Mrs Wilma Downs

Profession: Dietitian

Registration Number: DT25827

Hearing Type: Final Hearing

Date and Time of hearing: 12:00 21/05/2018 End: 16:00 21/05/2018

Location: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Voluntary Removal agreed

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Allegation

During the course of your employment as a Dietitian for Leeds Teaching Hospitals NHS Trust:

 

1. In or around September 2013, you failed the initial assessment of a Leeds Beckett University Behaviour Change course.

 

2. On or around 30 September 2013, in relation to Patient A:

a) you did not give a full clinical picture when seeking support from colleagues as to how to manage the patient’s care

b) as a result of your actions at 2(a) above Patient A was given an inappropriate feed and/or fluid advice.

 

3. In or around November 2013, you did not demonstrate the adequate provision of nutrients to a patient.

 

4. On or around 24 September 2014, in relation to Patient B, you:

a) did not write to the patient’s GP in a timely manner and/or organise the appropriate prescription with the GP;

b) did not provide Patient B with written information and/or a telephone follow-up.

 

5. In or around August/September 2014, you:

a) did not document information regarding the patient's weight loss in the medical notes;

b) did not discuss and/or record any discussion of the dietetic concerns with the medical team;

c) did not use the weight chart to inform your estimation of intake requirements

d) did not alter the patient’s nutritional plan despite continued weight loss

 

6. On or around 17 October 2014, in relation to Patient F you:

a) incorrectly documented the patient's weight;

b) used the incorrect weight to calculate the patient's protein requirements.

 

7. On or around 23 to 28 October 2014, you did not appropriately manage Patient C's high potassium level in that:-

a) you did not formulate and/or record any plan in relation to the potassium levels in the dietetic notes;

b) you did not communicate with and/or document any communication with the multidisciplinary team regarding the patient’s potassium levels;

c) you did not ensure that the patient’s nutritional supplements were changed;

d) you did not provide an adequate handover note for colleagues which referenced the patient’s potassium levels

 

8. In relation to Patient D, you:

a) did not send a letter to the referring doctor in a timely manner or at all;

b) breached patient confidentially by sending a letter to a Doctor dated 5 June 2014 who was not involved in the patient's care;

c) did not write the GP letter in a timely manner to request oral nutritional supplements;

d) sent a letter to the Consultant which had spelling mistakes and/or did not make sense;

e) did not arrange any follow-up for the patient.

9. On or around 15 May 2014, in relation to Patient E, you:

a) did not obtain and/or document biochemistry;

b) did not recommend that the patient commence vitamin D and/or calcium supplements

c) did not quantify and/or document the patient's requirements for;

i. calories;

ii. protein;

iii. sodium; and/or

iv. fluid

 

10. Your actions described in particulars 1 to 9 constitute misconduct and/or lack of competence.

 

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

Finding

Preliminary Matters

Proof of Service

1. The Panel was provided with confirmation that the Notice of Hearing had been posted to the Registrant’s registered address by first class post on 24 April 2018.  Accordingly, the Panel concluded that service had been complied with in accordance with Rule 3 of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2012 (“the Rules”).

Proceeding in Absence

2. The Panel went on to consider whether to proceed in the absence of the Registrant. The Panel was aware, in accordance with the HCPC’s Practice Note entitled “Proceeding in Absence”, that it is only in rare and exceptional circumstances that the Panel should proceed to hear the case in the absence of a Registrant and then only if it is in the interests of justice. The Panel noted that the Registrant had been served with notice of today’s hearing.  It further noted that there had been subsequent correspondence between the Registrant’s solicitors and the HCPC, most recently on the day of the hearing, in which the fact that the hearing would proceed today had been acknowledged.  The Panel noted that there was no application for an adjournment and that the hearing had been convened to consider a Voluntary Removal Application made by the Registrant, who had signed the Voluntary Removal Agreement.  In those circumstances, the Panel concluded that the Registrant had voluntarily absented herself from today’s hearing and determined that it was appropriate to proceed in her absence as it was in the interests of justice to do so.

3. Mr Mason, on behalf of the HCPC, referred the Panel to the written skeleton arguments dated 16 May 2018, which the Panel is content to quote from in full as they neatly summarise the issues before it:

“The Application

1. This is a skeleton argument on behalf of the Health and Care Professions Council (HCPC) for the Registrant’s name to be removed from the HCPC Register voluntarily.

