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Nursing and Midwifery Council Fitness to Practise Committee

Substantive Hearing 26 November – 4 December 2017

Nursing and Midwifery Council (NMC), Temple Court 13a Cathedral Road, Cardiff, CF11 9HA

Name of Registrant Nurse: Lolita Moniba NMC PIN: 05K0103O Part(s) of the register: Registered Nurse – sub part 1 Adult Nursing – 3 November 2005 Area of Registered Address: Wales Type of Case: Misconduct Panel Members: John Penhale (Chair, Lay member)

Claire Louise Gill (Registrant member) James Hurden (Lay member)

Legal Assessor: Charles Parsley Panel Secretary: Susan Curnow Representation NMC: Represented by Bryony Dongray, counsel,

instructed by NMC Regulatory Legal Team Registrant: Mrs Moniba was not present and not

represented Facts proved: 1; 2.1, 2.2, 2.3, 2.4, 2.5, 2.6; 3.1, 3.2; 4 (in

relation to 3.1 and 3.2) Facts not proved: None Fitness to practise: Impaired Sanction: Suspension order – 6 months Interim Order: Interim suspension order – 18 months

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Details of charges: That you, whilst employed as the Nurse in Charge of the Ty Llew Unit ("the Unit") at

Hafan-Y-Coed Care Home, Llanelli, between May 2013 and February 2015:

1. On various dates, displayed inappropriate behaviour towards your colleagues. [Proved]

2. On 16 February 2015, in relation to Resident A:

2.1 Did not conduct a body check on Resident A; [Proved] 2.2 Did not use a hoist to lift Resident A; [Proved]

2.3 Instructed a junior member of staff to inappropriately lift Resident A;

[Proved] 2.4 Did not identify Resident A had a fractured femur; [Proved] 2.5 Did not seek medical attention for Resident A; [Proved] 2.6 Did not to give a full handover of Resident A's fall. [Proved]

3. On or after 17 February 2015, retrospectively completed an incident report form

in that you:

3.1 Incorrectly dated the incident report form 16 February 2015; [Proved] 3.2 Recorded false information in the form, in that you recorded you had

"Checked & examined body parts, skin flap cleaned & dressing applied"

when you had not. [Proved]

4. And your actions in charge 3.1 [Proved] and/or charge 3.2 [Proved] were

dishonest.

And in light of the above, your fitness to practise is impaired by reason of your misconduct

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Decision on service of notice of hearing: Mrs Moniba was not in attendance, nor represented in her absence.

The panel was informed that written notice of this hearing had been sent to Mrs

Moniba’s registered address by recorded delivery and by first class post on 17 August

2017.

The panel took into account that the notice letter provided details of the allegation, the

time, dates and venue of the hearing and, amongst other things, information about Mrs

Moniba’s right to attend, be represented and call evidence, as well as the panel’s power

to proceed in her absence.

In addition, the Royal Mail “Track and Trace” documentation indicated that the notice

was received at the registered address on 18 August 2017. The printed name was given

as “Moniba”.

Ms Dongray 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 the information available, the panel was satisfied that notice had been

served, as advised by the legal assessor, in compliance and accordance with Rules 11

and 34 of the Rules;:

11 (2) The notice of hearing shall be sent to the registrant...

(b) in every case, no later than 28 days before the date fixed for

the hearing.

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34 (1) Any notice of hearing required to be served upon the registrant shall be

delivered by sending it by a postal service or other delivery service in

which delivery or receipt is recorded to

(a) his/her address in the register

Proceeding in the absence: The panel then considered continuing in the absence of Mrs Moniba. The panel heard

the submissions made by Ms Dongray on behalf of the Nursing and Midwifery Council

(NMC).

Ms Dongray informed the panel that Mrs Moniba had informed the NMC via a telephone

note dated 13 November 2017 that she would not be in attendance. [PRIVATE] She

referred the panel to the case of R. v Jones (Anthony William), (No.2) [2002] UKHL 5,

and GMC v Adeogba [2016] EWCA Civ 162 and submitted that hearing should proceed

as there was no good reason for not doing so. Mrs Moniba was aware of the hearing,

and this had been confirmed by telephone. She had not sought an adjournment and

there is no indication that she wishes to be represented. The NMC had offered her

alternative means of participating such as WebEx, which she had declined. Mrs Moniba

indicated that she is content that the hearing proceed in her absence.

Ms Dongray reminded the panel of the NMC’s duty to protect the public, and of the

substantial costs which had been incurred by scheduling this hearing. Furthermore, six

witnesses had been warned to attend over the coming days. She submitted that Mrs

Moniba had voluntarily absented herself and invited the panel to proceed in her

absence.

The panel accepted the advice of the legal assessor.

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In deciding whether to proceed in the absence of Mrs Moniba, the panel weighed its

responsibilities for public protection and the expeditious disposal of the case with Mrs

Moniba’s right to a fair hearing. The panel was mindful that this was a discretion that

must be exercised with the utmost care and caution as referred to in the case Jones.

In reaching this decision, the panel has considered the submissions of the case

presenter, and accepted the advice of the legal assessor, which included reference to

the recent case of Adeogba. It has had regard to the overall interests of justice and

fairness to all parties. The panel was satisfied that Mrs Moniba was aware of today’s

hearing. The panel had sight of a telephone note dated 13 November 2017, in which

Mrs Moniba informed the NMC that she is unable to attend due to her health, and also

stated that she feels unable to participate by WebEx. She confirmed that she is happy

for the hearing to proceed in her absence and is aware of the sanctions that the panel

can impose upon her practice. Mrs Moniba also stated that she has nothing further to

place before the panel at this stage.

The panel also noted that:

• No application for an adjournment has been made by Mrs Moniba and there is no

reason to suppose that adjourning would secure her attendance in person or by

representative at some future date;

• The panel noted that although Mrs Moniba had indicated that she would not be

attending because of her health, there had been no medical evidence provided in

support of this;

• [PRIVATE]

• The panel further noted that there were two witnesses for the NMC in attendance

today, and four more over the next two days. Not proceeding may inconvenience

the witnesses, their employers and, for those involved in clinical practice, the

patients who need their professional services;

• The allegations relate to a period between May 2013 and February 2015 and

there is a strong public interest in the timely disposal of the case.

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The panel noted that there is some disadvantage to Mrs Moniba in proceeding in her

absence. The panel can make allowance for the fact that the NMC’s evidence will not

be tested by cross examination and can itself explore any inconsistencies in the

evidence which it identifies. Furthermore, the limited disadvantage is the consequence

of Mrs Moniba’s decision to absent herself from the hearing, waive her rights to attend

and/or be represented and to submit only limited evidence on her own behalf.

In these circumstances, the panel has decided that it is fair, appropriate and

proportionate to proceed in the absence of Mrs Moniba. The panel will draw no adverse

inference from her absence in reaching its findings of fact.

Background: The charges arose whilst Mrs Moniba was employed as a Registered Nurse at Ty Llew

Unit (‘the Unit’) at the Hafan-Y-Coed Care Home, Llanelli (‘the Home’), and part of

Barchester Healthcare Limited (‘Barchester’). She had been employed as a staff nurse

since 1 December 2005, and at the time of allegations was the nurse in charge of the

Unit when on duty. Her responsibilities, as set out in her job description, included

assessing and continuously evaluating the residents physical, psychological and social

needs, delivery of care to her allocated residents such as administering medication,

conducting handover, liaising with healthcare professionals and recording care

delivered to residents. The Home is a general nursing and dementia care home with a total capacity of 106

beds, and is split into three units. Two of the Units are Elderly Mentally Infirm (EMI)

dementia units, and the other is a general nursing unit. Ty Llew Unit is a dementia unit

and has capacity for 32 residents. It is alleged that on various dates Mrs Moniba displayed inappropriate behaviour

towards her colleagues.

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On 16 February 2015, Mrs Moniba was working a twelve hour shift from 08:00 to 20:00,

during the latter half of which she was the only registered nurse on duty on the Unit.

One of the residents on the Unit, Resident A, suffered a fall at approximately 19:40 and

Mrs Moniba was called by the care staff to attend. Mrs Moniba was the nurse in charge

on that shift. On 17 February 2015 Resident A was admitted to hospital and following a

transfer to a second hospital, a fracture of the neck of the femur was identified. On 20

February 2015 Resident A’s wife raised concerns to the Home about the management

of her husband’s fall. Mrs Moniba was suspended from duty on 23 February 2015

pending an internal investigation into the allegations that she committed a serious

failure in her duty as a nurse in relation to Resident A’s fall. It is alleged that Mrs Moniba did not check Resident A for injuries and that with the

assistance of a carer lifted Resident A onto his chair, without using a hoist. It is further

alleged that Mrs Moniba completed an incident form on 17 February 2015 but dated it

16 February 2015.

Decision on the findings on facts and reasons: In reaching its decisions on the facts, the panel considered all the evidence adduced in

this case together, with the submissions made by Ms Dongray, on behalf of the NMC

and the witness statement received from Mrs Moniba.

The panel accepted the advice of the legal assessor.

The panel was mindful that the burden of proof rests on the NMC, and that the standard

of proof is the civil standard, namely the balance of probabilities. This means that the

facts will be proved if the panel was satisfied that it was more likely than not that the

incidents occurred as alleged.

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The panel heard oral evidence from six witnesses called on behalf of the NMC. The

titles below refer to the individuals’ positions at the time of the charges.

Ms 1 - Operations Manager, Barchester Care Homes. Ms 1 was working as the

peripatetic General Manager of the Home at the material time, and had been in that role

since July 2014. She also conducted the internal investigation into the events of 16 - 17

February 2015.

