Paramedicine Board of Australia v Fournier

QUEENSLAND CIVIL AND
ADMINISTRATIVE TRIBUNAL

CITATION:

Paramedicine Board of Australia v Fournier [2025] QCAT 155

PARTIES:

PARAMEDICINE BOARD OF AUSTRALIA

(applicant)

v

WAYNE FOURNIER

(respondent)

APPLICATION NO/S:

OCR211-23

MATTER TYPE:

Occupational regulation matters

DELIVERED ON:

22 April 2025 (decision)

21 May 2025 (reasons)

HEARING DATE:

On the papers

HEARD AT:

Brisbane

DECISION OF:

Judicial Member Dick SC
Assisted by:
Mr Lachlan Parker
Mr Benjamin Phipps
Mrs Kara Thomson

ORDERS:

IT IS THE DECISION OF THE TRIBUNAL THAT:

1. Pursuant to section 196(2)(a) of the National Law, the respondent is reprimanded.

2. Pursuant to section 196(4)(b) of the National Law, until 2 years from the date of these orders, the respondent is prohibited from providing any health service involving the provision of care to a person until such time he is registered as a health practitioner under the National Law, however, for the avoidance of doubt he is permitted to render first aid and undertake first aid activities to the extent required for his employment as an excavator operator and as a volunteer with the State Emergency Services.

3. Each party bears its own costs.

CATCHWORDS:

PROFESSIONS AND TRADES – HEALTH CARE PROFESSIONALS – OTHER HEALTH CARE PROFESSIONALS – where the respondent was a registered paramedic – where the respondent admits most of the conduct but denies part of it – whether the Tribunal is satisfied the disputed conduct is established by the evidence – whether the Tribunal is satisfied the conduct amounts to professional misconduct – whether the respondent should be disqualified

Health Practitioner Regulation National Law (Queensland)

Queensland Civil and Administrative Tribunal Act 2009 (Qld)

Paramedicine Board of Australia v Clark (Review and Regulation) [2023] VCAT 1192

APPEARANCES & REPRESENTATION:

This matter was heard and determined on the papers pursuant to s 32 of the Queensland Civil and Administrative Tribunal Act 2009 (Qld)

REASONS FOR DECISION

These proceedings were referred to the Tribunal pursuant to sections 193B(2) and 193B(3)(a)(i) of the Health Practitioner Regulation National Law (Queensland) (‘National Law’).

Referral before the Tribunal

The Paramedicine Board of Australia (‘Board’) is empowered to refer a matter about a registered health practitioner if it forms a reasonable belief that the practitioner has behaved in a way that constitutes professional misconduct, a term defined in section 5 to include:
(a)    unprofessional conduct by the practitioner that amounts to conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience;
(b)    more than one instance of unprofessional conduct that, when considered together, amounts to conduct that is substantially below the standard reasonably expected of a health practitioner of an equivalent level of training or experience; and
(c)    conduct of the practitioner, whether occurring in connection with the practice of the health practitioner’s profession or not, that is inconsistent with the practitioner being a fit and proper person to hold registration in the profession.
The Board has the onus of proving the practitioner engaged in the alleged conduct to the standard of proof articulated in Briginshaw v Briginshaw (1938) 60 CLR 336.
In relation to the alleged conduct the Tribunal may find the practitioner has:[1]
(a)no case to answer;
(b)has behaved in a way that constitutes unprofessional conduct; or
(c)has behaved in a way that constitutes professional misconduct.
[1]Health Practitioner Regulation National Law (Queensland) ss 196(1)(a), (b).
By way of sanction, the Tribunal may, amongst other things:[2]
(a)reprimand the practitioner;
(b)disqualify the practitioner from applying for registration for a specified period; and/or
(c)prohibit the practitioner from providing a specified health service.
[2]Ibid ss 196(2)(a), (4)(a)-(b).
In relation to a formally registered practitioner the Tribunal’s jurisdiction turns upon whether the alleged conduct occurred while the practitioner was registered, and that precondition is met here.
The respondent is a formally registered paramedic whose registration ceased on 1 January 2024. In this case the Board alleges that his conduct, viewed as a whole, fell substantially below the standard reasonably expected of a health practitioner of an equivalent level of training and experience. It seeks a global finding that he engaged in professional misconduct, that he is reprimanded and prohibited from providing any health service involving the provision of care to persons unless and until he is registered again.
The respondent admits most of the conduct alleged against him but denies some of it. The Board submits that the admitted conduct alone suffices to warrant a global finding of professional misconduct. The Board submits that the disputed conduct is established by the evidence and seeks findings accordingly.
The allegations arise from 2 incidents.

