DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Panel:

• Chairperson
• Member, RPN
• Member, RN

BETWEEN

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

• and -

E. Ruth Ritsema #GF-1285-6

DECISION AND REASONS

Counsel for E. Ruth Ritsema

Heard: January 21, 2000

A panel of the Discipline Committee of the College of Nurses of Ontario was convened at 9:15 a.m. at the College of Nurses of Ontario (the “College”) at Toronto to hear the allegations against the Member, Ruth Ritsema, on January 21, 2000.

The Member was present and was represented by counsel.

Notice of Hearing

Counsel for the College presented the panel with Exhibit #1, the Notice of Hearing, listing the following allegations:

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 on , 1998 while working as a Registered Practical Nurse at Grand River Hospital in Kitchener, Ontario, you contravened a standard of practice of the profession or failed to maintain the standards of practice of the profession with respect to the following incidents:

a. Your care and treatment of Client #1 on or about, 1998 and in particular your conduct in twisting the client’s hand or arm; and/or

b. Your care and treatment of client Client #2 on or about , 1998 and in particular your conduct in roughly turning the client; and/or

c. Your verbal comment to client Client #2 on or about, 1998; and/or

d. Your verbal comment to client Client #3 on or about, 1998; and/or

e. Your verbal comment to client Client #4 on or about, 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(7) of Ontario Regulation 799/93, in that on, 1998 while working as a Registered Practical Nurse at Grand River Hospital in Kitchener, Ontario, you

abused a client verbally, physically or emotionally with respect to the following incidents:

a. Your care and treatment of Client #1 on or about, 1998 and in particular your conduct in twisting the client’s hand or arm; and/or

b. Your care and treatment of client Client #2 on or about ,1998 and in particular your conduct in roughly turning the client; and/or

c. Your verbal comment to client Client #2 on or about

d. Your verbal comment to client Client #3 on or about

e. Your verbal comment to client Client #4 on or about

,1998; and/or

, 1998; and/or

, 1998; 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 , 1998 while working as a Registered Practical Nurse at Grand River Hospital in Kitchener, 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 with respect to the following incidents:

a. Your care and treatment of Client #1 on or about, 1998 and in particular your conduct in twisting the client’s hand or arm; and/or

b. Your care and treatment of client Client #2 on or about, 1998 and in particular your conduct in roughly turning the client; and/or

c. Your verbal comment to client Client #2 on or about

d. Your verbal comment to client Client #3 on or about

e. Your verbal comment to client Client #4 on or about

, 1998; and/or

, 1998; and/or

, 1998.

On presentation of the Notice of Hearing, the College counsel advised the panel that the College was proceeding with Allegations #1 c, d and e, as well as, Allegations #3 c, d and e, and that the College would not be presenting any evidence in Allegations #1 a and b, as well as, #2 a, b, c, d, e, #3 a and b.

AGREED STATEMENT OF FACTS

The College entered into evidence an Agreed Statement of Fact as Exhibit #2. It provided as follows:

Background

1. Ruth Ritsema (“the Member”) has been registered as a Registered Practical Nurse (RPN) with the College of Nurses of Ontario since 1976.

2. The Member was hired as a part-time RPN at the Grand River Hospital (GRH) in Kitchener, Ontario, in June of 1982. She held this position until April of 1986 when her position was changed to that of full-time RPN. The Member’s position at GRH was terminated

on , 1998, as a result of events that include the incidents described below. Prior to the allegations contained in the Notice of Hearing, Ms. Ritsema has not been the subject of a complaint or report to the College.

3. The incidents described below occurred during a single shift while the Member was working on unit GR3 in of 1998. The Member had recently been reassigned to

GR3; , 1998 was her first evening shift on that unit. She had previously been assigned to working the day shift.

4. The hospital administration had recently changed staffing levels on GR3, reducing nursing staff on the evening shift by one. The nursing staff were getting accustomed to the change in the staffing level. , 1998 was a very busy shift.

5. If she testified, the Member would say that she was under stress at the time of these incidents due to her working environment.

6. Clients residing on unit GR3 of the Freeport site of GRH are between 20 and 50 years of age and require complete chronic care as a result of congenital disorders or trauma.

Incidents Concerning Client #2

7. Client #2 is a 47-year old woman with blindness and paraplegia. Her level of cognitive functioning is significantly impaired. Client #2 is emotionally dependent on her father, and often calls out for him. She requires frequent reassurance in this regard.

8. On the evening of , 1998, the Member was on duty, as was another RPN. From the hallway outside Client #2’s room, the Member said “Shut up!” to Client #2 in an abrupt tone. The Member admits that she spoke to Client #2 in a rude and unprofessional manner.

9. The other RPN was present when this incident occurred. If she were to give evidence, she would say that Ms. Ritsema’s tone of voice was abrupt and that she told Client #2 to either be quiet or to shut up. The other RPN would also say that Ms. Ritsema yelled at Client #2 and was very short with her, and that Client #2 was lying in her bed and Ms. Ritsema was yelling at her from the hallway in such a way that other clients and visitors could have heard her. She reported the incident to the unit leader.

Incidents Concerning Client #3

10. Client #3 is a 70-year old male client with Gillean Barre Syndrome. Client #3 has had a tracheotomy and is quite focussed on spitting up, which he does frequently. He asks for clean washcloths or towels several times a day for this purpose.

11. During the evening of the day in question in 1998, the Member was in Client #3’s room. The Member had brought with her five clean washcloths for Client #3’s use. Client #3 asked the Member for an additional washcloth for the purpose of spitting up. The Member admits that she responded that there was a shortage of washcloths in a rude and unprofessional manner.

