Amanda L Tyler
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Allegation
- On 27 August 2014 and/or 30 September 2015, whilst working as an autonomous practitioner, performed an ultrasound examination in relation to Patient A and did not identify and/or record the following in your report, despite these being clearlyimaged;
- a) A cystic mass in thepancreas;
- b) Abnormalities in the liver with suboptimal vascular Dopplerassessment;
- c) Urinary echogenic debris in thebladder;
- d) Progressive splenomegaly
- e) Renal centile for the left kidney.
- On 16 March 2016, whilst working as an autonomous practitioner, performed an ultrasound examination in relation to Patient B and did not identify and/or record in your report 4 cystic masses in the pancreas, despite these being clearly imaged.
- On 11 April 2018 whilst working as an autonomous practitioner with restrictions in place regarding undertaking cranial ultrasound examinations unsupervised:
- a) Performed a portable cranial ultrasound examination in relation to Patient C and did not follow instructions and/or an agreement that was in place in thatyou;
- i) Performed the examination withoutsupervision;
- ii) Did not discuss the examination with the Radiology Clinical Director or Consultant Radiologist, despite being instructed to doso;
iii) Verified your own written report on PACs.
- b) Started to perform a second cranial ultrasound examination in relation to Patient D without supervision, despite being instructed to notify Colleague A when this patient arrived.
- On 9 October 2018, whilst being supervised, performing an ultrasound in relation to PatientE;
- a) Could not identify the biliary stent in theliver;
- b) Told the patient’s parents that this must havebiodegraded;
- c) Did not include in her ultrasound report the measurement of the PV at the liver edge and did not state the normal directional flow was in the PV, in line with the employer’s standard reporting template on PACS
- Between 2016 and 2019 did not ensure that;
- a) The quality and/or standardisation of your images was of the required standard in relation to the patients set out in Schedule A;
- b) Your ultrasound written reports were accurate and/or contained all relevant information in relation to the patients set out in Schedule B.
- Your actions at paragraph 3 constitute misconduct.
- Your actions at paragraphs 1, 2, 4 and 5 constitute lack of competence.
- By reason of your misconduct and / or lack of competence, your fitness to practise is impaired.
Schedule A:
i. Patient C
ii. Patient F
iii. Patient H
iv. Patient I
v. Patient J
vi. Patient K
vii. Patient L
viii. Patient N
ix. Patient O
x. Patient P
xi. Patient Q
xii. Patient R
xiii. Patient S
xiv. Patient T
xv. Patient W
xvi. Patient X
xvii. Patient Z
xviii. Patient AB
xix. Patient AC
xx. Patient AD
xxi. Patient AE
xxii. Patient AF
xxiii. Patient AG
xxiv. Patient AH
xxv. Patient AI
xxvi. Patient AJ
xxvii. Patient AK
Schedule B:
i. Patient C
ii. Patient F
iii. Patient G
iv. Patient H
v. Patient I
vi. Patient J
vii. Patient K
viii. Patient L
ix. Patient N
x. Patient O
xi. Patient P
xii. Patient Q
xiii. Patient R
xiv. Patient S
xv. Patient T
xvi. Patient U
xvii. Patient V
xviii. Patient W
xix. Patient X
xx. Patient Z
xxi. Patient AB
xxii. Patient AC
xxiii. Patient AD
xxiv. Patient AE
xxv. Patient AF
xxvi. Patient AG
xxvii. Patient AH
xxviii. Patient AI
xxix. Patient AJ
xxx. Patient AK
xxxi. Patient AL
xxxii. Patient AM
xxxiii. Patient AN
Schedule C:
i. Patient AO
ii. Patient O
iii. Patient AP
iv. Patient AQ
v. Patient AR
Finding
Preliminary matters:
Proof of Service
1. The Panel was provided with confirmation that a Notice of Hearing had been sent by the HCPC on 7 January 2022, to the email address shown for the Registrant on the HCPC register. The Panel noted that the email delivery receipt confirms that the email was delivered at 3.53pm. The Panel 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.
Proceeding in Absence
2. Ms Manning-Rees, on behalf of the HCPC, made an application for the hearing to proceed in the absence of the Registrant under Rule 11 of the Conduct and Competence Committee Rules.
3. The Panel was advised by the Legal Assessor and accepted that advice. The Panel also took into account the guidance as set out in the HCPTS Practice Note “Proceeding in the Absence of the Registrant.”
