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Abbagu, Elizabeth Dagdag

Elizabeth Dagdag Abbagu IA12558

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

FULL-TEXT DECISION

Note: This is the full text of the decision of the Discipline panel in this matter. Any information identifying clients, witnesses or facilities has been removed [ ]. The member’s name is omitted if the allegations have been dismissed or if the results are not placed on the public portion of the Register.

PANEL:

Gabrielle Bridle, RPN   Chairperson
Sandra Keating, RN   Member
Pat Collins, RPN   Member
Angus Taylor   Public Representative
Jayne Sanger   Public Representative

BETWEEN:

COLLEGE OF NURSES OF ONTARIO   Nick Coleman for
College of Nurses of Ontario
- and -    
ELIZABETH DAGDAG ABBAGU
#IA-1255-8
  Michelle Brodey for
Elizabeth Dagdag Abbagu
     
    Heard: January 14, 2002

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on January 14, 2002 at the College of Nurses of Ontario at Toronto.

The Allegations

The allegations against Elizabeth Dagdag Abbagu as stated in the Notice of Hearing (Exhibit #1) dated October 30, 2001 are as follows:

  1. You have committed an act of professional misconduct as provided by subsection 51(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c.32, as amended, and subsection 1(1) of Ontario Regulation 799/93 in that, while employed as a Registered Practical Nurse and/or Health Care Aide at [the Home], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession with respect to your care of the patient, [ ], in 1998 and/or 1999; and/or
  2. You have committed an act of professional misconduct as provided by subsection 51(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and subsection 1(7) of Ontario Regulation 799/93 in that, while employed as a Registered Practical Nurse and/or Health Care Aide at [the Home], you abused a client verbally, physically or emotionally with respect to your care of the patient, [ ], in 1998 and/or 1999; and/or
  3. You have committed an act of professional misconduct as provided by subsection 51(c) of the Health Professions Procedural Code of the Nursing Act 1991, S.O. 1991, c. 32, as amended, and subsection 1(37) of Ontario Regulation 799/93 in that, while employed as a Registered Practical Nurse and/or Health Care Aide at [the Home], you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional with respect to your care of the patient, [ ], in 1998 and/or 1999; and/or
  4. You have committed an act of professional misconduct as provided by subsection 51(b.1) of the Health Professions Procedural Code of the Nursing Act 1991, S.O. 1991, c. 32, as amended, in that, while employed as a Registered Practical Nurse and/or Health Care Aide at [the Home], you sexually abused the patient, [ ], in 1998 and/or 1999.
Member’s Plea

Counsel for the College advised the panel that agreement had been reached on the facts and that the Member had executed an Agreed Statement of Facts and Undertaking which contained the Member’s admissions to the allegations. In particular, the Member admitted all of the allegations set out in paragraphs 1, 2, 3 and 4 of the Notice of Hearing. The panel conducted a plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Agreed Statement of Facts

The Agreed Statement of Facts and Undertaking provides as follows:

