Nursing and Midwifery Council Fitness to Practise ...€¦ · 27/01/2020 · checked by another midwife as is required by the Hospitals labour clinical care guideline. Further allegations

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Nursing and Midwifery Council Fitness to Practise Committee

Substantive Hearing

21, 22, 23, 24 and 27 January 2020

Nursing and Midwifery Council 2 Stratford Place, Montfichet Road, London, E20 1EJ

Name of registrant: Ms Teresa Bernadine McLaughlin NMC PIN: 79B1397E Part(s) of the register: Registered Nurse – Sub Part 1 RN1 Nursing – July 1982 Registered Midwife – November 1987 Area of registered address: Surrey Type of case: Misconduct Panel members: Edward Lucas (Chair, Lay member)

Judith Robbins (Registrant member) Sue Heads (Lay member)

Legal Assessor: James Holdsworth Panel Secretary: Tafadzwa Taz Chisango Nursing and Midwifery Council: Represented by Ms Leeann Mohamed, Case

Presenter Ms McLaughlin: Not present and not represented in absence Facts proved: 1, 2, 4, 5, 6, 7, 8, 9, 10a, 10b, 10c, 10d, 10e,

10g, 10h and 11 Facts not proved: 3, 10f, 12a, 12b and 12c Fitness to practise: Impaired Sanction: Suspension order with a review (6 months) Interim order: Interim suspension order (18 months)

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Decision and reasons on service of Notice of Hearing

The panel was informed at the start of this hearing that Ms McLaughlin was not in

attendance and that the Notice of Hearing letter had been sent to Ms McLaughlin’s

registered address by recorded delivery and by first class post on 12 December 2019.

The panel had regard to the Royal Mail ‘Track and Trace’ printout which showed that

the Notice of Hearing was collected on 30 December 2019. It was signed for in the

name of ‘MCLAUGHLIN’.

The panel took into account that the Notice of Hearing provided details of the allegation,

the time, dates and venue of the hearing and, amongst other things, information about

Ms McLaughlin’s right to attend, be represented and call evidence, as well as the

panel’s power to proceed in her absence.

Ms Mohamed, on behalf of the Nursing and Midwifery Council (NMC), submitted that it

had complied with the requirements of Rules 11 and 34 of the Nursing and Midwifery

Council (Fitness to Practise) Rules 2004, as amended (the Rules).

The panel accepted the advice of the legal assessor.

In the light of all of the information available, the panel was satisfied that Ms McLaughlin

has been served with the Notice of Hearing in accordance with the requirements of

Rules 11 and 34.

Decision and reasons on proceeding in the absence of Ms McLaughlin

The panel next considered whether it should proceed in the absence of Ms McLaughlin.

The panel had regard to Rule 21(2), which states:

‘21. (2) Where the registrant fails to attend and is not represented

at the hearing, the Committee

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(a) shall require the presenter to adduce evidence

that all reasonable efforts have been made, in

accordance with these Rules, to serve the notice

of hearing on the registrant;

(b) may, where the Committee is satisfied that the

notice of hearing has been duly served, direct

that the allegation should be heard and

determined notwithstanding the absence of the

registrant; or

(c) may adjourn the hearing and issue directions.’

Ms Mohamed referred the panel to the documentation from Ms McLaughlin. Ms

Mohamed informed the panel that in an email dated 2 January 2020 from Ms

McLaughlin representatives stated that “we will not attend the NMC hearing and

disengage from this process…” Ms Mohamed as a consequence submitted that there

was no reason to believe that an adjournment would secure Ms McLaughlin’s

attendance on some future occasion and invited the panel to continue in her absence

on the basis that she had voluntarily absented herself.

The panel accepted the advice of the legal assessor.

The panel noted that its discretionary power to proceed in the absence of a registrant

under the provisions of Rule 21 is not absolute and is one that should be exercised ‘with

the utmost care and caution’ as referred to in the case of R. v Jones (Anthony William)

(No.2) [2002] UKHL 5. The panel further noted the case of R (on the application of

Raheem) v Nursing and Midwifery Council [2010] EWHC 2549 (Admin) and the ruling of

Mr Justice Holman that:

‘...reference by committees or tribunals such as this, or indeed judges, to

exercising the discretion to proceed in the person's absence "with the

utmost caution" is much more than mere lip service to a phrase used by

Lord Bingham of Cornhill. If it is the law that in this sort of situation a

committee or tribunal should exercise its discretion "with the utmost care

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and caution", it is extremely important that the committee or tribunal in

question demonstrates by its language (even though, of course, it need

not use those precise words) that it appreciates that the discretion which

it is exercising is one that requires to be exercised with that degree of

care and caution.’

The panel has decided to proceed in the absence of Ms McLaughlin. In reaching this

decision, the panel has considered the submissions of Ms Mohamed and the advice of

the legal assessor. It has had particular regard to the factors set out in the decision of R

v Jones and General Medical Council v Adeogba [2016] EWCA Civ 162 and had regard

to the overall interests of justice and fairness to all parties. It noted that:

No application for an adjournment has been made by Ms McLaughlin;

Ms McLaughlin has informed the NMC that she will not be attending the

hearing and has disengaged from this process;

There is no reason to suppose that adjourning would secure Ms

McLaughlin’s attendance at some future date;

Two witnesses have attended today to give live evidence, two more are

due to attend;

Not proceeding may inconvenience the witnesses, their employer(s) and,

for those involved in clinical practice, the clients who need their

professional services;

The charges relate to events that occurred in 2018;

Further delay may have an adverse effect on the ability of witnesses

accurately to recall events; and

There is a strong public interest in the expeditious disposal of the case.

There is some disadvantage to Ms McLaughlin in proceeding in her absence. Although

the evidence upon which the NMC relies will have been sent to her at Ms McLaughlin’s

registered address, Ms McLaughlin will not be able to challenge the evidence relied

upon by the NMC in person and will not be able to give evidence on her own behalf.

However, in the panel’s judgement, this can be mitigated. The panel can make

allowance for the fact that the NMC’s evidence will not be tested by cross-examination

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and, of its own volition, can explore any inconsistencies in the evidence which it

identifies. Furthermore, the limited disadvantage is the consequence of Ms

McLaughlin’s decision to absent herself from the hearing, waive her rights to attend,

and/or be represented.

In these circumstances, the panel has decided that it is fair, appropriate and

proportionate to proceed in the absence of Ms McLaughlin. The panel will draw no

adverse inference from Ms McLaughlin’s absence in its findings of fact.

