Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Meeting 16 October 2017 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of registrant: NMC PIN: Mrs Mary Margaret Bradley 04I1059S Part(s) of the register: Registered Nurse Sub part 1 Adult Nursing September 2007 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Scotland Misconduct/Lack of Competence Paul Powici (Chair, Lay member) Anne Witherow (Registrant member) Helen Eatherton (Registrant member) Ben Stephenson Nour Shaheen Order being reviewed: Outcome: Suspension Order 3 months Striking-Off Order to come into effect at the end of 30 November 2017 in accordance with Article 30(1). 1
Service of Notice of Meeting: The panel was informed that the notice of this meeting was sent to Mrs Bradley on 5 September 2017 by recorded delivery and first class post to her registered address stating that a meeting would be held on or after Monday 16 October 2017. 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 11A and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended) (the Rules). Decision and reasons on review of the current order: This is the third review of a suspension order, originally imposed by a panel of the Conduct and Competence Committee on 30 July 2015 for 12 months. On 22 July 2016 a panel reviewed Mrs Bradley s case and imposed a 12 month suspension order. A panel reviewed the order on 27 June 2017 and imposed a 3 month suspension order. The current order is due to expire at the end of 30 November 2017. This panel is reviewing the order pursuant to Article 30(1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). The panel decided to impose a striking-off order. This order will come into effect at the end of 30 November 2017 in accordance with 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 Band 5 Nurse, whilst employed at Hairmyres Hospital by NHS Lanarkshire Health Board ( the Board ) between 4 October 2010 and 4 March 2013 failed to demonstrate the standard of knowledge, skills and judgement required for practice without supervision as a Registered Nurse in that you: 2
Theatre 4 1. In 2010, whilst working in Theatre 4, were unable to use the Kardex system effectively for setting up cases; Theatre 3 2. Whilst working in Theatre 3, were unable to: a. ensure that all appropriate equipment required was available; b. carry out swab, needle and instrument counts as per policy; c. understand the differences in suture and ligature materials; d. anticipate surgical requirements. 3. On 10 November 2011, had to be prompted to carry out an instrument count following a hernia repair with mesh. 4. In or around November 2011 were unable to prepare the theatre for an upper endoscopy Ward 6 5. On 29 March 2012 you administered Simvastatin to Patient A in the morning when it was prescribed to be taken at night. 6. On 31 May 2012 you dispensed and/ or administered double the prescribed dose of Salbutamol nebuliser to Patient B. 7. On or about 9 July 2012 you did not administer the prescribed medication Gentamicin to Patient C. 3
8. On 18 July 2012 you gave an IV antibiotic to Patient D in the morning but did not continue to give the prescribed dose to that patient throughout the day. 9. On 18 July 2012 you failed to give Patient E an evening dose of Clexane injection. 10. On 18 July 2012 you signed a medication Kardex to indicate that the Clexane injection referred to in charge 9 above had been given to Patient E, when this was not the case. 11. On 25 August 2012 you administered two 20mg tablets of Sevredol to Patient F when that patient was in fact prescribed 40mg MST twice daily. 12. On 31 December 2012 you administered Gentamicin to Patient G, when you should not have done so. 13. On 16 February 2013 you administered 600mcg of Octreotide to Patient H instead of the 300mcg that was prescribed. 14. Between 25 February 2013 and 4 March 2013 you signed the controlled drugs register on approximately eleven occasions, as set out in Schedule 1, which was not in accordance with the instructions you had been given. And in light of the above your fitness to practise is impaired by reason of your lack of competence. Alternatively, in relation to charge 14, your fitness to practise is impaired by reason of your misconduct. Schedule 1 25/2/13 Oxycontin 20 mg 07:20 hours 25/2/13 Oxycontin 20mg 07:25 hours 25/2/13 - Oxynorm 10 mg 07:25 hours 4
25/2/13 Oxynorm 10 mg 15:00 hours 3/3/13 - Oxynorm 10 mg 18:05 hours 3/3/13 Morphine injection 5mg 17:45 hours 3/3/13 Oxynorm 5 mg 18:05 hours 4/3/13 Oxynorm 5 mg 10:30 hours 4/3/13 Oxynorm 5 mg 13:35 hours 4/3/13 Oxynorm 5mg 18:00 hours 4/3/13 Oxynorm 5mg 19:00 hours The second reviewing panel determined the following with regard to impairment: The panel had no information before it to indicate that there has been any change in circumstances since the last substantive order review. It noted that Mrs Bradley has not engaged with the NMC at all during these proceedings. The panel therefore had nothing to indicate that she has developed insight into her clinical failings or worked to remediate her practice and minimise the risk of repetition identified by the previous panel. The panel noted, as the previous panel did, that this was not a matter of single error or an inability to carry out a particular nursing duty, but rather a persistent catalogue of serious errors and deficiencies which spanned a significant period of time and involved a number of patients. The panel therefore concluded that, given the risk of repetition, the risk of harm to the public was high and a finding of current impairment was required to protect the public. The panel bore in mind the overarching objective of the NMC: to protect, promote and maintain the health safety and well-being of the public and patients and the wider public interest which includes promoting and maintaining public confidence in the nursing and midwifery professions and upholding the proper professional standards for members of those professions. The panel determined that, in this 5
