Miss Camilla L Hewitt

Profession: Radiographer

Registration Number: RA49567

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 30/11/2021 End: 17:00 30/11/2021

Location: Virtual hearing - Video conference

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

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

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

Schedule 1

16 October 2018 – Patient A

20 November 2018 – Patient B

Finding

Preliminary Matters

Service

1. The certificate of the Registrant’s registration shows both a postal address and an email address for the Registrant. The Panel is satisfied that on 29 October 2021 notice of the hearing was sent by the HCPC to the registered email address of the Registrant.

2. The notice informed the Registrant that this review of the current Order would take place today by video conference and email confirmation that the notice of hearing had been delivered was received. The Registrant’s representative Mr Peter Higgs has stated that he will be participating in the hearing today. The Panel was satisfied there had been good service of the hearing notice to an email address of the Registrant.

Background

3. This is a third Review Hearing under Article 30 (1) of the Health Professions Order 2001, which requires the review of a substantive order prior to its expiry.

4. The Registrant is a Band 6 radiographer. She worked at the Walsall Healthcare NHS Trust (“the Trust”) between June and November 2018 in the role of a Band 5 Radiographer in the Imaging Services Unit. She was employed through an agency: RIG Healthcare. In two separate incidents on 16 October and 20 November 2018, the Registrant incorrectly exposed paediatric patients to adult levels of radiation. After the first incident, the Registrant met with AC the Governance and Quality Lead Radiographer at the Trust, to discuss what had happened and to draw up an Action Plan to prevent a further occurrence.

5. 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 referred the Registrant to the HCPC on 30 November 2018.

6. The incident on 16 October concerned a child patient who attended for an abdominal x-ray. An adult radiation exposure was selected for the patient by the Registrant rather than the correct paediatric setting. Therefore, the patient received an exposure greater than intended and a second x-ray was performed. The patient received radiation approximately 50 times greater than the expected exposure. The level of over-exposure has been reported to the Care Quality Commission. A full investigation was required to identify why the incident happened, to reduce the likelihood of a recurrence and provide training. The low risk nature of this event had to be communicated to the patient, and also that the patient was told not to be concerned by the radiation risk. Following this incident an Action Plan was agreed, with the Registrant to enable her to produce diagnostic paediatric images consistently adhering to protocols and adhering to the two-stage process of exposure factor settings.

7. On 25 October 2018 the Registrant completed and signed an Incident Reflection Form. In it, under the heading “Can you identify any Root Causes (Why did it happen?)” she wrote: “I didn’t check the exposure factors. I was clear I’d selected the free detector and didn’t need a grid for this patient and didn’t select the paed. option on the drop-down menu. I was rushing as the paed. was wriggling and crying and I wanted to ensure I exposed when they were still”. Under the heading “What could you have done differently?” the Registrant wrote “I should have checked the exposure factors before positioning the patient and then before exposing. I could have asked for a pair of hands – one person positioning and one person behind the control panel ready to prep. and two pairs of hands with a crying paed. nurse and relative is probably a good idea”. Finally, under the heading “Future prevention” she wrote “I may ask for help from colleagues in the future with paed. I must always check twice exposure factors with DR [Digital Radiography] – as I would with CR [Computed Radiography] to not get caught out again like this.”

8. The original panel heard evidence from AC and DW, the Registrant’s line manager. AC confirmed that the Registrant’s previous experience at other hospitals was on a slightly different system, but the principles, particularly that of “double checking” (which required the radiographer to check the exposure both before and after positioning the patient) still applied. In the Trust they used a system of Digital Radiography, which contained pre-set exposures on the machines, including pre-set paediatric exposures.

9. Whilst the Registrant was working through the Action Plan, the second incident occurred on 20 November 2018 when again the Registrant x-rayed a child using an adult setting. The panel noted the Registrant administered adult doses of radiation to children, which had the effect of increasing their potential to develop cancer. However (upon analysis of the amount of over-exposure to radiation contained in the Incident Reports) the risk of Patients A and B developing cancer in the future was stated to be relatively minimal. However, the fact remains that the patients were put at risk of harm.

