Mrs Jane Onoh

Profession: Radiographer

Registration Number: RA73867

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 22/01/2019 End: 17:00 23/01/2019

Location: Park Inn by Radisson Aberdeen, 1 Justice Mill Lane, Aberdeen, AB11 6EQ

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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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 Monday’s 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 SI, 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 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 Panel has considered sequentially:

a. whether the factual particulars are proved;

b. if the proved facts amount to lack of competence, and if so;

c. is the Registrant’s fitness to practise currently impaired?

4. The Panel accepted the advice of the Legal Assessor that the burden of proof is upon the HCPC on the balance of probabilities, in relation to findings of fact. Whether any proved facts in this case amount to the statutory ground of lack of competence and the issue of current impairment are not matters which need to be proved, but are matters of judgement for the Panel.

5. The Panel heard oral evidence from the following HCPC witnesses:

• MA who the Panel found to be honest, helpful, credible, consistent and fair. She was corroborated by the evidence of LS, reflected upon her observations of the Registrant over a period of eight days and recorded the observations made by her on the last day she supervised the Registrant.

• LS who the Panel found credible and independent. She reflected on her observations of the Registrant made on one day.

The Panel had no concerns in relation to the reliability of either witness for the HCPC.

6. The Panel also heard oral evidence from the Registrant. 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).


Half-Time Submissions

7. The Registrant made a Half-Time Submission at the conclusion of the HCPC’s case in respect of Particular 2, which states that she: “Placed patients at risk of exposure to unnecessary levels of radiation as a result of ineffective coning/collimation”. The Registrant submitted that, taking the HCPC’s case at its highest, sufficient evidence had not been adduced upon which a panel properly directed, could find this factual particular proved. The Panel took into account the HCPTS Practice Note entitled “Half–time Submissions”. In applying the “Galbraith Test” (see R v Galbraith [1981] 2 A11 ER 1039) the Panel considered the following in respect of Particular 2:

i. Has the HCPC presented any evidence upon which the Panel could find Particular 2 proved? If not, then the answer is straightforward. There is no case to answer.

ii. Is the evidence so unsatisfactory in nature that the Panel could not find Particular 2 proved? Where the HCPC has presented some relevant evidence, then the Panel should ask itself whether the evidence is tenuous, inherently weak or inconsistent with other evidence. 

8. The Panel finds that Particular 2 is not consistent with the oral evidence of MA. MA stated in her evidence that due to the level of supervision of the Registrant at Fraserburgh Hospital between July and August 2017, patients were never actually placed at risk of exposure to unnecessary levels of radiation by the Registrant, as a result of ineffective coning / collimation. Accordingly, the Panel finds there is no case to answer in respect of Particular 2.


Decision on Facts

Particular 1(a) to (d)

9. The Registrant admitted Particulars 1(a) to (d) inclusive. These admissions were taken into account but the Panel also found these particulars were each proved based upon the evidence of MA and LS and the documentary evidence which corroborated the concerns and supported the witness statements evidencing the Registrant’s failings identified in Particulars 1(a) to (d). The Panel found the factual Particulars 1(a) to (d) inclusive were proved to the requisite standard which is the balance of probabilities.


Decision on Grounds

10. 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.

11. 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.

12. The Panel found the Registrant to have failed to meet the following HCPC Standards of Proficiency for Radiographers.

• Standard 13 – understand the key concepts of the knowledge base relevant to their profession.

• Standard 14.1 – be able to draw on appropriate knowledge and skills to inform practice

• Standard 14.18 – be able to use physical, graphical, verbal and electronic methods to collect and analyse information from a range of sources including service user’s clinical history diagnostic images and reports, pathological tests and results, dose recording and treatment verification systems.

• Standard 14.24 – be able to position and immobilise service users correctly for safe and accurate diagnostic imaging examinations or radiotherapy treatments.

13. A lack of competence connotes a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of work. The standard to be applied is that applicable to the position occupied by the Registrant and the work she was carrying out. 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.


Decision on Impairment

14. The Panel considered the Practice Note on “Finding that Fitness to Practice is Impaired”. In determining whether fitness to practise is impaired, Panels must take account of a range of issues which, in essence, comprise two components:

• The ‘personal’ component: the current competence, behaviour etc. of the individual registrant; and

• The ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

15. The HCPC submits that the Registrant’s fitness to practise is impaired on public and personal grounds. When asked to reflect on her practice, the Registrant said she was feeling more confident but her reflective practice did not reflect the difficulty she was having with positioning. MA stated that the first two years of practice straight after qualifying is always a huge learning curve for newly qualified Radiographers - with the opportunity to grasp and fine tune basic radiography skills. The HCPC submits the Registrant requires additional training to get her skills up to date and to practice independently as a qualified Radiographer. Without further training there is a risk of repetition of the errors observed by MA and LS.

16. The test of impairment is expressed in the present tense that fitness to practise is impaired at the current date. The Panel has taken into account the lapse of time since these matters occurred and has looked at the Registrant’s past actions in order to assess her likely future performance.

17. 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. 

18. 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”.

19. 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.


Decision on Sanction 

20. The Panel considered the submissions made by the Registrant and Mr Foxsmith and accepted the advice of the Legal Assessor. The Panel is aware that the purpose of any sanction is not to be punitive, though it may have a punitive effect. The Panel’s primary function at this stage is to protect the public, while deciding what, if any, sanction is proportionate, taking into account the wider public interest and the interests of the Registrant. The Panel has taken into account the HCPC “Indicative Sanctions Policy” and applied it to this case.

21. The Panel identified the following mitigating factors:

• The Registrant has recognised the need for supervision of her work and had voluntarily undertaken supervised work and had shown improvements over an eight day period.

• She is willing to undertake further training and has also spent time carrying out CPD and private study;

• The Registrant has engaged in the regulatory process; and

• She has demonstrated insight and admitted the proved facts.

22. The Panel finds due to the nature and extent of the current impairment taking no further action or mediation is not appropriate.

23. A Caution Order would be insufficient to mark the significance of the Panel’s findings. It would offer no restriction on the Registrant’s practice and would therefore be insufficient to protect the public and uphold the wider public interest. There is a continuing risk of repetition and the Registrant’s failings were not isolated incidents.

24. The Panel concluded that it would be possible to formulate workable and practicable conditions of practice that would adequately address the risk and the public policy issues identified and also be proportionate to the proved facts giving rise to the finding of a lack of competence.

25. 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.

26. In the judgement of the Panel, a Suspension Order would be disproportionate and unduly punitive in the circumstances. Accordingly the Panel determined that a Conditions of Practice Order was the necessary and proportionate order.

27. This Order will be reviewed before it expires the reviewing panel is likely to be assisted by a written reflective piece on how the Registrant’s practice has developed during her period of supervision.

Order

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).

Notes

The Panel makes an Interim Conditions of Practice Order under Article 31(2) of the Health and Social Work 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) the final determination of that appeal, subject to a maximum period of 18 months.

1. The Panel accepted the advice of the Legal Assessor to consider whether an interim order was necessary under Article 31, to protect the public or in the public interest or the Registrant’s own interest because of the nature of the findings made in this case. The HCPC submitted that an interim order is necessary. The Panel is satisfied that it is appropriate to direct that the Registrant’s registration should be subject to conditions of practice on an interim basis, in the same terms as the substantive order set out above. This order is required for the protection of the public, is in the public interest and is in the Registrant’s own interest. The Panel concluded that the appropriate length of the Interim Conditions of Practice Order is 18 months, as an interim order would continue to be required pending the resolution of an appeal, in the event of the Registrant giving notice of an appeal within 28 days.

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