Care home nurse avoids being struck off over neglect

ON CONDITION ... Daphne Joseph. Inset, Joyce Wordingham.
ON CONDITION ... Daphne Joseph. Inset, Joyce Wordingham.

A CARE home nurse whose neglect ended in the death of a frail South Tyneside pensioner at a scandal-hit care home has avoided being kicked out of the profession.

Daphne Joseph, 47, did not call for help despite dementia sufferer Joyce Wordingham, an 80-year-old resident at St Michael’s View care home, in Westoe, South Shields, showing symptoms that put her in obvious need of urgent medical care.

Joseph, a single mum who came to the UK from Guyana in 2004, pleaded guilty to wilful neglect at Newcastle Crown Court last year, when she received a nine-month prison term, suspended for a year.

Yesterday she faced a Nursing and Midwifery Council hearing which could have seen her struck off the nursing register.

But after deliberating until nearly 6.30pm last night, a London-based panel let Joseph off with a one year conditions of practice order.

She will be required to work under a mentor and must always have a registered nurse on duty at the same time as her.

Joseph will also be required to carry out a personal development plan, which will involve training on how to deal with deteriorating patients.

Panel chairman Brian Yates declined to read out his reasons for not providing a harsher sanction because of the ‘lateness of the day’.

He refused requests from the press to see his full judgement, instead saying they would ‘have to content themselves’ with hearing the conditions of practice when the full judgement is published online next week.

Joseph has not worked as a nurse since, and has supported her 11 year-old daughter through job seekers allowance, the panel was told.

Joseph told the hearing she is not fit to work without restriction and accepted that if she had done her job better, Ms Wordingham would have lived “a little longer.”

The panel heard Joseph recorded blood pressure of 80 over 64, a pulse of 128 and temperature of 39.2 at 11.19am on February 19, 2010.

She realised the figures were irregular, but decided to treat the patient through ‘nursing care’ as she was not on any medication.

She said: “I went back to the office and I looked at the medication sheet of the resident. She wasn’t on any, so I told myself I can do one of two things, I can call a doctor or do nursing care, so I just proceeded to do nursing care.

“I did a bit of sponging on the resident, I removed the bed clothes and opened the window so she could have some fresh air coming in.”

Her lawyer, David Dukes, asked: “Ms Joseph you have had a great deal of time in which to reflect on this matter. Looking back, what did this observation actually indicate?”

She replied: “It indicates the patient was in dire need of medical aid, which I failed to provide.

“If I had done better, she would have been able to live a little longer.”

She told the panel she had asked to meet Mrs Wordingham’s family to apologise in person for what she had done.

“At court I asked if I could see the family and apologise for whatever happened because I really didn’t know them,” she said.

“If I have the opportunity, this is something I will never do again. If I see the vital signs are not normal, I will not only call for the GP, but I will call for the emergency team.”

The panel heard she had worked four night shifts in a row before the incident, as the only nurse on duty, helped by two or sometimes just one care assistant.

Joseph said she had raised concerns about being overworked with bosses before, as she was expected to carry out duties such as laundry as well as caring for the patients.

She told the panel there was no real supervision at the home, with nurses expected to work on their own initiative most of the time.

When asked what training was available, she said: “Most of the time, training that was being given at the home was for fire safety, or food hygiene.”

Questioned by Louise Hoggett-Jones, on behalf of the NMC, she admitted she sought no training for elderly care, having never done it before coming to the UK in 2004.

She also admitted she had not undergone CPR training since coming to the country.

Ms Hoggett-Jones called for Joseph to be booted out of the profession, saying the failings were her responsibility alone.

But Mr Duke asked the panel to let her resume her career, and pointed to the background she was working against at the home.

He said: “It is right to note the circumstances to which Mr Justice Coulson referred, that the shortcomings at St Michael’s care home were many and varied.

“Staffing levels were woefully inadequate and the training levels were well below what was expected.

“Her knowledge that her actions caused the death of this patient will be a heavy burden to bear throughout the rest of her life.”

The panel ruled Joseph was not fit to continue working without restrictions.

Chairman Brian Yates told her: “You have been convicted of a serious criminal offence, which not only connected with your practice but arose directly from failures to respond to the patient’s needs.

“As the judge remarked in giving sentence you knowingly ran a risk which you should not have done, and Patient B died as a result of that risk.

“The panel was unable to see evidence that you had shown proper insight into your actions, except obvious and genuine remorse.’

A CROWN Court judge said Joyce Wordingham, 80, would not have died if emergency medical care had been sought.

Mrs Wordingham had been a resident at the Southern Cross run care home St Michael’s View.

On the night shift of February 19, Joseph took blood pressure, pulse and temperature readings which a doctor later branded ‘10 out of 10’ on a scale of severity.

But instead of calling for emergency help, the nurse just sponged the patient down and left her in bed.

She carried out the same checks in the morning and again failed to call for help. Mrs Wordingham, a former cinema usherette, was found dead in her bed at 8am. A post-mortem revealed the Alzheimer’s sufferer had died from bronchial pneumonia.

Joseph admitted wilful neglect of a person who lacks capacity in relation to Mrs Wordingham.

Judge Mr Justice Coulson handed her a suspended sentence at Newcastle Crown Court in January last year because he said an ‘endemic culture of neglect’ at the home had been partly responsible.

Joseph was the only qualified nurse on duty that night, caring for 29 residents.

Mr Justice Coulson said: “When a doctor saw the readings, he considered them so bad that he recalled thinking how more unwell does a patient have to get before an ambulance is called.

“When asked to rate the figures on a scale of one to 10, 10 being when a doctor must be called, he put them right at 10.

“Any competent registered nurse should have known that pulse, blood pressure and temperature readings of this kind were evidence representing a serious deterioration of the patient.

“The evidence is that on the balance of probabilities she would not have died if you had sought urgent medical care when you should have done.

“Your neglect was part of an endemic culture of neglect. You had not been trained properly and that failure, which was not your responsibility, was directly relevant to the tragedy that happened.”

The care home had previously been given a zero-star review by Care Quality Commission for not following care plans and not training or managing staff properly.

“The home was run by Southern Cross, a company that have been subject to serious adverse publicity,” the judge added.

“Unhappily there were a number of failings in the way this care home was run.

“Care plans were not followed, there was a lack of management plans for patients who were deteriorating, there were numerous management failings and an absence of proper training of staff.”