Conduct and Competence Committee Substantive Meeting 22 May 2012 Nursing and Midwifery Council, 61 Aldwych, London, WC2B 4AE Name of Registrant Nurse: NMC PIN: Mrs Roshnee Jahoor 94C1330E Part(s) of the register: Registered Nurse Sub Part 1 Adult March 1997 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Facts Admitted and Found Proved: Surrey Misconduct Andrew Coleman (Chair/ Registrant member) Pradeep Khuti (Lay member) Reuben Livingston (Lay Nurse) Philip Barlow Darrell Vincent n/a Facts Found Proved: 1a, 1b, 1c, 1d, 1e, 2. Facts Not Proved: Fitness to practise: Sanction: Interim Order: n/a Impaired Striking Off Order Interim Suspension Order 18 months Details of charge: That you, whilst working as a registered nurse for the King s College Hospital NHS Foundation Trust between 24 April 2007 and 4 March 2008: 1. Submitted false medical certificates on: a. 25 April 2007 b. 12 July 2007 c. 1 October 2007 d. 15 October 2007 e. 10 December 2007 1
2. And your actions as set out in charge(s) 1a) to e) was dishonest. And in light of the above, your fitness to practise is impaired by reason of your misconduct. Decision on the findings on facts and reasons: In reaching its decisions on the facts, the Panel has considered all the evidence in the bundle of documents. The burden of proof in the case rests with the NMC throughout. Mrs Jahoor is not required to prove, or disprove, anything. The standard of proof is the civil standard, namely on the balance of probabilities. This means that a fact will only be proved if the Panel finds that it was more likely than not that the incident occurred as alleged. The background to the case is as follows. The registrant, Roshnee Jahoor (aka Kannick), was employed as a Junior Sister on the Haemodialysis Unit ( the Unit ) at Kings College Hospital NHS Foundation Trust ( the Trust ). Mrs Jahoor was employed on the Unit between 10 July 2006 and 4 March 2008. On 23 March 2007, Mrs Jahoor went on annual leave and was due to return to the Trust on 26 April 2007. On 24 April 2007, the Matron of the Unit received an international phone call from Mrs Jahoor who explained that she was in Trinidad visiting family and she thought she had slipped a disk. On 25 April 2007 Mrs Jahoor emailed a GP certificate certifying her off work for 3 months to receive rehabilitation. Mrs Jahoor provided medical certificates dated 12 July 2007, 1 October 2007, 15 October 2007 and 10 December 2007. The Matron of the Unit raised concerns regarding the authenticity of the medical certificates with Barbara Conroy, the Senior Human Resources Manager at the Trust. On 14 February 2008 she inputted Mrs Jahoor s name into the Google search engine. The website for Global Dialysis was one of the results of the search. One of the contacts provided on the results page was for a Lighthouse Dialysis Centre in Tobago which had the email address of Mrs Jahoor as a contact. The Senior Human Resources Manager telephoned the number of the Lighthouse Dialysis Centre and Mrs Jahoor answered the call. After the Senior Human Resources Manager introduced herself to Mrs Jahoor, she first stated that she was attending to a patient. Later she claimed that the Lighthouse Dialysis Centre had been started by her sister and that she was working only in an advisory capacity. Later still she claimed that she was doing charity work. Subsequently the Human Resources Manager telephoned the number of the doctor listed on the medical certificates. The number called was not answered and went through to a voicemail which appeared to belong to a Malissa Kannick, the sister of Mrs Jahoor who had worked at the Trust a number of years previously. 2
Mrs Jahoor never returned to work and on 4 March 2008 a disciplinary hearing was held in her absence. The decision of the disciplinary panel was to summarily dismiss Mrs Jahoor for gross misconduct relating to fraud and unauthorised absence. This decision was not appealed by Mrs Jahoor. The panel has received the witness statements from Rachel Mwansa, Matron on the Unit at the Trust; Barbara Conroy, Senior Human Resources Manager at the Trust; Iris Lewis, Assistant Head of Management Accounts and Senior Finance Manager at the Trust; Dr Lue Chin, a Registered Doctor practicing from AJ Dental & Medical Care Clinic which is based in Trinidad, West Indies and Monica Mccann, the Matron from Renal Services at St Georges Health Care NHS Trust. Facts: Charge 1 - submitted false medical certificates to the Trust to claim sick pay dated: 1a) 25 April 2007; 1b) 12 July 2007; 1c) 1 October 2007; 1d) 15 October 2007 and 1e) 10 December 2007. The panel found charge 1 proved in its entirety. Ostensibly, the medical certificates supplied by Mrs Jahoor are in the name