Fitness to Practise Committee Substantive Order Review Hearing 01 March 2019 Nursing and Midwifery Council, 2 Stratford Place, 61 Aldwych, London WC2B 4AE Name of Registrant Nurse: NMC PIN: Susan Ruth Bradbury 75J2855E Part(s) of the register: Registered Nurse - Mental Health (2001) Type of Case: Area of Registered Address: Panel Members: Legal Assessor: Panel Secretary: Nursing and Midwifery Council: Registrant: Orders to be reviewed: Outcome: Misconduct England Najrul Khasru (Chair/Lay Member) Paul Webb (Registrant Member) Angharad Davies (Lay Member) Nigel Pascoe QC Richard Webb Represented by Samantha Forsythe, Case Presenter Not present and not represented Suspension order 6 month suspension order to take effect upon expiry of the current order at the end of 04 April 2019 under Article 30(1) (b) of the Nursing and Midwifery Order 2001. Page 1 of 12
Decision on service of notice of hearing: Ms Bradbury was not in attendance, nor legally represented. Ms Forsythe, on behalf of the Nursing and Midwifery Council (NMC), informed the panel that notice of this hearing was sent to Ms Bradbury on 30 January 2018 by recorded delivery and first class post to her address on the register. The panel accepted the advice of the legal assessor. The panel was advised with regards to a bundle of documents in relation to proof of posting. This contained a notice of hearing sent to Ms Bradbury and a print out of the NMC database (Wiser) showing her registered address. In the light of the information available the panel was satisfied that notice had been served in accordance with Rules 11A 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: Upon the application of the NMC, the panel considered proceeding in the absence of Ms Bradbury. The panel accepted the advice of the legal assessor. The panel exercised the utmost care and caution in deciding whether or not to use its discretion to proceed in the absence of Ms Bradbury. There has been no correspondence from Ms Bradbury to the NMC since March 2018. The notice of this hearing was returned to the NMC as Not known at this address. The NMC attempted to contact Ms Bradbury by email on 05 February 2019 and by telephone on 28 February 2019 but there has been no response. Page 2 of 12
It appears Ms Bradbury has disengaged with the NMC and there was no reason to believe that an adjournment today would serve any useful purpose. The panel also had in mind the public interest in reviewing the order prior to its expiry. In the circumstances, the panel has decided that it is fair, appropriate and proportionate to proceed in the absence of Ms Bradbury. Decision on review of the order: This is a review, under Article 30 (1) of the Nursing and Midwifery Order (2001), of a 6 month suspension order imposed by a panel of the Fitness to Practise Committee at a substantive hearing on 04 September 2018. The order is due to expire at the end of 04 April 2019. The findings made at the substantive hearing in September 2018 are as follows: That you, a registered nurse: 1) Whilst employed at Darwin Court Care Home: a) On 29 February 2016: i) Left the medication trolley unattended and / or unlocked and / or with the keys in the door in an unlocked room; in part ii) Left one or more medications in pots on the medication trolley whilst the trolley was unattended in an unlocked room; b) On 7 March 2016: i) Left medication in a pot in an unlocked room; ii) Instructed Colleague A to administer medication to Patient D when he was not competent to do so; iii) Not Page 3 of 12
c) Not 2) Whilst employed at Park Farm Lodge Care Home: a) On or around 13 or 14 August 2016: i) Not ii) Did not assess Patient A on one or more occasion after colleagues had raised concerns with you about her condition; iii) Did not take Patient A s blood pressure; iv) Did not take Patient A s pulse; v) Did not take Patient A s temperature; vi) Did not take Patient A s oxygen saturation levels; b) On 14 August 2016: i) Did not assess Patient A when requested to attend by Colleague B; ii) Did not escalate Patient A s condition to a doctor and / or the emergency services; in part iii) Did not attend Patient A in a timely manner when requested to by Colleague B; iv) Not v) Did not include sufficient detail of the care you provided to Patient A in her care notes; vi) Not Page 4 of 12
c) On 31 August 2016, having taken a blood sugar reading from Patient B of 3.8mmol per litre: i) Administered insulin; ii) Did not call a doctor to review whether to administer insulin; iii) Did not delay insulin until after the patient had eaten and you had taken a further blood sugar reading; AND in light of the above, your fitness to practise is impaired by reason of your misconduct. The findings made at the substantive hearing are as follows: The panel next went on to decide if, as a result of this misconduct, Ms Bradbury s fitness to practise is currently impaired. Patients and their families must be able to trust nurses with their lives and the lives of their loved ones. To justify that trust, nurses must be open and act with integrity. They must make sure that their conduct at all times justifies both their patients and the public s trust in the profession. In this regard the panel considered the judgment of Mrs Justice Cox in the case of Grant [2011] EWHC 927 (Admin). The panel accepted Mr Mladenovic s submissions that the first three limbs of the test are engaged. It determined that Ms Bradbury has in the past put patients at unwarranted risk of harm, bringing the nursing profession into disrepute and consequently breaching a fundamental tenet of the nursing profession. The panel was particularly concerned about the incident in which Patient B was given insulin despite having a low blood sugar level reading. Regarding insight, the panel noted the written evidence of Ms 4, within which she states; Page 5 of 12
