Petya B Somerville

Preliminary Matters

Service of Notice of Hearing

1. The Panel had sight of the Notice of today’s hearing, dated 17 May 2021, which confirmed the date and time of today’s hearing, and that it would be conducted remotely. The Panel had sight of the certificate of proof of service which confirmed that the email address to which it was sent was that of the Registrant on the register.

2. The Panel accepted the advice of the Legal Assessor and was satisfied that service had been effected in accordance with Rules 3 and 6 of the Conduct and Competence Committee (Procedure) Rules 2003.

Proceeding in Absence

3. Ms Penfold, on behalf of the HCPC applied for the hearing to proceed in the absence of the Registrant. Ms Penfold referred to the “Response Proforma: Notice of Allegation” completed by the Registrant, dated 3 June 2020, in which she stated that “it is impossible for me to appear in person at the hearing”, and she also confirmed that she did not intend to be represented. Ms Penfold also referred to another form, namely the “Response Proforma and Pre Hearing Information  Form” which was completed by the Registrant and emailed to the HCPTS on 21 April 2021, in which the Registrant confirmed that she was not planning to attend the hearing and that she did not have a representative. Ms Penfold submitted that the Registrant had voluntarily absented herself.

4. The Panel took into account the HCPTS Practice Note entitled “Proceeding in the Absence of the Registrant” and accepted the advice of the Legal Assessor. The Panel was aware that the discretion to proceed in absence is one which should be exercised with the utmost care and caution. The Panel took into account that the Registrant initially stated in the Proforma Response form dated 3 June 2020 that it was “impossible” for her to attend a hearing. The Panel was aware that her registered address is in Bulgaria, and considered that this may have been the explanation for her statement that it was “impossible” for her to attend. However, the Response Proforma form emailed by the Registrant on 21 April 2021 informed her that the hearing was likely to be heard virtually, and the Registrant nevertheless confirmed that she would still not attend. The Panel noted that she engaged with the HCPC in returning these forms, as well as sending written submissions to the Investigating Committee Panel. However, she has not applied for an adjournment of this hearing. The Panel did take into account the potential disadvantage to the Registrant in proceeding in her absence, but considered that she had voluntarily waived her right to attend, and also noted that she has provided a response to the Allegation in her written submissions. The Panel also took into account that there are four live witnesses due to give evidence, and bore in mind that any further delay was likely to impact upon their memories in light of the age of the Allegation. In all the circumstances the Panel decided that it would be fair and in the public interest to proceed.

Application to Offer No Evidence and to Amend the Allegation

Original Allegation

As a registered Radiographer (RA55225) your fitness to practise is impaired by reason of misconduct and/ or lack of competence. In that:

1.  You did not apply the necessary safety measures when undertaking diagnostic Magnetic Resonance Imaging (MRI) procedures, in that:

(a) On or around 4 February 2019, you did not select “normal mode” to scan a patient with sternal wires in situ;

(b) On or around 4 February 2019, you did not check on SECTRA to see the scanning conditions which must be adhered to, regarding a patient with metal staples in situ, which would advise you if it was safe to proceed or not;

(c) On or around 7 February 2019, you did not advise a patient to remove nose and ear piercings, prior to a scan and a colleague had to intervene;

(d) On or around 19 February 2019, you simultaneously commenced moving the table up, whilst instructing the patient to lie flat on the table.

(e) Between 04 January 2019 and 11 January 2019 you did not advise a patient to remove her boots prior to a scan, when the patient had felt pulling as the heels of the boots were magnetic.

(f) On or around 26 March 2019, you failed to ask the patient to remove their metal dental plate prior to the scan and a colleague had to intervene.

(g) You failed to recognise a patient with a drain in situ and a colleague had to intervene.
 
2.  You did not communicate effectively with patients in that:

(a) On or around 4 March 2019, you told  a patient to stay still and stop moving, when in fact they were panicking and needed reassurance to be able to proceed with the scan.

(b) On or around 4 March 2019, you had the intercom system on so that the patient could hear you say that you needed to include the mass, which is information that should not be shared in this manner.

(c) On or around 8 March 2019, you did not inform a patient that you were going to remove an Electrocardiogram (ECG) lead and proceeded to pull off the electrode from the patient’s chest and replacing it with another, without advising the patient of your actions.

(d) On or around 27 February 2019, you were unable to correctly ascertain the patient’s pregnancy status following the completion of a safety questionnaire which resulted in the patient becoming confused and a colleague had to intervene.

3.  You did not adhere to safe practice when preparing patients, in that:

(a) On or around 11 March 2019, you did not get a patient to sign their completed MRI safety questionnaire before intending to conduct an MRI scan.

(b) On or around 14 March 2019, following a failed attempt at cannulation you did not discard the used cannula and instead intended to re-use the cannula for your second attempt.

(c) On or around 14 March 2019, you did not fill the pump injector in a safe and proper manner and purged air bubbles with contrast instead of saline.

(d) On or around 26 March 2019, you did not document that the patient had bilateral hip replacements.

4.  You did not retain passed competencies in that:

(a) On or around 14 March 2019, following being signed off as being competent using SECTRA, you were unable to access a previous report on SECTRA.

5.  On or around 4 March 2019, when imaging, you did not identify the need to perform Short-TI Inversion Recovery (STIR) and/or in/out phase imaging.

6.  You did not treat patient with dignity and respect in that:

(a) On 25 January 2019 when placing ECG stickers on a female patient in the scan room, you completely exposed her chest to complete this activity;

(b) On 01 February 2019 you removed ECG stickers from a female patient’s chest whilst she was sitting in a wheel chair with her top rolled up in view of the main waiting area;

(c) On 08 March 2019, you ripped the patient’s disposable top in order obtain access to apply the ECG electrodes;

7.  On or around 26 March 2019, you were unable to ascertain MRI safety status of stents inserted on 2 occasions in 2 different patients.

8.  You struggled to maintain competency and anatomical knowledge associated with Magnetic Resonance Cholangiopancreatography (MRCP) studies in that:

(a) you experienced difficulty identifying the Common Bile Duct (CBD) on an image and was only able to identify this after 2 attempts.

(b) you demonstrated inability to appreciate which field of view needed to be increased to ensure accurate region of interest is captured.

(c) On 04 March 2019 you took 30 minutes to perform a MRCP scan which should typically take 10 minutes.

9. On 20 February 2019 you were undertaking a cardiac scan whilst under supervision and a wrap appeared on your LVOT2 view which you were unable to identify.

10. You demonstrated difficulties in completing liver scans in that:

(a) You experienced difficulty in identifying breathing artefact on liver sequences and thus when to repeat scans;

(b) You experienced difficulty in performing a liver scan whilst simultaneously giving breathing instructions unaided; HCPC Offered No Evidence

(c) When completing a liver scan with gadivist contrast agent, you were unable to detect motion artefact on the coronal images

11. The matters set out in allegations 1 to 10 above constitute misconduct and/or lack of competence.

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

5. Ms Penfold applied to offer no evidence in respect of Particular 10(b) and told the Panel that the HCPC did not intend to pursue it.

6. The Panel took into account that the evidence in respect of Particular 10b) was said to be insufficient, and decided to accede to Ms Penfold’s application.

7. Ms Penfold also applied to amend the rest of the Allegation as set out in a letter which had been sent to the Registrant on 5 November 2020. Ms Penfold also highlighted that there were further minor amendments of grammar sought, which did not alter the substance of any part of the Allegation. The Panel accepted the advice of the Legal Assessor.

8. The Panel considered that the notice of the HCPC’s intention to amend  the Allegation had been communicated to the Registrant by letter dated 5 November 2020. This gave her substantial advance notice, and adequate opportunity to challenge the application, which she had not done. The Panel was of the view that the amendments sought added clarity to the Allegation, and that such clarity was of assistance to both parties, as well as to the Panel. The Panel considered that it was fair to allow the amendments, including the minor grammatical amendments sought on the first day of the hearing which were minor and did not alter the meaning of the particulars of the Allegation to which they related.

Background

9. The Registrant is a registered Radiographer. She was employed as a Band 6 MRI Radiographer at the Belfast Health and Social Care Trust (“the Trust”) between 26 November 2018 and 19 April 2019 at the MRI Department at Mater Hospital. The Registrant was employed on the basis that she had, prior to commencing her employment, 20 years’ experience as a Radiographer, and 4 years’ MRI experience. 

10. Concerns were raised about the Registrant’s competence, skills and training from December 2018, and it was considered that the induction and training were not meeting the Registrant’s needs. The Registrant was placed on an informal Capability Process on 4 February 2019 for a period of 4 weeks. She was assigned two mentors, CD, Band 6 MRI Radiographer, and MS, Band 6 MRI Radiographer, each of whom spent time working alongside the Registrant. The Registrant always worked under supervision, and following the instigation of the informal Capability Process, she predominantly worked with either CD or MS. There were also weekly meetings held with LMCK, MRI Lead Radiographer, the Registrant, and either CD or MS. On 11 March 2019 the informal stage of the Capability Process was extended by 4 weeks. On 25 March 2019, the Registrant emailed her resignation to LMCK.

Decision on Facts

11. The Panel read the HCPC’s final hearing bundle.

12. The Panel heard oral evidence from the following HCPC witnesses, all employed by the Trust:

i. LMCK, MRI Lead Radiographer;
ii. LM, Band 6 MRI Radiographer;
iii. CD, Band 6 MRI Radiographer and the Registrant’s mentor;
iv. MS, Band 6 MRI Radiographer and the Registrant’s mentor.

13. The Panel considered that LMCK was a balanced witness who tried to help the Panel. The Panel considered that she was slightly guarded when asked about how the Registrant fitted into the team. Her recollection as to events was somewhat limited, however the Panel considered that she was a credible witness.

14. The Panel considered LM to be a clear and credible witness.

15. The Panel was of the view that CD gave a clear, balanced picture of her mentoring relationship with the Registrant and demonstrated empathy towards the Registrant. She was a credible witness who had a good recollection of events.

16. The Panel considered MS to have a good recollection of many of the events which she witnessed. She was balanced and fair to the Registrant and credible. It was clear that she had developed a close working relationship with the Registrant, and gave full and detailed answers to questions which were helpful to the Panel. Her evidence was also useful in that when the Registrant began her employment, MS had herself been employed at the Trust for some 18 months, and therefore she was able to give evidence about the induction and training process in the MRI department. 

17. The Panel drew no adverse inference from the Registrant’s absence in coming to its decision on facts.

18. The Panel read the Registrant’s written submissions, as well as the “Response Proforma: Notice of Allegation” completed by the Registrant, dated 3 June 2020 and the “Response Proforma and Pre Hearing Information  Form” which was completed by the Registrant and emailed to the HCPTS on 21 April 2021.