of Dr Lue Chin at the AJ medical centre. Dr Roger Lue Chin asserts in his statement that the medical certificates of 25 April 2007, 12 July 2007, 1 October 2007, 15 October 2007 and 10 December 2007 were not written by him. He states that the main stamp on the medical certificate is not his personal medical stamp. Dr Lue Chin also states that the name, address and telephone numbers on the medical certificate are not correct and the signatures on the certificates are not his. The panel accepts the statement of Iris Lewis that Mrs Jahoor was paid sick pay from the Trust at the times alleged. It therefore finds proved that Mrs Jahoor submitted false medical certificates with the intention of claiming sick pay. Charge 2 - your actions described at paragraph 1 above were dishonest The panel had regard to the case of R v Ghosh [1982]. The panel was in no doubt that according to the ordinary standards of reasonable and honest people Mrs Jahoor s actions in submitting false certificates to claim sick pay were dishonest. It was also in no doubt that Mrs Jahoor herself must have realised that what she was doing was by those standards dishonest. This was an intentional act to defraud the Trust. The panel therefore find charge 2 proved. Decision on Misconduct and Impairment: This determination should be read in conjunction with the Panel s earlier determinations on the facts. The Panel has determined that Mrs Jahoor s fitness to practise is currently impaired. The NMC defines fitness to practice as a registrant s suitability to remain on the register unrestricted. 3
In considering that matter, the Panel first determined whether or not the facts found proved amounted to misconduct. In so doing it had regard to all the information available to it. In relation to the charges the panel had regard to the following points of the NMC code of professional conduct: standards for conduct performance and ethics (NMC 2004) ( the Code ): Point 1.2 As a Registered Nurse, Midwife or Specialist Community Public Health Nurse, you must: uphold and enhance the good reputation of the professions. 1.5 You must adhere to the laws of the country in which you are practising. Point 7.1 you must behave in a way that upholds the reputation of the professions. Behaviour that compromises this reputation may call your registration into question even if it is not directly connected to your professional practice. It is clear from the evidence that Mrs Jahoor s actions constituted an orchestrated deception to defer her return to work at the Trust and draw sick pay whilst working else where. Mrs Jahoor actively defrauded the Trust of around 27,500. This was not a one-off incident but an ongoing, highly organised series of events. In the panel s judgment there is no doubt that Mrs Jahoor s actions in this regard were in breach of the NMC s code of conduct, were dishonest, and constitute misconduct. When considering impairment the panel had regard to, Ronald Jack Cohen v General Medical Council [2008], whether Mrs Jahoor s misconduct is easily remediable, whether it has been remedied and whether it is likely to be repeated. The panel considers that dishonesty is a state of mind that is not easily remediable. Furthermore Mrs Jahoor has not engaged with the NMC and there is no evidence before the panel that she has shown any insight into her dishonesty. In the time since the incidents of 2007 there is no evidence that she has made any attempt to put right her failings. Indeed, there is evidence to the contrary. The panel has seen the application form that Mrs Jahoor submitted to St George s Healthcare NHS Trust in 2010 for the post of Senior Staff Nurse, Haemodialysis Unit. Although she had been dismissed from Kings College Hospital Trust in 2008 she stated in her application form that the reason for leaving had been a job offer abroad. The panel also accepts the statement of Monica McCann that Mrs Jahoor failed to notify Saint George s Trust that she was subject to an investigation by the NMC. Mrs Jahoor has not engaged with the NMC throughout the process. Dishonesty is difficult to remediate. There is no evidence of insight or remorse and the panel has nothing before it to suggest that Mrs Jahoor has made any attempt to remediate her misconduct. In the circumstances the panel has determined that Mrs Jahoor s fitness to practice is currently impaired. 4
