Mrs Christy A Henderson
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(As amended at the Final Hearing)
During the course of your employment as a Radiographer with University Hospital of North Staffordshire NHS Trust between July 2013 to November 2013, you:
1. Not proved.
2. Knowingly deleted 30 mammographic images you took, contrary to the
Ionising Radiation (Medical Exposure) Regulations 2000, (IR(ME)R 2000).
3. Did not make an accurate records of the dosage / exposure received by the patients by not accurately completing for each of the images you had deleted and/or repeated:
(a) a Technical Recall/Technical Repeat form;
(b) a Screening Forms.
4. Your actions set out in paragraph 2 were dishonest.
5. The matters described in paragraphs 2 and 4 constitute misconduct.
6. The matters described in paragraphs 1 and 3 constitute misconduct and/or lack of competence.
7. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.
On the available documents the Panel was satisfied that proper notification of this hearing had been given.
Proceeding in Absence
1. The Panel then went on to consider whether to proceed in the absence of the Registrant. In doing so, it considered the submissions made on behalf of the HCPC. The Panel noted the e-mail of 6 March 2016 where the Registrant states that she is aware of the Hearing today. The Registrant appears from that email to be content that today’s Hearing proceed in her absence and that the Panel takes into consideration the additional submission she had forwarded to the HCPC. The Presenting Officer submitted that the Panel can be satisfied that the Registrant’s absence today is voluntary and she has waived her right to attend and/or to be represented. The Presenting Officer submitted that in the light of this, an adjournment would serve no useful purpose and there was a public interest in this matter being dealt with expeditiously.
2. The Panel heard and accepted the advice of the Legal Assessor. He advised that it is clear from the correspondence that the Registrant is aware of today’s Hearing and the Panel can therefore be satisfied that the HCPC has taken all reasonable efforts to serve the Notice of today’s Hearing on the Registrant. He reminded the Panel that it should exercise its discretion to proceed with the utmost care and caution and drew the Panel’s attention to the case of R v Jones  UKHL 5. He further advised that the Panel must consider the nature and circumstances of the Registrant absenting herself, in particular whether the decision was voluntary and if so, whether she had waived her right to be present and/or represented; and the general public interest that a substantive order be reviewed before it expired.
3. The Panel was satisfied that all reasonable efforts have been made to notify the Registrant of today’s Hearing and is satisfied that she is aware of today’s Hearing. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPC practice note entitled ‘Proceeding in the Absence of a Registrant’. It weighed its responsibilities for public protection and the expeditious disposal of the case with the Registrant’s right to a fair hearing. The Registrant has made no application to adjourn today’s hearing and it is implicit in her e-mail to the HCPC she is expecting it to proceed in her absence. Further, there is a public interest that this Substantive Order is reviewed before it expires.
4. The Panel was satisfied that the Registrant had voluntarily absented herself today and has waived her right to be represented. It determined that it was unlikely that an adjournment would result in her attendance at a later date and that an adjournment would serve no useful purpose. After weighing the Registrant’s own interest with the public interest in the expeditious disposal of this case the Panel decided to proceed in the Registrant’s absence.
5. The Registrant was employed as a trainee Mammographer at the University Hospital of North Staffordshire NHS Trust [the Hospital] between 2 September 2012 and 16 January 2014 when she was dismissed. Mammographers are required to complete a breast screening form for every patient. The screening form requires basic information such as the patient’s name, date of birth and address. The form also records information pertaining to the mammogram including how many radiographic exposures the patient was subjected to, how many repeat mammograms were undertaken and the reasons for and any such repeat mammograms.
6. It was Departmental Policy that no breast screening images should be deleted, even if the image was of poor quality. This was because any such image might contain some diagnostic information that could be of value when considering whether the patient has or is susceptible to breast cancer. Moreover it is important for it to be known what dosage of radiation a patient has been exposed to and how many images were obtained. It was also Departmental Policy that if a mammographic image was of such poor quality that it needed to be retaken, the Mammographer was required to complete what was known as a Technical Recall/Technical Repeat form [TR/TP form] which recorded the reason why it had been necessary to retake the image. The Departmental Policy was that if it was necessary to repeat the image, a trainee Mammographer should get the approval of a more senior member of staff who would, if appropriate, authorise the repeat image on the TR/TP form, so there would be formal authorisation to expose the patient to further ionising radiation.
7. Departmental Policy also required that the TR/TP form would be stored as part of the patient records and the poor quality image and any additional images would be archived. It was essential that the Mammographer completed the TR/TP form so that the reasons for the repeated image were recorded for audit purposes as the TR/TP was regarded as a key performance measure.
8. Following a routine check on the Hospital computer system by an Advanced Practitioner Radiographer in October 2013, it was discovered that the Registrant appeared to have deleted two mammographic images. The Registrant was asked about the deleted images and initially denied having deleted the two images. Subsequently in November 2013 it was discovered that the Registrant appeared to have deleted a further 28 mammographic images. Following an investigation into the 30 images that the Registrant was alleged to have deleted, it was concluded that there was a case for the Registrant to answer. A disciplinary hearing was conducted on 15 and 16 January 2014. That disciplinary panel concluded that the Registrant had indeed deleted the images and failed to record this, and that her actions amounted to gross misconduct. The Registrant was dismissed from the Hospital with immediate effect.
9. Following a Substantive Hearing on 16 – 18 March 2015 the panel found allegations 2, 3 and 4 proved. That panel found that the allegations proved amounted to misconduct and that the Registrant’s fitness to practice was impaired. That panel decided that a 12 month Suspension Order was the appropriate and proportionate sanction.
