Mr Muhammad Siddiq

Preliminary Matters:

Service of Notice

1. The Panel found that there had been good service of the Notice of Hearing by a letter dated 8 October 2019 which informed the Registrant of the date, time and venue of the hearing.

Proceeding in the Absence of the Registrant

2. Mr Bridges made an application for the hearing to proceed in the absence of the Registrant. He referred the Panel to an e-mail chain between the Registrant and an HCPC case manager. On 18 October 2019 the Registrant sent an e-mail stating “Yes I can confirm that this correct email address…” providing his name and date of birth. The HCPC Case Manager replied to this e-mail on the same day and advised that the bundle for the hearing had been sent in the post.

3. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.

4. The Registrant confirmed his e-mail address and the Panel was satisfied that he is aware of today’s hearing. His engagement with the HCPC has been minimal and he has not requested an adjournment. In the circumstances, the Panel considered that he had voluntarily absented himself. The Panel did not consider that there was a prospect that the Registrant might attend a hearing at a later date. There were two HCPC witnesses present and ready to give evidence to the Panel. Although the Registrant might be prejudiced if the hearing were to proceed in his absence, the Panel decided that his interests were outweighed by the public interest, including the need for the expeditious disposal of the Allegation.

Amendment of the Allegation

5. Mr Bridges made an application to amend the Allegation. He referred the Panel to a letter dated 29 August 2019, which informed the Registrant that the HCPC would be making an application to amend the Allegation and set out the details of the proposed amendments.

6. The Panel accepted the advice of the Legal Assessor and considered whether the proposed amendments prejudiced the Registrant.

7. The Panel decided that it was appropriate to make the amendments to the Allegation proposed by Mr Bridges. The amendments were minor and they did not increase the seriousness of the Allegation. They clarify the Allegation and better reflect the evidence relied on by the HCPC. The Panel did not consider that the proposed amendments prejudiced the Registrant.

Background:

8. The Registrant was employed by Kettering General Hospital (“the Hospital”) as a Radiographer from 2 October 2017 to 21 November 2018. On 19 December 2018, the HCPC received a referral from the Head of Radiology at the Hospital, raising concerns regarding the Registrant’s practice in relation to two CT scans that he had performed.

9. The first incident involved a CT scan taken by the Registrant on 31 July 2018. It is alleged that the Registrant made an identification error and carried out a CT head scan for Patient A when a CT scan had not been requested for this patient. The Registrant reported this matter promptly to his immediate line manager ZS, a Superintendent Radiographer.

10. Due to this incident and other instances involving failures by Radiographers to comply with IR(ME)R Employers Procedures in an eighteen month period the Hospital introduced a new Standard Operating Procedure which strictly outlined the steps the Radiographer was required to take before and following a scan. A letter was subsequently issued to all CT Radiographic staff including the Registrant setting out the checks that were required and advising that failure to adhere to the procedures “may lead to disciplinary action and a report being made to the HCPC”.

11. The second incident involved a scan taken by the Registrant on Patient B on 7 October 2018. It is alleged that the Registrant made an error and conducted a scan of Patient B’s head when he should have scanned the pelvis. This incident came to the attention of GW, a Superintendent Radiographer when she was advised that the Registrant had made a request to Colleague A to move a CT head scan from Patient B’s patient image record folder into another patient image record folder in the Registrant’s own name. GW carried out an investigation and identified that Colleague B had reported on the CT head scan that had been moved into the Registrant’s patient image folder.

12. GW spoke to the Registrant on 15 October 2018 about the incident and asked him why he had requested Colleague A to move the scans of Patient B into the Registrant’s own patient image record folder. The Registrant is reported to have said that ‘he had been having visual disturbances and headaches so he decided to scan himself.’ He claimed that the CT head scan images moved were of his own CT scan.

13. GW challenged the Registrant about the truth of his account that he had scanned himself. When challenged, the Registrant gave an account that he had panicked when he realised that he had made the error in undertaking the incorrect scan of Patient A, because of the departmental letter stating that any more mistakes would result in disciplinary action. He had therefore asked Colleague A to move the CT head scan of Patient B into the Registrant’s own patient image record folder.

14. GW carried out an investigation into the incident and interviewed witnesses. During the course of an investigation meeting on 8 November 2018, the Registrant said that he had contacted Colleague B on 9 October 2018 and asked him to report on the image of the CT head scan in the Registrant’s patient image record folder.

