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:

Elizabeth Baker, RN(EC) Chairperson Liliana Canadic, RN Member

Patricia Collins, RPN Member

Veronica Kerr Public Representative

Tom Clifford Public Representative

Tom Clifford Public Representative

BETWEEN

COLLEGE OF NURSES OF ONTARIO Linda Rothstein for College of Nurses of Ontario

• and -

LUCIE SHANK #86-2598-0

DECISION AND REASONS

Susan Ballantyne for Lucie Shank

Heard: November 13, 2000

This matter came on for hearing before a panel of the Discipline Committee on November 13, 2000, at the College of Nurses of Ontario at Toronto.

The Allegations

The allegations against Lucie Shank as stated in the Notice of Hearing dated October 6, 2000, 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 subsection 1(1) of Ontario Regulation 799/93, in that on or about September 29 and/or September 30, 1999, while employed as a Registered Nurse at [the Hospital], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession with respect to your care and treatment of one or more of the following patients:

(1) [client “A”] (7) [client “G”]

(2) [client “B”] (8) [client “H”]

(3) [client “C”] (9) [client “I”]

(4) [client “D”] (10) [client “J”]

(5) [client “E”] (11) [client “K”]

(6) [client “F”] (12) [client “L”]

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 subsection 1(1) of Ontario Regulation 799/93, in that on or about September 29 and/or September 30, 1999, while employed as a Registered Nurse at [the Hospital], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession by misappropriating property from a client or workplace and in particular, 75 mg. of Demerol.

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 subsection 1(37) of Ontario Regulation 799/93, in that on or about September 29 and/or September 30, 1999, while employed as a Registered Nurse at [the Hospital], 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 you provided false information to nursing colleague(s) with respect to your care of [client “A”] and/or [client “B”].

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 subsection 1(14) of Ontario Regulation 799/93, in that on or about September 29 and/or September 30, 1999, while employed as a Registered Nurse at [the Hospital], 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 you falsified a record relating to your practice and in particular, you falsified Narcotic Administration Records for [client “A”] and/or [client “B”].

Counsel for the College advised the panel that the College was withdrawing Allegation #1.

Member’s Plea

The Chairperson conducted a plea inquiry as follows:

Do you understand the nature of the allegations that have been made against you?

Are you aware of the date, location, and particulars of the allegations made against you?

Do you understand that by admitting to the allegations, you are waiving the right to require the prosecution to prove the case against you and the right to have a hearing?

Do you understand the consequences of admitting to the allegations made against you? Are you aware that there will be a record of your admission and a penalty imposed?

Are you aware that the penalty could include a fine, suspension or revocation of your certificate of registration?

Are you aware that in most cases, depending on the order of the Discipline panel, the results of this proceeding will be available to the public from the College’s register, and that the College must publish the panel’s decision and a summary of its reasons in Communiqué, including your name?

Did you voluntarily decide to admit the allegations against you?

Were you pressured in any way by a person in authority to admit the allegations?

Were you offered any inducement or bribe, or promised any reward to admit to the allegations?

Do you understand that any agreement between the prosecution and defence counsel with respect to the penalty proposed does not bind the Discipline panel?

Based on the Member’s response the panel was satisfied that the Member’s admission was voluntary, informed and unequivocal.

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 which provides as follows:

THE MEMBER

1. Lucie Shank, registration number 886-2598-0 (“the Member”) received her nursing diploma from [ ] in 1986 and has been registered as a Registered Nurse with the College of Nurse of Ontario (“the College”) since June of 1986. Immediately following graduation, she worked at the [ ] full- time in general medicine, as both a staff nurse and team leader. She left there in 1995 to move to [

] with her family and from there to [ ]. In December of 1998, she and her family moved back to [

2. The Member began working at [the Hospital] in January 1999, on a casual basis on various units. In July of that year, she started working part-time, three eight-hour night shifts every two weeks, in the Family Birthing Centre. By the time of the incident in question, the Member had not yet finished her orientation to the floor.

3. Subsequent to the events described below, the Member was away on sick leave from October 1 to November 22, 1999. As a result of the incidents, the Member was suspended on October 23, and resigned her employment with the Hospital in March of 2000.

THE HOSPITAL AND UNIT

4. [The Hospital] is a 163-bed facility serving the residents of [ ].

