Conduct and Competence Committee. Substantive Hearing

Transcription

1 Conduct and Competence Committee Substantive Hearing 05 May The Hilton Belfast, 4 Lanyon Place, BT1 3LP 21 June The Hilton Belfast, 4 Lanyon Place, BT1 3LP Name of Registrant Nurse / Midwife: NMC PIN: Annette Dolores McCartney 94Y0020N Part(s) of the register: Registered Nurse sub part 1 Adult September 1997 Type of Case: Panel Members: Legal Assessor: Council s Officer: Nursing and Midwifery Council: Nurse: Misconduct Paul Hindley (Chair/ Lay member) Jude O Neill (Lay panellist) Ian Potter (Registrant panellist) Conor Heaney Alex Morrison (Original) Edward Briggs (Resuming) Represented by Neil Moloney, Nursing and Midwifery Council Regulatory Legal Team Ms McCartney did not attend and was not represented on either occasion Facts proved: 1, 2.(a)(b)(c)(d), 4, 5(a)(ii),(b),(c) and 6 Facts not proved: Fitness to practise: Sanction: Interim order: 2.(e)(f), 3 and 5(a)(i) Impaired Striking Off Order Interim suspension order for 18 months Details of charge: That Ms McCartney, while employed as a band 5 nurse by Belfast Health and Social Care Trust ( the Trust ) on Ward 6 South at Belfast City Hospital: 1. On one or more occasions between 1 May and 4 August 2010: a. Took Oramorph from a medication trolley for her personal consumption; Page 1 of 15

2 b. Diluted bottles of Oramorph with other fluids to disguise that she had taken Oramorph for her personal consumption; c. Allowed patients to be given diluted Oramorph; d. Supplemented the reduced dose of Oramorph given to patients with other medication; e. Administered medication to patients that had not been prescribed; f. Did not record that she had administered supplemental medication to patients; 2. On one or more occasions between 1 May and 4 August 2010: a. Took Oxycodone liquid prescribed for patients for her personal consumption; b. Diluted a bottle or bottles of Oxycodone with other fluids to disguise that she had taken Oxycodone for she personal consumption; c. Allowed patients to be given diluted Oxycodone; d. Supplemented the reduced dose of Oxycodone given to patients with other medication; e. Administered medication to patients that had not been prescribed; Not Proved f. Did not record that she had administered supplemental medication to patients; Not Proved 3. On or about 5 July 2010, altered Patient A s medication kardex to obtain Co-codamol 30/500 effervescent tablets that had not been prescribed for Patient A; Not Proved 4. On 30 July 2010, took an open bottle of Oramorph from a medication trolley for her own personal use; 5. On 4 August 2010: a. At about hours: i. poured a dose of Oramorph into a measuring cup when she should have used a syringe; Not Proved ii. did not accurately measure the prescribed dose: Page 2 of 15

3 b. At about hours, poured a quantity of Oramorph into a measuring cup and took it yourself; c. At about hours, poured a quantity of Oramorph into a measuring cup, added a dose of Lactulose, and took the mixture herself; 6. Her conduct as set out in the following paragraphs was dishonest: a. 1(a), (b), (c), (d), (e), (f) b. 2(a), (b), (c), (d), (e), (f) c. 3 d. 4 e. 5(b), (c) And in light of the above, her fitness to practise is impaired by reason of her misconduct. Decision on whether to proceed in the absence of the registrant The panel has decided to proceed in the absence of Ms McCartney. The panel has heard and accepted the advice of the legal assessor. It has examined the documents relevant to proof of service. It is satisfied that service of the Notice of today s hearing has been effected in accordance with Rules 8 and 34 of the NMC Fitness to Practise Rules 2004 and that it was served in a reasonable time in advance of the hearing. The panel then went on to consider whether to exercise its discretion to proceed in Ms McCartney s absence. It has borne in mind that it must exercise the utmost care and caution before doing so. Any registrant has the right to a fair hearing and the right to participate in it. However, the right to attend is not absolute. A registrant may have voluntarily absented herself, or the right to attend may be outweighed by other public interest considerations. The panel had regard to the CCC case management form, signed by Ms McCartney, and dated 6 November 2011, in which she states: I will not be attending any further hearings investigations etc. The panel considered the Registrant s response to notice of hearing document, signed by Ms McCartney, and dated 20 February 2012, which states: Page 3 of 15

