Conduct and Competence Committee Substantive Hearing Name ... · 11/4/2016 · The notice letter...

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Conduct and Competence Committee

Substantive Hearing 4 November 2016

Nursing and Midwifery Council 2 Stratford Place, Montfichet Road, London, E20 1EJ

Name of Registrant Nurse: Ravi Dass

NMC PIN: 94H0206E

Part(s) of the register: RNA – Registered Nurse (Sub part 1)

V300 – Nurse Independent / Supplementary

Prescriber

Area of Registered Address: England

Type of Case: Misconduct

Panel Members: Paul Powici (Chair Lay member)

Allison Hume (Registrant member)

Nalini Varma (Lay member)

Legal Assessor: William Hoskins

Panel Secretary: Atanas Angelov

Mr Dass: Not present and not represented

Nursing and Midwifery Council: Represented by Paul Andrews, counsel,

instructed by NMC Regulatory Legal Team.

Outcome: CPD accepted: Caution Order (5 years)

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Decision on Service of Notice of Hearing: The panel was informed at the start of this hearing that Mr Dass was not in attendance

and that written notice of this hearing had been sent to his registered address by

recorded delivery and by first class post on 19 August 2016. Royal Mail “Track and

Trace” documentation confirmed that the notice of hearing was sent to Mr Dass’s

registered address by recorded delivery on that date.

The notice letter provided details of the allegation, the time, dates and venue of the

hearing and, amongst other things, information about Mr Dass’s right to attend, be

represented and call evidence. Mr Andrews submitted the NMC had complied with the

requirements of Rules 11 and 34 of the Nursing and Midwifery Council (Fitness to

Practise) Rules 2004, as amended (“the Rules”).

The panel accepted the advice of the legal assessor.

In the light of all of the information available, the panel was satisfied that Mr Dass has

been served with notice of this hearing in accordance with the requirements of Rules 11

and 34.

The panel was aware that this matter was listed for a Consensual Panel Determination

and that the signed agreement stated that Mr Dass did not intend to attend the hearing

and was content for it to proceed in his and his representative’s absence. He also stated

that he would endeavour to be available via telephone should any clarification on any

point be required.

In those circumstances the panel proceeded to consider the provisional agreement. The

panel accepted the advice of the legal assessor as to the appropriate approach: in

particular that the provisional agreement should be considered in the round and in the

light of the Indicative Sanction Guidance.

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Conduct and Competence Committee

Consensual panel determination: provisional agreement

Mr Dass is aware of the CPD hearing. Mr Dass does not intend to attend the hearing

and is content for it to proceed in his and his representative’s absence. Mr Dass will

endeavour to be available by telephone should any clarification on any point be

required.

The Nursing and Midwifery Council and Mr Yashwant Mohan (Ravi) Dass, PIN

94H0206E (‘the parties’) agree as follows:

The Charges

1. Mr Dass admits the following charges:

That you, whilst employed by Peterborough and Stamford Trust as a Band 7

Charge Nurse within the Department of Sexual Health between July 2012 and 1

July 2014:

1. The manner in which you addressed issues with staff and/or managed staff

on occasions, led to staff feeling intimidated and/or threatened at times.

2. On one or more of the occasions, made comments of a sexual nature to one

or more of your colleagues, as set out in Schedule 1.

3. On an unknown date or dates

3.1 said to Colleague A that disabled people who were taking part in the

Paralympics should be "locked up", or words to that effect

3.2 said to Colleague B

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3.2.1 That the flowers in Cambridge were nice because "the Soham girls

were rotting underground", or words to that effect

3.2.2 that all Paralympians should be "culled", or words to that effect

3.2.3 that most men have affairs when their other halves are heavily

pregnant, or words to that effect, when Colleague B was pregnant

4. In September 2012, when asked by Colleague D whether the garden centre

in Soham was where the two little girls were murdered, said "that is why the

flowers are growing so well in the area"

5. On or around 3 or 4 January 2013 asked Relative 1 if he was planning on

breastfeeding from Colleague B

6. On 5 September 2013 said to Colleague C, in relation to her ex-partner who

had been diagnosed with an aneurism, "do you want to punch him in the

stomach and burst that thing?" or words to that effect

And as a result of your actions, as detailed above, your fitness to practice is

impaired by reason of your misconduct.

Schedule 1 1. Said to Colleague A

a. "how do you think your husband would feel if he knew you had your

hands around another man's cock", or words to that effect

b. in relation to an unknown patient who had previously been in a

heterosexual relationship but at the time of her appointment was in a

lesbian relationship, "could she not decide if she wanted vag or cock?",

or words to that effect

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2. Said to Colleague B "you get the swab and shove it in", or words to that

effect, when asked how to take a rectal swab

3. Said to Colleague C that staff should use the word "cunt" if a female

patient referred to their anatomy in this manner

4. Handed Colleague C a cucumber and said “I know you haven’t got a

husband at home I thought you might be glad of this” or words to that

effect.

