Mr Fazal Karim

Preliminary Matters

Privacy

1. The Panel was advised that information regarding the Registrant’s health may arise in the course of the hearing. Having taken advice from the Legal Assessor as to the interests of justice and the importance of the open justice principle, the Panel concluded that it was fair and appropriate in the circumstances to balance the interests of the public with those of the Registrant by conducting the hearing in private when and if issues regarding the Registrant’s health arise.

Application to Amend the Allegation

2. Mr Bridges applied to amend the Allegation and sought to amend Particulars 1 and 7. Mr Bridges for the HCPC submitted that these proposed amendments were minor and better reflected the evidence and in Particular 7, improved the grammar. On 9 February 2024 Mr Foxsmith sought to amend Particular 5 to better reflect the evidence. The Registrant did not object to any of the amendments sought by the HCPC.

3. The Legal Adviser reminded the Panel about the need for fairness and to consider whether the proposed amendments altered the nature and gravity of the allegations. The Panel accepted the legal advice and decided to allow the proposed amendments which corrected the grammar and clarified the particulars, but did not alter the gravity or the nature of the Allegation. The Panel was satisfied that no prejudice to the Registrant arises as a result. The applications to amend were granted.

Hearsay Application

4. Mr Bridges for the HCPC applied to have the witness statements of Colleagues B and C admitted as hearsay evidence. He referred to his detailed skeleton argument and to the relevant case law. He submitted that all reasonable efforts had been made by the HCPC to secure the attendance of Colleagues B and C. It was accepted by the HCPC that Colleague C provides the sole and decisive evidence in respect of Particulars 6 a) and 6 b). Mr Bridges submitted that Colleague B was not the sole and decisive evidence in respect of Particulars 4 and 6 d) and that it would be fair to admit these witness statements into the evidence.

5. The Registrant said that all the allegations are denied. He opposed the hearsay application stating that the evidence of Colleagues B and C was fabricated and that they were motivated by their own interests to get him out of the role.

Decision on Hearsay application

6. The Legal Assessor reminded the Panel of the central importance of fairness and the need to consider the guidance in Thorneycroft v NMC [2014] EWHC 1565 (Admin) and NMC v Ogbonna (2010) EWCA Civ 1216.

7. The Panel was satisfied from the documentary evidence that the HCPC have made all reasonable efforts to secure the evidence of both of these witnesses. There are good and cogent reasons as to why neither can attend.

8. The Panel was mindful that Colleague C’s evidence is the only evidence for Particulars 6 a) and 6 b), as is accepted by the HCPC. Colleague B’s evidence is not sole and decisive, and can to an extent be tested. However, the Registrant submits that both witnesses were unhelpful towards him, undermined him, and both bore him ill will.

9. The Registrant's concerns in this regard are independently supported by the decision of the Capability Appeal Hearing conducted by Peter Higgs of the Society of Radiographers, which upheld the Registrant’s appeal. Whilst it does not name these witnesses, in conclusion it states that “Mr Karim has found himself in a situation where his abilities have been questioned but he has struggled to find support in the department. Where when [SIC] he achieves the targets set for him the goal posts are moved….Mr Karim has not experienced the tolerance and understanding that he would reasonably expect and that his treatment at the trust, has on occasion, trespassed very close to that of bullying or even harassment”.

10. The Panel considered that the appeal hearing decision is indicative of some difficulties and tensions in the department, particularly around the Registrant’s performance. Colleagues B and C both worked in that department with the Registrant, and the Registrant told the Panel that both bore him ill will and wanted him to leave his role at the Trust.

11. Further, the Panel was of the view that the evidence of neither of these witnesses is demonstrably reliable. There is no means of testing Colleague C’s evidence. Neither Colleague B or C can be cross examined by the Registrant or questioned by the Panel. There is a strong indication in the material before the Panel that these witnesses may have borne ill will toward the Registrant, and thus have a possible motive not to tell the truth. The Panel decided in these circumstances that there is considerable disadvantage and prejudice to the Registrant in being unable to cross examine and to test the evidence of these two significant witnesses. The Panel decided that in such circumstances the reliability and credibility of their witness statements cannot be sufficiently or fairly tested in the absence of their live evidence.

12. Whilst the Panel was mindful of the overarching objectives of the HCPC and the importance of protecting the public, that is always subject to a Registrant’s fundamental entitlement to a fair hearing. In these circumstances, the Panel decided that it would not be fair to admit the evidence of Colleague B or C and it refused the hearsay application.

13. Mr Bridges confirmed that the HCPC would offer no evidence in respect Particulars 6 a) and 6 b) of the Allegation given that they rely upon the evidence of Colleague C.

Background

14. The Registrant is a registered Radiographer who was employed at Gloucestershire Hospitals NHS Foundation Trust (“the Trust”) between 1 February 2019 and 16 August 2019 as a Band 7 Senior / Lead Radiographer. His direct line manager was Colleague A.

15. Concerns first came to light shortly after the Registrant commenced employment following an event that occurred on 4 February 2019, his first clinical day working in the department. On that date the Registrant and another member of staff were undertaking the injection of a patient for myocardial perfusion studies, which it is alleged the Registrant attempted to do without wearing finger dosimeters, which is a requirement under the Local Rules. Following this it is alleged there were further incidents calling into question the Registrant’s competence - two incidents on 7 and 18 February 2019, which were witnessed by Colleague A, one on 14 February 2019, witnessed by Colleague D, and one on 22 February 2019.

16. An informal meeting was held with the Registrant on 25 February 2019 to discuss the concerns about his competence. As a result of this informal meeting a performance improvement plan was put into place.

17. Over the next few weeks the Registrant and Colleague A held regular supervision meetings on a weekly basis to monitor the Registrant’s progress. By 20 March 2019 due to a lack of improvement a formal meeting was held with the Registrant. Following this meeting, further improvement plans were put in place. In addition to concerns surrounding the competence of the Registrant, further concerns came to light regarding his conduct as alleged. The Registrant was suspended from duties in July 2019 and resigned from the Trust in August 2019.

18. On 6 December 2019, the Trust made a referral to the HCPC.

19. Subsequently, the Registrant applied for and was offered a role as a Band 6 Radiographer at Royal Berkshire Hospital from 1 June 2020. On 12 May 2020 the Registrant’s prospective line manager MA spoke to the Registrant who told him he had been suspended by the Trust and that there were “ongoing issues with the HCPC”. On the same day, the HCPC received an email from MA. He made enquiries about the fitness to practise review that was taking place in respect of the Registrant and advised the HCPC that they had not been aware that the Registrant had previously been employed by the Trust.

Evidence

Witness 1 - TD

20. TD is the Head of Medical Physics for the Gloucestershire Hospitals NHS Foundation Trust (“the Trust”). He adopted his witness statement. He is responsible for the overall management of the Medical Physics Department and for the provision of expert scientific and professional leadership in the field of Medical Physics.

