Mr Edward Betts

Profession: Radiographer

Registration Number: RA74731

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 02/07/2018 End: 16:00 06/07/2018

Location: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Not well founded

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Allegation

During the course of your employment as a Radiographer for Papworth

Hospital NHS Trust, you:

1. Refused to perform x-rays and/or were unwilling to perform x-rays as the sole radiographer on or around:

i) 28 October 2016; and/or

ii) 1 November 2016; and/or

iii) 3 November 2016; and/or

iv) 9 November 2016; and/or

v) 17 November 2016; and/or

vi) 18 November 2016.

2. On an unknown date in October or November 2016, demonstrated a reluctance to perform an x-ray for a post-operative patient, despite the patient experiencing oxygen desaturation and such request being authorised by a more senior radiographer.

3. Left your position in the radiology department unattended with patients waiting, on or around;

i) 1 November 2016 and/or

ii) 3 November 2016.

4. During October and/or November 2016, unnecessarily queried and/or repeatedly checked information on x-ray requests.

5. The matters set out in paragraphs 1 - 4 constitute misconduct and/or lack of competence.

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

Finding

Preliminary Matters

1. An application was made and subsequently granted in relation to a matter pertaining to the Registrant’s health being heard in private session.

2. At the commencement of the hearing Mr Ferson on behalf of the HCPC informed the Panel that one of the witnesses in this matter, Mr Paul Mitchell, was himself subject to HCPC Fitness to Practise proceedings and that his final hearing was also being heard this week. The Panel note that Mr Mitchell would not be giving oral evidence in the case of the Registrant however the Panel were advised that the matters faced Mr Mitchell may become relevant to them later in considering the weight to be attached to his evidence.

Background

3. The Registrant, Edward Betts, worked at Papworth Hospital NHS Trust (“the hospital”) as a Radiographer in the Radiology department from 5 September to 21 November 2016, when he resigned.

4. During this time, concerns about the Registrant were reported by different members of staff to AB, Lead General Imaging Radiographer, who was his line manager. These concerns related to him being unable to work without assistance from other Radiographers and on several occasions it is alleged that he refused to perform x-rays and left patients waiting to be seen. The matter was reported to the HCPC on 14 December 2016, by CD, Radiology Manager.

Admissions and Denials

5. At the outset of the hearing the Registrant made certain admissions and denials:

During the course of your employment as a Radiographer for Papworth
Hospital NHS Trust, you:

1. Refused to perform x-rays and/or were unwilling to perform x-rays as the sole radiographer on or around:

i) 28 October 2016; and/or  denied
ii) 1 November 2016; and/or denied
iii) 3 November 2016; and/or denied
iv) 9 November 2016; and/or denied
v) 17 November 2016; and/or denied
vi) 18 November 2016.  denied

2. On an unknown date in October or November 2016, demonstrated a reluctance to perform an x-ray for a post-operative patient, despite the patient experiencing oxygen desaturation and such request being authorised by a more senior radiographer.
     Denied

3. Left your position in the radiology department unattended with patients waiting, on or around;
i) 1 November 2016 and/or
ii) 3 November 2016.
Admitted that left department on one occasion but registrant unable to say which.
 
4. During October and/or November 2016, unnecessarily queried and/or repeatedly checked information on x-ray requests.

Admitted that were repeatedly checked; denied that these were unnecessarily queried 

5. The matters set out in paragraphs 1 - 4 constitute misconduct and/or lack of competence.

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

Hearing

6. Live evidence was heard from the following witnesses in this case:

a) AB, Lead General Imaging Radiographer and line manager;
b) JA, Diagnostic Radiographer and colleague;
c) TW, Picture Archive and Communications Systems (“PACS”) Manager also a HCPC registered Radiographer;
d) SF, Senior Radiographer and colleague;
e) RB, Senior Radiographer and colleague.

7. The Panel listened carefully to the evidence of each and assessed their credibility and demeanour:

a) AB: the Panel found his cavalier attitude to the requirements of the Ionising Radiation (Medical Exposure) Regulations 2000 (“IR(ME)R Regulations”) to be extremely concerning and in particular in regard to staff induction and the keeping and maintaining of training records in relation to radiation protection. In addition, the Panel was also concerned and surprised by his evidence that he discussed confidential staff matters with colleagues on a social basis within his home. When challenged he was unable to identify why this was not appropriate. Overall the Panel did not find AB to be a credible or reliable witness. However, he did admit that the Registrant took “far better” x-rays than he did and he accepted that the Registrant had not refused to work alone and had simply been concerned that nobody was present to supervise him.

b) JA: the Panel found JA to be a credible and reliable witness. She answered questions asked of her directly and to the best of her ability.

c) TW: the Panel considered him to be an impressive witness. He was fair and considered in his approach and made appropriate concessions where necessary.

d) SF: the Panel found him to be a particularly impressive witness. He was alive to the possibility of unconscious bias in his assessment of the Registrant. He was empathetic with the situation the Registrant faced as a newly qualified Radiographer working in a highly specialised hospital. SF had an excellent understanding of the IR(ME)R Regulations and the Panel found his evidence extremely helpful.

e) RB:  the Panel found RB inherently unreliable as she was evasive in answering questions from both parties and did not focus her answers on the questions asked. RB admitted becoming frustrated with the Registrant’s repeated questions and told the Panel that due to this frustration she did not listen to the Registrant as carefully as she could have.

