Conduct and Competence Committee. Substantive Hearing. Nursing and Midwifery Council (NMC), 61 Aldwych, London, WC2B 4AE 18 March 2016

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1 Conduct and Competence Committee Substantive Hearing Nursing and Midwifery Council (NMC), 61 Aldwych, London, WC2B 4AE 18 March 2016 Name of registrant: NMC PIN: Perlin Thompson-Douglas 69K0965E Part(s) of the register: Registered Nurse Sub Part 2 Adult Nursing November 1969 Registered Nurse Sub Part 1 Mental Health Nursing December 1975 Area of registered address: Type of Case: Panel members: Legal Assessor: Panel Secretary: Nursing and Midwifery Council: Registrant: Facts proved: England Misconduct and Caution Julian Weinberg (Chair, lay member) Deborah Tymms (Registrant member) Michael Libby (Lay member) David Marshall Susan Curnow Represented by Monwara Shah, Case Presenter, instructed by NMC Regulatory Legal Team Mrs Thompson-Douglas was not present and not represented Misconduct 1, 2, 3, 4 (by way of admission) Caution 5 (by way of admission and caution) Facts not proved: Fitness to practise: Sanction: Interim Order: N/A Impaired Striking off order Interim Suspension order 18 months Page 1 of 19

2 Charges: (Misconduct) That you, a registered nurse: 1. On or around 27 September 2014, took 2 Paracetamol tablets from Byron Ward for your own personal use; 2. Were dishonest in your actions at Charge 1 in that the Paracetamol tablets were the property of The North London Clinic and had not been provided for your personal use; 3. On or around 01 October 2014, lied to Ms 1, in that you told her that although you had taken Paracetamol from Byron Ward for yourself you did not have any knowledge about how 9 Zopiclone tablets could be missing and said that you did not take them, or words to that effect; 4. Were dishonest in your actions at Charge 3 above in that your actions were with the intention of concealing from your employer that you had stolen 9 Zopiclone tablets; AND, in light of the above, your fitness to practise is impaired by reason of your misconduct. (Conviction) 5. On 18 December 2014, admitted the offence of theft by employee contrary to section 1 of the Theft Act 1968 and received a simple caution from the Metropolitan Police; AND, in light of the above, your fitness to practise is impaired by reason of your caution. Page 2 of 19

3 Decision on Service of Notice of Hearing: Mrs Thompson-Douglas was neither present nor represented. Notice of this hearing, containing the information required by the Rules, was sent to Mrs Thompson-Douglas at her address as recorded on the NMC Register, by Post Office Signed For service and first class post on 18 February Royal Mail Track and Trace documentation confirms that the notice letter was delivered and was signed for on 19 February The printed name of the person recorded as having accepted delivery of the notice letter is Perlin. The panel heard and accepted the advice of the legal assessor. In the light of the information available, the panel was satisfied that notice had been served, as advised by the legal assessor, in compliance and accordance with Rules 11 and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended 2012) (The Rules). 11. (2) The notice of hearing shall be sent to the registrant (b) in every case, no later than 28 days before the date fixed for the hearing. 34. (1) Any notice of hearing required to be served upon the registrant shall be delivered by sending it by a postal service or other delivery service in which delivery or receipt is recorded to, (a) her address in the register Proceeding in the absence The panel then considered continuing in the absence of Mrs Thompson-Douglas. The panel heard the submissions made by Ms Shah on behalf of the Nursing and Midwifery Council ( NMC ) and took account of the legal assessor s advice. Page 3 of 19

4 In deciding whether to proceed in the absence of Mrs Thompson-Douglas, the panel weighed its responsibilities for public protection and the expeditious disposal of the case with Mrs Thompson-Douglas s right to a fair hearing. The panel read the telephone note dated 2 March The NMC had contacted Mrs Thompson-Douglas to discuss the substantive hearing and a consensual panel determination ( CPD ) agreement. The note stated that Mrs Thompson-Douglas had said that she will not be attending the hearing and that she was content for the hearing to proceed in her absence. In the light of the information available and in accordance with the legal advice, the panel was satisfied that notice had been served in accordance with Rules 11 and 34 of the Rules and that Mrs Thompson-Douglas had been sent notice of today s hearing. The panel was therefore satisfied that she was aware of today s hearing and it concluded that she has chosen to voluntarily absent herself. The panel had no reason to believe that an adjournment would result in Mrs Thompson-Douglas attendance and an adjournment had not been requested. Having weighed the interests of Mrs Thompson-Douglas with those of the NMC and the public interest in an expeditious disposal of this hearing, the panel has determined to proceed in Mrs Thompson- Douglas absence. Consensual panel determination agreement: The panel heard from Ms Shah on behalf of the NMC that prior to this hearing a provisional agreement to a consensual panel determination had been reached between Mrs Thompson-Douglas and the NMC. The agreement, which was put before the panel, sets out Mrs Thompson-Douglas full admission to all charges (both misconduct and caution), an acceptance by her that her actions amounted to misconduct, and that her fitness to practise is currently impaired by reason of that misconduct and caution. It is further agreed between Mrs Thompson- Douglas and the NMC that the appropriate sanction in this case is a striking off order. Page 4 of 19