4 I am not coming to the hearing because further public humiliation at reliving my shame, will not affect the panel s inevitable [inevitably] severe sanction. The panel had regard to these documents and is accordingly satisfied that Ms McCartney has voluntarily absented herself. It considers that, in these circumstances, an adjournment would serve little purpose. The panel is satisfied that it is in the interests of justice, in Ms McCartney s interest and in the public interest to proceed in Ms McCartney s absence. Decision on whether to refer the matter to the health committee The panel had sight of written submissions of Ms McCartney contained in the CCC case management form, signed by Ms McCartney and dated 6 November 2011 and in the CCC Registrant s response to notice of hearing, also signed by Ms McCartney and dated 20 February In her submissions Ms McCartney refers to an ongoing health condition which, she states, existed at the time of the events alleged. In his submissions, the NMC case presenter, Mr Moloney, asked that the panel consider whether the matter might need to be referred to a health committee. The panel heard and accepted the advice of the legal assessor who referred it to Rule 14 (1) and (2) of the NMC Fitness to Practise Rules Rule 14(2) states; The Conduct and Competence Committee shall not transfer an allegation to the Health Committee unless it is satisfied that, if the registrant s fitness to practise were found to be impaired, it would not make a striking-off order. The panel noted that the charges referred to conduct that threatened the safety of patients as well as allegations of widespread dishonesty. It had no doubt that the allegations contained in the charges were of a very serious nature and the panel held that, should the facts be found proved, and Ms McCartney s practice found currently impaired, it could not rule out the possibility of making a striking off order in this matter. Accordingly, on the basis of Rule 14(2) the panel is satisfied that this is not a matter that should be referred to the health committee. Decision on whether Ms McCartney s submissions amount to admissions in relation to charges 2 to 6. The panel heard the submissions of Mr Moloney who asserted that it might be inferred, from Ms McCartney s written submissions, that she had admitted all the charges. However, he noted that to be considered as admissions of fact, the panel might need to find her admissions to be unequivocal. He asserted that her admissions in relation to charges 2 to 6 might be deemed to fall short of that threshold. The panel heard and accepted the advice of the legal assessor. It considered Ms McCartney s submissions, which do not provide any explicit admissions in relation to charges 2 to 6. It also had regard to her written response contained in the registrant s response to notice of hearing document, which states: Page 4 of 15

5 I have already admitted guilt to most charges. The panel considered this statement sufficient to show that Ms McCartney s admissions in relation to charges 2 to 6 were not unequivocal and accordingly it does not accept that they can be found proved by way of her admissions. Decision on admission of written witness statements in evidence The panel heard an application from Mr Moloney that witness statements of David McCook, Angela Peters and Olive MacLeod be read into evidence. In his submissions Mr Moloney asserted that Ms McCartney had been informed that those witnesses would attend the hearing and would read their statements into evidence. No objection had been received from her to this procedure. However, following Ms McCartney s decision not to attend the hearing the NMC had decided that the witnesses presence was not required and it would instead read into evidence their written statements. He noted that Ms McCartney had seen the written statements and no objection to their contents had been received from her. However, he noted that he was unable to confirm whether Ms McCartney had been made aware that the NMC would make this application. The panel heard and accepted advice from the legal assessor who referred it to Rule 31(1) of the 2004 Fitness to Practise Rules, which states that: Upon receiving the advice of the legal assessor, and subject only to the requirements of relevance and fairness, a Practice Committee considering an allegation may admit oral, documentary or other evidence, whether or not such evidence would be admissible in civil proceedings. He also referred to the case of Bonhoeffer which relates to the absence of a witness at a hearing in which the registrant is in attendance. That matter concerned contentious issues for which the registrant sought clarity through cross-examination of that witness. Mr Maloney accepted that the registrant in that case had attended and had raised an objection to the fairness of the proceedings if the admission of the witness statement was admitted without the maker of the statement being present to give evidence. The panel accepted Mr Moloney s submission that the statements are of relevance. It then considered the issue of fairness. It noted that in this matter Ms McCartney has made general admissions which, although not sufficiently explicit to amount to admissions of the facts of all the charges, are sufficient to indicate the facts as alleged by the witnesses are unlikely to be considered contentious. The panel considered notable that Ms McCartney had seen the witness statements and not objected to their contents, had made partial admissions to the charges, and by voluntarily absenting herself had waived her right of cross examination. Accordingly, the panel is satisfied that the facts in this case are suitably distinguished from the facts contained in Bonhoeffer. Accordingly it is satisfied that the statements are both relevant and that there would be no unfairness to the registrant in their admission. The Panel reminds itself that the question of admitting the witness statements at this Page 5 of 15

