Nursing and Midwifery Council: Fitness to Practise Committee

Transcription

1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Hearing February 2018 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of registrant: NMC PIN: Shane Paul White 08I1210E Part(s) of the register: Registered Nurse Sub part 1 Registered Mental Health Nurse (September 2009) Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Mr White: Nursing and Midwifery Council: Facts proved: England Misconduct Adrian Ward (Chair, Lay member) Joanne Lay (Registrant member) Yvonne Brown (Lay member) Nicholas Leviseur Ayesha Patel Present but not represented Represented by Helen Guest, Case Presenter N/A Facts proved by admission: 1 and 2 Facts not proved: Fitness to practise: N/A Impaired Sanction: Interim Order: Suspension Order - 6 months Review of order not necessary in accordance with Article 29 (8A) No Order Page 1 of 21

2 Details of charge (as amended): That you, a Registered Nurse: 1) Failed to declare your dismissal from Berkshire Healthcare NHS Foundation Trust in your application form to Surrey and Borders Partnership NHS Foundation Trust; Proved by admission 2) Your actions at charge 1 above were dishonest in that you deliberately failed to disclose the fact that you were dismissed from your former employment in an application for a new job Proved by admission AND in light of the above, your fitness to practise is impaired by reason of your misconduct. Impairment found Page 2 of 21

3 Decision and reasons on application to amend the charge The panel heard an application made by Ms Guest, on behalf of the NMC, to amend the wording of charge 1. The proposed amendment was to correct a typographical error from Boarders in charge 1 as below: 1) Failed to declare your dismissal from Berkshire Healthcare NHS Foundation Trust in your application form to Surrey and Boarders Partnership NHS Foundation Trust; To Borders as follows: 1) Failed to declare your dismissal from Berkshire Healthcare NHS Foundation Trust in your application form to Surrey and Borders Partnership NHS Foundation Trust; It was submitted by Ms Guest that the proposed amendment would more accurately reflect the evidence and would not alter the substance of the charge. You agreed to the proposed amendment. The panel accepted the advice of the legal assessor that Rule 28 of the Rules states: 28. (1) At any stage before making its findings of fact, in accordance with rule 24(5) or (11), the Investigating Committee (where the allegation relates to a fraudulent or incorrect entry in the register) or the Fitness to Practise Committee, may amend (a) (b) the charge set out in the notice of hearing; or the facts set out in the charge, on which the allegation is based, unless, having regard to the merits of the case and the fairness of the proceedings, the required amendment cannot be made without injustice. (2) Before making any amendment under paragraph (1), the Committee shall consider any representations from the parties on this issue. Page 3 of 21

4 The panel was of the view that such an amendment, as applied for, was simply correcting a typographical error. The panel was satisfied that there would be no prejudice to you and no injustice would be caused to either party by the proposed amendment being allowed. It was therefore appropriate to allow the amendment, as applied for, to ensure accuracy. Background You submitted an application form to the Surrey and Borders Partnership NHS Foundation Trust (the Trust) on 4 December Within the application form, you were asked the reason for leaving your previous role at Berkshire Healthcare NHS Foundation Trust (Berkshire). You had stated in the form that your reasons for leaving your previous role were that you would like to continue to develop as a nurse and a leader; that your previous role was not stable, and that you were not treated correctly. You had also stated that you would like to find a role more suited to [your] skills and experience. It is alleged that you failed to disclose that you had been dismissed from Berkshire. Further, the application form declaration stated: The information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed by the organisation. Where applicable, I consent that the organisation can seek further clarification regarding professional registration details. You placed an x in the box alongside I agree to the above declaration. Having submitted the application form, you were successful and commenced your role as a Band 7 Team Leader in the County Forensic Team on 30 January Following an audit of recruitment files by the Trust, it was discovered that you had not provided a current reference from your previous employer. You had provided a reference from a Line Manager/Colleague/Friend who last worked with you in September The Page 4 of 21

