Conduct and Competence Committee Substantive Hearing 4 November 2016 Nursing and Midwifery Council 2 Stratford Place, Montfichet Road, London, E20 1EJ

Transcription

1 Conduct and Competence Committee Substantive Hearing 4 November 2016 Nursing and Midwifery Council 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of Registrant Nurse: Ravi Dass NMC PIN: 94H0206E Part(s) of the register: RNA Registered Nurse (Sub part 1) V300 Nurse Independent / Supplementary Prescriber Area of Registered Address: England Type of Case: Misconduct Panel Members: Paul Powici (Chair Lay member) Allison Hume (Registrant member) Nalini Varma (Lay member) Legal Assessor: William Hoskins Panel Secretary: Atanas Angelov Mr Dass: Not present and not represented Nursing and Midwifery Council: Represented by Paul Andrews, counsel, instructed by NMC Regulatory Legal Team. Outcome: CPD accepted: Caution Order (5 years) Page 1 of 29

2 Decision on Service of Notice of Hearing: The panel was informed at the start of this hearing that Mr Dass was not in attendance and that written notice of this hearing had been sent to his registered address by recorded delivery and by first class post on 19 August Royal Mail Track and Trace documentation confirmed that the notice of hearing was sent to Mr Dass s registered address by recorded delivery on that date. The notice letter provided details of the allegation, the time, dates and venue of the hearing and, amongst other things, information about Mr Dass s right to attend, be represented and call evidence. Mr Andrews submitted the NMC had complied with the requirements of Rules 11 and 34 of the Nursing and Midwifery Council (Fitness to Practise) Rules 2004, as amended ( the Rules ). The panel accepted the advice of the legal assessor. In the light of all of the information available, the panel was satisfied that Mr Dass has been served with notice of this hearing in accordance with the requirements of Rules 11 and 34. The panel was aware that this matter was listed for a Consensual Panel Determination and that the signed agreement stated that Mr Dass did not intend to attend the hearing and was content for it to proceed in his and his representative s absence. He also stated that he would endeavour to be available via telephone should any clarification on any point be required. In those circumstances the panel proceeded to consider the provisional agreement. The panel accepted the advice of the legal assessor as to the appropriate approach: in particular that the provisional agreement should be considered in the round and in the light of the Indicative Sanction Guidance. Page 2 of 29

3 Conduct and Competence Committee Consensual panel determination: provisional agreement Mr Dass is aware of the CPD hearing. Mr Dass does not intend to attend the hearing and is content for it to proceed in his and his representative s absence. Mr Dass will endeavour to be available by telephone should any clarification on any point be required. The Nursing and Midwifery Council and Mr Yashwant Mohan (Ravi) Dass, PIN 94H0206E ( the parties ) agree as follows: The Charges 1. Mr Dass admits the following charges: That you, whilst employed by Peterborough and Stamford Trust as a Band 7 Charge Nurse within the Department of Sexual Health between July 2012 and 1 July 2014: 1. The manner in which you addressed issues with staff and/or managed staff on occasions, led to staff feeling intimidated and/or threatened at times. 2. On one or more of the occasions, made comments of a sexual nature to one or more of your colleagues, as set out in Schedule On an unknown date or dates 3.1 said to Colleague A that disabled people who were taking part in the Paralympics should be "locked up", or words to that effect 3.2 said to Colleague B Page 3 of 29

4 3.2.1 That the flowers in Cambridge were nice because "the Soham girls were rotting underground", or words to that effect that all Paralympians should be "culled", or words to that effect that most men have affairs when their other halves are heavily pregnant, or words to that effect, when Colleague B was pregnant 4. In September 2012, when asked by Colleague D whether the garden centre in Soham was where the two little girls were murdered, said "that is why the flowers are growing so well in the area" 5. On or around 3 or 4 January 2013 asked Relative 1 if he was planning on breastfeeding from Colleague B 6. On 5 September 2013 said to Colleague C, in relation to her ex-partner who had been diagnosed with an aneurism, "do you want to punch him in the stomach and burst that thing?" or words to that effect And as a result of your actions, as detailed above, your fitness to practice is impaired by reason of your misconduct. Schedule 1 1. Said to Colleague A a. "how do you think your husband would feel if he knew you had your hands around another man's cock", or words to that effect b. in relation to an unknown patient who had previously been in a heterosexual relationship but at the time of her appointment was in a lesbian relationship, "could she not decide if she wanted vag or cock?", or words to that effect Page 4 of 29