6 stage can be kept under review by the Panel to ensure the rights of the registrant are not prejudiced if material which is not relevant to the charges is contained in the witness statements once they are admitted. The panel also noted that it was open to its professional judgment to treat the evidence as hearsay and to apply the appropriate weight to it as they see fit. Decision and reasons for proceeding in absence of the registrant: The panel heard that the Notice of Hearing had been posted by 1st class and recorded delivery on 15 May 2012 to Ms McCartney s registered address. The panel took advice from the legal assessor and concluded that service had been effected in accordance with Rules 34 and 21 of the (Fitness to Practise) Rules Order of Council In deciding whether to proceed in the absence of Ms McCartney the panel has been careful to exercise the utmost care and caution as required by case law. In exercising its discretion the panel took into account the fact that Ms. McCartney failed to attend the previous hearing. The panel noted that Ms McCartney has not corresponded with the NMC to indicate her intention to attend this resumed hearing or to request that the proceedings be adjourned on grounds of health or to seek representation. The panel therefore concluded that the Registrant has voluntarily absented herself from today s hearing and that an adjournment would serve no useful purpose. Having regard to all the circumstances, and the submissions made by Mr. Moloney on behalf of the NMC, the panel is satisfied that in view of the seriousness of the allegations it is fair and reasonable, in the interests of justice and in the public interest to proceed in Ms McCartney s absence. Decision on facts Ms McCartney was employed as a registered nurse by Belfast City Hospital ( the Hospital ) from 1998 as a Band 5 nurse. She worked 22 hours a week on Ward 6 South and was considered to be a Senior Staff Nurse who would take charge of the Ward on occasions. Ward 6 South is a 25 bed adult mixed sex, acute medical ward. It consists of 3 sections all of which have their own medicine trolley. These are the A-B male section, the C-D female section and a 6 single room and 3 bed female bay, E-L. Problems first arose on the ward on Friday 28 May 2010 when a patient in Bay C-D was given a dose of Oramorph medicine which had been borrowed from the E-L medicine trolley, as the bottle in the C-D trolley was empty. The patient commented that the medicine tasted funny. Charge Nurse, David McCook and ward pharmacist, Angela Peters examined the bottle of Oramorph from which the dose had been taken and found it to be smelling of linctus which is a common cough medicine. Linctus is also stored on the medicine trolleys and is in a similar size bottle to the Oramorph. The suspect bottle was therefore removed from the ward and two new bottles of medicine were ordered. One of these was for the C-D trolley and the other for the E-L trolley. Page 6 of 15

