DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

The following is a public record of the hearing between the COLLEGE OF NURSES OF ONTARIO and Judy V. Johnson # 90-0714-7 heard on July 6, 1998

REASONS FOR DECISION

Reasons for Decision

A panel of the Discipline Committee was convened on July 6, 1998 to hear the following allegations.

The panel ruled to ban publication of the client’s identity. An official from the institution, Humber Memorial Hospital, delivered the original records to the College. The College accepted custody of the records.

The Notice of Hearing was submitted.

1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c.32, as amended, and defined in subsection 1(7) of Ontario Regulation 799/93, in that in 1996, while employed as a registered nurse at Humber Memorial Hospital, in Weston, Ontario, you abused a client known as “the Client” physically and/or verbally;

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c.32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that in 1996, while employed as a registered nurse at Humber Memorial Hospital, in Weston, Ontario, 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, and in particular with respect to a client known as “the Client” you:

i. made a threatening and/or deprecating remark or remarks to the client; and/or

ii. put a pillow over the client’s face; and/or

iii. hit the client in the face.

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c.32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that in 1996, while employed as a registered nurse at Humber Memorial Hospital, in Weston, Ontario, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession with respect to the care and/or treatment you provided to a client known as “the Client”

AGREED STATEMENT OF FACTS

Agreed Statement of Facts

1. Ms. Judy Johnson has been registered as an RN with the College of Nurses of Ontario since 1990.

2. Ms. Johnson commenced employment as a full-time staff nurse at the Humber Memorial Hospital (the “Hospital”) on March 12, 1990. In 1996, her employment was terminated following the events described below. Throughout the period of Ms. Johnson’s employment with the Hospital she worked in the Mental Health Program with psychiatric clients.

3. Ms. Johnson was certified as an RPN in 1967 and practised as such in a variety of settings for twenty two years. In 1989, Ms. Johnson graduated from George Brown College with her diploma as a Registered Nurse and was registered in 1990.

4. From the date of her registration through 1996 Ms. Johnson worked in psychiatric settings as a staff RN in a variety of institutions.

5. In 1991 Ms. Johnson took Part 1 of the Mental Health Course offered by Humber College.

6. On the day of the incident in 1996, Ms. Johnson, two other nurses, and a security guard were called to restrain a client, the “Client”, who was in a psychotic state. He was agitated, yelling, and blowing air at the staff. The Client was known to be violent. He was already in three-point restraints and the security guard and the three nurses were attempting to place him into the fourth restraint.

7. While the Client was in the process of being restrained he began to spit. Ms. Johnson put a pillow over the face of the client in an effort to block his spit. The security guard removed the pillow.

8. Moments later, while the staff were still attempting to restrain the Client, saliva landed on Ms. Johnson. Ms. Johnson’s hand went up and she hit the Client in the face.

9. Had this case proceeded to a full hearing, expert evidence would have been led about the act of placing the pillow over the Client’s face. This evidence can be summarized as follows:

a. Placing a pillow over the face of a client erodes the therapeutic rapport between client and health care provider and constitutes disgraceful dishonourable and unprofessional conduct. It humiliates the client, degrades him, and thereby demeans the prestige of the profession; and

b. In a situation where a nurse knows the client has a history of aggression and a known spitting behaviour, and in a situation where a member is troubled by the spitting behaviour, she ought to take a position in the restraining procedure where she is less likely to be subjected to the spittle.

10. Ms. Johnson acknowledges that the act of placing the pillow on the Client’s face constitutes disgraceful, dishonourable or unprofessional conduct and would reasonably be regarded by members as such, and she is guilty of professional misconduct as set out in Allegation 2 in the Notice of Hearing.

11. Ms. Johnson also acknowledges that by hitting the Client, she engaged in an act of physical abuse and is guilty of professional misconduct as set out in Allegation 1of the Notice of Hearing.

12. In light of these admissions, both counsel for the College and counsel for Ms. Johnson agree that the panel need make no finding with respect to Allegation 3 in the Notice of Hearing.