5 2. Said to Colleague B "you get the swab and shove it in", or words to that effect, when asked how to take a rectal swab 3. Said to Colleague C that staff should use the word "cunt" if a female patient referred to their anatomy in this manner 4. Handed Colleague C a cucumber and said I know you haven t got a husband at home I thought you might be glad of this or words to that effect. 5. When discussing the sexual activity of homosexuals with Colleague D described it as "fucking up the arse" 6. On an unknown date in early 2013 said to Colleague D "would you like Colleague E to lick you out and for you to have done a poo and not to have used any toilet paper?" or words to that effect And as a result of your actions, as detailed above, your fitness to practise is impaired by reason of your misconduct. The Agreed Facts 2. The Registrant was referred to the NMC on 25 March At that time the Registrant was working at Peterborough and Stamford Trust ( the Trust ) as a Charge Nurse (band 7) within the Department of Sexual Health ( the Department). The Registrant was responsible for the complete operational management of the Department, including managing nurses, healthcare assistants ( HCAs ) and clerical staff. He also worked clinical shifts. The Registrant had been employed in that capacity since July The names of the Colleagues referred to in the charges are set out in an Anonymity Schedule [appendix 1]. Page 5 of 29

6 4. On 16 September 2013 Colleague C (a Healthcare Assistant who worked in the Department) made a formal complaint about the Registrant s conduct. The complaint was made to Ms 1, a Human Resources Business Partner. As a result of this complaint the Registrant was assigned to work outside of the Department (on 18 September 2013) and an investigation was carried out by Ms 2 (a Ward Sister). The investigation included interviews with the Registrant on 26 September 2013 and 14 October 2013 as well as interviews with other members of staff. Charge 1 5. On numerous occasions the Registrant sent forceful s to members of staff which indicated that failure to comply with his requests would lead to disciplinary action or performance management. The Registrant accepts that these s, which were sent to numerous members of staff, amounted to unacceptable threats. 6. The Registrant also imposed an arbitrary ban on a doctor whom he did not manage, Dr 1, from entering the reception area. Dr 1 may have needed to go to the Department in the course of her employment and the Registrant had no right to ban Dr 1 from entering the reception area. 7. The Registrant also told members of staff under his management that they should not talk to Dr 1. This instruction given by the Registrant was entirely without justification. 8. At all material times Colleague B was employed by the Trust as a Sexual Health Staff Nurse in the Department. The Registrant was one of Colleague B s managers. Colleague B raised concerns directly with the Registrant about his behaviour. These concerns related to the matters referred to in these proceedings. The Registrant responded to Colleague B s concerns by saying that she was making a fuss. He told her that she was hormonal. Colleague B was pregnant at the time. The Registrant told Colleague B that if she had a problem with him she could report him to Human Resources. But he stated that if she did so he would report Colleague B to Human Resources for issues (the Registrant did not indicate what these might Page 6 of 29

7 have been). The Registrant told Colleague B that she was not needed and was useless within the Department. He stated that Colleague B could be replaced with a HCA. The Registrant did not respond to Colleague B s concerns in a sensible manner. 9. At the material time Colleague D was employed by the Trust as a Specialist Nurse Practitioner in the Department. The Registrant was Colleague D s manager. Colleague D recalls having concerns about the Registrant s conduct within the first two or three months of him arriving in the Department. Colleague D recalls an occasion where she told the Registrant that staff morale was low in the Department. The Registrant replied by stating that he was not there to baby people. He said that if people don t want to work, I ll get rid of them. The Registrant also told Colleague D not to listen to any concerns raised by her colleagues. He stated that if they are moaning, don t listen. 10. At various times the Registrant inappropriately raised his voice and/or swore when speaking to Colleagues. 11. Colleague A was employed by the Trust as a Staff Nurse (band 5) in July She was employed in the Department and the Registrant was her manager. In paragraph 6 of her signed statement drafted for the purpose of these proceedings (signed and dated 17 November 2015), Colleague A describes that she was often upset by what the Registrant said to her and that she felt nervous around him and would physically shake in his presence. She states that the Registrant would ask how her husband put up with her. This caused Colleague A to become upset and when the Registrant saw that she was upset he would say that he would refer her to Human Resources because there was something wrong with her. Charge 2 Page 7 of 29

8 12. On one occasion the Registrant was observing Colleague A freezing a patient s genital warts. Colleague A had to be observed undertaking this procedure before she could be signed off as competent to undertake it on an unsupervised basis. After Colleague A had completed the procedure and after the patient had left the room, the Registrant said how do you think your husband would feel if he knew you had your hands around another man s cock? This comment made Colleague A feel shocked and embarrassed. Colleague A thought that the Registrant was trying to engage in banter but she felt that the Registrant had gone too far. Colleague A attempted to dismiss the comment by saying Oh Ravi. 13. On another occasion Colleague A was in the laboratory processing a sample for a patient. The patient had previously been in a heterosexual relationship but at the time of her attendance at the Department she was in a lesbian relationship. The Registrant was in the laboratory with Colleague A. The patient was not present. The Registrant said could she not decide if she wanted vag or cock? This comment caused Colleague A to feel embarrassed. 14. Colleague B recalls that at the time when the Registrant started working on the Department he stated that nurses should perform rectal swabs. This was a procedure that had formerly been carried out by doctors. There was nothing inappropriate about the Registrant s request that nurses undertake rectal swabs. But when the Registrant was asked how to take a rectal swab he said you get the swab and shove it in. The Registrant did not provide appropriate training on how to take rectal swabs. Colleague B describes that the Registrant as being very crude and states that he would use the word piss rather than urine. 15. Colleague C recalls attending a training session led by the Registrant on history taking. She recalls that the Registrant began using offensive language during the training session. The Registrant said that if a female patient attended the clinic and said that her cunt is sore then staff should use the word cunt when speaking to the patient. He said that there was no point using appropriate medical terminology if the patient does not use the language. All of the staff attending the meeting said that the language was inappropriate and that the Registrant should not have used it. The Page 8 of 29

