DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

BETWEEN

COLLEGE OF NURSES OF ONTARIO Council for College of Nurses of Ontario

• and -

CONCHITA SIAPNO # 89-2192-6

REASONS FOR DECISION

Council for Conchita Siapno

Heard: June 3, 1999

A panel of the Discipline Committee was convened on June 3, 1999 to hear allegations against the Member as outlined below in the Notice of Hearing.

NOTICE OF HEARING

Notice of Hearing

1. You have committed an act of professional misconduct as provided by subsection 51(1)(b.1) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c.32, as amended, in that on May 2, 1997, while working as a Registered Nurse at Mount Sinai Hospital, in the city of Toronto, in the Province of Ontario, you sexually abused a patient, namely [Client X], by fondling his scrotum on two occasions from outside his diaper; and/or

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(7) of Ontario Regulation 799/93, in that on May 2, 1997, while working as a Registered Nurse at Mount Sinai Hospital, in the city of Toronto, in the Province of Ontario, you abused a client physically and/or emotionally, namely [Client X], by fondling his scrotum on two occasions from outside his diaper; and/or

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(37) of Ontario Regulation 799/93, in that on May 2, 1997, while working as a Registered Nurse at Mount Sinai Hospital, in the city of Toronto, in the Province of 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, in that you fondled a client's scrotum, namely [Client X], on two occasions from outside his diaper; and/or

4. 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 on April 16, 1997, while working as a Registered Nurse at Mount Sinai Hospital, in the city of Toronto, in the Province of Ontario, you abused a client verbally and/or emotionally by stating, words to the effect of "Be quiet. Stay still. It's your fault that I missed"; and/or

5. 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 on April 16, 1997, while working as a Registered Nurse at Mount Sinai Hospital, in the city of Toronto, in the Province of

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 in that you stated to a client, words to the effect of "Be quiet.

Stay still. It's your fault that I missed".

Proposed Amended Wording to Paragraph 3 of the Notice of Hearing dated April 5, 1999:

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(37) of Ontario Regulation 799/93, in that on May 2, 1997, while working as a Registered Nurse at Mount Sinai Hospital, in the City of Toronto, in the Province of 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 unprofessional, in that you inappropriately touched the scrotum of a client, namely [Client X], on two occasions from outside his incontinence brief while checking the client for incontinence;

THE PLEA

The Plea

When called upon to indicate whether she admitted or denied the allegations, the Member admitted amended Allegation #3 and Allegation #5. The Chairperson conducted a plea inquiry to ensure that the Member's admission was informed and voluntarily made. The remaining allegations were withdrawn.

AGREED STATEMENT OF FACT

Agreed Statement of Fact

The panel was presented with the following Agreed Statement of Fact:

1. Conchita Siapno (the "Member") has been registered with the College of Nurses of Ontario (the "College") as a Registered Nurse since 1989.

2. The Member began working at Mount Sinai Hospital in the City of Toronto, Province of Ontario, on January 15, 1990, in the Ward. When the programme was relocated on April 1, 1997, she began working in the Ward, and remained there until her termination on May 16, 1997.

3. The incidents referred to below occurred when the Member was working as a Registered Nurse in the Ward of Mount Sinai Hospital.

4. On May 2, 1997, the member and another RN (Ms F), had just finished changing the incontinence brief of a client known as Client X Shortly thereafter, while checking the client for incontinence, the Member placed her hand on Client X's scrotum from outside the incontinence brief and made a circular motion that lasted approximately 3 to 5 seconds.

5. When Ms. F questioned the Member about touching Client X in the way that she had, the Member replied that she was just checking to see if he was wet, and remarked that "these people are always peeing".

6. The Member repeated this action a few minutes later.

7. The Member admits that by inappropriately touching Client X scrotum from outside his incontinence brief, she committed professional misconduct by engaging in conduct or committing an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional, as is set out in Allegation No. 3 of the amended Notice of Hearing.

8. On April 16, 1997, the Member was engaging in a supervised attempt to draw blood from a client. The insertion of the needle caused the client to comment about pain and to move slightly. The Member replied in a rude and abrupt manner: "Be quiet. Stay still. It's your fault I missed."

9. The Member admits that by making the comments "Be quiet. Stay still. It's your fault I missed." to a client, she committed professional misconduct by engaging in conduct or committing 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, as is set out in Allegation #5 of the amended Notice of Hearing.

10. The College will not be calling evidence in relation to the allegations contained in paragraphs 1, 2, and 4 of the amended Notice of Hearing.

FINDING OF PROFESSIONAL MISCONDUCT

Finding of Professional Misconduct

The panel deliberated, accepted the Agreed Statement of Fact and found the Member to have committed professional misconduct as outlined in Allegation #3 and Allegation #5.

The panel accepted the Joint Submission on Penalty and an oral reprimand was issued.. In finding that the Member committed an act of professional misconduct in Allegation #3 (as amended) and Allegation #5 of the Notice of Hearing, the panel found that the Member did act unprofessionally and had admitted to an inappropriate touching of the client's scrotum on two occasions from outside of his incontinence brief, while checking the client for incontinence. The Member also admitted to talking to a client in a rude and abrupt manner when attempting to draw blood: "Be quiet. Stay still. It's your fault I missed".

The panel regarded this behaviour to be unacceptable and unprofessional. Since there was a third party present during both incidents, the panel was convinced that there was no intent of wrongdoing on the part of the Member. Therefore, the panel believed that these actions were incidents of poor nursing practice, rather than abusive behaviour.

JOINT SUBMISSION ON PENALTY

Joint Submission on Penalty

The counsel presented the Joint Submission with Respect to Penalty as follows;

Conchita Siapno ( the "Member") and The College of Nurses of Ontario (the "College") jointly submit that the panel of the Discipline Committee should make an order directing the Executive Director to:

1. Require the Member to appear before a Panel of the Discipline Committee to be reprimanded;

2. Impose the following terms, conditions and limitations on the Member's certificate of registration:

a. The Member is to complete, at her own expense, the next available offering of a course of study approved by the Director of Investigations & Hearings of the College ("Director"), the primary focus of which is appropriate professional communication and conflict resolution;

b. The Member is to provide proof to the Director of her successful completion of the course referred to in subparagraph "a", above, within 30 days of the conclusion of the course;

c. The Member is to review the College's Ethical Framework for Nurses in Ontario and Standard for the Therapeutic Nurse-Client Relationship;

d. Within 90 days from the date of this hearing, June 3, 1999, the Member is to complete the College's abuse prevention program, One is One Too Many, by viewing the videotaped presentation and completing the self-directed learning guide;

e. Within 90 days from the date of this hearing, June 3, 1999, and shortly after completing the One is One Too Many program, the Member is to meet with a College Practice Consultant to review the completed self-directed learning guide referred to in subparagraph "d" above, and to informally discuss and demonstrate her understanding of the One is One Too Many program, the Ethical Framework for Nurses in Ontario, and the Standard for the Therapeutic Nurse-Client Relationship, with an emphasis on clients' dignity and privacy, and the prevention of client abuse.

The panel asked for clarification concerning the proposed course and length of study to be taken by the Member as set out in the Joint Submission on Penalty. College counsel provided clarification concerning the possible content and the length of the course.

DECISION AS TO PENALTY

Decision as to Penalty

Due to the Member's previously unblemished record and willingness to admit inappropriate practice, the panel members regarded the penalty to be suitable and equitable. The panel accepted that the conditions imposed would improve the Member's quality of practice and at the same time provide for protection of the public.

I, [Panel Chair], 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: