DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
Panel:
Chairperson, RN
Member, RN
Member, RPN
Public Representative
Public Representative
BETWEEN
COLLEGE OF NURSES OF ONTARIO Counsel for College of Nurses of Ontario
- and -
Teresa Thompson #90-1824-3
REASONS FOR DECISION
Member Unrepresented
Heard: January 27-28, 1997
A panel of the Discipline Committee met on January 27 and 28, 1997 to hear evidence regarding the following allegations.
IT IS ALLEGED THAT:
- 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 in 1995, while a Registered Nurse with (the facility) in the City of Amherstview, in the Province of Ontario, you physically, and/or verbally and/or emotionally abused clients on one or more occasions, in that:
a. on or about May 6, 1995 you slapped the hand of a resident known as “Client A”; and/or
b. on or about June 28, 1995, you placed a client known as “Client B” in a darkened room with the door closed for approximately 5 hours; and/or
c. on or about July 14, 1995, you slapped the hand or arm of a client known as “Client A”; and/or
d. on or about July 19, 1995, you yelled at a client known as “Client C” and/or threatened the client and/or did not attend to the client when his incontinence briefs were wet with urine;
- In the alternative, 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 subsection 1(37) of Ontario Regulation 799/93,in that in 1995, while a Registered Nurse with (the facility) in the City of Amherstview, in the Province of Ontario, you engaged in conduct that would reasonably be regarded by members as disgraceful, dishonorable or unprofessional, with respect to your care and treatment of one or more clients, in that:
a. on or about May 6, 1995 you slapped the hand of a resident known as “Client A”; and/or
b. on or about June 28, 1995, you placed a client known as “Client B” in a darkened room with the door closed for approximately 5 hours; and/or
c. on or about July 14, 1995, you slapped the hand or arm of a client known as “Client A”; and/or
d. on or about July 19, 1995, you yelled at a client known as “Client C” and/or threatened the client and/or did not attend to the client when his incontinence briefs were wet with urine;
- In the further alternative, 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 subsection 1(1) of Ontario Regulation 799/93, in that in 1995, while a Registered Nurse with (the facility) in the City of Amherstview, in the Province of Ontario, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, with respect to your care and treatment of one or more clients, in that:
a. on or about May 6, 1995 you slapped the hand of a resident known as “Client A”; and/or
b. on or about June 28, 1995, you placed a client known as “Client B” in a darkened room with the door closed for approximately 5 hours; and/or
c. on or about July 14, 1995, you slapped the hand or arm of a client known as “Client A”; and/or
d. on or about July 19, 1995, you yelled at a client known as “Client C” and/or threatened the client and/or did not attend to the client when his incontinence briefs were wet with urine.
Ms. Thompson was not present nor was she represented by legal counsel. The panel received the affidavit of the Notice of Hearing and faxed correspondence from Ms. Thompson dated January 24, 1997, to the College stating she would not be able to attend the hearing.
The panel ruled to proceed with the hearing
BACKGROUND FACTS:
The facility (the Centre) is in the City of Amherstview in the Province of Ontario. This Centre has two components: a lodge of 70 residents and a nursing home of 42 residents varying in light, moderate and chronic care needs. The staff on the shift of 2300 to 0700 hours consisted of 1 RN and 3 Health Care Aides (HCA). The RN had responsibility for the nursing home and the lodge. The HCA component was broken into one HCA for the nursing home and two HCAs for the lodge. The alleged incidents occurred in the nursing home section of the Centre.
Ms. Thompson, whose conduct is in question, is an RN who had approximately three years of experience in Medical/Surgical settings at two general hospitals. She worked nights at the Centre on a part-time basis from March to August 1995 when her employment was terminated. The panel heard evidence that she received a two day orientation session by an RN on the night shifts of March 15th and 16th, 1995. She did not attend in service training on Elder Abuse offered by the Centre.
Exhibits received by the panel included the agency’s employment manual describing the RN’s responsibilities on night shifts, the agency policy on the Centre elder abuse, application of employment of Ms. Thompson and accompanying letter with resume. Also received as exhibits were photographs of the area in the institution where the alleged incidents occurred. In addition, the panel received as an exhibit, a letter from Ms. Thompson addressed to the Manager, Discipline program, denying all the allegations.
