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 23 November 2018 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of registrant: NMC PIN: Mr Gheorghe-Ionut Ticala 16B0335C Part(s) of the register: Registered Nurse Sub Part 1 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: England Misconduct Mrs Deborah Jones (Chair, lay member) Mrs Pauline Esson (Registrant member) Ms Susan Tokley (Registrant member) Mr Richard Ferry-Swainson Order being reviewed: Outcome: Conditions of Practice Order (12 months) Suspension Order (12 months) to come into effect on 29 December 2018 in accordance with Article 30 (1)

2 Service of notice of meeting The panel was informed at the start of this meeting that notice had been sent to Mr Ticala on 19 October 2018 by recorded delivery and first class post to his registered address. The notice informed Mr Ticala that his conditions of practice order would be reviewed before its expiry at a meeting on or after 19 November 2018 date and gave him the opportunity to request a hearing. The panel noted that no request for a hearing had been made by Mr Ticala. The panel observed that notice of this hearing was delivered to Mr Ticala s registered address on 20 October Further, the panel noted that information about his upcoming review was sent to Mr Ticala by on 5 September The following day Mr Ticala had called the NMC by telephone and indicated that he was in Romania and would not be returning to the UK for the review. He said he was happy for the review to be dealt with at a meeting. 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 11 and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended February 2012) (the Rules).

3 Decision and reasons on review of the current order The panel decided to make a suspension order for 12 months. This order will come into effect at the end of 29 December 2019 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the first review of a conditions of practice order, originally imposed by a Fitness to Practise panel on 29 November 2017 for 12 months. The current order is due to expire on 29 December 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: That you, a Registered Nurse, whilst working at Manchester House Nursing Home: 1. Incorrectly administered an additional dose of Amlodipine 10mg to Resident A on one or more of the following occasions: a. 16 March 2016 b. 18 March 2016 c. 21 March 2016 d. 22 March 2016 e. 24 March 2016 f. 26 March 2016 g. 27 March 2016 h. 28 March Failed to administer Sodium Valproate 100mg and/or Sodium Valproate MR300 mg to Resident B on one or more of the following occasions: a. 16 May 2016 b. 17 May 2016 c. 22 May 2016

4 d. 25 May 2016 e. 26 May 2016 And, in light of the above, your fitness to practise is impaired by reason of your misconduct. The substantive hearing panel determined the following with regard to impairment: The panel was of the view that, by incorrectly administering an additional dose of Amlodipine to Resident A on eight occasions, and failing to administer the Sodium Valproate doses to Resident B, on seven occasions, Mr Ticala put both Residents A and B at unwarranted risk of harm. Further, by failing to carry out a fundamental aspect of his role in administering the medicines according to valid prescriptions, Mr Ticala has brought the nursing profession into disrepute. The panel considered that, by placing patients in his care at risk of harm and by failing to deliver basic care, Mr Ticala has breached fundamental tenets of the nursing profession. Regarding insight, the panel took into account Ms 1 s witness statement and oral evidence. The panel noted that Mr Ticala had admitted to and apologised for his error in an informal counselling session with Ms 1 on 31 March 2016, in relation to Resident A. With regard to Resident B, Ms 1 s evidence stated that: We specifically asked Mr Ticala if he was fully aware of why we were holding the investigation and the disciplinary inquiry. He confirmed that he did know but he had no explanation to give except that this was a mistake. The panel acknowledged Mr Ticala s recognition of his mistake. Nevertheless, the panel considered that there was no evidence before it to indicate any meaningful remorse on his part or that he has developed any insight into his actions. The panel noted that Mr Ticala has returned to Romania. There was no information before the panel concerning his current employment and whether he

5 has undertaken any steps to remediate his misconduct, which the panel considered to be of a remediable nature. The panel considered that Mr Ticala had repeatedly made medicines administration errors despite being given a warning by the Home. In the absence of any evidence of remorse, insight and remediation, the panel was satisfied that there remains a high risk of Mr Ticala repeating his actions. The panel therefore decided that a finding of impairment is necessary on the grounds of public protection. The panel bore in mind that the overarching objectives of the NMC are to protect, promote and maintain the health safety and well-being of the public and patients, and to uphold/protect 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. The panel went on to ask itself whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment of fitness to practise were not made in the current circumstances. The panel concluded that it would and that a finding of impairment on public interest grounds is required. Having regard to all of the above, the panel was satisfied that Mr Ticala s fitness to practise is currently impaired. The substantive hearing panel determined the following with regard to sanction: The panel had regard to the mitigating and aggravating features of the case. The panel considered that these could be summarised as follows: Mitigating factors: There was no evidence of any previous regulatory concerns in relation to Mr Ticala s practice;

