Mr Timothy J Stringer

: Paramedic

: PA22687

Interim Order: Imposed on 13 Oct 2015

: Final Hearing

Date and Time of hearing:10:00 22/01/2018 End: 17:00 25/01/2018

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

: Conduct and Competence Committee
: Caution

Allegation

Whilst registered as a Paramedic:

 

1. Between 23 May 2015 and 29 May 2015, you behaved inappropriately towards Person A, whom you did not know, in that:

 

a) You approached Person A’s house and advised her that you worked for the ambulance service;

b) You followed Person A into her house;

c) You said to Person A: “when does one’s sex life finish?” or words to that effect;

d) You hugged and/or put your arm around Person A;

e) You kissed Person A;

f) You bought Person A flowers;

g) You telephoned Person A;

 

2. Your actions described at particular 1 were sexually motivated;

 

3. Your actions described at particulars 1 and 2 constitute misconduct;

 

4. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary matter:


Application to Amend the Allegation


1. Mr Paterson made an unopposed application to amend particular 1 c) of the allegation, substituting the words ‘said to Person A when does one’s sex life finish?’ or words to that effect’ with ‘brought up the topic of sex during conversation on one or more occasions(s).


2. Conscious that due notice of this proposed course had been given to the Registrant in a letter dated 8 August 2017, the Panel agreed to allow this amendment.


Background:


3. At the relevant time, the Registrant was employed as a Band 5 Paramedic for the West Midlands Ambulance Service NHS Foundation Trust (the Trust) within their Emergency and Urgent Operations Department. This was 9 years after he had qualified as a Paramedic.


4. On 23 May 2015 the Registrant, whilst not on duty, went into the house of Person A (a widow, aged 88 at the time) after informing her that he was a Paramedic and had apparently lost his stethoscope.


5. Once he had gained entry, it is alleged that he walked into Person A’s living room and started to talk to her about sex. According to Person A, he asked her how frequently she had sex and he talked a good deal about his own sex life. 

6. The Registrant then put his arms around Person A tightly, and kissed her on the mouth. The Registrant then departed.


7. A little while later, the Registrant returned bearing a bunch of flowers and he made an apology to Person A. At the same time he left her a note which read ‘Lovely to see you again, Tim xxx’. Included within the note was what purported to be the Registrant’s personal telephone number.


8. Person A gave him her own telephone number, hoping that if he returned to her house he would call her in advance and she would be able to arrange for someone to be with her.

9. The Registrant did phone Person A about a week later, but she told him that her daughter was with her and her other daughter would be coming to stay next week. 


10. Having received advice from her family, Person A reported matters to the Police.


11. On 15 July 2015 the Registrant was arrested on suspicion of having committed a sexual assault.  The next day he was suspended by the Trust.  He was charged by the Police on 12 September 2015.  The trial took place at Worcester Crown Court in June 2016. The jury were unable to reach a verdict and the Crown Prosecution Service decided not to pursue a re-trial.   

Decision on Facts


12. The HCPC called three witnesses to give live evidence.


13. Witness 1, a Consultant Paramedic, gave evidence of his role as the Investigating Officer for the Trust. What he had to say, which was accepted by the Panel, was principally of a formal nature.  Nothing of substance was challenged.


14. The same applied to the evidence of Witness 2, a Safer Neighbourhood Officer for West Mercia Police, who was the arresting and interviewing officer in the police investigation of this case. Her evidence, uncontroversial as it was, was accepted by the Panel.


15. By some distance the most important witness called by the HCPC was Person A now aged 90 years.  She gave her evidence, with the leave of the Panel, over the telephone. Her eyesight was so poor that it was necessary for her daughter to assist her with documents. There were occasions in the giving of her testimony when she acknowledged that her memory was not what it used to be and some inconsistencies arose in the various accounts of the incidents she gave. The Panel’s view is that they were attributable to fading memory, not unconnected with the passage of time and her advanced age. Although she was doing her best to be truthful, not all of her evidence could be described as reliable.


