Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
Page 1 of 63
Conduct and Competence Committee Substantive Hearing
1- 12 June 2015 5- 6 October 2015
16-17 November 2015 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ
Registrant Nurse: Margaret Munangatire
NMC PIN: 99B0589E Part(s) of the register: Registered Nurse- Sub part 1
Adult Nursing- March 2004 Midwife- September 2008
Area of Registered Address: England Type of Case: Misconduct Panel Members: Caroline Healy (Chair, Registrant member)
Sylvia Dean (Lay member) Sheena Payne (Registrant member) Legal Assessor: Adrienne Morgan Panel Secretary: Susannah Jury [1- 12 June 2015 and
5- 6 October 2015]
Rachael Victoria Omowo [16-17 November 2015] Registrant: Present and represented by Stella Hayden,
Counsel instructed by Thompsons Solicitors Nursing and Midwifery Council: Represented by David Collins, Counsel
instructed by NMC Regulatory Legal Team Facts proved by admission: 2, 6.1, 6.2 Facts proved: 1, 3, 4, 5.1, 5.2, 5.3, 6.3, 6.4, 6.5, 6.6, 7.1, 7.2,
8.1, 9.1, 9.2, 10.1, 10.2, 10.3 Facts not proved: 6.7, 8.2, 8.3, 8.4, 8.5, 9.3 Fitness to practise: Impaired Sanction: Striking off order
Page 2 of 63
Interim order: Interim suspension order - 18 Months
Page 3 of 63
Decision on application to amend charges
The panel heard an application made by Mr Collins, on behalf of the NMC, to amend,
and in doing so, add a charge to the schedule of allegations.
Mr Collins submitted that the proposed additional charge reads as follows:
3. Provided or caused to be provided to your employer reference(s) dated 13 July 2012
and/or 7 February 2013, purportedly completed in full by [Ms 2] which had not been so
completed.
4. Your conduct, as set out in charges 1, 2 and/or 3 above, was dishonest in that your
intention was to mislead your employer.
Mr Collins drew the panel’s attention to his written application to amend the charge, the
matter of which came to light from Ms 1, an NMC witness’, evidence dated 13 March
2014. This statement and the exhibits were served on you prior to the IC. He submitted
that the proposed additional charge would cause only limited injustice to you and any
injustice would be outweighed by the public interest in that the additional serious matter
would be investigated and tested during the hearing. He further submitted that it would
be of significant benefit to hear this matter alongside the original charges.
Ms Hayden, on your behalf, submitted that you refute the proposed additional charge.
She submitted that the references were exhibited by an NMC witness in her statement
dated 13 March 2014, it was 14 months after the references were produced that a
statement was obtained from Ms 2. Ms Hayden submitted that there would be injustice
caused to you were the panel to allow this amendment and, had it been known earlier,
you may have conducted further investigation including the issue of whether the
handwriting was that of Ms 2. She also submitted that there is no time at present to
explore any line of enquiry.
The panel accepted the advice of the legal assessor that Rule 28 of The Nursing and
Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended 2012)
(The Rules) states:
Page 4 of 63
28.—(1) At any stage before making its findings of fact…
(i)… the Conduct and Competence Committee, may amend—
(a) the charge set out in the notice of hearing…
unless, having regard to the merits of the case and the fairness of the proceedings, the
required amendment cannot be made without injustice.
The panel considered that the proposed amendment raises a further serious matter. It
bore in mind that you and your representative were not put on notice of this additional
allegation until Wednesday 27 May 2015. Nevertheless, it considered that nothing has
been submitted by you or your representative in relation to the existing charges 1- 3
before this hearing despite having been alerted to these issues being raised earlier on
in the investigation. It had been open to you last week to require an adjournment of this
hearing on the basis of the addition of this charge but you did not do so.
Given the similarity to the existing charge 1, and the fact that you have already had
sight of the statement where this matter was raised, the panel considered that you have
had an opportunity to raise a defence to the issue in principal, if not in detail. It was
therefore of the view that allowing the amendment would not disadvantage you in
preparing your defence.
Bearing in mind the merits of the case, fairness to you, the public interest and the
interests of justice, the panel determined to grant the application.
Page 5 of 63
Details of charge (as amended)
That you, whilst employed by Pulse Agency as a registered nurse between August 2010
and September 2013;
1. Provided or caused to be provided to your employer a reference dated 6 February
2012, purportedly completed in full by [Ms 3] which had not been so completed.
2. Provided a falsified safeguarding children training certificate dated 8 January 2013 to
your employer.
3. Provided or caused to be provided to your employer reference(s) dated 13 July 2012
and/or 7 February 2013, purportedly completed in full by [Ms 2] which had not been
so completed.
4. Your conduct, as set out in charges 1, 2 and/or 3 above, was dishonest in that your
intention was to mislead your employer.
5. Whilst working at George Eliot Hospital on the night shift commencing 27 May 2013;
5.1. Left the ward for significant lengths of time.
5.2. Self-administered drugs whilst on duty
5.3. Discharged your duties whilst under the influence of drugs.
Whilst working at Northampton General Hospital as a registered midwife;
6. On the night shift commencing 15 November 2012
6.1. Used your mobile phone whilst on duty
6.2. Used the internet whilst on duty.
6.3. Slept and/ or dozed whilst on duty
6.4. Failed to respond to a request to care for a patient
6.5. Failed to respond to one or more call bells
6.6. Failed to adequately assist the team throughout the shift
6.7. Left the shift early without authorisation to do so
Page 6 of 63
7. On the night shift commencing 20 November 2012
7.1. Failed to respond to a request to assist a patient with breastfeeding support
7.2. Read a magazine whilst on duty
8. Before the end of your shift on 29 November 2012 you failed to complete and/or
adequately handover the following tasks in relation to Patient B:
8.1. Completion of the safeguarding paperwork
8.2. Labelling of the baby
8.3. Administration of vitamin K to the baby
8.4. Labelling of the placenta
8.5. Completion of the post natal VTE assessment
9. During your shift ending on 29 November 2012 you failed to follow safeguarding
procedure in relation to patient B in that you:
9.1. Failed to complete the pre-birth plan
9.2. Failed to inform the necessary persons of Patient B’s admission to the ward
9.3. Failed to inform the necessary persons of Patient B’s delivery
10. On the night shift commencing 24 May 2013
10.1. Left the ward for significant lengths of time
10.2. Self-administered drugs whilst on duty
10.3. Discharged your duties whilst under the influence of drugs
And in light of the above, your fitness to practise is impaired by reason of your
misconduct.
Page 7 of 63
Application to hear witness evidence by telephone Mr Collins, on behalf of the NMC, made an application to hear the evidence of a
witness, the Head of Midwifery at Northampton General Hospital NHS Trust, via the
telephone. He submitted that this witness’ evidence is directly relevant to charge 2 and
reminded the panel that the facts relating to the charge are admitted in any event. He
submitted that the opportunity to question this witness would be useful. Mr Collins
informed the panel that this witness was only available to attend the hearing in person
next Wednesday, 10 June 2015, but that she was available to give telephone evidence
tomorrow, Friday 5 June 2015, after 2pm.
Ms Hayden, on your behalf, did not oppose the application. Ms Hayden submitted that
the questions she intends to ask are not those which would directly challenge the
witness’ evidence.
The panel accepted the legal assessor’s advice.
The panel considered your interests as well as the public interest in determining
whether it would be fair to hear the evidence of this witness via telephone. It took into
consideration that this witness is the only witness whose evidence relates to charge 2
but bore in mind that the facts of the charge are admitted and that the application is not
opposed. It determined that the evidence of this witness is confined to a discrete aspect
of the allegation and refers to documentary evidence rather than any engagement with
the registrant or any part of the investigation.
Overall, the panel was of the view that it was both relevant and fair to hear the evidence
of this witness via the telephone. The panel therefore determined that it would allow the
application.
Page 8 of 63
Application to hear information in relation to your health in private Ms Hayden, on your behalf, made an application under Rule 19 of The Nursing and
Midwifery Council (Fitness to Practise) Rules 2004 to hear information relating to your
health in private.
Mr Collins did not oppose the application.
The panel heard and accepted the advice of the legal assessor.
The panel determined that the evidence to be given related to confidential and sensitive
matters concerning your health. It determined that your interests in having such matters
heard in private outweighed the public interest in having the hearing held entirely in
public. The panel therefore concluded that those matters relating to your health and
personal circumstances would be heard in private session.
Decision on adjournment Having not yet fully reached its decision on the facts, the panel was unable to conclude
the hearing within the time allocated. The hearing therefore adjourned part-heard.
The hearing will resume in camera on 5 and 6 October 2015, anticipating that a decision
on facts will be formally handed down with parties present at 4pm on 6 October 2015. It
will then resume on 16 November 2015 for four days.
Decision on findings of fact
At the commencement of this hearing, you admitted charges 2, 6.1 and 6.2. You denied
all other charges against you. The panel thereby found charges 2, 6.1 and 6.2 proved
by way of your admission and they were so announced under Rule 24(5).
Background
Page 9 of 63
By way of background, the panel heard that the allegations made against you, arose
whilst you were working as a midwife with your main employer, Northampton General
Hospital NHS Trust (‘the Trust’), and whilst you worked with PULSE Staffing Agency
(Pulse) as an agency nurse and midwife at George Eliot Hospital.
The following allegations relate to your employment with the Trust as a midwife.
It is alleged that on 15 November 2012 you used your mobile phone whilst on duty;
used the internet whilst on duty; slept and/ or dozed whilst on duty; failed to respond to
a request to care for a patient; failed to respond to one or more call bells; failed to
adequately assist the team throughout the shift and left the shift early without
authorisation to do so.
It is alleged that on a night shift commencing 20 November 2012 you failed to respond
to a request to assist a patient with breastfeeding support and read a magazine whilst
on duty.
It is alleged that during your night shift which ended on the morning of 29 November
2012 you failed to follow safeguarding procedures in relation to Patient B in that you
failed to complete the pre-birth plan; failed to inform the necessary persons of Patient
B’s admission to the ward and failed to inform the necessary persons of Patient B’s
delivery.
It is further alleged that on the night shift commencing 24 May 2013, you left the ward
for significant lengths of time, self-administered drugs whilst on duty and discharged
your duties whilst under the influence of drugs.
Having received complaints from your colleagues, the Trust carried out an investigation.
Following a disciplinary hearing on 2 October 2013 you were dismissed on 3 October
2013. You appealed that decision but it was upheld by the Trust on 8 January 2014.
The following allegations arose whilst you were working as a nurse at George Eliot
Hospital which was arranged through Pulse.
Page 10 of 63
On 27 May 2013, you were sent to work as a nurse on Dolly Winthrop Ward at George
Eliot Hospital by Pulse. It is alleged that during that shift you left the ward for significant
lengths of time, self-administered drugs whilst on duty and discharged your duties whilst
under the influence of drugs.
Pulse commenced an investigation in relation to your conduct, but you resigned from
the agency before the investigation could be completed.