She [Ms Bradbury] appeared to me to be genuinely upset at the meeting and said something along the lines of I don t come to work to hurt people but that is what I have done, I need to stop nursing. Despite this admission by Ms Bradbury at a local meeting, the panel noted that it had no further evidence before it in relation to any in-depth insight into her shortcomings. When considering remediation, the panel determined that the misconduct found proved is remediable, particularly the administration of medication, by way of further training and assessment. However, the panel were concerned by the fact that it had no evidence of any remediation before it which could satisfy it that Ms Bradbury s failings would not be repeated. In light of this, the panel is of the view that there currently remains a risk of repetition of the misconduct found proved and therefore decided that a finding of impairment is necessary on the grounds of public protection. The panel bore in mind that the overarching objectives of the NMC are to protect, promote and maintain the health safety and well-being of the public and patients, and to uphold and protect the wider public interest, which includes promoting and maintaining public confidence in the nursing and midwifery professions and upholding proper professional standards for members of those professions. The panel determined that, in this case, a finding of impairment on public interest grounds was required. Having regard to all of the above, the panel was satisfied that Ms Bradbury s fitness to practise is currently impaired. Determination on sanction: The panel has considered this case very carefully and has decided to make a suspension order for a period of six months. The effect of this order is that the NMC register will show that Ms Bradbury s registration has been suspended. In reaching this decision, the panel has had regard to all the evidence that has been adduced in this case. The panel accepted the advice of the legal assessor. The panel has borne in mind that any sanction imposed must be appropriate and proportionate Page 6 of 12
and, although not intended to be punitive in its effect, may have such consequences. The panel had careful regard to the Sanctions Guidance ( SG ) published by the NMC. It recognised that the decision on sanction is a matter for the panel, exercising its own independent judgment. The panel considered the following aggravating and mitigating factors: Aggravating Ms Bradbury s failure in medicines management on 7 March 2016 occurred despite a final written warning, dated 3 March 2016, being issued to her in relation to a similar event; Patients at Darwin Court, some of whom have dementia, were placed at a real risk of harm in relation to unattended medication; Ms Bradbury s shortcomings in care provided to Patient A took place over a period of about 24 hours, despite concerns expressed to her at various stages by family members and by three colleagues on four occasions; Ms Bradbury has not engaged with these proceedings since writing an undated letter to an NMC case officer around March 2018. Mitigating Ms Bradbury has demonstrated some insight and remorse although limited. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the seriousness of the case. Next, in considering whether a caution order would be appropriate in the circumstances, the panel considered that Ms Bradbury s misconduct was not at the lower end of the spectrum and that it would be neither proportionate nor in the public interest to impose a caution order. The panel next considered whether placing conditions of practice on Ms Bradbury s registration would be a sufficient and appropriate response. The panel is mindful that any conditions imposed must be proportionate, measurable and workable. The panel reminded itself that the errors in medicines management found proved were repeated and that Ms Bradbury had failed to respond to concerns regarding Patient A s condition, despite being approached on numerous occasions. Further the panel was particularly Page 7 of 12
concerned by Ms Bradbury s flawed decision to administer insulin to Patient B when he had a low blood sugar level. In light of these poor decisions, the panel determined that there was a lack of general competency in Ms Bradbury s nursing practice. Taken together with her recent lack of engagement with these proceedings, the panel could not be satisfied that Ms Bradbury would comply with any conditions of practice at this time or that any conditions could be formulated that would protect the public and meet the wider public interest at this time. The panel then went on to consider whether a suspension order would be an appropriate sanction. The panel noted that this was not a single instance of misconduct and that the misconduct was serious. The panel also noted that there was no evidence before it of a deep seated attitudinal problem in this case. However, the panel considered that it had no explanation before it as to why the failings occurred or what, if any, remediation Ms Bradbury had undertaken to remediate the concerns regarding her practice. The panel considered that a suspension order was necessary to protect the public and to meet the wider public interest. The panel further considered whether a striking-off order would be proportionate in Ms Bradbury s case. Taking account of all the information before it, the panel concluded that it would be disproportionate and unnecessary to impose a strike off order in order to protect the public interest. Balancing all of these factors the panel has concluded that a suspension order would be the appropriate and proportionate sanction. The panel noted the hardship such an order will inevitably cause Ms Bradbury. However this is outweighed by the public interest in this case. The panel considered that this order is necessary to mark the importance of maintaining public confidence in the profession, and to send to the public and the profession a clear message about the standard of behaviour required of a registered nurse. Page 8 of 12