5. When discussing the sexual activity of homosexuals with Colleague D

described it as "fucking up the arse"

6. On an unknown date in early 2013 said to Colleague D "would you like

Colleague E to lick you out and for you to have done a poo and not to

have used any toilet paper?" or words to that effect

And as a result of your actions, as detailed above, your fitness to practise is

impaired by reason of your misconduct.

The Agreed Facts

2. The Registrant was referred to the NMC on 25 March 2015. At that time the

Registrant was working at Peterborough and Stamford Trust (‘the Trust’) as a

Charge Nurse (band 7) within the Department of Sexual Health (‘the Department).

The Registrant was responsible for the complete operational management of the

Department, including managing nurses, healthcare assistants (‘HCAs’) and clerical

staff. He also worked clinical shifts. The Registrant had been employed in that

capacity since July 2012.

3. The names of the Colleagues referred to in the charges are set out in an Anonymity

Schedule [appendix 1].

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4. On 16 September 2013 Colleague C (a Healthcare Assistant who worked in the

Department) made a formal complaint about the Registrant’s conduct. The complaint

was made to Ms 1, a Human Resources Business Partner. As a result of this

complaint the Registrant was assigned to work outside of the Department (on 18

September 2013) and an investigation was carried out by Ms 2 (a Ward Sister). The

investigation included interviews with the Registrant on 26 September 2013 and 14

October 2013 as well as interviews with other members of staff.

Charge 1

5. On numerous occasions the Registrant sent forceful emails to members of staff

which indicated that failure to comply with his requests would lead to disciplinary

action or performance management. The Registrant accepts that these emails,

which were sent to numerous members of staff, amounted to unacceptable threats.

6. The Registrant also imposed an arbitrary ban on a doctor whom he did not manage,

Dr 1, from entering the reception area. Dr 1 may have needed to go to the

Department in the course of her employment and the Registrant had no right to ban

Dr 1 from entering the reception area.

7. The Registrant also told members of staff under his management that they should

not talk to Dr 1. This instruction given by the Registrant was entirely without

justification.

8. At all material times Colleague B was employed by the Trust as a Sexual Health

Staff Nurse in the Department. The Registrant was one of Colleague B’s managers.

Colleague B raised concerns directly with the Registrant about his behaviour. These

concerns related to the matters referred to in these proceedings. The Registrant

responded to Colleague B’s concerns by saying that she was “making a fuss”. He

told her that she was “hormonal”. Colleague B was pregnant at the time. The

Registrant told Colleague B that if she had a problem with him she could report him

to Human Resources. But he stated that if she did so he would report Colleague B to

Human Resources for “issues” (the Registrant did not indicate what these might

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have been). The Registrant told Colleague B that she was not needed and was

useless within the Department. He stated that Colleague B could be replaced with a

HCA. The Registrant did not respond to Colleague B’s concerns in a sensible

manner.

9. At the material time Colleague D was employed by the Trust as a Specialist Nurse

Practitioner in the Department. The Registrant was Colleague D’s manager.

Colleague D recalls having concerns about the Registrant’s conduct within the first

two or three months of him arriving in the Department. Colleague D recalls an

occasion where she told the Registrant that staff morale was low in the Department.

The Registrant replied by stating that he was not there to “baby” people. He said that

“if people don’t want to work, I’ll get rid of them”. The Registrant also told Colleague

D not to listen to any concerns raised by her colleagues. He stated that “if they are

moaning, don’t listen”.

10. At various times the Registrant inappropriately raised his voice and/or swore when

speaking to Colleagues.

11. Colleague A was employed by the Trust as a Staff Nurse (band 5) in July 2013. She

was employed in the Department and the Registrant was her manager. In paragraph

6 of her signed statement drafted for the purpose of these proceedings (signed and

dated 17 November 2015), Colleague A describes that she was often upset by what

the Registrant said to her and that she felt nervous around him and would physically

shake in his presence. She states that the Registrant would ask how her husband

put up with her. This caused Colleague A to become upset and when the Registrant

saw that she was upset he would say that he would refer her to Human Resources

because there was ‘something wrong’ with her.

Charge 2

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12. On one occasion the Registrant was observing Colleague A freezing a patient’s

genital warts. Colleague A had to be observed undertaking this procedure before

she could be signed off as competent to undertake it on an unsupervised basis. After

Colleague A had completed the procedure and after the patient had left the room,

the Registrant said “how do you think your husband would feel if he knew you had

your hands around another man’s cock?” This comment made Colleague A feel

shocked and embarrassed. Colleague A thought that the Registrant was trying to

engage in ‘banter’ but she felt that the Registrant had gone too far. Colleague A

attempted to dismiss the comment by saying “Oh Ravi”.

13. On another occasion Colleague A was in the laboratory processing a sample for a

patient. The patient had previously been in a heterosexual relationship but at the

time of her attendance at the Department she was in a lesbian relationship. The

Registrant was in the laboratory with Colleague A. The patient was not present. The

Registrant said “could she not decide if she wanted vag or cock?” This comment

caused Colleague A to feel embarrassed.

