Emmanuel I O Ehiwe

Background

1. The background to this application for restoration is that the Applicant was formerly a registered Radiographer. He was struck off the Register after a hearing before a panel of the Conduct and Competence Committee held on various dates between 01 April 2017 and 3 May 2018 when his fitness to practise was found to be impaired by reason of misconduct in relation to the above Allegation.

2. At the relevant time the Applicant had been employed as a locum Sonographer by Diagnostic Healthcare. On the 12, 13, 26 and 27 April 2012, the Applicant was working in that capacity at the Liverpool Women’s Hospital NHS Foundation Trust (“the Trust”) and was based in the Imaging Department of the Liverpool Women’s Hospital (“the Hospital”).

3. On 28 August 2021, Patient A gave birth to a baby with a spinal abnormality, a large myelomeningocele, a form of spina bifida. This defect had not been detected before the birth and so the Hospital reviewed the anatomy scan which had been taken on 26 April 2012 in relation to Patient A’s pregnancy at approximately 20 weeks gestation. The scan had been taken by the Applicant and it appeared that he had not identified the myelomeningocele.

4. As a result of this, the Trust reviewed all the Applicant’s work on 26 and 27 April 2012 when he had been working at the Hospital as a locum Sonographer. This review resulted in the concerns set out in the Allegation in relation to Patients B to K inclusive. At a later date, the Trust also reviewed the Applicant’s work on 12 and 13 April 2012 and this resulted in the concerns set out in the Allegation in relation to Patients 1 to 7 inclusive. The Allegation therefore involved concerns about the Applicant’s competency as a Sonographer in relation to 18 different patients which had occurred over a four-day period.

Decision that led to the Striking Off Order

5. At the outset of the final hearing, the HCPC indicated that it did not intend to proceed with a number of the specific particulars in the Allegation. The panel decided that it would formally record these as having been found not proved when it gave its decision on the other allegations.

6. In reaching its decision on the remaining facts of the Allegation, the panel heard evidence from three witnesses called by the HCPC: CD, a Radiographer and the Trust’s Clinical Manager of Imaging; Dr DR, an Obstetrician who was the Trust’s Imaging Lead for the Maternity and Imaging Executive; and an expert witness, Mrs Tracey Butcher, a Consultant Sonographer. The panel also heard evidence from the Applicant who had represented himself during the hearing. He called two witnesses. The panel found the Applicant to have been an inconsistent witness and decided that it needed to approach his evidence with “a significant degree of caution”. Not only had the Applicant changed his position from the account regarding Patient A which he had given to the Hospital during the Trust’s internal investigation, but he had also changed his account of what had occurred in relation to various matters during the hearing, particularly in relation to Patient A. The panel found that there were aspects of the Applicant’s case which could only be described as “deceitful”. The panel referred to the Applicant being unable to accept that anyone could hold any opinion opposite to the case he was seeking to advance.

Statutory ground

7. In relation to the statutory ground of misconduct: the panel concluded that with the exception of the matters found proved in Particulars 4(d), 16(g), 18(e), and 19(g), the remainder of its findings, when considered either individually or together, were sufficiently serious failings to constitute misconduct. The panel referred to the purpose of competently taken scans which was that patients could then make informed decisions as to their pregnancies and other medical professionals can make informed decisions about future treatment and care of those patients. The panel’s reasons for concluding that there was misconduct in this case were:

• “The Registrant was an experienced Sonographer. He came to the United Kingdon in 2005 and practised as a Sonographer for a period of approximately seven years before the matters being considered by the Panel.

• The Panel is satisfied that that the Registrant knew what he should have been doing. A lack of familiarity with local protocols does not excuse failing to follow FASP or FMF guidelines.

• As it had been demonstrated that the Registrant had the ability to scan to an acceptable standard, it followed that in each instance in which the Panel has found that there was a shortcoming, he had failed to do what he was able to.

• The majority of the Panel’s findings are of omissions on the part of the Registrant – that is to say, failures to take required images or, for example, to record that the patient required a repeat scan or test. However, in the case of Patient H, the use of the Spectral Doppler to listen to the baby’s heartbeat was a positive act that demonstrated, in this instance, a clear disregard for patient safety.

