Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 1 March 2018 Nursing and Midwifery Council sitting at Regus, Forsyth House, Cromac Square, Belfast, BT2 8LA Name of registrant: Eileen Lucia Geoffroy NMC PIN: 81Y0012N Part(s) of the register: Registered Nurse Sub Part 1 Adult Nursing July 1985 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Registrant: Nursing and Midwifery Council: Order being reviewed: Outcome: Northern Ireland Misconduct and Lack of Competence Alexander Coleman (Chair, Lay member) Dorothy Keates (Registrant member) Margaret Rogan (Registrant member) Laura McGill Sophie Cubillo-Barsi Not present and not represented Represented by Bryony Dongray, counsel, instructed by NMC Regulatory Legal Team. Suspension order 6 months Striking off order to come into effect 31 March 2018 in accordance with Article 30 (1) 1
Service of Notice of Hearing The panel was informed at the start of this hearing that Ms Geoffroy was not in attendance, nor was she represented in her absence. The panel was informed that the notice of this hearing was sent to Ms Geoffroy on 29 January 2018 by recorded delivery and first class post to her registered address. The panel noted that notice of this hearing was signed for on 31 January 2018 and the printed name was Geoffroy. 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). Proceeding in absence The panel then considered proceeding in the absence of Ms Geoffroy. The panel was mindful that the discretion to proceed in 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 Ms Dongray, on behalf of the Nursing and Midwifery Council (NMC). The panel accepted the advice of the legal assessor. Ms Dongray informed the panel that Ms Geoffroy, in an on table letter dated 7 February 2018, would not be attending today s hearing. Ms Dongray invited the panel to proceed in her absence and informed the panel that no request for an adjournment had been made and that there was no reason to believe that an adjournment would secure Ms Geoffroy s attendance. Ms Dongray referred the panel to the cases of R. v Jones (Anthony William), (No.2) [2002] UKHL 5 and GMC v. Adeogba & GMC v. Visvardis [2016] EWCA Civ 162. 2
The panel noted the letter from Ms Geoffroy dated 7 February 2018, within which she states: I wish to inform you that I will no longer be able to engage with the Fitness to Practise Review process due to poor health. The panel was satisfied that Ms Geoffroy was aware of today s hearing and is of the view that she had chosen voluntarily to absent herself. The panel does not have any medical evidence from Ms Geoffroy and the panel had no reason to believe that an adjournment would result in Ms Geoffroy s attendance. Having weighed the interests of Ms Geoffroy with those of the NMC and the public interest in an expeditious disposal of this hearing the panel determined to proceed in Ms Geoffroy s absence. 3
Decision and reasons on review of the current order: The panel decided to impose a striking off order. This order will come into effect at the end of the current order in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the fourth review of a suspension order, originally imposed by a panel of the Conduct and Competence Committee on 28 August 2015 for 12 months. The current order is due to expire at the end of 31 March 2018. The panel is reviewing the order pursuant to Article 30(1) of the Order. The charges found proved which resulted in the imposition of the substantive order were as follows: That you, whilst employed by the Western Health and Social Care Trust ("the Trust") as a Staff Nurse on the Renal Unit at Altnagelvin Hospital, and whilst undergoing the Renal Unit Induction Programme between December 2012 to May 2013, failed to demonstrate the standards, knowledge, skills and judgement required to practice as a Staff Nurse in that you: 1. Between December 2012 and May 2013 failed to demonstrate that you were competent in the following areas of your Induction Programme: 1.1. Section 1: Infection control, in particular: 1.1.1. Demonstrate hand hygiene, Aseptic Non Touch Technique ( ANTT ) 1.1.2. Demonstrate correct hand-washing technique/use of hand gel 1.1.3. Safe disposal of SHARPS, dirty linen and clinical waste 1.2. Section 2: Renal knowledge, in particular: 1.2.1. Functions of the kidney 1.2.2. Describe principles of haemodialysis 1.3. Section 3: Preparation for Haemodialysis, in particular: 1.3.1. Line and prime haemodialysis machine 4
1.3.2. Describe monitoring and safety features, alarms 1.4. Section 4: Patient preparation; pre dialysis assessment, in particular: 1.4.1. Jugular venous pressure ( JVP ) 1.4.2. Body composition analysis 1.4.3. Dehydration 1.5. Section 5: Commencing Haemodialysis, in particular: 1.5.1. Preparation of self: handwashing 1.5.2. Aseptic connection of vascular access lines to haemodialysis lines using high impact intervention Renal Catheter Care Bundle 1.5.3. Insertion of arteriovenous ( a/v ) fistula needles and/or understand needling techniques e.g. buttonhole 1.5.4. Safe commencement of haemodialysis treatment 1.5.5. Give prescribed treatment, sign and document on dialysis sheet, Emed 1.6. Section 6: Cannulating arteriovenous fistula, in particular: 1.6.1. Is able to explain what an arteriovenous fistula is 1.6.2. Inspects fistula 1.6.3. Palpates, auscultates fistula, able to use stethoscope to listen for bruit 1.6.4. Is able to determine if fistula should not be cannulated 1.6.5. Show rationale for chosen sites 1.6.6. Cannulation 1.6.7. Follow Renal Unit standards for cannulation 1.6.8. Problem solving 1.7. Section 7: Care of patient during Haemodialysis, in particular: 1.7.1. Monitor patient throughout treatment and/or do regular observations 1.7.2. Report problems/complications to nurse in charge and/or document appropriately 1.7.3. Recognise complications of haemodialysis 1.7.4. Safe administration of fluid on haemodialysis 1.7.5. NOT PROVED 5