9 Registrant replied that they were old fashioned. He called them a bunch of old women and stated that they needed to move with the times. 16. Colleague C began recording her concerns about the Registrant in August The Registrant would sometimes take fruit and vegetables to work with him. There was nothing inappropriate about this (the Registrant grew his own fruit and vegetables). On 19 August 2013 Colleague C had just returned to work following two weeks of annual leave. As she was putting her coat into a locker in the changing room the Registrant told Colleague C that he had a present for her. There were no other members of staff present in the changing room at this time. The Registrant left the room and then came back with a bag. The Registrant pulled a cucumber out the bag. The cucumber was about six inches long. The Registrant said that I know you haven t got a husband at home I thought you might be glad of this. Colleague C felt that this comment was inappropriate but she did not want her first day back at work to start with an argument so she said thank you very much. Colleague C states that she felt that if she reacted in a shocked manner then the Registrant would laugh. 18. On an unknown date Colleague D attended a training session with the Registrant in relation to history taking. During the session the sexual activity of homosexual men was discussed. The Registrant referred to this as fucking up the arse. Colleague D felt that this was crude and inappropriate. 19. In early 2013 Colleague D was in the changing room. She was combing her hair and putting her make up on before the start of her shift. The Registrant said, which of the Consultants are you trying to attract? Colleague D joked oh Dr 2 but I would have to squat as he is a little bit short in height. Colleague D was not insinuating anything of sexual nature. The Registrant replied would you like Dr 2 to lick you out and for you to have done a poo and not to have used any toilet paper? Colleague D was shocked, disgusted and horrified by this comment. Colleague D stated that she could not think of anything more revolting and that he was lowering the tone. The Registrant did not say anything in response. Page 9 of 29

10 Charge On another occasion the Registrant said to Colleague A that the disabled people taking part in the 2012 Paralympics should be locked up. [PRIVATE] 21. During a lunch break the Registrant was speaking to Colleague B. He stated that the flowers in Cambridge were so nice and that the garden centre is lovely. The Registrant went on to say that this was probably because the Soham girls were rotting underground. This incident happened shortly after the Registrant started working in the Department. Colleague B was shocked by the Registrant s comment. 22. Following the 2012 Paralympics, Colleague B was again having her lunch break when the Registrant said all paralympians should be culled and that if he was disabled he would want to be killed. 23. On an unknown date the Registrant was in the laboratory with Colleague B. They were the only two people in the room. The Registrant said you know when most men start affairs? It is when their other halves are heavily pregnant. The Registrant then went quiet as if waiting for a response. At the time Colleague B was heavily pregnant. Colleague B told the Registrant that his comment was inappropriate and she left the room. The Registrant did not say anything in response. Charge Colleague D had a conversation with the Registrant in September 2012 in which the Registrant told Colleague D that he had visited a garden centre in Soham. Colleague D was interested in flowers, as is the Registrant. Colleague D asked, is that where those two little girls were murdered? The Registrant replied that is why the flowers are growing so well in the area. Colleague D found this comment offensive. Charge 5 Page 10 of 29

11 25. Colleague B gave birth [PRIVATE]. On that day, or possibly the day after, Colleague B took her baby daughter to the Department, which was based in the hospital where Colleague B had given birth. Colleague B went to the Department to see her friends and colleagues there. The Registrant s office is the first room after entering the Department. Colleague B went into the office and asked if she could take her baby onto the Department. The Registrant said that she could. The Registrant spoke to Colleague B s husband (Relative 1). The Registrant asked Relative 1 if he was planning on breastfeeding from Colleague B. Colleague B s husband laughed nervously. Charge On 5 September 2013 Colleague C asked the Registrant if she could attend a medical appointment with her ex-husband who had been diagnosed with an aortic aneurism. Colleague C wanted to attend this appointment to provide her ex-husband with support and ensure that he understood all of the advice provided to him. The Registrant said that Colleague C could go to the appointment. After the appointment Colleague C returned to work. The Registrant asked Colleague C how it went. The Registrant then said did you not want to punch him in the stomach and burst that thing? The Trust s Disciplinary Hearing 27. As a result of the Trust s investigation a disciplinary hearing was held on 7 January The hearing was chaired by Ms 3 (General Manager). Ms 3 recommended that the following actions as a consequence of her disciplinary findings: 1) Coaching support from a designated coach; 2) Mentoring from an experienced operation lead; 3) MBTI management training, to enable the Registrant to understand his natural management preferences and become more self-aware of his behaviour; 4) Regular one to one meetings with the Registrant s manager; 5) Supervision Management training; and Page 11 of 29

