Miss Camilla L Hewitt

Profession: Radiographer

Registration Number: RA49567

Interim Order: Imposed on 09 Nov 2020

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 07/05/2021 End: 17:00 07/05/2021

Location: Virtual hearing - On Papers

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

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

  1. On one or more of the dates set out in Schedule 1 exposed paediatric patients to excessive radiation in that you exposed them to an adult dose of radiation.
  2. On or about 27 November 2018 exposed Patient C to excessive radiation in that you imaged the left ankle as opposed to the right ankle during a follow up of a previous right ankle fracture.
  3. Your actions at particulars 1 and / or 2 constitute misconduct.
  4. By reason of your misconduct, your fitness to practise as a radiographer is impaired.

Schedule 1

16 October 2018 – Patient A

20 November 2018 – Patient B

 

Finding

Preliminary Matters

Service

The Registrant attended the hearing by video link. She was represented by Mr Higgs. There was no issue regarding service of the documents. This is the second review hearing following a 6 month Suspension Order imposed after a final hearing on 11 November 2020. On 11 February 2021 it was replaced by a Conditions of Practice Order.

Factual Background

2. The Registrant worked for Walsall Healthcare NHS Trust (“the Trust”) between June and November 2018 as an Agency Radiographer in the Imaging Services Unit. On 16 October and 20 November 2018, the Registrant exposed paediatric patients to adult levels of radiation. An Action Plan was drawn up after the first incident to avoid the possibility of repetition. Despite this there was a second incident, as set out above. On 27 November 2018 the Registrant x rayed the incorrect ankle of an adult patient. The Registrant’s contract was terminated by the Trust, which then referred the Registrant to the HCPC.

Procedural Background

3. The final hearing was held between 9-11 November 2020. The decision to impose a Suspension Order was based, in part, on the fact that the Registrant did not attend the final hearing and did not appear to have engaged with the HCPC in respect of that hearing.

4. When the Registrant received the decision on 18 November 2020, she drew the HCPC’s attention to the fact that in reaching its decision, the Panel had not referred to documentation that she had submitted for the hearing. The documents included a written witness statement from her and two references from ex-colleagues (a Radiographer and a Superintendent Radiographer). By the time this became apparent, the Registrant was outside the time period for lodging an appeal and the parties agreed to list the case for an early review, which was held on 11 February 2021.

5. The Registrant attended the hearing on 11 February 2021 and gave oral evidence. The panel replaced the 6 month Suspension Order with a Conditions of Practice Order, until 8 June 2021.

6. In deciding to impose a Conditions of Practice Order, the panel wrote:-.

25. “This Panel accepts that an error was made on the part of the HCPTS and that the statement of the Registrant and the two references were not made available to the original Panel sitting in November 2020.

26. The Panel considered the Practice Notes referred to above and took into account all of the evidence from the Registrant, in particular the statement and references she had provided. It was clear to the Panel that the Registrant did not yet have adequate familiarity with IR(ME)R. It also was not clear to the Panel that the Registrant had taken full opportunity to ensure that she was up-to-date on recent developments within her profession. The Registrant was able to give only one example of areas of practice that she had read about since the time the Suspension Order being imposed. To her credit, the Registrant has herself accepted that deficiencies in her plain film practice related to her unfamiliarity with certain pieces of equipment. The Panel concluded that the Registrant’s insight into her deficiencies in practice was still developing and that she had not yet carried out proper remediation or remedy in respect of those deficiencies.

27. For the above reasons, the Panel has concluded that the Registrant’s fitness to practise still remains impaired on personal component grounds. That is mainly because the Registrant has not yet undertaken adequate remediation to show that she would not cause a risk of harm to members of the public if she were now permitted to return to unrestricted practice.

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

7. After a thorough review of the evidence, the panel considered that a Conditions of Practice Order would protect the public and was the proportionate order. It noted that a factor that militated against the making of such an order at the final hearing was the fact that the Registrant appeared not to have engaged with the process. The panel took into account that the Registrant had engaged, and had worked as a Radiographer for many years. The misconduct on her part occurred over 6-week period. It found that the Registrant’s failings were remediable and that she could be trusted to comply with the conditions of practice and that workable and enforceable conditions could be identified. It imposed the following conditions of practice:-

1. Before commencing work in a clinical post you must:

a. successfully complete an update course on IR(ME)R which includes an assessment component.
b. forward to the HCPC confirmation of successful completion of the IR(ME)R course assessment.

2. In keeping with IR(ME)R, you must be signed off as competent in the relevant area before working unsupervised.

3. You must inform the HCPC, within 7 days, if you commence work in a new clinical post.

4. You must inform the HCPC within 7 days of any disciplinary proceedings taken against you by your employer.

5. You must inform the following parties that your registration is subject to these conditions:

a. any organisation or person employing or contracting with you to undertake professional work (at the time of your application);
b. any agency you are registered with or apply to be registered with (at the time of your application);
c. any prospective employer (at the time of your application).

6. You will be responsible for meeting any and all costs associated with complying with these conditions.

The Hearing

8. In reaching a decision, the Panel has considered the HCPC bundle, the written submissions prepared by Mr Higgs, the Registrant’s statement, the IR(ME)R certificate, the letter from Jenni Reeves Radiographers Agency, dated 20 April 2021, and the oral submissions of Ms Sampson for the HCPC and Mr Higgs for the Registrant.