The panel heard evidence from the following witnesses: Witness #2, Director of Care for the Centre,
Witness #1, a Health Care Aide with 13 years of experience at the Centre, who witnessed three of
the four incidents,
Witness #4, a student Health Care Aide who witnessed one of the incidents,
Witness #5, a student Health Care Aide who also witnessed the same incident as Witness #4, and Witness #3, who was tendered by the College as an expert witness in the area of elder abuse.
The three patients involved in the four alleged incidents were:
Client A an elderly woman with a diagnosis of dementia and Alzheimer’s Disease, agitated and resistive to care. She also tended to pinch, slap and yell.
Client B also had a diagnosis of dementia and Alzheimer’s Disease, was losing her mobility, had poor balance, was frequently agitated , and had a tendency to chant loudly.
Client C was an ambulatory patient in his seventies, with a diagnosis of schizophrenia. Client C was often restless, tended to rise early in mornings, needed assistance with activities of daily living, and responded fairly well to the directions of staff.
INCIDENT: (a) Slapping a Patient
Evidence: The panel heard testimony from witness Witness #1, HCA, that on May 6th, 1995, around 0530 hours while she was getting patients up for a.m. care, she looked up to see if Ms. Thompson was ready for assistance in moving Client A and observed Ms. Thompson slap the hand of Client A. She stated that Client A was her “normal agitated self” at the time.
The panel heard testimony from Witness #2, that this incident was reported to her by Witness #1, HCA, in August 1995.
Decision: The panel concluded that this behaviour constituted physical and emotional abuse.
Reasons: In reaching this decision the panel found Witness #1’s testimony to be believable. In further questioning from the panel the witness’ description of the incident was consistent. The panel also considered the testimony of Witness #3, the expert witness. He stated that there would be no circumstances under which such an offensive action could be justified. It was his opinion that this action constituted physical and emotional abuse.
The panel also reviewed the College’s definition of abuse, exhibit #15, and concluded that this behaviour clearly fell within the scope of this definition. The panel also looked at the elder abuse policy of the Centre which clearly outlines this type of behaviour as an example of abuse.
The panel concluded that the action as described by the witness was physical abuse and inherent in the action was emotional abuse as it is demeaning to the patient. Had the panel not been able to find that this action was physical abuse, panel members would have found Ms. Thompson’s behaviour to be disgraceful, dishonourable and unprofessional.
INCIDENT (b): Isolating a Patient
Evidence: The panel heard from Witness #1, HCA, that on June 28, 1995, at the beginning of the night shift, the patient, Client B, was sitting in a geri chair in the circle area beside the nursing station. She was agitated and making loud chanting noises. The witness quoted Ms. Thompson as saying at this time, “She is going to drive us crazy”. The witness proceeded to testify that Ms. Thompson put Client B in the chapel in her geri chair which was in a reclining position. She shut the chapel door and turned the lights out. The panel was shown photographs which illustrated the distance from the chapel to the nursing station as being a substantial distance. She testified that the patient remained in the chapel for approximately five hours The panel also heard that there was potential for injury due to Client B’s physical condition. As well, the absence of a tray on the geri chair put Client B at risk of falling out of the geri chair. Witness #2 testified that she heard about this incident from Witness #1 and subsequently
confronted Ms. Thompson who acknowledged she did this and did not see any harm in it. Decision: The panel concluded that this was physical and emotional abuse to a patient.
Reasons: On the basis of the testimony of the expert witness, the panel concluded that isolating a patient such as this in a dark room without any stimulation could exacerbate the patient’s agitated condition and that this constituted emotional abuse. The action of placing the patient in the chapel unattended and without protective apparatus, placed the patient in jeopardy for physical harm and therefore, constituted physical abuse.
The panel again found Witness #1’s evidence to be compelling in her description of the incident. She was forthright in her testimony, spoke without hesitation and was very clear about her description of the incident. Had the panel not been able to find that this action was physical abuse, panel members would have found Ms. Thompson’s behaviour to be disgraceful, dishonourable and unprofessional.
INCIDENT (c): Slapping a Patient
Evidence: Witness #2 testified that she heard from the coordinator of the training course at Kingston Learning Centre that two students witnessed an incident of an RN slapping the arm of a patient. When confronted with this information, the witness reported that Ms. Thompson stated that she may have caught her arm when the patient tried to strike her.
