Mrs Christy A Henderson

: Radiographer

: RA48227

Interim Order: Imposed on 31 Mar 2014

: Review Hearing

Date and Time of hearing:10:00 13/09/2017 End: 12:00 13/09/2017

: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Suspended

Allegation

During the course of your employment as a Radiographer with University Hospital of North Staffordshire NHS Trust between July 2013 to November 2013, you:

1. Knowingly deleted 30 mammographic images you took, contrary to the Ionising Radiation (Medical Exposure) Regulations 2000, (IR(ME) R 2000).

2. Did not make an accurate record of the dosage / exposure received by the patients by not accurately completing for each of the images you had deleted and / or repeated:
a) a Technical Recall/Technical Repeat form;
b) a Screening Form

3. Your actions set out in paragraph 1 were dishonest.

4. The matters described in paragraphs 1 and 3 constitutes misconduct.

5. The matters described in paragraph 2 constitutes misconduct and / or lack of competence.

6. By reason of that misconduct and / or lack of competence, your fitness to practice is impaired.

Finding

Background
1. The Registrant was employed as a trainee Mammographer at the University Hospital of North Staffordshire NHS Trust (the Hospital) between 2 September 2012 and 16 January 2014 when she was dismissed. Mammographers are required to complete a breast screening form for every patient. The screening form requires basic information such as the patient’s name, date of birth and address. The form also records information pertaining to the mammogram including how many radiographic exposures the patient was subjected to, how many repeat mammograms were undertaken and the reasons for any such repeat mammograms.

2. It was departmental policy that no breast screening images should be deleted, even if the image was of poor quality. This was because any such image might contain some diagnostic information that could be of value when considering whether the patient has or is susceptible to breast cancer. Moreover, it is important for it to be known what dosage of radiation a patient has been exposed to and how many images were obtained. It was also departmental policy that if a mammographic image was of such poor quality that it needed to be retaken, the Mammographer was required to complete what was known as a Technical Recall/Technical Repeat form (TR/TP form) which recorded the reason why it had been necessary to retake the image. The departmental policy was that if it was necessary to repeat the image, a trainee Mammographer should get the approval of a more senior member of staff who would, if appropriate, authorise the repeat image on the TR/TP form, so there would be formal authorisation to expose the patient to further ionising radiation.

3. Departmental policy also required that the TR/TP form would be stored as part of the patient records and the poor quality image and any additional images would be archived. It was essential that the Mammographer completed the TR/TP form so that the reasons for the repeated image were recorded for audit purposes as the TR/TP was regarded as a key performance measure.

4. Following a routine check on the Hospital computer system by an Advanced Practitioner Radiographer in October 2013, it was discovered that the Registrant appeared to have deleted two mammographic images. The Registrant was asked about the deleted images and initially denied having deleted the two images. Subsequently in November 2013 it was discovered that the Registrant appeared to have deleted a further 28 mammographic images. Following an investigation into the 30 images that the Registrant was alleged to have deleted, it was concluded that there was a case for the Registrant to answer. A disciplinary hearing was conducted by the Trust on 15 and 16 January 2014. That disciplinary panel concluded that the Registrant had indeed deleted the images and failed to record this, and that her actions amounted to gross misconduct. The Registrant was dismissed from the Hospital with immediate effect.

5. Following a Substantive Hearing on 16–18 March 2015 the panel found the allegations set out proved. That panel found that the allegations proved amounted to misconduct and that the Registrant’s fitness to practice was impaired. That panel decided that a 12 month Suspension Order was the appropriate and proportionate sanction.

6. On 17 March 2016, the Suspension Order was reviewed and on that occasion the panel considered there was a lack of evidence of full insight and remediation, and imposed a further Suspension Order of 12 months. The Registrant was not present at that hearing but made submissions by email. That panel considered that a future reviewing panel would be assisted by the following:
• Hearing from the Registrant in person
• Evidence of continuing professional development (CPD) specifically to address the Registrant’s understanding of the risk to service users from her failure accurately to record the radiation they have been subjected to
• If she wishes to return to a career in radiotherapy, evidence from the Registrant that she has up to date CPD knowledge of that field
• Evidence, either written or oral (should she choose to attend the review hearing) that she fully accepts responsibility for the facts found proved at the substantive hearing in addition to the misconduct
• Evidence that the Registrant has developed full insight into the risks to service users arising from her actions and the way her actions have brought her profession into disrepute
• Evidence to reassure a future panel there is no longer a risk of repetition of her dishonesty.

Review on 14 March 2017.
7. On 14 March 2017, there was a further review of the original Order. That panel was informed of a letter from the Mid Cheshire Hospitals Foundation Trust dated 25 August 2016 in which that Trust found that the Registrant had acted dishonestly in withholding relevant information in employment application forms submitted to that Trust in 2014 and in failing to disclose her HCPC suspension. But for the Registrant’s resignation she would have been dismissed for gross misconduct. The Presenting Officer informed the panel that the HCPC did not intend to commence fitness to practise proceedings in relation to that matter.