7 On Tuesday 01June 2010, following discussions between David McCook and Angela Peters, it was decided to send the bottle of Oramorph for analysis and testing in case there was a manufacturing issue. A sample was also taken from a control bottle. On taking a sample from the bottle which had been put in the E-L trolley the previous Friday it was noted that this now looked very watery in comparison from the bottle out of the C-D trolley which had also been obtained on the same Friday. As a result the pharmacy manager, Julia Tolan was informed. The results of the test came back 10 days later and indicated that the bottle of Oramorph that smelt of linctus was of a 67% concentrate of an expected 100% and the watery appearing Oramorph, was just 44% concentrate of an expected 100%. This confirmed that both bottles had been diluted without authorisation. The panel had sight of written witness statements from the following colleagues of Ms McCartney at Belfast City Hospital: Angela Peters, Clinical Pharmacist; David McCook, Charge Nurse and Olive MacLeod, Co-Director of Nursing at the Belfast Heath and Social Care Trust. The panel carefully considered all the evidence, and Ms McCartney s response from the case management papers and the submissions of the NMC case presenter. It has accepted the advice of the legal assessor and has proceeded on the basis that the burden of proof lies with the NMC and that the facts must be proved on the balance of probabilities. The panel has considered in detail the three witness statements referred to above together with related exhibits. The panel note that the Ms McCartney has not sought to challenge the veracity of these documents in her case management form, submitted before the commencement of the hearing. The panel has borne in mind that the failure of Ms McCartney to attend these proceedings in no way strengthens the case against her. The panel has carefully evaluated the witness material and considers that it is a reliable and consistent base upon which to test the allegations against Ms McCartney. 1. On one or more occasions between 1 May and 4 August 2010: a. Took Oramorph from a medication trolley for her personal consumption; b. Diluted bottles of Oramorph with other fluids to disguise that she had taken Oramorph for her personal consumption; c. Allowed patients to be given diluted Oramorph; d. Supplemented the reduced dose of Oramorph given to patients with other medication; e. Administered medication to patients that had not been prescribed; f. Did not record that she had administered supplemental medication to patients; The panel find charge 1 proved by way of Ms McCartney s admission. 2. On one or more occasions between 1 May and 4 August 2010: a. Took Oxycodone liquid prescribed for patients for her personal consumption; Page 7 of 15

8 b. Diluted a bottle or bottles of Oxycodone with other fluids to disguise that she had taken Oxycodone for she personal consumption; The panel had regard to the witness statement of Mr McCook who stated that he met with Ms McCartney on 07September 2010 as part of the Hospital s disciplinary proceedings. Mr McCook records that at this meeting: When asked how long the tampering and diluting of medicine had been going on for Annette McCartney replied that it was from May 2010 following an incident at work and a road traffic accident. She denied taking Oxycodone in February or March 2009 but admitted that she may have taken it once or twice in 2010 and that she did top up the bottle. Annette denied taking Oxycodone capsules but stated that she would take the Oxycodone liquid and Oramorph herself and would give the patient at Co-codamol 30/500 tablet as a supplement. This Co-codamol would not have been prescribed for the patient. The panel also had sight of typed notes taken during this meeting which demonstrate that Ms McCartney was asked if she had ever taken oxycodone liquid. To which she replied: Yes. Probably once or twice, and yes I topped it up. In light of Ms McCartney s comments during her employer s disciplinary proceedings the panel find charge 2(a) and (b) proved. c. Allowed patients to be given diluted Oxycodone; d. Supplemented the reduced dose of Oxycodone given to patients with other medication; The panel notes that Ms McCartney admitted taking oxycodone, topping up the bottle and placing it back on the medication trolley. The panel determined that these actions had the effect of allowing any patients prescribed oxycodone to be given a diluted dose of the medication. In Ms McCartney s interview of 07 September 2010 she was further asked if she ever took oxycodone capsules for herself and replied: No. I don t think so. I have taken oxycodone and oramorph myself and given the patient co-codamol 30/500 tablets as a supplement. In light of these comments the panel consider that Ms McCartney has evidently supplemented the reduced dose of oxycodone which patients would have received with co-codamol tablets. Accordingly the panel find charge 2(c) and (d) proved. e. Administered medication to patients that had not been prescribed; f. Did not record that she had administered supplemental medication to patients; Page 8 of 15

