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During the course of your employment as a Radiographer at The Christie NHS Foundation Trust between August 2005 and 9th August 2011:
1. You were unable to perform routine set-up and imaging processes, for example;
a) In the week to 30 March 2011
i. You failed to check moves on the “Tattoo” system when completing FSD sheets and
ii. You failed to calculate “+ to –“moves correctly
b) On 6 April 2011
i. you wrote “clear” on an FSD sheet when your colleague had identified the LPO beam as not clear and had to be reset and
ii. you moved a patient’s hips instead of their shoulders when setting up a “parallel pair”
2. You were unable to communicate effectively with patients, for example
a) On 9 March 2011 you asked a patient to confirm ID four times before colleagues intervened because the patient could not understand what you were saying
b) You failed to consistently check that patients had emptied their bladders before commencing treatment
c) You did not consistently establish side effects and contraindications with patients, for example
i) On 18 April you did not respond appropriately to a patient who reported side effects (patient with scalp soreness in meningioma treatment)
ii) On 18 April 2011 you did not adapt when questioning a patient who found talking difficult due to mouth pain (mucosistis patient)
3. You were unable to communicate effectively with colleagues, for example;
a) You asked a question about lateral origin in respect of a patient set up
i. Your supervisor could not understand what you were asking despite your repeating the question a number of times
b) On 25 March 2011 you interrupted a colleague’s conversation with a patient;
i. to check the patient’s ID and ii. To explain the set- up procedure before the patient was prepared
4. You were unable to demonstrate competent handling of equipment, for example;
a) During your suite four rotation
i) You set up a bed so that your supervisor had to intervene to prevent damage to the electron scanner viewer screen and
ii) You set up a bed so that your supervisor had to intervene to prevent injury to a patient
iii) On 18 April you checked lateral markings instead of anterior lateral shift as instructed b) During your suite 7 rotation
i. You failed to set the correct couch angle for a ‘wedged pair technique’
ii. You did not adjust the couch angle when the beam failed to hit the target
iii. On 4 May 2011 you did not adjust gantry/collimator beam settings in between treatments for a ‘whole brain’ patient
iv. On 4 May 2011 you could not describe safety procedures for Linac beam interruption or emergency termination.
5. The matters set out in 1-4 above constitute lack of competence
6. By reason of that lack of competence your fitness to practise is impaired.
1 The Panel was satisfied that service had been effected in accordance with Rule 3 of the Health and Care Professions Council (Investigating Committee) (Procedure) Rules 2003 (“the Rules”). The relevant documents concerning this hearing were sent to the Registrant’s registered address and to his e-mail address.
Proceeding in absence
2 The Panel exercised its discretion under Rule 11 of the Rules to proceed in the absence. It took account of the Practice Note on proceeding in absence and heard the advice of the Legal Assessor. Under the circumstances and in light of the Registrant having voluntarily absented himself by way of his email of 20 November 2015, the Panel determined that it is in the public interest that this matter be dealt with expeditiously and in the absence of the Registrant. The Panel noted that this was a mandatory review. It weighed the interests of the Registrant in appearing or being represented at a hearing on a later date on the one hand with the public interest on the other hand. The Panel concluded that, as the Registrant has not indicated that he would attend a postponed hearing, it was in the public interest to proceed today.
3 The Panel had sight of the evidence relied on at the substantive hearing of this matter and at the previous Review hearings. It heard submissions on behalf of the HCPC and took advice from the Legal Assessor.
4 The Panel took account of the background to this matter. The Registrant is a Radiographer. He was employed at Band 5 the Christie NHS Foundation Trust (“the Trust”) from August 2005. The concerns about his capability and communication skills are described in the matters set out in the allegations. He was dismissed on the grounds of lack of capability on 09 August 2011. He then self-referred to the HCPC. At the Final Hearing on 19-20 November 2012, the facts as alleged were found proved. The Registrant’s fitness to practise was found to be impaired and a suspension order was imposed for a period of one year. That order was reviewed and continued for periods of twelve months at review hearings which took place on 08 November 2013 and 24 November 2014.
5 It was submitted on behalf of the HCPC that the Registrant has now been suspended continuously for three years. There is no evidence of remediation and his fitness to practise remains impaired. Further, the Registrant has engaged minimally with the process and has maintained denial of the allegations, now found proved. It would therefore now be appropriate to impose a striking off order.
6 The Panel took the advice of the Legal Assessor and had due regard to the provisions of Article 29(6) and 30(1) of the Health Professions Order 2001, the HCPC Guidance on “Finding that fitness to practise is impaired” and the Indicative Sanctions Guidance.
7 The Panel noted the Registrant’s minimal engagement with the process save for refuting the allegations and informing the Council that he has now retired. Consequently, there is no evidence of any remediation undertaken by the Registrant. The Panel concluded that there remains a high risk of repetition of the conduct which founded the proven allegations. The Registrant’s fitness to practise therefore remains impaired.
8 This Panel concurs with the previous Panel that the Registrant would continue to present a risk to the public if he were to be allowed to practise without restraint. There is no evidence that the deficiencies identified by the final hearing Panel have been or will be addressed. The Registrant has been suspended continuously for a period of three years. He is now retired and has not indicated that there are any steps which he would take or would be able to take to achieve remediation. He has not accepted that remediation is required. He has demonstrated lack of insight through his refutation of the findings made at the Final Hearing.
9 In considering sanction, the Panel started by considering whether a sanction was needed. Having decided that a sanction was required, it first considered whether the protection of the public could be assured by a Caution Order. It was not satisfied that a Caution Order would be sufficient. Further, there are no workable or verifiable conditions which could be formulated to address the identified issues. Therefore a conditions of practice order would not be an appropriate sanction The Registrant has been subjected to an order of suspension since 20 November 2012. The Panel therefore considered whether to extend the period of suspension, but concluded that this would no longer meet the public interest.
10 In making its determination, the Panel took careful note of the provisions of the Indicative Sanctions Policy and concluded that the Registrant’s lack of insight and remediation indicate that he is unwilling or unable to remedy his failings. The Panel is mindful that striking-off is a sanction of last resort but, under the circumstances, it is a proportionate sanction because it provides protection for the public in preventing the Registrant from practising in the future. Accordingly, the Panel is satisfied that the Registrant should now be struck off the register.
11 The Panel is satisfied that the public interest will be served by removing the Registrant from the register and bringing this matter to a conclusion.
History of Hearings for Ramani Ramaswamy
|Date||Panel||Hearing type||Outcomes / Status|
|20/11/2015||Conduct and Competence Committee||Review Hearing||Struck off|