Mrs Aminah Migisa

Background

1. The Registrant was employed by Brighton and Sussex University Hospitals NHS Trust (‘the Trust’) in March 2016, as a Band 7 Sonographer. She had reported having completed a Diploma in Diagnostic Ultrasound in 2014 in Uganda, but had not worked as a Sonographer in the UK. As the Registrant had not worked before in the NHS as a Sonographer, she was initially placed under the Trust’s four week Preceptorship programme in order to provide additional support and direct supervision.

2. Early concerns regarding her performance led to the Registrant continuing to be supervised and having to undergo assessments in order to document her progress and provide her feedback. As the Registrant was not progressing as expected it was agreed with her that she would undergo formal clinical assessment that students undertake before qualifying as Sonographers. The assessment indicated that the Registrant missed pathology; failed to identify relevant anatomy; failed to gain accurate measurements; and struggled to stay within the timescales allocated to each patient.

3. More formal performance measures were eventually commenced. The Registrant had taken maternity leave of twelve months during her employment, plus other accrued annual leave, meaning that the time that she was actually at work was limited during her time employed by the Trust and amounted to less than nine months in total. The Registrant tendered her resignation on 19 December 2017.

4. Between 04 – 06 March 2019 the Conduct and Competence Committee heard the Health and Care Professions Council’s (‘HCPC’) case regarding the Allegation. The hearing concluded on 06 March 2019 whereby the substantive hearing panel concluded that the Allegation, faced by the Registrant, was proved and that her fitness to practise was impaired. The Panel imposed a Conditions of Practice Order for a period of 3 years. The Conditions of Practice imposed were as follows:

Whilst undertaking any employment in respect of which you are required to be a registered Radiographer:
1. You must not work as a Sonographer unless directly supervised at all times until you have successfully completed a course in sonography accredited by the Consortium for the Accreditation of Sonographic Education, (“CASE”).
2. Before starting work as a Sonographer without supervision, you must forward to the HCPC a copy of your results from the course referred to in Condition 1 above.
3. The person supervising your work as a Sonographer must be registered with a UK healthcare regulatory body recognised by the HCPC, with a qualification in Sonography, accredited by CASE, or an equivalent.
4. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
5. You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).

Registrant’s evidence

5. The Registrant gave evidence to the Panel. During her evidence she stated the following:

i. She thanked the Panel for its time and for the opportunity to address it;
ii. She accepted that she remains currently impaired as she has not been able to fully comply with the Conditions of Practice Order as she was unable to undertake a UK accredited course;
iii. She informed the Panel that she had applied to a number of accredited courses in the UK but had been unsuccessful in her applications. She stated that one accredited course provided, in the UK, had informed her that she could have a place on its course should another student drop out but this did not occur, so she took the decision to return to Uganda to undertake a Masters course;
iv. During the last three years, she has worked hard to address the shortcomings identified within the substantive hearing panel’s findings. Including addressing her communication and skills and has chosen to work with very experienced practitioners who she can learn from;
v. She is not the same practitioner as she was before;
vi. She did not provide references from her current workplace, because she had thought that according to the conditions imposed that she was only supposed to work with UK accredited practitioners and consequently she didn’t think that non-UK practitioners references would carry much weight;
vii. At the moment she has no immediate plans to return to the UK to practise but she does not know what the future holds and would like to keep the possibility of returning to the UK to work open;
viii. She would like the opportunity to demonstrate that she can improve herself;
ix. Being removed from the HCPC register as a Radiographer would close the chapter of working in the UK as a Radiographer also and these were not where her failings were identified;
x. She would like the chance to prove herself to the HCPC and a future panel;
xi. She agreed with the proposed amendment to the Conditions of Practice Order and would like the opportunity to be supervised so that she could demonstrate her abilities;
xii. Within the Masters course she studies different modules, but started with ultrasound physics. She practices both theory and practical learning. She has had to provide reports, which are approved by her supervisors and she has done abdominal and obstetrics and also other areas. The course is student centred and she has to present her learning to her peers. She has to undertake practical examinations and write papers and then undertake exams. She has undertaken medical ethics, management and other modules also;
xiii. When she started her course, she had the benefit of knowing her identified deficiencies and has been trying to work on those in addition to learning new skills;
xiv. Having returned to Uganda in 2018, she applied for a voluntary role as a Radiographer in October 2018 and worked on a voluntary basis until April 2019. In May 2019, the place she is currently employed had an opening and she was offered the position. She is currently working as a Radiographer part-time (working from 3pm- 10pm 6 days a week) so that she can complete her course;
xv. She joined her Masters programme in March 2019. She has practical learning on the Masters course in the mornings (Monday - Thursday) and then has theory sessions on Friday’s and Saturday’s (also 6 days a week);
xvi. She is currently employed as a Sonographer unsupervised, but when she started working in this role she worked under the supervision of a Sonographer (for a period of seven months) as she made her supervisor aware of the HCPC concerns;
xvii. She has had no issues raised by her employer, other than when she first started, she had issues with time management, which increased patient waiting times, but this has been resolved; and
xviii. She feels that she could now pass the previous assessments undertaken during her employment with the Trust.