Details of charge

That you, a registered midwife whilst working a night shift at the Royal Surrey County

Hospital on 30/31 March 2018, in relation to Patient A:

1) Incorrectly identified the perineal tear as a first degree tear when it was a second

degree tear; (PROVED)

2) Failed to identify that the tear required suturing; (PROVED)

3) Failed to discuss your decision regarding the perineum needing no repair with

the Patient; (NOT PROVED)

4) Failed to ensure that a fellow midwife or doctor checked that the perineum did

not require repair; (PROVED)

5) Failed to monitor blood loss; (PROVED)

6) Failed to conduct timely and frequent observations in respect of the Patient, post-

delivery; (PROVED)

7) Failed to escalate the Patient after recording a blood pressure reading of 95/60

and a pulse of 100 bpm; (PROVED)

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8) Failed to recognise that there was only one placenta; (PROVED)

9) Failed to identify Patient A’s deteriorating condition; (PROVED)

10) Failed to keep adequate records in respect of the Patient in that:

a) You did not sign the Perineal Trauma Assessment and Repair Proforma to

confirm that the tear did not require suturing; (PROVED)

b) You did not ensure that your assessment at a) was signed as having been

second checked; (PROVED)

c) You did not time the entry of observations on the Summary of Delivery;

(PROVED)

d) You did not record any observations on the MEOWS chart; (PROVED)

e) You did not time an entry in the Labour Record regarding asking the doctor to

review the Patient; (PROVED)

f) You did not time the entries in the Labour Record concerning the placenta; (NOT

PROVED)

g) You did not record whether there had been a discussion with the Patient

regarding the decision that the perineum required no repair; (PROVED)

h) You did not record that the Patient had been warned of the risks of opting for a

physiological third stage of labour; (PROVED)

11) Had made an entry in the Patient’s Labour Record that you had requested the

doctor to review the Patient; (PROVED)

12) And your action specified in charge 11 was dishonest in that:

a) You did not request the doctor to review the Patient; (NOT PROVED)

b) You knew it was wrong to make an inaccurate entry; (NOT PROVED)

c) You intended the reader of the Record to believe that you had escalated the

condition of the Patient to a doctor when you had not done so; (NOT PROVED)

AND in light of the above, your fitness to practise is impaired by reason of your

misconduct.

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Facts

In reaching its decisions on the disputed facts, the panel took into account all the oral

and documentary evidence in this case together with the submissions made by Ms

Mohamed on behalf of the NMC. The panel also had regard to Ms McLaughlin’s

responses to the allegations.

The panel has drawn no adverse inference from the non-attendance of Ms McLaughlin.

The panel was aware that the burden of proof rests on the NMC, and that the standard

of proof is the civil standard, namely the balance of probabilities. This means that a fact

will be proved if a panel is satisfied that it is more likely than not that the incident

occurred as alleged.

The panel heard live evidence from the following witnesses called on behalf of the

NMC:

Ms 1: Band 6 midwife at the Royal

Surrey County Hospital;

Ms 2: Band 7 senior midwife and

delivery suite coordinator at the

Royal Surrey County Hospital;

Ms 3: Obstetrics Registrar at the Royal

Surrey County Hospital at the time

of the incident;

Ms 4: Delivery Suite Matron at the Royal

Surrey County Hospital. She also

acts as Investigation manager for

the maternity unit.

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Background

The charges arose whilst Ms McLaughlin was employed as a band 5 agency midwife.

She was registered with Pulse Staffing Agency. Ms McLaughlin had worked a number

of shifts on the maternity unit at the Royal Surrey County (the Hospital) between

December 2017 and 30/31 March 2018.

This case involves inadequate care received by Patient A during her stay on the

delivery suite at the Hospital on 30/31 March 2018. Patient A suffered a second degree

perineal tear following delivery of her baby on 30 March 2018. Ms McLaughlin is alleged

to have recorded on a perineal tear proforma that she had a first degree tear which did

not require suturing. Ms McLaughlin is alleged to not have had this perineal tear

checked by another midwife as is required by the Hospitals labour clinical care

guideline. Further allegations are that Ms McLaughlin did not identify and escalate

Patient A’s deteriorating condition, did not keep accurate clinical records and

dishonestly recorded that she had asked a doctor to review Patient A.

Before making any findings on the facts, the panel heard and accepted the advice of the

legal assessor. It considered the witness and documentary evidence provided by the

NMC.

The panel considered the evidence of the witnesses and came to the following

conclusions. The panel found that all four witnesses were reliable, credible and

straightforward and that their oral evidence was consistent with the written statements

they provided to the NMC. The panel found that all of these witnesses tried their utmost

to assist the panel to the best of their abilities made appropriate concessions where

needed.

The panel had careful regard to Ms McLaughlin’s responses to the allegations which

were contained in the response bundle.

The panel then considered each of the charges and made the following findings.

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Charge 1

Incorrectly identified the perineal tear as a first degree tear when it was a second

degree tear;

This charge is found proved.

In reaching this decision, the panel took into account the documentary evidence and the

evidence of Ms 1, Ms 2, Ms 3 and Ms 4. The panel also had regard to Ms McLaughlin’s

response to the allegation.

Ms 1 in her evidence stated that Ms McLaughlin had told her that Patient A’s perineum

was intact and had not required suturing. She said that Ms 3’s subsequent examination

could not have worsened the tear and that the second degree tear would have been

present following delivery.

Ms 2 in her evidence stated that when she examined Patient A she saw that there was

a tear and confirmed that it was a multidimensional second degree tear. Ms 2 was

shocked that Ms McLaughlin had not noticed the tear. She explained to the panel that a

first degree tear is a tear to the skin only and that a second degree tear is a tear to the

vaginal wall and muscle. Ms 2 in her evidence stated that when she reviewed the notes

she noticed that Ms McLaughlin had recorded a first degree tear on the perineal trauma

assessment proforma.

Ms 3 in her evidence stated she was sure that her examination did not exacerbated the

perineum tear. She went on to state that the perineum should be examined for trauma

within an hour of delivery and this is usually done by the midwife. Ms 3 stated that in

Patient A’s notes she noticed that Ms McLaughlin had documented in the perineal

trauma assessment proforma that Patient A had a first degree tear which did not require

repair. Ms 3 stated that Ms McLaughlin had incorrectly identified the tear as first degree

because when she checked it at around 01:00 it was clearly a second degree tear.

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Ms 4 in her evidence stated that on examination by Ms 3 at around 00:55 Patient A was

found to have a second degree tear which was bleeding. Ms 4 in her evidence stated

that Ms McLaughlin should have taken steps to find out where the blood loss to Patient

A was coming from. One step is to check the perineum to see if the blood is coming

from a tear. Had Ms McLaughlin checked the perineum she would have noticed that

there was in fact a second degree tear which was actively bleeding and she had

incorrectly identified it as a first degree tear.

Ms McLaughlin in her response to the allegations stated that at the time she examined

Patient A she had a first degree tear which did not require suturing. Ms 3 assessed the

tear and in her opinion Ms 3 may have caused perineal trauma which lead to a second

degree tear while she was examining the patient.

