Thursday, 28 May 2015

The Facts Which Informed the Decision to Sack Eddie Daly and an Appeal to Jason Killens

In the wake of my investigation into Eddie Daly's dismissal, which seems to suggest that staff welfare plays a very distant second to other priorities upheld by LAS senior management, Jason Killens, LAS Director of Operations and chair of the disciplinary hearing which brought the axe down on Eddie Daly's career, has made claims that 'there are things which he cannot discuss which informed [his] decision'. This is a claim he made to me when I spoke with him earlier this month and one which he has since made elsewhere.

I contacted Eddie Daly about this, concerned that there was something of which I hadn't been made aware. Eddie was also confused and concerned about it, with the implication of Jason Killens' claims being that there was some dark secret that 'only 4 people know about'. Eddie confirmed to me that he knew of no such secret and to his knowledge everything was in the open.

When I met with Jason Killens to discuss his part in the Eddie Daly case, Jason had referred to documentation that had been sent to Eddie Daly as a result of the hearing which Mr Killens said detailed everything that informed his decision. Indeed, any information that had an impact on the decision should and would have been included in this documentation. My understanding was that those documents would be the source of any previously unreleased insight.

I joked to Eddie that even if he'd been caught eating babies on shift, by Mr Killens' logic it would not have been 'central to the allegations' and could not be considered (a poor taste joke I accept, but it seems that inappropriate humour is one of the 'facts' which 'informed' Mr Killens' decision - more on this shortly). In any case, if a fact wasn't mentioned in the official documentation, then it couldn't be one of the factors which Mr Killens feels gives weight to his decision.

In order to get to the bottom of this potential smokescreen, I have been given permission by Eddie to publish the documents in full, which should save Mr Killens the trouble of dealing with potential obstructions from Human Resources and the LAS legal team in his effort to defend his decision. The following links for the Outcome Letter and the Supporting Narrative detail this information in its entirety.

What Does Mr Killens Know?

Having worked my way through these documents numerous times, it seems to me that the essence of Mr Killens decision comes down to the simple fact that he didn't believe Eddie's health was a factor. According to the supporting narrative, Eddie Daly did not bring up health concerns as a reason for his refusal of the call for several weeks. Points 25 and 26 state:

'25. I noted that the recording of the conversations between Mr Daly and EOC made no mention of illness being the reason for refusing the emergency call and that this was also not a feature of the conversation on the balcony with [redacted] nor had Mr Daly made mention in the four weeks between the incident and the meeting of 23 June of the refusal to a DSO or AOM being caused by illness'.

'26. Illness was only introduced as a reason for refusal on 26 June after suspension had taken place'.

Eddie explained that his reluctance to discuss his struggles was due to embarrassment and the fact that he had been hiding his health problems as he continued to work. This seems plausible, but playing Devil's advocate, it could also be the desperate attempt of a man trying to save his career at any cost after making one poor decision while heavily fatigued after 11 hours of relentless emergency work.

Jason Killens' supports his assertion that Eddie's ill health defence was constructed after the fact by referring to Mr Daly's demeanour as heard on the tapes of the conversation between him and EOC on the night of the 29th May 2013. Jason Killens writes, 'I noted that Mr Daly was laughing and joking through the tape recorded conversations, that he did not say he was unwell and did not appear unable to continue his shift as a result of illness'.

It seems a bit of a leap to make broad assumptions about someone's state of physical or mental health based on their capacity to find humour in frustrating situations, especially in this line of work. Perhaps, with 'hear and treat' skills like this, Mr Killens' ability to rule out all forms of illness by analysing laughter patterns should be included in the 111 algorithm.

Further, Mr Killens felt that the Area Controller's account of meeting Eddie after his return to station was also clinical evidence of Eddie's well-being. Counter to this, Eddie's ongoing problems with PTSD and subsequent diagnosis of diverticular disease do not get considered in the documentation.

On reflection, perhaps relying on the Killens method of assessment and diagnosis will aid ambulance response times and utilisation in the future; telling the patient a joke over the phone and performing a brief visual assessment whilst smoking a cigarette would certainly take a lot of pressure off clinical staff.


Further mention of Eddie's comments in the telephone conversation with EOC are made and include the statements 'I am not accepting it and I think it is dangerous' and 'you can make us patients too because right now I am tired', but these were not examined in terms of any kind of risk assessment made by a respected clinician. Instead they are used simply as evidence that Eddie Daly was not ill. Jason Killens interpretation of the the entire episode never really moves beyond the three allegations:

1. You failed to respond to emergency call CAD 707 of 29 May 2013.
2. By your actions you failed to act in the best interests of the patient.
3. You failed to exercise appropriate leadership behaviours as a Team Leader.

Jason Killens found all of these allegations proven based on the facts he was presented, underlined by point 38 of the Supporting Narrative:

'38. Having considered all 3 allegations and the fact that I have found, on balance, that they are proven I have carefully considered the aggravating and mitigating features of this case before deciding what action is reasonable and appropriate in the circumstances. I must now state that I do not accept Mr Daly's case that his reason for not accepting the call was that he was too unwell to do so but did not state this. Mr Daly's demeanour on the tape and the number of opportunities to state he was unwell if that was the case, do not for me make this a credible argument'.

This seems tantamount to calling Eddie a liar.

It's interesting to note that, on the second allegation, Mr Killens identified that 'From the tape, it is also clear that Mr Daly was informed that there was no other resource available and that there was "no possibility of any vehicles coming up". Mr Daly was also aware that the call had been held "for some time" '(Supporting Narrative point 32)  which is clearly a failure of service for which Mr Killens himself is ultimately responsible as Director of Operations, but shows no remorse or recognition for the fact that these very failings contributed to the conditions which led to the incident. Eddie Daly's circumstances, his fatigue and ill health arose as a direct result of LAS's failure to provide reasonable working conditions for their staff. Mr Killens, not Mr Daly, should be answerable for this.

The Blade Should Cut Both Ways

Further, Jason Killens felt that there was no other course of action aside from dismissal for gross misconduct:

'I believe that these proven allegations cannot be rectified through remedial training, education or a sanction designed to change behaviour as clear and unequivocal refusal of an emergency is clearly a matter of gross miss conduct [sic]. "Avoidance of, or non response to calls, or not activing once a call has been accepted" are all listed in the Disciplinary as issues that fall into potential gross misconduct.'

However, evidence was brought up (and dismissed) at Eddie Daly's appeal hearing that a paramedic officer who refused a 999 call received far more lenient punitive action, which suggests that there is in fact a choice to explore other conduct pathways when those in charge so choose. A choice that Mr Killens chose to ignore.

So in summary, it seems that the hearing was never going to move beyond the fact that refusing an emergency call was a matter of gross misconduct and any mitigating circumstances were always going to be considered irrelevant. It boils down to the fact that Jason Killens did not believe Eddie Daly and was not prepared to seek a more positive or supportive resolution.

Throughout the hearing documentation, it is clear that it is Jason Killens who decides who and what is and isn't credible. This gives me a great sense of unease as Jason Killens is a man who is ultimately responsible for the physical and psychological meatgrinder which is the UK's worst-performing and most brutally over-utilised ambulance service. If anything isn't credible, it's the judgement of a man who cannot see that his own failings are ruining the health and lives of his own staff.

An Appeal to Jason Killens

I make this appeal directly to Mr Killens:

As a senior executive officer, if you hold any hope of preserving your work force's ability to withstand the ongoing challenges of delivering the world-class pre-hospital care you aim to provide, then there needs to be a change in the approach to the welfare of staff.

The case of Eddie Daly seems evidence enough of a blinkered and remorseless system which does not effectively take into account the human impact of ambulance work. Prevention is better than cure and no amount of LINC or TRiM is going to repair damage already done by pushing your staff beyond reasonable limits. Your claim that the majority of paramedics are leaving LAS for career advancement reasons doesn't ring true, it carefully sidesteps the issue of grassroots discontent. You told me that the days of working on the front line for an entire career are long gone, but this should not be because you have planned around that by exhausting your crews, dismissing them when they break or driving them away and then just draughting in some new ones.

First and foremost, you are a healthcare professional and although you primarily work making high-level decisions, you still have a duty of care to your staff. If they cannot function, your service cannot function and your strategies will fail. I appreciate that you are attempting to alleviate the pressures by improving utilisation figures and targets, but if your handling of the Eddie Daly case is anything to go by, you have lost your compassion and your grasp of how individuals respond to the dire circumstances which are part of their everyday work. You are no longer able to see that your people are as fragile as the patients you serve.