5. The Hospital’s Family Birthing Centre (“the Birthing Centre”) is comprised of 6 labour and delivery rooms, 3 outpatient beds, and 15 post-partum beds. Patients cared for in the Birthing Centre are women with low-risk pregnancies, and on occasion, medical and surgical cases.

6. The nursing care delivery system in the Birthing Centre is that of combined mother-infant care. EVENTS OF SEPTEMBER 29/30, 1999

7. The Member was working in the Nursery of the Birthing Centre from 2330 hrs on September 29 to 0730 hrs on September 30, 1999. The shift was a busy one. During the shift, the Member provided care for [client “A”], who had just had had abdominal surgery two or three days earlier, and [client “B”], who had a Caesarean section four days earlier. Both clients had standing orders for prn Demerol.

8. If the Member were to give evidence about the events of that shift, she would say as follows:

a. She suffers from migraine headaches. Although they are not frequent (four major episodes a year), she has had them almost her entire life. She has become quite adept at identifying the warning signs of a migraine, and when she does so, she is usually able to avert a full- blown headache by lying quietly in a dark room.

b. Before going to work, she felt the beginning of a headache. She took Extra Strength Tylenol. This is usually sufficient, and on this occasion appeared to have the desired result, since the headache disappeared. She reported for work feeling fine. At around 0100 hrs, the headache returned. She tried to have something to eat, since taking food often relieved the symptoms of her headaches. Unfortunately, the headaches got much worse. The Member knows she should have called her supervisor and told her that she was not able to complete her shift.

c. Sometime during the shift, and after the headache had returned, the Member attempted to draw out a 75-mg ampoule of Demerol for a client, and by mistake withdrew a 100-mg ampoule of Demerol. When she tried to replace the 100-mg ampoule, it, and another 100- mg ampoule, broke.

d. Instead of recording the wastage, with the countersignature of another member, the Member documented that [client “A”] received 100 mg of Demerol i.m. (by intramuscular injection) on two occasions that shift in the Narcotics Register, the times for which are illegible. She also recorded that she had administered 100 mg of Demerol i.m. on two occasions to [client “A”] in the Pharmaceutical Profile, entries she later scribbled out.

9. Near the end of her shift, the Member gave report to [RN “A”] and [RN “B”]. The Member did not indicate to either that she had a headache that day. The Member did not seem herself. [RN “B”] assumed that the Member was feeling stress from lack of sleep. The Member cannot recall what she said when giving report.

10. While giving report, the Member indicated that she had given i.m. Demerol to [client “A”]. She could not remember the dose(s). She also reported that she had given “a shot” of Demerol to [client “B”], but was unable to recall the time of the administration.

11. Soon after hearing the report, [RN “A”] spoke to [client “A”] about her medications, encouraging her to consider taking her Demerol orally since she was soon to be discharged. During that conversation, [client “A”] indicated that she had not received any injections during the night.

12. When [RN “A”] confronted the Member about this discrepancy, the Member initially confirmed that she had given the Demerol injections to [client “A”]. However, when [RN “A”] questioned the Member about her entries in the Narcotic Register, she indicated that she had dropped the two 100 mg vials, that she had intended to get an unnamed nurse to countersign, but had forgotten.

13. [RN “A”] asked the Member to complete an incident report about the wastage, which she did.

14. Sometime between 0800 and 1200 hrs, [RN “B”] asked [client “B”] if she needed anything for pain, and mentioned that she had received Demerol during the night. The client replied that she had not received any Demerol that night.

15. Throughout the shift, the Member made numerous incorrect and irrelevant entries in the records of several clients, or failed to make required entries in the records of clients.

SUBSEQUENT EVENTS

14. At a meeting called for October 1, Hospital representatives questioned the Member concerning the discrepancies regarding Demerol and her incorrect, irrelevant or missing chart entries. If the Member were to give evidence, she would say that she explained that a migraine had developed after her shift began, but that she had not wanted to leave. She would also say that she confessed that she had taken one of the 75-mg ampoules of Demerol to administer to herself, and had done so at 1000 hrs on September 30.

15. After the meeting, the Member was seen in the Occupational Health Department, and as a result, went on sick leave starting October 1. The Member met with [Dr. “A”], the Occupational Health and Safety Physician for a consultation on October 13. During the consultation, [Dr. “A”] indicated that the Member should have a psychiatric consultation, and later arranged for her to meet with [Dr. “B”].

