Part(s) of the register: Registered nurse sub part 2 Adult nursing L2 October 1980 Registered nurse sub part 1 Adult nursing L1 Sept 1998

Transcription

1 Fitness to Practise Committee Substantive order review meeting 23 May 2018 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of registrant: NMC PIN: Joanna Roma Bryans 77B0369E Part(s) of the register: Registered nurse sub part 2 Adult nursing L2 October 1980 Registered nurse sub part 1 Adult nursing L1 Sept 1998 Area of registered address: England Type of case: Panel Members: Legal Assessor: Panel Secretary: Order to be reviewed: Misconduct Helen Potts (Chair Lay member) Diane Corderoy (Registrant member) Alice Rickard (Lay member) David Marshall Anita Abell Conditions of Practice order for 3 years Outcome: Striking off order to take effect from end of 8 July

2 Decision on Service of Notice of hearing The legal assessor informed the panel that written notice of this hearing had been sent to Ms Bryans registered address by recorded delivery and by first class post on 11 April The notice stated that the substantive order review meeting would take place on or after 21 May The panel accepted the advice of the legal assessor. The panel had before it a copy of the first page of the notice of hearing bundle, and an envelope which was returned to the NMC marked not called for. The panel also had before it a telephone note, dated 25 April 2018, which gave details of a conversation between the case officer and Ms Bryans sister. Her sister informed the case officer that Ms Bryans was currently living abroad with family. She declined to provide an alternative address for Ms Bryans but she said all correspondence sent to Ms Bryans home address was forwarded to her abroad. The panel accepted the advice of the legal assessor. In the light of all of the information available the panel was satisfied that Ms Bryans had been served with notice of this hearing in accordance with the requirements of Rules 11A and 34 of the Nursing and Midwifery Council (Fitness to Practise) Rules

3 Decision and Reasons: The panel determined that Ms Bryans fitness to practise remains impaired. It decided to impose a striking off order with effect from the end of 8 July This hearing was the fourth review of an order imposed on Ms Bryans registration by a panel of the Conduct and Competence Committee on 4-6 March That order was a suspension order for 9 months. The order was reviewed on 2 December 2013 and a suspension order for 12 months was imposed. That order was reviewed on 1 December The reviewing panel imposed a further suspension order for a period of 6 months. That order was reviewed on 5 June 2015 and it was replaced by a conditions of practice order for a period of 3 years. The order expires at the end of 8 July Substantive hearing 4-6 March 2013 At the substantive hearing held in March 2013 the following charges were found proved: That you whilst employed as a Band 6 registered nurse by South Central Ambulance Service NHS Trust: 1. On 27 November 2010 inappropriately assessed an emergency call in that you: a. Used the incorrect protocol; b. Assessed the call as Category C instead of Category A; 2. On 22 December 2010 inappropriately assessed an emergency call in that you: a. Used the incorrect protocol; b. Assessed the call as Category C instead of Category A; 3

4 That panel found that Miss Bryans fitness to practise was impaired by reason of misconduct, and noted in its determination: The panel has heard no evidence whatsoever regarding any remedial action Ms Bryans may have undertaken since the incidents which gave rise to her misconduct. Ms Bryans has not provided the panel with any evidence which demonstrates any understanding of her failings. She expressed no concern or remorse regarding the unwarranted risk of harm to which she exposed vulnerable patients. The panel found this to show a lack of understanding of her responsibilities, shortcoming and lack of insight. That panel determined that a suspension order for a period of 9 months was the appropriate and proportionate sanction. Decision of last review panel 5 June 2015 The panel that last reviewed this order on 5 June 2015 determined that Miss Bryans fitness to practise remained impaired. Its decision is set out below in italics; At the outset of the proceedings the panel also invited Ms Jones to make submissions on whether to transfer this matter to the Health Committee, based on the information contained in the letter from the RCN, dated 3 June 2015, the letter from Miss Bryans GP, dated 28 June 2012 and the letter from Miss Bryans family dated 15 August With regard to the review of the substantive order Ms Jones, on behalf of the NMC, referred the panel to the findings of the previous panels at the substantive hearing on 4-6 March 2013 and at the subsequent reviews of the substantive order on 2 December 2013 and 1 December Ms Jones submitted that the only new information since the last review hearing is that contained in the letter from the RCN. Ms Jones accepted that Miss Bryans does express some remorse and insight into her actions and submitted that the panel 4

