Mrs Louise J Middleton

: Dietitian

: DT6126

: Final Hearing

Date and Time of hearing:10:00 04/09/2017 End: 17:00 28/09/2017

: Hilton Edinburgh Carlton, 19 North Bridge, Edinburgh, Midlothian, EH11SD

: Conduct and Competence Committee
: Adjourned part heard

Allegation

During the course of your employment as a Dietitian with NHS Fife, on dates in or between February and August 2011, an audit of 10 of your cases showed that:

1. On dates between May and June 2011 in relation to Case 1, you did not maintain accurate patient records, in that:
(a) You created a false record. In that:
i. you altered an electronic version of a dietetic letter originally dated 25 May 2011; and/or
ii. You destroyed the paper copy of the dietetic letter dated 25 May 2011, previously filed in the dietetic notes, and replaced it with the amended version.
(b) . you did not file three emails in the dietetic records on or between the Following dates:
i. 1-3 June 2011.

2. On dates between February and June 2011 in relation to Case 1, you did not conduct an adequate assessment of a Service User, in that:
(a) . You did not take the case history of a service user into account when conducting your own dietetic assessment and plan;
(b) . You did not use the correct growth chart and/or did not plot or interpret the growth chart correctly;
(c). You did not pay sufficient attention to the information provided by the Health Visitor.

3. On dates between February and June 2011 in relation to Case 2, you:
(a) , did not undertake an adequate assessment in respect of a Service User, in that:
i. you did not adequately review medical notes, nursing and drug kardex, to determine an appropriate dietetic intervention for the Service User's clinical condition; and/ or
ii. you did not complete and/or plot or interpret the preterm growth chart correctly.
(b) . did not formulate an appropriate dietetic plan, in that:
i. there was no plan for frequency of review; and/ or
ii. you did not identify that the Service User was being given diuretics.
(c) . did not follow a jointly agreed dietetic plan;
(d) . from 21 March to 5 April 2011, did not liaise with consultant medical staff in respect of the Service User's dietetic plan;
(e) . did not communicate effectively with nursing staff, resulting in the failure of the team to carry out the proposed dietetic plan.

4. On or around 25 March 2011 in relation to Case 4, a premature infant living with their grandparent with growth faltering and requiring surgery for cleft palate repair, an urgent referral was made to you and you:
(a) . did not carry out a visit until 11 April 2011;
(b) . did not ensure an accurate anthropometric assessment of the Service User was undertaken in that, you:
i. did not calculate the infant's gestational age correctly; and/ or
ii. did not plot or interpret the growth chart correctly.
(c) . did not undertake an adequate initial assessment in that, you:
i. did not assess the infant's actual consumed intake; and/ or
ii. did not calculate actual intake for current weight, timing of feeds, length of time to complete feeds, sucking ability, feed losses (e.g reflux, poor lip seal) to determine an appropriate dietetic intervention for the infant's clinical condition.
(d) . did not take appropriate account of the child's diagnosis and the likely impact on feeding;
(e) . did not make appropriate plans for frequency of review;
(f) . did not seek advice from consultant medical staff.

5. On or around 5 May 2011 in relation to Case 5, a teenage girl with irritable bowel syndrome and consideration of a wheat free diet, you:
(a), did not follow the medical management plan;
(b). did not discuss a change of plan with the doctor or document reasons for a different course of action;
(c) . did not undertake an adequate assessment of the Service User in that, you:
i. did not take account of information in the medical notes, including blood results; and/ or
ii. did not assess information provided by the Service User and carer qualitatively and quantitatively and/or interpret information using dietetic knowledge and experience.
(d) . did not ensure that an accurate anthropometric assessment was undertaken in that, you:
i. did not measure the Service User's height accurately;
ii. did not plot the Service User's age correctly on the growth chart;
iii. did not review the anthropometric data in the medical notes; and/ or
iv. did not correctly interpret data relating to the Service User's nutritional status.
(e) . did not determine an appropriate dietetic intervention for the Service User's clinical condition;
(f) . did not set clinically appropriate treatment goals/ rationales for treatment of the Service User's condition;
(g) . worked outside your scope of practice in requesting that a GP undertake blood tests,including some that were unnecessary;
(h) . did not put in place an appropriate plan for review.

