Mrs Jane Onoh

Profession: Radiographer

Registration Number: RA73867

Interim Order: Imposed on 23 Jan 2019

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 15/04/2019 End: 17:00 15/04/2019

Location: Jurys Inn Aberdeen, Union Square, Guild Street, Aberdeen, AB11 5RG

Panel: Conduct and Competence Committee
Outcome: Hearing has not yet been held

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Allegation

Whilst Registered as a Radiographer and while volunteering in the X-Ray department at Fraserburgh Hospital between July and August 2017, you:

1. Did not consistently demonstrate the clinical skills and / or expertise of a registered Radiographer in respect of:

a. appropriate positioning of a patient for a radiograph;

b. correct orientation of the radiographic cassette;

c. the need to appropriately position equipment, including the bucky and x-ray tube; and

d. the use of the light beam diaphragm.

2. Placed patients at risk of exposure to unnecessary levels of radiation as a result of ineffective coning / collimation.

3. The matters set out at paragraphs 1 and 2 constitute lack of competence.

4. By reason of your lack of competence your fitness to practice is impaired.

Finding

Background

1. The Registrant is registered in the Radiographer part of the HCPC Register. Since her arrival in the UK, she has not worked as a Radiographer. She volunteered to work at the Community Radiology Department of the Fraserburgh Hospital from July to August 2017, working on Mondays only. MA informally supervised the Registrant during this period. The Registrant was working voluntarily in order to complete ‘return to work’ sessions to assist her to obtain a full-time role as a newly-qualified Radiographer. Shortly after the Registrant had started working at the Fraserburgh Hospital, MA noted that she was unable to conduct basic examinations which a qualified Radiographer would be expected to conduct. MA had to largely teach the Registrant basic radiography skills. After seeing no improvement in the Registrant’s practise, on 21 August 2017, MA documented her observations and the errors that the Registrant had made. MA later raised her concerns about the Registrant’s practice with a manager, who subsequently referred the matter to the HCPC.

2. LS, a Senior Radiographer, had also worked with the Registrant at the Fraserburgh Hospital on one occasion. LS produced a statement detailing her observations, and similar concerns to those MA had expressed. Both Radiographers observed that the Registrant lacked basic radiography skills with regards to patient positioning and the appropriate use of equipment. These were not isolated incidents and the errors were repeated, despite advice being given on the correct procedures.

3. The Registrant gave evidence at the Final Hearing and the Panel stated:

“The Registrant gave evidence which was honest about her abilities, she recognised where she had made mistakes. She was credible, although understandably nervous. The Panel had no concerns in relation to the reliability of her evidence and she demonstrated insight and a willingness to remediate her failings as identified in factual Particulars 1(a) to (d).”

4. Following a half-time submission the original Panel found no case to answer in respect of Particular 2. The Registrant had admitted Particulars 1(a) to (d) inclusive and the Panel found them proved.

5. The original Panel found the statutory ground of Lack of Competence to be well founded and stated:

“The observations of the Registrant made by MA and LS were not just of isolated errors. The Registrant demonstrated the same lack of knowledge throughout her work with MA and repeatedly made the same mistakes, despite being corrected and guided through the process. In some instances she would make the same mistake, immediately following the correction. For example, on the same patient she managed to get the position of the oblique foot image correct on the right foot but then proceeded to get it wrong on the left foot. As a qualified Radiographer she was expected to know the basics of imaging which she did not appear to know. The Registrant stated that she had not been trained on computed radiography equipment prior to her voluntary work at Fraserburgh Hospital. She is aware of her failings as regards to practical radiography skills, including patient positioning, coning / collimation and orientation of radiographic cassettes. She accepts she is in need of a return to practice course and / or practical placement and some retraining in diagnostic radiography. She has engaged in private study, research and online courses. However since this matter was referred to the HCPC in September 2017, she has been unable to obtain employment as a Radiographer, with a supervisor monitoring her work.”

“The Panel is satisfied that Particulars 1(a) to (d) inclusive, demonstrate a serious falling short by the Registrant of the standards of proficiency to be expected of a newly qualified Band 5 Radiographer, giving rise to a lack of competence. The Registrant was making basic errors repeatedly which should not have been made by a newly qualified Band 5 Radiographer. The Panel concludes that in August 2017, based on the proved facts, the Registrant was not competent to work as a Band 5 Radiographer to the required standard.”