You could have made different choices with regard to Eddie Daly, but you didn't because you claim to have had no choice. However, just as you chose not believe Eddie, I choose not believe you. I think you had to make the call you did because to do otherwise would have shone too much light on your own failings. I urge you to undertake some reflective practise of your own and remember why you signed up to work in healthcare in the first place, before you needlessly destroy any more careers.

Perhaps you are just a product of the system, a system which your choices have shown to be deeply flawed. But you are now at the top of that system so you are in a position to change it for the better. And by better, I don't just mean more efficient and leaner, but more inclusive and sustainable. Look after your staff, look out for your staff, treat them as you would your patients when you were still new.

They deserve better. Eddie deserved better.

[This is just my interpretation of the available information. Please feel free to review the Outcome Letter and Supporting Narrative documents yourself to find the facts which Mr Killens says 'informed' his decision. At the very least, their publication means that he can no longer claim to have exclusive knowledge of facts which he feels give him more insight than everyone else.]

Eddie Daly's Outcome of Disciplinary Hearing Letter

[This article is a supporting document to the article 'The Facts Which Informed the Decision to Sack Eddie Daly and an Appeal to Jason Killens'. Names of junior personnel have been redacted at the request of LAS.]

12 June 2014

Dear Mr Daly

Outcome of disciplinary hearing

I write to confirm the outcome of the disciplinary hearing which you attended on Friday 30 May and Tuesday 3 June 2014 at London Ambulance Service Headquarters, Waterloo.

I was advised by [redacted], Senior Human Resources Manager, Ambulance Operations Manager Keith Miller presented the management case, assisted by [redacted], Human Resources Manager. You were represented by Josef Kane.

At the start of the hearing I gave introductions and explained the process for the hearing. I also informed you that one potential outcome of the hearing could be your dismissal from the London Ambulance Service.  This has also been outlined in both the letter inviting you to attend the hearing. I confirmed that all parties had copes of the same documentation and stated that should anyone require an adjournment at any time that this should be requested through me. I then listed the issues to be considered as I saw them that sat outside the allegations being considered at the hearing, these being your grievances; the delays in this process; your wish to have character witnesses present at the hearing; the availability of the Investigating Officer, your crewmate on the day being unavailable to attend the hearing; your view that there had been a lack of support given throughout the process, the lack of transcript and copy of the EOC tape; the priority of sickness absence over suspension.

I took an adjournment to consider all eight issues. As you are aware, I explained my position on these and then dealt with the grievances in more detail. You agreed that the grievances regarding Kevin Brown not chairing the hearing had been dealt with and that bar apologising again for the inclusion of your OHD report in the pack, I could not see what more could be done with regards redress. You agreed with this, stating that it "felt reasonable" and that there was "learning for the LAS" in this going forwards. In regards to the lack of support, we were awaiting contact from your support officer and I said that we would return to this point later in the hearing. With all parties' agreement, we then proceeded with the hearing.

The purpose of the hearing was to examine the findings of [redacted]'s investigation into the following allegations:

1. You failed to respond to emergency call CAD 707 of 29 May 2013.
2. By your actions you failed to act in the best interests of the patient.
3. You failed to exercise appropriate leadership behaviours as a Team Leader.

You denied all three allegations,  taking a brief adjournment before denying the third. You stated that this was because it was not your "behaviour to  act in that way as a Team Leader or an individual" but because your were "ill at the time".

Mr Miller presented the management case as per the documents which had been previously circulated. I heard that on 28 May 2013 you were crewed with Paramedic [redacted] on  F102 for an 1830-0630 shift. Mr Miller stated that the failure to respond to an emergency call occurred on 29 May 2013 at 0524 following your request to return to Waterloo to allow [redacted] to return to Westminster for an 0600 hours finish (as no rest break had been allocated during the shift). Whilst the conversations between yourself and the Emergency Operations Centre (EOC) regarding the call were on-going, [redacted] was driving back to Waterloo and away from the call. Mr Miller stated that there was no record of amber to scene being pressed signalling to the control room that you were responding to the emergency call, nor were either of the cancellations accepted when sent. Your vehicle was then made unavailable by EOC at 0540 hours. Mr Miller highlighted Ambulance Service Policy TP/003 Statement of Duties to Patients which states "Staff are required to be ready and willing to work at all times during their contractual hours". Mr Miller then provided some detail regarding your conversations with EOC.

[redacted], Area Controller, was then called to the hearing as a witness. We heard the tape of your conversations with EOC, including the conversation with [redacted]. During the initial conversations, you were heard to say " this is not really acceptable". "sorry mate, I'm not accepting this", "I think this is unacceptable because I have never had a problem before", "it is not acceptable and I am not accepting it either", "I am not accepting it and I think it is dangerous". During the conversation with [redacted], you were heard to say "you can make us patients too because right now I am tired... I am tired and I am sure my colleague who has been driving all night is tired", "I think it is dangerous and it is unreasonable", "it is not fair" (3 times), "it is still not right. I don't feel this is right". When [redacted] said "I will say you are not going to take this call and then that is it" you replied with "yeah, thank you". At the hearing, [redacted] recalled the conversation with you , saying that you had said you were "tired", but not that you were unwell, nor that you needed to use the facilities on station. [redacted] was clear that in the conversations you had with EOC you could have said "I don't feel well; I feel sick" but that you did not do so. When asked if you looked different when you spoke to [redacted] on the balcony, [redacted] replied "no" and that you were "just Eddy". On questioning from Mr Kane, [redacted] said she would "never have thought that you would refuse a call" and that she had "never come across a crew that had refused a call" in her 18 years working in EOC. After some further questioning. [redacted] was released from the hearing as a witness and an adjournment was taken.

On reconvening, Mr Miller continued with the management representations, referring to your investigations interviews and the alleged 31 disparities in the notes cited by you following your interview of 3 July 2013. At this stage, [redacted], HR manager, was called to the hearing as a witness. [redacted] stated that his handwritten notes were contemporaneous notes and that there were no other notes from the meeting. When asked if he considered the notes to be a true account of the meeting, [redacted] replied "yes". After some further questions, [redacted] was released from the hearing as a witness. As an adjournment was not required, Mr Miller concluded his presentation citing his belief with his supporting rationale that each of the allegations were proven.

You confirmed that your crewmate for the shift had not made a request to return to station nor for you to decline a call.

Mr Kane then commenced the presentation of your case. Due to the time, Mr Kane requested that I hear from the character witnesses first, including their views on a specific scenario (the Bolam test). I agreed to this request and we then heard from your four character witnesses individually. All spoke highly of your character and stated when they thought it would be reasonable to ask to return to station prior to the end of a shift. All four also agreed, albeit one stated if forced, that they would respond to an emergency call which was allocated after they had requested to return. Mr Kane then continued with a number of questions regarding Mr Miller's presentation. Concerns were raised regarding managers allegedly being aware of the issue, but failing to act. I undertook to take this forward separately and can confirm that I have now done so. Mr Kane also stated that there should have been the opportunity to question certain parties who were not available at the hearing. I questioned how relevant these people were to the central facts as they were not present on 29 May 2013; however I stated that if you had a genuinely held belief that they were central to your case and by not being able to question them it was detrimental to it, I said we would need to adjourn the hearing. I asked that you take a break to consider this.

On reconvening, Mr Kane said that you wished to proceed. As I informed you, I was very clear that the hearing needed to be a fair one and if you felt that it would hinder your case not to question people,  I could not continue the hearing on that day. You said that you wanted to go ahead and that it would not affect your case. On that basis, I agreed that the hearing would continue.

You then presented your case, saying that you had been absent due to sickness earlier that month and had had symptoms for the previous 18 months/2 years. At the start of the shift you said you were "a bit queasy", but that your pain did not commence until around 0300. You said that you knew you could not have made that call and that you were "desperate to get back". You said you sounded happy on the original call to EOC as you were looking forward to getting back. You thought the job coming down was "a mistake". You said you had not reported sick as you were "embarrassed" and spoke at length regarding the Camberwell fire. You said you hadn't handled things as well as possible and that you were "ashamed" of yourself. You said you felt "let down" by the investigation team and did not know how they had reached their decision. You said you could not have done the call that day "physically or mentally". You said you would now say you were ill were the situation to arise.

