ROYAL COLLEGE OF VETERINARY SURGEONS RESPONDENT NICOLA FAY BUTTLER RVN

Transcription

1 ROYAL COLLEGE OF VETERINARY SURGEONS V RESPONDENT NICOLA FAY BUTTLER RVN DECISION OF THE DISCIPLINARY COMMITTEE ON FINDINGS OF FACTS AND ON DISGRACEFUL CONDUCT IN A PROFESSIONAL RESPECT AND UNFITNESS TO PRACTICE AND SANCTION 1. The Respondent faced three charges: i) Between 25 April 2016 and 28 April 2016, worked as a locum veterinary nurse at Garston Veterinary Group, Frome, Somerset when under the influence of alcohol; and/or ii) Between 3 July 2016 and 4 July 2016, worked as a locum veterinary nurse at Vets Now Salisbury when under the influence of alcohol AND in relation to the matters set out above, whether individually or in any combination, you are guilty of disgraceful conduct in a professional respect; iii) On 19 November 2013, were convicted at the North and East Devon Magistrates Court of driving with excess alcohol (namely 115 microgrammes of alcohol in 100 millilitres of breath on 27 October 2013 at Bickleigh, Devon) contrary to section 5(1)(a) of the Road Traffic Act 1988 and Schedule 2 to the Road Traffic Offenders Act 1988; and were sentenced to a Community Order of 120 hours unpaid work to be completed within twelve months, disqualified from driving for 28 months and ordered to pay costs of and a victim surcharge of 60.00; AND it is alleged that this conviction renders you unfit to practice as a veterinary nurse. 1

2 2. On 2 May 2017, Ms Buttler was served with a notice of inquiry with the relevant documents to her registered home address. The notice was sent by first class post and recorded delivery. The Royal Mail track and trace indicated that on 9 June 2017, the notice had not been collected. The notice of inquiry has since been returned to the College. 3. On 25 May 2017, the College's solicitors wrote to the Respondent, enclosing the Inquiry Bundle and unused material bundle. The letter and its enclosures were sent by post and in two s, to an address which the Respondent had previously used to contact the College. On 31 May 2017, the clerk to the Committee telephoned Ms Buttler but there was no reply; a voic message was left. The inquiry bundle and unused bundle sent by post was returned to the College. 4. On 1 June 2017, the Respondent ed the College s Solicitors, stating: Please stop ing me, I am no longer practicing as a veterinary nurse due to the stress and pressure you have all put on me. I have repeated this many times. It is a Shame as I have served and worked hard for over 20 years but will not [sic] longer be subject to this form of abuse for something I have not done! 5. Ms Buttler did not attend the hearing and was not legally represented. Proceeding in Absence 6. Ms Curtis on behalf of the College submitted that Ms Buttler had received both s sending her the Inquiry bundle which included the three charges and the unused bundle, because her reply on 1 June 2017, responded directly to the second of those . She therefore asked the Committee to presume that the first sent minutes earlier, enclosing the inquiry notice and bundle would also have reached Ms Buttler. 7. The Committee considered whether it should proceed in Ms Buttler s absence pursuant to Rule 13 of the Veterinary Nurse Conduct and Discipline Rules 2014 and Rules 5.1 and 5.5 and 10.4 of The Veterinary Surgeons and Veterinary Practitioners (Disciplinary Committee) (Procedure and Evidence) Rules Order of Council It considered the factors set out in the cases of R v Jones [2003] 1 A.C. 1 and Tait v Royal College of Veterinary Surgeons [2003] UKPC The Committee took into account the submissions made by the College, the correspondence within its bundles, including s from Ms Buttler and the advice of the Legal Assessor, before reaching its decision. 9. The Committee was satisfied on the basis of the correspondence it had seen that Ms Buttler had been properly served with the notice of hearing in accordance with the rules. 2

