Fitness to Practise Committee Substantive Meeting 3 October Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE. (29 November 1978)

Transcription

1 Fitness to Practise Committee Substantive Meeting 3 October 2017 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of Registrant Nurse: NMC PIN: Part(s) of the register: Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Gillian Mary Griffiths 75I0135W RN1, Registered Nurse (sub part 1) Adult (29 November 1978) Wales Misconduct Andrew Gell (Chair, Lay member) Anita Underwood (Registrant member) Alison Lyon (Lay member) Oliver Wise Atanas Angelov Facts proved: 1 (in its entirety), 2, 3 and 4 Facts not proved: None Fitness to practise: Sanction: Interim Order: Impaired Caution order (4 years) Not applicable 1

2 Details of charge: That you, whilst working as a Band 5 Staff Nurse at Neath Port Talbot Hospital, on 15 March 2015: 1. Removed the following items of Abertawe Bro Morgannwg University Health Board property for your own personal use without permission: 1.1 Incontinence pads; 1.2 Gloves; 1.3 Tea bags; 1.4 Sachets of sauce; 2. Removed a kettle that belonged to a colleague for your own personal use without their permission; 3. Were dishonest in your conduct at charges 1 and 2 in that you knew that those items did not belong to you and that you did not have permission to remove them; 4. Consumed hospital stock Gaviscon (or similar medication) whilst on duty; And, in light of the above, your fitness to practise is impaired by reason of your misconduct 2

3 Decision on Service of Notice of Meeting: The panel was informed at the start of this meeting that Ms Griffiths was not in attendance and that written notice of this meeting had been sent to Ms Griffiths registered address by recorded delivery and by first class post on 25 August Royal Mail Track and Trace documentation confirmed that the notice of meeting was sent to Ms Griffiths registered address by recorded delivery on that date. The notice letter provided details of the allegation, the time, dates and venue of the meeting. It informed her of the meeting protocol and of her right to request that the matter be considered at a hearing, instead of a meeting, if she so chose. The panel accepted the advice of the legal assessor. In the light of all of the information available, the panel was satisfied that Ms Griffiths has been served with notice of this meeting in accordance with the requirements of Rule 11A of the Nursing and Midwifery Council (Fitness to Practise) Rules 2004, as amended ( the Rules ). Background The charges arose whilst Ms Griffiths was employed as a Band 5 Staff Nurse, based in Ward E at Neath Port Talbot Hospital ( the Hospital ) by Abertawe Bro Morgannwg University Health Board ( Health Board ). It is alleged that items of Health Board Property that had gone missing had been found in Ms Griffiths locker. This included incontinence pads, gloves and sachets of sauce. Further, staff had found in Ms Griffiths locker, a kettle that belonged to another staff member and a bag of tea bags. Ms Griffiths was then seen placing a bag containing all these items in her car, at the end of her shift. It is also alleged that on 15 March 2015 Ms Griffiths self-administered Gaviscon, which was the property of the Hospital. 3

4 Ms Griffiths initially denied the allegations. However, subsequently during an internal investigation by the Health Board she admitted to taking incontinence pads, a kettle and having consumed Gaviscon. Ms Griffiths did not attend her disciplinary interviews, citing health reasons. A disciplinary hearing took place in Ms Griffiths absence and a decision was taken to dismiss her. Ms Griffiths states that she has now retired from nursing. She has been a registered nurse since 1999 and she has not come to the attention of the NMC previously or since this referral. Her employer, who she has worked with since 2001, has not raised any other concerns about her. Decision on the findings on facts and reasons The panel accepted the advice of the legal assessor. The panel was aware that the burden of proof rests on the NMC, and that the standard of proof is the civil standard, namely the balance of probabilities. This means that the facts will be proved if the panel was satisfied that it was more likely than not that the incidents occurred as alleged. In reaching its decisions on the facts, the panel took into account all of the evidence in this case. The panel had regard to the witness statements from 5 witnesses on behalf of the NMC: Ms 1, Health Visiting Lead at the Health Board; Ms 2, Healthcare Assistant at the Hospital; Ms 3, Staff Nurse at the Hospital; Ms 4, Senior Nurse at the Hospital; 4

