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 6 April 2018 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of Registrant: Veronica Rose Smyth NMC PIN: 88A0032S Part(s) of the Register: Registered Nurse Sub Part 1 Adult (24 May 1991) Area of Registered Address: Scotland Type of Case: Panel Members: Legal Assessor: Panel Secretary: Order being reviewed: Outcome: Misconduct Deborah Jones (Chair, lay member) Mark Gibson (Registrant member) Linda Redford (Lay member) David Clark Siobhán Hamill Suspension Order (6 months) Striking-off order 1

2 Decision on Service of Notice of Meeting The Nursing and Midwifery Council (NMC) sent written notice of this meeting to Mrs Smyth at her address, as recorded in the NMC s electronic Register, by Royal Mail Signed For service and by first class post on 27 February The notice made clear that the case would be considered at a meeting and would be held in private on or after 3 April The letter also invited Mrs Smyth to submit any written evidence she wished the panel to consider and detailed the powers available to the panel in disposing this case. The panel accepted the advice of the legal assessor. In the light of all of the information available, the panel was satisfied that Mrs Smyth has been served with notice of this meeting in accordance with the requirements of Rules 11A and 34 of the Nursing and Midwifery Council (Fitness to Practise) Rules 2004, as amended ( the Rules ). Decision and reasons on review of the current order The panel decided to impose a striking off order. This order will come into effect at the end of 17 May 2018 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) ( the Order ). The panel is reviewing the order pursuant to Article 30(1) of the Order. The charges which resulted in the imposition of the substantive order were as follows: That you a registered nurse, whilst working at Raigmore Hospital, on the nightshift commencing on 12 March 2015: 1. Did not promptly attend an alarming infusion pump and/or instructed Colleague A to turn the alarm off. 2

3 2. Used a derogatory term when referring to an unknown patient. 3. On one or more occasions, did not respond promptly and/or appropriately to unknown patients requests for pain relief. And, in light of the above, your fitness to practise is impaired by reason of your misconduct. The first reviewing panel determined the following with regard to impairment: The panel today has considered carefully whether Mrs Smyth s fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decision of the previous panel. However, it has exercised its own judgement as to current impairment. The panel heard and accepted the advice of the legal assessor. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. The panel considered whether Mrs Smyth s fitness to practise remains impaired. It considered all the information before it. The panel acknowledged that the substantive hearing panel considered Mrs Smyth s failings to be, in nature, remediable. However, this panel has not been presented with any new evidence to suggest that Mrs Smyth has yet taken any steps to remediate her failings and therefore to reduce the risk of repetition, or to demonstrate to the regulator that she has any insight into the effect of her actions on the public and profession at large. In fact, she has not engaged with the 3

4 regulator and has provided none of the evidence recommended to her by the previous reviewing panel to assist today s panel. The panel noted that Mrs Smyth had indicated to the substantive panel that she does not wish to return to nursing. The panel found that Mrs Smyth has been provided with the opportunity to demonstrate her full insight, remediation and reflection. She has not supplied any further documentation or information and has not engaged with the NMC since the substantive hearing. For these reasons, the panel concluded that the risk of Mrs Smyth repeating her past failings, thus putting patients at risk of harm and bringing the profession into disrepute has not been addressed, and therefore, Mrs Smyth s fitness to practise remains impaired. The first reviewing panel determined the following with regard to sanction: Having found Mrs Smyth s fitness to practise is currently impaired, the panel then went on to consider which sanction, if any, would now be appropriate in the circumstances of this case. The panel heard and accepted the advice of the legal assessor. In reaching its decision on sanction, the panel exercised its own independent judgement. The panel took account of the NMC Sanctions Guidance in addressing what order, if any, to impose. The panel also had regard to the need to protect the public as well as the wider public interest. It reminded itself that the purpose of a sanction is to protect the public and to maintain public confidence in the profession and in the NMC as its regulator. A sanction should not be punitive, although it may have a punitive effect. The panel first considered allowing the suspension order to lapse and taking no further action. The panel was satisfied that this was not one of those cases where, having found impaired fitness to practise, the appropriate step was to take 4

5 no action. The panel considered that taking no action would be inappropriate, as it would not address the continuing risk to patients and the public, or address the wider public interest concerns in this case. The panel then went on to consider a caution order. The panel determined that due to the lack of remediation there remains a risk of repetition. The misconduct in this case is not at the lower end of the spectrum. The panel therefore considered that a caution order would not be appropriate as it would not protect the public as no restriction would be placed on Mrs Smyth s practice. The panel next considered a conditions of practice order. It agreed with the conclusions of the previous, substantive panel in this regard. The panel has no information which suggests that Mrs Smyth would be willing to respond positively to a conditions of practice order, given her continued disengagement and the question as to whether she intends to return to nursing. The panel determined that conditions of practice would not be appropriate in this case since it is not possible to formulate conditions that are workable and practicable. The panel next considered imposing a further suspension order. It was of the view that a suspension order would allow Mrs Smyth further time to fully reflect on her previous failings. The panel determined that a further suspension order would be the appropriate and proportionate response at this time and would afford Mrs Smyth the opportunity to develop her insight and remediation. Having considered a suspension order to be the appropriate sanction in this case, the panel then considered the next sanction up and decided whether or not a striking-off order would be appropriate. The panel determined that whilst Mrs Smyth s disengagement, in particular, may give rise to the imposition of such sanction, the panel concluded that a striking-off order is not the only sanction available to it which would protect the public and the public interest in this case. The panel concluded that at this stage, a striking-off order would be inappropriate and determined to afford Mrs Smyth further time to potentially remedy her practice and to provide evidence of this to a future reviewing panel. The panel 5

