In an earlier post, Two Queensland paramedics disciplined for inappropriate sexual conduct whilst at work (July 19, 2022) I reported on cases where paramedics had been disciplined by QAS for inappropriate sexual conduct directed to their colleagues. In Health Care Complaints Commission v McAlpine  NSWCATOD 92 a paramedic had his registration suspended for 12 months for conduct directed to his patient.
The gist of the complaint was that the paramedic said to to the patient ‘For an anorexic you’ve got nice boobs’ (). Then during the course of an abdominal examination he ‘pulled down her pants, put his finger down her pants touching her pubic hair’ (). Finally he took her hand and put it toward his groin, allegedly to let her feel where he had a hernia (). She claimed ‘the practitioner moved her hand four or five times and that each time this caused her hand to touch his semi erect penis’ ().
The patient made a report to medical staff as soon as she arrived at hospital. She repeated the complaints in interviews with investigators from NSW Ambulance and from the Health Care Complaints Commission (the HCCC) Her complaints were consistent with evidence given by her mother and the other paramedic who attended and drove the ambulance whilst McAlpine was alone in the rear of the car with the patient.
The practitioner did not deny the claims nor did he challenge the recommendation from the HCCC that the his registration be suspended for 12 months and, further, that he ‘be prohibited from providing “ambulance services” as defined in s 4 of the Health Care Complaints Act 1993 (NSW) during the same period’ (). Apart from confirming that he did not oppose the orders sought, the paramedic took no part in the proceedings.
The Tribunal cited, with approval, statements made in HCCC v Litchfield  NSWCA 264 (at ). Their Honours said:
Female patients entrust themselves to doctors, male and female, for medical examinations and treatment which may require intimate physical contact which they would not otherwise accept from the doctor. The standards of the profession oblige doctors to use the opportunities afforded them for such contact for proper therapeutic purposes and not otherwise. This is the standard that the public in general and female patients in particular expect from their doctors, and which right thinking members of the profession observe, and expect their colleagues to observe. In this context we would adopt, with respect, the following statement from the dissenting judgment of Priestley JA in Richter v Walton (15/7/93, unreported) at 8-9:
“The degree of trust which patients necessarily give to their doctors may vary according to the condition which takes the patient to the doctor. Even in regard to the most commonplace medical matters the trust a patient places in a doctor is considerable. In some cases, of which the present seems to me to be an example, the patient’s trust cannot help but be almost absolute. The doctor’s power in regard to the patient in such cases is also very great. I do not mean power in an abstract way but as a matter of fact; the extent of the power will vary according to the temperament of the patient, but the doctor with some patients and for limited periods, because of the relationship in which they are temporarily placed, is in a position to do whatever the doctor wants with the body of the patient. This is one of the reasons why doctors are subject to correspondingly great obligations and are expected to maintain very high standards: all this being very much in the public interest”.
The Tribunal said (at ):
The comments in HCCC v Litchfield and the Code [the Paramedicine Board of Australia: Code of Conduct (Interim)] are particularly apposite in the circumstances of this case. Paramedics, as first responders, are frequently called upon to provide emergency care for very vulnerable patients. Extreme care must be afforded to such patients to ensure they are not exploited or subject to inappropriate examinations without their informed consent. These patients and their families rely on the integrity and professionalism of paramedics often in circumstances of heightened emotional stress and distress.
The Tribunal was satisfied that the paramedic’s conduct amounted to professional misconduct and made the orders sought by the HCCC.
Legal principle is developed when Courts, and Tribunals, have to make rulings on issues argued by the parties to the litigation. The case develops little in the way of legal principle given that the practitioner did not defend the allegations or challenge the proposed orders.
The case is important because it confirmed, if it needed confirmation, that patients are vulnerable and trust practitioners and this trust needs to be reflected in their practice. If they do not that is a serious breach of trust and professional disciplinary bodies must take action to protect the community.
The advantage of paramedic registration
One of the advantages of, and arguments for, paramedic registration is that outcomes like this are public. That benefits both the public by building confidence in paramedicine and paramedics by allowing them to learn from the actions of others.
If these matters are dealt with by way of internal discipline only, they tend to remain private. What makes some cases public (such as those reported in my earlier post) is that the paramedics involved chose to appeal the decision to a public forum. Had they elected to just accept their employer’s determination we would all be none-the-wiser. Privacy may have advantages for the paramedics involved but it is not transparent and paramedics who pose a danger to the public continue to practice eg by getting a job with another ambulance service (see for example Queensland paramedic’s application for reinstatement rejected (October 17, 2018).
By recording the results in public and, more importantly having the power to suspend or cancel a paramedic’s registration, this process ensures that paramedics can be removed from the profession (either permanently or as in this case, for a prescribed period) and only readmitted when the Board is satisfied that they are again a fit and proper person to practice without risk to the public.
It is worth observing that the conduct described may well be criminal conduct but it is not my place to speculate on that. There may be a seperate criminal investigation or there may be good reason why there are no further criminal proceedings. It would be inappropriate for me (or others) to speculate on whether McAlpine is guilty of any offence and whether he will be or should be charged with any offence.
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.