5 Ms 5, Staff Nurse at the Hospital; The panel considered each charge and made the following findings: The panel first considered charge Removed the following items of Abertawe Bro Morgannwg University Health Board property for your own personal use without permission: 1.1 Incontinence pads; 1.2 Gloves; 1.3 Tea bags; 1.4 Sachets of sauce; This charge is found proved in its entirety. In reaching this decision, the panel took into account all the evidence in this case. Insofar as charge 1.1 is concerned, during an investigation meeting held by Ms 4 on 16 March 2015 Ms Griffiths admitted to having taken fluffy pads the previous day, as well as on other occasions as her cat was experiencing continence problems. This was consistent with the witness statement of Ms 2, that she had seen incontinence pads in a pink and white bag in Ms Griffiths locker, as well as with Ms 5 s statement that she had seen Ms Griffiths placing a pink and white carrier bag, full of items from the ward, in her car. The panel was satisfied that it was more likely than not that Ms Griffiths had removed incontinence pads from the Health Board, without permission. Accordingly, it found charge 1.1 proved. 5

6 Insofar as charge 1.2 is concerned, Ms Griffiths denied that she had taken any gloves and explained that they must have fallen out of her uniform. However, she could not explain why the gloves were found in her locker in the middle of her shift. The panel also had regard to the witness statement of Ms 2, which said that she had seen gloves in a pink and white bag in Ms Griffiths locker, and to the witness statement of Ms 5 which said that she had seen Ms Griffiths placing a pink and white carrier bag full of items from the ward in her car. In all the circumstances, the panel concluded that it was more likely than not that Ms Griffiths had removed gloves from the Health Board, without permission. Accordingly, it found charge 1.2 proved. Insofar as charge 1.3 is concerned, Ms Griffiths denied that she had taken any tea bags from the Ward and explained that she always bought her teabags from Poundstretcher. However, the panel had regard to the witness statement of Ms 2, that she had seen tea bags in a pink and white bag in Ms Griffiths locker and with the witness statement of Ms 5 statement that she had seen Ms Griffiths placing a pink and white carrier bag full of items from the ward in her car. In all the circumstances, the panel concluded that it was more likely than not that Ms Griffiths had removed a bag of teabags from the Health Board, without permission. Accordingly, it found charge 1.3 proved. Insofar as charge 1.4 is concerned, the panel had regard to the statement of Ms 2, that she had seen sachets of sauce in a pink and white carrier bag in Ms Griffiths locker and to the statement of Ms 5 that she had seen Ms Griffiths placing a pink and white carrier bag full of items from the ward in her car. In all the circumstances, the panel concluded that it was more likely than not that Ms 6

7 Griffiths had removed sachets of sauce from the Health Board, without permission. Accordingly, it found charge 1.4 proved. The panel therefore found charge 1 proved in its entirety. The panel next considered charge Removed a kettle that belonged to a colleague for your own personal use without their permission; This charge is found proved. In reaching this decision, the panel took into account all the evidence in this case. The panel was mindful that during an investigation meeting held by Ms 4 on 16 March 2015, Ms Griffiths had admitted to having borrowed a kettle from the Ward on the previous day with the intention to return it. Ms Griffiths also admitted that she had not asked for permission or told anyone as there was no one to tell. This was consistent with the witness statement of Ms 2, that she had seen a kettle in a pink and white bag in Ms Griffiths locker. It was also consistent with Ms 5 s statement that she had seen Ms Griffiths placing a pink and white carrier bag, full of items from the ward and including a kettle, in her car. The panel found charge 2 proved. 3. Were dishonest in you conduct at charges 1 and 2 in that you knew that those items did not belong to you and that you did not have permission to remove them; This charge is found proved. 7

