By Matt Williams
The Press Association
CHESHIRE, England — A paramedic who failed to spot the fractured skull of a two-year-old boy hours before he died was cautioned for misconduct at an employment tribunal today.
A Health Professions Council (HPC) panel said Andrew Orme was not responsible for the death of Lewis Urmson-Brown, but that his failings in relation to the case were “serious’’.
It earlier determined that the paramedic conducted an insufficient examination of the youngster from Cheshire and failed to give adequate advice to his parents.
It was also found that the paramedic did not honestly account for the time he spent on the emergency call and did not insist forcefully enough that the toddler be taken to hospital.
Documenting patient care By Art Hsieh, EMS1 Editorial Advisor This story serves as a reminder that the patient refusal process is a “high risk” procedure, not just for EMS but for patient care professionals overall. There is a meticulous process that must be followed in order to protect the patient’s health care rights, as well as afford legal protection for the provider. Many EMS systems have protocols in place to reinforce the principles. If your system does not, consider the following tips: 1) Evaluate the patient - always. Assess each patient with the same level of attention, no matter how slight the complaint. And document when and why you can’t. 2) Consider the possible clinical ramifications of a patient refusing your care or transport offer. Remember that we as EMS providers do not have many of the evaluation tools that emergency department staff has access to. 3) Clearly and precisely explain to the patient those possible events that might occur if they are not evaluated at the receiving hospital. And even if the risk is infinitesimally remote, mention the possibility of severe disability or death as possible outcomes associated with refusing care or transport. 4) Have the patient repeat back to you, in his or her words, what you explained. Ensure that your message was not only heard but understood. 5) If possible, have a credible witness observe the refusal process. Keep HiPAA rules in mind. 6) Document. Many of our colleagues will suggest that documenting a patient refusal is much more difficult and burdensome than a transport. Be clear to yourself, so that you can recall this incident months, or years down the road. Obtain a signature in accordance to your local protocols. Art Hsieh, MA, NREMT-P, is Chief Executive Officer & Education Director of the San Francisco Paramedic Association, a published author of EMS textbooks and a national presenter on clinical and education subjects. |
But despite ruling that his fitness to practise is impaired, the HPC panel decided that Mr Orme had “learnt from this experience’’ and opted against striking off or suspending the paramedic.
Instead he was handed a caution order which will remain on the books for four years.
In announcing the decision, panel chairman Dr Alexander Yule said that the child, who was referred to as patient A throughout the hearing, did not die as a result of the paramedic’s “shortcomings’’.
But nonetheless, his failings were “serious’’ and warranted a “lengthy’’ caution order.
Mr Orme has 28 days to appeal against the ruling.
Playground fall
Lewis suffered the fatal injury on 15 June 2008 following the fall at a playground near his home in Runcorn, Cheshire.
His concerned parents dialled 999 that evening and he was seen by paramedics at around 7.40pm.
But the child was pronounced dead at Warrington Hospital early the next day after his parents called for an ambulance a second time, shortly after 3am.
The first examination of the child, conducted by Mr Orme, lasted around 15 minutes, the panel earlier heard.
They ruled that although a torch was shone into the toddler’s eyes, “Mr Orme did not sufficiently assess patient A’s interaction with his surroundings.’'
He also failed to conduct a Glasgow Coma Scale (GCS) test that checks the conscious state of an individual.
In addition, the child’s parents were not told in “sufficiently clear and forceful’’ language that the child should be taken to hospital.
The paramedic also failed to give adequate advice in that he did not tell the parents to rouse Lewis at intervals during the night to check on him.
‘Dishonest statement’
Mr Orme was also found to be dishonest in stating how long he was at the injured boy’s house, the panel ruled.
The hearing heard that the two-year-old sustained the injury after he fell whilst being carried by his father.
He received a 15cm fracture to his skull as a result of the accident, an inquest found last year.
A post-mortem examination revealed a blood clot weighing 56 grams.
Following the incident, Lewis’s parents Michelle Urmson and Chris Brown were arrested on suspicion of murder but they were later released without charge by Cheshire Police.
Today’s HPC hearing also ruled that Mr Orme failed to give the parents proper documentation recording his visit.
At the hearing, Mr Orme’s legal representative described his client as a “very, very valuable asset to his employer and the community’’.
Ray Carrick pointed to work the paramedic carried out helping sports clubs and schools with first aid training.
But Melinka Berridge, representing the HPC said there was overwhelming evidence that his fitness to practise is impaired.
She noted above all his “dishonesty’’ in accounting for his time spent on the emergency call.
The panel accepted that “this tragic case’’ had affected Mr Orme and that they were confident that he would “apply his skill and knowledge in the future’’ and not repeat the mistakes.
But it ruled that the misconduct was of sufficient severity to impair his fitness to practise, resulting in the caution.
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