Conduct and Competence. Substantive Order Review Hearing. 9 February Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE

Transcription

1 Conduct and Competence Substantive Order Review Hearing 9 February 2017 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of Registrant Nurse: NMC PIN: Simon Christopher Watts 99I1488E Part(s) of the register: Registered Nurse - Sub part 1 Adult Nursing October 2002 Area of Registered Address: Panel Members: Legal Assessor: Panel Secretary: Nursing & Midwifery Council: Registrant: Order being reviewed: Outcome: England Cindy Barnett (Chair, lay member) Claire Blackwood (Registrant member) Paul Pharaoh (Lay member) Robert Frazer Rebekah Isaacs Represented by Ben Edwards Case Presenter, instructed by the NMC Regulatory Legal Team Not present and not represented in his absence Suspension Order (12 months) Striking-off order to take effect upon the expiry of the current Suspension Order (12 months) on 23 March 2017 in accordance with Article 30 (1) 1

2 Service of Notice of Hearing The panel was informed at the start of this hearing that Mr Watts was not in attendance, nor was he represented in his absence. The panel was informed that the notice of this hearing was sent to Mr Watts on 9 January 2017 by recorded delivery and first class post to his registered address. 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 of the Registrant: The panel then considered proceeding in the absence of Mr Watts. 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 Mr Edwards, on behalf of the NMC. Mr Edwards invited the panel to continue in the absence of Mr Watts on the basis that he has not engaged or communicated with the NMC in relation to today s hearing, and had chosen to voluntarily absent himself. Mr Edwards told the panel that there had been no response from Mr Watts in relation to the notice of today s hearing, and that Mr Watts has not engaged since before the substantive hearing, which he did not attend, he did not attend but sent submissions in advance. The panel accepted the advice of the legal assessor. 2

3 The panel noted that the Track and Trace service indicated that the notice was delivered to Mr Watts registered address on 10 January The panel concluded that Mr Watts had been sent a notice of today s hearing and were satisfied that he was aware of today s hearing. The panel was of the view that he had chosen to voluntarily absent himself. The panel had no reason to believe that an adjournment would result in Mr Watts attendance. Having weighed the interests of Mr Watts with those of the NMC and the public interest in an expeditious disposal of this hearing the panel determined to proceed in Mr Watts 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 23 March 2017 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (the Order). This is the first review of a suspension order, originally imposed by a panel of the Conduct and Competence Committee on 19 February 2017 for 12 months. The current order is due to expire on 23 March 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: That you, a Registered Nurse: 1. Whilst employed as a Band 5 Nurse by Coventry and Warwickshire Partnership NHS Trust: a) On 20 November 2011, administered medication to an unknown patient via a syringe driver when the medication ampoules were out of date. b) On 23 July 2012, administered an incorrect dose of insulin to an unknown patient. c) On 17 February 2013 administered a further dose of insulin to an unknown patient who had already received the required dose of insulin. d) On or around 4 December 2013 in respect of Patient A: i. Left Patient A s house when Patient A was showing signs of anxiety and/or breathlessness. 4

5 ii. Did not document in Patient A s care records that you had left Patient A in an unsettled state. iii. Did not inform your colleagues that you had assisted Patient A with administering Oramorph when you were stopped from administering medication. 2 Whilst employed as an Agency Nurse by Pulse Nursing Agency ( Pulse ) failed to inform Pulse before 10 March 2014 that your fitness to practise had been called into question in respect of incidents on: a) 20 November b) 23 July c) 17 February d) 4 December And in light of the above, your fitness to practise is impaired by reason of your misconduct. The original panel determined the following with regard to impairment: In the panel s judgment Mr Watts behaviour did put his patients at risk of harm as the medication errors, and leaving Patient A in the state he did, were potentially very serious. Further the fact that the errors occurred because of his disregard for established policies and procedures would bring the profession into disrepute, as would his lack of disclosure of the incidents to the Pulse agency. By breaching all bullet points in the preamble to the Code Mr Watts has breached the fundamental tenets of the profession. The panel also considered the guidance in the case of Cohen v GMC [2008] EWHC 581 at paragraph 65, Silber J said: 5

