Conduct & Competence Committee Substantive Meeting

Conduct & Competence Committee Substantive Meeting Date: 18-19 June 2012 Held at NMC, 61 Aldwych London WC2B 4AE Registrant: NMC PIN: Margaret Bridget Rickard 80Y1638E Part(s) of the register: Registered Nurse sub part 1 Adult Nursing 28 August 1988 Registered Nurse sub part 2 Adult Nursing 23 February 2983 Type of Case: Area of Registered Address: Panel Members: Legal Assessor: Panel Secretary: Misconduct/Caution Order England Michael Cann (Chair/ Lay Member) Jennie Fecitt (Registered Member) Jo Hathaway (Lay Member) Ian Ashford-Thom Alexandra Scott Facts Found proved: 1,2 and 3 Facts not proved: Fitness to practise: Sanction: Interim order directed: N/A Impaired Striking Off Order Interim Suspension Order for a period of 18 months Charges: That you, whilst employed by the Royal Cornwall Hospitals NHS Trust ( the Trust ) as a Haematology Cancer Clinical Nurse Specialist, at the Royal Cornwall Hospital ( the Hospital ), were; 1. On or around the 25 th July 2008, unfit for duty at the Hospital due to and/or contributed to by, the influence of alcohol and as a result, you left the Hospital Page 1 of 8

premises at the suggestion of staff members of the Hospital; 2. On or around the 15 th June 2009, unfit for duty at the Hospital due to and/or contributed to by, the influence of alcohol and as a result was removed from the Hospital premises. That you, a registered nurse, 3. Accepted a Police Caution on 30 May 2010 from Devon & Cornwall Constabulary for the offence of criminal damage. AND in light of the above, your fitness to practice is impaired by reason of your misconduct and/or your caution. Determination on the findings of fact: The allegations in this case refer to matters that occurred whilst Ms Rickard was employed by the Royal Cornwall Hospital NHS Trust as a Heamatology Cancer Clinical Nurse Specialist at the Royal Cornwall Hospital. Ms Rickard commenced her employment with the Trust on 18 June 2007. On 25 July 2008 Ms Rickard s colleagues became suspicious that she was under the influence of alcohol as a result of her behaviour. It is alleged that Ms Rickard s tone of voice was aggressive and she was argumentative and repetitive when she started work on the above date. It also appeared that Ms Rickard was struggling to understand what other nurses were saying to her. Ms Rickard s colleague, Ms Sarah Johns, Clinical Nurse Specialist, smelt alcohol on Ms Rickard and consulted Dr Desmond Creagh, Consultant Haematologist and Clinical Lead Haematology. Ms Rickard was advised to leave the premises. Ms Rickard denied that she had been drinking, however she was struggling to have rational conversations. Ms Rickard was subsequently suspended from work and referred to Occupational Health. A disciplinary hearing was held in October 2008. It was concluded that Ms Rickard did attend work under the influence of alcohol on 25 July 2008. Ms Rickard was issued with a final written warning which would be kept on her record for 12 months. On 15 June 2009, colleagues of Ms Rickard, Ms Johns and Caroline Edwards, Clinical Nurse Specialist, became concerned Ms Rickard was at work under the influence of alcohol. Ms Rickard was acting in a loud and inappropriate manner. This was reported to Kathryn Radcliffe, Senior Matron. Ms Radcliffe met with Ms Rickard later that day. Ms Radcliffe reported that she smelt alcohol on Ms Rickard s breath and that her eyes appeared glazed during the conversation. Ms Radcliffe raised the concerns with Ms Rickard who neither confirmed nor denied the allegations. Ms Rickard was suspended with immediate effect from the Trust. Ms Rickard was invited to attend an Occupational Health appointment on 18 June 2009 which she failed to attend. Ms Rickard was made aware of a disciplinary meeting held on 1 July 2009. However she informed the Trust that she would not be attending the meeting because of health issues and provided a medical certificate. Ms Rickard attended an occupational health appointment on 20 July 2009. Occupational Health advised that Ms Rickard was suffering from personal stresses. Page 2 of 8