During the course of that investigation Ms 1, Lead nurse with Pulse, realised that the file
relating to you was not fully compliant with the company’s standards. Following an audit
of your file she concluded that references which Pulse had received for you were
fraudulent.
It is alleged that between August 2010 and September 2013 you provided or caused to
be provided to your employer Pulse a reference dated 6 February 2012, purportedly
completed in full by [Ms 3] which had not been so completed and that you provided or
caused to be provided to Pulse reference(s) dated 13 July 2012 and/or 7 February
2013, purportedly completed in full by [Ms 2] which had not been so completed.
It is further alleged that you provided a falsified safeguarding children training certificate
dated 8 January 2013 to Pulse.
Decision
In reaching its decisions on facts, the panel considered all of the oral written and
documentary evidence adduced in this case. It also considered the submissions
advanced by Mr Collins, on behalf of the NMC, with those of Ms Hayden, on your
behalf.
The panel heard oral evidence from the following witnesses for the NMC:-
• Ms 4 – Maternity Support Worker, Balmoral Ward at the Trust
• Ms 5 – Midwife, Balmoral Ward at the Trust
• Ms 6 – Maternity Support Worker at the Trust
Page 11 of 63
• Ms 7 – Midwife at the Trust
• Ms 8 – Midwife at the Trust
• Ms 9 – Midwife for Safeguarding Children at the Trust
• Ms 10 – Maternity Support Worker at the Trust
• Ms 11 – Midwife at the Trust
• Ms 12 – Practice Development Manager; Lead Midwife at the Trust
• Ms 3 – Midwife at the Trust
• Ms 1 – Regional Manager, Pulse Midlands
• Ms 2 – Midwifery Sister in the Labour Ward Sturtridge at the Trust
• Ms 13 – Head of Midwifery at the Trust (via telephone)
• Ms 14 – Registered Nurse at George Eliot Hospital
• Ms 15 – Senior Sister at George Eliot Hospital
• Ms 16 – Health Care Assistant at George Eliot Hospital
• Ms 17 – Matron for Women Services at the Trust
The above named witness titles refer to their positions at the time of their involvement in
your case.
You gave evidence at this stage of the hearing.
In relation to the alleged incidents on 15 November 2012 as set out in charge 6, you told
the panel that you were sent to work on Balmoral Ward at midnight due to the number
of patients on that Ward. Balmoral Ward was a low risk post natal ward at Northampton
General Hospital. You told the panel that on arrival on the Ward you did not receive a
detailed handover from Ms 5 and you were to “Just read the board”. You were told to
carry out observations, counter sign the notes of the care assistants, complete the baby
notes and answer call bells. You said following your arrival at midnight that you
welcomed a mother who you had delivered. This involved carrying out observations of
the mother and baby, checking the baby was labelled and giving the welcome pack.
You told the panel that you also had to undertake observations and answer call bells as
and when required.
Page 12 of 63
You said that you had an hour break during that shift either between 2am – 3am or 3am
– 4 am during which you went into a side room which, in your words, is common
practice. You said that you do not accept that you were dozing on that shift and that the
office was very cold and the light was bright. You said that the room you had had your
break in was dark and returning to the bright office affected your eyes, which led your
colleagues to presume that you were dozing.
You accepted that you looked at your phone in the office briefly but not in the presence
of a patient. You said that it is common for staff to look at their phones in a private area
and you said that you understood that patients come first.
You said that you were not on the internet but that the hospital policies are on the
computer and staff are allowed to access them. You denied that you had been looking
at houses on the computer that night.
You told the panel that midwives and midwife support workers (MSWs) can answer call
bells. You said that there was no logging system, whoever was nearest would answer
and that you answered your share of the bells during the shift.
In relation to charge 6.4 and the patient in room 3, you told the panel that Ms 4
answered the call bell as she was nearer the room but that you, a few minutes later,
went to the door of the room which the patient’s husband opened and he told you that
his wife was settled. You then went back to the office and checked the mother’s notes
and found that the patient was not due for any medication. You said that you spoke to
Ms 5 about this. You said that you felt you had completed all your allocated tasks during
that shift and that you adequately assisted the team. You said that you counter-signed
the work of the MSWs and had to do all the observations. Following this you said you
documented notes for the babies. At the end of your shift you were told you would not
be required for handover as only one midwife was required for this; you therefore left
the Ward at 7:20am, and your shift was due to end at 7:30am. You said that normal
practice at the Trust was to go home when the lead midwife allowed it, and that you
were not told to ask the Labour Co-ordinator for permission to leave.
Page 13 of 63
In relation to the alleged incidents of 20 November 2012 as set out in charge 7, you told
the panel that you were again sent to Balmoral Ward at 4am; your shift was due to end
at 7:30am. You said that on arrival you had a handover from Ms 7 and at that point the
other staff were chatting in the office. You said that it was not really a meeting and that
nobody said that it was a meeting. Whilst on the ward you said that you welcomed
mothers, documented notes in the office and did observations at 6am for about 4 or 5
patients.
You maintained that you did not read a magazine at any time.
You denied that you had failed to answer a call bell from room 5.
In relation to alleged incidents on 29 November 2012 as set out in charges 8 and 9, you
said that during the course of that shift you cared for Patient B who was a ‘high-risk’
lady. You told the panel that this was a safeguarding case as Patient B had had a child
taken into care. In view of this, the baby and mother needed to be kept in hospital over
the weekend to ensure that she was able to effectively care for her baby. You said that
you were aware of what was to happen in this case as you had read the notes. You told
the panel that the baby delivered at 6:29am and your shift was due to end at 7:30am.
Following the delivery, you made sure that the placenta had been delivered, you dried
the baby, checked the baby’s oxygen levels, left the placenta in the sluice in a pot with
the patient’s label on top of the pot. You said that the patient’s label had the woman’s
name, date of birth, and hospital number on it.
You said that you made an initial request to reception to complete a baby label and took
the delivery labels to reception to do this, at which time you were told the computer was
working slowly. You said that the placenta needed to be put in a plastic bag in formalin
to be sent to histology which you did not do as there was a great deal else to do in
relation to Patient B.
You offered the baby to the mother to see if she would like to do “skin to skin” and you
made sure that the mother was clean and comfortable. You told the panel that you
Page 14 of 63
consider the main priorities after delivery are ensuring that the mother is safe and not
bleeding heavily and to ensure that the baby is safe, warm and fed.
You said that you went to reception for a second time to ask for the labels but you were
told that they were not yet ready. You also said that Patient B and her baby were in their
own room, that you did not anticipate Patient B and her baby being moved for some
time and therefore you felt that you should wait for reception to complete the labels. You
told the panel that labels used to be hand-written but a new policy at the Trust came in
requiring printed labels. In hindsight you said that you could have waited to leave until
after the labels were printed, even if that was after the end of your shift, but that this
would not be ideal. You said that normally someone from reception brings the labels
and puts them in the room or will give them to the midwife if she sees her.
You told the panel that it is common for matters to be outstanding at handover. You said
that completing labour notes is the most important thing. You explained that you did not
give Vitamin K to the baby as the labels had not yet been completed and you had no
concerns about handing this over. You also said that there was no urgency in
completing the post natal Venous Thromboembolism (VTE) Assessment and you were
content to leave this outstanding. You said that you did not have the opportunity to
complete the pre-birth plan as you had to be directly attending to Patient B. You told the
panel that when you handed over to Ms 8 there was no indication that she was
dissatisfied with the handover.
You said that you knew that social services needed to be told that the lady was
delivered but that you did not have the opportunity to do that because you were rushed.
[PRIVATE - REDACTED]
In relation to alleged incidents on 24 May 2013 and charge 10, you told the panel that
you were working on Robert Watson Ward at the Trust in a supernumerary capacity.
You said you felt able to return to work and initially, when you started the shift, you felt
fine. You told the panel that you only used the toilet near the office that night. You
accepted that you spent longer in the toilet than may have been normal [PRIVATE -
Page 15 of 63
REDACTED]. You told the panel that when you went to the toilet you did not see
anything suspicious in there. [PRIVATE - REDACTED].
You said that your priority at handover following that shift was to ensure that everything
was in order in relation to the patients. You said that you did not explain your health
issues with anyone at the meeting which followed the handover. You said you were
unhappy and worried to be linked to the items in the toilet.
In relation to charge 5 and the shift on 27 May 2013 at George Eliot Hospital on Dolly
Winthrop Ward, you said you had to leave the Ward to use the toilet which was
accessed with a code. You said that Ms 14 did not tell you that you should ask
permission to go to the toilet and this is not something you would normally do. You also
said that you did not consider using the toilet to be leaving the ward. [PRIVATE - REDACTED] You said that you think you went to the toilet about two or three times.
You said that you cannot recall seeing Ms 16 when you left the toilet around 6am.
[PRIVATE- REDACTED]. Your evidence was that the items found in the bin had
nothing to do with you. You told the panel that you were approached by Ms 15, she
asked you to empty your handbag and you were content for her to do so. [PRIVATE- REDACTED]. You gave the following evidence in relation to charges 1, 2 and 3 which relate to
references;
You said that you first submitted a reference in support of work as an agency nurse in
August 2010. Such references were to be submitted yearly. You explained that you give
the name of the person and telephone number to the agency and they usually provided
you with the appropriate form so that you could complete your details. You then gave it
to the referee to fill out her section and then the referee would send it on to the agency.
You said you asked Ms 3 for a reference in early 2012 and provided her with a form to
fill out which she had completed and dated 6 February 2012, but her email address was
not working. You said that because Ms 3’s email address was not working you told the
agency to forget about that reference. When asked to explain why there were two
references from Ms 3 dated February 2012 and July 2012 when Ms 3 said in evidence
Page 16 of 63
that she had filled in one reference only in July 2012, you were unable to provide an
explanation. You said that you could not explain the similarities between the reference
dated 6 February 2012 and that of 12 July 2012.
You told the panel you asked Ms 2 for a reference and she was happy to provide one.
You said that on the reference dated 7 February 2013 you filled in the referee name,
position/band, the organisation name and organisation address and you said that Ms 2
filled in the rest of the form. You said that when she was doing this, she was called
away and that she told you ‘Just fill in the bits that’s left for me’. You said that Ms 2 said
that you could fill in the further information box and Ms 2 said that if the agency asked
her, if they called, she would say that she knew about it. You said that she came back,
that you couldn’t remember at what stage the form was signed, but that you left the form
with her. You said that Ms 2 should have filled in all of the form but said that she was
aware of what you were writing on the form and she was content with it. When she
came back she had taken the form herself. You told the panel that Ms 2 had provided
references on previous occasions in 2010, 2011, 2012 and possibly 2013 although you
were not 100 percent sure. You said that it is for the agency which provides the
reference forms to clarify the inconsistent dates at the bottom of the references.
