QUEENSLAND CIVIL AND 
ADMINISTRATIVE TRIBUNAL

CITATION:	Paramedicine Board of Australia v Loveridge  [2025] QCAT 101	
PARTIES:	paramedicine board of australia 	

(applicant)	

	v	
	jonathan loveridge 	

(respondent)	

APPLICATION NO/S:	OCR037-24	
MATTER TYPE:	Occupational regulation matters	
DELIVERED ON:	8 April 2025	
HEARING DATE:	On the papers	
HEARD AT:	Brisbane	
DECISION OF:	Judge Dann, Deputy President 
Assisted by: 
Ms C McKenzie
Mr L Parker ASM
Mr M Halliday	
ORDERS:	1.	Pursuant to s 196(1)(b)(iii) of the Health Practitioner Regulation National Law (Queensland) (‘National Law’), the respondent has behaved in a way that constitutes professional misconduct pursuant to sub-paragraph (a) of the definition of that term in s 5 of the National Law. 
2.	Pursuant to s 196(2)(a) of the National Law, the respondent is reprimanded.
3.	Pursuant to s 196(4)(a) of the National Law, the respondent is disqualified from applying for registration as a paramedic for a period of twelve months from the date of this order. 
4.	Pursuant to s 196(4)(b) of the National Law the respondent is prohibited from providing any health service for twelve months from the date of this order. 	
CATCHWORDS: 	PROFESSIONS AND TRADES – HEALTH CARE PROFESSIONALS – OTHER HEALTH CARE PROFESSIONALS – where the respondent was a registered paramedic – where the Board alleged the respondent used unreasonable force against a patient – where the patient was an 81 year old woman with dementia – whether the conduct constitutes professional misconduct – where the degree of insight developed by the respondent is relevant – where the respondent has been disengaged from these proceedings – whether the Tribunal should disqualify the respondent from applying for registration  
Health Practitioner Regulation National Law (Queensland)
Queensland Civil and Administrative Tribunal Act 2009 (Qld)
Briginshaw v Briginshaw (1938) 60 CLR 336. 
Craig v South Australia (2001) 79 SASR 545
Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630
Nursing and Midwifery Board of Australia v Anderson [2020] SACAT 49
Nursing and Midwifery Board of Australia v Du Maurier [2023] VCAT 26
Nursing and Midwifery Board of Australia v Jones [2022] VCAT 498
Nursing and Midwifery Board of Australia v Lockie [2022] QCAT 391 
Nursing and Midwifery Board of Australia v Peter Graham Dickerson [2024] TASCAT 113 
Nursing and Midwifery Board of Australia v Suzanne Smith [2020] VCAT 173
Psychology Board of Australia v Cameron [2015] QCAT 227	
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)	

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
What is the referral about? 
[1]	On 23 February 2024 the Paramedicine Board of Australia (‘Board’) filed a referral in the Tribunal alleging that the respondent had used unreasonable force against a patient (‘Patient A’) on an occasion in June 2019 in a nursing home and that, arising out of the same incident, alleging the respondent had failed to use appropriate de-escalation techniques during his treatment of Patient A.  
Is it appropriate to proceed to determine this matter on the papers? 
[2]	In a telephone call to the Tribunal on 29 July 2024 in response to receiving a notice of directions hearing, Mr Loveridge informed the Tribunal that he had received the notice of the directions hearing, he would be unable to attend because he was overseas, he was suffering mental health issues and he did not wish to participate in the proceeding. 
[3]	By email dated 18 August 2024 to the Tribunal, amongst other things Mr Loveridge stated he was unable to attend the directions hearing as he was overseas, he did not intend to be represented at the directions hearing which could go ahead and he did not intend to engage with the hearing in any way, after discussion with his legal representatives and his doctor. 
[4]	On 28 August 2024 the Tribunal noted that given Mr Loveridge’s statements, it would not require him to take any steps in the matter but it would provide for him to be given copies of all materials, if he asked for them, and would give him an opportunity to indicate that he wished to engage in the proceeding and provide any material he wanted to rely on.  Directions were made on that day accordingly.  
[5]	On 7 February 2025 my associate emailed the parties confirming that the Board had complied with all the directions to get the matter ready for hearing.  In that email the options for each of an oral hearing or a hearing on the papers were explained.  Mr Loveridge was asked to advise the Tribunal and the Board in writing within seven days if he wished to appear at an oral hearing and was told that if he did not give that indication, the matter would be listed to be heard on the papers, based on the material which had been filed. 
