Mr Maclane Mudenda

Profession: Radiographer

Registration Number: RA54317

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 04/03/2019 End: 17:00 05/03/2019

Location: 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

Whilst registered as a Radiographer and working as a Locum Sonographer for InHealth Limited between 16 December 2015 and 27 June 2016:

1. In relation to Patient A:

a) you sent a blank report to the referrer when the clinical findings were urgent; and

b) you did not mark the report as urgent. and/or failed to recommend a specialist referral.

2. In relation to Patient C:

a) you did not respect the patient’s dignity, in that you left the door open whilst she was undressing;

b) you did not identify that the thickened endometrial lining was abnormal;

c) you did not identify that the left ovarian cyst appeared septated; and

d) in light of not identifying the pathology in (a) – (c) you did not appropriately escalate the patient, in that you did not recommend an urgent specialist pathway referral.

3. In relation to Patient D:

a) you did not measure and/or record the degree of proximal retraction; and

b) you inaccurately identified and/or recorded that there was a full rupture of the SS tendon.

4. In relation to Patient E:

a) you incorrectly recorded the measurements of the tear observed in on the images in your report;

b) you inaccurately identified and/or recorded that there was a full rupture of the SS tendon; and

c) you failed to make a specialist referral.

5. In relation to Patient G, you inaccurately described the abnormality observed in the images;

6. In relation to Patient H:

a) you did not include the maximum AP diameter measurement of the focal thickening in your report; and

b) you did not suggest an indication of Tendinopathy.

7. In relation to Patient M:

a) you described findings of full thickness tears, but did not include this in your report conclusion; and

b) you did not refer the patient to a specialist.

8. In relation to Patient N:

a) you did not accurately record in your report the reason(s) for the poor quality of the images taken; and

b) you did not recommend in your report that a re-scan was required.

9. In relation to Patient O, you did not appropriately escalate the patient in light of your clinical findings, in that you did not refer the patient to a specialist;

10. In relation to Patient P:

a) you did not perform and/or record a scan of the patient’s urinary bladder;

b) you did not follow a request from the GP to perform an abdominal and pelvic scan;

c) you described the urinary bladder wall as appearing normal in your report, contradicting your recommendation for a rescan of the patient;

11. On or after 14 March 2016, you did not:

a) conduct an adequate examination of Patient Q’s pelvis; and/or

b) produce image(s) of Patient Q’s pelvis which were of an adequate standard and/or quality.

12. In relation to Patient S, you did not advise the GP to undertake a specialist referral for further tests and/or imaging with regards to the abnormal pancreas identified;

13. In relation to Patient T:

a) you did not accurately measure the ovarian cyst on the images;

b) you did not identify and/or record the cyst as being a ‘complex’ cyst; and

c) you did not appropriately escalate the patient, in that you did not recommend and/or arrange a follow-up scan.

14. Your actions described at particulars 1 to 13 constitute misconduct and/or lack of competence;

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

Finding

Background

1. The Registrant is a registered Radiographer who first obtained HCPC registration in December 2006.

2. He was employed as a Locum Sonographer by InHealth Limited between 16 December 2015 and 27 June 2016. InHealth Limited provided healthcare services to the NHS and the private sector. He worked at various sites in London, including the Braintree Community Hospital. Part of his role included conducting both general and musculoskeletal specific scanning.

3. InHealth Limited conducted routine monthly audits of work carried out by its Sonographers and Radiographers. A portion of the Registrant’s work was audited in February 2016 as part of this routine process. A number of discrepancies in the Registrant’s work were identified. As a result of this, other audits were conducted, which revealed further discrepancies. The employer’s concerns included discrepancies in characterisations of abnormalities and a failure to suggest referrals for further investigations in the manner specified by the employer.

4. As a result of these concerns, the Registrant’s manager made a referral to the HCPC on 19 October 2016.

5. On 27 October 2017, a panel of the Investigating Committee determined that there was a case to answer in respect of allegations brought against the Registrant.