21. TD explained in his witness statement that he was involved in the recruitment of the Registrant at the Trust. He said the Registrant was pleasant and likeable and was employed as a Band 7 Radiographer. He understood that regular supervision meetings were held which he believed took place on a weekly basis with the Registrant to discuss the incidents and they had tried to agree a resolution.

22. TD recalled that on 19 February 2019, after several incidents had been reported, he spoke with the Registrant personally. TD explained that on the basis of shortcomings in the Registrant’s general competence and safe handling of unsealed sources, he stated that he realised that it had become unsafe for the Registrant to work independently, so he told him to stop any work that was unsupervised and allow colleagues to oversee his work until his line manager Colleague A returned and could discuss a feasible way forward.

23. TD said he was not an eyewitness to any of the particular allegations and that Colleague A dealt with the incidents and shared her notes with him. TD stated that the Registrant had really wanted to keep his role and they rallied around him and had done their best to support him by providing the training and supervision he needed.

24. TD explained the requirement to wear finger (dosimeters) badges whilst injecting patients for Myocardial Perfusion studies. He referred to the Local Rules which clearly state at paragraph 3 that “finger dosimeters should be worn when preparing and administering or handling radioisotopes”. He stated that finger dosimeters are personally issued to staff as they must be worn on the end of the fingers, under their gloves, whenever they are handling unsealed radioactive sources. He also exhibited a Sharps Risk Assessment Form listing that extremity dosimeters should be worn as part of control measures. TD stated that one would never handle any open sources of radiation without finger badges, body dosimeters, and gloves, and that would be “second nature”. Staff would never be asked to do anything if there were not the correct dosimeters and PPE.

25. TD explained in answer to cross examination by the Registrant, that dosimeters were routinely available. When there was not a finger badge, he said that the work of staff would be restricted until a finger badge was available. As regards the CT room, TD said there was no door into the room, but there were both visible and audio signs on the panel to alert users about the gamma camera. He agreed that there was no door at that time and that staff were trained about where to stand. He said it was a low dose CT/Gamma Camera hybrid machine so there was no door, but that there was now a door in the newly rebuilt unit.

26. TD explained that Colleague B, was the existing lead Radiographer at the time, and the plan was to keep her in place for a time to support her successor, the Registrant. TD said that was explained to the Registrant at the time of his interview / appointment. TD said that all his colleagues were aware of that plan and the department had a good record of welcoming new members of staff and was a diverse team. TD said that he was aware that the appointment of the Registrant was not going well but he understood that was due to concerns about his competence.

27. TD said that he recalled the Capability Appeal took place in about March 2019. TD said that he had spent many hours with the Registrant to try to get him working well, and that he was satisfied that he had made real efforts to do so and to respect the Registrant’s dignity. He agreed that the allegations on 4 and 7 February 2019 were in the first week of the Registrant starting work in the department. He did not know when the Registrant received induction training.

Witness 2 – Colleague D

28. Colleague D is a Band 6 Radiographer who worked with the Registrant two or three days a week at the Trust from February 2019. She adopted her witness statement.

29. Colleague D said in her witness statement that her first impression of the Registrant was that he was very intelligent and would often respond extensively when she talked to him about their work, and tell her about his impressive record of experience, and his knowledge of radiography. She said her initial impression was that he was intelligent and had a “brilliant depth of experience.”

30. Colleague D stated that the Registrant was due to have responsibility for all of the patients who visited the department as a Lead Radiographer. He was due to have management responsibility for clinical staff in Band 6 and below. She said it was always intended that he would initially observe staff within the department, including her, so that he could become familiar with the machinery and receive the necessary training. She had encouraged him to make and refer to notes to make sure he was competent.

31. Colleague D said that after working with the Registrant on a few occasions she began to think that he probably needed more time with the equipment. However, even after few months passed, she said he still could not operate equipment properly. It was often the case that he would be taught something by her and then forget about it the next day, almost going back to square one. She recalled two specific issues where she had taught the Registrant and he had not retained the information and continued to make errors.

32. Colleague D told the Panel about the alleged incidents on 14 and 22 February 2019. On 14 February 2019 she said that it appeared that the Registrant may have concealed the error with the injection of the patient because he appeared to have rushed to apply the cotton wool swab to the patient after he had carried out the injection. She stated that it was almost as if the Registrant had placed tape on the patient straight after the injection so that nobody could see that tissuing had occurred. However, the injection procedure appeared to her at the time to have been done correctly by the Registrant. She said it was her first encounter observing the Registrant, so she gave him the benefit of the doubt and she had not completed a Datix. She accepted that the patient had not been recalled and that it was a judgement call. Colleague D said that when she subsequently saw the diagnostic bone scan it appeared to her there was tissuing, and that the Registrant may have sought to conceal that at the time of the injection.

33. Colleague D recounted the incident on 22 February 2019 when there had been a spill and a contamination. She told the Panel about the contamination incident and how the Registrant had walked right into the contaminated area when he should not have done so, and ought to have known not to do so. She referred to the Datix record of the incident on 22 February 2019 which she had created.

34. In cross examination, Colleague D said that whilst the department was different in some ways from other places she had worked, she had felt that the team had been welcoming. She recalled that she had tried to support the Registrant, but that he frequently did not seem to retain what she had told him and became defensive.

35. Colleague D told the Panel about the incident on 15 March 2019 which gives rise to Allegation, Particular 6 c) and said that her statement at the time was an accurate record of the incident. After that date she had told her managers that she could not continue to work with the Registrant. She said that the record of the incident in the DATIX was written shortly after the incident. She said that she had asked Colleague A if she could leave early, and whilst she had always been open to teach the Registrant, on 15 March 2019 she had to go home early. She said he had been difficult and he had refused to let her do so.

36. At this point in the hearing concerns regarding the Registrant’s health arose. The hearing was adjourned.

Resumed In-Person Hearing in Gloucester on 7 February 2024

Witness 3 – Colleague A

37. Colleague A affirmed and adopted her written witness statement. She is Head of Nuclear Medicine for Gloucestershire Hospitals NHS Foundation Trust and is a registered Radiographer. She was the Registrant’s direct line manager in 2019. She told the Panel about the induction process at the Trust which was undertaken by the Registrant who was employed as a Band 7 Radiographer.

38. Colleague A stated that at times she found that the Registrant would talk over her and was at times rude and condescending. Following a number of complaints the Registrant was placed on informal capability proceedings around March 2019. Subsequently, Colleague A and TD concluded that the Registrant had not completed the set objectives and a formal performance management meeting was arranged and took place during 2019. The Registrant’s employment ended on 16 August 2019.

