Susan Okafor v Nursing and Midwifery Council

JurisdictionEngland & Wales
JudgeThe Honourable Mr Justice Picken
Judgment Date01 July 2015
Neutral Citation[2015] EWHC 1872 (Admin)
Docket NumberCase No: CO/3292/2014
CourtQueen's Bench Division (Administrative Court)
Date01 July 2015

[2015] EWHC 1872 (Admin)




Royal Courts of Justice

Strand, London, WC2A 2LL


The Honourable Mr Justice Picken

Case No: CO/3292/2014

Susan Okafor
Nursing and Midwifery Council

The Appellant in person.

Miss Aja Hall (in-house counsel at the Respondent) for the Respondent

Hearing date: 17 June 2015

The Honourable Mr Justice Picken



This is an appeal by Susan Okafor ("Miss Okafor") under Article 38 of the Nursing and Midwifery Order 2001 against a decision of a panel of the Conduct and Competence Committee ("the Panel") of the Nursing and Midwifery Council (the "NMC") made on 18 July 2014 that Miss Okafor's fitness to practise was impaired, and that she should, as a result, be struck off the register pursuant to Article 29(5)(a) of the 2001 Order.

The background facts


The proceedings before the Panel entailed three broad allegations of misconduct and lack of competence:

(1) The first related to an incident on 15 July 2009, whilst Miss Okafor was working on the Joseph Barnes Ward at the Chelsea and Westminster Hospital, and consisted of allegations that Miss Okafor failed properly to care for a patient, Patient A, who was in labour.

(2) The second related to an incident on 25 March 2011, when Miss Okafor was working on the Labour Ward at the same hospital and entailed a complaint that Miss Okafor recorded in a document that she had completed an assessment of a patient on four occasions when, in fact, she had only done so on two occasions. This incident also involved the allegation that Miss Okafor had stated to her clinical mentor that " you're not God" or words to that effect.

(3) The third set of allegations concerned the period between 20 April 2010 and 8 April 2011, whilst Miss Okafor was employed as a Band 6 midwife at the Chelsea and Westminster Hospital, and comprised various charges that she failed to demonstrate the standards of knowledge, skill and judgment required to practise without supervision as a Band 6 midwife.

The allegations referred to in sub-paragraphs (1) and (2) above were misconduct allegations, whereas (3) concerned Miss Okafor's competence.


The hearing before the Panel spanned 24 days and took place on various dates between 4 November 2013 and 18 July 2014. It was a hearing which Miss Okafor attended throughout, save for the impairment stage and save also on the last day when the Panel announced its sanction.


Following the hearing, the NMC wrote to Miss Okafor on 23 July 2014. In this letter ("the Decision Letter"), which was 58 pages long, very detailed reasons were given for the Panel's decision, both in relation to fitness to practise and in relation to the decision to impose the sanction of striking-off.


The Panel's conclusions are very usefully summarised by Miss Aja Hall, counsel for the NMC, in paragraphs 5 to 22 of her skeleton argument. I draw on that summary in what I set out below. I should make it clear, however, that I have studied the Decision Letter in considerable detail, and that I have not merely relied on Miss Hall's summary. I have also had regard to Miss Okafor's equally helpful (albeit undated) document described as " Rationale for points of resistance to document dated 4 June 2015" document (the "Rationale Document"). In that document, in a number of places, Miss Okafor explained why she disagrees with the Panel's factual findings, but she does not appear to disagree that Miss Hall's summary accurately sets out what the Panel decided.


As I have previously mentioned, at the time of each of the allegations, Miss Okafor was working for the Chelsea and Westminster Hospital, more accurately for the Chelsea and Westminster Foundation Trust, as a Band 6 midwife on a rotational part-time contract.


As to the first of the incidents, the incident which took place on 15 July 2009, the NMC's case, which was accepted by the Panel in the findings which were made, was as follows:

(1) Patient A attended the Josephine Barnes Ward for an induction of labour. Miss Okafor recorded that Patient A was admitted to the ward at 10.30 am, the NMC's case being that Miss Okafor then became responsible for the care and treatment of this patient.

(2) Ms Julie Hanley (described in the Decision Letter as " Ms 7") was the midwife in Charge of the Josephine Barnes Ward on that day. She took charge of A Bay and gave responsibility for B Bay to Miss Okafor.

(3) At about 1.00 pm Ms Hanley looked into B Bay to check on Patient A, only to find that Miss Okafor was not in attendance and that Patient A was hyper-stimulating. Hyper stimulation is a possible side-effect of prostaglandin, a medicine which is used to induce labour.