The panel determined that a suspension order for a period of six months was appropriate in this case to mark the seriousness of the misconduct and allow Ms Bradbury time to demonstrate insight and remediation into the failings found proved. At the end of the period of suspension, another panel will review the order. At the review hearing the panel may revoke the order, or it may confirm the order, or it may replace the order with another order. Any future panel may be assisted by: Ms Bradbury s attendance at a future reviewing hearing; A reflective piece evidencing her insight and remediation into the charges found proved; Evidence of any training courses Ms Bradbury has successfully completed in relation to the misconduct found proved and evidence of any training Ms Bradbury intends to undertake in the future. Decision on review: The panel today has considered all of the information before it and has taken account of the submissions made by Ms Forsythe on behalf of the NMC. There was no new information before the panel relevant to Ms Bradbury s case. The panel accepted the advice of the legal assessor. The panel had regard to the principle of proportionality and the need to balance the public interest against Ms Bradbury s own interests. The public interest includes protection of the public, the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and performance within the profession. The panel has had careful regard to the decision of the previous panel and has exercised its own independent judgment based on the information before it. Page 9 of 12
The panel first considered whether or not Ms Bradbury s fitness to practise remains impaired. Ms Bradbury has not attended the hearing and has not provided any evidence relevant to remediation or insight. There was no evidence as to any training she has undertaken, such as certificates or attendance on relevant courses. The panel could not be satisfied, on the evidence before it, that Ms Bradbury has addressed the concerns identified in her practice and it noted her own previous comments that she needs to stop nursing. In the circumstances, the panel determined that Ms Bradbury remains at risk of repeating matters of the kind found proved so as to put patients at unwarranted risk of harm, bring the nursing profession into disrepute and to breach fundamental tenets of the nursing profession. The panel therefore decided that a finding of continuing impairment is necessary on the grounds of public protection. The panel also kept in mind the need to promote and maintain public confidence in the nursing profession and to promote and maintain proper professional standards for members of the profession. The panel noted that Ms Bradbury has been suspended for a period of 6 months. Nevertheless, the panel has identified a risk of repetition in relation to her past misconduct. The panel therefore determined that a finding of continuing impairment on public interest grounds is required. Accordingly, the panel found Ms Bradbury s fitness to practise is impaired on both public protection and public interest grounds. Having found that Ms Bradbury s fitness to practise remains impaired, the panel then went on to consider what sanction, if any, to impose. In relation to allowing the order to lapse, the panel considered that this would be inappropriate, given the concerns that remain in this case and the risk to patients that has been identified. Page 10 of 12
The panel next considered a caution order. The panel recognised that a caution order would not restrict Ms Bradbury s practice, and in light of its finding of a risk of repetition and seriousness of the concerns, the panel concluded that such an order would not sufficiently protect the public, nor would it satisfy the public interest. The panel next considered following the current suspension order with a conditions of practice order. Conditions of practice could be formulated to address the clinical failings identified in Ms Bradbury s practice. Ms Bradbury has not attended the hearing nor has she provided any independent evidence regarding any relevant learning or remediation, of those failings, which Ms Bradbury has undertaken. The panel has not received independent references in relation to her honesty, integrity and reliability. In these circumstances the panel was of the view that, at this time, there remain no workable conditions which could be formulated to sufficiently satisfy the public protection and public interest concerns in Ms Bradbury s case. The panel considered the imposition of a further period of suspension. The panel has yet to receive sufficient evidence that Ms Bradbury is currently safe to return to unrestricted practice. In light of the serious nature of the concerns in this case and the risk that they may recur, the panel was also of view that public confidence in the profession and the regulator could not be maintained if Ms Bradbury were to return to practise at this time. The panel did consider a striking-off order however, it concluded that, at this stage, it would be disproportionate and unnecessary to impose a strike off order in order to protect the public interest. The panel bore in mind that a suspension order continue to provide protection to the public and also allows Ms Bradbury an opportunity, should she wish to take it, to re-engage with the process. The panel noted that the next review panel would have all sanctions, including that of a striking-off order, open to them and will be required to consider that option. Page 11 of 12
In the circumstances and for the reasons above, the panel concluded that the only appropriate sanction to provide protection to the public and uphold public confidence in the profession is a further suspension order for a period of 6 months to come into effect upon expiry of the current order at the end of 04 April 2019. The suspension order will be reviewed prior to its expiry, usually around a month beforehand, and Ms Bradbury will be given 28 days notice of the next hearing or meeting. Ms Bradbury or the NMC are able to call for an early review. At the next review hearing the panel may revoke the order, or it may confirm the order, or it may replace the order with another order. Any future panel may be assisted by: Ms Bradbury s attendance at a future reviewing hearing; A reflective piece evidencing her insight and remediation into the charges found proved; Evidence of any training courses Ms Bradbury has successfully completed in relation to the misconduct found proved and evidence of any training Ms Bradbury intends to undertake in the future. That concludes this hearing. Page 12 of 12