39. Colleague A told the Panel about a number of the complaints and concerns about the Registrant’s practice. On 4 February 2019 a concern was raised about the Registrant’s failure to use finger dosimeters and when challenged he had responded inappropriately to a colleague; on 7 February 2019 the Registrant attempted to enter the Gamma Camera room when the CT was on a ‘warm up’; on 18 February 2019 the Registrant entered the CT room when it was operating, which Colleague A described as a mistake that an experienced Radiographer should not make. She directly witnessed the 7 February 2019 incident, the later incident on 18 February 2019 was reported to her by a colleague and a DATIX formal incident report was completed as a result. As his line manager Colleague A was required to investigate the DATIX report and reported to TD. It was treated as a learning exercise, it was not about apportioning blame. She said she would always give someone the benefit of the doubt and discuss matters informally with those involved in any incident.

40. Colleague A told the Panel about a further incident on 14 February 2019 when an injection administered by the Registrant had “tissued”, that has gone into the tissues under the skin rather than into the vein. She recalled that the Registrant had not been open about the event. On 22 February 2019 a further incident occurred when there was a radiation spill which the Registrant walked into and became contaminated. She said that she thought he had been trying to be helpful but that he should have known the consequences of entering an area of a spill.

41. Colleague A said that on 1 May 2019 the Registrant had used the words alleged “dirty Paki Nigger” in anger and, whilst he was referring to himself not her, she had been really shocked and taken aback. Her grievance statement made the next day reported those words and she said that she was sure those words were used.

42. In cross examination, Colleague A explained that the Registrant was appointed as the Lead in Nuclear Medicine Imaging, but that was never achieved. She said induction should take place immediately, but usually takes place within the first month. Colleague A could not recall particular conversations with the Registrant about the examinations that he was involved in, but he was only expected to observe on his first day, 4 February 2019. She said that she did not distribute finger dosimeters, that would have been for KD, and there was access to other protective equipment such as aprons and gloves.

43. Colleague A said that on 7 February 2019 the Registrant had attempted to enter the CT room as there was nowhere else to go from his position. She had said to him not to enter the CT room, and he did not do so. She said that in respect of the tissuing that had occurred on 14 February 2019, she had completed a fact finding investigation and questioned the Registrant and the other colleagues.

44. Colleague A did the same exercise in respect of the DATIX regarding the Registrant entering the CT room on 18 February 2019 which was witnessed by a colleague (Colleague B). Colleague A was required to estimate the radiation exposure suffered by the Registrant as a result and said that he seemed to have received scatter radiation exposure, but despite the low reading, entering the room was a risk and not in accordance with the rules.

45. Colleague A explained that she had also completed a fact finding exercise in respect of the spillage and contamination on 22 February 2019, and said that it appeared the Registrant had wanted to help, but his actions had led to further contamination.

46. Colleague A said that she clearly recalled the words used by the Registrant and the hand washing issue being discussed with him was not a criticism of him, but part of the protocols that had to be followed.

47. She said that the work environment was not hostile or uncooperative and that, unusually, the department had kept the outgoing lead (Colleague B) for a time in order to better support the Registrant. She said there was no professional jealousy or rivalry in the team. She told the Panel that the word “aggressive” had been the word used by Colleague D to describe the Registrant’s conduct towards her on 15 March 2019 when she asked to leave work early, and that she had been crying.

48. Colleague A said that the emails she sent to colleagues in March 2019 about the Registrant were about the Registrant’s training and about arranging to get his competencies signed off and getting him more support. She said she was trying to get factual feedback from colleagues about the incidents and would have given the Registrant the “benefit of the doubt”.

Witness 4 - SB

49. SB is a Band 5 Clinical Technologist at the Trust and worked with the Registrant in 2019. She undertakes a range of diagnostic imaging and non-imaging procedures. SB adopted her witness statement.

50. SB told the Panel about the incident on 22 February 2019 when there was a spill. She said that after injecting a patient, the used syringe fell out of the syringe holder and the small bit of residue was spilled on the floor. She said because of the radioactivity there was a risk of contamination. She said that there were Trust local rules about dealing with spills and there were also decontamination kits. She said the Registrant walked into the place where the spill happened to check the residue. She said she would expect a Band 7 to worry about the spill, not the residue. SB said that the Registrant was behind her and that he came forward to check the residue and walked into it and contaminated his shoes.

51. SB said with reference to the terms of the Allegation that she did not consider that the Registrant was “attempting to clean up a radiation spill” but had been checking the residue.

Amendment application of Particular 5

52. Before the cross examination of SB by the Registrant, Mr Foxsmith applied to amend the Allegation, Particular 5 to better reflect the evidence heard from SB and Colleague D. He asked the Panel to allow an amendment of Particular 5 to remove the words “attempting to clean up” and replace it with the words “following”. The amended Particular 5 would then read “5. On 22 February 2019, following a radiation spill, you contaminated your shoes which led to further contamination of the floor”.

53. The Registrant advised the Panel that he did not object to the proposed amendment. The Legal Assessor reminded the Panel about the importance of fairness and the interests of justice and that it should consider whether the proposed amendment alters the nature or the gravity of the Allegation.

54. The Panel agreed to the proposed amendment. It narrows, simplifies and focusses the Particular and better reflects the evidence. The Panel was satisfied that the amendment did not alter the nature or the gravity of Particular 5 and did not cause prejudice to the Registrant.

Cross examination of SB

55. SB agreed that the senior person, the Registrant, was responsible to deal with the spill. She said that once the spill happened you were not meant to move. SB said it was only the syringe that fell and the impact was between her, the patient and Colleague D. She said that the Registrant was behind the patient, but then moved forward towards the spill. She stated that the Registrant was too far away to be splashed by the residue, about 10 feet away. She recalled that Colleague D had said to the Registrant to stop, but he had moved forward and stepped into the spill area.

56. When questioned about decontamination, SB said that Colleague D later obtained the decontamination kit and she explained that, after the spill, they had used monitors to check themselves for radioactive contamination, and the whole room was also checked. She did not recall the Registrant conducting any monitoring. SB said that she and Colleague D were not contaminated as they did not move after the spill occurred, and that it was for her, not the Registrant, to check the residue in the syringe.

Witness 5 – MA

57. MA affirmed and adopted his witness statement. He has been the Head of Nuclear Medicine at the Royal Berkshire NHS Foundation Trust since 2020.

58. MA was on the interview panel who interviewed the Registrant for a role as a Band 6 Radiographer at the Royal Berkshire Hospital in 2020. He referred to the application form completed by the Registrant, which discloses that the last place of his employment was Barts Health, London, and not Gloucester NHS Trust. MA said that the Registrant did mention Gloucester NHS Trust, but only in the supporting text in the application form, but he had not stated that as being the most recent employment. He said he had been misled by the application about the identity of the Registrant’s last employer.

59. MA in cross examination said that he recalled the Registrant had mentioned at interview relocating from Gloucester, but he could not recall the Registrant mentioning working at Gloucester NHS Trust. He said perhaps the Registrant has mentioned temporary positions, but not that his most recent substantive employment was at Gloucester. MA said that the mention of Gloucester by the Registrant was “bundled” with other temporary roles. MA said that the DBS check on his employment only took place after the conditional offer was made, and so if Gloucester was mentioned then by the Registrant, that had come after the offer had been made, and he had not seen that in any event. MA said that the “application process” starts as soon as the application form is submitted, and finishes when the candidate starts work. MA said that in respect of any temporary role of less than three months a reference would not be sought, but any permanent role would require a reference, irrespective of the length of service.

