Conduct and Competence Committee Substantive Order Review Meeting 13 October 2015 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of Registrant: Sheilagh Anne Hathaway NMC PIN: 79Y1904E Part(s) of the register: Registered Nurse Sub part 2 Adult 26 May 1981 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: England Substantive Order Review Robert Barnwell (Chair/Lay member) David Bleiman (Lay member) Jennifer Frost (Registrant member) Paul Hester Hailey Robinson Substantive Order Reviewed: Suspension order Outcome: Striking off order to come into effect upon the expiry of the current order under article 30(1) Page 1 of 8
Decision on Proof of Service: The panel considered whether notice of this meeting has been served in accordance with the rules. Rules 11A and 34 of the Nursing and Midwifery Council (Fitness to Practise) Rules 2004, as amended state: 11A.(1) Where a meeting is to be held in accordance with rule 10(3), the Conduct and Competence Committee or the Health Committee shall send notice of the meeting to the registrant no later than 28 days before the date the meeting is to be held. 34.(3) Any other notice or document to be served on a person under these Rules may be sent by (a) ordinary post The panel noted that the letter of notice of this substantive meeting was sent to Ms Hathaway s address on the register by both first class post and recorded delivery on 10 September 2015. The panel is satisfied that the notice was sent more than 28 days in advance of this meeting. The panel therefore finds that notice has been served in accordance with the Rules. The panel also noted that Ms Hathaway, in an email to the NMC dated 20 August 2015, stated Thank you for your letter dated 18 August 2015 concerning the review of my substantive Order. And I would like the review to be a meeting. Decisions and Reasons: This was a mandatory review of a substantive order under article 30(1) of the Nursing and Midwifery Order 2001. The suspension order was originally imposed by a panel at a Conduct and Competence Committee Substantive Hearing on 11 November 2015. This is the first review of that order. The panel has considered this case carefully. It has decided to impose a striking off order to come into effect upon the expiry of the current order under article 30(1). Page 2 of 8
In considering this review, the panel noted the decisions of the previous substantive panel however it has exercised its own judgment in coming to its decision today. The panel had regard to all of the documentation before it. The panel heard and accepted the advice of the legal assessor who referred the panel to its powers under Article 30(1), 30(2) and 30(4) of the Nursing and Midwifery Order 2001. He advised that this review requires the panel to make a comprehensive reconsideration all the information before it. He advised that the panel must only consider a sanction if it finds that Ms Hathaway s fitness to practise is impaired. The panel noted that at the substantive hearing, on 11 November 2015, that panel found that Ms Hathaway s fitness to practise was impaired by reason of her misconduct. The panel found the following charges proved by admissions: That you, whilst employed as a Band 5 Registered Nurse by North Bristol NHS Trust at the Burden Centre, Frenchay Hospital: 1. On 23 January 2013, in relation to Patient A: a) Failed to check that the correct discharge medication was listed for Patient A upon her discharge; b) Failed to provide Patient A with a discharge letter outlining her discharge medication; c) Incorrectly provided Patient A with 10mg Clobazam in her discharge medication; 2. On 25 January 2013, in relation to Patient B: a) Failed to administer Pyridostigmine at 10:00; b) Failed to administer and/or failed to sign in Patient B s medication chart that you had administered Pyridostigmine at 14:00; 3. On 31 January 2013, incorrectly administered 75mg of Pregabalin to Patient C instead of her prescribed 25mg; Page 3 of 8
4. On 1 February 2013, omitted to administer Patient C s prescribed 25mg Pregabalin; 5. On 1 February 2013, signed Patient C s medication chart to indicate that you had administered 25mg Pregabalin when in fact you had not; 6. On or about 1 February 2013, failed to report your medication error outlined in Charge 3 when you became aware of that error; 7. Your actions as outlined at Charge 5 were dishonest in that you attempted to conceal your medication error; And in light of the above, your fitness to practise is impaired by reason of your misconduct. The charges arose whilst Ms Hathaway was employed as a Band 5 registered nurse by North Bristol NHS Trust ( the Trust ). At the material time, she was working in the Burden Centre ( the Unit ), a neuropsychiatric unit, at Frenchay Hospital ( the Hospital ). Ms Hathaway had been based on the Unit for eight years at the time of her resignation in May 2013. The charges relate to a period of time in January and February 2013 when Ms Hathaway made a number of medication errors and omissions, which included falsifying patient documentation to indicate that she had administered 25mg of Pregabalin when she had in fact not done so. When considering misconduct, the substantive panel noted that not every breach of the Code, and not every falling short of what would be proper in the circumstances, would amount to misconduct. However, Ms Hathaway has admitted to a series of errors including: failing to check patient documentation; incorrectly providing a patient with medication; failing to administer medication to two patients; incorrectly administering the wrong dose of medication to a patient; failing to report a medication error when made aware of it; and acting dishonestly by attempting to conceal a medication error. Page 4 of 8
In relation to impairment, that panel was of the view that, at the relevant time, Ms Hathaway s conduct was liable to put patients at unwarranted risk of harm. The panel determined that Ms Hathaway s actions were liable to bring the profession into disrepute, as members of the public would consider that nurses should maintain higher standards than those demonstrated in this case. The panel also determined that, in failing to adhere to a high standard of nursing practice and to uphold the reputation of the nursing profession, Ms Hathaway breached fundamental tenets of the profession. Further, she acted dishonestly in attempting to conceal a medication error. In the absence of full insight and any remediation, the panel considered that there is a risk of repetition of Ms Hathaway s misconduct, which could, once again, put patients at risk of harm, breach fundamental tenets of the nursing profession, and bring the profession into disrepute. Further, in the absence of full insight into Ms Hathaway s past dishonesty, the panel was not satisfied that she would not repeat her dishonest behaviour in the future. The panel concluded that confidence in the profession would be undermined if a finding of impairment were not made in the light of Ms Hathaway s misconduct, involving as it did