12 6) Regular one to one meetings with a Human Resources Business Partner 28. The Registrant engaged with the plan which was put in place by the Trust. His employment transferred to Cambridge Community Trust on 1 July 2014 and at this point he had completed most of the required training and supervision. Cambridge Community Trust ( CCT ) 29. The Registrant s role at CCT was that of Charge Nurse (band 7) in the Integrated Sexual Health Service. He left this employment on 15 May He subsequently worked at CCT as a Bank Specialist Nurse and worked regular shifts at the clinic. CCT have no concerns about the Registrant. Further information in respect of the Registrant s work at CCT is set out below under the heading Current Impairment. Barts Health NHS Trust ( Barts Health ) 30. The Registrant commenced employment with Barts Health on 18 May His role was lead nurse for a sexual health team in Barts Sexual Health Centre. Barts Health has no concerns about the Registrant. Further information in respect of the Registrant s work at Barts Health is set out below under the heading Current Impairment. Misconduct 31. In the case of Roylance v General Medical Council (No.2) [2000] 1 AC 311, Lord Clyde stated that: misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by the medical practitioner in the particular circumstances. Page 12 of 29

13 32. The Registrant admits that his conduct fell seriously short of the standards of behaviour expected of Registered Nurses. Moreover, the Registrant accepts that his actions breached the following provisions of The Code, Standards of conduct, performance and ethics for nurses and midwives effective from 2008 ( the NMC Code ): Paragraph 24 You must work cooperatively within teams and respect the skills, expertise and contributions of your colleagues. Paragraph 25 You must be willing to share your skills and experience for the benefit of your colleagues. Paragraph 27 You must treat your colleagues fairly and without discrimination. Paragraph 48 You must demonstrate a personal and professional commitment to equality and diversity. Paragraph 61 You must uphold the reputation of your profession at all times. 33. The admitted facts span a substantial period of time over which the Registrant acted in an unprofessional and inappropriate manner towards his colleagues. His comments were offensive and many of them were derogatory to women. The comments made to Colleague B were said at a time when she was pregnant and the Registrant knew that to be the case. The comments also include comments which are derogatory to those with disabilities. The Registrant s actions caused substantial distress to his colleagues. 34. Accordingly, for the reasons above, the Registrant accepts that the facts amount to misconduct. Current Impairment 35. The Registrant admits that his fitness to practise is currently impaired by reason of his misconduct. Page 13 of 29

14 36. The parties have considered the questions formulated by Dame Janet Smith in her Fifth Report from Shipman, approved in the case of CHRE v Grant & NMC [2011] EWHC 927 (Admin) ( Grant ) by Cox J. 37. The parties agree that admitted facts do not amount to the Registrant placing a patient or patients at unwarranted risk of harm: there is no suggestion that any of the Registrant s conduct was witnessed by a patient. 38. Similarly, the parties agree that there is no dishonesty in this case. 39. The parties agree that the Registrant has in the past brought the nursing profession into disrepute. The Registrant s conduct raises an attitudinal concern and both fellow practitioners and members of the public alike would consider his actions deplorable. 40. The parties agree that the Registrant s actions did breach fundamental tenets of the profession. In particular, the parties agree that paragraphs 27 and 48 of the NMC Code (set out above) are fundamental tenets of the profession. Insight, remorse and current practice 41. The Registrant has provided a reflective piece dated 22 August 2016 [appendix 2]. The paragraphs below set out some of the key passages from that document but the panel should read appendix 2 in its entirety. The document begins with a candid acceptance by the Registrant of his misconduct: I accept that on several occasions I had made comments of a sexual nature to colleagues, and accepted that I have made comments which were unprofessional and discriminatory towards disabled people. I also accepted that on multiple occasions I made offensive comments about breastfeeding, the murdered girls of Soham, infidelity etc to colleagues. These comments were made during my band 7 charge nurse position in the Department of Sexual Health (DOSH) at Peterborough City Hospital from July 2012 to August The comments were made before clinic started or at lunch times when staff Page 14 of 29

