Miss Camilla L Hewitt

Profession: Radiographer

Registration Number: RA49567

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 11/02/2021 End: 17:00 11/02/2021

Location: Virtual hearing - Video conference

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

Whilst registered as a Radiographer and working as an agency radiographer at Walsall Manor Hospital you:

1. On one or more of the dates set out in Schedule 1 exposed paediatric patients to excessive radiation in that you exposed them to an adult dose of radiation.

2. On or about 27 November 2018 exposed Patient C to excessive radiation in that you imaged the left ankle as opposed to the right ankle during a follow up of a previous right ankle fracture.

3. Your actions at particulars 1 and / or 2 constitute misconduct.

4. By reason of your misconduct, your fitness to practise as a radiographer is impaired.

Schedule 1

16 October 2018 – Patient A

20 November 2018 – Patient B

Finding

Preliminary Matters
1. This is the first review of a Suspension Order to run for 6 months that was imposed on 11 November 2020 on Miss Camilla Hewitt (“the Registrant”). The Order is due to expire on 8 June 2021. The Registrant has attended these proceedings, by video link, and is represented. There was no issue regarding service of the hearing notice.

Background
2. The Registrant did not attend the hearing in November 2020 and nor was she represented in those proceedings. When the Registrant subsequently received the written decision it seemed to her that documentation she had provided within the proceedings had not been considered by the Panel. That documentation comprised a statement made by the Registrant and two references (one from a Radiographer and one from a Superintendent Radiographer who had previously worked with the Registrant).
3. On 18 November 2020, the Registrant sent an email to the HCPC to express concern that her documentation may not have been submitted to the Hearing Panel. In an email dated 30 November 2020 a Case Manager within the HCPTS confirmed that the documentation referred to, had in fact been received by the HCPTS. On 10 December 2020 the same Case Manager emailed the Registrant to say “I can confirm that I have requested for a Review Hearing to be scheduled so that your submissions can be considered by the Panel. I’ll provide you with an update in due course”.
4. This is a Review Hearing under Article 30 (2) of the Health and Social Work Professions Order 2001 which permits a review of a substantive order on the application of the Registrant concerned or the HCPC. The parties agreed that this should be treated as a Review Hearing at the request of the Registrant and the Registrant gave oral evidence within the hearing.

Representations on behalf of the Registrant
5. Mr Higgs submitted that the Registrant would have been disadvantaged within the original hearing by the fact that the documents she had submitted were not before the Panel. The Registrant had always accepted she had made errors and she had not attempted to apportion blame on others. It was accepted that harm had been caused to at least two of the patients. However, the relevant actions of the Registrant had occurred over a limited period of time. The outcome decision of the original Panel may well have been different if the missing documents had been available. The Panel was now asked to take into account that there were no other examples of misconduct throughout the Registrant’s career both before and after the events in question and that there was doubt that the three events in question could really be seen as properly representative of the Registrant’s usual standard of work. The original panel had had noted the evidence of witnesses that the errors of the Registrant were remediable. At paragraph 69 of the decision of the original panel it was recorded that the reason why a Conditions of Practice order was not appropriate was the lack of engagement on the part of the Registrant. But, of course, that comment was made when the Panel was unaware that the Registrant had submitted relevant material.
6. Mr Higgs asked the Panel to take into account the two years of faultless practice undertaken by the Registrant since the events in question. It was submitted that the Panel may feel that an appropriate sanction was now a Conditions of Practice Order. The Panel allowed a brief adjournment whilst Mr Higgs took specific instructions from the Registrant on that point. Upon resuming, Mr Higgs submitted that possible conditions could include requirements that the Registrant would bring any conditions to the attention of any employer, that she should undertake further training in the Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R) and provide appropriate certification in that respect, that she show competence in the use of necessary specific equipment and that competence should be assessed before working with any individual type of equipment unsupervised and that the Registrant should provide an audit of work in plain film. That last suggestion was made in recognition of the Registrant’s acceptance that the errors in question had occurred whilst she was carrying out plain film work rather than Computed Tomography (CT) work.
7. On behalf of the HCPC, Mr Lloyd asked the Panel to take into account both the Finding Impairment Practice Note and the Article 30 Sanctions Orders Practice Note. The Panel may well want to consider the matters of insight, remorse and remediation when considering the question of Impairment. The position of the HCPC was that the errors on the part of the Registrant amounted to extremely dangerous conduct and the fact that the outcome may have been negligible was irrelevant.
8. Mr Lloyd asked the Panel to take into account that during the Registrant’s evidence it appeared that the Registrant did not properly know or understand the IR(ME)R regulations. Further, her evidence appeared to be that she in the past had worked in situations where she had unfamiliarity with the equipment. These were all aspects to be taken into account when assessing insight and remediation.
9. In the context of the public component, Mr Lloyd submitted that the shortfalls in the Registrant’s understanding of different types of x-ray equipment usage and of the relevant regulations would cause members of the public considerable concern if the Registrant were now permitted to return to unrestricted practice. Mr Lloyd submitted that a continuation of the existing Suspension Order was appropriate and proportionate.