A Half Time Submission of No Case to Answer

8. A half time submission of No Case to Answer was made in relation to all the particulars of the Allegation, notwithstanding that some admissions had already been made by the Registrant.

Submissions made on behalf of the Registrant

9. Ms Nelson’s argument on behalf of the Registrant was that more than one witness had praised the excellent x-rays that he took and his patient care. It was submitted that his careful attitude to checking details was due to his lack of experience, unfamiliarity with the procedures at this specialist hospital and his professional responsibility to ensure that every x-ray for which he shared any responsibility for was taken accurately and was clinically necessary.

10. Her submission was based on the fact that at the time of the Allegation, the Registrant had only been qualified for a number of weeks and had worked for less than ten weeks in total by the time he resigned. His lack of experience was not considered to be out of the ordinary by SF or TW. SF admitted in evidence that he was not fully conversant with all the procedures at the hospital in his first twelve weeks working there.  Ms Nelson further submitted that the evidence presented to the Panel could not be considered to be a fair sample of the Registrant’s work.  All the circumstances of the Registrant’s work needed to be taken into account including his very recent qualification as a Radiographer and being new to a specialist unit. Accordingly, Ms Nelson submitted that neither statutory ground alleged in the alternative could be made out.

11. In relation to supervision of the Registrant by more experienced colleagues Ms Nelson submitted that TW felt that it was not unreasonable of the Registrant in his position as a newly qualified radiographer to expect support whilst conducting x-rays. Further, that AB had given an undertaking that the Registrant would be under the direction supervision of another Radiographer. Regrettably this was not communicated with colleagues working with the Registrant who were unaware of this “special deal”.

Submissions made on behalf of the HCPC

12. Mr Ferson responded to the submission by acknowledging that the Registrant was newly qualified in his role at the relevant period and that one might expect it would take time to adjust to that role especially in a specialist hospital. However, he was clear that the Registrant upon registering with the HCPC became subject to it’s the rules and standards which place upon him an obligation to act in the best interests of service users and to be able to act autonomously. He invited the Panel to consider that despite the training and guidance that the Registrant received, the repeated explanation of procedure and protocol and the assistance of other experienced radiographers, the standard of his work in respect of processing x-ray requests was consistently low. The understanding of any “special deal” was not accepted.

13. Mr Ferson on behalf of the HCPC submitted that the HCPC’s case taken at its highest is such that a panel, properly directed, could find the facts, in whole or in part, proved on a balance of probabilities. Insofar as the statutory grounds are concerned he submitted that either could be made out. A fair sample of the Registrant’s work had been considered and this work was unacceptable he said, causing delay and not following the procedures that operated at the hospital as explained to him by more senior staff.

Legal Advice from the Legal Assessor

14. The Panel accepted the advice of the Legal Assessor.  She commended the HCPC Practice Note on Half Time Submissions to it and took them through the cases of R v Galbraith (1981) 73 Cr App R 124, [1981] and R v Shippey (1988) Crim LR 767. She reminded them of the need to consider the Particulars of the Allegation in turn so that the whole as well as parts thereof are considered, as well as the concept of the facts taken at their highest amounting to a statutory ground and a finding of impairment. She also detailed the concept and case law relating to novices in a certain area of skill must show the same standard of care as a reasonable person with that particular skill, without allowance being given for the defendant's lack of experience, (Nettleship v Weston (1971) 3 All ER 581; Wilsher v Essex Area Health Authority (1986) 3 All ER 801; Wells v Cooper (1958) 2 All ER 527).

Decision of the Panel

15. The Panel considered the written and oral submissions of both parties, all oral and written evidence and the advice of the Legal Assessor.  In relation to each Particular of the Allegation.

Particular 1 of the Allegation

During the course of your employment as a Radiographer for Papworth
Hospital NHS Trust, you:
1. Refused to perform x-rays and/or were unwilling to perform x-rays as the sole radiographer on or around:
i) 28 October 2016; and/or  
ii) 1 November 2016; and/or 
iii) 3 November 2016; and/or 
iv) 9 November 2016; and/or 
v) 17 November 2016; and/or 
vi) 18 November 2016.  

