Mr Ajeesh George
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The following Allegation was considered by a Panel of the Conduct and Competence Committee at a Substantive Hearing on 3 – 6 December 2018.
Whilst registered as a Radiographer and employed by ABM University Health Board, you:
1. Between 14 December 2015 and 13 October 2016:
a) did not display appropriate knowledge of radiation protection in that you:
i. Did not check the pregnancy status of female patients of child- bearing age that were referred for x-rays of the abdominal area on the following dates:
a. 5 February 2016;
b. 9 February 2016;
c. 10 February 2016;
d. 20 June 2016;
e. 29 June 2016;
f. 29 July 2016.
ii. Did not consistently demonstrate adequate centering and/or positioning of the detector, including on the following occasions:
a. On 20 May 2016, you positioned the detector too high for a chest x-ray;
b. On 23 May 2016, you did not move the detector appropriately for an angled-up clavicle x-ray;
c. On 27 June 2016, you centred the detector too low for a knee x-ray;
d. On 28 June 2016, you centred the detector too low for a knee x-ray;
e. On 29 June 2016, you centred the detector too low for an abdomen x-ray;
f. On 21 July 2016, you centred the detector too distally for an elbow x-ray;
g. On 15 August 2016, you did not centre to the bucky for a pelvis x-ray.
b) displayed a limited knowledge of radiographic technique in that you:
i. Did not adequately and/or correctly adapt the exposure parameters depending on the patient and/or area being x- rayed, including on the following occasions:
a. On 30 March 2016, you increased the mAs from 16 to 100 to account for the use of a grid on a pelvic x-ray;
b. On 1 April 2016, you did not adapt the exposure settings for an x-ray of a pelvis on a trolley;
c. On 17 May 2016, you did not increase the exposure for a larger patient;
d. On 23 May 2016, for an x-ray of a 1 year old, you selected an exposure setting that was suitable for an adult;
e. On 25 May 2016, you did not increase the exposure for a patient with large arms;
f. On 27 June 2016, you selected the setting for the pelvis instead of hip only for a patient that had been referred for an x-ray of their right hip;
g. On 11 July 2016, you conducted an incorrect Antero- Posterior (AP) x-ray for a tibula and fibula in that:
i. [not proven]
ii. [not proven]
h. On 14 July 2016 when conducting a hand x-ray:
i) you did not set the right exposure for the x-ray in that it was too low;
ii) when conducting the lateral view x-ray you did not increase the exposure to the correct value;
i. On 1 August 2016, for an x-ray of a child’s tibula/fibula, you set a high exposure;
j. On 3 August 2016, when conducting a c-spine x-ray;
i) did not use the correct exposure;
ii) did not notice that the resultant image demonstrated features of over-exposure
ii. Did not adequately adapt the Film-Focal Distance depending on the area being x-rayed, including on the following occasions:
a. On 26 May 2016, you did not adapt the distance for an x- ray of a tibula/fibula to enable the whole are to be included in one film;
b. On 25 July 2016, you used too great a distance when taking a lateral view x-ray of a hip;
iii) Did not recognise and/or adapt to the limitations of the patient being x-rayed, including on the following occasions:
a. On 12 May 2016, you continued to position a patient for c- spine, chest and shoulder x-rays despite the patient feeling faint and/or looking like they were about to collapse;
b. On 12 May 2016, you continued to position a patient for a knee x-ray despite the patient looking like they were about to collapse;
c. On 23 May 2016, you physically and/or forcefully lifted the chin of a patient that potentially had a fracture of the cervical spine;
d. On 24 May 2016, you started to sit a patient up into an erect position when they potentially had a neck of femur fracture;
e. On 24 May 2016, you physically and/or forcefully lifted the chin of a patient that potentially had a fracture of the cervical spine;
f. On 27 May 2016, you attempted to raise the arms of a patient with a pacemaker despite the patient explaining he was not allowed to raise his arms;
g. On 9 June 2016, while attempting to x-ray the humerus of a post-operative patient, you did not recognise that the patient was struggling to remain standing;
h. On 3 August 2016, you tried to move an unsteady, elderly patient onto the bed instead of leaving him in his chair for an x-ray of his foot.