Decision on Facts:

15. The Panel carefully read the HCPC bundle of exhibits. The Registrant did not provide any documents or written submissions. The HCPC exhibits included the Hospital’s investigation report which included notes of meetings with the Registrant, Colleagues A and B and a letter of admission and apology from the Registrant sent to the Hospital.

16. The Panel heard from two HCPC witnesses, GW and ZS. Both witnesses had a good relationship with the Registrant and did their best to assist the Panel.

17. The Panel found that GW was a credible, consistent, and fair witness. She was willing to admit when she did not know something and did not display any bias against the Registrant.

18. ZS was nervous at the start of her evidence, but the Panel found that her evidence was consistent and credible.

19. The Panel admitted and gave weight to hearsay evidence relied on by the HCPC where that evidence was consistent with the other evidence and the Registrant’s admissions.

Particular 1(a)

20. The Panel found Particular 1(a) proved by the evidence of ZS and the documentary evidence. ZS prepared her investigation report into the incident on 31 July 2018 based on information provided to her by the Registrant. ZS identified that one of the root causes of the mistake as to the identity of Patient A was that the Registrant did not carry out a three point identification check.

Particular 1(b)

21. The Panel found Particular 1(b) proved by the evidence of ZS and the documentary evidence, particularly ZS’s investigation report. A CT scan was performed on Patient A erroneously because of the Registrant’s identification error.

Particular 2(a)

22. The Panel found Particular 2 (a) proved by the evidence of GW and the documentary evidence. On 15 October 2018 and in the investigation meeting with GW on 8 November 2018, the Registrant admitted to GW that he had incorrectly performed a scan on Patient B’s head.

Particular 2(b)

23. The Panel found Particular 2(b) proved by the evidence of GW and the documentary evidence. On 15 October 2018 and in the investigation meeting on 8 November 2018, the Registrant told GW that he requested colleague A to move a CT scan of Patient B’s head in to his own personal file.

Particular 3

24. The Panel found Particular 3 proved by the evidence of GW and the documentary evidence. In the investigation meeting on 8 November 2018 the Registrant told GW that he asked Colleague B to report on the image “on Tuesday”. The Registrant knew that the brain on the scan would look older than his age, and he told Colleague B that the date of birth on the request form was wrong. This Particular is also proved by the hearsay evidence of Colleague B which is consistent with the Registrant’s admission to GW.

Particular 4

25. In considering Particular 2 the Panel accepted the advice of the Legal Assessor. Applying the guidance from the Supreme Court decision in Ivey v Genting Casinos it first considered the Registrant’s state of mind. Having considered the Registrant’s understanding and beliefs, it applied an objective test, and considered whether the Registrant’s conduct was honest or dishonest by the standards of ordinary decent people.

26. The Panel considered the Registrant’s state of mind. When he realised that he had made an error the Registrant panicked, but he knew that he was taking steps to cover up his error. He was a competent and experienced Radiographer and he knew that it was wrong to ask Colleague A to move Patient B’s scan and to ask Colleague B to report on the scan. There were many occasions on which the Registrant had the opportunity to be candid about his error, but he persisted in his actions. He made repeated requests to Colleague A, and his request to Colleague B was not made until 9 October 2018, two days after the scan.

27. There is no explanation for the Registrant’s actions other than that it was a deliberate attempt to cover up and conceal the error he had made.

28. The Panel decided that the Registrant’s conduct in Particulars 2(b) and 3 was dishonest applying the standards of ordinary reasonable people.

Decision on statutory grounds:

29. The question of whether the facts constitute misconduct is for the judgment of the Panel and there is no burden or standard of proof.

30. There is no statutory definition of misconduct, but the Panel had regard to the guidance of Lord Clyde in Roylance v GMC (No 2) 1 AC 311: “Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a practitioner in the particular circumstances…” The conduct must be serious in that it falls well below the standards.

31. The Panel considered the HCPC Standards of Conduct Performance and Ethics (2016) and the Standards of Proficiency for Radiographers (2015) The Panel considered that the Registrant’s conduct was a breach of the Standards of Conduct Performance and Ethics, standards 1, 6, 8, and 9 and a breach of the Standards of Proficiency for Radiographers paragraphs 2, 4, 10 and 15.