6. The HCPC then instructed an expert to review the patient records and to give his opinion on the issues identified in the allegation with reference to the standards to be expected of a reasonably competent Radiographer at the time. The expert concluded that there was sufficient evidence to support the majority of the allegations that had been brought, but not all. As a result of this the allegation has been amended accordingly.

7. On 21 November 2018 the Registrant’s Representative enquired whether the HCPC would in principle be willing to explore disposal of the case by consent. He confirmed on 5 December 2018 that the Registrant admitted the allegations and impairment.

8. The Registrant provided a response to the allegations in a document dated 30 December 2018 in which he accepted the allegations and outlined the remedial steps he had taken and intends to take moving forwards.

9. The Registrant provided a reference dated 10 December 2018 from the Diagnostic Clinical Lead at Care UK, his current employer, who confirmed that the Registrant commenced working for them in January 2017. They stated that they had conducted regular audits on all clinical staff, but that these had not raised any clinical issues of concern relating to the Registrant.

10. The Registrant also provided a letter dated 10 December 2018 from his agency confirming that there have been no clinical concerns relating to him since the matters relating to this case.

11. The Registrant provided a number of positive testimonials from Sonographers who have worked with him in the recent past.

12. On 4 February 2019 the HCPC wrote to the Registrant’s Representative to confirm that disposal of consent by way of a Conditions of Practice Order had been approved by the Director of Fitness to Practice. The proposed Conditions, designed to be in place for a period of 12 months, are as follows:

1. If you work as a Sonographer, you must place yourself and remain under the supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within 7 days of commencing work.

2. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

3. You must promptly inform the HCPC of any capability or disciplinary proceedings taken against you by your employer.

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 application); and

c. any prospective employer (at the time of your application).

5. You must formulate a Personal Development Plan, which is signed off by your workplace supervisor, designed to address the deficiencies in the following areas of your clinical practice:

(i) demonstrating knowledge and practise in obtaining good quality images;
(ii) competent report writing and analysis of image results;
(iii) good communication of report results and/or findings to referrers, including GPs.

6. Within three months of the Operative Date, you must forward a copy of your Personal Development Plan to the HCPC.

7. You must meet with your supervisor on a monthly basis to:
a. Consider your progress towards achieving the aims set out in your Personal Development Plan;
b. Show to your supervisor a reasonable sample of images which you have taken for the purposes of addressing the quality of these images

8. Within 6 months of the Operative Date, you must complete training to address the deficiencies outlined in particular 5 of this Order.

9. At least 28 days before this Order is reviewed, you must provide evidence to the HCPC of any training completed during the course of this Order. 

10. Reflecting on the allegations, you must write a reflective piece demonstrating your understanding of the impact of your actions on others e.g. patients, colleagues etc., and how you have improved your practise whilst this Order has been in effect. You must provide your reflective piece to the HCPC within 28 days prior to the date when this Order is reviewed.

13.  The Registrant signed the Consent Order on 8 February 2019.

Submissions

14. Ms Senior submitted that this is a case which is suitable for disposal by consent. The Registrant had admitted the allegations, and had accepted that his practice did not meet the required standards and was willing to put matters right by undertaking further learning and development. She submitted that the reflection on the part of the Registrant, together with the steps identified and undertaken by him to move forward, provided evidence of insight into the allegations. She submitted that there was clear evidence of remedial steps which had been undertaken by the Registrant in response to the concerns. For example, as a result of the allegations the Registrant now reviews all images prior to finishing an examination, to ensure that all the essential images have been included before the patient leaves the room. She submitted that the HCPC has taken into account the lack of further clinical concerns relating to the Registrant’s work. She submitted that conditions of practise are the proportionate sanction in light of the fact that the Registrant remains employed as a locum sonographer and has continued to practise without concern.

15. Ms Senior submitted that in relation to the public interest the allegations are not so serious as to warrant a contested hearing and that the competency concerns can be suitably addressed through conditions designed specifically to support and address the deficiencies in the Registrant’s practice, as identified by the expert witness.