Ms Rickard was sent another letter inviting her to an investigatory meeting on 14 September 2009, however Ms Rickard indicated she would not be able to attend because of medical issues and submitted another medical certificate. The relevant witnesses were interviewed during a Trust investigation and the disciplinary hearing was held on 19 December 2009. Ms Rickard did not attend and did not submit a written statement. Ms Rickard was dismissed from the Trust on 29 December 2009. It is further alleged that on 29 May 2010 Ms Rickard received a Caution from Devon and Cornwall Cornwall Constabulary for the offence of criminal damage, in that she destroyed a pane of glass to the value of 20.00p, intending to destroy or damage such property or being reckless as to whether such property would be destroyed or damaged. The panel took into account that the burden of proof rests with the Nursing and Midwifery Council (NMC) and that it should consider whether, on the balance of probabilities, the facts alleged were more likely than not to have occurred. The panel has considered the witness statements of: Teresa Batchelor who is and was at the time a staff nurse at the Royal Cornwall Hospitals NHS Trust; Sue Derbyshire who was at the time and is currently a staff nurse at the Royal Cornwall Hospitals NHS Trust; Sarah Johns who was at the time and is a Clinical Nurse Specialist at Royal Cornwall Hospitals NHS Trust; Kathryn Radcliffe; Caroline Edwards who was at the time and is a Haematology Nurse Specialist at Royal Cornwall Hospitals NHS Trust; Kathryn Radcliffe was at the time and is a Senior Matron at Royal Cornwall Hospitals NHS Trust; Frazer Underwood who was at the time and is the Consultant Nurse for Older People s Service and Associate Director of Nursing at Royal Cornwall Hospitals NHS Trust; Beverley Hales who was at the time and is Clinical Nurse Manager at Royal Cornwall Hospitals NHS Trust; Dr Desmond Creagh who was at the time and is Consultant Haematologist and Clinical Lead Haematology at Royal Cornwall Hospitals NHS Trust. The panel attached appropriate weight to the evidence in all the circumstances of the case. Charges: That you, whilst employed by the Royal Cornwall Hospitals NHS Trust ( the Trust ) as a Haematology Cancer Clinical Nurse Specialist, at the Royal Cornwall Hospital ( the Hospital ), were; 1. On or around the 25 th July 2008, unfit for duty at the Hospital due to and/or contributed to by, the influence of alcohol and as a result, you left the Hospital premises at the suggestion of staff members of the Hospital; Found Proved The panel considered and accepted the evidence of Sarah Johns, Beverley Hales, Dr Desmond Creagh and Kathryn Radcliffe. Page 3 of 8

Sarah Johns in her witness statement gives direct evidence to Ms Rickard working whilst under the influence of alcohol. She outlines Ms Rickard s behaviour when she arrived at work stating that when she entered our office her tone of voice was aggressive and she appeared argumentative because she aggressively interrupted an ongoing conversation between two colleagues. Ms Johns also states that Ms Rickard smelt of alcohol. The panel also considered Ms Hales witness statement regarding the disciplinary hearing held on 24 October 2009. Ms Hales indicates in her statement During the disciplinary hearing Ms Rickard admitted that she attended work on 25 July 2008 after consuming a bottle of wine late into the evening on 24 July 2008 and the early hours of 25 July 2008. Further Ms Hales statement says that Ms Rickard admitted that she was not fit to have attended work on 25 July 2008. The panel also had regard to the witness statements of Kathryn Radcliffe and Dr Desmond Creagh that they encountered Ms Rickard on the 25 July 2008 and considered that she was inebriated by the effects of alcohol and did not consider she was fit to be on duty whilst assessing patients. Considering all the evidence before it the panel has determined that the facts of Charge One are proved. 2. On or around the 15 th June 2009, unfit for duty at the Hospital due to and/or contributed to by, the influence of alcohol and as a result was removed from the Hospital premises. Found Proved The panel has considered the witness statements of Terese Batchelor, Sue Derbyshire, Sarah Johns and Caroline Edwards. Each of these witnesses give a direct account of Ms Rickard attending work whilst under the influence of alcohol on 15 June 2009. Ms Johns indicates that Ms Rickard s tone of voice was overly aggressive and I could smell alcohol on her. She continues to state that she considered her demeanour inappropriate because she was speaking very loudly and having inappropriate conversations. Ms Edwards approached Ms Rickard as staff members raised concerns that Ms Rickard was under the influence of alcohol. Ms Edwards states that when she approached Ms Rickard regarding the allegation she could smell alcohol on Ms Rickard s breath. She further stated that Ms Rickard was acting inappropriately because she was talking loudly and hugging and kissing her colleagues. It was not normal behaviour for Ms Rickard to hug and kiss her colleagues. Considering all of the evidence the panel has determined that the facts in Charge two are proved. 3. Accepted a Police Caution on 30 May 2010 from Devon & Cornwall Constabulary for the offence of criminal damage. Found Proved Page 4 of 8

