witness 2 returned to his vehicle to obtain his gloves, leaving the defibrillator. Upon his return, he asked the responders for an overview, and specifically about the patient’s heart rhythm. It was at this point he discovered that a defibrillator had not been attached to the patient and he proceeded to check the patient’s heart rhythm and noted that he was in asystole. This is a non-shockable rhythm, meaning there is no electrical activity in the heart. All subsequent attempts at resuscitation were unsuccessful and the patient was recognised as life extinct at the scene.       

29. By not taking the defibrillator into the patient’s home, the Registrant caused a delay in the attachment and use of the defibrillator. This was potentially very serious, although it cannot be said whether in fact this would have made any difference to the outcome for the patient.       

Particular 1(b) – found proved
30. The Panel finds this Particular proved.

31. The evidence from Witness 2 was that after attaching the defibrillator and continuing to perform CPR, he asked the Registrant if the patient’s airway was good, and whether the patient had been administered any oxygen. On a visual inspection, he noted that the oxygen had not been connected to the bag valve mask. Witness 2 asked the Registrant to connect the oxygen. He replied that he “could only do one thing at a time.” The bag containing the oxygen was at the Registrant’s right elbow, but he could not reach it. Witness 2 lent over the Fire Community Responder who was performing CPR to get hold of the oxygen cylinder, and the Registrant then connected the piping to the cylinder.

32. The Panel was shown a sequence of events document which was discussed with Witness 2.  The Panel noted that the timings may not be entirely reliable as, for example, they may note the arrival of a vehicle at the address rather than the time a responder reached the patient.  Nonetheless, this evidence is important in establishing the events during the critical time-period. 

33. The first key entry, recorded at 08.58.08 states that Call Sign PN1928 arrived on scene at 08.58.06.  Witness 2 confirmed that this was the Registrant and this is also confirmed at the start of the sequence of events document. 

34. Subsequently at 08.59.07 Call Sign PCR25 is noted as arriving at 08.59.00.  This appears to represent the Fire Community Responder and Witness 2 agreed that seems to be the case. Therefore, within the margin of error of the document the Fire Community Responder arrived 54 seconds after the Registrant. 

35. Then Call Sign N1972, confirmed as Witness 2, arrived at 08.59.15 (noted at 08.59.20) so 15 seconds after the Fire Community Responders and 1 minute 9 seconds after the Registrant. 

36. Finally, Call Sign N1621, the crewed ambulance, is noted as arriving at 09.04.35.

37. Witness 2 gave evidence that he arrived approximately 3 minutes after the Registrant, having been given that information by his control. The Panel finds this unlikely given the sequence of events document, although is satisfied that Witness 2 was passing on information he had received informally in good faith. 

38. The Panel concludes that there was a delay in attaching oxygen, but that this was a short delay in the context of a fast moving emergency situation. The Panel is supported in this view by Witness 2’s report of the Registrant’s comment being ‘I can only do one thing at a time.’

39. Oxygen should be administered to a patient in cardiac arrest at the earliest opportunity and it forms part of the ALS protocol (Appendix E Yorkshire Ambulance Service Resuscitation Policy) that oxygen should be administered during CPR. The JRCALC UK Ambulance Service Clinical Practice Guidelines 2013 state that in the assessment and management of adult ALS, once a cardiac arrest is confirmed the clinician should: “ventilate with high concentration oxygen”. This is because hypoxia is a reversible cause during a cardiac arrest and supplementary oxygen assists in keeping the tissues and organs perfused. 

40. The Panel has also seen the Yorkshire Ambulance Service Resuscitation Policy, Appendix E (under the heading CPR). This states: “Give Oxygen.”

41. The Registrant’s letter, dated 02 December 2016, admits that Witness 2 asked him about the oxygen. He says: “I said I was unable to connect it (due to the fact I couldn’t twist to obtain it), he leaned over took out the cylinder and connected it up, I considered this act to be helpful.”

42. The Registrant’s letter, dated 10 August 2017, states: “I was able to ventilate the patient whilst a Fire Fighter commenced chest compressions, but as I got down to the patient [due to a health condition] I was unable to even turn within the tight area to connect the oxygen up to the BVM.”

