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Publications & Resources > The Standard > September 2005

   Last modified: Aug. 25, 2005

Summarized Discipline Decisions

The following decisions and reasons of the Discipline Committee form part of the College’s annual report and are published as a requirement of the Regulated Health Professions Act.

By publishing these decisions, CNO educates nurses and informs the public about what does and does not constitute professional misconduct and incompetence. These decisions also provide direction to RN s and RPN s on practice standards and professional behaviour should they find themselves in similar situations.

The name of the member who is the subject of the hearing may or may not be included, depending on the decision of the Panel of the Discipline Committee. Information revealing the names of witnesses and clients has been removed. Following a decision by Council, the institutions/agencies where the incidents occurred are identified. If this unduly increases the likelihood of identifying clients, the facility is not named.

Click here for copies of full decisions, or contact Deborah Jones, Editor, at 416 928-0900 or 1 800 387-5526, ext. 6308.

Current discipline decisions:

INAPPROPRIATE CARE, TREATMENT AND COMMUNICATION

Member

Allegations and Plea

The College alleged that the member committed acts of professional misconduct pertaining to client care, treatment and communications and by abusing clients verbally, physically or emotionally. The College also alleged that the member communicated inappropriately with a personal support worker (PSW) regarding a client.

The member denied the allegations, and the Panel of the Discipline Committee proceeded with a hearing.

Evidence

The Panel heard testimony that the member had forced client A to take a medication. Specifically, after client A spat out the medication, the member used a raised voice and forced the medication into the client’s mouth with a spoon, causing bruising. According to the testimony, the member and the client then began crying. There was inconsistent evidence regarding whether the client had bruising.

A PSW testified that after the member was told that client B would be fed by a student, the member spoke about getting the “God damned” tray for another client — client C. The member allegedly slammed the food tray down and then pushed client C’s geri-chair, causing the client’s legs to hit the table. The PSW indicated that the member subsequently “shovelled” food into the client’s mouth. This incident was not charted until one week later, and the names in the entry were blacked out.

The member testified that this was the first complaint to the College during an established career. While the member admitted that there was an incident during which the member became upset with client A and used a raised voice, the member denied forcing the client to take medication with a spoon and causing bruising. After the incident, the member spoke to the RN on duty, apologized to the client and attended an anger management in-service session.

The member denied the allegations pertaining to the other client and the communication with the PSW.

Finding

The Panel found that the evidence supported a finding that the member committed professional misconduct by failing to meet the practice standards with respect to the care, treatment and communication pertaining to client A. Given the inconsistencies in the PSW’s testimony and the delayed charting of the incident involving client C, the Panel considered that the evidence respecting the other allegations was not clear, convincing or cogent and found it difficult to believe that these events had occurred.

Submission on Penalty

The College and the member jointly sought an oral reprimand.

Penalty

The Panel accepted the submission on penalty, noting that it serves the public interest and addresses the issue of deterrence. The Panel noted that the member voluntarily completed rehabilitative and remedial measures, recognized that the College’s standards were breached and was remorseful for the inappropriate behaviour.

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INAPPROPRIATE BEHAVIOUR TOWARD A CLIENT

Susan George, RPN
IF-0346-5
Toronto

The member appealed the Panel of the Discipline Committee’s decision to Divisional Court. The appeal was heard and dismissed on May 11, 2004 – Court File No: 342/03.

Allegations and Plea

The College alleged that the member committed professional misconduct by yelling at a client, commanding that she clean up her own feces and holding the client by the hand or back of the neck in an effort to force her to do so.

The member denied the allegations, and the Panel proceeded with a hearing.

Background and Evidence

The member was employed as a personal service provider and cared for cognitively impaired clients. The senior client involved in the events had chronic obstructive pulmonary disease and schizophrenia.

The member denied that she shouted at the client or tried to force her to wipe up her own feces. On finding feces in the client’s room, the member instructed the client not to clean it up, but the client proceeded to clean up the floor. The member specifically denied that she held the client by the back of the neck.

