FTP51906 Miss Kelly Meaden

Profession: Radiographer

Registration Number: RA72520

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 28/06/2019 End: 12:30 28/06/2019

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

During the course of your employment as a Radiographer at Portsmouth
Hospitals NHS Trust:

1. On 11 October 2015 you:

a) selected the wrong detector programme for a clavicle scan

b) selected the wrong detector programme for a thumb scan

2. On 9 December 2015, while performing a chest x-ray on a 4-month old child, exposed the patient to a higher level of radiation than necessary.

3. On 25 January 2016, you electronically implanted incorrect anatomical markers on rheumatology images of the patient's hands and feet so that left and right images were transposed.

4. On 19 April 2016, you x-rayed the wrong humerus of a patient

5. On 21 June 2016, you x-rayed the incorrect femur of a patient

6. On 14 July 2016, whilst x-raying a bilateral shoulder, you selected the wrong detector programme

7. On 26 August 2016 you:

a) x-rayed a patient without supervision, which was in contravention of what had been agreed at a formal Capability meeting on 17 August 2016; and

b) selected the incorrect detector for the shoulder x-ray of that patient

8. The incidents at paragraphs 1, 2, 4, 5, 6 and/or 7b resulted in over exposure for the patient and/or repeat imaging

9. The matters set out in paragraphs 1 – 8 constitute lack of competence and/or misconduct.

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

Facts proved: 1,2,3,4,5,6,7a), 7b) and 8.

 

Finding

Preliminary Matters


Proof of Service

1. The Panel was satisfied that Notice of the hearing had been properly served both by post and email in accordance with the Rules at the Registrant’s last known address. The Registrant did not attend, nor was she represented.

Proceeding in the absence of the Registrant

2. Ms Mbah, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence.

3. The Panel was satisfied that notice of this hearing was sent to the Registrant’s registered address by letter dated 29 May 2019. A copy of the notice was also sent to her by email on the same date. The Panel considered that the HCPC had made all reasonable efforts to serve the notice on the Registrant and that she had been provided with the means of knowledge as to when and where this hearing was to take place. She had not applied for an adjournment of this hearing.

4. Having seen copies of email correspondence from the Registrant, the Panel was satisfied that the Registrant was aware of today’s hearing and had voluntarily decided not to attend the hearing, or to seek an adjournment of it. The Panel noted that the Registrant emailed the HCPC on 29 May confirming that she would be unable to attend the hearing as she was abroad for the foreseeable future. She had, however, submitted written representations, including a reflective piece, for the purpose of being considered by the Panel in her absence.

5. The Panel heard and accepted the advice of the Legal Assessor who advised that the Panel’s discretion to proceed in the Registrant’s absence should only be exercised with the utmost care and caution. He referred the Panel to the cases of R v Hayward, Jones & Purvis in the Court of Appeal ([2001] EWCA Crim 168), and GMC v Adeogba and Visvardis [2016] EWCA Civ 162.

6. Having done so, and having considered the submissions made, the Panel decided to proceed in the Registrant’s absence. The Panel was satisfied that there would not be a significant risk of unfairness to the Registrant if it decided to proceed in the Registrant’s absence, and further recognised that there was a public interest in conducting a mandatory review of the Substantive Order currently in place.


Background

7. The Registrant was employed by Portsmouth Hospitals NHS Trust (‘the Trust”) in the Diagnostic Imaging, Radiology Day Care Unit, from   29 June 2015. The Registrant joined the department as a newly qualified Band 5 Radiographer.

8. The Registrant undertook a general rotation around the departments working alongside students and staff attending to patients. The Lead Interventional   Radiographer was allocated as the Registrant’s supervisor and as such assessed the Registrant’s competency at the end of her induction. This induction is routine and is completed before signing off new members of staff as competent to begin night shifts. On 30 September 2015, at the end of the induction period, the Registrant was signed off by her superiors as competent to perform her role as a Band 5 Radiographer.

9. Concerns were raised following a number of DATIX (an electronic incident reporting system for risk management) incidents that had been reported by the Registrant. Following this, a Performance improvement Plan was drafted in order to support the Registrant.

10. The allegations were found proved at the substantive hearing between 2 – 4 July 2018. The Final Hearing Panel concluded that the Registrant’s failings placed patients at unwarranted risk of harm and amounted to conduct falling sufficiently far short of the standard expected of a Radiographer so as to amount to a lack of competence and / or misconduct.

11. That panel found the facts proved in relation to particulars 1, 2, 3, 4, 5, 6, 7a),7b) and 8. Lack of competence was found in relation to 1, 2, 3, 4, 5, 6, 7b) and 8. Misconduct was found in relation to particulars 4, 7a) and 7b).