9. There was no dispute between Ms Sampson and Mr Higgs. They both submitted that the Conditions of Practice Order, imposed on 11 February 2021 would need to continue because the Registrant had not had the opportunity to comply with all of the conditions imposed by the panel on that date.

10. The current position is that the Registrant has not worked since the suspension order but now has a job offer. She completed an IR(ME) R course but because of Covid -19, this was an online course without a meaningful assessment component.

11. The Registrant did not give oral evidence. In her written statement she stated that she had refreshed her knowledge of radiation and now had a greater understanding of the need to keep doses at ALARP levels for the safety and protection of the public. She stated that going forward she would ensure that she was signed of as competent before she used any equipment unsupervised. She had reflected on her actions, the resultant damage to the public, the Trust, her own reputation and to her profession.

12. Ms Sampson submitted that although the Registrant had completed an IR(ME)R course, she had not been able to complete the assessment component of the IR(ME)R course because of Covid-19, nor had she been in employment. She submitted that Conditions 1 & 2 had not been fully met and that the Registrant had only shown limited insight in her written statement. She invited the Panel to vary the conditions to include a condition that the Registrant be assessed and supervised whilst working.

13. Mr Higgs submitted that Condition 1 should be removed and that the assessment component of the IR(ME)R course could be met with a condition of supervision until the Registrant was deemed competent by her employer as reflected in Condition 2.
Decision

14. Article 30 (1) provides that a conditions of practice order must be reviewed before it expires and that the reviewing Panel may inter alia:

⦁ extend, or further extend the period for which the order has effect;
⦁ make an order which could have been made when the order being reviewed was made or;
⦁ vary any conditions.

15. In reaching a decision, the Panel has considered the earlier decisions, the reasons for replacing the Suspension Order with a Conditions of Practice Order, the steps the Registrant has taken since the imposition of the Conditions of Practice Order to address the failings identified in the previous decisions and the Registrant’s insight. It has also taken into account the steps that the Registrant has taken to comply with the order of 11 February 2021.

16. The Panel accepted the advice of the Legal Assessor and considered the Practice Note: Review of Article 30 Sanction Orders.

17. It was clear to the Panel that the Registrant has engaged and has attempted to meet the conditions imposed by the last panel. However, she has not been working and there is no evidence of how she will apply the principles in the IR(ME)R course which she completed, in practice in a work setting. The Registrant’s statement was short and the Panel finds that the Registrant has not yet been able to show in a meaningful manner, that she has remedied her deficiencies by a sustained period of competence in the workplace and by a full reflective piece. She has not been able to show that her working practice is now safe and that if she were to return to unrestricted practice that she would no longer place members of the public at risk. The Panel therefore concluded that the Registrant’s fitness to practice remained impaired on the personal component.

18. The Panel also concluded that the Registrant’s fitness to practice remained impaired on the public component ground. It found that members of the public would not have confidence in the profession of Radiography, or in the regulator, if the Registrant were permitted to return to unrestricted practice at the moment.

19. In reviewing sanction, the Panel found that very little had changed since the last order.

20. The Panel has considered the available sanctions in ascending order with its overarching duty to protect the public at the forefront of its mind. It has also considered proportionality and the fact that the Registrant has engaged since the last hearing.

21. The Panel has concluded that to take no action or to impose a Caution Order would not protect the public and would not be proportionate.

22. The Panel has concluded that the correct order is to continue the Conditions of Practice Order for a further 6 months. The Registrant’s fitness to practise remains impaired but is taking steps to remedy her failings. She has completed an IR(ME)R course and has a placement with an agency. She will now need to provide evidence that she can apply her learning to the work environment. The Panel has decided to vary the conditions to include a condition which will require the Registrant to provide references from her placements as well as copies of her competence sign-off’s. This is necessary as the IR(ME)R course was an online course line and the practical component of the course was not available because of Covid-19. This condition will address concern over the possible lack of familiarization with equipment in different clinical settings and will help the Registrant to demonstrate to a future panel that she has remedied her actions and that she can practice safely.

23. A future panel will be assisted by:-

⦁ The Registrant’s attendance at a future hearing.
⦁ Evidence of ongoing CPD undertaken.
⦁ A full reflective piece which provides examples of how the Registrant has applied the contents of the IR(ME)R course in the workplace. It should also contain examples of the potential impact, both physical and psychological of excessive radiation on patients and their families.

Order

ORDER: The Registrar is directed to vary the existing Conditions of Practice Order for a further period of 6 months:

1.In keeping with IR(ME)R, you must be signed off as competent in the relevant area before working unsupervised.

2. You must provide copies of the competencies sign off’s and departmental feedback from each of your placements.

3. You must inform the HCPC, within 7 days, if you commence work in a new clinical post.

4. You must inform the HCPC within 7 days of any disciplinary proceedings taken against you by your employer.

5. You must inform the following parties that your registration is subject to these conditions:

a. any organisation or person employing or contracting with you to undertake professional work (at the time of your application);
b. any agency you are registered with or apply to be registered with (at the time of your application);
c. any prospective employer (at the time of your application)

Notes

Right of Appeal

You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

Under Articles 30(10) and 38 of the Health Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

Hearing History

History of Hearings for Miss Camilla L Hewitt

Date Panel Hearing type Outcomes / Status
30/11/2021 Conduct and Competence Committee Review Hearing Conditions of Practice
07/05/2021 Conduct and Competence Committee Review Hearing Conditions of Practice
11/02/2021 Conduct and Competence Committee Review Hearing Conditions of Practice
09/11/2020 Conduct and Competence Committee Final Hearing Suspended
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