6. In respect of Case 6, an infant with growth faltering, you:
(a) did not plot accurately the Service User's weight and height measurements on a growth chart;
(b) . incorrectly estimated nutritional requirements for the Service User's age and condition in order to plan the feed;
(c) . incorrectly described the infant as small gestational age without plotting measurements on centile charts;
(d) . documented the need to discuss pump feeding with the Service User's parents, but did not document any such discussions
(e) . were unable to advise the Service User's parents on an effective, practical feeding plan to achieve satisfactory weight gain.

7. In respect of Case 7, an infant with growth faltering, you:
(a) , did not obtain any information about the infant's recent feeding history;
(b) . did not ensure that an accurate anthropometric assessment was undertaken, by failing to plot the growth chart correctly;
(c) . did not discuss your findings with the doctor, when you calculated the baby's feed intake was only 119 ml/kg;
(d) . did not re-assess nutritional intake to compare with requirements when you realised that despite your request to the GP to prescribe SMA High Energy formula, the baby was still consuming standard formula.

8. On dates between 25 May 2011 and 2 June 2011 in relation to Case 7, you:
(a) , did not assess the Service User's actual nutritional intake or document nutritional aims;
(b) . did not record in the dietetic record the date when the infant's feed changed to SMA High Energy formula;
(c) . did not record in the dietetic record any advice given regarding maximum length of time to feed.

9. On or around 18 May 2011 in relation to Case 8, you did not make an Accurate record of
a Service User assessment in that, you:
(a) , did not make it clear whether the infant changed to SMA High Energy milk;
(b) . documented that a prescription request was sent on 18 May 2011 when in fact it was sent on 30 May 2011.

10. In respect to Case 9, involving a child with a suspected wheat allergy, you:
(a), did not communicate effectively with the Service User's parents in that, you:
i. provided the Service User's parents with conflicting and/or misleading information about the child's condition; and/ or
ii. gave the Service User's mother inadequate written supplementary information, such as a diet sheet and/ or recipes and/ or information about suitable food subsidies.

11. In respect of Case 10, an infant with growth faltering, you:
(a) did not measure the child's height accurately, (87.5 cm=75th centile), where his previously recorded height in the medical notes was 78th =25th centile and another measurement 4 months later was 84 cm=9th centile;
(b) did not plot available weights and lengths from medical correspondence or medical notes, as expected, which may have highlighted the discrepancy in your own measurements
(c) . did not carry out an assessment of the Service User's total fluid intake juice/water/tea/milk/portion sizes/timing of meals and snacks, eating environment and number of children in the household;
(d) . did not formulate and deliver appropriate advice based on nutritional Strategies that are known to work with this client group.

12. Your actions at particular 1(a) (i) and 1(a) (11) were dishonest.

13. The facts set out in paragraphs 1-11 constitute misconduct and/ or a lack of competence.

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

Finding

No information currently available

Order

No information currently available

Notes

This hearing adjourned part - heard. The date for the reconvened hearing is to be confirmed.

 

Hearing history

History of Hearings for Mrs Louise J Middleton

Date Panel Hearing type Outcomes / Status
31/10/2017 Conduct and Competence Committee Interim Order Review Interim Conditions of Practice
24/10/2017 Conduct and Competence Committee Interim Order Review Hearing has not yet been held
04/09/2017 Conduct and Competence Committee Final Hearing Adjourned part heard
28/06/2017 Conduct and Competence Committee Interim Order Review Interim Conditions of Practice
30/03/2017 Conduct and Competence Committee Interim Order Review Interim Conditions of Practice