The panel took account of all the evidence before it. The panel noted that in the perineal

trauma assessment and repair form Ms McLaughlin had ticked that Patient A had a first

degree tear. The panel had regard to all the witnesses and noted that they had all

stated that Patient A had suffered a second degree tear and Ms McLaughlin had

incorrectly identified it as a first degree tear. The witnesses further clarified to the panel

that Ms 3 was most unlikely to have caused a second degree tear upon examination of

Patient A. Having considered the suggestion made by Ms McLaughlin that Ms 3 could

have caused a second degree tear upon further examination of Patient A, the panel,

having considered all of the evidence, concluded that it is most unlikely that Ms 3

caused the tear in the course of her examining the patient. The panel accepted the

evidence of Ms 1, Ms 2, Ms 3 and Ms 4.

Based on the evidence before it the panel found on the balance of probabilities this

charge proved.

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Charge 2

Failed to identify that the tear required suturing;



evidence of Ms 1 and Ms 3. The panel also had regard to Ms McLaughlin’s response to

the allegation.

Ms 1 in her evidence stated that Ms McLaughlin had told her that Patient A’s perineum

was intact and had not required suturing.

Ms 3 in her evidence stated that the perineum should be examined for trauma within an

hour of delivery and this is usually done by the midwife. Ms 3 stated that Ms McLaughlin

had completed the perineal trauma assessment proforma identifying that Patient A had

a first degree tear which did not require repair.

Ms McLaughlin in her response to the allegations stated that at the time she examined

Patient A she had a first degree tear which did not require suturing. The panel took

account of all the evidence before it. The panel noted that in the perineal trauma

assessment and repair form Ms McLaughlin had ticked that Patient A had a first degree

tear. Ms McLaughlin had also ticked “no” to the question relating to whether the

perineum required repair. The panel had regard to the evidence before it. It noted its

findings in charge 1 that Ms McLaughlin had not identified the tear correctly. The panel

accepted the evidence of Ms 1 and Ms 3 that Ms McLaughlin had failed to correctly

identify that the tear needed suturing.

Based on the evidence before it the panel found this charge proved.

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Charge 3

Failed to discuss your decision regarding the perineum needing no repair with the

Patient;

This charge is found NOT proved.


evidence of Ms 2 and Ms 4.

Ms 2 in her evidence stated that Ms McLaughlin had not recorded that consent had

been obtained from Patient A to not have the tear repaired. Ms 2 stated that Ms

McLaughlin had not signed the proforma to show this.

Ms 4 in her evidence stated that Ms McLaughlin should have discussed with the patient

the decision to not repair the first degree tear and ticked the box on the proforma under

‘Decision and Consent for Repair’ to confirm that she had done so. Ms 4 stated that Ms

McLaughlin did not tick the boxes to confirm she had discussed the matter with the

patient. Ms 4 concluded that Ms McLaughlin did not have the discussion with Patient A.

The panel noted the evidence before it. The panel had regard to the Perineal Trauma

assessment and repair form. The form showed that Ms McLaughlin did not tick that she

discussed or obtained informed consent from the patient in regard to repairing the

perineum. The panel is of the view that there is sufficient evidence to show that Ms

McLaughlin did not record that she had discussed the repair with Patient A. However,

the panel is also of the view that there is insufficient evidence to show that Ms

McLaughlin did not have the discussions with Patient A. Ms McLaughlin could have

discussed the repair of the perineum but failed to record this. The panel find it is most

unlikely that, having examined the patient to look for tears, Ms McLaughlin would have

had no discussion whatsoever with the patient regarding her physical condition. The

panel reminded itself that the burden of proof in this matter was on the NMC and

considered that the NMC had failed to discharge that burden.

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Based on the evidence before it the panel found this charge NOT proved.

Charge 4

Failed to ensure that a fellow midwife or doctor checked that the perineum did not

require repair;



evidence of Ms 2. The panel also had regard to Ms McLaughlin’s response to the

allegation

Ms 2 in her evidence stated that if a perineal tear does not require repair, it should be

checked by a second midwife and consent obtained and this should be documented in

the notes. Ms 2 stated that Ms McLaughlin had not signed the proforma and there was

no evidence that a midwife or doctor had second checked the tear. Ms McLaughlin

could have asked any midwife on the delivery suite to perform the second check.

Ms McLaughlin in her response to the allegations stated that “I accept I completed the

Perineal Tear Proforma after checking Patient A and that this tear was not checked by a

second checker”.

The panel had regard to the Perineal Trauma assessment and Repair form. The panel

noted that a second checker had not signed the form where required. The panel also

noted Ms McLaughlin had stated that she did not get a second checker to ensure that

the perineum did not need repair.


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Charge 5

Failed to monitor blood loss;




the allegation.

Ms 1 in her evidence stated that Ms McLaughlin had estimated that Patient A’s blood

loss was 400ml which is not unusual and within normal limits. However, Ms 1 stated that

there was definitely more than 400ml blood on the sheets and in the room. Ms 1

estimated there was 350ml of blood on the floor alone. Ms 1 stated that she would have

expected it to be obvious that Patient A was losing a lot of blood. Ms McLaughlin should

have called a senior midwife or doctor to come and review. Ms 1 further stated that she

could not see any observations from Ms McLaughlin. She would have expected Ms

McLaughlin to have recorded observations when Patient A stated she was dizzy.

Ms 2 in her evidence stated that she had informed Ms McLaughlin to monitor Patient A

for blood loss and to call her if blood loss was not within normal limits. Ms 2 informed

the panel that Ms McLaughlin did not raise any concerns so she assumed that

everything was normal. At around 00:30 Ms 2 spoke to Ms McLaughlin about the patient

and Ms McLaughlin had informed her that Patient A was exhausted and still in bed. At

around 00:55 or 01:00 Ms 2 stated that she was informed by Ms 1 that Patient A was

feeling faint and dizzy.

Ms McLaughlin in her response to the allegations stated that at birth she recorded that

was 400ml of blood which is within the normal range. Ms McLaughlin left the room when

Patient A went to the toilet. Ms McLaughlin stated that when Patient A returned from the

toilet she informed her she was feeling faint. This is when she requested IV fluids and

when Ms 1, Ms 2 and Ms 3 went into the room. Ms McLaughlin states that she was not

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aware of ongoing blood loss as she was at the midwives’ station awaiting colleague

access to open the system to register the birth data.

The panel had regard to the labour notes dated 30 March 2018. The panel noted that

Patient A’s observations were taken at 21:57. There were no other observations noted

in the labour notes until 01:00. There were also no observations noted in the MEOWS

chart as required. The panel noted in Ms McLaughlin’s response to the allegations

bundle she had stated that Patient A had informed her that she was feeling dizzy. The

panel had no evidence before it of any steps that Ms McLaughlin should have taken to

monitor the blood loss suffered by Patient A. Ms 1 and Ms 2 stated that the blood loss

would have occurred over a period of time. Ms McLaughlin would have seen the blood

loss if she monitored the patient. It was ultimately found that the patient had lost over

2200mls of blood over the relevant period. The panel accepted the evidence of Ms 1

and Ms 2.


