Ms Rowena N Stone

Profession:

Registration Number: RA21582

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 27/11/2018 End: 12:00 27/11/2018

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

Panel: Conduct and Competence Committee
Outcome: Struck off

Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via tsteam@hcpts-uk.org or +44 (0)808 164 3084 if you require any further information.

 

Allegation

As found proven at the final hearing on 27 November 2017:


During the course of your employment as a Radiographer at Royal United Hospitals Bath NHS Foundation Trust, between 1 May 2012 and September 2015:
1. Having received a request on or around 29 May 2012 to x-ray patient A’s left wrist you incorrectly x rayed Patient A’s chest.

2. On or around 7 June 2012, you incorrectly booked Patient B onto the Computerised Radiology Information System (CRIS)

3. On 18 July 2012, you incorrectly marked Patient C’s right hand x-ray with a left marker.

4. In relation to Patient D, on 15 August 2012 you:
a) x-rayed the patient’s hands without the appropriate clinical justification.
b) Did not request a new referral for the hand x-ray.

5. On 12 September 2012, you did not conduct an open mouth view x-ray on Patient E as required.

6. On or around 18 September 2012, you placed images that did not belong to Patient F in that patient’s folder on PACS.

7. On or around 27 November 2012, you incorrectly put 2 x-ray images into Patient F’s file on PACS.

8. On or around 13 November 2012, incorrectly booked Patient G to have their left wrist x-rayed on CRIS.

9. In relation to Patient H, on or around 16 January 2013, you incorrectly annotated an x-ray of the patient’s right tibia and fibula as being of the left tibia and fibula;

10. On 05 July 2012, in the case of Patient K, you placed images in the wrong Patient’s folder on PACS and/or CRIS

11. In relation to Patient N on or around 14 December 2012 labelled their x- ray images with the incorrect name.

12. Having received a referral for Patient O to have an ultrasound you incorrectly x-rayed Patient O’s abdomen on 9 January 2013.

13. Your x-ray image of Patient P taken on 11 January 2013 had poor collimation.

14. On 14 February 2013, you incorrectly x-rayed Patient Q’s left shoulder when the request was for the right shoulder to be x-rayed.

15. On 20 February 2013 in relation to Patient R:
a) you x-rayed the patient’s spine and you:
i. did not follow Scoliosis protocol;
ii. did not show the form to a radiologist prior to exposing the patient to radiation
iii. took the x-ray image with the ruler for leg lengths still in situ;
iv. did not select the ‘whole spine’ algorithm on the Remote Operating Processor (ROP) for the first image;
b) Your oblique-view x-rays of the patient’s hands did not capture the whole of the right hand;
c)  Not proven

16. In relation to Patient S, on 10 June 2014, you incorrectly annotated/marked an X-ray of the patient’s left hip as being of the right hip.

17. In relation to Patient U, you:
a) on 27 May 2014, did not check the request card immediately prior to taking the patient’s x-ray;
b) on 27 May 2014, performed a chest x-ray that had not been requested
c) did not complete a Datix incident form regarding the incident in 17(b) above in a timely manner.

18. On 25 July 2014, in relation to Patient V, you took an x-ray cassette which had already been exposed and gave it to another Radiographer to use in a second x-ray of the Patient

19. The time it took you to image Patients was longer than what is considered to be reasonable:
a) on 25 June 2014, in relation to approximately 8 patients;
b) on 04 August 2014, in relation to approximately 8 patients.

20. On 26 June 2014 you did not annotate an x-ray of Patient W’s right knee to say that it was weight-bearing.

21. On 26 June 2014 in relation to Patient X:
a) you did not identify that an x-ray had not been taken until the image was processed
b) did not scan the x-ray cassette barcode on the ROP until prompted to do so by Colleague A;
c) you were required to take a lateral view x-ray of the patient’s right knee and:
i. the quality of your x-ray was poor;
ii. when prompted to repeat the x-ray by Colleague A, the quality of your second x-ray was worse than your first attempt;
d) you took an axial view x-ray of the patient’s knee which was poor quality in that it did not show the joint space under the knee cap sufficiently;
e) had to be prompted by Colleague A to move a clip marker so that it did not obscure the image;
f) Not proven

22. Not proven

23. On 04 August 2014, when asked by Colleague B, you:
a) were unable to explain to Colleague B where the centering points were for a pelvic x-ray;
b) were unable to explain to Colleague B the correct exposure to set for an x-ray on a child’s tibia and fibula.