16. The Panel additionally took into account the contents of the two witness statements that were read (Witness statement of Neighbour A and a Police Officer) and the bundle of documentary exhibits.


17. The Panel heeded the advice given by the Legal Assessor in relation to his directions on hearsay, which had particular application to the witness statement of Neighbour A. 


18. The Registrant was called to give evidence on his own behalf. In scrutinising what he said, the Panel gave due weight to the Registrant’s good character – both as to his credibility as a witness and the absence of any previous complaints about him.


19. The Registrant’s evidence, too, was punctuated with inconsistencies. There were differences in the various accounts he gave to the Police, the Trust’s investigators and the Panel. Nevertheless, in relation to the major issue in this case, namely whether or not his behaviour was sexually motivated (something the Registrant had consistently and emphatically denied from the outset), the Panel was prepared to accept that, on the balance of probabilities, he may have been telling the truth.


20. Particular 1 a) ‘You approached Person A’s house and advised her that you worked for the ambulance service;’


The Registrant admitted the bare facts of this particular. In her oral evidence Person A stated that the Registrant said ‘I am a Paramedic looking for my stethoscope’. Person A in her police interview said that the Registrant told her ‘I work with the ambulance people and I’ve left my stethoscope one place we called at’.


Accordingly the Panel finds Particular 1 a) proved.


21. Particular 1 b) ‘You followed Person A into her house;’


The Registrant admitted this allegation on the basis that he followed Person A into her house after being invited in. In her oral evidence, Person A was asked ‘had you invited the Registrant in?’ She replied ‘no, not at all, he walked in.’ She maintained this in cross-examination.


Accordingly, the Panel finds Particular 1 b) proved.

22. Particular 1 c) ‘You brought up the topic of sex during conversation on one or more occasion(s)’


The Registrant denied this allegation. Person A, in her oral evidence, stated ‘the Registrant started talking about sex. This sent me into a state of shock.’ In cross-examination, it was suggested to Person A that the Registrant ‘didn’t talk incessantly about sex,’ to which she responded ‘no, he did, he did’. The Registrant stated in his police interview that he hadn’t discussed sex with Person A but had discussed ‘the attraction to your partner or the intimacy and how it changes throughout your relationship as you get older.’ In cross-examination the Registrant stated he had discussed physical intimate contact with Person A and when asked ‘you mean sex?’ the Registrant replied ‘no’. However, when asked ‘do you accept sex was mentioned, perhaps not explicitly?’ the Registrant replied, ‘it was mentioned’.


The Panel concluded, on the balance of probabilities, that the Registrant had brought up the topic of sex during conversation on one occasion.


Accordingly the Panel finds Particular 1 c) proved.

23. Particular 1 d) ‘You hugged and/or put your arm around Person A;’


The Registrant admitted this allegation. In his police interview he stated ‘I touched her shoulder and kissed her on the cheek’. ‘I stretched my arm across to her opposing shoulder, kissed her on the cheek and then left’. The Registrant in his oral evidence confirmed what he had said in his police interview. Person A, in her police interview, stated that the Registrant ‘leant across and put his arms right around me’, and in her oral evidence she stated the Registrant ‘put both arms around me tightly’. Therefore, on the balance of probabilities, the Panel found that a hug had taken place and that the Registrant had put his arm around Person A.

The Panel finds Particular 1 d) proved.


24. Particular 1 e) ‘You kissed Person A’


The Registrant admits this allegation. Person A in her police interview stated that the Registrant ‘kissed me… at the side of my mouth. She stated this happened for a few seconds. In her oral evidence she stated that the kiss lasted for ‘about four seconds’. Person A was cross-examined about where on her face the Registrant kissed her. She replied ‘I remember it as being on the lips’. As above, the Registrant in his police interview said he kissed Person A on the cheek and he confirmed this to his employers during the Disciplinary Investigation. Accordingly, on the balance of probabilities, the Panel finds that the Registrant kissed Person A.