19. The Registrant did not admit any of the facts alleged in the Allegation.

20. The Panel read the skeleton argument of Ms Penfold and took into account her oral submissions on facts.

21. The Panel accepted the advice of the Legal Adviser who advised that the Registrant should be taken to be a person of good character, and that she is entitled to her good character being taken into account by the Panel when considering her credibility and her propensity to act as alleged.

22. The Panel was aware that the burden of proof is entirely on the HCPC to the civil standard, namely the balance of probabilities.

Particular 1(a)

23. The Panel took into account the evidence of MS who told the Panel that during an MRI scan, the body absorbs energy which can cause heating. There are two different modes which can be employed in scanning, “normal mode” or “first level mode”. This is relevant because “normal mode” limits the effect of heating, while “first level” increases the degree of heat generation in patients which can cause burns.

24. MS stated that on 4 February 2019, the Registrant had completed an MRI safety questionnaire in respect of a patient who was due to be scanned. The patient had stated that they had undergone open heart surgery, and MS had noted that the Registrant had recorded this on the MRI safety questionnaire. MS’s evidence was that when the Registrant commenced scanning the patient, she selected “first level” imaging, and that the first image taken showed an artefact from a sternal wire. MS’s evidence was that the Registrant should not have selected “first level” imaging because the patient had informed her that they had undergone open heart surgery and therefore the risk of sternal wires in the patient should have been identified. It was expected that “normal mode” would be selected due to the metal implant which could heat up and cause burns to the patient. MS’s evidence was that this was part of very basic knowledge expected of a Radiographer.

25. MS’s evidence was that when she discussed this with the Registrant at the time, the Registrant confirmed that she did not know what sternal wires were, and had never scanned a patient who had undergone open heart surgery. MS’s evidence was that she found this “unbelievable” considering the Registrant’s experience, even outside of MRI and this is part of the required training to become a Radiographer. In any event MS said that the first scan showed a metallic artefact which would have been “a red flag that there was something in the patient causing the artefact on the image” and she would have seen the sternal wires on the image in front of her.

26. Concerns about this incident were raised in a meeting on 7 February 2019 at which LMCK , MS and the Registrant were present. At that meeting, the notes of which were before the Panel in evidence, the matter was discussed with the Registrant. The notes of the meeting record that the Registrant stated that in her 20 years’ experience as a radiographer and 4 years’ experience working in MRI she had never dealt with any patients who had undergone open heart surgery, and therefore was unaware of sternal wires. The notes also record that she would be aware of this issue going forward.

27. In her written submissions, the Registrant did not address this Particular.

28. As a result of the evidence, the Panel was satisfied that the Registrant did not apply the necessary safety measures when undertaking the MRI procedure.

29. The Panel therefore found Particular 1(a) proved.

Particular 1(b)

30. MS’s evidence was that SECTRA is an electronic information system. There are two parts to the system. The first part allows any previous images of the patient to be viewed. The second part is a Radiology Information System (RIS) which is used to identify if a patient has had any other imaging throughout the province and to see if there are any alerts about a patient and if they are safe to be scanned.

31. MS’s evidence was that on 4 February 2019 a patient arrived in the department for a scan with metal staples in situ. Before the Registrant had brought the patient into the scan room, MS herself had checked RIS, and her evidence was that a radiographer had previously looked up the scanning conditions of the staples and scanned the information onto RIS. The Registrant had not looked on SECTRA or RIS, and MS had to prompt her to do so.

32. MS’s evidence was that the Registrant’s omission to check SECTRA, could have had serious implications for the patient. Staples can come loose during a scan and cause harm to a patient, and as they were metal this could have caused heating and burns.

33. This concern was raised at a meeting  on 7 February 2019 at which LMCK, MS and the Registrant were present. The notes of that meeting record that the matter was discussed with the Registrant and she was recorded as “fully” agreeing that checking SECTRA was “vitally important”.

34. As a result of the evidence, the Panel was satisfied that the Registrant did not apply the necessary safety measures when undertaking the MRI procedure.

35. The Panel therefore found Particular 1(b) proved.

Particular 1(c)

36. The evidence of LMCK was that on 7 February 2019 she noticed that after a patient had changed into a gown for a scan, and before the patient was brought into the scan room, the patient had piercings. A note in the meeting between the Registrant, LMCK and MS confirms that on 7 February 2019 LMCK confirmed that these were nose and ear piercings. LMCK’s evidence was that the Registrant told her that the patient was unable to remove the piercings, and that they were “probably sterling silver” or words to that effect. LMCK stated that a patient cannot be scanned with ferromagnetic piercings, and if the metal piercings are magnetic, there will be a projectile effect which could cause injury to the patient or the Radiographer.

37. Further, LMCK’s evidence was that if a patient is unable to remove a piercing, it should be checked by a testing magnet. LMCK’s evidence was that this requirement was contained in the MHRA Safety Guidelines for MRI Equipment in Clinical Use (“the Safety Guidelines”),  (a copy of which was before the Panel), which refers to the need for the use of a testing magnet. The Panel also took into account that the Registrant had signed and dated her Induction and Training document to confirm she had read this on 7 December 2018, and on 1 March 2019 she signed a declaration confirming she had read and understood the MR Local Rules and the Safety Guidelines. These documents were before the Panel.

38. The evidence of LMCK was that if the piercing is attracted to the magnet, it is unsafe to bring the patient into the scan room. The patient will be given the option not to pursue the scan or to have the piercing removed. If the patient does not want to have the piercing removed, their wishes are respected and a report is issued back to the referrer setting out the situation. If the piercing is not magnetic and the MRI scan is warranted, the next step is to discuss the piercing with the patient and the burning potential. It was expected that the Radiographer would set out that the piercing does not appear to pull or be magnetic, but that with a metal object being close to the patient’s skin, there is a chance that the metal could heat up and cause a burn. This information should then be written down on the MRI safety questionnaire form and the patient should be asked to counter sign the information confirming that they provide the Radiographer with informed consent for the scan to occur. It is important that the Radiographer ensures that all of the relevant information has been given to the patient so that they are able to make an informed decision about whether they wish to proceed with the scan.

39. In her written submissions, the Registrant stated that she never allows patients to enter the scanning room wearing jewellery unless it is a gold wedding ring outside of the scanning area.

40. However, the evidence of LMCK was clear and detailed, and her concern was recorded in the notes of the meeting held on the same date with the Registrant and MS when the event was fresh in her mind.

41. In light of the evidence, the Panel was satisfied that the Registrant did not identify the risk as alleged and that she did not apply the necessary safety measures.

Particular 1(d)

42. The evidence of LMCK was that on 19 February 2019 she witnessed that a patient whom the Registrant was going to scan was sitting on the table when the Registrant started to move the table up and asked the patient to lie flat on their back. The table then moved slightly into the scanner and LMCK intervened and stopped the Registrant and the patient. LMCK’s evidence was that as the table had moved slightly into the bore, if the patient had leaned back they would have hit their head on the scanner.

43. LMCK’s evidence was that the table of an MRI scanner reaches up quite high off the ground. When the table is moved up, patients often lose awareness of how high off the ground they are. The table is also extremely narrow. LMCK stated that no table should be moved until a patient is in a stationary position and lying on their back. Further, there is an expectation that there will be communication from the Radiographer to the patient explaining that they are taking the table up and that the patient is a distance off the ground. This is expected practice.

44. LMCK’s evidence was that during the induction it is discussed with a new MRI Radiographer how to position a patient on the table for scanning. This would have included informing the Radiographer that the patient should be stationary before moving the table. LMCK also referred to the Registrant’s 20 years’ experience as a Radiographer and 4 years as an MRI Radiographer, prior to commencing her role at the Trust. LMCK stated that the use of moving tables would have been common practice within the x-ray, CT and MRI departments across the Registrant’s experience and so it was expected that she would have been aware that this was not good practice.

45. In the notes of a meeting between LMCK, the Registrant and her mentor CD on 26 February 2019, the Registrant is noted as stating that she did not know why she had done this as she recognised it was not good practice.

46. On the basis of the evidence, the Panel was satisfied that the Registrant commenced moving the table whilst simultaneously instructing the patient to lie flat on the table, and that in doing so, she did not apply the necessary safety measures while undertaking MRI procedures.

47. The Panel therefore found this Particular proved.

Particular 1(e)

48. The evidence of LM was that  on one occasion when she was working with the Registrant, she was removing the patient from the scanner and the patient immediately reported that she could not move her legs during the scan and she was very uncomfortable. LM noticed that she was wearing boots. The boots had a block heel on them. LM ‘s evidence was that she knew from experience that the block heel can have a metal nail to hold the boot together. As a result, the boots should have been removed prior to going into the MRI environment. LM stated that as a result of the Registrant’s prior experience as an MRI Radiographer she would expect her to know from experience that footwear like the ones the patient was wearing should be removed prior to entering the MRI environment. LM also stated that routine practice was to remove all a clothing and footwear prior to entering the scan room.

49. LM told the Panel that the potential impact of not telling a patient to remove metal prior to entering the MRI environment is that it can create a pulling effect. The patient in this situation reported that she felt like she could not move her legs. This could lead to harm to the patient in the pulling effect of the metal being attracted to the scanner. There was a risk of a projectile effect which could cause harm to the patient and to the scanner.

50. LM’s evidence was that she raised this with her line manager LMCK, whose evidence was that the incident occurred between 4 January and 11 January 2019. In notes of a meeting on 11 January 2019, it is recorded that when the matter was raised with the Registrant she understood  and said she would ensure patients are appropriately changed into a gown to ensure MRI  safety.

51. The Panel was satisfied from all of the evidence that the Registrant did not advise the patient to remove her boots prior to the scan and that therefore she did not apply the necessary safety measures when undertaking MRI procedures.

52. The Panel therefore found this Particular proved.

Particular 1(f)

53. LMCK’s evidence was that she was working with the Registrant on 26 March 2019 when she noted that a patient had a metal dental plate. LMCK stated that some dental plates are plastic and some have metal on the sides and that it is not good practice to allow a patient into a scan room with metal on them. Instead, if a metal object can be easily removed, the patient should be asked to remove the object to minimize risk.

54. The Panel took into account that one of the questions asked when filling out the MRI safety questionnaire form is whether the patient has any dental plates. LMCK expected that at this point the Registrant would have become aware of the dental plate and asked the patient to remove it before taking them into the scan room. Because if it is metal there is the potential for it to heat up in the scanner and cause a burn to the patient, or the metal object to become a projectile if attracted to the magnetic force.

55. LMCK’s evidence was that the Registrant was trained in all of the safety checks to be carried out prior to a scan and how to carry out an MRI safety questionnaire with a patient during her initial induction. The Panel took into account that within section 3 of the Registrant’s induction checklist, she was signed off as competent in completing the patient MRI safety questionnaire. LMCK expected that the Registrant would have known how to carry this out with the patient and the need to identify the dental plate and ask the patient to remove it before taking them into the scan room.