3 10. Furthermore, the Committee noted that Ms Buttler had responded most recently by indicating that she was aware she was subject to disciplinary proceedings but expressing that she did not wish to engage with the process. It further noted that the from Ms Buttler dated 1 June 2017 responded specifically to an from the College dated 25 May It therefore concluded that both s had been received by Ms Buttler and that she had received by the notice of inquiry, the inquiry bundle and the unused bundle. 11. The Committee noted that Ms Buttler had not requested an adjournment, so it was satisfied that if the proceedings were adjourned there was no prospect of her attending in the future; it concluded she had disengaged with the process. 12. The Committee further noted that there was no medical evidence to explain Ms Buttler s absence. The Committee took into account that nine witnesses were to be called by the College and that any further delay would not only inconvenience them but might have an effect on their memories of events dating back to April and July The Committee concluded that Ms Buttler had voluntarily absented herself since having determined that she was aware of the time and date of the hearing, she had chosen not to attend. The Committee was satisfied that it was in the interests of justice and it was fair to all parties, including Ms Buttler, that the case be heard expeditiously. It therefore decided to proceed in Ms Buttler s absence. Finding of Facts 14. The Committee took into account the limited contact from Ms Buttler and decided to proceed on the basis that she denied all the allegations. It chose not to draw any adverse inference from Ms Buttler s absence when deciding on the case. 15. Ms Curtis confirmed that Ms Buttler had no previous disciplinary findings against her and that there was evidence within the unused bundle that the agency through which Ms Buttler worked had received two positive references about her work. 16. The Committee gave detailed consideration to all the evidence in this case, the submissions of Ms Curtis and the advice of the Legal Assessor. It applied the law on the burden and standard of proof, namely that the burden of proof is on the College and that the standard of proof required is that it has to be sure before it finds any charge proven. 17. It also accepted the advice of the Legal Assessor that it should not use its findings on one charge to support its findings on another charge and it decided to consider its findings on facts on each charge separately. 3

4 Charge On 19 November 2013 at the Exeter Magistrates Court, the Respondent was convicted of driving with excess alcohol, namely 115 micrograms of alcohol in 100 millilitres of breath, on 27 October 2013 at Bickleigh in Devon. She was sentenced to a Community Order of 120 hours unpaid work, and disqualified from driving for 28 months. The relevant legal limit is 35 micrograms of alcohol in 100 millilitres of breath. 19. Having considered the certificate of conviction from the magistrates court and the to the College from Ms Buttler, dated 2 August 2016 in which she said what would you like me to add? My drink-drive conviction was three years ago!, the Committee was satisfied that Ms Buttler had been convicted of driving with excess alcohol as set out within charge 3. Further it noted Rule 23.4 of the The Veterinary Surgeons and Veterinary Practitioners (Disciplinary Committee) (Procedure and Evidence) Rules Order of Council 2004 stated that findings of fact of any court or tribunal shall be admissible as conclusive evidence of those facts. 20. The Committee therefore found the facts proved in respect of charge 3. Charge Charge 1 alleged that Ms Buttler worked as a locum veterinary nurse at the Garston Veterinary Group in Frome. 22. The Committee heard evidence from five witnesses Ms Gemma Smith (RVN), Ms Sarah Holmes (RVN), Mr Christopher Mangham (MRCVS), Ms Cynthia Macey and Ms Anne- Marie Sweet (RVN). 23. The evidence from each of them related to the April Three of them were veterinary nurses and one was a veterinary surgeon. 24. The evidence from those witnesses indicated that Ms Buttler had worked day shifts and was provided with overnight accommodation in a flat above the practice between 25 and 28 April The Committee had no difficulty in finding that Ms Buttler worked at the Garston Veterinary Group during those dates. Her correspondence with the College indicated that she denied the allegations but she did not deny that she had worked there. All the witnesses named Ms Buttler as having worked at Garston Veterinary Group between those dates. 26. The Committee went on to consider whether Ms Buttler was under the influence of alcohol at any time between those dates whilst on duty working at Garston Veterinary Group. 4

