Mrs Blessing Chabvamurambo

: Radiographer

: RA64282

: Review Hearing

Date and Time of hearing:12:30 13/09/2017 End: 17:00 13/09/2017

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

: Conduct and Competence Committee
: Struck off

Allegation

During the course of your employment as a Radiographer at the Dudley Group NHS Foundation Trust, you:

1. On or around 10 April 2013:
a) In respect of Patient A:
i. Removed her arm brace when it was not safe to do so;
ii. Did not note from Patient A’s records that the fracture had occurred recently;
iii. (Not proved)
iv. (Not proved)

b) In respect of Patient B:
i. Produced a chest X-ray which was not of diagnostic quality;
ii. Sent the X-ray mentioned in 1(b)(i) to PACS;
iii. Did not re-xray Patient B;
iv. Did not advise colleagues at handover that Patient B would need to be re-xrayed.

c) In respect of Patient C:
i. (Not proved)
ii. (Not proved)

2. On or around 12 July 2012, did not carry out appropriate identity checks with the result that you X-rayed the wrong patient.

3. The matters set out in paragraphs 1 and 2 constitute misconduct and/or lack of competence.

4. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary matters
Service
1. This Panel is aware that written notice of these proceedings was posted by air mail post to the Registrant at her registered address on 11 August 2017. Notice was also given by email on the same day. The Panel was shown documents which established the fact of the service and the identity of the Registrant’s registered postal and email address. In these circumstances the Panel accepted that proper service of the notice had been effected.

Proceeding in the absence of the Registrant
2. Ms Benamaisia on behalf of the HCPC submitted that this hearing should proceed in the absence of the Registrant. There has been no communication from or on behalf of the Registrant. The Panel heard and accepted the advice of the Legal Assessor

3. This Panel was aware of the need to consider the application to proceed in the absence of the Registrant with great caution. However after giving that application very careful thought, the Panel has determined to allow it. Its reasons are as follows;
• Notice of this hearing has been properly served on the Registrant.
• The Registrant has not applied for an adjournment.
• Since the  original hearing the Registrant has not engaged with the HCPC. She did not attend and was not represented at the review hearing on 14 September 2016.
• There is no reason to suppose that if an adjournment was granted, the Registrant would attend.
• This is a mandatory review of the present order.
• In all the circumstances the absence of the Registrant can be regarded as voluntary.

Background
4. The Registrant was employed as a Band 5 Radiographer in the X-ray department of Dudley Group NHS Foundation Trust (the Trust) from 2010 until her resignation in June 2013. She worked mainly evening and night shifts. The matters found proved raised concerns regarding patients which occurred on 10 April 2013 and an earlier clinical incident which occurred in July 2012.

5. On or around July 2012, the Registrant was working a night shift. At approximately 04.00 she received a portable X-ray request for a child who was due to be taken to the Emergency Department by another member of staff for the X-ray. The Registrant attended the department and found a child who appeared to match the description as stated on the X-ray request. The Registrant made partial identity checks and the child was X-rayed. The Registrant returned back to the X-ray department and she later received a telephone call querying why the child had not been X-rayed as per the request. The Registrant had X- rayed the wrong patient.

6. In respect of this matter the Registrant completed a clinical incident report. The matter was considered at a disciplinary hearing and the Registrant was issued with a final warning.

7. On 10 April 2013, the Registrant was working an evening shift, which was due to finish at midnight. Sometime around 11.45 Patient A was sent for an X-ray by the Emergency Assessment Unit. The patient had a spiral humeral fracture, which was approximately one week old at the time. This was detailed on the X-ray request form. She was wearing an arm brace, which was made of fabric with a Velcro fastening. The Registrant removed the arm brace to X-ray the arm. Another Radiographer began her shift shortly before midnight and joined the patient and the Registrant in the X-ray room. The Registrant then finished her shift.

8. During the shift on 10 April 2013, at approximately 21:00, the Registrant was called on to a ward to X-ray Patient B. She attended and completed a portable X-ray towards the end of her shift. In respect of Patient B, another Radiographer later spoke on the telephone to a doctor, who expressed that he was not happy with the X-ray image he had received of Patient B. The image was re-requested. That Radiographer subsequently reviewed the original X-ray image and established that it was taken by the Registrant. The image was of no diagnostic quality. He had not been informed by the Registrant that Patient B’s X-ray would need to be redone.

9. The concerns in relation to patients were investigated and a disciplinary hearing was scheduled. Prior to the hearing, the Registrant resigned.

10. The matter was considered by a Fitness to Practise Panel which commenced in November 2014 and was concluded in March 2015. A number of matters were found proved and that Panel concluded that the Registrant’s fitness to practise was impaired by reason of lack of competence. That panel imposed a Conditions of Practice Order for a period of 18 months.

