DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

FULL-TEXT DECISION

Note: This is the full text of the decision of the Discipline panel in this matter. Any information identifying clients, witnesses or facilities has been removed [ ]. The member’s name is omitted if the allegations have been dismissed or if the results are not placed on the public portion of the Register.

Panel:

Janise Johnson, RN Chairperson Cheryl Beemer, RN Member Kien Campbell, RPN Member

Tom Clifford Public Representative Antony Cunningham Public Representative

BETWEEN

COLLEGE OF NURSES OF ONTARIO Nick Coleman for College of Nurses of Ontario

• and -

JEANNE TELLIS #67-2159-1

Elizabeth McIntyre for Jeanne Tellis

Heard: November 3, 2000

AMENDED DECISION AND REASONS

A panel of the Discipline Committee of the College of Nurses of Ontario convened in Toronto on November 3, 2000 to commence a hearing concerning allegations brought by the College of Nurses against the Member, Jeanne Tellis. The Member was present and represented by Counsel.

The Allegations

The allegations against the Member, Jeanne Tellis, as stated in the Amended Notice of Hearing dated October 12, 2000, are as follows:

1. You have committed an act or acts 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, while employed as a registered nurse at [the Hospital], you contravened the standard of practice of the profession or failed to meet the standard of practice the profession with respect to your care of [the client] on or about March 27, 1999 and with respect to your care of [the client], on or about April 19, 1999; and/or

2. You have committed an act or acts 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, while employed as a registered nurse at [the Hospital], you abused a patient verbally, physically or emotionally with respect to your care of [the client], on or about March 27, 1999 and with respect to your care of [the client] on or about April 19, 1999; and/or

3. You have committed an act or acts 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, while employed as a registered nurse at [the Hospital], you engaged in conduct or performed acts, 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 your care of [the client] on or about March 27, 1999 and with respect to your care of [the client] on or about April 19, 1999.

Withdrawal of Allegations

Counsel for the College advised that the College was not calling any evidence with respect to the Allegation set out in paragraph 2 of the Amended Notice of Hearing.

Counsel for the College advised that the College was not calling any evidence with respect to Allegations 1, 2, and 3 of the Amended Notice of Hearing with regard to [the client].

Agreed Statement of Facts

Counsel for the College advised the panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts (Exhibit #2) which provided as follows:

The Member

1. Ms Tellis received her nursing training from the [ ] School of Nursing in 1966, becoming a member of the College in 1967.

2. Following several years of employment at [another hospital] in the pediatric unit, Ms Tellis commenced a full-time position in 1970 at [the Hospital] on the Pediatric unit (the Unit). She held a part-time position on the Unit from 1973 to 1990, at which time she transferred to a job sharing position. Ms Tellis was terminated from her position in April 1999 following the incident which is described below.

3. During her employment at [the Hospital], Ms Tellis also worked with [ ], as a Cabin Medical Attendant and a Transport Registered Nurse, transporting critically ill clients by land and air to hospital.

The Facility and the Unit

4. [The Hospital] is a regional health centre with approximately 430 beds, which was formed in 1999 as a merger of [ ].

5. The Unit currently holds twenty-five client beds, including clients requiring intensive care. The Unit also has eight beds for adult clients.

6. Children 18 years of age and under are admitted to the Unit with all diagnoses, including psychiatric illnesses. Most clients suffer from respiratory and gastro-intestinal problems.

7. The Unit is staffed by RNs who work 12 hour shifts. On the day shift, three RNs are assigned to client care. A fourth RN is designated as the charge nurse and is also assigned to care for several clients.

The Client

8. The Client, [ ], was born on April 13, 1996. She had a variety of problems including developmental delay and severe mental retardation, cleft lip and palate, a seizure disorder, asthma and had a gastric jejeunostomy tube in place for feeding. At the time of her admission to the unit, she weighed approximately 18 pounds and had significant motor and cognitive developmental delay.

9. [The client] was admitted to the Unit on April 19, 1999 at approximately 1100 hours with a diagnosis of pneumonia. On admission, the Client’s respirations were 72 per minute and her oxygen saturation levels were between 84 to 86%.

10. Ms Tellis was assigned to care for the Client. The initial doctor’s orders included intravenous antibiotic administration, inhalation therapy and continuous oxygen saturation monitoring. The orders provided that oxygen be administered as necessary in order to keep the client’s oxygen saturation over 95%.

Allegations 1 and 3 - Failure to maintain the standards of practice / Disgraceful, dishonourable and unprofessional conduct with respect to the care of [the client] on April 19, 1999

11. During the afternoon of April 19, 1999, the Client’s oxygen saturation level was monitored and was found not to meet the level ordered by the physician in that it stayed between 86% and 90%. Continuous oxygen therapy was required through an application of nasal prongs and/or face mask. However, the Client was resistant to the therapy and made constant efforts to remove both the mask and later the nasal prongs. Frequent repositioning of the nasal prongs was therefore necessary. The proper size palate restraints were not available on the Unit. Accordingly, ongoing nursing care was required to maintain the oxygen therapy. Ms Tellis was frustrated in her efforts to provide the oxygen therapy ordered by the physician and required by the Client. Ms Tellis was also attempting, at the same time, to change the Client’s diaper.