I then asked for the tape to be played again. I informed you that I did not hear you say "I don't feel right", but "it don't feel right". I then referred to your first interview on 23 June 2013 (which was not challenged at the hearing) where you were asked "did you refuse the call" and you replied "yes". I put it to you that during the three calls with EOC; the time in between (circa three weeks) and at your interview on 23 June at no point did you say you were not well. Following your suspension, you then stated that illness was the reason for your failure to respond. You said this was because you had "time to reflect". You then said you had not said you were sick "due to annual leave". When I repeated this to you, you said this was not the case and that you had been "hiding" your illness. Again you said you regretted "not saying it" and said I should believe what you had said at the hearing.

As there were no further questions, I adjourned the hearing to allow all parties to prepare for summing up.

On reconvening, we heard from Mr Miller, Mr Kane and finally your summing up.

Due to the lateness of the hour, I adjourned the hearing at 2210 hours to consider all that I had heard, having agreed to reconvene on Tuesday 3 June.

On reconvening, I informed you that I would read from a prepared narrative which I attach to this outcome letter for ease.

having found all three allegations proven, I informed you that I did not accept your case that your reason for not accepting the call was that you were too unwell to do so, but that you did not state this. I was of the view that your demeanour on the tape and the number of opportunities you had to state you were unwell did not make this a credible argument. I informed you that I did not believe the proven allegations could be rectified through training, education or a sanction designed to change behaviour as clear and unequivocal refusal of an emergency call is clearly a matter of gross misconduct. "Avoidance of, or non-response to calls, or not acting once a call has been accepted" are all listed in the Disciplinary Policy as issues that fall into potential gross misconduct.

I informed you that my decision was to dismiss you without notice from the London Ambulance Service; your last day being Tuesday 3 June, 2014 the date of the decision hearing.

You are entitled to appeal against this decision. Should you wish to do so, you should write to David Prince, Director of Support Service at London Ambulance Service.

Jason Killens

Eddie Daly Outcome Supporting Narrative

[This article is a supporting document to the article 'The Facts Which Informed the Decision to Sack Eddie Daly and an Appeal to Jason Killens'. Names of junior personnel have been redacted at the request of LAS.]


1. Thank you for attending on Friday and for adjusting arrangements through the day to enable us to make progress

2. We started by confirming the papers and confirming areas of remaining grievance and further issues associated with the hearing

3. The issues were summarised and agreed as:
   a. Grievances
   b. Delays
   c. Character references
   d. Investigating officer
   e. Ms Motin not being present
   f. Confirmed witnesses for both management and Mr Daly
   g. Noted concern regarding perceived lack of support
   h. Sickness v Suspension primacy
   i. Delay in sharing tape and transcript

4. We took a short adjournment to consider these points following which I confirmed my position and rationale on each of them and it was agreed by all parties that the hearing would continue.

5. We took frequent adjournments throughout the 12 hours of the hearing.

6. Prior to management presenting their case it was confirmed that all 3 allegations were denied by Mr Daly

7. Keith Miller then presented the management case and we heard from [redacted] and then listened to the tape recording of three conversations between Mr Daly and staff within Emergency Operations Centre where it was confirmed that Mr Daly and his crewmate were to proceed with the emergency call that had been dispatched to them

8. I noted that Mr Daly was laughing and joking through the tape recorded conversations, that he did not say he was unwell and did not appear unable to continue his shift as a result of illness

9. In my view [redacted] was a credible witness, she offered a clear recollection of events and was clear in her mind that the emergency was appropriate to task to Mr Daly and his crewmate, that there was no other suitable resource to assign, that Mr Daly was within his shift and able to respond to the call and that Mr Daly did refuse to attend the emergency call having discussed with him the circumstances of his shift times and calls being held

10. [redacted] confirmed that a conversation took place with Mr Daly on the balcony at HQ after he had returned to station where he did not appear unwell nor did he report sick, when questioned by Mr Miller [redacted] said Mr Daly's demeanour and appearance was normal saying "it was just Eddie"

11. Mr Daly suggested to [redacted] that his shoulders were down, she said she didn't recall that save for Mr Daly saying he was tired and continued by remarking that everyone looks tired at that time in the morning.

12. [redacted] was clear that if she had been made aware that Mr Daly was unwell that the ambulance would have been taken off the road and that the emergency call would have been re-assigned or held for further resource

13. Mr Miller continued to present the management case and called [redacted], HR manager who was present at some of the investigation interviews

14. [redacted] was not in my view a compelling witness and whilst his statements were available he struggled to recall much of the supporting details although he did set out to confirm that the content of the statements were a true account of what was said and that the statements presented arose from contemporaneous notes

15. Given the concerns raised over the notes being so full and so clear as Mr Kane remarked in the hearing I have referred these concerns for consideration to Tony Crabtree, Assistant Director of Workforce

16. Mr Smith concluded his evidence by confirming that the notes were and accurate reflection of what was said at the meeting

17. After Mr Miller concluded the management case all parties present agreed to Mr Kane's request to hear, out of sequence, from the character witnesses that had been proposed

18. These witnesses went further than simply providing testimony on Mr Daly's character as it was agreed by all parties present that scenario testing, the bolam test would take place - I agreed to this request given the seriousness of the case as I believed it to be reasonable in the circumstances

19. Three of the four character witnesses were clear when questioned that they would not refuse an emergency call when passed with the fourth witnesses suggesting a challenge would take place dependent on the category of the call but that ultimately the fourth witness confirmed they would respond if they were "forced"

20. After hearing from these four witnesses Mr Kane posed a number of questions to Mr Miller pertaining the details within the management case during which Mr Kane noted that it was detrimental to Mr Daly's case not to have certain witnesses available to the hearing

21. I set out my position I would not proceed further with the hearing if it was believed that not having the witnesses would be detrimental to Mr Daly, Mr Daly confirmed after a short adjournment that he was content to proceed without the witnesses being present saying that it would not affect his case as they were not central to it.

22. Mr Kane raised concerns that members of the management team had prior knowledge of the alleged incident where Mr Daly refused to attend the emergency call and that they had failed to act on it, I can now confirm that these matters have been referred for separate investigation

23. Mr Kane presented Mr Daly's case noting that he was unwell during the shift and that he was looking forward to going back to station, he remarked that Mr Daly had never been in these circumstances before and noted that he was ashamed of his behaviour on the day going on to say that if the circumstances arose again he would say that he was ill

24. At the conclusion of Mr Kane's presentation there followed some questions from the panel that explored the statement of 23 June which noted that Mr Daly replied yes when asked did you refuse the call and made no mention of him being ill; I noted that this was the first written record following the incident the content of which was not challenged during the course of the hearing and that this was follwoed by the statement of 26 June where for the first time illness was introduced as the reason for not accepting the call

25. I noted that the recording of the conversations between Mr Daly and EOC made no mention of illness being the reason for refusing the emergency call and that this was also not a feature of the conversation on the balcony with Patricia Smith nor had Mr Daly made mention in the four weeks between the incident and the meeting of 23 June of the refusal to a DSO or AOM being caused by illness

26. Illness was only introduced as a reason for refusal on 26 June after suspension had taken place

27. I summarised the salient points of the hearing ahead of adjourning prior to summing up as focusing around one central point that being do I believe on balance of probability the version of events contained in the tape and the interview of 23 June or what has been said at the hearing and since Mr Daly's statement of 26 June

28. Mr Daly said that I should believe what had been said at the hearing on Friday at which point we adjourned for colleagues to prepare their final submission for summing up where I confirmed that Mr Daly would have the last word

29. Both parties summarised their case and placed before the panel the salient points of their presentation throughout the 12 hour hearing and due to the lateness of the hour all parties agreed it would be unreasonable to reach a decision on Friday

30. I have reflected for 72 hours on the content of the hearing, considered carefully what was said, revisited my notes, the papers, the notes of [redacted] and the tape of the conversations and the fact that Mr Daly denied all 3 allegations in coming to my decision

31. For ease, I will take each allegation in turn. The first allegation, "that you failed to respond to emergency call CAD 707" was denied. It is a fact that Mr Daly did not respond to this call and from the tape it is also clear that [redacted] asked if Mr Daly wished for her to "cancel you down and say you are refusing a call". After subsequently stating that she would not argue, [redacted] said "We are going to cut you down. I will say you are not going to take the call". Mr Daly responded "yeah! Thank you!" Mr Daly's case was that he was ill and as a result did not respond to the call. Additionally at the hearing, Mr Kane said that the conversation between Mr Daly and [redacted] then ended and Mr Daly did not have the opportunity to state he was unwell. As stated at the hearing there were an number of options open to Mr Daly to state this either by phone or radio; in the conversation on the balcony; by speaking to a DSO or AOM or to Resource. Mr Daly did not do any of these, however. As a result, Mr Daly did not report that he was unwell and was not stood down or shown as sick. It is my view therefore that you failed to respond to this call and thus I find this allegation proven. I must state that in my view this is the most serious allegation against Mr Daly.