5 The panel considered the signed consensual panel determination agreement ( CPD ) and the reflective statements submitted by Mrs Thompson-Douglas dated 16 February 2016 and 11 March The panel has considered the provisional agreement reached by the parties as set out below: The Nursing and Midwifery Council ("the NMC") and Mrs Thompson-Douglas ("the Registrant'), PIN 69K0965E, (collectively "the parties") agree as follows: - 1. The Registrant admits the following charges: 'That you, a registered-nurse: 1. On or around 27 September 2014, took 2 Paracetamol tablets from Byron Ward for your own personal use; 2. Were dishonest in your actions at Charge 1 in that the Paracetamol tablets were the property of The North London Clinic, and had not been provided for your personal use; 3. On or around 01 October 2014 lied to Ms 1, in that you told her that although you had taken Paracetamol from Byron Ward for yourself you did not have any knowledge about how 9 Zopiclone tablets could be missing and said that you did not take them, or words to that effect; 4. Were dishonest in your actions at Charge 3 above in that your actions were with the intention of concealing from your employer that you had stolen 9 Zopiclone tablets; 5. On 18 December 2014 admitted the offence of theft by employee contrary to section 1 of the Theft Act, 1968 and received a simple caution from the Metropolitan Police; AND, in light of the above, your fitness to practise is impaired by reason of your misconduct in respect of Charges 1and/or 2 and/or 3 and/or 4, and / or by reason of your caution in respect of Charge 5. Page 5 of 19

6 2. The facts are as follows: 2.1.The Registrant was first admitted to the NMC's register on 27 November She is registered under sub part 2 as a Registered Nurse - Adult (Level 2) and, since 02 December 1975, under sub part 1 as a Registered Nurse Mental Health From 06 November October 2014, the Registrant was employed by The North London Clinic (Partnerships in Care) Partnerships in Care are an independent provider of secure and step down care including specialist services in respect of mental health, learning disability, personality disorders, autism spectrum disorders and acquired brain injury and neuro-rehabilitation. The North London Clinic forms part of Partnerships in Care's London region. 2.4.On 26 September 2014, the Registrant was working as Night Co-ordinator for Byron Ward, a ward within the North London Clinic, along with Nurse 2, Staff Nurse At 19.30, on 26 September 2014, a handover took place between Nurse 2 and, Ms 3, in which the controlled drugs for Byron Ward were checked and counted. The quantities of controlled drugs being handed over were signed for by both Nurse 2 and Ms 3. It was noted by Nurse 2 that 27 Zopiclone tablets were handed over. 2.6.The controlled drugs for Byron Ward are stored securely in a locked medicine trolley and, on the 26/27 September 2014 night shift, Nurse 2 was responsible for the keys to that medicine trolley. 2.7.At or about 06.45, on 27 September 2014, the Registrant asked Nurse 2 to provide her with the keys to the medicine trolley. She explained that she was suffering with a headache and that she intended to take Paracetamol from the medicine trolley. She was provided with the keys by Nurse The Registrant proceeded to take 2 Paracetamol tablets from the medicine trolley for her own use. Page 6 of 19