Decision
10. The Panel is dealing with a Review under Article 30(2) of the Health and Care Professions Order 2001 and has taken into account the HCPTS Practice Note: Review of Article 30 Sanction Orders.
11. The Panel has taken into account that Article 30(2) of the Order provides that, on the application of the person concerned or otherwise, a caution order, conditions of practice order or suspension order may be reviewed at any time it is in force and that the reviewing Panel may:
• confirm the order;
• extend, or further extend, the duration of the order;
• reduce the duration of the order;
• replace the order with any other order which the Panel could have made (to run for the remaining term of the original order); or
• revoke the order or revoke or vary any condition imposed by it.
12. Article 30 (2) is a discretionary power and does not specify the circumstances in which it may be exercised. Consequently, reviews are not limited to cases in which new evidence has come to light but may encompass any case where a significant and material change in circumstances has occurred since the original order was made. Any order made following an Article 30 (2) review has immediate effect but, where an order is confirmed or replaced by another kind of order, it will only have effect for the remaining period of the order under review.
13. The Panel has taken into account that prior to the hearing in November 2020 the Registrant sent an email to the HCPTS to say that “After a great deal of deliberation I have decided I won’t be in attendance of (sic) the hearing”. The Panel at the original hearing then decided to proceed in the absence of the Registrant.
14. In summary, the Allegation against the Registrant was that, over a six-week period, she exposed two paediatric patients (Patients A and B) to excessive radiation in that she exposed them to an adult dose of radiation and, further, that she exposed an adult patient (Patient C) to excessive radiation by unnecessarily imaging the patient’s left ankle.
15. The Panel sitting in November 2020 particularly took into account that the administration of adult doses of radiation to children had the effect of increasing their potential to develop cancer. Furthermore, in respect of one of the children, a second x-ray, albeit at a correct child setting, had to be taken. The Panel went on to record, in respect of the two child patients: “The Panel appreciates that (upon analysis of the amount of over exposure to radiation contained in the Incident Reports) the risk of both Patients A and B developing cancer in the future was stated to be relatively minimal, but the fact remains that the patients were put at risk of harm. Moreover, the Panel notes that, in relation to Patient A the dose was 50 times greater than required and accordingly had to be reported to the CQC, thereby causing reputational damage to the Trust”.

16. With regard to Patient C the Panel commented: “although the over exposure to radiation was stated to be minimal, nonetheless the fact remains that Patient C was put at risk of harm by having to have the correct ankle x-rayed three times. Moreover, there was the danger, in x-raying the incorrect ankle, that the injury to the other ankle could have gone undiagnosed”.

17. The Panel went on to say: “Finally, the Panel notes that these incidents occurred over a very short period of time (about five weeks) and no explanation has been provided by the Registrant for what have been described as “fundamental errors of practice”. Accordingly, the Panel is drawn to the inevitable conclusion that the Registrant’s actions were serious and that her conduct fell for below the standards expected of a registered radiographer in such a way that fellow practitioners would find her behaviour “deplorable””.

18. Following its finding that the Registrant had committed misconduct, the Panel went on to consider whether the Registrant’s fitness to practice was then impaired. The Panel went on to consider what are referred to as the “personal” and “public” components as those are referred to in the HCPTS Practice Note “Fitness to Practise Impairment”. In the context of the personal component the Panel took into account that: “……. the Registrant had not engaged with the HCPC and had provided no information about her current circumstances or what she did following her departure from the Trust in November 2018”. The Panel commented that it had “…… no evidence before it that the Registrant had remediated her practice” and, further, “Finally, the Panel reminds itself that the Registrant had not engaged with the HCPC and had provided no information about her current circumstances or what she did following her departure from the Trust in November 2018. There is, in addition, no indication from her that she has maintained her CPD. Accordingly, not only is there no evidence that, as at today, the Registrant has remediated her conduct, but there is no evidence that she has developed any, or any meaningful, insight into her actions. Consequently, it follows that the Panel cannot be satisfied that the Registrant will not repeat these errors”.
19. In respect of the “public” component the Panel dealing with the original hearing stated: “In relation to the Public component, the Panel concluded that the Registrant’s misconduct was such that the need to declare and uphold professional standards and maintain public confidence in the profession would be undermined if a finding of impairment were also not made in these circumstances. The Panel believes that a right-minded member of the public, with full knowledge of all of the circumstances, would be concerned if a finding of current impairment were not made”.
20. The Panel found that fitness to practice was impaired and went on to consider an appropriate sanction. By way of mitigating factors, the Panel noted:
• “The Registrant’s previous good character;
• She had co-operated with the Trust’s investigation into the first and second incidents and had made some attempts to comply with the Action Plan;
• She had engaged with the HCPC, albeit to a limited extent in that she has not provided any information for this hearing or attended;
• She had accepted responsibility for the first and second incidents in her reflective pieces (although she had not provided any real explanations for her actions in all three incidents);
• She had worked at the Trust without any concerns being raised for about four months prior to the first incident”.