24. Not proven

25. The matters set out in paragraphs 1 – 24 constitute misconduct and/or lack of competence.

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

Finding

Preliminary Matters:
Notice of Hearing
1. The Panel had information before it that Notice of today’s hearing dated 22 October 2018 was sent to the Registrant’s address on the Register on the same date by first class post this letter was also sent to the Registrant’s email address. The Panel accepted the advice of the Legal Assessor and was satisfied that service had been effected in accordance with Rules 3 and 6 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules).
Proceeding in Absence
2. Ms Wills, on behalf of the HCPC, applied for the Panel to proceed today. She informed the Panel that the Registrant has not corresponded or engaged at all with regard to today’s hearing or been in contact since the final hearing almost a year ago.
3. During the course of her submissions, Ms Wills referred to a number of attempts by the HCPC to contact the Registrant.  On 12 January 2018 a letter was sent by post to the Registrant by the HCPC but it was returned with the envelope marked “No longer at this address return to sender”.  Ms Wills emailed to the Registrant a further letter dated 22 November 2018 reminding her of today’s hearing, Ms Wills confirmed that no response had been received. Ms Wills also produced a telephone attendance note which recorded her attempts to call the Registrant on 26 November 2018. On calling the Registrant’s given mobile and Registrant’s home number there was no response.  Ms Wills reminded the Panel that no application to adjourn has been received from the Registrant, and there is no indication that she will attend in the future.  Ms Wills reminded the Panel that the Order expires on 29 December 2018 and in light of that imminent expiry, it is in the public interest to proceed.
4. The Panel took into account the HCPTS Practice Note entitled “Proceeding in the Absence of the Registrant” and accepted the advice of the Legal Assessor. The Panel was aware that the discretion to proceed in the absence of a Registrant should be exercised with the utmost care and caution. The Panel was of the view that there is no indication that an adjournment would secure the Registrant’s attendance at a future date on the basis of the absence of a request for an adjournment from the Registrant, the lack of a response to several attempts to communicate with her, and noting that she has not engaged with the HCPC since the substantive hearing. The Panel took into account the potential disadvantage to the Registrant if it were to proceed. However, taking into account the lack of a response or request for an adjournment from the Registrant, and mindful that this is a mandatory review of a substantive order the Panel was satisfied that it is fair and in the public interest, for today’s review to proceed expeditiously.
5. In all the circumstances, the Panel decided to proceed today.
Background:

