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Lancelot E. Williams
Allegations and Plea
The College alleged that the Member failed to provide appropriate care and treatment before, during and after a client’s anxiety attack, failed to follow a physician’s order, failed to appropriately document and failed to provide appropriate measures to the client when the client was discovered with vital signs absent. The College alleged that this conduct would be regarded as disgraceful, dishonourable or unprofessional.
The Member admitted to the allegations, and the College and the Member jointly submitted an agreement to the following facts.
The Member worked in a tertiary care mental health facility. The Unit was divided into three pods. The Member and RN A were the only staff members in pod two at the onset of the shift.
The Client involuntarily entered the Unit about three months prior to the incident, and had a long history of recurrent psychosis, disorganized and disruptive behaviour, self-injurious behaviour and extreme episodic anxiety attacks. The Member was assigned to the Client on the evening/night shift in question.
There was a continuing order for the Client to be on constant observation during an anxiety attack, which required that a staff member must be present with the client at all times, have a clear visual of the client and be within hearing distance. The Member did not initiate constant observation. He did not agree with the order as he did not believe it was beneficial to the Client, however he did not document or raise concerns regarding the order with the manager or physician.
During the evening, the Client’s behaviour escalated; he was undressed and running around the Unit. After the Client was redirected, the Member observed the Client rolling around on his bed and soiling the room. The Member did not document the behaviour nor did he document routine checks at any point during the shift. The Member settled other clients and when the Member returned to the Client’s room, the Client was found with extremities mottled, face discoloured and vital signs absent. Neither the Member nor RN A initiated CPR or a Code Blue, despite being advised by several colleagues. There was at least 11 minutes between finding the Client vital signs absent and beginning CPR, and 15 to 20 minutes between finding the Client vital signs absent and calling Code Blue.
Following the Client’s death, the Member charted the events of the evening in the progress notes, these being the only notes the Member made regarding the Client all shift (excluding an entry for medication administration).
The Panel found that the evidence supported findings of professional misconduct as alleged, and that the Member’s conduct would be regarded as unprofessional. The Panel noted that the conduct demonstrated serious disregard for the Member’s professional obligations.
Submissions on Order
The College sought an oral reprimand and a two-month suspension. The Member would be required to complete specified remediation activities in preparation for a series of meetings with a nursing expert. For 24 months after the suspension ends, the Member would be required to advise the College of his employers, provide employers with a copy of the Panel’s decision and reasons, and only practise for an employer who agreed to advise the College if the Member breached the standards of practice of the profession.
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 satisfies the principles of specific and general deterrence, remediation, and protection of the public interest.