[6]	Mr Loveridge did not provide any response indicating he wished to have an oral hearing.  He did not respond at all. 
[7]	In those circumstances, the Tribunal proceeds to determine the matter on the papers in accordance with s 32(2) of the Queensland Civil and Administrative Tribunal Act 2009 (‘QCAT Act’). 
What law applies to the referral? 
[8]	The referral proceeds before the Tribunal pursuant to sections 193B(2) of the Health Practitioner Regulation National Law (Queensland) (‘National Law’). 
[9]	The Tribunal is exercising original jurisdiction.  The Board has the burden of proof of each of the allegations.  Because of the potential consequences to the respondent of adverse findings, the Tribunal may only find that the respondent engaged in the alleged conduct and that it should be characterised as professional misconduct or unprofessional conduct if it is satisfied of these matters according to the standard of proof articulated in Briginshaw v Briginshaw (‘Briginshaw’).
[10]	Further, there is no obligation on the respondent to provide any evidence, either by giving evidence or calling evidence.  As noted earlier in these reasons, the respondent has not participated in the proceeding.  The respondent provided an account in the interview in the original Queensland Ambulance Service (‘QAS’) investigation, further email communication with the investigator dated 27 January 2020 and 4 February 2020, and submissions (some with attachments) through solicitors then acting for him in the show cause process prior to the Board taking immediate action prior to the referral commencing.  The Board has included that material in the hearing brief before the Tribunal, together with the decision of the Queensland Industrial Relations Commission dismissing the respondent’s application for reinstatement and his correspondence to Ahpra relinquishing his registration and responding to the notification.  The Tribunal has had regard to the material he has provided, however, in doing so, he has not assumed any burden of proof.  The Tribunal considers all the evidence before it and it is only if, after doing so, the Tribunal is satisfied the matters the Board alleges are established by the Board on the Briginshaw standard, that the allegations can be proven and any finding of professional misconduct or unprofessional conduct can be made.   
[11]	The Tribunal must observe the rules of natural justice, is not bound by the rules of evidence and may inform itself in any way it considers appropriate. 
What facts does the Tribunal find the referral proceeds on?
[12]	It is not contested that: 
(a)	The respondent was dispatched to attend the nursing home early in the evening of 11 June 2019 with a more junior partner.  The respondent was responsible for the paramedic care of Patient A;
(b)	Patient A was 81 years old, a patient of the nursing home and suffering from advanced dementia;
(c)	The nursing home staff had called the QAS to attend to take the patient to hospital because the patient was agitated and aggressive, had open wounds on her arms and would not tolerate dressings on those wounds.  Earlier that afternoon, Patient A had thrown a hot cup of tea at another resident and was assessed as a high risk to herself, fellow residents and staff; 
(d)	The respondent and his partner, together with nursing home personnel were endeavouring to coax Patient A onto the stretcher for transportation to hospital;
(e)	A formal complaint was lodged with the QAS local area command and a mandatory report was made to the Department of Health in accordance with the Aged Care Act 1997;
(f)	The QAS terminated the respondent’s employment following the incident. 
[13]	Information about Patient A’s health includes: 
(a)	One of the witnesses to the incident stating that Patient A was probably 45 kilos, skin and bones;
(b)	Another witness to the incident on 11 June 2019 stated Patient A was mumbling and not making any sense;
(c)	Earlier in June 2019, Patient A’s Agreed Care and Services Plan recorded she needed assistance and supervision when transferring or mobilising, was a falls risk, was known to be aggressive, had to be supervised during dressing/undressing and with personal hygiene and needed to be reoriented to her surroundings regularly; and
(d)	The nursing home notes for approximately six months preceding the day of the incident refer to Patient A needing pressure relieving aids including an air mattress, needing high protein shakes for weight maintenance, falling frequently and having wound care needs. 
[14]	The respondent recorded in his SHE Incident Investigation Report that given the patient’s age, size and physical condition he assessed the risk to himself as low.  
[15]	The Tribunal finds that Patient A was frail. 
[16]	In attempting to engage Patient A onto the stretcher for transportation to hospital, the respondent reported in his eARF completed some little time after the incident that he said to Patient A words to the effect “if you hit me, I will have to defend myself”. Others present state he said to Patient A “these girls may not defend themselves, but I will” and “if you hit me, I will hit you back”. 
[17]	The Tribunal observes that the substantial import of these statements is broadly the same and finds that the respondent made a comment to the general effect that if Patient A was physical with him, he would be physical with her in response.  That is significant in the context of the disputed conduct. 
