Miss Nicola Hewitt

Profession: Biomedical scientist

Registration Number: BS40514

Hearing Type: Review Hearing

Date and Time of hearing: 13:00 11/03/2016 End: 15:30 11/03/2016

Location: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

During the course of your employment as a biomedical scientist with Worcestershire Acute Hospitals NHS Trust:

 

1. In March 2012 you approved an erroneous result in Haematology which resulted in a patient being admitted for a blood transfusion.

 

2. On 18 May 2013 you incorrectly labelled the red cell units for two cross matches for two patients which resulted in:

a) an uncross-matched red cell unit being available for one patient; and

b) an ABO incompatible uncross-matched red cell unit being available for a second patient.

 

3. On 2 October 2012 you changed patient A's cardinal blood group on the internal WINPATH computer system following a bone marrow transplant without:

a) following the standard operating procedure;

b) adequately discussing the proposed change with a senior colleague.

 

4. On 8 November 2012 you input two samples from different patients onto one patient's records on the internal WINPATH computer system.

 

5. The matters described in paragraphs 1 - 4 constitute misconduct and/or lack of competence.

 

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

Finding

Preliminary Matters

Service of Notice

1. The Notice of Hearing, confirming the date, time and venue of today’s proceedings, was posted to Ms Hewitt’s address on 08 February 2016 by first class post and also sent by email on the same date. The Panel noted that in an email dated 24 February 2016, Ms Hewitt confirmed that she will not be attending today’s hearing. In these circumstances, the Panel was satisfied that notice of today’s hearing was properly served, in accordance with the Rules.

Proceeding in Absence

2. Having determined that service of the Notice of Hearing had been properly effected, the Panel went on to consider whether to proceed in Ms Hewitt’s absence. The Panel was advised by the Legal Assessor and followed that advice.
 The Panel took into account Ms Hewitt’s email, dated 24 February 2016, which  confirmed that she would not be attending the hearing. The Panel determined that  it was  reasonable and in the public interest to proceed in Ms Hewitt’s absence for  the following reasons:

a) The Registrant clearly indicated that she would not be attending today’s    hearing, which demonstrated a deliberate and voluntary waiver of her right to be present.

b)  There has been no application to adjourn and no indication from the   Registrant that she would attend on any future date;

c) The Registrant has provided written representations;

d) This is a mandatory review hearing pursuant to Article 31 of the Health and   Social Work Professions Order, and as such should proceed expeditiously.
 
Background:

3. The Registrant started employment at the Worcestershire Acute Hospital Trust (‘the Trust’) as a Band 6 Biomedical Scientist in the Haematology and Blood Transfusion Department on 17 March 2008.
 
4. On 28 March 2011, AN, a Departmental Manager, noticed that an error had occurred involving the approval of an erroneous blood result some three days earlier. The allegation was that the Registrant was responsible for this, in that she had entered on the laboratory computer system her approval of an abnormal result which wrongly stated that the patient in question had extremely low haemoglobin.
 
5. As a result, the patient was unnecessarily admitted to the Acute Medical Unit for a blood transfusion.
 
6. Shortly after being questioned about this error, the Registrant left work on long term sick leave until 04 August 2011. To facilitate her return to work, competencies were put in place for training purposes.
 
7. On 18 May 2012, an incident occurred concerning two surgical patients who were due to be operated upon at the hospital. Their blood was cross-matched by the Registrant, but it was discovered that she had incorrectly labelled the red cell units. The numbers on the labels did not correspond with the numbers on the relevant units of blood. As a result, an uncross-matched red cell unit was available for one of the patients and an ABO incompatible uncross-matched red cell unit was available for the second patient.
 
8. The Registrant was placed on supervision for her transfusion work. On 02 October 2012, the Registrant, at work in the transfusion laboratory, was entering the details of a patient, who had had a bone marrow transplant, onto the internal WINPATH computer system. This involved her changing the patient’s cardinal blood group without authorisation.
 
9. On 08 November 2012, the Registrant was responsible for inputting details of two blood samples from different patients onto the records of a single patient on the internal WINPATH computer system.
 
10. As a result of these additional mistakes coming to light, the Registrant was issued with a Final Written Warning on 12 June 2013.
 
11. The Registrant resigned from her post on 21 June 2013.

12. At the final hearing the panel found the facts proved and determined that the Registrant’s acts and omissions amounted to misconduct. A six months Conditions of Practice Order was imposed.

13. On 17 September 2015 the Conditions of Practice Order was reviewed.  In reaching its decision on impairment the previous review panel stated:

“The Panel is satisfied that the Registrant’s fitness to practice is still  impaired noting that the burden is on the Registrant to show that she has  addressed all past concerns. The Panel has noted the last Panel’s  concern that at the time of the first hearing there had been no independent  verification of where the Registrant was working, details of how she was  addressing her deficiencies or details regarding her health. The Panel is  satisfied that a similar situation applies today. It has not received  independent information about these matters and notes that the  Registrant has indicated little expression of remorse”. 

