Conduct and Competence Committee. Substantive Hearing. Hilton Belfast, 4 Lanyon Place, Belfast, BT1 3LP

Transcription

1 Conduct and Competence Committee Substantive Hearing Date: 3 rd 4 th January 2013 Hilton Belfast, 4 Lanyon Place, Belfast, BT1 3LP Name of Registrant: NMC PIN: Carol Anne Scott 94J0278N Part(s) of the register: Registered Nurse Sub-part 1 Adult (September 1999) Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Representation: Nursing and Midwifery Council: Northern Ireland Conviction Alexander Coleman (Chair, Lay member) Jennie Fecitt (Registrant member) Jacinta Mackie (Lay member) Patricia Gordon Brendan Metaxas Miss Scott was present and represented by Mr John Guerin, Campbell Fitzpatrick Solicitors, instructed by the Royal College of Nursing Represented by Ms Miranda Stotesbury, Counsel, NMC Regulatory Legal Team Facts proved: Facts not proved: Fitness to practise: Sanction: Interim Order: 1 (by way of admission) None Impaired Suspension Order 12 months Interim Suspension Order 18 months 1

2 Details of charge That you, a registered nurse, whilst employed by Western Health and Social Care Trust: 1. On 17 November 2011 were convicted at Londonderry Magistrates Court of 9 counts of Forgery and 9 counts of Fraud by False Representation and subsequently sentenced to 200 hours community service for each offence, sentences to run concurrently AND in light of the above, your fitness to practise is impaired by reason of your convictions. Application under Rule 19 for the hearing to be held in private Ms Stotesbury, on behalf of the NMC, and Mr Guerin, on your behalf, made a joint application under Rule 19 of The Nursing and Midwifery Council (Fitness to Practise) Rules 2004 ( the Rules ) to have part of these proceedings heard in private. Ms Stotesbury indicated that this was necessary as the registrant s health would be referred to by both parties. The panel heard and accepted the advice of the legal assessor who referred them to Rule 19(3) of the Rules. In balancing public expectations that hearings should be held in public so as to promote transparency and public confidence in the regulatory process with the rights of the registrant to have matters of health discussed in private, the panel concluded that the registrant s health conditions would be discussed in private. However, the panel concluded that other parts of the hearing should be in public. This application under Rule 19 is granted. Decision on the findings on the facts and reasons The panel noted that you have admitted the charge. The panel had sight of your certificates of conviction dated 21 March 2012 and certified as a true copy on 30 April Rule 31(2) of the Rules states that a copy of the certificate of conviction is conclusive proof of the conviction and the findings of fact upon which the conviction is based is admissible as proof of the facts. The panel took into account the advice of the legal assessor and was satisfied that the certificates of conviction provide sufficient evidence of the convictions in this case. The panel therefore find the facts set out in the charge proved. Decision on misconduct and impairment Miss Scott, having announced its finding on all the facts, the panel then moved on to consider first whether the facts found proved amount to misconduct and, if so, 2

3 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 without restriction. The panel noted that you admit that your fitness to practise is currently impaired. The panel is mindful that the decision on impairment is a matter for the panel s own professional judgment. The circumstances giving rise to the convictions involve you forging prescriptions and presenting these prescriptions to pharmacists between April and July These incidents occurred whilst you were employed as a Band 5 Nurse at Altnagelvin Area Hospital in the Western Health and Social Care Trust ( the Trust ). Your partner with whom you resided was at that time a trainee general practitioner working locally in the Trust area. On 28 July 2010, a pharmacy contacted the practice where your partner worked to raise concerns about the authenticity of a prescription that you had presented. The prescription was for Tramadol 50mg 60 tablets (an opiate analgesic prescribed for pain relief) and was seemingly signed by your partner. The prescription was passed to the medical practice and it was noticed that the address of the patient was the same as your partner. When asked about the prescription your partner denied that he had completed or signed it and confirmed that it was your writing on the prescription. At the conclusion of the police investigation, in total, 57 prescriptions for Tramadol were identified as being written and fraudulently signed by you. The prescriptions were dated from April 2010 to July 2010 and in total made up over 3,000 Tramadol tablets. Police arrested you on 29 September 2010 and searched your address under Article 10 of The Police and Criminal Evidence (Northern Ireland) Order Subsequently you were interviewed under caution. During the police interview on 29 September 2010 you admitted to stealing in secret prescriptions from your partner s prescription pads and forging the prescriptions for Tramadol. You told police you found out the combination to your partner s briefcase after he left it unsecured on one occasion at your home and regularly took prescription scripts from there without his knowledge. You also told police that you had written the prescriptions, forged your partner s signature, collected the prescriptions from different pharmacies and consumed all the Tramadol tablets yourself for an existing health condition. Your partner did not know you had taken the prescription scripts and did not know that you were abusing Tramadol until the practice he worked at was contacted by the local pharmacy on 28 July You were again interviewed by police on 8 February On 17 November 2011 you were convicted at Londonderry Magistrates Court of 9 counts of Forgery for writing and signing the prescriptions and 9 counts of Fraud by False Representation for presenting these prescriptions to the pharmacies. You 3