4. The Panel determined that it was fair and reasonable to proceed with the hearing in the absence of the Registrant for the following interrelated reasons:
i. The Panel Registrant signed a consensual disposal proforma on 28 October 2021 in which she confirmed that she wanted the HCPC to consider her request for Voluntary Removal from the register. The HCPC has agreed that Voluntary Removal would be an appropriate outcome. Therefore, the purpose of today’s hearing is to consider the signed agreement which is, in effect, a joint application made on behalf of both parties. In these circumstances, the Panel concluded that it would be in the Registrant’s interest to proceed with the hearing.
ii. The Registrant’s representatives, the Society of Radiographers, stated in an email dated 14 January 2022, that “We will not be attending.” The Panel took this to mean that the Registrant was aware of the hearing date but would not be attending and neither would her representatives. The Panel was satisfied that the Registrant’s absence is a deliberate and voluntarily waiver of her right to attend.
iii. The Registrant has not made an application to adjourn and there is no indication that even if the case were to be adjourned that she would be willing to attend on any future date. Therefore, an adjournment would serve no useful purpose.
iv. There is no disadvantage to the Registrant as she is represented and has made it clear in her communications with the HCPC that she wishes to be removed from the Register.
v. It is in the wider public interest that this hearing commences and proceeds expeditiously.
Background
5. The Registrant is a registered Radiographer with the HCPC. She commenced employment as a Radiographer with Birmingham Children’s Hospital (‘the Trust’) in December 1981. She started working as a Band 7 Sonographer on 12 August 2003, working 21 hours per week. At her request, the Registrant’s contracted hours were reduced to 15 hours per week on 1 December 2011. Following an external review of the Ultrasound Department, the Band 7 Sonographers including the Registrant, were re-banded to Band 8a Paediatric Clinical Specialist Sonographers on 9 January 2015.
6. The Registrant self-referred to the HCPC on 3 May 2019 informing the HCPC that she was subject to restricted practice. The concerns were also brought to the HCPC’s attention by the Trust on 18 June 2019. The concerns reported related to an extended period of time and were wide ranging. They included:
⦁ a lack of understanding of basic ultrasound principles;
⦁ a lack of recognition of basic pathology;
⦁ a lack of confidence when attempting examinations beyond routine renal and abdominal examinations;
⦁ poor report writing; and
⦁ poor time keeping.
7. As a result of these concerns, the Registrant was made subject to the Trust’s capability proceedings which involved an extensive programme of support and supervision.
8. In addition, an extensive review was undertaken by the Trust in relation to 317 of the Registrant’s scans and reports. This followed the discovery that in 2014 and 2015 the Registrant had failed to identify and record a cystic mass, despite these being clearly imaged. This particular concern was identified when the patient was being scanned and the radiographer looked back at previous scanned images and reports. In relation to the audit, it was found that 107 scans revealed areas of concern or issues which required improvement and 11 of those raised significant concerns involving poor quality scans and failure to report adequately.
9. Following an internal investigation and disciplinary process by the Trust, the Registrant was dismissed from her position on 16 May 2019.
10. On 22 October 2021 the Registrant, via her representative, expressed a desire to pursue Voluntary Removal. On 8 November 2021, the Registrant returned a signed disposal by consent proforma and on 5 January 2022 she sent, by email, a signed copy of the Voluntary Removal Agreement (‘VRA’).
11. The Allegation against the Registrant is as follows: [the alllegation as seen above]
HCPC Submissions
12. Ms Manning-Rees, on behalf of the HCPC, submitted that the VRA is an appropriate means of resolving the case against the Registrant. She referred the Panel to the skeleton argument prepared by the case manager which she adopted as part of her oral submissions. The skeleton argument states that the Registrant has been provided with detailed information about the consent process and the effect of voluntary removal from the Register, should the application be granted. The Registrant has also had time to review this information and query its implications with HCPC.
13. The Panel was informed that after receiving all relevant information about the Voluntary Removal Process and having had time to consider the matter, the Registrant confirmed she wished to be removed from the Register. It was also drawn to the Panel’s attention that the Registrant has signed the VRA admitting her fitness to practise is impaired.
14. Ms Manning-Rees submitted that the VRA would ensure public protection and maintain public confidence in the profession. She further submitted that voluntary removal would not be detrimental to the wider public interest.
