Megan Fletcher, instructed by James Wilkinson of Thompsons Solicitors, represented a nurse in fitness to practice proceedings before the Nursing and Midwifery Council.
Megan’s client faced six charges, described as being part of a catalogue of errors whilst Patient A was under the care of the Trust (many of the failings occurred before Megan’s client had any involvement with Patient A’s care).
Megan’s client admitted to failings in their practice on four charges; including acting against Trust Policies by not escalating Patient A’s significantly raised National Early Warning Score (NEWS) and poor urine output, and not undertaking observations at intervals deemed appropriate for a patient with raised NEWS.
Megan’s client denied two other charges. The two charges denied were 1) that the nurse did not undertake a full assessment of Patient A within 30 minutes of the patient arriving on the ward, and 2) that the nurse did not immediately commence CPR when Patient A was found unresponsive.
The NMC applied to add two new charges on the first day of the substantive hearing. Megan used her robust advocacy style and secure knowledge of the case to successfully persuade the panel that her client would be irreparably prejudiced by the amendments sought.
In relation to the first disputed charge (her client not undertaking a full assessment within 30 minutes), Megan cross-examined the NMC witnesses; including the Ward Matron who had undertaken the internal investigation. The diligent cross-examination revealed damning lacunas in the Trust’s investigative process, and Megan’s deep understanding of the factual matrix of this case revealed the vague premise on which the charge was based.
The Matron agreed that there was no Trust Policy as to: a) what amounts to a full assessment; b) who was responsible for undertaking a full assessment; c) when a full assessment should be undertaken; d) whether a full assessment or any part of it could be delegated; or d) any time limits on completing a full assessment. A full assessment within 30 minutes was described as an ‘expectation’ as opposed to a policy, but the Matron was unable to explain from where that expectation arose, or whether it had been communicated in any way to other members of staff.
Under cross-examination, other NMC witnesses gave varying accounts as to what a ‘full assessment’ could and should include and how soon it should be undertaken. However, it was common ground that a full assessment should be undertaken and that a Health Care Assistant would not have the sufficient training to holistically assess a patient but would be able to take observations.
Megan’s client gave evidence as to this charge, revealing that an assessment which could have amounted to a ‘full assessment’ had been undertaken in part by the registrant and in part by a Health Care Assistant to whom observations had been delegated. Megan made successful submissions that as such, there was no misconduct in her client’s actions or inactions on this charge.
In relation to the second denied charge (that the nurse did not immediately commence CPR); through a careful, methodical and detailed cross examination, Megan was able to demonstrate that it was not accepted good practice within the Trust to commence chest compressions without first lowering the bed and checking airways, breathing and circulation. She was further able to adduce evidence from the NMC’s witnesses to demonstrate that her client had acted swiftly and could not have done anything more than she did in the circumstances, within the relevant time frame. As such, the disputed CPR charge was the subject of a Galbraith submission. The panel agreed with Megan that on this charge there was no case to answer.
On the remaining charges, despite the NMC’s submissions that insight was incomplete, Megan persuaded the panel that her client had demonstrated significant insight and remorse and had fully remediated their failings. Impairment of fitness to practice was therefore found on public interest grounds only and put Megan’s client in a strong position for sanction submissions.
Having heard submissions as to sanction, the panel determined that a 1 year Caution Order would be an appropriate and proportionate sanction in this case. Megan’s client can continue to provide quality care in an acute medical setting, doing the job they love. Having a determined, focussed and experienced nurse in such a role is just as much in the public interest as declaring and upholding professional standards.
Megan represents nurses, midwives and other healthcare professionals before their regulatory bodies. Her thorough preparation and no-nonsense advocacy style have assisted her in obtaining excellent results for her clients; who have valued her professional advice and representation, and her willingness to go above and beyond for those she represents.