4 were sentenced to 200 hours community service for each offence, sentences to run concurrently. In her submissions Ms Stotesbury submitted that the nature of your convictions represented serious dishonesty. She referred the panel to the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) with particular reference to paragraphs 74, 75 and 76. Paragraph 103 of Grant states that the more serious the misconduct found the more difficult it should be, in general, to justify a finding that fitness to practise is not impaired. Ms Stotesbury referred the panel to the case of Bolton v Law Society [1994] 1 W.L.R 512 which states that the reputation of the profession is more important than the fortunes of any individual member. She also referred the panel to Dame Janet Smith s Fifth Report into Shipman and submitted that a finding of impairment was necessary on the following three grounds: Firstly, Ms Stotesbury submitted that your convictions have brought the nursing profession into disrepute and that you behaved in a way that was unbefitting of a registered nurse. Secondly, she submitted that you breached one of the fundamental tenets of the profession and referred the panel to the preamble of The code: Standards of conduct, performance and ethics for nurses and midwives 2008 (the code). Ms Stotesbury submitted that you failed to be open and honest, act with integrity and uphold the reputation of the profession. She also told the panel that you failed to act lawfully, whether those laws relate to your professional practice or your personal life. Thirdly, Ms Stotesbury referred to the case of Grant and submitted that without a finding of impairment, there is no power to warn a nurse that this type of conduct is unacceptable. Ms Stotesbury then moved on to the issue of impairment, and addressed the panel on the need to have regard to protecting the public and the wider public interest. This included the need to declare and maintain proper standards and maintain public confidence in the profession and in the NMC as a regulatory body. Mr Guerin told the panel that you admit your fitness to practice is currently impaired and that you should be given credit for your admission. When determining whether the facts found proved amount to misconduct the panel had regard to the terms of the code. The panel also had regard to the public interest and accepts that there is no burden or standard of proof and the panel exercised its own professional judgement. The panel heard and accepted the advice of the legal assessor who referred to the cases of General Medical Council v Meadow [2007] QB 462 (Admin) and Grant. 4

5 The panel adopted a two stage process in its consideration as advised. The panel was referred to the case of Roylance v GMC (No. 2) [2000] 1 AC 311, in which Lord Clyde said misconduct was 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. The panel is of the view that your actions seriously departed from the relevant standards expected of a registered nurse, and that your actions did amount to a breach of the code. Specifically, but not limited to: The people in your care must be able to trust you with their health and wellbeing To justify that trust, you must: be open and honest, act with integrity and uphold the reputation of your profession You must always act lawfully, whether those laws relate to your professional practice or personal life. Be open and honest, act with integrity and uphold the reputation of your profession 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 appreciated that breaches of the code do not automatically result in a finding of misconduct. However, the panel has decided that the facts admitted and found proved are serious. Notwithstanding that the Tramadol was for personal use, you misused your professional knowledge and skills to engage in behaviour which you knew was unlawful. As a registered nurse with your level of experience you would have been aware and indeed acknowledged during the police interview on 29 September 2010 that Tramadol was an addictive opiate. You would have also known that you were not qualified or lawfully allowed to prescribe medication. The panel is of the view that your actions were not only dishonest but they were also deliberate. Over a four month period, you repeatedly forged your partner s prescription scripts to illegally obtain Tramadol from a number of different pharmacies for your own personal use. The panel is mindful that there is no evidence that your clinical competence was at any stage impaired nor is there any evidence to suggest that there was any risk to patients in your care. However, due to the breaches identified above, the panel concluded that your actions seriously departed from the relevant standards set out in the code and your actions amounted to misconduct of a serious nature. 5