8. The Registrant was present at that hearing and gave evidence. The panel determined that the Registrant’s fitness to practise was still impaired. The panel gave as its reason that, particularly in light of this new information it could not completely exclude the risk of repetition and further that public confidence in the profession and in the regulatory powers of the HCPC would be undermined if a finding of impairment was not made. The panel also held that the need to maintain appropriate standards required a finding of current impairment.   

9. Having determined that the Registrant’s fitness to practise remained impaired, the March 2017 review panel imposed a further period of suspension of 6 months. It explained its reasons in the following terms:

The Panel had regard a number of considerations including the need for the Registrant to demonstrate that she has fully addressed and learnt from her previous dishonesty and to satisfy the public interests of upholding proper standards, and maintaining confidence in the profession and the regulatory process. It would also enable the Registrant to do what a further reviewing panel might require in order to satisfy that panel that her fitness to practise was no longer impaired.”

10. The panel gave guidance as to what would assist a reviewing panel and stated as follows;

The Panel considered that a future reviewing panel would be greatly assisted by the following:
• The presence of the Registrant at the review hearing
• Any character references and testimonials from recent employers as to her character and conduct, and also to confirm the fact that the Registrant has disclosed to them the facts associated with these proceedings and those that led to the action taken by the Mid Cheshire Hospitals NHS Foundation Trust.
• A written reflective piece setting out what the Registrant has learnt from the present proceedings
• Evidence of the Registrant’s CPD portfolio giving details of how she has kept her professional skills up to date
.”

Decision
11. Ms Dudrah on behalf of the HCPC made submissions, which in summary were as follows; the Registrant had not practised as a Radiographer for 7 years; the Registrant’s  skills and knowledge as a Radiographer had not been maintained and were not up to date; there was limited evidence that the Registrant had remediated her failings and that in all the circumstances a finding that the Registrant’s fitness to practise remained impaired was required;  no appropriate conditions of practice could be formulated; the Registrant had been suspended for over two years and in the public interest a striking off order should now be considered.

12. The Registrant has submitted a number of documents all of which this Panel has read; those documents include the following;
• A reflective statement.
• A document entitled “Continuing Professional Development”.
• A reflective diary.
• Copies of several professional journal articles which she has read.
• Three references.
• Three certificates relevant to historic Continuous Professional Development.

13. The Registrant also gave  oral evidence, responded to questions and made submissions. In summary, what she said was as follows; she has not worked as a Radiotherapy Radiographer since 2011 and has not worked at all as a Radiographer since 2013 (4 years). She currently works in insurance but she would very much like to return to work as a Radiographer. She gave details of her professional career to date. She recognises that if she was enabled to return to work as a Radiographer, she would have to retrain, attending the relevant courses. She explained the CPD that she had done in order to maintain her skills and knowledge. On questioning she accepted that this was confined to reading articles and had primarily been in the last few months. Referring to the allegations that were found proved, she said that she was deeply ashamed of her action for which she apologised “unreservedly”. She assured this Panel that she would never again behave in the way she had and that she fully accepted the importance of adhering to the Ionising Radiation (Medical Exposure) Regulations (IRMER). She explained that at the time to which the allegations related she was going through a very difficult and stressful time, but since then, her personal circumstances had improved and she had in place effective coping mechanisms. She explained the importance that she attached to caring for patients and  patient contact. She hoped that this Panel would give her another chance to return to her chosen profession.

14. The Registrant’s husband made a statement to this Panel. He told this Panel that his wife was one of the most caring persons that he knew. This was the reason why she wanted to resume work as a Radiographer.  He explained that their finances were such that she did not have to work. He said that he believed that at the time to which the allegations related, his wife was suffering from post natal depression.

15. This Panel heard and accepted the advice of the Legal Assessor.

16. This Panel is aware that it has all the powers that are set out in Article 30 (1) of the Health and Social Work Professions Order 2001 (The Order) and which are summarised in the letter dated 11 August 2017 addressed to the Registrant, and giving notice of this hearing .

17. This Panel is aware that the process under Article 30 (1) of the Order is one of review, not one of appeal and that its function is to determine whether the Registrant’s fitness to practise is still impaired and if so whether the suspension order under review remains the appropriate and proportionate means of public protection or should be varied or replaced by some other order.