• The findings demonstrate repeated examples of failures to follow established national guidelines, poor technique and rushed acquisition times.

• Overall, the Panel finds in relation to each and every one of the 15 patients included in the particulars found proved, there was a failure to act in the best interests of service users. This constituted a breach of Standard 1 of the HCPC’s Standards of conduct, performance and ethics.”

8. The panel decided that the two statutory grounds of lack of competence and misconduct were mutually exclusive. The panel did not therefore find lack of competence in relation to those matters where it had concluded there had been misconduct. In relation Particulars 4(d), 16(g), 18(e), and 19(g), the panel concluded that these did not amount to lack of competence because the shortcomings were neither sufficiently serious nor wide-ranging to enable an inference of lack of competence.

Fitness to practise impairment

9. In considering whether the Applicant’s fitness to practise was impaired, the panel heard further evidence from the Applicant. It concluded that in certain respects the Applicant had been evasive in his answers to the Presenting Officer and cited by way of example, that it took several repetitions of the straightforward question whether he had undertaken any re-training in obstetrics before the Applicant finally answered that he had not. The panel noted that there was no supporting evidence that the Applicant had shadowed colleagues in obstetric work, and he could not name the colleagues he had shadowed; that certain documents produced by the Applicant were incomplete or undated or missing elements such as attachments to emails. The panel also noted that there were inconsistencies in the Applicant’s account, such as his purported acceptance of its findings coupled with assertions which flatly contradicted elements of those findings.

10. In relation to the personal component, the panel found that the Applicant had no meaningful insight. The panel concluded that the Applicant was not a self-critical individual and that he did not truly reflect on matters. The panel considered that the written reflections produced by the Applicant were out of date and inadequate. The panel was left with the impression that the Applicant understood what he was expected to say that he had insight but that, in fact, he had none. The panel noted that the Applicant had not demonstrated any genuine remorse for his shortcomings.

11. The panel considered that the misconduct was remediable but that the Applicant had not taken sufficient steps to remedy this. The panel rejected the Applicant’s evidence that he had shadowed a number of his colleagues in obstetrics who were undertaking obstetric ultrasound scanning. The panel was concerned that the Applicant was not willing to admit mistakes. It noted that in his conduct of his case, the Applicant had failed to accept criticisms of his work despite the clear and obvious evidence with which he was presented. The panel referred to the Applicant having sought to justify the unjustifiable. The panel concluded that there was no material available to it to conclude that the Applicant would change in the future and be willing to acknowledge mistakes.

12. The panel concluded that there was a high risk of repetition of the Applicant’s shortcomings given the absence of meaningful insight, the absence of retraining and the Applicant’s propensity not to admit mistakes, when taken together.

13. The panel therefore found the Applicant’s fitness to practise to be impaired on the personal component.

14. In relation to the public component, the panel concluded that given the seriousness of the findings of fact made, even if significant efforts had been made towards remediation, fair-minded members of the public would have significant concerns about the prospect of a practitioner in these circumstances being permitted to return to practise unrestricted. The panel took the view that those concerns would escalate in circumstances where the remediation was as incomplete, and the risk of repetition as great as the panel had found it to be in the Applicant’s case. The panel decided that a finding of impairment was required to satisfy public confidence in the profession and in its regulation.

15. The panel was satisfied that by his misconduct, the Applicant had put patients and unwarranted risk of harm and was liable to do so in the future. He had also brought his profession into disrepute and was liable to do so in the future, and he had breached a fundamental tenet of his profession, namely, to put the interests of service users first, and was liable to breach it in the future.

16. The panel therefore found that the Applicant’s fitness to practise was also impaired on the public component.

Sanction

17. In considering whether to impose a sanction, the panel found that the aggravating factors were:

• “the fact that the misconduct was not isolated, but was repeated in respect of a number of patients;

• The unnecessary exposure of patients to risk of harm

• A very significant lack of insight”.

18. The panel found the following mitigating circumstances:

• “That there were no previous fitness to practise proceedings against the Registrant”.

• The findings against the Registrant occurred six years ago and he has had the case hanging over him for most of that period.

