Mr Ajeesh George

Profession: Radiographer

Registration Number: RA73105

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 02/12/2020 End: 17:00 02/12/2020

Location: Virtual hearing - Video conference

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

The following Allegation was considered by a Panel of the Conduct and Competence Committee at a Substantive Hearing on 3 – 6 December 2018.

Whilst registered as a Radiographer and employed by ABM University Health Board, you:

1. Between 14 December 2015 and 13 October 2016:

a) did not display appropriate knowledge of radiation protection in that you:

i. Did not check the pregnancy status of female patients of child- bearing age that were referred for x-rays of the abdominal area on the following dates:

a. 5 February 2016;

b. 9 February 2016;

c. 10 February 2016;

d. 20 June 2016;

e. 29 June 2016;

f. 29 July 2016.

ii. Did not consistently demonstrate adequate centering and/or positioning of the detector, including on the following occasions:

a. On 20 May 2016, you positioned the detector too high for a chest x-ray;

b. On 23 May 2016, you did not move the detector appropriately for an angled-up clavicle x-ray;

c. On 27 June 2016, you centred the detector too low for a knee x-ray;

d. On 28 June 2016, you centred the detector too low for a knee x-ray;

e. On 29 June 2016, you centred the detector too low for an abdomen x-ray;

f. On 21 July 2016, you centred the detector too distally for an elbow x-ray;

g. On 15 August 2016, you did not centre to the bucky for a pelvis x-ray.

b) displayed a limited knowledge of radiographic technique in that you:

i. Did not adequately and/or correctly adapt the exposure parameters depending on the patient and/or area being x- rayed, including on the following occasions:

a. On 30 March 2016, you increased the mAs from 16 to 100 to account for the use of a grid on a pelvic x-ray;

b. On 1 April 2016, you did not adapt the exposure settings for an x-ray of a pelvis on a trolley;

c. On 17 May 2016, you did not increase the exposure for a larger patient;

d. On 23 May 2016, for an x-ray of a 1 year old, you selected an exposure setting that was suitable for an adult;

e. On 25 May 2016, you did not increase the exposure for a patient with large arms;

f. On 27 June 2016, you selected the setting for the pelvis instead of hip only for a patient that had been referred for an x-ray of their right hip;

g. On 11 July 2016, you conducted an incorrect Antero- Posterior (AP) x-ray for a tibula and fibula in that:

i. the exposure was too high;

ii. when conducting the lateral view x-ray you did not notice that the sensitivity value was not in range and/or was over exposed;

h. On 14 July 2016 when conducting a hand x-ray:

i) you did not set the right exposure for the x-ray in that it was too low;

ii) when conducting the lateral view x-ray you did not increase the exposure to the correct value;

i.  On 1 August 2016, for an x-ray of a child’s tibula/fibula, you set a high exposure;

j. On 3 August 2016, when conducting a c-spine x-ray;

i) did not use the correct exposure;

ii) did not notice that the resultant image demonstrated features of over-exposure

ii. Did not adequately adapt the Film-Focal Distance depending on the area being x-rayed, including on the following occasions:

a. On 26 May 2016, you did not adapt the distance for an x- ray of a tibula/fibula to enable the whole are to be included in one film;

b. On 25 July 2016, you used too great a distance when taking a lateral view x-ray of a hip;

iii) Did not recognise and/or adapt to the limitations of the patient being x-rayed, including on the following occasions:

a. On 12 May 2016, you continued to position a patient for c- spine, chest and shoulder x-rays despite the patient feeling faint and/or looking like they were about to collapse;

b. On 12 May 2016, you continued to position a patient for a knee x-ray despite the patient looking like they were about to collapse;

c. On 23 May 2016, you physically and/or forcefully lifted the chin of a patient that potentially had a fracture of the cervical spine;

d. On 24 May 2016, you started to sit a patient up into an erect position when they potentially had a neck of femur fracture;

e. On 24 May 2016, you physically and/or forcefully lifted the chin of a patient that potentially had a fracture of the cervical spine;

f. On 27 May 2016, you attempted to raise the arms of a patient with a pacemaker despite the patient explaining he was not allowed to raise his arms;

g. On 9 June 2016, while attempting to x-ray the humerus of a post-operative patient, you did not recognise that the patient was struggling to remain standing;

h. On 3 August 2016, you tried to move an unsteady, elderly patient onto the bed instead of leaving him in his chair for an x-ray of his foot.

