DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Panel:

[Panel Members] Independent Legal Counsel

BETWEEN

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

• and -

Nizam Mohammed #76-4529-4

DECISION AND REASONS

Council for Nizam Mohammed, RN

Heard: September 22 & November 18, 1999

A panel of the Discipline Committee of the College of Nurses of Ontario (hereinafter referred to as CNO) held a hearing in the hearing room of the College of Nurses of Ontario at Toronto.

AMENDED NOTICE OF HEARING

The allegations against the Member as stated in the Amended Notice of Hearing are as follows:

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(1) of Ontario Regulation 799/93, in that, during the years 1996 to 1998, inclusive, while working as a Registered Nurse at the Humber River Regional Hospital, in the City of Toronto, in the Province of Ontario, you contravened a standard of practice of the profession or failed to meet a standard of practice of the profession

a. with respect to your care and treatment of a client known as [client #1] on or about December 7, 1997, and/or

b. with respect to your care and treatment of a client known as [client #2] on or about March 20, 1998, 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(6) of Ontario Regulation 799/93, in that, on or about November 29, 1996, and/or February 24, 1998, while working as a Registered Nurse at the Humber River Regional Hospital, in the City of Toronto, in the Province of Ontario, you practiced the profession while your ability to do so was impaired by a substance, 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(7) of Ontario Regulation 799/93, in that, during the years 1997 to 1998, inclusive, while working as a Registered Nurse at the Humber River Regional Hospital, in the City of Toronto, in the Province of Ontario, you verbally and/or physically and/or emotionally abused a client

a. on or about December 7, 1997, by using excessive force in your care and treatment of a client known as [client #1]., and/or

b. on or about March 20, 1998, by speaking and/or behaving in an aggressive or hostile manner with a client known as [client #2], 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(37) of Ontario Regulation 799/93, in that, during the years 1996 to 1998, inclusive, while working as a Registered Nurse at the Humber River Regional 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, and in particular:

a. on or about November 29, 1996, you behaved in an hostile or threatening manner with one or more colleagues, and/or

b. on or about December 7, 1997, you used excessive force in your care and treatment of a client known as [client #1]., and/or

c. on or about February 24, 1998, you behaved in an aggressive or threatening manner toward the Manager of Mental Health, and/or

d. on March 20, 1998, you spoke and/or behaved in an aggressive or threatening manner with a client known as [client #2], and/or

e. on March 20, 1998, you spoke and/or behaved in a hostile or threatening manner with one or more colleagues.

The College of Nurses of Ontario withdrew allegations 1 and 3. No evidence was presented regarding allegation 4(b) and therefore no decision was required of the Panel regarding this allegation.

MEMBER’S PLEA

The Member admitted to the allegations as set out in the Amended Notice of Hearing.

AGREED STATEMENT OF FACTS

An Agreed Statement of Facts, presented to the panel as Exhibit #2, provided as follows:

1. Nizam Mohammed (“the Member”), has been registered with the College of Nurses of Ontario as a Registered Nurse since 1976.

2. The Member worked as a Registered Nurse at the Humber River Regional Hospital and its predecessors (“the Hospital”) from April 4, 1988 to March 20, 1998, when his employment was terminated. The Member worked primarily in the area of psychiatric nursing on the Mental Health Unit of the Hospital.

3. On or about November 29, 1996, the Member reported for work in the night shift smelling of alcohol. He was scheduled to work the shift together with [co-worker #1], another RN. When the Member saw [co-worker #1] he became extremely angry and began to gesticulate and yell at [co- worker #1] in an aggressive and threatening manner about an incident in which [co-worker #1] had relayed a patient’s complaint about the Member to her supervisor. The Member called [co- worker #1] a “snake in the grass” and threatened to throw water over her head. [Co-worker #1] was extremely frightened and shaken by the Member’s behaviour.

4. The Emergency Supervisor was called to the Unit by other staff who witnessed the incident. Her assessment was that the Member was under the influence of alcohol and that it was not appropriate for him to provide nursing care during the shift. She consequently sent the Member home.

5. The Member received a three-month unpaid suspension as a result of this incident.

6. On or about February 24, 1998, the Member was scheduled to work the evening shift. The Member arrived for work under the influence of alcohol. One of the staff members who observed the Member advised the Manager of the Mental Health Unit (“the Manager”) that the Member appeared to be under the influence of alcohol, and that she was concerned for the safety of the

Unit’s patients and staff.