Mr 2 – Care Supervisor and healthcare assistant at the Home. Mr 2 had been working

as a carer at the Home since 2007, and since approximately 2013 had been employed

as a Care Supervisor. He worked on the Unit from December 2014 and was present on

the day shift on 16 February 2015.

Ms 3 - Healthcare Assistant, at the Home. Ms 3 had been employed as a carer at the

Home since 2012 and was working the day shift on 16 February 2015.

Ms 4 - Agency Nurse. She had been a registered nurse since 1979 and had been

working as an agency staff nurse since 2008 within different care homes. Although she

had worked at the Home previously, the night shift of 16 February 2015 was the first

time she had worked on the Unit.

Ms 5 - Registered Nurse, Head of the Unit at the Home. Ms 5 worked as a registered

nurse on the General Unit at the Home from 28 February 2014 until she was appointed

as Head of the Unit in December 2014.

Mr 6 - Registered Nurse, Deputy Manager/Clinical Manager, at the Home. Mr 6 was

responsible for line managing all nursing and care staff at the Home, managing the

standards of care within the Home and deputising to the General Manager.

The panel considered the credibility of these witnesses. It found each of them to be

broadly reliable and credible.

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The panel bore in mind that Ms 1 was in a managerial role and conducted the Home’s

internal investigation into the incidents, but that she was not a registered nurse. She

provided detailed information regarding her investigation but was unable to provide a

clinical opinion. The panel found her evidence credible and that she tried to assist the

panel.

The panel found Mr 2 tried to assist the panel, and was straight forward and candid in

his responses when questioned. If he could not remember specific details he was

honest in saying so. The panel found his evidence to be reliable, credible and

consistent.

The panel had some reservations about the reliability of some of the details provided by

Ms 3. It bore in mind, however, the time that had elapsed between the events that

occurred on 16 February 2015. In her oral evidence there were some discrepancies

compared with the statements Ms 3 provided as part of the internal investigation (21

February 2015, 12 March 2015, 5 and 9 April 2015) and to her written statement

provided to the NMC (4 December 2015). However, the panel determined that the

differences in her various accounts were not sufficient to undermine her overall

credibility. Ms 3 was a witness to Resident A’s fall and to the arrival of Mrs Moniba. She

appeared nervous when giving oral evidence and she admitted to having a difficult

relationship with Mrs Moniba.

The panel found that Ms 4 was an experienced nurse and a credible, reliable witness.

Although she had not worked on the Unit before, she provided the panel with evidence

of the circumstances she found on the Unit when she arrived. She gave a balanced,

informed account of what she understood to constitute a full body check. She described

the handover provided by Mrs Moniba and that Mrs Moniba had stayed for over an hour

following the end of her shift. She considered Mrs Moniba provided a good handover in

relation to the thirty residents on the Ward. When asked specifically about Resident A

she stated that “You cannot hand over what you do not know” but, on reflection, she

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considered that Mrs Moniba could have provided more detail. In relation to her written

evidence, the panel noted that she had been interviewed by Mr 6 briefly over the

telephone on 8 April 2015, but had provided a more detailed account of the events of

the night shift on 16 February 2015 in her statement to the NMC dated 6 December

2015 and in her oral evidence. The panel noted that she had a clear memory of Mrs

Moniba cleaning and dressing the skin flap on Resident A’s arm following the handover,

and of Resident A standing and having a light hearted exchange with the health care

assistants when receiving personal care later that evening.

Ms 5, a registered nurse, provided evidence directed towards the allegations of Mrs

Moniba’s inappropriate behaviour towards her colleagues, with particular reference to

an occasion on 13 April 2014. The panel also found her evidence in respect of the usual

procedures and practices at the Home, particularly regarding the care of residents who

have fallen, was clear and detailed. The panel found that she tried to assist the panel

and that her evidence was credible and reliable.

The panel found that Mr 6, a registered nurse and experienced manager, was open and

straight forward. The panel found him a credible and reliable witness.

In reaching its findings, the panel also had careful regard to the witness statement

provided by Mrs Moniba dated 23 March 2016, and the notes of the interviews

undertaken with her as part of the local investigation. The panel has drawn no adverse

inference from the non-attendance of Mrs Moniba in its findings on facts.

There were no formal admissions made by Mrs Moniba in relation to the charges.

The panel therefore considered each charge in turn and made the following findings:

That you, whilst employed as the Nurse in Charge of the Ty Llew Unit ("the Unit") at Hafan-Y-Coed Care Home, Llanelli, between May 2013 and February 2015:

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It is not in dispute that, at the relevant times, Mrs Moniba was employed by Barchester

Healthcare Limited as the Nurse in Charge of the Unit. She commenced employment in

this role in 2005.

Charge 1: On various dates, displayed inappropriate behaviour towards your colleagues.

This charge is found proved.

The panel noted that the charge was unspecific and generally worded. In reaching its

decision, the panel took into account the evidence provided by Ms 5, in relation to a

single incident, and Mr 6 including his Notes of Supervision Sessions dated 26

November 2013 and 23 April 2014. The panel was aware that the notes of both

sessions had been signed by both Mr 6 and Mrs Moniba.

The panel noted the entries in the notes of the Supervision session on 26 November

2013, that she [Mrs Moniba] felt “some care staff don’t respect the nursing staff … she

never raises her voice … or speaks to them inappropriately.” However, Mr 6 goes on to

record that Mrs Moniba “Admitted afterwards that sometimes loses her temper / shouts

at staff”

Ms 5 said that she had been informed at the beginning of her shift on 12 April 2014 that

Mr 6 had asked Mrs Moniba to work on the General Unit at the Home, because there

were no other nurses available for this shift. It was commonplace for nurses to be

allocated shifts on different units in the Home.

Ms 5 stated in her written evidence that on 13 April 2014, when Mrs Moniba came on

duty and walked onto the General Unit that “Lolita immediately raised her voice towards

me and shouted, ‘I’m not putting my pin on the line, I only work on Ty Lliw.’ I felt

threatened by Lolita’s behaviour as she can be intimidating. I was shocked that Lolita

raised her voice in this manner towards me, given that there were several residents

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present in the foyer whilst the conversation took place.” In her oral evidence, Ms 5

confirmed that one of the residents who had witnessed this incident commented: “Is she

crazy?” Ms 5 stated that she felt Mrs Moniba had behaved in unprofessional manner in

that it was not appropriate to raise her voice in front of residents.

Ms 5 stated in her oral evidence that there were no other occasions when she had

observed such behaviour; she was aware that other members of staff had concerns

about the way Mrs Moniba spoke to them, but she could not be more specific than that.

Mr 6 stated that a staff meeting took place on 23 April 2014, in which all senior staff

were present. During the meeting he informed Mrs Moniba of her tasks and that “Lolita

responded to me in an argumentative manner.” Following the meeting, Ms 1 informed

Mr 6 that she did not think it was appropriate that Mrs Moniba speak to him in such a

way, and that he needed to discuss this with Mrs Moniba.

In the notes of the session on 23 April 2014 it is recorded that “Despite previous

supervisions there remains a recurrent problem with rudeness and abruptness, the

latest episode being directed towards a colleague during a staff meeting.”

Ms 4 also stated that when she arrived on shift at 20:00 on 16 February 2015, that Mrs

Moniba appeared “abrupt in attitude but gradually this abruptness lessened and her

manner became amenable.” She also stated that she was aware it had been a long and

difficult shift, during the latter half of which Mrs Moniba had been the sole registered

nurse on duty, and that Mrs Moniba was “very het-up and there was obvious friction

between her and the care staff.”

The panel found that the accounts provided by Ms 4, Ms 5 and Mr 6 indicate that Mrs

Moniba could be abrupt, rude and could shout at colleagues. It considered that this

could amount to inappropriate behaviour. The panel also had regard to the evidence of

Ms 3, who stated that on the 16 February 2015, Mrs Moniba shouted at her and blamed

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her for allowing Resident A to fall. The panel was aware that it appeared that at times

there had been a difficult relationship between Mrs Moniba and the care staff.

Nevertheless, the panel was satisfied that there was sufficient evidence to suggest that

on at least three occasions, Mrs Moniba had displayed inappropriate behaviour towards

her colleagues.

The panel therefore concluded on the balance of probabilities that charge 1 was found

proved.

Charge 2: On 16 February 2015, in relation to Resident A:

The panel noted that Resident A had fallen on the Unit at approximately 19:40 on the 16

February 2015, towards the end of the day shift. The Unit is on the first floor, and is

carpeted throughout, except the lounge/dining area which has a hard floor. Mr 6 said

that two registered nurses and six care assistants are allocated to care for residents on

a day shift.

The panel was aware that on 16 February 2015, the second nurse, who was heavily

pregnant, had been unwell and left half way through her shift. Mrs Moniba completed

the second half of the shift on her own. The evidence indicates that the shift was busy,

and the panel was also aware that one of the residents on the Unit required end of life

support.

The panel accepted the evidence that Resident A was a tall, frail elderly gentleman. He

often tried to walk by himself and, because of his dementia, was unaware that he was

no longer capable of doing so. He would often place himself on the floor. Ms 2 stated

that when he tried to walk unaided, care staff encouraged him to sit down and that they

would “never leave him if we see him walking”.

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Mr 6 stated in his evidence that Resident A was difficult to look after: he was tall and

could be intimidating/challenging but was quite frail and slim. He was often disorientated

and was not encouraged to move independently as he was known to fall, but would

often slide himself to the floor and move around the Unit in a seated position.

