Conduct and Competence Committee Substantive Order Review Meeting 25 September 2015 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ/ Name of Registrant Nurse: NMC PIN: Ms Rezen Kasiye 01L1888O Part(s) of the register: Registered Nurse Sub Part 1 Adult 10 December 2001 Area of Registered Address: Panel Members: Legal Assessor: Panel Secretary: Order being reviewed: Outcome: Zimbabwe Alan Harris (Chair lay member) Susan Greenwood (Registrant member) John Wilkes (Lay member) Michael Hosford-Tanner Manisha Hirani Suspension Order 6 months Suspension Order 4 months
Service of Notice of Hearing: The panel was informed that the notice of this hearing was sent to Ms Kasiye on 25 August 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). The panel also noted that Ms Kasiye s letter to the NMC dated 16 September 2015 indicated that she had received the notice. Decision and reasons on review of the current order: The panel decided to impose a suspension order for 4 months. This is the first review of a suspension order which was imposed at a previous review hearing on 13 April 2015 by a panel of the Conduct and Competence Committee. The current order is due to expire on 12 November 2015. The panel is reviewing the order pursuant to Article 30(1) 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: Charges:
That you, whilst a registered nurse at Galtee More Care Home, between 2008 and July 2011: 5. On various occasions left medication for residents to take including but not limited to Resident E. 6. On various occasions completed medication administration record sheets (MARs) after completing the drugs round. And in light of the above, your fitness to practise is impaired by reason of your misconduct. As to charge 5, misconduct was not found, but the substantive panel found misconduct in relation to charge 6. Decision on impairment and sanction (Substantive hearing 7-9 April 2014): Between 2008 and July 2011 Ms Kasiye was employed as a Band 6 registered nurse at Galtee More Care Home in Barnsley ( the Home ). The Home had 28 beds and was registered as a nursing/residential home, with provision for patients with a diagnosis of dementia. The facts found proved at the substantive hearing related to Ms Kasiye leaving medication for residents to take themselves on various occasions without directly witnessing their consumption and to her completing medication administration record (MAR) sheets after the drugs round had finished, rather than whilst she was administering the medication. In deciding whether those facts amounted to misconduct, the substantive panel concluded that only Ms Kasiye s failure to complete MAR charts contemporaneously was serious enough to amount to misconduct. The panel concluded that Ms Kasiye s fitness to practise was impaired. When considering sanction the substantive panel concluded that as there was only partial insight and no evidence of remediation no further action or a caution order were inappropriate.
That panel concluded that a conditions of practice order would be sufficient to protect the public and imposed the following conditions for a period of one year Decision on impairment and sanction (Review hearing 13 April 2015): The panel concluded, from the contents of the email of 18 May 2014, that Ms Kasiye was aware of the outcome of the substantive hearing and was therefore aware of the conditions imposed on her practice. Condition 1 states that she must notify the NMC within 21 days of any nursing or midwifery appointment (whether paid or unpaid) you accept within the UK or elsewhere. No such notification has been received. The panel has therefore assumed that Ms Kasiye is not working as a nurse at present. The panel does not know the reason for this. Ms Kasiye has not been in contact to suggest that the conditions of practice are too onerous and have prevented her from obtaining employment. On the assumption that Ms Kasiye is not working and there is no evidence before the panel that she complied with the conditions imposed on her practice, the panel concluded she has not remediated the deficiencies in her practice and that her fitness to practise remains impaired The panel then considered whether a suspension order would be appropriate. It took into account its reasons for concluding that a conditions of practice order was not appropriate at present. It considered that a suspension order will give Ms Kasiye an opportunity to reflect on whether she wishes to continue in nursing and, should she wish to do so, she will have an opportunity to indicate her intentions to the panel reviewing this order. The period of suspension is for six months to give Ms Kasiye time to consider her future, explore the issue of returning to work, to provide evidence of reflection on her misconduct and to engage meaningfully with the NMC The panel was of the view that a panel reviewing this order would benefit from engagement from Ms Kasiye and, if she is undertaking any non-nursing work in a health or care setting, recent testimonials. It would be further assisted by receiving evidence that she has developed insight into the deficiencies in her practice, particularly in relation to administration of medicines and record-keeping, and the potential risk of harm caused to patients by her actions.