Particular 1(c) – found not proved
43. The Panel found this Particular not proved. The Panel has already found proved that the Registrant should have taken the defibrillator into the patient’s house, and that he did not initially provide oxygen to the patient. To some extent, the Panel felt that this Particular could be regarded as a “catch all” - being somewhat ambiguous and imprecisely worded, potentially encompassing both the above Particulars. The Panel has therefore disregarded the factual issues pertaining to the defibrillator and the oxygen, and looked to ascertain any additional evidence that the Registrant did not make substantial efforts to resuscitate the Registrant.
  
44. The HCPC’s case was that the Registrant should have commenced ALS if he believed that the Fire Community Responders were competent to carry out Basic Life Support (BLS).

45. In the Registrant’s statement for the internal investigation, he says that he and the two Fire Community Responders: “commenced BLS with myself securing the airway (OP airway) and doing inflations at the CPR usual rate of 30/2.” The Fire Community Responders are trained in BLS and who, according to the Registrant, had followed him down the path into the patient’s house.

46. Secondly, it is alleged that the Registrant did not take the bag containing the necessary resuscitation drugs to the patient. The Registrant’s statement for the internal investigation confirmed that he had only taken: “…the big green drug bag that contains oxygen and bag and mask and most of my drugs, I did not take anything else…I find it almost impossible to carry the Green bag the resuscitation bag and the defib…”

47. The HCPC allege that without the resuscitation drugs, a patient would not be given the best chance of survival during a cardiac arrest, as certain drugs available could potentially reverse the possible cause of the cardiac arrest. The resuscitation drugs were taken to the scene by one of the Paramedics on the Double Crewed Ambulance.

48. Witness 2’s evidence was that the Registrant failed to ensure that CPR was performed at the correct ratio. The YAS Resuscitation Policy and JCALC ALS Guidelines state: For shockable rhythms defibrillate and resume chest compressions (30:2) for 2 minutes without reassessing.

49.  In his internal investigation fact finding interview, Witness 2 states that this was not in fact what was taking place. “The fireman was just doing chest compressions and DP [the Registrant] was just doing breaths. There was no 30 to 2 being done.”

50. Witness 2 confirmed in oral evidence, that in his view that the 30:2 ratio was not being complied with by the Fire Community Responders and that the Registrant was not taking steps to ensure the correct ratio was being administered, but was ventilating the patient. 

51. The Registrant, in his letter 02 December 2016 disputed Witness 2’s evidence on this issue: “A Fire Fighter commenced effective chest compressions, despite what is in the statement by NS a ratio of 30:2 was being carried out on his arrival.” 

52. The Panel did not feel it was able to resolve this dispute of fact, as to whether the appropriate CPR ratio was being strictly complied with, throughout the actually short period in which it was being administered to the patient.  On this basis, the Panel was not able to conclude that the HCPC had discharged the burden of proof to make a finding that substantial efforts had not been made to resuscitate the patient.

53. Similarly, the Panel found there was insufficient evidence to conclude that the presence or absence of resuscitation drugs would have any impact on the question of whether substantial resuscitation efforts were made in those initial few minutes. 

54. The evidence from Witness 2, as the Clinical Supervisor, was that when he arrived at the scene, efforts were being made to resuscitate the patient. The patient’s airway was being managed, he was being ventilated and CPR was taking place. The Panel concluded that it was highly significant that having arrived at the scene, and having observed the initial treatment being provided, Witness 2, as the Clinical Supervisor, concluded the situation was sufficiently under control, that it was appropriate for him to return to his vehicle, to obtain his gloves. Had he formed the view, on his arrival, that substantial efforts were not being made to resuscitate the patient, the Panel concluded that he would have intervened straight away.

55. The Panel, in these circumstances, concluded that efforts were being made to resuscitate the patient and could not find on the balance of probabilities that any failings in relation to the resuscitation bag or the CPR ratio were such that it could be said with any confidence that the efforts which were being made, were insubstantial.       

Particular 1(d) – found proved
56. The Panel found this Particular proved.

57. The HCPC’s case is that by not being able to carry the required minimum level of equipment from the RRV to the patient, that the Registrant was not fit for duty.

58. The Registrant had a long standing health condition. This has resulted in periods of absence from work over a number of years. The Registrant had disc damage which was not anticipated to improve.  The Registrant’s letter, dated 02 December 2016, says that he was assaulted at work in 2013 and that this exacerbated his condition.