7 2.9.In addition to taking from the medicine trolley the 2 Paracetamol tablets referenced above, the Registrant also took 9 Zopiclone tablets. In taking the 9 Zopiclone tablets, the Registrant had no professional purpose in that they were not required by any patient on Byron Ward and had not been requested on loan by any other ward in the North London Clinic In the course of the 26/27 September 2014 night shift neither the Registrant nor Nurse 2 had any need to administer Zopiclone tablets or to loan such tablets to any other ward At 07.30, on 27 September 2014, a handover took place between Nurse 2 and Mr 4. It was noted by Nurse 2 and Mr 4 that 9 Zopiclone tablets were unaccounted, in that there were 18 Zopiclone tablets when previously there had been 27 Zopiclone tablets Having noted that 9 Zopiclone tablets were unaccounted for Nurse 2 attempted to contact the Registrant but was unable to reach her On 27 September 2014, the Registrant and Nurse 2 were scheduled to work another night shift together At or about 19.30, on 27 September 2014 Nurse 2 asked the Registrant if she knew what had happened to the missing Zopiclone tablets and mentioned in conversation with the Registrant, that the Registrant had been the last person to access the medicine trolley on the previous night shift The Registrant denied having any knowledge of the missing medication or its whereabouts Having been questioned as to the whereabouts of the missing 9 Zopiclone tablets the Registrant went to Tennyson House, another ward within The North London Clinic, and asked Nurse 7, Staff Nurse, to give her some Zopiclone tablets. Nurse 7 provided the Registrant with 11 Zopiclone tablets. The Registrant did not fill in a medical loan Page 7 of 19

8 form in respect of the medication taken from Tennyson House and returned to Byron Ward At or around the Registrant returned to Byron Ward and provided Nurse 2 with the Zopiclone tablets she had taken from Tennyson House saying to her that this was the missing medication. Nurse 2 noted that there were 11 tablets but as only 9 were missing, she cut out 9 tablets and gave the remaining tablets back to the Registrant Following the events described above Nurse 2 was concerned about how and why the Registrant had been able to produce 11 tablets of Zopiclone and wrote a letter of concern dated 27 September 2014 to Mr 5, Ward Manager At or around on 27 September 2014, the Registrant returned to Tennyson House and was informed that the Zopiclone audit of the Tennyson House stock had indicated that Tennyson House was now missing 7 tablets of Zopiclone. The Registrant handed a strip of Zopiclone to Ms James, who cut out 7 tablets and added these to the Tennyson House stock. She handed the remaining tablets back to the Registrant The Registrant then put 2 Zopiclone tablets in an envelope which she placed in The North London Clinic's spare medication cupboard. She then placed another 2 Zopiclone tablets in another envelope which she placed in another medication cupboard On 29 September 2014, the Registrant telephoned Nurse 6, Practice Nurse, and explained that due to a deficit in Byron ward's stock of Zopiclone she had borrowed a strip of Zopiclone from Tennyson House. When asked if she had signed for these she confirmed she had not. The Registrant further indicated that she had left an envelope with 2 Zopiclone tablets in the spare medication cupboard and asked Nurse 6 to retrieve this. Nurse 6 found this envelope and in the course of her shift also found the second sealed envelope containing 2 Zopiclone tablets, referenced above. Page 8 of 19

9 2.22. In light of the concern raised with Mr 5 by Nurse 2, an investigation was undertaken by Ms 1, Lead Nurse. The Registrant was suspended from duty to allow the investigation to proceed on 01 October 2014 and was interviewed on the same date In interview, the Registrant stated that she did not know what had happened to the missing tablets and said that she had thought she was being 'set up' or words to that effect The Registrant was specifically asked if she had taken the 9 Zopiclone tablets noted to be missing on the morning of 27 September 2014 to which she stated that she had not. In the course of this interview, the Registrant confirmed that she had taken 2 Paracetamol tablets from the medicine trolley for her own use On 02 October 2014, the Registrant resigned from her employment with Partnerships in Care with immediate effect On 21 November 2014 in an interview under caution the Registrant admitted that she had stolen 9 Zopiclone tablets On 18 December 2014, the Registrant formally admitted the offence of theft by employee contrary to section 1 of the Theft Act 1968 and received a simple caution from the Metropolitan Police. At this time the Registrant stated that she had taken the 9 Zopiclone tablets intending to give them to a friend. 3. The Registrant admits that the facts as described at paragraph 2 of this agreement amount to misconduct in that her actions fell short of what would have been proper with reference to the rules and standards ordinarily required to be followed by a nurse in the particular circumstances (Roylance v General Medical Council [1999] UKPC 16) In particular, the Registrant admits that her conduct breached the following parts of the Code: Preamble you must: Provide a high standard of practice and care at all times; Page 9 of 19