Decision and reasons on Sanction: This determination should be read in conjunction with the Panel s earlier findings on the facts and impairment. Having determined that Mrs Jahoor s fitness to practise is currently impaired by reason of misconduct, the Panel went on to consider what sanction, if any, should be imposed in respect of her registration. In doing so the Panel has born in mind the need to act proportionately and has referred to the NMC s Indicative Sanctions Guidance. It has also reminded itself of the cases of Tait v Royal College of Veterinary Surgeons [2003], Atkinson v General Medical Council [2009] and Parkinson v Nursing and Midwifery Council [2010]. The Panel noted that the decision as to what sanction, if any, should be imposed is a matter for its professional judgment. It has applied the principle of proportionality, weighing the interests of the public with those of Mrs Jahoor. The Panel took account of the mitigating and aggravating factors in the case. The Panel has noted all of the sanctions which are available to it together with the option of taking no action. It also noted that it should impose the least restrictive sanction which is necessary to allow the Panel to exercise its duty to protect the public and maintain public confidence in the profession. The Panel first considered and rejected taking no action. In the light of Mrs Jahoor s misconduct, public confidence could not be maintained without a sanction. The Panel next considered imposing a Caution Order. Having regard to the NMC Indicative Sanctions Guidance document, the Panel concluded that such an Order was not appropriate or sufficient in the circumstances of this case. Although Mrs Jahoor s actions did not cause direct patient harm, a fraud of this scale had the effect of depriving the Trust of funds and this will undoubtedly have had an impact on the care of other patients. There has been no admission of the facts; no evidence of insight, regret or apology; and the conduct was deliberate and ongoing. The panel has taken into account that Mrs Jahoor had a previous good record before the incident. However, there is no evidence that she was acting under duress and there has been a repetition of dishonesty as evidenced by her application to Saint George s NHS and Health Trust. She has not submitted testimonials or evidence of rehabilitative steps. The panel next considered Conditions of Practice, but determined that this sanction is not appropriate as Mrs Jahoor has not demonstrated the potential or willingness to respond positively considering her lack of engagement in this case. Mrs Jahoor lacks any understanding or insight into her dishonesty. The panel considered that it would not be possible to formulate appropriate and practical conditions of practice to address the dishonest conduct. 5
The panel then considered whether a suspension order would be sufficient. The misconduct was in breach of fundamental tenets of the profession as set out in the Code. The dishonesty in this case was calculated and sustained such that it would undermine public confidence in the NMC if Mrs Jahoor were allowed to remain on the register. Furthermore, Mrs Jahoor has not engaged with the NMC process and has not asked to attend a hearing to explain her actions. She has shown no insight or remorse. In these circumstances the panel decided that a suspension order is insufficient. The panel has decided that Mrs Jahoor s behaviour is fundamentally incompatible with continuing registration with the NMC. There has been a serious departure from the relevant standards as set out in the Code. The panel has considered the issue of proportionality. Mrs Jahoor has provided no information as to the effect that such an order will have upon her but the panel has born in mind that its decision will prevent her working as a registered nurse. However, the panel considers that the public interest, including the need to protect patients from indirect harm caused by fraud, the maintenance of public confidence in the professions, and the need to declare and uphold proper standards of conduct and behaviour, takes priority over Mrs Jahoor s own interests in this case. In all the circumstances the panel has determined to make a striking off order. Mrs Jahoor will have 28 days from the date when written notice of the result of this hearing is deemed to have been served upon Mrs Jahoor in which to exercise her right of appeal against this direction. A letter explaining her right of appeal will be supplied to Mrs Jahoor by the NMC. Reasons for an Interim Order: In light of the appeal period and any ongoing process if an appeal is made, the panel has determined an Interim Suspension order for 18 months is necessary for the same reasons as above. If an appeal is not made the Interim Suspension order will lapse and the striking Off Order will replace it. This order is made on the grounds that it is necessary to protect the public, in the public interest and to maintain public confidence in the professions. This will be confirmed in writing and that concludes this meeting. 6