c) required clinical supervision at all times in that you:
i. Did not consistently position and/or x-ray the correct area, including on the following occasions:
a. On 3 May 2016, you positioned the wrong knee for exposure;
b. On 24 May 2016, you x-rayed the whole hand of a patient who had been referred for an x-ray of their little finger;
c. On 9 June 2016, you x-rayed the hand but missed the little finger of a patient who had been referred for an x-ray of their little finger;
d. On 22 June 2016, you x-rayed the right knee of a patient who had been referred for an x-ray of their left knee and marked the image of the right knee as the left knee.
ii. Did not demonstrate good infection control practice in that:
a. On 3 May 2016, you did not consistently wash your hands and/or the equipment between patients;
b. On 18 July 2016, you did not change your gloves before touching the patient and/or equipment.
iii. Did not consistently demonstrate effective communication including on the following occasions:
a. On 3 May 2016 you gave little or no instructions to patients when positioning them for their x-rays;
b. On 26 May 2016, you uncovered a patient’s legs without giving any prior warning to the patient;
c. On 10 June 2016, you physically touched and/or moved a patient that had been referred for a chest x-ray without giving any prior warning to the patient;
d. [not proven]
2. The matters set out at particulars 1 a) – c) constitute misconduct and/or lack of competence.
3. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
Potential prior knowledge
1. At the outset of the proceedings, the Radiographer Panel member drew to the Panel’s and HCPC’s attention that he believed he knew a colleague, referenced as ‘KE’, in the HCPC bundle of documents. He explained that KE was a current colleague of his and that whilst he had not discussed this case with KE at any time, and indeed had no prior knowledge of the case prior to receiving and reading the bundle, he wanted to raise it to be transparent and so that the parties could make submissions on the point.
2. Mr D’Alton, appearing on behalf of the HCPC, submitted that he had no objection to the Panel member continuing to hear the case. He stated that the Panel’s primary purpose, during this hearing, was not one of fact finding, the facts already having been determined by the substantive hearing panel. He further submitted that KE did not provide evidence during the course of the hearing and that whilst she had performed the initial concerns report, concerning the Registrant’s practice, the Panel today, was tasked with considering current impairment and then sanction, should current impairment be found. On that basis, he raised no objection to the Panel member remaining.
3. The Panel accepted the Legal Assessor’s advice which had drawn its attention to the case of Porter v Magill  2 AC 357 and the test of whether a fair minded and informed observer, having considered the facts of the case, would conclude that there was a real possibility that the Panel was biased.
4. The Panel determined having regard to all of the facts of the case, that a fair-minded observer would not consider the Panel to be biased and concluded that the Panel could proceed to hear the case. It formed this view based on the following reasons:
i. KE did not give evidence during the course of the substantive hearing, the information provided by her to the substantive hearing panel was of a contextual or background nature;
ii. the substantive hearing panel had already determined the facts in this case, which this Panel could not, and would not seek to, go behind;
iii. this Panel was primarily concerned with reviewing and accessing the Registrant’s current fitness to practise;
iv. the Panel member and KE had not previously discussed the case and the Panel member had no prior knowledge of the facts of the case prior to receiving the bundle; and
v. the Panel was satisfied that the Panel member could place his association with KE, as a professional colleague, out of his mind, whilst making a decision in respect of the Registrant’s fitness to practise.
5. The Panel was provided with a signed certificate as proof that the Notice of Hearing had been sent by email, on 01 February 2021 to the email address shown for the Registrant on the HCPC register.
6. The Panel was also shown a copy of delivery receipt, confirming delivery of the HCPC Notice of Hearing, to the Registrant’s email address, on the same date (01 February 2021).
7. The Panel accepted the advice of the Legal Assessor and was satisfied that Notice had been properly served in accordance with Rule 3 (Proof of Service) and Rule 6 (date, time and venue) of the Conduct and Competence Committee Rules 2003 (as amended) (‘the Rules’).
Proceeding in absence of the Registrant
8. Mr D’Alton, on behalf of the HCPC, made an application for the hearing to proceed in the Registrant’s absence as permitted by Rule 11 of the Rules. The Panel accepted the advice of the Legal Assessor and took into account the guidance as set out in the HCPC Practice Note “Proceeding in Absence”.
