College of Nurses of Ontario v. Syed, 2006 ONCNO 81751

PANEL: Denise Dietrich, RPN Chairperson Anne McKenzie, RPN Member Claudette Drapeau, RPN Member Karen Harder, Public Member Faira Bari, Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO Marie Henein for College of Nurses of Ontario

and -

JAMILA SYED, RN Registration No. 0022657 Timothy Hannigan for Jamila Syed, RN

Heard: November 21, 2006

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on November 21, 2006 at the College of Nurses of Ontario (the “College”) at Toronto.

The Allegations

The hearing proceeded in relation to the following allegations against Jamila Syed (the “Member”) as stated in the Notice of Hearing dated September 30, 2006:

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 May 12, 2003 while working as a Registered Nurse at [the detention centre], you contravened a standard or 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) were asked to assess the client who was complaining of chest pains but initially said you would not do so until your medication rounds sometime later; and/or

(ii) when you did attend at the cell of the client who complained of chest pains, you failed to conduct an assessment of [the client’s] medical condition; and/or

(iii) when you spoke to the client who complained of chest pains, you told [the client] that [the client] could not be having chest pains and must be mad, or words to that effect; and/or

(iv) when the client asked you what [the client] should do, you responded “die”.

[withdrawn]
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, c. 32, as amended, and defined in subsection 1(37) of the Ontario Regulation 799/93, in that between May of 2003 and March of 2005, while working as a Registered Nurse at [the detention centre], 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:

(i) you were asked to assess [the client] who was complaining of chest pains but initially said you would not do so until your medication rounds sometime later; and/or

(ii) when you did attend at the cell of the client who complained of chest pains, you failed to conduct an assessment of [the client’s] medical condition; and/or

(iii) when you spoke to [the client] who complained of chest pains, you told [the client] that [the client] could not be having chest pains and must be mad, or words to that effect; and/or

(iv) when [the client] asked you what [the client] should do, you responded “die”; and/or

(v) [withdrawn] ; and/or

(vi) you disparaged [the health care coordinator] by telling her and others that she “was stupid”, and/or an “idiot”, and/or had “no brain”, and/or was “not fit to run the unit”; and/or

(vii) [withdrawn] ; and/or

(viii) you told [RN A], a junior nurse and other colleagues that you “hated” [RN A].

College Counsel sought the panel’s permission to withdraw an allegation that the Member verbally and/or emotionally abused [the client] and two aspects of the allegation that the Member engaged in conduct or performed an act, relevant to the practice of nursing, that would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. The panel granted leave to withdraw these aspects of the allegations.

Member’s Plea

Jamila Syed admitted the allegations as set out in paragraphs #1 and #3(i), (ii), (iii), (iv), (vi) and (viii) in the Notice of Hearing. The panel conducted a plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

The panel also received a written and signed plea inquiry.

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

Jamila Syed, (“the Member”), has been registered as a Registered Nurse with the College of Nurses of Ontario (“the College”) since 2000. Prior to enrolling in a nursing program, the Member worked for some years as a Health Care Aide. Following the completion of her nursing diploma at [ ], the Member worked at the [ ] Retirement Home. In 2001, the Member began working at [a hospital] as a part-time Registered Nurse on a medical/surgical unit. She maintained that position until 2003. As well, on January 30, 2001, the Member commenced full-time employment at [the detention centre] where she performed nursing duties as part of the [ ] Health Care Unit (hereinafter “HCU”).

THE FACILITIES

[The detention centre] holds persons on remand (awaiting trial, sentencing or other proceedings), offenders sentenced to short terms (approximately 60 days or less) and offenders awaiting transfer to a federal or provincial correctional facility. [The detention centre] is a maximum security facility.
The HCU is located in [the detention centre]. The HCU is staffed by 4 or 5 nurses during the day shift and 3 or 4 nurses during the evening shift. It contains the nursing station and the medication room and is operated by Registered Nurses who attend at inmate cells and provide nursing care to the inmates of [the detention centre]. Adjacent to the HCU is the medical unit. The medical unit is a range, or group, of cells that house inmates who are segregated for either behavioural or medical reasons.
Nurses assess inmates with medical problems, administer medications and treatments, and collaborate with outside physicians who visit [the detention centre] on a regular basis.
Following the incidents described below, an internal investigation was conducted by [ ] and the Member was terminated from [the detention centre] on March 24, 2005. The Member was subsequently reinstated to her employment, and the issues relating to her termination were fully resolved to the satisfaction of her Employer.