Charge 6

Failed to conduct timely and frequent observations in respect of the Patient, post-

delivery;


The panel noted its reasons in charge 5. Based on those reasons and the evidence the

panel found this charge proved.

Charge 7

Failed to escalate the Patient after recording a blood pressure reading of 95/60 and a

pulse of 100 bpm;


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Ms 2 in her evidence stated that some observations had been recorded on the summary

delivery form. These observations were blood pressure of 95/60 and pulse 100. Ms 2

stated that a blood pressure of 95/60 was very low for Patient A. Ms McLaughlin had

also recorded in the labour notes blood pressure of 95/55 and a pulse of 96. Ms 2

stated that she would have expected Ms McLaughlin to be concerned with these

observations. She would have expected Ms McLaughlin to seek help.

Ms 4 in her evidence stated that Ms McLaughlin had taken some observations which

were recorded. The observations were blood pressure 95/60 which would have

categorised as yellow “thereby necessitating calling a doctor” and a pulse of 100bpm

which would also have been categorised as yellow. Ms 4 stated that Ms McLaughlin

should have called a doctor to review Patient A when she took those observations.

Observations should have been taken and recorded on the MEOWS chart. If

observations were not normal they would be categorised as yellow or red. If any one

observation was red, or two yellows this should be escalated to a doctor. Ms 4 would

have expected Ms McLaughlin to have been aware of the escalation criteria.

The panel noted that it was Ms McLaughlin who had made the recording of a blood

pressure reading of 95/60 and pulse 100 bpm. There is no evidence of Ms McLaughlin

having escalated the situation. In the circumstances, the panel find this charge proved.

Charge 8

Failed to recognise that there was only one placenta;


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allegation.

Ms 1 in her evidence stated that she had seen in the notes that Ms McLaughlin

recorded that there were two separate placenta due to two IVF embryos. Ms 1 stated

that she did not see the placenta and was not informed that there were two. Ms 1

explained that Patient A had a single pregnancy and there would only have been two

placentae if the pregnancy had started as a twin pregnancy.

Ms McLaughlin in her response to the allegations stated that Patient A had IVF with two

embryo insertion and had two identical placentas which was an anomaly. Therefore, her

uterus had two bleeding placentas which could have also led to excessive blood loss.

The panel had regard to the summary of delivery form in which Ms McLaughlin had

made an entry that of “x2 distinct separate placentae”. The panel also noted Ms

McLaughlin’s explanation that there were two placentas. The panel had regard to Ms 1’s

evidence in which she had stated that Patient A had one placenta and you only get two

when you have twins. Patient A did not have twins. The panel accepted the evidence of

Ms 1.


Charge 9

Failed to identify Patient A’s deteriorating condition;


The panel noted its reasons for the charges found proved above in particular charges 5

and 6. It further noted the evidence of Ms 4 below.

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Ms 4 in her evidence stated that she would have expected Ms McLaughlin to have

taken timely observations of Patient A after delivery. These would have included pulse

rate, blood pressure and blood loss. Ms 4 further stated that she would have expected

Ms McLaughlin to have recognised that there was an urgent need for medical

assistance when Patient A had lost a lot of blood and when the patient had said she

was feeling dizzy and faint. Ms 4 confirmed in evidence that Ms McLaughlin did not

recognise that the patient was deteriorating.


Charge 10a)

Failed to keep adequate records in respect of the Patient in that, you did not sign the

Perineal Trauma Assessment and Repair Proforma to confirm that the tear did not

require suturing;




Ms 1 in her evidence stated that Ms McLaughlin had informed her that Patient A’s

perineum was intact and had not required suturing. Further this would have needed to

be recorded and signed in the perineal tear proforma. Ms 1 stated that Ms McLaughlin

had recorded that there was a first degree tear which did not require suturing but this

was not signed for.

Ms 4 in her evidence stated that Ms McLaughlin had recorded on the Perineal Trauma

Assessment and Repair Proforma that there was a first degree tear to Patient A’s

perineum which did not require suturing. Ms 4 stated that Ms McLaughlin should have

signed at the bottom of the proforma to confirm that the tear did not require suturing and

she did not do so.

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The panel had regard to the Perineal Trauma Assessment and Repair Proforma. The

panel noted that Ms McLaughlin had put an entry that there was a first degree tear

which did not require suturing. However there was no signature at the bottom of the

page as required. Therefore Ms McLaughlin had failed to keep an adequate record.


Charge 10b)

Failed to keep adequate records in respect of the Patient in that, you did not ensure that

your assessment at a) was signed as having been second checked;




the allegation.

Ms 1 in her evidence stated that Ms McLaughlin had informed her that Patient A’s

perineum was intact and had not required suturing. Ms 1 stated that there was a second

degree tear and this would have needed to be second checked by a midwife. Further

this would have needed to be recorded and signed in the perineal tear proforma. Ms 1

stated that Ms McLaughlin had recorded that there was a first degree tear which did not

require suturing but this was not signed for or second checked.

Ms 4 in her evidence stated that Ms McLaughlin had recorded on the Perineal Trauma

Assessment and Repair Proforma that there was a first degree tear to Patient A’s

perineum which did not require suturing. Ms 4 stated that Ms McLaughlin should have

signed at the bottom of the proforma to confirm that the tear did not require suturing and

she did not do so. She should have also had a midwife or doctor check the perineum

and sign the bottom of the proforma as a second checker. There is no evidence that she

had done this.

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Ms McLaughlin in her response to the allegations stated that “I accept I completed the

Perineal Tear Proforma after checking Patient A and that this tear was not checked by a

second checker.”

The panel had regard to Perineal Trauma Assessment and Repair Proforma. The panel

noted that the form had not been signed by Ms McLaughlin and that there was no

signature from a second checker. The panel noted that Ms McLaughlin had stated that

the tear was not second checked as required. The panel accepted the evidence of Ms 1

and Ms 4 that Ms McLaughlin should have had this second checked and signed.


Charge 10c)

Failed to keep adequate records in respect of the Patient in that, you did not time the

entry of observations on the Summary of Delivery;




allegation.

Ms 3 in her evidence stated that she was looking in the notes for a record of Patient A’s

observations. Ms 3 stated that she could see that some observations had been

recorded by Ms McLaughlin on the Summary of Delivery form but there were no times

recorded. It is important that observations are recorded and timed so that intervals of

improvement or deterioration can be monitored. Every delivery room has a clock in it

and there are clocks all around the delivery suite so there would have been a way to

record the time.

Ms McLaughlin in her response to the allegations stated that in relation to the

observations these were recorded and can be seen in the birthing notes. There are no

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timings due to the fact that there was no clock in the birthing room. Ms McLaughlin

stated that she checked other birth rooms for clocks and some were missing.

