PUBLISHED JUNE 2002

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:

Marg Axelson, RN Chairperson

Cheryl Beemer, RN Member Christine Barber, RPN Member

Kay Wetherall Public Representative

William Weichel Public Representative

BETWEEN

COLLEGE OF NURSES OF ONTARIO Michelle Fuerst for College of Nurses of Ontario

and -

Vera Malek #91-2675-6

REASONS FOR DECISION

Mary Anne Kuntz for Vera Malek

Heard: August 18, 2000

A panel of the Discipline Committee met on August 18, 2000 to hear the following allegations as set out in the 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(1) of Ontario Regulation 799/93, in that on or about May 9, 1999 while working as a Registered Nurse at the [Psychiatric Hospital], you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession in that you

a. Failed to make an appropriate investigation of the circumstances when you learned that clients “A” and “B” had been locked in the special observation room by staff, and that one or both clients had moved furniture so as to block the door; and/or

b. Failed to intervene when you learned that clients “A” and “B” had been locked in the special observation room by staff, and that one or both clients had moved furniture so as to block the door; and/or

c. Failed to do a mental status examination of clients “A” and “B” when you learned that the

clients had been locked in the special observation room by staff and that one or both clients had moved furniture so as to block the door; and/or

d. Failed to report to supervisory nursing personnel, and/or the duty doctor, and/or the officer- in-charge that clients “A” and “B” had been locked in the special observation room by staff and that one or both clients had moved furniture so as to block the door; and/or

e. Remained off duty on break in excess of your allotted break period; and/or

f. Failed to make complete and accurate entries of the events involving clients “A” and “B” in the health record of client “B”; and/or

g. Failed to document the events involving clients “A” and “B” in the health record of client “A”.

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 May 9, 1999 while working as a Registered Nurse at the [Psychiatric Hospital], you abused a client or clients physically, in that you

c. Failed to do a mental status examination of clients “A” and “B” when you learned that the clients had been locked in the special observation room by staff and that one or both clients had moved furniture so as to block the door; 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(7) of Ontario Regulation 799/93, in that on or about May 9, 1999 while working as a Registered Nurse at the [Psychiatric Hospital], you abused a client or clients emotionally, in that you

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 May 9, 1999 while working as a Registered Nurse at the [Psychiatric 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, in that you

b. Failed to intervene when you learned that clients “A” and “B” had been locked in the

special observation room by staff, and that one or both clients had moved furniture so as to block the door; and/or

e. Remained off duty on break in excess of your allotted break period; and/or

f. Failed to make complete and accurate entries of the events involving clients “A” and “B” in the health record of client “B”; and/or

g. Failed to document the events involving clients “A” and “B” in the health record of client “A”.

The College of Nurses proceeded with Allegations 1(a), 1(c), 1(f), 1(g), and 4(b). No evidence was presented in regard to the other allegations and, therefore, no finding was made.

Member’s Plea

The Member admitted to Allegations 1(a), 1(c), 1(f), 1(g), and 4(b).

Plea Inquiry

The chair conducted a plea inquiry in order to ensure that the Member’s admission of professional misconduct as alleged was informed and voluntary. The text of the plea inquiry is attached as Appendix “A”.

The panel was satisfied that the Member’s admission of professional misconduct was informed and voluntarily made.

Agreed Statement of Fact

The panel was advised that the parties had agreed to a statement of facts. The Agreed Statement of Fact states as follows:

