Mr Julius B Odu

Profession: Radiographer

Registration Number: RA33509

Hearing Type: Review Hearing

Date and Time of hearing: 12:30 08/02/2018 End: 17:00 08/02/2018

Location: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

The following allegation was concluded by a Panel of the Conduct and Competence Committee at the substantive hearing on 7 February 2017. All parts of the allegation were found proven, with regard to particular 11 of the allegation of misconduct was upheld.

During the course of your employment as a Radiographer with North Middlesex University Hospital NHS Trust:

1. Between 28 June 2013 and 11 July 2013, you breached Ionising Radiation (Medical Exposure) Regulations 2000 (IR(ME)R 2000) Regulations 5(1) and Trust protocols, namely the Clinical Incidents Procedure and/or the Department Breast Imaging Protocol, in that you:

a) did not report that the image verification movie loop had been omitted on fraction 2 of the treatment whilst treating:

i. Patient A’s fraction 3; and
ii. Patient C’s fraction 3. 

b) on Patient’s B’s fraction 10 you did not repeat the image verification movie loop despite the previous fraction’s loop being out of tolerance.

c)  your acts and/or omissions at 1(a)(i) and (ii) above occurred further to a direction to re-read the Clinical Incidents Procedure in November 2011.

2. You did not record and/or document the changeover in entitled operators and/or the complexity of the treatment set up on the 28 June 2013, in Patient B’s treatment record. 

3. Between the 24 July 2013 and 30 August 2013, you accessed medical records of patients B and C and added notes retrospectively in an attempt to conceal your actions as described in paragraphs 1a)(ii), 1b) and 2. 

4. On 7 March 2012 you covered a patient’s tracheotomy site with cling film.

5. On 5 and/or 7 March 2012, you did not follow the correct process for identifying patients in that you called up the details of a different patient on the Record and Verify system to the patient who was set up in the treatment room.

6. On 5 March 2012 you did not correctly follow imaging action levels for a patient receiving radical radiotherapy to the head and neck regions in that you treated them out of tolerance by 4mm or thereabouts. 

7. On or around 6 March 2012 you refused to complete Multi Leaf Collimator (MLC) checks prior to treating a patient which could have potentially led to a non-recoverable error.

8. Your actions described in paragraph 3 were dishonest. 

9. The matters described in paragraphs 3 and 8 constitute misconduct. 

10. The matters described in paragraph 1 to 2 and 4 to 7 constitute misconduct and/or lack of competence. 

11. By reason of that misconduct and/or lack of competence your fitness to practise is impaired. 

Particulars 1 - 8 found proved. The allegation of misconduct and impairment to fitness to practise was upheld.

Finding

Background

1. The Registrant is an experienced radiographer with over 20 years’ experience.  He joined North Middlesex University Hospital NHS Trust (the Trust) as a Band 6 radiographer in 2005.

2. In  2012  the Registrant  was  suspended  from  duties  pending  an  investigation  into allegations  of misconduct,  which resulted in the Trust issuing him with a final written warning.  In 2013 he was again suspended from duties pending an investigation into allegations of misconduct. Following the Trust’s disciplinary hearing the Registrant was summarily dismissed in April 2014 for gross misconduct. The Registrant appealed against the Trust’s decision.  His appeal was dismissed following an appeal hearing on 29 August 2014.  The Registrant’s last day of service was 1 April 2014.

3. The Trust’s conduct and performance concerns were subsequently referred to the HCPC.

4. The Registrant was responsible for carrying out patient assessments, including their fitness for procedure through a formal review, updating medical staff with any changes, and assessing treatments as well as the delivery of radiotherapy treatment. He was also responsible for reporting incidents and any ‘near misses’. A patient is referred for radiotherapy by a doctor who prescribes a course of treatment; the appointments are known as fractions. Radiotherapy is a treatment used to destroy cancer cells. A beam of radiation is targeted on the cancer with the aim of shrinking it. Radiotherapy uses megavoltage x-rays which targets the cancer cells directly. In order to ensure the radiotherapy treatment is delivered to each patient accurately, and does not put the patient in danger, there are a number of protocols and procedures in place that must be followed by the radiographer. If the protocols are not followed, the patient may be at risk of harm.