case, given the lack of progress in relation to remediation and insight, a finding of continuing impairment on public protection and public interest grounds is required. For these reasons, the panel finds that Mrs Bradley s fitness to practise remains impaired. The second reviewing panel determined the following with regard to sanction: The panel first considered whether to take no action but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to take no further action. The panel also determined that a caution order would be inappropriate for the same reasons, as some restriction on Mrs Bradley s practice is necessary to protect the public and uphold the public interest. The panel next considered the imposition of a conditions of practice order. Although the panel considered, as the last panel did, that there are identifiable areas of Mrs Bradley s practice in need of retraining, it determined that a conditions of practice order would not be workable given Mrs Bradley s lack of engagement and therefore any indication that she would be willing to comply with conditions. The panel also considered that Mrs Bradley s persistent lack of engagement with her professional regulator suggests an attitudinal problem, which could not be addressed through conditions. The panel determined that it was unable to formulate appropriate and practicable conditions which would be sufficient to protect the public. It also determined that it would be neither proportionate nor in the public interest to impose a conditions of practice order. The panel then considered the imposition of a further period of suspension. The panel received advice from the legal assessor regarding Article 29(6) of the Order, and the inability to impose a striking off order on a registrant who is impaired due to lack of competence until she has been subject to a substantive order for at least two years. It noted that, given the timing of this review, Mrs 6
Bradley would not quite have been subject to a substantive order for two years on the date of expiry of the current order. The panel therefore accepted that a suspension order was, given its previous findings, the only sanction available to it which would sufficiently protect the public and uphold the public interest. Decision on current fitness to practise The panel has considered carefully whether Mrs Bradley s fitness to practise remains 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 has had regard to all of the documentation before it provided by the NMC. The panel 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. The panel considered whether Mrs Bradley s fitness to practise remains impaired. Regarding insight, the panel noted that the last panel found that there has been no evidence to demonstrate any insight on Mrs Bradley s part into her misconduct and lack of competence. Indeed, Mrs Bradley has failed to engage with the NMC at all and consequently she has demonstrated no insight into her misconduct and lack of competence. In its consideration of whether Mrs Bradley has remedied her practice, this panel took into account that the previous panel found that there was no evidence to suggest that Mrs Bradley had taken any steps to remediate the persistent catalogue of serious errors 7
and deficiencies. This panel found that the position today remained unchanged. This panel considered that, although her misconduct and lack of competence were capable of remediation through re-training, there has been no evidence to suggest that any attempts to remediate have been made by Mrs Bradley. The last panel determined that Mrs Bradley was liable to repeat matters of the kind found proved. This panel has received no new information from Mrs Bradley which indicates that the position has since changed. In light of this the panel determined that Mrs Bradley is still liable to repeat the errors of the kind found proved. The panel therefore decided that a finding of continuing impairment is necessary on the grounds of public protection. The panel had borne in mind that its primary function was to protect patients and the wider public interest which includes maintaining confidence in the nursing profession and upholding proper standards of conduct and performance. The panel determined that, in this case, a finding of continuing impairment on public interest grounds is also required. For these reasons, the panel finds that Mrs Bradley s fitness to practise remains impaired. Determination on sanction Having found Mrs Bradley s 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 Sanctions Guidance (SG) 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. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to take no further action, nor would it adequately protect the public. 8
The panel then considered whether to impose a caution but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to impose a caution order, nor would it adequately protect the public. The panel then considered whether a conditions of practice order would be appropriate in this matter. However, the panel concluded that this would not be appropriate because, in the absence of any new information, the concerns identified by the panel at the substantive hearing, the first review, and the second review, remain current. Further, the panel considered that, as a result of Mrs Bradley s complete disengagement throughout this process, it had no evidence before it that Mrs Bradley would be willing to comply with conditions on her practice. The panel next considered imposing a further suspension order. The panel noted that Mrs Bradley has not shown remorse for her misconduct or lack of competence. Further, Mrs Bradley has not demonstrated any insight into her previous failings. This panel noted that the previous reviewing panel, when imposing a further suspension order, stated that they were giving Mrs Bradley sufficient time to engage with the NMC and demonstrate that she has addressed matters appropriately. This panel has no evidence that Mrs Bradley has chosen to do so. The panel determined that a further period of suspension would not serve any useful purpose in all of the circumstances. The panel determined that it was necessary to take action to prevent Mrs Bradley from practising in the future and concluded that the only sanction that would adequately protect the public and serve the public interest was a striking-off order. The striking-off order will take effect on the expiry of the current order, namely, at the end of 30 November 2017. This decision will be confirmed to Mrs Bradley in writing. That concludes this determination. 9