10 Be open and honest, act with integrity and uphold the reputation of your profession; Always act lawfully, whether those laws relate to your professional practice or personal life Body 49 -You must adhere to the laws of the country in which you are practising 57 -You must not abuse your privileged position for your own ends 61 - You must uphold the reputation of your profession at all times 4. The Registrant admits that her fitness to practise is impaired by reason of her misconduct and, with reference to the factors outlined by Dame Janet Smith in the 5th Shipman Report, she admits that she: 4.1. Has in the past brought the professions into disrepute, and; 4.2. Has in the past breached one of the fundamental tenets of the professions, and; 4.3. Has in the past acted dishonestly The premise upon which healthcare is built is that patients are able to put their trust in those responsible for their care. The public expects nurses to behave with honesty, integrity and trustworthiness; any dishonest conduct is accordingly particularly serious Dishonesty in the form of the theft of medication is particularly serious as.it: Exposes patients to a risk of harm as essential medication may be unavailable when required, and; Exposes the public to a risk of harm as controlled medicines are then at large in the community and are not subject to the proper controls. Page 10 of 19

11 4.6. The Registrant has demonstrated limited insight into her failings. In her reflective statement (Appendix 1 to the draft provisional agreement), the Registrant considers at length the context within which her misconduct arose but has not reflected as to the nature of her dishonesty and the impact of dishonesty on patients, her employer and the profession. Notably, the Registrant's reflective piece does not provide any clear explanation for the theft of Zopiclone, nor does it address the dishonest efforts she made to conceal the theft of Zopiclone. The Registrant has not addressed the misappropriation of paracetamol The Registrant has expressed general remorse as to her actions and offers her apologies both to the North London Clinic and the NMC. 5. The parties agree that the appropriate sanction in this case is a striking-off order In a case involving serious, repeated and elaborate dishonesty involving the theft of medication from the Registrant's employer and efforts to conceal that theft, to take no further action would be manifestly inappropriate and such an order would be neither sufficient nor proportionate Equally, a caution order would be inappropriate and is neither sufficient nor proportionate. With regard to the NMC's Indicative Sanctions Guidance, a caution order is appropriate where a case-is at the lower end of the spectrum of impaired fitness to practise. Any case involving dishonesty, especially when sustained and in the clinical context is extremely serious and cannot be categorised as being at the lower end of the spectrum Further, a conditions of practice order would be inappropriate and is neither sufficient not proportionate. With regard to the NMC's Indicative Sanctions Guidance, the following factors indicate that such an order would not be appropriate: Dishonesty is a deep-seated personality or attitudinal problem; There are no identifiable areas of Mrs Thompson-Douglas' practice in need of assessment or retraining; Page 11 of 19

12 There is no evidence of general incompetence and as such no indication that retraining would yield a positive response; Conditional registration would put patients at risk as no conditions can be formulated to ensure dishonest behaviour is not repeated Further, a suspension order would not be sufficient or proportionate. With regard to the NMC's Indicative Sanctions Guidance, the following factors indicate that a suspension order would not be appropriate: The Registrant stole two types of medication from her employer, has gone to considerable lengths to conceal her theft of Zopiclone and has lied to her employer during the investigation of the events; Dishonesty on the part of a registered nurse is extremely serious and is often fundamentally incompatible with continuing registration (see NMC v Parkinson [2010] EWHC 1898 (Admin); Dishonesty is a harmful deep-seated personality or attitudinal problem which is hard to remedy; The Registrant's insight is limited and as such there exists a risk of her engaging in dishonest conduct in the future; 5.5. A striking-off order is the only sanction which will be sufficient to protect the public interest, in that, the seriousness of Mrs Thompson-Douglas' misconduct is incompatible with ongoing registration and the public confidence cannot be maintained if she is not removed from the register In particular and with regard to the NMC's Indicative Sanctions Guidance, the following factors indicate that a striking-off order is appropriate: The Registrant's actions constitute serious departures from the provisions of the Code as set out above; The Registrant abused her position as a nurse to gain access to controlled medication, something which is particularly serious when considered in light of the fact the Registrant was. Night Co-ordinator at the relevant time and therefore had managerial responsibility; The Registrant's actions were dishonest, this dishonesty was persistent and elaborate, and in the course of the theft of Zopcilone and her efforts to Page 12 of 19