5 27. The Committee found the evidence of Ms Holmes and Mr Mangham to be persuasive and compelling evidence. Ms Holmes described that as a result footsteps going up to the flat every 15 to 20 minutes for several days in the week starting the 25 April 2016, she looked out and saw a person going upstairs. She said she met and spoke to that person who was Ms Buttler on 28 April On that day, Ms Holmes said shortly after hearing Ms Buttler going upstairs and coming back down, Ms Holmes had gone up to the flat and looked in the fridge. She saw in the fridge an open bottle of wine and she carefully looked at how much wine was in the bottle. Shortly after Ms Buttler had come down the stairs again, Ms Holmes went immediately upstairs and checked the level of wine in the open bottle in the fridge; she noticed it had gone down by the equivalent of a good mouthful. She had also seen Ms Buttler going upstairs holding two supermarket bags containing two wine bottles. 28. Ms Holmes fetched a marker pen and went back to the flat. She marked the bottle of wine at the level of its contents, showing the mark to Mr Mangham. She then placed the bottle back into the fridge. About minutes later she heard Ms Buttler again and saw the way Ms Buttler reached out for the bannister as she was climbing the stairs. She said the way Ms Buttler did so was similar to someone who was under the influence of alcohol. Ms Holmes stated that after Ms Buttler had come downstairs she immediately went to check the level of wine in the wine bottle which she had marked and she found that the level of wine had gone down below the first line she had marked. Ms Buttler stated she had showed Mr Mangham the marks she had made on the bottle. 29. The Committee questioned Ms Holmes as to whether anyone else could have had access to the flat at this time; she said she believed Ms Buttler was the only person upstairs in the flat at the time. Ms Curtis informed the Committee that Ms Buttler was not the only nurse sleeping at the practice at that time due to a statement in the unused bundle. 30. However, the Committee was satisfied that by marking the level of wine in the bottle and the fact that the level of wine decreased on two occasions immediately after Ms Buttler had been upstairs indicated that Ms Buttler had been drinking wine in the flat whilst on duty. The presence of wine being brought into the flat by Ms Buttler was also confirmed by Ms Holmes. 31. The Committee heard and found other circumstantial evidence which supported its finding. 32. Ms Smith and Ms Sweet, both noticed Ms Buttler absent herself from her duties whilst working and frequently going upstairs to the flat within the practice for short periods of time. Ms Smith recollected that Ms Buttler would disappear every 15 to 30 minutes and Ms Sweet recalled she absented herself approximately at hourly intervals. Since the witnesses stated that there were toilet facilities downstairs, the Committee found there was no good reason why Ms Buttler would have needed to go upstairs so frequently and that this was evidence which supported its finding that Ms Buttler was creating the opportunity to drink whilst on duty. 5

