Nursing and Midwifery Council determination — substantive hearing
NMC panel strikes off mental health nurse James Cole over medication errors and dishonesty
The NMC's Fitness to Practise Committee has struck mental health nurse James Cole off the register after finding he administered controlled drugs without a witness, gave a patient an incorrect lorazepam dose and dishonestly altered the medicine card to conceal the error.
MedicWatch editorial · Published 15 May 2026 · Updated 10 July 2026
Erasure (struck off the register)
Added to MedicWatch: 10 July 2026Report a correction
What does “struck off the register” mean?
Being struck off (the regulator calls this "erasure") removes the practitioner from the register. They are no longer permitted to practise this profession in the UK. Erasure can be reviewed after a minimum of five years, but is otherwise indefinite.
Concerning James Cole, nurse (Nursing and Midwifery Council 16K0423E).
Decision date: 15 May 2026 · Hearing started 13 May 2026 and ended 15 May 2026
In plain English
The NMC's Fitness to Practise Committee found that James Cole, a mental health nurse in Essex, administered controlled drugs without a witness on two occasions, gave a patient double the maximum prescribed dose of lorazepam, and dishonestly amended the patient's medicine card to conceal the error. It also found he failed to record a prescription change in a patient's handover notes. The panel found his fitness to practise impaired and made a striking-off order.
Charges
That, as a Band 5 registered nurse: (1) on 8 August 2019 he failed to record a prescription for IM medication in patient SD's handover notes; (2) he failed to follow medication policies, in that he administered controlled drugs without a witness on 5 October 2018 and 21 February 2019, administered an incorrect dosage of PRN medication to patient KT on 11 July 2019, and did not complete an incident report or escalate once aware of the error; (3) those failures amounted to a failure to preserve patient safety; (4) on 11 July 2019 he amended the dosage of PRN medication on patient KT's medicine card to give the misleading impression that he had administered the correct dosage; and (6) his actions in charge 4 amounted to dishonesty. A further charge of amending a medicine card on another, unknown, date (charge 5) was found not proved.
Findings
The panel found charges 1, 2a-2d, 3, 4 and 6 proved and charge 5 not proved. It found Mr Cole administered 2mg of lorazepam when the doctor had prescribed 0.5-1mg, then amended the doctor's entry on the MAR chart to cover up the error, which was dishonest applying the test in Ivey v Genting. It found the misconduct serious, identified deep-seated attitudinal concerns, and found fitness to practise impaired on public protection and public interest grounds. Noting Mr Cole's disengagement from the process, absence of insight and stated intention not to return to nursing, the panel concluded a striking-off order was the only sufficient sanction, with an 18-month interim suspension order to cover the appeal period.
Mitigating and aggravating factors
Mitigating factors
Admissions at local level.
Aggravating factors
Absence of insight into failings; conduct which deliberately or recklessly put people receiving care at direct risk of suffering harm; multiple deliberate breaches of the Code; deliberate and dishonest falsification of medical records to cover up wrongdoing; failure to act on supervision guidance and training; a pattern of misconduct over a period of time; failure to engage in the Fitness to Practise process; deep-seated attitudinal concerns.
Source
All facts on this page are drawn from the publicly published Nursing and Midwifery Council determination linked below. MedicWatch does not editorialise the regulator’s findings.
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