In relation to charge 2, you informed the panel that you did alter the safeguarding
children training certificate as you thought 8 January 2013 was the correct date. The
original date on the certificate was 8 February 2012 .You said in hindsight you should
have double-checked that the date was correct before providing the certificate. You said
you were aware that safeguarding training takes place annually. You conceded that you
went over your name on the certificate in a thicker pen and that you also went over the
date on the certificate with thicker pen in order to reflect a different date. You said that
with hindsight you realise that what you did was wrong. You accepted that it was a
requirement of the agency that you were working with to obtain this safeguarding
children certificate on an annual basis. You accepted that the certificate was valid for a
year only and you needed to be awarded a new certificate every year.
Page 17 of 63
In coming to its decision the panel had regard to all the evidence before it, both oral and
documentary, and took into account the submissions of Mr Collins on behalf of the NMC
as well as those of Ms Hayden on your behalf.
Mr Collins submitted that the NMC has proved on the balance of probabilities that you
acted in the way set out in the charges. He drew the panel’s attention to the evidence
matrix and opening note he had previously provided. Mr Collins took the panel through
each charge and drew its attention to the relevant evidence that, in his submission, the
panel could rely upon to find each charge proved. He invited the panel to assess the
credibility of each witness.
Ms Hayden, on your behalf, submitted that the panel had heard all the evidence and
was best placed to assess that evidence. She highlighted what she believed were the
relevant evidential issues, addressing each charge in turn.
The panel heard and accepted the advice of the legal assessor.
The panel considered the evidence of the NMC witnesses. It found their evidence to be
consistent, credible, impartial and reliable. The panel was satisfied that there was no
evidence of any collusion between the witnesses and concluded that it could give their
evidence significant weight.
The panel found you to be inconsistent in your responses. It did not find you to be
credible and considered that it could not place a great deal of weight on your evidence.
The panel considered each charge in turn and reached the following conclusions:
Charge 1
That you, whilst employed by Pulse Agency as a registered nurse between August 2010
and September 2013;
Page 18 of 63
1. Provided or caused to be provided to your employer a reference dated 6 February
2012, purportedly completed in full by [Ms 3] which had not been so completed.
Charge found proved.
Ms 1, Lead Nurse with Pulse, told the panel that a review of your file revealed that
original references dated 2010 and 2011 were genuine. However, subsequent annual
references appeared to have information added or were photocopies of these original
references.
In considering the allegation the panel had regard to a copy of the reference dated 6
February 2012, for the position of RGN/Midwife, along with a copy of another reference
dated 12 July 2012, for the position of A&E Nurse. Whilst comparing the two, the panel
considered that they were identical save for the front sheet. The panel noted that the
pre-printed date at the bottom of the front sheet of the 6 February 2012 reference was
‘5/10/11’ yet throughout the rest of the document the pre-printed date at the bottom of
each page was ‘16/11/2011’. The reference dated 15 July 2012 had the pre-printed date
16/11/2011 printed at the bottom of every page.
The panel heard evidence from Ms 1 that the reference documentation for Pulse would
never have such a discrepancy in dates. The process was for the reference forms to be
printed and dated each time a reference request was sent out. It also heard that Pulse
requires two separate references annually one for work as a midwife and one for work
as a nurse.
The panel bore in mind the evidence of Ms 3 that she did not provide the reference
dated 6 February 2012 for the position of Midwife/RGN. Ms 3 said that although pages 2
and 4 of the reference appeared to be in her writing she had not completed this
reference. Indeed, you admitted during your evidence that you did fill in some of the
boxes on the front sheet but not the signature and date.
You told the panel that you asked Ms 3 for a reference in early 2012 and provided her
with a form to fill out which she had completed and dated 6 February 2012, but her
Page 19 of 63
email address was not working. You said that because Ms 3’s email address was not
working you told the agency to forget about that reference.
The panel also bore in mind your evidence that you could not explain the similarities
between the reference dated 6 February 2012 and that of 12 July 2012.
In all the circumstances, the panel considered that the genuine reference filled out by
Ms 3 was that dated 12 July 2012. The panel bore in mind that you had faxed that
reference, dated 12 July 2012, to Pulse and therefore the completed reference for the
post of A&E Nurse had been in your possession. It therefore determined that, as you
required separate references for nursing and midwifery, you altered the front page on
the reference, dated 12 July 2012, in order to create a false one dated 6 February 2012
for the post of RGN/Midwife. It considered that you required this additional reference to
continue working for the agency.
In view of this, the panel concluded on the balance of probabilities that you, whilst
employed by Pulse Agency as a registered nurse between August 2010 and September
2013, provided or caused to be provided to your employer a reference dated 6 February
2012, purportedly completed in full by [Ms 3] which had not been so completed.
The panel therefore found charge 1 proved.
Charge 2 2. Provided a falsified safeguarding children training certificate dated 8 January 2013 to
your employer.
Charge found proved by way of admission.
Ms 1 told the panel that following the audit of your file, concerns were raised concerning
a safeguarding children training certificate dated 8 January 2013.
Page 20 of 63
Although this charge is admitted and thereby proved, the panel did note that the date
was written over on the previous year’s certificate, dated 8/2/12. It also noted that your
name had been painstakingly written over on the falsified certificate in order to have
consistent handwriting for the name and the date.
Charge 3 3. Provided or caused to be provided to your employer a reference/ reference(s) dated
13 July 2012 and/or 7 February 2013, purportedly completed in full by [Ms 2] which had
not been so completed.
Charge found proved. The panel had regard to the evidence of Ms 1, Lead Nurse for Pulse, concerning the
audit of your file and the concerns noted by her relating to references.
In considering this charge the panel had regard to Ms 2’s evidence that she did fill in the
‘Reference Request completed by’ box on the front page of the reference for the post of
A&E Nurse dated 13 July 2012. The panel was also mindful that Ms 2 stated she did not
complete the ‘any further information’ box on the front sheet of this reference, nor did
she fill in the fourth and final page. In view of this, the panel determined that Ms 2 did
not fully complete the reference dated 13 July 2012. The pre-printed date at the bottom
of pages 1-4 of this reference was 16/11/2011.
The panel also considered the reference dated 7 February 2013 for a Band 7 midwife
post. It noted that at the bottom of the front sheet of this reference the pre-printed date
was 05/10/2011 yet throughout the rest of the document the date at the bottom of the
pages is 16/11/2011.
The panel relied on Ms 2’s evidence that she did not complete any sections of this form.
The panel bore in mind your oral evidence that Ms 2 had provided references on
previous occasions in 2010, 2011, 2012 and possibly 2013 although you were not 100%
Page 21 of 63
sure. You said that it is for the agency which provides the reference forms to clarify the
inconsistent dates at the bottom of the references.
It also considered your evidence that you had filled out the front sheet of the reference
but not the signature. In light of all the evidence, the panel determined that Ms 2 did not
fully complete the reference dated 7 February 2013.
Accordingly, the panel concluded on the balance of probabilities that you, whilst
employed by Pulse agency as a registered nurse between August 2010 and September
2013, provided or caused to be provided to your employer reference(s) dated 13 July
2012 and/or 7 February 2013, purportedly completed in full by [Ms 2] which had not
been so completed.
The panel therefore found charge 3 proved.
Charge 4 4. Your conduct, as set out in charges 1, 2 and/or 3 above, was dishonest in that your
intention was to mislead your employer.
Charge found proved.
When considering this charge the panel had regard to both sets of references as well as
the falsified safeguarding children training certificate. It had regard to its findings in
relation to charges 1, 2 and 3.
When asked to explain why there were two references from Ms 3 dated February 2012
and July 2012, when Ms 3 said in evidence that she had filled in one reference only in
July 2012, you were unable to provide an explanation. You also said that you could not
explain the similarities between the reference dated 6 February 2012 and that of 12 July
2012.
In relation to charge 2, the panel bore in mind that you admitted altering the
safeguarding children training certificate as you had said you thought 8 January 2013
Page 22 of 63
was the correct date. You conceded that you went over your name on the certificate in a
thicker pen and that you also went over the date on the certificate with thicker pen in
order to reflect a different date. You said that with hindsight you realise that what you
did was wrong. The panel bore in mind that in order to continue working for Pulse
Agency it was a requirement that you provide evidence of annual safeguarding children
training and annual references in relation to both midwifery and nursing.
In relation to charge 3, you said that it is for the agency which provides the reference
forms to clarify the inconsistent dates at the bottom of the references.
The panel was of the view that in providing your employer with references purportedly
completed in full by colleagues, but which were not so completed, and in providing a
falsified safeguarding children training certificate to your employer, you acted
deliberately and dishonestly in order to mislead your employer. It considered that you
would have been aware that you were acting dishonestly in doing so and you should
have known, as a responsible nurse, that it is wrong to change documents in the way
that you did. The panel was of the view that these were pre-meditated acts in order to
continue employment with Pulse Agency.
The panel concluded on the balance of probabilities that your conduct, as set out in
charges 1, 2 and/or 3 above, was dishonest in that your intention was to mislead your
employer.
The panel therefore found charge 4 proved.
Charge 5.1 5. Whilst working at George Eliot Hospital on the night shift commencing 27 May 2013;
5.1 Left the ward for significant lengths of time.
Charge found proved.
Page 23 of 63
In considering this allegation the panel bore in mind that during this shift you were
working as an Agency nurse on Dolly Winthrop Ward, that the toilet was not within the
clinical area and that you had to leave the ward to go to the toilet.
The panel had regard to Ms 14’s statement dated 28/5/13 which states that at 2am ‘the
agency nurse was again found to be in the toilet for 30 minutes. She then went on break
for 1.5 hrs and returned at 04:30…she went to the toilet again at approx. 05:45 without
informing the nurse in charge she was leaving the ward. She then returned at 06:15.’
The panel also bore in mind Ms 14’s oral evidence that you left the ward that evening on
at least three separate occasions, each for a period of 30 - 40 minutes without notifying
any member of staff. Ms 14 stated that you disappeared during the medication round
[PRIVATE - REDACTED]. Ms 14’s statement says that you failed to answer call bells
when a colleague was on her break. Ms 14 said that she had to leave the ward to go
looking for you, was unable to find you and, as a result, had wasted time trying to find
you. Ms 14’s evidence was that she was extremely conscious of time that night because
she was busy doing observations, drug rounds and delegating work throughout the shift.
At one point when you came back to the ward and you were asked where you had
been, you said that you were in the toilet.
The panel took into account your own evidence that you had to leave the Ward to use
the toilet which was accessed with a code. You said that Ms 14 did not tell you that you
should ask permission to go to the toilet and this is not something you would normally
do. You also said that you did not consider using the toilet to be leaving the ward.
[PRIVATE - REDACTED] You said that you think you went to the toilet about two or
three times. The panel had regard to Ms 15’s oral evidence that you left the ward unsafe
by disappearing frequently for long periods of time.
The panel found Ms 14 to be a credible and consistent witness who had a very clear
recollection of what occurred during that shift. It also found Ms 15 to be a consistent and
credible witness.
Page 24 of 63
The panel considered that you were leaving the ward for significant periods of time on a
number of occasions. This would amount to a disproportionate amount of time away
from your clinical duties and was unauthorised absence from the ward.