7. The Manager met with the Member and confirmed that the Member had reported for duty under the influence of alcohol. The Manager informed the Member that he was going to suspend him for a day, record that he had been given a verbal warning, and provide him with cab fare since he was in no condition to drive. The Manager also expressed his concern for the Member’s welfare and encouraged him to contact the Hospital’s Employee Assistance Program. As the Member was being escorted to the Hospital’s main entrance, he told the Manager, with a smile on his face, that he was going to puncture the ties of the Manager’s car and blow it up.

8. On or about March 20, 1998, the Member was working the morning shift. He used a loud voice to reprimand a patient, [client #2] from taking her chair out of her room and threatened to put the patient back in her room if she did not do so. He also abruptly grabbed a food tray from [client #2] and waved his hand in threatening manner. The client was overheard to respond, “Please tell me nicely and I will do what you want me to do. I would like to be treated with respect like a human being.”

9. Following the above incident, the Member returned to the Nursing station and spoke to one of his co-workers. He stated to the co-worker that if he was called back to the Manager’s office, he was going to “choke this son-of-a-bitch”.

10. The Member admits that on or about November 29, 1996 and February 24, 1998, he committed professional misconduct by practising the profession while his ability to do so was impaired by a substance, namely alcohol.

11. The Member admits that he has committed professional misconduct by engaging in conduct or performing an act, relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional in that

a. on or about November 29, 1996, he behaved in an hostile or threatening manner with one or more colleagues, and/or

b. on or about February 24, 1998, he behaved in an aggressive or threatening manner toward the Manager of the Mental Health Unit, and/or

c. on March 20, 1998, he spoke and/or behaved in an aggressive or threatening manner with a client known as [client #2], and/or

d. on March 20, 1998, he spoke and/or behaved in a hostile or threatening manner with one or more colleagues.

PLEA INQUIRY

The panel conducted its usual plea inquiry and asked certain questions of the Member. The panel was satisfied that the Member’s admission of professional misconduct was informed and voluntarily made.

FINDING OF PROFESSIONAL MISCONDUCT

Both parties made submissions regarding the Agreed Statement of Fact. The Panel accepted the Agreed Statement of Fact as presented.

The panel finds that the Member committted an act of professional misconduct as alleged in allegation #2 to the Amended Notice of Hearing and as alleged in allegations #4(a), (c), (d) and (e) of the Amended Notice of Hearing.

JOINT SUBMISSION ON PENALTY

A Joint Submission on Penalty, presented to the panel as Exhibit #3, provided as follows:

Nizam Mohammed (“the Member”), and the College of Nurses of Ontario (“the College”) jointly

submit that the panel of the Discipline Committee should make an order

1. Requiring the Member to appear before the panel to be reprimanded;

2. Directing the Registrar to suspend the Member’s certificate of registration for at least four months from the date of this decision or such further period as is required to enable the Member to successfully complete any residential counselling program recommended by the Addiction Specialist described in paragraph 3(a) provided that in the event no residential counselling program is available to the Member within the four-month period of suspension, he shall have the right to attend before a panel of the Discipline Committee to make submissions as to the duration of the suspension and the Discipline Committee shall decide that issue based on all information available at that time;

3. Directing the Registrar to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a. The Member must be assessed by Dr. Graham Cunningham or such other specialist in addiction medicine (“the Addiction Specialist”) as is approved by the Director of Investigations and Hearings. The purpose of the assessment is to determine whether the Member suffers from a substance abuse disorder, and in the event that the Addiction Specialist so finds, to make recommendations with respect to the Member’s treatment and rehabilitation.

b. The Member is to be restricted from practicing in the area of psychiatric nursing unless or until the Addiction Specialist agrees that he is fit to do so.

c. The Member must comply with all recommendations for treatment and rehabilitation made by the Addiction Specialist and will enter into an undertaking with the College which includes all recommendations.

d. The Member must demonstrate his completion in a course in anger management that has been approved by the Director of Investigations & Hearings to the Director of Investigations & Hearings.

Counsel for CNO and counsel for the Member made submissions regarding the Joint Submission on Penalty. Following deliberations regarding the Joint Submission on Penalty, the panel returned for clarification on the submissions from both parties. Following further deliberation and consultation with ILC, the panel was concerned that there were issues that were not addressed in the Joint Submission on Penalty.

