Fife nurse Pauline Cafferkey put the public at potential risk of ebola infection when she let her temperature be wrongly recorded, it was claimed.
At a fitness to practice hearing, she has admitted allowing her temperature to be recorded as 37.5C during screening at Heathrow Airport after it had been measured at 38.3C.
She also admitted leaving Public Health England’s screening area without reporting her true temperature and not telling a doctor who later took her temperature at 37.5C that she had taken paracetamol.
However, she argued at the hearing of the Nursing and Midwifery Council in Edinburgh that the “errors of judgement” did not amount to misconduct and that her judgement was impaired by the onset of her illness and exhaustion.
During what was described as “chaotic” scenes at Heathrow on her return from six weeks helping the sick in Sierra Leone, Ms Cafferkey and other nurses and doctors in her group were allegedly “encouraged” to take each other’s temperatures.
Her legal representative Anu Thompson said screening staff were unprepared for the volume of passengers returning from at-risk countries on December 28, 2014.
A doctor in Ms Cafferkey’s group, referred to as Doctor 1, took her temperature at 38.2C then 38.3C a few minutes later, but said a nurse nearby, Registrant A, said she would record it as 37.2C and they would “get out of here and sort it out”.
Ms Thompson said: “Ms Cafferkey has stated she recalls the words ‘let’s get out of here’ being used but now cannot remember who said it or who entered the temperature of 37.2 on her screening form.”
She and the rest of her group were permitted to leave the screening area, but Ms Cafferkey returned after a doctor she met on the way to the arrivals area said she should not travel to Glasgow.
Ms Cafferkey, 40, originally from Crossgates but now living in Cambuslang, contacted the local health protection team and told them about her temperature and that she had taken paracetamol.
Public Health England’s health protection consultant was informed and the information passed to the ebola screening manager at Heathrow.
However, another doctor, Doctor 4, who accompanied Ms Cafferkey back to the screening area was not told she had taken paracetamol and the screening protocol form she filled in did not ask if she had.
The form has subsequently been changed and now requires information about paracetamol use.
Dr 4 recorded her temperature three times at or only slightly above 37.5C and cleared her for onward travel.
In the early hours of the next day Ms Cafferkey awoke feeling ill and was admitted to Glasgow’s Gartnavel Hospital with the highest viral load ever recorded of ebola.
Ms Cafferkey spent almost a month in isolation in London’s Royal Free Hospital and has twice been readmitted to hospital, once with a relapse and once with chronic meningitis.
Dr Emma Thomson, who treated Ms Cafferkey at Gartnavel, said that she was already in the early stages of her illness at Heathrow.
She said: “I have no doubt that a combination of early ebola virus infection and fatigue resulting from a busy night shift followed by a lengthy journey by bus across Sierra Leone then by plane to the UK via Morocco would have impaired Pauline’s judgement at the time of entering the screening process at Heathrow Airport.”
Ms Thompson said Ms Cafferkey was still acting in her professional capacity when she entered screening at Heathrow.
She and her fellow volunteers, more than anyone else, would have understood the significance of having their temperature taken, she said.
Indeed, she said, there was evidence that Ms Cafferkey had acted to distance herself from other passengers on her flight to Glasgow.
The risk of infection rises as symptoms of ebola progress and Ms Thompson acknowledged the risk in this case was low.
She said: “Ms Cafferkey did not start to develop those symptoms at the time she was in Heathrow or on the plane on her journey to Scotland however the fact she did not was down to misfortune.
“Ms Cafferkey did potentially put the public at risk at that time through her actions.”
Ms Cafferkey’s lawyer Joyce Cullen argued she was not acting in her professional capacity as she arrived in Heathrow.
At a very early stage when her elevated temperature became apparent, she said, she instead became a patient and she was relying on the guidance and influence of more senior health professionals around her.
She said: “As a result of chaotic procedures at Heathrow Ms Cafferkey and her party were encouraged to take their own temperatures. They should not have been allowed to do so by Public Health England.”
If the general public was put at risk, she said, it was for only a very short period of time.
She said: “The real damage done as a result of the failure to have Ms Cafferkey admitted to hospital when she should have been admitted to hospital was done to Ms Cafferkey herself.”
The panel heard that Ms Cafferkey had suffered significantly from her prolonged period in isolation and the intense media interest in the case.
It also heard that she was still recovering from her infection and her prognosis was uncertain.
Allegations she acted dishonestly were dropped.
The hearing in Edinburgh continues.