Witness 6 – KD

60. KD affirmed and adopted her witness statement, with the exception of the section in her statement entitled “Opinion”. Mr Foxsmith advised the Panel that the HCPC would not be referring to or relying upon that part of KD’s statement as it was not relevant, or of assistance to it. She is a Senior Clinical Technologist at the Trust. She told the Panel about the incident with the dosimeters on 4 February 2019 and explained that dosimeters are used to monitor staff’s exposure to radiation and are checked every month. It was a basic safety issue to ensure that the radiation dose limit was not exceeded. She was the Radiation Protection supervisor for the department and she said she was obliged to enforce the rules and challenge the Registrant, as this was a health and safety issue.

61. KD stated that the use of finger dosimeters was a requirement of the local rules at the Trust and she was ”surprised” when the Registrant appeared to think it was appropriate to carry out an injection without wearing a dosimeter, also called “finger badges”. She had told him not to proceed with the injection and to let someone else do it. She said that she was enforcing the local rules and the Registrant was not happy when she challenged him. The Registrant did not then proceed with the injection.

62. KD said that there were some concerns about the Registrant’s conduct and practice and she had raised the concerns unofficially. She would have challenged anyone in that position and was concerned given that the Registrant was senior, a Band 7 and the clinical lead.

63. KD said that she was aware that 4 February 2019 was the Registrant’s first day in the job, but that he had no dosimeters and she did not expect him to draw up any injections. She said that she recalled the dosimeters would have been ordered but they had not arrived by 4 February 2019, but the Registrant did have a body monitor. KD said that the Registrant, had a thermoluminescent dosimeter (TLD) or body monitor. KD said that as a Band 7 the Registrant was the lead clinician and he was in charge, and if he did not have appropriate monitors and dosimeters he should not have entered the treatment room in the first place. She said the Registrant was not competent, and that the department was not hostile or uncooperative and was welcoming.

The Registrant’s evidence

64. The Registrant summarised his position and told the Panel about his starting date with the Trust on 1 February 2019. He referred the Panel to a number of references from Dr Haroon from Barts NHS Trust (“Barts”) dated 4 January 2021, Dr Lugman dated 28 August 2020 and from another colleague at Barts dated 2 September 2020. He told the Panel that he had been employed at Barts for 12 years without incident. He also referred to certificates relating to cannulation training from his previous employer. The Registrant said these showed that he is competent and he had no difficulties at Barts.

65. The Panel proposed and it was agreed by Mr Bridges and the Registrant, that he would give evidence in respect of each particular of the Allegation and be cross examined in turn on each particular.

Particular 1

66. The Registrant said this incident had occurred on his first day when he was rostered with KD. He said he had been happy to assist but he had no dosimeters. He wondered whether KD understood him and he was not sure that she was fully qualified. He said he had asked KD about protective equipment and she had said there was no equipment for him but they had ample time to order what was required. He had merely offered to help subject to availability of PPE. No injection was carried out and he had not read the Local Rules as it was his first day.

67. In cross examination, the Registrant agreed that he had read the Local Rules and signed them on 20 February 2019 and he considered that they were “bread and butter” Rules. He had used finger dosimeters for many years during his career since 1993. He agreed that the rules were common sense and common knowledge and you did not need to have a Masters to understand that. The Registrant denied that he had said to KD that he would inject without a dosimeter and her evidence was fabricated, and she had lied under oath.

Particular 2

68. The Registrant said that no attempt was made by him to enter the gamma camera room and that was a subjective view, a “mere perception” by Colleague A. He had no intention of entering the room. A door should have been fitted. In cross examination, the Registrant said he had started the quality control checks and then Colleague A came to see him as rumours were already circulating about his conduct. He said his appointment was “futile” as they had already recruited another person in the role and that there was a concerted effort by his colleagues to get him out and they were not supporting him.

69. The Registrant referred to a number of emails on 4, 14 and 22 March and 23 and 27 April 2019 which he said appeared to be asking colleagues for information about him and discussing his professional practice. He said they wanted to “knock him down” and were “ganging up on him." He said that TD eventually offered him a “golden hand shake” to leave, only 2 weeks into his employment. He said there was a conspiracy to get him out of the job, but said that his colleagues were not “malicious.”

Particular 3

70. The Registrant said that GS had been his supervisor and this was his first or second injection. He said that the DATIX exhibited by TD states that the images were clinically diagnostic. He said there had been two injections at that time. Colleague D stated in her evidence that the Registrant had been too quick to apply the swab, but the Registrant disagreed and stated that had the injection tissued, the quality of the image would have been adversely affected. There was no attempt to conceal. He said that Colleague D said and did nothing at that time. In cross examination, the Registrant said that no significant tissuing occurred, it was insignificant. He said that what Colleague D said was “nonsense”.

Particular 4

71. The Registrant said that in his written statement dated 4 January 2021 that Colleague B had prompted him by asking him if he had cleaned the camera bed of the CT scanner and he had then offered to do so immediately. He had stepped to the border of the controlled area but said that he had not entered the area. He said that in the DATIX exhibited by TD reports that it was a low risk incident, and that the Registrant received a low level of exposure. He said that was insignificant and minor. He said that Colleague B prompted him deliberately and that she was in violation by doing so. He said he could not have moved in to the controlled area, given the low exposure of the readings taken. He said he was being friendly when he had got up to clean the camera.

72. In cross examination, the Registrant said he was plotted against by Colleague B but she was “fighting her corner” to extend her contract. He said the DATIX has been changed since he completed it. He denied that he had said to Colleague A on 25 February 2019 that he had forgotten about the CT when he entered the gamma room. He said that his colleagues were lying in the DATIX and that Colleague A had deleted and changed the words in the DATIX. He denied that he had ever admitted that he had entered the room.

Particular 5

73. The Registrant said that he was only observing this matter despite being the most senior person. He said he was behind the patient, about 2 metres or an arms-length away from the patient. He said Colleague D passed the syringe to SB and the equipment was faulty. He said that SB had “pushed” the syringe toward him as she dropped it. He had asked them where the radiation decontamination kit was and nobody knew. He then asked them what they were going to do and they left and returned about 40 minutes later with the kit. Before they left he had moved to the wall. He said that it was SB’s responsibility to tell him not to move towards the spillage. He said that, logically, the splash had hit his feet and trousers. He said Colleague A and SB had been “cheating” when they rejected his version of the incident. He said the DATIX was contradictory and wrong and it all looked like it had been changed.

