Miss Khadijha Sundus

Profession: Radiographer

Registration Number: RA71075

Hearing Type: Consent Order Hearing

Date and Time of hearing: 10:00 24/09/2020 End: 17:00 24/09/2020

Location: Hearing taking place virtually

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

While registered as a Radiographer with the Health and Care Professions Council and during your employment with The Leeds Teaching Hospitals NHS Trust, you:

1. On 8 August 2017, in relation to a child patient, administered a second fraction 14cm below the correct location, which resulted in:

a. An under dose of 1.8Gy to the treated site.

b. An overdose of 1.8Gy to tissue which should not have been treated, which included:

i) the patient’s hip;

ii) the patient’s penis;

iii) the patient’s testes.

2. Your actions as set out in paragraph 1 amount to misconduct.

By reason of that misconduct, your fitness to practise as a Radiographer is impaired.

Finding

Preliminary Matters

Service and Proceeding in Absence

1. The Panel is satisfied that the Notice of Hearing dated 16 July 2020 was sufficiently served on the Registrant by service at her registered email address, giving her reasonable notice of today’s hearing and informing her of its purpose.

2. Ms Welsh, on behalf of the HCPC, made an application for the hearing to proceed in the Registrant’s absence and referred in particular to the Registrant’s solicitors’ letter dated 29 July 2020. This stated that the Registrant would be neither present nor represented at the hearing and that she had no written submissions to make in view of the nature of the hearing, namely a disposal of the case by consent. The Legal Assessor gave legal advice and the Panel directed itself in accordance with that advice.

3. The Panel decided that the Registrant had voluntarily absented herself from the hearing in view of the letter of 29 July 2020 and, in the circumstances, that it was fair to proceed in her absence. Therefore, the Panel decided to proceed in the absence of the Registrant.

Hearing in private

4. A discrete matter relating to the Registrant’s personal circumstances arose at the beginning of the hearing. This prompted the Panel to direct that any mention of this matter be heard in private. It was very limited in scope and concerned the private life of the Registrant.

Background

5. The Registrant is a registered Radiographer who was employed by Leeds General Hospitals NHS Trust (‘the Trust’) from January 2016 to February 2018.

6. In a referral to the HCPC by the Trust dated 27 February 2018, it was alleged that on 8 August 2017 the Registrant administered a second fraction (i.e. dose of radiation) to a male child patient below the correct location, which resulted in an under-dose of 1.8 Gy to the treated site and an overdose of 1.8Gy to tissue that should not have been treated. It also appeared from documents made available to the HCPC that in 2016, during a CT-simulation process, the Registrant did not recognise that a measurement was in centimetres and not millimetres. In a third incident, an incorrect radiation dose was given to a patient following an error the Registrant was alleged to have made in the process of data preparation.

7. The Trust also provided to the HCPC copies of documents included in its internal investigation and subsequent disciplinary proceedings, which resulted in a decision letter of 20 February 2018. By that time, the Registrant had ceased to be employed by the Trust and the decision was that the Registrant would have been given a final written warning had she remained employed by them.          

8. The Registrant had taken a full part in those investigations and participated in the Trust hearing, but decided to leave her employment with the Trust to go travelling.

9. The HCPC referred the allegations concerning the three incidents to a panel of the Investigating Committee on 8 November 2019. That panel decided that there was a case to answer as set out in an allegation of misconduct with respect to the single incident on 8 January 2017. The detail of that allegation is set out at the start of this determination.

10. Following that referral, the HCPC and the Registrant’s solicitors agreed with the HCPC’s proposal that the case was suitable for disposal by means of a Caution Order of three years. A Consent Order signed by the Registrant on 29 July 2020 was provided to the Panel, in which she admitted the allegation and that her fitness to practise is currently impaired and she consents to a Caution Order of three years.

The Application and the Submissions for the HCPC    

11. In support of this application, the HCPC relied on a bundle of documents, in addition to a service bundle of unredacted documents.  Ms Welsh relied on a written Skeleton Argument dated 10 September 2020 and she also made oral submissions to the Panel.

12. Ms Welsh submitted that the case should be disposed of by consent in view of the admissions made by the Registrant, the nature and duration of the sanction she was prepared to accept, the insight and remediation she had shown, and her engagement with respect to these proceedings. In addition, Ms Welsh submitted that the case raised no wider public interest issues and a Caution Order of three years would secure the necessary level of public protection in view of the low risk of repetition. She submitted that the requirements set out in the HCPTS Practice Note on “Disposal of Cases by Consent” (‘the Practice Note’), had been met and that, in the circumstances, the Order sought by the parties should be made.