It is not disputed that Resident A fell at approximately 19:40 on 16 February 2015. The

fall was witnessed by Ms 3 who was accompanied by a second healthcare assistant as

they entered the lounge/dining area. He was standing at the time they entered the area

and it appeared he was trying to reach some sweets. Ms 3 stated that Resident A fell on

his side. The other healthcare assistant went to Resident A’s assistance, and Ms 3 went

to call Mrs Moniba. Ms 3 said that she had to “call Lolita a couple of times and she

arrived within a couple of minutes.” Mrs Moniba then called Mr 2 to assist her.

2.1 Did not conduct a body check on Resident A; This charge is found proved.

In reaching its decision, the panel construed a “body check” as meaning a “full body

check” or “examination”. It considered the evidence provided by Ms 4, Ms 5 and Mr 6 as

to what constituted a full body check when a patient has experienced a fall. It found that

a full body check involved a top to toe examination of the patient, including a visual and

a manual check, patting down the body, checking for pain, and any shortening or

displacement of the limbs.

The panel had regard to the evidence provided by Ms 3. It found that Ms 3 had been

consistent throughout her evidence that Mrs Moniba had not undertaken a body check

of Resident A following his fall on 16 February 2015. In her contemporaneous account

of 21 February 2015 Ms 3 states “No” when asked by Ms 1 whether Mrs Moniba

checked that Resident A was “ok?” Ms 3 also states that “I told [Mr 2] that [Mrs Moniba]

had not examined him.”

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Ms 3 was similarly consistent in her statement to the NMC: “I said to [Mr 2] that I was

concerned Lolita had not examined Resident A” and “Lolita should have examined

Resident A before moving him but she failed to do so”.

The panel also had regard to the notes of the Investigation meeting between Ms 1 and

Mrs Moniba dated 18 March 2015, and the notes of the Notes of the Disciplinary

Hearing 17 April 2015. The panel found that Mrs Moniba accepted that although she

had undertaken a check, it was not a complete body check and/or examination. She

states in the Investigation meeting dated 18 March 2015: “No I could not assess his

condition. I could not touch him as he was very aggressive and was struggling”, “he was

aggressive I asked night staff to assess him” and “I did not do a thorough investigation

until the other Nurse came on duty … He is an aggressive man”.

In her witness statement Mrs Moniba writes: “I deny that that I did not conduct a body

check, but accept that the body check was incomplete” … “I accept I did not carry out a

complete examination, but this was because Resident A was being aggressive.” In

regard to the issue of Resident A’s aggression, the panel noted that Mrs Moniba was

the only person who stated that the resident displayed such behaviour at the time. Both

Mr 2 and Ms 3 were consistent in their accounts that Resident A was not aggressive

following this fall. The panel preferred the evidence of Mr 2 and Ms 3 in regard to this

issue.

The panel was satisfied that Mrs Moniba did not conduct a full body check/examination

on Resident A, and therefore charge 2.1 proved.

2.2 Did not use a hoist to lift Resident A;

This charge is found proved.

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In reaching its decision the panel considered that this charge presented a

straightforward issue. It concluded that all the evidence indicated that a hoist had not

been used to lift Resident A.

Mr 2 and Ms 3 provided evidence that Mrs Moniba and Mr 2 lifted Resident A by each

putting an arm around Resident A’s back and supporting his elbows to lift him into the

armchair. Ms 3 states in the meeting of 21 February 2015 that “[Mr 2] and Lolita picked

him up off the floor. They didn’t use the hoist. They helped him stand and Resident A

helped to [sic].”

The panel noted that Mrs Moniba also accepts that she had not used a hoist to lift

Resident A, stating that, “I did not think to use a hoist to move him” in the meeting on 18

March 2015, and that “I then instructed [Mr 2] … to help me lift Resident A back into the

armchair, which we did. I accept that I did not use a hoist despite this being in Resident

A’s care plan. The reason for this was that Resident A would get aggressive when being

put in the hoist and so we never used the hoist for Resident A.”

The evidence of Mr 2, Ms 3 and Mrs Moniba was that Resident A was regularly lifted

and moved without using a hoist. The panel did not have sight of Resident A’s care

plan, but had regard to Resident A’s Moving & Handling Risk Assessment dated 28

September 2014. Mr 6 had stated that this is a four page document although each page

is separate. The fourth page of the document is entitled “Safe System of Work” and

indicates that when moving Resident A, a hoist is to be used; this page is undated and

the panel was not satisfied that it related directly to the first page of that assessment.

The panel could place no reliance on the document.

However, the panel took account of the evidence provided by Ms 5 and Mr 6, who

stated that a hoist should always be used when a resident has experienced a fall. This

was the safest method of moving a resident when it could not be determined whether a

resident had sustained an injury.

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The panel concluded that a hoist had not been used to lift Resident A following his fall

on 16 February 2015 and therefore found charge 2.2 proved.

2.3 Instructed a junior member of staff to inappropriately lift Resident A;

This charge is found proved.

The panel determined that there were two elements to this charge; one that Mrs Moniba

instructed a junior member of staff to lift Resident A, and secondly that that instruction

was inappropriate.

In reaching this decision, the panel took into account of the evidence provided by Ms 3,

including the information provided in the notes of the Meeting of 21 February 2015 in

which she states: “Lolita called [Mr 2] into the room and she told him, “help me get him

up, he is alright”. This is consistent with her oral evidence and witness statement in

which she states: “Lolita asked [Mr 2] to help her lift Resident A up and sit him back into

the armchair.”

Mr 2 stated that “I asked if Resident A was OK, Lolita informed me that he had fallen but

was OK and asked me to help get him up. … I assumed that Lolita had conducted

general observations on Resident A before my arrival in order to assess if Resident A

was in any pain, or had caused any harm to himself.”

Mrs Moniba said in her witness statement: “I then instructed Mr 2 … to help me lift

Resident A into the armchair, which we did.”

The panel found that Mrs Moniba had asked Mr 2 to help her lift Resident A from the

floor onto an armchair and that the request by a nurse in charge to a care assistant

amounted to an instruction.

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The panel then considered whether that instruction had been appropriate. The panel

noted that the evidence was that following a fall, a resident should be hoisted rather

than lifted. When questioned by the panel, Ms 4 had stated that a hoist should always

be used if a resident is immobile and that Resident A, having experienced a fall, should

have been moved using a hoist, unless or until it had been ascertained that he had not

sustained injury.

The panel noted that Mr 2 stated he could not remember Resident A being moved or

lifted using a hoist prior to this date. However, Mr 2 also stated that he assumed that

Mrs Moniba had “conducted a set of observations on Resident A” before he entered the

room. He would not have agreed to lift Resident A had he known Resident A had not

been properly examined. The panel determined that Mrs Moniba’s failure to conduct a

proper examination following the fall made her decision to instruct care staff to perform

a manual lift inappropriate.

The panel also had regard to the evidence provided by Mrs Moniba. It noted that in the

Investigation Meeting of 18 March 2015 Mrs Moniba stated that “I didn’t think of hoisting

him, we have not used a hoist for a long time, I just wanted him to go into the chair”. It

also had regard to the notes of the Disciplinary Hearing on 17 April 2015: “I didn’t hoist

him because he falls a lot and I never hoisted him before when he fell, just helped him

up. It’s hard to put a sling under him when he’s aggressive…. He is strong and he could

move so I didn’t use a hoist. … I admit not hoisting him but there was no need. He was

aggressive.”

The panel had regard to the evidence of Ms 5 who stated that “If a resident has fallen a

full hoist should be used if they can’t get themselves up, if a resident is “feisty” this

should not affect the care provided.”

The panel found that Resident A had been lifted inappropriately in those circumstances.

Mrs Moniba should have used a hoist to move Resident A who had sustained a fall, and

when she had not, or had not been able to, undertake a full examination to ensure

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Resident A’s wellbeing. It concluded that on the balance of probabilities, Mrs Moniba

had instructed a junior member of staff to inappropriately lift Resident A without using a

hoist and therefore found charge 2.3 proved.

2.4 Did not identify Resident A had a fractured femur;

This charge is found proved.

In reaching its decision the panel considered that, in order for this charge to be made

out, it would have to be satisfied, firstly, that Resident A had suffered a fracture of the

femur, and secondly, that Mrs Moniba had failed to identify that that was the case. It

concluded that all the evidence indicated that Mrs Moniba had not identified that

Resident A had a fractured femur.

The panel noted that Ms 3 had stated that Resident A fell to the floor and had shouted

“my hip, my hip”. She also stated that she had informed Mrs Moniba that he had

experienced a “nasty fall” and had “really hurt his hip.” Mrs Moniba denies that Ms 3

said this to her at the time.

The panel took account of Mr 2’s evidence that he sat with Resident A in the lounge

area following the incident until his shift finished at 20:00. He stated that “Resident A

seemed as though he was in pain. His face was “scrunched up” and he kept touching

his hip.” He also said he assumed Ms 3 had informed Mrs Moniba that Resident A was

in pain and that “Lolita would attend to Resident A for further checks.” Mr 2 did not ask

Mrs Moniba “to attend to Resident A”.

The panel also took account of the evidence that at the end of the shift, and following

the handover Mrs Moniba gave to Ms 4, Mrs Moniba attended Resident A to dress the

skin flap on Resident A’s arm. This was observed by Ms 4. Ms 4 also stated that later

on that night she clearly remembers when Resident A was receiving personal care, he

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was laughing with the healthcare assistants and standing upright with the aid of a

zimmer frame.