32. The second allegation "By your actions you failed to act in the best interests of the patient (CAD 707)" was also denied. It is clear that Mr Daly did not respond to this call. From the tape, it is also clear that Mr Daly was informed that there was no other resource available and that there was "no possibility of any vehicles coming up". Mr Daly was also aware that the call had been held "for some time". Given all of these facts, I do not believe that Mr Daly acted in the best interests of the patient at the time; hence I find this allegation proven.

33. The third allegation "You failed to exercise appropriate leadership behaviours as a Team Leader" was also denied. I must note, however, that although Mr Daly denied this allegation, he also stated that it was not in his behaviour "to act in that way as a Team Leader or an individual" stating he was "ill at the time". I am aware that on this occasion Mr Daly was attending and Paramedic [redacted] was the driver. Although both crew members are HCPC register paramedics, Mr Daly is a Team Leader and was therefore the most senior member of staff. Mr Daly undertook all the conversations with EOC regarding this call and was very clear, when I asked, that there was no suggestion that [redacted] had asked Mr Daly not to respond to this call. By Mr Daly's actions he did not display the leadership and direction I would reasonably expect from a Clinical Team Leader, I therefore find this allegation proven.

34. having found all three allegations proven, I have considered what I believe to be aggravating and mitigating factors surrounding this incident.

35. Aggravating features - what makes this matter serious in my view:
   a. Mr Daly is a Clinical Team Leader and as such a role model for other staff
   b. Mr Daly knew the call had been held and was told that there was no other resource to attend
   c. It was clear to Mr Daly as he confirmed it in the conversations with control room staff that he was within the operational times of his shift.
   d. That this is a "never event"
   e. Mr Daly knew he was shown as green and available for calls as this was said by control room staff
   f. The initial refusal to respond was immediately escalated by the control room dispatcher to his line manager indicating the gravity of the situation
   g. Mr Daly's tone and approach to control room staff changes following the allocation of the call and Control's insistence that Mr Daly needs to respond.
   h. The number of opportunities for Mr Daly to report his inability to respond to the call through illness were that to have been the case

36. Mitigating features cited by Mr Daly
   a. Mr Daly has 30 years service
   b. The number of positive character reference provided
   c. Mr Daly's underlying health conditions and the fact that he is a very private person hence he did not state he was unwell as he was hiding his illness

37. I have again considered the delays in the investigation process - as a result of all parties and the issues raised generally around and throughout the investigation. Although I have some concerns (which I have taken forward) and appreciate some elements such as witness availability were not ideal, I do not believe any or all of these matters fatally flaw this case and make it unreasonable for me to proceed.

38. Having considered all 3 allegations and the fact that I have found, on balance, that they are proven I have carefully considered the aggravating and mitigating features of this case before deciding what action is reasonable and appropriate in the circumstances. I must now state that I do not accept Mr Daly's case that his reason for not accepting the call was that he was too unwell to do so but did not state this. Mr Daly's demeanour on the tape and the number of opportunities to state he was unwell if that was the case, do not for me make this a credible argument

39. I am of the view that these proven allegations constitute gross misconduct and go to the very heart of our contract of employment with Mr Daly as such I have considered the full range of sanctions available to me withing the Trusts disciplinary procedure

40. I believe that these proven allegations cannot be rectified through remedial training, education or a sanction designed to change behaviour as clear and unequivocal refusal of an emergency is clearly a matter of gross miss conduct [sic]. "Avoidance of, or non response to calls, or not activing once a call has been accepted are all listed in the Disciplinary as issues that fall into potential gross misconduct.

41. I have therefore decided that you will be dismissed without notice from the London Ambulance Service

42. You have the right of appeal against my decision the details of which will be set out in the outcome letter from the hearing which will follow next week

Thursday, 21 May 2015

‘If You Rush a Miracle Man You Get Rotten Miracles!’: SECAmb's IPHEC Conference Brighton 2015 Report (Day 1):

South East Coast Ambulance Service NHS Foundation Trust (SECAmb) has just finished hosting its first two day international pre-hospital emergency care conference in Brighton. Annelies van Wamel, roving paramedic and friend of this blog, attended the conference and has kindly provided this overview of the first day.

Innovation for Pre-Hospital Emergency Care 2015 - Day 1
by Annelies van Wamel

Since the late 1970s, there has been an understanding that the role of pre-hospital care has become a specialised role. The two-day conference focused on the developments in pre-hospital cardiac care in myocardial infarcts and cardiac arrests. An astonishing development over the past 45 years has seen it develop from ‘scoop and run’ in now antique vehicles to state of the art interventions on scene.

Attending the first day, I was presented with a well-equipped venue (American Express Community Stadium in Brighton), a variety of knowledgeable speakers, several exhibitors and roughly 1000 attendees.

The conference was opened by the Chief Executive of SECAmb, Paul Sutton, who claims to be the only operational CE of a UK ambulance Trust. Although some areas of the Trust see him more frequently than others, rumour has it he still responds regularly, as do several of the senior managers. I wish somebody would invite him to do a few shifts in our remote corner of SECAmb (lovingly indicated as ‘deepest, darkest Kent’ by one of the speakers) which struggles with a so-called rest day rota in which all goes and only your rest days are set in stone. It poses major issues for staff with stress levels increasing dramatically.

The first speaker was Dr Craig Ellis, a Specialist Pre-hospital and Emergency Physician based in New Zealand. As he introduced himself he commented he was in the unique position to be able to drop a few bombs quite safely because he had to leave to catch his plane back to New Zealand immediately after his presentation. He was true to his word.

Dr Ellis told us that one rule doesn’t fit all patients; by rolling out a standard protocol regardless the etiology of the cardiac arrest we miss opportunities to improve outcomes which haven’t changed for the last several years. He showed us how PEA isn’t always a PEA and why we shouldn’t abandon a ‘chronic VF’ as unviable. He made an interesting point about good CPR with a 30 degree head tilt to relieve ICP: it can perfuse the brain to the point where the patient can vocalise and even object to (painful) CPR even though the patient is still in arrest. What do we do about pain relief for these patients? His main message was: think about the causes, we need more pragmatism and less dogmatism.  I loved his departing message: ‘If you rush a miracle man you get rotten miracles!’

The second speaker was Dr Adam de Belder, Director of Cardiac Services at Brighton and Sussex University Hospitals. He took us on a tour about what we thought and think about the cause of Acute Coronary Syndrome and how treatment equally evolved. One of his slides showed how patients were once advised to be semi-starved or put on a diet of fruit, sugar and a bit of milk and left in bed for weeks, guarded and assisted by nursing staff to prevent any form of exercise or exertion. One wonders about the prevalence of DVTs and PEs!  Having moved on from that view we now focus on the inflammation of arterial walls, plaque forming and the body’s response. Interesting little detail: ‘infarcire’, of which our ‘infarct’ is derived, means ‘to stuff’!

Having digested this it was time for coffee, tea and refreshments after which there was a choice of workshops. I attended the EZ-IO workshop which focused on the proximal humerus insertion. It led to a demonstration of how to define the landmarks and we all had a go at each other. The advantage of this site is that the flow rate is fast, with approximately 3 to 4 seconds to the heart, allegedly the pain is less (less requirement for analgesia), and if you are working at the head end of the patient you have immediate access to the drugs route. Adrenaline free Lidocaine is advocated when inserting in conscious patients yet this would take several minutes and does that not defeat the object of a quick vascular access? There were four other workshops but unfortunately only one could be attended.