6 It must be highly relevant in determining if a doctor's fitness to practise is impaired that first his or her conduct which led to the charge is easily remediable, second that it has been remedied and third that it is highly unlikely to be repeated. The panel considered that Mr Watts behaviour was remediable. There are identified shortcomings which could be addressed. However, Mr Watts has not worked as a nurse for some time and has indicated that he does not intend to return to the nursing profession. He has provided no evidence that he has remediated, undertaken any appropriate refresher training courses, or kept his knowledge up to date. In the bundle there is evidence of remorse, some insight and he accepted all the charges against him. The panel concluded that given the lack of remediation and the limited remorse and insight, that there remains a risk of repetition of these events if Mr Watts were to find himself in a similar situation. The panel therefore concluded that he remains a risk to the public and that his fitness to practise is impaired on the grounds of public protection and public interest. The panel has determined that for the above reasons Mr Watts fitness to practise is currently impaired. The original panel determined the following with regard to sanction: The panel first considered the aggravating features of this case. These are that Mr Watts repeatedly made medication administration errors because he did not follow established practices and procedures although he was assessed as competent, his attitudinal issues resulted in continuing poor practice there was the potential for serious patient harm 6

7 he failed to appreciate the seriousness of the situation in relation to Patient A which was a failure of his professional judgement and which ultimately caused considerable emotional distress to the family of Patient A he was not candid with his employing agency. The panel then considered the mitigating features. These are that Mr Watts has indicated that he has long-term health problems which he suggests may have affected his performance on some occasions has shown some insight and remorse has engaged with the NMC and admitted all charges put to him at the initial stage and he admitted misconduct and impairment was consistently rated as very good or excellent on the feedback forms supplied by the Pulse agency. The panel first considered taking no further action and decided that this would be inappropriate as the misconduct in this case was too serious. There was a significant risk of patient harm. In these circumstances it would not be in the public interest to take no further action. To do so would not protect patients from risk of harm nor would it maintain the standards of, or confidence in, the profession and the regulator. The panel then went on to consider whether a caution order would be appropriate.. The panel considered that the misconduct was not at the lower end of the spectrum of impaired fitness to practice and that a caution order would be insufficient to address the areas of concern. It would not protect patients from risk of harm nor would it maintain the standards of, or confidence in, the profession and the regulator. The panel next considered whether imposing a conditions of practice order would be appropriate. The panel considered that there were identifiable areas of practice which could be addressed by imposing a conditions of practice order. However, Mr 7

8 Watts has indicated that he no longer wishes to work as a nurse so the panel concluded that he is unlikely to be willing to engage with a conditions of practice order. The panel also have a concern that some of the reasons for the repeated medication failures are attitudinal i.e. an unwillingness to adhere to policies and procedures. The panel therefore concluded that, at present, it would not be possible to formulate workable and practical conditions which address its concerns about Mr Watts shortcomings. The panel next considered whether imposing a suspension order would be appropriate. The panel took into account that Mr Watts has expressed remorse, has demonstrated some insight. The panel concluded t that his behaviour is remediable and that it is not fundamentally incompatible with remaining on the register. The panel concluded that a suspension order would be sufficient to protect the public and it would also be in the public interest. The panel took into account Mr Watt s assertion that he no longer wished to work as a nurse but considered that a period of suspension would give him an opportunity to reflect on that decision and to take action should he wish to return to nursing. The panel did consider whether it would be appropriate to impose a striking off order in this case. The panel noted that this option would be open to the next panel and concluded that a striking off order, at this time, would be disproportionate and punitive. The seriousness of the case is not incompatible with on-going registration. It is not the only sanction available to the panel which will protect the public interest. This order will be reviewed before its expiry. The panel considered that any reviewing panel would be assisted by the following: Mr Watts attendance at the review panel hearing, and A reflective piece from Mr Watts which addresses the issues of concern. Training certificates and information on how he has kept his nursing skills up to date References or testimonials from any employers whether for paid or unpaid work 8