8 In reaching this decision, the panel took into account all the evidence in this case. The panel was mindful that it should not regard dishonesty as proved unless if was satisfied of dishonesty by cogent evidence. The panel was mindful that there is a two part test in relation to dishonesty. Firstly, the panel had to determine whether Ms Griffiths actions were dishonest according to the standards of reasonable and honest nurses. Secondly, and only if the first test was met, the panel had to determine whether it is more likely than not that Ms Griffiths realised that what she was doing was, by those standards, dishonest. The panel therefore considered whether Ms Griffiths actions as particularised in charges 1.1, 1.2, 1.3, 1.4 and 2 were objectively dishonest. Whilst the panel has made its determination cumulatively, it did consider each allegation of dishonesty separately. The panel considered that the items as particularised in charges 1.1, 1.2 and 1.4 were intended for use by patients or for their care and the items as particularised in charges 1.3 and 2 were intended for use by staff at the Hospital. The panel had no doubt that reasonable and honest nurses would find Ms Griffiths actions of removing property of the Health Board and of other staff members, without authorisation, as dishonest. She did not tell anyone else what she was doing either by seeking permission or by leaving a note or otherwise. Without any plausible justification there was no good reason for Ms Griffiths to act in the described manner other than to make a gain at the expense of the Health Board and other staff members. The panel was satisfied that Ms Griffiths herself would have realised that what she was doing was dishonest by those same standards. Accordingly, the panel found charge 3 proved in respect of charges 1.1, 1.2, 1.3, 1.4 and 2. 8

9 The panel next considered charge Consumed hospital stock Gaviscon (or similar medication) whilst on duty; This charge is found proved. In reaching this decision, the panel took into account all the evidence in this case. The panel was mindful that during an investigation meeting held by Ms 4 on 16 March 2015, Ms Griffiths had admitted to having self-administered from a bottle of hospital stock Gaviscon whilst on duty the previous day. This was consistent with corroborated witness evidence that she was seen observed with a bottle of Gaviscon in her possession. Accordingly, the panel found charge 4 proved. Decision on misconduct The panel has accepted the advice of the legal assessor which included reference to the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin). The panel adopted a two-stage process in its consideration, as advised. First, the panel must determine whether the facts found proved amount to misconduct. This requires that the conduct should be a serious breach of professional duty. Secondly, only if the facts found proved amount to misconduct, the panel must decide whether, in all the circumstances, Ms Griffiths fitness to practise is currently impaired as a result of that misconduct. 9

10 When determining whether the facts found proved amount to misconduct the panel had regard to the terms of the Standards of conduct, performance and ethics for nurses and midwifes 2004 ( the Code ). The panel, in reaching its decision, had regard to the public interest and accepted that there was no burden or standard of proof at this stage and exercised its own professional judgement. The panel was of the view that Ms Griffiths actions did fall seriously short of the standards expected of a registered nurse, and that her actions amounted to breaches of the Code. Specifically: Preamble The people in your care must be able to trust you with their health and wellbeing To justify that trust, you must: be open and honest, act with integrity and uphold the reputation of your profession. The panel appreciated that breaches of the Code do not automatically result in a finding of misconduct. However, Ms Griffiths acted dishonestly by removing from the Hospital for her own personal use and without permission property belonging to the Health Board and to other staff members. Honesty, integrity and trustworthiness are the bedrock of a nurse s practice. The panel considered that Ms Griffith s behaviour would be considered as deplorable by the public. It also concluded that her actions and dishonesty, both individually and cumulatively, demonstrated a lack of integrity falling far short of the standards expected of a registered nurse and were sufficiently serious to amount to misconduct. 10

11 Decision on impairment The panel next went on to decide if as a result of this misconduct Ms Griffiths fitness to practise is currently impaired. Nurses occupy a position of privilege and trust in society and are expected at all times to 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 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 commended the following as the appropriate test for panels: Do our findings of fact in respect of the [nurse 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. 11