10. In relation to Particular 2 the overexposure to radiation on 27 November 2018 in relation to adult patient C was minimal. Patient C nevertheless was at risk of harm by having to have the correct ankle x-rayed three times. The Registrant’s error in x-raying the left ankle had the potential to cause the injury to the right ankle to have gone undiagnosed.

11. These three incidents occurred over a short period (about five weeks) and were each described as “fundamental errors of practice”. The original panel stated that the Registrant’s actions were serious and that her conduct fell far below the standards expected of a registered Radiographer, in such a way that fellow practitioners would find her conduct deplorable.

12. The original panel had no information about the Registrant’s circumstances following her departure from the Trust in November 2018. It was aware that she had worked as a Radiographer for a few years and that she was occupying a Band 5 post as a relatively senior Band 6 Radiographer. Further, it took account of the fact that she apparently worked without any difficulty for three or four months at the Trust (where DW estimated that she might have carried out up to 50 x-rays per day). It noted that she apparently had an aversion to working in theatre. DW indicated that it was not unusual, for a Radiographer to have individual preferences. Both AC and DW, stated that her errors were remediable and could be eradicated by reflection and training. She demonstrably reflected upon the first two incidents involving the child patients, but her resolve in her first reflection never to make the same mistake again had a hollow ring to it, since she repeated the error within a month. Her further reflections, on the very day that she made the third error in relation to Patient C, were similarly undermined, by the subsequent mistake and demonstrated that she had not really understood what caused her to make such fundamental errors. On the evidence available to it the panel could not be satisfied that the Registrant would not repeat these errors.

13. The panel found the Registrant’s fitness to practise impaired under both the personal and the public components. In reaching a decision on Sanction the panel took account of various mitigating factors namely: The Registrant’s previous good character. She had co-operated with the Trust’s investigation into the first and second incidents and had made some attempts to comply with the Action Plan. She had engaged with the HCPC, albeit to a limited extent. She had accepted responsibility for the first and second incidents in her reflective pieces (although she had not provided any real explanations for her actions in all three incidents). She worked at the Trust without any concerns being raised for about four months, prior to the first incident.

14. The panel also noted the following aggravating features: The Registrant’s actions were serious and potentially could have caused significant harm to the patients. Her misconduct had been repeated over a short period. There did not appear to have been any real expression of genuine or timely remorse, or apology. None could be recalled by her line manager, (DW), or discerned by the panel, within her written reflections. Given the seriousness of the misconduct, it appeared to the panel that the Registrant continued to display little or no insight into her actions in this matter. On the evidence before it, the panel could not be satisfied that the Registrant would not act in this way again; and that, consequently, there was no available evidence to reassure the panel that there was the required level of insight and understanding to indicate that a Conditions of Practice Order was an appropriate and proportionate response. It concluded that there was insufficient evidence before it that the Registrant would be able or willing to comply with such an Order. The panel considered that a possible and proportionate response would be to afford the Registrant an opportunity to show that she is willing to remedy her failings; by imposing a short Suspension Order, commensurate with the gravity of her failings so as to mark the seriousness of those failings.

15. The Order would be reviewed before the end of the suspension period providing an opportunity for the Registrant to demonstrate in the interim that she has gained insight into her errors and wished to remedy them. At the review hearing the reviewing panel may be assisted by: Evidence of reflection about this matter together with evidence of insight and remorse. Evidence that the Registrant had kept her skills and knowledge up to date, together with evidence of Continuing Professional Development (CPD). Evidence of the Registrant’s future intentions about practising as a radiographer and details of her plans, if any, for such a return. References and testimonials.

The 11 February 2021 review

16. The first reviewing panel noted that the Registrant did not attend the final hearing in November 2020, and nor was she represented at that hearing. When she received the original panel’s decision, it seemed to her that documentation had not been considered by that panel. Her documentation comprised her statement and two references, from a Radiographer and a Superintendent Radiographer who had previously worked with the Registrant. On 18 November 2020, the Registrant sent an email to the HCPC to express her concerns. In an email dated 30 November 2020, the HCPC Case Manager confirmed that her documentation had been received in an early Review Hearing was scheduled.