9 The panel note that they have not had sight of any patient prescription records to demonstrate incorrect medication had been administered to patients. In all the circumstances the panel determined that there is insufficient evidence before it to demonstrate, on the balance of probabilities, that Ms McCartney administered medication to patients which had not been prescribed or failed to properly record that she had done so. Accordingly the panel find charge 2(e) and (f) not proved. 3. On or about 5 July 2010, altered Patient A s medication kardex to obtain Co-codamol 30/500 effervescent tablets that had not been prescribed for Patient A; Angela Peters reported an incident on 05 July 2010 where there had been an alteration of a patient s medication. The alteration was an amendment of the prescription for paracetamol to 30/500 effervescent. In Ms McCartney s interview with Mr McCook on 07 September 2010, in answer to whether or not she had ordered from an altered medicine kardex to obtain co-codamol 30/500 effervescent she stated: Yes those were for me. I also took 30/500 effervescent for myself on occasions. The panel have had sight of the amended Kardex which contains a signature. However it is not possible to determine if this is Ms McCartney s signature or not. The panel note Ms McCartney s comments in her disciplinary proceedings that she had ordered from an altered Kardex. However Ms McCartney did not admit to altering the Kardex herself. In all the circumstances the panel determined that there is insufficient evidence to prove on the balance of probabilities that Ms McCartney altered Patient A s medication Kardex. Therefore charge 3 is found not proved. 4. On 30 July 2010, took an open bottle of Oramorph from a medication trolley for her own personal use; The panel notes the evidence of Angela Peters who states that around the time of the 30 July 2010 a bottle of Oramorph was found to have gone missing when a patient for whom the Oramorph had been prescribed had passed away. In her statement Ms Peters explains that in these situations the Oramorph would have been kept for the use of another patient. She stated that she and Mr McCook conducted a search of the ward but were unable to locate the missing bottle. In her interview with Mr McCook, Ms McCartney was asked if she had taken a full bottle [of Oramorph] from the ward on Friday 30 July 2010, to which she replied: I can t remember but I may have. The panel notes that Ms McCartney has admitted to using Oramorph, and to taking Oramorph from the bottles kept in the medication trolleys on the ward. In all the circumstances the panel concludes that it is more likely than not that Ms McCartney took the open bottle of Oramorph around the 30 July 2010 for her own use. Page 9 of 15

10 Accordingly this charge is found proved. 5. On 4 August 2010: a. At about hours: i. poured a dose of Oramorph into a measuring cup when she should have used a syringe; In his statement Mr McCook described that he watched CCTV which had been taken on 04 August He stated that at 09:13:04 Ms McCartney was observed to pour out a measure of Oramorph Liquid into a measuring cup which was graduated in 5ml intervals. The panel notes that Mr McCook stated that for any dose of less than 5ml a syringe should be used to measure the correct dose. He went on to state that in the video Ms McCartney was seen to pour the measure of Oramorph at waist height and that it should in fact have been poured at eye level. Based on the evidence before it the panel cannot be clear as to what dose of Oramorph was prescribed to the patient and therefore cannot be clear as to how such a dose should have been measured. Accordingly charge 5(a)(i) is found not proved. ii. did not accurately measure the prescribed dose: The panel notes Ms McCartney admission that she poured the dose of Oramorph into a measuring cup at waist level rather than at eye level which was the correct procedure. The panel therefore find charge 5 (a)(ii) proved. b. At about hours, poured a quantity of Oramorph into a measuring cup and took it yourself; At 10:21:40 of the CCTV Ms McCartney is observed accessing her handbag from the nearby filing cabinet and again pouring out a measure of Oramorph liquid. In her interview of 07 September 2010 Ms McCartney was shown the CCTV of this incident. Upon view it she stated: I took that dose. Do we need to watch any more? In light of her admissions and the CCTV evidence the panel find that Ms McCartney did take the quantity of Oramorph she poured into a measuring cup. Therefore charge 5(b) is found proved. c. At about hours, poured a quantity of Oramorph into a measuring cup, added a dose of Lactulose, and took the mixture herself; Page 10 of 15

11 At 12:08:35 Ms McCartney is observed taking tablets; pouring out a measure of Oramorph, adding lactulose solution to the mixture and consuming the mixture at the medication trolley. In interview Ms McCartney stated: I took both the lactulose and Oramorph mixture. I don t know about the tablets, but they definitely were not Pregabalin [Lyrica]. In light of the CCTV evidence and Ms McCartney s admission the panel find this charge proved. 6. Her conduct as set out in the following paragraphs was dishonest: a. 1(a), (b), (c), (d), (e), (f) b. 2(a), (b), (c), (d), (e), (f) c. 3 d. 4 e. 5(b), (c) The panel notes that in interview Ms McCartney was asked if she had ever diluted Oramorph, to which she replied: Yes I did dilute to cover my track. The panel considers that this comment clearly demonstrates that Ms McCartney took actions to conceal her misconduct. The panel consider that there is no other explanation for her conduct other than the dishonest appropriation of medication for her own use. The panel is satisfied, having regard to her admissions and the other available documentary evidence that Ms McCartney s actions were dishonest applying the standards of reasonable and honest people and, further that she herself realised that her actions were dishonest. Accordingly the panel determines that Ms McCartney s conduct as set out in the charges which it has found proved was dishonest. Determination on Misconduct and Impairment: The panel considered, on the basis of the matters found proved, whether Ms McCartney s fitness to practise is currently impaired by reason of her misconduct. It had regard to all the evidence adduced and considered the submissions of Mr Moloney on behalf of the NMC and Ms McCartney s responses to these charges contained within her case management form. The panel heard and accepted the advice of the legal assessor. Page 11 of 15

