Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 22 March 2018 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of registrant: NMC PIN: Mrs Caroyln Ann Marshall 76I0170E Part(s) of the register: RN1, Registered Nurse (sub part 1) - Adult (29 November 1979) RM, Registered Midwife- Midwifery (15 February 1982) RHV, Health Visitor Specialist Community Public Health Nurse (8 October 1988) V100, Community Practitioner Nurse Prescriber (23 August 2000) Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Ms Marshall: Nursing and Midwifery Council: Order being reviewed: Outcome: England Misconduct Edward Lucas (Chair, Lay member) Judith Robbins (Registrant member) Alison Lyon (Lay member) Mark Sullivan Karel Kingsley Present and not represented Represented by Kim Elcoate May, Case Presenter Conditions of Practice Order 18 months Suspension Order 12 months to come into effect immediately in accordance with Article 30 (2) Page 1
Decision and reasons on review of the current order: The panel decided to replace the current conditions of practice order with a 12 month suspension order. This order will come into effect immediately in accordance with Article 30(2) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the third review of an order originally imposed by a Conduct and Competence Committed on 17 March 2016 and most recently reviewed on the 14 September 2017. The current order is due to expire on 18 April 2019. The panel is reviewing the order pursuant to Article 30(2) of the Order. The charges found proved by way of admission which resulted in the imposition of the substantive order were as follows: That you, a registered nurse, whilst employed by Morton House Nursing and Residential Home: 1. On the night shift of the 3/4 January 2014: a. Worked as the nurse in charge whilst unfit from alcohol consumption; b. Slept whilst on duty; c. Moved/attempted to move a resident whilst unfit from alcohol consumption; d. Conducted a drugs round whilst unfit from alcohol consumption. AND in light of the above your fitness to practise is impaired by reason of your misconduct. The second reviewing panel determined the following with regard to impairment: 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. Page 2
The panel considered whether Mrs Marshall s fitness to practise remains impaired. [PRIVATE] The second reviewing panel determined the following with regard to sanction: The panel next considered the imposition of a conditions of practice order. The panel took account of the representations made by the RCN in its letter dated 13 September 2017. [PRIVATE]. The panel was of the view that a conditions of practice order remains sufficient to protect patients and the wider public interest. [PRIVATE]. The panel also noted that, whilst working at Dorset House, Mrs Marshall struggled to adapt to working on night shifts. The panel considered that given the risk of repetition identified, Mrs Marshall s practice should be restricted to working on day shifts only. Accordingly, the panel determined, pursuant to Article 30 of the Nursing and Midwifery Order 2001, to vary the existing conditions imposed by the order and to extend the period by 18 months. These changes to the existing order will come into immediate effect under Article 30 (4). The panel decided that the following varied conditions were appropriate and proportionate: 1. [PRIVATE] 2. [PRIVATE] 3. [PRIVATE] 4. [PRIVATE] 5. [PRIVATE] 6. [PRIVATE] Page 3
7. You must notify the NMC within 7 days of any nursing appointment (whether paid or unpaid) you accept within the UK or elsewhere, and provide the NMC with contact details of your employer. 8. You must inform the NMC of any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 14 days of you receiving notice of them; 9. You must within 14 days of accepting any post or employment requiring registration with the NMC, or any course of study connected with nursing or midwifery, provide the NMC with the name/contact details of the individual or organisation offering the post, employment or course of study; 10. You must immediately inform the following parties that you are subject to a conditions of practice order under the NMC s fitness to practise procedures, and disclose the conditions listed at (1) to (9) above, to them: a. Any organisation or person employing, contracting with, or using you to undertake nursing work; b. Any agency you are registered with or apply to be registered with (at the time of application); c. Any prospective employer (at the time of application) where you are applying for any nursing appointment; and d. Any educational establishment at which you are undertaking a course of study connected with nursing or, or any such establishment to which you apply to take such a course (at the time of application). Decision on current fitness to practise Ms Elcoate May outlined the background facts to the previous panels decisions. She informed the panel that today s hearing was an early review of the current conditions of practice order at the request of the NMC. Ms Elcoate May submitted that Page 4