59. The Trust’s Wellbeing Strategy states that the onus is on the employee to take responsibility for managing their own health, safety and wellbeing; to recognise the limits to what they can do; to seek advice promptly about fitness to work when symptoms arise; and to raise any issues of concern with their line manager, HR or a senior manager.

60. The HCPC’s case is that the Registrant should have requested the assistance of his colleagues when his health condition arose. It was a difficult situation, as he was in a small bathroom, surrounded by equipment, colleagues and the patient. However, if a Paramedic’s health condition undermines their ability to provide treatment to a patient, they have the ability to inform the control centre that they require assistance, via a radio and/or a mobile telephone.   

61. Witness 3’s evidence was that if the Registrant was unfit for work, he should have let his employers know about his health condition, and/or gone off sick. If the Registrant became unwell during the visit, he should have contacted the control centre who would have sent an alternative vehicle, over the radio. Witness 3 gave a previous example of where a Paramedic had suffered a injury whilst lifting a patient and had made an open channel request for assistance over the radio.   

62. The Panel has seen the Physiotherapy Initial Assessment document dated 22 January 2016. There is a record: Fit for all duties, but would request no lifting > 7kg for the next 3 weeks if possible. Witness 3’s evidence was that the assessment is likely to have taken place over the telephone, and that this document was not available on the Trust’s system, until 02 February 2017.

63. Witness 3 also told the Panel that it was not operationally feasible for a Paramedic to work in a RRV in circumstances where they could not lift in excess of 7kgs. This was because of the weight of the equipment which had to be carried from the vehicle to the patient. This included the green bag (excess of 10kg) and the combined weight with the defibrillator (Lifepak 1000 which weighed approximately 5kgs). In addition, with the oxygen cylinder, it would have weighed in excess of 7kgs.  

64. The Panel concluded, in these circumstances, that the Registrant knew that because of his health condition, he would be unable to carry both the green bag and the defibrillator into a patient’s house, during a cardiac arrest, given the weights involved. The Registrant was therefore unfit for duty, and should have passed this information onto his line manager, and/or taken ill health absence. 

65. The Panel were concerned about the Trust’s own responsibilities in relation to the Registrant’s health and noted Witness 3’s evidence that with hindsight a risk assessment of his capabilities would have been useful.  However, the Trust’s responsibilities are separate from those of the Registrant and any failings on their part do not exculpate him.    

Decision on misconduct and/or lack of competence   
66. The Panel then considered whether the Registrant’s actions amounted to misconduct.
 
67. The Panel accepted the Legal Assessor’s advice on the definition of misconduct. In particular, the Panel paid regard to the definition given by Lord Clyde in Roylance v General Medical Council (No.2) [2000] 1 AC 311: “Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances…” 

68. The Panel also had regard to the guidance in Nandi v GMC [2004] EWHC 2317, where Collins J suggested that misconduct could be defined as: “conduct which would be regarded as deplorable by fellow practitioners…”

69. The Panel concluded that the Registrant’s actions in respect of Particulars 1(a) and 1(d) amounted to misconduct. The Registrant’s actions were serious, and fell short of what would be regarded as proper in the circumstances, in failing to carry the defibrillator, being unfit for duty and failing to communicate this to his manager. 

70. On its own, the Panel did not conclude that the Registrant’s conduct in relation to Particular 1(b) was sufficiently serious to amount to misconduct. However, it forms part of the overall background to the finding that the Registrant was unfit for duty, in particular 1(d), which the Panel did regard as being serious enough to amount to misconduct.
 
71. The Panel also considered whether the facts found proved amounted to a lack of competence. The Panel had regard to  the principles in R. (On the application of Calhaem) v General Medical Council [2007] EWHC 2606 (Admin). A lack of competence denotes 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 professional’s work. The Panel has only seen evidence of the single incident on the 25 January 2016, and has not seen a fair sample of the Registrant’s work upon which to base any such judgement. Although, a single incident of negligent treatment, is capable of constituting a lack of competence, if very serious, the Panel concluded that the evidence in this case, did not warrant such a finding. In short, the Panel concluded that it was neither necessary or appropriate to extend the interpretation of a lack of competence, to include the actions of the Registrant, which more properly constituted misconduct.     

72. The Panel noted that in both the internal Trust investigations and his correspondence to the HCPC, the Registrant has pointed to his medical condition and his employer’s response to that as mitigation for his actions.    