56. At a meeting between LMCK, the Registrant and her mentor MS on 29 March 2019, as documented in the notes of that meeting, LMCK raised her concern about this incident as it had been noted that she had to intervene to ensure that the plate was removed prior to the patient entering the scan room.

57. The Panel was satisfied that the Registrant had a duty to ask the patient to remove their metal dental plate prior to the scan and that she breached that duty, and that LMCK had to intervene. The Panel was satisfied that the Registrant did not apply the necessary safety measures when undertaking MRI procedures.

58. The Panel therefore found this Particular proved.

Particular 1(g)

59. The evidence of CD was that she was mentoring the Registrant when a hospital inpatient attended for an MRI scan. The patient had a long tube coming from his skin and abdomen which was draining fluid into an external bag. CD was clear that the drain was visible and was not hidden by clothing or sheets.

60. CD identified this as a drain but this did not appear to CD to raise any alarm bells with the Registrant. CD stated this should have raised alarm bells and the Registrant would have needed to check if the drain was MRI safe. CD’s evidence was that sometimes a drain may have a metal clip on it or a metal attachment inside the patient. If a patient has a drain, the Radiographer must check the drain before conducting the scan to ensure that it is MRI safe. CD stated that if  the drain had metal in situ and the patient was moved into the MRI machine, this could have potentially caused the metal in the drain to heat up and burn the patient. Further, the metal could have been magnetic and therefore become attracted to the scanner. This would potentially cause harm to the patient. By placing the drain inside the scanner, this could have prevented the drain from doing what it was placed in the patient to do. This would require the drain to be removed and put back into the patient on the ward and therefore the Registrant’s conduct had potentially serious implications.

61. CD’s evidence was that during her initial induction period, the Registrant would have been required to read and understand the MR Local Rules. She would also have been required to read the Safety Guidelines which makes reference to the potential hazards associated with implantable devices in the MR environment and patient safety.

62. The Registrant signed her induction checklist to confirm that she read the MR Local Rules on 3 December 2018 and the Safety Guidelines. On 1 March 2019 she signed a declaration confirming she had read and understood the MR Local Rules and the Safety Guidelines. CD expected that the Registrant would have known the dangers associated with the drain in the MR environment and this would have triggered her to conduct further investigations into the drain before taking the patient into the MR environment.

63. CD’s concern was raised at a meeting with LMCK, CD and the Registrant on 26 February 2021, and is recorded in the notes of that meeting.

64. The Panel was satisfied that the Registrant had a duty to recognise that a patient with a drain would need to be checked to ensure that it was safe to proceed, and that she breached that duty. The Panel was therefore satisfied that she did not apply the necessary safety measures when undertaking diagnostic MRI procedures

65. The Panel therefore found this Particular proved.

Particular  2(a)

66. The evidence of CD was that on 4 March 2019, the Registrant told a patient to stay still and stop moving when, in fact, the patient was panicking and needed reassurance to be able to proceed with the scan. CD stated that the patient was very nervous and became clearly distressed. The Registrant spoke through the intercom system and told the patient to stay still and stop moving but did not give the patient the opportunity to respond on the intercom system. The patient was crying in the scanner and was visibly distressed, kicking her legs to get out. CD went into the patient to get her out of the scanner and she was extremely upset.

67. CD expected that the Registrant would have spoken to the patient on the intercom system, asked the patient politely to stay still, asked if the patient was okay and given the patient the chance to respond. CD stated that the Registrant did not communicate well with the patient and did not give the patient a chance to reply, nor did the Registrant recognise that the patient was extremely distressed.

68. This concern was raised at a meeting between CD, LMCK and the Registrant on 11 March 2019, the notes of which were before the Panel. In response, the Registrant is recorded to have agreed that a constant two way communication between the operator and the patient inside the scanner must be maintained.

69. The Panel was satisfied that the Registrant did not communicate effectively with the patient.

70. The Panel found this Particular proved.

Particular 2(b)

71. CD’S evidence was that on 4 March 2019, CD was sitting with the Registrant whilst the Registrant was conducting a scan. The Registrant had the intercom system on whilst scanning a patient so that the patient could hear her say that she needed to include the mass which is information that should not be shared with a patient. CD’s evidence was that the intercom system enables the Radiographer to speak to the patient whilst they are in the scanner. Whenever the Radiographer presses the button, a red light comes on to indicate that the patient can hear them speaking. This is usually used to give breathing instructions during a scan or to ask if the patient is okay. On this occasion, the Registrant had spoken to the patient and left her finger on the intercom system button. Whilst her finger was on the button, the Registrant  said, “I need to include that big mass” or words to that effect. As her finger was on the button, the patient was able to hear everything that she said. CD was unable to say if the patient did actually hear, rather the patient could have heard.

72. CD told the Panel that the patient may have come to the scan without knowing the reason for why they were being scanned. Sometimes they are informed by the referrer that they need to come for a scan but not told further detail about why. A Radiographer should be sensitive to this and conscious of what information should be communicated to a patient and how. For a patient to be lying in the scanner, and hear reference made to a “mass” can be very daunting and could scare the patient or cause them emotional distress. This may affect the quality of the images obtained if the patient is distressed or may lead to them moving in the scanner, putting the patient at risk of harming themselves. The patient may also come out of the scan and ask questions about what they heard disclosed on the intercom system.

73. CD’s evidence was that it is not within the scope of a Radiographers practice to discuss what is seen within images. A Radiographer’s job is to obtain images of the patient and ensure that these images are high quality. The results should be sent to the referrer to allow them to diagnose the patient and then to communicate this diagnosis to the patient. This is something that is emphasised during the training to become a Radiographer. CD stated that Radiographers have to be very careful what information they communicate with a patient and how they communicate this.

74. This concern was raised at a meeting between CD, LMCK and the Registrant on 11 March 2019, the notes of which were before the Panel. The Registrant is noted to have said she will be more mindful of removing her hand from the “on” button of the intercom system.

75. The Panel was satisfied that from the evidence, the patient could have heard what was said by the Registrant. The Panel was satisfied that the Registrant did not communicate effectively with the patient.

76. The Panel found this Particular proved.

Particular 2(c)

77. The evidence of MS was that during the week prior to the meeting on the 11 March 2019, an inpatient arrived in the department for a scan and he was very nervous. He was wearing a disposable top and trousers. During the scan, the patient needed to be removed from the scanner to have the electrode stickers on his chest replaced to obtain a better signal. In order to place the electrodes on the patient’s chest, the Registrant ripped the patient’s top off his chest. Whilst she did this, she did not inform the patient of what she was doing or why. Once the Registrant had gained access to the patient’s chest, she proceeded to rip off the stickers from the patient’s chest. This came as a shock to the patient who had not been informed of what the Registrant was doing or going to do and he vocalised his discomfort. During her oral evidence, it was clear to the Panel that MS had a good recollection, and she remembered that the patient reacted audibly.

78. MS’s evidence was that it was expected that the Registrant would have explained to the patient that she needed to replace some stickers on his chest to monitor his heart during the scan.

79. Further, MS stated that it is natural for a patient to automatically assume that something is wrong when the Radiographer has to stop the scan and approach them. In order to ease their anxiety, the Radiographer should always update them of the situation and explain what is being done and why. MS expected that the Registrant would have explained to the patient what she was going to do and why by explaining that she was going to change the electrodes in order to obtain a better signal.

80. The evidence of LMCK was that MS provided written feedback to her raising a concern that on 8 March 2019, the Registrant did not inform a patient that she was going to remove an Electrocardiogram (ECG) lead and proceeded to pull off the electrode from the patient’s chest and replaced it with another without advising the patient of her actions. 

81. The Panel noted that this concern was raised at the meeting between MS, LMCK and the Registrant  on 11 March 2019, the notes of which were before the Panel. The patient is described as having “yelled” and the Registrant is recorded as having agreed to be more mindful of her actions.

82. The Panel was satisfied that the Registrant did not communicate effectively with the patient and that she should have informed the patient of what she was going to do and why.

83. The Panel found this Particular proved.

Particular 2(d)

84. The evidence of CD was that on 27 February 2019, the Registrant was unable to correctly ascertain a patient’s pregnancy status following completion of the MRI safety questionnaire, causing the patient to become confused. On this day, the Registrant was completing the MRI safety questionnaire with the patient and CD was present as her mentor and able to hear. CD states that when the Registrant got to the question where she asked the female patient whether there was any possibility of pregnancy, she was unable to ascertain the patient’s pregnancy status.

85. CD’s evidence was that  normal protocol is to explain to a patient that if there was any doubt or query, the MRI scan cannot proceed. The Radiographer would also advise that once the patient had her next period or a negative pregnancy test the MRI would be able to proceed accordingly. The Registrant on this occasion, advised the patient to go to her General Practitioner (GP) and obtain an ultrasound scan as this was the only way to find out if the patient was pregnant. The Registrant then began discussing her previous experience with pregnancy tests and how she had needed an ultrasound scan to be performed.

86. CD’s evidence was that when the Registrant advised the patient to go to the GP, the patient seemed taken aback, and the Registrant was “very overexcited and forceful” with the advice she provided and it appeared to be too much information for the patient to absorb at the time. CD’s evidence was that the Registrant did not appear to realise that the way she spoke to the patient was forceful and that her tone of voice was unpleasant.

87. CD had to step in and explain that the patient was not required to attend her GP and obtain an ultrasound scan. CD stated that it is not within the scope of MRI Radiographers to advise a patient to go to their GP and get an ultrasound scan. If the patient chooses to go to her GP of her own volition, the GP is responsible for advising whether the patient should get an ultrasound scan done. Prior to an MR scan, CD stated that Radiographers need the patient to be confident that they are not pregnant and are happy to proceed. This may be helped by the patient obtaining a negative pregnancy test if they have any uncertainties. LMCK provided evidence of how she had intervened at the request of CD and completed the MRI Safety questionnaire with the patient herself which elicited a very valid reason as to how the patient knew she could not be pregnant. LMCK then provided the correct advice to the patient.

88. The Panel took into account that the MR Local Rules document how to deal with a patient and how to deal with the issue of pregnancy. Section 7.10, under patient management, sets out how to deal with a scan and pregnancy and also sets out how to determine pregnancy by setting out the questions that need to be asked of the patient, and the action required based upon those answers.

89. The Panel took into account that the Registrant had signed her induction checklist to confirm that she had read and understood these rules and therefore it is expected that she would have understood how to manage a patient and ascertain the patient’s pregnancy status. On 1 March 2019 she signed a declaration confirming she had read and understood the MR Local Rules and the Safety Guidelines.