The Panel finds Particular 1 e) proved.


25. Particular 1 f) ‘You bought Person A flowers’


The Registrant admitted this allegation. He admitted he bought Person A flowers when interviewed by the police, during the Trust investigation, in his submissions to the Investigating Committee and in his oral evidence. Person A confirmed that the Registrant bought her flowers in her interview with the police and in her oral evidence. The neighbour of Person A stated that she saw ‘the man walking back towards Person A’s house with a bunch of flowers’.


Accordingly the Panel finds Particular 1 f) proved.


26. Particular 1 g) You telephoned Person A


This allegation was admitted by the Registrant. Person A told the Police and confirmed in her oral evidence that the Registrant telephoned her. The Registrant in his police interview stated that he had telephoned Person A. He also accepted the telephone call took place when interviewed by the Trust and in oral evidence.


Accordingly the Panel finds Particular 1 g) proved.


27. Having found the above bare facts proved, the Panel then went on to consider whether the evidence showed that the behaviour was inappropriate. The Panel applied the Oxford English Dictionary definition of the word inappropriate: ‘not suitable or proper in the circumstances.’ The circumstances of this case involved a professional man, albeit not on duty, approaching a vulnerable elderly lady in her late 80s, whom he did not know, entering the privacy of her house and behaving in the fashion that has been proved.


28. The Panel noted that the Registrant accepted, in an answer in cross-examination, that he agreed that the mention by him of the topic of sex was inappropriate.  He added, in response to a question in cross-examination, that it was highly unusual to leave a note with three kisses inscribed upon it for someone you have just met and that ‘you could see it that way’. These responses confirmed the Panel’s view that all the aspects of behaviour that have been found proved were inappropriate.


The Panel found this element of the stem of Particular 1 proved.


29. Particular 2 ‘Your actions described at particular 1 were sexually motivated’


In considering this particular, the Panel reminded itself of the definition of the word ‘sexual’ as set out in section 78 of the Sexual Offences Act 2003:
‘For the purposes of this Part, penetration, touching or any other activity is sexual if a reasonable person would consider that -


(a) whatever its circumstances or any person’s purpose in relation to it, it is because of its nature sexual, or:


(b) because of its nature it may be sexual and because of its circumstances or the purpose of any person in relation to it (or both) it is sexual.

30. In regard to Allegation 1 a), applying the definition above, the Panel did not find that this sub-particular was sexually motivated.


31. In regard to Allegation 1 b), applying the definition above, the Panel also did not find that this sub-particular was sexually motivated.


32. In regard to Allegation 1 c), it was only the Registrant who provided detailed context of the relevant conversation with Person A on the general topic of sex. Person A conceded that, although she found him ‘creepy’, he was nothing other than polite.

Whilst not disbelieving what Person A said on this subject, the Panel was not satisfied that this Particular was proved.


33. In regard to Allegation 1 d) and 1 e), Person A was not consistent in telling the Panel on which part of her face she remembered the Registrant planting his kiss. On the other hand, the Registrant consistently maintained, being a tactile person by nature, that he had put his arm across Person A’s shoulder as a hug and that all that he was doing was showing affection. The Panel’s view is that, irrespective of whether this behaviour breached professional boundaries, it could not be satisfied that sexual motivation played a part in either the hug or the kiss.


34. In regard to Allegation 1 f) the Panel does not find this allegation was sexually motivated. The Registrant in oral evidence stated that he had bought his fiancée flowers and decided to give them to Person A. In his police interview the Registrant said that he bought Person A flowers as it was a nice thing to do. Person A stated in her police interview and in oral evidence that the Registrant apologised if he may have upset her at the same time as he gave her the flowers.

35. In regard to Allegation 1 g) it is clear that the Registrant in this telephone call was making plans to meet Person A in the near future. The reasons provided were contradictory in his various accounts. The Registrant had withheld his number when making the telephone call but explained in oral evidence that this was a default setting on his mobile. The Panel took into account that the Registrant had already provided his number to Person A in the note that was left with the flowers and that he had identified himself to Person A in the telephone conversation. Given the circumstances and the content of the telephone call the Panel do not find this particular was sexually motivated.