• The Registrant has engaged in this fitness to practise process”.

19. The panel then went on to identify the crucial findings it had already made which would inform its decision on sanction. These were:

• “The absence of any meaningful insight into the identified shortcomings.

• The absence of remediation, of which the absence of meaningful insight was one, but not the only element.

• The fact that without remediation, patients would be exposed to the risk of harm by the Registrant being permitted to return to unrestricted practice.

• The continuing denial of criticism of his work in the face of clear evidence presented to him and a full opportunity to consider and reflect upon those criticisms. Hand in hand with this, was the presentation of a case that was at times selective and, on occasions, positively deceitful”.

20. The panel concluded that this was a case in which a sanction should be imposed. It considered the lesser sanctions of a Caution Order and Conditions of Practice Order and concluded that neither was appropriate. The panel decided that its findings were far too serious for a Caution Order and such a sanction would not provide sufficient protection for the public. In relation to a Conditions of Practice Order, the panel concluded that the Applicant would still pose a risk to patients even if conditions were imposed on his practice. The panel concluded that this was because the Applicant’s inability or unwillingness to admit errors would make him an unsafe practitioner in all aspects of his professional work.

21. In relation to a Suspension Order, the panel noted that the Applicant had had plenty of time in which to accept and learn from criticisms of his practice and concluded that the fact that he had not done so indicated that he was unable or unwilling to remedy his shortcomings. The panel was therefore satisfied that imposing a Suspension Order would serve no useful purpose because the risks presented by the Applicant at the end of the period of suspension would be as great as they were then. The panel took the view that the risks posed by the Applicant were very considerable. The panel therefore concluded that a Suspension Order was not the appropriate sanction.

22. In imposing a Striking Off Order, the panel recognised that this was a sanction of last resort. It considered that it was appropriate as the misconduct involved serious and numerous acts and omissions. The panel referred to the lack of insight and to the Applicant having persisted in his denials. The panel referred to the Applicant’s inability or unwillingness to resolve his shortcomings and decided that this had the consequence that a Striking Off Order was the only sanction which would provide effective public protection. The panel concluded that a Striking Off Order was the only sanction which would maintain a proper degree of confidence in the profession and in its regulator. It was also satisfied that any lesser sanction would not be a sufficient to declare and uphold proper professional standards.

Restoration Hearing

Evidence

23. The Applicant gave evidence and asked the Panel to view him as a different person now. He apologised for how he had conducted himself at the final hearing and said that he knew he was not acting as he should have done but he had not had the courage to stop himself at that time and admit his errors. He accepted that he had not had insight at that time but submitted that over the last six years he had gained insight. He referred to the number of people he had apologised to since then for his actions, including the HCPC. He explained that he had spent the time since his being struck off the Register in trying to remedy his shortcomings and referred the Panel to the documentation which he had produced to evidence this. He said that there was nothing to justify what he called “his errors” in reference to the findings of fact made by the original panel. The Applicant explained that he had used the findings of that panel as a “template” for him to refer to going forward.

24. The Applicant said that previously he had been looked up to by his colleagues in the Nigerian Radiographers in Diaspora in the United Kingdom and Republic of Ireland (“NIRAD UK/ROI”) but that he had let everyone there down. He accepted that he had brought his profession into disrepute and had failed his colleagues. The Applicant said that he had let down members of the public who looked up to him. He explained that his actions had impacted adversely on his family.

25. The Applicant stated that he had apologised to as many people as possible from 2018 onwards, including apologising to the HCPC. He had used his experience to help others and had taught other healthcare professionals of the importance of working to proper standards. He said he had tried to remediate in the five years since he was struck off the Register. He had put patients at risk. He had had time to reflect and make efforts to be a better person.

26. In relation to competency issues, the Applicant stated that he had tried, unsuccessfully, to get help. He had contacted the Hospital and another hospital in Walsall. He said he had gone outside the UK, to Ethiopia, The Democratic Republic of the Congo and to Nigeria to give the same training programme and referred the Panel to certificates from these three countries confirming that he had attended voluntary training sessions in ultrasound. The Applicant referred to two periods of supervised practice in the UK: one at Mediscan Ltd and the other at the Ultrasound Clinic, but said that neither place covered practice in obstetrics.