First incident

The first incident concerns Patient A.
At 6:28pm on 4 August 2019, the respondent and another officer were dispatched to what was said to be a fall relating to a 47-year-old male. That male had an extensive medical history including hepatitis C, HIV, hemochromatosis and anxiety. The officers arrived separately because both were on call and the other officer arrived moments before the respondent. The primary care officer for the case was the respondent.
The allegation in respect of Patient A was largely that no appropriate testings were done and that the treatment provided was unacceptable. Patient A was advised to go to hospital but cited his intention to go to detox the next day. The respondent and the other officer left Patient A with his mother. There was a report that Patient A:
was a conscious male detoxing, numbers are good, will be left in care of mother and nil transport.
Importantly, the Voluntary Informed Relevant Capacity Advice (‘VIRCA’) documentation was not completed during the incident or immediately after it. The respondent gave a number of reasons for this but effectively said that he was tired and just wanted to go home. The documentation was not completed until the next day.
On the following day (i.e., 5 August 2019) at 2:55am, the same officers were again dispatched to Patient A under a code which signified altered loss of consciousness. The respondent acknowledge the call at 2:55am, and at 2:57am the officers were advised of the case by phone.
Automatic vehicle location data indicates that the ambulance used by them did not leave the Canungra station until 3.13am, some 18 minutes after the respondent first acknowledged the call. When the officers arrived at the scene, CPR was being performed by Patient A’s brother-in-law who lived next door, the patient was unconscious and had pink and brown fluid coming from his nose, mouth and ears. There was no attempt to use the defibrillator. Eventually Patient A was pronounced dead and paramedics waited for Queensland Police Service officers to arrive. During this time, they completed the VIRCA documentation for the first incident.

Second incident

The next incident occurred on 7 August 2019 in relation to Patient B. The husband of Patient B, who was in the kitchen, called out to her but didn’t receive a response. He found her on the bathroom floor unconscious. He said that from the time she left his presence until he found her was no more than 4 minutes. He called 000.
At 12.43pm the same two officers were dispatched to a code indicating cardiac arrest and identified Patient B as a 70-year-old female unconscious and not breathing. At the commencement of the shift, the respondent did not carry out a mandatory vehicle inspection to ensure the ambulance was fully equipped with stock.
At 12.43pm the respondent responded to the call, acknowledged the code and told the operations centre:
We’re going to have a slight delay. We’re just coming up to the station now, we need to stop and throw some gear in after the last couple of jobs we’ve done and we’ll continue to respond.
Automatic vehicle location data indicates that the ambulance was stationary at Canungra Ambulance station for a period of 6 minutes and 50 seconds. Radio location data indicates the radios assigned to the officers had them arriving at Patient B’s address some 14 minutes and 22 seconds after they were first dispatched to the job.
Sometime in the next five minutes Patient B was located, the defibrillator was activated and applied to the patient’s chest. Eventually Patient B passed away.
In an impromptu call to the senior investigating officer the respondent admitted that no CPR was performed by himself or the other officer.
Following the incident, it is alleged that he and the other officer amended the time of arrival on scene to 12.49pm. This was not made out on the evidence from the locating signals described.