The panel had regard to the entries made in the observations on the summary of

delivery. The panel noted there were observations recorded such as BP, temperature

and pulse. However, there was no time recorded in the box ‘time taken’. The panel also

noted Ms McLaughlin had stated that there were no timings due to the fact there were

no clocks. The panel had regard to Ms 3’s evidence in which she confirmed that there is

a clock in every room. Ms 4 further confirmed that she had checked shortly after the

event and there was a clock in the relevant room. The panel accepted the evidence of

Ms 3 and concluded that Ms McLaughlin had failed to keep adequate records in respect

of the patient in that, she did not time the entry of observations on the Summary of

Delivery.


Charge 10d)

Failed to keep adequate records in respect of the Patient in that, you did not record any

observations on the MEOWS chart;




the allegation.

Ms 3 in her evidence stated that she was looking in the notes for a record of Patient A’s

observations from when she delivered and could not find that Ms McLaughlin had made

any record of them. Observations should have been recorded on the partogram, written

in the body of the labour notes or recorded on a MEOWS chart.

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Ms 4 in evidence stated that Ms McLaughlin’s record keeping had been inadequate in a

number of ways. Ms 4 confirmed that Ms McLaughlin did not record observations on a

MEOWS chart. Observations should be done as soon as possible after delivery and

should be recorded on a MEOWS chart in order to monitor deterioration.

Ms McLaughlin in her response to the allegations stated that she does not accept that

her record keeping was inadequate. She said that the records were not completed due

to the fact that Ms 2 took the notes from her and Ms 3 held onto them after that. She

was then allocated to a different patient.

The panel had regard to the MEOWS chart which showed that Ms McLaughlin had not

made any entries. The panel noted the evidence of Ms 4 who stated that she would

expect the MEOWS chart to be filled in an hour of delivery for every patient. The panel

had no evidence before it that Ms McLaughlin had filled the MEOWS chart every hour

after delivery. The panel concluded that Ms McLaughlin had failed to keep adequate

records in respect of the patient in that she did not record any observations on the

MEOWS chart.


Charge 10e)

Failed to keep adequate records in respect of the Patient in that, you did not time an

entry in the Labour Record regarding asking the doctor to review the Patient;




allegation.

Ms 2 in her evidence stated that she was looking over Patient A’s notes and considered

that Ms McLaughlin’s record keeping to be of a poor standard. Ms 2 had noted that Ms

Page 23 of 43

McLaughlin’s notes were inaccurate, in that she had recorded that she had asked a

doctor for a review of the patient when she had not asked for this review.

Ms 3 in her evidence disputed that she was asked to review the patient but accepted

that the Ms McLaughlin spoke to her but denied that this amount to direct request for a

review.

Ms McLaughlin in her response to the allegations stated that she had asked Ms 3 to

review the patient and write up fluids, which she did. Ms McLaughlin stated that it could

be possible that Ms 3 did not hear her request to review the patient but she actioned her

request.

The panel had regard to the labour record and the entry which states “asked Dr to

review”. However the panel noted that Ms McLaughlin had not recorded a time next to

this entry. Therefore, no one would have seen when this was requested or what time it

was actioned. The panel noted that entries required a time to be recorded. In light of this

evidence, the panel concluded that Ms McLaughlin had failed to keep adequate records

in respect of the patient in that, she did not time an entry in the Labour Record

regarding asking the doctor to review the Patient.


Charge 10f)

Failed to keep adequate records in respect of the Patient in that, you did not time the

entries in the Labour Record concerning the placenta;




Page 24 of 43

Ms 2 in her evidence stated that she was looking over Patient A’s notes and considered

that Ms McLaughlin’s record keeping to be of a poor standard. Ms 2 had noted that Ms

McLaughlin did not put timings to some of the entries made in the labour notes.

Ms 4 in her evidence stated that Ms McLaughlin made an entry in the labour notes

concerning the placenta. However there was no time recorded on this entry.

The panel had regard to the whole of the Labour Record. The panel noted that Ms

McLaughlin had made an entry on 30 March 2018 concerning the placenta. Next to the

entry in the records Ms McLaughlin had put a time of 21:57 next to the placenta entry.

The panel therefore concluded that Ms McLaughlin had not failed to keep adequate

records in respect of the patient in that she did in fact enter a time in the Labour Record

concerning the placenta.

Based on the evidence before it the panel found this charge NOT proved.

Charge 10g)

Failed to keep adequate records in respect of the Patient in that, you did not record

whether there had been a discussion with the Patient regarding the decision that the

perineum required no repair;




Ms 2 in her evidence stated that it is in the Trust Policy that if a perineal tear does not

require repair it should be checked by a second midwife and consent obtained from the

patient. This should also be documented in the notes. Ms 2 further stated that there was

no record that consent had been obtained from Patient A to not have the tear repaired.

Page 25 of 43

Ms 4 in her evidence stated that Ms McLaughlin did not record in the labour record or

on the perineal tear proforma that she had discussed with the patient that the perineal

tear did not require repair. Ms 4 would have expected this to be discussed with the

patient and that discussion recorded.

The panel had regard to the records and noted that Ms McLaughlin had recorded that

the perineum did not require repair. The panel noted that Ms McLaughlin did not tick the

yes box to ‘repair/non repair discussed’ nor did she tick yes to the box ‘informed

consent’. The panel had regard to all the records and noted that there was no record of

this discussion taking place. The panel concluded that Ms McLaughlin failed to keep

adequate records in respect of the Patient in that she did not record whether there had

been a discussion with the Patient regarding the decision that the perineum required no

repair.


Charge 10h)

Failed to keep adequate records in respect of the Patient in that, you did not record that

the Patient had been warned of the risks of opting for a physiological third stage of

labour;




Ms 2 in her evidence stated Ms McLaughlin had made an entry in Patient A’s labour

notes “physiological third stage decided”. Ms 2 did not think this was an accurate

record. Ms 2 had recommended to Patient A to have an active third stage and explained

the risks of a physiological third stage. Ms 2 would have expected Ms McLaughlin to

have recorded this conversation in the notes and also that when the patient had been

recommended syntometrine, she had declined.

Page 26 of 43

Ms 4 in her evidence stated that Ms 2 had recommended an active third stage but the

patient wanted a physiological third stage and Ms McLaughlin supported the patient. Ms

McLaughlin had recorded in the notes “physiological third stage decided”. Ms 4 stated

that an active third stage was the appropriate course of action and would not have

expected Ms McLaughlin to recommend a physiological third stage. There was no

record that Patient A had been informed of the risks. Ms 4 would have expected a fuller

note of the discussion to have been recorded by Ms McLaughlin.

Ms McLaughlin in her response to the allegations stated that she and Ms 2

recommended syntometrine injection post birth for third stage of delivery. Ms 2 drew up

the injection but did not administer it as the parents refused. The parents insisted on a

physiological delivery.