6 33. Mr Mangham also stated he believed Ms Buttler was under the influence of alcohol on 28 April 2016, when he had seen her stagger and sway her way up the stairs and when he had later watched the live feed of CCTV showing Ms Buttler stumbling and regaining her balance as she came through the door into the practice. He stated he had also seen that in one of the bags she was carrying she had two bottles of wine. The Committee had no reason to doubt the veracity of Mr Mangham s assessment of Ms Buttler. Since he had also seen her returning to the flat with alcohol this was further supporting evidence showing where the alcohol had come from and that Ms Buttler had brought it into the practice. 34. The Committee found the bringing of alcohol back to the practice was to some extent supported by Ms Macey, the cleaner. She stated she had stood in a queue in the supermarket behind Ms Buttler when she was purchasing wine earlier on that week; either on the 26 or 27 April The Committee accepted the evidence from Ms Stacey that she saw Ms Buttler buying wine because she said she had stood behind her for about six minutes. The Committee therefore found that Ms Buttler had bought alcohol that she would have been able to consume whilst she was on duty. Ms Macey also stated she had noticed that the room where Ms Buttler had slept smelt strongly of alcohol when she was cleaning it on 29 April The Committee accepted her evidence and found it to be further evidence to support there being alcohol drunk by Ms Buttler at the practice. 35. The Committee further accepted the evidence of Ms Sweet who noticed that when Ms Buttler went upstairs in a hurry she looked noticeably more relaxed when she came downstairs again. Ms Sweet also explained that Ms Buttler when returning downstairs would be chewing gum, eating something or would have a glass of squash in her hand. The Committee was satisfied that this evidence was persuasive in suggesting that Ms Buttler was trying to cover up the smell of alcohol on her breath and that her behaviour was the effect of drinking alcohol whilst she was on duty. 36. Ms Smith and Ms Sweet both described Ms Buttler s manner and expression in terms which suggested she was under the influence of alcohol Ms Smith said she felt that Ms Buttler was not really listening to her and that she had a vacant expression and was restless and fidgety and that she appeared not to be with it. The Committee was satisfied that cumulatively the evidence from four staff members suggested that Ms Buttler s behaviour whilst she worked at the practice was further evidence which supported its finding that the Ms Buttler was under the influence of alcohol whilst on duty. 37. Although the witnesses were careful not to discount a medical problem such as diabetes, which had been later raised by Ms Buttler, none of them stated that Ms Buttler had explained that her demeanour at the time was due to diabetes. 38. The Committee therefore found the facts of charge 1 proved. 6

7 Charge Mr McGuire (MRCVS), Ms Read, Ms Flett (RVN), and Ms Pope (MRCVS) gave evidence about Ms Buttler working at Vets Now in Salisbury between 3-4 July Ms Buttler appeared to accept having worked there in her correspondence with the College. In any case the Committee found the evidence of all four witnesses supported the fact Ms Buttler had worked at Vets Now between 3-4 July Both Ms Pope and Mr McGuire stated they had smelt alcohol on Ms Buttler s breath whilst she had been on duty. The Committee accepted their evidence and found that Ms Buttler s breath had smelt of alcohol because she had been drinking alcohol. The Committee went on to consider if Ms Buttler had been drinking alcohol whilst on duty. 42. Mr McGuire stated Ms Buttler had slurred speech and a flushed face at the end of a fourteen hour shift and so he discounted that this was due to drinking only prior to starting work because he believed the effect of any earlier drinking would have worn off. The Committee accepted his evidence and considered him to be a truthful witness. 43. Ms Flett and Ms Pope both provided supporting evidence that Ms Buttler s unusual demeanour indicated she had been under the influence of alcohol whilst on duty and both described her as slurring her speech and red faced or flushed. The Committee found their evidence supported the evidence of Mr McGuire that Ms Buttler was under the influence of alcohol whilst on duty. 44. Ms Buttler had been confronted as to her behaviour at this practice and she had been asked whether she was had been drinking, the Committee found none of her explanations to be credible. The explanations Ms Buttler had given over time for her behaviour were: that she was suffering from diabetes, that just because she liked to drink it did not mean she could not do her job properly and that she had a glass of wine before she went to sleep in the morning. 45. Ms Pope said she had questioned Ms Buttler as to whether the diabetes Ms Buttler said she had was controlled. Ms Pope said Ms Buttler had told her it was well controlled and that she did not have episodes of hyperglycaemia or hypoglycaemia. The Committee was satisfied on Ms Pope s evidence and in the absence of any medical evidence that Ms Buttler was not displaying behaviour which could be explained by a diagnosis of diabetes. Rather the Committee preferred to accept the assessment of Mr McGuire that Ms Buttler was under the influence of alcohol whilst on duty. 46. The Committee concluded that the fact that Ms Buttler had supplied a number of inconsistent explanations about her behaviour left it in no doubt that Ms Buttler was 7

