Nursing and Midwifery Council Fitness to Practise Committee. Substantive Order Review Meeting

Transcription

1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Meeting 15 January 2019 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of registrant: NMC PIN: Chiper Laurentiu-Adrian 14E0496C Part(s) of the register: Nursing Sub Part 1 Registered Nurse Adult (May 2014) Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Romania Lack of Competence Julie Tindale (Chair, Registrant member) Susan Greenwood (Registrant member) Gill Madden (Lay member) Nigel Mitchell Order being reviewed: Suspension Order (6 months) Outcome: Striking Off Order, to come into effect at the end of 27 February

2 Service of Notice of Meeting The panel was informed that the notice of this meeting was sent to Mr Laurentiu-Adrian on 28 November 2018 by recorded delivery and first class post to his registered address. The notice informed Mr Laurentiu-Adrian that this order would be reviewed before its expiry at a meeting on or after 14 January 2019 and gave him the opportunity to request a hearing. The panel accepted the advice of the legal assessor. In the light of the information available the panel was satisfied that notice had been served in accordance with Rules 11A and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended February 2012) (the Rules). Decision and reasons on review of the current order The panel decided to make a striking-off order. This order will come into effect at the end of 27 February 2019 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the third review of a suspension order, originally imposed by a panel of the Conduct and Competence Committee on 29 July 2016 for 12 months. The order was reviewed on 12 July 2017, where a further period of suspension for 12 months was imposed. At the second review, on 18 July 2018, a further suspension for a period of 6 months was imposed. The current order is due to expire at the end of 27 February The panel is reviewing the order pursuant to Article 30(1) of the Order. The charges found proved which resulted in the imposition of the substantive order were as follows: 2

3 That you, a Registered Nurse, failed to demonstrate the standard of knowledge, skill and judgement required for practice without supervision as a registered nurse as set out in, but not limited to, the following charges: 1. The required skills and/or knowledge in the administration of medication on one or more of the following occasions: 1.1 On an unknown date between 5 July 2015 and 11 August 2015, without prompting: Did not take the top off a needle in order to administer medication to Resident K; Did not check Medication Administration Records ("MAR") sheets to determine what medication had to be administered to unknown resident/s; Did not take the medication trolley with you when completing a drugs round; 1.2 On 22 August 2015, without prompting: Did not support Resident A's head with a back rest when administering medication to her; Did not administer the correct dose of Co-codamol medication to Resident C; Did not check bowel charts prior to administering anticonstipation medication to Resident A and/or Resident C and/or Resident D; Did not check the MAR sheet for Resident F to determine what controlled drug patch medication needed to be administered; 2. The required skills and/or knowledge in the practice of infection control measures on one or more of the following occasions: 3

4 2.1 On one or more occasions on unknown date/s between 5 July 2015 and 11 August 2015 wore: A long sleeved shirt and/or a jumper under your nursing tunic; An unclean uniform; 2.2 On an unknown date between 5 July 2015 and 11 August 2015: During the treatment of Resident L's ulcer by a colleague using aseptic technique, touched the area around the ulcer; Did not wash your hands after assisting a colleague in changing an unknown resident's incontinence pad/s; 2.3 On 22 August 2015 did not wash your hands without being prompted to do so after attending to Resident B; 3. The required skills and/or knowledge in record keeping on one or more of the following occasions: 3.1 On an unknown date/s between 5 July 2015 and 11 August 2015, did not complete MAR sheet/s to record medication administered to unknown resident/s; 3.2 On 16 August 2015 did not complete without prompting the following record/s for unknown resident/s of the care delivered to them: Fluid chart/s; Turn chart/s; Continence chart/s; 4

