Nurse struck off for faking patient notes in attempt to cover up

Bupa, the owner of the Cornwall Park Hospital, has apologised for the unacceptable care provided to the patient and said it now had better policies and processes in place. Photo / Google

A registered nurse who managed a dementia care unit has been found guilty of falsifying patient notes and destroying the original documents after the woman died in the facility's care.

The owner of the Cornwall Park Hospital Bupa has apologised for the unacceptable care provided to the patient and said it now had better policies and processes in place.

The New Zealand Health Practitioners Disciplinary Tribunal found Rekha Devi, the facility manager at Cornwall Park Hospital, guilty of seven charges laid by the Nursing Council's Professional Conduct Committee relating to misconduct and malpractice.

The charges included leading a group of nurses to rewrite a patient's notes with false dates and some made-up content, falsifying a temperature chart, instructed a nurse to destroy the original patients notes and other documentation, falsifying a standing order, instructing another nurse to prepare a short-term care plan after the patient's death and failing to report the falsification in order to cover up the care given to the woman.

In May 2014, the patient, referred to as Mrs S, developed a rash on her right forearm and was initially treated with hydrocortisone.

She developed septicaemia which quickly deteriorated and was admitted to hospital before dying later that day.

Mrs S's daughter was upset about what happened and Devi told Bupa's dementia care adviser Beth McDougall and the care home manager for a dementia service in Nelson, Jackie MacKenzie-Howe, who happened to be on site, that her documentation was "not good".

Ms McDougall told the professional conduct committee she advised her to photocopy documentation and start a timeline, but rejected Devi's claim they had told her to edit the notes.

Devi then met the nurses involved in Mrs S's care who claimed they were instructed to rewrite the notes so that they were comprehensive "for the safety of Cornwall Park".

One nurse, Ms Hansen was told to delete the notes in the original document that she had made referring to cellulitis and her concern for infection.

Another claimed he was told make-up a short-term care plan after Mrs S died and backdate it, while another said she instructed him to destroy the original patient notes and other documentation.

The nurses claimed they were also told to make sure the notes were consistent with Bupa's policy on infection control and to specifically related to a standing order regarding the use of hydrocortisone cream which was also fabricated after Mrs S died.

The faking of the documents only came to light month later after a nurse, Ms Hansen, blew the whistle on the actions of Devi to a Bupa operations manager while at a national care home and clinical manager forum.

In its decision, the tribunal said the charges were of a "serious nature" and involved dishonesty and deception and that a message needed to be sent to Devi and her profession that that type of behaviour would not be tolerated.

Devi was ordered to pay $9,300 in cost and her nursing registration was cancelled. She no longer works at Bupa.

Bupa New Zealand managing director Jan Adams apologised to the family for the "unacceptable" and care "well below our standards" that Mrs S received and the distress caused.

As a result, Bupa had reviewed and improved its practices and policies particularly in the area of wound management.

"We realise that these improvements to practice in no way make up for the standard of care delivered, but we are taking all possible steps to eliminate the factors that contributed to the unacceptable level of care," Adams said.

The family laid a complaint to the Health and Disability Commissioner.

In a statement, deputy commissioner Rose Wall told the Herald the commissioner determined that the care provided to Mrs S was of a poor standard.

Furthermore the actions of those involved had harmed the reputation and trustworthiness of the nursing profession.

The commissioner considered the misconduct and breach of ethical and professional standards were very serious.

As a result, the commissioner took the following action:

• the seven registered nurses were referred back to the nursing council for review of their professional conduct and ethics.
• Bupa was required to undertake a number of follow up actions including revising their policies relating to complaints management; providing updates on their supervision of their registered nurses, and completing an internal local nursing strategy; and report back on follow up actions.
• The complaint and all supporting information were brought to the attention of Auckland DHB as the funder of the service and HealthCERT at the Ministry of Health as the agency responsible for certifying and monitoring standards for rest homes.