PUBLISHED December 2001

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:

Marsha Taylor, RPN Chairperson Christine Barber, RPN Member Ruth Kitson, RN Member

Sandra Millar Public Representative

Tom Clifford Public Representative

BETWEEN

COLLEGE OF NURSES OF ONTARIO Megan Shortreed for College of Nurses of Ontario

• and -

MIRIAM BEAUMONT # FH-1843-3

DECISION AND REASONS

Craig Parry for Miriam Beaumont

Heard: February 22, 2000

A panel of the Discipline Committee met on February 22, 2000 at the College of Nurses of Ontario (the “College”), Toronto.

Ms Miriam D. Beaumont (the “Member”) was not present but was represented by Counsel.

Amended Notice of Hearing

The allegations against the Member as stated in the Notice of Hearing (Exhibit #1) 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(8) of Ontario Regulation 799/93, in that in August and September, 1998, while working as a Registered Practical Nurse at [the facility], you misappropriated property from a client or workplace with respect to the following incidents:

a. Your conduct in misappropriating medication belonging to [client A] and/or [client B] on or about August 28, 1998;

b. Your conduct in misappropriating medication belonging to patient [client B] on or about August 30, 1998;

c. Your conduct in misappropriating medication belonging to [clients, A, B, C, D and/or E] on or about September 3, 1998.

MEMBER’S PLEA

In the absence of the Member, the Member’s counsel assured the panel that the Member had full understanding of the consequences of her plea and had directed him in writing to proceed with the plea.

Through her Counsel, the Member admitted she was guilty of professional misconduct as set out in in allegations 1(a), (b) and (c) of the Notice of Hearing.

PLEA INQUIRY

As the Member was not present, a formal Plea Inquiry could not be carried out. The Member’s counsel assured the panel that the Member had acknowledged that she had reviewed and understood the allegations made against her and waived her rights by pleading guilty. The panel inquired of the Member’s counsel whether the Member understood that the results of this hearing would be made public through the public registrar and the College Communique. Counsel for Defence indicated he had reviewed the consequences of her plea with the Member.

AGREED STATEMENT OF FACTS

The Agreed Statement of Facts was tendered as Exhibit # 2 by Counsel for the College. It provided as follows:

The Member

1. Ms Beaumont graduated from [ ] in [ ]England with a Registered Practical Nurse Diploma in 1968

2. Ms Beaumont worked at [the facility] as a full time health care aid from September 23, 1996 to September 8, 1998 when her employment was terminated as a result of the incidents described below. Prior to working at [the facility], Ms Beaumont worked as a health care aid [ ] from 1994 to 1996. Since her termination from [the facility], Ms Beaumont has worked as a health care aid for [ ].

The Facility

3. [The facility] has approximately 32 clients.

4. There is always one RN or RPN on duty or on call at the home. During the evening shift, from 1600 hours to 2400 hours on weekdays or 1500 hours to 2300 hours on weekends, there is one RPN on duty who is responsible for administration of medications. Ms Beaumont worked the evening shift.

5. In particular, Ms Beaumont worked the evening shift on August 28, 30, and September 3, 1998.

The Clients

6. [Clients A, B, C, D and E] were [clients] of the [facility]. All of them were prescribed Ativan 0.5 mg or 1 mg to be administered P.R.N. in the evening.

The Medication

7. Ativan (Lorazepam) is a sedative usually prescribed to assist with sleep. It can also be used for agitation and to treat symptoms of alcohol withdrawal. Ativan is ordered for each of the clients referred to paragraph 6 above in pharmacards that contain 34 pills per card.

Allegation 1(a), 1(b) and 1(c) – Misappropriation of Medication

8. [The Director of Care] (DOC) of [the facility] was notified by the pharmacist who filled the prescriptions for the [facility] that Serax was being reordered for some of the patients earlier than it should have been. In addition, [ ] another nurse at [the facility], advised [the DOC] that she had noticed the Ativan was also being replaced more often than it should have been.

9. [The DOC] began counting the Ativan and Serax on August 20, 1998 and comparing the amount of medication missing on each shift with the [clients’] medication administration records (MAR).

10. [The DOC] noticed that medications were missing and not accounted for during Ms Beaumont’s shifts when no one else in the building had keys to the locked medications cart.

11. On August 28, 1998, [the DOC] and a witness, [ ], conducted counts of the [clients’] medications before and during Ms Beaumont’s shift, once at 1515 hours and once at 1715 hours:

Between the counts, two Ativan pills went missing from [client A]. According to [client A’s] MAR, no Ativan was administered on August 28, 1998.

Between the counts, six Ativan pills went missing from [client B]. According to [client B’s] MAR, no Ativan was administered on August 28, 1998.

12. Ms Beaumont admits misappropriating Ativan medication from [clients A and B] on August 28, 1998.

13. On August 30, 1998, [the DOC] conducted counts of the [clients’] medications before and during Ms Beaumont’s shift, once at 1500 hours and once at 1715 hours:

Between the counts, three Ativan pills went missing from [client B]. According to [client B’s] MAR, no Ativan was administered on August 30, 1998.