[18]	The issue which the respondent has always disputed is that he struck Patient A, in response to Patient A striking him, or lashing out at him, first.  In that regard, two personnel from the nursing home, who were eye witnesses to the events, stated that the respondent struck or slapped Patient A’s face, as, ultimately, did the respondent’s colleague.  The two nursing home personnel made written statements shortly after the events.  The QAS investigated the matter, including interviewing each of them and some others, including the respondent. The QAS investigation concluded that the respondent had struck Patient A. 
[19]	The Queensland Industrial Relations Commission, which had the benefit of hearing from witnesses including the respondent, the two eye witnesses already referred to (plus a further eye witness), the respondent’s colleague and others concluded it preferred the evidence of the three eye witnesses that the respondent had stuck Patient A over the respondent’s evidence.
[20]	Whilst the respondent has always denied doing so, in his letter of 24 October 2023 to the Board, in responding to the proposed notification against him, the respondent stated he found himself in the position he could not morally and ethically make admissions to something he did not do but he must respect the recollections of others and the decision of the Industrial Commissioner. 
[21]	In view of:
(a)	the versions given by each of the two personnel employed by the nursing home as to what occurred which were given contemporaneously and adhered to consistently in the subsequent investigations and proceedings;
(b)	the immediacy of the report by the nursing home of what the respondent was alleged to have done;
(c)	the finding by the employer that it accepted the versions of the nursing home’s eye witnesses which were contained in contemporaneously written statements and did not differ in substance in their later interviews in the investigation, together with the later version provided by the respondent’s colleague;
(d)	the decision of the QIRC that it was satisfied that the respondent had acted as the eye witnesses alleged;
(e)	the respondent’s advised position to the Board in October 2023; and  
(f)	that the respondent has not participated in this proceeding to advance his position;
the Tribunal finds that the respondent struck or slapped Patient A’s face in response to Patient A striking out or slapping him. 
[22]	In accepting the eye witness evidence, the Tribunal also accepts and finds that the respondent did not attempt to de-escalate the situation involving Patient A in that he: 
(a)	raised his voice to Patient A;
(b)	threatened to hit Patient A; and 
(c)	did not communicate effectively with Patient A. 
[23]	There is evidence that the respondent was trained in good practice techniques that can be used to encourage compliance with directions for patients who are agitated or exhibiting behavioural disturbances, as set out in the QAS Occupational Violence Prevention Handbook (2016).  
What is relevant about the practitioner? 
[24]	On the day of the incident the practitioner was a paramedic employed by the QAS. 
[25]	He first gained registration as a paramedic on 8 February 2019. 
[26]	On or around 18 January 2021 (almost 7 months after the incident), the Board decided to take immediate action and impose conditions on the practitioner’s registration, which remained on the National Register until he relinquished his registration.  At the time  the Board took immediate action, it noted in its reasons that the practitioner had an unblemished employment history of 13 years working for the QAS and he had continued to practise as a paramedic  for 15 months without incident.  The conditions included that the practitioner could only practise in places of practice approved by the Board and no such place was approved.
[27]	By letter dated 2 August 2023 the respondent requested to relinquish his registration.  He has informed the Board by letter dated 24 October 2023 that he does not intend to practice as a paramedic ever again. 
How should the Tribunal characterise the practitioner’s conduct?
[28]	The Tribunal having found that each of the allegations is substantiated now needs to characterise the conduct. 
[29]	Section 5 of the National Law includes a definition of professional misconduct by a registered health practitioner as including: 
(a)	Unprofessional conduct by the practitioner which is conduct 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 registered health practitioner of an equivalent level of raining 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. 
[30]	In turn, unprofessional conduct is defined as professional conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner’s professional peers. 
[31]	In submissions the Board has set out relevant clauses of the with Code of Conduct for paramedics in effect from 15 June 2018 to 28 June 2022 (‘Code of Conduct’).  A code of conduct approved by a National Board is admissible in proceedings under the National Law as evidence of what constitutes appropriate professional conduct or practice for the health profession. 
[32]	The Tribunal is comfortably satisfied that the established conduct in each allegation is, as the Board submits:
(a)	a significant departure from the professional conduct obligations of a paramedic;
(b)	inexcusable and cannot be tolerated, no matter what provocation is offered or what the background circumstances may be.  The respondent accepted in his interview in the QAS investigation that prior to this occurring the nursing home personnel had told the respondent that Patient A suffered from advanced dementia, had had a history of being unpredictable, agitated, aggressive and violent, and had been aggressive and lashed out at two staff members and thrown a cup of tea over another resident that day. 