1.7.6. Administration of E.P.O. and Iron 1.7.7. Administration of IV drugs as per hospital policy 1.7.8. Closed circuit 1.8. Section 8: Discontinuing Haemodialysis, in particular: 1.8.1. Aseptic and safe washback procedure 1.8.2. Disconnecting patient lines from haemodialysis machine lines 1.8.3. Safe removal and disposal of needles as per unit policy 1.8.4. Assessment of patient post dialysis prior to safe discharge 1.8.5. Document and report problems to nurse in charge 1.8.6. Demonstration of haemodialysis machine, bed equipment, dialysis 1.8.7. Correct disposal of lines and cleaning of haemodialysis machine 1.8.8. Disinfecting haemodialysis machine using correct method 1.9. Section 9: Blood values and blood sampling, in particular: 1.9.1. Demonstrate safe venepuncture and blood sampling from haemodialysis lines 1.9.2. Accurately label bloods and forms 1.9.3. Uses correct blood bottles and forms relevant for each blood test and/or safely collect and sends samples to laboratories 1.9.4. Know unit policy in relation to blood sampling 1.9.5. Is able to access blood results from laboratory and/or Emed 1.9.6. Knows normal blood values and/or knowledge of blood values that are significant for renal patients and/or knows how to do monthly audit 1.9.7. Can measure dialysis adequacy using URR, KT/V and/or can access anaemia by checking EPO bloods 1.9.8. Can measure blood results against Renal Association Standards and/or D.O.Q.I. guidelines 1.10. Section 10: Diet and fluids, in particular: 1.10.1. Understands special dietary needs for renal patients 1.10.2. Understands why diet is important for the management of patients with End Stage Renal Failure ( ERF ) 6
1.10.3. Understands the importance of managing fluid balance for patients with E.R.F. 1.10.4. Understands the concept of dry weight 1.11. Section 11: Psychological and social impact of E.R.F., in particular: 1.11.1. Consider the impact of E.R.F. and haemodialysis on patient and family 1.11.2. Maintain confidentiality 1.11.3. Good communication skills 1.11.4. Refer patients to multidisciplinary team when required 1.12. Section 12: Further procedures undertaken in the Haemodialysis Unit, in particular: 1.12.1. Will be able to do the following procedures: 1.12.1.1. NOT PROVED 1.12.1.2. Recirculation studies 1.12.1.3. Sodium and U.F. 1.12.1.4. Profiling 1.12.1.5. Isolated U.F. 1.12.1.6. H.D.F. 1.12.2. NOT PROVED 1.12.3. NOT PROVED 1.12.4. NOT PROVED That you, whilst employed by the Trust as a Staff Nurse on the Renal Unit at Altnagelvin Hospital, and whilst undergoing the Trust s Informal Capability Procedure between May 2013 to June 2013, failed to demonstrate the standards, knowledge, skills and judgement required to practice as a Staff Nurse in that you: 2. Between May 2013 and June 2013 on one or more occasion failed to demonstrate that you were competent in the following areas:: 2.1. Recording the administration of Heparin correctly on patient dialysis worksheets 2.2. Recording all relevant details on patient dialysis worksheets 7
2.3. Priming Heparin properly or accurately 2.4. Escalating concerns and/or take appropriate action when one or more patient s blood pressure was recorded as low 2.5. Monitoring patient blood pressure appropriately 2.6. Take appropriate action to check why the dialysis machine was alarming 2.7. Locate patients pre-dialysis electrolyte profile ( EP ) or post dialysis EP blood results on the computer 2.8. Following the ANTT procedure 2.9. Following the seven step hand-washing technique procedure 2.10. Assess and/or needle a fistula correctly 2.11. Capping the haemodiafiltration priming line after removing the rinse connector 2.12. Appropriate disposal of SHARPS 2.13. Securing of dialysis lines to patients AND in light of the above your fitness to practise is impaired by reason of your lack of competence 3. On an unknown date between 10 December 2012 and 21 June 2013, when speaking with your colleagues, referred to Patient D as: 3.1. an evil bitch or words to that effect 3.2. a liar or words to that effect 3.3. Said she had something wrong with her head or words to that effect 4. On or around 20 May 2013: 4.1. Before administering medication to Patient K, failed to check Patient K's medication prescription 4.2. Attempted to administer the incorrect medication to Patient K in that you attempted to administer Paracetamol instead of Co-Codamol AND in light of the above your fitness to practise is impaired by reason of your misconduct. 8
The third reviewing panel determined the following with regard to impairment: The panel noted that you have not been engaging with the NMC process until recently, and have not attended any of the substantive order review hearings since the imposition of the substantive panel s decision on 28 August 2015. The panel noted that personal circumstances prevented you from engaging with the NMC in 2016, and that the NMC substantive proceedings did take its toll on you. The panel first considered your insight. The panel determined that you continue to demonstrate a limited degree of insight. The panel took into account that while you do accept the substantive panel s findings, and that you did bring a risk of harm to patients and colleagues, the panel was not satisfied that you have full insight into your previous failings. During your period of suspension, the panel has seen minimal improvement