Conduct and Competence Committee Substantive Hearing Monday 3 August 2015 Nursing and Midwifery Council, 61 Aldwych, London, WC2B 4AE Name of Nurse: NMC PIN: Mr David Hadfield 85Y2084E Part(s) of the register: Registered Nurse Sub Part 1 Adult Nursing April 1988 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Representation: Nursing and Midwifery Council: England Conviction Dr Howard Freeman (Chair/Lay member) Ms Stella Tracey (Registrant member) Ms Khairun Butt (Lay member) Mr Ian Ashford-Thom Miss Bose Kayode Mr Hadfield was not present and was not represented in absence Represented by Ms Unnatti Bhatt, counsel, instructed by NMC Regulatory Legal Team Facts proved: 1 Facts not proved: Fitness to practise: Sanction: Interim Order: N/A Impaired Striking off order (By way of consensual panel determination) Interim Suspension order 18 months 1
Decision on Service of Notice of Hearing: The panel was informed at the start of this hearing that Mr Hadfield was not in attendance. 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 February 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) his address in the register Notice of this hearing was sent to Mr Hadfield on 2 July 2015 by recorded delivery and first class post to his address on the register which complies with the rules for service. In addition, although not a requirement for proper service, the Royal Mail track and trace document indicates that the notice was delivered and signed for on 3 July 2015. 2
Proceeding in absence: The panel considered whether it should proceed in the absence of Mr Hadfield. The panel heard the submissions made by Ms Bhatt, on behalf of the Nursing and Midwifery Council (NMC). It took account of the legal assessor s advice. The panel was mindful that this was a discretion that must be exercised with the utmost care and caution. In deciding whether to proceed in the absence of Mr Hadfield, the panel weighed its responsibilities for public protection and the expeditious disposal of the case with Mr Hadfield s right to a fair hearing. Ms Bhatt submitted that the panel should proceed in the absence of Mr Hadfield. She informed the panel that there was a proposed agreement for this case to be dealt with by means of Consensual Panel Determination (CPD), on which she would address the panel in due course. She referred to a paragraph within the provisional agreement signed by Mr Hadfield which acknowledges that he is content for the CPD hearing to proceed in the absence of himself and/or his representative if he is not present. She submitted that, in light of the signed CPD agreement, there would be no purpose in adjourning matters until a later date. She also reminded the panel of the public interest in the expeditious disposal of cases. The panel considered carefully whether to exercise its discretion to proceed in the absence of Mr Hadfield and was satisfied that he had been sent notice of today s hearing by both first class post and recorded delivery. That notice had been delivered. Mr Hadfield has not requested an adjournment. The panel was mindful that a provisional agreement has been reached in this case, and that Mr Hadfield has agreed for the matter to be heard in his absence. The panel concluded, therefore, that there is nothing to suggest that an adjournment of today s hearing would result in Mr Hadfield s future attendance. The panel concluded that it is in the public interest and in Mr Hadfield s own interest to proceed with this hearing. 3
Charges: That you, whilst a registered nurse, employed by East Lancashire Hospitals NHS Trust: 1. On the 14th of October 2014 was convicted of the offence of Wound/ Inflict grievous bodily harm contrary to section 20 of the Offences Against the Person Act 1861 And, in light of the above, your fitness to practise is impaired by reason of your Conviction 4
Consensual Panel Determination: The panel heard from Ms Bhatt, on behalf of the Nursing and Midwifery Council (NMC) that a provisional agreement on a Consensual Panel Determination had been reached between Mr Hadfield and the NMC. The agreement, which was put before the panel, sets out Mr Hadfield s admission to the charge and his acceptance that his fitness to practise is currently impaired by reason of his conviction. It is agreed that an appropriate sanction in this case would be a striking off order. The panel has considered the agreement which was signed by Mr Hadfield on 16 June 2015 and by an officer of the NMC on the 19 June 2015. The provisional agreement reads as follows: The Nursing and Midwifery Council ( NMC ) and David Hadfield, PIN 85Y2084E ( the parties ) agree as follows: 1. Charges 1. David Hadfield ( the registrant ) admits the following charges: That you, whilst a registered nurse, employed by East Lancashire Hospitals NHS Trust: On the 14th of October 2014 was convicted of the offence of Wound/ Inflict grievous bodily harm contrary to section 20 of the Offences Against the Person Act 1861 And, in light of the above, your fitness to practise is impaired by reason of your Conviction 2. Facts 2. The facts are as follows: 3. The registrant was referred to the NMC on 23 August 2013 by his former employer, the East Lancashire Hospitals NHS Trust (the referrer ) where he was employed as a nurse. The referral alleged that on the evening of 5 August 2013, the registrant had assaulted a patient. The referral stated that the patient was a vulnerable adult who lacks capacity and was very ill and that the 5