14. Colleague B recalls that at the time when the Registrant started working on the

Department he stated that nurses should perform rectal swabs. This was a

procedure that had formerly been carried out by doctors. There was nothing

inappropriate about the Registrant’s request that nurses undertake rectal swabs. But

when the Registrant was asked how to take a rectal swab he said “you get the swab

and shove it in”. The Registrant did not provide appropriate training on how to take

rectal swabs. Colleague B describes that the Registrant as being very crude and

states that he would use the word “piss” rather than “urine”.

15. Colleague C recalls attending a training session led by the Registrant on history

taking. She recalls that the Registrant began using offensive language during the

training session. The Registrant said that if a female patient attended the clinic and

said that her “cunt is sore” then staff should use the word “cunt” when speaking to

the patient. He said that there was no point using appropriate medical terminology if

the patient does not use the language. All of the staff attending the meeting said that

the language was inappropriate and that the Registrant should not have used it. The

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Registrant replied that they were “old fashioned”. He called them “a bunch of old

women” and stated that they needed to move with the times.

16. Colleague C began recording her concerns about the Registrant in August 2013.

17. The Registrant would sometimes take fruit and vegetables to work with him. There

was nothing inappropriate about this (the Registrant grew his own fruit and

vegetables). On 19 August 2013 Colleague C had just returned to work following two

weeks of annual leave. As she was putting her coat into a locker in the changing

room the Registrant told Colleague C that he had a present for her. There were no

other members of staff present in the changing room at this time. The Registrant left

the room and then came back with a bag. The Registrant pulled a cucumber out the

bag. The cucumber was about six inches long. The Registrant said that I know you

haven’t got a husband at home I thought you might be glad of this. Colleague C felt

that this comment was inappropriate but she did not want her first day back at work

to start with an argument so she said “thank you very much”. Colleague C states that

she felt that if she reacted in a shocked manner then the Registrant would laugh.

18. On an unknown date Colleague D attended a training session with the Registrant in

relation to history taking. During the session the sexual activity of homosexual men

was discussed. The Registrant referred to this as “fucking up the arse”. Colleague D

felt that this was crude and inappropriate.

19. In early 2013 Colleague D was in the changing room. She was combing her hair and

putting her make up on before the start of her shift. The Registrant said, “which of

the Consultants are you trying to attract?” Colleague D joked “oh Dr 2 but I would

have to squat as he is a little bit short in height”. Colleague D was not insinuating

anything of sexual nature. The Registrant replied “would you like Dr 2 to lick you out

and for you to have done a poo and not to have used any toilet paper?” Colleague D

was shocked, disgusted and horrified by this comment. Colleague D stated that she

could not think of anything more revolting and that he was lowering the tone. The

Registrant did not say anything in response.

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Charge 3

20. On another occasion the Registrant said to Colleague A that the disabled people

taking part in the 2012 Paralympics should be “locked up”. [PRIVATE]

21. During a lunch break the Registrant was speaking to Colleague B. He stated that the

flowers in Cambridge were “so nice” and that the garden centre is lovely. The

Registrant went on to say that this was probably because “the Soham girls were

rotting underground”. This incident happened shortly after the Registrant started

working in the Department. Colleague B was shocked by the Registrant’s comment.

22. Following the 2012 Paralympics, Colleague B was again having her lunch break

when the Registrant said “all paralympians should be culled” and that if he was

disabled he would want to be killed.

23. On an unknown date the Registrant was in the laboratory with Colleague B. They

were the only two people in the room. The Registrant said “you know when most

men start affairs? It is when their other halves are heavily pregnant.” The Registrant

then went quiet as if waiting for a response. At the time Colleague B was heavily

pregnant. Colleague B told the Registrant that his comment was inappropriate and

she left the room. The Registrant did not say anything in response.

Charge 4

24. Colleague D had a conversation with the Registrant in September 2012 in which the

Registrant told Colleague D that he had visited a garden centre in Soham. Colleague

D was interested in flowers, as is the Registrant. Colleague D asked, “is that where

those two little girls were murdered?” The Registrant replied “that is why the flowers

are growing so well in the area.” Colleague D found this comment offensive.

Charge 5

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25. Colleague B gave birth [PRIVATE]. On that day, or possibly the day after, Colleague

B took her baby daughter to the Department, which was based in the hospital where

Colleague B had given birth. Colleague B went to the Department to see her friends

and colleagues there. The Registrant’s office is the first room after entering the

Department. Colleague B went into the office and asked if she could take her baby

onto the Department. The Registrant said that she could. The Registrant spoke to

Colleague B’s husband (Relative 1). The Registrant asked Relative 1 if he was

planning on “breastfeeding” from Colleague B. Colleague B’s husband laughed

nervously.

Charge 6

26. On 5 September 2013 Colleague C asked the Registrant if she could attend a

medical appointment with her ex-husband who had been diagnosed with an aortic

aneurism. Colleague C wanted to attend this appointment to provide her ex-husband

with support and ensure that he understood all of the advice provided to him. The

Registrant said that Colleague C could go to the appointment. After the appointment

Colleague C returned to work. The Registrant asked Colleague C how it went. The

Registrant then said “did you not want to punch him in the stomach and burst that

thing?”

