After a couple of days of intense media scrutiny the fitness to practise case against Pauline Cafferkey, the nurse who survived ebola, has resulted in her being cleared of all allegations of misconduct.
A hearing panel decided that the virus impaired her judgement when she returned to the UK at the end of 2014 after volunteering in Sierra Leone.
The panel said it was due to illness and exhaustion that she allowed her high temperature to be wrongly recorded – below the threshold for further assessment - at the airport in London and then left the Public Health England screening area without flagging feeling unwell.
For most people, the panel’s conclusion has put an end to any suggestion that Ms Cafferkey acted dishonestly – one of the original charges that was later dropped – or that she is not fit to practise as a nurse.
But what the case has not dealt with is a series of other issues uncovered along the way.
”A string of PHE professionals were involved in testing and assessing Ms Cafferkey”
A string of PHE professionals were involved in testing and assessing Ms Cafferkey while she was at the airport and yet she was still cleared for onward travel back to Scotland.
Ms Cafferkey had at some point taken paracetamol – information that was passed between some doctors involved in assessing her, but not others. This included the one who ended up allowing her to continue her journey after re-testing her temperature a further three times and finding it was only above a normal range on one reading.
Meanwhile, the PHE screening area at the airport was described as “busy, disorganised and even chaotic” and PHE was said to be unprepared for the amount of people coming back from infected countries.
As Ms Cafferkey’s lawyer pointed out in a statement following the conclusion of the hearing, “it is perhaps ironic that given the criticisms made of Public Health England’s processes it was their complaint that’s led to the NMC investigation and these proceedings being initiated against Pauline”.
”There is also the mystery of who recorded Ms Cafferkey’s wrong temperature”
Then there is also the mystery of who recorded Ms Cafferkey’s wrong temperature on the PHE screening form – at which point she, the doctor taking her temperature, and also another unnamed registrant were present.
Ms Cafferkey’s temperature – of more than 38 degrees - was read out to both her and the unnamed registrant but there is a difference of opinion of what happened next.
The doctor said the other registrant stated she would record the temperature as 37.2 degrees – which was lower than the 37.5 threshold - on the form and they would “get out of here and sort it out”. But Ms Cafferkey said she recalled the words “let’s get out of here” being used but could not remember who said it or who entered the temperature on her screening form.
”Ms Cafferkey’s judgement was impaired by this point because she was ill – but what about the doctor and other registrant?”
The panel has now decided Ms Cafferkey’s judgement was impaired by this point because she was ill – but what about the doctor and other registrant?
Not only has the case thrown up questions about official PHE procedures as well as the actions of individual health care workers - and at what point they should be considered accountable as a patient or professional - it has also put the spotlight on the Nursing and Midwifery Council.
Supporters of Ms Cafferkey have questioned why the NMC allowed the case to be brought to this stage in the first place, accusing the regulator of wasting registrant fees and targeting a nurse who deserved praise – not punishment – after volunteering.
But, while there are ongoing discussions about how to improve the efficiency of the regulator and its dealings with FtP cases, it is of course the NMC’s job to investigate allegations of misconduct.
As NMC chief executive Jackie Smith said in a statement, the referral of the case by PHE included a “highly unusual set of circumstances” which “required a thorough and proper investigation”.
And considering the details, criticisms and discrepancies that have been uncovered in the hearing in the past week, this will probably not be the last investigation stemming from the set of events.