The Panel heard testimony from two nurses on the unit on the night of the incident. Nurse A testified that she found feces in the hallway and instructed nurse B to find someone to clean it up. Nurse A subsequently heard loud shouts and noise coming from the hallway, and heard the member telling the client to “wipe it up.” Nurse A observed the member holding the client by the back of the neck and pushing her along the ground, while telling the client to wipe up the mess. Nurse A recounted that she had to tell the member to release the client a number of times before she complied. Nurse B confirmed that she had asked the member to pick up the feces. She also indicated that she heard the member telling the client to “clean it up” in a loud, firm voice.

Finding

The Panel found that the member committed professional misconduct as alleged. The serious nature of the allegations required proof based on particularly cogent, convincing evidence. In reaching its finding, the Panel considered the member’s inconsistent testimony, the credibility of the two nurses who testified for the College and the absence of supporting witnesses on behalf of the member. The Panel regarded the member’s behaviour to be unacceptable and a serious breach of standards.

Submission on Penalty

Counsel for the College sought an oral reprimand, suspension of the member’s Certificate of Registration for 120 days and completion of the One is One Too Many abuse prevention program, including submission of the completed workbook to the College. It was also submitted that for one year the member must notify the College of any employers who hire her to practise nursing and provide the employers with a copy of the Panel’s decision.

Penalty

The Panel accepted the proposed penalty, noting that the member had demonstrated an abuse of trust and authority and had shown no remorse for her behaviour. The Panel noted that trust is integral to the nurse-client relationship and is one of the cornerstones of the profession. The Panel noted that the client was vulnerable and that the member’s actions compromised the client’s dignity.

The penalty serves as a specific deterrent for the member and provides general deterrence for the membership. It addresses rehabilitation for the member and protection for the public. The penalty also serves to promote high professional standards and preserve public confidence in the profession.

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VERBAL, PHYSICAL AND EMOTIONAL ABUSE

Louise Jarrett, RPN
JJ-0864-9
Mississauga

The member filed a Notice of Appeal pertaining to the Panel of the Discipline Committee’s decision in Divisional Court. The member failed to perfect her appeal, and the College brought a motion to dismiss the member’s appeal on February 18, 2005. An order dismissing the appeal was issued on February 18, 2005 – Court File No: 273/04.

Allegations and Plea

The College alleged that the member committed an act of professional misconduct by verbally, physically and/or emotionally abusing a client.

The member denied the allegations, and the Panel proceeded with a hearing.

Evidence

The member provided care to a senior client who was cognitively impaired, aphasic and unable to communicate or follow or understand directions.

An RPN testified before the Panel that she heard a slapping sound coming from the client’s room and the words “Stop it stupid, stop it stupid.” On looking into the room, she saw the client lying on the client’s left side and the member repeatedly hitting the client on the right arm while saying the words as recounted. The RPN waited and the abuse stopped. About five to 10 minutes later, she returned to the client’s room and the member was no longer there. The RPN observed that the client was red-faced and agitated, and there were red fingermarks on the client’s right arm.

An RN on duty that night and the facility’s program manager testified that the RPN had been consistent in reporting what she had observed.

The member testified that she did not hit or use harsh words with the client. She pointed out that she and the RPN together were turning and repositioning the client in bed at the time that she was alleged to have abused the client. The member recounted that co-workers subsequently called her at home, informing her about the allegation of abuse. However, the member was unable to recall the co-workers’ names.

Finding

The Panel found that the member committed an act of professional misconduct as alleged. The RPN had a clear view of the incident, and the evidence given by the RPN, the RN and the program manager was consistent and credible. The Panel considered the member’s testimony, including her inability to recall the names of the co-workers who had contacted her, not to be credible. The member had a strong motive to deny the allegation and failed to offer any reason why the witnesses would give false testimony.

Submission on Penalty

The College sought an oral reprimand, a three-month suspension, completion of the One is One Too Many abuse prevention program and a meeting with a Practice Consultant. Counsel for the College also submitted that the member notify the College of her employers for one year, provide a copy of the Panel’s decision to any employers and arrange to have her employers monitor her practice periodically.

Penalty

The Panel accepted the submission on penalty with the exception of the monitoring/reporting component, which it amended by requiring the member to have written performance appraisals submitted to the College every three months for one year. The Panel considered the more stringent requirement to be necessary to protect the public, noting that the member denied any wrongdoing and showed no remorse for her actions.