The panel noted in the labour notes that an entry had been made by Ms McLaughlin of

“physiological third stage decided”. The panel had regard to the evidence of Ms 2 who

had stated that there was a discussion with the patient in regard to the risks of opting for

a physiological third stage of labour. Ms 3 in her evidence was unsure whether a

discussion had taken place with the patient as to risks. Ms 3 stated that this discussion

should have been documented and it would be more appropriate if the 1 to 1 midwife

documents this, who would have been Ms McLaughlin. Ms 4 had also stated in her

evidence that she would have expected this discussion to be documented.

The panel accepted the evidence of the witnesses. Ms McLaughlin was the 1-1 midwife

and she should have kept a fuller record of discussions with the patient. The panel

noted that the entry was very limited. In light of this evidence, the panel concluded that

Ms McLaughlin had failed to keep adequate records in respect of the patient in that she

did not record that the patient had been warned of the risks of opting for a physiological

third stage of labour.

Page 27 of 43

Charge 11

Had made an entry in the Patient’s Labour Record that you had requested the doctor to

review the Patient;



evidence of Ms 3.

Ms 3 in her evidence had stated that when she was writing an entry in the notes she

noticed that Ms McLaughlin had written in the notes “asked Dr to review mum as feeling

faint on getting up to toilet”.

Ms McLaughlin in her response to the allegations stated that she had asked a doctor to

review the patient.

The panel had regard to labour record and noted there was an entry made by Ms

McLaughlin which stated “Asked Dr to review mum as feeling faint”. This was signed by

Ms McLaughlin. The panel therefore concluded that Ms McLaughlin had made an entry

in the Patient’s Labour Record that she had requested the doctor to review the patient.


Charge 12a, b and c)

And your action specified in charge 11 was dishonest in that, you did not request the

doctor to review the Patient;


Page 28 of 43

The panel accepted the advice of the legal assessor who in addressing the panel in

relation to the issue of dishonesty, referred to the case of Ivey v Genting Casinos (UK)

Ltd t/a Crockfords [2017] UKSC 67:

“When dishonesty is in question the fact-finding tribunal must first ascertain

(subjectively) the actual state of the individual’s knowledge or belief as to the facts. The

reasonableness or otherwise of his belief is a matter of evidence (often in practice

determinative) going to whether he held the belief, but it is not an additional requirement

that his belief must be reasonable; the question is whether it is genuinely held. When

once his actual state of mind as to knowledge or belief as to facts is established, the

question whether his conduct was honest or dishonest is to be determined by the fact-

finder by applying the (objective) standards of ordinary decent people. There is no

requirement that the defendant must appreciate that what he has done is, by those

standards dishonest”.

The panel noted Ms McLaughlin’s evidence in which she stated that she had requested

Ms 3 to review the patient. However, she now accepts that Ms 3 may not have heard

her request at the time. The panel had regard to Ms 3’s evidence in that she disputes

that Ms McLaughlin had asked her to review the patient. There is no doubt that at about

00:55 hours Ms McLaughlin approached Ms 1 and Ms 3 at the nurse’s desk and

informed them that the patient was dizzy. She requested Ms 1 to reinsert the cannula

which had become displaced during the birth. Ms 3 also said that she asked her to

prescribe intravenous fluid for the dizziness. However, she did not consider that it was a

specific request to review the patient. During the course of her evidence Ms 3 was

prepared to accept on a number of occasions that there may well have a

misinterpretation of what was been said and who was been addressed during the

course of this conversation due to human error.

Having considered all the evidence the panel has come to the clear conclusion that

there was such a misinterpretation on the part of both Ms McLaughlin and Ms 3. On the

balance of probabilities the panel consider that Ms McLaughlin genuinely did believe

she had asked Ms 3 to review the patient.

Page 29 of 43

It follows that the entry made in the Labour record that Ms McLaughlin had requested

the doctor to review the patient was a genuine entry on the basis of Ms McLaughlin’s

genuine belief.

Although this charge is proved simply on the basis that the entry was made, that entry

was a genuine entry honestly made.

It follows that all of charge 12 is found NOT proved. The panel’s judgement is that Ms

McLaughlin was not dishonest under the test in Ivey or any other test.

Page 30 of 43

Fitness to practise

Having reached its determination on the facts of this case, the panel then moved on to

consider, whether the facts found proved amount to misconduct and, if so, whether Ms

McLaughlin’s fitness to practise is currently impaired. There is no statutory definition of

fitness to practise. However, the NMC has defined fitness to practise as a registrant’s

suitability to remain on the register unrestricted.

The panel, in reaching its decision, has recognised its statutory duty to protect the

public and maintain public confidence in the profession. Further, it bore in mind that

there is no burden or standard of proof at this stage and it has therefore exercised its

own professional judgement.

The panel adopted a two-stage process in its consideration. First, the panel must

determine whether the facts found proved amount to misconduct. Secondly, only if the

facts found proved amount to misconduct, the panel must decide whether, in all the

circumstances, Ms McLaughlin’s fitness to practise is currently impaired as a result of

that misconduct.

Submissions on misconduct and impairment

Ms Mohamed invited the panel to take the view that the facts found proved amount to

misconduct. The panel had regard to the terms of ‘The Code: Professional standards of

practice and behaviour for nurses and midwives (2015)’ (the Code) in making its

decision. Ms Mohamed identified breaches of specific, relevant standards where Ms

McLaughlin’s actions amounted to misconduct.

Ms Mohamed submitted that Ms McLaughlin’s failings were widespread and covered

some basic areas of midwifery practice which included taking observations, record

keeping and effective monitoring of patient deterioration. Ms Mohamed submitted that

Ms McLaughlin’s actions were sufficiently serious to amount to misconduct.

Page 31 of 43

Ms Mohamed moved on to the issue of impairment and addressed the panel on the

need to have regard to protecting the public and the wider public interest. This included

the need to declare and maintain proper standards and public confidence in the

profession and in the NMC as a regulatory body. This included reference to the case of

Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2)

and Grant [2011] EWHC 927 (Admin).

Ms Mohamed submitted that Ms McLaughlin’s actions put Patient A at unwarranted risk

of harm. Ms McLaughlin’s failings included basic fundamental nursing skills. Ms

Mohamed informed the panel that any member of the public would expect registered

midwives to carry out basic observations, monitor patients, escalate where necessary

and be able to clinically assess a patient post-delivery. Ms Mohamed stated that Ms

McLaughlin’s failures have brought the profession into disrepute and she breached one

of the fundamental tenets of the profession.

Ms Mohamed explained to the panel that Ms McLaughlin has not provided any evidence

of insight, remorse or remediation for her actions. In light of this, she submitted that a

finding of current impairment is necessary on both public protection grounds and in the

public interest, in order to maintain and uphold proper standards of the profession.

The panel took note of Ms McLaughlin’s response to the allegations in a reflective

summary, dated 1 December 2019, which stated:

“My uninterrupted working career in the NHS began in 1979 and completed in the

summer of 2018. I chose to retire formally from the NHS in June 2018 to pursue

other interest outside of “health and social care”. I no longer practise as a

midwife, although the NMC successfully revalidated my practice in 2019.