of insight on your part, other than a reflective piece dated September 2017 which is more of an acknowledgement of the original findings by the substantive panel as opposed to: an up to date written reflection for a hearing or a meeting addressing Ms Geoffroy s misconduct and lack of competence. Such a reflection should consider the impact of these proceedings and the charges found proved on her future practice and give evidence of real insight into her failings and how these have impacted on the reputation of the nursing profession; which the previous panel recommended. The panel noted that after you secured employment in your current role, you did not tell your employer about your NMC proceedings, although they were aware that you had been dismissed from the Trust. The panel considered that you therefore, continue to have limited insight into your past failings. The panel noted that you have provided a certificate which attempts to address your failings in relation to sharps, evidenced by a certificate dated 22 and 23 June 2016. 9
However, while you have attempted to address your deficiencies as to charge 1, this evidence was not corroborated by references/ testimonials demonstrating that you have put your training into practice. The panel also took into account your written outline as to how you have kept your nursing practice up to date. The panel noted that while you are working with clients in your current role as an outreach support worker, this does not of itself address remediation in your practice, nor is this evidence of sufficient information for the panel to demonstrate how you have kept your nursing knowledge up to date. The panel noted that you have made some attempt to comply with the recommendations from the previous panel, however, the panel was not satisfied that you have provided it with enough information or sufficient evidence to assess your current fitness to practise. The panel determined that you have provided it with limited information that addresses your specific failings, and you have not provided the panel with any supporting information confirming your contention that you have been undertaking training other than a two day sharps training course. The panel considered that you could have provided references, completed online training, given evidence of articles that you might have read, for example. In light of all the information before it, and due to the limited insight and remediation on your part, the panel decided that the risk of repetition of your failings remains. Therefore, the panel determined that a finding of continuing impairment is necessary on the grounds of public protection, due to the wide ranging nature of the charges, some of which relate to basic nursing care. The panel had at the forefront of its considerations 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 your fitness to practise remains impaired. The third reviewing panel determined the following with regard to sanction: 10
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 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. The panel then considered substituting the current suspension order with a conditions of practice order. The panel considered took into account the NMC s Sanction Guidance (July 2017), in particular: no evidence of harmful deep-seated personality or attitudinal problems identifiable areas of the nurse or midwife s practice in need of assessment and/or retraining no evidence of general incompetence potential and willingness to respond positively to retraining the nurse or midwife has insight into any health problems and is prepared to agree to abide by conditions on medical condition, treatment and supervision patients will not be put in danger either directly or indirectly as a result of conditional registration the conditions will protect patients during the period they are in force it is possible to formulate conditions and to make provision as to how conditions will be monitored The panel noted your recent engagement with the NMC proceedings and that you do 11
intend to return to work as a registered nurse in the future. The panel noted that it was your intention to begin a return to practice course, but that you had not enquired about this because of your current suspension order. The panel determined that since the imposition of the substantive order made on 28 August 2015, there has been no substantial change in this case. The panel has been provided with limited evidence that you have remediated your failings, or fully explore your insight in the specific areas of your failings. The imposition of a conditions of practice order would therefore not be workable. The panel noted that there is evidence of general incompetence, and that it is difficult to formulate conditions which would address the wide-ranging failings, including basic nursing care. The panel noted that it is your wish to begin a return to practice course. However, the panel decided that a return to practise course is not there to address deficiencies in your practice, and it is a course which assumes a registered nurse is in need of updating their practice only. The panel has not been provided with evidence that you would be ready to begin such a course, due to the lack of remediation on your part. The panel concluded that no workable conditions of practice could be formulated in this case, which would protect the public or satisfy the wider public interest. The panel then considered the imposition of a further period of suspension. It was of the view that a suspension order would allow you further time to fully reflect on your previous failings. The panel concluded that a further six month suspension order would be the appropriate and proportionate response and would afford you adequate time to further develop your insight, and allow you to fully reflect on your failings in detail and take significant steps towards remediation. It would also give you an opportunity to approach past and current health professionals, and others where relevant, to attest to your practice in the workplace since the substantive hearing. The panel considered whether a striking off order would be the appropriate sanction. However, in the circumstances of this case, it deemed a striking off order would be 12