The panel concluded on the balance of probabilities that whilst working at George Eliot
Hospital, on the night shift commencing 27 May 2013, you left the ward for significant
lengths of time.
The panel therefore found charge 5.1 proved.
Charge 5.2 5. Whilst working at George Eliot Hospital on the night shift commencing 27 May 2013;
5.2 Self-administered drugs whilst on duty
Charge found proved.
The panel had regard to the fact that you deny self-administering drugs during the shift
in question. It bore in mind your oral evidence in which you stated that you could not
recall seeing Ms 16 when you left the toilet around 6am. [PRIVATE- REDACTED].
The panel took into account Ms 16’s witness statement [PRIVATE- REDACTED].
The panel also had regard to Ms 16’s oral evidence which was entirely consistent with
her witness statement. [PRIVTAE- REDACTED].
Ms 14’s witness statement read that you had left the ward again around 5.30-5.45
[PRIVATE - REDACTED]
The panel took into account the evidence of Ms 15, the Senior Sister who was alerted to
the items in the bin by Ms 16. Ms 15’s witness statement reads that she and the Head
of Nursing met with you and enquired about your absences from the ward [PRIVATE-REDACTED].
Page 25 of 63
When asked if the items were yours, you denied that this was the case. Ms 15’s
statement continues:
[PRIVATE - REDACTED]
[PRIVATE - REDACTED]
[PRIVATE - REDACTED]
[PRIVATE - REDACTED]
In your own statement you wrote [PRIVATE - REDACTED]
The panel bore in mind your oral evidence [PRIVATE - REDACTED]
[PRIVATE - REDACTED]
The panel also noted the striking similarity between the alleged events with occurred in
a completely different hospital on 24 May 2013 which resulted in Charge 10.2, where it
is alleged you self-administered drugs whilst on duty, and the events which occurred
three days later during this shift.
[PRIVATE - REDACTED]
The panel found Ms 16 to be a very honest, reliable witness who was extremely clear
about what was found in the toilet. The panel also found Ms 15 a clear, consistent and
reliable witness. It considered that it could place a great deal of weight on their
evidence.
[PRIVATE - REDACTED]
[PRIVATE - REDACTED]
Page 26 of 63
Taking all this into account, the panel concluded on the balance of probabilities that
whilst working at George Eliot Hospital on the night shift commencing 27 May 2013 you
self-administered drugs whilst on duty.
The panel therefore found charge 5.2 proved.
Charge 5.3 5. Whilst working at George Eliot Hospital on the night shift commencing 27 May 2013;
5.3 Discharged your duties whilst under the influence of drugs.
Charge found proved.
In considering this allegation the panel had regard to its previous finding that you self-
administered drugs during the shift commencing 27 May 2013.
[PRIVATE - REDACTED]
[PRIVATE - REDACTED]
The panel therefore concluded on the balance of probabilities that whilst working at
George Eliot Hospital on the night shift commencing 27 May 2013 you discharged your
duties whilst under the influence of drugs.
The panel found charge 5.3 proved.
Charge 6.1 6. On the night shift commencing 15 November 2012
6.1 Used your mobile phone whilst on duty
Charge found proved by way of admission. Charge 6.2
Page 27 of 63
6. On the night shift commencing 15 November 2012
6.2 Used the internet whilst on duty.
Charge found proved by way of admission. Charge 6.3 6. On the night shift commencing 15 November 2012:
6.3 Slept and/ or dozed whilst on duty
Charge found proved.
The panel heard detailed information from Ms 4 about the layout of Balmoral Ward
which was described as being a square ward, with an office in the middle, and that most
of the time staff were aware of where others were working.
The panel first had regard to your evidence in which you did not accept that you were
dozing on the shift of 15 November. You explained that you had just come off your
break in a ‘dimly lit’ room and had subsequently gone into the bright lights of the office,
the adjustment of which would have led to the assumption that you were dozing.
The panel had regard to the statement of Ms 4, taken on 25 November 2012 which was
shortly after the incident. In this Ms 4 stated ‘Maggie took the first break on the shift and
when she returned from this she immediately sat back in her chair and dozed. [Ms 5]
took her break and during this Maggie did not speak and continued to doze.’ The panel
also had regard to the minutes of an Investigation Interview at the Trust on 14 January
2013 in which Ms 4 stated that you had to be woken up.
The panel then had sight of a statement written by Ms 5 on 2 December 2012 in which
she states that you ‘sat in the office and was obviously very tired because she began to
close her eyes and doze.’ In addition the panel had regard to the minutes of an
Investigation Interview at the Trust on 14 January 2013 in which Ms 5 described your
dozing as ‘eyes closed and head dropping.’
Page 28 of 63
The panel found both Ms 4 and Ms 5 to be consistent and credible witnesses and
preferred their evidence to your own.
The panel concluded on the balance of probabilities that on the night shift commencing
15 November 2012 you slept and/ or dozed whilst on duty.
The panel therefore found charge 6.3 proved.
Charge 6.4 6. On the night shift commencing 15 November 2012:
6.4 Failed to respond to a request to care for a patient
Charge found proved. The panel first considered that ‘failed’ denotes a duty and responsibility on you as a
registered midwife on duty to care for patients according to their needs. The panel was
aware that this incident occurred whilst Ms 5, the only other registered midwife on duty
during the shift, was on her break. It therefore bore in mind that at that time you were
the sole registered midwife on duty.
The panel took into account your oral evidence that Ms 4 answered the call bell as she
was nearer the room but that you, a few minutes later, went to the door of the room
which the patient’s husband opened and told you that his wife was settled. You then
went back to the office and checked the patient’s notes and found that she was not due
for any medication. You said that you spoke to Ms 5 about this.
The panel also had regard to your statement and in particular to your response in
relation to this allegation that you ‘went to the room and knocked on the door. The door
was opened by the husband of the client and I asked if his wife was OK as I could see
that she was actually resting with her eyes shut. Her husband said that she had now
settled and that she had been feeling nauseous. I checked on the drug chart to see if
Page 29 of 63
the patient had been prescribed any anti-sickness medication, having done so being
happy that the client was alright I then left the room and returned to the nurses station.’
The panel had regard to Ms 4’s statement dated 25 November 2012 which states ‘A call
bell went in Room 3 which I answered. I found the patient coughing and vomiting into
the sink and she complained of feeling very unwell. I went back to the office and told
Maggie but she did not respond. I assumed that she would do so in her own time so
decided to return to the patient and take her pulse and temperature and to see if I could
make her more comfortable. As Maggie had still not come to the room I returned to the
office and told her a second time about the patient. She still did not respond.’
The panel also took into account notes of the Trust’s Investigation Interview 14 January
2012 in which Ms 4 stated that by failing to attend to the patient you ‘completely
disregarded the lady, it was totally inappropriate.’
The panel noted Ms 4’s oral evidence that she had not seen you go to check on the
patient nor was she aware that you had spoken to the patient’s husband. Ms 4’s
evidence was that she had asked you to assist in Room 3 and then she had returned to
the room. You did not go to the room. Ms 4 then left the room to ask Ms 5 to attend to
the patient. She met Ms 5 coming back from her break and asked her to go the room.
Ms 4 accepted that it might be possible that you had visited the room but was very
doubtful that this could have happened. The panel noted this evidence in light of what it
had heard about the layout of Balmoral Ward.
The panel considered that Ms 4 was a very consistent, credible and reliable witness and
it preferred her evidence to your own. It concluded on the balance of probabilities that it
was more likely than not that you had not gone into Room 3.
The panel determined that as the sole registered midwife on shift at the time when Ms 4
requested that you care for a patient you were entirely responsible and under a duty to
do so. It considered that at the time of the request by Ms 4 you were not otherwise
engaged and so were able to attend to the patient, yet you did not. The panel was of the
Page 30 of 63
view that you were reluctant to do what Ms 4, a MSW, asked of you, and through such
reluctance you disregarded your clinical duties.
The panel concluded on the balance of probabilities that on the night shift commencing
15 November 2012 you failed to respond to a request to care for a patient.
The panel therefore found charge 6.4 proved.
Charge 6.5 6. On the night shift commencing 15 November 2012:
6.5 Failed to respond to one or more call bells
Charge found proved. The panel considered that ‘failed’ denotes a duty to respond to call bells during the night
shift.
In considering this allegation the panel had regard to your written statement in which
you wrote ‘The call bells can be answered by any member of staff. I believe that during
the shift I answered a percentage of the calls. However during that time I was actively
engaged as I had been given responsibility of carrying out observations through the
night.’
The panel also took into account your oral evidence in which you stated that you had
answered your share of the call bells during the shift.
The panel had sight of Ms 5’s statement dated 2 December 2012 which states ‘Whilst I
was in this room another call bell sounded from Room 8. The bell continued for some
considerable time. The two MSW’s were helping other patients with breastfeeding
support and Maggie was sitting in the office dozing in her chair and ignoring activity on
the ward.’ Ms 5 reiterated this in her oral evidence and said that as she walked between
rooms 3 and 8 she passed the office and saw you in the chair.
Page 31 of 63
The panel noted this evidence in light of what it had heard about the layout of Balmoral
Ward.
The panel also took into account the notes of the Trust’s Investigation Interview on 14
January 2012 in which Ms 4 said she did not find it appropriate that you did not answer
call bells and remained in your chair. The panel was mindful that it found both Ms 4 and
Ms 5 to be consistent and credible witnesses and it preferred their evidence to your
own.
The panel determined that a qualified midwife on duty has an obligation to respond to
call bells and work as member of team throughout the time allocated on that ward. It
was of the view that you failed to do so.
The panel concluded on the balance of probabilities that on the night shift commencing
15 November 2012 you failed to respond to one or more call bells.
The panel therefore found charge 6.5 proved.
Charge 6.6 6. On the night shift commencing 15 November 2012:
6.6 Failed to adequately assist the team throughout the shift
Charge found proved.
The panel again was mindful that ‘failed’ denotes a duty on your part as a registered
midwife to adequately assist the team throughout the shift.
The panel had regard to Ms 4’s statement dated 25 November 2012 that ‘Throughout
the shift Maggie offered no help to any other member of staff and was reluctant to carry
out any duties which [Ms 5] asked her to do.’
Page 32 of 63
The panel also had sight of Ms 5’s statement dated 2 December 2012 which set out
‘Maggie was very reluctant to assist me’ and ‘She had very little communication with the
other staff members all through the shift and did not contribute to the work.’
The panel had regard to your statement dated 1 June 2015 in which you wrote ‘I
undertook the tasks that were allocated to me during the course of my shift and I
completed all my tasks without any complaint.’ It also bore in mind your oral evidence
that you felt you completed all your allocated tasks during that shift and that you
adequately assisted the team.
The panel preferred the evidence of Ms 4 and Ms 5 and considered that you failed in
your duty as a registered midwife on shift to assist the team. It was of the view that
there is a difference between completing allocated tasks and generally assisting a team
as and when possible.