The panel accepted the evidence of Ms 4 and Ms 5, both registered nurses that it could

be difficult to detect an undisplaced fracture of the femur even when a full body check

had been undertaken. The panel also noted that in addition to Ms 4’s observation of

Resident A when he was receiving personal care she had made an entry in the

Progress & Evaluation Record: “Resident A was able to move both legs and stand with

assistance no shortening or external rotation of the legs [observed]. Ms 5 stated that

only an x-ray would confirm whether a fracture had been sustained.

The panel had regard to the evidence provided in the Disciplinary Hearing on 17 April

2015 in which she stated she would have sent Resident A to A&E if she felt Resident A

had been in pain. She also stated that “When staff escorted him to hospital [“The Prince

Phillip Hospital”] they said the doctor could not tell if the fracture was new or old so he

was sent to Glangwili Hospital for another x-ray.” In his oral evidence Mr 6 confirmed

there was no medical evidence available to support or disprove that statement.

The panel was also aware that Ms 4 administered painkillers to Resident A that night,

and that he slept soundly. She confirmed that a care assistant informed her the next

morning that Resident A was experiencing some pain. The panel noted that Ms 1 and

Mr 6 conducted a walk around on the morning of 17 February 2015. Mr 6 confirmed that

there was no evidence at the time of any shortening or displacement of Resident A

lower limbs. The panel noted an entry written at 13:50 by Mrs Moniba in Resident A’s

Progress and Evaluation Record dated 17 February 2015, that Resident A was referred

to Prince Phillip Hospital A&E in a wheelchair.

In her witness statement Mrs Moniba accepts that she did not identify that Resident A

had a fracture femur and “neither did anyone else.”

21

The panel concluded that, in all likelihood, Resident A had suffered a fracture of the

femur at some point, more likely than not in the fall on 16 February 2015. Further, it was

clear that Mrs Moniba had not identified the fracture.

The panel therefore found charge 2.4 proved.

2.5 Did not seek medical attention for Resident A;

This charge is found proved.

The panel bore in mind that this related to the 16 February 2015. It also noted that that

Resident A appeared to have fallen at approximately 20 minutes before the end of Mrs

Moniba’s scheduled shift, but that following the handover to Ms 4 and attending to the

wound on Resident A’s arm, she did not leave the Unit until around an hour after her

shift had ended.

In reaching its decision, however, the panel noted that Mrs Moniba had not sought

medical attention for Resident A before leaving the Unit that evening.

The panel noted that Mrs Moniba accepts that she did not seek medical attention

immediately after the incident as “there appeared to be no need.” There is no evidence

that the information provided by Mr 2, that Resident A was in pain and that kept

touching his hip during the time he sat with him in the lounge until the end of his shift at

20:00 was given to Mrs Moniba. Mrs Moniba cleaned and dressed the wound he

sustained on his right arm and was observed by Ms 4, another registered nurse. Neither

make any mention that Resident A was experiencing pain in his hip or leg. Ms 4 states

clearly that she observed him later that evening standing with the support of a zimmer

frame and laughing. She further acknowledged that Mrs Moniba had informed her of the

fall sustained by Resident A during the handover.

22

When in turn, Ms 4 gave the handover to Mrs Moniba at beginning of the shift on 17

February 2015, she informed Mrs Moniba that Resident A was in pain and that she felt it

was necessary to contact a GP during their shift, so that a GP could attend to review

Resident A.

However, there was no evidence before the panel that Mrs Moniba had sought medical

attention for Resident A on 16 February 2015.

The panel therefore found charge 2.5 proved.

2.6 Did not to give a full handover of Resident A's fall.

This charge is found proved.

In reaching its decision, the panel took into account the evidence provided by Ms 4 in

her witness statement dated 6 December 2015 and qualified in her oral evidence.

In her witness statement Ms 4 stated, that she would expect that, following a fall, that

she would expect to be provided with information “such as the time of the fall, the

specific checks and observations that [Mrs Moniba] had conducted, including if the

resident was in pain or had any sores and to inform me if an accident form had been

completed.”

In her oral evidence Ms 4 detailed the handover she received from Mrs Moniba with

respect to Resident A, and when questioned, stated that looking back, it was not

sufficiently detailed. She said Mrs Moniba had informed her that Resident A had

damaged his arm and that she had checked he could move his arm and hands freely.

Ms 4 said that Mrs Moniba had not mentioned how or when he fell, if he had hit his

head, whether Resident A had reported any pain, or whether there had been any other

abrasions, or shortening of the limbs. Mrs Moniba did not provide any information as the

23

specific checks and observations she had conducted. She confirmed, however, that Mrs

Moniba had asked her to keep an eye on him.

Ms 4 confirmed that this was her first time on the Unit. She also told the panel that Mrs

Moniba had stayed over an hour after the shift had officially ended, and that “it can often

be difficult to ensure that all documents are completed as there are often distractions,

and other patients take priority.” In the note of her telephone interview of 8 April 2015

Ms 4 provided as part of the internal investigation dated 8 April 2015 she stated: “Lolita

said she had not documented it but would do it in the morning.”

Mrs Moniba stated in her witness statement that as Ms 4 was an agency nurse and it

was her first time on the Unit, the handover took “about an hour”. She spent 30 minutes

discussing the residents of whom the panel noted there would have been around 30,

including Resident A, and one resident on end of life care. She then provided a tour of

the clinical room and fire procedures. Then they both returned to Resident A to tend to

his skin flap. Mrs Moniba also stated that she tried examining Resident A again, but he

was agitated and struggling and she therefore suggested that Ms 4 “keep an eye on

him.”

The panel determined that Mrs Moniba’s failure to conduct a full body check (found

proved at 2.1) meant that she did not possess sufficient clinical information to provide a

comprehensive picture of Resident A’s condition during the handover to Ms 4.

The panel accept there would have been some discussion about the fall when Mrs

Moniba was dressing the wound sustained in the fall with Ms 4 present. It also noted

that in Ms 4’s entry detailing the care she had provided to Resident A during the night

shift, she had difficulty identify the location of the pain. Also as indicated above, Mrs

Moniba states that she was unable to conduct a full examination on two occasions both

at the time of the fall and when dressing the wound on his arm due to his agitated state.

Nevertheless the panel concluded that because Mrs Moniba had not conducted a full

24

examination, she could not have been in a position to give a full handover in relation to

Resident A’s fall.

The panel therefore found, on the balance of probabilities and in the circumstances that

the handover which Mrs Moniba gave Ms 4 in respect of Resident A’s fall, was less than

full handover, and therefore it found charge 2.6 proved.

Charge 3. On or after 17 February 2015, retrospectively completed an incident report form in that you:

The panel had sight of the Incident and Accident Report Form (“the Incident

Form”) dated 16 February 2015. The form is in two parts, Part A and Part B. Part A

is information about the accident/ incident, and Part B is called “Managers

Accident / Incident Investigation.” Part A is divided into seven sections, and

includes a body map.

Part A, section 5 is signed by Mrs Moniba as both the person completing the form,

and the nurse in charge at the time of the incident/accident. The date given on

both entries is 16 February 2015. Page 3 of the form is called “Body map”, the

right arm is marked and an entry: Skin flap R outer elbow” and signed by Mrs

Moniba and dated 16 February 2015. There is an entry under Section 3 of the

form: “… dressing applied, pain killers given by night Nurse.”

The panel also had sight of the Progress & Evaluation Records and noted the untimed

entry on 16 February 2015 made by Ms 3, which documents the fall and states:

“[Resident A] fell before we could get to him, he fell on his L, hip we called the nurse on

duty and reported it to her she helped pick him up with [Mr 2] and put him in his chair.”

This is followed by an entry on 17 February 2015 at 06:20, made by Ms 4 which refers

to the fall, and the care which she provided overnight. There is a further entry at 07:15

again by Ms 4, referring to the pain in “R groin area Analgesia given”. This is followed

25

by an entry timed 09:00 apparently made by Mrs Moniba referencing the fall, and a

further entry made by her at 13:50.

3.1 Incorrectly dated the incident report form 16 February 2015;

This charge is found proved.

The panel had regard to the incident form and noted that it had been signed and dated

16 February 2015 by Mrs Moniba. The panel found there was no provision within the

incident form where a person using the form was directed specifically to enter the date

that they were completing the form. The evidence provided by Ms 5 and Mr 6 was that

the signed and dated the entries in Section 5 indicated when the form had been

completed.

The panel heard the oral evidence of Ms 1 who said the date and time of the form’s

completion should be entered below the body map on page 3. The panel preferred the

evidence of Ms 5 and Mr 6 as they were clinicians who were experienced at completing

the form; Ms 1 was in a managerial/non-clinical role.

Ms Dongray submitted that the panel should accept the evidence of Ms 4 that “[Mrs

Moniba] said she had not had time to document Resident A’s fall, but that she intended

to do so during her next shift” and that the documentation she referred to was the

Accident and Incident Form. Ms 4 stated in her oral evidence that she did not have sight

of the Incident Form. Furthermore, there is evidence in the document that post-dates

Mrs Moniba finishing her shift on 16 February 2015: “pain killers given by night Nurse.”

In the notes of the Disciplinary Hearing on 17 April 2015, which were confirmed as an

accurate record by Mr 6, Mrs Moniba states that “I filled it in on 17th. I came into work in

the morning and filled it in. Staff told me that he’d been in pain overnight. … I …

[Interviewer: It is also alleged that you falsified documentation] ….I did the second

26

thing.” Ms Dongray invited the panel to consider that if Mrs Moniba had completed the

form on 17 February 2015, then the form is incorrectly dated.