27. In cross examination, the Applicant said he had come to the UK in 2005 having qualified as a Radiographer in Nigeria in 1994. He had obtained a PhD in May 2014 from Birmingham City University. The Applicant said that since May 2018 he had rarely had a job and when he had it was in roles as a handyman, cleaner and caretaker in connection with a family guest house. He said that he was aware of the general requirements for restoration and knew that he had to do 60 days updating and that a day of updating consisted of at least 7 hours work. The Applicant said he had worked as a Health Care Assistant with Mediscan Ltd between 3 February 2021 and 31 August 2021. He said he had worked on 3 – 4 days a week and that his shifts were longer than 7 hours a day. The Applicant said he had also done at least 60 days with the Ultrasound Clinic.

28. In relation to formal study, the Applicant explained that he had taken four different online courses with the Fetal Medicine Foundation: The 11 – 13 week scan, Doppler Ultrasound, Fetal abnormalities, and Placenta Accreta Spectrum. These courses had involved different modules which had to be completed before the next one could be undertaken and concluded with an examination. The Applicant said that these courses involved 2 – 3 hours study everyday over 3 – 5 days per week over a 5-week period. The Applicant referred to his attendance at a course on ethics.

29. When asked what steps he would take to make sure that he did not repeat his behaviour, the Applicant said that he had the feedback from the original hearing at his fingertips, that he would not rush scans, and he would not take too many images and he would follow relevant protocols. He said that he would have patient safety at the forefront, and he would now ask for help if he thought he needed it. He said he understood that safe practice was to keep to the standards. He would seek help from his line manager in the first instance. He said he would now hold his hands up if he made a mistake. The Applicant conceded that he would be nervous of working in obstetric ultrasound as he had not been able to do supervised practice in that area in the UK to gain confidence. He said he was willing to take any opportunity for re-training, having done the theoretical work in private study, but felt he would need to be signed off as competent to do that sort of work in practice.

30. When asked about his level of insight and to explain what had changed, the Applicant said he accepted the original panel’s findings and that his fitness to practise had been impaired at that time. When asked about the impact of his actions on patients the Applicant said there were many impacts, and when asked to explain further, he said that things could get worse, and referred to Patient A who was not able to decide if she should terminate her pregnancy or not. He said that the patients on whom he had used Doppler ultrasound had been put at risk of harm which was avoidable.

31. When asked about the impact of his actions on colleagues, the Applicant said that he had disappointed them and had apologised to them. When asked again, the Applicant stated that his actions could have affected the treatment provided by his colleagues. In relation to public perception, the Applicant said that the public would be disappointed in him and he had brought the profession into disrepute. Again, when pushed, the Applicant stated that his actions could have resulted in members of the public having less confidence in professionals.

32. The Applicant said that his plan for the future was to be a safe practitioner within the scope of his profession. He did not envisage working in obstetric ultrasound without help and training and practical supervision. He confirmed that he was willing to comply with conditions of practice.

33. In answer to questions from the Panel, the Applicant explained that the Excel log of work which he had produced only included a few of the cases he had seen. The clinics where he had been undertaking supervised practice saw up to 20 patients per day and he had not noted all cases in the log, just those where the detail was relevant to this case such as gynaecological, abdomen, liver, and urinary tract scans. He had not included scans of, for example, shoulders or elbows. The Applicant explained that in some cases, he would conduct a scan after the patient had already been scanned as part of his supervised practice. When this occurred, he could get feedback on his technique which he would note down.

34. The Applicant confirmed that the testimonial dated 31 August 2022 from Dr CO, a senior sonographer at the Ultrasound Clinic was from the same Dr CO who had given evidence on his behalf at the final hearing.

35. When asked what he understood by reflective practice, the Applicant said that it helped to work at the standard of competency and safety required and expected to be met. The Applicant said that he did not previously reflect on his practice but that he does it now. He had looked at the standards he should have met then, and at what he could do better and where there were obvious gaps where he needed help, he said that he should have asked for it. When pressed, the Applicant referred to the Gibbs Reflective Cycle.