patient was assaulted on the evening of 5 August 2013. This occurred whilst 3 members of staff were turning the patient within the critical care unit. The incident was witnessed by 2 members of staff within the room and by a number of other staff members on the units CCTV. The referral also stated that The patient suffered injuries requiring treatment to the head and showed overall deterioration. In addition, the patient required intubation and ventilation. 4. The police conducted an investigation into the incident. On 7 August 2013 the registrant was arrested on suspicion of assault, and released on bail until 18 September 2013. On 29 October 2013, the police confirmed that the CPS had authorised charges of section 18 wounding against David Hadfield and on 27 December 2013, confirmed that the registrant was charged with a section 18 wounding. A plea and case management hearing was scheduled for 19 February 2014 at which the registrant pleaded not guilty plea. The case was scheduled for trial on 6 October 2014. 5. On the 14th of October 2014, after trial, the registrant was convicted of the offence of wounding/ inflicting grievous bodily harm contrary to section 20 of the Offences Against the Person Act 1861. The case was adjourned for sentencing until 25 November 2014, when His Honour Judge ( HHJ ) Newell sentenced the registrant to 15 months imprisonment. The full transcript of the sentencing observations is annexed to this document marked Exhibit 1. HHJ Newell s sentencing observations include reference to the following relevant matters: 5.1 At the time of the incident, the registrant was working in the critical care unit and he was highly respected and had been respected for over 30 years. 5.2 Patient A, aged 72, attended Royal Blackburn Hospital and he was diagnosed with pancreatitis. Patient A s health deteriorated and he was transferred to the critical care unit. A patient on the critical care unit will have one to one nursing and very close monitoring and observation of patients both directly face to face via various monitors and televisions. 5.3 During his stay at the hospital, Patient A s breathing had become compromised and it was discussed that he could require ventilation to assist. He wore a Continuous Positive Airway Pressure (CPAP) hood to aid his breathing in the interim. Throughout Patient A s stay at the hospital, he had become distressed and upset and had suffered hallucinations. However, the evening he was on the critical care unit, he was settled, sleeping and happier in his situation. 5.4 The registrant came on duty and took over the care of [A]. Prior to the day to night shift handover, the registrant visited A, accompanied by two other nurses. Patient A was described as difficult and somewhat aggressive but nothing that is out of the ordinary it 6
seems with some patients within a hospital environment. The registrant and the two nurses tried to calm the situation and there was a clash of heads which resulted in the registrant saying Come on then and then proceeded to head butt A three times. 5.5 Patient A was wearing the CPAP hood at the time but three cuts to his forehead was sustained by him. HHJ Newell describes how In the context of the cuts only, not the incident, the cuts were relatively superficial, they did not need to be stitched, they were dealt with by gluing. He further adds how the registrant s loss of control was for seconds only because he immediately reverted to type, namely a highly experienced, well trained and well respected nurse of 30 years, [he] dealt with A in a very sensible way. Other nurses attended to Patient A and the registrant was asked to leave. 5.6 As a result of the incident, Patient A, needed to be ventilated that night, nonetheless, HHJ Newell added this incident accelerated that, but it was anticipated in any event. Furthermore, HHJ Newell explains how this was a brief and unexplained incident. and that it was in response to the actions of A, there was no premeditation at all. 6. The incident received national publicity in that the sentencing outcome was reported on the evening of 25 November 2014 in a BBC News online article, entitled Nurse jailed for headbutting patient, 72. The article explained that the registrant was jailed for 15 months because he headbutted an elderly and seriously ill patient. 3. Impairment 7. The registrant was released from prison, and continues to serve the balance of his sentence in the community. 8. The registrant admits that his fitness to practise is impaired by reason of his conviction because he: 8.1. 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 8.2. Has in the past brought and/or is liable in the future to bring the professions into disrepute; and/or 8.3. Has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the professions. 7
9. The registrant has not worked as a nurse since his arrest. Accordingly, the registrant has taken no steps to remediate his shortcomings and agrees that his fitness to practise remains impaired on public protection grounds. 10. The parties also agree that the registrant s departure from the appropriate standards of care towards a vulnerable patient and the nature of the conviction are so serious that the public interest calls for a finding of impairment to maintain trust and confidence in the profession and regulatory system. 4. Sanction 11. The appropriate sanction in this case is a striking off order. 12. It is agreed between the parties that this is not a matter in which it would be appropriate to take no further action in that such a sanction would not be sufficient to protect the public, nor mark the seriousness of the misconduct. Similarly, it is agreed that a caution order is not an appropriate sanction, in that this is not a case which can be said to be at the lower end of the spectrum of impaired fitness to practise (para 64 of ISG), nor would such an order provide adequate public protection in that it would not restrict the registrant s practice rights (para 65 of ISG). 