6 Aggravating factors: Mr Ticala committed multiple medicines administration errors in the direct care of vulnerable residents, which put them at risk of harm He had made a second set of medicines administration errors after receiving a warning with regard to the first set, two months prior There is no evidence of insight or remediation The panel first considered whether to take no action but concluded that this would not provide sufficient public protection given the risk of repetition and would be insufficient to satisfy the public interest in light of the seriousness of the misconduct. The panel decided that it would be neither proportionate nor in the public interest to take no further action. In considering whether a caution order would be appropriate in the circumstances, the panel took into account the NMC Sanctions Guidance, 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. The panel considered that although Mr Ticala s misconduct could be regarded as towards the lower end of the spectrum, a caution order would be inappropriate because of the need to protect the public against the risk of repetition identified. The panel next considered whether placing conditions of practice on Mr Ticala s registration would be a sufficient and appropriate response. The panel is mindful that any conditions imposed must be proportionate, measurable and workable. The panel took into account the Sanctions Guidance, in particular: Conditions may be appropriate when some or all of the following factors are apparent (this list is not exhaustive): no evidence of harmful deep-seated personality or attitudinal problems identifiable areas of the nurse or midwife s practice in need of assessment and/or retraining no evidence of general incompetence

7 .. patients will not be put in danger either directly or indirectly as a result of conditional registration the conditions will protect patients during the period they are in force it is possible to formulate conditions and to make provision as to how conditions will be monitored. The panel was mindful that Mr Ticala had not been subject to regulatory proceedings, other than this case. There was no evidence before the panel to suggest that he has any deep seated personality problems or that is he generally incompetent. The panel was also of the view that Mr Ticala s failings are potentially remediable. Whilst the panel noted that Mr Ticala had not attended the hearing and that there was no evidence before it to suggest that any steps towards remediation had been undertaken by him, the panel was mindful that his errors were related solely to medicines administration and it was satisfied that conditions could be formulated, with provision for monitoring, which would protect patients during the period they are in force. The panel therefore determined that it would be possible to formulate practicable and workable conditions which would address the failings highlighted in this case. Further, having taken into account both the aggravating and mitigating features of this case, the panel determined that that the appropriate and proportionate sanction is that of a conditions of practice order. The panel was of the view that the imposition of a conditions of practice order would allow Mr Ticala the opportunity to remediate his failings and address the concerns identified with regard to his practice, within a practical setting, whilst ensuring that the public would be protected. The panel was of the view that to impose a suspension order would not allow Mr Ticala the opportunity to demonstrate remediation in a practical setting and would be disproportionate. The panel considered the NMC Sanctions Guidance which

8 indicates that a key consideration in relation to the imposition of a suspension order is does the seriousness of the case require temporary removal from the register? In the panel s judgment, Mr Ticala s misconduct, although serious, was not so serious as to require temporary removal from the register. Furthermore, having regard to the matters it has identified, the panel has concluded that a conditions of practice order will mark the importance of maintaining public confidence in the profession, and will send to the public and the profession a clear message about the standards of practice required of a registered nurse. The panel determined that the following conditions are appropriate and proportionate in this case: 1. At any time that you are administering medicines you must place yourself and remain under supervision. Such supervision is to consist of direct observation by another registered nurse for a period of at least three months and must not be withdrawn until you are assessed as being competent and reliable in the administration of medicines by a supervisor nominated by your employer. 2. You must send a report from your line manager, mentor or supervisor (or their nominated deputy) setting out the standard of your general conduct, and performance with regard to medicines administration, to the NMC at least 14 days before any NMC review hearing or meeting. 3. You must tell the NMC within 7 days of any nursing appointment (whether paid or unpaid) you accept within the UK or elsewhere, and provide the NMC with contact details of your employer. 4. You must tell the NMC about any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 7 days of you receiving notice of them.