Witness #4, an HCA student testified that Ms. Thompson was giving peri care to Client A on or about July 14, 1995 when the patient thrust out with a closed fist, possibly hitting Ms. Thompson on the bottom of her jaw. The witness quoted Ms. Thompson as saying, “I don’t have to put up with this shit!” and stated that she saw Ms. Thompson slap the top of the patient’s forehand. Witness #4’s evidence was corroborated by Witness #5, another Health Care Aide student, who testified that she also saw the slap. Although her recollection of the details around the incident was not as clear as Witness #4’s, her evidence was consistent as to the slap and the comment by Ms. Thompson. She stated that it was her impression that Ms. Thompson was angry at the time. Both students agreed not to report the incident for fear of reprisal from Ms. Thompson, but did relay the incident to another student who did report it to the teacher.
Decision: The panel concluded that these actions constitute physical, emotional and verbal abuse.
Reason: This decision was reached after consideration of the consistent evidence of the two witnesses and the testimony of the expert as it applied to incident (a). The same rationale for incident (a) was applied to this incident . The verbal aspect of this abuse was evidenced by both witnesses quoting the demeaning comment made by Ms. Thompson at the time of the slap. Had the panel not been able to find that this action was physical abuse, panel members would have found Ms. Thompson’s behaviour to be disgraceful, dishonourable and unprofessional.
INCIDENT (d): Yelling at a Patient and Failing to Change a Wet Brief
Evidence: The panel heard evidence from Witness #1 that on the night shift of July 19th, 1995 around 0430 hours, Ms. Thompson was sitting in a recliner with a pillow, blanket and refreshments watching a video in the activation room when Client C entered the room. He was 10 to 15 steps from Ms.
Thompson when she yelled at him from her chair to go back to his room. She claimed yelling was necessary as residents are hard of hearing. Client C proceeded to go towards the kitchen. The witness said his brief was hanging low and looked wet. Ms. Thompson approached the patient and told him to go back to his room when he asked for assistance with his sagging brief. She helped him by pulling the
wet brief up and he went back to his room.
Decision: The panel found Ms. Thompson committed an act of physical, emotional and verbal abuse.
Reasons: This decision was reached after consideration of Witness #1’s clear testimony describing the incident and the testimony of the expert who considered this an abusive situation. In failing to assist the patient to change into a dry brief, Ms. Thompson committed an act of physical abuse. The expert indicated that failing to change the wet brief and the resulting physical discomfort to the patient would be physical abuse. In yelling at the patient, the rights and dignity of the patient were not respected and this constitutes verbal and emotional abuse. Had the panel not been able to find that this action was physical abuse, panel members would have found Ms. Thompson’s behaviour to be disgraceful, dishonourable and unprofessional.
PENALTY
The panel hereby revokes Ms. Thompson’s certificate of registration.
RATIONALE:
With no defence being presented, the panel was unable to consider any possible mitigating factors that would have contributed toward Ms Thompson’s behaviour.
The panel accepted the submission from Counsel for the College that revocation of Ms. Thompson’s certificate of registration was the most appropriate penalty in this case. The professional misconduct, demonstrated by Ms. Thompson, was based on a pattern of behaviour over a three month period that is much more problematic than a single incident. Counsel for the College also indicated, and the panel accepted, that the probability of Ms. Thompson cooperating in any remedial aspect of the penalty appeared to be low due to the fact that she did not attend the hearing.
The panel did not see any evidence of Ms. Thompson suffering remorse or any degree of insight into the gravity of her actions. For example, she acknowledged, to the Director of Care, that incident (b) and incident (d) had occurred, but she did not see them as causing any harm to the patient. For example, she said she saw no harm in placing a patient in the chapel turning off the lights and closing the door. This lack of insight led the panel to believe that revocation was preferable to any other kind of suspension with conditions because the onus would now be upon Ms. Thompson to demonstrate the initiative of remediation if and/or when she ever applied for reinstatement.
The panel believes that revocation is justified because the four incidents of abuse towards vulnerable, elderly residents represent a very serious form of professional misconduct, clearly demonstrating blatant abuse of power and a fundamental betrayal of trust in the nurse-client relationship.
I 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 Member, RN
Member, RPN
Public Representative Public Representative
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