8 attempting to explain away the evidence that suggested she had been drinking because she did not want to admit that she had been drinking whilst on duty. 47. Further the Committee discounted that her demeanour was due to previous drinking off duty or diabetes. It did not consider her other explanation, that just because she liked a drink it did not mean she could not do her job properly, as evidence which could assist her denial of the charge. Furthermore her explanation that she had been drinking heavily over the weekend was rebutted by the evidence of Mr McGuire who had stated she continued to exhibit signs of being under the influence of alcohol at the end of her shift. 48. Finally the Committee considered the evidence of Ms Read who said that she had seen a wine bottle in Ms Buttler s bag on 4 July It found this indicated that Ms Buttler was bringing alcohol into the practice. The Committee found Ms Read to be a credible witness when she conceded she did not see how much was in the wine bottle in Ms Buttler s bag. In contrast the Committee found that Ms Buttler lacked credibility because she had denied having any alcohol on the premises when she was confronted by Ms Pope at the time but she had later admitted in an to the College that she had had an open bottle of wine in her bag. The Committee therefore preferred the evidence of Ms Read which it found supported the evidence of Mr McGuire. 49. Having considered all of the evidence cumulatively it concluded that Ms Buttler had been working whilst under the influence of alcohol. 50. The Committee therefore found the facts of charge 2 proved. Disgraceful Conduct in a professional respect 51. The Committee exercised its judgement in deciding whether the facts found proved, amounted to disgraceful conduct in a professional respect (charges 1 and 2). 52. Disgraceful conduct in a professional respect means conduct that falls far short of that which is to be expected of a member of the veterinary profession. The RCVS Disciplinary Committee Procedure Guidance states this is conduct described as serious professional misconduct and conduct which falls far short of that which is expected of the profession. 53. The Committee considered that being under the influence of alcohol when working as a veterinary nurse was conduct which fell far short of the standards to be expected of members of the veterinary nursing profession. 54. The Committee determined that Ms Buttler by doing so, had put animals at increased risk and she had therefore breached paragraph 1.1 of the Code of Professional Conduct for Veterinary Nurses 2014, which said Veterinary nurses must make animal health and welfare their first consideration when attending to animals. It further determined that she 8

9 had breached paragraph 6.5 of the Code which said Veterinary nurses must not engage in any activity or behaviour that would be likely to bring the profession into disrepute or undermine public confidence in the profession. The Committee decided that Ms Buttler by presenting as under the influence of alcohol whilst on duty at work had undoubtedly placed animals at risk. 55. Furthermore the Committee found that by being under the influence of alcohol whilst on duty as a veterinary nurse on two occasions Ms Buttler had brought the profession into disrepute and undermined public confidence in the profession. 56. The Committee noted that at both Practices other members of staff had expressed concern at the behaviour and competence of Ms Buttler whilst she had been under the influence of alcohol. The Committee highlighted by way of example from the evidence it accepted from the witnesses: i) Ms Sweet had concerns that on one occasion when working in theatre, Ms Buttler did not maintain sterility resulting in a sterile kit having to be resterilised with the result that the dog being operated on had to remain under anaesthetic for forty minutes longer than would otherwise have been the case. ii) Ms Sweet had concerns that Ms Buttler did not put the blood pressure monitor on animals under anaesthetic even after she had told her on a number of occasions how essential this was. (re charge 1 and the practice in Frome, Somerset) iii) that Mr McGuire had concerns over Ms Buttler failure to follow his instructions regarding a dog with a torn claw. He stated that he expressly told Ms Buttler that she should speak to him before treating the animal so that for example he could decide whether or not it might additionally need some pain relief; however she did not do so and she advised the owner the to take the dog to their own vet the next morning. (Re charge 2 and the practice in Salisbury). 57. The Committee accepted that there was no evidence to show that at either practice Ms Buttler had actually caused harm to any animals but there was clearly a risk to animals if the nurse involved in their care was under the influence of alcohol; the examples above illustrated how she put animals at risk. 58. The Committee found that Ms Buttler had since 2016 displayed no insight regarding her actions. It noted that when confronted in July 2016 by Ms Pope, at Vets Now in Salisbury, Ms Buttler denied having alcohol with her although a bottle of wine had been seen by Ms Read in her bag. However, she later admitted to the College that an open bottle of wine had been in her bag. She had also said to Ms Pope that just because I like to drink, it doesn t mean that I can t do my job properly or words to that effect. The Committee considered her lack of frankness and failure to admit that she had been drinking at the time showed that she lacked insight into her drinking. 9