12. The substantive hearing panel considered that the Registrant’s conduct breached Standards 1 and 6 of the HCPC’s Standards of Conduct, Performance and Ethics (2016) and Standards 2, 4, 14 and 15 of the Standards of Proficiency for Radiographers (2013). The substantive hearing panel noted that, in relation to the matters at paragraph 7, the Registrant acted without supervision in contravention of what had been specifically agreed at a formal capability meeting.

13. The Panel noted that the Registrant had substantially reflected on her practice and had adjusted her methodology of working, but that she still lacked sufficient insight. The Panel did note that the Registrant accepted in her reflections on the incidents that she was in need of further support before she could be a confident, competent professional.

14. However, the Panel considered that the Registrant’s practice had not sufficiently responded to training and support. It concluded that the Registrant had placed patients at unwarranted risk of harm, had brought the profession into disrepute and had breached a fundamental tenet of the profession. It concluded, given the lack of response to training and support, and the Registrant’s limited insight, that there remained a risk of repetition of her misconduct and / or lack of competence.

15. The Panel therefore concluded that her fitness to practise was impaired on the basis of the personal component.

16. The Panel also concluded that, given the identified ongoing risk, the wider public interest demanded a finding of impairment, given that the Registrant had failed vulnerable service users and had failed to uphold proper standards of proficiency.

17. Given the lack of evidence of insight and remediation by the Registrant, it therefore imposed a Suspension Order for a period of 12 months. It considered that this would give the Registrant the opportunity to demonstrate insight and remediation to a future reviewing panel. The Panel gave consideration to a striking off order but concluded that, in the circumstances, such a sanction would be disproportionate.

18. The Panel considered that a reviewing panel might be assisted by the Registrant’s attendance, evidence of training activities, shadowing and / or professional development undertaken and any evidence of reflection / developing insight into her failings.

 

HCPC Submissions

19. Ms Mbah outlined the background of the case in relation to the substantive panel’s findings of fact, the statutory grounds, and its finding of impairment.

20. She drew attention to the Registrant’s recent email dated 29 May 2019, referring to recent CPD she had undertaken and steps she has taken to improve her performance and address her failings.

21. She stated that the Registrant had taken steps to keep her knowledge up to date and had developed some insight into her failings as set out in her reflective statement. She maintained a neutral stance and stated that it was a matter for the Panel to reach its own conclusions as to whether the Registrant’s fitness to practise remains impaired.

22. Having heard from the Registrant, Ms Mbah recognised that the Registrant had developed insight into her failings and that she had taken steps to remediate them. It was therefore a matter for the Panel as to whether her fitness to practise remained impaired.


Registrant’s submissions

23. The Registrant provided a bundle of documents for today’s hearing, including a reflective statement. She stated that since being suspended, she has had time to reflect on her failings and the implications of being suspended. She now lived abroad, but on her return to the UK, she hoped to return to practise radiography.

24. She stated that she had kept up to date with current practice by reading relevant articles even though she has not been working as a Radiographer. She stated that she had undertaken ongoing relevant CPD.

25. She recognised that she had made mistakes for which she recognised the risk her actions presented to patients. She expressed regret for her conduct, and stated that she takes responsibility for her work now. If a similar scenario arose to that which gave rise to these proceedings, she would be more assertive to ensure she received all the information she required in relation to casework duties and knowledge of known or potential risks to service users. She stated that she now understands that her priority should not be about seeing as many patients as possible, but about performing accurate examinations safely and correctly.


Legal advice

26. The Legal Assessor reminded the Panel that its purpose today was to conduct a comprehensive review to determine if the Registrant is fit to return to unrestricted practice. Its role was not to conduct a rehearing of the allegations nor was it to go behind the previous findings. He advised that in carrying out this assessment, the Panel must exercise its own independent judgment.

27. The Legal Assessor advised that the Panel might find the questions formulated in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin) of some assistance, albeit slightly modified for these proceedings:

Does the evidence before the Panel today show that the Registrant’s fitness to practice remains impaired by reason of her misconduct in the sense that she:
a) has in the past acted dishonestly and/liable in the future to act so as to put a service user at unwarranted risk of harm; and/or
b) has in the past acted dishonestly and/liable in the future to bring the social work profession into disrepute; and/or
c) has in the past acted dishonestly and/ liable in the future to breach one of the fundamental tenets of the profession?
d) …...”
28. The Legal Assessor advised the Panel that if it determined that the Registrant’s fitness to practise remained impaired then the Panel must go on to consider what sanction, if any, should be imposed. The Legal Assessor advised the Panel that, if it determined that the Registrant’s fitness to practise remained impaired, any of the options under Article 30 of the 2001 Order could be exercised by the Panel. He also advised the Panel that it should bear in mind the principles of fairness and proportionality and have regard to the Indicative Sanctions Policy document issued by the HCPC. He reminded the Panel that any order that it makes under Article 30 should not be punitive in purpose, and that it should be the least restrictive order that would suffice to protect the public and/or is otherwise in the public interest.