c) required clinical supervision at all times in that you:

i. Did not consistently position and/or x-ray the correct area, including on the following occasions:

a. On 3 May 2016, you positioned the wrong knee for exposure;

b. On 24 May 2016, you x-rayed the whole hand of a patient who had been referred for an x-ray of their little finger;

c. On 9 June 2016, you x-rayed the hand but missed the little finger of a patient who had been referred for an x-ray of their little finger;

d. On 22 June 2016, you x-rayed the right knee of a patient who had been referred for an x-ray of their left knee and marked the image of the right knee as the left knee.

ii. Did not demonstrate good infection control practice in that:

a. On 3 May 2016, you did not consistently wash your hands and/or the equipment between patients;

b. On 18 July 2016, you did not change your gloves before touching the patient and/or equipment.

iii. Did not consistently demonstrate effective communication including on the following occasions:

a. On 3 May 2016 you gave little or no instructions to patients when positioning them for their x-rays;

b. On 26 May 2016, you uncovered a patient’s legs without giving any prior warning to the patient;

c. On 10 June 2016, you physically touched and/or moved a patient that had been referred for a chest x-ray without giving any prior warning to the patient;

d. On 2 August 2016, you palpated a post-operative patient on their affected side without giving any prior warning or explanation.

2. The matters set out at particulars 1 a) – c) constitute misconduct and/or lack of competence.

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

The panel found all the particulars of the Allegation proved with the exception of 1(b)(i)(g)(i), 1(b)(i)(g)(ii) and 1(c) (iii) (d), the grounds of lack of competence were established and fitness to practice was found impaired.

Finding

Preliminary Matters

Service and Proceeding in Absence

1. The Panel has seen the Notice of today’s hearing dated 04 November 2020 which the HCPC sent by email to the Registrant at his registered email address. The Notice of Hearing made clear that this hearing would take place today as a virtual hearing. The Notice informed the Registrant of the time and date of this hearing. The Notice also invited the Registrant to make submissions and to provide any new information as to what may have happened since the last hearing.

2. Having heard Ms Lykourgou on behalf of the HCPC and having heard and accepted the advice of the Legal Assessor, the Panel was satisfied that good service of the Notice of Hearing has taken place.

3. The Panel considered whether to proceed in the Registrant’s virtual absence and in the absence of any representation from him. It is aware that the discretion to proceed in absence is one which should be exercised with the utmost care and caution. The Panel took account of the HCPTS Practice Note entitled “Proceeding in the Absence  of  the  Registrant”. It heard the submissions by Ms Lykourgou on behalf of the HCPC. It heard and accepted the advice of the Legal Assessor.

4. The Panel determined to proceed in the absence of the Registrant. Its reasons are as follows:

· It is satisfied that there has been good service of the Notice of this Hearing.
· The Registrant has not applied for an adjournment.
· The Registrant did not attend and was not represented at the substantive hearing in December 2018 or at the review hearing on 03 December 2019.
· The Registrant has not engaged with the HCPC as regards this hearing.
· This is a mandatory review and it is in the interests of the Registrant and the public interest that it should proceed.
· In all the circumstances, it is proper to conclude that the Registrant has voluntarily decided not to engage with these proceedings.

Background

5. The Registrant was employed by Abertawe Bro Morgannwg University Health Board (“the Board”) as a Band 5 Radiographer at the Princess of Wales Hospital from 17 December 2015. Upon commencement of his employment, as was routine, he was monitored and supervised to allow the Board to be satisfied that he was competent to practise autonomously. Concerns were raised about the Registrant’s knowledge of radiation protection and radiographic technique by his colleagues from early 2016. Monitoring and extensive support was provided by the Board to the Registrant to facilitate him becoming an autonomous practitioner. Notwithstanding this support, the Registrant was only able to work under supervision. There being no evidence of improvement in the Registrant’s capability despite the support provided to him, the Board commenced capability processes in respect of the Registrant in accordance with its policy. A formal capability meeting took place on 7 July 2016.

6. The Board informed the HCPC of its concerns about the Registrant following the formal capability hearing on 7 July 2016.

7. A second capability meeting took place on 11 August 2016. It was established that the Registrant continued to fail to meet the objectives set for him and he was therefore granted a further 4 week period to meet the required standard of performance. During this period, his work was observed and recorded, with both the Registrant and the supervising radiographer signing off the records of observations and interventions.

8. The Registrant’s performance was reviewed on 14 September 2016 and it was determined that he still had not achieved the standard of performance expected by the Board, and that significant concerns about his practise remained. He was informed that his employment with the Board would be terminated by reason of his capability.