5 Trust sought and obtained a current reference from Berkshire, which disclosed that you had been suspended on 22 February 2017, and dismissed for gross misconduct following a disciplinary hearing on 1 March Decision on the findings on facts and reasons At the start of this hearing you admitted the following charges: That you, a Registered Nurse: 1) Failed to declare your dismissal from Berkshire Healthcare NHS Foundation Trust in your application form to Surrey and Borders Partnership NHS Foundation Trust; 2) Your actions at charge 1 above were dishonest in that you deliberately failed to disclose the fact that you were dismissed from your former employment in an application for a new job In accordance with the Rules, these charges were therefore announced as proved. Submissions on misconduct and impairment: Having announced its finding on all the facts, the panel then moved on to consider whether the facts found proved amount to misconduct and, if so, whether your fitness to practise is currently impaired. There is no statutory definition of fitness to practise. However, the NMC has defined fitness to practise as a registrant s suitability to remain on the register unrestricted. In her submissions Ms Guest invited the panel to take the view that your actions amounted to a breach of The Code: Professional standards of practice and behaviour for nurses and midwives (2015) (the Code). She then directed the panel to specific paragraphs and identified where, in the NMC s view, your actions amounted to misconduct. Ms Guest referred the panel to the case of Roylance v GMC (No. 2) [2000] 1 AC 311 which defines misconduct as a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. Page 5 of 21

6 Ms Guest then moved on to the issue of impairment, and addressed the panel on the need to have regard to protecting the public and the wider public interest. This included the need to declare and maintain proper standards and maintain public confidence in the profession and in the NMC as a regulatory body. Ms Guest referred the panel to the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin). You explained to the panel that, after your dismissal from Berkshire, you had planned on taking the matter to a tribunal in order to get the decision reversed. [PRIVATE]. You said that, at the time of submitting the application, as stupid as it was, I was scared of not being able to provide for my family. I knew [not disclosing the dismissal] was a big mistake and a stupid thing to do. I had a knot in my stomach it was not the honourable thing to do to not be honest. You said that you knew that your dishonesty would be found out and you could not do your job properly, knowing that I had not gone in in the correct manner. Since your dismissal, you have been working as a support worker at a small private supported living service working with people who have learning disabilities. You told the panel that being a nurse is a large part of your identity and that you have been a nurse for 13 years. You described to the panel your pride in your role, how colleagues perceived you, and your love for nursing. You said that, looking back on the minutes of the Trust s disciplinary hearing, you realised that you had not apologised for your actions and had been very defensive and in denial about what you had done wrong. You stated that, should you have the opportunity to nurse again, you would never make the same mistake. You said that you are ashamed to let the profession down and that it was shaming to be in this position. If you were ever to apply for a nursing job again, you said you would contact a previous employers, explain what had happened, and discuss the possibility of future employment. You said that you recognised that other nurses would have felt disappointed and let down by your actions. Further, you said that the public would also be disappointed; you need to have trust in people who care for you it is not possible to build rapport and gain trust when you re not honest. You said that, for a long time after this incident, you Page 6 of 21

7 did not want to go back to nursing. You said on a number of occasions that it has been a lot to cope with, all my own fault, but that doesn t make it any easier. Further you said that you wished for this incident to not define who you are. You said that you have children at home. I teach them about honesty and have not set a good example myself. The panel has accepted the advice of the legal assessor which included reference to a number of judgments which are relevant, these included: Roylance v General Medical Council (No 2) [2000] 1 A.C. 311 and Nandi v GMC [2004] EWHC 2317 (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. Secondly, only if the facts found proved amount to misconduct, the panel must decide whether, in all the circumstances, your fitness to practise is currently impaired as a result of that misconduct. Decision on misconduct When determining whether the facts found proved amount to misconduct the panel had regard to the terms of 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 your actions fell short of the standards expected of a registered nurse, and that your actions amounted to a breach of the Code. Specifically: 20 Uphold the reputation of your profession at all times 20.1 keep to and uphold the standards and values set out in the Code 20.2 act with honesty and integrity at all times, 20.3 be aware at all times of how your behaviour can affect and influence the behaviour of other people Page 7 of 21

