Miss Nicola Hewitt
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Found proved at Final Hearing
During the course of your employment as a Biomedical Scientist with Worcestershire
Acute Hospitals NHS Trust:
1. In March 2011 you approved an erroneous result in Haematology which resulted in a patient being admitted for a blood transfusion.
2. On 18 May 2012 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.
6. By reason of your misconduct your fitness to practise is impaired.
1. The Panel was satisfied that notice of the hearing was properly served by a Notice of Hearing dated 15 August 2016.
Proceeding in absence
2. Mr Thompson submitted that the hearing should proceed in the absence of the Registrant. The Panel was advised by the Legal Assessor and followed that advice.
3. The Panel exercised its discretion with the utmost care and caution and decided that it was reasonable and in the public interest to proceed with the hearing in the Registrant’s absence. The Registrant has not expressly stated that she would not attend today’s hearing. However, the content of her e-mails, particularly her clear statement that she wishes to be removed from the register, indicate that she does not wish to engage in the HCPC process. The Panel inferred that the Registrant’s absence is a waiver of her right to be present. The Registrant has not applied for an adjournment and there is no indication that she would attend on a future date. This is a mandatory review hearing and it is in the public interest for it to proceed expeditiously.
4. 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.
5. 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.
6. As a result, the patient was unnecessarily admitted to the Acute Medical Unit for a blood transfusion.
7. Shortly after being questioned about this error, the Registrant left work on long term sick leave until 4 August 2011. To facilitate her return to work competencies were put in place for training purposes.
8. 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.
9. The Registrant was placed on supervision for her transfusion work. On 2 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.
10. On 8 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.
11. As a result of these additional mistakes coming to light, the Registrant was issued with a Final Written Warning on 12 June 2013.
12. The Registrant resigned from her post on 21 June 2013.
13. At the final hearing on 18 March 2015 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. The Panel noted that some references had been made to the Registrant’s health at the material time and there was no independent evidence that she was currently in good health.
14. On 17 September 2015 the Conditions of Practice Order was reviewed. The Registrant did not attend the hearing. She provided a written submission which was limited to statements about her current employment, the lack of any further incidents and confirmation that she was complying with the conditions. She did not provide a report from her supervisor or anything from her GP. The Panel found that the Registrant’s fitness to practise was still impaired. It noted that there remained a lack of independent evidence of where the Registrant was working, details of how she was addressing her deficiencies or details regarding her health.
15. The review panel on 17 September 2015 decided to vary and extend the Conditions of Practice Order for a further six months.
16. On 11 March 2016 the Conditions of Practice Order was reviewed. The Registrant again did not attend the hearing. She provided written submissions, a training log and competency assessment form dated August 2014, certificates of achievement and a reference letter from her supervisor at Great Western Hospitals, Swindon.
17. The panel found that although the Registrant had engaged with the HCPC since the hearing in September 2015, she had not fully complied with the Conditions of Practice Order, nor had she provided any independent verification that the deficiencies identified by the original panel have been remediated. In particular the Panel found that the Registrant had not complied with condition 2 because the letter from her 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)”. It was unclear to the Panel whether the Registrant had fully complied with condition (7), to notify employers and others that her registration is subject to conditions. A file note dated 22 October 2015 recorded a conversation with the Registrant’s employer indicating that she discovered information about the Conditions of Practice only on the HCPC website. The Registrant stated that she had fully complied with this condition, but provided no corroboration.
18. The review panel on 11 March 2016 was not satisfied that there had been any significant change and concluded that the Registrant’s fitness to practice remained impaired. The review Panel considered a Suspension Order, but decided that it would not be appropriate at that time because of the Registrant’s partial engagement with the process. The review Panel decided that the Registrant should be given a further opportunity to demonstrate that the deficiencies in her practice have been remediated or that she would be willing to engage with conditions. The Panel stated that 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 the hearing.
19. The panel decided to vary and extend the Conditions of Practice Order:
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).
20. Mr Thompson submitted that there was nothing to suggest that the Conditions of Practice had been complied with or that the Registrant had remedied the deficiencies in her practice. He invited the Panel to consider whether there would be any purpose in extending the conditions because the Registrant’s position was that she did not want to work as a biomedical scientist and that she wished to be removed from the register.
21. The Registrant provided written submissions. In an e-mail dated 28 June 2016 she stated that she is unable to comply with the Condition of Practice Order imposed in March 2016 because she does not have a work supervisor and has not worked as a biomedical scientist since October 2015 and she wants to be removed from the register. In an e-mail dated 19 July 2016 she states that she is not working as a biomedical scientist, has no intention of working as one and cannot afford the fees to stay on the register. She also states that she has asked to be removed and the HCPC are telling her this is not possible.
