“They didn’t give value to Nicole’s life” – Ann Norton

COUNCILLOR Ann Norton still feels sick in her stomach seven years after recalling a “horrendous” experience in University Hospital Limerick when a Do Not Attempt Resuscitation (DNAR) was allegedly placed on her daughter’s medical file without their consent.

While Nicole Norton (25), who is a wheelchair user with Cerebral Palsy, is still very distressed over this incident, she felt strongly this had to be challenged to ensure no other vulnerable patient or family will experience what she and her mother went through in UHL back in April 2016.

A hospital consultant appeared before a medical inquiry over his direction that Nicole Norton did not have the capacity to decide herself if she should be resuscitated in the event of a cardiac arrest.

Dr Hassan Zaid was accused of poor professional performance at Irish Medical Council’s (IMC) fitness-to-practise committee following two separate complaints submitted by Ann and Nicole within weeks of this “distressing” incident.

Following a screening process, the IMC decided the complaints warranted a full investigation.

On April 7, 2016, Nicole had to be admitted by her GP to the ED in UHL with suspected pneumonia and sepsis.

In an interview with the Clare Champion, Ann recalled she told Dr Zaid Nicole wasn’t intellectually challenged and was very aware of what was happening and could hear what was being said.

When Dr Zaid asked her to sign a DNAR, Ann said she refused as she had seen Nicole go through major surgeries previously and she felt a DNAR was unwarranted.

“I was standing there with my mouth open. We didn’t think it was anywhere near that stage. I remember asking why, I was in such shock. I was totally speechless. He gave no explanation or logical reasons as to why he wanted me to sign it. I don’t remember signing the DNAR.”

About two hours later, Ann said Dr Zaid came back explained the DNAR to Nicole, describing in detail what he would need to do to he if she had a cardiac arrest.

“Nicole said she didn’t want to die, she was not dying. She was hysterically crying. He didn’t spend enough time with her at all. Dr Zaid was horrified that we didn’t see his point of view and stormed out,” she claimed.

Acknowledging every patient’s experience of UHL is different, Ann pointed out a number of family members have not been happy with their care in UHL.

“They didn’t give value to Nicole’s life. That is something I found very difficult. As a parent, I have been fighting for Nicole for 25 years and a split second changes that. What happened is heartbreaking.

“It is something that will never leave our heads. It was unbelievably so horrendous. You still feel sick in your stomach now almost seven years later. It still has a traumatic effect on us.

“We were delighted to show that Nicole is still here to tell her story, she has gone to study psychology, counselling and business in Maynooth and TUS in third level and gives her time to families who come to Clare Crusaders’ Clinic.

“We want people to hear Nicole’s story so that it doesn’t happen to other families and so they don’t go through what we went through over the last seven years,” she said.

The hearing was told Dr Zaid had not completed his specialist training at the time but was acting up as a locum consultant due to the shortage of consultants at UHL.

The DNAR order by Dr Zaid was revoked within a few hours after the girl’s family had raised concerns with the hospital and their family doctor.

Nicole said she didn’t want anyone else in a similar situation to have her experience.

“I know one or two families who have been in a similar situation. I still have the affects from it.

Every time I need to go to the ED in UHL my heart rate goes so high I am at risk of a heart attack.

I don’t want doctors presuming I shouldn’t be consulted in decision making or don’t understand what they are doing because I have Cerebral Palsy.

I have been through all the health system. I give advice to my GPs on ways of communicating with children who have disabilities,” she said.

Dr Zaid, who now works as a consultant gastroenterologist at Bon Secours Hospital in Tralee, apologised unreservedly at the end of the hearing to Nicole, her mother and family for not demonstrating sufficient respect for the then teenager.

However, the inquiry heard that the doctor does not accept a complaint of poor professional performance.

Counsel for the IMC, Neasa Bird BL, said Dr Zaid faced six allegations of poor professional performance over his treatment of the patient and her mother.

It was claimed the (DNAR) order for the patient was not clinically warranted or in her best interest and wasn’t obtained by adequate agreement.

Another allegation was Dr Zaid had wrongly presumed or concluded that the patient lacked the capacity to make her own decision about resuscitation or had failed to facilitate her participation in the decision-making process.

It was claimed he had also failed to communicate adequately with the patient’s mother and to obtain further information about the girl’s quality of life.

Counsel for Dr Zaid, Michael Counihan SC, made a successful application to stop the hearing on the basis that his client would give an undertaking not to repeat the conduct which was the subject of the complaint.

Mr Counihan pointed out that Dr Zaid, was dealing with a “very difficult hospital situation” on the day as he was providing care for 70 patients, including 40 new patients.

The barrister said Dr Zaid’s dealings with the patient were “out of character” with his normal standards and professionalism.

The committee noted that Dr Zaid has demonstrated insight and has undergone remedial training and will undergo further remedial training focusing on communication with vulnerable patients.

It noted the admissions made by Dr Zaid about his conduct and his undertaking not to repeat this.

Stating the Dr Zaid was not on the special register in April 2016, the committee noted he was on duty on his first day of acting up as a locum consultant, his patient cohort was 40 in-patients plus 30 new admissions.

The committee noted the standard applicable to non-consultant hospital doctor is different to that of a consultant, which created another issue in this case.

It was stated during the end of the hearing there has been no prior or subsequent issues about the professional conduct of Dr Zaid, who was supported by two very strong testimonials from two senior consultants about his clinical competence, knowledge and skill, as well as his exemplary behaviour and conduct with patients.

The committee believes from all it has heard that this was a singular event in which Dr Zaid “let himself down” in his interactions with Nicole Norton and her family.

It acknowledged this must have been a very distressing event for Nicole.

The committee is satisfied that Dr Zaid has apologised fully, remediated his conduct, demonstrated acceptance of the failings in his conduct and shown insight into his own behaviour such that he doesn’t represent a danger to the public.

It considers that this case has been a salutatory lesson and a steep learning curve for Dr Zaid and that he has learned from this incident.

The committee reassured Nicole that it fully considered and took into account her wishes, but having regard to the very many complex issues in this case, and the admissions and apology of Dr Zaid, it considered the undertakings offered by him are appropriate in all of the circumstances.

Committee chairman, Ronan Quirke requested Dr Zaid to provide an undertaking under oath and in written form to the solicitors for the MC chief executive officer.

Dr Zaid gave an undertaking not to repeat the conduct that was the subject of the complaint; complete a course on communications with vulnerable patients within 12 months of the signing of this undertaking and provide evidence of his successful completion of this course to the Medical Council.

This has to be accompanied by a reflective statement of the key learnings from this course.

Dan Danaher