Mr Stuart Grave
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During the course of your employment as an Operating Department Practitioner for The Royal Liverpool and Broadgreen University Hospitals NHS Trust:
1. On 14 November 2011 whilst on duty you self-administered oxygen from an anaesthetic machine.
2. On 2 August 2013, whilst on duty you:
a) Misappropriated 2 ampoules of tramadol from your workplace;
b) Self-administered the tramadol described in paragraph 2a).
3. Your action as described in paragraph 2a) was dishonest.
4. Your actions as described in paragraphs 1 – 3 constitute misconduct.
5. By reason of that misconduct your fitness to practise is impaired.
1. The Panel was satisfied that proper notification of this hearing had been given as a notice setting out the date, time and venue of this hearing had been sent to the Registrant’s registered address on 19 November 2015.
Proceeding in absence:
2. The Panel heard a submission by Miss Kavanagh for the case to proceed in the absence of the Registrant. The Registrant was not present or represented. He had sent an email on 3 December 2015 stating that he did not intend to attend making specific reference to this hearing. The Registrant did not submit any written representations for this review. The Panel accepted the Legal Assessor’s advice and has exercised the principle of proportionality at all times. It also took account of the relevant Practice Note on Proceeding in the Absence of the Registrant.
3. The Panel carefully exercised the severely constrained discretion in favour of proceeding in the Registrant’s absence as all reasonable steps had been taken to notify him of this hearing. Firstly, he had been properly notified in accordance with the rules. Secondly, he was also given notification by email on the same date. Thirdly, there had been the communication of 3 December 2015. The Panel determined that the Registrant was aware of today’s hearing. Furthermore, the Panel noted that the Registrant had not applied for an adjournment. In addition, this is a review of a substantive order and time is of the essence to ensure that the sanction does not expire before any further date for this review could be arranged. The Panel has determined that the Registrant has exercised his choice not to attend on a voluntary basis and, for the reasons set out, that it would be fair, proportionate and in the interests of justice to proceed in his absence. It was also in the public and Registrant’s own interest for a decision as to the future of the case to be made expeditiously.
4. Miss Kavanagh made an application that part of the hearing should be held in private. The Panel received advice from the Legal Assessor. The Panel determined that pursuant to article 10(1) (a) of the Conduct and Competence (Procedure) Rules 2003 there was discretion to hold a hearing in private. The Panel decided to hold part of the hearing in private to avoid a disproportionate interference with the Registrant’s right to a private life when there would be any detailed reference to his health condition.
5. The Panel does not intend to rehearse the full background to this case suffice to say that the Registrant, an Operating Department Practitioner, was employed as an ODP in the Theatres and Anaesthetics Directorate at the Broadgreen University Hospital (the Hospital) between 1 July 2002 and 1 June 2014. His role involved tasks such as preoperative support, patient care, and organising medication and equipment for specific procedures.
6. On 14 November 2011, the Registrant was witnessed with the patient end mouthpiece of the breathing system apparatus, from an oxygen anaesthetic machine, in his mouth. During his disciplinary hearing on 2 July 2012, the Registrant made full admissions in relation to self-administering oxygen from an anaesthetic machine.
7. On 2 August 2013, the Registrant self-administrated Tramadol that he had taken from the Hospital medications cupboard. He was found collapsed in the corridor outside surgical theatres by colleagues who had responded when they heard a commotion. The collapse took place during a working shift. Empty ampoules of Tramadol were found around the Registrant’s body. The Registrant admitted in writing to the unauthorised taking and use of the Tramadol.
8. It was determined by the Final Hearing Panel that the facts were found proved, including dishonesty, and that the Registrant’s fitness to practise was impaired at the time by reason of his misconduct, breaching fundamental ODP Standards. During the course of its determination, the Panel determined that it was dealing with two serious allegations. The Registrant’s actions had an impact upon the normal working of the operating theatre and other professionals who were attending to patients who were about to go into theatre. Taking ampoules of medication intended to be used in theatre that day had put service users at risk of harm. The Panel concluded that the conduct was remediable but that there remained a risk of repetition. That Panel determined that an appropriate and proportionate sanction was to impose a Suspension Order of 12 months’ duration and suggested ways in which a future review panel might be assisted. Whilst in no way seeking to bind this Panel, the Final Hearing Panel envisaged that the Registrant would need to first, provide evidence that he had successfully addressed his health issues and that he no longer posed a risk to service users or to himself. This evidence may take various forms and that Panel encouraged the Registrant to consider a wide range of sources for such evidence. However, the Registrant was given specific guidance that there should be some form of medical/clinical evidence. Secondly, evidence that the Registrant has kept his skills and professional knowledge up-to-date. Thirdly, personal testimonials and that Panel invited the Registrant to garner as wide a spectrum of sources as possible. The Panel would also commend the production of professional testimonials from previous colleagues and employers and any professionals with whom he has more recently had contact. The Registrant has not submitted such evidence.
