In Paramedicine Board v Hampton [2024] TASCAT 22, the Tasmanian Civil and Administrative Tribunal (TASCAT) had to deal with a paramedic who admitted that he had ‘provided false information regarding the amount of medication administered to a three month old baby while on route to the Royal Hobart Hospital (RHH) and second, encouraged, advised or directed a junior paramedic under his supervision to falsify clinical records in relation to the doses of medication recorded in the patient’s records.’
The incident occurred in December 2019. Paramedics had been called to a baby in cardiac arrest. On arrival they observed a premature baby that had been discharged from hospital only 24 hours earlier. The baby was ‘displaying seizures’ ([5]). Paramedics determined to transport the baby to hospital and called for backup from an intensive care paramedic. Mr Hampton was the on-call ICP. He had been on duty for 11.5 hours. He got home at 7:15pm and was paged to respond at 7:30pm ([6]). He met the ambulance en route. The paramedics in the ambulance had stopped the vehicle to administer midazolam but they had made an error in their calculations where they calculated the dose, based on the babies weight, in mls rather than mgs. They drew up 0.45mls when they should have been giving 0.45mg. The correct dose should have been 0.09mls. 0.45mls gave a dose of 2.25mg or five times the correct dose. Mr Hampton did not check the dose calculated by the other paramedics.
After patient handover the treating paramedics realised their error and approached Mr Hampton. At [12] when setting out the agreed facts, Deputy President Clues said:
[Mr Hampton] … told the other paramedics that he would inform the RHH ED treating team (RESUS) of the mistake. The respondent advised RESUS that the patient had been given 2 doses of midazolam, each dose being 0.45mg.
By this conduct, the respondent knowingly provided false information regarding the amount of medication administered to the patient while in transport to RHH.
[He then] … told a junior paramedic in the team to state in the electronic patient care record (ePCR) that the patient had been administered two doses of midazolam, each dose being 0.45mg…
Later, while the junior paramedic was in the write-up area, the respondent asked to speak with her. The respondent again told the junior paramedic to state in the ePCR that the patient had been administered two doses of midazolam, each dose being 0.45mg.
By this conduct, the respondent encouraged, advised or directed a junior paramedic under his supervision to falsify clinical records in relation to the doses of midazolam recorded in the patient’s ePCR.
It was admitted that this conduct was a breach of the Interim Code of Conduct for Paramedics that was then in force. The Tribunal was satisfied that the respondent’s conduct amounted to Professional Misconduct ([19]).
The respondent said that it was agreed that the hospital staff should be advised of the error. He went to the ED to do that but ‘It appeared the baby was safe. The effective life of midazolam (half life) had passed without any detrimental effects. To be very clear – the baby was safe – the effective life has passed so the overdose did not have any consequence’ ([21]). At [23] his response to a 2022 interview was quoted. At that time he said:
I felt this crew knew what they had done quite well and they didn’t really need a long, laborious clinical examination of it, given, that it was a baby and it was upsetting for them. Now all of that I assumed probably within 5, 6 seconds. It was something I spent an hour thinking about. It was just, this is what I am going do [sic]. This is what we’re gonna do, the damn thing can go away. Otherwise, you’re gonna sit here and savour it for you know, two years, and guess what happened, been savouring it for two years.
The text above is how it appears in the judgement, but presumably it is meant to say ‘It was not something I spent an hour thinking about’?
There was a concern that the respondent’s actions reflected a ‘punitive/negative safety culture’ in Ambulance Tasmania. Whether there was or was not such a culture, the fact was that the respondent was a clinical support officer which put ‘him within the management structure responsible for safety event investigation and follow up’. Deputy President Clues said (at [25]) ‘Whilst it may be possible that an adverse safety culture did exist at Ambulance Tasmania, it does not provide an excuse for the respondent’s actions.’
The respondent said that he was stood down from work five days after the event. There was a clinical review which he cooperated with. In February he came to work expecting to be given non-clinical duties pending the outcome of the review. On his first day back he had been stood down and he was escorted off the premises.