Counsel for the College further amended and withdrew allegation #3. Ms. Johnson admitted through her counsel, to the allegations of Professional Misconduct as outlined in the Agreed Statement of Fact. The panel deliberated and accepted the plea and the evidence as presented.

JOINT SUBMISSION WITH RESPECT TO PENALTY

Joint Submission with Respect to Penalty

1. Since the events described in the Agreed Statement of Facts, Ms. Johnson has taken a course entitled “Attitudes, Values and Beliefs”, a one-day program held at the Clarke Institute designed to assist health care professionals to further their understanding of the values and beliefs of psychiatric clients.

2. In the Spring of 1997, Ms. Johnson successfully completed a three-day course entitled “The Prevention and Management of Aggressive Behaviour” sponsored by the Queen Street Mental Health Centre’s Educational Services. Further, in February, 1997, Ms. Johnson joined the Inter- Agency and Planning group, “Team Intervention Strategies.” The goal of this planning group is to develop an educational module that will provide mental health clinicians in hospital settings with the skills to physically restrain an aggressive or violent client in a way that is safe and non- abusive to the client and safe for staff members. In the future, Ms. Johnson will be one of the facilitators in the Team Intervention Strategies half-day (3 hour) module to be delivered to hospitals in Metropolitan Toronto and other sites in Southern Ontario.

3. It is jointly submitted that the panel of the Discipline Committee make an order directing the Executive Director to:

4. Require Ms. Johnson to appear before the panel to be reprimanded.

5. Suspend Ms. Johnson’s Certificate of registration for a period of six (6) months from the date of this decision.

6. Impose the following terms, conditions and limitations (collectively the “Conditions”) on

Ms. Johnson’s Certificate of Registration, as follows:

a. after serving the suspension described in paragraph 3(2) above and prior to obtaining any employment in nursing, Ms. Johnson must advise a prospective employer of the requirement to provide evaluations to the College as described in paragraph 3(3)(c) and obtain from the prospective employer its approval to do so;

b. Ms. Johnson shall advise the Director of Investigations and Hearings (the “Director) of the name and address of her nursing employer(s) and the person directly responsible for her supervision at that employer(s), for a period of two (2) years of actual nursing employment;

c. Ms. Johnson shall provide an evaluation to the Director after each six (6) months of nursing employment from her immediate registered nurse supervisor or such other registered health care professional acceptable to the Director. Each evaluation shall indicate Ms. Johnson is adhering to the standards of practice of nursing and that there have been no other incidents of verbal or physical abuse of clients. This condition shall expire once a total of four (4) evaluations representing two (2) years of nursing employment have been received by the Director provided Ms. Johnson has otherwise complied with the Conditions;

d. Ms. Johnson shall view the video “One is Too Many”;

e. any dispute respecting the interpretation or application of these Conditions shall be determined by a panel of the Discipline Committee held for that purpose.

4. The results of this proceeding shall be included in the public register.

Decision on Penalty

The panel heard submissions from both counsel regarding the agreed upon penalty. Counsel for the College reinforced the College’s position of zero tolerance regarding abuse. However, it was acknowledged that Ms. Johnson has had a lengthy nursing career and no previous problems with the College. The College acknowledged that this is not the first time that there has been allegations involving difficult clients and that members can become frustrated. However, members must be aware that the protection of the public must be paramount.

Counsel for the defence highlighted the educational initiatives that Ms. Johnson had taken since the allegations were brought forth. The programs that Ms. Johnson participated in were a voluntary commitment, and Ms. Johnson will continue to participate. Letters were submitted supporting Ms. Johnson’s character, nursing abilities, and community involvement.

The panel deliberated on submissions from both counsel and accepted the Joint Submission with respect to Penalty. The panel assessed the penalty according to the criteria of remediation, specific deterrence, and general deterrence. The panel found that it was commendable that Ms. Johnson had recognized the need to take these courses and voluntarily did so. The penalty met the criteria for specific and general deterrence in that a six-month suspension and a requirement to submit performance appraisals for a two year period sends a strong message to Ms. Johnson and to the membership that this behaviour will not be tolerated. The panel agreed that the penalty was appropriate as it met the mandate of the College to protect the public interest. An oral reprimand was issued.