Background

2. On 16 July 2015, the HCPC received a referral from the Registrant’s employer, St James’s University Hospital (Leeds Teaching Hospital NHS Trust) (the Trust).


3. The Registrant began working at the Trust in November 2012, as a locum in a Band 5 Dietician role. In February 2013, she was appointed a full time Band 5 position with the Trust. She remained in this role until November 2014, when she took time off due to illness. In February 2015, the Registrant undertook a phased return to work in an administrative role. In June 2015, she was redeployed as a Dietetic Assistant.

4. The referral provided details of ongoing concerns throughout 2013 to 2015, which indicated that Registrant had not been adequately performing in her role as a dietitian. 

5. In October 2013, the registrant commenced a capability procedure implemented by the Trust.

6. The capability process had been instigated as a result of various ongoing performance issues, including concerns regarding errors in completing patient assessments, communication skills, writing discharge letters in a timely manner  and her recognition  of her scope of practice and when to seek senior support. The Registrant underwent ongoing supervision but was unable to demonstrate competency to the required standards.

7. Following a final supporting performance meeting in March 2015, the Registrant agreed to be redeployed to a Dietetic Assistant role (Band 3), where she continues to work.

8. On 20 April 2016, the Investigating Committee (IC) of the HCPC determined that there was a case to answer regarding the allegations against the Registrant.

9. After further investigation, an application to a Panel of the Conduct and Competence Committee was made on 10 July 2017 to amend and discontinue some particulars of the allegation.

10. As a result, the allegation to be considered is the following:

During the course of your employment as a Dietitian for Leeds Teaching Hospitals NHS Trust:

1. In or around September 2013, you failed the initial assessment of a Leeds Beckett University Behaviour Change course.

2. On or around 30 September 2013, in relation to Patient A:

a) you did not give a full clinical picture when seeking support from colleagues as to how to manage the patient’s care

b) as a result of your actions at 2(a) above Patient A was given an inappropriate feed and/or fluid advice.

3. On or around 22 November 2013, you did not demonstrate the adequate provision of nutrients to a patient.

4. On or around 24 September 2014, in relation to Patient B, you:

a) did not write to the patient’s GP in a timely manner and/or organise the appropriate prescription with the GP;

b) did not provide Patient B with written information and/or a telephone follow-up.

5. On or around 26 September 2014, you:

a) did not document information regarding the patient's weight loss in the medical notes;

b) did not discuss and/or record any discussion of the dietetic concerns with the medical team;

c) did not use the weight chart to inform your estimation of intake requirements.

d) did not alter the patient’s nutritional plan despite continued weight loss

6. On or around 17 October 2014, in relation to Patient F you:

a) incorrectly documented the patient's weight;

b) used the incorrect weight to calculate the patient's protein requirements.

7. On or around 23 to 28 October 2014, you did not appropriately manage Patient C's high potassium level in that:

a) you did not formulate and/or record any plan in relation to the potassium levels in the dietetic notes;

b) you did not communicate with and/or document any communication with the multidisciplinary team regarding the patient’s potassium levels;

c) you did not ensure that the patient’s nutritional supplements were changed;

d) you did not provide an adequate handover note for colleagues which referenced the patient’s potassium levels

8. In relation to Patient D, you:

a) did not send a letter to the referring doctor in a timely manner or at all;

b) Breached patient confidentiality by sending a letter to a Doctor dated 5 June 2014 who was not involved in the patient's care;

c) did not write the GP letter in a timely manner to request oral nutritional supplements;

d) sent letter to the GP Consultant which had spelling mistakes and/or did not make sense;

e) did not arrange any follow-up for the patient.

9. On or around 15 May 2014, in relation to Patient E, you:

a) did not obtain and/or document biochemistry;

b) did not recommend that the patient commence vitamin D and/or calcium supplements;

c) did not quantify and/or document the patient's requirements for;

i. calories;

ii. protein;

iii. sodium; and/or

iv. fluid

10. Your actions described in particulars 1 to 9 constitute misconduct and/or lack of competence.

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

11. The HCPC received correspondence from the Registrant indicating that she would like to explore disposal of the case by consent. The HCPC sent the Registrant and her representative information regarding this process. The Registrant was invited to consider the Disposal by Consent Practice Note and asked to confirm her position in respect of disposing of her case by means of a voluntary removal application.

12. The Registrant confirmed that she would like to be removed from the HCPC Register as she would no longer be practising as a Dietician.

13. The Registrant confirmed that she would like to continue to practice in her role as a Dietetic Assistant, for which she does not require HCPC registration.

