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

Marsha Taylor, RPN Chairperson Janise Johnson, RN Member Christine Barber, RN Member Tom Clifford Public Representative Kay Wetherall Public Representative

BETWEEN

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

and -

ANNA BALDIN #HF-0623-8

Robert Miller for Anna Baldin

Heard: April 20, 2001

This matter came on for hearing before a panel of the Discipline Committee on April 20, 2001 at the College of Nurses of Ontario at Toronto. The Member was present and represented by legal counsel.

The allegations against Anna Baldin, as stated in the Notice of Hearing dated March 8, 2001, are as follows:

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 January 11, 2000, while employed as a Registered Practical 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 for [the Client]; 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 about January 11, 2000, while employed as a Registered Practical Nurse at the [hospital], you abused a client verbally, physically or emotionally with respect to your care for [the Client]; 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(37) of Ontario Regulation 799/93, in that on about January 11, 2000, while employed as a Registered Practical Nurse at the [hospital], you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all circumstances, would be reasonably regarded by members as disgraceful, dishonourable or unprofessional with respect to your care for [the Client].

Counsel for the College advised that the College was not calling any evidence with respect to the allegations set out in paragraphs #1 and #3 of the Notice of Hearing.

Counsel for the College advised the panel that the hearing would be proceeding by way of an Agreed Statement of Fact.

Anna Baldin admitted to allegation #2 in the Notice of Hearing. The panel conducted a plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

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

The Member

Ms Baldin attended and completed the Registered Nursing Assistant program at the [nursing school ]. In 1996 and 1997, she completed the Medication Course and Venipuncture/Intramuscular Course for Registered Practical Nurses at [a community College].
Ms Baldin was employed as an RPN with the [the hospital] from October, 1989 until January, 2000 when she was terminated from the position. From 1989 to 1992, Ms Baldin worked on a surgical unit, transferring to the Continuing Care Unit (the Unit) in 1992.

The Facility and the Unit

The Hospital is a 284-bed community site of [name and location removed]. The Hospital includes, amongst other facilities, the Unit to which Ms. Baldin was assigned and a Psychiatric Unit on the 3rd Floor.
The Unit provides care to 36 clients who are awaiting placement in the community. The clients typically have suffered from strokes, chronic respiratory diseases, dementia and general debility.
On the evening shift, the Unit was staffed with 1 Registered Nurse, 1 Registered Practical Nurse and 2 non-regulated health care providers.

The Client

The Client, [initials deleted], was an 84 year old male with a primary diagnosis of dementia. He was non-ambulatory, being confined to a Geri-chair throughout the day and restrained in bed at night. The Client was totally dependent on nursing staff for his needs.
The Client had fragile skin and several pre-existing skin tears on his forearms.
The Client was known to have agitated periods on occasion. All nursing staff were aware that the appropriate approach to take with the Client when he was agitated was to leave him on his own to settle, usually in the Unit’s sunroom.

Allegation 2 – Verbal and Physical Abuse

On January 11, 2000, Ms Baldin was assigned to provide care to the Client on the evening shift.
At approximately 9 p.m., the Client was in the sunroom, restrained in a Geri-chair. As Ms Baldin wheeled the Client from the sunroom down the hallway to his room, he became agitated and was grumbling. At the doorway to his room, the Client was clearly in an agitated state, holding out his hands to hold onto the doorway, in an attempt to prevent his entrance into the room.
Ms Baldin continued to wheel the Client into his room and positioned him at the foot of his bed. The Client then grabbed a wicker basket of candies on his bedside table and threw them to the ground. As Ms Baldin bent over to pick the candies up from the floor, the Client removed his terrycloth bib and swung it at Ms Baldin, hitting her on the right cheek with the metal fastening snap end of the bib.
Ms Baldin responded angrily by raising her voice, calling the Client a “bugger” and by telling him that he “belonged up on the third floor with all the other nutcases.”
As Ms Baldin stood up, she became concerned that the Client was attempting to strike out at her. In response, Ms Baldin roughly grabbed the Client’s forearms above his head and held them with more force than was necessary, resulting in the re-opening of a previous skin tear and bleeding on the Client’s right forearm. Ms. Baldin then forcibly restrained the arms of the Client to the chair.
Ms Baldin admits that she committed an act or acts of professional misconduct as set out in allegation 2 of the Notice of Hearing in that on or about January 11, 2000, while employed as a Registered Practical Nurse at the Hospital she abused a patient verbally, physically and emotionally with respect to her care of the Client [initials deleted] and in particular that she:

responded angrily and raised her voice to the Client and called him a “bugger”;

told the Client that he “belonged up on the third floor with all the other nutcases”; and roughly grabbed the Client’s forearms, held them with more force than necessary and restrained the arms of the Client to the chair.

Allegations 1 and 3

The College tenders no evidence with respect to these allegations.

Decision

The panel considered and accepted 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 paragraph #2 of the Notice of Hearing in that the Member abused a client verbally, physically or emotionally with respect to her care for [the Client].

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:

Directing the Executive Director to suspend the Member’s certificate of registration for a period of three months to commence on the date this order becomes final;
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration on the date this order becomes final:

a. The Member shall successfully complete a course or counselling program in anger and/or stress management acceptable to the Director of Investigations and Hearings (the Director) within six months of the date this order becomes final or such later date as is acceptable to the Director, provided that the Member can demonstrate unforeseen events or circumstances reasonably prevented the Member from completing the course or counselling program; and

b. The Member shall review the video and complete the One is One Too Many abuse prevention self-directed package and meet with a Practice Consultant to discuss the incident from which the findings of professional misconduct arose within three months of the date this order becomes final. In particular, the meeting with the Practice Consultant shall include a review of the definition of abuse and strategies to deal with aggressive clients.

Requiring the Member to appear before the panel to be reprimanded within three months of the date this order becomes final.

Counsel for the College informed the Panel that to accept the Joint Submission on Penalty would serve as a message of deterrence to the Member, the members of the Profession and most importantly to the public, that abuse will not be tolerated. The penalty would also appropriately address concerns of rehabilitation for the Member.

Penalty Decision

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

the Executive Director to suspend the Member’s certificate of registration for a period of three months to commence on the date this order becomes final;
the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration on the date this order becomes final:

the Member to appear before the panel to be reprimanded within three months of the date this order becomes final.

The panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions. A review of the ‘One is One Too Many’, and the completion of the abuse prevention self directed package of the College of Nurses and participating in a counselling program in anger and/or stress management will enhance the Member’s practice.

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 Janise Johnson, RN

Christine Barber, RN

Tom Clifford, Public Representative Kay Wetherall, Public Representative

College of Nurses of Ontario v. Anna Baldin, 2001 ONCNO 62534

Case Summary