6. The Registrant was employed as a Band 5 Radiographer at Royal United Hospitals Bath NHS Foundation Trust (the Trust), between 14 May 2012 and 27 September 2015. Witness CF, Head of Radiology, had originally interviewed the Registrant when she applied for the position of community Radiographer.
7. In about June 2012 CF became aware of issues with her performance whilst the Registrant was working at community hospitals within the Trust. CF spoke to her informally about those issues. On 24 January 2013 a more formal process to support her performance began and CF arranged for her to work at the Royal United Hospitals, alongside colleagues who would supervise her practice. A meeting was arranged on 8 March 2013 under the Trust’s Formal Performance Management Policy.
8. Following the Registrant being absent from work, a phased return to work was arranged in about September 2013. A further phased return to work commenced towards the end of December 2013. In June 2014 a formal Performance Management Process began due to a re- occurrence of the performance issues and formal meetings were held on 25 June and 17 July 2014. The Registrant was moved from the community hospital to work at the Royal United Hospitals under the supervision of other radiographers. A formal review meeting was held on 11 August 2014 where concerns from other radiographers during this period were discussed.
Decision of the Panel:
9. Ms Wills submitted that, in light of the lack of any evidence from the Registrant to address the concerns found, and the lack of evidence of insight before the Panel, the Registrant’s fitness to practice remains impaired. Ms Wills submitted that, a 12 month Suspension Order would be the minimum order necessary, to protect the public and public confidence in the profession.  She submitted that it was unlikely a further suspension will result in the engagement of the Registrant and the Panel should consider imposing a Striking Off Order in light of the Registrant’s limited engagement.  
10. There were no submissions from the Registrant before the Panel.
11. The Panel accepted the advice of the Legal Assessor.
12. The Panel approached this review in two stages. Firstly, whether the Registrant’s fitness to practise is still impaired by reason of misconduct and/or lack of competence. Secondly, if the Registrant’s fitness to practice is impaired, what sanction it should impose.
13. The Panel was aware that its purpose today was to conduct a comprehensive review of the Registrant’s fitness to return to unrestricted practice and considered the HCPTS Practice Note entitled “Review of Article 30 Sanction Orders”.
14. The Panel reminded itself it must exercise its own independent judgement with regard to impairment.
15. In reaching a decision the Panel had regard to the substantive panel’s decision in particular this review Panel would be assisted by the Registrant’s attendance at the review hearing. In addition it is likely that the Registrant would need to demonstrate significant evidence of learning, during the period of her suspension, which encompasses all aspects of radiography practice and is not just limited to the IR(ME)R regulations.
16. There has been no evidence before today’s Panel from the Registrant demonstrating the level of her insight since the substantive hearing in November 2017. Further, there is no evidence or information that she has taken any steps to address her previous failings nor has she maintained her professional skills and knowledge since the substantive hearing. These factors have led the Panel to conclude that there remains a high risk of repetition both in respect of the Registrant’s misconduct and lack of competence.
17. The Panel therefore concluded that the Registrant’s fitness to practise remains impaired.
18. The Panel next went on to consider sanction, and took into account the Indicative Sanctions Policy (ISP). The Panel was mindful that sanction is a matter for its own independent judgment, and that the purpose of a sanction is not to punish the Registrant but to protect the public. Further, any sanction imposed must be proportionate, so that any order that it makes be the least restrictive order necessary to protect the public interest, including public protection. 
19. The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s misconduct and lack of competence which has not been remedied, and the ongoing risk to public protection, it would be inappropriate to take no action. It would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.
20. The Panel then considered a Caution Order. The Panel noted paragraph 28 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.”
21. The Registrant’s misconduct and lack of competence were serious in nature, and furthermore, the Registrant has not demonstrated that she has taken any of the steps required to address the concerns. Therefore, the Panel concluded that a Caution Order would be inappropriate and insufficient to protect the public and meet the public interest.
22. The Panel next considered a Conditions of Practice Order. Para. 33 of the ISP states that
“Conditions will rarely be effective unless the registrant is genuinely committed to resolving the issues they seek to address and can be trusted to make a determined effort to do so. Therefore, conditions of practice are unlikely to be suitable in cases:
where the registrant has failed to engage with the fitness to practise process, lacks insight or denies any wrongdoing…”
23. On the basis of the Registrant’s lack of engagement since the substantive hearing, there is no indication that she would be willing or able to comply with conditions. The Panel therefore decided that conditions would be unworkable and in any event would not be sufficient to protect the public, nor would it be in the public interest.
24. The Panel next considered a Suspension Order.
25. In coming to this decision, the Panel took into account the principle of proportionality, and the impact that such a sanction will have on the Registrant’s right to practise her profession, as well as the likely reputational and financial impact.
26. The Panel was of the view that there is a high risk of repetition and serious failings remain. In light of the Registrant’s non engagement and failure to submit any of the evidence recommended by the Substantive panel, she is either unable or unwilling to resolve her failings.  The Panel noted even though the Registrant attended the Substantive Hearing in 2017, there has been no contact with the HCPC since that time. The underlying issues of non-engagement with this hearing, no evidence of remediation and the ongoing risk of repetition, led the Panel to conclude that Suspension would neither be appropriate nor sufficient to protect the public or would be in the wider public interest.
27. The Panel was aware that, at this stage, a Striking Off Order could only be imposed in respect of the Registrant’s misconduct, and not in relation to her lack of competence as found proved.
28. Taking all of these matters into consideration, the Panel has determined that Striking Off is an appropriate response to ensure the public can be protected, and which will uphold the wider public interest.
29. The Panel therefore decided to impose a Striking Off Order which will come into effect on the expiry of the current Order.

Order

That the Registrar is directed to strike the name of Rowena M N Stone from the Register on the date this order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Ms Rowena N Stone

Date Panel Hearing type Outcomes / Status
27/11/2018 Conduct and Competence Committee Review Hearing Struck off
27/11/2017 Conduct and Competence Committee Final Hearing Suspended
09/11/2017 Conduct and Competence Committee Interim Order Review Interim Suspension