The Trust’s Disciplinary Hearing

27. As a result of the Trust’s investigation a disciplinary hearing was held on 7 January

2014. The hearing was chaired by Ms 3 (General Manager). Ms 3 recommended

that the following actions as a consequence of her disciplinary findings:

1) Coaching support from a designated coach;

2) Mentoring from an experienced operation lead;

3) MBTI management training, to enable the Registrant to understand his natural

management preferences and become more self-aware of his behaviour;

4) Regular one to one meetings with the Registrant’s manager;

5) Supervision Management training; and

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6) Regular one to one meetings with a Human Resources Business Partner

28. The Registrant engaged with the plan which was put in place by the Trust. His

employment transferred to Cambridge Community Trust on 1 July 2014 and at this

point he had completed most of the required training and supervision.

Cambridge Community Trust (‘CCT’)

29. The Registrant’s role at CCT was that of Charge Nurse (band 7) in the Integrated

Sexual Health Service. He left this employment on 15 May 2015. He subsequently

worked at CCT as a Bank Specialist Nurse and worked regular shifts at the clinic.

CCT have no concerns about the Registrant. Further information in respect of the

Registrant’s work at CCT is set out below under the heading ‘Current Impairment’.

Barts Health NHS Trust (‘Barts Health’)

30. The Registrant commenced employment with Barts Health on 18 May 2015. His role

was lead nurse for a sexual health team in Barts Sexual Health Centre. Barts Health

has no concerns about the Registrant. Further information in respect of the

Registrant’s work at Barts Health is set out below under the heading ‘Current

Impairment’.

Misconduct

31. In the case of Roylance v General Medical Council (No.2) [2000] 1 AC 311, Lord

Clyde stated that:

misconduct is 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 the medical practitioner in the particular circumstances.

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32. The Registrant admits that his conduct fell seriously short of the standards of

behaviour expected of Registered Nurses. Moreover, the Registrant accepts that his

actions breached the following provisions of ‘The Code, Standards of conduct,

performance and ethics for nurses and midwives’ effective from 2008 (‘the NMC

Code’):

Paragraph 24 – You must work cooperatively within teams and respect the skills,

expertise and contributions of your colleagues.

Paragraph 25 – You must be willing to share your skills and experience for the

benefit of your colleagues.

Paragraph 27 – You must treat your colleagues fairly and without discrimination.

Paragraph 48 – You must demonstrate a personal and professional commitment

to equality and diversity.

Paragraph 61 – You must uphold the reputation of your profession at all times.

33. The admitted facts span a substantial period of time over which the Registrant acted

in an unprofessional and inappropriate manner towards his colleagues. His

comments were offensive and many of them were derogatory to women. The

comments made to Colleague B were said at a time when she was pregnant and the

Registrant knew that to be the case. The comments also include comments which

are derogatory to those with disabilities. The Registrant’s actions caused substantial

distress to his colleagues.

34. Accordingly, for the reasons above, the Registrant accepts that the facts amount to

misconduct.

Current Impairment

35. The Registrant admits that his fitness to practise is currently impaired by reason of

his misconduct.

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36. The parties have considered the questions formulated by Dame Janet Smith in her

Fifth Report from Shipman, approved in the case of CHRE v Grant & NMC [2011]

EWHC 927 (Admin) (‘Grant’) by Cox J.

37. The parties agree that admitted facts do not amount to the Registrant placing a

patient or patients at unwarranted risk of harm: there is no suggestion that any of the

Registrant’s conduct was witnessed by a patient.

38. Similarly, the parties agree that there is no dishonesty in this case.

39. The parties agree that the Registrant has in the past brought the nursing profession

into disrepute. The Registrant’s conduct raises an attitudinal concern and both fellow

practitioners and members of the public alike would consider his actions deplorable.

40. The parties agree that the Registrant’s actions did breach fundamental tenets of the

profession. In particular, the parties agree that paragraphs 27 and 48 of the NMC

Code (set out above) are fundamental tenets of the profession.

Insight, remorse and current practice

41. The Registrant has provided a reflective piece dated 22 August 2016 [appendix 2].

The paragraphs below set out some of the key passages from that document but the

panel should read appendix 2 in its entirety. The document begins with a candid

acceptance by the Registrant of his misconduct:

I accept that on several occasions I had made comments of a sexual nature to

colleagues, and accepted that I have made comments which were

unprofessional and discriminatory towards disabled people. I also accepted that

on multiple occasions I made offensive comments about breastfeeding, the

murdered girls of Soham, infidelity etc to colleagues. These comments were

made during my band 7 charge nurse position in the Department of Sexual

Health (DOSH) at Peterborough City Hospital from July 2012 to August 2013.

