May 23, 2011 (Monday) - A Disciplinary Offence...?


Because the HPC’s disciplinary and competence hearings are a matter of pubic record, we can reflect on them. I do this quite often, but because this one involved what I do on a daily basis I find I’m taking the outcome rather personally.

A biomedical scientist in Devon was working on a late shift. There was an “incident, and now she’s been disciplined and given strict conditions of practice. From what I can determine from the public record it looks like she’s been sacked, but this is not stated explicitly.

Ms “X” (I’ll cell her Ms “X”, even though her name is openly available) was doing blood counts on the late shift. She found one of the blood count samples was clotted, and reported it as such on the hospital’s I.T. system. However she did not phone the fact. It transpired that the patient in question had a massively high white cell count which went undetected until a subsequent blood count was performed a day later. The white cell count was so high that it was judged that Ms “X” ‘s actions (or lack of)  “were serious and had a potential of causing patient harm”.

I have grave reservations about this decision.

If the late shifts Ms “X” works are anything like mine, they are not easy shifts. Telephoning results to a busy A&E department is not an easy task – they are often too busy to answer the phone, and when they do, results are often mislaid. Also patients have often moved on to other wards by the time lab results are available. Lab staff also do not have the luxury of time to spend hunting down patients. In the time it takes to phone one result, a biomedical scientist can generate another twenty sets of results. Far better to make results available (on a computer system) to people who will act on those results.

I honestly think that Ms “X” did the right thing in putting the result of “clotted” onto the computer. When the clinicians reviewing the case were in a position to consider the blood count, then they would realise the need for a repeat sample. Let us look at the facts of the case: the sample had been clotted and had not been noticed by any ward staff. Surely the fact that a patient had been in hospital for a day with a white cell count of 80 was far more “serious and had a potential of causing patient harm”?
Let us look at the causes of high white cell counts:

  • Chronic leukaemia: May not be clinical symptoms evident. A Wbc of 80 could be left overnight
  • Acute leukaemia: Patient would (most likely) have symptoms of anaemia and thrombocytopenia
  • Acute infection: Patient would (most likely) have symptoms: fever and rigors.
I honestly believe that either the patient could have been left overnight with no untoward effect, or if harm would have been done by leaving the patient, then clinical symptoms would have been evident to those looking after the patient regardless of the results of the blood count. After all, in this case she was on a hospital ward.
The fact that the first person to become aware of the report of “clotted” was another member of lab staff, and that that was a day later speaks volumes.

But Ms “X” remains with restrictions on her clinical practice, has to undergo a period of re-training, and has the only consolation that her ex-employer would “employ her in a clinical role as a Biomedical Scientist once her training is completed”.
All of which for doing what I feel I would have done in the same situation.

I can’t help but feel I’m missing something here….

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