5. The allegation related to the Registrant’s omitting to follow the protocols in various areas of his practice, as well as to dishonesty in retrospectively amending patients’ records.

Hearing on 18-26 July 2016, 30-31 January 2017 and February 1-7 2017.

6. With the exception of February 03 2017 when he was unwell, the Registrant attended the substantive hearing and gave evidence. He was not represented. All the allegations made against the Registrant were found proved. The Panel made the following comments about the evidence that the Registrant gave to it:

“The Registrant chose to give evidence. The Panel recognised that giving evidence is a stressful event, that the Registrant was representing himself and that English is his second language. The Panel made appropriate allowances for these factors. However, the Panel concluded that the Registrant was a poor witness who did himself no favours in the manner of his evidence.

At times there may have been a genuine misunderstanding of the question that had been put to him, but on numerous occasions the Panel concluded that the Registrant was being deliberately evasive. He frequently gave long rambling answers to straightforward questions. The Registrant's frequent digressions whilst giving his evidence demonstrated a serious lack of rigour and focus, and an inability to concentrate on issues, even in the formal atmosphere of the hearing room. At times the Panel found it difficult to understand his evidence which resulted in numerous interventions to seek clarification.  

The Panel had no hesitation in finding that the Registrant was a thoroughly unreliable witness. For example, there were a number of occasions when the Registrant raised new lines of defence for the first time during cross examination, which undermined his credibility as a whole.  
When the evidence of the Registrant conflicted with the evidence of the HCPC witnesses, the Panel preferred the genuine, unembellished account by those witnesses. The Panel found that on the key issues, it could not accept the Registrant's evidence, in the face of reliable evidence to the contrary.”

7. The Panel gave careful consideration to whether the Registrant’s conduct as found proved amounted to misconduct. They concluded that it did. The Panel made the following observations:

“The Panel was aware that breach of the standards alone does not necessarily constitute misconduct. However, the Registrant’s conduct and behaviour fell far below the standards expected of a registered practitioner. The Registrant, despite 20+ years of experience as a radiographer, repeatedly failed to meet the standards expected of him for a significant period of time. The Registrant’s behaviour cannot be described as a momentary failure or a temporary lapse of clinical judgement. Although the Registrant was warned and made subject to an action plan, by the Trust in November 2011, for failing to follow the departmental Protocols, he went on to repeat these failings on several occasions. When the Registrant’s errors were brought to his attention rather than addressing his wrongdoing he sought to cover it up. 
 
The Panel noted that no harm came to any of the patients as a direct consequence of the Registrant’s acts or omissions. However, in the Panel’s view his conduct and behaviour presented a significant risk of harm, which was unnecessary and avoidable.
 
In addition to patients, the Registrant’s conduct had the potential to adversely affect colleagues within his team, the wider profession and the reputation of the Trust. Confidence and trust amongst colleagues is extremely important; they should be able to expect that individuals within the team can be relied upon to work in accordance with established policies and act with honesty and integrity at all times.
 
The Panel was satisfied that the Registrant’s failure to follow the Protocols and his conscious and deliberate decision to dishonestly attempt to mislead the Trust when his failings were discovered amounts to serious misconduct as described in the Roylance case.”

8. The Panel concluded that the Registrant’s fitness was impaired “firstly from the personal perspective and then from the wider public perspective”. Its reasons were as follows:

“The Panel considered the Registrant’s current fitness to practise firstly from the personal perspective and then from the wider public perspective. 
 
The Panel noted that the relevant events date back to March 2012 to August 2013. However, there was very little indication that he had reflected on his behaviour in any meaningful way or any clear expressions of remorse for the impact his behaviour had on others. 
 
Although the Registrant has engaged with these proceedings there was no evidence before the Panel that he fully appreciates the gravity of his misconduct, there was no explanation as to how he would behave differently in the future and no assurance that such serious misconduct would not be repeated. There was also no evidence before the Panel that the Registrant has kept his clinical skills up to date. The Registrant informed the Panel that he has not worked in a clinical role as a radiographer for 3 years, although he has lectured at a University of Calabar, Nigeria and worked in a fellowship role at the International Atomic Energy Agency.  In the absence of a sufficient level of insight and any steps he has taken towards remediation since the events of 2012/2013, the Panel concluded that there is a real risk of repetition. The Panel was particularly concerned by the pattern of behaviour over an extended period of time. As a consequence, the Panel has determined that there is a current and ongoing risk of harm to patients. 
 