Agreed Statement of Facts

The Member and the Facility
  1. The Member is a Registered Practical Nurse who obtained her Nursing Assistant Certificate from [ ], in 1991. She has been a member of the College of Nurses since 1991. [ ].
  2. The Member admits to the facts set out in this Agreed Statement of Facts.
  3. The Member was employed at [the Home] from 1991 to January 15, 2000, when she resigned as a result of the incidents described below. The Member is currently employed as a Health Care Aide at [another facility].
  4. Between April 1998 and November 1999, the Member worked on the 4th floor at [the Home] as both a Registered Practical Nurse or as a Health Care Aide. She worked the evening shift (from 1500 hours to 2300 hours).
  5. [The home] is a four-unit, 268-bed inpatient facility, which also offers community programs. [Specific reference to facility’s residents deleted] The 4th floor at [the Home] is a continuing care unit for clients with complex care needs. The 2nd and 3rd floors are designated for residents who are independent and require minimal assistance with care.
The Client
  1. The client, [ ], is an eight-five year old male resident at [the Home]. [The client] was a resident who required a minimal amount of care and was independent. He came and left [the Home] as he wished.
  2. [The client’s wife], was also a resident at [the Home]. Her health was poorer than her husband’s, in that she was cognitively impaired with dementia and other significant health problems. She required a high level of care and was a palliative patient. Because of her care needs, [the client’s wife] was a resident on the continuing complex care unit (4th floor). [The client] resided on the 4th floor with his wife.
  3. The [client and his wife] shared a semi-private room which consisted of two single beds and a bathroom.
  4. On October 5, 1999, [the client’s wife] died, and shortly thereafter, [the husband] was transferred to the 2nd floor at [the Home] – the unit for residents who are independent and require minimal assistance with care.
The Member’s Relationship with [the client]
  1. While [the client] resided on the 4th floor with his wife, the Member was assigned to provide care to both [the client and the client’s wife]. On certain shifts, the Member worked in the capacity of a Registered Practical Nurse, and on others she worked as a Health Care Aide.
  2. Commencing in or about November 1998, the Member and [the client] initiated a personal and non-professional relationship. This personal relationship was fostered by the Member and it developed into a romantic relationship which continued for a period of approximately one year, until November 1999.
  3. The personal relationship between the Member and [the client] involved meetings both in the facility in [the client’s] room (with or without [the client’s wife] present) and elsewhere, as well as outings to local shopping malls and restaurants.
  4. On occasions when the Member and [the client] would see each other in the context of this personal relationship, they would express personal affection for each other. On a regula basis the Member would telephone [the client] and express her affectionate feelings for him, as he would for her.
  5. The Member accepted modest gifts of clothing from [the client], and [the client] would pay for food when he and the Member would go out together.
  6. The physical displays of affection between the Member and [the client], which took place during the course of the relationship, included hugging, kissing, and embracing each other. The Member and [the client] also engaged in sexual touching while clothed, which included the Member caressing [the client] on his back, chest and buttocks and [the client] caressing the Member’s breasts.
  7. The Member denies that any of the sexual touching constituted intercourse, masturbation, encouragement to masturbate, or genital to genital, genital to anal, oral to genital, or oral to anal contact.
  8. In approximately September 1999, the Member began to withdraw from [the client] both emotionally and physically. When this took place, [the client] became very emotionally distraught.
  9. On September 23, 1999, [the client] disclosed the intimate nature of his relationship with the Member to a social worker employed at [the Home]. At that time, [the client] would not disclose the Member’s name. Although the Member was interviewed by the Hospital administration at that time, she did not admit to any impropriety and ultimately the investigation could not proceed.
  10. [The client’s wife] died on October 5, 1999.
  11. In November 1999, the Member terminated the personal relationship with [the client]. This was emotionally devastating to him.
  12. On November 23, 1999, [the client] disclosed the Member’s name to the hospital administration and alleged that he and the Member had an intimate relationship with a sexual component. As a result of the allegations made against the Member by [the client], the Member was suspended from her employment on November 25, 1999 pending an investigation. In the course of the investigation, and on January 15, 2000, the member resigned from her position at [the Home] and received a severance package.
  13. The Member has expressed that she is deeply ashamed of her conduct as outlined in this agreement. She does not wish to return to the practice of nursing prior to her retirement. To this end, she has undertaken to resign from the College of Nurses and not to return to the practice of nursing as set out in the attached Undertaking.
  14. The College submits no other evidence regarding the allegations.
Allegation 1 - Failure to meet the standards of practice
  1. The Member admits that she has committed an act of professional misconduct as set out in allegation 1 in the Notice of Hearing in that while employed as a Registered Practical Nurse or Health Care Aide at [the Home], she contravened or failed to meet the standards of practice of the profession with respect to her care of [the client] in 1998 and 1999 by engaging in a personal relationship with him;
Allegation 2 – Emotional Abuse
  1. The Member admits that she has committed an act of professional misconduct as set out in allegation 2 of the Notice of Hearing in that while employed as a Registered Practical Nurse or Health Care Aide at [the Home], she abused a client emotionally with respect to her care of the patient [ ] in 1998 and 1999 by engaging in and withdrawing from a personal relationship with him;
Allegation 3 – Disgraceful, Dishonourable and Unprofessional Conduct
  1. The Member admits that she committed an act of professional misconduct as set out in allegation 3 of the Notice of Hearing in that she has engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional with respect to her care of the patient [ ] in 1998 and 1999 by engaging in a personal relationship with him;
Allegation 4 – Sexual Abuse
  1. The Member admits that she has committed an act of professional misconduct as set out in allegation 4 of the Notice of Hearing in that while employed as a Registered Practical Nurse or Health Care Aide at [the Home], she abused a client sexually with respect to her care of the patient [ ] in 1998 and 1999 by engaging in a personal relationship which involved sexual touching with a client as described in paragraph 15 above;