The comments were made before clinic started or at lunch times when staff

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would get together for a chat, or when having a patient case discussion or

training. The comments were made in front a range of junior staff including junior

nurses, healthcare assistants and reception staff and the comments caused

great offense to my colleagues. I realised that I had over stepped the mark during

the normal staff banter by making comments which were of a sexual nature,

unprofessional and discriminatory as well as offensive. I made several errors of

judgement and behaved in an unprofessional manner

42. Next the Registrant sets out his initial reaction to the complaint made against him at

the Trust:

I was extremely shocked when my colleagues reported me for bullying and

harassment and I went into denial. I could not believe what was happening and

initially I tried to mitigate all my actions, without fully accepting the damage I had

done. I accepted the outcome of the disciplinary hearing in 2013 having realised

that I had behaved in an unprofessional manner, and I used that experience to

change my behaviour. I tried to build bridges with some of the staff who remained

in DOSH but this was difficult because I had put them through an extremely

stressful situation where they had to give evidence at my disciplinary hearing. In

hindsight, things may have been different if I had initially accepted the charges

and worked with my colleagues to improve our working relationship.

43. Further the Registrant states:

What do I think about it?

The sexual comments were inappropriate for a work environment and were not of

a professional nature and I deeply regret making comments of a sexual nature to

my colleagues. I realise that I allowed my professional boundaries and standards

to fail, and in hindsight I have failed to behave in a way which was expected of a

senior nurse. As a result of my comments, I realise that I have caused offense

and distress to my colleagues, for which I am extremely sorry and offer my most

sincere apology. Following the disciplinary hearing, I made a great effort to build

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a happy and productive working relationship with my colleagues, ensuring that I

behaved in a professional manner and use language which was professional.

I realised that my comments about disabled people were stupid and I should

have never made such comments. I deeply regret making those comments and

will never make such comments again. I was working in a service which was

non-judgemental, where members of the public could come to receive sexual

health care without being judged, and my comments about disabled people were

totally inappropriate, offensive and not what one would have expected from a

senior nurse.

I deeply regret making the offensive comments about breastfeeding, the

murdered girls of Soham, infidelity etc all of which were insensitive and I realised

how upsetting and hurtful it would have been to my colleagues. I have caused an

immense amount of stress to my colleagues for which I am deeply sorry for,

especially knowing that my colleagues are probably still affected by my offensive

comments. I had no intention of causing harm to my colleagues, and my lack of

professionalism and boundaries made my colleagues uncomfortable and lost

confidence and respect for me.

I am now more self aware of how to behave professionally at all times and I can

now use my experience to offer advice and support if any of my colleagues were

to behave in an unprofessional manner or use inappropriate language.

What could I/ should I have done

When I started work in Peterborough I should have maintained professional

boundaries whilst still being friendly with junior colleagues. I should have carried

out my duties in a professional manner expected by my employer and the NMC. I

could have encouraged staff to give regular feedback so that I could have

changed by behaviour and language before it got to the point where staff felt they

had to report me. I could have accepted my failings sooner and possibly avoided

my colleagues having to go through a long period of stress. I could have worked

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harder at repairing my working relationship with colleagues and let them see that

I am a kind and caring person. I should have made an effort to contact

colleagues who left the department and offer a sincere apology.

What was the impact?

My inappropriate language was not what was expected of a professional nurse,

and this brought my profession into disrepute and would have given other

professional groups of colleagues a negative view of nurses. As a result of my

unprofessional behaviour I also failed to meet the standards expected by my

employers, and breached several of the Trust equal opportunity policies. I have

since worked extremely hard to maintain the standards expected of my

profession, to give other professional colleagues a positive view of nurses, and to

maintain the high standards expected by my employers. My manager’s feedback

has shown that I am successfully maintaining the professional standards

expected by my profession and my employer. My inappropriate comments were

not made when patients were around and I am horrified of how patients would

have felt if they have overheard my comments. Patients or the public would have

been distressed and upset by my comments, and would have lost respect for

nurses, other colleagues and the service/ Trust. By maintaining a strict

professional relationship with colleagues I can ensure that I never give patients

or the public a negative view of myself, my profession, nor my service/ employer.

I have also used my experience to offer advice to current colleagues when there

is any language or behaviours at work which may be offensive to others, for

example, in my current role I have asked senior colleagues not to swear/ use

inappropriate language in front of junior staff.

I accept that my comments about disabled people were also inconsistent with the

standards expected of the nursing code of conduct and had failed to meet the

non-judgemental and non-discriminatory requirements of my job and my

employer. I am extremely disappointed by my comments, especially because I

personally know how hurtful discrimination can be, having been on the receiving

end. I'm now more self aware and I would not use language which could be

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offensive or discriminatory as I would never want to hurt anyone. I am very

ashamed of what I said, especially because I was brought up to respect others

and their differences and to never harm anyone. I have also let my friends and

family down as my offensive and discriminatory comments were not what they

would have expected from me as they have a very high expectation of nurses.

This experience has enabled me to champion a non discriminatory work

environment and I am currently supporting a trainee nurse practitioner to be our

learning disability link nurse and to ensure people with learning disabilities are

able to access our services.

My offensive comments were in breach of my professional code of conduct as

well as what was expected from colleagues and my employer. Patients or

members of the public would have been very upset and appalled by my offensive

comments, and as I am more self aware I do not use offensive language at work

to ensure that patients are treated with respect and dignity. At the time I did not

mean to cause any offense and I deeply regretted my lapse of judgement and

any distress I would have caused to staff. I am more self aware of how others

may find jokes and comments offensive or insensitive and since the disciplinary

process I have maintained a strict professional conversations and relationship

with work colleagues.