The Panel recognised that demonstrating remediation in a case involving dishonesty is particularly difficult, as probity issues are reliant on attitude, which can often only be inferred from conduct.  The Panel noted that the Registrant’s dishonest conduct relates to a discrete set of circumstances, which may have the potential to be remediated, provided that there is evidence of sincere and meaningful reflection that demonstrates that the dishonesty is firmly in the past and is not a deep seated attitudinal trait. However, the Registrant has provided no information that would assist the Panel in this regard. His dishonest conduct demonstrated a conscious and deliberate attempt to mislead colleagues and the Trust. As a consequence of the Registrant’s pattern of behaviour the Panel took the view that the risk of repetition is high.

The Panel concluded that for these reasons the Registrant’s fitness to practise is currently impaired based on the personal component.
 
In considering the public component the Panel had regard to the important public policy issues which include the need to maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour.
 
Members of the public would be extremely concerned to learn that a radiographer had delivered treatment to patient outside the relevant policies and Protocols and then sought to cover some of these omissions up, as this clearly has the potential to compromise the safety and well-being of patients. It is critically important that colleagues and service users can rely on the integrity of radiographers at all times. Candid and honest admissions, when things go wrong, are a vital part of that process. 
 
A significant aspect of the public component is upholding proper standards of behaviour. The Registrant’s conduct fell far below the standard expected of a registered practitioner and the Panel takes the opportunity to declare that it is not acceptable a radiographer to dishonestly attempt to mislead colleagues and his employer. The Panel takes the view that until the Registrant has remediated his wrongdoing, he poses a risk to patients. The Panel also concluded that the Registrant has also brought the profession into disrepute, breached a fundamental tenet of the profession by failing to act in the best interest of patients and on more than one occasion demonstrated a lack of integrity. There is a risk that all of these features are likely to be repeated in the future.
 
In all the circumstances the Panel determined that public trust and confidence would be undermined if a finding of impairment is not made.
 
The Panel concludes that the Registrant’s current fitness to practise is impaired on the basis of both the personal component and the wider public interest and therefore the HCPC’s case is well-founded.”
 
9. Having concluded that the Registrant’s fitness to practise was impaired, the Panel considered the order that it should make. The Panel’s conclusion, having reviewed all the orders available to it, was that a Suspension Order for a period of 12 months was appropriate and proportionate. The Panel stated its reasons as follows:

“The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s repeated misconduct and dishonest behaviour and in the absence of exceptional circumstances, to take no action on his registration would be wholly inappropriate. Furthermore it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession. 
 
The Panel went on to consider whether to impose a Caution Order and noted paragraph 22 of the ISP which states: 

 “A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate action.  A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practice would be disproportionate.  A caution order is unlikely to be appropriate in cases where the registrant lacks insight.” 

In view of the Panel’s findings that the Registrant has demonstrated limited insight into his misconduct, provided no evidence of remediation, and that the possibility therefore remains his behaviour may be repeated, the Panel concluded that a Caution Order would be inappropriate and insufficient to meet the public interest.
 
The Panel went on to consider a Conditions of Practice Order. The Panel noted that the ISP states:
 
‘conditions of practice are unlikely to be suitable in situations where problems cannot be overcome, such as serious overall failings, lack of insight, denial or matters involving dishonesty or the abuse of service users’. 
 
The Registrant’s dishonest actions are not amenable to conditions, as the basis for this type of misconduct is an attitudinal failing. Furthermore, as the Registrant failed to comply with the policies and Protocols within the Trust, has demonstrated only limited insight into his failings and has not kept his clinical skills up to date, the Panel had no confidence that conditions are currently workable. In any event, the Panel concluded that conditions would not adequately address the serious nature of the Registrant’s misconduct and so would undermine public confidence in the profession and undermine the need to uphold standards of conduct and behaviour. 
 
