Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 11 May 2018 Nursing and Midwifery Council, Temple Court 13a Cathedral Road, Cardiff, CF11 9HA Name of registrant: NMC PIN: Part(s) of the register: Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Ms Kuzniarska: Nursing and Midwifery Council: Order being reviewed: Outcome: Marta Kuzniarska 12I0179C Registered Nurse Adult September 2012 Poland Misconduct John Penhale (Chair, Lay member) Jodie Banner (Registrant member) Claire Corrigan (Lay member) Lee Davies Karel Kingsley Present and not represented Represented by Hannah Smith, Case Presenter Suspension order - 12 months Striking-off order Page 1
Decision and reasons on application under Rule 19: Ms Smith made an application to hold the parts of the hearing pertaining to Ms Kuzniarska s health in private under Rule 19 of the Rules. The panel accepted the advice of the legal assessor. The panel decided to hold the parts of the hearing pertaining to Ms Kuzniarska s health in private on the grounds that her right to have matters of her health heard in private outweighed the public interest in this matter being heard in public. Service of Notice of Hearing The panel was informed at the start of this hearing that Ms Kuzniarska 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 Kuzniarska on 12 April 2018 by recorded delivery and first class post to her registered address. The panel noted that notice of this hearing was delivered to Ms Kuzniarska s registered address on 18 April 2018. 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 Kuzniarska. 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 Smith, on behalf of the Nursing and Midwifery Council (NMC). Page 2
The panel accepted the advice of the legal assessor. The panel noted the contents of the email correspondence between the NMC and Ms Kuzniarska. The panel was satisfied that Ms Kuzniarska was aware of today s hearing and had chosen to voluntarily absent herself. It noted that she did not provide a reason for her non-attendance. The panel had no reason to believe that an adjournment would result in Ms Kuzniarska s attendance. Having weighed the interests of Ms Kuzniarska with those of the NMC and the public interest in an expeditious disposal of this hearing, the panel decided to proceed in Ms Kuzniarska s absence. 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 14 June 2018 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the second review of a conditions of practice order originally imposed by a panel of the Conduct and Competence Committee on 12 May 2016 and a suspension order imposed on 15 May 2017. The current order is due to expire at the end of 14 June 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 as a band 5 Registered Nurse at Madog Nursing Home: 1. Between 23 September 2014 and 27 September 2014, on one or more occasion administered 100mg of oxycodone hydrochloride to Patient A when 20-25mg oxycodone was prescribed. Page 3
2. Between 25 September 2014 and 27 September 2014, on one or more occasion failed to record on Patient A s MAR chart that you had administered oxycodone hydrochloride. 3. Between 25 September and 27 September 2014, on one occasion mistakenly recorded that you had withdrawn 10ml of oxycodone hydrochloride for Patient A; 4. Incorrectly dated an entry for administration of 10ml oxycodone to Patient A as 26/09/14 instead of 25/09/14 in the controlled drug book. 5. On 28 September 2014 left Madog Nursing Home with no qualified nursing staff for approximately 40 minutes. 6. Failed to administer and/or record that you had administered insulin to Patient B on: a. (Not proved) b. 28 September 2014 AND in light of the above, your fitness to practise is impaired by reason of your misconduct. The first reviewing panel determined the following with regard to impairment: Regarding insight, the panel noted that the last panel found that you had limited insight into your actions. At this hearing, the panel considered that you have not used your time in Poland effectively to remediate your failings as a registered nurse. The panel felt that you have not addressed the findings of the substantive panel, and that you have shown no evidence of accepting responsibility for your actions. As such, the panel decided that you had shown no development of your insight into the original charges, and have not paid attention to the current conditions of practice. The last panel determined that you were liable to repeat matters of the kind found proved. This panel has heard no new information as to your efforts to remediate Page 4
your practice, with the exception of two training courses (on healthy eating and vaccinations) that are not relevant to the concerns which led to the current conditions of practice. In light of this, the panel determined that there remains a risk that you will repeat matters of the kind found proved. The panel therefore decided that a finding of continuing impairment remains necessary on the grounds of public protection. The panel has 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. Thus, the panel determined that, in this case, a finding of continuing impairment on public interest grounds is still required as public confidence in the profession would be undermined if you were allowed to return to unrestricted practice while you still pose a risk to patient safety. For these reasons, the panel finds that your fitness to practise remains impaired. The first reviewing panel determined the following with regard to sanction: The panel felt that your lack of compliance with the current conditions mean that the above sections of the ISG would not be satisfied if your current conditions were to be extended. On this basis, the panel concluded that a conditions of practice order is no longer practicable. In all the circumstances, the panel considered that a conditions of practice order is no longer the appropriate order in this case. The panel concluded that no workable conditions of practice could be formulated which would protect the public or satisfy the wider public interest. The panel considered whether to impose a suspension order. A suspension order would both protect the public and satisfy the wider public interest. The panel felt that your deficiencies as a registered nurse are still remediable, and that a period of suspension would give you the opportunity to reflect upon your Page 5