Dr Ali Dana is Consultant Cardiologist at Portsmouth Hospitals NHS Trust. He gave us an interesting presentation on the pros and cons of several anti-coagulants and why cardiologists are not necessarily happy with our doped up with morphine patients even though they arrive pain-free, relaxed and their blood pressure under control; sadly, opioids have a tendency to delay gastric emptying and hence absorption of anti-coagulants given before the angioplasty procedure! There was a touch of political debate when he stated he didn’t care whether Clopidogrel was cheaper than Ticagrelor – that was for procurement and NICE to debate but he, as a doctor, preferred Ticagrelor mainly because the re-occlusion rate was lower and it worked faster. An interesting point of view if you work in a service which, for cost reasons, insists to provide its clinicians with the lower dose of Clopidogrel so that patients in their miserable state are regularly required to take at least 8 tablets to make the total dose!

After an excellent lunch Chris Walker, Nurse Consultant at Queen Alexandra Hospital, Cosham, took up the baton and advised us that the Emergency Department was a bad place to go with our ACS patient. Taking care not to alienate his predominantly SECAmb audience he showed us how going to A&E presents major delays in definitive care for ACS/STEMI patients whether they selfpresent, are taken there by ambulance or just decide to develop a STEMI on the spot. Shockingly, ending up at the wrong department (A&E in this case) was shown to add on average 60 minutes delay in definitive care! Bearing in mind the ‘mind minute myocardium’ slogan this costs the patient dearly in lost cardiac tissue. Chris advised to make sure patients were adequately dosed up with Ondansetron: Cardiologists tend to have an expensive taste and their shoes are in a vulnerable position next to the patient...

Next, fondly and humorously introduced, Professor Douglas Chamberlain, retired cardiologist and ‘father of the UK paramedic profession’, warned us that he was a fan of ‘Teaching by Terror’: every attendee he spotted with the eyes closed at the end of this day would be publicly asked a question and woe betide if he couldn’t answer! We all shot upright and paid close attention to his 10 rules of a normal ECG. We often forget the basics but it makes sense to start with knowing what is normal. I will take the ‘Bear Test’ away from his presentation: He stressed that limb electrodes should be on the limbs i.e. arms. To make sure this was the case he advocated a positive Bear Test: if a bear were to come in, rip off the patient’s arm, he should be running off with the electrode on that arm as well...   He continued by showing us some ECGs with ‘weird’ complexes; simply because the electrodes were wrongly placed!

Unfortunately, I missed the presentation of Dr Richard Lyon, Registrar in Emergency Medicine and Prehospital Care. His interests include prehospital resuscitation, therapeutic hypothermia and trauma care, working closely with Helicopter Emergency Medical Services (HEMS), event and expedition medicine.

It was a long but interesting day, with many aspects of our profession highlighted. Looking at how quickly and professionally our young branch of the medical tree has matured I couldn’t help look at the gathered attendees, many of which were estimated under 35 years of age. Fresh faces, but there was also the West Sussex Retirement Association, with many pictures of ambulance material which seemed to stem from a former century. It made me wonder how we cope, how we manage to adapt, develop and maintain our professional knowledge and attitude. These men and women are all so proud of such different professional stages. All aimed to serve the public as well as they could offer.

The reverence of the flag bearer at the opening of the conference was touching; his salute to the flag made me quietly wonder: who salutes him, who has seen so much?

Tuesday, 19 May 2015

Visiting London Ambulance Service HQ (Part Three): Executive Views on the Case of Edmund Daly

My visit to London Ambulance Service on 5th May 2015 was a mission to learn more about the organisation's approach to supporting its workforce as its operational staff toil to provide a service in increasingly demanding conditions. With front line staff routinely facing relentless 12-hour shifts without respite, delivering emergency care to the best of their abilities despite skill-sapping fatigue and health-eroding stress, it seemed clear to me that whatever measures were currently in place were insufficient.

An audience with Chief Executive Dr Fionna Moore and Director of Operations Jason Killens gave me the opportunity to learn more about their understanding of the conditions and the measures they were taking to provide relief for their beleaguered ambulance crews. You can read more about their general thoughts and their approach to the challenges in the previous installment of this series, but at the core of the issue was one particular incident which initially alerted me to the LAS dilemma.

News of 30-year veteran LAS paramedic Edmund Daly's dismissal and subsequent suspension of HCPC licence hit the headlines of various media outlets earlier this year and the focus of the coverage was broadly on the fact that he had 'refused to attend a 999 call because he was "tired".'

As I read the reports, it became evident to me that there were more to these circumstances than was featured in the coverage. I read the documentation arising from the HCPC hearing with growing concern. Edmund Daly's case seemed to be a glaring example of the institutional disregard for crew welfare which has become more critical as demand continues to rise and resources become increasingly thin on the ground. At every turn, front line staff are expected to make up for the shortfalls and the inadequacies of the emergency ambulance system and here was a man who had stood up to say 'enough was enough' and had been destroyed for it.

I met with Mr Daly - Eddie - and learned everything he had to tell about his case. His account only compounded my fears, he was every inch the trustworthy professional, a mild-mannered, gentle man who was a credit to his employer and to the paramedic profession, certainly not deserving of such an ignominious end. Furthermore, his reasons for refusing the 999 call seemed justifiable - he was fatigued and unwell with ample evidence to prove it after the fact. Following our meeting, I continued with my research, building a thorough understanding of the entirety of his experience; his career, the night of the 'refusal' incident and the subsequent investigation and multiple hearings.

It just didn't make sense to me that London Ambulance Service would opt to end the career of a loyal, positive and - according to both Dr Fionna Moore and Jason Killens - brilliant clinician in such a way. It was Jason Killens himself who had brought the axe down, so during my interview with him, I resolved to gain an understanding of his part in Eddie's downfall in the hope that it would make more sense.

Seeking An Explanation

'...caring for the people who visit, live and work in the capital.'
In the earlier part of the interview about the general challenges LAS faced, the flow of the discussion had been conversational and positive. But the moment the topic turned toward staff perception of the executive management team and whether the Edmund Daly case set a precedent which fed a culture of fear, things got decidedly more tense.

My initial question, 'It does come down to the precedent set by the Edmund Daly case. What message do you think that that has sent to the people on the front line?' was countered by Jason with another, guarded, question.

'So you tell me what you think about the Edmund Daly case,' he riposted.

There was a long pause as I considered how hard I could push. 'I asked you first,' I chanced.

There was a peel of nervous laughter. The atmosphere remained tense. Jason had the face of a poker player who wasn't going to budge. It looked like I was going to have to lay a card first.

I set about describing Eddie Daly as the 30-year veteran who was highly-regarded by his peers and those in higher stations (a reference to the fact that Fionna Moore herself had provided a character reference in Eddie's defence at his hearing). Every few words I spoke were interrupted by Jason proclaiming his agreement with my statements. An attempt to set me off balance? A knee-jerk need to defend his decision? Or an overbearing attempt to be agreeable? I couldn't be sure.

I then described Eddie’s experiences at the Lakanal House fire in Camberwell in 2009, which left him with some deep-seated issues which permanently undermined his physical and mental well-being, and his ongoing struggles up until the night of his 'misconduct' on 29th May 2013. Killens' interruptions became less frequent and less audible. Dr Moore listened silently throughout.

I highlighted the erosion of his coping mechanisms, the heightened state of fatigue that afflicts PTSD sufferers, and how this would have contributed to his decision on the night of his refusal, finishing with, 'So there you have a man who has done his best for 30 years and to spin forward a year, he's now been sacked for gross misconduct. So how does that come about? What am I missing? What don't I know?'

Jason's response was, 'So, there's probably a whole bunch of things that you don't know that you'll appreciate that I can't talk to you about.'

'A Very Stupid Decision'

Jason Killens, LAS Director of Operations
I explained that Eddie had given me full permission to discuss his case, but Jason had this covered with, 'But he hasn't given me, so I can't breach that confidentiality to you.' Inwardly I was frustrated, I should have got something in writing. He continued:

So what you know is what you know. What I would say, what I would say - and of course you know I'm the bloke who dismissed him - so it was my decision and my decision alone. A dismissal decision is the most difficult thing I have to do in this place. Thankfully, they're rare. Very rare. But it's life-changing for the individual. I recognise that. It's life-changing for them because they lose the job that they love. In most cases. In most cases when people get dismissed it's because they do something so serious, in the spur of the moment, that you can't step back from it. And that's the case, that's what happened here. Eddie... I've known Eddie for a long time, he's a nice bloke as you described at the top. He was a good paramedic, he was well-respected by staff, he was a good team leader, he had a good rapport with patients, he was brilliant clinically. But he made a stupid decision. A very, very stupid or bad decision, whatever you want to call it.'