Discussion and sanction

The matter in due course went to the Health Ombudsman who referred the matter to the Board. The Board decided to accept an undertaking from the respondent not to practise in any role requiring direct or indirect clinical patient contact, effective from 14 August 2020. He did apply to revoke this undertaking, but the Board refused that application and, on 8 September 2023, the Board referred the matter to the Tribunal.
The allegations are lengthy; I will deal with them as shortly as I can.
Allegation 1 is that the respondent provided inadequate and/or inappropriate treatment to Patient A during the first visit by failing to undertake adequate testing and/or recognise suboptimal vital signs in Patient A; and further, by failing to provide the patient and his mother adequate information about whether to go to hospital.
Allegation 2 is that the respondent provided false and/or misleading information to the Queensland Ambulance Service Operations Centre by advising that Patient A was stable and his numbers were good.
Allegation 3 is that, during the second visit to Patient A, the respondent provided inadequate or inappropriate treatment, including by failing to undertake effective resuscitation methods.
Allegation 4 relates to Patient B, in that the respondent provided inadequate or inappropriate treatment to her by failing to make reasonable enquires about her history and failing to immediately commence CPR. This allegation has been denied by the respondent and I will deal with that again later.
Allegation 5 is that the respondent kept inadequate health records by failing to complete electronic ambulance report form (‘eARF’) for Patient A in a timely manner following the first visit.
Allegation 6 is that the respondent created an inaccurate or misleading eARF regarding his initial attendance on Patient A by describing his circulation as adequate, cardiovascular signs as normal and vitals as within normal limits.
Allegation 7 is that the respondent created or allowed his partner to create a false or misleading amendment to the form for Patient B by stating the time they arrived on scene was 12:49pm. That allegation is denied, and I will deal with it again shortly.
Allegation 8 is that the respondent inappropriately delayed the care of the first patient on the second visit by not leaving the Canungra station for about 18 minutes.
The respondent denies allegations 7 and 8, which I will deal with shortly.
Allegation 9 is that the respondent inappropriately delayed the care of Patient B by stopping at the Canungra station for nearly seven minutes after receiving the dispatch.
Allegation 10 is that he failed to undertake professional obligations by failing to carry out the mandatory daily vehicle inspection check at the start of his shift on 7 August 2019.
As above, the respondent denies allegations 4, 7 and 8.
The respondent admits:
(a)allegation 1 insofar that he failed to recognise sub-optimal vital signs in Patient A obtained by the vital signs survey (‘VSS’) and failed to provide information obtained by the VSS to Patient A and his mother;
(b)allegation 2 insofar that he provided false and/or misleading information to the Operations Centre in respect of Patient A’s status;
(c)allegation 3 insofar that the discontinuation of resuscitation of Patient A did not meet the QAS Clinical practice Guidelines and that the rapid discontinuation criteria were not met as Patient A had not been pulseless for at least ten minutes prior to arrival;
(d)allegation 5 insofar that he failed to complete his eARF form in a timely manner;
(e)allegation 6 insofar that his eARF form omitted details regarding his assessment and management of Patient A and the rationale for not transporting him to hospital;
(f)allegation 9 insofar that he and his partner stopped at the Canungra Station and did not arrive at the scene until 12:57pm; and
(g)allegation 10 insofar that he did not carry out the mandatory daily vehicle inspection check at the start of his shift on 7 August 2019.
The respondent otherwise denies or does not admit allegations 1, 2, 3, 5, 6, 9 and 10. The Board submits the respondent has admitted the gravamen of all allegations except 4, 7 and 8.
In relation to the disputed conduct much of the evidence comes from either people who were present at the scene, but more importantly comes from computerised information obtained from the automatic vehicle location data and the radio location data. On the basis of that data, the Tribunal is comfortably of the opinion that the denied allegations are made out.
The Tribunal has also been assisted by expert opinion of Associate Professor Paul Simpson, the director of academic program at Western Sydney University who, in respect of a number of the allegations if not all, is of the view that the respondent behaved in a manner constituting conduct well below the conduct expected of someone of his seniority and standing.
So, when it comes to the characterisation of the conduct globally, the Tribunal is comfortably satisfied it amounts to professional misconduct.
The Board has referred to what is said to be a comparable matter. Comparable matters are helpful in providing guidelines and in avoiding the Tribunal stepping outside the appropriate sanctions.
These proceedings are not punitive; they are protective. They are also designed to maintain professional standards of the profession. In this case there is a significant need for general deterrence, that is, a sanction that sends a strong message to the community and the profession that paramedics who indulge in this type of conduct will be the subject of meaningful disciplinary action.
In this case the Board accepts that the respondent has provided four dated personal references and there is an unsworn statement containing some degree of remorse and insight. The Board’s position is that: but for the references, unsworn statement and the five and a half years that have elapsed since the alleged conduct occurred, a disqualification period of a longer time in accordance with the case of Paramedicine Board of Australia v Clark (Review and Regulation) [2023] VCAT 1192 (‘Clark’) would have been appropriate. However, the Board seeks that the respondent be disqualified for a period of two years, given the very significant amount of time that has passed, the fact that the respondent has no intention of returning to practice as a registered health practitioner again and that he has exhibited some degree of remorse and insight. The Board accepts that the protective purposes of these proceedings will be appropriately served by him being reprimanded and prohibited from providing health services unless and until he obtains registration in the future.
The respondent’s position is that, apart from the allegations he denies, he accepts the general findings and accepts that there needs to be a reprimand, which has often been said not to be a trivial order, and that a two-year period prohibiting his provision of any health services is appropriate.
There is no dispute that it is not within the Tribunal’s power to order that he not hold a first aid certificate and the Board does not press that he not be allowed to render first aid and undertake first aid activities to the extent required for his employment.

Orders

In those circumstances the orders of the Tribunal are:
Pursuant to section 196(2)(a) of the National Law, the respondent is reprimanded.
Pursuant to section 196(4)(b) of the National Law, until 2 years from the date of these orders, the respondent is prohibited from providing any health service involving the provision of care to a person until such time he is registered as a health practitioner under the National Law, however, for the avoidance of doubt he is permitted to render first aid and undertake first aid activities to the extent required for his employment as an plant operator and volunteer with the State Emergency Services.
Each party bears its own costs.

[2025] QCAT 155

22 April 2025 (decision) 21 May 2025 (reasons)