Amy Nugent 9611617
Allegations and Plea
The College alleged that the Member failed to provide care to clients and charted that she had in fact provided care in relation to wound dressing changes for three clients and medication administration for thirteen clients, and that this conduct would be regarded as dishonourable, disgraceful or unprofessional.
The Member was neither present nor represented by counsel at the hearing. The hearing proceeded on the basis that the Member denied the allegations.
The Panel heard from the Director of Nursing (DON), a RN and a RPN who worked with the Member, and one expert witness.
The Member worked at a long-term care facility. On the day in question, she was responsible for dressing changes and medication administration for approximately 30 clients. The Member claimed to have completed her tasks earlier than expected. At the end of her shift, some dressing changes had not been completed although the Member signed that she had completed them. Further investigation uncovered 96 pills discarded in the garbage container on the Member’s medication cart. The pills were to have been administered to 13 clients, and the Member charted that she had administered the pills.
The DON asked the RPN to put her initials on dressings that the RPN had completed for three clients, and to check them after the Member’s shift to see whether the Member had changed them. The RPN’s dressings remained intact a day later, as the Member did not change them during her shift. The RN also observed the dressings and confirmed that two of them still had the RPN’s mark on them.
The expert testified that failure to administer medications or change dressings as ordered could put clients at risk, and that documenting that these actions were completed compromised communication between shifts. It appeared to the expert that the Member had not intended to do the dressings or give the medications, and that she had little regard for potential outcomes for the clients.
The Panel found that the evidence supported findings of professional misconduct as alleged, except that the allegations regarding the dressing changes applied to only two of the three clients and the allegations regarding medication applied to only twelve of the thirteen clients. The Member’s conduct would be regarded as disgraceful, dishonourable and unprofessional. She falsified records and signed records that she knew were false or misleading. Her conduct displayed a serious disregard for her professional obligations and involved deceit. The clients were cognitively impaired and extremely vulnerable.
Submissions on Order
The Member was the subject of three prior decisions of the College’s Complaints Committee: in 1998, she was issued a letter of caution for failing to complete a wound dressing but documenting that treatment had been completed; in 1999, a second letter of caution outlined expectations that the Member’s documentation would accurately reflect the care given; and in 2004, concerns about the Member’s administration and documentation of medications and her falsification of documentation were referred to the Quality Assurance Committee. Given this history, the College advocated for a significant suspension and prolonged period of remediation.
The College sought an oral reprimand and a six-month suspension. The Member would be required to complete specified remediation activities in preparation for a series of meetings with a nursing expert. For 18 months after the Member returns to nursing practice, she would be required to advise the College of her employers, provide employers with a copy of the Panel’s decision and reasons, and only practise for an employer who agreed to perform periodic random spot audits of the Member’s practice and advise the College if the Member breached the standards of practice of the profession. The Member would also be required to pay costs in the amount of $500.
The Panel accepted the College’s submission, with one addition: given the element of dishonesty in the Member’s misconduct, the Panel required her to review the Ethics standard in addition to the standards outlined in the College’s submission.
The penalty met the objective of public protection and serves as both specific and general deterrents. The panel agreed that a modest cost order was appropriate given the Member’s lack of engagement in the discipline process. The costs of $500 represent a small portion of the actual costs incurred by the College.