9. Following a hearing of the Conduct and Competence Committee between 3 - 6 December 2018, which was not attended by the Registrant or a representative acting on his behalf, a number of particulars alleged were held to be well-founded as set out above, and the Registrant’s fitness to practise was assessed as being impaired by reason of his lack of competence. A Suspension Order was imposed by the Panel for a period of 12 months.

10. The Panel was provided with a bundle of documents by the HCPC for the review hearing. The Registrant had not supplied any documentation or representations to the Panel.
Review Hearing on 03 December 2019.

11. The Registrant was not present or represented at the review hearing on 03 December 2019.

12. The panel determined that the Registrant’s fitness remained impaired. It stated its reasons in the following terms:
The Panel concluded that there was insufficient evidence that the risks identified by the substantive panel considering this matter have decreased. The Registrant had submitted no information to the Panel as to his insight into the serious, sustained and widespread failings identified in his practice. He also had provided no information which demonstrated that he had remediated the failings, or expressed remorse for his actions. Accordingly, the Panel found that the Registrant’s fitness to practice remains impaired.

13. Having concluded that the Registrant’s fitness to practise remained impaired it considered which sanction to impose and determined to extend the Suspension Order for a further 12 months. It stated its reasons in the following terms:
Having conducted an assessment of impairment, the Panel went on to consider what, if any, Order was appropriate in the circumstances to manage the risks to the public identified in this matter. It was satisfied that an Order was still necessary and proportionate with regard to the protection of the public and in the wider public interest – a member of the public aware of the circumstances of the failings would be concerned if no Order were made. The Panel determined it would not be appropriate to impose no Order or issue a Caution given the seriousness and extent of the deficiencies found. The Registrant was no longer employed by the Board and therefore mediation was also not an appropriate Order to make. Given the lack of evidence of employment in the profession, and the absence of any evidence of remediation of the failings identified, the Panel did not believe that an adequate level of public protection could be achieved through the imposition of a Conditions of Practice Order – given the breadth of concerns to be addressed, even if conditions could be drafted they would in all likelihood be tantamount to a suspension order. The Panel also concluded that a Conditions of Practice Order would be insufficient to address the issue of trust and confidence in the profession and the requirement to uphold the integrity of the regulatory process. Further, the Registrant had not demonstrated any willingness to engage in the regulatory process and therefore a Conditions of Practice Order would be wholly inappropriate in the circumstances.

The Panel was not able to consider a Striking Off Order as the impairment was by reason of lack of competence and the Registrant has not been continuously suspended, or subject to a conditions of practice order, for a period of two years. The Panel was conscious that an Order of Suspension would have a punitive impact upon the Registrant, however it was satisfied that the interests of the Registrant were outweighed by its duty to give priority to the public interest and maintain confidence in the regulator. The Panel was satisfied that no lesser sanction would be appropriate in the particular circumstances of this case.

Having determined that an Order was required, and that the most appropriate Order would be that of Suspension, the Panel then considered the length of time for which the Order should be imposed. Given the serious, sustained and widespread failings identified, and the fact that the Registrant has not demonstrated to his regulator any desire or commitment to return to the profession, the Panel concluded that the Order of Suspension should be imposed for a period of 12 months.

14. The panel indicated what might assist a reviewing panel and said as follows:

The Panel considered that a reviewing panel may be assisted by the Registrant:

• engaging with the regulatory process;
• providing evidence such as a reflective piece showing remorse, insight and remediation;
• detailing how he has addressed the key issues the Panel identified, for example through relevant work, paid or unpaid, and supplying details of any relevant training and professional development;

Today’s Review Hearing

15. Ms Lykourgou on behalf of the HCPC submitted that the Registrant’s fitness to practise was still impaired by reason of his lack of competence and that the only sufficient and appropriate Order to make  was a continuation of the Suspension Order for a short period when a Striking Off Order would become available. In support of these submissions she said:

• That the Registrant had not recently engaged with the HCPC with regard to this hearing or the previous two hearings.
• The Registrant had not produced any evidence to show he had addressed or remediated his lack of competence. In these circumstances there was nothing to undermine the decisions of the previous panels that the Registrant’s fitness to practise was impaired. In these circumstances the Registrant posed a continuing risk to service users. Furthermore, the confidence of the public, in the profession of Radiography and in the HCPC as its regulator, would be undermined if a finding of impairment was not made.  
• That the only appropriate order for the Panel to make was to confirm and extend the Suspension Order. In support of this submission she said that appropriate conditions of practice could not be formulated as there was no information as to the Registrant’s present circumstances. She also said that as the Registrant had not engaged with the HCPC as regards the fitness to practise proceedings, it was unlikely that he would comply with any Conditions that might be imposed.  She reminded the Panel that a Striking-Off Order was not presently available.  

