Joanne Lay (Registrant member) Seamus Magee (Lay member)

Transcription

1 Conduct and Competence Committee Substantive Hearing 28 April 2017 Nursing and Midwifery Council, Regus Belfast, Forsyth House, Cromac Square, Belfast, BT2 8LA Name of Registrant Nurse: Jacqueline Belshaw NMC PIN: 89J0149N Part(s) of the register: Registered Nurse- sub part 1 RN1 Adult- December 1992 SPA- Specialist Practitioner April 2001 Area of Registered Address: Northern Ireland Type of Case: Caution Panel Members: Barbara Stuart (Chair Lay member) Joanne Lay (Registrant member) Seamus Magee (Lay member) Legal Assessor: Marian Killen Panel Secretary: Marina Jones Registrant: Present and represented by Katrina Gray from BLM Law Nursing and Midwifery Council: Represented by Gregory Wedge, instructed by NMC Regulatory Legal Team. Facts proved by admission: 1 Facts not proved: N/A Fitness to practise: Sanction: Impaired Caution order (five years) 1

2 Details of charge: That you a registered nurse: 1. On 28 June 2016 received a police caution for theft of sleeping tablets, to an unquantified value from Belfast City Hospital. And, in light of the above, your fitness to practise is impaired by reason of your caution. 2

3 Decision and Reasons on application under Rule 19 At the outset of the hearing Ms Gray on your behalf made a request that the hearing of your case be held in private on the basis that proper exploration of your case involves your health condition. Mr Wedge supported the application. The legal assessor reminded the panel that while Rule 19 (1) provides, as a starting point, that hearings shall be conducted in public, Rule 19 (3) states that the panel may hold hearings partly or wholly in private if it is satisfied that this is justified by the interests of any party or by the public interest. Having heard that there will be reference to your health, the panel determined to hold such parts of the hearing in private. The panel determined to rule on whether or not to go into private session in connection with your health as and when such issues are raised. Background The NMC received a referral dated 17 May 2016 from the Executive Director of Nursing and User Experience at Belfast Health and Social Care Trust (BHSCT) regarding you. At the material time you were employed as a Band 5 Staff Nurse in Belfast City Hospital Ward 2B of Cancer Centre Ward. On 11 April 2016 the Service Manager in the Cancer Centre was notified by staff that ward 2b had been using three boxes of Zopiclone 7.5mg each week. This was the ward s entire stock and the usage could not be accounted for by patient numbers. The ward Pharmacist was instructed to count the number of tablets at the start and then at the end of each shift. 3

4 That night you were moved from ward 2b to ward 3b. That ward Sister counted her stock of Zopiclone and reported to have two full boxes, each box containing two strips of 14 tablets. The stock was counted the following morning and a strip of 14 tablets had been taken from each box. This could not have been accounted for by patient prescriptions. On 14 April 2016 the ward stock of Zopiclone was 112 tablets. On 18 April 2016 only 42 tablets remained. You worked a night shift on 15 April 2016 and 17 April You also worked a night shift on 18 April 2016 and on 19 April 2016 it was found that a further 14 tablets were missing. On 19 April 2016 CCTV observed you taking a quantity of Levomepromazine 12.5mg from a drug cupboard in the clinical room. No patients were prescribed that drug at that time. You admitted taking the tablets in a meeting between you and the Service Manager. On 20 April 2016 you attended Musgrave PSNI voluntarily and made a full admission to the theft of the tablets. On 28 June 2016 you received a police caution for theft of sleeping tablets, to an unquantified value from Belfast City Hospital. Decision and Reasons on facts The panel noted that you admit charge 1. It also had regard to the certificate of caution dated 28 June The panel found charge 1 proved by way of admission. Decision on impairment: 4

5 Having announced the charge proved by way of admission, the panel then moved on to consider whether your fitness to practise is currently impaired by reason of your caution. The NMC has defined fitness to practise as a registrant s suitability to remain on the register unrestricted. The panel bore in mind that impairment is a matter for its professional judgment. The panel considered all of the information before it including a bundle of documents from you [PRIVATE] [PRIVATE] The reference dated 23 February 2017 from your former employer, the Nurse Manager at Phoenix Healthcare, for whom you worked as a Healthcare Assistant between October 2016 and January 2017 states: Jacquie made us fully aware from the beginning about the NMC proceedings. Jacquie was well liked by staff and residents and always acted in a professional manner, showing great care and compassion to our residents. Her appraisals were excellent and we were sorry to lose her. The reference dated 21 April 2017 from your current employer, the Haematology Assistant Service Manager at BHSCT. You have worked as a Band 5 Staff Nurse to the Anticoagulant Service since 22 February 2017, although you took a period of leave [PRIVATE]. This states: Jaqueline has settled well into the team and is very keen to learn and develop her skills I have only known Jacqueline for a short period, but I have always found her very respectful, and have no cause to be concerned re her honesty and integrity. 5