Decision

29. The Panel accepted the advice of the Legal Assessor. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel took into consideration all the documentation before it, the evidence of the Registrant and the submissions of Ms Mbah. In particular it noted that this is both a case of misconduct and lack of competence. The Panel considered that this required the Registrant to demonstrate both developed insight and remediation of her failings for her to be considered suitable for return to unrestricted practice. The panel was mindful that the Registrant’s failings covered basic areas of a Radiographer’s practice in relation to undertaking X ray images of incorrect body parts, using wrong detectors and exposing patients to excessive radiation.

30. The Panel was satisfied that the Registrant had developed insight into her failings. She had expressed regret for her actions and, in her written submissions, she recognised that she had placed patients at unwarranted risk of harm. She had recognised how personal factors had affected her confidence and judgment and that she had, at times, felt overwhelmed. She had stated that she felt passionate about her job, but at times felt lost. However, having sought professional help, she had sought to address these issues as a result of which, she stated that she has gained in maturity and confidence.

31. However, the Panel is mindful of the fact that the Registrant has not been able to work as a Radiographer within a clinical setting as a result of the imposition of the suspension order, and that she has worked in other fields since. The Panel was therefore not satisfied that the Registrant could demonstrate that she had remediated her failings and that she was fit to return to unrestricted practice.

32. The Panel therefore concluded that there remained a risk that her misconduct and / or lack of competence could be repeated. In such circumstances, the public could be put at unwarranted risk of harm. In those circumstances, public confidence in the profession and in the regulatory process would be undermined if the Registrant were able to practise without restriction

33. In the light of all of the above, the Panel determined that the Registrant’s fitness to practise remains impaired.

34. The Panel then went on to consider what the appropriate and proportionate sanction should be, starting with the least restrictive. It bore in mind that the purpose of a sanction was not punitive, although a sanction may have that effect.

35. The Panel also bore in mind that its over-arching objective is:

a) to protect, promote and maintain the health, safety and wellbeing of the public;
b) to promote and maintain public confidence in the social work profession; and
c) to promote and maintain proper professional standards and conduct for members of the profession.
36. It had regard to the Indicative Sanctions Policy issued by the HCPC and considered the available sanctions in order of severity, starting with the least restrictive. The Panel concluded that taking no further action or imposing a caution order would not be sufficient to protect the public, nor would either be in the public interest. Neither outcome restricted the Registrant’s practice and would therefore not adequately protect the public or safeguard the public interest.

37. The Panel considered whether to impose a Conditions of Practice Order. Such an outcome would enable the Registrant to return to practice, albeit under supervision. The Panel was satisfied that the Registrant was genuinely committed to addressing her failings and could be trusted to abide by any conditions imposed. The Panel considered that imposing conditions on her registration would adequately meet the need to protect the public and address any public interest concerns. Despite the seriousness of the misconduct / lack of competence found proved, in all the circumstances, conditions of practice could now be formulated that would be appropriate, workable and verifiable and which could effectively address the concerns raised in this case.

38. The Panel considered extending the current Suspension Order but determined that this would be disproportionate given the suitability of imposing a conditions of practice order, which would enable the Registrant to return to practice, albeit subject to conditions.

39. The Panel considered that a subsequent reviewing panel would be assisted by the Registrant’s attendance in person; up to date and relevant testimonials from paid or unpaid work and a report from your workplace supervisor addressing the extent to which you have met the objectives of your personal development place and your level of competence as a Radiographer.

Order

ORDER: The Registrar is directed to annotate the Radiographer part of the HCPC Register to show that, for a period of 18 months from the date that this Order takes effect (“the Operative Date”) you, Kelly Meaden, must comply with the following conditions of practice:

1. You must place yourself and remain under the direct supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within 14 days of the Operative Date or the date of commencing employment as a Radiographer, whichever is the later. You must attend upon that supervisor as required and follow their advice and recommendations.

2. You must work with your workplace supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice: selection of appropriate detector panel; using correct exposure factors to avoid excessive radiation; correct legend / radiographic markers for identification on images.

3. Within three months of commencing employment as a Radiographer, you must forward a copy of your Personal Development Plan to the HCPC.

4. You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

5. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

6. You must promptly inform the HCPC if you take up any engagement as a Radiographer and if you cease to be engaged with any future employer.

7. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer or other person who has engaged you as a Radiographer.

8. You must inform the following parties that your registration is subject to these interim conditions of practice:

A. any organisation or person employing or contracting with you to undertake professional work as a Radiographer;

B. any agency you are registered with or apply to be registered with (at the time of application) to work as a Radiographer.

Notes

No notes available

Hearing History

History of Hearings for FTP51906 Miss Kelly Meaden

Date Panel Hearing type Outcomes / Status
28/06/2019 Conduct and Competence Committee Review Hearing Conditions of Practice
02/07/2018 Conduct and Competence Committee Final Hearing Suspended