16. Ms Senior submitted that the proposed period of 12 months was a proportionate length to protect the public and to allow the Registrant an opportunity to rectify his failings. She reminded the Panel that before the order expires a review hearing will take place to assess whether the Registrant has remedied his failures and is now fit to practise, and this would provide an added safeguard.

17. The Registrant confirmed that he agreed with the proposed consent order. He informed the Panel that he had already booked onto a number of relevant training courses with the aim of complying with the terms of the order.

Decision

18. The Panel carefully considered all of the information and evidence within the hearing bundle, including the Allegation, the bundle of evidence for a contested hearing, the Registrant’s written representations, and the Order itself. The Panel took into account the guidance contained within the HCPTS Practise Note entitled ‘Disposal of Cases by Consent’ and accepted the advice of the Legal Assessor. The Panel understood that it could conclude the case on an expedited basis, based on the terms of the draft Consent Order. Alternatively the Panel could reject the proposal and set the case down for a full substantive hearing.

19. The Panel agreed that it was appropriate to deal with the matter by approving the proposal set out in the draft Consent Order. The Panel understood that the Registrant accepted the facts of the allegation. The Panel was satisfied that the Registrant had demonstrated an appropriate level of insight by recognising the relatively serious nature of the Allegation and that a Conditions of Practise Order was the appropriate and proportionate sanction in the circumstances. The Panel was satisfied that the appropriate level of public protection would be secured by the draft Order, and that to resolve the case in this way would not be detrimental to the wider public interest. In so concluding the Panel took into account the references that had been submitted on behalf of the Registrant. In particular the employer confirmed that the Registrant had been subject to regular audits which had raised no concerns. The Panel was encouraged to hear that the Registrant has already booked himself onto a number of training courses so that he would be in a position to comply with the order. In addition, he already has a workplace supervisor in place. The Panel was satisfied that the Draft Conditions adequately address the concerns identified by the case. The Panel was satisfied that an order for a period of 12 months provides the necessary degree of public protection and is the proportionate length of time.

20. Accordingly the Panel considers that this case is suitable for disposal by way of consent in the way suggested and approves the proposed order.

Order

That the Registrar be directed to annotate the Register to show that for a period of 12 months from the date that this Order comes into effect you, Maclane Mudenda, must comply with the following conditions of practice:

1. If you work as a Sonographer, you must place yourself and remain under the supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within 7 days of commencing work.

2. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

3. You must promptly inform the HCPC of any capability or disciplinary proceedings taken against you by your employer.

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 application); and

c. any prospective employer (at the time of your application).

5. You must formulate a Personal Development Plan, which is signed off by your workplace supervisor, designed to address the deficiencies in the following areas of your clinical practice:

(iv)  demonstrating knowledge and practise in obtaining good quality images;

(v) competent report writing and analysis of image results;

(vi)  good communication of report results and/or findings to referrers, including GPs.

6. Within three months of the Operative Date, you must forward a copy of your Personal Development Plan to the HCPC.

7. You must meet with your supervisor on a monthly basis to:

a. Consider your progress towards achieving the aims set out in your Personal Development Plan;

b. Show to your supervisor a reasonable sample of images which you have taken for the purposes of addressing the quality of these images

8. Within 6 months of the Operative Date, you must complete training to address the deficiencies outlined in particular 5 of this Order.

9. At least 28 days before this Order is reviewed, you must provide evidence to the HCPC of any training completed during the course of this Order.

10. Reflecting on the allegations, you must write a reflective piece demonstrating your understanding of the impact of your actions on others e.g. patients, colleagues etc., and how you have improved your practise whilst this Order has been in effect. You must provide your reflective piece to the HCPC within 28 days prior to the date when this Order is reviewed.

 

Notes

The order imposed today will apply with immediate effect. This order will be reviewed again before its expiry on 04 March 2020.

Hearing History

History of Hearings for Mr Maclane Mudenda

Date Panel Hearing type Outcomes / Status
04/03/2019 Conduct and Competence Committee Final Hearing Conditions of Practice