12 The panel exercised its own judgment in determining the issues before it and it took into account the need for the protection of the public, the maintenance of public confidence in the profession, and the upholding of proper standards of conduct and behaviour. The panel also had regard to the preamble of the Code: Standards of Conduct Performance and Ethics for Nurses and Midwifes 2008 (the Code) which states: 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, treating them as individuals and respecting their dignity be open and honest, act with integrity and uphold the reputation of your profession. The panel also had regard to the following numbered standards of the Code: 32 You must act without delay if you believe that you, a colleague or anyone else may be putting someone at risk. 49 You must adhere to the laws of the country in which you are practising. 61 You must uphold the reputation of your profession at all times. The panel carefully considered the aspects of the Code to which it was referred and the facts found proved. The panel concluded on the basis of the facts found proved that Ms McCartney had breached the preamble of the Code as well as paragraghs 32, 49 and 61 of the Code. The panel concluded that Ms McCartney s behaviour put patients at risk and her actions in attempting to conceal her theft of medication, further compounded her dishonesty. The panel consider that her conduct falls seriously short of the conduct and standards expected of a registered nurse and amounts to misconduct. Accordingly, the panel then went on to consider whether by reason of Ms McCartney s misconduct her fitness to practise is currently impaired. For this purpose the panel had careful regard to the questions posed by Lady Justice Smith in her 5th Shipman Report, repeated in CHRE v NMC & Grant. The panel first considered whether Ms McCartney: (a) had acted so as to put a patient or patients at unwarranted risk of harm; (b) had brought the profession into disrepute; (c) had breached one of the fundamental tenets of the profession. (d) had in the past acted dishonestly The panel concluded that by her actions Ms McCartney put patients at clear risk of harm. The panel further concluded that her actions had brought the profession into disrepute, had breached fundamental tenets of the profession as identified in the NMC Code of Professional Conduct and acted dishonestly. Page 12 of 15

13 The panel next considered whether Ms McCartney is liable in the future to: (a) act so as to put a patient or patients at unwarranted risk of harm (b) bring the profession into disrepute (c) breach one of the fundamental tenets of the profession. (d) act dishonestly The panel considered all the circumstances of this case and considered whether Ms McCartney s misconduct is easily remediable; whether it has been remedied and whether it is likely to be repeated. The panel also took into consideration the issue of Ms McCartney s insight into her misconduct. The panel considered that Ms McCartney s actions constituted a clear breach of trust which took place over a number of months, and in the course of her employment as a Registered Nurse. Ms McCartney s behaviour and dishonesty also raises serious concerns about her attitude and trustworthiness. The panel noted that Ms McCartney took steps to conceal her misconduct by diluting medication. The panel considers that her actions in this respect had the effect of allowing patients to receive a reduced dose of medication and thereby posed a real risk to patient safety. The panel noted that Ms McCartney has engaged with the NMC to some extent by sending written responses to the case management form. However the panel notes that Ms McCartney has not provided the panel with any information to suggest that she has taken any actions to remedy her specific failings. The panel has not seen evidence of insight by Ms McCartney which has been reflected in modifications to her practise as a nurse. Her conduct and lack of trustworthiness raises a fundamental concern about her ability to practise safely as a registered nurse. Further, dishonesty is not easily remediable and the panel are unable to conclude that Ms McCartney s behaviour will not be repeated in the future. The panel has determined that Ms McCartney s actions and dishonesty have brought the profession into disrepute. She breached fundamental tenets of professional behaviour and her integrity cannot be relied upon. In addition it is the panel s judgment that public confidence in the profession and the maintenance of proper standards would be undermined if a finding of impairment were not made in this case. In all the circumstances the Panel was of the clear view that Ms McCartney s fitness to practise is currently impaired. Sanction: The panel took into account the submissions from Mr Moloney on behalf of the NMC, and the documentation produced by Ms McCartney. It also heard and accepted the advice of the legal assessor. The panel took into account the Council s Indicative Sanctions Guidance. It had regard to both the public interest and Ms McCartney s own interests. It took account of the principle of proportionality, weighing the interests of the public with Ms McCartney s own interests, and took account of the mitigating and aggravating factors in the case. Under Article 29 of the Nursing and Midwifery Council Order 2001, the panel may: Page 13 of 15