6 The panel also had regard to your response to the charges dated 25 May 2016 in which you admit the charge. [PRIVATE] You gave evidence to the panel. You told the panel that you first started working in Belfast City Hospital in 1993, shortly after qualifying. You said that you have worked in the Oncology Department for 20 years. You said that following the police caution you went through an investigation and disciplinary hearing and were dismissed in September You appealed the decision and were re-instated to your current post in February You said that you currently work in the Outpatients Department for BHSCT. You said that you are under an interim conditions of practice order which restricts your practice to your current employer and prevents you from working with medication. You said that the department you currently work in has very little to do with medication and you personally have no access to it. You told the panel that you will be registering for an administration of medicines management course if you are permitted to deal with medication following this hearing. [PRIVATE] You said that you are remorseful about what happened and you would never repeat your actions. You said that you know what you did was wrong and you would never want to lose your job or bring your profession into disrepute ever again. [PRIVATE] you do not feel that, if you were working with medication in the future, you would be tempted to repeat your actions. 6

7 Mr Wedge, on behalf of the NMC, submitted that there is agreement between the NMC, you are your representative that your fitness to practise is impaired. He submitted that there is a risk to patients in that medication is for patients and if medication is being stolen then it is not available for patients. He submitted that you committed theft and therefore it is clear that you brought the profession into disrepute and breached fundamental tenets of the profession. Mr Wedge reminded the panel that it must take into account the steps you have taken towards remedying your practice and whether or not there is a risk of repetition and in considering this it must take into account your evidence. He submitted that the panel may feel that there is no risk of repetition bearing in mind the steps you have taken and the fact that your conduct has been exemplary throughout the NMC process. Mr Wedge submitted that the panel should find that your fitness to practise is impaired both on public protection and public interest grounds. However, if the panel consider that you have sufficiently remediated your practice then he submitted that the panel should find that your fitness to practise is impaired on the grounds of the public interest in order to maintain and uphold public confidence in the profession. Ms Gray submitted that you admit impairment. However, she recognised that this is a matter for the panel and referred it to all the evidence before it. The panel has accepted the advice of the legal assessor. Nurses occupy a position of privilege and trust in society and are expected at all times to be professional and to maintain professional boundaries. Patients and their families must be able to trust nurses with their lives and the lives of their loved ones. To justify that trust, nurses must be honest and open and act with integrity. They must make sure that their conduct at all times justifies both their patients and the public s trust in the profession. In this regard the panel considered the judgement of Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery 7

8 Council (2) Grant [2011] EWHC 927 (Admin) in reaching its decision, in paragraph 74 she said: In determining whether a practitioner s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances. Mrs Justice Cox went on to say in Paragraph 76: I would also add the following observations in this case having heard submissions, principally from Ms McDonald, as to the helpful and comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman, referred to above. At paragraph she identified the following as an appropriate test for panels considering impairment of a doctor s fitness to practise, but in my view the test would be equally applicable to other practitioners governed by different regulatory schemes. Do our findings of fact in respect of the doctor s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he: a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or 8

9 c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or d. has in the past acted dishonestly and/or is liable to act dishonestly in the future. The panel finds that you have in the past placed patients at risk of harm, have brought the profession into disrepute, have breached fundamental tenets of the profession and have acted dishonestly in stealing medication from your place of work. The panel was of the view that you were a credible and sincere witness. You admitted what you had done and it was clear to the panel that you regret your actions. [PRIVATE] You have recognised the impact that your actions had on patients and the reputation of the profession and have put in place tested support structures to ensure that you would not bring the profession into disrepute in the same way in the future. You have fully engaged with the Trust s investigation and the NMC process and fully admitted the charge at the earliest opportunity. The panel was of the view that you have shown deep remorse for your actions and have a high level of insight into your behaviour. [PRIVATE] Given the high level of insight and remorse you have shown, in addition to the steps you have taken to remediate your practice, the panel decided that the risk of repetition is low. However, the panel noted that you have committed multiple thefts from your workplace which could have had a large impact on the safety of your patients. The seriousness of your actions and the level of dishonesty demonstrated by you in stealing from your 9

10 place of work, albeit dishonesty that was committed with extenuating circumstances, means that the panel has to conclude that your fitness to practise is impaired on the grounds of public protection. In addition, the panel bore in mind the overarching objective of the NMC: to protect, promote and maintain the health safety and well-being of the public and patients and the wider public interest which includes promoting and maintaining public confidence in the nursing and midwifery professions and upholding the proper professional standards for members of those professions. Your conduct in stealing medication from your workplace was serious and the panel conclude that a finding of impairment was necessary in order to uphold public confidence in the profession. Having regard to all of the above, the panel was satisfied that your fitness to practise is currently impaired on both public protection and public interest grounds. 10