22. The Panel took into account the documentary evidence, the submissions of Mr Thompson, and the Registrant’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 the Panel first considered the issue of current impairment applying the guidance in the HCPC Practice Note “Finding that Fitness to Practise is Impaired”. The Panel next considered the issue of the appropriate sanction applying the guidance in the HCPC Indicative Sanctions guidance.
23. There is no evidence that the Registrant has remediated the deficiencies in her practice. There is no evidence that she is developing the level of insight the Panel would expect.
24. The Registrant stated in her e-mail dated 28 June 2016 that she was unable to comply with the Conditions of Practice Order imposed in March 2016 because she has not worked as a biomedical scientist and is not able to obtain employment. The Panel acknowledges that the Registrant is not in breach of the conditions which apply to work as a biomedical scientist (conditions 2-6). However, condition 1 was that the Registrant should provide a personal reflective statement. The Registrant’s correspondence with the HCPC does not include a personal reflective statement which complies with the requirements of condition 1. The Registrant’s e-mails do not include reflection on her past misconduct, learning points, or steps the Registrant has taken to remedy the deficiencies in her practice or keep her knowledge and skills up to date.
25. The Panel concluded that there remains a significant risk of repetition of similar misconduct and therefore a risk to patients. The Panel could not be satisfied that there has been any significant change since the last review and concluded that the Registrant’s fitness to practise remains impaired.
26. The Panel then moved to consider what, if any sanction it should impose. The Panel carefully reviewed the statements made by the Registrant about her current position. The Registrant has made it clear that she does not want to practise in the profession and that she wishes to be removed from the Register. She is very clear that she wishes to be removed from the Register and has stated this in her e-mails of 28 June 2016 and 19 July 2016. When the HCPC sent her information about a Voluntary Removal Agreement her response on 21 July 2016 was “All I want is a guarantee that you will not be chasing me for fees which I cannot afford to pay”.
27. The Panel considered the prospect that the Registrant would change her mind in the future. The Panel found that there was no ambiguity in the Registrant’s statements, and nothing to indicate any real prospect that she would change her mind.
28. The Panel decided that to take no action or to impose a caution would not be sufficient to protect the public because of the ongoing significant risk of repetition and the consequent risk to patients.
29. The Panel next considered a Conditions of Practice Order. The Panel found that it was unlikely that the Registrant would comply with conditions. The previous Panel and this Panel have found that she has not fully complied with conditions. The statements made by the Registrant do not give the Panel any confidence that she would comply with conditions. There is no evidence of commitment on the Registrant’s part to comply with conditions and work towards remediation of the deficiencies in her practice. The Registrant’s statements do not indicate that she has or is developing the level of insight required to acknowledge her past deficiencies and demonstrate remediation. In particular, the Panel noted that she had not submitted a reflective statement as required by condition 1, completion of which is not dependent on her working.
30. The Panel next considered a Suspension Order. A Suspension Order would be appropriate if there was a prospect that the Registrant was willing to engage with the process, acknowledge her past misconduct, and remediate the deficiencies in her practice. The Panel carefully reviewed the history of the case and noted that the Registrant has been given opportunities over a period of approximately eighteen months to demonstrate that she has the required level of insight and that she is remedying the deficiencies in her practice. The position today is that the Registrant is not engaging in the process. The Panel’s view was that there would be no purpose in a Suspension Order because in this case there is no realistic prospect of rehabilitation and no realistic prospect that the Registrant will change her mind that she wishes to be removed from the Register.
31. The Panel next considered a Striking Off Order. A Striking Off Order is the sanction of last resort. The guidance in the HCPC Indicative Sanctions Policy is that a Striking Off Order may be appropriate where a Registrant is unwilling to resolve matters. The Panel carefully considered and balanced the Registrant’s interests. However, this is not a case where the Registrant wishes to continue to work as a biomedical scientist and, indeed, she has stated quite the contrary. The Panel’s view was that a Striking Off Order was in the public interest. It is not in the public interest that the HCPC process should continue where it would serve no purpose. A Striking Off Order would protect the public and it would maintain public confidence in the profession and the regulatory process.
32. The Panel decided that the appropriate and proportionate order is a Striking Off Order.
Order: The Registrar is directed to strike the name of Nicola Hewitt from the Register on the date of the expiry of the Conditions of Practice Order.
The order imposed today will apply from 15 October 2016.
Right of Appeal:
You may appeal to the appropriate court against the decision of the Panel and the order it has made against you. The appropriate court is the High Court in England and Wales.
Under Articles 30(10) and 38 of the Health and Social Work Professions Order 2001, an appeal must be made to the court not more than 28 days after the date when this notice is served on you.
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|