36. In relation to the four certificates from the Fetal Medicine Foundation, the Applicant confirmed that he had taken an examination for all four online courses on the same date which had to be passed in order to obtain a certificate. The examinations involved both multiple choice questions and others requiring a specific written answer.

37. In further cross examination, the Applicant explained that the log entries in 2023 related to scans which had been performed in Nigeria under the supervision of professionals there who were not registered with the HCPC in this country.

Decision

38. The Panel heard evidence from the Applicant. It also received and considered the documentation in two bundles prepared for the hearing (one of 364 pages and one of 37 pages). The documentation included:

a) the decision of the panel at the final hearing heard in 2017 and 2018;

b) the Applicant’s application for restoration dated 20 June 2023;

c) the Applicant’s documentation relating to 70 days of formal study;

d) the Applicant’s documentation relating to 70 days of private study;

e) the Applicant's documentation relating to 70 days of supervised practice days;

f) the Applicant’s certified proof of identity documentation;

g) a letter from the Applicant in support of his application for Restoration;

h) a letter of apology from the Applicant to the Panel dated 5 October 2023;

i) a number of letters of apology from the Applicant and/or letters seeking retraining opportunities;

j) various emails between the Applicant and the HCPC regarding his application for restoration, including supporting evidence of return to practice requirements sent by the Applicant;

k) testimonials for the Applicant;

l) various certificates relating to courses attended in the UK and abroad;

m) a reflective piece by the Applicant dated 11 January 2024

39. The Panel also had in mind the submissions made by both parties and the matters set out in the HCPTS Practice Notes on “Restoration to the Register” (June 2022) and “Fitness to Practise Impairment”. The Panel received and accepted legal advice.

40. The Panel was aware that it should only grant the Applicant’s application for restoration to the Register if he has satisfied the Panel, on the balance of probabilities:

(i) that the Applicant meets the general requirements for registration; and

(ii) that the Applicant is a fit and proper person to practise as a Radiographer, having regard to the particular circumstances that led to the striking off.

41. The Practice Note makes clear that in considering whether the Applicant is a fit and proper person, the Panel should have regard to whether the Applicant’s current fitness to practise is impaired, and to the following matters:

• the matters which led to striking off and the reasons given by the original Panel for imposing that sanction;

• whether the applicant accepts and has insight into those matters;

• whether the applicant has resolved those matters, has willingness and ability to do so, or whether they are capable of being resolved by the applicant;

• what other remedial or rehabilitative steps the applicant has taken;

• what steps the applicant has taken to keep his or her professional knowledge and skills up to date.

Submissions

The Applicant

42. The Applicant began his submissions by thanking the Panel for the opportunity he had been provided with for applying for restoration and for hearing him in person so that he could demonstrate his insight and answer any questions. He said he knew that the allegations found proved against him were very serious. The Applicant submitted that he was a different person now and he had reflected on his practice, his profession and on himself and how he had fallen short and put patients at risk. He said he understood the impact of his actions on patients, colleagues, and his profession and he had reflected on this.

43. The Applicant submitted that he accepted full responsibility for his errors. He said he was very sorry not to have explained this to the original panel when he had had the opportunity to do so. He submitted that he had used the last years to make himself a better person and had worked to restore confidence in himself and in his profession. He wanted patients to be safe and said he had been honest with everyone about having been struck off and why this had happened. He submitted that his reflections had allowed him to see areas where his practice had fallen down and where to take steps to rectify this.

44. The Applicant submitted that he was willing to be under supervision if he was working in obstetric ultrasound.

The HCPC

45. Ms Welsh reminded the Panel that the burden of proving the application for restoration was on the Applicant which involved demonstrating that he met the general requirements for registration and that he is a fit and proper person to practise as a Radiographer, having regard to the particular circumstances that led to the striking off order, in accordance with Article 33 (5) of the Health Professions Act 2001 (“the 2001 Order”). Ms Welsh referred to the HCPTS Practice Notes on Restoration to the Register and to Fitness to Practise Impairment.