9 5. a) You must within 7 days of accepting any post of employment requiring registration with the NMC, or any course of study connected with nursing or midwifery, provide the NMC with the name/contact details of the individual or organisation offering the post, employment or course of study. b) You must within 7 days of entering into any arrangements required by these conditions of practise provide the NMC with the name and contact details of the individual/organisation with whom you have entered into the arrangement. 6. You must immediately tell the following parties that you are subject to a conditions of practice order under the NMC s fitness to practise procedures and disclose the conditions listed at (1) to (5) above, to them 1. Any organisation or person employing, contracting with or using you to undertake nursing work 2. Any agency you are registered with or apply to be registered with (at the time of application) to provide nursing services 3. Any prospective employer (at the time of application) where you are applying for any nursing appointment 4. Any educational establishment at which you are undertaking a course of study connected with nursing or midwifery, or any such establishment to which you apply to take a course (at the time of application). The period of this order is for 12 months. The panel was of the view that this period would satisfy the public interest and allow Mr Ticala sufficient time to develop insight and address the issue of remediation.

10 Decision on current fitness to practise The panel has considered whether Mr Ticala s fitness to practise is currently 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 had regard to all of the documentation before it and 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 considered whether Mr Ticala s fitness to practise remains impaired. At the substantive hearing, the panel determined that Mr Ticala had provided no evidence of insight or remediation and that there was, therefore, a real risk that he would repeat the medicine administration errors that had brought him before his Regulator. That panel noted that Mr Ticala had made repeated medicine administration errors despite having been given a warning by the Home he was working in. That panel considered that in light of the nature of the misconduct, namely clinical errors which could be remediated, it was appropriate to allow Mr Ticala that opportunity by making a conditions of practice order. It also indicated that a reviewing panel would be assisted by: Mr Ticala s attendance at and engagement with these proceedings A reflective piece demonstrating insight into his actions, and their impact upon patients, colleagues and the wider nursing profession Evidence of any training that he has undertaken and/or how he has managed to keep his knowledge and skills up to date Recent testimonials from his employer

11 Mr Ticala has not heeded these suggestions. He has returned to Romania and thus not be in a position to comply with the conditions of practice order. He has not provided a reflective piece, nor has he provided any evidence of training or how he has kept his skills and knowledge up to date. He has not provided any testimonials. The substantive order panel provided Mr Ticala with an opportunity to develop his insight and remediate his failings. He has not taken up that opportunity. Accordingly, almost one year on, this panel still has no evidence of insight, remorse or remediation. It follows that there remains a risk that Mr Ticala will repeat his errors and put patients at unwarranted risk of harm were he allowed to return to practise without restriction. The panel therefore finds that Mr Ticala s fitness to practice remains impaired on public protection grounds. The panel went on to ask itself whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment of fitness to practise were not made in the current circumstances. The panel concluded that it would in light of the serious errors made. It therefore concluded that a finding of impairment on public interest grounds is required. Determination on sanction Having determined that Mr Ticala 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 30 of the Order. The panel has also taken into account the NMC s Sanctions Guidance (SG). 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 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.

12 The panel next considered the imposition of a further conditions of practice order. However, in light of Mr Ticala s return to Romania, and his complete lack of engagement with the previous conditions of practice order, the panel considered that to extend the current order or indeed make a new one would be futile. Whilst the errors made are of a kind that could be remedied, a conditions of practice order requires the active engagement of the registrant concerned in order to ensure that he reaches a stage where he is fit to practise safely. Since Mr Ticala is in Romania it is simply not possible to devise conditions of practice that could be workable. The panel next considered imposing a suspension order and whether such an order would protect the public and meet the public interest considerations of this case. The panel noted from his telephone call to the NMC on 6 September 2018, that Mr Ticala said that whilst he was not currently working as a nurse he felt like he might like to return to it in the future. Since conditions would not currently be workable, and the public would not be protected if Mr Ticala were allowed to return to unrestricted practice, the panel concluded that the appropriate and proportionate sanction at this stage was to make a suspension order. This would allow Mr Ticala the opportunity to return to the UK, and to nursing, by demonstrating his willingness to do so. It would always then be open to him to request an early review of this order and for consideration to then be given to a further conditions of practice order. The panel did not consider a striking off order to be appropriate or proportionate at this stage, given Mr Ticala s indication that he might like to return to nursing in the future and given that the errors made are of a kind which could be remediated. In accordance with Article 30 (1) of the Nursing and Midwifery Order 2001, this suspension order will come into effect upon the expiry of the existing suspension order, namely 29 December The panel considers that a future reviewing panel would be assisted by: Mr Ticala making it clear whether he actually intends to return to nursing in the UK Mr Ticala s attendance at and engagement with these proceedings

13 A reflective piece demonstrating insight into his actions, and their impact upon patients, colleagues and the wider nursing profession Evidence of any training that he has undertaken and/or how he has managed to keep his knowledge and skills up to date Recent testimonials from his employer This decision will be confirmed to Mr Ticala in writing. That concludes this determination.