32. The Registrant was an experienced and competent Radiographer. GW and ZC had no concerns about his level of skill, knowledge, the quality of his work, or his professionalism, other than in relation to the HCPC Allegation.

33. The Registrant’s conduct in Particulars 1(a), 1(b) and 2(a) had an impact on the patients concerned. Patient A received an unintended radiation dose equivalent to approximately nine months of background radiation in the UK. The risk of cancer for this dose for Patient A was 1 in 200,000. Patient B also received an unintended radiation dose equivalent to approximately nine months of background radiation in the UK. For Patient B the risk of cancer is approximately 1 in 44,000.

34. The Registrant’s dishonest actions had an impact on the team, particularly Colleagues A and B, who trusted the Registrant to give them accurate information.

35. The Panel considered the culpability of the Registrant in relation to the errors in Particulars 1(a), 1(b), and 2(a). The Panel recognised that on 31 July 2018 the Hospital’s revised procedure and warning letter was not yet in place and that there had been errors by other Radiographers. Nevertheless, in the Panel’s judgment it is fundamental for any Radiographer to carry out an identification check for each patient prior to performing a scan. The Registrant’s error was not carrying out such a check at all. In the Panel’s judgment the Registrant’s conduct in Particulars 1(a) and 1(b) fell well below the standards for a Radiographer and was sufficiently serious to constitute misconduct.

36. At the time of the second error the Registrant had been alerted to the importance of carrying out a “pause and check” by his error in July 2018 and by the Hospital’s warning letter. If the Registrant had paused and checked, he would have identified that the order was for a CT scan of Patient B’s pelvis. In the Panel’s judgment, the Registrant’s conduct in Particular 2(a) fell well below the standards for a Radiographer and was sufficiently serious to constitute misconduct.

37. The Registrant’s action in requesting Colleague A to move a CT scan of Patient B’s head into his own folder was a dishonest attempt to cover up his own wrongdoing. The Registrant was persistent in his requests over a period of time. The Registrant’s actions were the opposite of the requirement placed on all radiographers to be open when things go wrong.

38. The Registrant’s dishonest action in telling Colleague B that he was experiencing headaches and asking him to write a report on the brain scan of Patient B was another attempt by the Registrant to conceal or cover up his wrong doing. If there had been no report on the scan, it would have been flagged and investigated. Furthermore, the Registrant’s deception drew in two other colleagues.

39. The Registrant’s dishonest actions in Particulars 2(b) and 3 were not simply a spur of the moment response to his mistakes. They involved a degree of planning to cover up his actions and the Registrant continued to lie until he was directly challenged in an interview with GW on 15 October 2018.

40. The Registrant’s conduct in Particulars 2(b), 3, and 4, considered both individually and cumulatively, fell well below the standard required for a Radiographer and was sufficiently serious to constitute misconduct.

Decision on Impairment:

40.  The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note “Finding that Fitness to Practice is Impaired”. The Panel considered the Registrant’s fitness to practise at today’s date.

41.  The Panel first considered the personal component which is the Registrant’s current behaviour.

42. The Registrant has not attended the hearing and his engagement with the HCPC has been limited. There was limited information available to the Panel to assess his level of insight.

43. The Registrant’s admission of dishonesty was made only after he was directly challenged by GW on 15 October 2018. The Registrant persisted in his account until GW paused and told the Registrant directly that she did not think he was telling her the truth.

44. In his letter of admission and apology the Registrant expresses his remorse. He refers to “feeling so shameful” and describes not being able to face his colleagues and the impact on himself. In his interview with GS he described his behaviour as “wrong”. In his statement for appeal he emphasised his apology “to everyone”.

45. In the Panel’s judgment, the Registrant recognised his wrongdoing, but he did not address the impact of his behaviour on patients or colleagues, or the potential risk of harm to patients. The Panel noted the absence of any evidence that the Registrant has reflected on his past actions in respect of his departure from professional standards or the impact on public confidence in himself or the profession. In the Panel’s judgment, the Registrant’s lack of engagement in the process and the very limited insight shown by him is insufficient to reassure the Panel that there will be no repetition of the misconduct.

46. The Panel was of the view that the dishonesty in this case, involving a deliberate attempt by the Registrant to conceal his own error, is difficult to remedy. There is no evidence before the Panel that the Registrant has taken any remedial steps.