Impairment
18. This Panel has concluded that the Registrant’s fitness to practise is  currently impaired. This Panel’s reasons are as follows; notwithstanding the reflective piece which the Registrant has produced, this Panel is not satisfied that the Registrant has developed full insight into the gravity of her dishonesty. In particular, the Panel is not satisfied of the Registrant’s insight into the effect of the dishonesty found proved in relation to the original allegation and the further dishonesty demonstrated by her concealment of her dismissal and her non-disclosure of the HCPC suspension, and its effect on the reputation of the profession and the confidence of those in her care. Moreover, the Registrant’s actions could have had a serious impact on the health of her patients and this Panel is not satisfied that the Registrant has shown a proper recognition of that. In these circumstances this Panel has decided that a finding of impairment to the Registrant’s fitness to practise is required in order to ensure  proper protection to members of the public and also to ensure public confidence in the profession, in its regulatory procedures and so as to maintain proper standards of behaviour and clinical competence on the part of Radiographers. 

Sanction
19. Having concluded that the Registrant’s fitness to practice is still impaired, this Panel proceeded to consider what order is appropriate, proportionate and sufficient to protect the public and safeguard the public interest. This Panel took into account the principles of proportionality, balancing the interests of the Registrant with the public interest.

20. This Panel has had regard to the contents of the Indicative Sanctions Policy  published by the HCPTS and is aware that sanctions should be considered in ascending order of severity. This Panel is aware  that the purpose of sanctions is not punitive but to protect members of the public and to safeguard the public interest. The latter objective includes maintaining standards within the profession, together with public confidence in the profession and in its regulatory processes.

21. This Panel has concluded that to take no action, thus allowing the present order to lapse,  making a mediation order or imposing a caution order would be inappropriate having regard to the nature and gravity of the matters found proved. Such outcomes would not sufficiently protect the public or the public interest.

22. This Panel concluded that a Conditions of Practice Order would not be appropriate. In substance, its reasons are the same as those stated by the panel on 14 March 2017 namely that the Registrant is not currently in relevant employment and  that there are no conditions which this Panel could reasonably formulate, which would address the deficiencies established.

23. This Panel then considered an extension of the existing Suspension Order.  This Panel has noted that the Registrant has not worked as a Radiographer since 2013. In such circumstances it is inevitable that her professional skills would decay.  However this Panel noted from all the material before it, that the Registrant has not done all that she could have done to keep her knowledge base up to date; in particular her self directed learning appears to have been limited and has not been targeted towards the issues identified by the previous panels. It does not address the concerns about her understanding of the risk to patients from her failure accurately to record radiation doses. There is no evidence that she has effectively explored return to practise courses or alternative means of retraining, including voluntary work and/or observing practice. It is quite clear that without effective re-training, the Registrant will not be able to resume work as a Radiographer. Moreover this Panel would have welcomed more extensive evidence that the Registrant is a person whose integrity can now be relied upon and in this context, more extensive references would have been welcome, particularly (as suggested by the previous panel), confirming that the Registrant has disclosed to them the facts associated with these proceedings.

24. The Panel notes, however, that the Registrant appears strongly motivated to return to therapeutic radiography and that her performance issues seem to have arisen after she transferred to the field of diagnostic radiography. It also notes the support network now available to the Registrant and the coping strategies about which she advised the Panel.

25. This Panel has applied the principle of proportionality and in doing so has concluded, albeit not without some hesitation, that on this occasion, it would be disproportionate to make a striking off order. Accordingly this Panel has decided to make a further 12 month Suspension Order.

26. Whilst not in any way seeking to bind any future Panel, this Panel  considers that a future reviewing panel would be greatly assisted by the following;
• Hearing from the Registrant in person.
• Evidence that would reassure a future panel that there is no longer a risk of repetition of her dishonesty.
• Evidence that on further reflection, the Registrant has developed full insight as to the risks that her actions and her lack of honesty posed to patients, the reputation of her profession, and the confidence that patients would have in the care that she and fellow practitioners provide.
• Evidence that if she wishes to resume a career as a Radiographer, she has brought her CPD knowledge up to date and has maintained it in accordance with the recommendations set out in the HCPC publication ‘Continuing Professional Development and your Registration’.
• Evidence of the steps that she has taken to obtain a place on relevant return to practice courses and/or in respect of alternative means of retraining.

27. In the absence of evidence available to the next reviewing panel that the Registrant is well placed safely and effectively to resume employment as a Radiographer, it is inevitable that very serious consideration will be given to a striking off order. In the absence of such evidence it is unlikely that continued suspension would be regarded as being in the public interest.

Order

The Registrar is directed to suspend the registration of Mrs Christy A Henderson for a further period of 12 months on the expiry of the existing order.

Notes

The Order imposed today will apply from 15 October 2017.

This Order will be reviewed again before its expiry on 15 October 2018.

Hearing history

History of Hearings for Mrs Christy A Henderson

Date Panel Hearing type Outcomes / Status
13/09/2017 Conduct and Competence Committee Review Hearing Suspended
14/03/2017 Conduct and Competence Committee Review Hearing Suspended
17/03/2016 Conduct and Competence Committee Review Hearing Suspended
16/03/2015 Conduct and Competence Committee Final Hearing Suspended