90. In addition, CD’s evidence was that during the Registrant’s training when she commenced employment at the Trust, she would have been trained on how to complete the MRI safety questionnaire. Part of this training would have required her to watch the questionnaire being completed, as well as being observed competently completing the checklist herself. This provided the Registrant with opportunities to see how the questionnaire should be completed and how to handle a situation involving a patient who is unable to ascertain their pregnancy status. CD’s evidence was that as the Registrant also had previous experience scanning in MRI, she would have completed MRI safety questionnaires during this time and therefore it is expected that she would have known how to complete this as well as the advice that she would need to provide to a patient. The Registrant was signed off in section 3 of her induction checklist as competent in completing the MRI safety questionnaires and therefore CD expected that she would have known how to manage this patient appropriately and the correct advice to give.

91. The Panel noted that this concern was raised at the meeting between CD, LMCK and the Registrant on 1 March 2019, the notes of which were before the Panel.

92. The Panel was satisfied that the Registrant was unable to correctly ascertain the patient’s pregnancy status during completion of a safety questionnaire and  inappropriately advised the patient that they needed to see their GP to obtain an ultrasound scan. The Panel was also satisfied that she did not communicate effectively with the patient.

93. The Panel therefore found this Particular proved.

Particular 3(a)

94. The evidence of CD was that on 11 March 2019 the Registrant did not get a patient to sign their completed MRI safety questionnaire before conducting an MR scan. The Registrant completed the safety questionnaire with the patient and then did not ask the patient to sign the questionnaire. This meant that the patient was on the scan table and the scan was being undertaken without the questionnaire being signed.

95. CD’s evidence was that the concern was that the patient may then have decided to come out of the scan and refuse to sign the document despite the fact the scan had already been conducted. If the patient had gone into the machine and forgotten to mention an implant or something that should be documented on the MRI safety questionnaire and the questionnaire is not signed by the patient, the patient may escalate a complaint. The patient may argue that they were not taken through the questionnaire or provided with the relevant information that should be given to them ahead of a scan to allow them to give informed consent for the scan to proceed. This would be demonstrated by the fact that their signature is not on the document confirming that they have read the document and confirmed the accuracy of the information present. With the patient’s signature on the form, if the patient has not declared something that should be declared ahead of the MRI scan, the culpability no longer lies with the Radiographer. In this instance, the patient was asked to sign the MRI safety questionnaire form after the scan had been completed and the patient was happy to do this.

96. CD’s evidence was that it was expected that the Registrant would have known that when the safety questionnaire is completed, she should then sign it and ask the patient to sign it too. This is part of the standard process for completing the form ahead of the MRI scan being performed. CD’s evidence was that during her induction, the Registrant was trained on how to complete the MRI safety questionnaire and shown how to complete this. She was subsequently signed off as competent in completing the questionnaire within her induction checklist. It was therefore expected that she would have known that she was required to ask the patient to sign the questionnaire before conducting the MRI scan.

97. The Panel took into account that this concern was raised at a meeting on 15 March 2019 between LMCK, CD, MS and the Registrant in which it was explained by LMCK that this was an incomplete safety form.

98. The Panel was satisfied that by acting in this way, the Registrant did not adhere to safe practice when preparing patients prior to a scan.

99. The Panel found this Particular proved.

Particular 3(b)

100. The evidence of CD was that on 14 March 2019, the Registrant did not discard the used cannula following a failed attempt at cannulation and instead intended to re-use the cannula for her second attempt. CD observed this directly, as she was in the scan room with the Registrant. CD’s evidence was that normal practice is to remove the cannula and put it into the correct sharps bin. She should then have taken a brand new, clean cannula out of the packet and proceeded with a second attempt. CD’s evidence was that the Registrant put the used cannula in the tray to the side of the patient after the failed attempt, looking for a vein in the patients arm to go again and then picked up the cannula from the tray to use it again.

101. CD described this  conduct as “extremely bad practice”. CD explained that the Trust follows the  Aseptic Non-Touch Technique (ANTT) to ensure when cannulating that it is done in a sterile way and provides less risk to the patient. CD’s evidence was that as the Registrant had touched the open cannula it was no longer clean. If she had used this for the second attempt, this could have led to an infection in the patient. CD’s evidence was that the Registrant responded by saying that she only did this because the sharps bin was not nearby.

102. CD expected that the Registrant would have known not to re-use the cannula on her second attempt from her training on IV cannulation. CD’s evidence was that in order to cannulate anyone, an individual must have completed this training and received a certificate confirming that they had completed the training. CD stated that LMCK would have obtained the Registrant’s certificate before allowing the Registrant to carry out cannulation and so CD would have expected the Registrant to have been taught correct procedure during her cannulation training.

103. CD also stated that when the Registrant first commenced her employment at the Belfast Trust, she would have been required to complete training on ANTT. This is mainly e-learning conducted online. Further, within the department, as CD stated, there are posters on the ANTT which set out what to do step by step. This meant that there were several opportunities for the Registrant to know how to carry out the process. CD referred to the Registrant’s induction checklist where it is documented that ANTT was discussed with the Registrant during her first week of employment and therefore she should have been aware that this process needed to be followed.

104. The Panel took into account that in her written submissions, the Registrant denied that she had ever re-used a cannula. The Registrant also referred to the intravenous course which she had completed at St James’ Hospital, Dublin. There was a copy of the certificate of competency in the evidence provided.

105. However, as well as CD’s direct evidence, the Panel noted that this concern was raised at a meeting on 15 March 2019 with LMCK, the Registrant and CD and MS, and that the Registrant is recorded as stating that she will be more mindful and not do it again, and repeated that the reason for her action was that the sharps bin was not nearby.

106. In light of the evidence, the Panel was satisfied that the Registrant intended to re-use the cannula for the second attempt and that she did not adhere to safe practice when preparing cannulation

107. The Panel found this Particular proved.

Particular 3(c)

108. The evidence of CD was that on 14 March 2019, the Registrant did not fill the pump injector in a safe and proper manner and purged syringe tubing with contrast instead of saline.

109. CD explained that the Registrant was loading Gadovist contrast agent for a liver scan. In order to expel any air bubbles, the Registrant purged the contrast agent instead of the saline. CD identified that the line had been purged with contrast agent and not saline as the contrast value in the pump should have been 15mls. Instead, when she checked the pump she noted that there was less that 15mls in the pump. From this, she established that the Registrant had purged the tubing with contrast instead of saline. CD stated that she had to remove the syringes the Registrant had filled and discarded these as they could not be used.

110. CD stated that by purging the tubing with contrast agent and not saline this could have led to an increased dosage of contrast to the patient. The amount of contrast that should be administered to a patient is calculated based on the patient’s weight. If the patient receives more than the calculated dose, it can affect the kidney function. It could also lead to an increased risk of the patient having a reaction if they receive more than their body can take. This could have resulted in some quite serious implications.

111. CD’s evidence was that during her induction at the Trust, the Registrant would have seen many of these procedures carried out before she was able to be signed off in this competency. There is also specific training for loading the pump that the Registrant would have been required to complete. CD’s evidence was that the Registrant  would have witnessed this being carried out many times before carrying it out herself under observation. Once she was able to competently do this task herself, she would have been signed off in the competency. CD referred to the Registrant being signed off as competent under section 4 of her induction checklist and  therefore CD expected that she would have known how to carry this process out safely and correctly.

112. This issue was raised in the meeting with the Registrant on 15 March 2019 and LMCK and CD and MS. It is recorded in the notes that the Registrant recognised her mistake and agreed she should refresh her competency on filling the injector pump.

113. The Panel was satisfied that the Registrant did not fill the pump injector in a safe and proper manner in that she purged air bubbles with contrast instead of saline, and that this was not safe practice when preparing for contrast administration.

114. The Panel therefore found this Particular proved.

Particular 3(d)

115. The evidence of CD was that on 26 March 2019, whilst supervising the Registrant, the Registrant was completing the MRI safety questionnaire with a patient when the patient informed her that they had 2 hip replacements in situ. The Registrant did not, however, document this on the MRI safety questionnaire.

116. CD’s evidence was that whenever a Radiographer comes to scan a patient, the technique may need to be altered or a different series of sequences used if they have some form of implant. It was expected that bilateral hip replacements would be documented on the MRI safety questionnaire to make Radiographer’s aware. In order to ensure patient safety whilst carrying out the scan, the Radiographer may have to alter the scan accordingly. If a future Radiographer were to look back at the MRI safety questionnaire completed by the Registrant and see that the bilateral hip replacements were not noted on the safety questionnaire, it could not be guaranteed that the patient’s safety would be protected. CD confirmed that this is not good practice.

117. CD expected that the Registrant would have known that this information needed to be documented on the MRI safety questionnaire form from the training she received on how to complete the questionnaire. The Registrant was signed off as competent in completing the MRI safety questionnaire in her induction checklist and so it is expected that she would have known to do this.

118. The Panel noted that the safety questionnaire for that particular patient was not in evidence, however CD’s evidence was clear and she had directly observed the incident. Further, a blank sample document was in the hearing bundle, and it is clear that it contains a section in which one question asks about prior surgery and a second question identifies “joint replacements” with space to complete the details.

119. The Panel noted that the concern was raise with the Registrant at a meeting on  29 March 2019 between the Registrant, LMCK and MS.

120. The Panel was satisfied that the Registrant did not document that the patient had bilateral hip replacements on the MRI safety questionnaire and that this was not safe practice when preparing the patient.
Particular 4
121. The evidence of MS was that on 13 or 14 March 2019, the Registrant was unable to access a previous report on SECTRA despite being signed off as competent to use SECTRA.

122. MS expected that the Registrant would have known how to access a previous report on SECTRA, particularly as she had already been signed off as competent to use the system on her induction checklist. That document was before the Panel.

123. The Panel noted that this concern was raised in a meeting on 15 March 2019 between the Registrant, LMCK, MS and CD, and was described as an integral aspect of a Radiographer’s role.

124. The Panel was satisfied that following being signed off as being competent using SECTRA, on or around 14 March 2019 the Registrant was unable to access a previous report on SECTRA.

125. The Panel therefore found this Particular proved.

Particular 5

126. The evidence of MS was that STIR refers to a sequence of images that would be taken during a scan that would provide doctors with information relating to an underlying pathology query, or more specifically, a lesion. If there was any lesion, it would have shown up brighter on the image compared to other sequences that may be used. This would give them the ability to definitively diagnose the patient’s condition. In/out phase imaging is another sequence that is used to provide specific images to assist in diagnosing a patient’s condition. As these sequences are used to diagnose a potential lesion, if there is a query regarding a lesion for a patient, it is expected that the Radiographer would know that these sequences need to be performed.