Decision on Grounds

36. Whether or not the facts found proved amount to misconduct is a matter for the professional judgement of the Panel. The Panel has found that the Registrant acted inappropriately in his behaviour towards a vulnerable 88-year old lady, whom he did not know. Mr Smith, in his submissions upon this subject, did not seriously contest that there was misconduct here, although he stressed that it was entirely a matter for the Panel’s judgement. Mr Paterson reminded the Panel of the case law on misconduct, the serious nature of the misconduct and the impact on Person A.


37. The Panel has been referred to Standard 3 of the ‘Standards of Conduct, Performance & Ethics’ that binds the duties of an HCPC registrant.


‘3: You must keep high standards of personal conduct’ ~ You must keep high standards of personal conduct, as well as professional conduct.  You should be aware that poor conduct outside of your professional life may still affect someone’s confidence in you and your profession’


 Although the Registrant was not on duty at the material time, it is plain that this standard has been breached. 


38. Accordingly, the Panel finds that the Registrant’s conduct fell seriously short of the standards required of a Registered Paramedic. The Panel is satisfied that the allegation of misconduct is well-founded.


Decision on Impairment 


39. Again, whether or not a Registrant’s fitness to practise is impaired is a question for the Panel alone. The Panel took due notice of the submissions from both sides and the contents of the HCPTS Practice Note on ‘Finding that Fitness to Practise is Impaired’. It also accepted the advice of the Legal Assessor.


40. In reaching its determination, the Panel considered the personal component and, in so doing, amongst other matters, reminded itself that the bare facts contained within particular 1 were almost all accepted by the Registrant from the outset of these proceedings. The issue that did require determination by the Panel was whether or not the admitted behaviour could properly be described as inappropriate.

41. To this extent, the Panel takes the view that the Registrant has displayed some insight. Although the evidence showed that the Registrant, by virtue of his later telephone call, wanted to see Person A again, Person A stated that the Registrant offered her an apology for his behaviour when he gave her the flowers. The Panel has noted that the only aspect of his misconduct which he accepted was inappropriate was in relation to particular 1 c), bringing up the topic of sex, and this was during cross-examination.


42. The Panel was conscious that these encounters, which took place about two and a half years ago, were the first and only example of misconduct by the Registrant in his career. The Registrant provided the Panel with testimonials and a certificate to verify the fact that in May 2017 he passed an examination entitled ‘Emergency First Aid at Work’.


43. When giving evidence as part of Stage 2 of these proceedings (after the Facts in particular 1 had been found proved) the Registrant acknowledged he had been overly familiar with Person A, causing her great upset and he was sorry. He said that he had altered his ways and would never find himself again in a position like the one that confronted him with Person A. For example, the Registrant stated that he would be more guarded in his behaviour when representing the profession and that he had spent considerable time reflecting on his personal conduct since the incident. These concessions would have struck a deeper chord with the Panel had they been made earlier.


44. A pertinent question for the Panel’s judgement was whether it is highly unlikely that this sort of behaviour will be repeated by the Registrant.  Although he stressed that he had learnt his lesson, the Panel was not inclined to the view that he has gained full insight. He did not, for instance, acknowledge that the allegations contained within particulars 1 a) b) d) f) and g) were inappropriate until he gave evidence for the second time. Despite his protestations to the contrary, the Panel’s view is that full remediation has not yet been achieved.

45. The Registrant, since his suspension and subsequent termination from the Trust in December 2015, has not worked as a Paramedic until March 2017 when he started occasional work in First Aid and Paramedic cover in the private sector, involving his presence at a number of large outdoor sports events. This work, which was seasonal, came to an end in November 2017. Since this date he has obtained temporary work delivering hire cars.  It is plain to the Panel, having heard evidence from the Registrant on this subject that he has suffered a great deal since losing his NHS job in 2015.  The Panel also heard from the Registrant that he has been keeping up to date with his professional development.