6. When finding current impairment, the original Panel stated:

“There is a need to uphold the HCPC “Standards of Proficiency for Radiographers” by finding that there is current impairment in this case and public confidence in the profession would be undermined if a finding of impairment was not made. The Registrant stated that she had not been trained on computed radiography equipment, prior to her voluntary work at Fraserburgh Hospital. She accepts there were failings as regards to her practical radiography skills, including patient positioning, coning / collimation and orientation of radiographic cassettes. She also accepts she is in need of a return to practice course including some retraining in diagnostic radiography.

The Registrant has not been working as a radiographer since August 2017 and she has taken some steps to remediate her impairment. She has engaged in private study, research and online courses and has insight as to the extent to which her lack of knowledge impacted upon her work. She states in her written submissions to the Panel that she would like to have an opportunity to retrain: “…because I know I still have a lot to offer”. However there is a risk of repetition by reason of the Registrant’s current lack of competence and the public would lose confidence in the profession and the regulatory process, if a finding of current impairment was not made in this case. It is also necessary to do so to uphold the HCPC “Standards of Proficiency”. Accordingly the Panel finds the Registrant’s fitness to practise is impaired under the personal and the public components. The additional CPD and YouTube training undertaken by the Registrant, whilst helpful, has not adequately addressed the gaps in her knowledge and is insufficient to enable the Panel to conclude that there is no longer a current impairment. The Registrant has demonstrated insight and the Panel is satisfied that her impairment is capable of being remedied. There is a risk of repetition until she has completed successfully the necessary further training. Public confidence in the profession and the Regulator would be undermined by a finding that she is not impaired.”

7. In reaching its decision on sanction the original Panel said:

“The Panel has identified that the Registrant’s failures are capable of being remedied and is satisfied that allowing the Registrant to remain in practice, albeit subject to conditions will protect the public and is in the Registrant’s own interests. Furthermore, given the proactive way in which the Registrant has engaged with the HCPC, the Panel is confident that she will comply with conditions which focus upon her further supervision. Such conditions will also enable a future reviewing panel to determine whether the necessary further supervised practice has been successfully completed.”

8. The Conditions imposed were as follows:

The Registrar is directed to annotate the Register to show that, for 6 months from the date that this Order comes into effect (“the Operative Date”), you, Mrs Jane Onoh, must comply with the following conditions of practice:

1. Undertake a period of supervised practice, either voluntary or paid, under the supervision of an experienced Radiographer for a period of no less than 3 months.

2. A written review of the period of supervision completed by the supervising Radiographer is to be provided to the HCPC by you 14 days prior to the review of this Order. (This review by the supervising Radiographer is to be the same type of review as is carried out with a newly qualified Radiographer at the end of a probationary period to confirm that the newly qualified Radiographer is competent to work unsupervised).

3. 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 to be registered with (at the time of the application); and

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

9. The original panel imposed an Interim Conditions of Practice Order in the same terms for a period of 18 months.

Decision

10. This case was listed for an early review of the Order at the request of the HCPC because it was considered necessary to seek clarification from a Panel of the Conduct and Competence Committee on the intended practical operation of the current conditions of the Order imposed upon the Registrant’s registration.

11. The task for today’s Panel is to review what, if any, progress the Registrant has been able to make to address the impairment found by the last Panel and to comply with the conditions imposed and also to consider whether, if the Registrant is still found to be impaired, the current Order in its current form is appropriate and workable.

12. The Panel considered, with care, the parties submissions, together with the documentation provided. The Panel accepted the advice of the Legal Assessor and in reaching its decisions referred to the HCPTS Practice Note on ‘Finding Fitness to Practise is Impaired’. The Panel carried out a comprehensive review of the current order in light of the circumstances as they exist today.

13. The Panel first considered the issue of current impairment. The Panel took account of the principle set out in Abrahaem v GMC [2008] EWHC 183 (Admin) that there is, in practical terms, a persuasive burden at a review hearing for the Registrant to demonstrate that he or she has “fully acknowledged why past performance was deficient and through insight, application, education, supervision or other achievement sufficiently addressed the past impairments.”

14. Ms Whitby, on behalf of the HCPC, detailed the background to the case and stated that the early review had been requested by the HCPC because the Council wished for clarity about how the conditions were intended to operate. For example, Condition 1 did not make it clear that the supervised practice should be completed first, before the Registrant returned to unsupervised practice. Furthermore, it did not make it clear what precisely was meant by “supervised practice”, nor did it make it clear that Conditions 1 and 2 only came into effect once she had obtained either a voluntary or paid role as a Radiographer. Ms Whitby added that it may be thought the length of the Order needed to be longer in order to provide the Registrant with sufficient time to obtain either a paid or voluntary post which allowed for a three month period of supervised practice.