The panel has seen the record from the police data base that indicates Ms Rickard s Caution. Further the panel has seen a copy of the Simple Caution signed by Ms Rickard dated 30 May 2010 In light of the above records the panel has determined that the facts of Charge Three are proved. Determination on Impairment: The panel has considered, on the basis of the matters found proved, whether Ms Rickard s fitness to practise is currently impaired by reason of misconduct and Police Caution. It has had regard to all the evidence. The panel considered the 2008 edition of the NMC Code of Professional Conduct: Standards of Conduct, Performance and Ethics. The panel has exercised its own judgment in determining the issues before it, and in this context it has considered the need for appropriate weight to be given to protection of the public, the maintenance of public confidence in the profession, and the upholding of proper standards of conduct and behaviour. The panel first considered the issue of misconduct. The panel had regard to the NMC code, in particular the preamble to the NMC code 2008, which requires all Registered nurses to: make the care of people your first concern, treating them as individuals and respecting their dignity provide a high standard of practice and care at all times be open and honest, act with integrity and uphold the reputation of your profession. As a professional, you are personally accountable for actions and omissions in your practice, and must always be able to justify your decisions. The panel further considered the following sections of the Code: 32 You must act without delay if you believe that you, a colleague or anyone else may be putting someone at risk. 56 You must cooperate with internal and external investigations. 61 You must uphold the reputation of your profession at all times. The panel concluded that by reason of its findings of fact in Charge one and Charge two Ms Rickard s conduct breached these standards. The panel gave further consideration to the Code, in particular: 49 You must adhere to the laws of the country in which you are practising. Page 5 of 8

And found that by reason of Ms Rickard s Police Caution she had breached the above standard in the code as well as the duty to act with integrity and uphold the reputation of the profession at all times. The panel considers that Ms Rickard s actions constituted misconduct of a serious nature. Ms Rickard attended work whilst under the influence of alcohol. The panel notes patients must be able to trust that registered nurses, attend work in a fit state to provide a high standard of care. Further a nurse should be able to recognise when they are not fit to care for patients. The panel concluded that the facts found proved amount to misconduct in respect of each charge found proven. The panel then went on to consider whether by reason of Ms Rickard s misconduct her fitness to practise is currently impaired. The panel concluded that by reason of Ms Rickard s misconduct and Police Caution she had put patients at unwarranted risk of harm, had brought the profession into disrepute, and breached the NMC Code of Professional Conduct. The panel considered whether Ms Rickard s misconduct is easily remediable; whether it has been remedied and whether it is likely to be repeated. The panel had regard to all the circumstances of the case and also to the issue of Ms Rickard s insight in respect of her misconduct. The panel notes that it has evidence that Ms Rickard initially addressed her health issues by attending occupational health and other health services. However the panel notes that Ms Rickard s engagement has become erratic over time. Ms Rickard has not engaged in the regulatory process and the panel has no information regarding Ms Rickard s current circumstances. The panel notes that these were not isolated incidents, and occurred over extended periods of time. The panel has not had the benefit of any current references or testimonials to assist in determining if Ms Rickard has any current insight into her actions or of any steps taken to remediate her failings. There is no information as to current employment. The panel concluded that Ms Rickard had not remedied her misconduct, that the pattern of misconduct indicated that it would not be easy for her to do so, and that there is a real risk of her misconduct being repeated. The panel further had regard to the question of whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment of fitness to practise were not made in the circumstances of this case. The panel has no doubt that it would. For all the reasons outlined above, the panel has determined that Ms Rickard s fitness to practise is currently impaired by reason of her misconduct and Police Caution. Page 6 of 8