Mrs Moniba says in her witness statement that she completed the incident form on

16 February 2015 and stated “In the incident report form I stated “Checked and

examined body part, skin flap cleaned” and dated the form. The next morning I

checked the form and noted I had not mentioned that I applied a dressing and

added this before submitting the form. … At the time I thought the recording was

sufficient as [Ms 4] was aware of the situation and had assured me she would

keep an eye on things. … At no point did I admit filling in the incident report form

on 17 February 2015.”

The panel noted that in addition to adding the information about applying a

dressing, Mrs Moniba had also included the note that pain killers had been given

by the night nurse, and she would only have been aware of this when she

attended work on the 17 February 2015. Therefore, although it is possible that Mrs

Moniba started the form on 16 February 2015, because of her own evidence and

the information contained within the form, she must have completed it on 17

February 2015. There is nothing to indicate that any additional information was

added later than 16 February 2015.

The panel noted that Mrs Moniba herself accepts that she made additions to the

form on the morning of the 17 February 2015.The panel had regard to the notes of

the meeting on 18 March 2015, when Mrs Moniba states: “I completed the form

after he fell, before I finished my shift.” She has also accepted that she made

additions to the form on the morning of the 17 February 2015, and it would appear

that this was done early on the shift that day. Mrs Moniba had been consistent in

her account of filling in the Incident Form during the Home’s investigatory

meetings and in her evidence given to the NMC.

27

The panel had regard to the comments she made during the Disciplinary Hearing

on 17 April 2015, some two months later; “No I filled it in on the 17th. I came into

work in the morning and filled it in. Staff told me he had been in pain overnight.” …

“I remembered the next day to do the form. … that’s my evidence that I filled it on

17th”. In addition, on 17 February 2015 at approximately 09:00 Mrs Moniba had

documented in Resident A’s Progression & Evaluation Records: “Accident form

done and informed his wife in the morning.” Furthermore, the evidence of Ms 4

and Mr 6 was that there was no evidence so far as it were concerned that the

incident had been completed on 16 February 2015.

The panel concluded that Mrs Moniba had completed the Incident form on 17

February 2015 and not 16 February 2015, and therefore incorrectly dated the

Incident form.

The panel therefore found charge 3.1 proved.

3.2 Recorded false information in the form, in that you recorded you had "Checked & examined body parts, skin flap cleaned & dressing applied" when you had not.

This charge is found proved.

In reaching this decision, the panel took into account the evidence provided by Ms 4

and Mr 6 in relation to this charge, with particular regard to the interpretation of

“examined” in the context of undertaking a body check. The panel considered that the

use of the phrase “checked and examined body parts” conveys the impression of a

more thorough or extensive examination of the whole body than a simple visual

assessment.

28

According to Ms 3, Mrs Moniba had not examined Resident A before calling Mr 2. Mr 2

stated that he did not see her conduct any observations or examination of Resident A

whilst he was attending to him.

Mrs Moniba says in her witness statement: “I deny that I did not conduct a body check,

but accept that the body check was incomplete.” She also refers to the difficulty of

examining Resident A because of his aggressive and agitated state.

On that basis, the panel concluded that the entry “checked and examined body parts”

was inaccurate and therefore found charge 3.2 proved.

Charge 4. And your actions in charge 3.1 and/or charge 3.2 were dishonest.

This charge is found proved in relation to charge 3.1 and charge 3.2.

Ms Dongray submitted that Mrs Moniba must have known she was being

dishonest when she submitted the Incident Form dated 16 February 2015, having

at the very least, made an amendment to the form on the 17 February 2015, if not

completed it in full on that day. She further submitted that entering an incorrect

date onto an incident form is clearly dishonest by the standards of ordinary, decent

people.

In relation to charge 3.2, Ms Dongray submitted that Mrs Moniba had been

dishonest because she was aware that she had not undertaken a complete check

of Resident A and her entry that she had “Checked & examined body parts”

implied that a specific standard of care had been provided when it had not. She

submitted that entering inaccurate information into an Incident Form is clearly

dishonest by standards of ordinary decent people/nurses.

29

In relation to the charge of dishonesty, Mrs Moniba states in her witness statement

that she does not accept that her behaviour was dishonest. She states that she

completed the form on the 16 February 2015, and checked the form the next

morning before submitting the form. She further states that she believes what she

put on the form was the truth. She also states that she thought “the recording

sufficient as Ms 4 was aware of the situation and would keep an eye on things”

and “that she was wrong to think that and should have made a fuller note” in

reference to not carrying out a complete examination, because Resident A was

being aggressive.

In reaching its decision panel had regard to the legal authorities to which it was referred

namely the cases of: Ivey v Genting Casinos Ltd [2017] UKSC 67, Barlow Clowes v

Eurotrust International Ltd [2006] 1 WLR 1476 and Kirschner v GDC [2015] EWHC

1377 (Admin). The panel bore in mind the test laid down by Lord Hughes in the case of

Ivey:

"When dishonesty is in question the fact-finding tribunal must first ascertain

(subjectively) the actual state of the individual's knowledge or belief as to the

facts. The reasonableness or otherwise of his belief is a matter of evidence (often

in practice determinative) going to whether he held the belief, but it is not an

additional requirement that his belief must be reasonable; the question is whether

it is genuinely held. When once his actual state of mind as to knowledge or belief

as to facts is established, the question whether his conduct was honest or

dishonest is to be determined by the fact-finder by applying the (objective)

standards of ordinary decent people. There is no requirement that the defendant

must appreciate that what he has done is, by those standards, dishonest."

When determining the alleged dishonesty in relation to charge 3.1, the panel considered

whether it was Mrs Moniba’s intention to mislead people into thinking that she had filled

out and completed the form on the 16 February 2015, when she admitted that she

completed the form on the 17 February 2015. The panel noted that Mrs Moniba had told

Ms 4 that she would complete the documentation when she returned to work the

30

following day, and her entry in the Progress & Evaluation Records clearly indicate that

the entry was made on 17 February 2015.

The panel determined that whilst there was some ambiguity as to how to correctly date

a retrospectively completed Incident Form, it did not accept Mrs Moniba’s evidence that

it was started on 16 February 2015 and then added to on 17 February 2015. The panel

therefore concluded that on the balance of probabilities Mrs Moniba had completed the

Incident Form in its entirety on 17 February 2015. The panel considered that this not a

simple lack of care or an act of poor judgement. Consciously entering an incorrect date

was necessarily misleading to anyone subsequently reading the form. In doing so the

panel concluded that Mrs Moniba was dishonest.

The panel therefore concluded that charge 4, in relation to 3.1 was found proved.

When considering the allegation of dishonesty in relation to charge 3.2, the panel

found that an entry in a patient’s record indicating that a clinical test in the form of

an examination of body parts had been undertaken when it had not was

misleading and inaccurate. The word “examination” carries with it a specific clinical

interpretation, and Mrs Moniba has admitted that she did not do a complete body

check.

The panel noted that Mrs Moniba stated that she made this addition the following

morning. The panel was mindful that at that time Mrs Moniba had received a

handover from Ms 4 and was aware that Resident A was experiencing pain in his

groin area. The panel concluded that the likely explanation of Mrs Moniba’s

making the addition was that she realised that the original entry that she made on

the Incident Form was insufficient and added a further entry. The panel also noted

that Mrs Moniba had admitted during the Disciplinary Hearing 17 April 2015 that

she had “falsified documentation” and the panel took the view that this referred to

the retrospective entry she made regarding her check and examination of body

parts in the Incident Form.

31

The panel accepted that Mrs Moniba had conducted some degree of assessment

of Resident A following his fall, but that this was not a complete body check and/or

examination. The panel found that Mrs Moniba had made an entry on the Incident

Form, implying she had conducted a full body check and/or examination on the 17

February 2015, when she knew she had not. The panel concluded that she had

done this with the intention of conveying the impression that a full check had been

undertaken, when, by her own admission she had not done so.

The panel therefore found that Mrs Moniba had made an entry of “Checked &

examined body parts,” with the intention to mislead and that this would be seen as

dishonest by the standards of ordinary, decent people and/or nurses.

The panel therefore found charge 4 proved in relation to charge 3.2.

Submissions on misconduct and impairment:

Having announced its findings on all the facts, the panel then moved on to consider,

whether the facts found proved amount to misconduct and, if so, whether Mrs Moniba’s

fitness to practise is currently impaired. The NMC has defined fitness to practise as a

registrant’s suitability to remain on the register without restriction.

In reaching its decision, the panel had regard to all the evidence before it, including the

written submissions made by Mrs Moniba provided in her witness statement in relation

to this at this stage of the proceedings.

In her witness statement Mrs Moniba stated that “I can be a bit blunt and talk with a loud

voice at times … I accept that I do need to work on my manner and that there is room

for improvement, but do not accept that my behaviour is inappropriate.

32

Furthermore in relation to Resident A she states: “Resident A … was being aggressive,

punching and kicking out. …

I accept that I did not use a hoist despite this being in Resident A’s care plan. …

I did not conduct a full body check, but accept that the body check was incomplete …

I … accept that I instructed a junior member of staff to inappropriately lift Resident A in

that it was not in accordance with the care plan The method was appropriate for the

Resident because he would become aggressive whenever the hoist was used.

My failing there was to make sure that the care plan was properly amended to reflect

this. … I accept that I … should have made a fuller note”

When addressing current impairment, Mrs Moniba stated: “I deny that my fitness to

practice is impaired. I accept that there were things I have done wrong but these will not

be repeated. …

Whilst I accept that I need to work on my communication skills I do not consider them

sufficiently poor for my practice to be considered impaired. I am keen to work on this. …

As to the matter with Resident A, I accept my record keeping needed to be a lot better

than it was both in terms of the incident reporting and the care plans. I will make sure

that this happens in the future, not only because this will ensure better care for

residents, but also because this would have provided me with better protection against

colleagues seeking to pass blame to me.”