46. Ms Welsh referred to the final hearing panel’s reasons for finding misconduct which involved serious failings, both clinical and attitudinal, and submitted that the panel had concluded that there was a high risk that the Applicant would repeat his shortcomings. Ms Welsh invited the Panel to consider what had changed over the years since the final hearing and the Strike Off Order. Ms Welsh stated that the Applicant had acknowledged the impact of his shortcomings on patients, colleagues, and his profession. He had attended courses on ethics and provided reflective pieces and indicated that he was prepared to comply with conditions on his practice. Ms Welsh submitted that the Panel would have to consider the Applicant’s mindset at the time of the matters that led to the Allegation and his mindset at the current time to assess whether he was “a different person”, as claimed by the Applicant. She submitted that the Panel should consider what the Applicant had said about how he would handle similar events now.

47. In relation to whether the Applicant had met the general requirements for registration, Ms Welsh submitted that it was a matter for the Panel to consider whether the documents produced by the Applicant show that he has completed 60 days updating requirements.

48. In relation to whether the Applicant was a fit and proper person to be restored to the Register, having regard to the particular circumstances that led to the striking off, Ms Welsh referred the Panel to the cases of GMC v Chandra [2018] EWCA (Civ) 1898 and Bolton v Law Society [1994] 1 W.L.R. 512. In the former case, it was made clear that panels deciding on the restoration of a professional to a register should have in mind the overriding objectives of the protection of the public, the maintenance of confidence in the profession and in upholding its standards. In relation to the latter case, Ms Welsh submitted that it was authority for the proposition that in a restoration case damage to the reputation of a profession was a more important consideration than damage to the reputation of an individual.

49. Ms Welsh submitted that if the Panel was satisfied that the Applicant could be restored to the Register that this should be subject to conditions of practice for a period of 18 months. Ms Welsh suggested that the Panel should consider imposing conditions requiring the Applicant to be directly supervised, to be restricted from practising in certain areas unless and until his supervisor signed him off as being proficient in those areas, to prepare a Personal Development Plan to address any extra training needed and to address deficiencies in his practice, and the usual reporting conditions.

Decision

50. The Panel first considered whether the Applicant meets the general requirements for registration. The Panel noted that in his application form the Applicant states to have completed a period of updating totalling 210 days, comprising 70+ days each of Formal Study, Private Study and Supervised Practice. In support of this number of days of updating, the Applicant produced a number of documents which the Panel has considered in some detail. He has also produced a number of letters to the Panel to support his application for restoration, the latest dated 11 January 2024 in which he sets out under headings the various matters of concern from the last hearing.

51. The Panel has concluded that overall, there is insufficient evidence to persuade it on the balance of probabilities that the Applicant has completed the required 60 days of updating.

52. In relation to Supervised Practice, the Applicant produced two forms. The first was from Mediscan Ltd and indicated that the Applicant had completed 60 days of supervised practice between 3 February 2021 and 31 August 2021 and was signed by Dr NE, a GMC registered consultant Radiologist on 22 August 2022. The Panel noted that apart from this form, there was no independent evidence from Dr NE or from the Applicant to say on which dates the Applicant had attended a Mediscan Ltd clinic, or for how long he had worked on each date. There was no independent evidence as to what work the Applicant had been doing for Mediscan Ltd and no log of his cases showing what he had done, what he had learned from it and how this was relevant to his being restored to the Register.

53. The second form was from the Ultrasound Clinic and indicated that the Applicant had completed 60 days of supervised practice between 2 March 2022 and 13 August 2022 and was signed by Dr CO, who is an HCPC registered Radiographer. Dr CO also provided a testimonial for the Applicant dated 31 August 2022 recommending his restoration to the Register, in which he set out that the supervised practice covered “Abdominal and General Ultrasound, Gynaecology Ultrasound and Musculoskeletal Ultrasound…The exercise covered practical assessments and corrections of all the errors in the pelvic ultrasound examinations that were brought before the last panel”. The testimonial includes no detail about the dates of the supervision.