'Which you're prone to do when you're tired,' I replied. 'Better to make it on the radio rather than when he's trying to administer drugs.'

'As I say, there are some things that I probably know that you might not, which informed my decision at the time. He went through... it was a 12-hour hearing that we had in the end, so it wasn't a quick thing by any stretch. That is very unusual. Very unusual for a dismissal hearing, they would normally go three, four hours. Very unusual to go that long. We went that long because there were a number of things we needed to consider, not least Eddie's career and what happened leading up to the day and what happened on the day and what happened subsequently to the day. But in the end, having considered everything that came forward, the nub of it was that there was a refusal to respond to a call. That's the nub of it, yeah? He refused to go to a job when he should have gone to a job. He was in his shift time, yes? And he refused to go to that call, and on that basis, having struck right at the heart of what we're all here to do: respond to patients, help people.'

Are Patients more Valuable than Staff?

How many unwell people are in this picture?
I asked whether that mandate to help people extends to staff who are unwell as a result of the job, as in Eddie's case.

Jason replied, 'So, he was in his shift time. He was in his shift time and he had not said he was unwell and not able to continue and he refused to go to that call. And being in a position of responsibility, which he was - he was a role model for people, he was a team leader, yeah? That made it worse. And having got to that point, because of what he did on that day, not what happened in the previous thirty years, what he did on that day was so serious that we had no choice but to do what we did. What is easy? No. Was it something that was a split second decision? No. Did I reflect on it and decide whether this was the right thing to do? Yeah, long and hard.'

He went on to use the HCPC decision to suspend Eddie's paramedic licence as further vindication of his decision. The HCPC hearing was unopposed, Eddie had not attended to defend himself, and the evidence and witnesses used were provided by LAS, the same as those used by Jason in the hearing. Jason also pointed out that Eddie had chosen not to dispute the decision at industrial tribunal, apparently unaware that the £40,000 cost of doing so had been an insurmountable barrier for Eddie.

Jason was unrepentant. 'He chose not to represent himself at the HCPC hearing. They're Eddie's choices, not mine, yes? All I'm saying to you is it was not an easy decision. It was not an easy decision. They never are, but in this case it was particularly difficult because of who it was and what he was like as a person here. One of our people. But, because of what he did, I believe it was the right thing to do and I stand by that decision now and I'd do it again.'

What is 'Fitness to Practise?'

I asked, 'Is this indicative of a general management failure to understand what impact ambulance work at the present level of demand has on their operational staff?'

'No. It's not! I can't have...', Jason began, but tailed off as I laboured my point.

Does 'lack of competence' include fatigue or ill health?
'...If a paramedic who is responsible for his own abilities - fitness to practise - considers himself to be unfit to practise...'

At this juncture, Anna Macarthur tried to reign in the increasingly combative nature of our discussion, but Jason had a point to make, stating firmly, 'But that's not what he said!'

There was a brief exchange about the words Eddie used on the night. Eddie maintains that he said 'I don't feel right', Jason disputed this. In the final dismissal documentation issued by Jason (which I checked after the interview), the most similar phrase taken from recordings of the conversation on the night quote Eddie as saying 'I don't feel this is right'. This gives weight to Jason's assertions that Eddie was standing for a principle rather than claiming he was ill. As inconsequential as those two words may sound, it seems that this more than any other single fact was the final nail in the coffin for Eddie's career.

The Weight of Responsibility

Andrew Lansley visits the LAS control room in 2012
I moved on to my next question, 'The Daly case focused on the refusal of a single 999 call, yet no other resources were available for 90 minutes. Surely this indicates a far greater failure of service with responsibility far higher up the food chain? Did anyone answer for that?'

Jason claimed he couldn't recall the nature of the 999 call in question. I reminded him that it was to a 43-year-old female with nausea and vomiting. He also couldn't remember how long the call was held for. I pointed out that HCPC records indicated that it was 90 minutes.

His response, 'So, you heard me say earlier, you know we've got a real pressure of work problem here. We accept that. We've got the highest standard of utilisation in the country. We accept that, we know that. Our commissioners know that and the HSE know that. That's why we've come together this year to tackle it. With a big investment chunk again, we'll bring utilisation down. So it is understood that there is... there are calls which wait longer than we would want. We understand that, we know that.'

Fionna Moore backed him up, 'That's gone on over the last year. Even worse than it was back in 2009. So in the last year, we believe that we have continued to deliver a safe service on the basis of our response to Red 1s and Red 2s. We haven't hit our targets, but we believe we've still provided a safe response and we can evidence that by an internal review and indeed an external clinical review, but the quality of our service that we have provided has been poorer than we would have aspired to and that means that inevitably that C1s and C2s are waiting for a long time.'

Fionna repeated her claim that they were focused on providing a 'safe service' despite the extraordinary demand and lack of resources which sees LAS routinely in a state of 'surge red' with frequent escalations to 'surge purple' (usually reserved for major incidents).

'But safe for who[m] though?' I asked, 'Because in Eddie Daly's case, had he towed the line and gone and done the job, if he was as unwell as I believe he was, then would that have been safe for him to go and respond to a call?'

Her explanation saw her reinforce Jason's position, 'So if Eddie was unwell then he would have told us he was unwell. The evidence that we heard and that the HCPC heard was that if he had said that he was unwell and not able to continue his shift or respond to the call because he was unwell, then the conversation and the outcome would have been entirely different.'

'An Element of Control'

I pushed again for recognition that the moment-to-moment stressors of brutally overworked and under-supported staff wasn't being taken into consideration, but there was a united response of denial from the two executives. My suggestion that at the end of a difficult shift, an employee might not have the wherewithal to convey his condition, let alone treat a patient or operate a vehicle, was shut down.

Fionna stated, 'But then Eddie is not inarticulate. I'm sure, had he said 'I'm sorry, I'm not well' he'd still be here.'

Jason said, 'What I can't do... so, what I'm desperately trying to do through the restructure of management and put the right leadership across the organisation is empower everyone at the lowest possible level to make decisions and be autonomous in what they do, within boundaries. So everyone has to get paid the same, everyone has to wear the same uniform, that kind of stuff. But around that, I want people locally, the local teams to decide how they go about delivering service, within the rules that we have to set and are given to us through the regulations, statutes and so on. What I can't have people doing, is picking and choosing what they do. And the Eddie Daly example is a good one here. I can't have people deciding when they will and won't go to calls. There has to be doesn't there - you surely must see this - there has to be an element of control.'

Jason went on to suggest that there were other elements to the Eddie Daly case of which I wasn't aware but which 'informed' his decision. I was less than convinced, especially after having read through outcome documentation he referenced which I hadn't seen at the time of this interview, but that he insisted was vital and might change my understanding. It didn't. If anything it underlined to me that his decision was made entirely on the basis of Jason's inflexible belief that a rule had been broken and that the details were of no real consequence. As Jason himself had said earlier, ‘It was my decision and my decision alone’. This was apparent.

I wouldn't go as far as to say that the investigations and the disciplinary hearings were a charade, but there is certainly plenty of evidence to suggest that the process was deeply flawed, from a weak investigation to witheld evidence, suspect reports and precedents which were dismissed (the paramedic officer who refused a 999 call but kept his job and got a 'reflective practise' verdict from the HCPC). Most worryingly, it suggested an absolute disregard for Eddie’s welfare and the clear systemic collusion to disprove that as a factor relevant to the case.

Faith in the Process

'...improving the working lives of staff.'
Jason defended the process, 'Because it was messy, what we were trying to do was brick it all into a sensible place where Eddie and his representative can take the panel considering the decisions through what had gone on so that an informed decision could be made. One of the reasons, that I said earlier, that we had a 12-hour hearing was to tackle all of those issues. To get everything lined up and dealt with on the day. That was Eddie's choice, that's what he wanted to do.'

This seemed unfair on Eddie, he was very much a stunned passenger in the whole process. I said, 'I spoke to him about that particular point yesterday and he said that it was a... he opted for the lesser of two evils. He just wanted it over. It had been a torturous experience for him up until then. So he was presented with a choice of prolonging the agony further, or proceeding that day when it probably wasn't in the best interests of his case. So he was damned if he did and damned if he didn't.'