14 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 make a striking off order The panel kept in mind that the purpose of a sanction is not to be punitive, but is devised to ensure that the public is adequately protected. The panel recognised that a sanction may have a punitive effect. The panel first considered whether to take no action. In the circumstances of this case this would be wholly inappropriate. The nature of the misconduct in this case is far too serious to justify this course. The panel then considered a caution order. In the absence of any information to the contrary the panel treated Ms McCartney as a person of good nursing history. The panel noted that Ms McCartney admitted one of the charges and expressed limited regret and apology for her actions. However, the facts that have emerged in this case indicate a pattern of behaviour and attitude and do not relate to an isolated incident. Ms McCartney has shown extremely limited insight into her failings. Further the panel note that through Ms McCartney s actions patients received significantly reduced doses of medicine and other medication which had not been prescribed, thereby putting them at real risk of harm and suffering. In addition the panel has concluded that dishonest behaviour of the sort found proved is not easily remedied and there is no evidence before it to demonstrate that she has taken any remedial steps. In all the circumstances the panel considered that a caution order would not be a sufficient or proportionate sanction in this case. The panel next considered whether placing conditions of practice on Ms McCartney s registration would be a sufficient and appropriate response. The panel was mindful that any conditions imposed must be proportionate, measurable and workable. The panel has determined that repeated dishonesty is not something which can easily be addressed by conditions. The panel considered that it would not be possible to formulate conditions that would adequately address Ms McCartney s shortcomings and protect the public. Therefore, the panel concluded that a conditions of practice order would not be an adequate or proportionate response. The panel went on to consider whether a Suspension Order should be imposed in this case. As the panel stated in its determination on impairment, dishonesty and a disregard for patient safety is wholly unacceptable in a registered nurse. In the panels view Ms McCartney continues to pose a risk of harm to the public. The panel concluded that Ms McCartney s failings were so serious and represent such a departure from the standards required by the NMC code of conduct, that they are fundamentally incompatible with her remaining on the register. A suspension order would not, therefore, be appropriate. Page 14 of 15

15 The panel reminded itself of the case of Parkinson v Nursing and Midwifery Council [2010] EWHC 1898 (Admin) where it was held: That 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 to demonstrate remorse, a realisation that the conduct criticised was dishonest, and an undertaking that there will be no repetition, 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. In the circumstances the panel concluded, for all the reasons given above, that the only sufficient and proportionate sanction was to direct the registrar to strike Ms McCartney from the register. The panel considered a Striking Off Order was necessary in order to protect the public, to uphold proper professional standards and to maintain confidence in the nursing profession and the NMC. The panel recognised that this order may have financial consequences for Ms McCartney but considers that the public interest significantly outweighs her own interests in this respect. Interim order: The panel considered this case very carefully. It took into account the submissions from Mr Moloney on behalf of the NMC and accepted the advice of the legal assessor. The panel decided that it is necessary to make an interim suspension order for a period of 18 months. The panel was satisfied that an interim order was necessary for the protection of members of the public and that it was otherwise in the public interest in order to maintain confidence in the profession and its regulatory process. In reaching that decision the panel took into account the matters set out in its substantive decision on sanction. The registrant s record in the NMC register will show that Ms McCartney is the subject of an interim order and anyone who enquires about her registration will be informed about the order. The panel s decisions today will be confirmed in writing to Ms McCartney. Page 15 of 15