74. The Registrant said that his colleagues did not know what to do and were “lost”, “vague and poor.” He said he was protecting them so he had moved forward to determine the residue. They did not say stop to him and they had also started moving. He said he could not have exited as he was the most senior. He was trying to help his colleagues and he did not contaminate the room, it was his colleagues who did so. He reported the incident to TD who praised him for his actions. He did not blame anyone, although he could have done so. He said both Colleague D and SB were wrong when they said that he walked into the spill. He said that Colleague A had modified the DATIX and she had accepted Colleague D and SB’s version of events.

Particular 6 (c

75. The Registrant said he had a clinical competency test that day and he had told GS that had to be completed with her and that she could then leave at 17:00. Colleague A had forgotten to tell the Registrant about giving permission for Colleague D to leave early and was not present so the Registrant had asked Colleague D for written evidence about permission to leave early. He had simply said to her that she needed evidence and that he could not take her word for it. He had called Colleague A to discuss it and she had apologised for not telling him. He said it was “strange” that Colleague A said that Colleague D had been crying. He denied he had been aggressive.

Particular 6 (d

76. The Registrant said that Colleague A had said she wanted to meet with him about his performance. He had replied that his Union representative had advised him not to attend without him. He said it was not fair to meet, but that he had been persuaded. He said that he had repeatedly failed the handwashing test and this was an attempt to stop him rotating to the next post. He denied he had used the word “Nigger” but said “National” but he did say “dirty Paki” referring to himself. In cross examination, the Registrant accepted that there had been miscommunication with Colleague A, but that a person of his calibre would not be angry in those circumstances. This was all about him being set up and “defamed” by colleagues. He said Colleague A was wrong about the words he had used.

Particular 7

77. The Registrant stated that he had retired from Barts in 2018 and that in the application form to the Trust at Gloucester he had said in the additional information section that he had worked at Gloucester since retirement. He said he had left the Trust during his probation period as they had “got rid of him”. He said that he had completed the application on his mobile telephone and had entered more details but that information had not saved. He said he had told MA at the interview all about his role at Gloucester and he had been inconsistent but not dishonest.

78. In cross examination, the Registrant accepted that he was suspended by the Trust on 12 July 2019 and resigned on 16 August 2019. He accepted that he had completed the application form to Royal Berkshire, but “the system let him down” as he had entered but lost the ‘End date’ for the Barts Health NHS role. He said he had later completed a full form for HR. He said he had completed but then lost the details he had entered in the section entitled ‘Employment Gaps’ to explain the gap between August 2019 and January 2020. He said that he did not mention the suspension at the Trust as he had still been in his probationary period and that Mr Higgs, his Union representative had told him he did not need to mention about the payment he received or the suspension as he had not been dismissed. He also said he had updated the referees section and could not recall what he had changed on the application form. He said he had listed all of his previous employers, but it had all been lost when he had tried to save the additional information. The Registrant said that the form had reverted to a pre-populated version, although he could not explain the inconsistencies between previous and current amendments, other than it had saved in two parts.

Closing Submissions

79. Mr Bridges provided written submissions on the relevant law and submitted that the Panel should find all of the particulars proved. The Registrant asked the Panel to decide that the facts are not proved.

Decision on facts

80. The Panel accepted the advice of the Legal Assessor who reminded it that the standard of proof is the balance of probabilities and that the burden of proof rests entirely on the HCPC. The Registrant need prove nothing. He referred to the cases of Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67 on the issue of dishonesty and to Suddock v NMC 2015 EWHC 3612 (Admin) and Dutta v GMC [2020] EWHC 1974 (Admin) on the assessment of the evidence.

81. The Panel was mindful that the Registrant need prove nothing. The Panel took account of all the evidence it had heard from the witnesses and the Registrant. It took account of the evidence from the Registrant about the working environment and the context of the incidents alleged. The email from Colleague A dated 4 March 2019 asks for detailed factual accounts of all the incidents highlighting concerns about the Registrant’s practice. That was only one month after he started at the Trust. There is an email from the Registrant to TD and Colleague A about the difficulties he was facing getting the supervision that he was being required to have with staff who were rarely available to him. Only two members of staff were allocated to sign off his competencies, one was part time and worked two days a week and the other worked off site and visited Gloucester one day a week. It appeared to the Panel from the evidence of TD and Colleague A that there was a view swiftly formed that the Registrant was not performing and that he was required to be supervised and managed. TD stated in his evidence that as soon as 19 February 2019 discussions were had with the Registrant about his unsafe practice and “a feasible way forward” which the Registrant said was a “golden handshake” to get him to leave. It appeared to the Registrant that he faced an element of hostility and lack of support and cooperation in his short time at the Trust.

82. However, the Panel found no cogent evidence of a concerted or deliberate plan by his colleagues to remove the Registrant from his role, as stated by him. None of the witnesses appeared to bear ill will to the Registrant or had any axe to grind.

Particular 1

1. On 4 February 2019, you asked to inject patients for Myocardial Perfusion studies without the need to wear fingers dosimeters contrary to the Local Rules for the Nuclear Medicine Department.

83. The Panel heard from KD and Colleague A and the Registrant. The evidence of KD was clear and consistent. She said that the Registrant wanted to inject and that she was surprised when he wanted to proceed to inject without the finger dosimeter. That is consistent with what Colleague A found when she investigated the incident. It was agreed by everyone that finger dosimeters were not available and had been ordered for the Registrant. The Registrant said that he ought not to have been rostered and his colleagues should have given him dosimeters. That was not to the point, and it does not explain or justify the conduct described by KD. The Registrant was a Band 7, a senior clinician, and he ought to have known that he could not inject without a finger dosimeter, and he accepted in his evidence that finger dosimeters were a basic precaution. The Panel accepted the clear and credible evidence of KD that he had asked to inject without wearing a finger dosimeter and it found this proved.

Particular 2

2. On 7 February 2019, you attempted to enter a gamma camera room whilst the CT machine was operating.

84. Colleague A witnessed this incident. Her evidence was consistent, fair, professional and open. The Panel found her evidence credible and reliable. She said that the Registrant had attempted to enter the room when the CT machine was warming up as he walked towards the room. The Registrant did not deny that the CT machine was warming up but said that he did not enter the room, but he did accept that he walked towards the room. The Allegation is “attempted” and that is what Colleague A said she had witnessed. The Panel accepted her clear and credible evidence and found this proved.

Particular 3

3. On 14 February 2019, you administered an injection which tissued and attempted to conceal the error, preventing it from being rectified.

85. The Panel heard from Colleague D and saw the evidence of the bone scan which indicated that tissuing had occurred. The Registrant was adamant that the injection did not tissue. There was no evidence that due to the scan being clinically diagnostic that tissuing did not occur, and no evidence that those are mutually exclusive positions. The Panel found that the evidence from Colleague D, who witnessed the injection, was equivocal. She said that “on reflection” she “believed” that the Registrant may have concealed the tissuing and that it had looked alright at the time. On balance, the Panel found this not proved.

Particular 4

4. On 18 February 2019, you entered the gamma room whilst the CT machine was operating, exposing yourself to the risk of radiation.