13. A conditions of practice order is also inappropriate in that it would not be adequate to protect patients and the public interest (para 66.1 of ISG). Further, there are no identified areas of practice requiring retraining, in that the registrant has not worked as a nurse since his arrest in August 2013 and has no intention of returning to nursing (para 67.2 and 67.4 of ISG). Having regard to the nature of the conviction, it would not be possible to formulate conditions that would be effective, and to make provision to adequately monitor such provisions (para 67.8 of ISG), nor would such a sanction be sufficient to protect the public interest. Conditional registration would not provide adequate protection in the event of any repetition of the behaviour which lead to the conviction (paras 67.6 and 67.7 of ISG). 14. A suspension order is not an appropriate sanction in that a period of suspension will not be appropriate to protect patients and the public interest (para 69.2 of ISG), particularly taking into account the seriousness of the conviction and the extent of the registrant s departure from the standards expected of a registered nurse (para 70 of ISG). Further, the registrant s conduct is fundamentally incompatible with continuing to be a registered nurse (para 72.2 of ISG). 8
15. In view of the seriousness of the conviction, a striking off order is the only sanction sufficient to protect the public interest and maintain confidence in the nursing profession and the NMC as its regulator (para 74.1-74.3 of the ISG). This is because it is acknowledged that the registrant s conduct towards a vulnerable patient, leading to his conviction and imprisonment for a serious criminal offence, represented a serious departure from the relevant professional standards as set out in: The code: Standards of conduct, performance and ethics for nurses and midwives (para 75.1.1 of ISG). 16. The conviction involved physical harm to Patient A, and was exacerbated by the fact that the patient was vulnerable and the registrant was in a position of trust, which he breached in a way which caused unwarranted patient harm (para 75.2 and 75.3 of ISG). The conviction was for violent conduct towards a patient and so serious that the public interest can only be satisfied by removal (para 75.5 and 75.8 of ISG). 17. In all of the circumstances, it is agreed that the appropriate sanction is a striking off order. 5. Interim order 18. 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. 19. Furthermore, whilst the registrant may attend the Consensual Panel Determination hearing and/or be represented, he is content for the Consensual Panel Determination hearing to proceed in the absence of himself and/or his representative if he is not present. In addition, the registrant waives the relevant notice requirements for this Consensual Panel Determination hearing. The parties understand that this provisional agreement cannot bind a panel, and that the final decision on findings 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. 9
Panel Decision: The panel heard and accepted the advice of the legal assessor, who reminded it that in reviewing the proposed settlement, the panel should have regard to the general advice that is tendered in these circumstances in respect of both impairment and sanction. In summary, impairment should be current impairment and consideration of sanction should be made with regard to the NMC Indicative Sanctions Guidance (ISG). The panel considered whether the implementation of the provisional agreement would be in the public interest. This means that the outcome must ensure an appropriate level of public protection, maintain public confidence in the professions and the regulatory body, and declare and uphold proper standards of conduct and behaviour for nurses and midwives. The panel took into account that the referrer had seen and agreed with the proposed CPD. The panel were told that the family of Patient A had not been sent a copy of the proposed CPD in line with NMC policy, but that they would be able to see it on the NMC public website. Mr Hadfield has admitted charge 1 and therefore the panel finds the facts proved. He also admits that his fitness to practise is currently impaired by reason of his conviction. However, as in every fitness to practise case, this remains a matter of judgment for the panel. The panel has had regard to the Nursing and Midwifery Council Code (May 2008). The Code expressly states that as a professional, you are personally accountable for actions and omissions in your practice, and must always be able to justify your decisions. By acting as he did, Mr Hadfield was clearly in breach of the following provisions of the Code: Preamble The people in your care must be able to trust you with their health and wellbeing. To justify that trust you must: make the care of people your first concern, treating them as individuals and respecting their dignity provide a high standard of practice and care at all times Be open and honest, act with integrity and uphold the reputation of the profession. 10