54. The Panel considers the Applicant’s recollection of his supervised practice to have been unclear. He has provided no details, and the Panel found his Excel log of work to be confusing and designed to show specific points quoted directly from the original hearing rather than to show the extent of his supervised practice. It contained no annotations or qualitative description from his supervisor. The Panel also has concerns about the testimonial from Dr CO and notes the original panel’s assessment of him as a witness. That panel decided that Dr CO lacked independence in giving his evidence on behalf of the Applicant and that he was “trimming his evidence in a manner that he believed would assist the Registrant”. That panel decided that it could not accept Dr CO’s evidence in the absence of a reliable supporting factor. The Panel has similar reservations about Dr CO’s supporting evidence and testimonial in this application, noting that it is general and vague.

55. The Panel has seen a Formal Study Form, signed by the Applicant dated 5 January 2023 which indicates that he has completed 70 days formal study on a course entitled “Academic Review Module” provided by NIRAD UK & ROI. The Panel has also seen a certificate presented to the Applicant for completing “Journal Club & Academic Papers Review Programme with the NIRAD UK & ROI Education Committee between 25 March to 21 May 2022. This is a period of some 57 day and the Panel considers it concerning that there is a discrepancy between the 70 days declared and the 57 days covered by the certificate. In his description of the course provided as part of the Formal Study Form, which the Panel accepts is intended to be a brief summary of no more than 200 words, the Panel considers nevertheless that the Applicant has provided only a general description of the course and not how it addresses the concerns in this case. The Panel has concluded that this undermines the Applicant’s evidence and suggests that his evidence is in
accurate.

56. The Panel notes that this period was also during the time when the Applicant was also undertaking Supervised Practice with the Ultrasound Clinic. There is no evidence to explain to the Panel how the Applicant divided his time between his supervised practice and the formal study course. The Panel would have been assisted if the Applicant had provided a work log showing on a day-by-day basis what he had been doing and for how long each day which had been independently verified.

57. The Panel has also seen a number of certificates which confirm that the Applicant undertook what appear to be relevant online training courses with the Fetal Medicine Foundation. There is no separate Formal Study form in relation to these and it is not clear whether these form part of the 70+ hours of Private Study or the 70+ hours of Formal Study. In any event, the Panel noted that there is no independent evidence of what matters the individual courses covered, and nothing from the Applicant as to what the courses had taught him. There is no evidence of how long the courses were or of how long the Applicant took to pass the examinations.

58. The Panel accepts the Applicant’s evidence that he has completed two courses, which cover ethics but again there is insufficient evidence of what he has learned from this. The Panel has concerns that at several points in his evidence the Applicant, in referring to the original hearing, stated that he would have been better off staying silent and apologising. The Panel considers that this does not reassure it that the Applicant has understood the importance of being open and honest. The Panel also considered that in his evidence, the Applicant had, as he did in the original hearing, provided contradictory evidence. For example, in speaking of the volunteering in Ethiopia, the Democratic Republic of the Congo and in Nigeria, the Applicant had initially stressed that he had led the training sessions. Later when asked about these, the Applicant had said that there were other doctors there, so he had been able to observe them.

59. The Panel has also seen certificates confirming that on dates in 2019, 2020 and 2021 the Applicant attended voluntary training sessions outside of the UK, at least one of which referred to advanced ultrasound training and another referred to “ultrasound training in the area of reproductive, maternal and child public health advocacy.” It would appear from his evidence, that the Applicant was leading these training sessions, and it is not clear to what extent he was able to observe other professionals performing relevant ultrasound scans or the extent to which he was being supervised in practising such scans.

60. The Panel finds that it is not clear how many days of Formal Study have been completed by the Applicant.

61. In relation to Private Study, the Applicant claimed to have completed 70 days and produced in evidence copies of a number of documents which he had studied. He did not produce any work log and was unable to explain when and for how long he had studied these documents or what he had learned. The Panel has decided that without some such work log, it is unclear how many days the Applicant may have completed of Private Study.

62. The Panel has concluded that the Applicant has provided insufficient evidence of how he has reflected on what he has learned from his updating experience. His log is incomplete and simply records what he did and not what he learned, or how this would inform his practice going forward.

63. The Panel has therefore decided that it is not satisfied that the Applicant has discharged the burden of proving that he has completed the general requirements for registration.