21. By way of aggravating factors, the Panel noted:
• “The Registrant’s actions were serious and potentially could have caused significant harm to the patients;
• Her misconduct was repeated, albeit over a short period of time;
• There does not appear to have been any real expression of genuine or timely remorse or apology; none could be recalled by her line manager, DW, and none are contained within her written reflections;
• There is no evidence of any further reflection about these incidents since her departure from the Trust in November 2018 nor any subsequent indication that she would change her practice because of them;
• There is no evidence before the Panel that the Registrant has remediated her misconduct and, accordingly, there is a continuing risk of repetition;
• The Registrant has not supplied any evidence of CPD or any relevant testimonials”.

22. The Panel went on to consider a Conditions of Practice Order and noted: “The Panel determined that, despite the breaches being serious, the Registrant’s failings were capable of being remedied - the evidence of [the witnesses] made this clear. Moreover, it took into account that she had cooperated with the Action Plan and, according to the evidence of [a witness], feedback to him had indicated that she was “receptive and knew what needed to be done”. Consequently, it appeared that the Registrant might be willing to comply with conditions”.
23. Further on, the Panel recorded:
69. The difficulty that the Panel faced was that the Registrant had not engaged with these proceedings in any meaningful way so it had no information before it: as to her current situation; whether the Registrant was still working, or even intended to work in the future, as a radiographer; or whether she had reflected further upon these matters and/or had remediated her errors. Accordingly, the position remained that it appeared to the Panel that the Registrant continued to display little or no insight into her actions in this matter. On the evidence before it, the Panel could not be satisfied that the Registrant would not act in this way again; and that, consequently, there was no available evidence to reassure the Panel that there was the required level of insight and understanding to indicate that a Conditions of Practice Order was an appropriate and proportionate response.
70. Given the Registrant’s initial response to the Trust’s Action Plan, the Panel did give consideration to making a Conditions of Practice Order. However, based on the information, or indeed the lack of information, before it, the Panel felt that it was unable to draft workable, appropriate, realistic or verifiable Conditions of Practice. It concluded that there was insufficient evidence before it that the Registrant would be able or willing to comply with such an order.
24. In considering a Suspension Order the Panel stated:
72. The Panel was satisfied that, for instance, the concerns represented a serious breach of the Standards. It appreciated that there was no evidence before it to indicate that the Registrant currently had sufficient, or any, insight and therefore it could not be said that the issues were unlikely to be repeated.  However, there was evidence to suggest that she might be able to resolve/remedy her failings, namely her initial positive reaction to the Trust’s Action Plan, which suggested an eagerness to remedy her failings and learn.  Once again, the difficulty the Panel had was that there was no significant engagement by the Registrant with these proceedings, so it was unable to ascertain her current situation, and therefore address her current requirements.
73. However, the Panel appreciated that the Registrant, for whatever reason, might have found it difficult to engage in these proceedings. Consequently, the Panel considered that a possible and proportionate response could be to give her an opportunity to show that she is willing to remedy her failings by imposing a short Suspension Order, commensurate with the gravity of her failings so as to mark the seriousness of those failings. Such an order would be reviewed before the end of the suspension period, which would provide an opportunity for the Registrant to demonstrate in the interim that she has gained insight into her errors and wishes to remedy them. The Panel was also satisfied that a Suspension Order would maintain public confidence in the Regulator and the profession.
25. This Panel accepts that an error was made on the part of the HCPTS and that the statement of the Registrant and the two references were not made available to the original Panel sitting in November 2020.
26. The Panel considered the Practice Notes referred to above and took into account all of the evidence from the Registrant, in particular the statement and references she had provided. It was clear to the Panel that the Registrant did not yet have adequate familiarity with IR(ME)R. It also was not clear to the Panel that the Registrant had taken full opportunity to ensure that she was up-to-date on recent developments within her profession. The Registrant was able to give only one example of areas of practice that she had read about since the time the Suspension Order being imposed. To her credit, the Registrant has herself accepted that deficiencies in her plain film practice related to her unfamiliarity with certain pieces of equipment. The Panel concluded that the Registrant’s insight into her deficiencies in practice was still developing and that she had not yet carried out proper remediation or remedy in respect of those deficiencies.
27. For the above reasons, the Panel has concluded that the Registrant’s fitness to practise still remains impaired on personal component grounds. That is mainly because the Registrant has not yet undertaken adequate remediation to show that she would not cause a risk of harm to members of the public if she were now permitted to return to unrestricted practice.