16. As a result of the events of September 29/30, the Hospital suspended the Member on October 23, 1999.

17. On November 3, the Member met with the psychiatrist, [Dr. “B”]. In his report, [Dr. “B”] concluded that the Member became confused due to her migraine, that she may have had a reaction to the Demerol that she had injected herself with, that there was no indication that she consumed narcotics, and that there was no indication that she had acted in a similar fashion at any other time in her career.

18. In January, the Hospital wrote to the Member explaining that it was considering terminating her employment, and asking her to provide additional information that would bear on her behaviour on September 29/30. The Member did not provide additional information, and resigned from the

Hospital in March 2000.

19. On April 20, 2000, [Dr. “A”] replied to a letter from the Member’s counsel. A copy of the letter is attached at as Exhibit “A”.

ADMISSIONS OF MISCONDUCT

22. The Member admits that she has committed an act of professional misconduct as set out in paragraph 2 of the Notice of Hearing, in that she misappropriated 75 mg of Demerol from the Hospital for her own use on September 29 or 30, 1999.

23. The Member admits that she has committed acts of professional misconduct as set out in paragraph 3 of the Notice of Hearing in that she deliberately mislead her colleagues [RN “A”] and [RN “B”] on September 30, 1999, while giving report by telling them she had administered Demerol to [clients “A” and “B”], when she had not in fact done so.

24. The Member admits that she has committed acts of professional misconduct as set out in paragraph 4 of the Notice of hearing in that she knowingly made false entries in the Narcotic Register on September 29 and 30, 1999, indicating that she had administered Demerol to [clients “A” and “B”], when she had not done so. The panel requested clarification of the last sentence of paragraph 8b of the Agreed Statement of Facts. Counsel for the College advised that there was a typographical error and that the sentence should read: “She tried to have something to eat, since taking food often relieved the symptoms of her headaches. Unfortunately, the headache got much worse.” The panel also requested clarification as to the total number of vials of Demerol removed. Both Counsel advised that there was a total of 3 vials.

Decision

The panel considered the Agreed Statement of Facts and 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 2, 3 and 4 of the Notice of Hearing in that she (a) failed to meet the standards of practice of the profession by misappropriating property from a client or workplace and in particular, 75 mg. of Demerol from the Hospital for her own use (b) provided false information to nursing colleagues with respect to her care of [client “A”] and [client “B”] and (c) falsified a record relating to her practice and in particular, falsified Narcotic Administration Records for [clients “A” and “B”].

Penalty

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

Lucie Shank RN, (“the Member”) and the College of Nurses of Ontario (“the College”) jointly submit that, in view of the professional misconduct admitted to by the Member in the Agreed Statement of Fact, and the circumstances set out in the Agreed Statement of Fact, the panel of the Discipline Committee should make an order doing the following:

1. directing the Executive Director to suspend the Member’s certificate of registration for 30 consecutive days, such suspension to commence on the day the panel’s penalty order becomes final; and

2. requiring the Member to appear before the panel to be reprimanded. Counsel for the College confirmed the seriousness of this incident in that it concerned deliberate dishonesty and a grave error in judgement. The pre-hearing process presented no evidence of either substance abuse or concerns with the Member’s practice. It was a single incident on one specific shift.

Defence counsel articulated that the unit was chronically understaffed which contributed to the Member’s error in judgement in deciding to complete her shift.

Penalty Decision

The panel accepts the Joint Submission as to Penalty and accordingly orders:

1. That the Executive Director suspend the Member’s certificate of registration for 30 consecutive days, such suspension to commence on the day the Panel’s penalty order becomes final and

2. Requires the Member to appear before the Panel to be reprimanded.

Reasons for Decision

1. The Panel recognizes that this is a serious error of judgement and that such conduct constitutes professional misconduct.

2. The Panel agreed that the proposed penalty is a specific deterrent to both the Member and the profession in that it sends a clear message that this behaviour will not be tolerated.

3. The Panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions and has avoided unnecessary expense to the College.

The Penalty Order is effective immediately.

Date: Signed: ELIZABETH BAKER RN(EC),Chairperson

ON BEHALF OF THE FOLLOWING MEMBERS OF THE PANEL: LILIANA CANADIC, RN

Member

PATRICIA COLLINS, RPN

Member VERONICA KERR

Public Representative TOM CLIFFORD

Public Representative