(4) Ms Hanley considered that Patient A was having too many contractions, looked quite distressed and was breathing heavily. Ms Hanley, accordingly, informed Miss Okafor, who was at the nurses' desk, that she needed to keep a close eye on Patient A. Ms Hanley also informed Miss Okafor that she needed to carry out a long trace on the cardio tachograph (or CTG) to assess foetal well being, specifically to see how the baby was coping with the hyper-stimulation.

(5) It was then alleged that Ms Hanley returned to the nurses' station but was unable to find Miss Okafor. Ms Hanley, therefore, returned to B Bay, only to find Patient A sitting upright in her chair alone with the CTG still attached, but with contact with the foetal heart rate lost.

(6) Ms Hanley checked the CTG monitor, discovering that it had not recorded a trace for at least 50 minutes. Ms Hanley ensured that Patient A returned to her bed, where a trace was picked up by the CTG monitor straight away. The foetal heart rate was found to be fine. Patient A was told that a doctor was being called to assess her and that she would be transferred to the Labour Ward.

(7) Ms Hanley was unable to comment on foetal well being, owing to the loss of contact on the CTG. Ms Kidd, a Senior Midwife and Maternity Co-ordinator, was concerned about this and so asked Ms Hanley to inform Miss Okafor that she should stay with Patient A and monitor the foetal heart rate appropriately. Ms Kidd then called the consultant obstetrician on duty, so that Patient A could be reviewed.

(8) Ms Kidd then went to discuss the transfer of Patient A with Ms Hanley. Instead of going straight to Patient A to transfer her to the Labour Ward, Miss Okafor followed Ms Kidd to the desk where Ms Hanley was and, so it was alleged by the NMC, refused to go to Patient A.

(9) When asked why she was doing this, it was alleged that Miss Okafor responded by saying that she did not need to got to Patient A as she was being monitored.

(10) Ms Kidd then requested that Miss Okafor take her to Patient A so that an introduction could be made. When they entered the room, they found Patient A sitting in a chair in distress and with no monitoring in place.

(11) Miss Okafor was then asked to stay with Patient A for 10–15 minutes, in order to ensure appropriate monitoring was carried out whilst another midwife was found to take over the care of Patient A. It was alleged by the NMC that Miss Okafor refused to do this.


In these circumstances, Charge 1 before the Panel was put in these terms:

"1. On 15 July 2009 whilst working on the Josephine Barnes Ward, [you]:

(a) Did not stay with patient A in order to monitor the fetal heart rate despite being informed by Senior Midwife (Ms7) that:

i. Patient A may have been hyper-stimulating;

ii. Patient A needed a CTG trace;

(b) Left the ward and/or went for a lunch break without:

i. informing the senior midwife in charge, (Ms 7)

ii. handing over the care of patient A to (Ms 7)

(c) (i) Documented in Patient A's induction of labour proforma that you had handed over Patient A's care to (Ms 7) before going on your lunch break when you had not;

(ii) Your conduct at (i) above was dishonest;

(d) Refused to care for Patient A for 10 to 15 minutes after Patient A's transfer to the Labour ward to ensure appropriate assessment of fetal wellbeing;

(e) Informed (Ms1) of the Trust that Patient A was being monitored when she was not".


Miss Okafor did not accept that she had misconducted herself in any of the ways referred to above. She was insistent that all that was entailed in relation to the incident on 15 July 2009 was a "communication problem". She was adamant, before me as well as before the Panel, that she had done nothing wrong and that the incident was, as she repeatedly put it, only "minor".


The Panel did not agree with Miss Okafor about this. The Panel, accordingly, found that the charges against Miss Okafor in respect of the incident on 15 July 2009 were all proved.


The Panel then went on to consider the second and third sets of allegations, which were the subject of Charges 2 and 3 respectively and which stemmed from the investigation which was undertaken following the 15 July 2009 incident – a supervisory investigation performed by a Ms Hancock, Supervisor of Midwives at the Chelsea and Westminster Hospital. This investigation included an interview between Ms Hancock and Miss Okafor on 9 September 2009.


The investigation was completed by Ms Hancock three months later, on 9 December 2009. The investigation found that Miss Okafor had a number of deficiencies in her practice as a midwife, in particular that she had failed adequately to monitor the foetal heart rate and contractions during Patient A's labour. Ms Hancock also found the Miss Okafor had demonstrated a lack of insight in relation to the incident. Accordingly, Ms Hancock concluded...

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