The panel concluded on the balance of probabilities that on the night shift commencing
15 November 2012 you failed to adequately assist the team throughout the shift.
The panel therefore found charge 6.6 proved.
Charge 6.7
6. On the night shift commencing 15 November 2012:
6.7 Left the shift early without authorisation to do so.
Charge found not proved.
The panel had regard to your statement in which you wrote ‘At the beginning of the shift
I asked [Ms 5] if it would be possible for me to leave the shift a few minutes early. I
explained that I had to go to the garage to exchange cars. [Ms 5] agreed and I therefore
left the shift a few minutes early with permission.’
It also had regard to your oral evidence that at the end of the shift you were told you
would not be required for handover as only one midwife was required for this. You said
Page 33 of 63
you therefore left the Ward at 7:20am, and your shift was due to end at 7:30am. You
said that normal practice at the Trust was to go home when the lead midwife allowed it,
and that you were not told to ask the Labour Co-ordinator for permission to leave.
The panel bore in mind Ms 5’s oral evidence in which she stated that when you asked
whether you could leave she agreed that you could do so. The panel considered that
this amounted to authorisation to leave.
The panel was therefore unable to conclude on the balance of probabilities that you left
the shift early without authorisation to do so.
The panel found charge 6.7 not proved.
Charge 7.1 7. On the night shift commencing 20 November 2012
7.1 Failed to respond to a request to assist a patient with breastfeeding support
Charge found proved.
The panel bore in mind that ‘failed’ denotes a duty to, in this case, respond to the
request to assist a patient. It considered that a qualified midwife on shift has an
obligation to assist with breastfeeding support.
The panel first had regard to the statement of Ms 6, a maternity support worker (MSW)
at the Trust, which states ‘At 06:15 a call bell went off at room 5 [sic], a private room.
We knew that the patient was going to call because she needed breastfeeding support.
[Ms 7] was doing her drug round and [a colleague] and I were busy. As I walked past
the office, Maggie was still reading her magazine and I asked her if she could go to
room 5 to support the lady. Maggie did not do this.’
The panel bore in mind Ms 7’s oral evidence that she could hear the MSWs asking you
for assistance and that you did not go to help. Ms 7 said in her oral evidence that she
Page 34 of 63
was unable to assist with the breastfeeding support as she was holding a catheter and
assisting another patient.
The panel considered that in your evidence you ostensibly admitted to this charge
because you stated that you did not feel you were required to respond to the request
from an MSW, namely Ms 6. The panel was of the view that this was another example
of your reluctance to assist others or to do any tasks other than those that you were
specifically allocated. It determined that such reluctance amounted to a failure to
undertake your clinical responsibilities as a midwife.
The panel concluded on the balance of probabilities that on the night shift commencing
20 November 2012 you failed to respond to a request to assist a patient with
breastfeeding support.
The panel therefore found charge 7.1 proved.
Charge 7.2 7. On the night shift commencing 20 November 2012
7.2 Read a magazine whilst on duty
Charge found proved. The panel had regard to the statement of Ms 6 in which she stated that you ‘sat at a
desk reading a magazine’ and ‘was still reading her magazine.’
The panel also had regard to Ms 7’s statement that ‘On arrival Margaret appeared
unhappy to be sent to the ward and she was reading a magazine.’ The panel bore in
mind that Ms 7 confirmed this in her oral evidence.
The panel had sight of the minutes of the Trust’s Investigation meeting on 10 January
2013 in which Ms 7 stated that you were reading a magazine and added ‘It is never
appropriate to read magazines at work.’
Page 35 of 63
The panel had regard to your written statement in which you wrote ‘There were
magazines on the ward but I did not read any magazine whilst on duty.’ In your oral
evidence you said that in the office all the other midwifery staff were chatting and having
teas and you said that, as you had only just arrived at 4am having been transferred to
that ward, you were not listening. You maintained that you were not reading a
magazine.
The panel preferred the evidence of Ms 6 and Ms 7, both of whom were credible and
consistent witnesses, to your own.
The panel concluded on the balance of probabilities that on the night shift commencing
20 November 2012 you read a magazine whilst on duty.
The panel therefore found charge 7.2 proved.
Charge 8.1 8. Before the end of your shift on 29 November 2012 you failed to complete and/or
adequately handover the following tasks in relation to Patient B:
8.1 Completion of the safeguarding paperwork
Charge found proved. The panel considered that ‘failed’ indicates that as a qualified midwife following the
delivery of a baby you were responsible for completing a number of tasks and
adequately handing over what had been completed and what remained to be done
when finishing your shift.
The panel had regard to the statement of Ms 8, the midwife who received handover
from you. In her statement, Ms 8 set out that you ‘explained that there was a
safeguarding issue and I will have to read the paperwork myself.’ Ms 8 goes on to state
Page 36 of 63
‘I expected a more detailed handover from a more experienced midwife. I did not know
where most of the paperwork was and none of the paperwork was completed.’
The panel bore in mind your evidence that following the birth of the baby you had about
1 hour until the end of your shift. You said that you did not have sufficient time to
complete the paperwork within this hour as well as undertaking all other necessary
tasks following the delivery.
However, the panel heard from you that you cared for Patient B while she was in labour
and you subsequently delivered her baby.
The clinical records demonstrate that Patient B was in your care from 21:40 on 28/11/12
until her baby was delivered at 06:29 on 29/11/12.
The panel found Ms 8 to be a credible and consistent witness. It was of the view that
you would have had time to complete the paperwork, not least the pre-birth plan, before
the end of your shift.
The panel concluded on the balance of probabilities that before the end of your shift on
29 November 2012 you failed to complete the safeguarding paperwork in relation to
Patient B.
The panel therefore found charge 8.1 proved.
Charge 8.2 8. Before the end of your shift on 29 November 2012 you failed to complete and/or
adequately handover the following tasks in relation to Patient B:
8.2 Labelling of the baby
Charge found not proved.
Page 37 of 63
In considering this charge the panel first had regard to Patient B’s patient notes from 29
November 2012 which include a list which you wrote setting out ‘things to be done’, one
of which was ‘baby labels’.
The panel had regard to your oral evidence. You said that you made an initial request to
reception to complete a baby label and took the delivery labels to reception to do this, at
which time you were told the computer was working slowly. You said that you went to
reception for a second time to ask for the labels but you were told that they were not yet
ready. You also said that Patient B and her baby were in their own room, that you did
not anticipate Patient B and her baby being moved for some time and therefore you felt
that you should wait for reception to complete the labels. You told the panel that labels
used to be hand-written but a new policy at the Trust came in requiring printed labels. In
hindsight you said that you could have waited to leave until after the labels were printed,
even if that was after the end of your shift, but that this would not be ideal. You said that
normally someone from reception always brings the labels and puts them in the room or
will give them to the midwife if she sees her.
The panel heard evidence from Ms 2 that there are often delays with labels and that it is
no longer Trust policy to hand write labels.
The panel considered that although it would be the expectation that upon handover the
baby would be labelled, in the particular circumstances it was not top of the list of
priorities. The panel was mindful that you had written on the list of outstanding tasks
‘baby labels’ and therefore Ms 8, who was receiving handover, would have been aware
that this was not yet completed.
Although it was not ideal to handover when the baby had not yet been labelled, the
panel considered that you did adequately handover labelling of the baby.
The panel was therefore unable to conclude on the balance of probabilities that you
failed to complete and/or adequately handover labelling of the baby in relation to Patient
B.
Page 38 of 63
The panel therefore found charge 8.2 not proved.
Charge 8.3 8. Before the end of your shift on 29 November 2012 you failed to complete and/or
adequately handover the following tasks in relation to Patient B:
8.3 Administration of vitamin K to the baby
Charge found not proved. The panel heard evidence that if a baby has yet to be labelled, Vitamin K should not be
administered. It also heard evidence that consent must be sought from the mother as to
whether or not she wishes her baby to be administered Vitamin K, and in this case there
is no evidence of such consent having been given by Patient B.
The panel took into account your evidence that you did not give Vitamin K to the baby
as the labels had not yet been completed and you had no concerns about handing this
over.
The panel had regard to Patient B’s patient notes from 29 November 2012 which
include a list you wrote for handover setting out the ‘things to be done’, one of which
was ‘Vit K’.
In light of the fact that the baby had yet to be labelled and that no consent had been
sought, the panel was of the view that it was only right that you had not yet completed
this task. It considered that you had written on the list of outstanding tasks for Ms 8 ‘Vit
K’ and therefore determined that she would have been aware that this was not yet
completed.
The panel was therefore unable to conclude on the balance of probabilities that you
failed to complete and/or adequately handover administration of Vitamin K to the baby
in relation to Patient B.
Page 39 of 63
The panel therefore found charge 8.3 not proved.
Charge 8.4 8. Before the end of your shift on 29 November 2012 you failed to complete and/or
adequately handover the following tasks in relation to Patient B:
8.4 Labelling of the placenta
Charge found not proved.
The panel first had regard to Ms 8’s statement that ‘the placenta was in the sluice
unlabelled. When I had the chance to look at the placenta, it had been put in a sluice in
a white tub, this had no formalin it it, no histopathology card and no A4 accompanying
sheet’. The panel also bore in mind Ms 8’s oral evidence that the sticker detailing
Patient B’s name was on the side by the pot but not on the lid of the pot.
The panel considered that there was no evidence confirming that the placenta did not
have the patient’s name labelled on it. It determined that there was insufficient evidence
to find this charge proved.
The panel was unable to conclude on the balance of probabilities that before the end of
your shift on 29 November 2012 you failed to complete and/or adequately handover
labelling of the placenta in relation to Patient B.
The panel therefore found charge 8.4 not proved.
Charge 8.5 8. Before the end of your shift on 29 November 2012 you failed to complete and/or
adequately handover the following tasks in relation to Patient B:
8.5 Completion of the post natal VTE assessment
Charge found not proved.
Page 40 of 63
The panel first had regard to Ms 8’s statement that ‘Post natal VTE assessment had not
been completed.’
The panel bore in mind your oral evidence in which you said that there was no urgency
in completing the post natal VTE assessment and you were content to leave this
outstanding.
The panel also had regard to the notes of the Trust’s Investigation Interview on 17
January 2013 in which you said, when asked about the VTE assessment, that ‘it was
[Ms 8’s] duty to do it’.
The panel also heard evidence from Ms 8 that a VTE assessment did not need to be
completed straight away. The panel was of the view that this was a task that could be
completed later on that morning and that handing the task over for completion was
acceptable in the circumstances.
The panel was therefore unable to conclude that before the end of your shift on 29
November 2012 you failed to complete and/or adequately handover completion of the
post natal VTE assessment in relation to Patient B.
The panel therefore found charge 8.5 not proved. Charge 9.1 9. During your shift ending on 29 November 2012 you failed to follow safeguarding
procedure in relation to patient B in that you:
9.1 Failed to complete the pre-birth plan
Charge found proved.
The panel bore in mind your oral evidence that you did not have the opportunity to
complete the pre-birth plan as you had to be directly attending to Patient B.
