DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
Panel:
Chairperson, RN
Member, RN
Member, RPN
Public Representative
Public Representative
BETWEEN
COLLEGE OF NURSES OF ONTARIO Counsel for College of Nurses of Ontario
- and -
FLOR JESUS PALADIO #94-9037-6
DECISION AND REASONS
Counsel for Flor Jesus Paladio
Heard: January 9, 2001
This matter came on for hearing before a panel of the Discipline Committee on January 9, 2001 at the College of Nurses of Ontario at Toronto.
Notice of Hearing
The allegations against Flor Jesus Paladio as stated in the Amended Notice of Hearing dated December 14, 2000, are as follows:
You have committed an act of professional misconduct as provided by subsection 51(b.1) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, in that during the months of [month] 1999 and [next month] 1999, while working as a Registered Nurse at St. Joseph’s Health Centre in Toronto, Ontario, you sexually abused a client known as “Client #1” by behaviour or remarks of a sexual nature.
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, while working as a Registered Nurse at St. Joseph’s Health Centre in Toronto, Ontario, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard for all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, with respect to one or more of the following:
Client
Approximate Date(s)
Type of Incident(s)
(i) “Client #1”
April 1999 and May 1999
Inappropriate Contact
(ii) “Client #2”
January 1999
Inappropriate Contact
(iii) “Client #3”
March 1999 through June 1999
Inappropriate Contact
- 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 while working as a Registered Nurse at St. Joseph’s Health Centre in Toronto, Ontario, you contravened a standard of practice of the profession or failed to maintain the standards of practice of the profession, with respect to one or more of the following:
Client
Approximate Date(s)
Type of Incident(s)
(i) “Client #1”
April 1999 and May 1999
Inappropriate Contact
(ii) “Client #2”
January 1999
Inappropriate Contact
(iii) “Client #3”
March 1999 through June 1999
Inappropriate Contact
Counsel for the College advised that the College was not calling any evidence with respect to the allegations set out in paragraph 1of the Notice of Hearing.
Member’s Plea
Flor Jesus Paladio admitted the allegations set out in paragraphs 2 and 3 in the Amended Notice of Hearing.
Plea Inquiry
The panel conducted a plea inquiry and 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 provided as follows:
The Member completed a four-year nursing diploma program at the Ortanez School of Nursing in Quezon City in the Phillipines in 1969. He emigrated to Canada in 1971, and has been registered as a Registered Nurse (“RN”) with the College of Nurses of Ontario (“the College”) since 1994.
The Member was employed at the Hospital from 1971 to 1999. Until 1994 the Member was employed as a graduate nurse.
Prior to December 1997, the Member was employed in Long Term Care. In December 1997, the Member was relocated to the Hospital’s Psychiatric Unit. At that time he was taking a College Certification Program in Mental Health Nursing. The course included content on the nurse/client relationship and maintaining appropriate boundaries between nurse and client. Specifically, the Member was taught that in the context of an inclient psychiatric setting, it was never appropriate for a nurse to contact a client post-discharge except after discussion and approval of the clinical team in order to meet therapeutic objectives for the client. In all such cases, post-discharge interaction was to be documented.
In December 1998, the Member was counselled by the Manager of the Unit not to call or contact clients after discharge and to maintain professional relationships.
Client #3
Client #3 is a 35-year old male with a history of bipolar affective disorder. He was admitted on [date], 1999 with hypomania and discharged on [date - six weeks later], 1999. Client #3 had also had prior hospitalizations at the Hospital. Client #3 and the Member live in the same neighbourhood.
Some time after Client #3’s discharge, the Member met Client #3 on the street and obtained his telephone number. He then called Client #3 at home and arranged to go for a walk. He picked Client #3 up at his house, met his family, took him for a walk and then never had contact with him again.