12. An Aid/Orderly was also in Client #3’s room at the time of the incident. If she were to give evidence, she would say that Client #3 is overly focussed on his tracheotomy and with spitting up. He spits up a lot and will ask for a clean washcloth or towel frequently. She noted that there is not enough linen on the unit to meet this client’s requests and that everyone gets frustrated with him. The Aid/Orderly would confirm that the Member spoke to Client #3 on this occasion in a rude and unprofessional manner.

Incidents Concerning Client #4

13. Client #4 is a 26-year old female client with Huntington’s Chorea. Her level of cognitive functioning is impaired. When Client #4 eats without assistance, she does so very slowly.

14. During the evening of the day in question in 1998, the Member was in Client #4’s room during Client #4’s mealtime. The Member admits that she told Client #4 to “Hurry up and eat faster” and that she knew she could eat faster. The Member admits that she spoke to Client #4 in a rude and unprofessional manner.

15. The same Aid/Orderly was in the vicinity of Client #4’s room at the time of the incident. If she were to give evidence, she would say that she heard the Member speak to Client #4 as described above. She would also say that it was not what the Member said to the client that was problematic, but that it was the manner in which the words were spoken.

Admission Of Professional Misconduct

16. The Member admits that she has committed professional misconduct by contravening a standard of practice of the profession, or failing to maintain the standards of practice of the profession, as follows:

a. as set out in paragraph 1. c. of the Notice or Hearing, with respect to her verbal comment to Client #2 on or about , 1998, and

b. as set out in paragraph 1. d. of the Notice of Hearing, with respect to her verbal comments

to Client #3 on or about , 1998, and

c. as set out in paragraph 1. e. of the Notice of Hearing, with respect to her verbal comments to Client #4 on or about , 1998.

17. The Member admits that she 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 as disgraceful, dishonourable or unprofessional, as follows:

a. as set out in paragraph 3. c. of the Notice or Hearing, with respect to her verbal comment to Client #2 on or about , 1998, and

b. as set out in paragraph 3. d. of the Notice of Hearing, with respect to her verbal comments to Client #3 on or about , 1998, and

c. as set out in paragraph 3. e. of the Notice of Hearing, with respect to her verbal comments to Client #4 on or about , 1998.

Both counsel pointed out a typographical error on page one (1) and a numbering error on page three (3) in the Agreed Statement of Facts. Both errors were corrected accordingly.

PLEA INQUIRY

A Plea Inquiry of the Member was then conducted by the Chairperson. The plea inquiry is reproduced as Appendix “A” to the Decision and Reasons. The Member answered “yes” to all the questions asked. The panel accepted that the Member’s admission of professional misconduct was informed and voluntary.

FINDING

The panel accepted the Agreed Statement of Facts as presented and found the Member committed an act of professional misconduct with respect to Allegations #1 c, d and e, as well as, Allegations #3 c, d and

e. In making this finding, the panel applied the standard of proof on a balance of probabilities, based on clear, cogent and convincing evidence.

JOINT SUBMISSION ON PENALTY

Counsel for the College then tendered as Exhibit #3 a Joint Submission on Penalty, which provided as follows:

Ruth Ritsema (“the Member”) and the College of Nurses of Ontario (“the College”) jointly submit that the Panel of the Discipline Committee should make an order as follows:

1. Requiring the Member to appear before the Panel to be reprimanded, and

2. Directing the Registrar to impose the following terms, conditions or limitations on the Member’s Certificate of Registration:

a. before returning to practice as an RPN, the Member must complete the College’s abuse prevention programme One is One Too Many, consisting of the video and the workbook, must complete the programme, except for Module 5: Preventing the Abuse of Nurses, and must subsequently meet with a College Practice Consultant to review her understanding of the programme, and

b. within 5 months from the date the order becomes final, the Member must enter into a programme of personal or stress counselling, the duration of which will be determined by the counsellor and the Member, and

c. within 6 months from the date the order becomes final, the Member must provide the Director of the College’s Investigations and Hearings Department (“the Director”) with a

letter from her counsellor indicating that she began personal or stress counselling within the time prescribed in paragraph 2. b., and indicating the period of counselling that has been decided upon by the counsellor and the Member.

Both counsel pointed out typographical errors in the Joint Submission on Penalty. The errors were corrected accordingly.

Counsel for the College submitted that the penalty in this case was appropriate and that the oral reprimand was a general and specific deterrent to both the Member and the nursing profession as a whole. She also submitted that conditions and limitations placed on the Member’s certificate would provide an opportunity for rehabilitation for the Member.

The counsel for the Member provided the panel with a series of job evaluations of the Member over a period of several years as well as letters from co-workers which all attested to the Member’s excellent performance in her practice as well as her character.

Counsel for the Member submitted to the panel that the occurrences from which the allegations arose were isolated incidents and not in character with the Member or her practice. She also pointed out that the Member had already completed condition 2a of the Joint Submission on Penalty and is awaiting to meet with the College’s practice consultant.

Counsel for the Member further advised the panel that Ms Ritsema has also commenced with the conditions specified in 2b of the Joint Submissions on Penalty and submitted a letter (Exhibit #5) that indicated counselling had already commenced.

DECISION AND REASONS

After deliberation, the panel agreed that the penalty as submitted was appropriate in this case.

The panel, in reaching its decision, accepted the Member’s admission of misconduct and that the penalty had been fairly negotiated at the pre-hearing proceeding and was appropriate. The panel believes that the penalty will serve not only as a deterrent to the Member but also to other members of the profession.

After rendering its decision, the panel administered an oral reprimand.

I , Public Representative, 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, RPN

Member, RN

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