17. Mr Higgs submitted that the Registrant was disadvantaged, because her documents were not before the original panel. The Registrant had always accepted she made errors and she had not attempted to apportion blame on others. It was accepted harm had been caused to at least two of the patients. However, the relevant actions of the Registrant had occurred over a limited time. The outcome decision of the original panel may well have been different if the missing documents had been available. There were no other examples of misconduct throughout the Registrant’s career both before and after the events in question. There was doubt that the three events could be seen as properly representative of the Registrant’s usual standard of work. The original panel noted the evidence that the errors of the Registrant were remediable. The reason why a Conditions of Practice Order was not appropriate was the lack of engagement on the part of the Registrant; but the panel had been unaware that the Registrant submitted relevant material.

18. Mr Higgs asked the panel to take into account the two years of faultless practice undertaken by the Registrant since the events in question. It was submitted that the panel may feel an appropriate sanction was now a Conditions of Practice Order. Mr Higgs submitted possible conditions could include: requirements that the Registrant would bring any conditions to the attention of her employer, that she should undertake further training in the Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R) and provide appropriate certification in that respect, that she show competence in the use of necessary specific equipment and that competence should be assessed before working with any individual type of equipment unsupervised; and that the Registrant should provide an audit of work in plain film. This last suggestion was made in recognition of the Registrant’s acceptance that the errors in question had occurred whilst she was carrying out plain film work, rather than Computed Tomography (CT).

19. In the context of the public component, the HCPC submitted that the shortfalls in the Registrant’s understanding of different types of x-ray equipment usage and of the relevant regulations would cause members of the public considerable concern, if the Registrant were now permitted to return to unrestricted practice. Therefore, a continuation of the existing Suspension Order was appropriate and proportionate

20. The panel stated the Registrant did not yet have adequate familiarity with IR(ME)R. It also was not clear that the Registrant had ensured that she was up-to-date with 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 Suspension Order was made. To her credit, the Registrant 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 in respect of those deficiencies.

21. The panel concluded that the Registrant’s fitness to practise was impaired under the personal component, mainly because the Registrant had not undertaken adequate remediation to show that she would not cause a risk of harm to members of the public, if she returned to unrestricted practice. The Registrant’s fitness to practice was impaired under the public component because members of the public would not have confidence in the profession, or this regulatory process if the Registrant returned to unrestricted practice. The panel imposed a Conditions of Practice Order for the unexpired period of the Suspension Order. The panel stated that the Registrant has a significant length of service as a Radiographer, her misconduct occurred in an approximate 6-week period, her failings are remediable and the Registrant can be trusted to comply with Conditions of Practice. Workable and enforceable conditions, could be identified, in her case. The Registrant had shown a willingness to comply with Conditions of Practice. The proportionate and correct outcome was to replace the Suspension Order by a Conditions of Practice order for the remainder of the current term of the Suspension Order. There was no specific condition relating to Plain Film X ray, as the IR(ME)R update and signing off of relevant competencies, would address the lack of familiarisation with equipment in any clinical area involving ionising radiation. A future reviewing panel would be assisted by the following: attendance at the review hearing, evidence of targeted CPD relevant to the misconduct found and reflection on the learning that had taken place as a result of the update on IR(ME)R.

The 7 May 2021 review

22. The second reviewing panel considered written submissions prepared by Mr Higgs, the Registrant’s statement, an IR(ME)R certificate and a letter from Jenni Reeves of the Radiographers Agency, dated 20 April 2021. Also, oral submissions from the representatives. Both parties 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. The Registrant had not worked since the suspension order but had a job offer. She had completed an IR(ME)R course but because of COVID -19, this was an online course without a meaningful assessment component. The Registrant did not give oral evidence. Her written statement said she had refreshed her knowledge of radiation and had a greater understanding of the need to keep doses at ALARP levels, for the safety and protection of the public. She would ensure that she was signed off 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.

23. The HCPC 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; conditions 1 & 2 had not been fully met and the Registrant had only shown limited insight in her written statement. The panel was invited to vary the conditions, to include a condition that the Registrant be assessed.

24. 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.

25. The panel stated the Registrant had engaged and attempted to meet the conditions imposed by the previous panel. However, she had not been working and there was no evidence of how she will apply the principles in the IR(ME)R course which she had completed, in practice in a work setting. The Registrant’s statement was short and the panel found that the Registrant had not yet been able to show in a meaningful manner, that she had remedied her deficiencies by a sustained period of competence in the workplace and by a full reflective piece.