Decision on current fitness to practise: The panel has considered carefully whether Ms Kasiye s fitness to practise remains impaired. Whilst there is no statutory definition of the 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. The panel has had regard to all of the documentation before it, including the NMC bundle and correspondence dated 16 September 2015 from Ms Kasiye. Although the panel was pleased to note that Ms Kasiye had corresponded with the NMC, it noted that unfortunately the letter of 16 September 2015 dwelt on Ms Kasiye s views concerning the original charges rather than providing updating information or any of the information suggested by the reviewing panel on 13 April 2015. The panel 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. The panel considered whether Ms Kasiye s fitness to practise remains currently impaired. Regarding insight, the panel considered that since the substantive hearing on 9 April 2014 and review hearing on 13 April 2015 Ms Kasiye has failed to demonstrate an understanding of how her actions put patients at a risk of harm. Further, Ms Kasiye has failed to demonstrate an understanding of why what she did was wrong and how this impacted negatively on the reputation of the nursing profession. The panel was of the view that there had been no material change in circumstance and it had nothing before it to suggest that Ms Kasiye had gained any insight into her actions.
In its consideration of whether Ms Kasiye has remedied her practice the panel was of the view that considering the nature of the charges, she had failed to provide any 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 Kasiye has not demonstrated how she would act differently in the future, if faced with a similar situation. The panel therefore considered that Ms Kasiye 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 Kasiye s fitness to practise remains impaired. Determination on sanction Having found Ms Kasiye 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 Kasiye 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. Ms Kasiye failed to engage with the NMC following her previous conditions of practice order and did not take steps to remedy her practice in the way envisaged in that conditions of practice order. On this basis the panel concluded that a conditions of practice order is not practicable as it has no reason to believe that Ms Kasiye 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 no longer the appropriate order in this case. The panel concluded that 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. It was of the view that a suspension order would allow Ms Kasiye to decide whether she wishes to remain on the NMC register and practice as a nurse in the UK. If she so wishes the panel concluded that a further 4 month suspension order would be the appropriate and proportionate response and would afford Ms Kasiye adequate time to provide the evidence of her insight and remediation recommended by the previous panel on 13 April 2015, which will be reviewing the new 4 month suspension order. Ms Kasiye s letter dated 16 September 2015 did not assist or provide the necessary information for the review today. The information and documentation which Ms Kasiye should provide in order to assist the reviewing panel is as follows: A clear statement as to whether Ms Kasiye wishes to practise as a nurse in the UK and remain on the NMC register. Information from Ms Kasiye of all nursing and non-nursing work undertaken since she ceased to work at Galtee More Care Home in July 2011. A reflective piece demonstrating that she has developed insight into the deficiencies in her practice, particularly in relation to administration of medicines and record-keeping, and the potential risk of harm caused to patients by her actions. Documentary evidence of any training undertaken by Ms Kasiye since July 2011, particularly in relation to administration of medicines and record-keeping. A letter from her current employer if Ms Kasiye is working in a health or a care setting, giving full details of the job description and her performance in that role.
If Ms Kasiye is working as a nurse, based for example on her possible registration as a nurse in Zimbabwe, a letter from her line manager evaluating her performance particularly in administration of medicines and record-keeping and giving details of the period that Ms Kasiye has worked in that post. Ms Kasiye should also be aware, as indicated by the review panel on 13 April 2015, that if she fails to provide this information to a reviewing panel to show that she has developed insight and remediated her practice in relation to administration of medicines and record-keeping, that a reviewing panel will have the full range of sanctions available to it, including imposing a striking-off order. This decision will be confirmed to Ms Kasiye in writing. That concludes this determination.