UNDERTAKING

WHEREAS the Complaints Committee of the College of Nurses of Ontario referred specified allegations of professional misconduct concerning me to the Discipline Committee of the College of Nurse of Ontario in its Notice of Hearing, dated March 5, 2001, a copy of which is attached,

AND WHEREAS I am working as a Health Care Aide and do not wish to return to the practice of nursing,

AND IN CONSIDERATION for the College of Nurse of Ontario ("the College") entering into an Agreed Statement of Facts and Joint Submission on Penalty dated January 14, 2002,

I, Elizabeth Abbagu, #IA-1255-8, hereby undertake and agree to resign as follows:

  1. to resign as a member of the College, effective, January 14, 2003.
  2. my resignation is irrevocable;
  3. I will not apply for, and will not be entitled to, any further certificate of registration as a Registered Practical Nurse or a Registered Nurse of any class or category from the College;

I have been advised by the College to seek independent legal advice before signing this agreement and I have done so.

Decision

The panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct and, in particular, finds that the Member committed an act of professional misconduct as alleged in paragraphs #1, #2, #3 and #4 of the Notice of Hearing, in that, the Member contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, abused a client verbally, physically or emotionally, engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, all with respect to her care of the patient, [ ], and sexually abused the patient.

Penalty

Counsel for the College advised the panel that a Joint Submission as to Penalty (Exhibit #3) had been agreed upon. The Joint Submission as to Penalty provides as follows:

THE MEMBER AND THE COLLEGE JOINTLY SUBMIT that the appropriate penalty in this matter is for the Discipline Committee to make the following order:

  1. Directing the Executive Director to suspend the Member’s certificate of registration for a period of twelve months, commencing January 14, 2002.
  2. Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:
    1. The Member shall undergo a counselling session with an expert in the field of boundaries in the nurse client therapeutic relationship, as approved by the Director of Hearings and Investigations of the College. The counselling shall include a review of the importance of maintaining boundaries and how to avoid breaches of the boundaries in the nurse client relationship in the context from which the findings of misconduct arose. The Member shall undergo the counselling at her own expense;
    2. The Member shall provide a copy of the Agreed Statement of Facts and the Joint Submission on Penalty and the Decision of the Discipline Committee when it becomes available to her to the counsellor;
    3. The Member shall provide a written report from her counsellor within six months confirming that the Member has undergone the requisite counselling stipulated in a. above.
  3. Requiring the Member to appear before the panel of the Discipline Committee to be reprimanded, at a date to be arranged but in any event within 3 months of the date of the order.

Counsel for the College outlined for the panel that the main aspects of a penalty address:

  • specific deterrents
  • general deterrents
  • rehabilitation

Counsel for the College noted that the suspension of the Member’s certificate of registration for a period of twelve months was intended to be a clear message to the membership and sends a strong message to the public that this conduct will not be tolerated and warrants serious penalty.

Counsel for the College also noted that the direction to the Member to engage in counselling will assist in her effective rehabilitation in maintaining therapeutic relationships with clients to avoid such problems in the future.

Counsel for the College further noted that the oral reprimand would serve as a specific deterrent to the Member that such conduct will not be tolerated by her peers or by members of the public.

Counsel for the College directed the panel to Section l.3 and Section 51.5 of the Code to outline for the panel the two sections of the Code dealing with sexual abuse. Section 1.3 of the Code deals with sexual abuse of a touching, hugging and kissing nature, which applies in this case, while Section 51.5 of the Code deals with the more serious nature of sexual abuse involving direct sexual contact.