15 would get together for a chat, or when having a patient case discussion or training. The comments were made in front a range of junior staff including junior nurses, healthcare assistants and reception staff and the comments caused great offense to my colleagues. I realised that I had over stepped the mark during the normal staff banter by making comments which were of a sexual nature, unprofessional and discriminatory as well as offensive. I made several errors of judgement and behaved in an unprofessional manner 42. Next the Registrant sets out his initial reaction to the complaint made against him at the Trust: I was extremely shocked when my colleagues reported me for bullying and harassment and I went into denial. I could not believe what was happening and initially I tried to mitigate all my actions, without fully accepting the damage I had done. I accepted the outcome of the disciplinary hearing in 2013 having realised that I had behaved in an unprofessional manner, and I used that experience to change my behaviour. I tried to build bridges with some of the staff who remained in DOSH but this was difficult because I had put them through an extremely stressful situation where they had to give evidence at my disciplinary hearing. In hindsight, things may have been different if I had initially accepted the charges and worked with my colleagues to improve our working relationship. 43. Further the Registrant states: What do I think about it? The sexual comments were inappropriate for a work environment and were not of a professional nature and I deeply regret making comments of a sexual nature to my colleagues. I realise that I allowed my professional boundaries and standards to fail, and in hindsight I have failed to behave in a way which was expected of a senior nurse. As a result of my comments, I realise that I have caused offense and distress to my colleagues, for which I am extremely sorry and offer my most sincere apology. Following the disciplinary hearing, I made a great effort to build Page 15 of 29

16 a happy and productive working relationship with my colleagues, ensuring that I behaved in a professional manner and use language which was professional. I realised that my comments about disabled people were stupid and I should have never made such comments. I deeply regret making those comments and will never make such comments again. I was working in a service which was non-judgemental, where members of the public could come to receive sexual health care without being judged, and my comments about disabled people were totally inappropriate, offensive and not what one would have expected from a senior nurse. I deeply regret making the offensive comments about breastfeeding, the murdered girls of Soham, infidelity etc all of which were insensitive and I realised how upsetting and hurtful it would have been to my colleagues. I have caused an immense amount of stress to my colleagues for which I am deeply sorry for, especially knowing that my colleagues are probably still affected by my offensive comments. I had no intention of causing harm to my colleagues, and my lack of professionalism and boundaries made my colleagues uncomfortable and lost confidence and respect for me. I am now more self aware of how to behave professionally at all times and I can now use my experience to offer advice and support if any of my colleagues were to behave in an unprofessional manner or use inappropriate language. What could I/ should I have done When I started work in Peterborough I should have maintained professional boundaries whilst still being friendly with junior colleagues. I should have carried out my duties in a professional manner expected by my employer and the NMC. I could have encouraged staff to give regular feedback so that I could have changed by behaviour and language before it got to the point where staff felt they had to report me. I could have accepted my failings sooner and possibly avoided my colleagues having to go through a long period of stress. I could have worked Page 16 of 29

17 harder at repairing my working relationship with colleagues and let them see that I am a kind and caring person. I should have made an effort to contact colleagues who left the department and offer a sincere apology. What was the impact? My inappropriate language was not what was expected of a professional nurse, and this brought my profession into disrepute and would have given other professional groups of colleagues a negative view of nurses. As a result of my unprofessional behaviour I also failed to meet the standards expected by my employers, and breached several of the Trust equal opportunity policies. I have since worked extremely hard to maintain the standards expected of my profession, to give other professional colleagues a positive view of nurses, and to maintain the high standards expected by my employers. My manager s feedback has shown that I am successfully maintaining the professional standards expected by my profession and my employer. My inappropriate comments were not made when patients were around and I am horrified of how patients would have felt if they have overheard my comments. Patients or the public would have been distressed and upset by my comments, and would have lost respect for nurses, other colleagues and the service/ Trust. By maintaining a strict professional relationship with colleagues I can ensure that I never give patients or the public a negative view of myself, my profession, nor my service/ employer. I have also used my experience to offer advice to current colleagues when there is any language or behaviours at work which may be offensive to others, for example, in my current role I have asked senior colleagues not to swear/ use inappropriate language in front of junior staff. I accept that my comments about disabled people were also inconsistent with the standards expected of the nursing code of conduct and had failed to meet the non-judgemental and non-discriminatory requirements of my job and my employer. I am extremely disappointed by my comments, especially because I personally know how hurtful discrimination can be, having been on the receiving end. I'm now more self aware and I would not use language which could be Page 17 of 29

