Mr Fabio Pregnolato

Profession: Radiographer

Registration Number: RA74936

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 24/01/2019 End: 17:00 29/01/2019

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

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

During the course of your work at Conquest Hospital as a registered Radiographer:

1.On or around 20 December 2016 you sent a Facebook friend request to Patient A, who was  15 years old at that time, after having performed a dental orthopantomogram on Patient A earlier that day. 

2.The matters set out in paragraph 1 constitute misconduct.

3.By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Matters

Amendment of the Allegation

1.At the outset of the hearing Ms Vignoles applied for the allegation to be amended. She said that this was by way of clarification as the Registrant was in fact employed not by Conquest Hospital, part of the East Sussex NHS Trust (the Trust) but was an agency worker employed by Your World Health agency (the Agency).

2.Ms Sleeman did not oppose the application. The Panel was satisfied that no injustice would arise from such an amendment and therefore agreed to the application.  


Background

3.The Registrant qualified in Italy as a Radiographer in 2014. In late 2015 he came to the UK in order to seek employment. He registered with the Agency and on 16 January 2016 was deployed to work at the Trust.

4.At 9:30am on 20 December 2016 the Registrant conducted an Orthopantomogram dental X-ray (an OPG) of Patient A, who was a female aged 15 at that time. Later that day Patient A became aware of a Facebook friend request, timed at 10:37am. This request appeared to have been sent by Facebook but to have originated from the Registrant. That evening, Patient A reported this to her mother, who the next day, telephoned the Trust to report it.

5.Later that day the Registrant’s line manager, KP and another manager at the Trust CB, met with him to discuss the complaint. Late that day the Registrant made a statement in relation to it.

6.It was not in dispute that the Facebook friend request had been sent to Patient A by the Registrant. The sole factual issue, was whether he did this deliberately.

7.There was before the Panel a bundle of documents prepared by the HCPC, containing witness statements and exhibits. There was also a bundle from the Registrant containing his witness statements and exhibits together with character statements and work references.    
 
Evidence

8.Two witnesses were called on behalf of the HCPC, KP, and Patient A. KP, a registered Radiographer was employed by the Trust as a Modality Manager. She was the Registrant’s Line Manager.

9.On 21 December 2016 KP was appointed by the Trust to investigate the complaint. On that day she first spoke by telephone with Patient A’s mother who sent her a copy of the Facebook friend request email. She then, together with CB, met with the Registrant to discuss the complaint. She made no note of what was said, but later that day the Registrant produced a written account of his version of the events.

10.KP said that the Registrant was visibly shocked and instantly denied the allegation.  He offered his phone for examination but this did not reveal a Facebook friend request sent to Patient A.

11.KP said that she referred the complaint to the Agency as the Registrant’s employers, and was told that they would investigate and report to her. The matter was referred also to the police, to the Local Authority Designated Officer and to the HCPC. She said for that reason she was told by the Safeguarding Officer at the Trust not to investigate it further.

12.She said that some 3 or 4 months previously, there had been a similar complaint about another Radiographer. As a result, information about inappropriate use of Social Media was circulated and was the subject of a briefing at a team meeting attended by the Registrant.

13.KP’s evidence was limited in scope but the Panel found her to be a credible and fair witness.

14.Patient A, who was aged 15 at the time of the incident, gave her evidence clearly and without embellishment. Where she had no recollection, she said so. She said that she was “disgusted” to receive a Facebook friend request from a medical professional by whom she had been treated. The Panel found her to be a credible and reliable witness.

15.The Registrant gave evidence. He appeared personable and assured. He did not deny that the request had been sent, but said that it must have been sent accidently as he had no knowledge of it prior to the complaint. He said that there could have been a ‘mis-click’ on his phone whilst it was in his pocket unlocked, following a “people you know” message sent to his Facebook account.

16.The Registrant agreed that for this to have happened, there would have had to have been a series of coincidences.

17.The Registrant said that he was aware of the previous incident and had discussed it with the Radiographer concerned. He further said that such breaches of confidentiality and of professional boundaries were serious  and would be regarded as such by the public. He said also that he had been made aware of this during his time at university.

18.The various character statements refer to the Registrant as a person of honesty and integrity.

Panel’s Approach

19.In reaching its decisions the Panel considered the limited evidence before it, both oral and documentary, acknowledging that a full investigation had not been undertaken by the Trust or the Agency. It also considered, the submissions of Ms Vignoles and those of Ms Sleeman. It accepted the advice of the Legal Assessor.

Decision on Facts

20.The factual allegation is found proved on the basis of the evidence of KP and Patient A. The Facebook friend request email was sent to Patient A within about an hour of the X-ray examination. It could not be traced on the Registrant’s phone when this was examined by KP and CB. The Registrant was well aware of the previous incident involving a Radiographer colleague, whose phone revealed a Facebook friend request. Had the request to Patient A been sent innocently, the audit trail would have remained on the Registrant’s profile.