Submissions

HCPC

6. Mr D’Alton submitted that the Registrant’s practice remains impaired. He also submitted the following:

i. The substantive hearing panel determined that the concerns in this case were confined to the Registrant’s competence as a Sonographer and that the Registrant’s practice could be remedied by attendance on an accredited course;
ii. The Registrant is currently living and working in Uganda, and accredited courses are only available in the UK. The Panel could not be assured that the course undertaken by the Registrant in Uganda addressed the concerns, or is equivalent to that of an accredited UK course;
iii. The Panel have no references provided by the Registrant which address the concerns raised in this case;
iv. All options are available in terms of sanction as the Registrant has been subject to an order for a period of longer than two years;
v. A further order is required to restrict the Registrant’s independent practice;
vi. A further Conditions of Practice Order should be imposed. The Registrant has undertaken further studies and taken some steps to address the failings identified;
vii. The HCPC submit that a varied conditions of practice order, which would allow the Registrant to complete her Masters course (due to complete in May 2022). He proposed that conditions 1 and 2 of the current Conditions of Practice Order be varied to include the Registrant, upon successful completion of her current Masters course, be signed-off as competent to practise independently by a supervising sonographer registered with a UK healthcare regulatory body recognised by the HCPC;
viii. A further Interim Conditions of Practice Order should be imposed for 12 months to allow the Registrant to demonstrate safe and effective practice in the UK, or alternatively, to consider Voluntary Removal if the Registrant does not wish to return to practise as a Radiographer in the UK;
ix. She has been candid and honest in her evidence to the Panel. She has taken every opportunity to comply with the conditions of practice in the UK and was unable to do so. She has, as a consequence of this, returned to Uganda to undertake an alternative course and is also has worked as a Radiographer and a Sonographer;
x. The HCPC commends the Registrant for the steps that she has taken thus far.

Registrant

7. The Registrant elected not to make any further submissions to the Panel.

Decision

Panel’s approach

8. In considering the question of current impairment, the panel undertook a comprehensive review of the final order in light of the current circumstances. The Panel took into account the documents furnished to it by the HCPC and the Registrant and had regard to the Registrant’s oral evidence and the parties submissions. The Panel also had regard to the decision of the substantive hearing panel but exercised its own independent judgement in relation to the question of current impairment.
9. The Panel considered the relevant Practice Note issued by the HCPTS, ‘Finding that Fitness to Practise is ‘Impaired’’.
10. The Panel accepted the advice of the Legal Assessor.
11. In reaching its decision, the Panel was mindful of the need to protect the public and the wider public interest in declaring and upholding proper standards of behaviour and maintaining public confidence in the profession.
12. The panel first considered whether the Registrant’s fitness to practise remains impaired.