86. Colleague B witnessed the Registrant enter the gamma room, and Colleague A completed the DATIX which is consistent with her statement and her live evidence. The Registrant said the DATIX had been changed and that Colleague B was wrong to say that she saw him enter the room to clean the CT Scanner. Colleague A was clear and consistent about what she had reported. At times, the Registrant appeared to accept that he had entered the room, stating that he was asked to do so by Colleague B. The Registrant also said that he approached the boundary of the room but did not enter, and he said that Colleague A had lied on the DATIX. The Panel did not find the Registrant’s evidence consistent or credible. The Panel preferred the evidence of Colleague A and found this Particular proved.

Particular 5

5. On 22 February 2019, following a radiation spill, you contaminated your shoes which led to further contamination of the floor.

87. The Panel considered the DATIX of this incident and heard the evidence of Colleague D and SB. The Registrant reported the incident and Colleague A completed the DATIX. The evidence of Colleague D and SB was consistent that the Registrant had walked in to the contaminated area after the spill. Both expressed surprise that he did so. He contaminated his shoes, which he did not dispute. He said he was caught by a “splash” from the dropped syringe. In any event, the Panel had evidence before it that subsequent tests found that his shoes were contaminated. Colleague D and SB were not contaminated.

88. The Panel was mindful of the terms of the Particular which does not require any finding as to precisely how the Registrant’s shoes were contaminated, simply that such followed a radiation spill. The Panel therefore concluded that this Particular is part proved to the extent that the Registrant contaminated his shoes on the date alleged following a radiation spill. The Panel found no evidence that this led to further contamination. This is part proved.

Particular 6 c)

6. Between 15 March 2019 and 1 May 2019 your behaviour towards colleagues was inappropriate and/or unprofessional, in that:

c) On 15 March 2019 you were aggressive towards Colleague D and told her she was not allowed to leave work, although it had already been agreed with a manager.

89. The evidence of Colleague D was clear, credible and consistent with the DATIX report completed shortly after the event. Colleague D said that the Registrant spoke to her angrily and that she was upset by his behaviour. Colleague A said in her evidence that in the telephone call she received Colleague D was crying. Colleague D also reported to her that the Registrant had been aggressive towards her. The Registrant said that he had challenged Colleague D and had asked for written evidence of permission to leave early. He said that he was frustrated and concerned about the tests he was meant to be taking that afternoon. His evidence was largely concerned with the fact that that Colleague A had not told him that she had earlier given Colleague D permission to leave. Whilst he may have felt undermined and annoyed by that, the Panel preferred the evidence of Colleague D and Colleague A, and it found that the Registrant was aggressive towards Colleague D and found this proved.

Particular 6 d)

6. Between 15 March 2019 and 1 May 2019 your behaviour towards colleagues was inappropriate and/or unprofessional, in that:

d) On 1 May 2019 you said to Colleagues A and B that you felt as if you were being treated as a "dirty Paki Nigger''.

90. The Panel heard from Colleague A that she was clear that the Registrant had used the words alleged and she was shocked. She said she did not mishear what the Registrant said. The Panel found that Colleague A’s live evidence was clear, cogent and consistent with the statement she made shortly after in the grievance she raised.

91. The Registrant said she had misheard what he said and that she had lied. He said that he had used the word “national” not “nigger”. Those words are not phonetically similar. The Panel did not find the Registrant’s evidence about Colleague A mishearing or lying about this issue plausible or credible. Colleague A was clear that the Registrant had said the latter. It found nothing to support his assertion that Colleague A lied. The Panel preferred Colleague A’s evidence which was credible and reliable. It found this Particular proved.

Particular 7

7. In or around February or March 2020, during your application process with Royal Berkshire NHS Foundation Trust, you misled them as to who your most recent employer was, stating it was Barts NHS Trust when in fact it was Gloucestershire Hospitals NHS Foundation Trust.

92. The Panel heard from MA and from the Registrant. It heard considerable evidence from the Registrant explaining the application form he had completed and submitted to the Royal Berkshire NHS Foundation Trust in January 2020. He had resigned from the Trust in August 2019.

93. The Panel found that MA’s evidence was clear, balanced, direct and open. He said he found the application form was misleading as the current employer was stated as Barts, which was not correct. He had understood from the application form that the previous employer had been Barts, although he accepted that the Registrant had mentioned the Trust in the additional section at the end of the form. He did recall the Registrant mentioning Gloucester at the interview, but only with reference to his daughter and the need to relocate.

94. The Panel found the evidence of the Registrant confusing. Despite extensive evidence and questioning, the Panel could make little sense of his explanation about the “pre-population” of the application form and the issue about the failed saving of the correct details which the Registrant said he had entered. He accepted that the form contained no details of a number of his previous employers and that it stated his last employer was Barts, which he accepted was not correct. He said that the form had been pre-populated but he could not clearly explain what the application form had last been pre-populated for, and why it was, only in part, pre-populated as he claimed.

95. The Panel found the Registrant’s evidence was elaborate, inconsistent and at times it was incoherent. After a considerable amount of evidence from him, it was only in cross examination that the Registrant told the Panel that he had tried to save the form but had lost only some of the details on the application form, including significantly the “End date” of his employment with Barts in 2018, but that other details, such as the additional information mentioning the Trust, had inexplicably been saved. He could not explain that, nor how it was that his “current employer reference” was a doctor at Barts, who were not his current employer in January 2020. The Registrant accepted that he had not disclosed his suspension and resignation from the Trust and said that was because he was still within his probation period at the time He said that his Union had advised him that he need not disclose that information on the application form. There was no independent evidence to support that assertion. The Panel found the Registrant’s explanations on this matter were incredible and implausible.

96. The Panel did not accept the Registrant’s evidence and it concluded that the Registrant had deliberately completed the application form to mislead. It found that he did so dishonestly and with the intention to mislead Royal Berkshire as to his employment history and current employer. The Panel was mindful of the guidance in Ivey. It considered that, despite his extensive explanations, the Registrant had intended to mislead Royal Berkshire and that he knew, at the time he completed the application form, that he was being dishonest. Viewed objectively, the Panel concluded that what is alleged the Registrant did in completing this application form would be considered dishonest by any ordinary, decent member of the public. This is proved.

Grounds

Submissions on Misconduct

97. Mr Bridges provided the Panel and the Registrant with a written submission on misconduct and the relevant case law and invited the Panel to find misconduct. The Registrant had nothing to add.

98. The Panel accepted the advice of the Legal Assessor who reminded the Panel about the guidance on misconduct and seriousness in Roylance v GMC (no 2) [2000] 1 AC 311 and Remedy UK Ltd v GMC [2010] EWHC 1245 (Admin). He also referred it to the guidance on accumulation of findings in Schodlok v General Medical Council [2015] EWCA Civ 769.