Determination on Sanction: In reaching its decision on sanction, the panel has considered all the evidence that has been placed before it. It has exercised its own independent judgement. The panel has taken account of the Council s Indicative Sanctions Guidance and has had regard to the public interest, which includes the protection of the public, the maintenance of confidence in the profession and in the NMC. It has applied the principle of proportionality, weighing the interests of the public with Ms Rickard s interests, and has taken into account the mitigating and aggravating factors in the case. The panel has reminded itself that the purpose of a sanction is not to be punitive, though it may have a punitive effect. The purpose of a sanction is for protection of the public and to meet the wider public interest in maintaining the reputation of the profession. The panel first considered taking no action and gave consideration to paragraphs 60-62 of the Indicative Sanctions Guidance. Ms Rickard s misconduct requires a sanction to mark the serious departure from acceptable professional standards and to maintain the reputation of the profession. The panel next considered a Caution Order and gave consideration to paragraphs 63-65 of the Indicative Sanctions Guidance. The panel notes that Ms Rickard initially engaged in her disciplinary hearing at a local level, and has an otherwise unblemished 28 year record as a registered nurse. The panel is mindful that Ms Rickard s conduct did not cause direct patient harm however Ms Rickard s conduct had the potential to cause significant harm to patients. These were not isolated incidents but a pattern of misconduct over a two year period. Further the panel has no information of any remediating steps that Ms Rickard has taken to address her misconduct. Weighing all the circumstances of this case and the seriousness of Ms Rickard s misconduct and the Police Caution, the panel has concluded that a caution order is not a sufficient or appropriate sanction as it does not meet the need to protect the public and the public interest concerns in this case. The panel next considered a Conditions of Practice Order and considered paragraphs 66, 67 and 68 of the Indicative Sanctions Guidance. The panel is of the view that the nature of Ms Rickard s misconduct and Police Caution would not be addressed by such an order. Although the circumstances surrounding Ms Rickard s misconduct and Police Caution allude to possible health issues the panel has no information regarding her current medical circumstances. The panel has no information regarding Ms Rickard s current personal or employment circumstances or her willingness or ability to comply with any conditions that might be formulated. Further the panel considered that there is evidence of behavioural and attitudinal issues. In any event, the panel is not satisfied that Conditions of Practice would adequately reflect the seriousness of this case. Further, the panel considered that there were no conditions of practice which would meet the criteria of being appropriate, proportionate, workable and measurable. The panel next considered a suspension order and considered paragraphs 69-71 of the Indicative Sanctions Guidance. The panel is of the view that Ms Rickard s misconduct is a serious departure from the standards set out in the Code. The panel has no evidence Page 7 of 8

to show that Ms Rickard has shown insight into her misconduct or her Police Caution. Ms Rickard has been given the opportunity to engage with the regulator, her employer and health services, however she has neglected to take advantage of these opportunities. Ms Rickard was responsible for the care of her patients, however, she failed to appropriately care for patients by attending work under the influence of alcohol. Her conduct at work had the potential to cause serious harm to patients in her care. The panel notes that these were not isolated incidents but a pattern of misconduct that occurred over a two year period of time. The panel has no information of any steps that Ms Rickard has taken to remediate her failings. The panel is not satisfied that a suspension order would sufficiently mark the seriousness of Ms Rickard s misconduct, nor would it maintain public confidence in the nursing and midwifery profession, nor would it serve to declare and uphold proper standards of conduct and performance. The panel has concluded that Ms Rickard s failings are fundamentally incompatible with her continued registration as a nurse. In all the circumstances the panel has concluded that a striking off order is the only appropriate and proportionate response to Ms Rickard s misconduct. Accordingly the panel has determined to instruct the registrar to strike Ms Rickard from the register. Determination on interim order The panel is required to consider whether it is necessary to impose an interim order to cover the appeal period before the striking off order can take effect or to cover any time required to consider an appeal of this decision. Article 31 of the Nursing and Midwifery Order 2001 outlines the criteria for the imposition of an interim order. The panel may only make an interim order if it is satisfied that it is necessary on one or more of three grounds; for the protection of the public, otherwise in the public interest or in the registrant s own interest. The panel may make an interim conditions of practice order or an interim suspension order for a maximum of 18 months. The panel has concluded that it is necessary to impose an interim suspension order for the maximum period of 18 months on the grounds of public protection and that it is otherwise in the public interest. The panel relies on its reasons for its findings on facts, impairment and sanction for the imposition of the interim suspension order. The panel has determined that the period of the interim order shall be 18 months to allow for any appeal lodged to be dealt with. Page 8 of 8