8 20.8 act as a role model of professional behaviour for students and newly qualified nurses and midwives to aspire to 21 Uphold your position as a registered nurse or midwife The panel appreciated that breaches of the Code do not automatically result in a finding of misconduct. However, you admitted to failing to disclose your dismissal on your application form in order to get an interview for a job at the Trust. The panel considered that your dishonesty was premeditated and, at the time of your actions, you had felt justified in being deliberately dishonest so that you could gain employment. Further, the panel noted that you had been in a position of authority both in your previous role and in your new role at the Trust. The panel was of the view that your conduct did not uphold the standards and values expected of a senior nurse and that you failed to act as a role model of professional behaviour. The panel found that your actions did fall significantly short of the conduct and standards expected of a nurse and were serious enough to amount to misconduct. Page 8 of 21

9 Decision on impairment The panel next went on to decide if, as a result of this misconduct, your fitness to practise is currently impaired. Nurses occupy a position of privilege and trust in society and are expected at all times to be professional. Patients and their families must be able to trust nurses with their lives and the lives of their loved ones. To justify that trust, nurses must 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 went on to say in Paragraph 76: I would also add the following observations in this case having heard submissions, principally from Ms McDonald, as to the helpful and comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman, referred to above. At paragraph she identified the following as an appropriate test for panels considering impairment of a doctor s fitness to practise, but in my view the test would be equally applicable to other practitioners governed by different regulatory schemes. Page 9 of 21

10 Do our findings of fact in respect of the doctor 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. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or b. has in the past brought and/or is liable in the future to bring the medical 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 medical profession; and/or d. has in the past acted dishonestly and/or is liable to act dishonestly in the future. The panel finds that limbs b, c and d are engaged. The panel considered that, by failing to disclose your dismissal to the Trust, you had acted dishonestly and, in doing so, you had breached one of the fundamental tenets of the nursing profession, bringing it into disrepute. The panel acknowledged your presence at today s hearing and the fact that you made admissions at the outset of the hearing. The panel was of the view that you expressed remorse with regard to your actions and showed some recognition of how your actions were wrong and adversely affected the nursing profession and wider public. However, the panel considered that your evidence was focused more upon you and how the incident, which occurred over a year ago, affected your own situation rather than the effect of your behaviour on others and on the reputation of the profession. There was no evidence that you appreciated how your actions may have affected your previous employers, the Trust, or referees who had attested to your good character. The panel, having heard you give evidence, concluded that you have some insight but that this is still developing. Page 10 of 21

11 In its consideration of whether you have remedied your practice, the panel was mindful that dishonesty is inherently difficult to remediate. The panel bore in mind that the overarching objectives of the NMC are to protect, promote and maintain the health, safety and well-being of the public and patients, and to uphold/protect the wider public interest. This includes promoting and maintaining public confidence in the nursing and midwifery professions and upholding the proper professional standards for members of those professions. The panel noted your remorse but, given your limited insight, it could not entirely rule out the risk of your actions being repeated, were you to find yourself in a similar situation again. The panel therefore decided that a finding of impairment is necessary on the grounds of public protection. The panel went on to remind itself of the need to uphold proper professional standards and to consider whether public confidence in the profession would be undermined if a finding of current impairment of fitness to practise were not made in the circumstances of this case. Given that the charges relate predominantly to matters of dishonesty and integrity, the panel concluded that a finding of impairment on public interest grounds is required, both in order to uphold professional standards and public confidence in the profession, as well as in the NMC as the regulator. Having regard to all of the above, the panel was satisfied that your fitness to practise is currently impaired. Page 11 of 21