[33]	The respondent was an experienced health practitioner who had undertaken relevant training prior to the incident occurring and who was aware, or ought to have been aware of the recommended principles and methods for de-escalating the aggression and risk of violence Patient A was presenting. 
[34]	Patient A was, and to the respondent’s knowledge was, a vulnerable patient.  As the Board submits, it is a fundamental expectation of the public that a paramedic will act with courtesy, respect and understanding, when dealing with elderly patients who are frail and suffering from altered mental states caused by dementia. 
[35]	According to the eARF the entire time spent at the nursing home was 17 minutes.  The events giving rise to the two allegations essentially involve a single course of escalating conduct over that time.  Consequently, in the particular circumstances of this referral, the Tribunal finds the respondent’s conduct in respect of each allegation is substantially below the standard reasonably expected of a paramedic of an equivalent level of training or experience. 
What orders are appropriate for the conduct that has been established? 
[36]	The purpose of a sanction is to protect the public; it is not to punish the practitioner (although a practitioner may experience a protective action as a punishment, in the sense of negative consequences towards them).  The Tribunal’s disciplinary jurisdiction is exercised for the paramount purpose of protecting the health and safety of the public and the protection of the reputation of the profession in the public mind.  
[37]	There are well established considerations for the Tribunal on a disciplinary referral: 
(a)	preventing practitioners who are unfit to practice from practising; 
(b)	bringing home to the practitioner the seriousness of their conduct;
(c)	deterring the practitioner from future departure from appropriate standards or others who might be minded to act in a similar way; and 
(d)	imposing restrictions on the practitioner’s right to practice to ensure public protection.
[38]	An assessment of ongoing risk posed by the practitioner is essential to any determination of sanction.  In performing that assessment, the degree to which the practitioner has acquired insight will be relevant. 
[39]	Having decided that the practitioner has behaved in a way that constitutes professional misconduct, the Tribunal has a wide discretion to impose sanctions ranging from a caution or a reprimand of the practitioner to cancellation of registration.  
[40]	The Tribunal will consider a range of factors in a given case including the nature and seriousness of the alleged conduct, the extent to which the practitioner has shown contrition, insight or remorse for their conduct, the need for general or specific deterrence, evidence of rehabilitation and otherwise good character, including co-operation with the disciplinary process and the regulator and any mitigating factors which are personal to the practitioner.  
[41]	In this case, the Board has submitted that the authorities support that: 
(a)	physical abuse of a patient will usually attract a preclusion period from practice in the vicinity of 0 months up to 24 months; and
(b)	periods of prior preclusion, cooperation with an investigation and demonstrated insight and remorse will operate to reduce the preclusion period. 
[42]	Whilst the Tribunal has considered the authorities the Board has referred to for assistance with considerations on sanction, careful consideration of two of them supports the Board’s submission immediately above.  
[43]	In Nursing and Midwifery Board of Australia v Smith (Review and Regulation) the practitioner was dealing with a wheelchair bound and mentally unwell patient who was cognitively impaired at the time, verbally and physically aggressive and insisting on leaving the hospital to smoke a cigarette, before being examined and despite being at risk of collapse from a serious condition (having deliberately overdosed on drugs). The patient lashed out at the practitioner who, instead of taking steps to de-escalate the developing conflict, unnecessarily restrained the patient and slapped the patient across the face.  The practitioner, who had worked as a registered nurse in the emergency department of a regional hospital for 15 years, self-reported her behaviour and, as a result of the incident, lost her employment.  The referral proceeded on agreed facts, findings and determinations.  The parties agreed and submitted to the Tribunal the practitioner’s conduct was an isolated event (having considered expert evidence that given matters particular to the practitioner, similar conduct was unlikely to recur) and the patient’s behaviour had been extremely challenging.  The Tribunal observed it was ‘comfortably satisfied’ that the conduct amounted to professional misconduct within subparagraphs (a) and (b) of the definition.  The parties jointly proposed the practitioner be reprimanded and that her registration be subject to an education condition, which was that the practitioner provide a reflective practice report based on education she had already completed in occupational and aggression management.  (The practitioner in fact completed the education before the Board had determined to take disciplinary action).  The Tribunal observed that the primary focus was on general deterrence and was satisfied the sanction was appropriate and made the orders. 
[44]	In the Tribunal’s assessment, whilst the actual conduct in Smith is similar, it is less serious than in this case, as there is no suggestion of any threat to the patient prior to the ‘one off’ physical conduct.  Further, the practitioner’s immediate recognition and reporting of the event, the undertaking of relevant education prior to any referral being implemented and the co-operative approach to the determination of the referral all mark the practitioner in Smith with insight and remorse which is absent from the case presently before the Tribunal. 