The Member did not discuss with any members of the Health Care Team his intention to contact Client #3, nor did he advise anyone afterwards that he had done so. It was not part of the client’s discharge plan. The Member did not document his post-discharge contact with Client #3
Client #2
Client #2 is a 71-year old man with a history of anxiety and depression. He has been treated with electroconvulsive therapy and various anti-depressants. He was admitted on [date], 1998 and discharged on [date - 3 weeks later], 1999.
The Member called Client #2 at his home in [date] 1999. He explained that he made the call because he was worried that Client #2 might require assistance following a severe snowstorm.
The Member did not discuss with any members of the Health Care Team his intention to contact Client #2, nor did he advise anyone afterwards that he had done so. It was not part of the client’s discharge plan. The Member did not document his post-discharge contact with Client #2
Client #1
Client #1 is a 21-year old male with a history of depression and anxiety. He was hospitalized on the Unit from [month] 3 to 14, 1999. The Member was not Client #1’s primary nurse but he was assigned to care for Client #1 on [month] 8 to 11, 1999. During his hospitalization, the Member spoke to him and asked him questions about his sexual orientation. He also told Client #1 about his son and that Client #1 was like his son. He asked Client #1’s permission to call him post- discharge notwithstanding the fact that the Health Care Team was not aware of and had not authorized any post-discharge contact between the Member and Client #1.
In early [month following hospitalization] 1999, the Member telephoned Client #1 at his home. He went to Client #1’s home on [month following hospitalization] 5 or 6, 1999 and took Client #1 for a drive to a friend’s house. During the drive, the Member made a comment to Client #1 which Client #1 reasonably perceived to be of a sexual solicitation and which made Client #1 very uncomfortable. If the Member were to give evidence he would testify that he did not intend his comments to be of a sexual solicitation or of a sexual nature. The Member then drove Client #1 back to his home, used the bathroom, and left.
The Member did not discuss with any members of the Health Care Team his intention to contact Client #1, nor did he advise anyone afterwards that he had done so. It was not part of the client’s discharge plan. The Member did not document his post-discharge contact with Client #1
The Member acknowledges that he ignored the instruction referred to in Paragraph 4 in his contacts with Client #3, Client #2 and Client #1.
The Member acknowledges that he is guilty of professional misconduct as set out in paragraphs 2 and 3 of the Notice of Hearing.
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 and 3 of the Notice of Hearing in that having regard for all the
circumstances, his conduct would reasonably be regarded by members of the profession as disgraceful, dishonorable or unprofessional and that it contravened a standard of practice of the profession and/or failed to maintain the standards of practice of the profession.
Reasons for Decision
The panel reviewed and accepted the Agreed Statement of Facts with the clarification of paragraph 14 so the reference to “this instruction” refers to paragraph 4 in Exhibit 2.
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:
Flor Jesus Paladio, RN #94-9037-6 (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 Facts, it is appropriate for the panel of the Discipline Committee to make an Order as follows:
Requiring the Member to appear before the panel to be reprimanded;
Directing the Executive Director to suspend the Member’s Certificate of Registration for a period of five (5) months commencing on the first day after this Order becomes final;
Directing the Executive Director to impose the following specified terms, conditions and limitations on the Member’s Certificate of Registration:
a. Within four months from the date of the hearing, the Member must purchase and complete the College’s abuse prevention program, One is One Too Many, by watching the video and completing the workbook and must meet with the College’s Practice Consultant to discuss his understanding of the program and its application to his own practice;
b. Within two months from the date the panel releases its written decision and reasons, the Member must enter into counselling with a counsellor (the "Counsellor") approved by the Director of the College’s Investigation and Hearings Department (the "Director"). respectively. The Member must participate in counselling four times a month for at least twelve months;
c. Prior to commencing the counselling above, the Member must request of the Counsellor, and the Director must obtain from the Counsellor, a letter indicating that the Counsellor has received a copy of the panel’s decision in this case together with a copy of the College’s disclosure package. The content of the disclosure package will be agreed to by the parties. In the letter the Counsellor must also agree that the Member’s counselling will address the Member’s interaction with his clients, and the reasons for which the Member was disciplined by the College;
d. At the end of the twelve-month counselling period, the Member must request, and the Director must receive, a letter from the Counsellor indicating that the Member attended for counselling four times a month for the twelve-month period;
e. The Member shall not engage in the practice of mental health or psychiatric nursing;
f. Upon completion of the suspension and resumption of employment, the Member must provide the Director with the name and address of his current employer(s), and in the event of any change of employer, of the name and address of any subsequent employer(s) within one month of hiring for a period of two years from the date of hearing. Each employer must confirm in writing to the Director receipt from the Member of a copy of the panel’s decision and reasons regarding this matter. In that letter the employer must also agree that the Member’s practice will be monitored from time to time by another member of the College and to immediately notify the Director in the event any information comes to its attention that the Member is breaching the standards of practice in his interaction with his
clients, and agree to provide all necessary information to allow the College to ascertain whether the Member is breaching the standards of practice, and the extent of the breach.