18 offensive or discriminatory as I would never want to hurt anyone. I am very ashamed of what I said, especially because I was brought up to respect others and their differences and to never harm anyone. I have also let my friends and family down as my offensive and discriminatory comments were not what they would have expected from me as they have a very high expectation of nurses. This experience has enabled me to champion a non discriminatory work environment and I am currently supporting a trainee nurse practitioner to be our learning disability link nurse and to ensure people with learning disabilities are able to access our services. My offensive comments were in breach of my professional code of conduct as well as what was expected from colleagues and my employer. Patients or members of the public would have been very upset and appalled by my offensive comments, and as I am more self aware I do not use offensive language at work to ensure that patients are treated with respect and dignity. At the time I did not mean to cause any offense and I deeply regretted my lapse of judgement and any distress I would have caused to staff. I am more self aware of how others may find jokes and comments offensive or insensitive and since the disciplinary process I have maintained a strict professional conversations and relationship with work colleagues. 44. The Registrant ends by setting out the action he has taken following the events set out above: I took advantage of regular coaching and supervision offered after the disciplinary hearing and these have been extremely useful in helping me to stay focused and professional. My current employer has also continued to provide coaching, having explained how this has been beneficial to me. I have since completed the Myers-Briggs training as well as training in handling difficult conversation and managing performance and capability. These have been useful in helping me understand my colleagues better and to realise that other people perform differently. I now work with staff to help them to identify shortcomings in their own practice and to assist them with addressing any short comings. I am Page 18 of 29

19 more aware of the need for giving praise and developing a culture of constructive criticism, for example, allowing experienced healthcare assistants to audit the microscopy skills of myself and other senior nurses, and nurses to audit myself and each other patient care/ documentation. I have learnt how to be firm but fair and how to manage conflict as well as creating an environment where staff feel supported and can raise concerns. I realised how traumatic the whole experience would have been for others having experienced it myself, and deeply regretted what happened at Peterborough City Hospital. I am now focused on developing my career and those of the staff whom I manage whilst maintaining professional behaviour. I have always ensured that patients receive the best care possible, and will continue to do so. I have recently been awarded the Diploma of the Faculty of Sexual and Reproductive Healthcare (NDFSRH) having decided to complete similar training to my medical colleagues. I am using my new knowledge and skills to provide high quality holistic patient care and to support junior members of the team. have been for others having experienced it myself, and deeply regretted what happened at Peterborough City Hospital. I am now focused on developing my career and those of the staff whom I manage whilst maintaining professional behaviour. I intend to never again bring myself nor my profession into disrepute. 45. The NMC has received a reference dated 4 October 2016 from Barts Health NHS Trust, the Registrant s current employer [appendix 3]. The reference is signed by Ms 4. Ms 4 holds the position of Consultant Nurse in Sexual Health. Ms 4 is the Registrant s manager. Ms 4 states as follows: Ravi s role involves managing a team of Nurse Practitioners & I have had the opportunity to observe his interactions with both the team he manages and other members of our multi-disciplinary team. In these interactions he is direct, polite and professional. Page 19 of 29

20 I have said I have not directly observed his interactions with patients however I have discussed patient care with him, both in the context of what the service can operationally provide and also with reference to the clinical competencies of individual clinicians that he is managerially responsible for. From these discussions it is evidence that his clinical knowledge is of a high standard and that he provides appropriated clinical care to our patients. In addition from my conversation with both Ravi & the team he is managing I believe he supports and encourages those he manages to ensure they are competent and confident to provide appropriate clinical care to the patients attending our services. I have observed his interactions with both the team he is managerially responsible for & the wider multidisciplinary team. His interactions with the team are always professional, polite and appropriate to his role as a senior registered nurse. He is cautious regarding language used by the team and challenges those he manages if their behaviour or language strays beyond the boundaries of what is appropriate for a registered nurse. In my professional opinion I do not believe Ravi presents any risk to patient safety in his practice as a nurse. I believe he provides excellent clinical care and that he has expert clinical knowledge and skill that allows him to do so. I find Ravi to be open, honest and truthful and I have no doubts or worries regarding his integrity. 46. For the avoidance of doubt, the parties agree that there are no concerns about the Registrant s clinical practice and no concerns about his honesty. 47. The parties take the view that the reflective piece provided by the Registrant demonstrates real insight. In light of the following: Page 20 of 29

21 The Registrant s reflective piece; The letter provided by the Registrant s current manager, Ms 4 [appendix 3]; The absence of any further related incidents or complaints against the Registrant, The training and courses which the Registrant has undertaken, both following the disciplinary hearing, the coaching with his current employer and subsequent training; the parties take the view that the risk of repetition of the conduct in question is low. 48. In considering the question of whether the Registrant s fitness to practise is currently impaired, the parties have considered the following authorities. 49. In Meadow v GMC [2006] EWCA Civ 1390, the Court of Appeal emphasised that: The purpose of fitness to practise proceedings is not to punish the practitioner from past misdoings but to protect the public against the acts and omissions of those who are not fit to practise. It is, therefore, an exercise of looking forward and not back. However, in order to form a view, it is evident that you must take account of the way in which the Registrant has acted in the past. 50. In Cohen v GMC [2007] EWHC 581 (Admin), the court set out three matters which it described as being highly relevant to the determination of the question of current impairment: 1. Whether the conduct that led to the charge(s) is easily remediable 2. Whether it has been remedied Page 21 of 29