The panel heard submissions made by Ms Dongray on behalf of the NMC.

Ms Dongray invited the panel to find that Mrs Moniba's fitness to practise is currently

impaired. She referred the panel to the case of Roylance v General Medical Council (No

2) [2000] 1 A.C. 311, and invited the panel to take the view that Mrs Moniba’s actions

amounted to a breach of The code: Standards of conduct, performance and ethics for

nurses and midwives 2008) (“the Code”). She then invited the panel to consider specific

33

paragraphs and identified where, in the NMC’s view, Mrs Moniba’s actions amounted to

misconduct.

She reminded the panel that not every breach of the Code is sufficiently serious as to

amount to misconduct, and the panel must determine to what extent her actions

departed from the standard expected of a registered nurse.

In relation to charges 2.4 and 2.5, Ms Dongray invited the panel to consider whether or

not Mrs Moniba's actions amounted to misconduct. It was conceded by witnesses for

the NMC that such a fracture is not easy to identify. Ms 4, an experienced nurse who

observed Resident A overnight, and saw him standing apparently without pain was

unable to identify that Resident A had sustained a fracture. Nor, when he complained of

pain the next morning, where the pain was localised. However, by not using a hoist to

lift Resident A from the floor, the incompleteness of her handover regarding Resident

A's fall to Ms 4, and issues around completing the incident report form constitute a

serious failing in the care she provided to a vulnerable patient. She further submitted,

that having found charge 1 proved, Mrs Moniba has clearly demonstrated attitudinal

concerns regarding her colleagues, and that these charges taken individually and/or

collectively amount to misconduct.

Ms Dongray then moved on to the issue of impairment and referred the panel

to the case of Council for Healthcare Regulatory Excellence v (1) Nursing and

Midwifery Council (2) Grant [2011] EWHC 927 (Admin), and the questions

originally formulated by Dame Janet Smith in her Fifth Shipman Report: "Do

our findings of fact ... show that his/her fitness to practise is impaired in the

sense that she/he:

a. has in the past acted and/or is liable in the future to act so as to

put a patient or patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the

[nursing] profession into disrepute; and/or

34

c. has in the past breached and/or is liable in the future to breach

one of the fundamental tenets of the medical profession; and/or

d. has in the past acted dishonestly and/or is liable to act

dishonestly in the future.

Ms Dongray submitted that all four limbs of this test were engaged. Mrs Moniba had put

Resident A at an unwarranted risk of harm: although it was not clear how Resident A

was moved generally, on the occasion outlined in the charges, it is clear that a hoist

should have been used. An inappropriate lifting technique had been used instead, which

put the patient at a risk of further harm. In addition, Mrs Moniba's failure to provide a full

handover and the falsification of documents also put Resident A at risk of harm, as both

actions had the potential to adversely influence the ongoing care provided to the patient.

Ms Dongray submitted that Mrs Moniba, in failing to conduct a full body examination

and by moving Resident A inappropriately, had failed to provide basic nursing care and

had therefore breached a fundamental tenet of the profession. She had also acted

dishonestly. Accordingly, as a result of those failures, she submitted that the second

limb is engaged and therefore Mrs Moniba has brought the reputation of the profession

into disrepute.

Ms Dongray then referred the panel to the case of Cohen v GMC [2008] EWHC 581

(Admin)) which outlines a three stage ‘test’ for impairment. When deciding whether

fitness to practise is impaired panels should take account of:

i) Whether the conduct which led to the charge is easily remediable;

ii) Whether it has been remedied; and

iii) Whether it is likely to be repeated.

She submitted that clinical failings are capable of remediation, however, attitudinal

issues and dishonesty are more difficult to remediate.

Ms Dongray then addressed the panel on the need to have regard to protecting the

public and the wider public interest. This included the need to declare and maintain

35

proper standards and maintain public confidence in the profession and in the NMC as a

regulatory body.

Ms Dongray invited the panel to consider whether Mrs Moniba had any demonstrated

evidence of insight, remorse, good practice and training. She submitted that Mrs Moniba

had exhibited limited insight, and had been quite defensive throughout the internal

investigation at the Home, and throughout the NMC proceedings. There is no evidence

of concern expressed for Resident A, and no reflection on the impact her actions have

had on the reputation of the profession. Neither is there any evidence of any further

training to improve her skills. It is understood that Mrs Moniba is not currently working.

Given the lack of training, insight and remorse, and the risk of repetition, Ms Dongray

invited the panel to find impairment on the grounds of public protection.

She also submitted that a finding of impairment on the grounds of public interest was

also justified in this case in order to maintain confidence in the profession and the

regulatory process. Mrs Moniba had failed to provide the fundamentals of basic nursing

practice to a vulnerable patient, she falsified documentation and there were attitudinal

issues identified. Accordingly, Ms Dongray invited the panel to find that Mrs Moniba's

fitness to practise was currently impaired on the grounds of public protection and the

wider public interest.

The panel has accepted the advice of the legal assessor which included reference to

the cases of Grant and Cohen. He reminded the panel that impairment is a forward

looking process and the panel must consider matters of insight, remediation and the

likelihood of repetition. He reminded the panel that following the termination of her

employment at the Unit, Mrs Moniba worked for some time as senior healthcare

assistant at a second home and that working as a healthcare assistant might be

considered relevant when considering aspects of remediation.

Decision on misconduct:

36

The panel, in reaching its decision, had regard to the public interest and accepted that

there was no burden or standard of proof at this stage and exercised its own

professional judgement. The panel appreciated that breaches of the Code do not

automatically result in a finding of misconduct.

The panel bore in mind that, in relation to impairment by reason of misconduct, this is a

two stage process. It must first consider whether, on the facts found proved, a

registrant’s actions constitute misconduct, and secondly, if so, whether her fitness to

practise is currently impaired by reason of that misconduct. The panel was conscious

that misconduct and impairment are matters for its professional judgement.

When determining whether the facts found proved amount to misconduct the panel had

regard to the provisions of the Code in force at that time, namely the May 2008 edition.

The panel was of the view that Mrs Moniba’s actions fell short of the standards

expected of a registered nurse, and that her actions represented breaches of the Code.

Specifically from the preamble:

The people in your care must be able to trust you with their health and wellbeing To justify that trust, you must:

• make the care of people your first concern, treating them as individuals and

respecting their dignity

• work with others to protect and promote the health and wellbeing of those in

your care, their families and carers, and the wider community

• provide a high standard of practice and care at all times

• be open and honest, act with integrity and uphold the reputation of your

profession.

37

As a professional, you are personally accountable for actions and omissions in

your practice, and must always be able to justify your decisions.

The panel was of the view that Mrs Moniba's conduct in charge 1 breached paragraphs

24, 26 and 27 of the Code:

24: You must work cooperatively within teams and respect the skills, expertise

and contributions of your colleagues;

26. You must consult and take advice from colleagues when appropriate. 27. You must treat your colleagues fairly …

The panel considered whether the inappropriate behaviour found proved in charge 1

was sufficiently serious to amount to misconduct. The panel identified three occasions

over a period of 12 months whereby Mrs Moniba had displayed inappropriate behaviour

towards her colleagues. Ms 3 provided evidence of an occasion in relation to the

incident on 16 February 2015. Ms 3 stated that Mrs Moniba “was angry with me” and

spoke to her in an aggressive manner.

Ms 5 outlined an occasion when she stated she felt threatened and witnessed Mrs

Moniba raise her voice. Ms 5 said this was a single incident, and was at time when Mrs

Moniba had been assigned to work on another unit. Mrs Moniba does not dispute that

she may have acted in the way Ms 5 describes but adds: “is always stressful to work on

an unfamiliar ward as you are unfamiliar with your surroundings and the residents you

are supposed to be caring for.” Ms 4 described Mrs Moniba as initially appearing “abrupt

in attitude but gradually this abruptness lessened and her manner became amenable.”

The panel noted that Mr 6 appeared to accept that Mrs Moniba’s could be blunt and

occasionally rude, and had taken steps to address those issues as her line manager. Mr

6 stated that he had "not been bothered" by her comments within the meeting, and Ms 4

stated that Mrs Moniba had been rude and abrupt albeit at the end of a long and difficult

shift, and that “her manner became amenable” as the handover continued. In

considering this charge, the panel determined that this conduct was not sufficiently

38

serious as to amount to misconduct. Furthermore, Mrs Moniba states that “I have a

good relationship with most of the staff I work with”.

The panel therefore considered that, Mrs Moniba’s misconduct found in charge 1,

although inappropriate, was not sufficiently serious to amount to misconduct.

The panel was of the view that Mrs Moniba's behaviour in charges 2.3 and 2.6 breached

paragraph 21 of the Code which states:

21. You must keep your colleagues informed when you are sharing the care of others.

The panel noted that Mrs Moniba admits that she had not completed a full body check

before asking Mr 2 to help her lift Resident A, and when handing over the care of

Resident A to Ms 4. The panel found that instructing a colleague to lift Resident A

following a fall, and when she knew that a hoist should have been used, put both the

patient and her colleagues at potential risk of harm, and therefore amounted to

misconduct.

Mrs Moniba had failed to undertake a full body check, and therefore the information she

was able to handover to the night shift agency nurse was limited. The panel noted that

Ms 4 had said she thought the handover in relation to the other patients on the Unit was

otherwise adequate, and that looking back, with the knowledge that a full body check

had not been undertaken, the handover with respect to Resident A could have been

better. She told the panel that in this respect: “You cannot hand over what you do not

know”.