6 The panel next went on to decide if as a result of this misconduct your fitness to practise is currently impaired. Bearing in mind that the exercise which it is conducting is a forward-facing one, the panel considered what has happened since your criminal conviction. In this regard the panel considered the judgement of Mrs Justice Cox in the case of Grant in reaching its decision. In paragraphs 74, 75 and 76 she said: 74. I agree with that analysis and would add this. 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. 75. I regard that as an important consideration in cases involving fitness to practise proceedings before the NMC where, unlike such proceedings before the General Medical Council, there is no power under the rules to issue a warning, if the committee finds that fitness to practise is not impaired. As Ms McDonald observes, such a finding amounts to a complete acquittal, because there is no mechanism to mark cases where findings of misconduct have been made, even where that misconduct is serious and has persisted over a substantial period of time. In such circumstances the relevant panel should scrutinise the case with particular care before determining the issue of impairment. 76. I would also add the following observations in this case having heard submissions, principally from Ms McDonald, as to the helpful and comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman, referred to above. At paragraph she identified the following as an appropriate test for panels considering impairment of a doctor s fitness to practise, but in my view the test would be equally applicable to other practitioners governed by different regulatory schemes. Do our findings of fact in respect of the doctor s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he: a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or d. has in the past acted dishonestly and/or is liable to act dishonestly in the future. The panel considered that sections b, c and d apply. The panel noted that your convictions have brought the nursing profession into disrepute. Honesty, integrity 6

7 and trustworthiness are considered the bedrock of any nurse s practice. The panel noted that you breached a fundamental tenet of the profession by failing to be open and honest, act with integrity and uphold the reputation of the profession. Not only was your conduct fraudulent but you used the skills and knowledge of your profession to illegally obtain Tramadol. The panel noted that during the police interview on 29 September 2010, you stated that you did not know if you had an addiction to Tramadol as such. You went on to say that maybe you did have some dependency on it for health reasons. The panel noted the inconsistencies in your account during the police interview in regard to the number of Tramadol tablets you took on a daily basis. Initially during the police interview you claimed that you had ceased taking Tramadol. However, in the same interview, you confirmed that you had ordered Tramadol via the internet one month prior to that interview as you had been going through a low part and felt she needed it at the time. The panel had regard to Professor Roy McClelland s medical report dated 24 June With regard to insight and judgement, Professor McClelland stated that she feels she has brought a lot of misfortune both on herself and her partner, out of which she has difficulty with self-acceptance at the present time. This report appears to show that your insight is limited to the impact your convictions have had on you and your partner, both professionally and personally, and not as to how your actions have impacted on the reputation and public confidence in the nursing profession. The panel noted you admitted to Professor McClelland to taking up to 30 Tramadol tablets which differs from the account you gave to police on 29 September Professor McClelland s report indicates you have not used Tramadol since September The panel cannot be entirely satisfied that should you be placed under stress, either professionally or personally, or you experience low mood, you would not act in a similar manner again in order to obtain Tramadol. In consequence, the panel is concerned that there may be a possible risk to patients if these events were to reoccur in the future. The panel noted that you have accessed substance misuse counselling and have had regular screening for Tramadol which tested negative. The panel also had regard to the fact that you made admissions about many of the facts from the outset of the police investigation, as well as in these proceedings and have completed your community service. The panel reminded itself of the test set out in Grant. Although there is no evidence of direct patient harm, your past conduct was clearly dishonest, it brought the profession into disrepute and breached a fundamental tenet of the profession. The panel has serious concerns that your fraudulent behaviour was not isolated, was repeated and spanned a significant period of time. In terms of future risk the panel is not satisfied that you would not repeat these actions. The panel is of the view that your insight is limited to the impact your convictions have had on you and your partner. The panel has seen no evidence of insight on the wider impact of your actions both on the profession and maintaining public confidence in the profession. In addition, the 7

