Mr Mundatta Nundoo
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While registered as an Operating Department Practitioner and employed by Care UK:
1. On 17 June 2016, in respect of Patient X who attended North East London NHS Treatment Centre for a left knee Arthroscopy, you:
a) did not confirm the validity of the written consent form and/or the patient’s understanding of the nature of the operation in circumstances where the consent form was for a left knee aspiration and the patient said she expected to undergo a left knee arthroscopy;
b) did not escalate:
i) that the patient expected to undergo a left knee arthroscopy but the consent form was for a left knee aspiration; or
ii) the patient’s lack of understanding about the operation; and
iii) that the theatre list did not match the written consent form.
c) inaccurately documented that the consent information was accurate.
2. Your actions as described at particular 1 amount to misconduct.
3. By reason of your misconduct, your fitness to practise is impaired.
1. The registrant was employed as an Operating Department Practitioner (ODP) in the North East London NHS Treatment Centre (NELTC) from 2011.
2. On 17 June 2016, Patient X was admitted to the NELTC to undergo a left knee arthroscopy. She had previously undergone a left knee aspiration in February 2016 at the treatment centre. A General Anaesthetic was administered to Patient X and she was transferred to the operating theatre from the anaesthetic room where second stage checks were conducted. At this stage the scrub nurse checked the patient consent form and noticed that it made reference to a knee Aspiration rather than a knee Arthroscopy. This conflicted with the details on the theatre list which correctly indicated that the procedure to be performed was one of Arthroscopy. The scrub nurse alerted the team to this error and, on investigation it transpired that the consent form in question in fact related to the previous Aspiration procedure that Patient X had undergone in February 2016. The surgery therefore had to be abandoned.
3. As the responsible ODP, the Registrant took the lead in completing the Nursing Pre-Operative Checklist on the handover from the ward staff and the World Health Organisation (WHO) Surgical Safety Checklist in the anaesthetic room.
4. The Nursing Pre-Operative Checklist, as part of the patient pathway, required the Registrant to confirm that the consent form was “signed and verified against the theatre list”. The Registrant ticked this despite the existence of the discrepancy between the two forms. The Registrant also, in completing his part of the WHO Surgical Safety Checklist, remarked “patient identity/procedure consent/wristband confirmed”.
5. On noticing the discrepancy, the Registrant should have escalated matters immediately to the consultant Surgeon or others within the operating department team. This was so that proper enquiries could be made before the patient was anaesthetised. This did not happen. The surgery had to be abandoned and the result was a delay to the treatment of the patient, who had to endure ongoing knee pain until the appropriate procedure was conducted about a week later.
6. The Registrant did not attend and was not represented at the Final Hearing on 23-25 May 2018. At that Hearing the Panel found the facts proved and constituted misconduct, the Registrant’s fitness to practise was impaired and that the appropriate and proportionate sanction was a Suspension Order for twelve months. The Panel noted that there was no evidence of remediation and no evidence of any tangible remorse or personal reflection on the incident. The Registrant had not engaged with the process.
7. The Final Hearing Panel considered that a reviewing Panel would be assisted by the presence of the Registrant and a personal statement from him demonstrating that he is conscious of the gravity of his misconduct and its impact and that he has taken steps on the road to remediation.
8. Ms Iskander outlined the background and the powers of the Panel. She submitted that the HCPC was neutral as to whether the Registrant’s fitness to practise remained impaired.
9. The Panel heard evidence from the Registrant. This was the first occasion the Registrant had engaged with the HCPC in the process. The Registrant did not submit any documents. The Panel had some reservations about the Registrant’s evidence. For example, the Registrant told the Panel that he accepted responsibility at the disciplinary hearing, but the Final Hearing Panel found that it was only during the appeal process that the Registrant began to show an element of insight into his shortcomings.
10. The Panel heard and accepted the advice of the Legal Assessor.
11. In his evidence the Registrant told the Panel about the significant impact of the Suspension Order and the difficulties he has faced in obtaining employment. Although the Registrant apologised, the Panel was not persuaded that he had demonstrated remorse. The Panel recognised that the Registrant has faced financial and other difficulties, but considered that he has not fully focussed on the nature and gravity of the Final Hearing Panel’s finding of misconduct.
12. In the Panel’s judgment the Registrant has begun to reflect on the decision of the Final Hearing Panel and to develop some limited insight. He spoke about the impact on the patient, the patient’s family, the public and the reputation of the profession. He acknowledged that the patient suffered harm because she was subject to a second unnecessary anaesthetic.
13. In his evidence the Registrant described the events as a “mistake”. In the Panel’s view this did not properly reflect the nature or gravity of the Registrant’s misconduct. The Registrant not only failed to confirm the patient documentation. He also made a positive record that the consent information was accurate when he ticked the checklist. The checklist is not simply administrative, but is essential to ensure patient safety.
14. While the Panel noted that the incident was isolated in a long, previously unblemished forty year career, the Panel was concerned that there was no persuasive evidence that the Registrant would act differently in the future so that a similar incident would not be repeated. When he was asked what he would do differently the Registrant said that he would ask another member of staff to work alongside him and check the documentation. In the Panel’s view this was an unrealistic, impractical suggestion. The Registrant as an ODP is an autonomous practitioner and expected to take personal responsibility for the accurate completion of checklists.
15. The Panel noted that the Registrant has taken some steps to try to keep up to date with current practice within the limits of his ability to do so. However, the Registrant has not given any thought to the requirements to undertake a period of supervised practise before returning to practise.
16. In summary, the Panel remained concerned at the level of insight demonstrated by the Registrant and concluded that there remains a risk of repetition. The Panel therefore decided that the Registrant’s fitness to practise remains impaired.
17. The Panel next considered the appropriate Order. A Caution Order would not be sufficient to protect the public because there would be no protection for the public against the risk of repetition of misconduct.
18. The Panel next considered a Conditions of Practice Order. The Panel decided that conditions of practice would not be sufficient. Although the Registrant is now engaging with the process the Panel was not able to formulate realistic workable conditions to address the nature of the misconduct in this case. The Registrant has also not demonstrated a sufficient level of insight.
19. The Panel next considered the option of extending the current Suspension Order. The Panel decided that this was the appropriate order to protect the public and to maintain confidence in the profession and the regulatory process. A Suspension Order would give the Registrant the opportunity to reflect further on the decision of the Panel and to further develop the level of his insight.
20. The Panel decided that the appropriate length of the Suspension Order was twelve months. The Panel considered that this would give sufficient time for the Registrant to develop insight and prepare evidence for a Review Hearing. It is open to the Registrant to apply for an early review of the Suspension Order if he wishes to present new evidence relating to remedial action or the development of insight.
21. The Panel considered the option of a Striking Off Order, but decided that it would be disproportionate particularly given that the Registrant is now engaging with the process and that he wishes to return to practise.
22. A reviewing panel would be assisted by the presence of the Registrant (preferably in person) at the hearing itself, together with documentary support for evidence he wishes to be considered including a reflective piece in writing demonstrating his understanding of the nature and gravity of the misconduct and its wider impact on various parties; and details of what steps he has taken to facilitate his returning to practise.
ORDER: The Registrar is directed to suspend the Registration of Mr Mundatta Nundoo for a further period of 12 months from the date the current Suspension Order expires.
The Order imposed today will apply from 21 June 2019.
This Order will be reviewed again before its expiry on 21 June 2020.