Therefore, the panel found that Mrs Moniba’s actions in charge 2.3 were sufficiently

serious so as to amount to misconduct, but that that the misconduct in relation to charge

2.6 derived from the misconduct found in Mrs Moniba’s failure to undertake a full body

check (the matters found proved in charge 2.1).

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Mrs Moniba also admits that her record keeping was inadequate. The panel found that

Mrs Moniba had a duty to keep her colleagues accurately informed when sharing the

care of others, because of the impact of such communication on the care provided to

that patient.

The panel considered that Mrs Moniba's conduct in charges 2.1, 2.2 and 3.1 and 3.2

breached paragraphs 35 of the Code:

35. You must deliver care based on the best available evidence or best

practice.

The panel found that Mrs Moniba had not delivered care based on best practice, in that

she had instructed Resident A to be lifted without conducting an appropriate body check

and had lifted instructed that resident to be lifted inappropriately. The panel noted that

Mrs Moniba had informed Mr 2, before instructing him to help her lift the patient from the

floor without the use of a hoist and without having conducted a full body check, that “Its

ok, he’s fine.

The panel noted that Mrs Moniba accepts that she failed to complete a full body check,

but her failure was due to aggressive and/or agitated behaviour of Resident A. Her

account of such is behaviour was the only evidence in this respect presented to the

panel, and was contrary to the oral evidence provided by Mr 2 and Ms 3. The panel was

not satisfied that Resident A was aggressive and/or agitated, and that Mrs Moniba was

unable to undertake a full body check. Nor did the panel accept her account that

Resident A’s behaviour prevented her from using a hoist.

In relation to remediation, the panel was of the view that some of the misconduct in this

case is capable of remediation as much of it relates to aspects of basic nursing care;

these included failings to provide a high standard of care at all times, failings to keep

her colleagues informed and failing to keep accurate and clear records. However, when

considering the charges relating to her attitude and dishonesty, the panel found it may

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be more difficult to remedy other than by reflection and a demonstration of insight into

this specific concern.

Furthermore, Mrs Moniba had failed to complete an accurate incident report form. The

panel therefore also found that Mrs Moniba's conduct in charges 3.1 and 3.2 breached

paragraphs 42 and 43 of the Code:

42. You must keep clear and accurate records of the discussions you have,

the assessments you make, the treatment and medicines you give, and

how effective these have been

Mrs Moniba had failed to accurately date the incident report forms, and furthermore had

provided misleading information, and had therefore failed to provide a proper standard

of care. The panel was of the view that providing true and accurate records is a mistake

or an error of judgement. The ongoing care provided to patients is directly related to the

integrity of the information contained with patients’ records. Accordingly the panel

determined that Mrs Moniba’s conduct in relation to those charges was sufficiently

serious as to amount to misconduct.

The panel also found that Mrs Moniba's conduct overall had breached paragraph 61 of

the Code:

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

The panel found that in failing to provide proper care to Resident A and the dishonesty

demonstrated by falsifying the information on the incident report form Mrs Moniba had

failed to uphold the reputation of the professional at all times, and as such her conduct

in charges 2.1, 2.2, 2.3, 3.1, 3.2, and 4 was sufficiently serious as to amount to

misconduct.

The panel concluded that Mrs Moniba actions did fall seriously short of the conduct and

standards expected of a nurse/midwife and amounted to misconduct as defined, in the

respects identified above.

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Decision on impairment: The panel next went on to decide if as a result of this misconduct Mrs Moniba’s fitness

to practise is currently impaired.

In this regard the panel considered the judgement of Mrs Justice Cox in the case of

Grant:

In determining whether a practitioner’s fitness to practise is impaired by

reason of misconduct, the relevant panel should generally consider not

only whether the practitioner continues to present a risk to members of the

public in his or her current role, but also whether the need to uphold

proper professional standards and public confidence in the profession

would be undermined if a finding of impairment were not made in the

particular circumstances.

…

a. has in the past acted and/or is liable in the future to act so as to

put a patient or patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the

medical profession into disrepute; and/or

c. has in the past breached and/or is liable in the future to breach

one of the fundamental tenets of the medical profession; and/or

d. has in the past acted dishonestly and/or is liable to act

dishonestly in the future.

The panel was of the view that all four limbs were engaged. At the relevant time, Mrs

Moniba’s misconduct had put patients at unwarranted risk of harm. The panel also

determined that in failing to adhere to a high standard of nursing practice, and to uphold

the standards of the nursing professional Mrs Moniba had breached fundamental tenets

of the nursing profession.

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Nurses occupy a position of privilege and trust in society and are expected at all times

to be professional and to maintain professional boundaries. Patients and their families

must be able to trust nurses with their lives and the lives of their loved ones. To justify

that trust, nurses must be honest and open and act with integrity. They must make sure

that their conduct at all times justifies both their patients’ and the public’s trust in the

profession

The panel then considered whether Mrs Moniba is liable, now and in the future, to

repeat misconduct of the kind found proved. In considering this, the panel had careful

regard to the issues of insight and remediation.

In its consideration of whether Mrs Moniba has remediated her practice, the panel found

that Mrs Moniba has provided no real evidence of insight. She accepts that she should

have undertaken a full body check and used a hoist to lift Resident A and her reason for

not doing so was that Resident A was showing signs of aggression at the time. The

panel do not accept her evidence in this respect. The panel also found that, should a

resident have shown signs of aggression, it was her duty to ensure he was calm before

examining or attempting to move him; particularly when the resident was a dementia

patient. The panel heard evidence that patients with dementia may find it difficult to

articulate pain and this can often manifest itself as aggression or agitation. Therefore,

although she had demonstrated limited insight into her failings, the panel found that Mrs

Moniba does not accept responsibility for those failings.

Mrs Moniba has also not fully accepted that she incorrectly dated and recorded false

information in a patient’s record. The panel therefore found that, despite the

circumstances of this shift, she has not reflected fully on her duty of care to Resident A,

nor how her behaviour and actions impacted on her colleagues or the reputation of the

profession.

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In her statement Mrs Moniba said she had worked for some time as a senior care

assistant, and has recently experienced a period of poor health. However, there is no

evidence in front of the panel of testimonials from Mrs Moniba’s employer with regard to

her work as a senior care assistant or any training or professional development Mrs

Moniba has undertaken to address the failings that she has admitted to regarding her

clinical practice.

Mrs Moniba has also pointed to health problems as having impacted upon her nursing

performance; she stated that there had been a management change, and she was not

as supported as much as she should have been. [PRIVATE] While these matters may

go to mitigation, the panel was therefore unable to place any real weight on them at this

stage of the proceedings.

The panel noted that Mrs Moniba has engaged to a limited extent with her regulator

throughout these proceedings, by way of written representations. However, the panel

was of the view that much of her reflection focuses upon her own experience in the

workplace, with less emphasis on demonstrating a recognition of the impact of her acts

and omissions had upon patients and colleagues. Further, the panel considered that

Mrs Moniba has a tendency to apportion blame elsewhere, including her statement that

she did not get on well with certain members of staff. Therefore, the panel came to the

view that although Mrs Moniba has demonstrated some limited insight into her

misconduct, this insight is not yet fully developed.

In the absence of evidence of sufficient remediation and full insight, the panel

considered that there is a risk of repetition of Mrs Moniba’s misconduct, which could,

once again, put patients at risk of harm and breach fundamental tenets of the nursing

profession.

The panel had borne in mind that its primary function is to protect patients and the wider

public interest which includes maintaining confidence in the nursing profession and

upholding the proper standards and behaviour. The panel concluded that confidence in

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the profession would be undermined if a finding of impairment were not made in the

light of Mrs Moniba’s misconduct, relating as it did to basic aspects of nursing practice

and matters of dishonesty. The panel determined that the public interest outweighed

Mrs Moniba’s interests in allowing her to practise as a nurse without restriction.

Having regard to all of the above, the panel was satisfied that Mrs Moniba’s fitness to

practise is currently impaired.

Determination on sanction:

The panel has considered this case and has decided to impose a suspension order for

a period of 6 months.

In reaching this decision, the panel has had regard to all the evidence that has been

adduced in this case, together with the submissions of Ms Dongray on behalf of the

NMC and the written documentation provided by Mrs Moniba.

Ms Dongray submitted that the appropriate sanction was a matter for the panel to

determine. She referred the panel to the case of Lusinga v NMC [2017] EWHC 1458

(Admin) when considering the seriousness of the dishonesty found proved. She did not

recommend any particular sanction and asked the panel to bear in mind the NMC’s

Sanctions Guidance (“SG”), but did submit in the light of dishonesty found, a conditions

of practice order may not be appropriate. She also invited the panel to consider whether

the conduct found proved was sufficiently serious to warrant the permanent removal of

Mrs Moniba’s name from the register. She submitted that any order imposed should be

sufficient to not only protect the public but also address the wider public interest.

The panel heard and accepted the advice of the legal assessor, who referred the panel

to the case of Parkinson v Nursing and Midwifery Council [2010] EWHC 1898 (Admin)

and to the Sanctions Guidance.

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The panel has borne in mind that any sanction imposed must be appropriate and

proportionate and, although not intended to be punitive in its effect, may have such

consequences. The panel bore in mind that the public interest includes the protection of

patients, the maintenance of public confidence in the profession and the declaring and

upholding of proper standards of conduct and behaviour. The panel had careful regard

to the SG, and recognised that the decision on sanction is a matter for the panel,

exercising its own independent judgement.

The panel first considered the aggravating and mitigating factors in this case.