5 3.3 On 22 August 2015 did not complete the following record/s for unknown resident/s of the care delivered to them: Fluid chart/s; Mattress checks; Turn chart/s; And in light of the above, your fitness to practise is impaired by reason of your lack of competence. The first reviewing panel determined the following with regard to impairment: The panel has considered carefully whether Mr Laurentiu-Adrian s fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decision of the last panel. However, it has exercised its own judgment as to current impairment. The panel has had regard to all of the documentation before it. The panel heard and accepted the advice of the legal assessor. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. The panel was satisfied that there continues to be no engagement or new information about Mr Laurentiu-Adrian s fitness to practise since the imposition of the original suspension order and that therefore, with no evidence of any further 5

6 insight or remediation into his lack of competence, there remains a risk of repetition. The panel bore in mind that its primary function was to protect patients and the wider public interest which includes maintaining confidence in the nursing profession and upholding proper standards of conduct and performance. For these reasons, the panel finds that Mr Laurentiu-Adrian s fitness to practise remains impaired. The first reviewing panel determined the following with regard to sanction: Having found Mr Laurentiu-Adrian s fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel noted that its powers are set out in Article 29 of the Order. The panel has also taken into account the NMC s Indicative Sanctions Guidance (ISG) and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to take no further action. The panel then considered whether to impose a caution order but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to impose a caution order. The panel considered substituting the current suspension order with a conditions of practice order. Without any new information regarding Mr Laurentiu-Adrian s insight or remediation, the panel would not able to formulate workable or practicable conditions at this time that would manage the wide ranging lack of competence that has been identified. Further, as Mr Laurentiu-Adrian has not 6

7 engaged with these proceedings, there is no evidence that he would be willing to comply with any conditions imposed on his practice. The panel considered the imposition of a further period of suspension. It reminded itself that, at this time, it could not impose a striking-off order. The panel was of the view that a suspension order would allow Mr Laurentiu-Adrian a further opportunity to fully reflect on his previous failings and provide the next reviewing panel with evidence of his progress towards remediation. The panel concluded that a further 12 month suspension order would be the appropriate and proportionate response and would afford Mr Laurentiu-Adrian adequate time to develop his insight and remediation. At the end of the suspension order, another panel will review the order. At the review hearing the panel may revoke the order, or it may confirm the order, or it may replace the order with another order including a striking off order. The second reviewing panel determined the following with regard to impairment: In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. The last reviewing panel determined that Mr Laurentiu-Adrian was liable to repeat matters of the kind found proved. This panel has not received any new information in regards to Mr Laurentiu-Adrian s remediating his clinical failings. Mr Laurentiu-Adrian explained in an on 19 June 2018 that he is currently working in Romania as a nursing nurse. However, the panel determined that more information was needed to demonstrate remediation of the specific failings found proved. Without such evidence, the panel has no choice but to conclude that Mr Laurentiu-Adrian remains a risk to patients. For these reasons, the panel finds that Mr Laurentiu-Adrian s fitness to practise remains impaired. 7

8 The second reviewing panel determined the following with regard to sanction: The panel first considered whether to take no action but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel then considered whether to impose a caution order but concluded that this would be neither proportionate nor in the public interest, and will not protect the public. The panel next considered replacing the current order with a conditions of practice order. This panel agreed with the previous reviewing panel that it would not able to formulate workable or practicable conditions that would manage the wide-ranging lack of competence that has been identified in Mr Laurentiu- Adrian s practice. The panel next considered imposing a further suspension order. It reminded itself that, at this time, it could not impose a striking-off order. Mr Laurentiu-Adrian has not demonstrated any insight or evidence of remediation into his previous failings. The panel was of the view that considerable evidence would be required to show that Mr Laurentiu-Adrian no longer posed a risk to the public. The panel concluded that a further 6 month suspension order would be the appropriate and proportionate response that would protect the public. At the end of the suspension order, another panel will review the order. At the review hearing the panel may revoke the order, or it may confirm the order, or it may replace the order with another order including a striking off order should Mr Laurentiu-Adrian fail to provide evidence of remediation into his clinical failings. Decision on current fitness to practise The panel has considered carefully whether Mr Laurentiu-Adrian s fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register 8