21.The Panel therefore concluded that the only conceivable reason for its absence was that it had been deleted by the Registrant. Moreover, an unlikely series of coincidences would have been necessary for the request to have been sent accidently. The Panel found this theory to be implausible. 

Decision on Grounds

22.The Panel then considered whether the facts found proved amounted to misconduct.

23.The Panel found that the Registrant breached professional boundaries and confidentiality in sending the request. In doing so, he was in breach of paragraphs:

HCPC Standards of Conduct Performance and Ethics

1.1You must treat service users…as individuals, respecting their privacy and dignity.
1.7 You must keep your relationship with service users…professional.
2.7 You must use all forms of communication appropriately and responsibly including Social Media…
5.1 You must treat information about service users as confidential.
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

HCPC Standards of Proficiency for Radiographers

3.1[You must] understand the need to maintain high standards of personal and professional conduct.
24.The Registrant was well aware of the serious nature of his actions. The Panel found that they fell below the standard expected of a Radiographer and are sufficiently serious to amount to misconduct.

Decision on Impairment

25.The Panel then considered whether the Registrant’s fitness to practise is currently impaired by reason of his misconduct.

26.The Panel had in mind that the Registrant is regarded as a competent practitioner and that there have been no previous findings against him by this or any other HCPC panel.

27. In his evidence, the Registrant has shown some understanding of the likely effect of his misconduct on Patient A and her family. He referred to his reflection on the importance of maintaining professional boundaries and patient confidentiality.

28.However, since the incident, he has not attended any relevant training courses nor has he engaged in appropriate reading. Indeed, he said that he was aware of the importance of these matters about which he had been informed during his university studies and the team briefing.

29.The Registrant committed this act of misconduct in the knowledge of the previous incident involving a Radiographer and of the guidance concerning misuse of Social Media.

30.Although the Registrant has demonstrated some insight into misconduct of this nature, this is not fully developed. Furthermore, he has not demonstrated full and effective remediation. The Panel therefore cannot be satisfied that misconduct of this nature will not be repeated although the Panel regards the potential of this happening as low. It has concluded, that in regard to the personal component, his fitness to practise is currently impaired.

31.The Panel has also concluded that a finding of current impairment is required in the wider public interest. This is necessary to declare and to uphold proper professional standards. The public would expect a Radiographer to act in accordance with these standards. Public confidence in the profession and in the HCPC as its Regulator would be undermined if a finding of impairment were not made.

Decision on Sanction

32.In reaching its decision on Sanction, the Panel considered all the evidence and information before it, together with the submissions made by Ms Vignoles and those made by Ms Sleeman. It had regard to the HCPC Indicative Sanctions Policy. It accepted the advice of the Legal Assessor. It has exercised the principle of proportionality at all times.

33. The Panel found these to be aggravating factors:

•Patient A was aged 15 at the time.

•Patient A gave no indication that an approach would be welcome.

•The Registrant sent the Facebook friend request despite knowing of the previous incident involving a colleague and the briefing about the misuse of Social Media.

34.The Panel found these to be mitigating factors:

•The Registrant made no further approaches to Patient A.

•This was a one off incident and out of character in a previously unblemished career.

•There has been no repetition in the 2 years since the incident.

•The Registrant has engaged with the HCPC and attended the hearing.

•The Registrant has been open with his employers about the allegation.

•The period of 2 years since the incident has had a financial and professional impact upon the Registrant.

•The Registrant has taken some steps towards remediation.

•The Registrant has developed some degree of insight.

•There has been no criticism of the Registrant’s clinical abilities and he has demonstrated continuing commitment to his profession.

35.The Panel first considered whether to take no action, but the nature of the misconduct, involving a patient aged only 15, was such that this would be inappropriate. Misconduct of this nature requires a sanction. 

36.The Panel then considered mediation but this too would be inappropriate.

37.The Panel next considered a Caution Order and determined that such an order for a period of 1 year would be sufficient to protect the public and to address public interest concerns.

38.The Panel reached this conclusion in the light of its findings that this was an isolated incident, that the Registrant has demonstrated some insight and some degree of remediation. Furthermore the Panel has found that there is a low risk of repetition. The investigation and the hearing itself would doubtless have brought home to him the significance of his misconduct. Such an order will provide the Registrant with a learning experience and the period of 1 year will give him the opportunity for continuing reflection and remediation.

39.The Panel did consider a Conditions of Practice Order, but in the absence of any clinical concerns the Panel determined that no meaningful restrictions could be imposed. In all the circumstances such an order would be neither appropriate nor proportionate. 

Order

The Registrar is directed to impose a Caution Order on Mr Fabio Pregnolato for a period of 1 year from the date this order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Mr Fabio Pregnolato

Date Panel Hearing type Outcomes / Status
24/01/2019 Conduct and Competence Committee Final Hearing Caution