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Stafford HCA struck off after ‘losing it’ with older patient

A former Stafford Hospital healthcare assistant has been struck off after dragging an elderly dementia patient around by his pyjamas and calling him an animal.

Bonka Kostova’s fitness to practice was found to be impaired by the NMC after she physically and verbally abused the 73-year-old patient, telling him “you are no longer a human being but an animal” - or words to that effect.

She has now been struck off by an NMC tribunal, a spokeswoman said.

“Bonka Kostova has been struck off the NMC register after all charges against her were found proved and as a result her fitness to practise was found to be impaired,” she said.

The Bulgarian-qualified midwife, working on a night shift as a healthcare support worker at the time, was found to have pushed the man, named only as patient A, into his wheelchair when he stood up, and to have pushed him into a bathroom and onto a toilet.

Kostova then pulled the man out of the toilet using the collar of his pyjama top while his trousers were around his ankles and his genitals were exposed, shouting “I hate you” and “you are no longer a human being but an animal”, or words to that effect, the NMC found.

Staff nurses Jane Wilkinson and Lucian Smith saw the incident and intervened, the hearing was told, taking Kostova into an office and telling her that her behaviour had been “unacceptable” and that they would report the incident.

Mrs Wilkinson, who wept describing the incident to the tribunal on Tuesday, said Kostova was hard-working but could sometimes be abrupt with other members of staff, but that it was to do with her Bulgarian accent and demeanour.

But on this occasion Kostova, known as Bonnie to colleagues, was “losing it”, Mrs Wilkinson said.

The tribunal heard that the patient had been in the hospital just over a month receiving treatment for kidney stones when the incident took place just after 3am on July 22 2010.

He was said to be aggressive in his speech or manner around 80% of the time and usually had a one-to-one carer looking after him who would sometimes need the assistance of another if the patient became particularly difficult.

On this occasion, that carer went for a break, leaving Kostova in charge.

Kostova, who was not present for the hearing, had received general training in looking after vulnerable adults, but had not received specific training for dementia patients, ward manager Sharon Matthews told the tribunal.

She was suspended after the incident and has not worked at the hospital since, Mid Staffs Trust’s medical director said.

Robert Courteney-Harris said: “This incident was dealt with very swiftly when it happened in 2010.

“The member of staff was suspended pending our investigation and never returned to work at our Trust.”

A report into Mid Staffordshire Trust highlighted the “appalling and unnecessary” suffering of hundreds of patients between 2005 and 2009.

Some were left for hours sitting in their own faeces, food and drink was left out of reach and hygiene was so poor that relatives had to clean toilets themselves.

Readers' comments (42)

  • Susan Markham

    Actually she was a Bulgarian-qualified midwife, working as an HCA while her application to be admitted to the UK Nursing Register was being considered by the NMC.

    So she had her foot in the door (so to speak) but the NMC have now denied her Registration application... obviously as an applicant for registration that was why her case was dealt with by the NMC.

    Of course (and this is the stupidity of HCAs currently being unregulated) she will still be able to work as an HCA if she can find another hospital that will employ her.

    HCAs see... no accountability. For those HCAs who still don't get it... that's the difference between Registered Nurses and HCAs and APs.

    If an RN screws up the NMC can take away their licence to practice and they can't work again. If an HCA screws up there is no sanction and they can simply move to a different area and work at a different hospital.

    No public accountability.

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  • Thanks for that explanation Susan I was a bit confused why the NMC were dealing with it and why the article referred to a HCA being struck off when they are not registered in the first place.

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  • Agree with your comments Susan. Accountability is a joke. HCA regulation is necessary, regardless of the cost.

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  • What is even more astonishing is that Helen Moss the Director of Nursing at Mid Staffs between 2005 and 2009 and was in charge when all those patients died or who were abused - the NMC found 'no case to answer'!
    What ever happened to the new Act in 2010 of Corporate Homicide?

    Any lawyers out there to explain this!

    I am going to emigrate - this country frightens me.

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  • This can be a very difficult situation. I have witnessed dementia patients being aggressive and racially abusive to non white nursing staff. Looking after a patient on a one to one basis under those circumstances would try the patience of a saint. I am not for a minute condoning the action of this nurse or other who may have found themselves in similar situations.

    I do think the general public and the politicians need to acknowledge the huge stress involved in nursing challenging patients in busy short staffed wards.

    Try it Mr Cameron you would soon abandon your hourly rounding idea.

    Interesting that they can take a nurse to task but not the head of the NHS, David Nicholson, who was made fully aware of the consequences of staffing shortages.

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  • Anonymous | 15-Feb-2013 12:03 pm

    What is even more astonishing is that Helen Moss the Director of Nursing at Mid Staffs between 2005 and 2009 and was in charge when all those patients died or who were abused - the NMC found 'no case to answer'!
    What ever happened to the new Act in 2010 of Corporate Homicide?

    Any lawyers out there to explain this!

    I am going to emigrate - this country frightens me.

    It makes you wonder if she signed a gagging order.

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  • It may be that the NMC dealt with her while awaiting her registration to be confirmed, but there is a BIG flaw in all this...

    ...any registered nurse who has been sanctioned through the NMC Fitness to Practice can work as an HCA without any restrictions...

    So an RN who has been suspended (even while on an Interim Order) or struck off for all the reasons highlighted on the NMC website is free to continue to work with vulnerable children and adults should they find an employer who is willing to take the risk.

    As previously posted, the public and media don't always recognise the difference between us and HCA's.

    Regulation for all! Help rotect the public and the reputation of real NURSES

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  • Susan Markham

    Anonymous | 15-Feb-2013 12:08 pm

    Spot on... I was hoping someone would join the dots on that one.