12 Submissions on Sanction You drew the panel s attention to seven testimonials from your current and former colleagues, including from: Ms 1 - Contracts Manager at your current employer, Look Ahead Care, Support and Housing Services (Look Ahead) Mr 2 - former Senior Mental Health Practitioner at Berkshire, now a Teaching Fellow at the University of Surrey Ms 3 former Mental Health Practitioner at Berkshire, now a Social Worker in the Slough Community Team Ms 4 former Senior Mental Health Practitioner at Berkshire. You explained under affirmation that you had worked with your former colleagues at Berkshire for a period of one to two years, some two years ago. You told the panel that you had worked particularly closely with Mr 2 and Ms 3, alongside them on a daily basis. They are both aware of your dismissal and these NMC proceedings. Further, you maintain contact with Ms 4 with whom you had worked for several years. You added that you had lost contact with two of the referees since your dismissal. You said that, having read the panel s determination on misconduct and impairment, you had reflected on how the panel had perceived you during your evidence to the panel. You recognised that you had seemed to be self-absorbed and you apologised, explaining that this was the first time you had spoken to anyone about this, that it had been a difficult process and that you had found it hard to focus on the issues which were particularly relevant to the panel s determination. [PRIVATE] When asked, you said that, with hindsight, you would not have applied for the job at the Trust without disclosing your dismissal. You spent some time explaining the effect on colleagues and service users of your actions. You said that you recognised that your actions caused your department, and potentially another, to be left without a team lead, thus affecting both morale and the ability of staff to provide quality care to service users. Page 12 of 21

13 You said that you did disclose your dismissal and these NMC proceedings at the interview for your current role at Look Ahead. You said that, in future, you would declare your dismissal in any job application and you accept that this may result in you not getting an interview or a job. [PRIVATE]. Ms Guest outlined the aggravating and mitigating factors in this case. She submitted that it is a matter for the panel to determine where on the spectrum of dishonesty your misconduct lies. She informed the panel that she had managed to verify the authenticity of three of the testimonials and had no reason to doubt the authenticity of the remaining four. She added that she had spoken to Ms 1, who stated that she has had the opportunity to assess your honesty, albeit in a more financial context, and found you to be trustworthy, reliable, always willing, and a team player. Further, Mr 2, Ms 3 and Ms 4 all stand by the contents of their testimonials dated September Ms Guest spoke to Ms 4 by telephone; she said that she was surprised by your dishonesty and that it was clear that it was out of character. Ms Guest reminded the panel that your clinical practice has not been called into question. Ms Guest submitted that any sanction, if imposed, should balance public protection and public interest concerns with your interests. She submitted that the public interest in this case includes the return to practice of an otherwise good and safe nurse. She submitted, nevertheless, that in this case, public disapproval of your dishonest conduct would not be met by the imposition of no order or a caution order. Further, the imposition of a conditions of practice order would not be appropriate as matters in this case do not involve any clinical failings which can be addressed through specific training. She submitted that the imposition of a suspension order would mark the seriousness of your misconduct, which was not considered to be so serious as to be fundamentally incompatible with your remaining on the register. Ms Guest submitted that it is ultimately a matter for the panel to determine which sanction, if any, to impose, as well as the appropriate time period of that sanction. She referred the panel to the NMC s Sanction Guidance. Page 13 of 21

14 Determination on sanction: The panel has considered this case very carefully and has decided to make a suspension order. The effect of this order is that the NMC register will show that your registration has been suspended. 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 published by the NMC. It recognised that the decision on sanction is a matter for the panel, exercising its own independent judgement. The panel found the following to be aggravating factors in this case: your dishonesty was premeditated your actions resulted in personal gain you did not voluntarily confess your dishonesty prior to being found out. The panel found the following to be mitigating factors: this was an isolated incident of misconduct, without further repetition you have taken personal responsibility for your actions there were stressful factors in your personal life at the time of the incident you have shown some insight into your misconduct you have shown remorse. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the seriousness of the case. 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 NMC Sanctions Guidance, which states that a caution order may be appropriate where the case is at the lower end of the spectrum of Page 14 of 21