The suspension of the member’s Certificate of Registration provides specific deterrence for the member and general deterrence for the membership. It sends a clear message that abusive behaviour will not be tolerated. The rehabilitation and educational requirements are also appropriate and serve to protect the public. The Panel noted that the penalty is within the range of penalties imposed in similar cases.

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COLLECTING PAY UNDER FALSE PRETENCES /FORGERY

Susan Cuppage, RPN
GI-1164-7
Powassan
North Bay Psychiatric Hospital

Allegations and Plea

The College alleged that the member committed an act of professional misconduct by collecting sick benefits from her employer and submitting forged medical certificates.

The member was not present at the hearing, and the Panel of the Discipline Committee proceeded on the basis that she denied the allegation.

Evidence

The member was required to present a medical certificate when off work due to illness. The hospital manager was concerned that the member had faxed false medical certificates and asked the member to produce original documents for a specified time period. The member did not do so.

At the hearing, two doctors testified that one medical certificate presented by the member had been altered and another certificate had been forged.

The hospital’s chief nursing officer testified that the member had received approximately $1,300 in sick benefits for the time covered by the false certificates.

Finding

The Panel found that the evidence supported a finding that the member committed professional misconduct as alleged.

Submission on Penalty

Counsel for the College sought an oral reprimand, a 90-day suspension and a requirement that the member not resume practice until she had received the reprimand. Counsel also submitted that for one year after her return to practice, the member notify the College of any employers and provide a copy of the Panel’s decision to her employers.

Penalty

The Panel accepted the submission on penalty as fair and in keeping with the penalties imposed in similar cases. The penalty provides specific deterrence for the member and general deterrence for the membership, and the reporting component serves to protect the public. The penalty also reflects the seriousness of the member’s actions and demonstrates that such behaviour will not be tolerated. It reinforces the values of honesty, integrity and professionalism that form the cornerstones of the nursing profession.

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ADMINISTERING MEDICATION TO OTHER NURSES WITHOUT A PRESCRIPTION / MISAPPROPRIATION OF PROPERTY / OBSTRUCTION OF AN EMPLOYER’S INVESTIGATION

Paul Nero, RN
99-0304-8
Fenwick
Niagara Health System, Welland Hospital Site

Allegations and Plea

The College alleged that the member committed acts of professional misconduct by administering, while on duty, intramuscular injections of Toradol to other nurses without a prescription and without documentation of the medication. It was also alleged that the member misappropriated the Toradol and injection equipment from the facility and that he withheld information from his employer during an internal investigation.

The member admitted to the allegations, and the College and the member submitted a written statement to the Panel of the Discipline Committee in which they agreed to the following facts.

Agreed Statement of Facts

The hospital investigated concerns that nurses were receiving and giving inappropriate injections of Toradol. During an interview, the member admitted that he had administered Toradol to two nurses and had not documented the injections. However, he indicated that he had oral orders by two doctors to administer the injections. Although the member was told not to discuss his interview with others, he discussed the situation with another nurse and was overheard saying that they needed to get their stories straight. At a second interview, the member acknowledged that he had administered Toradol to a third nurse without a prescription and without documenting the injection. He also admitted that he did not have a physician’s order for two of the injections and that he had discussed the allegations with two other nurses who were being investigated by the hospital.

Finding

The Panel found that the evidence supported a finding that the member committed acts of professional misconduct as alleged.

Submission on Penalty

The College and the member jointly sought an oral reprimand and a 90- day suspension. They also sought terms requiring the member to complete a professional ethics course and meet with a Practice Consultant to review the College documents Professional Standards and Ethics.

Penalty

The Panel imposed the proposed penalty as reasonable and in the interest of public safety. The penalty provides a specific deterrent for the member and general deterrence for the membership. It also addresses rehabilitation and remediation for the member.

The Panel considered this a serious matter, noting that the member initially attempted to mislead his employer and did not document the administration of the medication. However, the Panel also noted several mitigating factors: the member had no prior discipline history, was relatively new to the profession and had experienced serious consequences as a result of his actions, including emotional hardship and loss of employment. The member cooperated with the College and, by agreeing to the facts and proposed penalty, accepted responsibility for his actions and saved the College unnecessary expense.

Implementation of the penalty was deferred for 60 days at the request of the member’s current employer.

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