73. Witness 3’s evidence, was that she and the Registrant, and his Trade Union representative had been involved in a meeting on the 28 August 2015. This was in relation to the Registrant’s health condition and carrying the defibrillator. This was the first occasion she became aware of the Registrant’s health condition. She was aware that the Registrant had been assaulted at work in 2013, causing ongoing pain. His symptoms had also been aggravated when previously working as a Paramedic on a motorcycle.

74. During the meeting, the Registrant asked whether an older defibrillator model (a Lifepak 15) could be installed on his RRV. He indicated that this would help balance the weight of the other medical equipment that he was required to carry from his vehicle. However, it proved  impossible to source an additional Lifepak 15.

75. Witness 3 gave evidence that a Lifepak 15 defibrillator weighed approximately 10kgs. She estimated that the Lifepak 1000 weighed approximately half of the Lifepak 15 - around 5 kgs. The weight of the green bag would depend on whether any additional equipment had been added to the standard bag, but this was probably in excess of 10kgs. The Registrant did not indicate that he could not carry the green bag.

76. In any event, Witness 3’s view was that this would not be practical to balance, carrying the heavier defibrillator, as the Registrant should be carrying the green bag rucksack correctly over both shoulders.   Although the Registrant requested alternative equipment, specifically the Lifepak 15, he did not say that he was unable to work with the Lifepak 1000 provided to him.  

77. Taken the evidence as a whole, the Panel were satisfied that neither the Registrant’s health nor his employer’s previous actions, were such as to excuse his conduct.        
  
78. The Panel also concluded that the Registrant was also in breach of the Standards of Conduct, Performance and Ethics (January 2016):
Standard 1:   Promote and protect the interests of service users and carers, 
Standard 3:   work within the limits of your knowledge and skills.
Standard 3.3   You must keep your knowledge and skills up to date and relevant to your scope of practice through continuing professional development,
Standard 3.4   You must keep up to date with and follow the law, our guidance and other requirements relevant to your practice. 
Standard 6:   Manage risk
Standard 6.2   You must not do anything, or allow someone else to  do anything which could put the health or safety of  a service user, carer or colleague at unacceptable  risk.
Standard 6.3   Manage your health: You must make changes to  how you practise, or stop practising, if your physical or mental health may affect your performance or judgment, or put others at risk for any other reason.     

Decision on impairment 
79. The Panel then had to consider whether the Registrant’s fitness to practise is currently impaired, in light of the misconduct found proved, and having regard to the HCPTS Practice Note: ‘Finding that Fitness to Practise is Impaired’.

80. The Panel is mindful of the forward looking test for impairment.

81.The Panel heard submissions on the issue of impairment from the       HCPC. Mr Paterson submitted on behalf of the HCPC that the  Registrant’s fitness to practise is impaired on both the public and private  components of impairment.     

82.The Panel, after reviewing all the evidence in this case, and the advice  from the Legal Assessor, has concluded that the Registrant’s fitness to  practise is currently impaired. In reaching its decision, the Panel had  regard to the following factors:
a) The Registrant did not attend the final hearing. There has only been very limited engagement with the regulatory process,
b) The Registrant stated in his Response Proforma: Service of Papers, that he admitted: “most” of the facts. However, it is impossible to ascertain from this, those which he continued to dispute, 
c) The Panel regarded the Registrant’s actions as being serious, with a potential risk of harm to the patient,       
d) The Registrant has indicated that he does not intend to return to practice as a Paramedic. However, the Panel has seen no evidence of this and cannot be sure of the Registrant’s future intentions. 
e) The Panel has seen insufficient evidence of remorse, insight or remediation. The Registrant has provided only scant details of his current employment and there is no evidence as to how he is managing his health condition. The Registrant has not provided a reference from his current employer, or other testimonial/character evidence. In the circumstances, the Panel cannot be satisfied that there will not be a repeat of similar behaviour in the future, if the Registrant’s health condition continued to cause intrusive symptoms. The Panel’s overall conclusion was that the personal component of impairment, was hence, well established. 
f) In relation to the public component, the Panel concluded that the Registrant had breached a fundamental tenet of the profession of being a Paramedic and has brought the Paramedic profession into disrepute. The Panel also had regard to the need to uphold the proper standards of behaviour, in concluding that the public component of impairment is clearly established. The Panel concluded that confidence in the profession would be undermined if there was no finding of impairment, for having not taken the defibrillator into the patient’s home, attending at the patient’s home whilst unfit for duty and not having communicated this to his employer, given the potentially serious consequences for the patient, in not doing so.  

