The High Court uphold an appeal by the Professional Standards Authority (PSA) and substitute NMC suspension with Striking Off Order.

In Professional Standards Authority for Health and Social Care (PSA) v Nursing and Midwifery Council & Anor, the PSA appealed a determination of the NMC’s fitness to practise tribunal to suspend a nurse who slept when they were supposed to look after a vulnerable patient.  The judgement transcript briefly outlines the circumstances of the case:

The allegations against the Nurse relate to her conduct whilst working on a night shift for Chelsea and Westminster Hospitals NHS Foundation Trust on 8th to 9th June 2019. She was tasked with caring for Patient A who suffered from Parkinson’s Disease and had additional medical needs due to hospital-acquired pneumonia. He was considered to be highly vulnerable and had been placed in a side room with two nurses allocated to care for him.

The patient’s grandson, a registered paramedic, arrived to visit his grandfather at 3am that night. On arrival, he found the door to the side room locked. Despite knocking repeatedly, there was no answer. He sought assistance from the sister in charge at the time. After several more minutes of knocking, the door was opened by the Nurse who then closed it again. When she re-opened the door a few minutes later, it appeared to both witnesses that she had just woken up because of her appearance and because the room was in virtual darkness. Blankets were seen rolled into pillows and there were other blankets on the chairs which gave the impression that the Nurse had been sleeping on a makeshift bed.

When the light was turned on, Patient A was found to be unresponsive on the bed with his head lowered down below his legs, and his legs bent but elevated at a 45-degree angle. His head was against the headboard and touching the bedrails which were raised. He had mucus all over the right side of his face and was at a high risk of aspiration. His pyjama top was up under his armpits and the rest of his body was naked save for an incontinence pad. He was described as being “hypoxic and blue” with secretions covering his face. It took around two hours to stabilise him, clean him and make him comfortable.

The PSA’s argued that the sanction imposed by the Panel was insufficient to protect the public and the Nurse should have been struck off the register of nurses and midwives maintained by the Council. The Authority asks that the Court exercise the statutory power available to it and substitute the current sanction of a suspension order with an order removing the Nurse from the register (strike-off). Alternatively, the Court should remit the sanction to be considered by a fresh panel with such directions as the Court thinks fit. 

“What was relevant to impairment was equally relevant to sanction.”

The Hon. Mrs Justice Thornton commented in her judgement:

“The findings of the Panel in relation to the Nurse’s misconduct and impairment to practice are expressed, in material part, in striking and stark terms. The Nurse’s actions were found to have left the patient “at a serious risk of severe harm”. Her actions were said to be “deplorable”, “unprofessional”, to “put the profession into disrepute” and to “be wholly unacceptable”. She was found to have “selfishly placed your own interests over the needs of a highly vulnerable patient”. Her actions were considered to be “deliberate and planned”, her misconduct was said to have “breached the fundamental tenets of the nursing profession and therefore brought its reputation into disrepute”. There was said to be “very limited insight with little responsibility taken or the seriousness of risk acknowledged”. A significant risk of repetition was identified. The Panel concluded that an informed member of the public, aware of the charges found proved in this case would be particularly “horrified” at the misconduct.

“It is apparent that the findings of the Panel in relation to impairment are apposite to the Guidance on striking off. What was relevant to impairment was equally relevant to sanction. Yet all the Panel said in relation to striking the nurse from the nursing register was that it would be disproportionate to do so on the basis that she had been working without regulatory concerns for three years since the incident in question. This finding appears wholly inconsistent with the Panel’s findings in relation to impairment that the Nurse had “very limited insight” and there was a significant risk of repetition of the misconduct. The apparent inconsistency is not explained, and the Panel’s reasoning is too generalised in the circumstances.”

She consequently upheld the PSA’s appeal, saying this case was one of “the somewhat rare category of case where I am able to safely conclude” (GMC v Stone [2017] EWHC 2534 at §66), that the Nurse must be erased from the register.”

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