9 Any other information he thinks would be of assistance. The panel considered that the period of suspension should be for twelve months. This is sufficient time for Mr Watts to take the opportunity to reflect and decide on his future. It is also a sufficiently long period to send a message to the profession and the public that his conduct was unacceptable. Decision on current fitness to practise The panel has had regard to all of the documentation before it and has taken account of the submissions made by Mr Edwards on behalf of the NMC. On behalf of the NMC, Mr Edwards explained the background to the case and guided the panel to the relevant elements of the substantive hearing panel s decision in relation to impairment and sanction and what evidence it was suggested Mr Watts should provide to assist a reviewing panel. Mr Edwards highlighted the previous panel s decision that Mr Watts behaviour in not following established procedures was serious and amounted to misconduct which brought the profession into disrepute, as did his lack of disclosure of the incidents to the Pulse agency. Mr Edwards submitted that Mr Watts had not remediated the failings in his practice, had not kept his skills up to date, had not provided up to date evidence of insight, and there remained a real risk of repetition. Accordingly, Mr Edwards invited the panel to find that Mr Watts was still impaired for these reasons. 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. 9

10 The panel has considered carefully whether Mr Watts fitness to practise remains currently 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. The panel took into account the submissions made by Mr Edwards and the previous panel s findings of fact and misconduct. The panel considered that the charges found proved by the previous panel were serious and indicated that Mr Watts poses a serious risk to the public. The panel noted that it has not received any new information from Mr Watts with respect to his insight or any attempts made by him to remediate his practice. The panel determined that in the absence of evidence of remediation and insight, Mr Watts is liable to repeat matters of the kind found proved. This panel has heard no information that the risk has reduced or that Mr Watts has remediated his failings. The panel therefore decided that a finding of continuing impairment is necessary on the grounds of public protection. The panel also considered that a finding of current impairment is necessary in order to maintain confidence in the nursing profession and to uphold proper standards of conduct and behaviour. For these reasons, the panel finds that Mr Watts fitness to practise remains impaired, both on the grounds of public protection and in the wider public interest. Determination on sanction Having found Mr Watts 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 Indicative Sanctions Guidance (ISG) 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. 10

11 The panel first considered whether to take no action but concluded that this would be inappropriate in view of the seriousness of the case and the ongoing public protection concerns. 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 impose a caution order but concluded that this would be inappropriate in view of the ongoing public protection concerns. The panel decided that it would be neither proportionate nor in the public interest to impose a caution order because this matter concerns very serious clinical failings that have not been remediated and there remains a real risk of repetition. A caution order would not provide any protection to the public. The panel next considered whether to impose a conditions of practice order. The panel noted Mr Watts current lack of engagement and the absence of evidence as to his employment status. The panel considered that there has been no further information of Mr Watts current circumstances, but noted that he previously indicated that he no longer wished to work as a nurse. The panel considered that it had no evidence that Mr Watts would be willing to agree to a conditions of practice order. The panel therefore concluded that it was not possible to formulate workable and practical conditions which would address these concerns. The panel next considered imposing a further suspension order. The panel noted that although the previous panel found that Mr Watts had demonstrated some remorse and insight in accepting the charges, there has been no further evidence that his insight into his previous failings had improved. The panel took into account Mr Watt s assertion that he no longer wished to work as a nurse and his failure to demonstrate sufficient insight into the seriousness of his actions and the consequences of them. Mr Watts had been given the opportunity to reflect on his position and to re-engage with his regulator; to provide the panel with information relating to his clinical practice; to provide evidence of remediation of his misconduct and insight into the impact on the public and the profession. No contact had been made and no evidence provided. In the absence of such evidence, Mr Watts continues to pose a risk and whilst a suspension order would continue to protect the public, the panel considered that the 11

12 public interest required to be fully addressed. In these circumstances, the panel considered that a suspension order was no longer appropriate and that a striking off order is now appropriate and proportionate in order to fully protect the public and satisfy the wider public interest. The panel concluded that Mr Watts behaviour is therefore fundamentally incompatible with being a registered professional and that if he were to remain on the register, public confidence in the profession and in the NMC would be undermined. The panel therefore directs the registrar to strike Mr Watts name off the register. The order will take effect on 23 March 2017 in accordance with Article 30 (1). The panel did consider whether to direct that the strike-off order should have immediate effect. The panel concluded that it was not necessary to make such a direction in view of the fact that Mr Watts is not currently practising and that in accordance with the existing suspension order he could not practise as a nurse. Therefore, there is no immediate risk to the public which would require Mr Watts name to be removed from the register with immediate effect. This decision will be confirmed to Mr Watts in writing. That concludes this determination. 12