10. The Presenting Officer referred the Panel to the bundle and the findings of the substantive hearing panel on 18 March 2015. He submitted that the original panel had considered that the Registrant had put patients at risk of harm given her lack of recording of the deleted images and that she lacked appropriate insight. The Presenting Officer submitted that this Panel should note the expectations of the original panel as regards the Registrant providing evidence of insight and remediation to a reviewing panel.
11. The Presenting Officer submitted that the 6 March e-mail did not offer any reflection by the Registrant on her actions and the risk of harm, neither did it deal with remediation. There are no recent references, testimonials, and there is no CPD evidence He submitted that the Registrant continued to show little insight and a lack of remediation.
12. The Presenting Officer submitted that conditions of practice were not appropriate as the Panel has no information about the Registrant’s current employment. He referred to the Panel’s powers at review and to the HCPC’s Indicative Sanctions Policy.
13. This is the first mandatory review of a Suspension Order of 12 months, which was originally imposed at the final hearing on 18 March 2015. This Panel is reviewing the Suspension Order pursuant to Article 30(1) of the Health and Social Work Professions Order 2001 (consolidated text). The Panel considered the submissions on behalf of the HCPC and the 6 March e-mail from the Registrant.
14. The Panel heard and accepted the advice of the Legal Assessor. He reminded the Panel that its purpose was to conduct a comprehensive appraisal of the Registrant to determine if she is fit to return to unrestricted practice. Its role is not to conduct a rehearing of the allegations nor is it to go behind the previous findings. He advised that in carrying out this assessment, the Panel must exercise its own independent judgment. He advised the Panel to make its determination based on the evidence before it today.
15. The Legal Assessor advised the Panel that if it determined that the Registrant’s fitness to practise remained impaired all the options under Article 30 of the 2001 Order could be exercised by the Panel. He advised the Panel that it should bear in mind the principles of fairness and proportionality and have regard to the “Indicative Sanctions Policy” document issued by the HCPC. He reminded the Panel that any order that it makes under Article 30 should not be punitive in purpose, and that it should be the least restrictive order that would suffice to protect the public and/or is otherwise in the public interest.
16. The Panel exercised its own independent judgment in determining whether the Registrant's fitness to practise remains impaired. It kept in mind the need to protect the public, to maintain public confidence in the profession, and to uphold proper standards of conduct and performance within the profession.
17. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel took into consideration all the papers before it, the submissions of the Registrant in her e-mail of 6 March 2016 and those of the Presenting Officer. It concluded that the Registrant's current fitness to practise remained impaired.
18. The Panel had regard to the HCPC’s Indicative Sanctions Policy and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive but to protect members of the public and to safeguard the public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.
19. The Panel next considered what would be the appropriate, proportionate and sufficient sanction in order to protect the public and meet the public interest. The Panel considered whether a Caution Order would be an appropriate order. However, the Panel concluded that a Caution Order would not be sufficient to address the seriousness of this case and the misconduct found. The Panel next considered a Conditions of Practice Order. It concluded that given the lack of information about the Registrant’s current employment it could not devise workable and appropriate conditions, particularly given the findings of misconduct and dishonesty.
20. The Panel was concerned about the lack of evidence of insight and remediation. The Panel was of the view that the e-mail of 6 March 2016 was not sufficient to demonstrate that the Registrant had developed full insight. The Panel remained concerned as to the lack of full insight by the Registrant into her dishonesty as found proved, the risk of harm she posed to service users and the disrepute she has brought to her profession.
21. The Panel carefully considered the findings of the original panel on 18th March 2015. The Panel remains concerned that the Registrant initially denied the deletions and it has seen nothing to indicate that she has fully accepted the finding of dishonesty. There continues to be a lack of full admission and acceptance by the Registrant of her serious failings. On the basis of the 6 March 2016 e-mail the Panel cannot properly assess the risk the Registrant presently poses.
22. In all the circumstances, the Panel considered that a Suspension Order would serve to provide the Registrant with a further opportunity to provide evidence of fully developed insight and remediation and so allow a future panel to properly assess current impairment and the risk of repetition.
23. In the light of the above, the Panel is satisfied that the appropriate and proportionate response to protect the public, and being otherwise in the public interest in these circumstances, is to further suspend the Registrant for 12 months.
24. This Panel considers that a future reviewing panel would be greatly assisted by the following :
· Evidence of continuing professional development (CPD) specifically to address the Registrant’s understanding of the risk to service users from her failure accurately to record the radiation they have been subjected to.
· If she wishes to return to a career in radiotherapy, evidence from the Registrant that she has up to date CPD knowledge of that field.
· Evidence, either written or oral (should she choose to attend the review hearing) that she fully accepts responsibility for the facts found proved at the substantive hearing in addition to the misconduct.
· Evidence that the Registrant has developed full insight into the risks to service users arising from her actions and the way her actions have brought her profession into disrepute.
· Evidence to reassure a future panel there is no longer a risk of repetition of her dishonesty.
25. The Panel seriously considered Striking Off the Registrant. However, it concluded that such would not be an appropriate or proportionate sanction at this stage. It considered that the Registrant should be given a further opportunity to demonstrate to a future review panel that she has developed full insight and accepted responsibility for her actions and dishonesty.
ORDER: The Registrar is directed to suspend the registration of Christy A Henderson for a further period of 12 Months on the expiry of the existing order.
The order today will apply from April 15 2016.
History of Hearings for Mrs Christy A Henderson
|Date||Panel||Hearing type||Outcomes / Status|
|27/07/2018||Conduct and Competence Committee||Final Hearing||Voluntary Removal agreed|
|13/09/2017||Conduct and Competence Committee||Review Hearing||Suspended|
|14/03/2017||Conduct and Competence Committee||Review Hearing||Suspended|
|17/03/2016||Conduct and Competence Committee||Review Hearing||Suspended|