College of Nurses of Ontario v. Jasvir Sidhu, 2006 ONCNO 81737

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Deanne Barber, RPN Chairperson Anne McKenzie, RPN Member Susan Silver, RN Member Grace Isgro-Topping Public Member Karen Harder Public Member

BETWEEN:

) MARIE HENEIN for

COLLEGE OF NURSES OF ONTARIO ) College of Nurses of Ontario

• and - )

JASVIR SIDHU ) KATE HUGHES for

Registration No. 9522087 ) Jasvir Sidhu

) Heard: October 18, 2006

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on October 18, 2006 at the JPR Mediation Place, 390 Bay Street, Toronto.

The Allegations

The Amended Notice of Hearing dated August 17, 2006 was entered as [an exhibit]. At the outset of the hearing, College counsel asked the panel for permission to amend allegations 1(ii), (iii) and (iv) and 3(ii), (iii) and (iv) as follows:

1. (ii) unintentionally slapped the client across the face; and/or

(iii) unintentionally slapped the client several times on the arm; and/or

(iv) allegation to be deleted

3. (ii) unintentionally slapped the client across the face; and/or

(iii) unintentionally slapped the client several times on the arm; and/or

(iv) allegation to be deleted.

College Counsel also advised that allegation #2 was being withdrawn.

The panel granted the College’s request. Accordingly, the remaining allegations against Jasvir Sidhu (the “Member”) as stated in the Amended Notice of Hearing are as follows:

1. You have committed an act or acts 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 the Ontario Regulation 799/93, in that on February 4, 2004, while working as a Registered Nurse at the [Hospital] in [ ], Ontario, you contravened a standard [of] practice of the profession or failed to meet the standard of practice of the profession with respect to your care, treatment and communication with the client [ ] in that you:

(i) yelled at the client; and/or

(ii) unintentionally slapped the client across the face; and/or

(iii) unintentionally slapped the client several times on the arm; and/or

(iv) deleted

(v) roughly removed the client’s clothing.

2. [withdrawn]

3. You have committed an act or acts 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 the Ontario Regulation 799/93, in that on February 4, 2004, while working as a Registered Nurse at the [Hospital] in [ ], Ontario, 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 respect of the client [ ] in that you:

(i) yelled at the client; and/or

(ii) unintentionally slapped the client across the face; and/or

(iii) unintentionally slapped the client several times on the arm; and/or

(iv) deleted

(v) roughly removed the client’s clothing.

Member’s Plea

The Member admitted the allegations set out in paragraphs numbered #1 and #3 in the Amended Notice of Hearing, as further amended by the panel’s order. The panel conducted an oral 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

1. Jasvir Sidhu (the “Member”) has been a Registered Nurse with the College of Nurses of Ontario (the “College”) since 1995 when she obtained certification in Ontario.

2. Since June 1, 1998 to the present, the Member has been employed as a full-time RN at [ ] (the “Hospital”), [ ] in the [ ] department.

3. The [ ] Unit is a 40-bed unit that deals with [clients] suffering from a variety of psychiatric illnesses including psychosis.

4. The Member does not have any prior disciplinary history with the College. The Member does not have any prior disciplinary history with any employer, except for a disciplinary suspension for this incident.

5. The Member has remained working with the Hospital since this incident[t] on the same unit. The Member has been monitored and has had no further incidents and has received a good evaluation from her Unit Manager and positive references from the Chief of Psychiatry for the Hospital, the Psychiatrist on the Unit and from the Chief Nursing Executive as well as the Hospital Security Supervisor.

THE ALLEGATIONS

6. On May 27, 2004, the College received a letter of report from the Patient Care Manager of Adult Mental Health at the [Hospital] regarding the Member. The report related to the Member’s treatment of [the client] on February 4, 2004.

7. On February 4, 2004, [the client] was admitted to the emergency unit. The stated reasons for the admission were “hearing voices/bizarre behaviour”. It was charted in triage as follows: “hearing voices yesterday saying “go away”, bizarre behaviour. Children’s Aid apprehending her [young son], treated in [ ] for mental health”. [The client] presented in triage as “alert”, “well kempt” and “compliant in triage”.

8. She was admitted in the emergency department on a Form 1 at 1720. The admitting psychiatrist Orders include “close observation”, “restraints prn for safety” and the medications Zydis 2.5 mg po TID prn, Serax 15 mg po HS prn and Ativan 2 mg po/Im TID prn. A social worker was also ordered to assist. At 1823 a phone order was received increasing the medication to Laxapine 5 mg IM TID prn if refused to increase Zydis to 5 mg po TID prn.

9. [RPN A] was on duty when [the client] was admitted onto the unit. The [client] was brought to the unit from the emergency department by the security officer [ ]. [The client] was initially calm but frightened. She is described as a petite and soft-spoken woman. When [RPN A] was left alone in the room, [RPN A] asked [the client] to change into a hospital gown but [the client] started to cry, became very upset, kept saying “no, no, no” and ran out of the room and attempted to leave the unit. She was stopped by the Security Officer [ ].