127. MS stated that in relation to a patient on 4 March 2019, the query lesion noted on the referral request should have indicated to the Registrant that she would need to perform these sequences during the scan. The use of these sequences is a standard part of the examination and does not only apply locally. MS expected that the Registrant would have encountered this during her 4 years’ MRI experience.

128. MS also stated that when the Registrant commenced employment at the Trust she would have been trained on spinal imaging as part of her initial induction and competencies. During this time it would have been highlighted what sequences need to be utilized from different clinical indications to provide the Radiologist with the information they require for a proper diagnosis. In order to be signed off as competent in spinal imaging during an induction, a Radiographer would have to demonstrate that they can use clinical information provided to determine which sequences the Radiologist would require. The Registrant  was signed off as competent in spinal imaging in her induction checklist and therefore MS expected that she would have known that she needed to perform these sequences during this scan.

129. This concern was raised in a meeting on 11 March 2019 between the Registrant, LMCK, ad CD. The Registrant was noted to have responded that she was not aware that she should have realized that the additional sequences should have been performed, but now knew and would apply the knowledge going forward.

130. The Panel was satisfied that on or around 4 March 2019, when imaging, the Registrant did not identify the need to perform Short-TI Inversion Recovery (STIR) and in/out phase imaging.

131. The Panel therefore found this Particular proved.

Particular 6(a)

132. The evidence of LMCK was that on 25 January 2019, she witnessed the Registrant expose a female patient’s chest in the scan room whilst placing electrocardiogram (ECG) stickers on her. LMCK’s evidence was that the patient’s chest was completely exposed and the patient displayed signs of being shocked and embarrassed at her chest being exposed.

133. LMCK’s evidence was that all cardiac patients needed to have 3 ECG stickers placed on their chests. One of these would need to be placed under a female patient’s breast between the intercostal muscles. For this process, patient’s would generally lie on a table and the ECG stickers placed with little or no exposure of the patient. The gown would be opened up from the front. LMCK’s evidence was that part of the Radiographer’s role is to make the patient feel as comfortable as possible and maintain their modesty and dignity. She stated that within the department we treat each patient as we would want either ourselves or a family member to be treated. Part of this would be to ensure that the patient’s modesty is maintained. LMCK’s evidence was that such activity as placing ECG stickers on a patient’s chest should be performed in a discrete manner with little to no exposure of the female patient’s breast area. A patient will be asked to remove their underwear before the scan but this does not prevent the area being kept fully covered by the gown when carrying out the exercise of placing ECG stickers on them.

134. LMCK expected that the Registrant would have known and been aware that exposing a female patient’s chest area was not very dignified. LMCK referred to the induction process which includes patient management and how to treat a patient with dignity and respect. Under Section 2 of the induction checklist the Registrant was signed off as competent in maintaining patient dignity at all times. LMCK stated that this had been demonstrated to the Registrant and then signed off by another Radiographer and the Registrant herself. LMCK’s evidence was that maintaining patient dignity is key to the role and it is expected that the Registrant would have been aware of this.

135. The Panel noted that this concern was raised in a meeting held with the Registrant on 25 January 2019, and that LMCK advised the Registrant how to deal with placing ECG stickers with discretion.

136. The Panel was satisfied that the Registrant, when placing ECG stickers on a female patient in the scan room, completely exposed her chest, and that this did not treat the patient with dignity and respect.

137. The Panel therefore found this Particular proved.

Particular 6(b)

138. The evidence of LMCK was that on 1 February 2019, she saw that the Registrant exposed a female patient’s chest in the patient preparation area when removing electrocardiogram (ECG) stickers from her. LMCK stated that she was walking into the MRI controlled access area from the main reception area. There were front doors into the department from the corridor that lead directly into the patient reception area. These doors were automatic doors with glass panels in them. Once in the reception area, one could look directly down to another set of automatic double doors with glass panels. At some points, the doors from the main corridor are open and the patient area can be seen by anyone walking past. As LMCK walked into the patient preparation  area, the patient was seated in her wheelchair at the doors and the Registrant was undertaking the removal of the ECG stickers while the patient was holding her top up fully exposing her entire chest area.

139. LMCK did not feel that the Registrant’s actions were in keeping with maintaining patient dignity. At this point, she stated, patients are already vulnerable and do generally follow the lead of a Radiographer. It was apparent to LMCK that the Registrant asked the patient to lift her top to remove the ECG stickers and the patient had followed her instructions.

140. LMCK stated that there were numerous different things that the Registrant could have done to prevent the patient’s chest being exposed. Firstly, there was a cordoned off area in the department with a curtain. The Registrant could have taken the patient into this area to remove the stickers. Further, there was a divider that could have been put up at the doors to the department. This would have obscured the view of anybody walking past and looking into the department through the doors. 

141. LMCK reiterated that patient dignity was part of the induction process and so she expected that the Registrant would have known how to maintain this patient’s dignity whilst removing the ECG stickers.

142. The Panel took into account that the previous week LMCK had a spoken to the Registrant about maintaining patient dignity in similar circumstances, and she had agreed to ensure this would be the case going forward, however, the following week the issue was identified again.

143. The Panel saw the notes of issues discussed between the Registrant and LMCK during the week commencing 28 January 2019, in which the incident in Particular 6(b) was raised, and the Registrant is recorded as agreeing with LMCK’s observations and agreeing to implement them in the future.

144. The Panel was satisfied that the Registrant removed ECG stickers from a female patient’s chest while the patient was sitting in a wheel chair with her top rolled up in view of the main waiting area and corridor, and that this did not treat the patient with dignity and respect

145. The Panel therefore found this Particular proved.

Particular 6(c)

146. The patient involved in this Particular was the same patient as in 2(c). The Panel took into account the evidence of MS which it considered in respect of that charge, which included MS’s evidence that the Registrant ripped the patient’s disposable to gain access.

147. The evidence of LMCK was that here were two options to maintain the patient’s dignity. Firstly, before taking the patient into the scan room, the Registrant could have asked the patient to put one of the gowns on in place of the disposable top. This would allow easy access to the front of the patient’s chest. Secondly, the Registrant  could have obtained access by lifting the patient’s disposable top up in the scan room and not ripping it.

148. LMCK told the Panel that patient dignity is part of the induction process and the Registrant had been signed off as competent in maintaining patient dignity at all times. LMCK expected that the Registrant would have been aware that ripping the patient’s disposable top would not be considered as acceptable, or respectful of the patient’s dignity.

149. The Panel was satisfied that this event occurred, and that that this did not treat the patient with dignity and respect.

150. The Panel found this Particular proved.

Particular 7

151. The evidence of LMCK was that on 26 March 2019, the Registrant was unable to ascertain the MRI safety status of stents inserted on 2 occasions in 2 different patients. Stents are tubes that are inserted into a patient’s vessels. Some stents are plastic and are MRI safe but some are metal. Metal stents are further divided into MR conditional and MR unsafe. It is important that stents are looked into and researched prior to taking a patient into the MRI scan room.

152. LMCK’s evidence was that with any form of foreign body in a patient, a radiographer has to be certain of the safety status of that implant prior to taking the patient into the MRI scan room. If there is any doubt in a Radiographer’s knowledge of the safety status, he or she should not take the patient into the scan room. This is highlighted in both the MR Local Rules  and the Safety Guidelines.

153. The evidence of LMCK was that a Radiographer should check what surgery or intervention a patient has had prior to arriving at the hospital with stents inserted. To do this, they would look up what surgeries the patient has previously had done on the electronic care records system. This may or may not identify the type of stents that the patient has inserted. They may also refer to the Radiology Information System (RIS) for a neighbouring hospital to identify any procedures the patient had done at that hospital. They can also check the system for any other MRI procedures the patient may have had done to see if the Radiographer had already gathered the information regarding the stents and recorded it on the system. LMCK further stated that if a Radiographer is able to obtain the name of the stents, he or she may then refer to MRIsafety.com, a website that is accepted and utilised by MRI Radiographers. This website has been devised by experts who are approved in the field of MRI and can be useful if you know the exact name of the stent. The Radiographer could also refer to the manufacturer’s website. If the Radiographer is unable to obtain the information and cannot guarantee the patient’s safety coming into the scan room, they may have to follow up with the doctor who inserted the stents. Sometimes, this requires the Radiographer to go back as far as the patient’s General Practitioner (GP) to see if they have any further information.

154. LMCK stated that given the point of the Registrant’s training and where she was within her induction, LMCK would not have expected her to be able to go and carry out that research into the stents independently. Her expectation would, however, have been for her to recognise that the patient had stents inserted, a question which is set out in the MRI safety questionnaire. LMCK then would have expected the Registrant to bring this to the attention of a senior MRI Radiographer and ask whether these stents were MRI conditional. Her expectation, therefore, was that the Registrant would recognise that stents were in place, that they may impose a safety concern and be able to raise that with a more senior MRI Radiographer.

155. LMCK stated that she would have expected the Registrant to have known to do this as she signed her induction checklist (Exhibit 32) to confirm that she had read and understood the MR Local Rules and MHRA Guidelines for MRI. These documents both allude to the need to check the safety status of stents prior to conducting a scan.

156. The Panel took into account that this concern was raised in the notes of the meeting between LMCK, MS and the Registrant on 29 March 2019.

157. The Panel was satisfied that the Registrant did not identify on one or more occasions that the status of stents should be established prior to completing an MRI.

158. The Panel found this Particular proved.

Particular 8(a)

159. The evidence of CD was that during the weekly meeting with the Registrant on 11 March 2019 CD raised a concern that during that week, the Registrant had experienced difficulty identifying the Common Bile Duct (CBD) on an image and was only able to do this after 2 attempts.

160. CD’s evidence was that Magnetic Resonance Cholangiopancreatography (MRCP) imaging is used to look at the biliary system. This includes the common bile duct, gall bladder and pancreas. The majority of these scans are to assess the CBD for dilation of the pancreatic duct or the CBD. These scans were common in CD’s  department and CD’s evidence was that the Registrant would have seen these carried out throughout the department several times, as well as performing them herself. CD would have been expecting the Registrant to be able to identify the CBD on this scan. This was particularly so, because, as CD recollected, the CBD was inflamed and easy to see.

161. CD stated that when the Registrant commenced employment at the Trust she would have been shown how to carry out some MRCP scans. This would at first give her the opportunity to see other Radiographer’s carrying out the scan before she carried them out herself. CD recalled several occasions where she showed and talked through anatomy with the Registrant. CD said that many times CD had shown the Registrant anatomy on images and pointed out the CBD to her. CD expected the Registrant to be able to identify the CBD on this scan with the patient but she seemed unable to.

162. The Panel read the notes of the meeting on 11 March 2019 at which the concern was raised.

163. The Panel was satisfied on the basis of the evidence that in or around the week commencing 4 March 2019 the Registrant experienced difficulty identifying the CBD on an image and was only able to identify this after 2 attempts.