Both counsel agree that the Joint Submission on penalty was a difficult balancing act and addressed and acknowledged the seriousness of the Member’s conduct.
Penalty Decision
The panel accepts the Joint Submission as to Penalty and accordingly orders the following:
Requiring the Member to appear before the panel to be reprimanded;
Directing the Executive Director to suspend the Member’s Certificate of Registration for a period of five (5) months commencing on the first day after this Order becomes final;
Directing the Executive Director to impose the following specified terms, conditions and limitations on the Member’s Certificate of Registration:
a. Within four months from the date of the hearing, the Member must purchase and complete the College’s abuse prevention program, One is One Too Many, by watching the video and completing the workbook and must meet with the College’s Practice Consultant to discuss his understanding of the program and its application to his own practice;
b. Within two months from the date the panel releases its written decision and reasons, the Member must enter into counselling with a counsellor (the "Counsellor") approved by the Director of the College’s Investigation and Hearings Department (the "Director"). respectively. The Member must participate in counselling four times a month for at least twelve months;
c. Prior to commencing the counselling above, the Member must request of the Counsellor, and the Director must obtain from the Counsellor, a letter indicating that the Counsellor has received a copy of the panel’s decision in this case together with a copy of the College’s disclosure package. The content of the disclosure package will be agreed to by the parties. In the letter the Counsellor must also agree that the Member’s counselling will address the Member’s interaction with his clients, and the reasons for which the Member was disciplined by the College;
d. At the end of the twelve-month counselling period, the Member must request, and the Director must receive, a letter from the Counsellor indicating that the Member attended for counselling four times a month for the twelve-month period;
e. The Member shall not engage in the practice of mental health or psychiatric nursing;
f. Upon completion of the suspension and resumption of employment, the Member must provide the Director with the name and address of his current employer(s), and in the event of any change of employer, of the name and address of any subsequent employer(s) within one month of hiring for a period of two years from the date of hearing. Each employer must confirm in writing to the Director receipt from the Member of a copy of the panel’s decision and reasons regarding this matter. In that letter the employer must also agree that the Member’s practice will be monitored from time to time by another member of the College and to immediately notify the Director in the event any information comes to its attention that the Member is breaching the standards of practice in his interaction with his clients, and agree to provide all necessary information to allow the College to ascertain whether the Member is breaching the standards of practice, and the extent of the breach.
The panel found that the penalty addressed the public’s protection providing a deterrence to the profession as a whole and a remedial and rehabilitative mechanism for the Member. This is accomplished by the suspension, the counselling and restriction on practice.
The penalty makes very clear that professional boundaries must be maintained in particular with the psychiatric client who is very vulnerable.
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 his actions and has avoided unnecessary expense to the College.
I, [chairperson], 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 Member, RN
Member, RPN
Public Representative Public Representative