10. [The client] was escorted back to the room by the Security Officer and [RPN A] and kept indicating that she wanted to go home and wanted to see her [child]. She would not cooperate with [RPN A] in admitting her to the unit or changing her clothes and was agitated.

11. Another security officer [ ] was called to assist with [the client] as was another RPN [ ] and the Member. The Member and [RPN B] were not assigned to the [client]; [RPN A] was the admitting nurse. The Member spoke [the client]’s native language and assisted [RPN A] and the security officers in changing the [client]’s clothes and putting her in two-point restraint.

12. The Member’s conduct in assisting with the admission of this [client] is at issue in this matter. There are differing recollections of what occurred raised several weeks after the incident. At some point [RPN B] left the room and at points the male security guard was not able to observe as he was behind a privacy curtain. On the day of the incident [RPN A] charted:

“patient received from ER with one security, when asked patient to take off clothing became very angry, second security guard called, patient clothes removed. Patient placed in two-point restraint. Clothes in 5010, valuables med room. Patient stated police brought her to hospital. She doesn’t know why, denies any problems, refusing food and fluids.”

13. It is agreed that the Member spoke to [the client] in [her native language] to try to get her to cooperate with [RPN A] and change into the hospital gown. The Member inappropriately yelled at [the client] during this interaction.

14. [The client] was on one side of the bed with the Member and [RPN A] was on the other side of the bed and the two security officers were at the end of the bed. The [client] grabbed at the Member’s arm. The Member slapped the [client] on the arm in an attempt to get her to let go. During the interaction, [the client] was grabbing the Member. The Member then slapped [the client] on the left cheek with an open hand. If the Member were to testify, she would indicate that the slap on the face was unintentional.

15. [The client] was still trying to grab at and push the Member away. The Member told [RPN A] not to stand there but to help her. All of the staff were talking to [the client] and trying to calm her down. [RPN A] came around the bed and moved closer to [the client]. [The client] grabbed at [RPN A] and scratched her arm. [The client] was fighting, crying and saying, “Let me go”.

16. [RPN A] was assisting in the removal of the clothing. As her clothing was being removed, [the client] became more frightened and agitated. The two security officers had to hold the client down in order to have her clothing removed. The Member was described as being very forceful and aggressive as she was removing the client’s clothing. [The client] appeared very frightened and confused.

17. [The client] was placed in a two-point restraint by both of the security officers and both nurses.

18. [The client] remained in the hospital for 12 days until she was released after agreeing to pharmacologic treatment. The Member cared for her February 9 and there were no problems with her care.

ADMISSIONS

19. The Member admits that she has committed acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, c.32, as amended, and defined in subsection 1(1) of the Ontario Regulation 799/93, in that on February 4, 2004, while working as a Registered Nurse at the [Hospital] in [ ], Ontario, she contravened a standard of practice of the profession with respect to her care, treatment and communication with the client [ ] in that she:

(i) yelled at the client; and

(ii) unintentionally slapped the client across the face; and

(iii) unintentionally slapped the client on the arm; and

(iv) roughly removed the client’s clothing.

20. The Member further admits that she has committed acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, c.32, as amended, and defined in subsection 1(37) of the Ontario Regulation 799/93, in that on February 4, 2004, while working as a Registered Nurse at the [Hospital] in [ ], Ontario, she 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:

(i) yelled at the client; and

(ii) unintentionally slapped the client across the face; and

(iii) unintentionally slapped the client on the arm; and

(iv) roughly removed the client’s clothing.

21. The College seeks leave of the Discipline Committee to withdraw allegation #2 in 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 #1 and #3 of the Notice of Hearing.

As to the factual basis for the panel’s findings, there is a slight discrepancy between the allegations as set out in the Amended Notice of Hearing and the facts as admitted in the Agreed Statement of Facts. The Amended Notice of Hearing alleges that the Member slapped the client “several times” on the arm; the Agreed Statement of Facts admits an unintentional slap on the arm but does not include the words “several times”.

In considering the nature and extent of the misconduct at issue, the panel relied on the facts as detailed in the Agreed Statement of Facts rather than the particulars contained in the Amended Notice of Hearing.

Submissions on 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:

Jasvir Sidhu (the “Member”) and the College of Nurses of Ontario (the “College”) respectfully submit that, in view of the circumstances set out in the Agreed Statement of Facts, and the Member’s admissions of professional misconduct, the panel of the Discipline Committee should make an Order as follows:

1. Directing the Executive Director to suspend the Member’s certificate of registration for 8 weeks, with the suspension to commence on October 18, 2006;

2. Requiring the Member to appear before the panel to be reprimanded;

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

(a) The Member shall review the video and complete the One is One Too Many abuse prevention self-directed package, at her own expense, and shall meet with a Practice Consultant to discuss the incident from which the findings of professional misconduct arose, within four months of the date of this Order. Before meeting with the Practice Consultant, the Member shall speak to the Practice Consultant to enable the Practice Consultant to recommend any reading and/or learning plans to be completed by the Member prior to meeting with the Practice Consultant;

(b) Upon return to the practice of nursing, the Member may practise only in an employment setting where:

i. The Member delivers to the Director of Investigations and Hearings at the College by courier or other verifiable method of delivery, written notification of the names, addresses and telephone numbers of all employers, as well as the name of her direct supervisor, for whom she practises nursing, within 14 days of commencing or resuming employment in any nursing position for a period of twelve (12) months of nursing practice;

ii. The Member will provide the employer with a copy of the panel’s finding and penalty order, or, if available, its decision and reasons in advance of commencing or resuming practice;

iii. The Member agrees to provide to the College a signed acknowledgement from the employer that the employer has received the documents identified in paragraph (ii).

iv. The terms and conditions set out in sub-paragraph 3.(b). shall remain in effect until the Member has been engaged in the regular practice of nursing for a total of 52 weeks.

