A nurse was suspended after an prison inmate died following 18 days of persistent vomiting.
Julie Warmington was employed as a band 5 nurse at HMP Garth, a category B prison near Leyland. In January 2017, a prisoner died following a perforated duodenal ulcer which the he was likely to have had for some time. A Nursing and Midwifery Council fitness to practice committee panel found that she was not responsible for every failing in the patient's history, but had her own failings.
The report stated one or more of these failings contributed to the patient's death, or alternatively, the loss of chance of survival. The report said 'patient A' was transferred from HMP Durham to Garth in 2016 and was found to have no physical health conditions, nor outstanding medical appointments.
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However, in May of that year the prisoner first complained of sharp abdominal pains and headaches on opening his bowels. LancsLive reported that in July the patient was still suffering with symptoms, but a GP "found nothing unusual but severe piles" and was referred to a colorectal specialist at the hospital.
An appointment was made for October 11, but this was cancelled by the hospital. Two further dates were offered, but these were declined by the prison and no dates were subsequently set. In November, the patient complained of vomiting and chest pains, stating he had "experienced vomiting every night over the last month". He was advised to rest and drink fluids and that he would be seen by the GP the next day, but this was not carried out.
The report added Ms Warmington had examined the patient but allegedly recorded his clinical observations as normal. It continued she "declined to issue Patient A with a sick note and advised him to apply for a GP appointment" – and she "recorded that Patient A had become agitated and that she opened the door and indicated he should leave".
Persistent vomiting for the patient had reached its 18th day, but he was advised to stay in his cell for 48 hours and use the cell bell if he needed anything. The report goes on to say: "On 2 December 2016 Dr 6 reviewed Patient A and recorded that he suspected a duodenal ulcer caused by H pylori bacteria. A stool sample was requested, and medication prescribed to reduce acid and prevent sickness."
In January 2017, Ms Warmington spoke with the prison officer on the wing after the patient complained of pain and how he couldn't get out of bed, but it is alleged the nurse said the complaints did not warrant an immediate GP review. A few days later, a Code Blue emergency was alerted, meaning someone was unconscious or not breathing. Three days later, the patient was still complaining of pain and Ms Warmington arrived at his cell, with a student nurse and two officers.
The report said: "You stated in interview that Patient A was on all fours on his bed and swore at you when you asked him to sit up. It is alleged that you exited from the cell and said that you would not treat him while he was being aggressive. Prisoners continued to express concern about Patient A and within an hour were refusing to attend work until Patient A was seen. Witness 9 spoke to you on the phone and it is alleged that you refused to see Patient A because of his earlier behaviour.
"Witness 9 remained very concerned about Patient A’s condition. Patient A was unable to walk at this point, so the officer and several prisoners carried him up two flights of stairs in a wheelchair before the officer wheeled him into the GP."
On January 11 at 9.10am, a routine check found that the patient's cell could not be opened as he was lying on the floor and restricting the door from opening. A Code Blue emergency was called. Ms Warmington alleges that she heard the call for assistance, but did not realise it was Code Blue.
After a colleague arrived and attempted CPR along with other staff, 'the resuscitation attempt was unsuccessful and at 09:57 Patient A was pronounced dead. The post-mortem concluded the cause of death was peritonitis caused by a perforated duodenal ulcer, the committee heard.
The panel looked at the nurse's fitness to practise and considered that Ms Warmington had continued to practise without restriction and in the seven years since the incidents in question, there had been no incidents or concerns. However, the panel considered the full lack of insight and risk of repetition and therefore, found the nurse's practise impaired on the grounds of public protection.
As a result, the panel decided to sanction the nurse with a suspension order for six months. The report concludes: "The panel considered that it was important for a proper understanding of the circumstances that led to the death of Patient A, to note that he had been subjected to systemic failings by the prison health service and that your failings were only a part of the much wider picture."
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