8 panel considers that the seriousness of the offences is such that public confidence in the profession and in its regulator would be undermined if a finding of impairment were not made, and therefore that the need to declare and uphold proper professional standards requires a finding of impairment in this case. As such, the panel finds that your fitness to practise is currently impaired by reason of your convictions. Response to panel s decision on impairment Ms Stotesbury, on behalf of the NMC, addressed the panel on its decision on impairment. She referred the panel to the case of Roylance mentioned by the panel in its decision and queried whether legal advice had been given to the panel in private by the legal assessor. Ms Stotesbury also noted the use of the word misconduct given that this is a conviction case. Mr Guerin, on your behalf, agreed with Ms Stotesbury s submission in regard to the use of the word misconduct and told the committee that in his submission the panel had taken into consideration matters upon which he had no opportunity to address them. He further submitted that the panel had unnecessarily considered information contained in the exhibits which should have been considered at a later stage in the proceedings. He specifically mentioned the contents of the police interview dated 29 September 2010 and the contents of Professor McClelland s medical report dated 24 June Ms Stotesbury submitted that it was the NMC s position that the panel could take into account all the information contained in the agreed exhibits in reaching their decision on impairment. The panel carefully considered the submissions made by Ms Stotesbury, on behalf of the NMC, and Mr Guerin, on your behalf, and accepted the advice of the legal assessor. The legal assessor has confirmed that in camera she did not provide any specific advice in regard to the case of Roylance. This is a well known case which the panel is aware of from their own professional experience. As regards to the submissions concerning the use of the word misconduct within the decision, the word misconduct has been used in a generic sense. The panel is aware that the charge before them arises out of your convictions. The panel s final decision on your fitness to practise is based on your convictions as set out in its findings. In reaching its decision on whether your fitness to practise is currently impaired, the panel had uppermost in its mind your convictions on 17 November 2011 and the agreed exhibits before it. In that respect the panel was referred by the legal assessor to Rule 31(2) of the Rules. The panel noted that both Ms Stotesbury and Mr Guerin were given the opportunity to address them on the allegations and the evidence produced. There was no application made by either party to exclude or redact any part of that documentation for the purposes of the decision on impairment. The exhibits 8

9 produced were agreed by both parties. This panel sits in the public interest and has a duty to make due inquiry into matters before it. The panel considered the documentary evidence submitted very carefully in a fair and balanced manner and considered only those matters relevant to the issue of impairment arising out of your convictions and the findings of fact upon which the convictions were based. Although you admit your fitness to practise is currently impaired, the panel reached its own decision on impairment based on all the evidence presented. Decision on sanction Miss Scott, the panel has considered this case very carefully and has decided to make a suspension order for a period of 12 months. In reaching this decision the panel has had regard to all the evidence that has been adduced in this case. Ms Stotesbury referred the panel to the Indicative Sanctions Guidance with specific reference to paragraphs 39 and 40 in relation to dishonesty and paragraphs in relation to criminal convictions. She also referred the panel to the case of Parkinson v Nursing and Midwifery Council [2010] EWHC 1898 (Admin) in which Justice Mitting said: 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 direct erasure. Ms Stotesbury submitted that the aggravating factors in this case include the convictions which represent a serious departure from the code and relate to serious dishonesty. Mr Guerin told the panel that your General Practitioner prescribed Tramadol to you in The panel was told that since the incident, you have sought assistance from your local mental health team and General Practitioner and have since been discharged from treatment. Mr Guerin told the panel that there has been a significant improvement in your health following treatment. He submitted that you have demonstrated insight into your actions as evidenced by you undertaking and completing counselling and medical interventions and you pleading guilty in the criminal proceedings. Mr Guerin referred the panel to Professor McClelland s medical report dated 24 June 2012 which stated that your Tramadol use was not a work based problem. Mr Guerin asserted at no stage does Professor McClelland suggest there is a risk of reoccurrence and in fact he considered there to be no significant risk from a return to professional duties. 9