I have discussed my position with Thompsons Solicitor representing me, and

conclude that I would be happy to voluntarily remove myself from the NMC

Register, alas there is a flaw in the current NMC options which would force me to

agree to the allegations made against me, this I am not prepared to do as it

would be untrue.”

Page 32 of 43

Decision and reasons on misconduct

The panel accepted the advice of the legal assessor which included reference to a

number of relevant judgments. These included: Roylance v General Medical Council

(No 2) [2000] 1 AC 311, Cohen v General Medical Council [2008] EWHC 581 (Admin),

Meadow v GMC [2006] EWCA Ci 1390, Zygmunt v GMC [2008] EWHC 581, Cheatle v

GMC [2009] EWHC 645 and Council for Healthcare Regulatory Excellence v (1)

Nursing and Midwifery Council (2) and Grant [2011] EWHC 927 (Admin).

In coming to its decision, the panel had regard to the case of Roylance v General

Medical Council (No. 2) [2000] 1 AC 311 which defines misconduct as a ‘word of

general effect, involving some act or omission which falls short of what would be proper

in the circumstances.’

When determining whether the facts found proved amount to misconduct, the panel had

regard to the Code and in particular, the Professional standards of practice and

behaviour for nurses and midwives (2015).

The panel reminded itself that a registered nurse is personally accountable under the

NMC Code for acts and omissions in their practice. The panel had regard to the relevant

version of the Code. The Code contains the underlying principles that guide the nursing

profession and is in place to protect the public and to ensure that proper standards of

the profession are upheld.

The panel deemed that Ms McLaughlin breached the following paragraphs of the code:

“1.2 make sure you deliver the fundamentals of care effectively;

1.4 make sure that any treatment, assistance or care for which you are

responsible is delivered without undue delay;

2.1 work in partnership with people to make sure you deliver care effectively;

Page 33 of 43

4.1 balance the need to act in the best interests of people at all times with the

requirement to respect a person’s right to accept or refuse treatment;

4.2 make sure that you get properly informed consent and document it before

carrying out any action;

8.1 respect the skills, expertise and contributions of your colleagues, referring

matters to them when appropriate;

8.2 maintain effective communication with colleagues;

8.3 keep colleagues informed when you are sharing the care of individuals with

other health and care professionals and staff;

8.4 work with colleagues to evaluate the quality of your work and that of the

team;

8.5 work with colleagues to preserve the safety of those receiving care;

8.6 share information to identify and reduce risk;

10.1 complete records at the time or as soon as possible after an event,

recording if the notes are written some time after the event;

10.2 identify any risks or problems that have arisen and the steps taken to deal

with them, so that colleagues who use the records have all the information they

need;

10.4 attribute any entries you make in any paper or electronic records to yourself,

making sure they are clearly written, dated and timed, and do not include

unnecessary abbreviations, jargon or speculation;

Page 34 of 43

13.1 accurately identify, observe and assess signs of normal or worsening

physical and mental health in the person receiving care;

13.2 make a timely referral to another practitioner when any action, care or

treatment is required;

13.3 ask for help from a suitably qualified and experienced professional to carry

out any action or procedure that is beyond the limits of your competence;

20.1 keep to and uphold the standards and values set out in the Code.”

The panel appreciated that breaches of the Code do not automatically result in a finding

of misconduct. However, the panel was of the view that Ms McLaughlin’s actions did fall

seriously short of the standards expected of a registered midwife and amounted to

misconduct.

The panel considered that undertaking observations, record-keeping and escalating a

deteriorating patient were all fundamental midwifery skills. The panel was of the view

that a registered midwife, particularly one with as much experience as Ms McLaughlin,

is expected to be able to provide the appropriate care to a patient post-delivery. Ms

McLaughlin failed to demonstrate these skills, resulting in Patient A experiencing delay

in care and suffering harm as a result.

The panel decided that Ms McLaughlin’s actions individually and cumulatively in this

matter fell seriously short of the conduct and standards expected of a registered midwife

and amounted to misconduct.

Decision and reasons on impairment

Midwives occupy a position of privilege and trust in society and are expected at all times

to be professional. Patients and their families must be able to trust midwives with their

lives and the lives of their loved ones. To justify that trust, they must make sure that

Page 35 of 43

their conduct at all times justifies both their patients’ and the public’s trust in the

profession.

In this regard the panel considered the judgment of Mrs Justice Cox in the case of

CHRE v NMC and Grant in reaching its decision. In paragraph 74, she said:

‘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.’

In paragraph 76, Mrs Justice Cox referred to Dame Janet Smith's “test” which reads as

follows:

‘Do our findings of fact in respect of the doctor’s misconduct, deficient

professional performance, adverse health, conviction, caution or

determination show that his/her fitness to practise is impaired in the

sense that s/he:

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 medical 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 medical

profession; and/or

Page 36 of 43

d) ...’

The panel found that limbs a, b and c of the Grant test were engaged in Ms

McLaughlin’s case and that Patient A was put at risk and suffered harm as a result of

Ms McLaughlin’s misconduct. Also, Ms McLaughlin’s misconduct had breached the

fundamental tenets of the nursing profession and therefore brought its reputation into

disrepute.

Regarding the issue of insight, the panel considered that there has been no evidence

before it that Ms McLaughlin has any remorse or insight into her failings. She has not

demonstrated an understanding of how her actions put Patient A at risk of harm, nor

has she demonstrated an understanding or any reflection as to how to prevent her

omissions recurring. The panel took into consideration Ms McLaughlin’s reflection of the

incident and that it was a busy shift. However the panel is of the view that Ms

McLaughlin has a tendency to deflect blame onto others for her own actions. Ms

McLaughlin is an experienced midwife and the panel is in no doubt that it is the

professional responsibility of a registered midwife to take responsibility for their actions.

The panel was not satisfied that Ms McLaughlin has any insight into her professional

responsibilities in this matter.

The panel was satisfied that the misconduct in this case is capable of remediation. It

bore in mind the evidence of Ms 4 who stated that this event was not formally registered

as a serious incident and that if Ms McLaughlin had not been an agency midwife the

matter would have been dealt with in house through remedial support and training.

Nevertheless Ms McLaughlin’s misconduct involves widespread failings in basic areas

of midwifery practice. Therefore, the panel carefully considered the evidence before it in

determining whether or not Ms McLaughlin has remediated her practice. The panel took

into account that there was no evidence before it that Ms McLaughlin had taken any

steps to remediate her midwifery practice. The panel noted Ms McLaughlin had stated

that she would not be practising midwifery in the future. However, she may always have

a change of heart.

Page 37 of 43

The panel is therefore of the view that there is a real risk of repetition of the misconduct

identified in Ms McLaughlin’s case were she to return to midwifery practice. The panel

therefore decided that a finding of impairment is necessary on the grounds of public

protection.