dishonesty, as well as clinical failings. The substantive panel In its consideration of a suspension order, bore in mind paragraph 71 of the Indicative Sanctions Guidance and concluded that this was not a single instance of misconduct, but that Ms Hathaway s failings took place within a period of some 10 days. Although Ms Hathaway acted dishonestly, she admitted to having done so, and the panel noted that her dishonesty was itself an isolated occurrence. Ms Hathaway s dishonesty took place in the context of an informal capability process when she had been warned about the consequences of medication errors, and the evidence before the panel indicates that she acted in this manner as she had boxed herself into a corner ; this places her dishonest behaviour into its proper context. The panel also considered that Ms Hathaway has expressed genuine remorse for her misconduct, and had regard to her repeated apologies in her written statements before the panel. Although limited, the panel has determined that Ms Hathaway has demonstrated some insight into her behaviour. The panel concluded that a period of suspension would be sufficient to protect patients and address the public interest considerations. The panel Page 5 of 8
determined that, in Ms Hathaway s case, her misconduct, whilst serious enough to warrant temporary removal, was not fundamentally incompatible with her remaining on the register. This panel noted that since the substantive hearing, Ms Hathaway has only had limited engagement with the NMC in the form of an email to the NMC dated 20 August 2015. The panel noted that whilst Ms Hathaway expresses remorse for her actions, she has not provided any further evidence of remediation of, or insight into, her failings. Further, the panel noted that Ms Hathaway has not provided or produced any of the documentation or information which the previous panel suggested would assist a future panel. As Ms Hathaway has not provided any further evidence, the panel concluded that there was a risk of repetition of her failings. In addition, the panel considered that Ms Hathaway has not demonstrated that she is safe to practise, and is therefore a risk to patients and the public if she were allowed to practise unrestricted. Accordingly, there is no evidence before this panel to indicate a change in circumstances, and as such, the panel can only conclude that Ms Hathaway s fitness to practise remains impaired. Having found that Ms Hathaway s fitness to practise remains impaired the panel went on to consider what order, if any, is appropriate and proportionate to impose in her case. The panel accepted the advice of the legal assessor and it is aware of the range of sanctions available. The panel applied the principles of fairness, reasonableness and proportionality, weighing the public interest with Ms Hathaway s own interests. The panel is mindful that the public interest includes the protection of members of the public, the maintenance of public confidence in the professions and the NMC and declaring and upholding proper standards of conduct and behaviour. The panel also had regard to the NMC s Indicative Sanctions Guidance for Panels of the Conduct and Competence and Health Committees (ISG) as well as to its powers under Article 30(1) of the Nursing and Midwifery Order 2001 bearing in mind that the decision on sanction is one for its own independent judgment. The panel first considered whether to take no action and allow the current order to lapse at its expiry. The panel was satisfied that such an order would not take into account the Page 6 of 8
panel s concerns regarding protection of the public and the public interest in upholding proper standards and maintaining confidence in the profession and in the NMC. The panel next considered whether to make a caution order. The panel determined that this sanction would not be proportionate or appropriate for the same reasons as outlined above. The panel then considered a conditions of practice order. The panel was mindful that any conditions imposed must be relevant, proportionate, measurable and workable. The panel had regard to the reasons as set out by the substantive panel. The panel was of the view that there are identifiable areas of Ms Hathaway s clinical practice in need of retraining, specifically in relation to the management and administration of medication. However, the panel noted that Ms Hathaway has asserted that she no longer feels fit to practise as a nurse and has no intention of working as a registered nurse in the future. In any event, the panel considered that a conditions of practice order would not adequately reflect the seriousness of Ms Hathaway s misconduct, given that it included dishonest behaviour in a clinical context. The imposition of a conditions of practice order would not, in the panel s judgement, adequately address the public interest considerations, namely declaring and upholding proper standards so as to maintain public confidence in the profession and in the NMC as its regulator. The panel went on to consider extending the existing suspension order. The panel considered that it had no new evidence, including that relating to remediation of Ms Hathaway s failings. The panel noted that the last panel set out a number of suggestions which might assist a reviewing panel. However, none of these suggestions have been acted upon. The panel concluded that Ms Hathaway, although expressing deep regret for her conduct, failed to demonstrate any further insight or remediation of her failings, and therefore poses a significant risk of repeating her behaviour. It determined that it would not serve any useful purpose, nor was it in the public interest, to extend the suspension order. The panel therefore concluded that in all the circumstances, a suspension order was not appropriate. Page 7 of 8
The panel considered imposing a striking off order. The panel noted that the misconduct in this case was serious, showing failings in basic fundamentals of nursing care which could have resulted in serious consequences for patients. The panel noted the ISG, particularly paragraph 75.7, which states a striking off order may be appropriate when there is a persistent lack of insight into seriousness of actions or consequences. In these circumstances, the panel concluded that protection of patients, the public interest in this case, and public confidence in the profession and the NMC, would only be maintained if Ms Hathaway is removed from the register. The panel concluded that this case was now incompatible with ongoing registration, and a striking off order was the only sanction appropriate and proportionate which would adequately protect the public, and also satisfy the public interest in this case. The panel directs the Registrar to strike Ms Hathaway s name from the Register. The panel concluded that the striking off order would come into effect upon the expiry of the current order under article 30(1). This decision will be confirmed to Ms Hathaway in writing. That concludes this determination. Page 8 of 8