disproportionate and unnecessary at this time. In this case, the panel considered that imposing a striking off order at this time would be punitive and disproportionate in light of your re-engagement with the NMC. Before the end of this order, there will be a further review. The review panel may be assisted by any evidence you are able to present as to your further learning and insight into your shortcomings. In particular a review panel may be assisted by (although not limited to): References from your employer about your practice and professional conduct towards patient, and demonstrating that you have put your training into practice; Articles that you might have read, or other evidence of how you have kept your nursing knowledge up to date; A reflective piece which uses a recognised reflective model, which addresses each of the failings; Your attendance at the next NMC review hearing. Decision on current fitness to practise The panel has considered carefully whether Ms Geoffroy 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, including the substantive reviewing bundle and a letter from Ms Geoffroy, dated 7 February 2018. It has also taken account of the submissions made by Ms Dongray, on behalf of the NMC. Ms Dongray invited the panel to consider the case of Grant [2011] EWHC 927 (Admin). She submitted that there is no new evidence before the panel today to demonstrate that 13
the issues and concerns raised in Ms Geoffroy s case have been remediated or that she is able to practise safely. Ms Dongray invited the panel to find that Ms Geoffroy remains impaired on public protection and public interest grounds. With regards to sanctions, Ms Dongray invited the panel to consider whether a striking off order would be appropriate in Ms Geoffroy s case, particularly when considering her lack of engagement or remediation. The panel heard and 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 Ms Geoffroy s fitness to practise remains impaired. The panel noted that Ms Geoffroy has, once again, failed to comply with the recommendations from the previous panel and found that there was no new evidence before it of any meaningful remediation into her widespread failings. In light of this, the panel determined that Ms Geoffroy remains liable to repeat matters of the kind found proved and 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 Ms Geoffroy s fitness to practise remains impaired. 14
Determination on sanction Having found Ms Geoffroy 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 neither proportionate nor in the public interest to take no further action. 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 was further satisfied, that a conditions of practise order would not be workable in the circumstances. It determined that it would be difficult to formulate sufficient conditions to adequately address the wide ranging general lack of competence in Ms Geoffroy s case, particularly when considering her lack of engagement. The panel next considered imposing a further suspension order. The panel noted that Ms Geoffroy has had numerous opportunities since 2015, to demonstrate remediation and compliance with the recommendations set out by reviewing panels, but has continuously failed to do. The panel found that Ms Geoffroy has demonstrated a serious lack of insight into her misconduct and lack of competence and was of the view that considerable evidence would be required to demonstrate that Ms Geoffroy no longer posed a risk to the public. The panel noted the letter from Ms Geoffroy, dated 7 February 2018, which indicates an intention to disengage with the NMC proceedings because of ill health. However, the panel had no independent evidence before it to support this assertion. The panel therefore determined that a further period of suspension would not be appropriate, given Ms Geoffroy s entrenched lack of any meaningful engagement with this process. The panel considered the factors on striking off orders within the SG, in particular the following points: 15
A serious departure from the relevant professional standards as set out in key standards, guidance and advice Persistent lack of insight into seriousness of actions or consequences. The panel determined that it was necessary to take action to prevent Ms Geoffroy from practising in the future. It found that repeated reviews of the same sanction, where there is no compliance with recommendations or meaningful engagement by Ms Geoffroy, would be detrimental to the public confidence in the nursing profession and the NMC as a regulator. It concluded that the only sanction which would now adequately protect the public and serve the public interest was a striking-off order. In accordance with Article 30 (1) of the Nursing and Midwifery Order 2001, this striking off order will come into effect upon the expiry of the existing suspension order, namely 31 March 2018. This decision will be confirmed to Ms Geoffroy in writing. That concludes this determination. 16