The Panel’s Approach
15. Although there were no written submissions from the Registrant, the Panel took into account the communication between the HCPC and the Registrant. The Panel also took into account the signed agreement itself, the Registrant’s supporting statement dated 28 October 2021 and her reflective practise notes dated 29 November 2021.
16. The Panel noted that a VRA is an agreement between the HCPC and the Registrant. The principal terms of the agreement are that the HCPC will apply to withdraw the Allegation on the basis of a signed request by the Registrant to be removed from the Register, and a commitment that the Registrant will cease and desist from practising and will not attempt to re-join the register within a period of 5 years. There are no express provisions for consent agreements, such as disposal of a matter by Voluntary Removal, under The Health Professions Order 2001. However, the HCPTS has produced a Practice Note that the HCPC has approved as a means of allowing matters, where suitable, to be disposed of by consent. This Practice Note states that a Panel should not agree to resolve a case in this way unless it is satisfied that:
i. The appropriate level of public protection is being secured; and
ii. That doing so would not be detrimental to the wider public interest.
17. On the advice of the Legal Assessor, the Panel considered the criteria for a VRA. The Panel noted that Article 11(3) of the 2001 Order and Rule 12(3) of the HCPC Rules, prevent a Registrant from seeking to resign from the Register whilst subject to an Allegation, a Conditions of Practice Order, or a Suspension Order. The Panel also took into account the guidance contained within the HCPC Practice Note: Disposal of Cases By Consent which, in respect of Voluntary Removal states that:
“In cases where the HCPC is satisfied that it would be adequately protecting the public if the Registrant was permitted to resign from the Register it may enter into a Voluntary Removal Agreement allowing the registrant to do so, but on similar terms to those which would apply if the registrant had been struck off.”
Decision
18. The Panel noted that the VRA mirrors the terms of a Striking Off Order, as it would prevent the Registrant from practising as a Radiographer, using any title associated with that profession and would prevent her from making an application to be re-admitted to the register within 5 years.
19. The Panel noted that the Registrant’s lack of competence could not have resulted in a Striking Off Order at the substantive hearing. However, in the alternative, the Allegation asserts that the Registrant’s actions amounted to misconduct for which she could be struck off. The Panel was satisfied that in these circumstances the VRA meets the underlying purpose of removal by consent, which is to avoid unnecessary substantive hearings, in circumstances where the public interest can be met by a consensual disposal.
20. The Panel then went on to consider whether acceptance of the VRA would provide adequate public protection and whether it would be detrimental to the wider public interest.
21. The Panel noted that if it was not satisfied that removal would adequately protect the public interest, the proposed voluntary agreement would have to be rejected, which would mean that the case will proceed towards a substantive hearing before a differently constituted panel of the Conduct and Competence Committee.
22. The Panel considered the Registrant’s own interests. Based on the documentary evidence and the views expressed by the Registrant, the Panel was satisfied that there was sufficient evidence to support a finding of current impairment of fitness to practise. The Panel noted the Registrant’s health concerns and her clear intention to work outside the field of radiography. Furthermore, the Panel was satisfied that the Registrant is fully aware of the consequences of voluntary removal and has willingly entered into the agreement with the HCPC.
23. In considering whether removal of the Registrant’s name from the Register was in the interests of the public the Panel noted that her lack of competence and/or misconduct relates to wide-ranging concerns which are fundamental to safe and effective practice as a radiographer. The Panel also noted that these concerns persisted for a significant period of time including during a period when the Registrant was subject to supervision. The shortcomings in the Registrant’s practice inevitably raised, and continues to raise, patient safety concerns which have the potential to damage the reputation of the profession and are likely to undermine public trust and confidence in the profession.
24. In all the circumstances, the Panel concluded that approval of the proposed VRA is both proportionate and appropriate. The Panel also determined that there is a legitimate public interest in avoiding a substantive hearing, in circumstances where the Registrant has expressed a clear desire to be removed from the Register.
25. Therefore, the Panel consented to the VRA and was satisfied that the professional disciplinary proceedings should be withdrawn.
Order
ORDER: The Registrar is directed to remove the name of Mrs Amanda L Tyler from the Register with immediate effect.
Notes
No notes available
Hearing History
History of Hearings for Amanda L Tyler
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 21/01/2022 | Conduct and Competence Committee | Voluntary Removal Agreement | Voluntary Removal agreed |