22 3. Whether it is highly unlikely to be repeated 51. In Cheatle v GMC [2009] EWHC 927 (Admin) the court gave the following guidance: Remediation is not the only factor and some matters are more easily remedied than others. A Committee is entitled to conclude that a practitioner s past conduct was so egregious that he is not fit to practise without restrictions or maybe at all. 52. The NMC has also considered the comments of Cox J in Grant at paragraph 101: The Committee should therefore have asked themselves not only whether the Registrant continued to present a risk to members of the public, but whether the need to uphold proper professional standards and public confidence in the Registrant and in the profession would be undermined if a finding of impairment of fitness to practise were not made in the circumstances of this case. 53. In light of the authorities set out above, notwithstanding the level of insight and remorse shown by the Registrant, the parties agree that a finding of impairment is required to declare and uphold proper standards of behaviour. There is no dispute that the Registrant s actions can be considered wholly inappropriate, unprofessional and made colleagues feel extremely uncomfortable, Confidence in the profession and in the NMC as its regulator would be undermined if a finding of impairment is not made in this case, particularly in light of the distress caused by the Registrant s actions to other Registered Nurses and HCAs. Sanction 54. The appropriate sanction in this case is a Caution Order for a period of five years. The parties considered the NMC Indiactive Sanctions Guidance, bearing in mind that it provides guidance not firm rules. 55. The aggravating features of the case are as follows: Page 22 of 29

23 The Registrant was in a senior position at the Trust and his behaviour was directed to junior colleagues under his management The Registrant s conduct was repeated over a substantial period of time A number of the inappropriate comments were of a derogatory/discriminatory nature, related to the protected characteristics of sex, sexual orientation, maternity/pregnancy and disability The Registrant s actions caused substantial distress to a number of his colleagues 56. The mitigating features of the case are as follows: The Registrant s inappropriate conduct was never directed to or witnessed by a patient or patients There are no concerns about the Registrant s clinical knowledge or skills, and he has in fact received a positive employment reference from his current employer Prior to the events in question the Registrant had an unblemished record There have been no subsequent concerns raised to the NMC since this referral The Registrant has fully engaged with the proceedings The Registrant has demonstrated a high level of insight The Registrant has undertaken training, coaching support, mentoring and supervision following the disciplinary hearing, and has undertaken coaching with his current employer and further training In light of the above, it is considered that the risk of repetition of the conduct in question is low 57. In considering what sanction would be appropriate the parties began by considering whether this is a case in which it would be appropriate to take no further action. The parties considered paragraphs 56 to 58 of the NMC Indicative Sanctions Guidance. Given that the Registrant has breached fundamental tenets of the profession, brought the profession into disrepute, the distress caused to the Registrant s colleagues and the fact that the inappropriate behaviour was repeated over a substantial period of time, the parties agree that taking no further action would not be adequate to mark the public interest in this case. Page 23 of 29

24 58. The parties next considered whether a Caution Order would be appropriate. The parties noted that a Caution Order will be disclosed to anyone enquiring about a nurse s fitness to practise. Paragraph 60 of the Indicative Sanctions Guidance states that: Therefore, a caution 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. 59. The parties agree that this case does not fall at the lower end of the spectrum of impaired fitness to practise, although it is not at the upper end either. But nevertheless this is a case in which a sanction is required to mark that the behaviour was unacceptable and must not happen again. 60. Paragraph 61 of the Indicative Sanctions Guidance states: When fitness to practise is impaired by reason of misconduct and a panel is minded to impose a caution order, it should consider whether such an order provides adequate public protection, bearing in mind that it does not restrict the nurse or midwife s practice rights. It might be appropriate where the nurse or midwife s history is such that the panel is confident that there is no risk to the public or to patients which requires the nurse or midwife s practice rights to be restricted. 61. The parties take the view that as there are no public protection concerns in this case and because the risk of repetition of the conduct in question is low, a Caution Order would be appropriate to address the misconduct. 62. The parties went on to consider whether a Conditions of Practice Order would be appropriate but they concluded that such an order would be inappropriate as the primary purpose of a Conditions of Practice Order is to address clinical failings and there are none in this case. 63. The parties went on to consider whether a Suspension would be appropriate. In Page 24 of 29