26. The Registrant had 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. Also, on the public component because 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. In reviewing sanction, the panel found that very little had changed since the last Order.

27. The Conditions of Practice Order was therefore extended for a further 6 months. The Registrant needed to provide evidence that she can apply her learning to the work environment. The panel varied the conditions to include a condition that the Registrant provide references from her placements as well as copies of her competence sign-off. 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. A future panel would 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.

28. The panel made the following 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)

Evidence from the Registrant

29. The Registrant has provided the following written submission to the Panel, by email on 16 November 2021:

“During the last 6 months since returning to practice I have complied with the conditions set out for me at the last hearing.
My Agency are fully informed on this matter and have communicated this with the relevant parties before my contract commenced and I emailed the HCPC to let them know I had returned to practice within the given time frame.
I have continued to ensure my practice is safe by writing down the protocol of the scan required on the patient’s request form or safety questionnaire to ensure I carry out the correct examination at the point of scanning. I will continue to do this moving forward to ensure I maintain safe practice.
I haven’t used any piece of kit unsupervised, and will ensure I won’t in the future either until I have been signed off as competent to do so.
I have not signed off competencies this last 6 months. In order to achieve this I would need to be rostered with a senior assessor and locum shifts are not scheduled far in advance, I am not informed who I am working with beforehand either. I have worked across 7 sites using 9 different scanners and have encountered over 60 members of staff so far-many of which are new to the company and/ or radiography and not signed off themselves. I have ensured that I’ve not used any scanner at any point unsupervised however.
I have recently done some Agency led shifts of which I have been signed off and this information has been requested and sent on from the Agency to yourselves.
There have been no issues of concern, complaints or disciplinary proceedings against my name to report at all since the last hearing.
I am sorry that my actions led to patients being overexposed. I understand that this could have caused concern and I regret if this has caused any feelings of anxiety to them. I will always ensure that my actions in the future are carefully considered and made to reduce any risk of harm to any person to the lowest level.”

Submissions by the HCPC

30. Mr D’Alton summarised the background of the case as recorded in the decisions of the previous panels. The Registrant returned to work on 30 May 2021 and she has received complimentary feedback from her employer the Jennie Reeves Agency. She has been signed-off as competent in respect of mobile CT radiography. However, the HCPC submits that the Registrant’s fitness to practise remains impaired.

31. The HCPC submits that there are outstanding concerns which must be addressed. In particular the application of the relevant Regulations, the need for signing-off as competent and departmental feedback. There is also a need for further reflection by the Registrant in relation to the application of the regulations and to demonstrate insight. She has been working without incident since June 2021 but she is still not signed-off as competent to work on CT scanners. Due to the nature of her work she is only signed off for “mobile orientation” not for specific competencies and the evidence from her employer is from a director not a supervisor. The Registrant’s statement to the Panel is brief and does not show how she has applied the learning from the course she has undertaken in the workplace. There is no full reflective piece with examples to evidence her insight or up to date CPD. The Registrant has some insight at a surface level but there is a lack of depth and no reflection of the impact of her misconduct on patients and their families. She has not fully remediated and there remains a risk of repetition.

32. The public component requires full compliance with the Conditions of Practice, in view of the serious findings of misconduct which have been made. The HCPC position is that the Registrant’s fitness to practise is still impaired on the public and personal components. There is insufficient evidence of insight and the Registrant’s misconduct was serious posing a risk to patients. The previous panels gave guidance on steps the Registrant could take to assist this Panel, including a need for future engagement. There is an obligation upon the Registrant to address the concerns raised but she has failed to do so fully, suggesting her fitness to practise is still impaired. As is noted in the relevant Practice Note the reviewing Panel’s task: is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed. The decision in Abrahaem v GMC [2008] EWHC 183 (Admin) states there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that he or she has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently.

33. If the Panel finds that the Registrant is still impaired, the HCPC submits that a further opportunity to comply with Conditions of Practice should be afforded to the Registrant. To enable the Registrant to demonstrate full remediation a further Order for 12 months would be appropriate. This would afford the opportunity for an early review if appropriate.

