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Pauline Cafferkey hearing urged to drop Ebola dishonesty charge Pauline Cafferkey hearing drops Ebola dishonesty charge
(about 3 hours later)
The British nurse who twice came close to death after contracting Ebola while working as a volunteer in Sierra Leone in 2014 should not face charges of dishonesty, a misconduct hearing has heard. An isolated incident of poor judgment brought about by extreme exhaustion and the early stages of Ebola infection should not be allowed to blight Pauline Cafferkey’s otherwise impeccable professional record, a misconduct panel has been told.
Pauline Cafferkey, 40, could be struck off by the Nursing and Midwifery Council if the remaining charges against her are proved. Those charges are that she allowed an incorrect temperature to be recorded on her return to the UK, and that she failed to report her elevated temperature to screening staff or tell them she had recently taken paracetamol. The Scottish nurse, who twice came close to death after contracting Ebola while working as a volunteer in west Africa in 2014, faces being struck off by the Nursing and Midwifery Council if misconduct charges against her are proved.
On Tuesday morning the panel at an NMC misconduct hearing in Edinburgh was urged by the case presenter for the council to strike out a charge that she had acted dishonestly. At a hearing in Edinburgh, the council’s representative submitted that following Cafferkey’s arrival at Heathrow from Sierra Leone at the end of December 2014 she allowed an incorrect temperature to be recorded by Public Health England’s airport screening facility and that, realising she had an elevated temperature, an initial symptom of Ebola, she left the screening area without reporting this to a member of staff.
Anu Thompson, for the NMC, told the panel that expert evidence suggested Cafferkey’s “ability to make decisions and reason properly were affected at the relevant time”. She referred to one medical expert, Dr Thomson, who submitted that: “I have no doubt that a combination of early Ebola virus infection and fatigue resulting from a busy night shift followed by a lengthy journey [from Sierra Leone] would have impaired Pauline’s judgement at the time of entering the screening process at Heathrow airport.” The panel struck out a charge that Cafferkey had acted dishonestly after hearing expert evidence that suggested her “ability to make decisions and reason properly” had been severely compromised by the time she reached the UK.
The hearing was told that on 28 December 2014 Public Health England’s Ebola screening facility at Heathrow airport had not been prepared for such a large influx of passengers, and that the screening area was “busy, disorganised and even chaotic”. A submission from a medical expert, a Dr Thomson, said: “I have no doubt that a combination of early Ebola virus infection and fatigue resulting from a busy nightshift followed by a lengthy journey [from Sierra Leone] would have impaired Pauline’s judgment at the time of entering the screening process at Heathrow airport.”
The hearing was told that on 28 December 2014, Public Health England’s Ebola screening facility at Heathrow airport had not been prepared for a large influx of passengers and the screening area was “busy, disorganised and even chaotic”.
An agreed statement of fact described how each person was given a port of entry Ebola health assessment form, on which their temperature and other relevant information was to be recorded by medical staff. As the delays continued and frustrations grew, one member of Cafferkey’s group suggested they take their own temperatures.An agreed statement of fact described how each person was given a port of entry Ebola health assessment form, on which their temperature and other relevant information was to be recorded by medical staff. As the delays continued and frustrations grew, one member of Cafferkey’s group suggested they take their own temperatures.
The hearing was told that a member of that group, Doctor 1, took Cafferkey’s temperature and found it to be 38.2C, then 38.3C when she took it again a few minutes later. The hearing was told that a member of that group, referred to as Doctor 1, took Cafferkey’s temperature twice and found it to be 38.2C, then 38.3C.
Doctor 1 stated that she read out both numbers in the presence of Cafferkey and Registrant A, another group member, who said that she would record the nurse’s temperature as 37.2C then they would “get out of here and sort it out”. Doctor 1 stated that she read out both numbers in the presence of Cafferkey and Registrant A, another member of the group, who said she would record the nurse’s temperature as 37.2C and then they would “get out of here and sort it out”.
Cafferkey, who sat quietly with her representative throughout the hearing, has stated that she remembers somebody using the words “let’s get out of here” but cannot remember who said them or who entered the temperature of 37.2C on her screening form. Cafferkey, who sat quietly with her representative throughout the hearing, has said she remembers somebody using the words “let’s get out of here” but cannot remember who said them or who entered the temperature of 37.2C on her screening form.
Any temperature above 37.5C was considered to be elevated and should have been reported to a consultant for further assessment. Any temperature above 37.5C was considered to be elevated and should have been reported to a consultant for further assessment, but Cafferkey left the screening area without alerting a member of PSE staff.
Cafferkey left the screening area, the hearing was told, but later returned after Doctor 1 raised further concerns about her elevated temperature. Her temperature was taken three more times, by Doctor 2, but only one reading was above 37.5C, and that by 0.1C. Cafferkey did not volunteer to Doctor 2 the information that she had recently taken paracetamol, nor was she asked directly about it, and she was cleared to travel home to Glasgow. Cafferkey’s representative, Joyce Cullen, suggested that this action was “entirely out of character” and the result of the previously established combination of illness and exhaustion.
The following day she was diagnosed with Ebola, suffering one of the highest viral loads ever recorded. Cullen added that although Cafferkey did not seek to blame others, the influence of the other medical professionals she was travelling with was a factor. “She went through the screening process with an elevated temperature with their approval and at their urging,” she said.
Earlier on Tuesday, Cafferkey’s representative, Joyce Cullen, applied for the hearing to be held in private, arguing that the “intrusive nature of press and media has already had a significant psychological impact on Miss Cafferkey”. Cullen insisted this was “a very short single incident of poor judgment”, emphasising that immediately after leaving the screening area Cafferkey informed another doctor of her elevated temperature.
Cullen added that an error by the NMC in publishing draft charges on their website last month had had an additional adverse effect, after which Cafferkey had required medical treatment and been forced to move out of her home for a period. Cullen argued that Cafferkey had a right to privacy regarding medical records that would be referred to during the hearing. She then returned to the screening area where her temperature was taken three times by Doctor 2. Only one of those readings was above 37.5C, and that was by 0.1C. Cafferkey did not volunteer to Doctor 2 that she had recently taken paracetamol, and nor was she asked directly about it.
The assembled media objected to the application for the hearing to be heard in private. A decision was due later on Tuesday after hearing submissions from the media’s legal representatives. She was cleared to travel home to Glasgow, and the following day she was diagnosed with Ebola, with one of the highest viral loads ever recorded.
The NMC made the case that Cafferkey’s actions potentially put the public at risk and jeopardised the reputation of her profession, rendering her unfit to practice.
The NMC’s representative Anu Thompson argued that Cafferkey’s exhaustion and illness “did not remove the expectation that she would disclose her elevated temperature at the earliest opportunity and that she would understand [its significance ] not just for herself but for the public as a whole.”
Thompson insisted that the NMC was not seeking to punish Cafferkey but to uphold professional standards, concluding that the nurse’s conduct “potentially put the public at risk and … undermines public trust and confidence in the profession.”
Following the conclusion of submissions, the hearing was adjourned until Wednesday morning.