14. With regards to Ms Hewitt’s non-attendance and written representations the previous panel made the following observations:
 
“The Panel notes that the Registrant has chosen not to attend today’s  hearing although she has provided a written submission which the Panel  has carefully considered. The Registrant’s submission is limited to her  statements about her current employment, the lack of any further incidents  and her confirmation that she is complying with the conditions imposed  upon her registration. Despite the clear recommendations by the previous  review panel that the Registrant should provide a report from her  supervisor and her GP she has not submitted anything in writing from  them. The Panel also notes that the Registrant has not submitted to the  Panel any observations about the action that it should take today in  respect of the current order”

15. At the sanctions stage, the previous review panel concluded that the original Conditions of Practice Order should be varied and extended for a further 6 months. The previous panel stated that the extended period ‘…will give the registrant sufficient time to collect all the necessary documentation and obtain independent evidence to present to the next review Panel. This should provide her with the opportunity to demonstrate that she has addressed her deficiencies.”

16. The varied and extended conditions are as follows:

 The Registrar is directed to vary the Conditions of Practice Order against the  registration of Ms Nicola Hewitt for a further period of 6 months on the expiry of  the existing order: the conditions are:

1. You must place yourself and remain under the supervision of a work place  supervisor registered by the HCPC or other appropriate statutory regulator  and supply details of your supervisor to HCPC within 14 days of taking up  any new position. You must attend upon that supervisor as required and  follow their advice and recommendations.
 
2. You must submit a report from your workplace supervisor(s) at least 14  days prior to any review hearing regarding your conduct, work  performance and insight into past deficiencies.
 
3. You must submit to the Committee at least 14 days prior to any review  hearing evidence from your GP about your current health status. 
 
4. You must cease practising immediately if you are advised to do so by your  General Practitioner and/or Occupational Health Specialist.
 
5. You must promptly inform the HCPC if you cease to be employed by your  current employer or take up any other or further employment.
 
6. You must promptly inform the HCPC of any disciplinary proceedings taken  against you by your employer.
 
7. You must inform the following parties that your registration is subject to  these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).
 
8. Any condition requiring you to provide any information to the HCPC is to be met by you sending the information to the offices of the HCPC, marked for the attention of the Director of Fitness to Practise or Head of Case Management.

HCPC Submissions

17. Ms Carson, on behalf of the HCPC, outlined the history of this case. She referred the Panel to the findings of the Conduct and Competence Committee that imposed the original Conditions of Practice Order on 18 March 2015 and the findings of the first review panel that considered this case on 17 September 2015. Ms Carson submitted that Ms Hewitt has failed to comply with: Condition (2) as the report from her supervisor is limited; Condition (3) as no report from her GP has been provided and Condition (7) as there is no indication that the relevant parties have been informed of the Conditions of Practice Order.

Registrant’s Submissions

18. In her email, dated 24 February 2016, Ms Hewitt, outlined where she had been working since leaving Worcester Royal Hospital and stated that she had made her employers aware of the Conditions of Practice. She had made written representations for the consideration of the Panel. She stated that she has been unable to comply with Condition (3) because her GP would not provide her with ‘some form of fitness to practice certification or letter’. However, she maintained that she has complied with the remaining conditions. The documents Ms Hewitt attached to her email include a training log and competency assessment form dated August 2014, certificates of achievement dating from 2013 - 2016 and a reference letter from her supervisor at Great Western Hospitals, Swindon. 

Panel’s Approach

19. In undertaking this review, the Panel took into account all of the documentary evidence, the submissions from Ms Carson, on behalf of the HCPC, and Ms Hewitt’s written representations. It has accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt. In particular that:

• The purpose of the review is to consider the issue of impairment based on the previous Panel’s findings of fact, the extent to which Ms Hewitt has engaged with the regulatory process, the scope and level of her insight, whether her previous misconduct has been sufficiently and appropriately remedied and the risk of repetition.

• In terms of remediation, relevant factors include whether there is any evidence before the Panel that Ms Hewitt:

(i) fully appreciates the gravity of her conduct and behaviour which led to the previous panel’s finding of impairment;

(ii)  has maintained her skills and knowledge;

(iii)  is likely to place patients at risk if she were to return to unrestricted practice.

• The Panel should have regard to the HCPC Practice Note: Finding that Fitness to Practise is impaired.
.
• It is only if the Panel determine that Ms Hewitt’s fitness to practise remains impaired that the Panel should go on to consider sanction by applying the guidance as set out in the HCPC Indicative Sanctions Policy and the principles of proportionality which require Ms Hewitt’s interests to be balanced with the interests of the public.

Decision:

20. The Panel first considered whether Ms Hewitt’s fitness to practise remained impaired based on her misconduct. In particular the Panel took into account the risk to patient safety, the risk of repetition and the wider public interest which includes upholding public trust and confidence. The Panel also bore in mind the need to uphold proper standards of conduct and behaviour.