Submissions by Mr Higgs

34. Mr Peter Higgs (South West Regional Officer for the Society of Radiographers) provided written submissions on behalf of the Registrant stating that:

At the initial hearing the facts and grounds as well as impairment of the registrant’s fitness were found proved and, erroneously believing her not to have engaged in any way with the HCPC, a decision to suspend her registration for 6 months was made. In fact, Ms Hewitt had engaged with the HCPC and provided documents to be considered but, in error, these were not made available to the panel.
At the second review meeting the panel made further revisions to the Conditions of Practice Order noting, “It was clear to the Panel that the Registrant has engaged and has attempted to meet the conditions imposed by the last panel.”
Since this hearing the registrant has been employed by an agency, The Jennie Reeve Radiographers Agency, in full knowledge of the terms of the Conditions of Practice Order that was imposed following the hearing of 7 May 2021.
A reference from Phoebe Sprinz, Director of this agency has been supplied to the HCPC and is copied below, attesting to her professionalism and reliability. I also understand that Ms Sprinz has also recently supplied the HCPC with copies of Ms Hewitt’s recent competency sign off.
Ms Hewitt has not been working unsupervised during the time since the last hearing due to the nature of her work within CT sites, however, we submit that the required competency sign off have now been provided to the HCPC from the registrants agency.
No disciplinary proceedings have been taken against the registrant and no complaints have been recorded.
As the reference from the director of her agency clearly states, “We are delighted to offer Camilla regular weekly shifts. This is a new venture for JRRA so having competent, excellent Radiographers is key to the success of us entering this space in the market. Camilla has proved to be hard working and an asset to JRRA.”
Sir, the incidents that led to Ms Hewitt’s referral to the HCPC occurred during a short period of time almost three years ago. Apart from a brief period of time during her suspension from the register, Ms Hewitt has practiced without concern being raised. Her current agency have receive positive feedback regarding her and are pleased to make use of her skills in a new venture they are commencing.
Ms Hewitt has engaged with and learnt from this process. She will always ensure that she is fully competent to practice in any unfamiliar area, working under supervision of other radiographers until this has been assessed to ensure that her practice will always remain safe.
Sir, Respectfully I submit that the fitness to practice of Ms Hewitt is no longer impaired and both the profession and public have much to benefit from her skills in unrestricted practice.

35. Mr Higgs stated at the hearing that the Registrant did not wish to give evidence or make an oral statement although she had attended the hearing via an audio link. He emphasised that the Registrant had made three errors over a six-week period, three years ago. She had returned to work after about 5 months in 2019 and there had been no further complaints against her. She has glowing testimonials from her current employer as supplied to the Panel. A recurrence of her misconduct is unlikely in the future. She has engaged with the HCPC, is being supervised by colleagues in her workplace and learned to “double check” on the course she has undertaken. She has insight and her statement confirms she is sorry. Her employment record shows she is a safe and competent practitioner. It has been difficult for her to obtain “departmental feedback” because she works on mobile scanning.

Legal Assessor’s advice

36. The Legal Assessor advised that the Panel is dealing with a Review under Article 30(1) of the Health Professions Order 2001 and should take into account the HCPTS Practice Note: Review of Article 30 Sanction Orders.

37. Article 30(1) provides that a Conditions of Practice Order or Suspension Order must be reviewed before it expires and that the reviewing Panel may: 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, replace a Suspension Order with a Conditions of Practice Order.

38. Any order made following an Article 30(1) review only takes effect from the date on which the order under review expires, so the Registrant must continue to comply with the expiring order until then.

39. The review process is not a mechanism for appealing against or ‘going behind’ the original finding that the Registrant’s fitness to practise is impaired. The purpose of review is to consider if the Registrant’s fitness to practise remains impaired; and, if so, whether the existing order or another order needs to be in place to protect the public. The key issue which needs to be addressed is what, if anything, has changed since the current order was made.

40. There is an obligation upon the Registrant to address the concerns raised. The Practice Note states the reviewing Panel’s task: is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed.

41. The decision in Abrahaem v GMC [2008] EWHC 183 (Admin) states there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that he or she has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement...”

42. Accordingly, the factors to be taken into account include: the steps which the Registrant has taken to address any specific failings or other issues identified in the previous decision; the degree of insight shown and whether this has changed; the steps which the Registrant has taken to maintain or improve his or her professional knowledge and skills; whether any other fitness to practise issues have arisen; whether the Registrant has complied with the existing Order.

