Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 22 June 2018 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of registrant: NMC PIN: Sarah Jane Watton-Gathua 11E1219E Part(s) of the register: Registered Nurse (Sub Part 1) Mental Health Nursing September 2011 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Mrs Watton-Gathua: Nursing and Midwifery Council: Order being reviewed: Outcome: England Misconduct Melissa D Mello (Chair, Lay member) Carole Panteli (Registrant member) Louise Fox (Lay member) Oliver Wise Caroline Pringle Not present and not represented in her absence Represented by Assad Badruddin, Case Presenter Suspension order (3 months) Striking-off order to come into effect at the end of 8 August 2018 in accordance with Article 30(1) Page 1 of 9
Service of notice of hearing The panel was informed at the start of this hearing that Mrs Watton-Gathua was not in attendance, nor was she represented in her absence. The panel was informed that the notice of this hearing was sent to Mrs Watton-Gathua on 14 May 2018 by recorded delivery and first class post to her registered address. This was returned to sender. Mr Badruddin also referred the panel to an email from Mrs Watton-Gathua, dated 11 June 2018, which indicated that she was aware of today s hearing. 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). It noted that the Rules do not require delivery. Proceeding in absence The panel then considered proceeding in the absence of Mrs Watton-Gathua. The panel was mindful that the discretion to proceed in the registrant s 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 Badruddin, on behalf of the Nursing and Midwifery Council (NMC). The panel accepted the advice of the legal assessor. Mr Badruddin invited the panel to proceed in the absence of Mrs Watton-Gathua. He submitted that Mrs Watton-Gathua has not engaged with these proceedings since June 2016, when she participated in this hearing by telephone. He further referred the panel to an email from Mrs Watton-Gathua, dated 11 June 2018. In response to an earlier email from her NMC case officer inviting her to participate by telephone, she wrote As to taking part, what is the point? In light of this correspondence, Mr Badruddin submitted that Mrs Watton-Gathua is aware of this hearing, has voluntarily absented Page 2 of 9
herself, and that there was no reason to believe that an adjournment would secure her attendance. The panel decided to proceed in the absence of Mrs Watton-Gathua. The panel was satisfied that she was aware of today s hearing and had chosen to voluntarily absent herself. Given Mrs Watton-Gathua s email of 11 June 2018, the panel had no reason to believe that an adjournment would result in Mrs Watton-Gathua s attendance. Having weighed the interests of Mrs Watton-Gathua with those of the NMC and the public interest in an expeditious disposal of this hearing, the panel determined to proceed in Mrs Watton-Gathua s absence. Decision and reasons on review of the current order This panel decided to make a striking-off order. This order will come into effect at the end of 8 August 2018 in accordance with Article 30(1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the fifth review of a substantive suspension order, originally imposed by a panel of the Conduct and Competence Committee on 6 July 2015, for a period of six months. A review of this order was made on 4 January 2016, with a decision to let the current order lapse. That decision was successfully appealed by the Professional Standards Authority (PSA). The High Court extended the period of suspension and directed a review. On 8 August 2016, a panel of the Conduct and Competence Committee reviewed the suspension order and decided to replace this with a conditions of practice order for 18 months. On 11 January 2018 a reviewing panel extended the conditions of practice order for 3 months. This order was reviewed by a Fitness to Practise Committee panel on 29 March 2018 and replaced with a 3 month suspension order. The current order is due to expire on 8 August 2018. The panel is reviewing the order pursuant to Article 30(1) of the Order. Page 3 of 9
The charges found proved which resulted in the imposition of the substantive order were as follows: That you, a registered nurse, whilst working as Team Leader on the Topaz Unit of the Redhill Care Centre: 1. On 9 August 2013, did not contemporaneously record your observations of Patient A s syringe driver pump on Patient A s syringe driver pump observation chart; 2. 3. On 10 August 2013 retrospectively completed Patient A s syringe driver pump observation chart for the 9 August 2013, without making it clear that your entries were retrospective; 4. Your conduct at charge 3 was dishonest in that you were intending to conceal your failure to record the observations contemporaneously; 5. On 10 August 2013 administered a controlled drug to Patient A via his syringe driver pump: 5.1. When you did not have the required competencies to do so; 5.2. Without a second nurse to check the administration; 6. On 10 August 2013 told members of Patient A s family that Patient A s syringe driver pump had only been turned off for a short period of time and that Patient A was not in pain; 7. Your conduct at charge 6 was dishonest, in that you knew that Patient A s syringe driver pump had been switched off for a number of hours and that as a result, Patient A was likely in pain; Page 4 of 9
And, in light of the above, your fitness to practise is impaired by reason of your misconduct. The last reviewing panel, in March 2018, determined the following with regard to impairment: The panel noted that the last time Ms Watton-Gathua demonstrated insight for her failings was to the reviewing panel in August 2016. Since then Ms Watton-Gathua has not provided any evidence of insight or remediation of the deficiencies identified in her practice. The panel noted that on 19 January 2018 in a telephone call Ms Watton-Gathua expressed that she wishes for her PIN to be deactivated from the NMC register. The panel noted that there was a material change in this case in a telephone call of 19 January 2018, Ms Watton-Gathua indicated her intention not to return to nursing. Further she demonstrated a disregard for the role of her regulator. The panel considered that this demonstrated a regression in her insight. Due to the lack of positive engagement with the NMC and her conditions of practice order the panel remains concerned that Ms Watton-Gathua could repeat the clinical failures identified in her practice. The panel therefore determined that Ms Watton-Gathua s fitness to practise remains impaired but, like the last reviewing panel, only on the grounds of public protection. The last reviewing panel, in March 2018, determined the following with regard to sanction: The panel considered continuing the current conditions of practice order. The panel has received information that Ms Watton-Gathua does not Page 5 of 9