16. The Panel has not received any submissions or representations made by or on behalf of the Registrant.

17. The Panel heard and accepted the advice of the Legal Assessor

18. The Panel is aware that it has all the powers that are set out in Article 30 [1] of the Health Professions Order 2001 [The Order] and which  are set out in the email sent to the Registrant giving notice of this hearing.

19. This Panel is aware that the process under Article 30 [1] of the Order is one of review and not one of appeal and that its function is to determine whether the Registrant’s fitness to practise remains impaired and if so whether the Suspension Order under review remains appropriate and proportionate or should be varied or replaced by some other order.

Panel’s Decision

Impairment

20. Having taking account of the submissions made by Ms Lykourgou, the Panel has concluded that the Registrant’s fitness to practise remains impaired. Its reasons are essentially the same as those given by the previous panels. The Registrants clinical failings were numerous, wide ranging, fundamental in character and occurred over an extended period. They continued despite the fact that the Registrant was given very considerable support, including one to one supervision.  The Registrant did not attend and was not represented at any of the previous hearings. There is no evidence that he has done anything to address or remediate his clinical failings.  The Panel has seen nothing to undermine the conclusion that by reason of the Registrant’s lack of competence, his fitness to practise remains impaired. The Panel considers that the Registrant continues to pose a serious risk to service users.   Moreover, the Panel also concludes that public confidence in the profession and in the HCPC as its regulator, would be gravely undermined if the Panel was to determine that the Registrant’s fitness to practise was not now impaired and the Registrant was permitted to return to unrestricted practice. 

Sanction

21. In considering the appropriate order the Panel had regard to the HCPC’s  Sanctions Policy published in March 2019, to the submissions of Ms Lykourgou and to the advice of the Legal Assessor.

22. The Panel has applied the principle of proportionality. The Panel is aware that the purpose of sanction is not to be punitive and that it must consider the risk the Registrant may pose to services users in the future and determine what degree of public protection is required.

23. The Panel has considered the sanctions available in ascending order of restriction. The Panel considered that to take no action or to impose a Caution Order would be wholly inappropriate, as neither would afford the necessary public protection or address the public interest.

24. The Panel next considered whether a Conditions of Practice Order would adequately address the concerns identified. The Panel considers that it cannot formulate Conditions of Practice that would sufficiently protect service users or address the public interest. Its reasons are essentially the same as those expressed by the previous panels: in particular, as the Registrant has not engaged with the HCPC with regard to the fitness to practise hearings, there can be no confidence that he would comply with conditions. Moreover, the Registrant’s proven lack of competence continued despite very considerable support and supervision from his former employer. The Panel also noted that it knows nothing about the Registrant’s present circumstances.

25. The Panel next considered a continuation of the Suspension Order. A Striking Off Order is not presently available to the Panel. Accordingly the Panel has decided to make a Suspension Order for a period of three months. This will enable the Registrant to engage with the HCPC. Such a period will also enable the Registrant to determine whether he wishes to continue in the profession of Radiographer and if he decides that he does, to consider how he can realistically address and remediate the serious lack of competence that was established in the substantive hearing. 

26. This Order will be reviewed before it expires. The full range of sanctions including a Striking Off Order will be available to the panel that reviews this Order. The Panel considered that a reviewing panel may be assisted by the Registrant:

• engaging with the regulatory process;
• providing evidence such as a reflective piece showing remorse, insight and remediation;
• detailing how he has addressed the key issues the Panel identified, for example through relevant work, paid or unpaid, and supplying details of any relevant training and professional development;

Order

Order: The Registrar is directed to suspend the registration of Mr Ajeesh George for a further period of 3 months upon the expiry of the existing order.

Notes

The Order imposed today will apply from 3 January 2021.

This Order will be reviewed again before its expiry on 3 April 2021.

Hearing History

History of Hearings for Mr Ajeesh George

Date Panel Hearing type Outcomes / Status
03/03/2021 Conduct and Competence Committee Review Hearing Struck off
02/12/2020 Conduct and Competence Committee Review Hearing Suspended
03/12/2019 Conduct and Competence Committee Review Hearing Suspended
03/12/2018 Conduct and Competence Committee Final Hearing Suspended