Page 41 of 63
The panel had regard to your statement in which you wrote ‘I was dealing with the lady
when she was in labour and that was my specific role.’ It bore in mind your evidence
that post-delivery you had approximately one hour before the end of your shift. The
panel was of the view that you would have had time to complete the pre-birth plan, that
it was your responsibility to do so and that you failed in this regard.
The panel heard from you that you cared for Patient B while she was in labour and you
subsequently delivered her baby.
The clinical records demonstrate that Patient B was in your care from 21:40 on 28/11/12
until her baby was delivered at 06:29 on 29/11/12.
The panel had regard to the evidence of Ms 9, in particular her statement which reads:
‘On reviewing the notes, the pre-birth plan had not been completed following delivery by
Margaret, so social services had not been notified of the delivery or anyone else that
was listed’.
The panel concluded on the balance of probabilities that during your shift ending on 29
November 2012 you failed to follow safeguarding procedure in relation to Patient B in
that you failed to complete the pre-birth plan.
The panel therefore found charge 9.1 proved.
Charge 9.2 9. During your shift ending on 29 November 2012 you failed to follow safeguarding
procedure in relation to patient B in that you:
9.2 Failed to inform the necessary persons of Patient B’s admission to the ward
Charge found proved.
The panel had regard to Ms 9’s witness statement which states ‘I am currently
employed as the named midwife for safeguarding children’ and ‘when [Ms 8] told me the
Page 42 of 63
patient’s name, I immediately recognised the patient, Patient B. However, I was not
even aware that she was in hospital.’
The panel considered that Ms 9 was the necessary person to be informed of Patient B’s
admission to the ward and it accepted her evidence that she was not informed of this
until handover to Ms 8.
The panel had regard to your statement in which you stated ‘The social worker was to
be notified by [Ms 8]. As far as my handover to [Ms 8] was concerned it was a complete
and thorough one and not rushed in any way. I gave her all the information about the
case which included the need to make a phone call to social services and I also referred
her to my notes about the case which is normal practice.’
The panel considered that you had a duty to inform the necessary person, in this case
Ms 9, of Patient B’s admission to the ward and you failed to, despite the fact that you
would have had a number of opportunities to do so throughout the shift.
The panel concluded on the balance of probabilities that during your shift ending on 29
November 2012 you failed to follow safeguarding procedure in relation to patient B in
that you failed to inform the necessary persons of Patient B’s admission to the ward.
The panel therefore found charge 9.2 proved.
Charge 9.3 9. During your shift ending on 29 November 2012 you failed to follow safeguarding
procedure in relation to patient B in that you:
9.3 Failed to inform the necessary persons of Patient B’s delivery
Charge found not proved. The panel took into account your oral evidence that you only had one hour between
Patient B’s delivery and the end of your shift and that, within that time, you were busy
Page 43 of 63
cleaning up Patient B, ensuring they were comfortable and asking reception for labels
for the baby. It also bore in mind your oral evidence that you knew that social services
needed to be told that the lady was delivered but you did not have the opportunity to do
that because you were rushed.
The panel also took into account the evidence of Ms 9 who stated that it was not ideal
but was acceptable to handover this particular responsibility to the midwife taking over,
in this case Ms 8.
The panel was of the view that it was understandable that within the hour following the
patient’s delivery and the end of your shift, informing the necessary persons of the
delivery was not your highest priority.
The panel was unable to conclude on the balance of probabilities that during your shift
ending on 29 November 2012 you failed to follow safeguarding procedure in relation to
patient B in that you failed to inform the necessary persons of Patient B’s delivery.
The panel therefore found charge 9.3 not proved.
Charge 10.1 10. On the night shift commencing 24 May 2013
10.1 Left the ward for significant lengths of time
Charge found proved. When considering this charge the panel bore in mind that it relates to Robert Watson
Ward and the layout of this was described in detail by Ms 11.
The panel was told that the staff toilet was located on the same corridor as the ward and
that, while the toilet could not be seen from the ward area, the toilet sink can be seen
from the staff office. The panel was informed by Ms 2 that only staff used this toilet.
Page 44 of 63
The panel had regard to Ms 11’s witness statement which sets out ‘During the night, I
recall that Maggie kept disappearing from the ward area without informing members of
the team. She was going to the toilet frequently.’ The panel also took into account Ms
11’s statement that ‘Maggie had disappeared from the ward on a number of occasions
and everyone in the team wondered where she had gone.’
The panel had regard to Ms 3’s statement: ‘It was brought to my attention that Maggie
was disappearing from the ward and going to the toilet too often. Initially, I did not ask
Maggie as the ward was busy at the time. However, it was brought to my attention again
and I asked Maggie if she was okay and she said she was fine.’
[PRIVATE - REDACTED]
The panel found Ms 12, Ms 11 and Ms 3 to be reliable, consistent and credible
witnesses and determined that it had no reason to doubt their evidence.
The panel took into account your oral evidence that you were using the toilet during that
shift but only for 10 minutes at a time.
Whilst the panel acknowledged that the toilet was on the same corridor as the ward, it
was of the view that whilst using that toilet on a number of occasions for a lengthy
period of time, you were not able to undertake your clinical responsibilities during the
shift.
Overall, the panel concluded on the balance of probabilities that on the night shift
commencing 24 May 2013 you left the ward for significant lengths of time.
The panel therefore found charge 10.1 proved.
Charge 10.2 10. On the night shift commencing 24 May 2013
10.2 Self-administered drugs whilst on duty
Page 45 of 63
Charge found proved.
The panel first had regard to the witness statement of Ms 10 [PRIVATE - REDACTED].
[PRIVATE - REDACTED].
The panel then had regard to the statement of Ms 11 [PRIVATE - REDACTED].
[PRIVATE - REDACTED]
[PRIVATE - REDACTED]
[PRIVATE - REDACTED]
[PRIVATE - REDACTED]
Ms 10 also said in her statement that she had never known anyone but staff use the
staff toilet.
Ms 12’s evidence was that she had never seen a patient go into the staff toilet which
was the worst toilet on what was quite an old ward and which was marked “Staff Toilet”.
The panel also had regard to Ms 3’s witness statement[PRIVATE - REDACTED]
The panel took into account your statement that ‘I deny that I self-administered drugs
whilst on duty or at all. At no stage did I see a needle and syringe on the floor of the
toilet.’ [PRIVATE - REDACTED] The panel took into account that this statement is
inconsistent with what you told Ms 12 during a meeting following the shift. [PRIVATE - REDACTED].
The panel also took into account the statement of Ms 12, who had taken handover from
you, in particular that ‘Maggie was unable to answer questions asked about the care of
these ladies and babies. In addition, Maggie had not documented the care provided for
Page 46 of 63
several of the patients…I looked back on a lot of the notes and Maggie had not
documented anything regarding her patients. I got the impression that Maggie did not
really know the patients…………….I felt her communication skills were appalling that
morning and it was not clear what she had done from looking at the notes’.
Ms 12’s statement went on say that following this incident she had called you to request
that you did not attend the next shift. [PRIVATE - REDACTED]
The panel was of the view that you had not completed necessary documentation for
patients and you had spent significant time in the toilet away from your clinical duties.
The panel found Ms 10, Ms 11 and Ms 12 consistent and credible witnesses. It
considered that it preferred the evidence of these witnesses to your own inconsistent
account of what occurred.
[PRIVATE - REDACTED]
It concluded on the balance of probabilities that you used such items to self-administer
drugs whilst on duty on the night shift commencing 24 May 2013.
The panel therefore found charge 10.2 proved. Charge 10.3 10. On the night shift commencing 24 May 2013
10.3 Discharged your duties whilst under the influence of drugs
Charge found proved.
In considering this charge, the panel had regard to the evidence it heard as to your
demeanour during the shift in question. [PRIVATE - REDACTED]
Page 47 of 63
The panel reminded itself of Ms 12’s evidence that during the handover it was clear that
you had failed to document any notes regarding patients in your care and that your
communication skills were appalling that morning. [PRIVATE - REDACTED]
The panel had regard to your statement dated 1 June 2015 in which you wrote ‘I did not
discharge my duties whilst under the influence of drugs. Again I am surprised to hear of
such an allegation as I was allowed to continue work throughout that shift.’
The panel also noted inconsistencies as to explanations of why you were in the toilet.
[PRIVATE - REDACTED] Again, in view of the inconsistencies in your evidence the
panel determined it could not place any weight on your account.
In all the circumstances, bearing in mind its previous finding that you self-administered
drugs whilst on duty, and the comments of Ms 12 who had taken handover from you,
the panel concluded on the balance of probabilities that on the night shift commencing
24 May 2013 you discharged your duties whilst under the influence of drugs.
The panel therefore found charge 10.3 proved.
Resuming hearing –16-17 November 2015 Determination on misconduct and impairment
Having announced its finding on the facts, the panel then moved on to consider,
whether the facts found proved amounted to misconduct and if so, whether your fitness
to practise is currently impaired. The NMC has defined fitness to practise as a
registrant’s suitability to remain on the register unrestricted.
The panel were provided with a further statement from you dated 16 November 2015. In
addition the panel were provided with three references, two of which were from your
current employers. In considering whether the facts found proved amount to
misconduct, the panel heard further oral evidence from you.
Page 48 of 63
Mr Collins on behalf of the NMC referred the panel to various sections of The Code:
Standards of conduct, performance and ethics for nurses and midwives 2008 (“the
Code”). He highlighted specific paragraphs in the Code that, in his assertion, had been
breached by your failings. He submitted that these breaches of the Code were serious
enough to amount to misconduct.
In considering whether your actions amount to misconduct, Mr Collins referred the panel
to the case of Roylance v General Medical Council (No 2) [2000] 1 A.C. 311, in which it
was stated that,
“Misconduct is a word of general effect, involving some act or omission which falls short
of what would be proper in the circumstances. The standard of propriety may often be
found by reference to the rules and standards ordinarily required to be followed by a
medical practitioner in the particular circumstances”.
Mr Collins submitted that the facts found proven and those which have been admitted
are deplorable, in particular, falsifying references and a safeguarding training certificate,
leaving the ward to self-administer drugs on a shift, working under the influence of those
drugs and sleeping on duty.
Further he submitted that by not responding to urgent call bells or requests for
assistance on a number of shifts and failing to follow safeguarding procedures, your
actions amount to a clear departure from what would be expected from a registered
nurse and midwife.
In relation to the matter of impairment, Mr Collins referred the panel to paragraph 76 of
the judgement in the case of CHRE v (1) NMC (2) Grant [2011] EWHC 927 (Admin). He
submitted that all the provisions set out are engaged in this case.
He submitted that your actions placed patients at unwarranted risk of harm and you are
liable to so again in the future. Further Mr Collins submitted that your actions brought
the profession into disrepute and that your actions are liable to do so, in the future.
Page 49 of 63
Mr Collins submitted that there remains a significant risk of repetition. He stated that this
was not an isolated incident but that there was a catalogue of failures over a significant
period of time.