13 conceal the theft, she told different lies to multiple people and manipulated ward stocks; The Registrant lacks insight into the seriousness of her actions or the potential effect of her actions on patients, the public and on the reputation of the nursing profession; The Registrant has received a criminal caution in respect of her actions as detailed above Notwithstanding the above, a striking-off order is also appropriate on the basis that the public interest in maintaining trust and confidence in the profession alone requires such a sanction in this case 6. It is also necessary for the protection of the public and otherwise in the public interest for there to be an interim suspension order of 18 months to cover the appeal period. The parties understand that this provisional agreement cannot bind a panel, and that the final decision as to facts, impairment and sanction is a matter for the panel. The parties understand that, in the event that a panel does not agree with this provisional agreement, the admissions to the charges set out at section 1 above, and the agreed statement of facts set out at section 2 above, may be placed before a differently constituted panel that is determining the allegation, provided that it would be relevant and fair to do so. Signed: Mrs Thompson-Douglas Dated 10 August 2015 Signed on behalf of the NMC Dated 1 March 2016 Decision and reasons on the consensual panel determination: The panel heard and accepted the legal assessor s advice. He referred the panel to the relevant principles and reminded the panel that they could either accept or reject the agreement in full. Page 13 of 19

14 The panel took into account that Mrs Thompson-Douglas has admitted the facts of the charges and the factual background to those charges. The panel took account the evidence of Mrs Thompson-Douglas acceptance of the simple police caution dated 18 December Accordingly the panel is satisfied that the charges are found proved on the basis of the full admissions made by Mrs Thompson-Douglas included in the CPD provisional agreement and by reason of the police caution for an offence of dishonesty. The panel next considered the issues of misconduct and impairment. It noted that Mrs Thompson-Douglas has admitted that her fitness to practise is currently impaired, by reason of her misconduct. The panel has exercised its own judgement in reaching its decision on misconduct, impairment and sanction. The panel took into account all the information before it, including the submissions made by Ms Shah on behalf of the NMC, the CPD document and the appendices to the CPD agreement, and Mrs Thompson-Douglas reflective pieces. The panel also noted that Mrs Thompson-Douglas has accepted that the facts found proved amount to misconduct although the panel recognises that any such finding is a matter for it alone. In relation to misconduct, the panel concurred with the CPD agreement that Mrs Thompson-Douglas s actions amounted to breaches of The Code: Standards of conduct, performance and ethics for nurses and midwives 2008 ( the Code ). Those outlined in the preamble: The people in your care must be able to trust you with their health and wellbeing To justify that trust, you must: Provide a high standard of practice and care at all times; Be open and honest, act with integrity and uphold the reputation of your profession; Always act lawfully, whether those laws relate to your professional practice or personal life. Page 14 of 19

15 The panel considered the proposed paragraphs of the code contained within the CPD document and reached its own conclusions. The panel concluded that the paragraphs of the Code, namely 49, 57 and 61 are engaged and that the facts in charges 1-5 are sufficiently serious to amount to misconduct. The panel appreciated that breaches of the code do not automatically result in a finding of misconduct, and that there must be an element of seriousness to any departure from the standards expected. In the panel s judgment, Mrs Thompson-Douglas actions in relation to the dishonest taking of drugs during the course of her employment, as found proved, are serious enough to amount to misconduct. In relation to impairment, the panel took into account that Mrs Thompson-Douglas admits that her fitness to practise is impaired by reason of her misconduct and caution. The panel accepted that Mrs Thompson-Douglas has demonstrated some insight into her misconduct, as evidenced by her acceptance of the facts in the CPD agreement and her written reflective statements. The panel also noted that Mrs Thompson-Douglas has expressed remorse and has apologised for her conduct to the NMC, her formal employer, colleagues, and friends. She states in her letter of 11 March 2016 I would like to take this opportunity to apologise for my conduct..i have let so many people down, including my family and myself. However, the panel noted that Mrs Thompson- Douglas has not given an explanation as to why she stole the medication. The panel accepted the conclusion of the CPD that a finding of impairment was necessary on the grounds of public protection and noted that the CPD makes no mention of a finding of the wider public interest in this case. The panel therefore considered that a finding of no impairment would be insufficient to declare and uphold standards and would undermine public confidence in the profession and the NMC as its regulator. Accordingly, the panel determined that Mrs Thompson- Douglas s fitness to practise is currently impaired by reason of her misconduct and caution. In relation to sanction, the panel considered the Indicative Sanctions Guidance ( ISG ). The purpose of a sanction is not to be punitive, although it may have that effect, but is intended to protect patients and the wider public interest. The wider public interest Page 15 of 19