15 impaired fitness to practise and the panel wishes to mark that the behaviour was unacceptable and must not happen again. The panel considered that your misconduct was not at the lower end of the spectrum and that a caution order would be inappropriate in view of the 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 next considered whether placing conditions of practice on your registration would be a sufficient and appropriate response. The panel is mindful that any conditions imposed must be proportionate, measurable and workable. The panel took into account the NMC Sanctions Guidance, in particular: Conditions may be appropriate when some or all of the following factors are apparent (this list is not exhaustive): no evidence of harmful deep-seated personality or attitudinal problems identifiable areas of the nurse or midwife s practice in need of assessment and/or retraining no evidence of general incompetence potential and willingness to respond positively to retraining The panel noted that there is no evidence that you have harmful deep-seated personality or attitudinal problems. In any case, the panel is of the view that there are no practical or workable conditions that could be formulated, given the nature of the charges in this case. The misconduct identified in this case was not something that can be addressed through retraining. The panel then went on to consider whether a suspension order would be an appropriate sanction. The NMC Sanctions Guidance indicates that a suspension order may be appropriate where some of the following factors are apparent: a single instance of misconduct but where a lesser sanction is not sufficient no evidence of harmful deep-seated personality or attitudinal problems no evidence of repetition of behaviour since the incident Page 15 of 21

16 the Committee is satisfied that the nurse or midwife has insight and does not pose a significant risk of repeating behaviour The panel was mindful that your dishonesty was premeditated and while your misconduct did not directly harm the service users in your care, you admitted that your actions did have a negative impact on the ability of your colleagues to care for the service users and, therefore, adversely affecting the quality of care the service users would have received. The panel also bore in mind that you had been in a position of leadership both in your previous role at Berkshire and in your role at the Trust. The panel considered that there is a spectrum of dishonest conduct. In all the circumstances, in the panel s judgement, your actions were not at the higher end of this spectrum. However, the panel determined that, although there had been a clear breach of a fundamental tenet of the profession and you had brought the nursing profession into disrepute, your misconduct was an isolated incident in the context of a 13 year nursing career. The panel considered the developing insight and reflection that you have demonstrated during these proceedings, specifically with regard to the adverse impact, of your actions, on both your colleagues and the services users at the Trust. The panel was also mindful that you disclosed your dismissal and these NMC proceedings to your current employer at your interview. The panel took into account the positive testimonials attesting to your honesty and integrity, as well as your good nursing practice. The panel is satisfied that the testimonials show you to be a good nurse, capable of providing leadership in a complex area of practice, namely mental health care. The panel particularly considered the oral feedback given to Ms Guest by Ms 1 and Ms 4, attesting to your good character, as well as Ms 1 s testimonial dated 12 February 2018, which stated: Page 16 of 21

17 In the time Shane has worked for Look Ahead he has proven himself to be a valuable asset to the service. He has demonstrated a willingness to go the extra mile to ensure the needs of the customers that we serve and the overall needs of the service are achieved. Shane has always shown himself to be a model of integrity, honesty and professionalism during the time I have known him. Indeed, he was open and honest about the circumstances that led him to losing his previous job as a mental health nurse and the ensuing hearing he will face with the Nursing and Midwifery Council. I have full trust in him as an employee. The panel considered Mr 2 s testimonial dated 1 September 2016, which stated: Despite the consistent pressure and lack of clarity from senior management about the role Shane regularly went above and beyond what was requested of him to support his colleagues and patients within our service... To me his professionalism is unquestionable I for one will continue to hold Shane s clinical skills and professionalism in high regard The panel also took account of Ms 3 s testimonial dated 5 September 2016 which stated: Shane has an excellent grasp of the crisis and home treatment model which is essential in providing competent, compassionate and effective care and treatment in our service Shane has excellent leadership skills Shane s passion for what he does and his drive towards service improvement for the benefit of service users and staff is inspirational I would trust him if he was to care for one of my friends or relatives and I would even go as far as to say that I would trust him with my life. Page 17 of 21