I can say that my soul was destroyed the day this happened. I was devastated by the severity of the reaction by Ambulance Tasmania despite my admission to parts of the allegations that were made. I have never set foot back in the place since…
It has been a difficult retirement, and not what I imagined. I have been embroiled in a lengthy and (at times) intense investigation process for the last 4 years. It took 18 months for the Ambulance Tasmania external investigation to complete and I had to request, if not actually demand, the clinical review to be sent to me. I decided to resign in 2021, with an assumption and hope that the matter would soon be over. Yet AHPRA then started its investigation, which has only extended my anguish longer. I can only hope the matter will be over by the end of the year.
I am retired. I will not return to work as a paramedic, or as a health worker.
At [30]-[33] the Tribunal said:
The Tribunal accepts that the respondent has suffered personally since the events occurred. The Tribunal also accepts that the respondent has an exemplary and very lengthy record of service spanning four decades. He has no disciplinary history. He understands the severity of his actions and regrets what he did. The Tribunal accepts that the respondent made a “silly impetuous decision”.
The Tribunal does note that personal matters such as shame, personal ordeal or financial difficulty are not relevant to its determination of the appropriate sanctions to be imposed…
In this case the conduct was serious and there is a significant risk of harm to patients if it were to be engaged by other paramedics. There is a need for general deterrence in order to protect the public and maintain the public’s confidence in and the reputation of the profession of paramedicine.
The parties agreed ([38]) to the following orders, which the Tribunal made (at [40]):
(a) That the respondent be reprimanded.
(b) That the respondent be disqualified from applying for registration as a registered health practitioner for a period of two years.
(c) That the respondent be prohibited from providing any health service for a period of two years.
Discussion
To quote (out of context) Pink Floyd’s song ‘One Slip’:
One slip and down the hole we fall
It seems to take no time at all
A momentary lapse of reason
That binds a life for life …’
A career ruined by a ‘spur of the moment’ decision to try and protect the crew from the very consequences that Mr Hampton suffered. But it demonstrates the seriousness of such actions and the need for paramedics, and all professionals to be upfront and honest in particular when errors occur. There is a push for ‘open disclosure’ of errors. Deciding not to tell family, or other members of a health team, that an error has been made is the antithesis of that approach.
The seriousness of his actions was compounded by his instructions to a junior paramedic to falsify the clinical records. As a clinical support officer, it was incumbent on Mr Hampton to lead by example. If there was a punitive/negative culture in Ambulance Tasmania it was his duty, as an officer in that process, to work against that and to support the paramedic to record the errors and then support her through the process and if necessary, advocate for a just learning culture.
But even so I am forced, again, to question why resolution of these matters take so long (4 years) when Mr Hampton cooperated with the various inquiries and admitted his errors. Whatever he did and whatever penalties imposed, the event and its trauma is compounded by having to ‘savouring it for [four] years’. Regardless of this event, I think we as a community can still thank Mr Hampton for his ‘exemplary and very lengthy record of service spanning four decades’ and wish him well in his retirement.
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.
Australian Emergency Law 
This reminds me of the need and value of a true ‘Just Culture’ shouldn’t be underestimated in healthcare. The just culture approach has been proven in healthcare and other more mature sectors to be an important means of improving reporting, improving systems and reducing risk and in doing so reducing needlessly negative outcomes such as was the case here. This seems to me to be a sad example of a painful and prolonged experience for a number of people who I expect would normally be considered caring, honest and capable but for their unplanned decision to act in a grossly inappropriate manner based on what appears to be their view of the likelihood of being judged as anything but caring, honest and capable, following a mistake made under circumstances that thankfully many will be fortunate enough to never experience or by managers who lack the empathy or an appropriate system such as a ‘Just Culture’ to address the situation in an optimal manner.
I encourage Paramedics to become familiar with just culture and to lobby for change in the workplace for the benefit of all health professionals and the communities they serve.