The panel bore in mind that the overarching objectives of the NMC to protect, promote

and maintain the health, safety, and wellbeing of the public and patients, and to uphold

and protect the wider public interest. This includes promoting and maintaining public

confidence in the nursing and midwifery professions and upholding the proper

professional standards for members of those professions.

The panel had regard to the serious nature of Ms McLaughlin’s failings and determined

that public confidence in the profession would be undermined if a finding of current

impairment was not made. For this reason, the panel determined that a finding of

current impairment on public interest grounds was also required.

Having regard to all of the above, the panel was satisfied that Ms McLaughlin’s fitness

to practise is currently impaired on both public protection and public interest grounds.

Page 38 of 43

Sanction

The panel has considered this case very carefully and has decided to make a

suspension order for a period of six months. The effect of this order is that the NMC

register will show that Ms McLaughlin’s registration has been suspended.

In reaching this decision, the panel has had regard to all the evidence that has been

adduced in this case and had careful regard to the Sanctions Guidance (SG) published

by the NMC. The panel accepted the advice of the legal assessor.

Submissions on sanction

Ms Mohamed informed the panel that the NMC would seek the imposition of a

suspension order for a period of 6 months with a review. This would allow Ms

McLaughlin time to reflect on the matters in this case.

Decision and reasons on sanction

Having found Ms McLaughlin’s fitness to practise currently impaired, the panel went on

to consider what sanction, if any, it should impose in this case. The panel has borne in

mind that any sanction imposed must be appropriate and proportionate and, although

not intended to be punitive in its effect, may have such consequences. The panel had

careful regard to the SG. The decision on sanction is a matter for the panel

independently exercising its own judgement.

The panel took into account the following aggravating features:

Ms McLaughlin delayed providing care and Patient A suffered harm;

Ms McLaughlin’s lack of insight, remediation or remorse into her failings;

Ms McLaughlin’s tendency to not accept any responsibility for her own actions.

Page 39 of 43

The panel also took into account the following mitigating features:

Ms McLaughlin had worked an otherwise unblemished career over a long period

as a registered midwife.

The panel first considered whether to take no action but concluded that this would be

inappropriate in view of the seriousness of the case. The panel decided that it would be

neither proportionate nor in the public interest to take no further action.

It then considered the imposition of a caution order but again determined that, due to

the seriousness of the case, and the public protection issues identified, an order that

does not restrict Ms McLaughlin’s practice would not be appropriate in the

circumstances. The SG 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

considered that Ms McLaughlin’s misconduct was not at the lower end of the spectrum

and that a caution order would be inappropriate in view of the issues identified. The

panel decided that it would be neither proportionate nor in the public interest to impose

a caution order.

The panel next considered whether placing conditions of practice on Ms McLaughlin’s

registration would be a sufficient and appropriate response. The panel is mindful that

any conditions imposed must be proportionate, measurable and workable. The panel

took into account the SG.

Whilst the panel accepts that the failings in this case are capable of remediation, Ms

McLaughlin has expressed a wish to not return to midwifery practice. Under these

circumstances it is difficult to see how the panel could frame conditions which are

workable, practical or would adequately protect the public or the public interest issues

raised in this case.

Page 40 of 43

The panel then went on to consider whether a suspension order would be an

appropriate sanction. The SG states that suspension order may be appropriate where

some of the following factors are apparent:

A single instance of misconduct but where a lesser sanction is not

sufficient;

No evidence of harmful deep-seated personality or attitudinal problems;

No evidence of repetition of behaviour since the incident;

In cases where the only issue relates to the nurse or midwife’s lack of

competence, there is a risk to patient safety if they were allowed to

continue to practise even with conditions.

The panel was satisfied that in this case, the misconduct was not fundamentally

incompatible with Ms McLaughlin remaining on the register. Although Ms McLaughlin’s

misconduct was serious, it was an isolated set of events in an otherwise long

unblemished career.

The panel accepted the NMC’s sanction bid in this case for a suspension order for a

period of six months with a review. The panel agreed and formed its own view that a six

month suspension order would address the public protection and public interest issues

raised in this case. The six month suspension will be reviewed by a future panel and will

give Ms McLaughlin sufficient time either to re-engage with the process or to maintain

her expressed wish to retire from the midwifery profession. Ms McLaughlin must

understand that if she fails to engage with the process a future reviewing panel will have

limited options available to it.

The panel did go on to consider whether a striking-off order would be proportionate but,

taking account of all the information before it the panel concluded that it would be

disproportionate. Whilst the panel acknowledges that a suspension may have a punitive

effect, it would be unduly punitive in Ms McLaughlin’s case to impose a striking-off

order.

Page 41 of 43

Balancing all of these factors the panel has concluded that a suspension order would be

the appropriate and proportionate sanction. The panel considered that this order is

necessary to mark the importance of maintaining public confidence in the profession,

and to send to the public and the profession a clear message about the standard of

behaviour required of a registered midwife. The panel noted the hardship such an order

will inevitably cause Ms McLaughlin. However, this is outweighed by the public interest

in this case.

The panel determined that a suspension order for a period of up to six months was

appropriate in this case to mark the seriousness of the misconduct.

At the end of the period of suspension, another panel will review the order. At the review

hearing the panel may revoke the order, or it may confirm the order, or it may replace

the order with another order.

If Ms McLaughlin decided to re-engage with the process a future panel reviewing would

be assisted by:

Full reflection from Ms McLaughlin into the issues that have been raised

in this case;

Evidence of remediation.

The panel will now consider the imposition of an interim order.

Page 42 of 43

Interim order

As the suspension order will not effect until the end of the 28-day appeal period, the

panel has considered whether an interim order is required in the specific circumstances

of this case. It may only make 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 Ms McLaughlin’s own

interest until the suspension sanction takes effect. The panel heard and accepted the

advice of the legal assessor.

Submissions on interim order

The panel took account of the submissions made by Ms Mohamed. She submitted that

an interim suspension order for a period of 18 months is a necessary and proportionate

order to cover the appeal period.

Decision and reasons on interim order

The panel was satisfied that an interim order is necessary for the protection of the public

and is otherwise in the public interest. The panel had regard to the seriousness of the

facts found proved and the reasons set out in its decision for the substantive order in

reaching the decision to impose an interim order.

The panel concluded that an interim conditions of practice order would not be

appropriate or proportionate in this case, due to the reasons already identified in the

panel’s determination for imposing the substantive order.

The panel therefore imposed an interim suspension order, as to do otherwise would be

incompatible with its earlier findings.

This will be for a period of 18 months to allow sufficient time for an appeal to be lodged

and heard.

Page 43 of 43

If no appeal is made, then the interim suspension order will be replaced by the

substantive suspension order 28 days after Ms McLaughlin is sent the decision of this

hearing in writing.

This decision will be confirmed to Ms McLaughlin in writing.

That concludes this determination.

Documents

Nursing and Midwifery Council Fitness to Practise ...€¦ · 27/01/2020 · checked by another midwife as is required by the Hospitals labour clinical care guideline. Further allegations