6 reminds Mrs Smyth that this is a finely balanced case and that if she continues to disengage, a striking-off order may be imposed on her registration. The panel determined that a striking-off order at this time would be disproportionate. Mrs Smyth s actions constitute significant departures from the standards of performance expected of a registered nurse. The panel concluded that a suspension order for a period further period of 6 months is the most appropriate sanction at this time. Such an order continues to protect patients and the public, and satisfies the public interest in this case, whilst affording Mrs Smyth the opportunity to potentially remedy her practice and provide evidence of this to the NMC. A future reviewing panel may be assisted by Mrs Smyth s: - Engagement with the regulator; - A reflective piece demonstrating insight as to the effect Mrs Smyth s actions had on patients, her colleagues, and the profession; - References or testimonials, provided in either professional or personal capacity. 6

7 Decision on current fitness to practise The panel has considered carefully whether Mrs Smyth s fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decision of the previous panels. However, it has exercised its own judgment as to current impairment. The panel has had regard to all of the documentation before it which comprises the substantive order review bundle. The panel accepted the advice of the legal assessor. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. The panel considered whether Mrs Smyth s fitness to practise remains impaired. The panel bore in the mind the reasons why the original substantive panel and the previous reviewing panel found Mrs Smyth s fitness to practise impaired. On reviewing the substantive order, the panel noted that Mrs Smyth has not engaged with this process nor indeed with the last review process. It has not been provided with any correspondence from Mrs Smyth since the substantive hearing in April On this basis, it concluded that Mrs Smyth has not provided any evidence of having taken steps to remedy her misconduct or having developed her insight further. The panel has not been provided with any representations on Mrs Smyth s progress and current circumstances in relation to her nursing practice. Further, the panel noted the decision of the last panel to afford Mrs Smyth a further period of suspension for six 7

8 months, to allow her the opportunity to take steps to remediate, engage with her regulator and demonstrate further insight. The panel was of the view that Mrs Smyth has not adhered to the recommendations of the last reviewing panel. She has not provided evidence of reflection so as to demonstrate her insight, nor has she provided testimonials from employers. She has not engaged with her regulator. The panel has concluded that the risk identified by the last panel remains. Therefore the panel is satisfied that a finding of current impairment is necessary on the grounds of public protection. The panel has borne in mind that its primary function is to protect patients and the wider public interest, which includes maintaining confidence in the nursing profession and upholding proper standards of conduct and behaviour. The panel determined that, in this case, a finding of current impairment on public interest grounds is required. For these reasons, the panel finds that Mrs Smyth s fitness to practise remains impaired. Determination on sanction Having found Mrs Smyth s fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel noted that its powers are set out in Article 29 of the Order. The panel has also taken into account the NMC s Sanctions Guidance and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. Given that Mrs Smyth s fitness to practise remains impaired, that the matters of concern were serious, that she has not demonstrated remediation or insight of any kind in relation to her misconduct and that she has not engaged with her regulator. The panel considered that taking no further action or imposing a caution order was not appropriate 8

9 in this case. To do so would be insufficient to protect patients or to maintain public confidence in the profession and in the regulator. The panel next considered whether a conditions of practice order would be appropriate. The panel had regard to the NMC s Sanctions Guidance. The panel has no information which suggests that Mrs Smyth would be willing to respond positively to a conditions of practice order, given her current disengagement and her earlier indication that she does not wish to return to nursing. The panel determined that conditions of practice would not be appropriate in this case since it is not possible to formulate conditions that are workable and practicable. Furthermore, the panel could not be confident that Mrs Smyth is able or willing to respond positively to retraining. The panel next considered a further suspension order. The panel determined that Mrs Smyth had not demonstrated that she has used her period of suspension to rectify the concerns relating to her practice and to take steps to demonstrate her remediation and insight. The panel concluded that Mrs Smyth s failure to take steps to remediate the deficiencies and her indication within her earlier correspondence with the NMC that she does not wish to return to practice were indicative of an unwillingness to take the steps necessary to enable her to return to safe and effective unrestricted practice. The panel considered that there would be no purpose in imposing a further period of suspension as it concluded there was no reason to believe that Mrs Smyth would now take the opportunity to remediate the concerns in relation to her misconduct. The panel then considered a striking off order. The panel noted that Mrs Smyth has had two suspension orders. The second suspension order was for a six month period and recommendations were made that she should engage with her regulator; develop a reflective piece demonstrating insight as to the effect of her actions had on patients, her colleagues, and the profession; and provide references or testimonials, provided in either professional or personal capacity. The panel noted that the previous panel considered a striking-off order at that time to be inappropriate and the previous panel went onto say this is a finely balanced case 9

10 and if she continues to disengage a striking-off order may be imposed on her registration. The panel determined that the only sanction that would both protect the public and satisfy the public interest is a striking-off order. Mrs Smyth has continue to be disengaged with her regulator, has not demonstrated the steps she has taken to return to safe and effective practice, and has not provided evidence of her insight into her misconduct, despite being given opportunities to do so. It would not be in the public interest to prolong the case with a further suspension order, nor would such an outcome maintain confidence in the profession or the regulator. Mrs Smyth continues to pose a significant risk to the public were she to return to unrestricted nursing practice. In considering all the circumstances, the panel determined that Mrs Smyth s behaviour can now be described as fundamentally incompatible with being a registered nurse. The panel concluded that public confidence in the profession and in the NMC as a regulator could not be sustained if Mrs Smyth were allowed to remain on the register. The panel concluded that a striking-off order was now the only appropriate and proportionate response. This decision will be communicated to Mrs Smyth in writing. That concludes this determination. 10