actions. The panel decided that a striking-off order would be disproportionate in the current circumstances. Accordingly, the panel determined to impose a suspension order for the period of 12 months. It considered this to be the most appropriate and proportionate sanction available. This [sic] The panel considered that a future reviewing panel would be greatly assisted by you providing a reflective piece on what you have learned throughout this process, how your actions affected patients, your colleagues, and the reputation of the nursing profession, how you are going to change your behaviour, and how you plan to return to safe practice as a registered nurse in the United Kingdom. In particular, it should address the two deficiencies identified by the panel in May 2016, namely: administration of medication, and recordkeeping. Decision on current fitness to practise At this review hearing, Ms Smith on behalf of the NMC outlined the background to the previous panels decision. She submitted that Ms Kuzniarska has not developed a full understanding of the concerns identified by the previous panels and therefore the risk of repetition remains. Ms Smith submitted that during the previous review concerns had arisen about the mental health of Ms Kuzniarska. She submitted that Ms Kuzniarska has repeatedly refused to consent and cooperate with psychiatric testing requested by the NMC. She further submitted that Ms Kuzniarska registered as a nurse in the Republic of Ireland but was removed from the register due to the fact that the Board was satisfied that Ms Kuzniarska had procured registration by fraud or misrepresentation. Ms Smith submitted that Ms Kuzniarska s failures have put patients at unwarranted risk of harm and she has breached fundamental tenets of the profession. She invited the panel to consider imposing a striking-off order on both public protection and public interest grounds. Ms Smith submitted that Ms Kuzniarska has been afforded opportunities to develop insight and remediate her practice and offered direction by both previous panels and her NMC case officer but her responses have not addressed this and have at times been incoherent and unprofessional. The panel accepted the advice of the legal assessor. Page 6
The panel has had regard to all of the documentation before it and has taken account of the submissions made by Ms Smith. 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 behaviour. The panel has considered carefully whether Ms Kuzniarska 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 took into account that Ms Kuzniarska has not demonstrated any evidence of remediation. It bore in mind that she has not accepted the original findings of the substantive hearing. The panel was not satisfied that Ms Kuzniarska sufficiently understood how her actions had brought the nursing profession into disrepute. It was deeply concerned to hear that Ms Kuzniarska had been removed from the register as a nurse in the Republic of Ireland for reasons of her dishonesty. The panel found that Ms Kuzniarska has not demonstrated sufficient insight to the extent that is required to address her misconduct. Her communication would suggest that she has no understanding of the issues that the panel are considering. In this conduct, she deflects blame onto others and does not accept or acknowledge her failings. This demonstrates a deterioration of her insight. [PRIVATE] For these reasons, the panel found that Ms Kuzniarska s fitness to practise remains impaired on public protection and public interest grounds. Determination on sanction Having found Ms Kuzniarska 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 Page 7
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 adequately protect the public or satisfy the wider 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 adequately protect the public or satisfy the wider public interest to impose a caution order. The panel next considered the imposition of a conditions of practice order. It noted that Ms Kuzniarska had not complied with conditions of practice in the past and was not satisfied that Ms Kuzniarska would comply with conditions of practice if imposed today. The panel therefore found that workable conditions could not be formulated to sufficiently protect patients and the wider public interest. The panel next considered imposing a further suspension order. The panel took into account the fraudulent entry onto the Nursing and Midwifery Board of Ireland and the fact that Ms Kuzniarska failed to adhere to the recommendations made by the previous panel. The panel also took into account the poor feedback and information regarding Ms Kuzniarska s induction training and employment in the Republic of Ireland with Sonas Nursing Homes dated 11 April 2018 where it was stated that Ms Kuzniarska was verbally aggressive, defensive and at times irrational. The panel determined that a further period of suspension would not serve any useful purpose in all of the circumstances. The panel was of the opinion that initially the misconduct was potentially remediable, however, Ms Kuzniarska have failed to address this misconduct. The panel was of the opinion that Ms Kuzniarska failed to take the opportunities afforded to her by the two previous panels and Ms Kuzniarska s subsequent conduct is incompatible with ongoing registration. The panel was of the view that public confidence Page 8
in the profession could not be maintained if Ms Kuzniarska was not removed from the register and felt that a striking-off order was the only sanction that would be sufficient to protect the public, satisfy the public interest and maintain public confidence in the profession as well as the NMC as the regulator. This decision will be confirmed to Ms Kuzniarska in writing. That concludes this determination. Page 9