Vera Malek (“the Member”) graduated from [ ] as a Registered Nurse in 1991 and was first registered as a Registered Nurse with the College of Nurses of Ontario in 1991. Since 1993 she has worked as a nurse at each of the [Psychiatric Hospital] and [another] Psychiatric Hospital.
In July, 1998 the Member began working as a nurse on [the Unit] at the [Psychiatric Hospital] (“the Unit”). [Information specific to Unit deleted.] On average, the Unit has 19 clients, with a maximum capacity of 25 clients.
Client A was admitted to the Unit on May 6, 1999 after she expressed suicidal thoughts and stabbed herself with scissors. She had a history of psychiatric problems including depression, borderline personality disorder, and physical and sexual abuse. She remained on the Unit until her discharge on May 19, 1999.
Client B was admitted to the Unit on May 3, 1999 because of aggressive behaviour and threats to kill other persons. Immediately before her admission she had been involved in a car accident and had injured her back. On admission to the Unit, she expressed thoughts of delusional persecution and grandiosity. She was diagnosed as suffering from bipolar disorder in the manic phase with psychotic features. She was difficult to handle on the Unit initially. She was discharged on August 20, 1999.
Both clients A and B were housed in the Unit’s Special Observation Room during the night shift on May 8-9, 1999. The Special Observation Room is directly across from the nursing station and has curtained windows and a window in the entrance door. It typically is used for clients who require ongoing observation by nursing staff.
On May 8-9, 1999 the Member worked the night shift on the Unit, from 7:00 p.m. on May 8 until 7:00 a.m. on May 9. The three other nurses who also worked that shift were Diane Allingham RN, David Meinert RPN, and Francine Metcalf RPN.
During the night shift, Client B was restless and unsettled. She was given medication around 3:00 a.m., but it seemed to have no effect on her behaviour.
At around 4:30 a.m. and 4:15 a.m., respectively, the other Registered Nurse Ms. Allingham, and the Member took their breaks. Mr. Meinert and Ms. Metcalf remained on duty on the Unit. In the absence of the Member and Ms. Allingham, client B again became unsettled. Sometime after 5:00 a.m., Mr. Meinert on the advice of Ms. Metcalf, locked the door of the Special Observation Room from the exterior. This meant that client B and client A were locked inside the Special Observation Room together.
The door of the Special Observation Room was locked for 15 to 20 minutes. However, by the time the door was unlocked, it was observed that client B had moved furniture against the door of the Special Observation Room, so as to barricade the door from the inside.
When the Member returned from her break around 5:45 a.m., the Unit was quiet. However, the door to the Special Observation Room remained barricaded from inside the room.
The Registered Practical Nurses told the Member what had been done while she and Ms. Allingham were on break. The Member took no steps to have the barricade removed from the door of the Special Observation Room, or to intervene in any other way. She made no other investigation of the events, nor did she attempt to enter the room to assess the mental status of either client A or client B.
The Member made no entry in the health record of client A to document the events, including the locking and unlocking of the door, the barricading of the Special Observation Room, and the client’s mental status. The Member made an incomplete entry in the health record of client B that referred only to the door being barricaded.
Around 7:00 a.m. the nurses on the day shift came on duty. The door to the Special Observation Room was still barricaded. The day shift received Report, then around 7:20 a.m. they entered the Special Observation Room, with some difficulty, and removed the barricade.
Neither client A nor client B suffered any physical injury as a result of the events. However, client A reported that client B had talked to her about having killed her husband, and that she had been fearful while she was confined in the room with client B.
The Member admits that she committed professional misconduct in that she:

a. Contravened a standard of practice of the profession or failed to meet the standards of practice of the profession in that when she learned that clients A and B had been locked in the Special Observation Room by staff and that client B had moved furniture so as to block the door, she failed to make an appropriate investigation of the circumstances; she failed to do a mental status examination of clients A and B; she failed to make complete and accurate entries of the events involving clients A and B in the health record of client B; and she failed to document the events in the health record of client A; and,

b. 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 in that she failed to intervene when she learned that clients A and B had been locked in the Special Observation Room by staff and that client B had moved furniture so as to block the door.

Finding of Professional Misconduct

The panel deliberated and accepted the Agreed Statement of Facts and found the member had committed acts of professional misconduct as alleged in paragraphs 1(a), 1(c), 1(f), 1(g) and 4(b) of the

Notice of Hearing.

Joint Submission on Penalty

The parties presented a Joint Submission on Penalty as follows:

Vera Malek ("the Member") and the College of Nurses of Ontario ("the College") jointly submit that the panel of the Discipline Committee should make an order directing the Executive Director to:

Impose the following terms, conditions and limitations on the Member’s Certificate of Registration:

a. During the 12 month period from the date that the order becomes final, the Member shall complete a course satisfactory to the Director of Investigations and Hearings of the College (“the Director”) in psychiatric nursing assessment;

b. During the 12 month period referred to in (a) above, the Member shall view the abuse prevention video One is One Too Many and meet with a Nursing Practice Advisor to discuss the video; and,

c. During the 12 month period referred to in (a) above, the Member shall, at 6 month intervals, provide the Director with a total of two written performance reports prepared by the employer.

Require 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.

The panel accepted the Joint Submission on Penalty.

Reason for Decision

The panel agreed that the proposed penalty was reasonable and appropriate. The Member should have assessed, investigated and intervened to ensure that the patients were not at risk in the barricaded room. She showed a disregard for the emotional and physical well being of the patients. There could have been serious consequences with one of the patients harming herself or the other patient in a barricaded room. The Member failed to document the events adequately. The penalty address a general deterrence for the profession, and specific deterrence and remediation for the Member. It serves the College of Nurses’ mandate to protect the public interest.

I, Marg Axelson, 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

Christine Barber, RPN

Kay Wetherall, Public Representative William Weichel, Public Representative

College of Nurses of Ontario v. Malek, 2000 ONCNO 50772

Case Summary