The Panel next considered a Suspension Order.  A Suspension Order would send a signal to the Registrant, the profession and the public reaffirming the standards expected of a registered radiographer. Although the Registrant has not worked as a radiographer for 3 years, he appears to remain committed to the profession. In the Panel’s view the Registrant should be given the opportunity to demonstrate that he can ‘redeem’ himself and noted that paragraph 31 of the Indicative Sanctions Policy states:

‘If the evidence suggests that the registrant will be unable to resolve or remedy his or her failings then striking off may be the more appropriate option. However, where the registrant has no psychological or other difficulties preventing him or her from understanding and seeking to remedy the failings then suspension may be appropriate.’

The Panel considered that the above paragraph may apply to the Registrant and that he should be given an opportunity to consider carefully the decision of this Panel and reflect on his previous conduct and behaviour. 135. In the Panel’s view the nature and seriousness of the Registrant’s dishonesty has the potential to undermine public confidence, however, in these circumstances a Suspension Order would be sufficient to maintain public confidence in the profession and the regulatory process and would have a deterrent effect on other registrants. The Panel balanced the wider public interest against the Registrant’s interests. In doing so the Panel took into account the fact that the Registrant has been unable to find full-time employment for a significant period of time and the consequential personal, financial and professional impact this has had upon him.
 
The Panel decided that the appropriate and proportionate order is a Suspension Order. A Striking Off Order would be disproportionate and punitive. The Panel determined that the Suspension Order should be imposed for a period of 12 months. The Panel was satisfied that this period would be sufficient for the Registrant to demonstrate an appropriate level of insight into his failings. If he is unable to demonstrate insight within that time frame it is highly unlikely that he will ever be able to do so.”
 
10. The Panel further indicated the material that might assist a future reviewing Panel. The Panel stated as follows:
“This Order will be reviewed shortly before expiry. Although this Panel cannot bind a future reviewing panel, that panel is likely to be assisted by the following:

(i) A full and substantive reflective statement from the Registrant which addresses his understanding of the need to comply with policies and protocols as a healthcare professional;
 
(ii) Details of how the Registrant has kept his radiotherapy skills and knowledge up to date during the period that he has not been working as a radiographer, which may include up to date CPD.
 
(iii) Evidence of insight into the impact his conduct and behaviour has had on patient safety, the profession and public confidence;
 
(iv)    Independent character references from individuals who are able to attest to the Registrant’s honesty and integrity.”

Decision of this Panel

11. Ms Bass on behalf of the HCPC made submissions to this Panel. In summary she said as follows; that the Registrant’s fitness to practise remained impaired. In support of this submission, Ms Bass said there had been no substantive change in the underlying facts since the previous hearing. She submitted that the Registrant had not provided evidence of sufficient remediation or insight; that the attitudinal issues remained unresolved and that the Registrant had not complied to any significant extent with the suggestions made by the Panel at the final hearing as to what would assist a reviewing Panel. Ms Bass further submitted that having regard to the totality of the material available, Striking Off was the only appropriate order for the Panel to make. 

12. The Registrant made oral representations to the Panel and responded to questions from Panel members. In addition he produced a lengthy reflective statement, a short essay on patient safety and two very short character references, all of which the Panel has read.  In his representations to the Panel, the Registrant sought to explain what he had learnt from the experiences which had led to his suspension and how he would act differently in the future. The Registrant also described his present circumstances and what he had done since his suspension.

13. This Panel heard and accepted the advice of the Legal Assessor

14. This Panel is aware that it has all the powers that are set out in Article 30 [1] of the Health and Social Work Professions Order 2001 [The Order] and which are summarised in the letter dated 05 January 2018 addressed to the Registrant and giving notice of this hearing.