Review on 14 September 2016
11. On 14 September 2016 the original order was reviewed. The Registrant did not attend and was not represented. The panel concluded that the Registrant’s fitness to practise remained impaired. The panel stated that “she has yet to demonstrate that she has remedied the failings that were identified by the previous panel. A finding of current impairment is required to protect patients, maintain confidence in the profession and to uphold proper standards of conduct and behaviour”

12. The panel proceeded to consider what sanction would be appropriate and proportionate. It concluded that the appropriate and proportionate sanction would be a suspension order for 12 months. It stated its reasons and the relevant considerations as follows;

The Panel noted, a sanction is only to be imposed to the extent that it is required to protect patients and to maintain a proper degree of confidence in the registered profession and this regulatory process.

The Panel determined that to take no action would be insufficient given that the Registrant has yet to demonstrate that she had remedied the failings identified in this case. The Panel considered that a Caution Order would not afford patients any degree of protection.

The Panel then went on to consider a Conditions of Practice Order. It considered that given the HCPC has heard nothing from the Registrant for 18 months and that her registered address remains in Australia, the Panel considered that conditions of practice are not practicable or workable. Given that the Panel does not know what the registrant is doing it concluded that to maintain such an order was neither practical nor realistic. The Panel has concluded that it could not formulate practical or workable conditions.

The Panel considered that the appropriate and proportionate order would be a Suspension Order for 12 months. Such a period of time would enable the Registrant to engage with the HCPC and demonstrate her commitment to remaining on the HCPC register as a Radiographer. The Panel concluded that a Suspension Order for a period of 12 Months was appropriate and proportionate.”

13. The panel gave guidance to what would assist a reviewing panel in the following terms;
Any future reviewing panel may be assisted by:
• Evidence of the deficiencies, highlighted by the previous panel, having been remedied
• Engagement with the HCPC
• Evidence of continuing professional development.
• References from an employer

Decision
14. Ms Benamaisia on behalf of the HCPC made submissions to this Panel. In summary, she said as follows; that as the Registrant has not engaged with the HCPC since March 2016 and has not produced any evidence to show that she has addressed or remedied the deficiencies that have been established, a finding of impairment to the Registrant’s fitness to practise was required. Conditions  of Practice could not be formulated; consequently the Panel should consider whether to extend the existing Suspension Order or make a Striking Off Order. The HCPC had no submissions  to make  as to which outcome should be preferred.

15. The Registrant has not made any submissions and has not provided any material or information or otherwise engaged with the HCPC since March 2015.

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

17. 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 .

18. This 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 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
19. This Panel has concluded that the Registrant’s fitness to practise is  currently impaired. This Panel’s reasons are as follows; the Registrant has not engaged with the HCPC since the hearing in March 2015; she has not provided any evidence that she has addressed or has remedied the deficiencies previously identified; she has not produced any of the material that was identified by the reviewing panel in September 2016. In all the circumstances this Panel concluded that a finding of impairment to the Registrant’s fitness to practise was required for the protection of members of the public and was also in the public interest. Such a finding is necessary so as to maintain proper standards of behaviour and to sustain public confidence  in the profession and in its regulatory processes.

Sanction
20. 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.

21. 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.

22. 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.

23. 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 September 2016.In particular this Panel has no information as to the nature of the Registrant’s current occupation and has received no evidence that she would comply with any order.

24. This Panel then considered an extension of the existing Suspension Order. However, it was deeply troubled by the fact that the Registrant has not engaged with the HCPC since March 2015 and has not complied with the suggestions made on 14 September 2016. The Registrant has not provided any of the material that was identified in September 2016 as being helpful to this Panel. There is no evidence that she has sought to address or to remedy the deficiencies previously established or that she understands the gravity of her failings.  In the opinion of this Panel the continued registration of the Registrant is incompatible with the public interest. This Panel has concluded that a Striking Off Order is the only order that appropriately addresses the need to protect the public and the public interest. Accordingly this Panel makes a Striking Off Order.

Order

That the Registrar is directed to strike the name of Blessing Chabvamurambo from the Register on the date this order comes into effect.

Notes

The order imposed today will apply from 14 October 2017 date.

Hearing history

History of Hearings for Mrs Blessing Chabvamurambo

Date Panel Hearing type Outcomes / Status
13/09/2017 Conduct and Competence Committee Review Hearing Struck off
14/09/2016 Conduct and Competence Committee Review Hearing Suspended
16/03/2015 Conduct and Competence Committee Final Hearing Conditions of Practice