164. However, the Panel considered carefully whether this inability was due to a struggle to maintain competency and/or anatomical knowledge associated with MRCP. The Panel was not satisfied that this was the case. There was insufficient evidence as to why the Registrant was unable to  identify the CBD until after 2 attempts. It was likely that there could have been a number of reasons, and the Panel was not satisfied that this was because of problems with her competency or anatomical knowledge, given the small number of attempts.

165. The Panel therefore found this Particular not proved.

Particular 8(b)

166. The evidence of CD was that during the weekly meeting with  the Registrant on 26 February 2019 she raised a concern that during that week, the Registrant demonstrated an inability to appreciate which field of view needed to be increased to ensure the accurate region of interest was captured.

167. CD recalled several occasions when the Registrant failed to open her field of view to image correctly. CD stated that the Registrant was expected to include the correct areas and therefore needed to open her field of view to do this.

168. CD referred to a  training manual that sets out the Trust’s protocols with images and stated that if the Registrant had any queries or was unsure of what part of the anatomy was visible on a scan, she could have referred to the training manual known as the work instructions for Mater MRI. It included detailed information on the departmental protocols and how to set these up. This included information on where positioning should be on certain images. CD stated that the training manual was kept on a shelf in the control room in a blue folder. CD stated that it was easily accessible to all team members, and the Registrant would have been aware of this manual as it was shown to her many times during the course of her employment and training. CD stated that during these scans, the Registrant did not refer to the training manual, nor did she ask CD for help, which would have been expected if she was struggling.

169. CD’s evidence was that if the region of interest was not captured on her scans, this would have led to the patient having to be recalled for a scan. This is because the images that would have been captured would not have assisted the referring doctor in diagnosing the patient’s condition and the patient would then have had to return for another scan to be performed. This would cause a delay in the diagnosis and treatment of that patient.

170. The Panel took into account that the Registrant’s inability to appreciate which field of view needed to be increased occurred on more than one occasion, according to the evidence of CD. It was the repeated nature of this inability that led the Panel to conclude that this was due to a struggle to maintain competence, although the Panel was not satisfied that there was sufficient evidence that the Registrant struggled to maintain her anatomical knowledge specifically.

171. The Panel therefore found this Particular proved on the basis of a struggle to maintain competence.

Particular 8(c)

172. The evidence of MS was that during the capability meeting on 11 March 2019 she raised a concern that, on 4 March 2019, the Registrant took 30 minutes to perform an MRCP scan which should usually only take between 10 – 15 minutes to perform.

173. MS’s evidence was that an MRCP scan is considered a basic scan and newly appointed MR Radiographers start off by learning how to complete these scans. MS stated that it is considered to be a basic skill and would have been learnt during initial training. When performing an MRCP scan, each Radiographer is given a 20 minute time slot to complete that scan with the patient. This time includes the time spent completing the MRI safety questionnaire, getting the patient changed, setting the patient on the scanner, scanning, getting the patient out of the scanner and turning the room around for the next patient. The time spent actually scanning the patient should therefore only take around 10 – 15 minutes. Therefore it is expected that the patient will arrive and leave the department all within the 20 minute time frame.

174. The Panel was satisfied from the evidence of MS that on 4 March 2019 the Registrant took 30 minutes to perform a MRCP scan which should typically take approximately 10 minutes. However, the Panel could not be satisfied from this one instance on that one date, that this length of time taken for the scan was due to the Registrant’s struggle to maintain competency and/or anatomical knowledge.

175. The Panel therefore found this Particular not proved.

Particular 9

176. The evidence of CD was that during the weekly meeting with the Registrant on 26 February 2019, she raised a concern that on 20 February 2019, the Registrant was unable to identify wrap which appeared on her LVOT2 view whilst she was undertaking a cardiac scan under supervision.

177. CD’s evidence was that wrap is a large artefact that appears on an image and is easily identifiable. Wrap can occur on all MRI images and it is important that a Radiographer is able to identify wrap. On this occasion, the Registrant was conducting an MRI cardiac scan and  LVOT view refers to a view of the Left Ventricular Outflow Tract. CD’s evidence was that it is common that a Radiographer will have to increase their field of view on this sequence in order to capture everything within the area of the field of view. Wrap on this particular view is easy to see as it prevents being able to see the structure you are looking at with wrap on the image. Instead, the image will appear to wrap back on itself and the image will not be clear at all. This will happen if the box showing the field of view is filled too much. Images with wrap will obscure the information contained within the scan and this would prevent the Cardiologist from obtaining the relevant information they require.

178. CD’s evidence was that in this scan, the structure was not within the field of view and this caused the Registrant to have wrap. To eradicate this, CD ‘s evidence was that the Registrant should have increased her field of view. CD’s evidence was that the Registrant did not identify that there was wrap on the image and CD had to instruct her to repeat the image.

179. CD’s evidence was that it is common that the field of view needs to be increased on the LVOT view and this would have been demonstrated and explained to the Registrant during her induction training, which would have included training about wrap and how to deal with it. CD confirmed that in her induction checklist, the Registrant was signed off in cardiac scanning and therefore she should have been competent to recognise wrap on the scan, alter the field of view to remove the wrap and take a new image without wrap. CD’s evidence was that the knowledge of wrap and the need to increase the field of view to eradicate wrap on an image would come from both MRI experience and training, both of which are things that the Registrant had. CD’s evidence was that  wrap is something that appears on scans across all MRI scans and therefore she would have at least expected the Registrant to have been able to identify this.

180. On the basis of the evidence the Panel was satisfied that the Registrant was unable to identify the wrap and that she had to be prompted to repeat the image.

181. The Panel therefore found this Particular proved.

Particular 10(a)

182. The evidence of CD was that during the weekly meetings with the Registrant on 11 March 2019 and 15 March 2019, she raised a concern that the Registrant had experienced difficulty in identifying breathing artefact on liver sequences and thus when to repeat scans, meaning that the images were poor quality. As a consequence, the Radiologist may have missed something or not been able to obtain all of the information from the image that they required. As a result, the patient would have to be recalled and the scan redone to capture better quality images to allow the Radiologist to obtain the relevant information.

183. CD’s evidence was that she would have expected the Registrant to be able to identify breathing artefact on the images from her MRI experience. CD stated that breathing artefact is something that an MRI Radiographer with experience should be able to identify. Further, when the Registrant commenced employment at the Trust, she watched CD and MS conduct  scans and then they sat with her whilst she performed some. The Registrant would also have seen artefact within the department whilst other Radiographers were working. If a patient was breathing during a scan, this would have been shown to her as part of her learning.

184. The evidence of MS was that during the capability meetings on 11 March 2019 and 15 March 2019, she raised a concern that the Registrant was experiencing difficulty identifying breathing artefact on liver images.

185. MS’s evidence was that when the Registrant was conducting liver scans under her supervision, she did not seem able to identify breathing artefact on the scan or the need to repeat the scan because of the breathing artefact. MS stated that she had sat down with the Registrant on numerous occasions and brought up different images where there was motion artefact caused by breathing on the liver scans. MS’s evidence was  that as a response to MS and LMCK identifying that this was an area that she needed to improve on, both MS and LMCK had gone over lots of images with the Registrant to try to help her identify if there was breathing artefact on the images.

186. MS stated that the Registrant would have been trained on how to carry out a liver scan during her initial induction training. Part of this training would have included training on how to recognise breathing artefact on an image. On her induction checklist the Registrant was signed off as competent for conducting liver scans. Therefore, MS expected that the Registrant would have been able to identify breathing artefact on a liver scan and know when a scan needed to be repeated.

187. Further, the evidence of LMCK was that she identified from the folder set up on SECTRA that the Registrant was already carrying out a number of these liver scans. She was concerned that the Registrant was unable to fulfil these competencies as she had identified that she was getting exposure to these scans.

188. The Panel was satisfied that the Registrant demonstrated difficulties in completing liver scans in that she experienced difficulty in identifying breathing artefact on liver sequences and thus when to repeat a scan.

189. The Panel therefore found this Particular proved.

Particular 10(c)

190. The evidence of CD was that during the weekly meeting with the Registrant on 26 February 2019 she raised a concern that during that week, the Registrant was unable to identify motion artefact on coronal images whilst completing a liver scan with Gadovist contrast agent. CD had to bring it to the Registrant’s attention and instruct her to repeat the image. The Registrant was not able to identify motion artefact on the images and was not able to identify the need to retake the image.

191. CD expected that the Registrant would have known how to identify motion artefact on the scan and the need to retake the image from the training that she had received during her induction. CD stated that the Registrant had watched CD and MS, her mentors, carry out liver scans and they had sat with her to complete a couple of scans. As the Registrant also had prior experience as an MRI Radiographer, CD would have expected her to be able to identify artefact on a scan as this is easy to identify and therefore she should have known to retake the image if artefact is present.

192. CD raised this concern at the capability meeting on 26 February 2019, and in the notes of that meeting, the Registrant is recorded as agreeing with the feedback from CD.

193. The Panel was satisfied that on one or more occasions when completing a liver scan with Gadivist contrast agent, the Registrant was unable to detect motion artefact on the coronal images and identify the need to redo the images, and this therefore demonstrates difficulties in completing liver scans.

194. The Panel therefore found this Particular proved.

Decision on Grounds

195. The Panel had regard to the submissions of Ms Penfold, both oral and in writing, who submitted, by way of primary submission, that the matters found proved constituted misconduct. She submitted that if the Panel did not agree, the Panel should find lack of competence.

196. The Panel was aware that there is no burden of proof on either party at this stage. The Panel accepted the advice of the Legal Assessor

197. The Panel was aware that  breaches of relevant professional Standards in themselves do not necessarily mean that the Registrant’s actions constitute misconduct.

198. In respect of the findings on fact, the Panel was of the view that the Registrant breached the following Standards:

HCPC Standards of conduct, performance and ethics

- Standard 1 – promote and protect the interests of service users and carers

- Standard 2 – communicate appropriately and effectively

- Standard 3 – work within the limits of your knowledge and skills

- Standard 6 – manage risk

Standards of Proficiency for Radiographers

- Standard 1 – be able to practise safely and effectively within their scope of practice

- Standard  3 – be able to maintain fitness to practise

- Standard 4 – be able to practise as an autonomous professional, exercising their own professional judgement

- Standard 8 – be able to communicate effectively

- Standard 9 - be able to work appropriately with others

- Standard 10 – be able to maintain records appropriately

- Standard 11 – be able to reflect on and review practice

- Standard 12 - be able to assure the quality of their practice

- Standard 13 – understand the key concepts of the knowledge base relevant to their profession

- Standard 14 – be able to draw on appropriate knowledge and skills to inform practice

- Standard 15 – understand the need to establish and maintain a safe practice environment.

