In Paramedicine Board of Australia v Reis  QCAT 120 (11 April 2022) the Queensland Civil and Administrative Tribunal had to consider the sanction to be imposed on a paramedic.
The paramedic transported a patient on 21 February 2019. On 2 March 2019 he accessed the QAS computer system to retrieve her personal details even though he “…had no clinical authorised or proper reason to access private records … entered in the restricted computer system” (). This conduct was the basis of a criminal charge of ‘using a restricted computer without consent in breach of section 408E of the Criminal Code (Qld)’ (). He entered a plea of guilty and ‘was sentenced to be of good behaviour for a period of 12 months, subject to a $750 recognisance. No conviction was recorded ().
Having obtained the former patient’s personal details, the paramedic then contacted her to initiate intimate communication. What followed () was “at least 200 text messages, including of a personal and/or sexual nature with her, between the 2nd of March 2019 and on or about the 14th of March 2019.”
The patient made a complaint on 14 March 2019. The respondent was suspended from his employment on 29 March. His employment was terminated on 16 April. On 5 June he gave an undertaking to AHPRA not to practice as a paramedic and on 29 October 2019 he surrendered his registration. The respondent had been working for QAS since January 2003. The Tribunal said (at ) “Prior to the conduct, the subject of this referral, he had no disciplinary or criminal history. … It is not disputed that prior to the relevant conduct, he had been a competent paramedic of good character.”
The respondent admitted his conduct and agreed that he had breached the Paramedicine Board’s Code of Conduct both by accessing the computer record for personal reasons and by initiating and maintaining the sexual communication (see  and -). He also admitted that his conduct amounted to both ‘professional misconduct’ and ‘unprofessional conduct’ as defined by the Health Practitioner Regulation National Law (Qld) (see -).
The Tribunal said (at -):
The conduct the subject of the criminal proceedings … involved a serious breach of the respondent’s employer’s trust; and a serious invasion of the privacy of the patient, and a breach of her trust. He allowed his own personal interests to overcome his duty to his employer and his patient not to access that private information for his own use. It is conduct that is apt to undermine public confidence in his profession, which has such a vital role to play in our health system. Not surprisingly, the Code requires paramedics to act lawfully and in a manner designed to protect the confidentiality of patients. Conduct statement 8 requires paramedics specifically to ensure records are held securely, and not subject to unauthorised access.
The admitted conduct in Ground 1 is clearly professional misconduct as defined in section 5(a) of the National Law. As against that, the actions of the respondent in accessing the QAS computer and database unlawfully does not constitute a particularly serious example of the offence. This was clearly the impression that the presiding Magistrate formed when he sentenced the respondent …
As for the failure to maintain a professional relationship, the Tribunal said (-):
The conduct in ground 2 is also very serious. He admits to unlawfully accessing the computer on the 2nd of March 2019 to obtain Ms MB’s confidential patient records for a private purpose. He then failed to maintain appropriate professional boundaries over approximately a 12-day period, by firstly contacting the patient via Messenger application, and then, once he had her telephone number, exchanging over 200 text messages with her including many of an overtly personal and/or sexual nature.
It is obvious that his conduct was deliberate and that he had a sexual interest in Ms MB. A fair reading of those messages, which extend over almost 100 pages of the hearing brief, does not suggest any suggestion that Ms MB, when she had realised who was contacting her, was not a willing participant in all the exchanges. It was completely inappropriate for the respondent to contact her in the first place using the personal information unlawfully obtained by him; however, it was she who offered to give him her telephone number in a text on the 2nd of March 2019 once he identified who he was.
It can be accepted that the authorities, for example, Health Ombudsman v Masamba  QCAT 227, to which the Board has referred, are to the effect that any contact (especially of a sexual nature) irrespective of consent, by a practitioner with a patient or an ex-patient outside the strict clinical setting, is almost always regarded as serious and constituting professional misconduct. It should be stressed however, that each case should be considered on its own merits and obviously there is a spectrum within the rubric of “boundary violations” from the very serious to conduct at the lower level of seriousness. The respondent in the case of Masamba was a registered mental health nurse and the patient met him in a clinical setting. His boundary violations involved making unwanted sexual advances via text.
I agree with the respondent that although Ms MB was his patient, in the sense that he was one of the paramedics who transported her from the medical centre to the Toowoomba Base Hospital on the 21st of February 2019, thereafter he had no personal contact with her other than through the Messenger application and then by text. There is no evidence at all that Ms MB was vulnerable. In fact, the evidence, such as it is, is to the contrary.
The way in which the respondent sought to end the contact is concerning and compounds the seriousness of his conduct, ultimately the patient felt able and empowered enough to make an almost immediate complaint to QAS on the 14th of March 2019. This is not to understate the seriousness of the respondent’s overall conduct – merely to make the point that although his conduct both in grounds 1 and 2 was substantially below the appropriate standard it falls at the lower end of seriousness of professional misconduct.
The Tribunal considered:
- That this conduct was ‘at the lower end of seriousness’;
- His remorse (‘demonstrated by his cooperation with the criminal proceedings – the Magistrate noted that it was a very early plea of guilty, and his own admission and cooperation with investigators, regulators and in these proceedings… He has on multiple occasions expressed his remorse and shame, which I accept is genuine’ -).
- His attempts to deal with his behaviour (‘He has since completed professional boundary courses and has engaged with a psychologist with a focus on developing more effective decision-making strategies and professional boundaries’ (); and
- The impact it had on the paramedic (‘He suffered depression and anxiety for a period of years, his family was adversely affected, and he felt deep shame for his conduct. He has not worked as a paramedic since the 29th of March 2019 – just over three years’ ().
The tribunal determined that a reprimand was the appropriate sanction, noting (at ):
… a reprimand is not a trivial offence. Relevantly to the need to deter others who might be minded to behave in a similar way, and to ensure the maintenance of public confidence in paramedicine health care providers, a reprimand is a serious form of censure and condemnation.
This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.