47. The Panel identified a risk of repetition of:

• errors involving patient care putting patients at risk of harm;

• dishonest conduct in a professional context;

• breach of a fundamental tenet of the profession.

48. In the Panel’s view all four limbs of the test for fitness to practise proposed by Dame Janet Smith in the fifth Shipman report and recommended by Cox J in CHRE v Grant [2011] EWHC 927 were met:

• the Registrant has in the past acted and is liable in the future to act so as to put patients at unwarranted risk of harm;

• the Registrant has in the past and is liable in the future to bring the profession into disrepute;

• the Registrant has in the past breached and is liable in the future to breach one of the fundamental tenets of the profession;

• the Registrant has in the past acted dishonesty and is liable to act dishonestly in the future.

48. The Panel therefore concluded that the Registrant’s fitness to practise is impaired on the basis of the personal component.

49. The Panel next considered the wider public interest considerations including the need to uphold standards of conduct and behaviour and to maintain confidence in the profession and the regulatory process.

50. The Registrant’s dishonest conduct was in the course of his professional duties and involved a breach of trust. It was a serious departure from the required standards of conduct and behaviour. The Panel considered that it was necessary to mark the regulator’s disapproval of such a serious breach and send a clear message to the profession and to the public that the Registrant’s dishonest conduct was entirely unacceptable. Members of the public are entitled to expect that Registrants act with honesty and integrity.

51. A finding of current impairment is also necessary to maintain confidence in the profession and the regulatory process given the seriousness of the Registrant’s misconduct and the ongoing risk of repetition

52. The Panel therefore concluded that the Registrant’s fitness to practise is impaired on the basis of the personal component and the public component. 

Decision on Sanction:

53. In considering which, if any, sanction to impose the Panel had regard to the HCPC Sanctions Policy (SP) and the advice of the Legal Assessor.

54. The Panel reminded itself that the purpose of imposing a sanction is not to punish the practitioner, but to protect the public and the wider public interest. The Panel ensured that it acted proportionately, and in particular it sought to balance the interests of the public with those of the Registrant, and imposed the sanction which was the least restrictive in the circumstances commensurate with its duty of protection.

55. The Panel decided that the aggravating features were:

• the Registrant’s minimal engagement with the HCPC process;

• the Registrant’s limited insight;

• the absence of any evidence of remediation or reflection;

• the potential for harm to patients;

• a breach of trust;

• the risk of repetition.

56. The Panel decided that the mitigating features were:

• the absence of any previous regulatory matters;

• the Registrant’s admissions in relation to Particulars 1(a) and 1(b) at the time of the events;

• the Registrant’s admission and apology at the stage of the Hospital investigation for Particulars 2 and 3;

• the positive evidence from the HCPC witnesses regarding the Registrant’s character and professionalism.

57. The Panel considered the guidance in the SP on dishonesty at paragraphs 56-58. The guidance at paragraph 58 states: “Given the seriousness of dishonesty, cases are likely to result in more serious sanctions. However, panels should bear in mind that there are different forms and different degrees of dishonesty that need to be considered in an appropriately nuanced way”. The Panel considered that the relevant factors were:

• dishonesty in the workplace;

• colleagues were drawn in;

• the Registrant tampered with records in an attempt to cover up his own misconduct;

• the dishonesty was a single act which took place over a period of approximately eight days;

• the aggravating features listed above.

58. In the Panel’s view the dishonesty was towards the higher end of the spectrum of seriousness.

59. The Panel considered the option of taking no action, but decided that this was an insufficient response given that the misconduct included dishonesty and the potential for harm to patients.

60. The Panel next considered a Caution Order. The Panel did not consider that the guidance in the SP for Caution Orders applied. The conduct was not minor and there was a risk of repetition. A Caution Order would also not be sufficient to address the wider public interest considerations because of the gravity of the misconduct.

61. The Panel next considered a Conditions of Practice Order. The Panel considered that conditions could not be formulated to address the Registrant’s dishonesty. There is no evidence of a sufficient level of insight which would be reuired for the Panel to consider the imposition of a Conditions of Practice Order. Further, the Registrant has not engaged with the HCPC and conditions would not be workable or realistic. A Conditions of Practice Order would also be insufficient to mark the gravity of the Registrant’s misconduct.