11 Determination on sanction: The panel considered this case very carefully and decided to make a caution order for a period of five years. The effect of this order is that your name on the NMC register will show that you are subject to a caution order and anyone who enquires about your registration will be informed of this order. In reaching this decision, the panel considered the submissions on behalf of the NMC and on your behalf. Mr Wedge submitted that the panel should balance the severity of the impairment and the protection of the public with your interests. He submitted that the panel should consider the findings it has made in respect of your insight and the steps you have taken to remedy your practice when reaching its decision. Ms Gray told the panel that you are a nurse of 25 years practice. She asked the panel to bear in mind that there are no clinical issues with your practice and referred the panel to the references which confirm you have worked well since this incident. She reminded the panel that there was no direct harm caused to patients with your actions, which were an error in judgment. She submitted that you have demonstrated insight, made full admissions and never sought to excuse your conduct. She submitted that you recognise your mistakes and what caused them and have now put in place measures to ensure it does not happen again. She referred the panel to the testimonials and references written on your behalf which state that you have shown remorse for your actions. Ms Gray reminded the panel that you have given clear evidence about what you would do to ensure there is no repetition of the behaviour in similar circumstances. Ms Gray submitted that a striking- off order and a suspension order would be disproportionate given the remedial steps you have taken. She submitted that you were under difficult personal circumstances at the time which you have taken steps to ensure 11

12 will not occur again. She submitted that these orders would be punitive and outlined your financial circumstances to the panel. Ms Gray submitted that a caution order at the highest level would be sufficient in order to mark the seriousness of your actions but would also take account of the steps you have taken to remediate your practice. Ms Gray submitted that in the alternative, a conditions of practice order would be workable. She told the panel that you have worked well under your current interim conditions of practice order and could continue to do so with your current employer. In reaching this decision, the panel has had regard to all the evidence that has been adduced in this case. The panel accepted the advice of the legal assessor. The panel has borne in mind that any sanction imposed must be appropriate and proportionate and, although not intended to be punitive in its effect, may have such consequences. The panel had careful regard to the Indicative Sanctions Guidance ( ISG ) published by the NMC. It recognised that the decision on sanction is a matter for the panel, exercising its own independent judgement. The panel first considered the aggravating and mitigating factors in this case. The panel identified the following aggravating factors in this case: Your conduct placed patients at risk; There was a risk that medication may not have been available to patients had they needed it; The panel noted the Disciplinary Appeal Hearing letter from BHSCT dated 02 November 2016 which references similar issues that arose in 2009; Your conduct was deliberate and took place over a period of time and was not simply an error in judgment; Your conduct brought the nursing profession into disrepute. 12

13 The panel identified the following mitigating factors in this case: Your difficult personal circumstances at the time; You have a huge amount of insight; You have shown remorse; You have put in place steps to ensure this would not happen again; There are no clinical issues in your practice; There is no evidence of actual patient harm; You have had a long career as a nurse; You admitted the theft and have never sought to excuse your behaviour. The panel bore in mind your evidence and the positive references written on your behalf. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the seriousness of the case. To take no action would not protect the public and would not satisfy the public interest. Next, in considering whether a caution order would be appropriate in the circumstances, the panel took into account the ISG, which states that a caution order may be appropriate where the case is at the lower end of the spectrum of impaired fitness to practise and the panel wishes to mark that the behaviour was unacceptable and must not happen again. [PRIVATE] You have shown a high level of insight and remediated your practice. The panel was satisfied that if you were to have access to medication whilst at work again, you would not repeat your conduct. Whilst your conduct was serious, the panel is of the view that this is not at the higher end of the spectrum of impaired fitness to practise. Given the low risk of repetition in this case, the panel is of the view that a caution order would adequately protect the public in this case. The panel noted that you have been re-instated by your employer as a Staff Nurse and your current employer has no concerns about your practice. It reminded itself of the reference from your current employer dated 21 April 2017 which states: 13

14 [I] have no cause to be concerned re her honesty and integrity. Given that there are no clinical issues with your practice, the panel is also of the view that a caution order would adequately protect the public. However, given the seriousness of police caution, and the fact that you took an unknown quantity of medication from your employer over a significant period of time, the panel was of the view that the caution order should be in place for a substantial period of time. The panel was of the view that a caution order for a period of five years was appropriate in order to mark the seriousness of this case and to send a message to the profession and the public that such conduct is not acceptable behaviour for a registered nurse. The panel did go on to consider a conditions of practice order but decided that this was not appropriate given that there are no clinical issues with your practice. The panel did consider imposing a suspension order given the seriousness of this case. However, the panel had the benefit of your full engagement with these proceedings and hearing from you in oral evidence. Given the high level of insight, the steps you have taken to remediate your practice and the positive references from your current employer about your current practice, the panel was of the view that this would be disproportionate. The panel was of the view that to impose a suspension order would not be in the public interest in that it would deprive the public of an experienced nurse. That concludes this determination. A copy of this determination will be sent to you in due course. 14