you informed the NMC on 4 January 2018 that you were convicted on 12 September 2017 for drink driving. She submitted that this was a breach of your current conditions of practice order and therefore demonstrates an increased risk of repetition. Ms Elcoate May submitted that your fitness to practise is currently impaired on grounds of public protection and public interest. Ms Elcoate May submitted that the circumstances of your case have changed as you have breached condition 3 of your current conditions of practice order. She reminded the panel that the NMC has a duty to uphold and declare proper standards of conduct and performance by maintaining confidence in the nursing profession and the NMC as the regulatory body. You told the panel that you said that you are sorry for your actions and that you feel like you have let the profession down. [PRIVATE]. You informed the panel that you are currently working 30 hours a week as a registered nurse and attending probation meetings on a regular basis. You said that you have made friends in similar circumstances to you and they have been very supportive towards you. [PRIVATE]. You said the most important thing for you is to keep on track and carry on nursing. [PRIVATE]. Ms Elcoate May submitted the breach of condition 3 indicates an increased ongoing risk to the public. She submitted that although, by your own admission, you delayed reporting your conviction to the NMC, the NMC would not have been aware of it without your admission and this should be borne in mind. She invited the panel to consider continuing the current order and remove condition 3 because it refers to a matter of your private life and the purpose of the order is that you are safe to practice. [PRIVATE]. The panel accepted the advice of the legal assessor. The panel has considered carefully whether your 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 Page 5
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 and has taken account of the submissions made by Ms Elcoate May and oral evidence from you. 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 your fitness to practise remains impaired. The panel was concerned to hear that you were convicted of drink driving in relation to an incident that occurred days after the previous review hearing. [PRIVATE]. The panel benefited from hearing evidence from you where you demonstrated your remorse and insight into your actions. [PRIVATE]. The panel determined that, in this case, a finding of continuing impairment on public interest grounds is required. For these reasons, the panel finds that your fitness to practise remains impaired. Determination on sanction Having found your fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. It 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 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 order but concluded that this would be inappropriate in view of the health conditions identified. The panel decided that it would be neither proportionate nor in the public interest to impose a caution order. Page 6
The panel next considered the continuation of the conditions of practice order. The panel was concerned to hear that you received a second conviction for drink driving in November 2017 in relation to an incident that occurred only days after the substantive order review on 14 September 2017. The panel considered that in these circumstances, the current order does not provide an adequate level of public protection and that public confidence in the profession would be undermined if you were allowed to continue to practice at the present time. It took no view whether you had actually breached the order, recognising you were not working as a nurse at the time of the incident. It will also be a matter for another panel to consider what sanction, is appropriate in relation to the actual conviction. This panel has carried out an assessment of the risk that you pose in light of what has happened since the last review and concluded that a conditions of practice order is neither proportionate nor appropriate. The panel determined therefore that a suspension order is the only appropriate sanction which would satisfy the wider public interest. Accordingly, the panel determined to impose a 12 month suspension order. It considered this to be the most appropriate and proportionate sanction available. This suspension order will replace the current conditions of practice order which was due to expire on 18 April 2019 in accordance with Article 30 (2) of the Nursing and Midwifery Order 2001. The panel did consider a striking-off order. [PRIVATE] [PRIVATE]. Before the end of the period of the order, a panel will review it. It considered that the following would assist any future reviewing panel: Your attendance [PRIVATE] Up to date references and testimonials from employers (both voluntary and paid); [PRIVATE] [PRIVATE] [PRIVATE] The panel was satisfied that the suspension order will satisfy the public interest in your case and will maintain public confidence in the profession as well as the NMC as the Page 7
regulator. Further, the suspension order will declare and uphold proper professional standards. This decision will be confirmed to you in writing. That concludes this determination. Page 8