14. The HCPC reviewed the case and considered the circumstances suitable for a Voluntary Removal Agreement. Accordingly, the HCPC and the Registrant have entered
15. into a Voluntary Removal Agreement and invite the Panel to consider it.

Guidance

16. The Disposal of Cases by Consent Practice Note states that “a Panel should not agree to a case being resolved by consent unless it is satisfied that:

• the appropriate level of public protection is being secured; and

• doing so would not be detrimental to the wider public interest”

17. The case of Cohen v GMC [2008] EWHC 581 (Admin) identified “critically important public policy issues” which must be taken into account by Panels when considering cases, specifically the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession

Reasons for Application

18. It is the Council’s submission that a voluntary removal is the appropriate and proportionate disposal of this case.
The Registrant has signed the Voluntary Removal Agreement, thereby accepting that her current fitness to practise is impaired and confirming she has no intention of returning to practise as a Dietitian. Her voluntary removal would secure public protection as she would no longer be able to practise as a Dietitian.

19. The allegation largely relates to competence matters, rather than any serious misconduct. As such, it would not be detrimental to the wider public interest for this matter to be dealt with by way of disposal by consent rather than at a full hearing.

Conclusion

20. The Panel is therefore respectfully invited to approve the proposed voluntary removal agreement between the HCPC and the Registrant.”

4. Mr Mason went on to clarify an issue regarding a typing error which had not been rectified (as originally agreed between the parties) in the schedule attached to the Voluntary Removal Agreement dated 24 April 2018 which had been signed by the Registrant.  The schedule attached to the agreement contained an allegation at 8 (c) which virtually duplicated that at 8 (b).  The allegation at 8 (b) was worded “breached patient confidentiality by sending a letter to a Doctor dated 5 June 2014 who was not involved in the patient's care” and that at 8 (c) stated “reached patient confidentiality by sending a letter to a Doctor dated 5 June 2014 who was not involved in the patient's care” (the Panel has underlined the relevant words).  The parties had agreed prior to the Registrant signing the agreement that the original 8 (c) should have been deleted (the agreed version of the Schedule is reproduced at paragraph 10 of the skeleton arguments above) but the un-amended schedule had been inadvertently attached to the agreement signed by the Registrant.  The Panel noted that the Legal Assessor confirmed that he had advised the parties outside the hearing that they could either have the Registrant sign a fresh agreement with the correct schedule attached, or she could simply agree to proceed with the existing schedule on the basis that, notwithstanding that she had admitted two virtually identical allegations, they were, in any event, being withdrawn by the HCPC so there was no practical difference between her respective situations.  This advice had been accepted by the parties and as a result the Registrant’s solicitors had sent an e-mail to the HCPC at 13.04pm that day confirming that the Registrant “agrees with the voluntary removal with the original Schedule A (with the duplicated allegation at 8c) to be put before the panel”.
Decision
5. The Panel has taken account of Mr Mason’s comprehensive submissions and the advice of the Legal Assessor, who in turn referred the Panel to the Practice Note, “Disposal of Cases by Consent”.  It has also considered the documentation provided.
6. The Panel has decided to grant the application for Voluntary Removal for the reasons stated in the skeleton arguments, which the Panel is persuaded by.  It notes that the Registrant has been open and candid about her failings and that she has fully engaged with the HCPC.  Moreover, the Panel was satisfied that the appropriate level of public protection would be secured and to grant the application would not be detrimental to the wider public interest, especially since the Registrant does not now and will not practise in the future as an autonomous Dietitian.  The Panel is persuaded that a reasonable member of the public in full possession of the facts of this case would not be surprised or concerned by such an outcome. 
7. In relation to the issue regarding the wrong schedule being attached to the Voluntary Removal Agreement, the Panel is satisfied from the e-mail from the Registrant’s solicitors that she is content with the matter being resolved in the way suggested and that as both allegations have been admitted and will be withdrawn by the HCPC, the proposal secures the identical result and is thus the most expeditious way of dealing with the matter.  
8. The Panel therefore concluded that the Voluntary Removal of the Registrant from the register was both appropriate and proportionate.

Order

ORDER: The Registrar is directed to remove the name of Wilma Downs  from the Register with immediate effect.

Notes

No notes available

Hearing History

History of Hearings for Mrs Wilma Downs

Date Panel Hearing type Outcomes / Status
21/05/2018 Conduct and Competence Committee Final Hearing Voluntary Removal agreed