16 includes maintaining public confidence in the profession and the NMC as the regulator, and declaring and upholding proper standards of conduct and behaviour. The panel considered each sanction in turn in ascending order of severity. The panel noted that the CPD document did not fully address the aggravating and mitigating factors. However, the panel considered that there were mitigating factors present as outlined in Mrs Thompson-Douglas reflective statement of 16 February 2015 (dated 2014). These included the stress she was under at the time of the incident, her commitment to the profession and, apart from matters complained of in this case, there is no evidence of adverse regulatory or disciplinary findings in her extensive nursing career. The panel also considered that Mrs Thompson-Douglas has demonstrated remorse and some insight regarding her failings outlined in her reflective statements: [PRIVATE] The panel have balanced these against the aggravating factors as set out in the CPD agreement. The panel first considered whether to take no action but determined that this would be wholly insufficient to protect the public and to maintain public confidence in the nursing profession, and in the NMC as its regulator, particularly as the dishonesty in the circumstances was found proved. Next, in considering whether a caution order would be appropriate, the panel took into account the ISG, which states as follows: a caution may be appropriate where the case is at the lower end of the spectrum of impaired fitness to practise and the panel wishes to mark that the behaviour was unacceptable and must not happen again. Page 16 of 19

17 It might be appropriate where the nurse or midwife s history is such that the panel is confident that there is no risk to the public or to patients which requires the nurse or midwife s practice rights to be restricted. The panel considered that Mrs Thompson-Douglas failings were not at the lower end of the spectrum and therefore concluded that a caution order would not be sufficient to mark the seriousness of the misconduct, protect the public or satisfy the public interest. The panel also considered whether this matter should be more appropriately dealt with by placing conditions of practice on Mrs Thompson-Douglas registration. The panel found that this was not a case that relates to any identifiable area of clinical practice. The panel concluded that in all the circumstances of this matter, a conditions of practice order would neither be appropriate nor proportionate given the nature of Mrs Thompson-Douglas failings. The panel then went on to consider whether a suspension order would be an appropriate and proportionate sanction. The panel had particular regard to paragraph 70 of the NMC s Indicative Sanctions Guidance which states: When considering seriousness, the panel should take into account the extent of the departure from the standards to be expected and the risk of harm to the public interest caused by that departure Mrs Thompson-Douglas received a caution and her dishonest behaviour is a serious departure from the standards of conduct and behaviour expected of a registered nurse. The dishonesty was directly related to her practice as a nurse. Nurses occupy a position of privilege and trust in society and are expected to adhere to their Code of Conduct at all times. They must ensure their conduct justifies the trust the public places in both them and the nursing profession. The panel is satisfied that Mrs Thompson-Douglas has breached a fundamental tenet of the nursing profession, namely to act with honesty and integrity and uphold the reputation of the nursing profession. For these reasons the panel has concluded that temporary removal from the register would not be an appropriate sanction given the serious nature of Mrs Thompson- Page 17 of 19

18 Douglas misconduct. The panel has no doubt Mrs Thompson-Douglas failings are so serious so as to be fundamentally incompatible with the role of a registered nurse such that it would not be appropriate to allow her to remain on the register. The panel has therefore concluded that a suspension order is not a sufficient sanction to address the wider public interest considerations in maintaining public confidence in the nursing profession or the NMC as a regulator and in the declaring and upholding of proper standards of conduct and behaviour. Balancing all of these factors, the panel has determined that the only appropriate and proportionate sanction in the particular circumstances of this case is a striking-off order. The panel has concluded that this order is necessary to mark the importance of maintaining public confidence in the profession and declaring and upholding of proper standards of conduct and behaviour. Furthermore, this will send to the public and the profession a clear message about the standards of conduct and behaviour required of a registered nurse. The panel therefore directs that the registrar strikes off Mrs Thompson-Douglas name from the NMC Register. She may not apply for restoration until five years after the date that this order takes effect. Unless subject to an appeal, this order will take effect 28 days from the date this decision is deemed to have been served upon Mrs Thompson-Douglas. Decision and reasons on interim order: The panel accepts the statement within the CPD that an interim suspension order for a period of 18 months is necessary for the protection of the public and otherwise in the public interest to cover the appeal period and therefore makes such an order. If no appeal is made against the panel s substantive decision then the interim order will cease to have effect upon the expiry of the applicable appeal period or, if an appeal is made, when the appeal is withdrawn or otherwise finally disposed of. Page 18 of 19

19 This decision will be confirmed to Mrs Thompson-Douglas in writing. That concludes this determination. Page 19 of 19