Mr Collins further submitted that your conduct was that of a practitioner who has no
regard for her colleagues, her patients and the profession as a whole. Further, he
submitted that as your conduct is a far departure from what would have been proper in
the circumstances, your whole judgment and approach to practice must be questioned.
Mr Collins referred the panel to the letter addressed to you from the NMC, which
outlined the outcome of the hearing which took place on 6 November 2014. He referred
this panel to the charges (dated 14 December 2012) which were considered at that
hearing and informed this panel that at that time, that panel found that although your
conduct was dishonest, you were not impaired. He informed this panel that whilst you
admitted the charges against you during that hearing, which was to your credit, you
have now to this panel demonstrated a clear disposition towards dishonesty and a
pattern of dishonest behaviour.
He submitted that in this instance, you would have to demonstrate a sustained degree
of insight and remediation to alleviate the concerns raised.
In relation to the matter of insight, Mr Collins stated that you have disputed a majority of
the charges and you made qualified admissions. He submitted that you have not
demonstrated any sustained insight into your actions.
In relation to whether you have remediated your misconduct, Mr Collins submitted that
although you have provided positive references from your employers and have provided
training certificates to the panel, these have little bearing on the failings that have been
established.
Mr Collins submitted that public confidence in the profession would be undermined if a
finding of impairment was not made. He submitted that the public would be appalled by
the notion that you, a registrant, with clinical responsibilities for patients, left the ward to
self-administer drugs, and then continued to practise whilst under the influence of those
drugs.
Page 50 of 63
For these reasons, Mr Collins submitted that your fitness to practise remains impaired.
Ms Hayden on your behalf made no submissions.
The panel heard and accepted the advice of the legal assessor.
The legal assessor advised that the panel must adopt a two stage process. First, the
panel must determine whether the facts found proved, amount to misconduct, namely a
serious departure from the standards expected of a registered nurse and midwife.
Secondly, if the facts found proved amount to misconduct, the panel must decide
whether, in all the circumstances, your fitness to practise is currently impaired as a
result of that misconduct, having regard to the gravity of the misconduct, the level of
your insight and any remedial steps you have taken to reduce the likelihood of repetition
in the future.
The legal assessor supported her advice by reference to the judgements in the cases
of: Roylance v General Medical Council (No 2) [2000] 1 A.C. 311, Nandi v. General
Medical Council [2004] EWHC 2317 (Admin), Parkinson v NMC [2010] EWHC 1898
(Admin), CHRE v NMC and Grant [2011] EWHC 927 (Admin) and Cohen v General
Medical Council [2008] EWHC 581 (Admin).
The legal assessor also referred the panel to Mitting J’s judgement in the case of
Nicholas-Pillai v General Medical Council [2009] EWHC 1048 (Admin), where he held
that the panel were entitled to take into account the fact that the practitioner had
contested critical allegations of dishonest note-keeping, observing that:
“In the ordinary case such as this, the attitude of the practitioner to the events which
give rise to the specific allegations against him is, in principle, something which can be
taken into account either in his favour or against him by the panel, both at the stage
when it considers whether his fitness to practise is impaired, and at the stage of
determining what sanction should be imposed upon him.”
The panel, in reaching its decision, accepted that there was no burden or standard of
proof at this stage and exercised its own judgement.
Page 51 of 63
In reaching its determination, the panel took account of all the evidence presented, both
oral and written, together with Mr Collins’ submissions on behalf of the NMC.
Decision on whether the facts found proved amount to misconduct:
The panel was of the view that your conduct set out in the charges found proved
constituted serious departures from the following standards of The Code: Standards of
conduct, performance and ethics for nurses and midwives 2008 (‘the Code’):
Preamble
The people in your care must be able to trust you with their health and wellbeing
To justify that trust, you must:
• make the care of people your first concern...
• work with others to protect and promote the health and wellbeing of those in your
care...
• 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
3. You must treat people kindly and considerately.
21. You must keep your colleagues informed when you are sharing the care of others.
24. You must work cooperatively with teams and respect the skills, expertise and
contributions of your colleagues.
42 You must keep clear and accurate records of the discussions you have, the
assessments you make, the treatment and medicines you give and how effective these
have been.
43 You must complete records as soon as possible after an event has occurred
61. You must uphold the reputation of your profession at all times.
Page 52 of 63
The panel recognise that not every breach of the Code, and not every area where there
are shortfalls in proper practice, would constitute misconduct. The panel was of the view
that your conduct covered a spectrum of failings including falsifying references and a
safeguarding training certificate, self-administering drugs, practising whilst under the
influence of drugs, poor record keeping, inadequate patient care and failing to respond
to requests from patients and colleagues.
The panel noted that your misconduct took place over a period in excess of one year
and involved repeated incidences of dishonesty.
In the light of all of the above, the panel concluded that taken individually and
collectively your misconduct including serious lack of patient care and dishonesty fell far
short of the conduct and standards expected of a registered nurse and midwife and was
sufficiently serious to constitute misconduct.
The panel next considered whether, as a result of the misconduct identified, your fitness
to practise is currently impaired.
The panel had in mind the case of CHRE v (1) NMC (2) Grant [2011] EWHC 927
(Admin) and the judgment of this case which cites Dame Janet Smith’s Fifth Report
from Shipman. The panel considered the issue of your current impairment in the terms
set out by Dame Janet Smith, specifically the questions of whether the registrant:
a) has in the past acted and/or is liable in the future to act so as to put a patient or
patients at unwarranted risk of harm; and/or
b) has in the past brought and/or is liable in the future to bring the […] profession
into disrepute; and/or
c) has in the past breached and/or is liable in the future to breach one of the
fundamental tenets of the […] profession; […]
d) has in the past and/or is liable in the future to act dishonestly.
The panel was of the view that, at the relevant time, your conduct placed vulnerable
dependent patients at unwarranted risk of harm, particularly by leaving patients, your
colleagues and the ward area for an extended period of time, self-administering drugs
and then continuing to work under the influence of those drugs.
Page 53 of 63
In addition the panel considered that your falsification of references and a safeguarding
training certificate were deliberate acts of dishonesty which breached one of the
fundamental tenets of the profession and brought the profession into disrepute.
In considering whether you are liable in the future to place patients at unwarranted risk
of harm and bring the profession into disrepute, the panel, in addition to assessing the
gravity of the misconduct, gave careful regard to matters of insight and remediation
which are important factors in any evaluation of the likelihood of repetition.
In relation to insight, the panel noted that at the outset of this hearing, you did make
some admissions in respect of the allegations against you. However the majority of the
charges were denied. You do now partially accept the panel’s findings and have
displayed some remorse during the oral evidence which you gave at this stage of the
hearing. However you were unable to recognise the impact that your actions could have
had on your patients, colleagues and the profession.
Further, the panel noted that during your oral evidence you maintained that the key
cause of your misconduct in this case, was due to your poor communication and team
working skills, which you will seek to remedy. Further, you maintained your stance that
you did not submit false references to your employer and that there must have been a
mix up with the references you had submitted. The panel was of the view that you have
not demonstrated limited insight into your dishonest conduct.
Whilst some of your misconduct might be capable of remediation, through relevant
training and reflective practice, the panel considered that dishonest conduct is
extremely difficult to remediate.
The panel noted that two of the references which you had provided to the panel today
were undated. Further whilst the panel considered the positive reference from your
current employer, it noted that this reference and the other references submitted did not
confirm that the authors of the references were aware of these NMC proceedings or that
the references had been submitted for the purpose of this hearing.
Page 54 of 63
The panel also took account of the training certificates which you had completed,
however it was of the view that taking account of the gravity of the misconduct in this
case and your dishonest conduct, they were of limited significance.
The panel took account of the letter addressed to you from the NMC, which outlined the
outcome of the hearing which took place on 6 November 2014. The panel noted that the
charges in that case took place on 14 December 2012 and also referred to dishonest
conduct. Whilst this panel noted that there was no finding of impairment in that case, it
was of the view that having appeared before a panel of the Conduct and Competence
Committee you would be in no doubt of the NMC’s expectations in relation to the
honesty and integrity expected of the profession and the NMC’s view of dishonest
conduct.
In the absence of sufficient insight or remediation, the panel considered that there is a
real risk of repetition, which could, once again, place patients at risk of harm and bring
the profession into disrepute.
Further, the panel had in mind that its primary function is to protect patients and the
wider public interest, which includes maintaining confidence in the profession and
upholding proper standards of behaviour. The panel took account of the case of Grant
in which Mrs Justice Cox stated:
“In determining whether a practitioner’s fitness to practise is impaired by reason
of misconduct, the relevant panel should generally consider not only whether the
practitioner continues to present a risk to members of the public in his or her
current role, but also whether the need to uphold proper professional standards
and public confidence in the profession would be undermined if a finding of
impairment were not made in the particular circumstances.”
The panel concluded that confidence in the profession and the NMC as its regulator
would be undermined if a finding of impairment was not made.
For these reasons, the panel determined that your fitness to practise is currently
impaired by reason of your misconduct.
Page 55 of 63
Determination on sanction:
The panel has determined to make a striking off order. The effect of this order is that you will be removed from the register, and you may not apply for restoration until five years after the date that this decision takes effect.
Having determined that your fitness to practise is impaired, the panel considered what
sanction, if any, it should impose in your case. In reaching its decision on sanction, the
panel has heard submissions from Mr Collins and Ms Hayden and it considered all the
evidence that has been placed before it, including your written submission which you
provided to the panel on the final day of the hearing.
Mr Collins submitted that the appropriate sanction was a matter for the panel and
referred it to the NMC Indicative Sanctions Guidance (ISG).
Ms Hayden stated that although one of the employer references had not initially been
provided to the panel, the references from both your employers were dated and written
on headed paper. She provided the panel with further copies of these references.
Ms Hayden on your behalf invited the panel to impose a suspension order. She
submitted that this sanction would serve to uphold public confidence in the profession
and mark the seriousness of your misconduct, whilst also providing you with a further
opportunity to remedy the deficiencies in your practice.
She reminded the panel that you have a long record of good service without any
incident. She referred the panel to the positive references submitted by your current
employers and stated that the authors of both references were aware that you are
currently subject to an interim suspension order. Further, she reminded the panel that
the references submitted on your behalf speak of your compassion and diligence and
describe you as a proactive and caring person.
Ms Hayden reminded the panel of your oral evidence, in which you informed them of
your continuing desire to remain within the nursing and midwifery profession. Further
she reminded the panel that during your oral evidence you provided examples of what
you would do differently and confirmed your understanding of the importance of
communication.
Page 56 of 63
Ms Hayden further reminded the panel that you have positively engaged with the NMC
proceedings and attended this hearing.
Ms Hayden stated that although there were a number of failings, this did not result in
direct patient harm. Further, she stated that although the panel had found that you had
self-administered drugs whilst on duty, this did not affect your presentation during the
shift and you continued to carry out your clinical duties and completed patients’
observations until the end of the shift.