(c) The Member shall notify the Director of Investigations and Hearings at the College of the name, address and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position, for a period of twelve (12) months of nursing practice. Notification shall be in writing and sent by verifiable form of delivery, such as courier, the proof of which delivery the Member shall retain.

Counsel for the College made submissions in support of the proposed penalty. She submitted that decisions as to penalty should be guided by the panel’s public interest mandate of protecting the public, deterring other members of the profession from engaging in this kind of behaviour, deterring the Member specifically from reoffending and rehabilitating the Member. She submitted that the proposed penalty met these criteria.

College counsel submitted that the aggravating factors were that the Member was dealing with a vulnerable, mentally ill client whose young [child] had been taken away from her. There were difficulties in communicating due to language constraints. Working in that situation requires compassion and patience rather than frustration. Another member of the profession had been scratched by the client but did not hit back, illustrating the conduct expected of RPNs.

As to mitigating factors, College counsel stated that the Member had no prior discipline history. She admitted her conduct and assumed responsibility for her behaviour. The work environment was one of high pressure, and by all accounts the incident did involve a difficult client.

Counsel for the Member also made submissions in support of the proposed penalty. She agreed with the College counsel, and pointed out that even though there were differing and competing recollections of facts, the Member has taken responsibility and chosen to admit the allegations and accept a significant penalty, rather than force the College on to a contested hearing.

The Member’s counsel highlighted the mitigating factors in this case. This was a difficult [client] in a psychotic state, hearing voices, hitting out. Two security guards as well as two other nurses were present. The Member was not the primary nurse, but was called in to assist. She had been employed for eight years and remained at [the] same facility for 2 ½ years since [the] incident. She had been monitored during that time, with no problems noted. She had been disciplined by the facility. Her employer is aware of all [the] facts and maintains a high level of confidence in the Member since this incident.

Finally, counsel for the Member submitted that the penalty is severe in that the Member is the sole support for her family. She stated that the penalty was more than adequate penalty with respect to protection of the public. This was an isolated incident in an otherwise unblemished career.

Penalty Decision

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

1. The Executive Director shall suspend the Member’s certificate of registration for 8 weeks, with the suspension to commence on October 18, 2006;

2. The Member shall appear before the panel to be reprimanded;

3. The Executive Director shall impose the following terms, conditions, and limitations on the Member’s certificate of registration:

(a) The Member shall review the video and complete the One is One Too Many abuse prevention self-directed package, at her own expense, and shall meet with a Practice Consultant to discuss the incident from which the findings of professional misconduct arose, within four months of the date of this Order. Before meeting with the Practice Consultant, the Member shall speak to the Practice Consultant to enable the Practice Consultant to recommend any reading and/or learning plans to be completed by the Member prior to meeting with the Practice Consultant;

(b) Upon return to the practice of nursing, the Member may practise only in an employment setting where:

i. The Member delivers to the Director of Investigations and Hearings at the College by courier or other verifiable method of delivery, written notification of the names, addresses and telephone numbers of all employers, as well as the name of her direct supervisor, for whom she practises, nursing within 14 days of commencing or resuming employment in any nursing position for a period of twelve (12) months of nursing practice;

ii. The Member shall provide the employer with a copy of the panel’s finding and penalty order, or, if available, its decision and reasons in advance of commencing or resuming practice;

iii. The Member shall provide to the College a signed acknowledgement from the employer that the employer has received the documents identified in paragraph (ii); and

iv. The terms and conditions set out in sub-paragraph 3.(b). shall remain in effect until the Member has been engaged in the regular practice of nursing for a total of 52 weeks.

(c) The Member shall notify the Director of Investigations and Hearings at the College of the name, address and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position, for a period of twelve (12) months of nursing practice. Notification shall be in writing and sent by verifiable form of delivery, such as courier, the proof of which delivery the Member shall retain.

Reasons for Penalty Decision

The panel concluded that the proposed penalty is reasonable and in the public interest. The Member has cooperated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions.

The penalty includes a significant suspension. It strikes a balance with respect to specific deterren[ce] and general deterren[ce], as well as being fair to the Member. The terms, conditions and limitations imposed on the Member’s certificate of registration address public protection and rehabilitation of the Member.

I, Deanne Barber, 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

Panel Members:

Anne McKenzie, RPN

Susan Silver, RN

Grace Isgro-Topping, Public Member

Karen Harder, Public Member