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

Transcription

1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 5 April 2018 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of registrant: NMC PIN: Shelagh Millar 87H0547E Part(s) of the register: Registered Nurse Sub Part 2 Adult Nursing 6 August 1991 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Registrant: Nursing and Midwifery Council: Order being reviewed: Outcome: England Misconduct Raymond Marley (Chair, Lay member) Natasha Duke (Registrant member) Terry Shipperley (Registrant member) Mark Sullivan Vicky Green Not present and not represented in her absence Represented by Ruth Ann Cathcart, Case Presenter Suspension Order (3 months) Striking off order to come into effect at the end of 15 May 2018 in accordance with Article 30 (1) 1

2 Service of Notice of Hearing The panel was informed at the start of this hearing that Mrs Millar was not in attendance, nor was she represented in her absence. The panel was informed that the notice of this hearing was sent to Mrs Millar on 27 February 2018 by recorded delivery and first class post to her registered address. The notice was returned to the sender. 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). Proceeding in absence The panel then considered proceeding in the absence of Mrs Millar. The panel was mindful that the discretion to proceed in absence is one which must be exercised with the utmost care and caution. The panel considered all of the information before it, together with the submissions made by Ms Cathcart, on behalf of the Nursing and Midwifery Council (NMC). The panel accepted the advice of the legal assessor. Ms Cathcart directed the panel to an on table document which contained telephone calls to landline and mobiles and s from the NMC to Mrs Millar in relation to her attendance at this hearing. Ms Cathcart told the panel that Mrs Millar has not replied and has not engaged at all throughout the entirety of these proceedings. She submitted that Mrs Millar has not contacted the NMC to provide any reason for her non-attendance at this hearing. 2

3 The panel noted that there had been no response from Mrs Millar in relation to the notice of hearing. The panel was mindful that Mrs Millar has not engaged with the NMC throughout these proceedings. Mrs Millar had been sent notice of today s hearing and the panel was satisfied that she was or should be aware of today s hearing. It is incumbent on registrant to update their regulator of any change of address or telephone number and the panel is of the view that Mrs Millar had chosen to disengage. The panel, therefore, concluded that she had chosen voluntarily to absent herself. The panel had no reason to believe that an adjournment would result in Mrs Millar s attendance. Having weighed the interests of Mrs Millar with those of the NMC and the public interest in an expeditious disposal of this hearing the panel determined to proceed in Mrs Millar s absence. 3

4 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 15 May 2018 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the third review of a suspension order, originally imposed by a panel of the Conduct and Competence Committee on 15 November 2016 for nine months. This order was reviewed on 8 September 2017 and extended for a period of three months. The last reviewing panel, on 9 November 2017, expended the suspension order for a further 5 months. The current order is due to expire on 15 May 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: 1. Between April 2014 and August 2014 did not ensure refrigerator temperatures were adequately monitored and/or recorded 2. Between 15 February 2013 and August 2014 you did not ensure the practice vaccine log book was updated. 3. On or before 1 July 2014, you did not ensure out of date medication was disposed of. 4. Before 2 April 2014 you did not update all internal policies; 5. On or before 1 July 2014 you left the work space in an unsatisfactory state in that 5.1. the practice nurse treatment room was dirty and/or dusty; 5.2.you did not ensure there were adequate means to clean surfaces between patients 5.3.medical equipment was stored but not cleaned; 4

5 5.4.you did not ensure records were kept for cleaning and sterilisation of equipment; 5.5.used single-use ear pieces and/or thermometer shields were kept with new supplies; 5.6. the spirometry machine was not clean 5.7.wound care supplies were kept in a pile in opened packaging; 6. On or before 1 July 2014, you did not ensure needles were stored in a safe manner in that: 6.1.They were kept in their plastic wrappers outside of their original boxes; 6.2.They were stored in a low, unlocked drawer, mixed with other medical supplies; 6.3.They were disposed of in an unsecured sharps box which kept on the floor. The second reviewing panel determined the following with regard to impairment: The panel has considered carefully whether Mrs Millar 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 decisions 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, including the substantive reviewing bundle. It has taken account of the submissions made by Ms Dongray on behalf of the NMC. Ms Dongray submitted that no evidence of remediation has been received by the NMC since the last review hearing and that there has been no known change in Mrs Millar s circumstances. Ms Dongray submitted that the risk of repetition 5

6 remains and, taking into consideration the seriousness of the allegations, she invited the panel to find that Mrs Millar remains impaired on public protection and public interest grounds. In relation to sanction, Ms Dongray invited the panel to impose a further period of suspension. She asked the panel to include a strong recommendation to Mrs Millar, within its determination, that should Mrs Millar continue to disengage with the NMC, she may be removed from the register. 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 Millar s fitness to practise remains impaired. The panel noted that it had no new information before it. Despite the concerns raised in Mrs Millar s case being remediable, the panel had no evidence of remediation insight or remorse before it. It further noted that Mrs Millar had failed to engage with the NMC since before the substantive hearing, which she did not attend. Further, the panel found that Mrs Millar had failed to comply with any of the suggestions made by the previous reviewing panel, such as providing today s panel with a reflective piece or testimonials. Noting the lack of information before it, the panel determined that the areas of concern identified by the substantive panel had not yet been addressed, and in light of this, this panel determined that Mrs Millar remained liable to repeat the behaviour identified. It therefore decided that a finding of continuing impairment is necessary on the grounds of public protection. 6