21. Although Ms Hewitt has engaged with the HCPC since the hearing in September 2015, she has not fully complied with the Conditions of Practice Order, nor has she provided any independent verification that the deficiencies identified by the original panel have been remediated. The Panel noted that Ms Hewitt has made some attempt to comply with the current Conditions of Practice Order but the information provided was wholly insufficient. In the Panel’s view the letter from Ms Hewitt’s supervisor was superficial. It was addressed “to whom it may concern” and gave no indication that the author is aware of these proceedings and makes no specific or detailed reference to the issues identified in Condition (2). The Panel therefore concluded that Ms Hewitt had not complied with Condition (2).

22. It was unclear to the Panel whether Ms Hewitt had fully complied with Condition (7). The Panel noted that in the File Note dated 22 October 2015, the person at Great Western Hospital London (sic) with whom the Case Manager had spoken had indicated that she was not aware that Ms Hewitt had been made subject to conditions. Ms Hewitt stated that she had fully complied with this condition but provided no independent corroboration.

23. The Panel noted Ms Hewitt’s explanation as to why she had been unable to submit a letter from her GP in connection to Condition (3). The Panel does not now consider this to be a material issue.

24. Nevertheless, in the absence of full and verifiable compliance with Conditions (2) and (7) the Panel could not be satisfied that there has been any significant change and therefore it was led to the inevitable conclusion that Ms Hewitt’s fitness to practise remains impaired.

25. The Panel then moved on to consider what, if any, sanction it should impose.  The Panel first considered whether to take no further action and to allow the order to lapse but concluded that this would not be sufficient to mark the seriousness of Ms Hewitt’s conduct and would therefore be wholly inappropriate.  Similarly, the Panel was of the view that a caution would not be appropriate since there was no evidence before it that Ms Hewitt had developed insight and had remediated her failings.  Accordingly, there remained a significant risk of repetition.

26. The Panel next considered a Conditions of Practice Order. The Panel had no information in relation to Ms Hewitt’s current circumstances. However, the Panel was satisfied that Ms Hewitt’s conduct is remediable. Despite Ms Hewitt’s failure to provide the independent evidence that had been requested on two separate occasions the Panel concluded that she should be given a further opportunity to demonstrate that she is no longer a risk to the public, that there is no risk of repetition and that the deficiencies in her practice have been remediated or that she would be willing to engage with conditions. 

27. The Panel gave consideration to imposing a Suspension Order but, in view of the Registrant’s partial engagement with the process, decided it would be appropriate to provide her with a further opportunity to demonstrate that she is fit to return to unrestricted practice. Suspension would also be disproportionate at this stage. The Panel at the next review hearing would be assisted by the Registrant attending to give direct evidence in addition to the documentation she will be required to submit in advance of that hearing.

Order

28. The Panel determined that the current Conditions of Practice Order should be extended for a further period of 6 months and varied as follows:

1) You must submit a personal statement to the next review hearing that  reflects on:

•  the shortcomings in your practice identified in the facts found proved

• your insight as to the potential consequences of such failings for patients,  colleagues and the public 

• the learning points you have drawn from this process

• the steps you have taken to remedy the deficiencies in your practice

• the steps you have taken to maintain your knowledge and skills.

2. In the event that you work in Haematology and/ or Blood Transfusion you  must place yourself and remain under the supervision of a work place supervisor registered by the HCPC within 14 days of taking up any new  position. You must inform your supervisor of the HCPC proceedings and  your conditions of practice. You must attend upon that supervisor as  required and follow their  advice and recommendations.

3. You must submit two reports from your supervisor addressed to the  Director of Fitness to Practise at the HCPC. The first report must be submitted 3 months from the operative date of this order and the second  report within 14 days of any review hearing. These reports must be based  on your supervisor’s direct observation of your performance in cross  matching, labelling and issuing of red cell units, result reporting and  entering reports on the laboratory computer system in accordance with  local SOPs.   
 
4. You must promptly inform the HCPC if you cease to be employed by your  current employer or take up any other or further employment.
 
5. You must promptly inform the HCPC of any disciplinary proceedings taken  against you by your employer.
 
6. You must inform the following parties that your registration is subject to  these conditions:

i. any organisation or person employing or contracting with you to  undertake professional work;

ii. any agency you are registered with or apply to be registered with (at  the time of application); and

iii. any prospective employer (at the time of your application).

Notes

The order will be reviewed before it expiry on 15 October 2016.

Hearing History

History of Hearings for Miss Nicola Hewitt

Date Panel Hearing type Outcomes / Status
15/09/2016 Conduct and Competence Committee Review Hearing Struck off
11/03/2016 Conduct and Competence Committee Review Hearing Conditions of Practice
17/09/2015 Conduct and Competence Committee Review Hearing Conditions of Practice