10 Mr Guerin told the panel that you cooperated fully with the police investigation and pleaded guilty at the criminal trial. You continue to volunteer for a charitable group. You accept that you were unwell at the time of the offences and the police interviews. He referred the panel to a letter from your General Practitioner, Dr Henderson dated 19 December 2012 outlining the treatment you are currently receiving for your health conditions. Mr Guerin told the panel that the case of Parkinson, which refers to a registrant who did not engage or cooperate with the NMC, does not apply in this case as you have admitted the facts. He told the panel that you have complied with all testing requests by the NMC and have submitted yourself to additional hair follicle and urine testing. Mr Guerin submitted that you have demonstrated remorse and fully accepts the impact your convictions have had on staff at the hospital. He referred the panel to a letter from Ms Caroline Gibbons, Shop Manager of Action Cancer received 2 January 2013 which states that you have been given the responsibility of using the till and doing the banking. She is trustworthy and I would never have any reason to doubt this. The letter also states that you are a great asset to our charity. Mr Guerin also referred the panel to a letter from Dr Hugh M Quigley, Psychotherapist dated 28 December 2012 which outlines the treatment program you engaged in and undertook. Mr Guerin told the panel that you attended 10 psychotherapy sessions with Dr Quigley over a 10 week period. The panel was told by Mr Guerin that you accept that your convictions have brought the profession into disrepute. Mr Guerin submitted that conditions of practice would be sufficient to protect the public and the public interest in this case. He told the panel that conditions of practice is the most appropriate and proportionate sanction and recommended a condition whereby you could undergo regular urine and hair follicle testing to allay any concerns about repeating this behaviour. Further conditions could include indirect supervision and supervision reports submitted to the NMC. Mr Guerin submitted that a suspension order or a striking-off order would be disproportionate and too severe in this case. The panel was told that you are not currently taking Tramadol and that you are not suffering from your underlying health condition at the moment. Mr Guerin told the panel that you are not currently in paid employment and that you are dependent on your partner financially. The panel has borne in mind that any sanction imposed must be proportionate and appropriate, and that its purpose is not to be punitive, although it may have a punitive effect, but to protect members of the public and the public interest. The public interest includes not only the protection of patients, but also the maintenance of public confidence in, and the reputation of, the profession and its regulatory process, as well as the declaring and upholding proper standards of conduct within the profession. The panel had careful regard to the NMC s 10

11 Indicative Sanctions Guidance. It recognised that the decision on sanction is a matter for the panel exercising its own independent judgement. In reaching its decision the panel had regard to mitigating factors identified in this case including your early admission to the charges; your engagement with the NMC s process including your willingness to submit to any additional medical tests required; your engagement with the police investigation; completion of your community service; your unblemished record up to this incident and no repetition since; negative testing results for Tramadol; and at no stage was there any risk of harm to patients. The panel had regard to Dr Henderson s letter dated 19 December 2012 which confirmed that urine tests were negative for any traces of Tramodol. The panel also had regard to the contents of the testimonial provided by Ms Gibbons as regards to your voluntary work at Action Cancer. The panel considered the information provided in the letter by Dr Quigley dated 28 December 2012 as regards the psychotherapy treatment program successfully completed by you. The panel had regard to findings of Dr Quigley which states: As part of the psychotherapy programme Carol Anne met all the criteria for change and understanding. She accepted responsibility for her actions and the consequences of these and explored the reasons for the causative factors involved in the misuse of the substance. She engaged in a relapse prevention programme through understanding the role the above factors played in her behaviours. The main component of this relapse prevention programme is the memory of the consequences the behaviours had on her life and career. This will act as a motivating factor in her taking responsibility for her life and moving towards a new understanding of her role in her chosen career. Having worked with Carol Ann in the psychotherapeutic process I would have no question in recommending that she receive an opportunity to explore her nursing career with understanding and consideration. She is extremely honest and open with me as to all that occurred which assisted the process greatly and allowed me to direct interventions towards those factors involved in the entire process. The panel also had regard to aggravating factors identified in this case including the serious dishonest behaviour involved in your convictions for fraud and forgery. The panel noted that this behaviour took place over a period of 12 weeks and was deliberate in which you used your professional knowledge and skills for your own personal use. The panel share the view of Professor McClelland that you have developed insight in your health condition. The panel consider however, that you have only begun your rehabilitative journey into developing a deeper and wider understanding of the effects your dishonesty has had on the profession, both in maintaining proper standards of conduct and maintenance of public confidence in the profession. The panel has accepted the advice of the legal assessor who referred them to Article 29 of The Nursing and Midwifery Order 2001 and the NMC s Indicative Sanctions Guidance. 11