15. This Panel is aware that the process under Article 30 [1] of the Order is one of review and not one of appeal and that its function is to determine whether the Registrant’s fitness to practise is still impaired and if so whether the  Suspension Order under review remains the appropriate and proportionate means of public protection or should be varied or replaced by some other order.
Impairment

16. Having considered very carefully the representations made by the Registrant and the additional information that he has produced, the Panel has concluded that the Registrant’s fitness to practise remains impaired. In the opinion of the Panel, the Registrant has not developed significant insight into the failings identified by the previous Panel and in particular has not addressed the findings of dishonesty. The Panel found that, not only did the Registrant’s written submissions not adequately address the key issues, but his oral evidence confirmed that he had not been able to develop adequate insight into his failings.

17. In the course of his evidence, it was clear that although the Registrant had tried to develop his insight and demonstrated an understanding of the need to follow protocols his insight had not extended further than this. In particular, as at his previous hearing, the Registrant continued to fail to acknowledge his own dishonesty, and to point to the behaviour of colleagues, to perceived failings of hospital management, and to pressures of work, rather than acknowledging his own failings.

18. The Panel was firmly of the view, as was the previous Panel, that the risk of repetition is high. The Panel was also of the view that well informed members of the public would be deeply disturbed were this Panel to find that the Registrants’ fitness to practise was not now impaired. This Panel agrees with the views expressed by the previous Panel as to the “public component” and which are set out above. Moreover this Panel does not think that the Registrant has complied with the suggestions made by the previous Panel as to what would assist a reviewing Panel. The Registrant has not kept his skills and knowledge up to date. He has not produced adequate character references. There is no adequate evidence of insight into the impact that his conduct could have had on patient safety and on the reputation of the profession. The Registrant has not, in his reflective statement, or in his oral representations demonstrated a sufficient understanding of the need to comply with policy and protocols.  

Sanction

19. Having concluded that the Registrant’s fitness to practise is still impaired, this Panel proceeded to consider what order is appropriate, proportionate and sufficient to protect the public and safeguard the public interest. This Panel took into account the principle of proportionality balancing the interests of the Registrant with the public interest and the need to provide protection to members of the public.

20. This Panel has had regard to the contents of the Indicative Sanctions Policy published by the HCPTS and is aware that sanctions should be considered in ascending order of severity. This Panel is aware that the purpose of sanctions is not punitive but to protect members of the public and to safeguard the public interest. The latter objective includes maintaining standards within the profession, together with public confidence in the profession and in its regulatory processes.

21. This Panel has concluded that to take no action, thus allowing the present order to lapse, or imposing a caution order would be inappropriate having regard to the nature and gravity of the matters found proved. Such outcomes would not sufficiently protect the public or the public interest.

22. This Panel concluded that a Conditions of Practice Order would not be appropriate. Its reasons are in essence the same as those expressed by the previous Panel. In the view of the Panel, the Registrant’s dishonest actions, which he does not appear to recognise or address, are not amenable to conditions. Moreover, he has previously failed to comply with the relevant policies and protocols, despite internal action previously taken against him by his employer. This raises serious doubts as to his willingness to comply with conditions. Furthermore and in the opinion of the Panel, conditions are incapable of addressing what, if known, would be justifiable public concern, about the Registrant’s clinical performance and lack of honesty.

23. This Panel has further concluded that a Suspension Order would not provide sufficient protection for members of the public and would not safeguard the public interest.  In coming to this conclusion this Panel noted and agrees with the words of the previous Panel when explaining the making of a 12 months Suspension Order “this would be sufficient for the registrant to demonstrate an appropriate level of insight into his failings. If he is unable to demonstrate insight within that time frame, it is unlikely that he will ever be able to do so”. This Panel has concluded that the Registrant has not developed any appropriate level of insight and that the failings in character which have been identified are, in his case, incapable of remedy. In the view of this Panel a further period of suspension would serve no purpose. Consequently, a Striking Off Order is the only appropriate and proportionate order that would protect the public and safeguard the public interest.

Order

That the Registrar is directed to strike the name of Mr Julius B Odu from the Register on expiry of the existing order.  

Notes

You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you. Any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

Hearing History

History of Hearings for Mr Julius B Odu

Date Panel Hearing type Outcomes / Status
08/02/2018 Conduct and Competence Committee Review Hearing Struck off
30/01/2017 Conduct and Competence Committee Final Hearing Suspended
18/07/2016 Conduct and Competence Committee Final Hearing Adjourned part heard