9. The Panel determined that it was reasonable and in the public interest to proceed with the hearing for the following reasons:
i. the Panel found good service in terms of the Notice of Hearing;
ii. the Panel noted the HCPC’s submissions in respect of the number of attempts made by the HCPC to contact the Registrant, both by email and telephone. A voicemail message had also been left on the Registrant’s mobile number on 02 March 2021 referring to today’s hearing and asking him to call Mr D’Alton urgently, to which there had been no reply;
iii. there has been no application to adjourn and no indication from the Registrant that he would be willing or able to attend on an alternative date and therefore re-listing the hearing would serve no useful purpose;
iv. the Panel noted that the Registrant had failed to engage in any way, throughout the duration of the regulatory proceedings. Whilst the Panel recognised that there may some disadvantage to the Registrant in not being able to make oral submissions, the Panel noted that he had been provided with every opportunity to attend and had failed to do so. The Panel therefore formed the view that the Registrant had voluntarily absented himself from the hearing and was unlikely to attend at a future date even if the Panel adjourned today; and
v. finally, the Panel noted its duty to act in a manner which was in the public interest and in order to achieve that aim should act in a fair, economical and expeditious manner. Therefore, taking all of the aforementioned points into account and noting that this was a mandatory review of an order due to expire on 03 April 2021, the Panel determined that it should proceed in the absence of the Registrant because the public interest in proceeding with the case outweighed any detriment to the Registrant in not being present.
10. The Registrant was employed by Abertawe Bro Morgannwg University Health Board (“the Board”) as a Band 5 Radiographer at the Princess of Wales Hospital from 17 December 2015. Upon commencement of his employment, as was routine; he was monitored and supervised to allow the Board to be satisfied that he was competent to practise autonomously. His colleagues, from early 2016, raised concerns about the Registrant’s knowledge of radiation protection and radiographic technique. The Board provided monitoring and extensive support to the Registrant to facilitate him becoming an autonomous practitioner. Notwithstanding this support, the Registrant was only able to work under supervision. There being no evidence of improvement in the Registrant’s capability despite the support provided to him, the Board commenced capability processes in respect of the Registrant in accordance with its policy. A formal capability meeting took place on 7 July 2016.
11. The Board informed the HCPC of its concerns about the Registrant following the formal capability hearing on 7 July 2016.
12. A second capability meeting took place on 11 August 2016. It was established that the Registrant continued to fail to meet the objectives set for him and he was therefore granted a further 4-week period to meet the required standard of performance. During this period, his work was observed and recorded, with both the Registrant and the supervising radiographer signing off the records of observations and interventions.
13. The Registrant’s performance was reviewed on 14 September 2016 and it was determined that he still had not achieved the standard of performance expected by the Board, and that significant concerns about his practise remained. He was informed that his employment with the Board would be terminated by reason of his capability.
14. Following a hearing of the Conduct and Competence Committee between 3 - 6 December 2018, which was not attended by the Registrant or a representative acting on his behalf, a number of particulars alleged were held to be well-founded as set out above, and the Registrant’s fitness to practise was assessed as being impaired by reason of his lack of competence. The Substantive Hearing panel imposed a Suspension Order, for a period of 12 months. The Suspension Order has been reviewed twice since. First on 03 December 2019 and then again on 02 December 2020. On each occasion the Registrant did not attend, and the previous reviewing panels determined that the Registrant’s fitness to practise remained impaired and extended the Suspension Order on both occasions.
15. The previous reviewing panel, in December 2020, considered that a future reviewing panel may be assisted by the Registrant:
i. engaging with the regulatory process;
ii. providing evidence such as a reflective piece showing remorse, insight and remediation; and
iii. detailing how he has addressed the key issues the panel identified, for example through relevant work, paid or unpaid, and supplying details of any relevant training and professional development
16. Mr D’Alton submitted, on behalf of the HCPC, that the Registrant’s fitness to practise remained impaired by reason of his lack of competence and that the only sufficient and appropriate order to make was one of a Strike-off Order. He stated:
i. the Registrant had not engaged with the HCPC with regard to this hearing or the previous hearings;
ii. the Registrant had failed to produce any evidence to demonstrate that he had remediated his lack of competence. In the circumstances, there was nothing to undermine the decisions of the previous panels decisions that the Registrant’s fitness to practise remains impaired;
iii. as a consequence, the Registrant continued to pose a risk to service users and the public. Furthermore, public confidence in the profession and the HCPC as its regulator would be undermined if a finding of impairment was not made; and
iv. given that two years had elapsed since the Order was first imposed, the only appropriate order for the Panel to impose was one of Strike-off. He stated that conditions could not be formulated as there was no information as to the Registrant’s present circumstances and given that the Registrant had not engaged with the proceedings, it was unlikely that he would engage with any conditions imposed. He also submitted that a further period of suspension was not appropriate given that the Registrant had failed to engage and had failed to provide any evidence of insight, remorse or remediation.
