Conduct and Competence Committee. Substantive Order Review Meeting. 19 October 2015

Transcription

1 Conduct and Competence Committee Substantive Order Review Meeting 19 October 2015 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of Registrant Nurse: NMC PIN: Venetsiya Miteva 10E0023C Part(s) of the register: Registered Nurse Sub part 1 Adult 7 May 2010 Area of Registered Address: Panel Members: Legal Assessor: Panel Secretary: Order being reviewed: Outcome: England Hilary Nightingale (Chair lay member) Simon Williams (Registrant member) Jeanette Whitford (Lay member) John Bromley-Davenport Manisha Hirani Suspension Order 6 months Strike-Off with immediate effect

2 Service of Notice of Hearing: The panel was informed that the notice of this meeting was sent to Ms Miteva on 11 September 2015 by recorded delivery and first class post to her registered address. The panel accepted the advice of the legal assessor. In the light of the information available the panel was satisfied that notice had been served in accordance with Rules 11 and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended February 2012) (the Rules). Decision and reasons on review of the current order: The panel decided to impose a striking-off order. This is the second review of a suspension order, originally imposed by a panel of the Conduct and Competence Committee on 23 October 2014 for 6 months. The current order is due to expire on 26 November The panel is reviewing the order pursuant to Article 30(4) of the Nursing and Midwifery Order 2001(the Order). The sanctions available to the panel that made the substantive order, and accordingly that are available to this panel, are contained within Article 29 of the Order. This panel may allow the present order to lapse upon expiry, revoke the present order with immediate effect, extend the present order, make a caution order, make a conditions of practice order, make a suspension order or strike-off. The charges found proved which resulted in the imposition of the substantive order were as follows:

3 Charges: That you, whilst employed as a registered nurse at Burnham Lodge Nursing Home: 1. On 26 April 2013 in respect of Resident A: 1.1. Forced her towards a chair 1.2. Tied her dressing gown belt in a rough manner 1.3. Failed to talk or reassure Resident A about what you were doing. 2. On or around 27 April 2013 attempted to force medication tablets into Resident A s mouth. 3. On or around 1 May 2013 in respect of Resident A: 3.1. Approached her in an abrupt manner 3.2. [ ] 3.3 Persisted in trying to take observations in spite of her refusal. 4. On 2 May 2013 insisted Resident A went to the toilet. 5. In respect of charge 1 and/or 2 and/or 3 and/or 4 above caused distress to Resident A. 6. On 2 May 2013 covertly placed medication in Resident A s drink when she refused to take her medication. 7. On 2 May 2013 caused distress to Resident B by feeding her too quickly. 8. On or around 28 April 2013 attempted to force medication tablets into Resident D s mouth. And, in light of the above, your fitness to practise is impaired by reason of your misconduct. Decision on impairment and sanction (substantive hearing 23 October 2014): The panel was of the view that Mrs Miteva had in the past and is likely in the future to place patients at unwarranted risk of harm due to her past misconduct. This misconduct has brought the profession into disrepute. The panel was of the view that kindness to patients is a fundamental tenet of the nursing profession and that this was breached by Mrs Miteva by her misconduct.

4 The panel also considered the following passage from the same case 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 considered that if impairment were not found in relation to Mrs Miteva s misconduct, the need to uphold proper professional standards and public confidence in the profession would be severely undermined. The panel therefore concluded that Mrs Miteva s fitness to practise is currently impaired The panel went on to consider a Suspension Order. The panel concluded that Mrs Miteva s misconduct was a serious departure from what is expected of a registered nurse. She presented no evidence of remorse, insight or reflection. There was no explanation for these incidents. The panel concluded that her misconduct was sufficiently serious to require temporary removal from the register. Decision on impairment and sanction (substantive hearing 23 April 2015): The panel considered whether Mrs Miteva s fitness to practise remains impaired. It has no new information before it to undermine the previous panel s finding that Mrs Miteva s fitness to practise is impaired. In particular, the panel was concerned about the lack of evidence of any insight, despite the clear recommendations of the previous panel in respect of how Mrs Miteva could demonstrate at this review that her fitness to practise was no longer impaired. The panel therefore concluded that Mrs Miteva s fitness to practise remained impaired

