Aminah Migisa

The decisions of the First Review Panel made on 3 March 2022

13. The First Review Panel determined that the Registrant’s fitness to practise remained impaired on both the public interest and the public protection grounds. Its reasons, as set out in its determination, include what is set out below. For ease of reference the paragraph numbers of its determination have been retained but are shown in brackets.

(8) In considering the question of current impairment, the panel undertook a comprehensive review of the final order in light of the current circumstances. The Panel took into account the documents furnished to it by the HCPC and the Registrant and had regard to the Registrant’s oral evidence and the parties submissions. The Panel also had regard to the decision of the substantive hearing panel but exercised its own independent judgement in relation to the question of current impairment.

(13) In making its decision, the Panel had regard to both the personal and public elements of impairment.

(14) The Panel considered the Registrant’s oral evidence to be genuine and credible. It was clear to the Panel that the Registrant had made a number of attempts to comply with the current Conditions of Practice Order and to undertake a UK accredited course to remedy her failings. However, the Panel also noted that this had not been possible for the Registrant and that she had sought to do the next best thing, by returning to Uganda to undertake a Masters course, to address the identified failings. The Panel commended the Registrant for her efforts in this regard. It was clear to the Panel that the Registrant showed good insight into her identified failings and also in respect of how public confidence may have been damaged as a result of her failings. The Panel noted that the Registrant had engaged in a meaningful way with the HCPC and also in the regulatory hearing today.

(15) However, the Panel also had regard to the fact that the Registrant candidly accepted that she had been unable to address or fully remedy the previous panel’s findings and that despite her best efforts to do so, she remained currently impaired. The Panel shared this view. The Panel had regard to the identified failings and, notwithstanding the significant steps taken by the Registrant in terms of undertaking a Masters Course in an attempt to address her failings, the Panel was not satisfied that the Registrant had remedied her failings and therefore determined that she continued to pose an ongoing risk to the public. In forming this view, the Panel noted that whilst it had some evidence of completed modules and exam results on the Registrant’s Masters Course in Uganda, it did not have any evidence before it to demonstrate that the Masters course was equivalent to that of an accredited UK course. Further, the Panel also noted that the Registrant began working for the Trust, with non-UK qualifications, and shortly after that, concerns were raised in respect of her practise as a Sonographer. The qualification material provided to the Panel did not reassure it.

(16) Additionally, the Panel noted that it had no testimonials or references before it from the Registrant’s current employers in respect of her current skills working as a Sonographer in Uganda. Whilst the Panel was encouraged by the Registrant’s suggestion that she would not seek to practise in the UK as a Sonographer without first being ‘approved’ or ‘signed-off’, the Panel was not satisfied that she did not pose an ongoing risk to the public at this time. The Panel was also not satisfied that the Registrant has, at this time, the requisite knowledge, skills and experience to ensure that she could practice safely as an independent Sonographer without supervision.

(17) The Panel recognised the need to uphold professional standards and in sending a clear message to other professionals and to maintaining confidence in the regulatory process. The Panel was not satisfied that informed members of the public would not have their confidence in the profession undermined if the Registrant was permitted to practise, without restriction.

(18) Accordingly, the Panel concluded that the Registrant’s fitness to practise remains impaired on both the public interest and public protection grounds.

14. Having concluded that the Registrant’s fitness to practise remained impaired, the First Review Panel considered the sanction that it should impose. It determined that a varied Conditions of Practice Order was the appropriate order for it to make. Its reasons, as expressed in its determination, are set out below. For ease of reference, the paragraph numbers of its determination have been retained, but are shown in brackets.

(19) 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.

(20) The Panel considered the option of a Caution Order however, decided that it would not provide adequate protection for the public.

(21) The Panel went on to consider whether a Conditions of Practice Order would address its ongoing concerns and concluded that it would. The Panel noted the previous panel’s determination and remained satisfied that the Registrant’s failings were capable of being remediated. In addition, this Panel noted that it had the benefit of hearing from the Registrant directly and was satisfied that appropriate conditions of practice could be formulated which would be workable and which would afford the appropriate level of public protection.

(22) In considering the option of conditions of practice, the Panel had regard to the Registrant’s evidence that she was, at this time, unsure whether she wished to return to the UK to practise, but noted that she had also expressed a deep desire to be afforded with a final opportunity to comply with the Conditions of Practice imposed so that she might remedy her failings. The Panel noted that the Registrant had made previous attempts to comply and had been unsuccessful in her endeavours. The Panel also noted that the Registrant had been committed to her studies for the last three years, enrolling in a Masters course, and determined that an amended Conditions of Practice Order, which afforded the Registrant with the possibility of being ‘signed-off’ by a UK accredited Sonographer was appropriate and proportionate to impose at this time. Taking into account the reasons and circumstances outlined by the substantive hearing panel; the Panel decided that, in the circumstances, the Registrant should be afforded with an opportunity to satisfy a future panel that her fitness to practise is no longer impaired.

(23) The Panel next considered the option of replacing the existing Conditions of Practice Order with a Suspension Order. However, the Panel decided that a Suspension Order would be disproportionate at this time.

(24) The Panel therefore decided that the appropriate and proportionate Order is to extend the current Conditions of Practice Order, but to vary the Order to reflect both the HCPC and Registrant’s submissions. The Panel decided that the Order should be extended for a period of two years to allow the Registrant time to apply to the UK either for a further accredited course or to find employment such that she can be ‘signed off’ as competent to practise independently by a supervising Sonographer registered with a UK healthcare regulatory body recognised by the HCPC.