9. Miss Kavanagh submitted that the Registrant’s fitness to practise remains impaired by reason of his misconduct. She submitted that no evidence had been provided by the Registrant and he had not engaged with the process.
10. Whilst the Panel has taken account of these submissions, it is not fettered by them and the decision whether the Registrant is impaired is a matter for this Panel exercising its own independent judgment.
11. In reaching its decision, this Panel has accepted the Legal Assessor’s advice and exercised the principle of proportionality. It has also had regard to the HCPC’s Indicative Sanctions Policy.
12. The Panel was disappointed that the Registrant has not engaged with the HCPC since the sanction was imposed, as the previous Panel had been clear about what a review Panel might consider helpful.
13. The only further information was the Registrant’s assertion that his health had improved, without there being evidence to support this, and his stated intention not to return to ODP practice. The Panel is left with no evidence upon which it can be satisfied that the public is protected if the Registrant was to be permitted to return to restricted or unrestricted practice. The Panel considered that, in the absence of any evidence of the Registrant having developed full insight into his failings and taken action to remedy these failings, he remains a risk to the public.
14. Despite his previous career before these events, the Panel has determined that there remains a risk of repetition. The matter is sufficiently serious to continue to put the public at risk in the absence of remediation of his health issues and sufficient insight. There is also a need for evidence that the Registrant has managed his health condition. It is for the Registrant to demonstrate that he has fully acknowledged the potential risks to the public that his conduct caused and its consequences. He has not done so. Accordingly, the Panel has determined that the Registrant’s fitness to practise remains impaired by reason of his misconduct.
15. Central to the Panel’s consideration on sanction was the public interest. The public interest includes the need to protect service users, to declare and uphold proper standards of behaviour and to maintain public confidence in the profession.
16. The Panel first considered taking no action or mediation and rejected these outcomes as, in the circumstances, either would be wholly inappropriate and inadequate.
17. The Panel next considered imposing a Caution Order and rejected this sanction. The Panel determined that this sanction could not meet the safeguards currently required to protect the public. The misconduct put the public at risk and undermined the trust that his work colleagues had in him, as well as confidence in the profession. The Registrant breached the trust vested in him when he misappropriated drugs for his personal use. The administration of the drugs meant that the Registrant had to be medically managed by health professionals who were treating patients in the operating theaters at the time.
18. The Panel next considered replacing the current Suspension Order with a Conditions of Practice Order. Given the very minimal engagement with the HCPC since the sanction was imposed and the stated intention not to return to ODP practice, there is no information before this Panel to reflect that he has addressed the health issues or gained sufficient insight. Also, in absence of any evidence, the Panel determined that there were no suitable, enforceable or workable conditions that could meet the level of concern relating to the misuse of drugs. It is impossible to devise conditions that would restrict an ODP’s access to drugs as this is a fundamental part of the work. There is also a lack of confidence in the Registrant’s honesty and integrity relating to drugs whilst concerns about his health remain. Therefore, the Panel has rejected this.
19. The Panel next considered whether to extend the existing period of Suspension. The Panel has limited confidence that the Registrant may engage in the future. However, there is no clinical information about the Registrant’s current health position and he may alter his stated view about ODP practice. Whilst this possibility remains it would be disproportionate to impose an order that is incapable of being reviewed. Whilst this is not a health case, health is a significant feature, and in such cases a Striking Off order is not available until there has been a continuous period of suspension for two years. In this case there has been a one year period of suspension so far. The Panel did not consider it proportionate to remove from the Registrant’s power the opportunity for him to demonstrate that he is, or might be, fit to practise. This Panel considered that the previous Panel had suggested some reasonable steps that the Registrant could take before this review, but he has not acted upon those suggestions. This Panel wishes to re-confirm that the previous Panel’s suggestions would have been useful for this Review to demonstrate remediation of the health issues in particular. This Panel does wish to give the Registrant an opportunity to engage with the regulatory process and provide information to a future reviewing Panel. The Registrant’s current unwillingness to engage may alter. Therefore there is merit in an Order that is capable of a further review.
20. There is the possibility that the Registrant will participate in a Voluntary Removal Agreement. In this way the time and expense associated with a further Review is avoidable if the Registrant genuinely does not wish to practise in the future. In the Panel’s view it would be fair to give the Registrant these opportunities. This having been said, the Panel is of the view that the length of the Suspension Order should be limited to 6 months. This is sufficient time for the necessary steps to be taken to evidence remediation, and the health improvements that the Registrant states have already occurred or to seek a Panel’s approval of a Voluntary Removal Agreement.
The Registrar is directed to extend the suspension of Mr Stuart Grave for a further period of 6 months on the expiry of the existing order.
The order imposed today will apply from 06 February 2016.
This order will be reviewed again before its expiry on 06 August 2016.
No notes available
History of Hearings for Mr Stuart Grave
|Date||Panel||Hearing type||Outcomes / Status|
|08/07/2016||Conduct and Competence Committee||Review Hearing||Struck off|
|21/12/2015||Conduct and Competence Committee||Final Hearing||Suspended|