Dietitian 'didn't know where intestines were'

A dietitian who could not explain where the intestines were or what a gallbladder did was able to get a job at the Manchester Royal Infirmary (MRI) after lying in her application.

Ifenyinwa Ndulue-Nonso was sacked in August 2024 after an investigation found she was unable answer basic questions about anatomy or how to help patients manage common conditions.

She has now also been struck off by regulator the Health and Care Professions Tribunal Service (HCPTS) after a panel concluded she had shown "premeditated and sustained" dishonesty.

Manchester University NHS Foundation Trust, which runs MRI, said no patients had been harmed and it had since "strengthened" its recruitment process.

Ndulue-Nonso applied for the job as Band 6 rotational dietitian and was the only applicant interviewed in September 2023.

The tribunal heard that during the application and interview process she "came across as confident" and scored 28 out of a possible 45 points.

In her application, she had described how she had "in-depth" knowledge of providing dietary support to specialties including endocrinology, gastroenterology, and artificial feeding.

She also said she had experience of providing "medical nutrition therapy" to help patients manage conditions including malnutrition, HIV/AIDs, cancer, coeliac disease, irritable bowel syndrome, dysphagia (difficulty swallowing), and eating disorders.

She was hired and started work on 19 February 2024, having moved to the UK from Nigeria.

The panel heard the hospital also received satisfactory references from her previous employer.

However on 28 February her line manager, Curtis Jones, returned from annual leave and held an induction meeting with Ndulue-Nonso - where he noted her description of her previous job did not match what she had written in her application.

The tribunal heard a supervision log had already been started by other senior staff concerned about her apparent lack of knowledge.

An investigation was launched and Ndulue-Nonso was spoken to by a number of senior staff.

One, critical care dietetic clinical lead Lorna Haywood, told a senior colleague she believed Ndulue-Nonso "did not know the fundamentals of dietetics such as medical conditions, biochemistry and medications".

It was Haywood who asked her what organ "came after the stomach", and after "some prompting" Ndulue-Nonso incorrectly answered the large intestine.

Haywood told the tribunal she was extremely concerned because "this is basic anatomy which is fundamental to the role of dietitian".

She also said she found Ndulue-Nonso could not calculate a BMI correctly and did not know what the symptoms of dysphagia were.

"She could not tell me the risks of allowing somebody with dysphagia to eat standard diet, she did not know how to dietetically manage refeeding syndrome, she could not interpret biochemistry and she could not interpret symptoms," Haywood said.

The tribunal heard when staff noticed she was struggling to identify types of feeding tube, she said they were "different in Nigeria".

Ndulue-Nonso was suspended in March 2024 and sacked in August.

In her evidence to the tribunal Ndulue-Nonso claimed she had "some knowledge" of the Band 6 role but accepted she did not have "in-depth" knowledge.

When she was questioned by the tribunal she was asked what a gallbladder does and incorrectly replied that it was "part of the kidney, where urine is stored".

In fact the gallbladder is located below the liver and is involved in storing bile.

The hospital trust said Ndulue-Nonso was registered with the HCPTS at the point of employment.

It said concerns were raised by staff "within a few days".

A spokesperson added: "We ensured she was always supervised in the workplace as we conducted a rapid fact-finding exercise, following which swift action was taken and she was removed from her post."

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