44. The Registrant ends by setting out the action he has taken following the events set

out above:

I took advantage of regular coaching and supervision offered after the

disciplinary hearing and these have been extremely useful in helping me to stay

focused and professional. My current employer has also continued to provide

coaching, having explained how this has been beneficial to me. I have since

completed the Myers-Briggs training as well as training in handling difficult

conversation and managing performance and capability. These have been useful

in helping me understand my colleagues better and to realise that other people

perform differently. I now work with staff to help them to identify shortcomings in

their own practice and to assist them with addressing any short comings. I am

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more aware of the need for giving praise and developing a culture of constructive

criticism, for example, allowing experienced healthcare assistants to audit the

microscopy skills of myself and other senior nurses, and nurses to audit myself

and each other patient care/ documentation. I have learnt how to be firm but fair

and how to manage conflict as well as creating an environment where staff feel

supported and can raise concerns. I realised how traumatic the whole experience

would have been for others having experienced it myself, and deeply regretted

what happened at Peterborough City Hospital. I am now focused on developing

my career and those of the staff whom I manage whilst maintaining professional

behaviour.

I have always ensured that patients receive the best care possible, and will

continue to do so. I have recently been awarded the Diploma of the Faculty of

Sexual and Reproductive Healthcare (NDFSRH) having decided to complete

similar training to my medical colleagues. I am using my new knowledge and

skills to provide high quality holistic patient care and to support junior members of

the team.

have been for others having experienced it myself, and deeply regretted what

happened at Peterborough City Hospital. I am now focused on developing my

career and those of the staff whom I manage whilst maintaining professional

behaviour. I intend to never again bring myself nor my profession into disrepute.

45. The NMC has received a reference dated 4 October 2016 from Barts Health NHS

Trust, the Registrant’s current employer [appendix 3]. The reference is signed by Ms

4. Ms 4 holds the position of Consultant Nurse in Sexual Health. Ms 4 is the

Registrant’s manager. Ms 4 states as follows:

Ravi’s role involves managing a team of Nurse Practitioners & I have had the

opportunity to observe his interactions with both the team he manages and other

members of our multi-disciplinary team.

In these interactions he is direct, polite and professional.

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I have said I have not directly observed his interactions with patients however I

have discussed patient care with him, both in the context of what the service can

operationally provide and also with reference to the clinical competencies of

individual clinicians that he is managerially responsible for. From these

discussions it is evidence that his clinical knowledge is of a high standard and

that he provides appropriated clinical care to our patients.

In addition from my conversation with both Ravi & the team he is managing I

believe he supports and encourages those he manages to ensure they are

competent and confident to provide appropriate clinical care to the patients

attending our services.

I have observed his interactions with both the team he is managerially

responsible for & the wider multidisciplinary team. His interactions with the team

are always professional, polite and appropriate to his role as a senior registered

nurse. He is cautious regarding language used by the team and challenges those

he manages if their behaviour or language strays beyond the boundaries of what

is appropriate for a registered nurse.

In my professional opinion I do not believe Ravi presents any risk to patient

safety in his practice as a nurse. I believe he provides excellent clinical care and

that he has expert clinical knowledge and skill that allows him to do so.

I find Ravi to be open, honest and truthful and I have no doubts or worries

regarding his integrity.

46. For the avoidance of doubt, the parties agree that there are no concerns about the

Registrant’s clinical practice and no concerns about his honesty.

47. The parties take the view that the reflective piece provided by the Registrant

demonstrates real insight. In light of the following:

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• The Registrant’s reflective piece;

• The letter provided by the Registrant’s current manager, Ms 4 [appendix

3];

• The absence of any further related incidents or complaints against the

Registrant,

• The training and courses which the Registrant has undertaken, both

following the disciplinary hearing, the coaching with his current employer

and subsequent training;

the parties take the view that the risk of repetition of the conduct in question is low.

48. In considering the question of whether the Registrant’s fitness to practise is currently

impaired, the parties have considered the following authorities.

49. In Meadow v GMC [2006] EWCA Civ 1390, the Court of Appeal emphasised that:

The purpose of fitness to practise proceedings is not to punish the practitioner

from past misdoings but to protect the public against the acts and omissions of

those who are not fit to practise. It is, therefore, an exercise of looking forward

and not back. However, in order to form a view, it is evident that you must take

account of the way in which the Registrant has acted in the past.

50. In Cohen v GMC [2007] EWHC 581 (Admin), the court set out three matters which it

described as being ‘highly relevant’ to the determination of the question of current

impairment:

1. Whether the conduct that led to the charge(s) is easily remediable

2. Whether it has been remedied

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3. Whether it is highly unlikely to be repeated

51. In Cheatle v GMC [2009] EWHC 927 (Admin) the court gave the following guidance:

Remediation is not the only factor and some matters are more easily remedied

than others. A Committee is entitled to conclude that a practitioner’s past conduct

was so egregious that he is not fit to practise without restrictions or maybe at all.