Decision

13. In making its decision, the Panel had regard to both the personal and public elements of impairment.
14. The Panel considered the Registrant’s oral evidence to be genuine and credible. It was clear to the Panel that the Registrant had made a number of attempts to comply with the current Conditions of Practice Order and to undertake a UK accredited course to remedy her failings. However, the Panel also noted that this had not been possible for the Registrant and that she had sought to do the next best thing, by returning to Uganda to undertake a Masters course, to address the identified failings. The Panel commended the Registrant for her efforts in this regard. It was clear to the Panel that the Registrant showed good insight into her identified failings and also in respect of how public confidence may have been damaged as a result of her failings. The Panel noted that the Registrant had engaged in a meaningful way with the HCPC and also in the regulatory hearing today.
15. However, the Panel also had regard to the fact that the Registrant candidly accepted that she had been unable to address or fully remedy the previous panel’s findings and that despite her best efforts to do so, she remained currently impaired. The Panel shared this view. The Panel had regard to the identified failings and, notwithstanding the significant steps taken by the Registrant in terms of undertaking a Masters Course in an attempt to address her failings, the Panel was not satisfied that the Registrant had remedied her failings and therefore determined that she continued to pose an ongoing risk to the public. In forming this view, the Panel noted that whilst it had some evidence of completed modules and exam results on the Registrant’s Masters Course in Uganda, it did not have any evidence before it to demonstrate that the Masters course was equivalent to that of an accredited UK course. Further, the Panel also noted that the Registrant began working for the Trust, with non-UK qualifications, and shortly after that, concerns were raised in respect of her practise as a Sonographer. The qualification material provided to the Panel did not reassure it.
16. Additionally, the Panel noted that it had no testimonials or references before it from the Registrant’s current employers in respect of her current skills working as a Sonographer in Uganda. Whilst the Panel was encouraged by the Registrant’s suggestion that she would not seek to practise in the UK as a Sonographer without first being ‘approved’ or ‘signed-off’, the Panel was not satisfied that she did not pose an ongoing risk to the public at this time. The Panel was also not satisfied that the Registrant has, at this time, the requisite knowledge, skills and experience to ensure that she could practice safely as an independent Sonographer without supervision.
17. The Panel recognised the need to uphold professional standards and in sending a clear message to other professionals and to maintaining confidence in the regulatory process. The Panel was not satisfied that informed members of the public would not have their confidence in the profession undermined if the Registrant was permitted to practise, without restriction.
18. Accordingly, the Panel concluded that the Registrant’s fitness to practise remains impaired on both the public interest and public protection grounds.
19. The Panel has borne in mind that sanction is a matter for its own independent judgment and that the purpose of a sanction is not to punish the Registrant but to protect the public. Further, that any sanction must be proportionate, so that any order must be the least restrictive order that would protect the public interest, including public protection.
20. The Panel considered the option of a Caution Order however, decided that it would not provide adequate protection for the public.
21. The Panel went on to consider whether a Conditions of Practice Order would address its ongoing concerns and concluded that it would. The Panel noted the previous panel’s determination and remained satisfied that the Registrant’s failings were capable of being remediated. In addition, this Panel noted that it had the benefit of hearing from the Registrant directly and was satisfied that appropriate conditions of practice could be formulated which would be workable and which would afford the appropriate level of public protection.
22. In considering the option of conditions of practice, the Panel had regard to the Registrant’s evidence that she was, at this time, unsure whether she wished to return to the UK to practise but noted that she had also expressed a deep desire to be afforded with a final opportunity to comply with the Conditions of Practice imposed so that she might remedy her failings. The Panel noted that the Registrant had made previous attempts to comply and had been unsuccessful in her endeavours. The Panel also noted that the Registrant had been committed to her studies for the last three years, enrolling in a Masters course, and determined that an amended Conditions of Practice Order, which afforded the Registrant with the possibility of being ‘signed-off’ by a UK accredited Sonographer was appropriate and proportionate to impose at this time. Taking into account the reasons and circumstances outlined by the substantive hearing panel; the Panel decided that, in the circumstances, the Registrant should be afforded with an opportunity to satisfy a future panel that her fitness to practise is no longer impaired.
23. The Panel next considered the option of replacing the existing Conditions of Practice Order with a Suspension Order. However, the Panel decided that a Suspension Order would be disproportionate at this time.
24. The Panel therefore decided that the appropriate and proportionate Order is to extend the current Conditions of Practice Order, but to vary the Order to reflect both the HCPC and Registrant’s submissions. The Panel decided that the Order should be extended for a period of two years to allow the Registrant time to apply to the UK either for a further accredited course or to find employment such that she can be ‘signed off’ as competent to practise independently by a supervising Sonographer registered with a UK healthcare regulatory body recognised by the HCPC.
25. The Panel also considered that a future reviewing panel may be assisted by the following:

i. up to date testimonials from her employers and/or tutors/supervisors;
ii. evidence that the Registrant has kept her skills and knowledge up to date such as any continuing professional development courses undertaken (detailed course syllabus’);
iii. evidence concerning any voluntary/paid work undertaken within a hospital or healthcare environment; and
iv. references or testimonials which may be from employment, voluntary work and/or the Registrant’s private life.

ORDER: The Registrar is directed to annotate the Register to show that Ms Migisa is subject to a conditions of practice order for a further period of 2 years from the date of the expiry of the current Order.

Whilst undertaking any employment in respect of which you are required to be a registered Radiographer:

1. You must not work as a Sonographer unless directly supervised at all times until you have successfully completed a course in sonography accredited by the Consortium for the Accreditation of Sonographic Education, (“CASE”) or being signed off as competent to practise independently by a supervising Sonographer registered with a UK healthcare regulatory body recognised by the HCPC.

2. Before starting work as a Sonographer without supervision, you must forward to the HCPC a copy of your results from the course referred to in Condition 1 above or alternatively, you must send evidence of having been signed off as a competent Sonographer by the independent UK registered practitioner supervising your practice outlined in Condition 1.

3. The person supervising your work as a Sonographer must be registered with a UK healthcare regulatory body recognised by the HCPC, with a qualification in Sonography, accredited by CASE, or an equivalent.

4. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

5. You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).

The order imposed today will apply from 03 April 2022.

This order will be reviewed again before its expiry on 02 April 2024.

History of Hearings for Mrs Aminah Migisa