46. In addressing the need to consider the public component, the Panel is conscious of the need to protect the public and the public interest and is well aware of its duty to protect service users and to declare and uphold proper standards of behaviour. The case concerns a serious departure from professional standards by a Registered Paramedic who, although off-duty at the time, behaved inappropriately towards a vulnerable and elderly lady in a fashion that has had a chronic effect upon her trust in strangers.


47. In all the circumstances, the view of the Panel is that the Registrant’s fitness to practise is currently impaired. To find otherwise would amount to a breach of the Panel’s duty to maintain confidence in the profession.


Decision on Sanction


48. In coming to its own independent decision on sanction, the Panel has paid careful regard to the submissions of both parties.  It has taken into account the contents of the Indicative Sanctions Policy (ISP). It has also noted the advice of the Legal Assessor that it should apply the principle of proportionality in weighing the interest of the public against those of the Registrant. The public interest includes not only the protection of service users, but also the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour. 

49. Mr Smith provided the Panel with three more written testimonials. He emphasised that his client had experienced a torrid time since these matters came to light. He had been the subject of an interim suspension order for five months and an interim conditions of practice order for the rest of the intervening period. Although the Registrant had not been able to obtain anything other than temporary work, none of the conditions had been breached. Mr Smith’s submission was that a caution order for the minimum period would be an appropriate sanction in this case.


50. The Panel took into account the following mitigating and aggravating factors:


• The mitigating factors include the previous unblemished record of the Registrant, his apology to Person A at the time, repeated in his evidence, and the fact that he has shown some insight into his misconduct. This was an isolated incident and the Registrant has engaged fully in the regulatory process. 


• The aggravating factors include inappropriate behaviour to an elderly and vulnerable woman and, as noted at Paragraph 44 above, the lack of full insight shown in not accepting from the outset that all of his behaviour, as described in particular 1 of the allegation, was inappropriate. Additionally, Person A has suffered enduring psychological harm. 


51. The Panel is satisfied that the Registrant’s actions would be regarded as sufficiently serious by fellow practitioners and the public at large as to merit the imposition of an appropriate and proportionate sanction. Given the nature of the Registrant’s misconduct and its potential to undermine the reputation of the profession, the Panel is of the view that it would not be sufficient to conclude this case by taking no action or by referring it for mediation. Neither course would serve to protect patients or maintain the standing of, and public confidence in, the profession.

52. The Panel then moved on to consider whether to conclude this case by the imposition of a Caution Order. In so doing, it took into account the Registrant’s recently professed determination to change his manner to ensure that such misconduct would never be repeated. The Panel does consider that the Registrant’s insight now is such as to render the prospect of repetition sufficiently low to justify the imposition of such a sanction. The Panel noted the Registrant’s positive references and that his attempts at rehabilitation have included attending counselling sessions.


53. In all the circumstances, the issuing of a caution to the Registrant would adequately reflect the seriousness of his misconduct and provide sufficient protection for service users. Such an outcome, in the judgement of the Panel, meets the criterion of proportionality. In weighing the mitigating and the aggravating factors and taking account of the impact that the Registrant’s misconduct had upon Person A, the Panel’s view is that the appropriate and proportionate period for such a caution order should be for two years.


54. The Panel is fortified in considering that this is the appropriate order by reflecting that the imposition of a Conditions of Practice Order, the next available sanction in order of gravity, would be disproportionate – not least because the misconduct took place ancillary to his clinical practice.

Order

ORDER: That the Registrar is directed to annotate the register entry of Mr Timothy J Stringer with a Caution which is to remain on the register for a period of two years from the date this order comes into effect.

Notes

A Final Hearing was held in London from 21-25 January 2018. A Caution Order was imposed.

Hearing history

History of Hearings for Mr Timothy J Stringer

Date Panel Hearing type Outcomes / Status
22/01/2018 Conduct and Competence Committee Final Hearing Caution