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Alistone T. Skepple 9105362
Allegations and Plea
The College alleged that the Member: completed a Do Not Resuscitate Form (DNR) that went against the wishes of the client; failed to properly transcribe and incorrectly documented medication orders; fabricated an ADP referral form and a late entry progress note; failed to properly document a physician’s order and/or failed to take the necessary steps to ensure there was an adequate supply of the medication; failed to perform and falsely documented a medication reconciliation; inaccurately documented that Nitrospray ordered for a client was covered by the Facility’s medical directives; and documented an order for a vitamin and mineral supplement without verifying the existing orders.
The College further alleged that the Member: failed to perform an assessment of a client who had fallen; failed to notify a client’s authorized representative of an incident involving another client; communicated inappropriately with the child of a client; inappropriately responded to an outbreak of disease at the Facility without properly coordinating with Ontario Public Health; and inappropriately discussed the personal health information of two clients in a location and/or in circumstances in which he was likely to be overheard. The College alleged that this conduct would be regarded as disgraceful, dishonourable or unprofessional, and that it demonstrated the Member’s incompetence.
The Member was employed at a long-term care home as the “Geriatric Nurse Specialist” from August 31, 2007, to May 15, 2014. This role was an expert position intended to provide leadership in the development, implementation, ongoing monitoring and evaluation of nursing services. In 2014, his employment was terminated. He grieved the termination and it was converted to a resignation.
The Member’s conduct included numerous documentation errors and the falsification of records. On May 1, 2012, the Member completed a DNR Confirmation Form indicating Client A’s expressed wish that CPR not be included in her plan of treatment. This was contrary to the Client’s advanced directives, signed by the Member on January 13. He also failed to perform a medication reconciliation for Client A, then documented that he had done so in the progress notes. On September 13, the Member wrote, “resume previous orders with the exception of the following,” on a physician’s order form for Client B. In other words, the Member wrote down a list of medications that the Client was not ordered to receive, and failed to write out any of the medications that the Client was ordered to receive. On December 27, the Member performed a medication reconciliation for Client C, and incorrectly noted that an order for acetaminophen 500 mg was covered under the Facility’s medical directives. In completing this same medication reconciliation, the Member documented a PRN order for medication to be administered only if the Client’s weight increased by a certain amount. He did not document in the e-MAR that, as a result of this order, the Client’s weight had to be checked daily. He also requested and documented an order for a vitamin and mineral supplement for Client C, without verifying the Client’s existing orders. As a result, the Client received a double-dose of the supplement for a period of two weeks. On June 24, 2013, the Member received an email from an RPN about the status of a wheelchair request for Client D. The following day, he fabricated the order form and a late-entry progress note to suggest he had requested the wheelchair on June 11. On April 15, 2014, the Member inaccurately documented that Nitrospray ordered for Client I was covered by the Facility’s medical directives.
In addition, on November 18, 2013, the Member failed to perform an assessment of Client E after she fell. Client E was admitted to the hospital when the nurse on the next shift called an ambulance. The Member was suspended for three days as a result of this incident. On February 13, 2014, the Member failed to order dressing supplies for Client F. As a result, she did not receive the prescribed treatment for eight days. On February 20, the Member failed to notify Client G’s authorized representative (POA) that an incident occurred involving inappropriate touching of the Client by another client. On April 30, the Member communicated to staff that the Facility was in isolation until May 1 as a result of an outbreak of disease. The Member did not properly coordinate with Ontario Public Health about the duration of the isolation and/or outbreak status. In fact, the outbreak status was not lifted until May 5, 2014. On May 2, the Member re-admitted Client J without properly coordinating with Ontario Public Health about the admission. Because the Facility was still in outbreak status, Client J should not have been admitted until the outbreak status was lifted.
On March 20, 2014, Client H died at the facility. The Member notified the Client’s daughter of her death in the lobby of the facility, rather than in a private area. As the Member was escorting the daughter back to the Client’s room, the Member took a phone call instead of providing comfort. On May 1 and 6, the Member inappropriately discussed Client J’s personal health information in areas that were not private. Both times, the Member’s conversations were overheard.
The Panel considered the Agreed Statement of Facts and found that they supported findings of professional misconduct as alleged, and that the Member’s conduct would be considered to be disgraceful, dishonourable and unprofessional. The Panel alsofound that the facts supported a finding of incompetence.
Submissions on Order
The College and the Member jointly sought an oral reprimand and revocation of the Member’s certificate of registration. The seriousness of incidents, the length of time over which the incidents occurred, and the variety of subject areas involved in providing nursing care were all aggravating factors.
The Panel accepted the joint submission as reasonable and in the public interest. The Member accepted responsibility for his actions and cooperated with the College by agreeing to the facts and proposed penalty. The penalty provides specific and general deterrence, and protection of the public interest. It ensures that public trust in the profession will be maintained. Due to the repeated unprofessional behaviour and breaches of professional standards, the Panel found that the Member lacked the capacity for remediation.