In relation to the matter of dishonesty, Ms Hayden stated that the references which were
falsely completed were not completed in an attempt to gain employment. She stated
that you were required to provide further references for the agency’s annual review.
Further, she stated that the falsely submitted references were all from individuals who
had provided references for you in the past.
Ms Hayden referred the panel to the case of Parkinson v NMC [2010] EWHC 1898
(Admin). She stated that this is not a case where you have not engaged with the
proceedings. She stated that you have admitted your misconduct and acknowledged a
number of your failings. Further she stated that you have given the panel an
undertaking that your dishonest conduct will not be repeated.
The legal assessor reminded the panel that the purpose of sanctions is to protect
patients and the wider public interest by maintaining public confidence in the profession
and declaring and upholding proper standards of conduct and behaviour. She reiterated
the need for the panel to act proportionately and to consider sanctions in ascending
order of severity, starting with the option of taking no action and only proceeding to a
more restrictive sanction if the lesser sanction was insufficient. She referred the panel to
various paragraphs in the NMC’s Indicative Sanctions Guidance (“ISG”) and reminded it
that this document acts as guidance and no more. She stated that this guidance must
not fetter the panel’s decision. She referred the panel to the case of CRHP -v- (1) GMC
(2) Leeper [2004] EWHC 1850 and the judgement made in that case.
In considering the aggravating and mitigating factors, the legal assessor reminded the
panel that evidence may be presented by way of references and testimonials. She
stated that the panel should first consider whether these are genuine and to be relied
Page 57 of 63
upon. It should consider whether the references have been signed by the author and
whether it is on headed paper.
The panel considered the sanctions available to it under Article 29 of the Nursing and
Midwifery Council Order 2001. The panel can take one of the following actions in
ascending order: it can take no action; make a caution order for one to five years; make
a conditions of practice order for no more than three years; make a suspension order for
a maximum of one year; or it can make a striking off order. The panel has borne in mind
that the purpose of a sanction is not to be punitive, although it recognises that it may
have a punitive effect.
The panel has applied the principles of fairness, reasonableness and proportionality,
weighing the interests of patients and the public with your own interests. The public
interest includes the protection of patients, the maintenance of public confidence in the
profession and declaring and upholding proper standards of conduct and behaviour.
The panel has also taken account of the current NMC publication Indicative Sanctions
Guidance (“ISG”).
The panel considered the aggravating and mitigating factors in this case.
The aggravating factors in this case include:-
• Previous admitted charges of dishonesty at a substantive NMC hearing in
November 2014;
• There was a spectrum of serious misconduct including a blatant disregard for
patients’ wellbeing;
• Repeated and premeditated dishonest conduct for your own financial gain;
• Self-administration of non-prescribed medication in the most unusual and
inappropriate circumstances;
• Varied and prolonged misconduct over a lengthy period, which brought the
nursing and midwifery profession into disrepute;
• Your misconduct occurred in two different hospital settings;
• Despite care and concern shown to you by your colleagues, you did not
acknowledge your health issues or take advantage of the support offered;
Page 58 of 63
• Lack of insight and remorse regarding your behaviour towards patients,
colleagues and the nursing and midwifery profession. No recognition of the
potential harm which could have been caused to patients or the damage which
may have been caused to the reputation to the profession.
The mitigating factors include:-
• You made admissions to some of the charges at the outset of the hearing;
• Positive references from current employers. Two of the references which were
submitted were of limited assistance to the panel;
• You have attended and given oral evidence twice during the hearing and have
engaged with the NMC proceedings.
The panel considered all the available sanctions in ascending order, considering the
least restrictive first.
The panel first considered whether to take no action but concluded that this would be
manifestly insufficient given the seriousness of your misconduct and the risk of
repetition identified at the impairment stage. It also took account of the aggravated
nature of your misconduct and the limited mitigation.
The panel noted paragraph 61 of the Indicative Sanctions Guidance which states that:
“panels will usually need to take action to secure patient safety, to secure public trust
and confidence in the profession, or to declare and uphold proper standards of conduct
and behaviour.” The panel determined that to take no action would not be in the wider
public interest, nor would it protect the public.
In considering a caution order, the panel took into account the Indicative Sanctions
Guidance, which states that a caution order may be appropriate where “the case is at
the lower end of the spectrum of impaired fitness to practise and the panel wishes to
mark that the behaviour was unacceptable and must not happen again.” The panel
recognised that a caution order would not restrict your practice. Given the gravity of the
misconduct and the significant risk of repetition, which has not been offset by any
Page 59 of 63
evidence of sufficient remediation, the panel concluded that such an order would not
sufficiently protect the public.
The panel next considered a conditions of practice order. Such an order may be
appropriate in cases where there are identifiable areas of nursing and midwifery
practice that require assessment and/or retraining. The panel noted that your
misconduct did not largely relate to your clinical practice. It was mindful that it has
identified various elements of dishonesty over a protracted period of time. The panel
therefore determined that it would be unable to devise practical, workable and
measurable conditions that would address your persistent dishonesty during the
relevant period. Further, the panel was of the view that there is evidence of deep-seated
attitudinal issues and that it could not be reassured that you would respond positively to
any conditions placed on your practice.
The panel therefore concluded that a conditions of practice order would be
inappropriate in this case as it would not sufficiently protect the public, nor would it
satisfy the public interest.
Having concluded that a conditions of practice order was not appropriate, the panel
considered the remaining available sanctions of suspension and striking off. It first
considered whether to impose a suspension order. The ISG indicates that suspension
may be appropriate where some or all of the following factors are apparent (this list is
not exhaustive):
• A single instance of misconduct but where a lesser sanction is not sufficient.
• The misconduct is not fundamentally incompatible with continuing to be a
registered nurse or midwife in that the public interest can be satisfied by a less
severe outcome than permanent removal from the register.
• No evidence of harmful deep-seated personality or attitudinal problems.
• No evidence of repetition of behaviour since the incident.
• The panel is satisfied that the nurse or midwife has insight and does not pose a
significant risk of repeating behaviour.
Page 60 of 63
The panel was of the view that your misconduct did not relate to a single instance of
misconduct.
The panel noted that you have failed to provide them with sufficient evidence of insight
or remediation. You have not provided any evidence that you considered the wider
impact of your misconduct on your colleagues, the public and the reputation of the
profession. Nor have you considered the harm your actions could have had on patients.
The panel was mindful that in the absence of such evidence it has been forced to
conclude that there remains a real risk of repetition. It has also concluded that your
behaviour whilst in both Hospitals (George Eliot Hospital and Northampton General
Hospital) indicated that there is a deep-seated attitudinal issue.
The panel considered that the misconduct in this case, which included dishonest
conduct, was premeditated and persistent and would not be sufficiently addressed by a
suspension order. In addition such an order would not adequately protect the public
interest, preserve patient safety or maintain and uphold proper professional standards.
The panel next considered the most severe sanction, that of a striking off order. The
panel had regard to the considerations in paragraph 74 of the ISG and determined that
all are relevant in this case:
74.1 Is striking-off the only sanction which will be sufficient to protect the public interest?
74.2 Is the seriousness of the case incompatible with ongoing registration…?
74.3 Can public confidence in the professions and the NMC be sustained if the nurse or midwife is not removed from the register?
The panel also determined that the following points of paragraph 75 are engaged;
75.1 Serious departure from the relevant professional standards as set out in key standards, guidance and advice including (but not limited to):
75.1.1 The code: Standards of conduct, performance and ethics for nurses and midwives
75.6 Dishonesty, especially where persistent or covered up
75.7 Persistent lack of insight into seriousness of actions or consequences
Page 61 of 63
The panel determined that there has been a serious departure from the relevant
standards as set out in the Code. You deliberately sought to mislead your employer by
submitting false references for your own financial gain and thereby acted contrary to the
basic requirements that a nurse/midwife should act openly, honestly and with integrity.
The panel has already determined that there is not sufficient evidence of insight or
remediation in this case and there is a real risk of repetition.
The panel considered the case of Parkinson. The following extract from the judgment of
Mitting J. is of particular relevance to this case:
‘A nurse found to have acted dishonestly is always going to be at severe risk of
having his or her name erased from the register. A nurse who has acted
dishonestly, who does not appear before the panel either personally or by
solicitors or counsel to demonstrate remorse, a realisation that the conduct
criticised was dishonest, and an undertaking that there will be no repetition,
effectively forfeits the small chance of persuading the panel to adopt a lenient or
merciful outcome and to suspend for a period rather than to direct erasure.’
Whilst you have taken the opportunity to appear before this panel, you have not
demonstrated sufficient remorse, insight or steps towards remediation. The panel
therefore had no information before it which might otherwise have persuaded it that a
more lenient course than a striking off order would be appropriate.
Given the wide spectrum and serious nature of the misconduct found proved, the panel
concluded that confidence in the profession and its regulator, and the need to uphold
and declare proper professional standards, would be undermined if you were to remain
on the Register.
The panel concluded that in all the circumstances of this case the nature and
seriousness of your misconduct is fundamentally incompatible with you remaining on
the register. It therefore concluded that a striking-off order is the only sufficient and
proportionate sanction which will protect the public and address the wider public
interest.
The panel was mindful of the potential impact that such an order could have on you in
terms of financial, personal and professional hardship. It bore in mind that you have
Page 62 of 63
expressed a wish to work as a registered nurse/midwife and, as such, such an order
could have an effect on your financial position and also on your reputation. In any event,
the panel determined that the interests of the public outweigh your interests in this
regard.
The panel concluded that your actions represented such a fundamental departure from
the relevant standards that public confidence in the nursing and midwifery profession
and in the NMC as its regulator would be undermined were the panel not to impose a
striking-off order.
The panel, therefore, directs the Registrar to strike your name from the Register. You
may not apply for restoration until five years after the date that this direction takes
effect.
Determination on interim order: Mr Collins on behalf of the NMC submitted that in the light of the panel’s findings on
impairment, an interim order should be made on the grounds of public protection and
that it was otherwise in the public interest. He submitted that an interim suspension
order should be imposed for the period of 18 months to cover the possibility of an
appeal being made in the 28 day appeal period.
Ms Hayden made no submissions.
The panel heard and accepted the advice of the legal assessor. The panel took account
of the guidance issued to panels by the NMC when considering interim orders and the
appropriate test as set out at Article 31 of The Nursing and Midwifery Order 2001. It
may only impose an interim order if it is satisfied that it is necessary for the protection of
the public, is otherwise in the public interest or in your own interest.
The panel was satisfied that an interim suspension order is necessary for the protection
of the public and is otherwise in the public interest. In reaching its decision to impose an
interim suspension order, the panel had regard to the risks identified in its determination
on impairment, and its reasons for imposing a substantive striking off order. To do
otherwise would be inconsistent with its earlier findings.
Page 63 of 63
The period of this order is for 18 months to allow for the possibility of an appeal to be
made and determined.
If no appeal is made then the interim suspension order will be replaced by the
substantive striking off order 28 days after you have been served with the decision of
this hearing in writing.
That concludes this determination.