5 must consider whether that is sufficient for it to be satisfied that her fitness to practise is no longer impaired. With regard to transferring this matter to the Health Committee Ms Jones submitted that this option is not available to this panel. She referred the panel to Rule 14 of the Rules and in particular Rule 14(1) which states: 14. (1) Where an allegation is being considered by the Conduct and Competence Committee and (a) at a preliminary meeting held in accordance with rule 18; (b) at the commencement of [the meeting or hearing] 22 of the allegation by the Committee; or (c) during the course of [the meeting or hearing] 23 of the allegation by the Committee, it appears that the allegation would be better dealt with by the Health Committee, the Conduct and Competence Committee may refer the allegation to the Health Committee and shall suspend its consideration of the allegation. Ms Jones submitted that there are two possible options open to the panel to address any concerns it may have regarding Miss Bryans health. The first option, which Ms Jones submitted was the preferred course, would be to direct the case presenter to make a referral to consider the health matters. The subsequent investigation would seek to establish if Miss Bryans health is impacting her fitness to practise and this process would run alongside the current proceedings. The second option open to the panel would be to address any concerns it may have about Miss Bryans health in its decision and any sanction that may be imposed should the panel find Miss Bryans fitness to practise remains impaired. Ms Jones reminded the panel that the medical information before it dates back to 2012 and there is no current medical evidence. Today s substantive order review panel first considered whether Miss Bryans fitness to practise continues to be impaired. In considering this review today, this panel has had careful regard to the decision of the panel at the substantive hearing and to the decisions of the previous reviewing panels. However, this panel has undertaken a 5

6 comprehensive review of the substantive order in light of the circumstances that exist today and has exercised its own independent judgement. The panel, having seen the letters from Miss Bryans GP and family, was aware of Miss Bryans previous serious and debilitating health issues. The panel also noted that from the RCN s letter, dated 3 June 2015, there appeared to be ongoing health issues. The panel, in these circumstances, was of the view that Miss Bryans previous lack of engagement and failure to comply with the suggestions made by previous reviewing panels could be due to her ongoing health issues. The panel acknowledged Miss Bryans has subsequently engaged with these proceedings through her representative and has expressed remorse, as well as demonstrating some insight. The panel considered that, despite these positive steps from Miss Bryans, there was no evidence that she has taken any steps to remedy the concerns with her practice identified by the previous panels. In all the circumstances the panel considered that there remains a risk of harm to the public if Miss Bryans were to be allowed to practice without restriction. The panel therefore concluded that Miss Bryan s fitness to practise continues to be impaired. The panel next considered what action, if any it should take. It has considered the options available to it in ascending order and had regard to proportionality. The panel concluded that there are no circumstances in this case which would justify allowing the order to lapse. The panel considered that the potential for harm to the public remains if Miss Bryans were permitted to practise unrestricted. Accordingly the panel concluded that taking no further action would be neither proportionate or in the public interest. Further, if it took no action, the panel concluded that it would undermine public confidence in the nursing profession and in the Council as its regulator. For the same reasons the panel considered that the imposition of a caution order would not protect the public or satisfy the public interest. 6

7 The panel noted that Miss Bryans previous lack of engagement appears to be as a result of ongoing health issues. However, the panel was of the view that to request a separate referral to the Health Committee at this stage would not be in the interest of Miss Bryan as she appears to have some insight into her ongoing health issues. The panel therefore considered whether a conditions of practice order would be sufficient to protect the public and to address any concerns regarding Miss Bryans health. It bore in mind that any conditions imposed would need to be appropriate, proportionate and workable. The panel considered that the facts found proved at the substantive hearing related to clearly identifiable areas of practice that could be addressed with conditions of practice. The panel also considered that conditions could be formulated that would address any concerns regarding Miss Bryans ongoing health. The panel concluded that a conditions of practice order that addressed Miss Bryans misconduct and her ongoing health issues would be sufficient to protect the public and to address the issue of public interest and uphold the standards of the profession. The panel also gave due consideration to an extension of the current suspension order. However, it considered that, in light of its decision not to ask for a NMC referral regarding Miss Bryans health, a further period of suspension would serve no useful purpose and would be disproportionate. The panel concluded that the public would be suitably protected by the implementation of the following conditions; 1. You must not return to practice until you have been assessed as fit to do so by your GP or other treating medical professional and have provided a report by them to the NMC. 2. Having first complied with Condition 1, before you return to practice you must successfully complete and pass an NMC-approved return to practice programme complying with the requirements set out below and provide evidence of having done to the NMC: The areas that the programme should focus on are communication, assessment and awareness of and adherence to relevant policies and protocols. 7

8 3. You must notify the NMC within seven days of any nursing or midwifery appointment (whether paid or unpaid) you accept within the UK or elsewhere, and provide the NMC with contact details of your employer. 4. You must inform the NMC of any professional investigation started against you and/or any professional disciplinary proceedings taken against you within seven days of you receiving notice of them. 5. You must immediately inform the following parties that that you are subject to a conditions of practice order under the NMC s fitness to practise procedures, and disclose the conditions listed at (1) to (4) above, to them: a. Any organisation or person employing, contracting with, or using you to undertake nursing or midwifery work b. Any agency you are registered with or apply to be registered with (at the time of application) c. Any prospective employer (at the time of application) d. Any educational establishment at which you are undertaking a course of study connected with nursing or midwifery, or any such establishment to which you apply to take such a course (at the time of application) The panel determined that the conditions of practice should be imposed for a period of three years to allow Miss Bryans sufficient time to address her health condition and then to consider the steps she needs to take to return to practice should she so choose. The conditions of practice order will take effect upon the expiry of the existing order on 8 July