intend to return to practise as a nurse. Ms Watton-Gathua has not positively engaged with the current conditions of practice order that is in place. In view of Ms Watton-Gathua s expressed intention not to return to nursing the panel considered that any conditions of practice order would not be workable and would serve no useful purpose. On this basis the panel concluded that a conditions of practice order is no longer practicable or appropriate in this case. The panel concluded that no workable conditions of practice could be formulated which would protect the public. The panel had regard to the telephone call of 19 January 2018. The panel was concerned that Ms Watton-Gathua s communication with the NMC demonstrated a disregard for the role of the regulator. The panel determined that a suspension order is the only appropriate sanction which would protect the public. Accordingly, the panel determined to impose a suspension order for a period of 3 months. The panel is of the view that a suspension order would allow Ms Watton- Gathua a further opportunity to reflect on her misconduct and also to allow her to genuinely consider whether she wishes to cease to practise as a nurse. It considered this to be the most appropriate and proportionate sanction available. The panel did consider whether a striking off order would be appropriate. The panel concluded that it would not on this occasion. The panel noted the last reviewing panel did not refer to a striking off order as a possible outcome. In the panel s view therefore, a striking off order would be disproportionate at this stage. If Ms Watton-Gathua continues to not positively engage, the next reviewing panel are likely to consider a striking off order. Page 6 of 9
If Ms Watton-Gathua wishes to return to practise a future panel will be assisted by: Ms Watton-Gathua s engagement either in person or by telephone A reflective statement on how Ms Watton-Gathua would deal with a stressful situation in the workplace and the role of the regulator. Evidence of any further training in nursing practice if any has been undertaken. Decision on current fitness to practise This panel considered whether Mrs Watton-Gathua s fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined it as a registrant s suitability to remain on the register without restriction. In considering this case, the panel carried out a comprehensive review of the order in light of the current circumstances. It noted the decision of the last panel. However, it exercised its own judgment as to current impairment. The panel had regard to all of the documentation before it, including the decisions and reasons of the previous panels. It took account of the submissions made by Mr Badruddin on behalf of the NMC. Mr Badruddin outlined the background of this case and the decisions of the previous panels. He submitted that there had been no new information provided by Mrs Watton- Gathua regarding her insight or remediation since the last review hearing. He submitted that Mrs Watton-Gathua s only engagement with the NMC since the last hearing was her email of 11 June 2018 which, in Mr Badruddin s submission, demonstrated a regression of her insight into her misconduct and an attempt to deflect responsibility. He submitted that Mrs Watton-Gathua s fitness to practise remained impaired and invited the panel to make no lesser sanction that a further suspension order. The panel accepted the advice of the legal assessor. Page 7 of 9
In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. The panel considered whether Mrs Watton-Gathua s fitness to practise remains impaired. Mrs Watton-Gathua has not provided any of the information recommended by the last reviewing panel in March 2018. Indeed, she has not provided any new information regarding her insight or remediation. The only new information before this panel was Mrs Watton-Gathua s email of 11 June 2018, which refers only to the facts of the incident which led to her referral to the NMC. The panel agreed with Mr Badruddin s submission that this email demonstrated a regression in her insight and an attempt to deflect responsibility. The panel concluded that, in the absence of any further insight or remediation, there remains a risk of repetition, and therefore a risk to patients. The panel therefore decided that Mrs Watton-Gathua s fitness to practise remains impaired on public protection grounds, for the reasons identified by previous panels. Determination on sanction Having found Mrs Watton-Gathua s fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel s powers are set out in Article 29 of the Order. The panel also took into account the NMC s Sanctions Guidance and bore in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the risk of repetition identified. The panel decided that it would be neither proportionate nor in the public interest to take no further action. Page 8 of 9
The panel then considered whether to impose a caution order but concluded that this would also be inappropriate in view of the risk of repetition identified. The panel decided that it would be neither proportionate nor in the public interest to impose a caution order. The panel next considered replacing the current suspension order with a conditions of practice order. The panel considered that it might be possible to formulate conditions which would adequately protect the public, given that the concerns in this case related to identifiable areas of Mrs Watton-Gathua s clinical practice. However, Mrs Watton- Gathua was either unable or unwilling to comply with the conditions of practice orders previously imposed by the reviewing panels in August 2016 and January 2018. She has continued to disengage with the NMC and has shown no efforts to remediate her practice. The panel therefore had no reason to believe that she would respond positively to a further conditions of practice order. Accordingly, the panel decided that a conditions of practice order was not an appropriate sanction. The panel next considered imposing a further suspension order. It considered that a further period of suspension would adequately protect the public for the time it was in force. However it was also mindful that Mrs Watton-Gathua has been the subject of a substantive order for almost three years. During this time she has demonstrated neither an ability nor a willingness to remediate her practice. She has not engaged meaningfully with the NMC since June 2016 and indicated, in a telephone call on 19 January 2018, that she wished to deactivate her PIN and leave the NMC register. The panel therefore concluded that a further period of suspension would serve no useful purpose and would not be in the public interest. Accordingly, the panel determined that the only appropriate sanction in this case was a striking-off order. This order will take effect upon the expiry of the existing suspension order on 8 August 2018. This decision will be confirmed to Mrs Watton-Gathua in writing. That concludes this determination. Page 9 of 9