Panel:

[Names of Panel Members]

BETWEEN

COLLEGE OF NURSES OF ONTARIO LINDA ROTHSTEIN for College of Nurses of Ontario

and -

REBECCA ANNE MANSON # 77-0992-6

for Rebecca Anne Manson

Heard: JUNE 1, 1999

A panel of the Discipline Committee was convened on June 1, 1999 to hear allegations against the Member as outlined below in the Notice of Hearing. The allegations contained in the Notice of Hearing are as follows:

Notice of Hearing

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 or about June 9 or 10, 1997, while working as a Registered Nurse at St. Michael's Hospital, in the City of Toronto, in the Province of Ontario, you verbally and/or emotionally abused a client known as [complainant #1] by making inappropriate comments in the client's presence concerning his entitlement to receive medical attention, his responsibility for his condition, and the costs incurred by the hospital or health care system as a result of caring for clients in his condition, and/or
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 on or about June 9 or 10, 1997, while working as a Registered Nurse at St. Michael's Hospital, in the City of Toronto, in the Province of Ontario, you contravened a standard or practice of the profession, or failed to meet the standards of practice of the profession by making inappropriate comments in the presence of a client known as [complainant #1] concerning his entitlement to receive medical attention, his responsibility for his condition, and the costs incurred by the hospital or health care system as a result of caring for clients in his condition, and/or
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 month of June or July, 1997, while working as a Registered Nurse at St. Michael's Hospital, in the City of Toronto, in the Province of Ontario, you contravened a standard or practice of the profession, or failed to meet the standards of practice of the profession by making inappropriate comments to [complainant

#2], the father of a client known as [complainant #1],

a. concerning the propriety of [complainant #2]'s hat or cap, and directing him not to wear the hat or cap, and/or

b. directing [complainant #2] not to wear the hat or cap, and/or

c. concerning the propriety of [complainant #2] looking at radiographs, and/or

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 or about June 9 or 10, 1997, while working as a Registered Nurse at St. Michael's 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 by making inappropriate comments in the presence of a client known as [complainant #1] concerning his entitlement to receive medical attention, his responsibility for his condition, and the costs incurred by the hospital or health care system as a result of caring for clients in his condition, and/or
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 month of June or July, 1997, while working as a Registered Nurse at St. Michael's 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 by making inappropriate comments to [complainant #2], the father of a client known as [complainant #1],

a. concerning the propriety of [complainant #2]'s hat or cap, and directing him not to wear the hat or cap, and/or

b. directing [complainant #2] not to wear the hat or cap, and/or

c. concerning the propriety of [complainant #2] looking at radiographs

THE PLEA

The Plea

When called upon to indicate whether she admitted or denied the allegation, the Member admitted Allegation #2. The balance of the allegations was withdrawn.

AGREED STATEMENT OF FACTS

Agreed Statement of Facts

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

The Member has been registered with the College of Nurses since 1977.
Commencing in December of 1988, the Member was employed at St. Michael's Hospital on a casual basis working in the Intensive Care Unit.
The Member has also, since 1991, been employed at the Toronto East General Hospital in the Critical Care Unit/Medical Intensive Care Unit, initially on a casual basis and, since November of 1998, on a regular part-time basis.
[Complainant #1] was admitted to the ICU on May 25, 1997 after sustaining serious injuries in a motor vehicle accident. He required extensive nursing care.
On June 9 or 10, 1997, [complainant #1] was visited by his father, [complainant #2] The Member was attending to the care of another patient and became engaged in a discussion with [complainant #2] During the course of their conversation the Member expressed opinions that were critical of those who, like the patient, [complainant #1], suffered extensive injuries in motor vehicle accidents because they were driving under the influence of alcohol and not wearing seat belts. She referred to the cost of the health care system of this conduct. Her tone was confrontational and judgmental and left the impression with the patient's family that there was a

risk that the quality of care available to [complainant #1] would be compromised.

The Member acknowledges that by expressing her opinions on the health care system and the patient's conduct in an adversarial and unsupportive way and by using a tone of voice that was judgemental, she failed to maintain the standards of practice and is guilty of professional misconduct as set out in Paragraph 2 of the Notice of Hearing.
The College submits no evidence with respect to Paragraphs 1, 3, 4 and 5 of the Notice of Hearing, which allegations are hereby withdrawn.
The Member is remorseful for any discomfort or anxiety which her conduct caused to [complainant #2]
The Member, at the time of the incident, was experiencing considerable personal stress from the work environment and from a combination of chronic pain and medical problems for which she has subsequently obtained treatment (see Appendix 1).
Since the incident, the Member has undertaken, in addition to the medical treatment set out above, stress counseling, and counseling to assist her with communication in stressful situations (see Appendix 2).
The Member has also attended a communication seminar sponsored by Toronto East General Hospital for nursing staff (see Appendix 3).
The Member has reviewed and reflected upon the following College publications: Standard for the Therapeutic Nurse/Client Relationship and the Ethical Framework for Nurses in Ontario. The Member has incorporated those standards into her nursing practice.

FINDINGS OF PROFESSIONAL MISCONDUCT

Findings of Professional Misconduct

The panel was asked to make a finding only on Allegation #2. No evidence was presented by the College concerning the Allegations of professional misconduct in the form of conduct that would be reasonably regarded as disgraceful, dishonourable or unprofessional of another related incident. The Chair conducted a PLEA INQUIRY in order to ensure that the Member's admission of professional misconduct was informed and voluntary.

The panel deliberated and then accepted the Agreed Statement of Facts and found the Member to have committed professional misconduct. The Member contravened a standard of practice of the profession by making inappropriate comments in the presence of a client concerning his entitlement to receive medical attention, his responsibility for his condition and the cost incurred by the hospital or health care system as a result of caring for clients in his condition.

The Counsel presented Joint Submission with Respect to Penalty as follows:

JOINT SUBMISSION WITH RESPECT TO PENALTY

The Counsel presented Joint Submission with Respect to Penalty as follows:

Joint Submission with Respect to Penalty

The College and the Member jointly propose that the Discipline Committee order that the Member be reprimanded and the fact of the reprimand be recorded on the Public Register.

PLEASE NOTE: It is agreed that neither the Appendices nor their contents will be included in any publication of this proceeding which may be made.

RATIONALE FOR DECISION

Rationale for Decision

The panel deliberated and then asked both counsel for additional submissions concerning the need to address specific deterrence. Following presentations by both counsel, the panel was satisfied that this incident was isolated and no pattern of previous misconduct was evident. The current employer is aware

of the proceedings before the College, and therefore the panel accepted that no follow-up in the form of review of future performance appraisals was warranted.

In accepting the penalty, the panel took into consideration all of the mitigating factors stated in the Agreed Statement of Facts. The mitigating factors included the Member taking ongoing medical treatment, stress counselling and counselling to assist her with communication skills. She also previously attended a communications seminar at the institution where she is now employed.

The panel agreed with counsel that the penalty was appropriate in that it fulfilled the objectives of specific deterrence in the Member's future conduct and a general deterrence to the profession, thereby serving the public interest.

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:

, Chairperson Date [Panel Members]

College of Nurses of Ontario v. Rebecca Anne Manson, 1999 ONCNO 36520

Case Summary