10 59. The Committee noted that Ms Buttler had been under the influence of alcohol whilst on duty in respect of charge 2 three months after she had been similarly under the influence of alcohol in respect of charge 1. She had been confronted by staff at Garston Veterinary Group in Somerset but she had nevertheless repeated her actions by being under the influence of alcohol a second time when working in July 2016 at Vets Now in Salisbury. It found such repeated conduct to be serious. 60. For all these reasons, the Committee decided that Ms Buttler was guilty of disgraceful conduct in a professional respect in relation to charge 1. For the same reasons, it also decided that in respect of charge 2, Ms Buttler was guilty of disgraceful conduct in a professional respect. Unfitness to practice as a veterinary nurse 61. The Committee exercised its judgement in deciding whether the facts found proved, amounted to unfitness to practice (charge 3). 62. RCVS Disciplinary Committee Procedure Guidance provides: A conviction may be related to professional or personal behaviour and whether it renders a respondent veterinary surgeon (nurse) unfit to practice is a matter of judgment for the Disciplinary Committee. Behaviour unconnected with the practice of veterinary surgery (nursing) can cause concerns about the protection of animals or the wider public interest. 63. The public interest is considered in paragraph 8 of the Guidance as follows: It is in the public interest that veterinary surgeons (nurses) protect and promote the health and welfare of animals and conduct themselves in a professional manner. The protection of public health is clearly in the public interest. The protection of the profession s reputation, and upholding and maintaining standards within the profession are also in the public interest. 64. The Committee noted that there was an absence of information provided by the College relating to the facts of the conviction for driving with excess alcohol. Ms Curtis informed the Committee that it was likely that Ms Buttler had completed her sentence. There was no evidence as to whether Ms Buttler was driving to work or for another reason whilst under the influence of alcohol. 65. Although she was three times over the legal limit for breath, the Committee considered that the conviction alone would not necessarily of itself lead it to a finding of unfitness to practice. 66. It noted that she had no other criminal convictions or disciplinary findings against her and that she had worked in other practices as a locum veterinary nurse on two occasions with positive references. However, the Committee had to consider the conviction for drink drive 10

11 in the context of later behaviour which it had found proved; whereby in 2016, Ms Buttler had repeated an activity (working) which required her to not be under the influence of alcohol. 67. The Committee went on to consider whether Ms Buttler had acknowledged the seriousness of her actions. In 2013, she had driven with excess alcohol and in 2016 she had worked whilst under the influence of alcohol. The Committee concluded there was evidence to show that she therefore continued to pose a risk to animals and the public in the future by virtue of her actions in 2016 following her conviction in Ms Buttler s to the College said My drink drive conviction was 3 years ago! I haven t had an issue since. I am anaemia (sic) so don t deal with nights well.... The Committee considered that this failure to acknowledge what she had done illustrated that Ms Buttler would continue to pose a risk to the public and animals. Taking into account her lack of insight in respect of what happened in 2016 in respect of charges 1 and 2, and the fact she had again performed another activity (working instead of driving) whilst under the influence of alcohol when she should not have done, the Committee found that she had not learned any lessons from her conviction in 2013 for driving with excess alcohol. 69. The Committee accepted the submission of Ms Curtis, that the conviction for driving with excess alcohol in the circumstances and wider context of this case undermined the reputation of the veterinary nursing profession because the offence inevitably involved a risk of injury to other road users. Moreover, the Committee was satisfied that Ms Buttler s lack of awareness generally regarding her alcohol intake and drinking alcohol when she was not meant to do so and the fact that the conduct which led to the charge did not appear to have been remediated, meant that the conviction for driving with excess alcohol in 2013 rendered Ms Buttler unfit to practice. Sanction 70. Ms Curtis highlighted the following aggravating factors: i) There was a risk of injury to an animal ii) Charges 1 and 2 involved premeditated conduct, Ms Buttler took wine into each of the two veterinary practices where she worked as a locum iii) Neither charge 1 or charge 2, was a single isolated incident, charge one related to four shifts and charge 2 related to two night shifts and the evidence was that Ms Buttler was under the influence of alcohol on more than one shift in each practice iv) There is no evidence of any insight from Ms Buttler at the time or since she worked at those practices v) The future risk to animals remains because there has been no remediation by Ms Buttler 11