28. The Panel has also concluded that the Registrant’s fitness to practice still remains impaired on public component grounds. That is because members of the public would not have confidence in the Radiographer profession or this regulatory process if the Registrant were permitted to return to unrestricted practice.

29. The Panel has considered an appropriate sanction. Any sanction must be proportionate and provide adequate public protection. The Panel has considered the available sanctions in ascending order. The Panel has concluded that to take no action or to impose a Caution Order would not be proportionate having regard to the serious nature of the misconduct, nor appropriate as no restrictions on practice would be in place.

30. The Panel considered a Conditions of Practice Order. If such an order were to be imposed it would run for the remaining unexpired period of the current Suspension Order. The Panel has taken into account all that was said in paragraphs 68 and 69 of the original decision which identified an arguable basis for such an Order. A factor that militated against such an Order was that the Registrant appeared not to have engaged with the process. It is clear to this Panel that that appearance was incorrect and that the Registrant had engaged in the manner described above. This Panel takes into account that the Registrant has a significant length of service as a Radiographer. The misconduct on her part occurred in an approximate 6-week period. This Panel is satisfied that the failings on the part of the Registrant are remediable and that the Registrant can be trusted to comply with Conditions of Practice and, further, that workable and enforceable conditions can be identified.

31. The Panel has concluded that a Conditions of Practice Order would be the most proportionate order that would provide adequate public protection and, at the same time, create a justifiable level of restriction on the Registrant’s practice.

32. The Panel went on to check the proportionality of such an order by considering whether the next step up, a Suspension Order, would be proportionate and appropriate. The Panel took into account the Registrant’s engagement in respect of the earlier hearing and her engagement and attendance at this Hearing. The failings in the Registrant’s practice are remediable. The Registrant has shown a willingness to comply with Conditions of Practice. For those reasons, the Panel concluded that the proportionate and correct outcome was to replace the current Suspension Order by a Conditions of Practice order to run for the remainder of the current term of the Suspension Order now being replaced.

33. The Panel is not minded to include a specific condition relating to Plain Film X ray, as in its view the IR(ME)R update and signing off of relevant competencies would address the lack of familiarisation with equipment in any clinical area involving ionising radiation, and would be sufficient to address the issues raised.

34. A future reviewing panel may be assisted by the following: 
• your attendance at the review hearing
• evidence of targeted CPD relevant to the misconduct found
• reflection on the learning that has taken place as a result of the update on IR(ME)R.

Order

ORDER: The Registrar is directed to replace the existing Suspension Order with a Conditions of Practice Order for the remainder of the term of the order it replaces. You, Camilla L Hewitt, must comply with the following:
1. Before commencing work in a clinical post you must:
a. successfully complete an update course on IR(ME)R which includes an assessment component.
b. forward to the HCPC confirmation of successful completion of the IR(ME)R course assessment.
2. In keeping with IR(ME)R, you must be signed off as competent in the relevant area before working unsupervised.
3. You must inform the HCPC, within 7 days, if you commence work in a new clinical post.
4. You must inform the HCPC within 7 days of any disciplinary proceedings taken against you by your employer.
5. 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 (at the time of your application);
 b. any agency you are registered with or apply to be registered with (at the time of your application);
 c. any prospective employer (at the time of your application).
6. You will be responsible for meeting any and all costs associated with complying with these conditions.

Notes

This Order will be reviewed before its expiry.

Right of Appeal:
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Articles 30(10) and 38 of the Health and Social Work Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

 

 

 

Hearing History

History of Hearings for Miss Camilla L Hewitt

Date Panel Hearing type Outcomes / Status
11/02/2021 Conduct and Competence Committee Review Hearing Conditions of Practice
09/11/2020 Conduct and Competence Committee Final Hearing Suspended