12 b. has in the past brought and/or is liable in the future to bring the profession into disrepute; and/or c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession; and/or d. has in the past acted dishonestly and/or is liable to act dishonestly in the future. The panel found that Ms Griffiths misconduct engaged a, b, and c of the above test both as to the past and the future. The panel bore in mind that its primary function is to uphold the wider public interest, which includes maintaining confidence in the nursing profession and upholding the proper standards of conduct and behaviour. It considered Ms Griffiths dishonest actions brought the nursing profession into disrepute and breached a fundamental tenet of the nursing profession. Dishonesty is by its very nature not easily remediable and Ms Griffiths has presented no evidence that she understands the seriousness of her actions and behaviour and the implications for patients, her colleagues and the reputation of the nursing profession. The panel therefore determined that there exists a real risk of repetition of Ms Griffiths dishonesty. The panel was also of the view that the public would find Ms Griffiths dishonesty deplorable. Having regard to the test set out in Grant, the panel is in no doubt that confidence in the profession would be undermined if, taking into account the serious nature of Ms Griffiths misconduct and behaviour, a finding of impairment were not to be made. Having regard to all of the above, the panel was satisfied a finding of impairment is necessary in order to uphold public confidence in the profession and the NMC as its regulator. 12

13 Determination on sanction: The panel considered this case very carefully and decided to impose a caution order for a period of 4 years. The effect of this order is that Ms Griffiths name on the NMC register will show that she is subject to a caution order and anyone who enquires about her registration will be informed of this order. 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 Sanctions Guidance ( SG ) published by the NMC. It recognised that the decision on sanction is a matter for the panel, exercising its own independent judgement. The panel considered the aggravating and mitigating factors in this case. It found the following to be aggravating factors: 1. Ms Griffiths had acted dishonestly. 2. There is no evidence of any insight, remorse or remediation. The panel found the following to be mitigating factors: 1. Ms Griffiths has indicated that at the time of the incidents she was dealing with significant physical and mental health issues. 2. Ms Griffiths had a previously long and unblemished career as a nurse. The panel considered each of the sanctions in ascending order. 13

14 The panel first considered whether to take no action but concluded that this would be inappropriate in view of the nature of Ms Griffiths misconduct. The panel decided that it would be neither proportionate nor in the public interest to take no further action. Next, in considering whether a caution order would be appropriate in the circumstances, the panel took into account the 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 the dishonesty found proved was at the lower end of the spectrum. It was mindful that the misconduct related to isolated incidents during Ms Griffiths otherwise long and unblemished career and that it took place in a particularly difficult period in her life when she was dealing with physical and mental health issues. However, Ms Griffiths has not engaged with her regulator and has provided no evidence of insight, remorse or remediation. The panel considered whether it would be proportionate to impose a more restrictive sanction and looked at conditions of practice. The panel concluded that, in the light of the nature of the misconduct and Ms Griffiths lack of insight, there are no practical or workable conditions that could be formulated. Ms Griffiths misconduct did not relate to her clinical competence, but to her honesty and integrity. It therefore cannot be addressed through imposing conditions upon her registration. The panel concluded that no useful purpose would be served by a conditions of practice order. It is not necessary to protect the public and would not assist Ms Griffiths return to nursing practice. The panel further considered that a suspension order would be wholly disproportionate in this case. 14

15 For the next 4 years Ms Griffiths employer or any prospective employer will be on notice that her fitness to practise had been found to be impaired and that her practice is subject to a caution order. Having considered the general principles above and looking at the totality of the findings on the evidence, the panel has determined that to impose a caution order for a period of 4 years would be the appropriate and proportionate response. It would mark not only the importance of maintaining public confidence in the profession, but also send the public and the profession a clear message about the standards required of a Registered Nurse. At the end of this period the note on Ms Griffiths registration in the register will be removed. However, the NMC will keep a record of the panel s finding that her fitness to practise had been found impaired. If the NMC receives a further allegation that Ms Griffiths fitness to practise is impaired, the record of this panel s finding and decision will be made available to any practice committee that considers the further allegation. This decision will be confirmed in writing. That concludes this determination. 15