199. The Panel took into account that the Registrant was the subject of an informal capability process, and that therefore the Trust was dealing with concerns about the Registrant’s practice as competency issues. However, the Panel also took into account the evidence of the Registrant’s previous experience. In the evidence before it, there is a handwritten note produced by the Registrant which lists her past experience, refers to 20 years of experience as a Radiographer, 4 years specifically as an MRI Radiographer, and lists various fields of experience, which are comprehensive. The Panel also took into account the evidence of the induction and training. The Registrant’s induction checklist was before the Panel, which was a detailed document, and showed areas of practice in the department  in respect of which she had been signed off as competent.

200. The Panel also took into account the evidence of LMCK, MS and CD, both oral and in their witness statements, as well as the notes of meetings with the Registrant and the accompanying Action Plans, which made numerous references to the Registrant’s inconsistency in her work. In particular, the Registrant would appear competent and do well on one day, but on the next occasion, she would not demonstrate the same knowledge and practice. None of the witnesses could give an explanation for this lack of consistency in the Registrant’s work. For example, MS stated in her witness statement that there appeared to be a pattern of the Registrant lacking consistency throughout her employment at the Trust. One day she would be fine completing a competency but the next day it would be as if she had never done it before and she had no knowledge of where to begin. It often appeared as though her competencies were regressing.

Particulars 1(a) –(c), (e) –(g)

201. The Panel carefully considered these factual findings which are all associated with  omitting to deal with metallic objects either in or on a patient’s body. The Panel was of the view that these omissions (including the breaches of duty in 1(f) and (g)) demonstrated a very basic inability to notice and deal with metallic objects which the Registrant should clearly have been aware of, and known how to deal with them. She had had training and had been signed off as competent in respect of the use of SECTRA, as well as the MRI safety questionnaire, and the MHRA Safety Guidelines for MR which referred to the need to use a testing magnet in relation to visible metal objects, as well as how to deal with implanted devices. It appeared to the Panel that not advising the patient to remove her boots in 1(e) was something that she clearly would have known to do, as a matter of common practice as a qualified Radiographer.

202. The Panel considered that the omissions were in relation to very basic knowledge and skills, and that there was no reason to expect that the Registrant did not have knowledge or skill to take the required steps. In addition, she put each patient at a  risk of harm by her actions as a result of the risks arising out of the metal in or on their bodies. This was clear from the witness evidence. In all the circumstances, the Panel considered that the Registrant fell far below the standards expected of her, and the omissions exhibited were serious. Therefore the matters found proved constituted misconduct.

Particular 1(d)
 
203. The Panel noted that this factual finding was different from the rest of the findings in Particular 1 as it related to patient safety on a moving table. The Panel was of the view that while the Registrant should have taken more care, this in itself was not so serious that it constituted misconduct.

204. However, this finding related to safety measures as did the rest of the findings in Particular 1, and therefore it was appropriate to view it cumulatively with them. In so doing, and taken together, the Panel was of the view that it did fall so far below what was expected that it constituted misconduct.

Particular 2(a) – (d)

205. The Panel was of the view that all of these findings related to the basic and fundamental need to communicate well with patients. This is a requirement of all health professionals, regardless of specific training. With regard to Particulars (2 (a) and (c), there was a basic requirement to speak clearly, effectively and with empathy to patients. With regard to Particular 2(b), the Registrant was not mindful or careful of what she said in front of the patient, and this could have caused significant  emotional harm. In respect of Particular 2(d), there was an inability to follow the training and the MR Local Rules, which would have told the Registrant which questions to ask about potential pregnancy, and how to act depending on the answer obtained. The Registrant signed her induction checklist confirming that she read the MR Local Rules.

206. The Panel was of the view that these factual findings were in respect of basic and fundamental skills which the Registrant should have implemented in the circumstances. The patients were put at risk of distress or emotional harm as a result of her actions and omissions. The omissions exhibited were serious and fell far below the standards expected of the Registrant, and therefore these matters found proved constituted misconduct.

Particular 3(a) – (d)

207. Once again, in respect of all of these failings, the Registrant had received a significant amount of training. In addition, the failings relate to basic and fundamental skills required of a registered radiographer. In respect of 3(a), the Registrant did not ask the patient to sign the MRI safety questionnaire before the scan began. This was a requirement which should have been obvious as matter of common practice, and the Registrant had been trained in its use and observed its completion by other radiographers many times. Her training in the use of the MRI safety questionnaire as well as having been signed off as competent in its use was relevant to Particular 3(a) and (d).  With regard to 3(b), the reason which the Registrant gave for her action was that the sharps bin was too far away. This was, it appeared to the Panel, an unmeritorious excuse. She had received sufficient training on cannulation and had been signed off as competent. The Registrant had also received training in ANTT. With regard to 3(c), the training which the Registrant had received is documented and she had performed that action under supervision multiple times, and had been signed off as competent.

208. The Panel considered that the omissions were in relation to basic knowledge and skills, and that there was no reason to consider that the Registrant did not have the knowledge or skill to take the required steps. In addition, she put patients at a risk of harm as set out by the witness evidence. In all the circumstances, the Panel considered that the Registrant fell far below the standards expected of her, and that the matters found proved constituted misconduct.

Particular 4

209. The Registrant  had been signed off as competent in the use of SECTRA and there was no evidence that she did not know how to use it. The Panel considered this omission carefully and came to the conclusion that on its own it was not so serious that it constituted misconduct. Nor was the Panel satisfied that this was a matter of lack of competence, as  there was no reason to consider that the Registrant did not have knowledge or skill to find a report on SECTRA. Furthermore, there is not a fair sample of the Registrant’s work before the Panel in order to make a finding on a lack of competence.

210. The Panel therefore decided that this Particular did not amount to either misconduct, or a lack of competence.

Particular 5

211. The Panel was of the view that this was a core skill of an MRI Radiographer and the Registrant had had significant training and supervision, and had been signed off as competent. The Panel considered that there was no reason to consider that that the Registrant did not know how to identify the required technique. The potential implications of her omission were serious, and could have given rise to  delay and/or incorrect diagnosis, leading to a risk to patients. The Panel decided that the Registrant fell far below the standards expected of her and that this matter found proved constituted misconduct.

Particular 6 (a) - (c)

212. All these findings related to a lack of basic communication, empathy and respect of patients, which should have been demonstrated by the Registrant in the circumstances. It was of note that the Registrant had been signed off in relation to patient dignity and respect on her induction checklist. This was not a matter of a lack of competence. The Panel found that the Registrant fell far below the standards expected of her and that this matter found proved constituted misconduct.

Particular 7

213. It appeared to the Panel that it was a basic and fundamental part of the practice of a radiographer to be aware that stents could be a problem to a patient undergoing an MRI scan and to seek further advice prior to that scan. The obligation on the Registrant was not that she herself had to establish the actual status of the stent but rather that she should have recognised that there was a need to establish the status of the stents, and that she should have sought advice. As made clear in the evidence of LMCK, the expectation was that the Registrant would recognise that stents were in place, that they may impose a safety concern and be able to raise that with a more senior MRI Radiographer. MR Local Rules and the MHRA Safety Guidelines for MR, both allude to the need to check the safety status of stents prior to conducting a scan.

214. The Registrant’s omission created a risk of harm to the patient.

215. The Panel found that the Registrant’s lack of identification of this issue fell far below the standard expected of her, and constituted misconduct.

Particular 8(b)

216. The Panel was aware that this finding was on the basis that the Registrant struggled to maintain competency. This led the Panel to discount misconduct as a ground at this stage. However, when it came to lack of competence, although the Panel was told that this happened on one or more occasion, the evidence before the Panel did not go into sufficient detail of each occasion, how many times and what precisely happened on each occasion for the Panel to make a finding on the ground of lack of competence. Therefore as the Panel did not have evidence of a fair sample before it, the Panel could not conclude that this amounted to a lack of competence.

Particular 9

217. The Panel took into account that cardiac MRI scans are a specialist area in MRI and the evidence before the Panel was that Mater hospital was one of 3 specialist hospitals in this particular area of Northern Ireland which undertook such scans. However, the Panel took into account that the Registrant had undertaken significant training in this area of scanning and that the presence of wrap was a fundamental feature of any MRI scanning which the Registrant, with her experience and training should have easily been aware of. Recognition of wrap on an image and subsequent repetition of the image to improve clarity are fundamental skills of an MRI radiographer. The Panel was of the view that this was not an issue of lack of competence. The Registrant’s lack of identification of the wrap and the need for her to be prompted to repeat the image gave rise to a potential risk to patients, fell far below the standard expected of her and constituted misconduct.

Particular 10(a) and (b)

218. The Registrant had declared in her handwritten note her experience in carrying out liver scans during her previous 4 year MRI experience. She had received training on how to carry out a liver scan during her initial induction training, including training on how to recognise breathing artefact on an image. On her induction checklist the Registrant was signed off as competent for conducting liver scans. There was no reason to consider that the Registrant did not have the skills and knowledge to identify breathing artefact on a liver scan and know when a scan needed to be repeated. Her omission led to a risk of a lack of a diagnostic-quality imaging, and a risk of misdiagnosis which gave rise to a risk to patients. In addition, there was a risk that the patients would have to be recalled and the scan repeated.

219. The Panel was of the view that this was not an issue of lack of competence, and that Registrant’s omission fell far below the standard expected of her, and constituted misconduct.

Decision on Impairment 

220. The Panel considered  Ms Penfold’s submissions, both oral and written,  that the Registrant is impaired on both the personal and public components.  The Panel accepted the advice of the Legal Assessor. The Panel took into account the HCPTS Practice Note entitled “Finding that Fitness to Practise is ‘Impaired’”. The Panel was aware that impairment is a matter for its own independent judgment and that public protection and the wider public interest should be considered.

221. The Panel accepted the advice of the Legal Assessor who referred to CHRE v (1) NMC (2) Grant [2011] EWHC 927.

222. The Panel was of the view that the Registrant’s written submissions do not suggest any insight into the matters found proved. Nor is there any evidence of reflection. However, there was some insight shown by her at the meetings with her manager and mentors in that she often accepted feedback and stated that she would make changes going forward. However, there is no evidence before the Panel of any steps taken by the Registrant to address the matters found proved, for example such as undertaking further training, since she resigned from the Trust.

223. The Panel took into account the questions formulated by Dame Janet Smith in the Fifth Shipman report, as set out in the case of CHRE v (1) NMC and (2) Grant  [2011] EWHC 927, which are presented in Grant  as a test of impairment and ask whether a practitioner:

“a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or

d. [this final question relates to dishonesty which is not an issue in this case].

224. The Panel decided that, in respect of the misconduct found proved, the Registrant had put patients at an unwarranted risk of harm, brought the profession into disrepute and breached fundamental tenets of the profession.