18 Further, the panel bore in mind Ms 4 s testimonial dated 6 September 2016, which stated: He is an excellent team player, able to use his own initiative when required and as a shift leader he is effective in delegating and managing tasks. Other team members frequently go to Shane for advice and support which he is always happy to provide. His ability to co-ordinate shifts under stressful circumstances, with limited staff and a high referral rate makes him a valuable asset to any employer. For me it is a pleasure to work with Shane and I look forward to working with him again. The panel was of the view that, in all the circumstances, there is no significant risk of your repeating this behaviour. Furthermore, the panel considered it to be significant that you have chosen to work in a care setting with vulnerable people, despite the lack of a financial incentive to do so. Your employer is aware of these proceedings, is supportive of you, and has found no fault with either your conduct or your clinical practice. As such, the panel considered that, in this case, your misconduct was not fundamentally incompatible with remaining on the register. Your dishonesty was not persistent and did not result in direct patient harm. Whilst the panel acknowledges that a suspension may have a punitive effect, it would be unduly punitive in your case to impose a striking off order. Balancing all of these factors the panel has concluded that a suspension order would be the appropriate and proportionate sanction. Taking account of all the information before it, and taking account of all the mitigating circumstances, the panel concluded that it would be disproportionate to remove you from the register. The panel noted the hardship such an order will inevitably cause you and your family. However this is outweighed by the public interest in this case. The panel considered that this order is necessary to mark the importance of maintaining public confidence in the profession, and to send to the public and the profession a clear message about the standard of behaviour required of a registered nurse. However, the panel also considered that the public interest includes the return to practice of an otherwise safe and competent nurse. Page 18 of 21

19 The panel therefore determined that a suspension order for a period of six months was appropriate in this case to mark the seriousness of the misconduct. After having found that your fitness to practise was currently impaired, the panel heard further evidence from you, which it regarded as important, and considered that you have continued to develop insight throughout the duration of these proceedings. In the light of this evidence, the panel was satisfied that there were no significant public protection concerns arising from its decision. In this respect, it found your fitness to practise impaired on the grounds of public interest. Article 29 (8A) of the Order provides that the panel may exercise its discretionary power and determine that a review of the substantive order is not necessary. Article 29 (8A) states 8A) If, at the time of making an order under paragraph (5)(b) or (c), the Fitness to Practise Committee is satisfied that, with effect from the date of the expiry of that order, it will not be necessary to (a) extend the period of the order; (b) vary the order; or (c) make any other order falling within article 29(5), the Committee may decide that article 30(1) does not apply to that order. The panel determined that it made the suspension order having found your fitness to practise currently impaired primarily in the public interest. Having heard your oral evidence after its determination on misconduct and impairment, and in the light of the very positive testimonials that it only received at the sanction stage, the panel is satisfied that the suspension order will satisfy the public interest in this case and will maintain public confidence in the profession(s) as well as the NMC as the regulator; and that in the particular circumstances of this case, there is no need for a review. Page 19 of 21

20 Accordingly, the current substantive order will expire, without review, on the date of its expiry. Determination on Interim Order Page 20 of 21

21 The panel has considered the observations made by Ms Guest that an interim order has not been imposed throughout these proceedings. Ms Guest submitted that an interim order should only be imposed solely in the public interest if the high bar of necessity has been met. The panel heard from you that you will continue to work with your current employer over the next 28 days, during which an appeal could be made. The panel accepted the advice of the legal assessor. In all the circumstances, and in the light of its previous decision, the panel was satisfied there is no real risk of harm posed to the public by your unrestricted practice as a registered nurse. Further, the high bar of necessity to impose an interim order solely in the public interest has not been met. That concludes this determination. This will be confirmed to you in writing. Page 21 of 21