43. The decision reached must be proportionate, striking a fair balance between interfering with the Registrant’s ability to practise and the overarching objective of public protection. Given that part of the Panel’s task is to assess whether the fitness to practise of the Registrant remains impaired, the Panel should also take into account the HCPTS Practice Note on Finding Impairment, the HCPC Sanctions Policy and relevant Professional Standards Authority (PSA) guidance. For example, the PSA has stated that it is important to provide equally detailed reasons with regard to public impairment and personal impairment. The Panel’s reasons should include the relevant considerations of public impairment in this case and not simply repeat the reasons with regard to personal impairment, in the section on public impairment. Personal mitigation is less relevant when considering the need to uphold professional standards and maintain public confidence.

Decision

44. The Panel accepted the advice of the Legal Assessor that there is a persuasive burden on the Registrant to demonstrate to this reviewing Panel that she has taken sufficient steps to develop her insight and to remedy her misconduct.

45. The Registrant is currently employed as a locum to conduct mobile CT scanning. The three incidents giving rise to the misconduct in this case concerned plain film x-rays not CT scans. The Registrant has not yet been signed-off as competent, and is currently practising with colleagues who themselves have not yet been signed off as competent. She has undertaken an on-line course and she is an experienced radiographer. However, the misconduct in this case was in breach of IR(ME)R. The sign-off which has been provided by the Registrant to the Panel, states that on 12 November 2021 she completed mobile CT Radiographer Orientation. This is not sufficient to establish her competence for CT scans. Furthermore, it has not been established how the course she has undertaken has been applied in her practice. The Registrant has not been signed-off as competent, to work on numerous different sites. The colleagues whom she is working with have also not been signed-off as competent. The Registrant’s work is not consistently supervised at present. There is a lack of recognition of the impact of her misconduct on paediatric patients and there is no evidence of CPD in relation to paediatric patients and x-rays. There is a burden on the Registrant to be proactive in relation to the safety of her practice.

46. The Panel has concluded that the Registrant’s fitness to practise is still impaired under the personal and the public component. The Panel find that there has been no significant change since the previous review. The previous panel found there was no evidence of how she will apply the principles in the IR(ME)R course which she had completed, in practice in a work setting. The Registrant’s statement to the Panel today was again short and this Panel also found that the Registrant had not yet been able to show in a meaningful manner, that she had remedied her deficiencies by a sustained period of competence in the workplace and by a full reflective piece. The Registrant has also 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 remains impaired on the personal component. Also, on the public component because members of the public would not have confidence in the profession of Radiography, or in the regulator, if the Registrant is permitted to return to unrestricted practice.

47. In reviewing sanction, the Panel found again that very little had changed since the last Order. The Panel finds there has been a lack of progress in relation to the current Conditions of Practice, in relation to the Registrant’s ability to reassure the Panel as to her future safe practice. The Panel has decided to extend and vary the existing Order. Any lesser sanction would not be sufficient to protect the public or safeguard the public interest. A further Suspension Order would be unduly punitive and unnecessary in view of the Registrant’s employer’s evidence that she is performing well in her current role.

48. The next reviewing panel is likely to be assisted by: The Registrant’s attendance at the next review hearing and evidence of her compliance with the Conditions of Practice imposed today.

Order

ORDER: The Registrar is directed to vary the existing Conditions of Practice Order for a further period of 12 months on expiry of the existing Order:

1. You must place yourself and remain under the supervision of a Radiation Protection Supervisor (RPS) and supply details of your supervisor to the HCPC within 14 days. You must attend upon that supervisor as required and follow their advice and recommendations.

2. You must formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice: radiation protection including paediatric radiation protection.

3. Within three months you must forward a copy of your Personal Development Plan to the HCPC.

4. To ensure compliance with IR(ME)R, you must practise under the direct supervision of your RPS until you are signed off as competent in relation to imaging modality utilising ionising radiation and before working unsupervised.

5. You must supply a full reflective piece to the HCPC not less than 14 days before the next review hearing. This should detail the progress you have made to meet the goals of your personal development plan and 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 and a record of CPD undertaken.

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

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

8. 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

The Order imposed today will apply from 8 December 2021.

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
;