Counsel for the College stated that the proposed penalty is appropriate.

Counsel for the Member identified several mitigating factors pertaining to the appropriateness of the Joint Submission on Penalty including:

  • this being the Member’s first time to appear in front of the Discipline Committee
  • the Member voluntarily agreeing to the Agreed Statement of Facts
  • the Member voluntarily agreeing to resign as a member from the College following the twelve month suspension
  • the Member voluntarily agreeing that the resignation is irrevocable
  • the Member voluntarily agreeing that she will not apply for, nor be entitled to, any further certificate of registration of any class or category from the College

Counsel for the Member also noted that there were several unique circumstances in this case, namely:

  • the Member is in the final stages of her career
  • the Member will be 63 years of age in May
  • the Member has no plans to return to nursing but plans to work as a Health Care Aide for one more year
  • a full hearing would have presented uncommon challenges for all parties because the patient is elderly and not fluent in English..

Defence Counsel then addressed the principles of penalty by outlining for the panel that this penalty is appropriate for public protection and addresses the College’s concern for a vulnerable sector of society.

Both Counsel for the College and for the Member agreed that the publication of the Member’s name and details of the decision and penalty in the College Communiqué was an important consideration as a deterrent and sends a message to the Member’s peers and to the public that such conduct will not be tolerated.

The panel was concerned that the terms of the Joint Submission on Penalty were not entirely clear and did not reflect the terms of the Undertaking. As a result, the following amendments, shown in bold italics, were made, which were accepted by both counsel:

     

  1. Directing the Executive Director to Suspend the Member’s certificate of registration for a period of twelve months, commencing January 14, 2002 at the end of which period all of the terms of the Undertaking, including irrevocable resignation from the College, will become effective.
  2.  

    1. The Member shall undergo a counselling session with an expert in the field of boundaries in the nurse client therapeutic relationship, as approved by the Director of Hearings and Investigations of the College.
    1. The Member shall provide a written report from her counsellor within six months of the date of signing this Joint Submission on Penalty confirming that the Member has undergone the requisite counselling stipulated in a. above.
Penalty Decision

The panel deliberated and accepted the Joint Submission on Penalty as amended and accordingly orders as follows:

  1. Directing the Executive Director to Suspend the Member’s certificate of registration for a period of twelve months, commencing January 14, 2002 at the end of which period all of the terms of theUndertaking, including irrevocable resignation from the College, will become effective.
  2. Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:
    1. The Member shall undergo counselling with an expert in the field of boundaries in the nurse client therapeutic relationship, as approved by the Director of Hearings and Investigations of the College. The counselling shall include a review of the importance of maintaining boundaries and how to avoid breaches of the boundaries in the nurse client relationship in the context from which the findings of misconduct arose. The Member shall undergo the counselling at her own expense;
    2. The Member shall provide a copy of the Agreed Statement of Facts and the Joint Submission on Penalty and the Decision of the Discipline Committee when it becomes available to her to the counsellor;
    3. The Member shall provide a written report from her counsellor within six months of the date of signing this Joint Submission on Penalty confirming that the Member has undergone the requisite counselling stipulated in a. above.
  3. Requiring the Member to appear before the panel of the Discipline Committee to be reprimanded, at a date to be arranged but in any event within 3 months of the date of the order.

The panel concluded that the above amendments provided clarity with respect to the completeness of the consequences on the Member, as outlined in the Undertaking, and clarity regarding the timelines and extent of counselling.

The panel was satisfied that the penalty, including the amendments which were accepted by both counsel, adequately protects the public and sends a strong message to the membership that such conduct will result in serious consequences.

The panel was further satisfied that this penalty addresses the panel’s concern that the 12-month suspension and the counselling requirement will ensure that the Member is better prepared to deal with boundary issues as she continues her employment as a HCA.

The panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions.

I, Gabrielle Bridle, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel as listed below:

____________________________ ____________________________
Chairperson Date

Sandra Keating, RN
Pat Collins, RPN
Angus Taylor, Public Representative
Jayne Sanger, Public Representative

Page mise à jour le septembre 28, 2010