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Reasons for the substantive hearing of the Conduct and CompetenceCommittee panelheld at77 Oxford Street, London, W1D 2ESOn1

& 2

June 09Name: Derek GreenPIN: 87C0558EPart (s) of register: AdultFacts proved:

Charge 1, 2, 3 and 4

Fitness to practise:

Impaired

Sanction:

Striking Off

Interim Order:

Interim suspension order imposed for 18 months

Reason for not proceeding in the absence of the registrant:

Having heard submissions from the case presenter and the advice given by the legalassessor the panel has decided that this case should proceed today for the followingreasons:1. The panel is satisfied that the registrant is aware of these proceedings andthat he had indicated that he does not intend to appear or be represented inthese proceedings2. The events that gave rise to this case occurred over two years ago. It is in theinterests of justice that this matter precedes as soon as possible, in the lightof the fact that witnesses’ memories inevitably fade with time.3. Whilst fairness to the registrant is of prime importance, fairness to the counciland the council’s witnesses is also relevant. We have been told that there areeight witnesses present today ready to give evidence in the case.4. Although the panel has heard no evidence as yet, the charges on their faceappear to be serious. In those circumstances issues of public safety areclearly relevant.In all the circumstances, the case should be dealt with as expeditiously as possible.

Charges read as follows:

That you, whilst working as a Registered Nurse at the Rossall Rehabilitation Hospitalon the night of 10

/11

April 2007:1. Contrary to Trust Policy and Procedure, did not record any observations forPatient A when you were notified of a change in her breathing by HealthcareAssistant Yvonne Wright on the evening of 10

April 2007;2. Contrary to Trust Policy and Procedure, did not record a full set ofobservations for Patient A at around 03.00 hours and/or 03.30 hours on themorning of 11

April 2007 in that you did not record:a. Patient A’s pulse;b. Patient A’s heart rate;c. Patient A’s temperature;d. Patient A’s blood pressure;e. An Early Warning Score for Patient A.

3. Did not contact the on-call doctor or seek a medical review of Patient A whenher condition deteriorated;4. Your conduct at 3 above was contrary to the Trust’s Medical Algorithm EarlyWarning Score.AND, in the light of the above, your fitness to practise is impaired by reason of yourmisconduct.

Reason for the finding of facts

The registrant has admitted charges 3 and 4 in this case. When considering charges1 and 2, the panel has taken no account of those admissions and has consideredcharges 1 and 2 on the basis of the evidence presented. The registrant denies bothof these charges.Charges 1 and 2 read as follows;1. Contrary to Trust Policy and Procedure, did not record any observations forPatient A when you were notified of a change in her breathing by HealthcareAssistant Yvonne Wright on the evening of 10

April 2007;2. Contrary to Trust Policy and Procedure, did not record a full set ofobservations for Patient A at around 03:00 hours and/or 03:30 hours on themorning of 11

April 2007 in that you did not record:a) Patients A’s pulse;b) Patient A’s heart rate;c) Patient A’s temperature;d) Patient A’s blood pressure;e) An Early Warning Score for Patient AUnder cover of a letter dated 16

May 2008, the registrant provided a statementdealing with the events of the night of 10

/11

April 2007. In that statement, heconceded that he made an assessment of Patient A at about the time referred to incharge 1, following a request from healthcare assistant Wright. He also concededthat he carried out a further assessment of the patient at about the time referred to incharge 2, again following concerns expressed by healthcare assistant Wright. Theregistrant has not attended this hearing but it is understood that he contends that onthe evening and the morning of the dates in question he commenced a new chart forobservations on patient A. The panel finds that this is inherently unlikely for thefollowing reasons;a) All of Patient A’s records were collected up before she was transferred to theRoyal Victoria Hospital but this document is the only one that appears to bemissing.b) On the morning of the 11

April 2007, patient A was assessed by NurseConnolly who recorded her findings on the observation chart which had beenin use for 8

and 10

April day shifts. Had the registrant created a newobservation chart we would have expected Nurse Connolly to have recordedher findings on the new chart. Further whilst there is an entry in the nursingnotes, made by Nurse Green during this shift, there was no indication that anew chart had been commenced, as good practice would have required.c) At 03:00 hours on 11

April 2007, the registrant recorded his assessment ofPatient A in the nurses’ notes. It is his case that he would have also recorded

those findings in the new observation chart which he created. After he waswarned about Patient A’s deteriorating condition at about 22:00 hours theprevious evening, there is no similar entry in the nurse’s notes. In theabsence of any record of

this

intervention, it seems inherently unlikely thatobservations would have been recorded elsewhere.d) Had the registrant recorded a proper assessment of Patient A at 03:00 on the11

April in the observation chart, with proper scoring on the EWS, it is mostunlikely that he would not have called for immediate medical assistance froma doctor.For these reasons, we find that on the balance of probabilities, no new observationchart was ever created.We now turn to the two charges, specifically. With regard to charge (1), it was thepolicy and procedure at the time that patients should have at least one complete setof basic observations in each 24 hour period. The observations which the registranthas admitted making should have been recorded in writing. For the reasons set outabove, the panel finds that, on the balance of probabilities, these observations werenot recorded by the registrant at 22.00.With regard to charge 2, it is clear that a record was made in the nurses’ notes inrelation to the assessment carried out at 03:00 hours on the 11

April 2007 but therecord failed to show the necessary particulars as required by the hospital’s policy asset out in exhibit 8. In particular, it failed to record an early warning score. The panel,therefore, finds, on the balance of probabilities that the facts set out in charge 2 isproved.

Reason for the finding of impairment

The registrant has admitted the facts in charges 3 and 4 and the panel have foundthe facts in charges 1 and 2 proved. We therefore turn to the issue of misconduct.Charges 1 and 2 relate to record keeping and we have already found that theregistrant did not record his observations of patient A on the evening of 10

April2007 and the early morning of 11

April 2007. Paragraph 4.4 of the NMC Code ofProfessional Conduct 2004, sets out a nurse’s obligation with regard to recordkeeping. The paragraph reads as follows “Health care records are a tool ofcommunication within the team. You must ensure that the health care record of apatient is an accurate account of treatment, care planning and delivery. It should beconsecutive, written with the involvement of the patient whenever practicable andcompleted as soon as possible after an event has occurred. It should provide clearevidence of the care planned, the decisions made, the care delivered and theinformation shared”. In the panel’s judgement, the registrant’s failures as set out incharges 1 and 2 constitute clear breaches of paragraph 4.4. Further it is the judgement of the panel that these failures amounted to serious misconduct.We now to turn to charges 3 and 4. Patient A was an elderly woman suffering fromthyroid problems. She was an in-patient at the Rossall Hospital for the purpose ofrehabilitation. The evidence was that she could expect to receive active treatment atall times to manage any condition that arose. On the evening of the 10

April 2007and the morning of 11

April the registrant was informed twice of the patient’sdeteriorating condition. The registrant assessed the patient himself and was fullyaware of the need for interventions and could have calculated a EWS that wouldhave raised concern. It appears from his statement, attached to his letter addressed