9 Substantive order review meeting 23 May 2018 The panel accepted the advice of the legal assessor. The panel first considered whether this matter was suitable for a meeting. The panel took into account that Ms Bryans has never attended any earlier NMC hearing, that she appears to be living abroad on a permanent basis and that her sister informed the NMC case officer in a telephone call on 25 April 2018 that Ms Bryans is unwell and would be unable to attend a hearing. The panel concluded that in these circumstances this matter should be dealt with at a meeting. The panel next considered whether Ms Bryans fitness to practise remains impaired. In reaching its decision, the panel took into account the need to protect the public, maintain public confidence in the profession, and in the regulator, and the need to declare and uphold proper standards of conduct and behaviour. In reaching its decision the panel considered all of the documentation before it. This consisted of the determinations of the earlier substantive panel and the three earlier substantive order review panels. The panel also had a telephone note dated 25 April 2018 which gave details of a conversation between the case officer and Ms Bryans sister, two letters from the Royal College of Nursing (RCN), dated 3 June 2015 and 20 February 2013, a GP letter dated 28 June 2012 and a letter from a member of Ms Bryans family dated 15 August The panel noted that this was a misconduct case but there have been frequent references at all of the hearings to Ms Bryans ill-health. However, with the exception of the GP letter in 2012 there has been no medical evidence to support or clarify what any on-going health issues in this case may be, or the extent to which 9

10 they may limit Ms Bryans ability to practise or to engage with the NMC. The panel therefore concluded it must proceed on the finding of misconduct alone. The only new information before this panel is that Ms Bryans is living abroad at present and her sister expressed the opinion that she is unable to do anything. The NMC have not been informed whether Ms Bryans has been assessed as fit to practise by her GP (Condition 1) nor whether she has completed a return to practice course (Condition 2). As such Ms Bryans has not attempted to practise under the conditions of practice order in the three years since the order was imposed in June 2015, nor has she produced any evidence to explain why. Ms Bryans has not worked as a nurse since at least March At the substantive hearing in 2013 the panel concluded that Ms Bryans showed a lack of understanding of her responsibilities, shortcoming and lack of insight. Although her representative submitted on her behalf in June 2015 that Ms Bryans feels great remorse for her actions, there is no evidence to support this. The panel therefore concluded that there remains a risk of repetition and therefore Ms Bryans fitness to practise is currently impaired on the ground of public protection. Further, a finding of impairment in the public interest was necessary in light of Ms Bryans continuing lack of engagement, in order to maintain confidence in the NMC as regulator. Sanction Having found Ms Bryans fitness to practise is currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel took into account the aggravating and mitigating features summarised by the substantive panel, and the conclusions of the reviewing panels. The panel considered the NMC s Sanctions Guidance (SG.) It bore in mind that the purpose of a sanction is to 10

11 protect the public and the public interest and not to be punitive, though it recognised that any sanction imposed may have a punitive effect. The panel first considered whether to take no action, that is to allow the order to lapse in accordance with the NMC s guidance on Allowing orders to expire when a nurse or midwife s registration will lapse (Reference : REV-3h last updated 09/04/2018). That guidance makes clear that a nurse s ongoing engagement with proceedings and a clear explanation of her plans for the future away from nursing are important factors in determining whether no further action is the appropriate outcome. Whilst the panel took into account that Ms Bryans has not worked as a nurse for over 5 years, there is no evidence before the panel from Ms Bryans to suggest that she intends to cease nursing. Her engagement with the NMC has been very limited and always made through third parties such as the RCN or a family member. As such the panel concluded there was insufficient evidence for it to be able to allow the conditions of practice order to lapse on its expiry, and that a sanction was required to protect the public and to maintain confidence in the profession and in the NMC as regulator. The panel next considered a caution order and concluded that this was not appropriate. The incidents which led to the misconduct were serious and have not been remediated, and a caution order would not offer the required public protection. The panel next considered a further conditions of practice order. The panel took into account that there was no evidence that Ms Bryans had ever attempted to practise under the conditions of practice order imposed in June 2015; neither has she engaged in any meaningful way to explain why. In these circumstances the panel concluded that conditions of practice were no longer appropriate. The panel next considered a suspension order. Ms Bryans has had three periods of suspension amounting in total to 23 months and a three year conditions of practice order. There is no evidence that she has used this time to reflect or remediate her practice and she has not demonstrated any development in her insight. The panel 11

12 therefore concluded that a suspension order would serve no purpose in these circumstances. The panel then considered a striking off order. The panel took into account that the incidents which led to the finding of misconduct were serious, one witness having described Ms Bryans during a call audit as having no idea of the role she was meant to be performing. The panel concluded that given the nature of Ms Bryans role the risk of harm was high. The panel determined that given the passage of time since the incidents and the lack of direct engagement from Ms Bryans, she has shown a persistent lack of insight. Further, she has apparently made no attempt at remediation, has produced no reflection and has produced no evidence to explain why. In these circumstances the panel has concluded that a striking off order is now the only sanction that will be sufficient to protect the public interest, and to maintain confidence in the profession and in the NMC. The persistent lack of insight and the persistent lack of direct engagement from Ms Bryans is now incompatible with her ongoing registration. 12