[45]	Conversely, in Nursing and Midwifery Board of Australia v Du Maurier (Regulation and Review) (‘Du Maurier’) the Tribunal reprimanded the practitioner, cancelled her registration as a registered health practitioner, disqualified her from reapplying for registration as a registered health practitioner for two years and prohibited her from, during that same period, providing any health service involving the provision of care in rehabilitation facilities, palliative care facilities, residential aged care facilities or to persons receiving home or community based aged care or disability care.  In this case the practitioner, who was a nurse with 28 years’ experience, was employed at an aged care facility.  She spat at a resident in response to the resident spitting at her.  Shortly after this, the respondent used vulgar language or inappropriate communication in the vicinity of staff members and other residents.  The patient who was spat at was elderly and had dementia and the practitioner had been warned of the risk that the patient would spit and refuse food before the shift started.  The Tribunal characterised this as professional misconduct within (a) and (c) of the definition.  The swearing which occurred subsequently was found to demonstrate an unacceptable attitude towards the residents/patients, uttered in the presence of staff and residents. 
[46]	The Tribunal observed that in an aged care facility caring for persons with dementia, patients/residents generally cannot speak out for themselves and are dependent on staff for their basic needs.  In these circumstances it is even more important to uphold a high standard and demonstrate respect for, and empathy with the residents who often do not have the means or ability to complain.  It was aggravating that the practitioner was in charge of the workplace when the conduct occurred. It was conduct which came within (a) and (c) of the definition.  Having contested the allegations, there was no evidence of remorse, insight or taking of responsibility.  Whilst the practitioner had retired and had no plans to return to nursing or to work in any related field, including as a personal care attendant, the Tribunal observed that circumstances may change in the future and protection of the public is the primary aim of the determinations. 
[47]	The practitioner in Du Maurier was much more experienced than the respondent here and held a leadership position of considerable significance.  Slapping is also not as serious as spitting in the respective contexts in which these events occurred.  These factors indicate that Du Maurier is a more serious case than the one before the Tribunal presently. 
[48]	The Board submits that the appropriate orders are: 
(a)	a reprimand;
(b)	disqualification of the respondent from applying for registration as a paramedic for a period of twelve months; and
(c)	a prohibition order prohibiting the respondent from providing any health service for a period of twelve months.
[49]	A reprimand is not a trivial penalty.  The Tribunal will impose a reprimand to mark the seriousness of the conduct. 
[50]	The gravity of professional misconduct is not to be measured by reference to the worst cases, but by the extent to which it departs from the proper standards.
[51]	In this case the respondent’s physical abuse of Patient A was a breach of the fundamental obligations of a paramedic.  Patient A’s obvious frailty and significantly depleted mental capacity are the hallmarks of a very vulnerable patient and this is an aggravating factor on the referral.  The respondent was an experienced practitioner, with training in relevant procedures prior to the conduct occurring. 
[52]	Further, the respondent has consistently denied that he physically abused Patient A and has not participated in this proceeding.  He has not provided any evidence that he has any insight into what occurred or shown any remorse for or understanding of his conduct. 
[53]	The practitioner’s conduct taken overall, is conduct which is inconsistent with aspects of the Code of Conduct, including, at its most basal level:
(a)	the duty to make the care of patients their first concern;
(b)	to practice safely and effectively;
(c)	to not take advantage of patients;
(d)	to display qualities such as integrity, truthfulness, dependability and compassion; and 
(e)	to understand effective communication in all forms underpins every aspects of good practice. 
[54]	Whilst it is relevant to future risk to note that the respondent has expressed an intention to never again seek registration as a paramedic, given the possibility for a change of mind, some measure of specific deterrence is called for given the respondent’s lack of insight.  General deterrence, too, is a consideration on this referral.  Members of our society are increasingly aging, with the consequent incapacities that age can bring, including suffering from dementia for lengthy periods of time.  Paramedics can expect to be continuously and increasingly at the front line of managing physically difficult, elderly, frail and uncomprehending patients.  
[55]	Protection of the public will also be served by both a disqualification order and a period of prohibition in the provision of any health service, for example by working in some aspects of the aged care sector. 
[56]	The Tribunal is satisfied that the sanction the Board proposes is appropriate.   
[57]	The Tribunal thanks the assessors for their thoughtful assistance in the determination of this referral.