225. In light of the lack of any evidence of sufficient insight, or any evidence of reflection or remediation shown by the Registrant, the Panel was satisfied that the risk of repetition was real, and therefore the Registrant is  liable to put patients at an unwarranted risk of harm, bring the profession into disrepute, and to breach fundamental tenets in the future.

226. In light of the Registrant’s past misconduct, the lack of sufficient insight, remediation and the ongoing real risk of repetition of such misconduct, the Panel was satisfied that a reasonable well-informed member of the public, with knowledge of all the facts and circumstances, would be seriously concerned if the Registrant were to be allowed to practise without restriction. The Registrant has not sought at any time to address the concerns since her resignation, and her engagement with the regulatory process has been limited. In all the circumstances, the Panel was therefore satisfied that the need to uphold proper professional standards of conduct and to maintain public confidence in the profession would be undermined if a finding of impairment were not made.

227. The Panel therefore found the Registrant’s current fitness to practise to be impaired on the basis of both the personal and public components.

Decision on Sanction

228. The Panel took into account the submissions of Ms Penfold, both written and oral, who referred to the HCPC’s Sanctions Policy (SP), and took the position that the kind of sanction to be imposed is a matter for the Panel.

229. The Panel took into account all of the evidence before it, its previous determinations, and the Registrant’s written submissions.

230. The Panel considered the SP and accepted the advice of the Legal Assessor. The Panel was aware that the aim of any sanction is not to be punitive. Rather, the aim is to protect the public and uphold the public interest. Sanction is a matter for the independent judgment of the Panel. The Panel took into account the principle of proportionality in coming to its decision on sanction.

231. The Panel identified the following aggravating factors:

i. a lack of evidence of insight, remorse or apology and remediation demonstrated for the purpose of this hearing;

ii. a repeated pattern of unacceptable practice;

iii. inconsistency in practice;

iv. a real risk of repetition.

228. The Panel identified the following mitigating factors:

i. the lack of any previous regulatory findings against the Registrant, and therefore that she was previously of good character;

ii. the conduct was not premeditated or malicious.

229. The Panel took into account the Registrant’s previous good character, as well as the fact that she had engaged with the capability process and is recorded numerous times as having accepted feedback from her mentors and manager and expressed a wish to apply the feedback going forward. There was no evidence that the Registrant had any underlying attitudinal issues.

230. However, the Panel was also of the view that the misconduct was at a relatively high level on the spectrum of seriousness in that the Registrant breached multiple professional standards, and her misconduct ranged across fundamental areas of practice. This included basic safety concerns as well as failing to respect patients, their dignity, and wellbeing on a number of occasions. Further, there was ongoing, repeated behaviour, despite significant support and supervision.
 
231. While there was some insight shown by the Registrant at the meetings with her manager and mentors in that she accepted feedback and stated that she would make changes going forward, there was no current evidence of insight or remediation which was presented to the Panel. As such, the Registrant has demonstrated insufficient insight as set out in the Panel’s decision on Impairment. The Registrant’s written submissions (to the Investigating Committee Panel) do not demonstrate insight, or any reflection on the impact of her misconduct on colleagues, patients, the profession and the general public. Instead, the written submissions contain numerous denials, and refer to ill-treatment, discrimination and lack of acceptance of her as part of the team by her colleagues at the Trust. The Panel noted in written evidence that the Registrant had not raised these issues during the Trust’s capability process. It probed these issues during witness evidence, but in light of the responses and the non-engagement of the Registrant at the hearing, the Panel was not able to substantiate these claims.

232. The Panel discounted taking no further action because the misconduct was too serious for such an outcome, and the lack of a sanction would not satisfy the need to protect the public or uphold the public interest in this case.

233. With regard to a caution, the SP states at paragraph 101:

“A caution order is likely to be an appropriate sanction for cases in which:

• the issue is isolated, limited, or relatively minor in nature;

• there is a low risk of repetition;

• the registrant has shown good insight; and

• the registrant has undertaken appropriate remediation.”

234. The Panel was of the view that a Caution Order is not appropriate or proportionate because the misconduct was not isolated or minor in nature, there was only limited insight shown in the past during the capability process, and nothing subsequent to the Allegation. The Panel has already decided that there is a real risk of repetition.
 
235. The Panel next considered a Conditions of Practice Order but was satisfied that this would not be appropriate. The Registrant has not attended this hearing, and there is no indication that she would be willing to comply with conditions. In addition, the Registrant was subject to significant support and supervision at the Trust, and continued to fall far below the professional standards expected of her. Her attitude seemed reactive rather than proactive, in that she would accept feedback and state that she would remember it in the future, yet would make the same mistakes in the following days and weeks. She was described as not asking for help, when it was clear that she needed it when she was being supervised by a mentor. In addition, LMCK, CD and MS, all senior members of staff who worked closely with her on a day to day basis, remarked on the inconsistency of her practice, and the reason for this was never understood by the witnesses. It was clear from their evidence, and the documentary evidence such as the notes of the capability meetings, that there were many instances of the Registrant performing particular procedures well on one occasion, and failing to do so on the next occasion. Furthermore there is no evidence of the Registrant identifying or engaging in remediation or development other than that which was directed by her manager and mentors. The Panel considered if it was appropriate to impose conditions of practice solely relating to MRI. However, the failings applied to fundamental areas of the practice of a radiographer including basic safety concerns as well as failing to respect patients, their dignity, and wellbeing in fundamental ways. In all the circumstances, the Panel decided that conditions of practice would not protect the public, nor would they be sufficient to uphold the wider public interest.

236. The Panel next considered a Suspension Order and considered paragraph 121 of the SP:
“A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:
• the concerns represent a serious breach of the Standards of conduct, performance and ethics;

• the registrant has insight;

• the issues are unlikely to be repeated; and

• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.”

237. The Registrant’s misconduct represents a serious breach of the relevant standards. While there is some evidence of insight, this was insight shown in the past during the capability process, and there is a real risk of repetition. However, Panel also took into account that the Registrant was previously of good character, and that she had previously engaged with the capability process over some months, and had been prepared to accept feedback on a regular basis. There was no evidence that her misconduct was premeditated or resulted from attitudinal problems. In applying the principle of proportionality to the individual circumstances of this case, the Panel was satisfied that a Suspension Order was sufficient to protect the public, as well as being sufficient to uphold the public interest in this case. In light of these factors, the Panel was satisfied that a Suspension Order is appropriate and proportionate.

238. The Panel concluded that to impose a Suspension Order for one year is appropriate and proportionate, because it reflects the seriousness of the misconduct, the lack of evidence of current insight, the absence of evidence of remediation since the Registrant resigned from the Trust, and the real risk of repetition of the misconduct. In light of the factors which the Panel has taken into account, as set out above, such duration will also sufficiently address the need to maintain public confidence in the profession and the regulatory process, uphold proper standards, and send a clear message that such conduct is unacceptable. This duration was also considered sufficient to allow the Registrant time to undertake further reflection, training and professional development to evidence remediation. The Panel was satisfied that such an outcome is a proportionate result when weighing these various factors in the balance.

239. The Panel considered paragraphs 130 and 131 of the SP:

“A striking off order is a sanction of last resort for serious, persistent, deliberate or reckless acts…

A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant:

• lacks insight;

• continues to repeat the misconduct or, where a registrant has been suspended for two years continuously, fails to address a lack of competence; or

• is unwilling to resolve matters.”

240. In the Panel’s view, while the Registrant has not demonstrated evidence of current insight, and the misconduct was serious. In light of the Registrant’s previous good character, and the Registrant’s previous engagement with the capability process, during which she demonstrated some insight into the failings in her practice, the Panel decided that a Striking Off Order would be disproportionate at this stage.

241. In coming to its decision, the Panel took into account the principle of proportionality, and the impact that a Suspension will have on the Registrant’s right to practise her profession, as well as the reputational and the financial impact. However, the Panel decided that the need to protect the public and uphold the public interest meant that a Suspension Order for one year is proportionate.

242. The Panel was of the view that a future Panel reviewing the Suspension Order may be assisted by the following:

i. the Registrant’s attendance at the review of the Suspension Order, whether in person or remotely (such remote attendance being a matter for the management of the HCPTS);

ii. a recent reflective statement written by the Registrant demonstrating an understanding of the impact of the misconduct on patients, colleagues, and public confidence in the Registrant herself and the profession as a whole;

iii. recent testimonials or references in respect of employment whether paid or unpaid;

iv. evidence of further training and CPD.

243. The Panel therefore decided to impose a Suspension Order for a period of one year.

Order: The Registrar is directed to suspend the registration of Mrs Petya Sommerville for a period of 12 months from the date this Order comes into effect.

Interim Order

1. The Panel heard an application from Ms Penfold for an 18 month Interim Suspension Order to cover the appeal period. She submitted that such an order is necessary to protect the public and is in the public interest.

2. The Panel considered the HCPTS’s Practice Note entitled “Interim Orders” as well as Paragraphs 133-5 of the Sanctions Policy. The Panel accepted the advice of the Legal Assessor.

3. The Panel decided whether or not hear the application for an interim order in the absence of the Registrant. In deciding this issue, the Panel took into account that the Registrant had been informed, in the Notice of Hearing dated 17 May 2021, that if this Panel found that the case against her is well founded,  and imposes a sanction which removes, suspends or restricts her right to practise, the Panel may impose an interim order. In addition, the Panel took into account the reasons set out in its earlier decision to commence the hearing in the absence of the Registrant. In the circumstances, and for the same reasons, the Panel determined that it would also be fair, proportionate and in the interests of justice to proceed in the Registrant’s absence to hear the application.

4. The Panel took into account its previous findings, and adopting its reasons, the Panel came to the conclusion that an interim order is necessary to protect the public and is in the wider public interest in order to maintain public confidence in the profession and to uphold proper standards.

5. The Panel was mindful of its decision at the sanction stage that conditions of practice were not appropriate. The Panel considered that not to impose an Interim Suspension Order would be inconsistent with its finding that a substantive sanction of Suspension is required.

6. The Panel recognised that it must take into consideration the impact of such an interim order on the Registrant as part of the principle of proportionality, and must balance the impact on the Registrant with the need to uphold the public interest. The Panel considered those matters; in the circumstances of the case, the Panel was satisfied that the need to protect the public and to uphold the public interest outweighed the Registrant’s interests in this regard.

7. The Panel decided to impose an Interim Suspension Order for a period of 18 months, a duration which is appropriate and proportionate in light of the Panel’s previous decisions, in order to allow any appeal which the Registrant may bring, to be concluded.

 

History of Hearings for Petya B Somerville

Date	Panel	Hearing type	Outcomes / Status
29/07/2022	Conduct and Competence Committee	Review Hearing	Struck off
19/07/2021	Conduct and Competence Committee	Final Hearing	Suspended