The panel identified the following as aggravating factors in this case:

• Resident A was a vulnerable patient and Mrs Moniba was the nurse in charge

and expected to safeguard his wellbeing;

• Mrs Moniba has demonstrated limited insight and remorse;

• There is no evidence of any clinical remediation.

The panel identified the following as mitigating factors in this case:

• The misconduct is isolated to one shift;

• The shift was busy and Mrs Moniba was the only registered nurse on shift at the

time of the incident;

• In terms of personal mitigation, there is evidence to suggest that Mrs Moniba was

in poor health at the time, and felt unsupported following a change in

management;

• There is no evidence before the panel of any previous regulatory or disciplinary

proceedings in an otherwise unblemished career of thirty years.

The panel then considered which sanction, if any, to impose. It considered each

available sanction in turn, starting with the least restrictive sanction and moving

upwards.

46

The panel first considered whether to take no action. The panel bore in mind that it had

identified at the impairment stage that there remained a risk of repetition in this case.

Any repetition would bring with it a risk of harm to patients. To take no action would

therefore not provide protection to the public. In addition, the panel considered that to

take no further action would be inadequate to mark the misconduct in this case. It would

be inconsistent with the panel’s findings on impairment and would not recognise the

public interest in declaring and upholding proper standards of conduct and behaviour

and maintaining public trust and confidence in the profession to take no further action.

Next, in considering whether a caution order would be appropriate in the circumstances,

the panel took into account the SG. This states that a caution order 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.’ The panel considered that Mrs Moniba’s misconduct was not at the lower end of

the spectrum. She provided inaccurate information about the care she had provided to

the resident in that she indicated she had undertaken a full body check when she had

not and had incorrectly dated an incident report form. Her misconduct was a serious

departure from the standards expected of a registered nurse and had put a vulnerable

resident at risk of harm. As such, a caution order would be inappropriate in view of the

seriousness of the case. A caution order would not provide sufficient protection to the

public, would not be proportionate nor would it be in the public interest to impose a

caution order given the panel’s findings at the impairment stage.

The panel next considered whether placing conditions of practice on Mrs Moniba’s

registration would be a sufficient and appropriate response. The panel bore in mind that

any conditions imposed must be relevant, proportionate, workable and measurable, and

must provide sufficient public protection. The panel found that there were identifiable areas of Mrs Moniba’s practice in need of retraining and reflection. Mrs Moniba’s

misconduct involved her failure to examine and move a vulnerable patient appropriately

and to correctly document an incident report. The panel found that such misconduct was remediable, and as such, it could be possible to formulate conditions that would

protect the public. The panel have rejected Mrs Moniba’s account regarding the

47

behaviour of Resident A when she tried to examine him; that she had made only

additions to the incident report retrospectively and had not sought to mislead when stating that she had checked and examined the resident. However, while the panel was

not of the view that this indicated a deep seated personality or attitudinal problem, it

determined that Mrs Moniba has not provided sufficient evidence of insight or

remediation into her failings at that time.

The panel considered that, while there could be identifiable areas of practice for

retraining, it was unable to formulate appropriate conditions of practice that would be

workable or would adequately address the dishonesty it had identified previously. The panel concluded that placing conditions on Mrs Moniba’s registration would not

adequately protect the public and would not address the public interest matters

identified in this case.

The panel then went on to consider whether a suspension order would be an

appropriate sanction. The panel noted that the key factors when considering a

suspension order are whether the seriousness of the case requires temporary removal

from the register, and whether a period of suspension would be sufficient to protect

patients and the public interest. The panel found that these were both applicable to this

case.

The SG also indicates that a suspension order would be appropriate where (but not

limited to):

• A single instance of misconduct but where a lesser sanction is not sufficient.

• No evidence of harmful deep-seated personality or attitudinal problems.

• No evidence of repetition of behaviour since the incident.

• The Committee is satisfied that the nurse or midwife has insight and does not

pose a significant risk of repeating behaviour.

The panel concluded that the seriousness of Mrs Moniba’s misconduct requires her

temporary removal from the register and that such an outcome would protect the public.

However at this point in time, the panel concluded that Mrs Moniba’s misconduct was

48

not fundamentally incompatible with her continuing to be a registered nurse and that the

public interest considerations in this case could be satisfied by a less severe outcome

than permanent removal from the register.

In reaching that conclusion, the panel carefully balanced the aggravating and mitigating

features of Mrs Moniba’s case. Although Mrs Moniba’s failings were serious, they

related to the care provided to a patient regarding a single incident of misconduct in an

otherwise unblemished career. Although the misconduct showed a failure on Mrs

Moniba’s part at the time, there has been no evidence of repetition of that behaviour

since the incident whilst she was working as a senior carer.

The panel considers dishonesty a serious departure from the standards expected of a

nurse, but Mrs Moniba’s actions were not at the most serious end of the spectrum of

dishonesty. Regarding the falsification of the incident report form, the panel considered

that her actions were not premeditated, and did not at that point indicate a further risk to

Resident A. Furthermore, Mrs Moniba has demonstrated some limited insight. Although

there remains a risk of repetition, the panel determined that the risk was not so

significant that a further period of reflection and developing insight would not reduce that

risk. Mrs Moniba has engaged with the NMC’s regulatory process to some degree,

although this has been affected by her health, and she has submitted responses to the

charges.

The panel concluded that it would be appropriate and proportionate, in all the

circumstances, to give Mrs Moniba the opportunity to further reflect upon her failings. A

period of suspension would also enable her to demonstrate to a future reviewing panel

that she is able to return to safe and effective practice, while satisfying the public

interest matters in this case.

The panel considered whether it should impose a striking-off order. In the light of Mrs

Moniba’s acceptance of some failings, and given her limited insight, the panel

considered that although these matters were serious, Mrs Moniba should be given an

opportunity to demonstrate further remediation should she wish to do so. Taking into

49

account the mitigating factors and applying the principles of proportionality, the panel on

balance found that Mrs Moniba’s misconduct could not at this stage be regarded as

fundamentally incompatible with remaining on the register. The panel considered that a

striking-off order would be unduly punitive and disproportionate at this time and was not

necessary because it was not the only sanction which would protect the public or satisfy

the public interest considerations of this case. The panel took into account the fact that

the public interest can also include allowing nurses with valuable skills to return to safe

and effective practice.

Balancing all of these factors the panel has concluded that a suspension order would be

the appropriate and proportionate sanction. The panel noted the hardship such an order

could cause Mrs Moniba, however this is outweighed by the public interest in this case.

The panel considered that this order is necessary to mark the importance of maintaining

public confidence in the profession, and to send to the public and the profession a clear

message about the standard of behaviour required of a registered nurse.

The panel determined that a suspension order for a period of 6 months was appropriate

in this case to mark the seriousness of the misconduct. The panel balanced the

seriousness of the behaviour while considering a suitable period of suspension that

would not unnecessarily damage Mrs Moniba’s career. Mrs Moniba had deliberately and

inappropriately moved a patient without undertaking a full assessment, and then had

deliberately written misleading notes. The panel concluded that a period of six months

suspension would allow Mrs Moniba to reflect fully on her misconduct and undertake

action to remediate her failings.

Towards the end of the period of suspension, another panel will review the order. At the

review hearing the panel may revoke the order, or it may confirm the order, or it may

replace the order with another order.

This panel was of the view that a future reviewing panel may be assisted by:

50

• Mrs Moniba’s attendance at the review of this order;

• A reflective statement demonstrating insight into the impact her actions had on

residents, colleagues, her employer and the wider public interest, and how this

experience has positively influenced her practice.

• References and testimonials, both in the form of character references and

references from any employment (paid or unpaid, and within or outside the

healthcare sector);

• Evidence of any relevant training, including manual training and record keeping,

and evidence that she has kept her nursing knowledge and skills up to date.

Mrs Moniba will have 28 days from the date when written notice of the result of this

hearing is deemed to have been served upon her in which to exercise her right of

appeal. A note explaining that right of appeal will be provided to her. Unless Mrs Moniba

exercises her right of appeal, the suspension order will take effect 28 days from when

written notice of this decision is served upon her.

Determination on Interim Order Pursuant to Article 29 (11) of the Nursing and Midwifery Order 2001, this panel’s

decision will not come into effect until after the 28 day appeal period, which commences

from the date that notice of the suspension order has been served.

Article 31 of the Nursing and Midwifery Order 2001 outlines the criteria for the

imposition of an interim order. The panel may only make an interim order if it is satisfied

that it is necessary for the protection of the public, otherwise in the public interest or is in

the registrant’s own interest. The panel may make an interim order for a maximum of 18

months.

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The panel has considered the submissions made by Ms Dongray that an interim order

should be made on the grounds that it is necessary for the protection of the public and

is otherwise in the public interest. She submitted that the interim suspension order,

which would take immediate effect, should be for a period of 18 months to cover the

possibility of an appeal being lodged by Mrs Moniba within the 28 day appeal period.

The panel accepted the advice of the legal assessor.

The panel was satisfied that an interim suspension order is necessary for the protection

of the public and is otherwise in the public interest. The panel had regard to the

seriousness of the facts found proved and the reasons set out in its decision for the

substantive order in reaching the decision to impose an interim order. To do otherwise

would be incompatible with its earlier findings.

The period of this order is for 18 months to allow for the possibility of an appeal to be

made and determined. If no appeal is made, then the interim order will be replaced by a

suspension order 28 days after Mrs Moniba is sent the decision of this hearing in

writing.

This order will be reviewed before it expires, unless Mrs Moniba or the NMC requests

for the order to be reviewed at an earlier date. That concludes this determination.