Jason considered this, arriving at, 'I think that's a fair assessment. This issue wasn't going to go away and it needed to be brought to a conclusion one way or another. And the choice for Eddie on the day was: do you deal with it today or do we put it off and postponed it for another day. Because it was not going to go away. It wasn't going to stop. We had to have the hearing, we had to come to a decision. ... He and his rep chose to carry on.'

We went on to discuss whether there might have been another way to deal with Eddie's 'misconduct', but Jason insisted that due to the grave nature of the allegation, despite Eddie being 'a model employee', the 'material breach of contract' gave Jason no choice in the matter. He said, 'if I had my time again, I'd be saying to Eddie “don't say the things you said. Don't do what you did that night. Do the job.” ... I'm not advocating telling fibs. What I'm saying is that if you're unwell, then the member of staff needs to say that they're unwell. … What I'd say to you is that Eddie Daly was a one-off, isolated case. There are very small numbers of people who were dismissed for circumstances like that. But having done what he did, I had no choice. And I believe that it was the right decision and I would do it again.'

Fionna offered this on Eddie’s traumatic experiences and whether she thought that related to the misconduct incident. ‘It doesn't take anything away from the fact that Eddie was a great bloke with thirty years of great service and in that dreadful incident in Lakanal House, the fire there, that was absolutely dreadful. I've listened to the tape of that, of Eddie on the phone, and I know how awful it was when we talked about it. So none of that [is relevant]... it's just two completely different episodes.’

Sword of Damocles or Executioner's Axe?

LAS execs at the 7/7 bombing inquest in 2011
In conclusion, neither Jason Killens nor Fionna Moore seemed to feel that there was any miscarriage of justice in the case of Edmund Daly. They could not - or would not - see any correlation between LAS putting its staff in intolerable positions and those same staff having an unavoidably human response to those same conditions.

I am sympathetic to the pressures and responsibilities of senior executives dealing with cases like Eddie Daly’s, and I understand that, in a way, Eddie’s brinkmanship left Jason Killens with a ‘damned if you do, damned if you don’t’ decision.

In my opinion, the ultimate problem is one of overworked staff, an unforgivable state of affairs caused by numerous factors, not all of them in Jason and Fionna’s control. It is fair to say that, had Mr. Killens been seen to allow Edmund Daly a pass for refusing a 999 call, it would have set a different precedent and potentially opened the floodgates to an increasing number of similar ‘refusals’.

However, with the Operations Director admitting himself that 'utilisation' is unacceptably high at 95%, staff are pushed far too hard. Dangerously so. Under those conditions, it is inevitable that clinician health, attitude, welfare and ability to function will be impaired. Had those intolerable circumstances been avoided in the first place, then Eddie Daly would never have felt the need to make his stand. It is Jason Killens and Fionna Moore who are ultimately responsible for pushing staff to the brink and that they fail to see their part in that - and its relationship to Eddie Daly's predicament - is worrying.

The hearing outcome which Jason Killens chose still sets a dramatic precedent, one which is deeply damaging to any claims that staff welfare is a priority.

Why should a single paramedic pay the highest price for failing to attend one 999 call when the executive management team who are ultimately responsible for the conditions which lead failures of far greater magnitude remain beyond recrimination?


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Monday, 18 May 2015

Eddie Daly's Story: The Paramedic Who Broke

[This account is Eddie Daly’s story, told from his perspective. As such, it is important to recognise that it is not entirely without bias. The perspective of London Ambulance Service executive officers are discussed in this article, to which the events detailed in this account will give context.]

Edmund Daly was a career paramedic who stood as one of the finest examples of his profession for nearly three decades. Until 2013, when London Ambulance Service saw fit to dismiss him for 'gross misconduct' after he reportedly refused to attend a 999 call at the end of a busy shift.

The decision, and Eddie's treatment by the ambulance establishment both before and after his dismissal, is viewed by many as a travesty.

I met Eddie on 24th April 2015, to see how he was coping with life after the ambulance service and to get his version of events. I found him to be a mild-mannered and softly spoken man who is still proud of his career, but deeply saddened by its end.

He started working for London Ambulance Service in 1984 and due to his care, empathy and diligence soon became widely respected and admired by his colleagues and the patients he treated. Unsurprisingly, his professionalism and attention detail saw him become one of the first generation of paramedics when the role was first introduced in the early 1990s.

Coverage of Eddie Daley's A&E Person of the Year' Award in 2005
His natural aptitude as a role-model and mentor led to him becoming a team leader in 2001, which made him responsible for guiding and advising junior clinicians as they attended emergency calls together.

Eddie was recognised for his excellence in 2005 when he was awarded 'A&E Person of the Year' at the yearly London Ambulance Service awards, at which he was described as 'a great ambassador for the Service for over 20 years and is more committed now than ever'.

But on 3rd July 2009, perhaps in part due to Eddie's undiminished enthusiasm and willingness to help, his world darkened.

Lakanal House: 'Six Killed in Tower Block Blaze'

Lakanal House, Camberwell, 3rd July 2009
A 999 call to a burning 14-storey tower block in Camberwell required ambulance officer attendance, but none were immediately available. Eddie offered his assistance and was despatched to attend. When he arrived, the London Fire Brigade was tackling fires spreading to several floors of Lakanal House. While Eddie was providing support on the ground in the absence of inbound ambulance officers, he was approached by a friend of Dayana Francisquini, who was on the telephone while trapped inside the burning building. Eddie took the phone and, while trying to reassure and advise the distraught woman on the line, trapped in Flat 81 with her two young children, he sought to inform commanding officers of their plight. By this time, an ambulance officer had arrived and taken control of ambulance co-ordination. Eddie reported to her, but felt he was chided for bringing unnecessary details when there was 'already enough to deal with'. Nonetheless, the information had been passed on. Or so Eddie hoped.

Although 30 people were rescued from the blaze and 15 were taken to hospital for treatment, 26-year-old Dayana Francisquini, son Felipe (3) and daughter Thais (6) were overcome by fumes and died along with other Lakanal House residents, Helen Udoaka (34), her three-week-old baby Michelle, and 31-year-old Catherine Hickman.

Eddie was devastated. He began to question his decisions and was angry at his commanding officer. Over the next few months, as he continued to work he became tormented by the events at Lakanal House and his part in it. Work colleagues noticed a change in his demeanour, he became more withdrawn and solitary. Eventually, some six months after Lakanal, he decided he had had enough, telling his line manager, 'I can't do this, I'm leaving.'

Eddie was persuaded instead to take some time off and to seek counselling and treatment, which he did. He returned to work some time later and managed to get back into the swing of things. He felt things were returning to normal and was once again able to cope with the demands of his paramedic duties.

A Nightmare Revisited

But in November 2012, preparation for a public inquest into the Lakanal House incident required Eddie to turn his mind to those harrowing events once again. Returning to the scene of the fire and providing input for the upcoming inquest triggered Eddie's torment again. He began once again to suffer bad dreams and sleepless nights.

By Spring 2013, Eddie was suffering from gastro-intestinal problems, which caused him further discomfort and anguish. Early investigation led to the need to rule out bowel cancer, but later that year, the problem would be diagnosed as severe diverticular disease.

Despite mounting health problems, Eddie was still a professional, passionate about his job, and continued to give the public and his colleagues his best. Indeed, as a single man living alone, the rewarding aspects of patient care and his interaction with his colleagues were of critical importance to his coping mechanisms and his motivation, especially while dealing with physical and mental illness. It is to his credit that he was still able to function ably.

But by now, he had begun to understand his limits. With eroded health due to his job and the continuing increase of an intolerable workload, his shifts were becoming more and more challenging. He did his best to endure.

Breaking Point

As dedicated as he remained, on 29th May 2013 after more than 11 relentless hours of ambulance attendances without a break, he had reached a critical point. He was fatigued and his still undiagnosed abdominal illness was causing him further distress. He was concerned for his crewmate too, a young female paramedic who was also showing signs of stress and fatigue. As they prepared to head back to their nearby base station from their latest drop-off at hospital, an 'amber' 999 call to a 43-year-old woman 'feeling faint, dizzy and vomiting' was assigned to them. Eddie contacted the control room and contested the assignment, trying to explain that he felt that neither he nor his crewmate were fit to attend another call. He explained that he 'didn't feel right' but was embarrassed to elaborate. In hindsight, he regrets that he wasn't more clear.

