Conduct and Competence Committee Substantive Hearing 1 ......2015/11/17 · Page 1 of 63 Conduct and Competence Committee Substantive Hearing 1- 12 June 2015 5- 6 October 2015 16-17

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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

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Interim order: Interim suspension order - 18 Months

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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:

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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.

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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


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

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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.

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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.

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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

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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.

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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


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

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• Ms 7 – Midwife at the Trust


• Ms 9 – Midwife for Safeguarding Children at the Trust

• Ms 10 – Maternity Support Worker at the Trust


• Ms 12 – Practice Development Manager; Lead 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.

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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.

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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

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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 -

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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

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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.

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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 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;

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1. Provided or caused to be provided to your employer a reference dated 6 February


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

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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


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.

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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.


Charge 4 4. Your conduct, as set out in charges 1, 2 and/or 3 above, was dishonest in that your



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.


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.


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.


5.2 Self-administered drugs whilst on duty


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


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:





In your own statement you wrote [PRIVATE - REDACTED]

The panel bore in mind your oral evidence [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.


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.



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.



5.3 Discharged your duties whilst under the influence of drugs.


In considering this allegation the panel had regard to its previous finding that you self-

administered drugs during the shift commencing 27 May 2013.



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


6.2 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


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.


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.


15 November 2012 you failed to respond to a request to care for a patient.



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.


15 November 2012 you failed to respond to one or more call bells.



6.6 Failed to adequately assist the team throughout the shift


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.


15 November 2012 you failed to adequately assist the team throughout the shift.


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.


7.1 Failed to respond to a request to assist a patient with breastfeeding support


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.


20 November 2012 you failed to respond to a request to assist a patient with

breastfeeding support.



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.


20 November 2012 you read a magazine whilst on duty.


Charge 8.1 8. Before the end of your shift on 29 November 2012 you failed to complete and/or


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.




8.2 Labelling of the baby


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.



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




8.4 Labelling of the placenta


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.




8.5 Completion of the post natal VTE assessment


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


9.1 Failed to complete the pre-birth plan


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.


Charge 9.2 9. During your shift ending on 29 November 2012 you failed to follow safeguarding


9.2 Failed to inform the necessary persons of Patient B’s admission to the ward


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.


Charge 9.3 9. During your shift ending on 29 November 2012 you failed to follow safeguarding


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.


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.’


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.


Charge 10.2 10. On the night shift commencing 24 May 2013

10.2 Self-administered drugs whilst on duty

Page 45 of 63


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].





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.


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


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.


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 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.

Documents

Conduct and Competence Committee Substantive Hearing 1 ......2015/11/17 · Page 1 of 63 Conduct and Competence Committee Substantive Hearing 1- 12 June 2015 5- 6 October 2015 16-17