62. The Panel next considered the option of a Suspension Order. A Suspension Order would guard against the risk of repetition of dishonesty in professional practice while the Registrant was suspended. However, Suspension Orders may be appropriate where there is a prospect that the Registrant can be rehabilitated to the Register as a safe practitioner. In this case there was nothing to indicate that the Registrant is motivated to take steps to reduce the risk of repetition to an acceptable level.

63. The Panel also considered whether a Suspension Order was a sufficiently severe sanction to act as a deterrent effect to other Registrants and to maintain public confidence in the profession and the regulatory process. The dishonesty in this case was in the course of the Registrant’s professional work and involved an attempt by the Registrant to involve other colleagues in covering up his own wrongdoing.

64. The Panel noted that in Parkinson v NMC [2010] EWHC 1898 Mitting J stated that a nurse “who has acted dishonestly, who does not appear before the Panel either personally or by solicitors or counsel to demonstrate remorse, a realisation that the conduct criticised was dishonest, and an undertaking that there will be no repetition, effectively forfeits the small chance of persuading the Panel to adopt a lenient or merciful outcome and to suspend for a period rather than to direct erasure”. This case has been followed by further case law which emphasises that the Panel has a discretion in respect of sanction and the need to consider and assess the seriousness of the dishonesty including the factors listed in the SP.

65. Before it discounted the option of a Suspension Order the Panel carefully evaluated the mitigating circumstance it had identified. The Panel’s view was that if the Registrant had attended the hearing or engaged with the HCPC, the Panel might have been persuaded to give weight to the mitigating factors and give the Registrant an opportunity to demonstrate in the future that trust could safely be placed in him. Given the very limited engagement by the Registrant, the Panel considered that the mitigating factors carried little weight, when considered in the context of the seriousness of the Registrant’s dishonesty.

66. In the Panel’s view the factors that would indicate that a Suspension Order was appropriate were not present. The Registrant has not demonstrated insight, there is not evidence that he has reflected on his past misconduct, there is no evidence that he is willing or able to remedy his failings, and there is a risk of repetition.

67. The Panel considered the more restrictive sanction of a Striking Off Order and noted that the criteria in the SP for a Striking Off Order applied; in particular this case involved serious dishonesty and a breach of trust. The Registrant has not engaged at all with the HCPC and has not attended the hearing to give reassurances to the Panel that the dishonesty will not be repeated. In these circumstances the Panel decided that a Striking Off Order was appropriate and proportionate. A Striking Off Order would mark the seriousness of the Registrant’s misconduct, act as a deterrent to other Registrants, and maintain the reputation of the profession.

68. In reaching its decision the Panel took into account the Registrant’s financial and reputational interests, but decided that they were outweighed by the need to protect the public and by the wider public interest considerations. The Panel decided that the appropriate and proportionate Order was a Striking Off Order.

Order: The Registrar is directed to strike the name of Mr Mohammed Siddiq from the Register from the date this Order takes effect.

Interim Order:

1. Mr Bridges submitted that the Panel should hear his application for an Interim Suspension Order in the absence of the Registrant.

2. The Panel accepted the advice of the Legal Assessor.

3. The Panel decided that it was fair and appropriate to proceed and hear the application in the absence of the Registrant. The Registrant was advised in the Notice of Hearing dated 8 October 2019 that an application for an Interim Order might be made. There was nothing to indicate that the Registrant wished to make submissions in relation to this application, and it was in the public interest to proceed.

4. Mr Bridges made an application for an Interim Suspension Order for the maximum period of 18 months to cover the 28 day appeal period and the time that might be required to conclude any appeal.

5. The Panel accepted the advice of the Legal Assessor.

6. The Panel decided that an Interim Order is necessary for the protection of the public because there is an ongoing risk of harm to patients and an ongoing risk of repetition of dishonesty. An Interim Order was also otherwise in the public interest to maintain confidence in the profession and the regulatory process. Informed members of the public would not expect the Registrant to be free to practise without restriction when the Panel have found that he was dishonest in the course of his professional work and there is a risk of repetition.

7. The Panel decided that it was not possible to formulate workable, realistic conditions of practice to address the risks it has identified. The Panel therefore decided to impose an Interim Suspension Order for the maximum period of eighteen months.

8. The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) upon the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Mr Muhammad Siddiq