The Conditions of Practice imposed by the First Review Panel

15. The Conditions of Practice Order as varied and imposed by the First Review Panel was in the following terms;

ORDER: The Registrar is directed to annotate the Register to show that Ms Migisa is subject to a conditions of practice order for a further period of 2 years from the date of the expiry of the current Order.

Whilst undertaking any employment in respect of which you are required to be a registered Radiographer:

You must not work as a Sonographer unless directly supervised at all times until you have successfully completed a course in sonography accredited by the Consortium for the Accreditation of Sonographic Education, (“CASE”) or being signed off as competent to practise independently by a supervising Sonographer registered with a UK healthcare regulatory body recognised by the HCPC.

2. Before starting work as a Sonographer without supervision, you must forward to the HCPC a copy of your results from the course referred to in Condition 1 above or alternatively, you must send evidence of having been signed off as a competent Sonographer by the independent UK registered practitioner supervising your practice outlined in Condition 1.

3. The person supervising your work as a Sonographer must be registered with a UK healthcare regulatory body recognised by the HCPC, with a qualification in Sonography, accredited by CASE, or an equivalent.

4. You must promptly inform the HCPC 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;

B. any agency you are registered with or apply to be registered with (at the time of application); and

C. any prospective employer (at the time of your application).

16. The First Review Panel also gave guidance as to what might assist a subsequent review panel. That guidance was in the following terms;

The Panel also considered that a future reviewing panel may be assisted by the following:

i. up to date testimonials from her employers and/or tutors/supervisors;

ii. evidence that the Registrant has kept her skills and knowledge up to date such as any continuing professional development courses undertaken (detailed course syllabus’);

iii. evidence concerning any voluntary/paid work undertaken within a hospital or healthcare environment; and

iv. references or testimonials which may be from employment, voluntary work and/or the Registrant’s private life.

Hearing on 11 March 2024

The Submissions made on behalf of the HCPC.

17. Ms Khorassani on behalf of the HCPC briefly summarised the determinations of the Substantive Order Panel and that of the First Review Panel. She submitted that the Registrant was still impaired on both the personal and the public components. She submitted that the appropriate order for the Panel to make was a Strike Off Order. In support of this submission, Ms Khorassani reminded the Panel that there had been no engagement by the Registrant with the HCPC since the first review hearing in March 2022. She also submitted that the Registrant was in breach of relevant provisions of the Standards of Conduct, Performance and Ethics of the HCPC.

Submissions by the Registrant

18. The Panel has not received any submissions by or on behalf of the Registrant.

The decisions of the Panel (the Second Review Panel) made on 11 March 2024

19. The Panel heard and accepted the advice of the Legal Assessor.

20. The Panel is aware that it has all the powers that are set out in Article 30 [1] of the Health Professions Order 2001 [The Order] and which are set out in the email sent to the Registrant giving notice of this hearing.

21. The Panel is aware that the process under Article 30 [1] of the Order is one of review and not one of appeal and that its function is to determine whether the Registrant’s fitness to practise remains impaired: if so, whether the Conditions of Practice Order under review remains appropriate and proportionate or should be varied or replaced by some other order.

Decision of the Panel on Impairment

22. Having taking account of the submissions made by Ms Khorassani, the Panel has concluded that the Registrant’s fitness to practise remains impaired. Its reasons are essentially the same as those given by the First Review Panel. The Registrant has not complied with any of the suggestions made by the First Review Panel as to what might assist a subsequent reviewing panel. She has not addressed any of the deficiencies that had been established at the previous hearings. She has not engaged with the HCPC since March 2022. In these circumstances it could not be said that the Registrant has addressed or remediated any of the concerns previously established. In substance, the Panel concluded that the Registrant had not discharged the persuasive burden of establishing that she was no longer impaired.

23. Moreover, the Panel has concluded that in all the circumstances it could not exclude a risk of repetition. It also concludes that public confidence in the profession and in the HCPC as its regulator, would be gravely undermined if the Panel was to determine that the Registrant’s fitness to practise was not now impaired and the Registrant was permitted to return to unrestricted practice. Consequently, for the same reasons that are set out in the determination of the First Review Panel, the Panel determines that the Registrant’s fitness to practise remains impaired on both the personal and the public components.

Decision of the Panel (The Second Review Panel) on Sanction:

24. In considering the appropriate order the Panel had regard to the HCPC’s Sanctions Policy updated in March 2019, to the submissions of Ms Khorassani and to the advice of the Legal Assessor.

25. The Panel has applied the principle of proportionality. The Panel is aware that the purpose of sanction is not to be punitive and that it must consider the risk of repetition and public confidence in the profession and its regulator.

26. The Panel has considered the sanctions available in ascending order of restriction. The Panel considered that to take no action or to impose a Caution Order would be wholly inappropriate.

27. The Panel has determined that a Conditions of Practice Order is no longer appropriate. A Conditions of Practice Order has been in place since 2019. There is no evidence that the Registrant has sought to comply with them. She has not engaged with the HCPC since March 2022. The Registrant may well be in Uganda. The Panel has no information as to her present whereabouts or the nature of her employment. The Panel did not consider that any purpose would be served by a Suspension Order. It was not in the public interest that the matter should be retained in the review cycle. In all the circumstances the appropriate and proportionate order was a Striking Off Order with immediate effect.