Janelyn Manong

Profession: Biomedical scientist

Registration Number: BS63095

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 01/09/2015 End: 16:00 03/09/2015

Location: Health and Care Professions Council, Park House, 184 Kennington Park Road, London, SE11 4BU

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

Allegation (as amended at the hearing):


The Health and Care Professions Council has made the following allegation against the Registrant:
1. On 5 November 2013 requested blood tests for yourself:
a. Using a false name in order to do so; and/or
b. using a hospital number in order to do so which;
i. was not allocated to you; and/or
ii. was already allocated to another patient, resulting in this patient’s records being inaccurate.
2. On 15 November 2013 requested blood tests on yourself by adding extra tests onto your General Practitioner’s request.
3. On 18 November 2013 requested blood tests on yourself
a. Using false name in order to do so; and/or
b. Using a hospital number in order to do so which;
i. Was not allocated to you; and/or
ii. Was already allocated to another patient, resulting in this patient’s records being inaccurate.
4. Your actions described in paragraphs 1-3 were dishonest.
5. Your actions described in paragraphs 1-4 constituted misconduct.
6. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary and procedural matters
Amendment of the allegation
1. Particulars 1, 2 and 3 of the Allegation, as approved by the Investigating Committee, and which was originally notified to the Registrant, read as follows:
1. Created a hospital number in order to request blood tests on yourself.
2. The hospital number you created in paragraph 1 belonged to a current patient, which resulted in the patient’s records being inaccurate.
3. Added extra laboratory tests, for yourself, onto your General Practitioner blood sample.
2. At the start of the hearing the Council applied to amend the Allegation. The terms in which it was proposed to be changed are reflected above in the terms of the amended Allegation.
3. It was advanced that there was no injustice caused to the Registrant by these amendments. Three bases were advanced in support of this argument.
4. First, the Registrant had been on notice of the changes since the 26 February 2015 and of the detail of the case she was to answer. The Registrant had not raised any objection nor observation on those proposed changes at that time or since.
5. Secondly, the changes did not widen the scope of the Allegation but gave further clarity to what was alleged by providing better particularisation. It did not cause any injustice.
6. Thirdly, the Registrant had framed her responses to accord with the amplified detail of the Allegation and the preparation of her case had therefore not been adversely affected or prejudiced.
7. The Registrant confirmed that she did not object to the proposed changes.
8. Having received advice the Panel made the decision to amend the Allegation as proposed as it did not widen the ambit of the matters alleged and there was no prejudice to the Registrant.
Substitution of page
9. The Panel was provided with an enlarged copy of exhibit page 18 which in its amplified state provided small, but legible, information as to what was shown on the screenshot.
Production of signed sworn statement
10. A copy of the signed statement for SH was requested. The copies which had been sent through the post to the Panel had been anonymised. As the Council was not producing this witness and intended to rely on the statement as admissible hearsay the Panel considered that it was important to see that it had in fact been affirmed as true and signed by SH.