5 The panel next considered a Suspension Order. It concluded that a Suspension order remains sufficient to protect the public for its duration, and to maintain public confidence in the nursing profession and the NMC as its regulator, given the seriousness of Mrs Miteva s misconduct. Decision on current fitness to practise: This panel has considered carefully whether Ms Miteva s fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in the light of the current circumstances. It has noted the decision of the previous substantive panel. However, it has exercised its own judgment as to current impairment. This panel has had regard to all of the documentation before it and it heard and accepted the advice of the legal assessor. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession, and the need to declare and uphold proper standards of conduct and behaviour. This panel considered whether Ms Miteva s fitness to practise remains currently impaired. Regarding insight, the panel considered that since the substantive hearing on 23 October 2014 and review hearing on 23 April 2015 Ms Miteva has failed to provide any evidence demonstrating an understanding of how her actions put patients at a risk of harm. Further, Ms Miteva has failed to demonstrate an understanding of her failures and how they had a negative impact on the reputation of the nursing profession. The panel was of the view that there had been no material change in circumstances and it had nothing before it to suggest that Ms Miteva had gained any insight into her actions. In its consideration of whether Ms Miteva has remedied her practice the panel was of the view that considering the nature of the charges, Ms Miteva has failed to provide any

6 evidence of remediation and it has no evidence to suggest that she has undertaken any further relevant training to remediate her failings. In light of the above, the panel is of the view that there is a risk of repetition as Ms Miteva has not demonstrated how she would act differently in the future. The panel therefore considered that Ms Miteva s fitness to practise remains impaired. The panel had borne in mind that whilst its primary function was to protect patients, there is also a wider public interest, which includes maintaining confidence in the nursing profession and upholding the proper standards and behaviour. The panel determined that, in this case, a finding of impairment on public interest grounds was required. For these reasons, the panel finds that Ms Miteva s fitness to practise remains impaired. Determination on sanction: Having found Ms Miteva s fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel noted that its powers in relation to sanction are set out in Article 29 of the Order. The panel has also taken into account the NMC s Indicative Sanctions Guidance (ISG) and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. The panel considered that taking no further action or imposing a caution order was not the appropriate or proportionate response in this case and allowing Ms Miteva to practice without any further restriction could cause a risk of harm to patients. The panel concluded that in light of the seriousness of this case it would be inappropriate to take such actions as it would not serve to protect the public or uphold the public interest. The panel next considered a conditions of practice order. The panel took into account that Ms Miteva has failed to engage with all NMC proceedings thus far, and despite being given the opportunity to provide evidence of remediation from the previous reviewing panel, she failed to do so. On this basis the panel concluded that a conditions

7 of practice order is not practicable as it has no reason to believe that Ms Miteva would be willing to engage with a conditions of practice order. In all the circumstances, the panel considered that a conditions of practice order is not an appropriate order in this case and no workable conditions of practice could be formulated which would protect the public or satisfy the wider public interest. The panel considered the imposition of a further period of suspension. However, the panel was of the view that the conduct was a significant departure from the standards expected of a registered nurse. The panel noted that the serious breach of the fundamental tenets of the profession evidenced by Ms Miteva s actions is fundamentally incompatible with her right to remain on the register. The panel today considers that Ms Miteva has not engaged with the NMC since the incidents in 2013 and she has not taken advantage of the existing and previous suspension order to provide any new information. The panel bore in mind that Ms Miteva has not provided the panel with evidence of any insight or remorse into her actions; there is a risk of repetition; and her actions involved a number of serious incidents involving vulnerable patients. In the absence of such matters, in this particular case, the panel determined that a further period of suspension would not be a sufficient or appropriate sanction. Finally, in looking at a striking-off order, the panel took note of the following paragraphs of the ISG; 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 Can public confidence in the professions and the NMC be sustained if the nurse or midwife is not removed from the register?

8 75. This sanction is likely to be appropriate when the behaviour is fundamentally incompatible with being a registered professional 75.1 Serious departure from the relevant professional standards as set out in key standards, guidance and advice 75.2 Doing harm to others or behaving in such a way that could foreseeably result in harm to others, particularly patients or other people the nurse or midwife comes into contact with in a professional capacity, either deliberately, recklessly, negligently or through incompetence, particularly where there is a continuing risk to patients. Ms Miteva s actions in 2013 and her continuing lack of any form of engagement with her regulatory body since then, were a significant departure from the standards expected of a registered nurse and are fundamentally incompatible with her right to remain on the register. Taking into account all of the evidence before it during this review meeting the panel determined that the appropriate and proportionate sanction is that of a striking-off order. The panel considered that this order was necessary to mark the importance of maintaining public confidence in the profession and to send to the public and the profession a clear message about the standard of behaviour required of a registered nurse. This new order will take effect from the date of this meeting pursuant to Article 30(2) and 30(4) of the Nursing and Midwifery Order The panel directs the Registrar to strike Ms Miteva s name off the register. This decision will be confirmed to Ms Miteva in writing. That concludes this determination.