25 considering the indicative sanctions guidance, the following is agreed: There has been no evidence of repetition since the incident. It is considered that the Mr Dass had demonstrated a high level of insight and remorse, and has taken steps to remediate, through training, supervision and mentoring following the disciplinary hearing, and further coaching with his current employer, and further training The Registrants behavior raises public interest concerns, but does not relate to his clinical practice 64. As per the indicative sanctions guidance, it is not the purpose of fitness to practise proceedings to punish the Registrant for past misdoings (Meadow v GMC), the parties took into account the reference from the Registrant s current employer (Ms 4, Appendix 3). This is a supportive and positive reference. This confirms that he provides appropriate clinical care to patients. It confirms that his interactions, both in a managerial capacity and in the wider team have been observed and that he is always professional, polite and appropriate, as well as supportive and encouraging to those he manages. Further as already noted, there are no public protection concerns in this case, the Registrant has demonstrated insight and it is considered that the risk of repetition is low. In all the circumstances the parties concluded that a suspension order would be disproportionate, that the circumstances do not require temporary removal from the register: it would amount to a punishment rather than a measure necessary to uphold and declare proper standards and mark the wrong doing. The parties also take the view that there is a public interest in permitting a skilled nurse to practise as this provides a benefit to the public. For the reasons above, the parties also considered that a Striking off Order would be disproportionate. 66. Accordingly, having ruled out taking no further action, a Conditions of Practice Order, Suspension and Striking off, the parties concluded that the only appropriate and proportionate sanction is that of a Caution Order. 67. Next the parties considered the length of the caution, noting that it may be for a period of not less than one and not more than five years. Because this is a case Page 25 of 29

26 which does not fall at the bottom of the spectrum of impaired fitness to practise and given the aggravating features of the case, the parties agree that the caution should run for the maximum period of five years. 68. Finally, the parties agree that an interim order is not required in this case. The parties understand that this provisional agreement cannot bind a panel, and that the final decision on findings impairment and sanction is a matter for the panel. The parties understand that, in the event that a panel does not agree with this provisional agreement, the admissions to the charges set out at section 1 above, and the agreed statement of facts set out at section 2 above, may be placed before a differently constituted panel that is determining the allegation, provided that it would be relevant and fair to do so. Signed.. Dated Ravi Dass Signed Dated (For and on behalf of the NMC) The panel has seen an appropriately signed copy of this agreement dated 28 October Page 26 of 29

27 Decision on the proposed CPD: The panel found the facts of the case proved by way of admission and fully accepted the reasoning in the CPD provisional agreement which supported a finding of current impairment by reason of Mr Dass s misconduct Mr Dass had behaved in an unprofessional and unacceptable manner towards his colleagues and had used highly inappropriate language. The panel was mindful that there is no suggestion that any of Mr Dass s conduct was witnessed by or directed towards a patient. However, in the particular circumstances of this case, the panel determined that a finding of impairment is necessary to uphold the public interest by maintaining public confidence in the profession and by declaring and upholding proper standards of conduct and behaviour. The panel considered that confidence in the profession and in the NMC as its regulator would be undermined if a finding of impairment is not made in in light of the serious attitudinal and behavioural concerns which are evident in this case and which caused distress to his colleagues. The panel went on to consider what sanction might be appropriate. The panel first considered whether to take no action, but determined that, in light of the facts in this case, this would not be sufficient to satisfy the public interest. By virtue of his inappropriate behaviour and comments towards his fellow colleagues Mr Dass has breached fundamental tenets of the profession and brought the profession into disrepute. The panel considered that the misconduct in this case needs to be marked by the imposition of a sanction. The panel then considered imposing a caution order. The panel did not consider that the misconduct in this case falls at the lower end of the spectrum of impaired fitness to practise. However, having had careful regard to the documentation before it today the panel decided that a caution order is appropriate and within the realm of reasonable decisions for the following reasons: Page 27 of 29

28 In his reflective piece dated 22 August 2016 Mr Dass has demonstrated sufficient insight into his misconduct and past behaviour. Mr Dass has taken steps to remediate his misconduct, through training, supervision, coaching and mentoring following the disciplinary hearing, and has engaged in further coaching with his current employer. Mr Dass has produced a positive reference from his current employer for whom he has worked since May 2015 in which Mr Dass is described as direct, polite and professional in interactions with his colleagues. Further, his referee states that: In addition from my conversation with both Ravi & the team he is managing I believe he supports and encourages those he manages to ensure they are competent and confident to provide appropriate clinical care to the patients attending our services. Mr Dass s behaviour raises public interest concerns, but does not relate to his clinical practice Prior to these events Mr Dass had an unblemished record, there have been no subsequent concerns, and he has fully engaged with these proceedings. For all these reasons the panel considers that the risk of repetition is low. In the panel s judgment, a conditions of practice order would not be appropriate since there are no areas of Mr Dass s clinical practice identified as in need of remediation. The reference from his current employer attests to his clinical abilities. The panel went on to consider whether to impose a suspension order, but determined it to be potentially disproportionate in light of Mr Dass s insight and remediation. A suspension order would neither be appropriate nor proportionate in the circumstances Accordingly, the panel agreed with the conclusions of the provisional CPD agreement and concluded that a caution order is the appropriate and proportionate sanction in this case. In the panel s view this order would satisfy the public interest in declaring and Page 28 of 29

29 upholding proper standards of conduct so that confidence in the profession and its regulation is maintained. The panel considers that a caution order for a period of 5 years sufficiently marks the seriousness of the misconduct. Accordingly, the panel has determined to accept the provisional CPD agreement dated 28 October That concludes this case. Page 29 of 29