52. The NMC has also considered the comments of Cox J in Grant at paragraph 101:

The Committee should therefore have asked themselves not only whether the

Registrant continued to present a risk to members of the public, but whether the

need to uphold proper professional standards and public confidence in the

Registrant and in the profession would be undermined if a finding of impairment

of fitness to practise were not made in the circumstances of this case.

53. In light of the authorities set out above, notwithstanding the level of insight and

remorse shown by the Registrant, the parties agree that a finding of impairment is

required to declare and uphold proper standards of behaviour. There is no dispute

that the Registrant’s actions can be considered wholly inappropriate, unprofessional

and made colleagues feel extremely uncomfortable, Confidence in the profession

and in the NMC as its regulator would be undermined if a finding of impairment is not

made in this case, particularly in light of the distress caused by the Registrant’s

actions to other Registered Nurses and HCAs.

Sanction

54. The appropriate sanction in this case is a Caution Order for a period of five years.

The parties considered the NMC Indiactive Sanctions Guidance, bearing in mind that

it provides guidance not firm rules.

55. The aggravating features of the case are as follows:

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• The Registrant was in a senior position at the Trust and his behaviour was

directed to junior colleagues under his management

• The Registrant’s conduct was repeated over a substantial period of time

• A number of the inappropriate comments were of a derogatory/discriminatory

nature, related to the protected characteristics of sex, sexual orientation,

maternity/pregnancy and disability

• The Registrant’s actions caused substantial distress to a number of his

colleagues

56. The mitigating features of the case are as follows:

• The Registrant’s inappropriate conduct was never directed to or witnessed by a

patient or patients

• There are no concerns about the Registrant’s clinical knowledge or skills, and he

has in fact received a positive employment reference from his current employer

• Prior to the events in question the Registrant had an unblemished record

• There have been no subsequent concerns raised to the NMC since this referral

• The Registrant has fully engaged with the proceedings

• The Registrant has demonstrated a high level of insight

• The Registrant has undertaken training, coaching support, mentoring and

supervision following the disciplinary hearing, and has undertaken coaching with

his current employer and further training

• In light of the above, it is considered that the risk of repetition of the conduct in

question is low

57. In considering what sanction would be appropriate the parties began by considering

whether this is a case in which it would be appropriate to take no further action. The

parties considered paragraphs 56 to 58 of the NMC Indicative Sanctions Guidance.

Given that the Registrant has breached fundamental tenets of the profession,

brought the profession into disrepute, the distress caused to the Registrant’s

colleagues and the fact that the inappropriate behaviour was repeated over a

substantial period of time, the parties agree that taking no further action would not

be adequate to mark the public interest in this case.

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58. The parties next considered whether a Caution Order would be appropriate. The

parties noted that a Caution Order will be disclosed to anyone enquiring about a

nurse’s fitness to practise. Paragraph 60 of the Indicative Sanctions Guidance states

that:

Therefore, a caution may be appropriate where the case is at the lower end of

the spectrum of impaired fitness to practise and the panel wishes to mark that the

behaviour was unacceptable and must not happen again.

59. The parties agree that this case does not fall at the lower end of the spectrum of

impaired fitness to practise, although it is not at the upper end either. But

nevertheless this is a case in which a sanction is required to mark that the behaviour

was unacceptable and must not happen again.

60. Paragraph 61 of the Indicative Sanctions Guidance states:

When fitness to practise is impaired by reason of misconduct and a panel is

minded to impose a caution order, it should consider whether such an order

provides adequate public protection, bearing in mind that it does not restrict the

nurse or midwife’s practice rights. It might be appropriate where the nurse or

midwife’s history is such that the panel is confident that there is no risk to the

public or to patients which requires the nurse or midwife’s practice rights to be

restricted.

61. The parties take the view that as there are no public protection concerns in this case

and because the risk of repetition of the conduct in question is low, a Caution Order

would be appropriate to address the misconduct.

62. The parties went on to consider whether a Conditions of Practice Order would be

appropriate but they concluded that such an order would be inappropriate as the

primary purpose of a Conditions of Practice Order is to address clinical failings and

there are none in this case.

63. The parties went on to consider whether a Suspension would be appropriate. In

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considering the indicative sanctions guidance, the following is agreed:

• There has been no evidence of repetition since the incident.

• It is considered that the Mr Dass had demonstrated a high level of insight and

remorse, and has taken steps to remediate, through training, supervision and

mentoring following the disciplinary hearing, and further coaching with his

current employer, and further training

• The Registrants behavior raises public interest concerns, but does not relate

to his clinical practice

64. As per the indicative sanctions guidance, it is not the purpose of fitness to practise

proceedings to punish the Registrant for past misdoings (Meadow v GMC), the

parties took into account the reference from the Registrant’s current employer (Ms 4,

Appendix 3). This is a supportive and positive reference. This confirms that he

provides appropriate clinical care to patients. It confirms that his interactions, both in

a managerial capacity and in the wider team have been observed and that he is

always professional, polite and appropriate, as well as supportive and encouraging

to those he manages. Further as already noted, there are no public protection

concerns in this case, the Registrant has demonstrated insight and it is considered

that the risk of repetition is low. In all the circumstances the parties concluded that a

suspension order would be disproportionate, that the circumstances do not require

temporary removal from the register: it would amount to a punishment rather than a

measure necessary to uphold and declare proper standards and mark the wrong

doing. The parties also take the view that there is a public interest in permitting a

skilled nurse to practise as this provides a benefit to the public. For the reasons

above, the parties also considered that a Striking off Order would be

disproportionate.