9 without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decision of the last panel. However, it has exercised its own judgment as to current impairment. The panel has had regard to all of the documentation before it. The panel accepted the advice of the legal assessor. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. The panel considered whether Mr Laurentiu-Adrian s fitness to practise remains impaired. This panel noted that in an , dated 19 June 2018, Mr Laurentiu-Adrian told the last reviewing panel that he was currently working in Romania as a nursing nurse. He provided no further information and he has not supplied any additional information, or indeed been in contact with the NMC, since then. In all the circumstances, this panel has no material or information to suggest that Mr Laurentiu-Adrian s fitness to practise is no longer currently impaired. For these reasons, and taking into account the charges found proved were serious and wide-ranging, the panel finds that Mr Laurentiu-Adrian s fitness to practise remains impaired, on both public protection and public interest grounds. The patients under his care were at significant risk of harm. Determination on sanction Having found Mr Laurentiu-Adrian s fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel noted that its powers are set out in Article 29 of the Order. The panel has also taken into account the NMC s Sanctions Guidance (SG) and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. 9

10 The panel first considered whether to take no action but concluded that this would be inappropriate in view of the seriousness and nature of the case. The panel decided that it would be neither proportionate nor in the public interest to take no further action. The panel then considered whether to impose a caution order but concluded that this would be inappropriate in view of the nature and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to impose a caution order. The panel considered substituting the current suspension order for a conditions of practice order, and determined that it could not formulate practicable or workable conditions that would manage and resolve the wide-ranging lack of competence identified in this case. Furthermore, save for the from June 2018, Mr Laurentiu- Adrian has not engaged with these proceedings; a conditions of practice order requires engagement on the part of the registrant to be workable. The panel considered that there would, in the circumstances of this case, still be a risk to patient safety were Mr Laurentiu-Adrian to practise, even with conditions of practice in place. The panel therefore considered that a conditions of practice order would be inappropriate in this case. The panel next considered imposing a further suspension order. This panel did note that the last reviewing panel reminded itself that, this being a lack of competence case, a striking off order was not available to it at that time. The panel considered that, since being first suspended on 29 July 2016, Mr Laurentiu-Adrian has not engaged with the NMC in relation to the wide ranging lack of competence identified in this case. The panel has no evidence therefore that he has any insight into his lack of competence, and therefore there remains a significant risk of repetition of the conduct which gave rise to the charges being found proved. This panel considered that the substantive panel imposed a 12 month suspension order to mark the severity of the case and to allow Mr Laurentiu-Adrian to engage with nursing in the United Kingdom, and to retrain. The first reviewing panel, when imposing a further 12 month suspension order, also commented that this would afford Mr Laurentiu-Adrian adequate time to develop his insight and remediation. As already stated herein, the last reviewing panel noted that this panel would have the power to make a striking-off order. 10

11 The panel determined that a further period of suspension would not serve any useful purpose in all of the circumstances. Further, there is a duty on registrants to engage with their regulator and Mr Laurentiu-Adrian has significantly neglected this duty. This panel considered that, given Mr Laurentiu-Adrian s wide-ranging lack of competence and protracted lack of engagement (despite repeated opportunities), Mr Laurentiu- Adrian s conduct was fundamentally incompatible with remaining on the NMC register. The panel therefore determined that it was necessary to take action to prevent Mr Laurentiu-Adrian from practising in the future and concluded, in light of Mr Laurentiu- Adrian s repeated non-engagement, lack of insight or remediation, that the only sanction that would adequately protect the public and serve the public interest in maintaining trust and confidence in the nursing profession and in the NMC as regulator was a striking-off order. The panel considered that the public are adequately protected by the current suspension order, and therefore this striking-off order will come into effect at the end of 27 February This decision will be confirmed to Mr Laurentiu-Adrian in writing. That concludes this determination. 11