His concerns fell on deaf ears. The dispatch manager said they had no other ambulances to send. But Eddie was insistent that they were unfit to endure yet another call. Although he never uttered the words 'I refuse', his concerns were documented as 'a refusal to attend' and Eddie doesn't dispute this. After eventually being stood down from the call by dispatch, he and his crewmate returned to their base station. As she departed in another vehicle to her home station, Eddie made use of the facilities in an effort to address his growing discomfort. There was evidence of bleeding.

Some time later, beyond the end of his shift, Eddie visited the dispatch manager to discuss the earlier altercation and offer an explanation. His high standing with colleagues extended to dispatch staff and he describes his relationship with the duty manager that night as a positive one. He explained his position to her, pointing out his poor physical condition. The dispatch manager seemed satisfied with this, gently scolding him with a slap on the wrist and a 'let that be the end of it'.

Sadly, it was far from the end of it.

The Institutionalised Response

Kevin Brown (ADO)
A few weeks later, following a meeting of managers on 23rd June 2013, the decision was taken by then Assistant Director of Operations (Acting) Kevin Brown, to suspend Eddie pending an investigation. The news was heartbreaking for Eddie and his torment was compounded by the LAS policy requiring him to have no contact with his colleagues while the investigation took place. As he continued to struggle with his demons, he found himself ostracised and alone.

His only permitted contact was his union representation and a management-appointed 'staff liaison officer', the latter with whom Eddie had no contact for the first 22 days of the investigation.

Eddie described a gruelling five-hour interview with the investigating officer, Maria Smith, who he felt had some sympathy for his circumstances but was powerless to do anything about it. He described a moment when her colleagues left the room and she appeared to want to say something but was unable, instead giving him a hug.

It wasn't until August that the Staff Liaison Officer informed Eddie that the investigation had been concluded.

Eddie acquired a new GMB union representative, Josef Kane, to defend him and preparations began to clear Eddie's name.

ADO Kevin Brown was initially expected to chair the subsequent misconduct hearing, but Mr. Kane and Eddie felt this was a conflict of interest due to Mr. Brown’s involvement in instigating the investigation. After significant delays, Director of Operations Jason Killens took the role. The hearing would not take place until 15th May 2014.

During preparations, it soon became clear that the investigation had been far from thorough, failing to take into account Eddie's health concerns. Additionally, the transcripts of the communication between Eddie and dispatch on the night of the incident when finally released by LAS were incomplete, missing out key parts of the exchange which could prove that Eddie had explained he was unwell.

Pressure to provide the full recording finally bore fruit two days before the hearing, but that left no time to prepare. As a result of the delayed evidence, Mr. Kane advised Eddie to ask for a postponement of the hearing, which gave them a further week to review the new material.

Prior to the hearing, an exchange of emails between Eddie, Mr. Kane and the presiding officer, Jason Killens, saw the senior officer dismiss grievances raised at Eddie’s treatment throughout the investigation and a breach of confidentiality as ‘at best peripheral to the disciplinary hearing’. A reply from Mr. Kane challenged this, but Eddie became worried that it would provoke a less favourable outcome and withdrew the grievances without consulting Mr. Kane. This caused friction between Eddie and Mr. Kane, with the GMB rep explaining that withdrawing the grievances would undermine Eddie’s case as in so doing, the points could not be considered later as a point of appeal. So Eddie, feeling that he had little choice, contacted Mr. Killens and reinstated the grievance email.

A Fair Hearing?

Jason Killens (Director of Operations)
On the day of the hearing on 29th May 2014, it soon became clear that it was going to be a whitewash, despite Eddie having a number of warm written testimonies from high level officers and the defence’s misgivings about Eddie’s treatment at the hands of his employer.

The grievances as detailed in the email were not heard, with Mr. Killens stating that they had no bearing on the allegations of the case.

The investigating officer, Maria Smith, was known to be unavailable to appear at the hearing (which had apparently been the case for previous hearing dates too), something which Eddie’s representation protested about. Instead, it was claimed that Keith Miller was the report author and investigating officer, despite documentation proving otherwise. Mr. Miller, when questioned on elements of the investigation documentation, was repeatedly only able to reply 'I don't know, I didn't conduct the investigation'. The investigation findings were accepted by Mr. Killens as is, without scrutiny.

The transcript evidence of Eddie's explanation that he couldn't continue to work that night because he was unwell was dismissed after focusing on his use of the phrase 'I don't feel right' (also reported as ‘I don’t feel this is right’, adding to the controversy). Eddie explained later that he was embarrassed to discuss the details of his ailment over the phone and pointed out that his choice of wording is perhaps also partly due to his natural language patterns and his fatigue. He is, however, documented as having said ‘you can make us patients too because right now I am tired’ and ‘I think this is dangerous and unreasonable’.

It seemed reasonable to the defence that, with so many procedural anomalies regarding various statements which were inappropriately withheld – and especially with a key investigating officer being unavailable (it has been suggested that her absence may have helped to disregard any shortfalls in the investigation) – that the case would be thrown out, the charge be lessened due to mitigating circumstances, or at least found to be requiring further consideration at a later date when the investigating officer was available.

Despite the host of reasons for a more favourable result, they were dismissed as not relevant and the charge of 'gross misconduct' was railroaded through, much to Eddie and Mr. Kane’s surprise and dismay.

Eddie had nothing left but the chance of appeal and with the management showing an apparent hunger for the most severe punishment, he held little hope.

Ignoring a Precedent: One Rule for One...

Eddie's torment continued until his appeal on 26th August 2014, at which Jason Killens presented the management’s case to the appeal panel.

During this hearing, the precedent set by another case of a paramedic failing to attend a 999 call was brought up as a defence. The incident which took place in late 2012 involved a paramedic manager (DSO) who was on a routine Health & Safety inspection travelling from Waterloo HQ to Bloomsbury station with an EMT passenger who was also a Health & Safety representative for the complex [LAS area subdivision]. An emergency call to a patient fitting in a public place was sent to them as they were the nearest resource. The manager refused the call despite his passenger allegedly reporting that they could see the incident from their location. The passenger expressed concern, identifying that 'I'd be sacked for doing that' to which the response was allegedly 'that's the fun of being a manager.'

The incident was reported, but no overt action was taken by London Ambulance Service and a subsequent third-party report to the Health & Care Professions Council regulatory body resulted in the officer being given a 'reflective practise' verdict, meaning he could continue in his role.

On hearing this evidence being brought up in Eddie Daly's appeal, Mr. Killens reportedly 'hit the roof', expressing a desire for disciplinary action against the Health & Safety EMT who had divulged the information, claiming 'we're going to have to sort him out' and 'I'm going to see what weight I can bear on this'. The precedent set by the case was not considered in Eddie Daly's appeal and what weight was brought to bear by Mr. Killens on the whistleblower is unknown at this time.

Evidence was produced that showed the initial investigation was conducted with a clear bias toward proving that Eddie Daly 'just wanted to get off on time' despite the fact that Eddie had remained on station long after his shift had finished. No regard toward his health and welfare was given.

The decision to dismiss Edmund Daly for 'gross misconduct' was upheld.

What Price Justice?

Eddie Daly considered taking his case to industrial tribunal. Frustratingly, his union was unwilling to take the case on as they ‘couldn’t be sure of LAS’s reasoning’ and so he was forced to spend £6,000 on independent legal advice. There is only a three month window in which industrial tribunal proceedings can be instigated and at the eleventh hour, the legal representation Eddie had engaged advised him that his was a ‘50/50’ case and would cost a further £34,000 with no guarantee he would get his money back even if he did win. He felt he had no choice but to abandon any attempt to proceed.

Edmund Daly’s 30-year career as a decorated London Ambulance paramedic was over. He had been forced out of the job he loved for reasons that he could not understand. To this day he still doesn't.

Eddie himself reported his case to the HCPC and in April 2015 it held a hearing. He did not attend, the burden of the endless litigation weighed heavily on him and couldn't face any more. The HCPC found him to have 'seriously undermine[d] public confidence in the profession' and suspended his paramedic licence for a year. Eddie’s lack of comprehension was documented as ‘not demonstrat[ing] any remorse’.

Today, Eddie continues to struggle with PTSD, he is still haunted by events from his career and saddened by his treatment at the hands of the organisation that was part of his life for so long. He is reported as being 'fragile' by friends, but is focused on putting his ambulance career behind him and has recently retrained as a care assistant.

Despite no-one being able to help him, he's still trying to help others.

[NEXT: Interviewing LAS Operations Director Jason Killens for the LAS perspective]