99. The Panel was satisfied that none of the findings amount to a lack of competence, and that was not a position advanced by the HCPC. The Registrant is a Band 7 senior clinician with many years of experience as a Radiographer. The Panel was satisfied that in all the circumstances and given the experience and seniority of the Registrant, that the conduct and behaviour found proved do not arise as a result of any lack of competence.

Particular 1

100. The process the Registrant ought to have followed is basic and fundamental to protecting himself and others when dealing with an unsealed source of radiation. He was a senior, lead clinician and he knew from his professional experience what he should have been doing. He failed to follow basic and fundamental procedures that were well known to him. Despite the absence of PPE he was at risk of unnecessarily exposing himself to a risk of contamination should he have been allowed to proceed. His conduct failed to set a proper and professional example. The Panel was of the view that his conduct fell short of what was proper and it was serious and amounts to misconduct.

Particular 2

101. The Registrant is a senior clinician, and not entering the room when the scanner is running is fundamental to safe and effective practice. Although this was an attempt only, the Registrant needed to be warned by his colleague not to proceed further. He failed to manage risk and to set an example to more junior colleagues. He unnecessarily exposed himself to risk and did not follow the Local Rules. The Panel concluded that his conduct fell short of what was proper and was serious and amounts to misconduct.

Particular 4

102. The Registrant was found to have entered the scanning room. He exposed himself to risk as a result and he failed to follow the Local Rules and failed to adhere to basic, safety procedures designed to manage and minimise the risk of radiation exposure. As a senior clinician he ought to have known far better. He failed to lead appropriately, failed to set a proper, professional example and failed to maintain core professional standards. The Panel concluded that his conduct fell short of what was proper and was serious and amounts to misconduct.

Particular 5

103. The Registrant contaminated his shoes after the spill occurred. There is no evidence that he contaminated anyone else. The precise manner in which the contamination of his shoes occurred is unknown. The Panel was of the view that this was conduct that, although ill-judged, was not conduct that itself was serious enough to amount to misconduct.

Particular 6 c)

104. The Registrant has been found to have been aggressive to a junior colleague. He was her manager and in being aggressive he was attempting to pursue his own needs by having his competency signed off and ignoring those of his colleague, who was reduced to tears by his conduct towards her. He failed to conduct himself in a respectful and professional manner. In those circumstances, and mindful of the power imbalance, the Panel was of the view that this conduct was serious and amounts to misconduct.

Particular 6 d)

105. The language used was wholly unprofessional and inappropriate and in no circumstances could it be acceptable. The Panel concluded this conduct was serious and fell far short of what would be proper in the circumstances, and amounts to misconduct.

Particulars 7 and 8

106. The findings in respect of Particular 7 and 8 include dishonesty. That conduct took place deliberately and the Panel found it was undoubtedly serious. It was a deliberate and dishonest act intended to mislead a prospective employer. The Panel found that the findings fell far short of what would have been proper in the circumstances and amounts to misconduct.

Standards Breached

107. The Panel considered the HCPC Standards of conduct, performance and ethics (2016) and found that the Registrant had breached standards 2.1 You must be polite and considerate; 2.5 You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers; 3.4 You must keep up to date with and follow the law, our guidance and other requirements relevant to your practice; and 9.1. You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

108. The Panel also found that the Registrant breached the HCPC Standards of Proficiency of Radiographers, standards 2.1 maintain high standards of personal and professional conduct; 2.11 recognise the power imbalance that comes with being a healthcare professional, and ensure they do not abuse this for personal gain; 8. work appropriately with others. 8.1 work in partnership with service users, carers, colleagues; 8.3 understand the need to build and sustain professional relationships as both an autonomous practitioner and collaboratively as a member of a team; and 14 establish and maintain a safe practice environment.

Impairment

109. The Registrant said he was not sure he could attend the hearing further and he told the Panel he would accept and learn from the decision of the Panel. He said he would be more cautious and was keen to learn. He said he wanted to continue to practice but he was content for the hearing to proceed in his absence.

110. The HCPC served a document on the Registrant and provided a copy to the Panel. This was a decision of a Conduct and Competence Committee of the HCPC in 2012 which resulted in a three year Caution Order on the Registrant.

111. Mr Bridges for the HCPC provided written submissions on impairment of fitness to practice setting out the relevant case law and inviting the Panel to find current impairment.

112. The Registrant attended the following day, 15 February 2024, and advised that he had reflected on the impact on the reputation of the profession and was willing to learn. He said he should have done things differently and would seek improvement. He told the Panel how he would now do things differently and said he was expressing remorse. He pointed out to the Panel the training certificates withing the bundle which reflected the training he had undertaken to address the fitness to practise issues.

Decision on Impairment

113. The Panel accepted the advice of the Legal Assessor who referred it to the HCPC Practice Note on impairment and the guidance in CHRE v NMC and Grant [2011] EWHC 927 (admin). He stressed the importance of assessing insight, remediation and the risk of repetition. He reminded the Panel about the critical importance of public interest issues as stated in Cohen v GMC [2008] EWHC 581 and the need to uphold and declare proper professional standards and maintain public confidence in the profession.

114. The Panel considered all the information before it and took account of what the Registrant said. The misconduct is in principle remediable, albeit dishonesty can be hard to remediate.

115. Throughout this hearing the Panel has seen the Registrant talk over others, including the Panel, witnesses, and fail to listen. Throughout his evidence, the Registrant showed a distinct lack of respect for his colleagues, whom he has criticised, blamed and accused of lying under oath to this Panel. The Registrant has not taken responsibility for his own conduct and behaviour. He has not apologised for his conduct, including his conduct in respect of Colleague A and D. He has not demonstrated any meaningful or genuine remorse. He has not shown that he accepts the negative impact of his conduct on his colleagues, the profession, or on public confidence in the profession. The Registrant has not remediated his practice. The training he has done is not relevant and the most recent training certificate is 2020.

116. The Panel found that the Registrant failed to acknowledge the findings of dishonesty. He appears to continue to blame the incident on the loss of data from his mobile telephone. He has not demonstrated that he takes responsibility for his dishonest conduct and he has shown no insight into this serious finding.

117. The Panel concluded that the Registrant did not demonstrate that he has acknowledged, recognised or understood his conduct, nor has he demonstrated his understanding of the impact of his behaviour on others. The Panel found that he consistently deflected responsibility for his actions on his colleagues whom he repeatedly accused of lying. He has not demonstrated to the Panel that he has meaningfully reflected on, or learned from his misconduct. The Panel found that the Registrant displayed no meaningful insight into his conduct and it concluded that there is a high risk of repetition of the misconduct.

118. The Panel considered the guidance in Grant on assessing impairment expressed in four limbs as follows:

“Do the finding show that fitness to practise is impaired in the sense that:

a) Has the Registrant in the past acted and/or is liable in the future to act in a way so as to put service users at unwarranted risk of harm;

b) Has the Registrant in the past brought and/or is liable in the future to bring the profession into disrepute;

c) Has the Registrant in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession?

d) has in the past acted dishonestly and/or is liable to act dishonestly in the future.”