Hearing in private
11. The Panel received an application from the Registrant’s representative that her evidence be heard in private. It was advanced that in addition to the medical matters related to the incidents identified in the Allegation, there would, of necessity, be reference throughout her testimony to health and family circumstances. In this instance the public interest in a public hearing was secondary to the Registrant’s right to a private life. The Council did not object to this application. The Panel agreed to the application as the consideration of the issues was inextricably intertwined with the Registrant’s personal health issues and personal circumstances.
Background
12. The Registrant is employed by Viapath as a Band 6 out-of-hours Biomedical Scientist based at King’s Hospital NHS Foundation Trust; she has been in this position since 8 January 2010. Her role includes providing a Haematology Service which involves analysing and reporting on patients’ blood samples. As a Band 6 Biomedical Scientist in the Blood Science Laboratory the Registrant is responsible for delivering a service to patients, outpatients, and GP practitioners.
13. On 18 November 2013, SH, Pathology IT, received an automatic notification of a discrepancy on the Patient Information Management System and the laboratory system, WinPath. The notification indicated a hospital number which is unique, had been used for two patients.
14. SH contacted RB Biomedical Scientist, to ask that the hospital number on WinPath be changed before the results were released to the wrong patient on the electronic patient record. RB spoke to the Registrant having discovered that she had inputted the data onto the system. The Registrant informed RB that the results were her personal test results.
15. The case was investigated by JR, Operations Manager for Viapath. She found that on 5 November 2013 tests were requested on this hospital number under the name ‘Jane Smith’ (which was not the patient’s name). The Registrant admitted that she had made this request and that the tests were for her.
16. On 15 November 2013 tests were requested by the Registrant’s GP in the Registrant’s correct name and under her hospital number. However, later the same day tests were added on to this request by the Registrant without her GPs authority.
17. Further tests were also requested on the 18 November 2013 on the previous hospital number in the name of ‘Jane Smith’. The Registrant admitted that she had made the request and that the tests were for her.
18. The test results from 5 November 2013 tests were not discovered before they were inputted onto the electronic patient record by the computer system. Accordingly, the patient, who was the true user of that hospital number, was associated for some time with test results which were not for her. This was later rectified by JR.
19. A disciplinary hearing took place on 14 January 2014 and it was found that the Registrant’s actions amounted to Gross Misconduct. She was issued with a Final Written Warning that would remain ‘live’ on her file for 30 months. From August 2014 the Registrant was on maternity leave.
20. The Matter was referred to the HCPC and the Registrant engaged in the investigatory and regulatory process. In her submissions she indicated that she admitted the factual basis of her actions but denied that she had been dishonest, stating that she did not have any intention to defraud or harm her employer, or the public. She offered mitigating circumstances for her temporary lapse in her professional judgment.
Decision on Facts
21. Before the Panel sets out its finding on fact the Panel confirms that it had regard to the fact that the burden of proof is on the Council to prove the allegations to the requisite standard, namely the civil standard of balance of probabilities.  There is no burden on the Registrant to disprove anything.
22. The Panel heard live evidence from two witnesses on behalf of the Council.
23. JR, Operations Manager, who had been asked to act as the Investigating Officer. She presented as a credible, honest and reliable witness. She gave evidence of the processes which should be adopted by a user of the Patient IT system and the steps she had taken in investigating and preparing a report on the incidents. She had personally corrected the erroneous entries on Patient A’s records. She gave testimony of the robustness of the data and the cross referencing that was undertaken to ensure that there were no errors in information placed on patient records.
24. RB, Biomedical Scientist, who had been working alongside the Registrant on the nightshift of the 18 November 2013, when a mismatch in the Patient IT data had been identified by the Pathology IT section. His evidence was therefore limited to the fact that he was contacted by SH and asked to speak to the Registrant about this anomaly. He gave evidence that at this stage, on the 18 November 2013, the Registrant had admitted that the blood sample was her own.
25. The Panel also received the sworn written evidence of SH, from the Pathology IT unit, which it accepted as reliable, disclosing as it did, the results of IT tests and analysis.
26. The Registrant gave evidence. Whilst she had been open and honest with her admissions she had not been consistent in her evidence. Although she asserted and felt that her intentions had been honourable she had struggled to explain clearly how her actions and intentions had not been dishonest with the result that she presented in a not wholly convincing manner.
27. Particulars 1, 2 and 3 – found proved on the evidence and the Registrant’s admissions.
28. The Panel had before it supporting documentary and testimonial evidence that showed clearly that the Registrant had on three separate occasions, run unauthorised tests on her own sample of bloods. In two instances she had recorded these test results under a false name and a false hospital number. These two matters were identified through the fact that the hospital number adopted by the Registrant – a combination of her date of birth and her husband’s – had already been allocated to a patient some years earlier.
29. Particular 4 relating to dishonesty – found proved.
30. Objectively the Registrant’s actions were dishonest and would be perceived by the public as dishonest. She had run three sets of tests without authorisation. On two occasions she had assumed a false identity and on a third occasion had retrospectively altered her GP blood sample form. These measures were actions done with a view to concealment. The Registrant had acknowledged and accepted that her action had been totally unacceptable.  The Panel considered that her actions could not be viewed as anything other than as dishonest irrespective of the Registrant’s intentions.
Decision on Grounds
31. The Panel took into account the representations of the parties and the advice of the Legal assessor.
32. The Panel referred to the relevant guidance issued by the Council and in particular the Standard of Performance, Conduct and Ethics. The Panel has concluded that the Registrant’s actions had been in breach of the Standards of Conduct, Performance and Ethics standards 1, 2, 3, 5, 7, 10, 12 and 13.
1- You must act in the best interests of service users.
2- You must respect the confidentiality of service users.
3- You must keep high standards of personal conduct.
5- You must keep your professional knowledge and skills up to date.
7- You must communicate properly and effectively with service users
and other practitioners.
10- You must keep accurate records.
12- You must limit your work or stop practising if your performance or
judgement is affected by your health.
13- You must behave with honesty and integrity and make sure that
your behaviour does not damage the public’s confidence in you or
your profession.

33. The Panel did not consider that there had been a breach of standard 4 which states:
4- You must provide (to us and any other relevant regulators) any important information about your conduct and competence.
 