17. The Panel did not receive any submissions or representations from the Registrant, or a representative on his behalf.
18. The Panel took into account the documents furnished to it by the HCPC and the Registrant and had regard to the evidence before it and the HCPC’s submissions.
19. The Panel considered the relevant Practice Note issued by the HCPTS, ‘Finding that Fitness to Practise is ‘Impaired’’, together with the HCPC’s Standards of Conduct, Performance and Ethics and the HCPC’s Standards of Proficiency for Radiographers.
20. The Panel accepted the advice of the Legal Assessor.
21. In making its decision, the Panel had regard to both the personal and public elements of impairment.
22. The Panel noted that the Registrant’s failings in this case, as determined by the substantive hearing panel, are fundamental and wide-ranging in nature. The Panel also noted that the Registrant has failed to engage at all during the course of the regulatory proceedings. He has failed to provide any evidence of a recognition of his failings; failed to demonstrate a willingness to address and/or remediate his failings; failed to provide anything which could lead the Panel to determine insight or remorse in respect of his failings; failed to provide evidence of further training or continuing professional development; and has failed to demonstrate any understanding of the severity and impact of his lack of competence. The Panel therefore concluded that in light of the above, taking the previous panel’s findings into account, the Registrant remains impaired on the personal component.
23. The Panel then went on to consider the public component of impairment. The Panel reminded itself that part of its role was to maintain professional standards and uphold confidence in the Radiography profession. The Panel considered that there remained a risk of potential harm due to the Registrant’s lack of competence. The Panel was satisfied that a member of the public, appraised of all of the circumstances of this case, would have their confidence in the profession, and the regulator, undermined if a finding of current impairment was not made on public interest grounds. The Panel therefore determined that the Registrant is impaired on the public interest component also.
24. Accordingly, the Panel concluded that the Registrant’s fitness to practise remains impaired on both the personal and public components.
25. The Panel has borne in mind that sanction is a matter for its own independent judgment and that the purpose of a sanction is not to punish the Registrant but to protect the public. Further, that any sanction must be proportionate, so that any order must be the least restrictive order that would protect the public interest, including public protection. The Panel had regard to the HCPC guidance titled ‘Sanctions Policy’.
26. The Panel considered the option of a caution order. The Panel determined that a caution order would not provide adequate protection given the wide-ranging failings and ongoing risk to the public identified by the substantive hearing panel.
27. The Panel next considered the option of replacing the existing Suspension Order with a conditions of practice order. The Panel was of the view, given the lack of engagement by the Registrant, that it could not be satisfied that the Registrant would engage with any conditions of practice imposed. Further, the Panel decided that conditions would not be proportionate, appropriate or workable, noting in particular that the Registrant was subject to personal supervision, during the course of his employment, and this was insufficient to address his fundamental and wide-ranging failings.
28. The Panel next considered extending the current Suspension Order. The Panel noted the Registrant’s lack of engagement and the fact that he has been subject to a suspension order for over 2 years and that he has continued to fail to engage in the proceedings or to demonstrate a willingness to address his failings. The Panel noted that the Registrant has also failed to provide any evidence or insight, remediation or remorse and concluded therefore that he had demonstrated an unwillingness to acknowledge or resolve matters. He had completely ignored his regulator and had shown no interest in remaining a member of the profession. The Panel considered that a further suspension order would serve no purpose.
29. Consequently, taking into account the very serious on-going potential risk that the Registrant posed to the public, the Panel was of the view that, notwithstanding a striking-off order being an order of last resort, in this case, it was the only sanction which was appropriate to safeguard members of the public from the very real risk posed by the Registrant’s wide-ranging and fundamental lack of competence. Further, the Panel was of the view that any lesser sanction would be insufficient to protect the public, public confidence in the profession and public confidence in the regulatory process.
That the Registrar is directed to strike the name of Mr Ajeesh George from the HCPC register with immediate effect.
Right of Appeal:
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Articles 30 and 38 of the Health Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.