12. When she entered the Client’s room, and observed the Client standing in her crib, and pulling at her IV and J tubing Ms Tellis spoke abruptly and loudly to the Client, saying something to the effect of, “Hey, I said to sit down. Do you not understand what I said?” Ms Tellis further handled the Client in a forceable manner in the process of changing her sleeper and repositioning the Client in her crib.

13. Ms. Tellis admits that her conduct amounts to professional misconduct as set out in allegation 1 of the Notice of Hearing in that she failed to meet the standards of practice of the profession with respect to her care of [the client] by treating in the manner described in paragraph 12. In addition, Ms. Tellis admits that her conduct amounts to professional misconduct as set out in allegation 3 in the Notice of Hearing in that she engaged in behaviour that members of the nursing profession would reasonably regard as disgraceful, dishonourable and unprofessional by treating [the client] in the manner described in paragraph 12.

Allegation 2 – Verbal, physical or emotional abuse

14. The College tenders no evidence with respect to this allegation.

Allegations 1, 2 and 3 – Failure to maintain the standards of practice / Disgraceful dishonourable and unprofessional conduct with respect to the care of [the client] on March 27, 1999

15. The College tenders no evidence with respect to these allegations.

Member’s Plea

Jeanne Tellis admitted the allegations set out in paragraphs numbered 1 and 3 in the Amended Notice of

Hearing with respect to [the client]. The panel made its usual “plea inquiry” and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Decision

The panel, having considered the Agreed Statement of Facts, finds that the facts support a finding of professional misconduct, and, in particular, finds that the Member committed an act of professional misconduct as alleged in paragraphs 1 and 3 of the Amended Notice of Hearing with respect to [the client] in that Jeanne Tellis failed to meet the standards of practice of the profession with respect to her care of [the client] on or about April 19, 1999. The Member also engaged in conduct or performed acts, 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 your care of [the client] on or about April 19, 1999.

Reasons for Decision

The Member admitted to the Allegations as set out in the Agreed Statement of Facts.

Joint Submission on Penalty

Counsel for the College advised the panel that a Joint Submission as to Penalty (Exhibit #3) had been agreed upon. The Joint Submission as to Penalty provides as follows:

1. The Member and the College jointly submit that the appropriate penalty in this case is for the Discipline Committee to make the following order:

a. Directing the Executive Director to suspend the Member’s certificate of registration for a period of three months from the date of this order, with two months of the suspension to be remitted on the following conditions:

i. That the Member complete the “One is One Too Many: Self-Directed Learning Package” and meet with a Practice Consultant from the College to discuss the learning package; and

ii. That the Member provide proof to the Director of Investigations and Hearings (the Director) that she has attended and completed a Stress Management counseling program suitable to the Director.

b. Requiring the Member to attend before the Discipline Committee for an oral reprimand within three months of the date of this order.

Penalty Decision

The panel deliberated and questioned the purpose of requiring the Member to actually serve one month of the three month suspension. The panel invited Counsel to make further submissions. Counsel for the College stated that the Crown had reviewed the Agreed Statement of Facts and the Joint Submission on Penalty and that withdrawal of the criminal charge of assault against the Member was incumbent upon the College dealing seriously with the matter as evidenced by the panel’s acceptance of the Joint Submission on Penalty. On further questioning as to how much “penalty” the Member had already “paid”, Counsel for the Member stated that an arbitration hearing was pending. Counsel for the College stated that this was irrelevant to the decision.

The panel accepts that, as stated by Counsel for the College, the intent of the penalty submitted is to serve as a deterrent to members of the profession and serve the public interest. However, the panel noted that the Member had an unblemished nursing record of some 34 years, the vast majority being in

pediatrics (Exhibit #4: Member’s Resumé); that the Member was currently employed as a Transport Registered Nurse in the care of critically ill patients; that the Member commanded the respect of her peers and colleagues, as evidenced by the letters of reference submitted as Exhibit #5. The Member had already attended and completed a stress counselling program. A letter from Family Counselling Service dated August 16, 2000 (Exhibit #6) indicated that the Member had attended six (6) sessions of individual counselling between July and October 1999, and nine (9) sessions of anger management and seven (7) of eight (8) sessions on stress management.

The panel deliberated further and, although it could see no purpose in serving one month of the three month recommended suspension, having regard to the interest of the Crown as stated by Counsel for the College, agreed that it was constrained to accept the Joint Submission on Penalty.

The panel directed that this decision take effect on November 3, 2000.

I, Janise Johnson, RN, 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 Cheryl Beemer, RN

Kien Campbell, RPN

Tom Clifford, Public Representative Antony Cunningham, Public Representative