34. The Panel reached this decision as it considered that on a strict construction of that standard the Registrant could not have been expected to inform the HCPC about her conduct in advance of the final determination and notification of the outcome of the internal disciplinary hearing in July 2014.
35. The Panel has also concluded that the Registrant’s actions are in breach of the Standards of proficiency for Biomedical Scientists standards 1, 2, 3.1, 3.2, 10, 15.1 and 15.6.
1- be able to practise safely and effectively within their
scope of practice

2- be able to practise within the legal and ethical
boundaries of their profession

                 3.1- understand the need to maintain high standards of personal and
professional conduct

3.2- understand the importance of maintaining their own health

10- be able to maintain records appropriately

15.1- understand the need to maintain the safety of both service users
and those involved in their care

15.6- understand the application of principles of good laboratory
Practice

36. These are serious breaches of the two sets of standards. By her own admission the Registrant knew that her actions had fallen below those expected of a Biomedical Scientist and were in breach of her employer’s established processes and practice procedures and the standards of her profession.
37. Her actions had exposed herself and Patient A to the potential risk of harm. Her actions would be viewed by the public as deplorable and they had brought her, her profession and in turn her employer into disrepute.
Decision on Impairment 
38. In reaching its decision the Panel took into account the following:
• In relation to impairment, the Panel reminded itself that the test of impairment is expressed in the present tense, that fitness to practise ‘is impaired’.
• Whether the Registrant’s fitness to practise is impaired is a matter of judgment for the Panel.
• Rule 9 of the Health Professions Council (Conduct and Competence Committee) (Procedure) Rules 20003 (as amended) provides ‘where the Committee has found that the health professional has failed to comply with the standards of conduct, performance and ethics established by the Council under Article 21(1)(a) of the Order, the Committee may take that failure into account, but such failure will not be taken of itself to establish that the fitness to practise of the health professional is impaired.
• The advice of the Legal Assessor
• The guidance issued by the Council entitled ‘Finding that fitness to practise is impaired.’

39. In relation to the personal component of its decision, the Panel considered whether the Registrant’s actions were capable of remedy, had been remedied and whether there was any likelihood of a repetition of the misconduct.
40. In relation to particulars 1, 2 and 3 the Panel considered that these actions were capable of remedy.  The evidence that remedial action had been taken was however insufficient to support a finding that her conduct had been wholly remedied. There was no evidence of a course or any training addressed at the specific elements exposed by her misconduct. There had been no piece of reflective writing presented which would show she had understood fully the potential impact her actions could have had. Further, there was limited insight into the potential impact her actions could have had. She had identified the potential for clinical harm to Patient A arising out of her actions however she had no insight into the impact her actions had on other professionals, her employer, her profession and the wider public. The Panel therefore concluded that on the personal component the Registrant’s fitness to practise remained impaired. The Panel was particularly concerned that the Registrant had not appreciated that there was a significant professional boundary between taking bloods and testing them and the clinical analysis and interpretation of those test results by a duly qualified clinical practitioner.
41. In relation to Particular 4, dishonesty, the Panel accepted that there was limited ability to remedy a finding of dishonesty. The Panel did however have a large number of testimonials which stated that in the opinion of her professional colleagues she was not an inherently dishonest person. The Registrant had stated that she would not do anything like this again. However that intent had not been tested within the workplace as she was still on maternity leave.   Further, her conduct, which involved concealment, would, in the Panel’s view, warrant a finding of impairment in the public interest.
Decision on Sanction
42. The Panel took into account the terms of the Indicative Sanctions Policy issued by the HCPC in formulating its view as to the appropriate and proportionate restriction to place on the Registrant’s registration.
43. The Panel noted during the conduct of this case that there were significant further elements that could have been investigated and particularised as part of the Allegation such as the procurement of two unauthorised blood samples through the offices of a fellow staff member; the falsification of the GP form; and, the incomplete removal of information from Patient A’s records. However, as advised, the Panel had previously discounted these matters from its consideration and at this stage continued to restrict its identification of relevant aggravating and mitigating factors to those relating to the matters as particularised.
44. Aggravating factors identified are:
• The Registrant’s actions were dishonest.
• The Registrant’s actions had exposed Patient A to potential risk.
• Her actions had been in breach of Local Standard Operating Procedures.
• Matters which the Panel considered to be mitigating features are:
• Early admission when confronted by RB about the anomalous IT data.
• Acceptance by the Registrant of her failings as an autonomous         professional.
• Expressions of genuine remorse, regret and apology.
• Acceptance that her judgment had been clouded by the presence of     physical and other stressors at the time of the events.
• Eleven professional testimonials (one from a senior manager) and one character reference, all of which attest to the Registrant’s positive qualities.
• This is the first time that the Registrant has been before her regulatory body and since 2010, with the exception of this incident, had worked without cause for concern.
• The Registrant has undertaken some remediation through attending an Information Governance course and undertaken reading of professional standards in anticipation of this hearing.
• The Registrant has fully engaged in the HCPC process.
• The personal, professional and financial impact the internal and these proceedings have had on the Registrant and her continued need to support her family.
• The Registrant has enjoyed the continued support of her employer such that she has not been either on suspension nor supervision and is relied upon to work alone on duty.