12 The panel first considered whether to take no action but concluded that this would be wholly inappropriate in view of the seriousness of the facts found proved. The panel decided that it would be neither proportionate nor in the public interest to take no further action given the findings on impairment. The panel next considered whether a caution order would be appropriate in the circumstances and concluded that the convictions were too serious for a caution order and not in the public interest. The panel concluded that in this case a caution order was not an appropriate or proportionate sanction to meet the public interest in this case. The panel also concluded that your conduct was not at the lower end of the spectrum of impaired fitness to practise in that these were a serious criminal convictions over a period of time involving repeated incidents. The panel next considered whether placing conditions on your practice would be a sufficient response. The panel was of the view that convictions involving dishonesty do not lend themselves to formulate conditions of practice which are workable and measurable. While conditions involving monitoring of your health issues could be formulated, they would not address the dishonesty in this case. The panel concluded that in addition, conditions of practice would not sufficiently protect the public interest nor would it maintain confidence in the profession or uphold proper standards of conduct and behaviour. Given your limited but developing insight into the effect of your actions on the profession and the serious nature of the dishonesty, a conditions of practice order is not an appropriate or proportionate sanction. The panel next considered whether to impose a suspension order. The panel considered that a suspension order an appropriate and proportionate sanction in this case. The panel are of the view that in these specific circumstances a strikingoff order would be disproportionate. The panel acknowledges that there is a fine line between a suspension order and a striking-off order in these particular circumstances. The panel placed considerable weight on Professor McClelland s report dated 24 June 2012 commissioned by the NMC which indicates that you have developed some insight into your health condition. The panel however is of the view that you have not developed full insight into the effect your convictions have had on the reputation of the profession. In taking into account the case of Parkinson, the panel noted that dishonesty can be difficult to remedy. However, the panel judges that there is sufficient linkage between your convictions and your various health issues both prior to and at the time of the incidents to indicate some possibility of you remedying your dishonesty. As was not the case in Parkinson, you appeared in person before this panel and you were legally represented at this hearing. You told the panel through your representative that you would not repeat your actions, you were remorseful and that you would be willing to undergo regular testing to allay any concerns about you repeating this behaviour. 12

13 The panel took into account the mitigating factors in this case, in particular, your engagement with the NMC s process including your willingness to submit to any additional medical tests as required and your negative testing results to date. The panel also took into account your unblemished record up to the date of this incident and that there has been no repetition since. The panel agrees with the opinion of Professor McClelland that your insight is specific to how your health condition has impacted on your family. However, the panel has concerns that you lack sufficient depth of insight into the realisation of how your dishonesty and its impact has had on the profession and the wider public interest. The panel determined that a suspension would be sufficient to satisfy the public interest and would be in your own interest. The panel considers that a suspension order for 12 months (the maximum time) is necessary to mark the importance of maintaining public confidence in the profession, and to send to the public and the profession a clear message about the standard of behaviour expected of a registered nurse. This will also provide you with an opportunity to provide evidence to a reviewing panel of your developing insight into the effect your dishonest behaviour has had on the profession, both in maintaining standards and upholding the reputation of the profession. This will also provide you with an opportunity to reflect and provide evidence to a reviewing panel. The panel also considers that this period of suspension would be of benefit to you in continuing the rehabilitative programs as suggested by Dr Quigley and the monitoring suggested by Professor McClelland. A subsequent review panel would benefit from up to date evidence concerning the completion of these programs. Decision on interim order and reasons The panel has considered the submissions made by Ms Stotesbury, on behalf of the NMC, that an interim suspension order should be made on the grounds that it is necessary in the public interest. She submitted that this is to cover the period before the substantive suspension order comes into effect. The suspension order will not come into effect until 28 days after you are sent this panel s decision in writing or you appeal, until your appeal is finally disposed of. Ms Stotesbury submitted that an interim suspension order should be made for a period of 18 months to allow for the possibility of an appeal being made and heard. Mr Guerin, on your behalf, submitted that in light of the panel s findings, he does not wish to oppose this application. The panel accepted the advice of the legal assessor. The panel is satisfied that an interim suspension order is necessary to maintain public confidence in the profession and the regulatory process. The panel also considered it was in your own interest. Given the reasons set out in its decision for the substantive suspension order, the panel determined that it would be contrary to the public interest not to impose an interim order. Further, the panel noted that although your conviction is unrelated to your nursing practice, your convictions would be considered by the public to be so 13

14 serious that confidence in the profession as a whole would be seriously undermined if an interim suspension order were not to be made today. In addition the panel considered that to do otherwise would be wholly incompatible with its decision on sanction. 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 order will be replaced by the substantive suspension order 28 days after the decision of this hearing in writing is sent. That concludes this determination 14