66. Accordingly, having ruled out taking no further action, a Conditions of Practice

Order, Suspension and Striking off, the parties concluded that the only appropriate

and proportionate sanction is that of a Caution Order.

67. Next the parties considered the length of the caution, noting that it may be for a

period of not less than one and not more than five years. Because this is a case

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which does not fall at the bottom of the spectrum of impaired fitness to practise and

given the aggravating features of the case, the parties agree that the caution should

run for the maximum period of five years.

68. Finally, the parties agree that an interim order is not required in this case.

The parties understand that this provisional agreement cannot bind a panel, and that

the final decision on findings impairment and sanction is a matter for the panel. The

parties understand that, in the event that a panel does not agree with this provisional

agreement, the admissions to the charges set out at section 1 above, and the agreed

statement of facts set out at section 2 above, may be placed before a differently

constituted panel that is determining the allegation, provided that it would be relevant

and fair to do so.

Signed …………………………………….. Dated ……………………………………

Ravi Dass

Signed …………………………………… Dated……………………………………

(For and on behalf of the NMC)

The panel has seen an appropriately signed copy of this agreement dated 28 October

2016.

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Decision on the proposed CPD: The panel found the facts of the case proved by way of admission and fully accepted

the reasoning in the CPD provisional agreement which supported a finding of current

impairment by reason of Mr Dass’s misconduct

Mr Dass had behaved in an unprofessional and unacceptable manner towards his

colleagues and had used highly inappropriate language. The panel was mindful that

there is no suggestion that any of Mr Dass’s conduct was witnessed by or directed

towards a patient. However, in the particular circumstances of this case, the panel

determined that a finding of impairment is necessary to uphold the public interest by

maintaining public confidence in the profession and by declaring and upholding proper

standards of conduct and behaviour. The panel considered that confidence in the

profession and in the NMC as its regulator would be undermined if a finding of

impairment is not made in in light of the serious attitudinal and behavioural concerns

which are evident in this case and which caused distress to his colleagues.

The panel went on to consider what sanction might be appropriate.

The panel first considered whether to take no action, but determined that, in light of the

facts in this case, this would not be sufficient to satisfy the public interest. By virtue of

his inappropriate behaviour and comments towards his fellow colleagues Mr Dass has

breached fundamental tenets of the profession and brought the profession into

disrepute. The panel considered that the misconduct in this case needs to be marked by

the imposition of a sanction.

The panel then considered imposing a caution order. The panel did not consider that

the misconduct in this case falls at the lower end of the spectrum of impaired fitness to

practise. However, having had careful regard to the documentation before it today the

panel decided that a caution order is appropriate and within the realm of reasonable

decisions for the following reasons:

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• In his reflective piece dated 22 August 2016 Mr Dass has demonstrated sufficient

insight into his misconduct and past behaviour.

• Mr Dass has taken steps to remediate his misconduct, through training,

supervision, coaching and mentoring following the disciplinary hearing, and has

engaged in further coaching with his current employer.

• Mr Dass has produced a positive reference from his current employer for whom

he has worked since May 2015 in which Mr Dass is described as ‘direct, polite

and professional’ in interactions with his colleagues. Further, his referee states

that: “In addition from my conversation with both Ravi & the team he is managing

I believe he supports and encourages those he manages to ensure they are

competent and confident to provide appropriate clinical care to the patients

attending our services.”

• Mr Dass’s behaviour raises public interest concerns, but does not relate to his

clinical practice

• Prior to these events Mr Dass had an unblemished record, there have been no

subsequent concerns, and he has fully engaged with these proceedings.

For all these reasons the panel considers that the risk of repetition is low.

In the panel’s judgment, a conditions of practice order would not be appropriate since

there are no areas of Mr Dass’s clinical practice identified as in need of remediation.

The reference from his current employer attests to his clinical abilities.

The panel went on to consider whether to impose a suspension order, but determined it

to be potentially disproportionate in light of Mr Dass’s insight and remediation. A

suspension order would neither be appropriate nor proportionate in the circumstances

Accordingly, the panel agreed with the conclusions of the provisional CPD agreement

and concluded that a caution order is the appropriate and proportionate sanction in this

case. In the panel’s view this order would satisfy the public interest in declaring and

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upholding proper standards of conduct so that confidence in the profession and its

regulation is maintained.

The panel considers that a caution order for a period of 5 years sufficiently marks the

seriousness of the misconduct. Accordingly, the panel has determined to accept the

provisional CPD agreement dated 28 October 2015.

That concludes this case.

Conduct and Competence Committee Substantive Hearing Name ... · 11/4/2016 · The notice letter...

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