45. The Panel considered that this was not a matter where it could take no further action. Mediation was inappropriate. A Caution Order was, in the Panel’s view, insufficient to note the seriousness of the matters found and would not provide any service user protection. Further there being no review of such an Order there was no mechanism for the HCPC to gauge whether there had been full reparation of the Registrant’s previous failings.
46. The Panel gave careful consideration as to whether it was able to fashion a Conditions of Practice Order that would address the particular failings and behaviour in this case. The Panel noted that the Registrant had gone some way to developing insight into her conduct. In particular she had immediately acknowledged her wrongdoing and had been able to articulate the threats and risks she had exposed herself, and Patient A, to through her misconduct.
47. A Conditions of Practice Order would provide the Registrant with the opportunity and the time to develop fully her insight into her actions, an ability which the Panel believes the Registrant possesses. She has been on maternity leave since August 2014 and in addition has had to face the challenges posed by her Mother’s death and her Father’s continued ill health. The Panel noted that those circumstances had, to date, limited the Registrant’s ability to remedy fully her behaviour.
48. Although it is difficult to demonstrate that dishonesty has been remedied, in this case the Panel accepts that the Registrant’s real remorse is genuine and coupled with development of further insight makes the likelihood of repetition remote. Conditions of Practice would allow further time for the Registrant to demonstrate that she continues to be an honest and trustworthy member of her profession.
49. The Panel has therefore imposed the Conditions of Practice that are set out below for a period of twelve months from the operative date. The Panel notes that it is unlikely that completion of the elements of the Conditions of Practice Order, and the development of full insight, will be achieved within a period of six months. This being the case, this Panel directs that the Registrant should not be able to call for an early review of the Conditions of Practice Order until the end of April 2016.
50. The Panel commends to the Registrant that it would be helpful to a future reviewing Panel to have the opportunity to question, in person, a senior member of staff from her employer, however the Panel accepts that this may prove difficult or impractical.
51. In deciding that a Conditions of Practice Order is the appropriate and proportionate measure the Panel assessed the degree to which a Suspension Order may be warranted. In the particular circumstances such a step would, in the Panel’s judgment, be punitive and disproportionate, particularly given the degree of remorse shown, and the absence of any attitudinal or personality issues. In the Panel’s view it will be of benefit to the Registrant, her profession and her employer that the Registrant is given the opportunity to show her ability to work with integrity in the workplace and to continue to provide financially for her family.
52. Although there has been a large amount of information relating to the Registrant’s heath which has supported the Panel’s findings that her judgment was, at the time of these events, adversely affected, the Panel considers that it is not necessary to produce a private version of this decision, as those matters have not influenced the Panel’s final determination on sanction and those issues are now historic health matters.

Order

Order:     The Registrar is directed to annotate the register to show that for a period of twelve months from the date that this order comes into effect [the operative date] you, Janelyn Manong, must comply with the following Conditions of Practice.

1. Prepare and present to the HCPC a detailed reflective piece of writing on the impact of her actions on Service Users, fellow professionals and the wider public.

2. Undertake extra curricular training in respect of Information Governance.

3. Prepare and present a report from a senior member of staff (within her place of employment) which sets out details of the Registrant’s conduct and practice since the Registrant’s return from Maternity Leave (which is September 2015). Such written report to be presented to the HCPC at least one month before a review of the Conditions of Practice Order.

4. You must inform the HCPC if you cease to be employed by your current employer or take up any other employment.

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

6. 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 too be registered with 9at the time of application); and

C Any prospective employer (at the time of your application).

Notes

Conduct and Competence Final hearing took place at the HCPC, London on 1-2 September 2015.

Hearing History

History of Hearings for Janelyn Manong

Date Panel Hearing type Outcomes / Status
19/08/2016 Conduct and Competence Committee Review Hearing No further action
01/09/2015 Conduct and Competence Committee Final Hearing Conditions of Practice