15. The Registrant submitted to the Panel that she had been unable to obtain a voluntary role since the Final Hearing. In written submissions, she said she had applied to four different hospitals but all had either turned her down or not responded. The answer was always the same, they could not provide the one-on-one supervision for the three months that she required. She told the Panel that she had been engaging in private studies, reading textbooks and research articles on radiographic technique and radiation protection. She had also been watching relevant YouTube demonstration videos.

16. The Panel was encouraged by the Registrant’s continued engagement and attendance at the review. It gave her credit for the attempts she had made to obtain a supervised role and the private study she had completed. However, there was, as yet, very little evidence of remediation.

17. Having carried out a comprehensive review of the current Order, the Panel determined that the Registrant’s fitness to practise remained impaired on both public protection and public interest grounds for the same reasons as detailed by the original Panel. She had not yet been able to undertake a period of supervised practice as required by Condition 1 and thus was not yet able to demonstrate that she is safe to return to unrestricted practice.

18. Having decided the Registrant was still impaired, the Panel was satisfied that a Conditions of Practice Order continued to be the appropriate and proportionate sanction in this case. A lesser sanction would not provide the necessary degree of protection for the public in light of the risks identified.  A more severe sanction would be disproportionate given the remedial nature of the failings and the Registrant’s commitment to remedy them.

19. The Panel decided that the appropriate course was to vary and extend the current Order for a period of 12 months from the expiry of the current Order. This would allow the Registrant sufficient time to comply with the Conditions and by varying them the Panel’s intention was to provide clarity about what exactly was required of the Registrant. The Panel noted the difficulties the Registrant had been facing in trying to obtain a period of supervised practice under the current conditions. It hoped that the variations now made would make it possible for her to undertake the necessary supervised practice in order to be able to satisfy a review Panel, in due course, that she could work to the requisite standard of a registered Radiographer.

20. In the event that the Registrant has been able to comply with the Conditions and satisfactorily completed the supervised practice before the expiry of the Order, it would be open to her to apply for an early review of this Order.

Order

ORDER: The Registrar is directed to vary and extend the current Conditions of Practice Order from the date it is due to expire, for a period of 12 months, in accordance with Article 30(2) of the HCPC Order 2001.
You, Mrs Jane Onoh, must comply with the following conditions of practice:

1. You must place yourself and remain under the supervision of a Radiographer registered by the HCPC and supply details of your supervisor to the HCPC within seven days of obtaining any role, whether voluntary or paid, as a radiographer. You must attend upon that supervisor as required and follow their advice and recommendations.

2. Before undertaking any unsupervised practice as a Radiographer you must:

a) satisfactorily complete a period of supervised practice of no less than 60 working days under the supervision of the person referred to in Condition 1; and

b) forward a written review by the
supervising Radiographer covering the period of supervision to the HCPC 14 days prior to the review of this Order. (This review by the supervising Radiographer is to be the same type of review as is carried out with a newly qualified Radiographer at the end of a probationary period to confirm that the newly qualified Radiographer is competent to work unsupervised).

3. Thereafter, you must continue to meet with your Supervisor on a fortnightly basis to monitor and review your practice. Such meetings should be recorded by your Supervisor and a copy of those records made available, by you, to the HCPC 14 days prior to the review of this Order.

4. 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 to be registered with (at the time of your application); and

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

Notes

Right of Appeal

You may appeal to the Court of Session against the Panel’s decision and the Order it has made against you.

Under Article 29(10) of the Health and Social Work Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s Order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

European Alert Mechanism

In accordance with Regulation 67 of the European Union (Recognition of Professional Qualifications) Regulations 2015, the HCPC will inform the competent authorities in all other EEA States that your right to practise has been restricted.

You may appeal to the County Court against the HCPC’s decision to do so. Any appeal must be made within 28 days of the date when this notice is served on you. This right of appeal is separate from your right to appeal against the decision and order of the Panel.

Hearing History

History of Hearings for Mrs Jane Onoh

Date Panel Hearing type Outcomes / Status
15/04/2019 Conduct and Competence Committee Review Hearing Hearing has not yet been held
22/01/2019 Conduct and Competence Committee Final Hearing Conditions of Practice