The panel was concerned that the penalty did not adequately address the issue of protection of the public. There was no requirement for monitoring of the Member in his workplace if he was not diagnosed as suffering from a substance abuse disorder. The panel returned and expressed its unanimous decision that this Joint Submission on Penalty was not acceptable for the above reasons. The panel was concerned that the Joint Submission on Penalty was based on the assumption that the Member was suffering from a substance abuse disorder. There was no specific acknowledgement of substance abuse by the Member. The panel, in consultation with ILC, therefore directed both CNO counsel and counsel for the Member to make further submissions on penalty that would address the concerns expressed by the panel.

Counsel for the Member was not prepared to accept any amendments to the Joint Submission on Penalty or any further submissions. Counsel for the Member stated that the Member had a personal commitment outside the country commencing the following day and strongly encouraged the panel to accept the Joint Submission on Penalty as presented. Due to time constraints, the panel was not prepared to make a hasty decision to accept the Joint Submission on Penalty. During deliberations the panel contacted ILC for advice regarding options to continue the hearing at a further date. The panel reconvened and ILC was present by telephone and set out the advice that she had given to the panel. The panel asked both parties to select future dates to accommodate everyone for the continuance of the hearing. Counsel for both parties asked the panel to give them more guidance as to what the panel might consider as an appropriate penalty. The panel agreed that during the period of adjournment it would provide, through

ILC, to both CNO counsel and counsel for the Member, further information with respect to its concerns and what the panel was considering as an alternative penalty, in order that both parties might provide further submissions. This was accepted by counsel for the parties and the hearing was adjourned to November 18, 1999.

On October 18, 1999, the panel met via a conference call with ILC available to the panel. ILC asked the panel for recommendations to relay to both counsel. The panel deliberated on-line without ILC. ILC returned on-line to offer advice on the recommendations. The panel asked ILC to relay the recommendations and her legal advice in writing to both parties as a basis for further submissions on the on penalty November 18, 1999.

AMMENDED JOINT SUBMISSION ON PENALTY

The hearing reconvened on November 18,1999 with ILC present. Counsel for CNO presented an Amended Joint Submission on Penalty, which provided as follows:

WHEREAS Nizam Mohammed (“the Member”) has pleaded guilty and been found to have committed professional misconduct as set out in allegations 4.(a), (c), (d) and (e) of the Notice of Hearing, and whereas the Member acknowledges that he has a substance abuse disorder and requires treatment for the disorder, the Member and the College of Nurses (the “College”) jointly submit that the panel of the Discipline Committee should make an order:

1. requiring the Member to appear before the panel to be reprimanded;

2. directing the Registrar to suspend the Member’s certificate of registration for at least four months from the date of this decision or such further period as is required to enable the Member to successfully complete any residential counselling program recommended by the Addiction Specialist described in paragraph 3(a) provided that in the event no residential counselling program is available to the Member within the four-month period of suspension, he shall have the right to attend before a panel of the Discipline Committee to make submissions as to the duration of the suspension and the Discipline Committee shall decide that issue based on all information available at that time;

3. directing the Registrar to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a. the Member must be assessed by Dr. or such other specialist in addiction medicine (“the Addiction Specialist”) as is approved by the Director of Investigations and Hearings. The purpose of the assessment is to make recommendations with respect to the Member’s treatment and rehabilitation and with respect to any terms, conditions and limitations on the Member’s certificate as the Addiction Specialists may determine is required.

b. The Member is to be restricted from practicing in the area of psychiatric nursing unless or until the Addiction Specialist agrees that he is fit do do so.

c. The Member must comply with all recommendations for treatment, rehabilitation, and such terms, conditions and limitations as are made by the Addiction Specialist and will enter into an Undertaking with the College which includes all such recommendations, terms, conditions and limitations.

d. The Member must demonstrate his completion of a course in Anger Management that has been approved by the Director of Investigations & Hearings.

e. The Member must view the video, “One is Too Many”, complete the workbook and review the video with a Nursing Practice Advisor that has been approved by the Director of Investigations & Hearings.

Both parties made brief submissions. The panel deliberated and unanimously accepted the Amended Joint Submission on Penalty.

DECISION AND REASONS

The panel concurred with the recommended penalty as put forward in the Amended Joint Submission on Penalty. The panel agreed that the Amended Joint Submission on Penalty fulfilled the mandate of the CNO to protect the public interest. The penalty met the criteria of general deterrence for the members of the profession as well as a specific deterrent to the Member and a rehabilitative process for the Member. This behavior is not acceptable and will not be tolerated. The panel agreed that the penalty was appropriate and adressed the concerns that the panel had with the original joint submission.

I, [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:

, Chairperson Date [panel]