Decision

13. The Panel was given, and accepted, advice from the Legal Assessor. It directed itself in accordance with that advice.

14. The Panel could either accept the proposal made by the parties or reject it and set the case down for a full hearing before the Conduct and Competence Committee. The case was solely concerned with the allegation relating to the single incident, and not with other incidents considered by the Investigating Committee, in respect of which there had been no case to answer.

15. The following principles set out in the Practice Note applied to the decision:

• The Panel should not agree to a case being resolved by consent unless it was satisfied that:

• the appropriate level of public protection was being secured; and
• doing so would not be detrimental to the wider public interest.

• Consequently, before considering a draft Consent Order, the Panel should satisfy itself that the HCPC:

• had provided a clear, appropriately detailed, and objectively justified explanation within its supporting Skeleton Argument of why the matter was suitable for disposal by consent on the terms set out in the draft Consent Order; and
• had made clear to the registrant concerned that cooperation and participation in the consent process would not automatically lead to a Consent Order being approved.

16. The Panel was satisfied that the Skeleton Argument provided an appropriately detailed explanation and gave an objectively justified view as to why the HCPC considered the case to be suitable for disposal on the terms as set out in the draft Consent Order. The HCPC letter dated 17 January 2020 also made clear to the Registrant that the consent procedure would not automatically result in approval of the proposal.

16. The Panel noted that the incident was serious. The patient was positioned incorrectly when receiving the radiation dose due to the Registrant’s misinterpretation of the written information used for the second fraction of the treatment. The Registrant manually overrode the machine which was used for the radiotherapy. Under the Trust’s treatment protocols, this should have required the consent of a third radiographer (she and a colleague were present). That protocol was not followed.

17. Following these errors, the  patient was exposed to radiation in a place (his groin area in particular) that should not have been exposed to it, and a further dose of radiation was required to an area that should have been treated with that dose.

18. An investigation into the incident conducted by the Trust concluded that the radiation delivered to the patient’s groin area was below a threshold of harm, but that it would be advisable for the patient to attend in early adolescence for tests to check that the dose had not harmed him.

19. There were some mitigating circumstances surrounding the Registrant’s errors. In particular, it was difficult to secure the necessary stillness in the patient to administer the dose. An anaesthetic team was present to assist and even then, full anaesthesia was not achieved. The situation was challenging.

20. When interviewed on behalf of the Trust as part of its investigation, the Registrant accepted that she had been in error, apologised fully, and expressed remorse. She participated fully in the Trust’s investigation and the final hearing of the disciplinary case against her, even though she was no longer employed by the Trust at that stage.

21. In the written representations dated 5 December 2019 made to the Investigating Committee by the Registrant’s solicitors on her behalf, she acknowledged that she had been in error and should not have overridden the protocol. She confirmed her remorse and regret for her actions. It was pointed out on her behalf that she had continued in her employment as a Radiographer with the Trust, which had allowed her to continue working without restriction after the incident.

22. The Panel agreed that the matters admitted by the Registrant amounted to misconduct, but it concluded that the Registrant has shown genuine remorse for her actions and complete insight into the errors that she made with respect to this patient, and that she has remediated those professional shortcomings by reflecting on her practice, in particular the use of override systems.

23. Although the risk of repetition is low, the Panel did consider that a finding of current impairment would mark the seriousness of the conduct. As to sanction, the Panel took into account the guidelines set out in the HCPC Sanctions Policy. It agreed that a Caution Order is appropriate in this case. The incident was isolated, there is a low risk of repetition, the Registrant has shown good insight, and she has undertaken appropriate remediation.

24. The minimum period for a Caution Order is one year. However, the Panel agreed with the parties that a period of three years would be the necessary and proportionate sanction in this case. A period of that length is needed to mark the seriousness of the misconduct in order to maintain public confidence in the profession and to declare and uphold professional standards. The Panel considered that in those circumstances, the order sought would secure the necessary degree of public protection and the making of the order would not be detrimental to the wider public interest.  

25. For those reasons, the Panel has decided to grant the application and to make the Order sought by the parties.

Order

That the Registrar is directed to annotate the register entry of Miss Khadijha Sundus with a caution which is to remain on the register for a period of 3 years from the date this order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Miss Khadijha Sundus

Date Panel Hearing type Outcomes / Status
24/09/2020 Conduct and Competence Committee Consent Order Hearing Caution