16. The Panel did consider that there was evidence that the Registrant was unhappy about being a sole radiographer.  However, this was in the context of him being appointed into a Band 5 - 6 training post at a specialist hospital. Further, the Panel heard evidence that AB had specifically agreed with the Registrant that he would be supported and supervised by another radiographer, which did not transpire.  The Panel noted that all the witnesses without exception spoke highly of the Registrant’s clinical skills and patient care. All witnesses commented on the high quality of the images the Registrant produced. No witness was able to say that the Registrant had ever refused to carry out an x-ray.

Particular 2:

On an unknown date in October or November 2916, demonstrated a reluctance to perform an x-ray for a post-operative patient, despite the patient experiencing oxygen desaturation and such request being authorised by a more senior radiographer.

17. It was clear to the Panel after hearing the evidence of SF that the Registrant was not refusing to perform the x-ray; “he just needed more reassurance that he was doing the right thing” as the request that had been provided had failed to specify the condition that the referrer was seeking to identify. SF further stated that in seeking clarification the Registrant would have been following what he had been told during his training. On this basis there is no evidence to suggest that the Registrant demonstrated a reluctance to perform the x-ray.

Particular 3: Left your position in radiology department unattended with patients waiting, on or around:

i) 1 November 2016 and/or
ii) 3 November 2016.

18. The Registrant made a partial admission to particular 3 in that he accepts that on one occasion he left his position in the radiology department unattended. The Registrant could not say on which date this occurred. It is apparent to the Panel that even if both limbs of the particular were found to be proved there would be no likelihood of lack of misconduct or lack of competence. As far as misconduct is concerned the Panel is satisfied that in leaving the department to seek further advice the Registrant was actually acting in the best interest of the patients. In relation to lack of competence this incident would not amount to a lack of competence as it does not represent a fair sample of the Registrant’s work.
 
Particular 4: During October and/or November 2016, unnecessarily queried and/or repeatedly checked information on x-ray requests.

19. The Registrant admits that on a number of occasions he repeatedly checked patient information but denies that doing so was unnecessary. It is clear to the Panel that the Registrant’s concern was for patient’s safety and full compliance with IR(ME)R Regulations. On the evidence the Panel heard they were satisfied that this was quite contrary to the culture which seemed to be in existence in the Department. It appeared to the Panel that the overriding consideration of the Department was throughput of work against a background of not questioning referrals even though an audit had identified an issue with inappropriate referrals at this hospital.

Overall Decision

20. The approach which the Panel adopted did not stop at simply considering the factual particulars of the Allegation.  All HCPC witnesses were consistent in admitting that the procedures and practices at the specialist hospital were unique, and on witness stated that they would certainly be challenged if they occurred in any general hospital.  Similarly, all admitted that the Registrant had a responsibility for ensuring that the identification of a patient, the checking of details and the assurance that the x-ray was clinically indicated for each patient was the responsibility of the Registrant.

21. While the witnesses were all very different they were consistent in agreeing that there was no outright refusal by the Registrant to complete x-rays for patients but rather real caution displayed. There was commendation for his patient care, even from those who found his slow and careful pace frustrating. The gravamen of the Registrant’s conduct appears to have been taking the time to verify patient identification and to check that each x-ray request was not deficient. Within a culture of an audit having been done at the hospital and unnecessary x-rays having been requested and undertaken, the Registrant’s particular care and caution is to be lauded.

22. The Panel was particularly impressed by colleagues who said that the Registrant had the makings of an “Outstanding Radiographer” and thought that he would be a credit to the profession.  Accordingly, notwithstanding that there are some particulars of the Allegation not admitted in full, the Panel finds that it is for the HCPC to prove the facts alleged and that the HCPC witnesses uniformly admitted to considering the requests of more senior staff as routinely to be complied with. It is the Registrant who has applied the specific requirements of the IR(ME)R Regulations and the HCPC Standards for Radiographers more cautiously and carefully than his line manager and some of his colleagues.

23. The Panel carefully considered that should the case proceed, the decision of whether it is ‘well founded’ would require them to determine whether, in its judgement, the facts alleged amount to the statutory ground of the misconduct and/or lack of competence and in turn, establish that a registrant’s fitness to practise is impaired.  Given the evidence which the HCPC has presented, the Panel considered that when taken at its highest, no reasonable Panel could properly conclude that: (a) the statutory ground of either misconduct and/or competence is met; or (b) that the registrant’s fitness to practise is impaired, in the particular circumstances of this case.

24. Given the overwhelmingly positive reflections about a newly qualified Radiographer, the Panel considers that the Allegation is misconceived, in that the evidence is not wholly disputed but the undisputed facts are insufficient to establish the statutory ground and, in turn, impairment.  Accordingly, the Panel concluded that there is no case to answer.

Order

No information currently available

Notes

No notes available

Hearing History

History of Hearings for Mr Edward Betts

Date Panel Hearing type Outcomes / Status
02/07/2018 Conduct and Competence Committee Final Hearing Not well founded