    For the very reasons that you have outlined HCA regulation is a MUST no matter what the cost of the standardised training might be. What price can you put on human lives? Isn't cost-cutting the very reason that this situation spiralled out of control in the first place?

    I cannot for the life of me, understand why HCAs would not want to become regulated and undergo a nationally standardised and recognised training.

    The excellent HCAs (and I have worked with a he11 of a lot of them over the years) should regulation with open arms.

    HCA accountability and training will weed out the 'poor' HCAs - get them out of the system -and let the good ones shine.

    Thus the reputation of the remaining HCAs would drastically improve. The public and their RN colleagues would know that each registered HCA had received a standard training and was professionally accountable.

    It would mean the end of the current situation where you can walk in off the street and start looking after patients with no qualifications or experience at all.

    They should also think about bring back the nurse cadets ("candy stripers" as they are called in Bermuda) to do voluntary work so that people under 18 could get experience of the hospital environment.

    But back to the point... NMC regulation could only be a positive way forward for HCAs.

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  • I agree that is is astounding the the Director of Nursing has no case to answer. The charges must have been very cleverly worded to find that. How many people have to die or be abused before some of the managers are held accountable for what is happening on their watch. Is it only junior staff who are accountable? Knowing the history and track record of the NHS and the DOH I expect her to be promoted to a senior national post shortly, thats what they do with those who can't do the job, is it not?

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  • Susan Markham

    Anonymous | 15-Feb-2013 12:31 pm

    Well actually this thread is about the "HCA" who managed to get struck off by the NMC... something I've never heard of happening before... a very unusual set of circumstances indeed.

    The thread I think you should be posting in is the one called "Mid Staffs culprits 'should be struck off', says Hunt."

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  • Ok, but how come it takes from 2010 to now to get a decision on something as bad as this? The backlog of cases. If she was suspended does that mean she was still being paid?? I don't know the in's and out's of that and certainly hope I never behave professionally to warrent suspension. I know that working with dementia patients is difficult and challenging. It is a stress for the staff but we are able to leave at the end of a shift. Their dementia is constant and not their fault. Treating them with dignity and with empathy and patience is frankly a nursing duty and morally human, abuse is abuse..full stop.

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  • I thought that you had helpfully clarified why an HCA was before the NMC, because she was applying for registration in the UK which has now been denied.
    The issue about who allowed and tolerated this care has been picked up by several others, there has been more than 1 incident.

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  • A lot of Chinese Whispers also go on in all media reporting and accounts often vary from one newspaper to another and change from day to day as the story evolves.

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  • Susan Markham

    Anonymous | 15-Feb-2013 1:36 pm

    Well it is 'ex-post-facto' now - all done and dusted. Her application to be admitted to the UK Register of Nurses has been refused - in effect she's been struck off. That's the first case I have ever heard of an HCA being struck off by the NMC.


    Anonymous | 15-Feb-2013 1:12 pm

    "Ok, but how come it takes from 2010 to now to get a decision on something as bad as this?.... If she was suspended does that mean she was still being paid??"

    Your first point is a good question... the answer is due to three letters... NMC! Getting decisions from the NMC is like two elephants making sweet loving... it's done at a very high level with lots of noise and grunting and it's two years before you know whether anything was produced by the process!

    Do HCAs get paid if they are suspended? Nope.

    Robert Courteney-Harris, medical director at Mid Staffordshire NHS Trust said: "This incident was dealt with very swiftly when it happened in 2010. The member of staff was suspended pending our investigation and never returned to work at our Trust."

    But like I was saying before... because HCAs are not regulated there is nothing stopping her getting another HCA job at a hospital in another area.

    Thankfully, she'll never work as an RN in this country though. This is the problem with importing nurses from Eastern European countries... their training simply isn't on a par with that of the UK.

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  • "...their training simply isn't on a par with that of the UK."

    it is not possible to generalise across all European Eastern countries who have different training in each. I have worked with some excellent nurses from Bosnia whose skill, knowledge and quality of all aspects of caring was far higher than some of what I have witnessed from RNs in the UK.

    It not only depends upon training but also level of experience as well as their attitudes towards their work, their patients and their colleagues, managers and employers.

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  • yes !!! susan hca will willingly be regulated a good percentage of us can do a full days work of basic care and all the pi**ing paper work to go with it? in our work we are not idiots as you make us out to be? But you will have to keep an eye on your coments as there becoming a bit racial we dont want you getting into trouble ?

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  • Susan Markham

    Anonymous | 15-Feb-2013 5:53 pm

    Could you please point out a post where I have said that I thought HCAs were idiots?

    No, I thought you couldn't because I don't even think that - let alone verbalise such a thing.

    My point is that, just like there is a demarcation between the professional roles of Registered Nurses and Doctors, there should be a similar delineation between the roles of the RN and the HCAs.

    Racism? That's quite funny. If you knew my nationality you'd have a chuckle too.

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  • I can think of about an hundred reasons why HCAs won't be pleased about regulation. They are £1 coins.

    Lets face facts our up-skilled HCAs/Assistant Practitioners or whatever they are being called this week are going to be SENs in all but name.

    As for Susan's closing line above racism comes in all colours. Anyway, I think the bit that was being hinted at was where she said that East European training isn't as good as ours. She might be right. Doesn't make her a racist/nationalist.

    Bloody hell I'm agreeing with Susan Markham, I need to go and lay down!!!

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  • Susan Markham | 15-Feb-2013 6:37 pm

    after your generalised comments about the training standards of Eastern European nurses compared to those in the UK, maybe it would be wise to leave race out of the current discussion?

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  • tinkerbell

    good she was struck off. Wouldn't trust her with a baby either or any vulnerable.

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