Decision on sanction
83. The Panel has heard submissions on sanction on behalf of the HCPC. It has paid regard to the HCPC’s Indicative Sanctions Policy and has accepted the advice of the Legal Assessor.

84. The Panel has had regard to the aggravating and mitigating circumstances in this case.

85. The aggravating features are:
(a) The Registrant’s misconduct was serious and deliberate, having regard to the findings set out above, 
(b) The Registrant has  engaged with the regulatory process to a limited extent and has not attended at the final hearing. The Registrant has provided very little information about his current employment circumstances, 
(c) The Registrant has not demonstrated any evidence of remorse, remediation or insight into his serious misconduct. The Panel has seen no evidence to suggest there is unlikely to be a repetition of such misconduct in the future, if the Registrant remained free to practice on an unrestricted basis.   
 
86.  The mitigating features are:   
(d) The Registrant had indicated that some facts were admitted in the Proforma, and made some admissions in his internal interview, namely in relation to his ability to carry the defibrillator, due to his health condition. 
(e) The Registrant has had no previous regulatory finding against him. 

87. The Panel was mindful that the purpose of imposing a sanction in regulatory proceedings is to protect the public, and not to punish the individual Registrant. The Panel also bore in mind the wider public interest and deterrent effect on other Registrants, the reputation of the profession and public confidence in the regulatory process. 

88. The Panel also had regard to the aggravating features above and in particular, the lack of evidence of insight on the part of the Registrant as to his failings and willingness to address them.

89. In light of these factors, the Panel determined that given the serious nature of the Registrant’s misconduct, that to take no action, or to impose a Caution Order would not be in the public interest, and would not retain public confidence in the regulatory process. The Panel further concluded that public confidence in the profession would be undermined by imposing no sanction or imposing a Caution Order.

90. The Panel further noted that according to the Indicative Sanctions Policy, a Caution Order would 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.’ The present case did not fall into this category and the Panel regarded the Registrant’s misconduct as being more serious. 

91.  The Panel next considered whether to make a Conditions of Practice Order, but  concluded that this was not an appropriate sanction. It was difficult to see how any workable or verifiable conditions could be imposed on the Registrant. The Registrant appears not to be working as a Paramedic and has indicated an intention not to return to the profession. The Panel has no evidence as to the Registrant’s current employment, or future plans. 

92. The Panel further noted that a Conditions of Practice Order would be appropriate where a failure or deficiency is capable of being remedied. Given the Registrant’s non-engagement with the regulatory process, the Panel could not be satisfied that the Registrant’s misconduct is capable of being remedied. The Panel considered that a Conditions of Practice Order would hence not be appropriate to protect the public and to retain confidence in the profession of being a Paramedic.

93. The Panel next considered a Suspension Order. This sanction should be considered where the Allegation is serious, but unlikely to be repeated and thus, a Striking Off order is not merited. The Panel regards the Registrant’s conduct as being serious and deliberate, in choosing not to take life saving equipment to the patient, despite being aware that he had suffered from a cardiac arrest. The Registrant was aware of his medical condition and his limitations when he reported for duty. The Panel cannot be satisfied that this misconduct is unlikely to be repeated in the future.
 
94. The Panel finally considered a Striking Off order, and noted that this was likely to be the most appropriate sanction where the evidence suggests that the Registrant will be unable to resolve or remedy his failings. The Panel was very conscious that a Striking Off Order is a sanction of last resort for serious, deliberate or reckless acts. The Panel concluded that there was no other way to protect the public in this case, given the lack of insight and engagement from the Registrant. The Panel has seen no evidence that the Registrant has taken any steps to remedy the deficiencies in his practice, which have been found in these proceedings.
 
95. The Panel further concluded, in light of the serious and deliberate nature of the misconduct, and lack of remediation, that any lesser sanction would lack deterrent effect, and undermine confidence in the Paramedic profession and the regulatory process.

Order

That the Registrar is directed to strike off the name of David Prideaux from the Register, on the date this order comes into effect.

Notes

 

Hearing history

History of Hearings for Mr David A Prideaux

Date Panel Hearing type Outcomes / Status
13/11/2017 Conduct and Competence Committee Final Hearing Struck off