12 71. Ms Curtis highlighted the following mitigating factors: i) Ms Buttler is of good character and she has no previous disciplinary findings against her ii) There had been no proven actual harm to any animal iii) There was no financial gain resulting from these charges iv) Ms Buttler suggested she had two medical conditions; anemia and diabetes. There was no independent confirmation of any medical issues. 72. Ms Curtis further submitted that a postponement of the Committee s judgement on sanction was inappropriate because Ms Buttler had not shown any insight and the risk to animals remained. 73. The Committee accepted the submissions of Ms Curtis and agreed with her identification of the aggravating and mitigating factors. It further noted that the agency for whom Ms Buttler worked indicated that there were two positive references it had received in 2016 about her work. The Committee took into consideration all the aggravating and mitigating factors when exercising its judgement regarding sanction. 74. The Committee first decided whether no further action was appropriate in this case. It considered the charges cumulatively were too serious for no further action to be taken and that closing the case without a sanction would be insufficient to protect animals and the wider public interest. 75. The Committee also decided not to exercise its power to postpone judgment (for a period of up to two years) because there was no reason to delay matters. Ms Buttler had disengaged with the regulatory process and the Committee considered it unlikely that she would engage in the future. There was no benefit apparent in postponing its judgement. 76. The Committee then decided whether the sanctions of a warning or reprimand was a sufficient sanction. It concluded that these sanctions would not provide adequate protection to animals and the wider public interest because neither sanction would restrict Ms Buttler s right to continue to practice as a veterinary nurse. Since Ms Buttler had shown no insight the Committee therefore concluded that these sanctions were inappropriate. Further, it noted that the Disciplinary Committee Procedure Guidance stated that a warning or a reprimand was appropriate where the charges found proved were at the lower end of the spectrum of seriousness; which these charges cumulatively were not. 77. The Committee went on to consider whether suspension would be the proportionate sanction. It reminded itself that a period of suspension would not protect animals because Ms Buttler continued to have no insight and she had not faced up to the fact that her use of alcohol had been inappropriate. The Committee could not be sure that she had remediated because following her disqualification from driving for 28 months in 2013, she had been under the influence of alcohol at work in She had also not engaged with the 12

13 disciplinary process. The Committee therefore decided that because Ms Buttler had not shown any insight and because there remained a risk of her repeating similar behaviour, a suspension was not the appropriate sanction. 78. The Committee noted that Ms Buttler said she had worked for twenty years without any problem and that she was previously of good character. However because there was no evidence that Ms Buttler would not repeat the conduct with regards to working whilst under the influence of alcohol, she could continue to pose a risk to animals or the public in the future. The Committee therefore was bound to consider her removal from the register. 79. Although it noted from the brief correspondence Ms Buttler had sent to the college that she said she did not intend to practice in the future, the Committee decided that until she had shown insight into her behaviour in 2016, she remained a risk to animals. It therefore decided that the proportionate action was to instruct the Registrar to remove her name from the register of veterinary nurses forthwith. 80. If Ms Buttler chose to re-engage with the College, she could apply for restoration to the register after ten months. Disciplinary Committee 21 June