7 The panel had borne in mind that its primary function was to protect patients and the wider public interest which includes maintaining confidence in the nursing profession and upholding proper standards of conduct and performance. The panel determined that, in this case, a finding of continuing impairment on public interest grounds is required. For these reasons, the panel finds that Mrs Millar s fitness to practise remains impaired. The second reviewing panel determined the following with regard to sanction: Having found Mrs Millar s fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel noted that its powers are set out in Article 29 of the Order. The panel has also taken into account the NMC s Sanctions Guidance (SG) and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. The panel first considered whether to revoke the current order but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel then considered whether to impose a caution order but decided that it would be neither proportionate nor in the public interest to impose a caution order as the case is not at the lower end of the spectrum of impaired fitness to practice. The panel next considered replacing the current suspension order with a conditions of practice order. It noted that it had no new information before it regarding Mrs Millar s current employment, if any. The panel determined that in light of Mrs Millar s failure to engage with the NMC and comply with suggestions made by the previous reviewing panel, it could not be satisfied, that should a conditions of practice order be imposed, Mrs Millar would comply with the conditions. The panel therefore concluded that there were no workable 7

8 conditions which could be formulated which would adequately protect the public or satisfy the wider public interest concerns in Mrs Millar s case. Despite the fact that Mrs Millar had not provided any information to the NMC during the period she has been suspended, the panel found that a further period of suspension should be considered. The panel determined that a striking off order was disproportionate at this stage. The panel was of the view that a suspension order would allow Mrs Millar a further chance to fully reflect on her previous failings. The panel concluded that a further five-month suspension order would be the appropriate and proportionate response. That period would afford Mrs Millar ample time to develop her insight, demonstrate remediation and begin to engage with the NMC. At the end of the period of suspension, another panel will review the order. At the review hearing, the panel may revoke the order or it may confirm the order, or it may replace the order with another order. The panel were very concerned at Mrs Millar s continuing lack of engagement with her regulator and determined that a future panel will be assisted by the following information: Evidence of Mrs Millar maintaining her knowledge of contemporary nursing practice; Mrs Millar providing details of any employment she has undertaken, either paid or unpaid during the period of suspension, including testimonials and references; Mrs Millar providing a reflective piece addressing the wider ranging failures identified in her case. Decision on current fitness to practise The panel has considered carefully whether Mrs Millar s fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decision of the last panel. However, it has exercised its own judgment as to current impairment. 8

9 The panel has had regard to all of the documentation before it, including the NMC bundle and the on table document. It has taken account of the submissions made by Ms Cathcart on behalf of the NMC. Ms Cathcart provided the panel with an overview of the history of this case and invited the panel to find that Mrs Millar s fitness to practise remains impaired. Ms Cathcart submitted that Mrs Millar has not responded to the NMC at any stage of these proceedings. She submitted that Mrs Millar s lack of engagement demonstrates a flagrant disregard for her regulator and the regulatory process. Ms Cathcart further submitted that, despite encouragement from previous reviewing panels, Mrs Millar has not provided any evidence of insight, remorse or remediation into her serious misconduct. In the light of the above, Mrs Cathcart submitted that a striking off order is the most appropriate sanction. If the panel were not minded to remove Mrs Millar from the register, Ms Cathcart invited the panel to consider a suspension order for a period of 12 months. 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 Millar s fitness to practise remains impaired. The panel had regard to the fact that Mrs Millar has not engaged with the NMC at all throughout these proceedings and has failed to respond to any communication, including recent telephone calls and s. 9

10 Mrs Millar, through her non-engagement, has deprived the panel of any evidence of insight, remorse or remediation. The panel considered that the charges that were found proved at the substantive hearing amounted to serious misconduct. The panel determined that due the lack of engagement, and in the absence of any evidence of insight, remorse or remediation, there remains a risk of repetition of her misconduct. The panel therefore decided that a finding of continuing impairment is necessary on the grounds of public protection. The panel had borne in mind that its primary function was to protect patients and the wider public interest which includes maintaining confidence in the nursing profession and upholding proper standards of conduct and performance. The panel determined that, in this case, a finding of continuing impairment on public interest grounds is required noting Mrs Millar has demonstrated a flagrant disregard for the regulator and the regulatory process. For these reasons, the panel finds that Mrs Millar s fitness to practise remains impaired. Determination on sanction Having found Mrs Millar 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(1) and 29 of the Order. The panel has also taken into account the NMC s Sanctions Guidance (SG) and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. 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 replace the existing order with a caution order but concluded that this would be inappropriate in view of the risk of repetition identified and 10

11 seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to impose a caution order. The panel considered whether to impose a conditions of practice order upon the expiry of the suspension order but concluded that this would be inappropriate in these circumstances. Mrs Millar has not engaged with the NMC and she has not worked in the nursing profession since the allegations arose. The panel considered the circumstances in which a conditions of practice order is the appropriate sanction. The panel determined that due to Mrs Millar s non engagement and lack of insight, it would not be possible to formulate workable conditions. The panel next considered extending the current suspension order. Mrs Millar has now been suspended for almost 18 months. Throughout that period she has failed to engage with the process, to attend any of the review hearings or to provide any of the material suggested by the previous panels. The panel noted that Mrs Millar has not shown remorse for her misconduct. Further Mrs Millar has not demonstrated any insight into her previous failings and demonstrated a flagrant disregard for her regulator and the regulatory process. The panel determined that a further period of suspension would not serve any useful purpose in all of the circumstances. The panel determined that it was necessary to take action to prevent Mrs Millar from practising in the future and concluded that the only sanction that would adequately protect the public and serve the public interest was a striking-off order. This decision will be confirmed to Mrs Millar in writing. That concludes this determination. 11