119. The Panel was satisfied that each of the limbs is engaged in this case. The Registrant has in the past and remains likely in the future to place his colleagues at risk of harm and to bring his profession into disrepute. He has breached fundamental tenets of his profession, notably integrity and honesty, and the Panel has found that he is likely to repeat his dishonest conduct in the future.

120. On the public interest element, the Panel decided, given the nature and gravity of the findings and misconduct, that the public would be most concerned were there not a finding of current impairment. To find that the Registrant’s fitness to practise was not currently impaired in this case would seriously undermine public confidence in the profession and the regulator, and it would fail to uphold proper professional standards. The Panel concluded that a finding of current impairment of fitness to practice is required in this case on public interest grounds.

121. The Panel therefore concluded that the Registrant’s current fitness to practice is impaired on both the personal and public elements of impairment.

Sanction

Submissions and Decision on Sanction

122. The Panel heard from Mr Bridges who provided a written submission on sanction. He referred to the relevant case law and asked the Panel to consider the Sanctions Policy and apply the proportionate sanction.

123. The Registrant offered his apologies to all the people on whom the Panel had found his conduct had impacted, and apologised to the Panel for speaking over them. He said he wholeheartedly accepted the Panel’s judgement. He said he would take all the remedial actions he needed to. He asked the Panel to take account that this was a new work place and it was an alien environment. He said there was rivalry and it was tense and said that there had been no patient harm. He said he promised that he would never repeat the misconduct and said he wanted to contribute to the profession and be given the chance to practice.

124. The Registrant said he was under great stress at the time and he now appreciated that it was his duty to earn the respect of his colleagues. He said he was at the mercy of the Panel. He reminded the Panel about his testimonials from colleagues at Barts.

125. The Panel accepted the advice of the Legal Assessor who referred it to the HCPC Sanctions Policy and the importance of acting proportionately. It must apply the least restrictive sanction that both protects the public and the wider public interest, and should balance the Registrant’s interests with the need to protect the public.

126. The Panel was mindful of the HCPC Sanctions Policy. It found the following aggravating factors:

• A serious lack of insight.

• The Registrant’s repeated reliance on others to direct him despite his experience and seniority.

• Failure to take personal responsibility and consistent deflection of responsibility onto colleagues.

• The previous Fitness to Practice findings in 2012.

127. The Panel found the following mitigating factors:

• No patient harm

• An unfamiliar working environment, and the Registrant’s perceived lack of support

• Some difficult personal circumstances at the time

• Some limited apology and remorse

128. The Panel found that the dishonesty element of the misconduct is the most serious. It has found that this conduct was a deliberate attempt to mislead a prospective employer for personal gain. The Registrant accepted that there were multiple omissions within the same application form, and conflicting accounts as to how he made the application but he has shown no insight or acknowledgement of this dishonesty. The Panel concluded that the dishonesty of this nature was at the upper end of the scale of dishonesty.

129. The findings also include a failure to work in partnership with colleagues, which is serious, and the Panel was mindful of paragraphs 61 and 62 of the Sanctions Policy.

130. The Panel found that the Registrant demonstrated deeply entrenched attitudinal behaviours into which he has shown no insight. The Panel was concerned about the arrogance and lack of respect for colleagues displayed by the Registrant during the hearing. This, at times, mirrored the behaviours that underpinned elements of the misconduct.

131. The Panel considered paragraphs 99 - 102 of the Sanctions Policy. Given the nature and gravity of the misconduct and lack of insight, the Panel found that to take no action or to impose a Caution Order would not be proportionate. To do so would significantly fail to reflect the seriousness of the findings, would fail to protect the public, which includes patients and colleagues, and would undermine public confidence in the profession and the regulator.

132. The Panel considered paragraphs 106 - 109 of the Sanctions Policy. This is not a lack of competence case. The Panel did not consider that Conditions of Practice would be appropriate given the seriousness of the findings, the dishonesty and the lack of insight. The findings are essentially attitudinal and behavioural in nature and are not liable to be effectively or sufficiently managed by any conditions of practise.

133. The Panel next considered paragraphs 118 – 121 of the Sanctions Policy on Suspension. The Panel took account of paragraph 121, and was mindful that it has found there is a high risk of repetition and no insight. The Panel had no evidence before it, and nothing to assure it that the Registrant is either likely or able to resolve the failings. The Panel also took account of the aggravating fact that is the previous FTP finding in 2012 which found that the Registrant had borrowed money from a patient.

134. The Panel concluded, given the dishonesty, lack of insight and remediation and the high risk of repetition, that a Suspension Order would not be sufficient to protect the public and would not maintain public confidence. The dishonesty was deliberate and planned. It was not a moment of madness, but a deliberate attempt to mislead an employer for personal gain.

135. The Panel next considered paragraphs 127 – 132 of the Sanctions Policy on Striking Off Order and, in particular, took account of paragraphs 130 and 131. There is no evidence of any insight into deliberate dishonesty, as well as the failure to work in partnership with colleagues. There has been no remediation and there is a high risk of repetition.

136. In all these circumstances, the Panel concluded that anything less than a Striking Off Order would not be sufficient to protect the public, and would not uphold and declare proper, professional standards or maintain public confidence in the profession. The Panel decided that a Striking Off Order is the proportionate and appropriate sanction to impose in this case.

137. The Panel is conscious that this Order will have a serious impact on the Registrant both personally and professionally, but in this case the need to protect the public and the wider public interests outweighs the Registrant’s interests.

 

Order: The Registrar is directed to strike the name of Mr Fazal Karim from the Register on the date this Order comes into effect.

Interim Order

Interim Order Application

1. In light of its findings on Sanction, the Panel next considered an application by Mr Bridges for an Interim Suspension Order to cover the appeal period before the Sanction becomes operative.

2. The Panel accepted the advice of the Legal Assessor who referred it to the HCPTS Practice Note on Interim Orders. He reminded the Panel that an Interim Order must be necessary to protect the public, or be otherwise in the public interest. The Panel must act proportionately and balance the interests of the Registrant with the need to protect the public.

3. The Panel was mindful of its earlier findings and concluded that an Interim Order is necessary to protect the public in the appeal period. The Panel decided that it would be wholly incompatible with its earlier findings and with the Striking Off Order imposed to conclude that an Interim Suspension Order is not necessary for the protection of the public, or otherwise in the public interest.

4. Accordingly, the Panel concluded that an Interim Suspension Order should be imposed on both public protection and public interest grounds. It decided that it is appropriate that the Interim Suspension Order be imposed for a period of 18 months to cover the appeal period. When the appeal period expires this Interim Order will come to an end, unless there has been an application to appeal. If there is no appeal the Striking Off Order shall apply when the appeal period expires.

Interim Order: The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.
This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Mr Fazal Karim

Date	Panel	Hearing type	Outcomes / Status
07/02/2024	Conduct and Competence Committee	Final Hearing	Struck off