14. Ms Beaumont admits misappropriating Ativan medication from [client B] on August 30, 1998.

15. On September 3,1998, [the DOC] and a witness, [ ], conducted counts of the [clients’] medications before and during Ms Beaumont’s shift, once at 1515 hours and once at 1700 hours:

Between the counts, two Ativan pills went missing from [client A]. According to [client A’s] MAR, no Ativan was administered on September 3, 1998.

Between the counts, four Ativan pills went missing from resident [client B]. According to [client B’s] MAR, no Ativan was administered on September 3, 1998.

Between the counts, two Ativan pills went missing from [client C]. According to [client C’s] MAR, no Ativan was administered on September 3, 1998. One Ativan pill was found in the medication room afterward and was poured back.

Between the counts, two Ativan pills went missing from [client D]. According to [client D’s] MAR, no Ativan was administered on September 3, 1998.

Between the counts, one Ativan pill went missing from [client E]. According to [client E’s] MAR, no Ativan was administered on September 3, 1998.

16. Ms Beaumont admits misappropriating Ativan medication from [clients A, B, C, D and E] on September 3, 1998.

17. When confronted by [the DOC] on September 3, 1998, Ms Beaumont denied taking the medications. She offered to allow [the DOC] to check her bag, but not her pockets and purse. On September 8, 1999, Ms Beaumont’s employment with [the facility] was terminated effective immediately.

18. Ms Beaumont admits that her conduct amounts to professional misconduct as set out in allegations 1(a), 1(b) and 1(c) of the Notice of Hearing in that she misappropriated medication belonging to clients [A and B] on August 28, 1998, she misappropriated medication belonging to client [B] on August 30, 1998 and she misappropriated medication belonging to clients [A, B, C,

D and E] on September 3, 1998.

FINDING OF PROFESSIONAL MISCONDUCT

The panel accepted the Agreed Statement of Fact and made a finding that the Member, Ms Beaumont had committed an act of professional misconduct in relation to allegations 1 (a), (b) and (c).

In doing so, the panel applied the standard of proof on a balance of probabilities, based on clear, cogent and convincing evidence in accordance with the decision of the Divisional Court in Re: Bernstein and College of Physicians and Surgeons of Ontario.

The panel found the Member engaged in unprofessional behaviour by misappropriating property from a client or workplace with respect to the following incidents:

a. misappropriating medication belonging to [client A] and/or [client B] on or about August 28, 1998;

b. misappropriating medication belonging to [client B] on or about August 30, 1998;

c. misappropriating medication belonging to [clients A, B, C, D and/or client E] on or about September 3, 1998.

The panel believes that the Member’s conduct failed to maintain the honesty and trust that the public expects in the provision of nursing care in Ontario.

JOINT SUBMISSION ON PENALTY

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

THE MEMBER AND THE COLLEGE jointly submit that the appropriate penalty in this case is for the Discipline Committee to make the following order:

1. Directing the Executive Director to suspend the Member’s certificate of registration for a period of six months. The suspension shall commence on the date this Order becomes final and shall run without interruption.

2. Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration, namely:

a. the Member shall provide prior written notice to the Director of Investigations and Hearings (the Director) of the name and address of her employer and of any change in the name or address of her employer thereafter;

b. the Member shall provide to the Director copies of performance appraisals by her employer every six months;

c. the Member shall provide her employer(s) with a copy of this Order upon commencing employment in any nursing position; The conditions imposed by virtue of paragraphs 2(a), (b), and (c) shall be removed from the Member’s certificate of registration two years following her return to nursing after the suspension imposed in paragraph 1 has run.

Requiring the Member to appear before the panel of the Discipline Committee to be reprimanded, at a date to be arranged, but in any event within three months of the date the order becomes final.

Counsel for the College tendered as Exhibit #4 a prior finding of professional misconduct dating to 1990.

Counsel for College submitted that the purpose of a penalty is threefold namely:

to provide deterence to the Member from repeating her act of professional misconduct; to provide an example of general deterence to other members of the profession; and

to provide a means for remediation and monitoring of the Member.

Counsel for the Member acknowledged the prior finding of professioanl misconduct by the Member and stated the Member understood the seriousness of the current proceedings. The Member through her counsel is willing to accept responsibility for her actions and the terms and conditions of the penalty.

The panel requested clarification regarding the Member’s employment status as a Health Care Aide and/or Registered Practical Nurse. The College Counsel assured the panel that the Member’s action is a “breach of fidelity of trust as an RPN (Registered Practical Nurse)” and that the “panel should impose a penalty as an RPN.”

Counsel for the Member acknowledged that the Member at the time of the alleged allegations was “functioning as an RPN at least for the administration of medications.”

DECISION

The panel unanimously accepted the Joint Submission on Penalty with the six (6) month suspension to commence on February 22, 2000. The panel requested the Counsel for the College and the Counsel for the Member to amend the wording of the Joint Submission on Penalty 2 (a) and (b) to include the phase ‘any nursing position’ after the word employer. Both counsel agreed to the amendment.

The panel believes that the penalty sufficiently recognizes the seriousness of the acts of misconduct and provides the right balance between specific deterrence to the Member and general deterence to other members of the profession.

As the Member was not present a waiver of appeal could not be signed at this time.

An oral reprimand will be administered by a panel of the Discipline Committee at a date to be arranged.

I, Marsha Taylor, RPN, 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 Christine Barber, RPN

Ruth Kitson, RN

Sandra Millar, Public Representative Tom Clifford, Public Representative