64. Although the Panel has found that the first part of the test for restoration to the Register has not been proved, the Panel has gone on to consider whether the Applicant is a fit and proper person to practise as a Radiographer, having regard to the particular circumstances that led to the Striking Off Order and whether the Applicant is currently fit to practise. The Panel considers that this may be of use to the Applicant were he to make a further application for restoration in the future.

65. In relation to current fitness to practise, the Panel considered the personal component and in particular whether the Applicant had remedied his misconduct. The Panel considered that the Applicant’s conduct was capable of being remedied. However, the Panel concluded that the Applicant had not yet demonstrated that he has remedied his misconduct. The Panel considered that this was because although he said he had accepted the findings of the last panel and accepted his misconduct, he has yet to explain fully why it happened and to own it. In his evidence the Applicant continually apologised for his misconduct and referred to all the various people or institutions to whom he had apologised since 2018. The Panel accepts that the Applicant is genuinely remorseful but considers that this is mainly because of the impact of his misconduct on his own reputation and practice, and on his family. The Panel considers that the Applicant had to be prompted in relation to the impact of his misconduct on patients and has concluded that this is indicative of a lack of meaningful insight. The Panel noted that harm was caused to two of the patients scanned by the Applicant, Patient A and Patient H, both of whom had to live with the consequences of the Applicant’s shortcomings and yet he only referred to these patients when prompted and then only cursorily.

66. The Panel has concluded that without meaningful insight, it cannot find that the Applicant has remedied his misconduct. The misconduct took place over only a 4-day period but during those 4 days in 15 patients he saw errors, were found in his work relating to a wide variety of aspects of his role. These errors did not relate solely to rushing his work, which the Applicant appears to consider it was.

67. The Panel considers that the Applicant has not reflected properly on his misconduct and has little understanding of what reflective practice is.

68. In these circumstances, the Panel has concluded that there is a risk that the Applicant will repeat his misconduct and so members of the public are at risk of harm from him. The Panel has therefore found that the Applicant’s fitness to practise is impaired on the personal component.

69. In relation to the public component, the Panel has concluded that in order to maintain public confidence in the profession and in the HCPC as Regulator, and to uphold proper standards of conduct in the Radiography profession, it must make a finding of impairment in this case. The Panel considered that a reasonable and informed member of the public would be very concerned if no finding of impairment was made in an application for restoration to the Register where the Applicant’s (i) professional work had fallen far below the standards expected of a radiographer in numerous ways in respect of a number of patients, on each of the 4 days when he worked as a locum at the Hospital, (ii) where his misconduct had caused significant harm to two patients, and where (iii) despite the events being some 12 years ago, he still did not yet fully understand why his professional work had fallen so far below acceptable standards, where he has not yet achieved meaningful insight or genuine remorse, and where the steps he has taken to remedy the misconduct are incomplete, or insufficiently evidenced. The Panel therefore finds that the Applicant’s fitness to practise is impaired on the public component.

70. It has considered the matters which led to the Striking Off Order. The Panel has had in mind the overarching objective of the HCPC which is the protection of the public.

71. The Panel has considered whether the Applicant has resolved the matters that led to the Striking Off Order, whether he has the willingness to do so, or whether they are capable of being resolved by him. The Panel has already concluded that the concerns are capable of being remedied but that the Applicant has not yet fully remediated his misconduct. The Panel does not consider that the Applicant is incapable or unwilling to resolve those matters rather that he has yet to fully focus on what needs to be remedied and on how he might go about this with properly focused reflection, and to do this he needs to gain proper insight into the concerns of the original panel which covered both clinical and attitudinal matters.

72. The Panel has considered the other steps taken by the Applicant and the steps he has taken to keep his professional knowledge and skills up to date. The Panel has already indicated that it is not satisfied that the Applicant has sufficiently evidenced the steps he has taken to comply with the updating requirements for restoration and these could cover steps taken to keep his professional knowledge and skills up to date.

73. In these circumstances, the Panel has concluded that the Applicant has failed to discharge the burden of proving that he is a fit and proper person to practise as a Radiographer having regard to the particular circumstances that led to striking off.

ORDER: The Panel refuses the application for restoration to the Register.

No notes available

History of Hearings for Emmanuel I O Ehiwe