Code: 1 You must treat people as individuals and respect their dignity 3 You must treat people kindly and considerately 49 You must adhere to the laws of the country in which you are practising. 61 You must uphold the reputation of your profession at all times. The panel noted that Mr Hadfield has not worked as a nurse since his arrest and as such he has not taken any steps to remediate his shortcomings. Mr Hadfield accepts that his fitness to practise is currently impaired. The panel concluded that as a result of the matters which led to his conviction, Mr Hadfield s departure from the appropriate standards of care towards a vulnerable patient and the nature of the conviction are so serious that the public interest calls for a finding of impairment to maintain trust and confidence in the profession and regulatory system. The panel was also satisfied that, in the absence of any remediation by Mr Hadfield, his fitness to practice is impaired on public protection grounds. Throughout its deliberations, the panel has borne in mind the NMC s responsibility regarding the public interest which includes not only protecting the public but also the maintenance of public confidence in the professions and the NMC as a regulator, and the declaring and upholding of proper standards of conduct and behaviour amongst members of the professions. The panel went on to consider the CPD and in doing so considered the Indicative Sanctions Guidance (ISG) to determine whether the agreed sanction was appropriate. The panel considered that the circumstances of this case do not justify taking no action, given the serious nature of Mr Hadfield s actions and the fact that the panel has found that his fitness to practise is currently impaired. Further, the panel considered that to take no further action in this case would be insufficient to maintain public confidence in the nursing profession, and in the NMC as its regulator. 11
The panel went on to consider whether a caution order would be appropriate. The panel has taken account of the ISG as it relates to caution orders. Mr Hadfield s actions were a serious breach of trust and the panel considers that this case is not at the lower end of the spectrum of impaired fitness to practise. Accordingly the panel s judgement is that it would not be sufficient or proportionate in this case. The panel considers that a caution order, even for the maximum period of five years, would be insufficient to protect the public or to mark the seriousness of his actions or to maintain the public s confidence in the nursing profession and the regulatory process. The panel next considered the imposition of a conditions of practice order. It noted the factors set out in paragraphs 66 to 68 of the ISG which indicate when such an order may be appropriate, in particular where there are identifiable areas of nursing practice that require assessment and/or retraining. The panel determined that a conditions of practice order was neither appropriate nor proportionate in the circumstances. Mr Hadfield has not worked as a nurse since his dismissal from the Trust. The panel considered that the circumstances of this case could not be adequately addressed by way of conditions. Additionally, appropriate and workable conditions of practice could not be formulated, which would protect the public and also uphold the wider public interest. The panel also concluded that this sanction would not adequately reflect the seriousness of the case. The panel next considered the imposition of a suspension order and had regard to paragraphs 71-76 of the ISG. The panel has already indicated that the behaviour which led to Mr Hadfield s conviction was serious and involved a vulnerable patient who was in his care. By his behaviour, Mr Hadfield brought the reputation of the profession into disrepute and breached a fundamental tenet of the profession. The panel noted that a suspension order may be appropriate when a panel is satisfied that a registrant has shown insight and does not pose a significant risk of repeating the behaviour. However, the panel has not been provided with any evidence from Mr Hadfield either in writing or in person to adequately explain his actions and the impact those actions had on others. The panel considered that Mr Hadfield s behaviour involved an assault on a vulnerable patient which inflicted an injury in the form of wounding and grievous bodily harm. Temporary removal from the register by way of a suspension order would not adequately protect members of the public or maintain public confidence in the profession and the NMC as a regulatory body, nor would it satisfy the need for the NMC to declare and uphold proper standards of conduct and performance within the profession. It concluded that Mr Hadfield s behaviour and conviction were incompatible with his ongoing registration. Further, in light of the serious nature of the conviction in this case, it concluded that public interest in this case cannot be satisfied by any lesser outcome than permanent removal from 12
the Register. The panel took into account the fact that the effect of such an order will be that Mr Hadfield may suffer financial hardship, but the panel was satisfied that the public interest outweighed Mr Hadfield s own interests in this regard. The panel therefore accepts the provisional agreement and makes a striking off order which is the appropriate and proportionate sanction in all the circumstances of this case. Mr Hadfield will be notified of the panel s decision in writing. The striking off order will come into effect 28 days after the service of the notification of the panel s decision upon him. If he appeals the panel s decision, the Order will not take effect until the appeal has been concluded. Mr Hadfield may not apply for restoration until five years after the date that this decision takes effect. 13
Interim Order: The panel considered the provision for an interim order as set out in paragraph 18 of the CPD and, having considered Article 31, imposes an interim suspension order. The interim suspension order will be for a period of 18 months to cover any appeal period. This interim order is made for the protection of the public and is otherwise in the public interest. This decision will be confirmed in writing. That concludes this determination. 14