FIRST INCIDENT

On May 12, 2003, at the beginning of the Member’s shift sometime between 15:00 to 15:30, [the client] arrived on the medical unit following [ ] transfer from [the] Hospital. [The client] had suffered a myocardial infarction fifteen days earlier and had been receiving cardiac treatment from [the] Hospital since then.
The Member was scheduled to work that day for an eight hour evening shift from 15:00 to 23:00.
At approximately 16:13, [the client] complained of chest pains and asked Correctional Officer, [ ], if he could be seen by a nurse.
At approximately 16:16, the correctional officer called the nursing station and told the Member that [the client] was having chest pains, requesting that she come to assess [the client]. The Member told [the correctional officer] that there could not be much wrong with the client and that she would see [the client] once she was done medication rounds approximately three hours later. [The correctional officer] then asked whether the Member was going to come to see the client or whether he would need to call a medical alert. According to [the correctional officer], the Member asked [the correctional officer] if he was threatening her and he stated that he was not.
Shortly thereafter, the Member attended at [the client’s] cell. The Member walked into the cell and [the correctional officer] heard her say in a loud voice to [the client], “What is wrong with you, you cannot be having chest pains. What is wrong with you? You are mad”, or words to that effect. According to [the correctional officer], at that point, the Member began to walk out of the cell. As the Member was walking out, [the client] asked her what [the client] should do, and the Member responded “die”. The Member does not recall the specific statements but acknowledges that these statements may have been made.
[The correctional officer] and [another] Correctional Officer [ ] confirm that [the correctional officer] then asked two other RN’s, [RN B and RN C] to assess [the client].
[RN C] attended to [the client] at 16:29.
At approximately 16:39, [RN B and RN C] were in attendance at [the client’s] cell. They assessed [the client], monitored [the client’s] vital signs and administered nitrospray and oxygen.
At 16:41 the Member called for an ambulance. The Member provided dispatch with details of [the client’s] condition. The ambulance arrived on the unit at approximately 16:52. [The client] arrived at [the hospital] at 17:19.

OTHER INCIDENTS

In and around August 2003 to February 2004, the Member made a number of negative comments about the Health Care Coordinator, [ ]. [The health care coordinator] was the Member’s supervisor. The comments were made while the Member was alone with [the health care coordinator] or in the presence of others. If [the health care coordinator] were to testify, she would say that the Member was disrespectful to her and repeatedly told her that she “was stupid”, and/or “no brain”, and/or “was not fit to run the unit”.
If [RN B and RN C] were to testify, they would state that they had witnessed the Member call [the health care coordinator] “that idiot”, and “stupid”. Two other RN’s, [RN A and RN D], would also testify that they heard the Member call [the health care coordinator] “stupid” and “no brains”.
[The health care coordinator, RN B and RN A] would also testify that at a general staff meeting hosted by the Operational Manager, [ ], the Member said loudly to [the health care coordinator] “you’re stupid” and “no brains”. They would also say that during that meeting, [the operational manager] had to repeatedly ask the Member to desist from using such language.
If [RN B] were to testify, she would also say that after the Member discovered [the correctional officer] had reported the Member, the Member made remarks which could be perceived by colleagues as threatening.
[RNs A, B, C, D] and another RN, [RN E], would also testify that the Member had, on numerous occasions, stated she “hated” [RN A] and/or [the health care coordinator]. The Member does not have a specific recollection of making this comment but agrees that such a comment could have been made.
The Member would agree that she made comments to other RN’s that could be reasonably construed as derogatory and disparaging, and that she used language that some could view as intimidating and/or threatening.

ADMISSIONS

The Member acknowledges that she committed acts of professional misconduct as set out in allegations 1 (i) and (ii) and (iii) and (iv), in that she contravened a standard or practice of the profession or failed to meet the standard of practice of the profession with respect to her care, treatment and communication with the client, [ ], in that the Member:

(i) was asked to assess the client who was complaining of chest pains but initially said she would not do so until her medication rounds sometime later; and/or

(ii) when the Member did attend at the cell of the client who complained of chest pains, she failed to conduct an assessment of [the client’s] medical condition; and/or

(iii) when the Member spoke to the client who complained of chest pains, she told [the client] that [the client] could not be having chest pains and must be mad, or words to that effect; and/or

(iv) when the client asked the member what [the client] should do, she responded “die”.

The Member also acknowledges that she committed acts of professional misconduct as set out in allegations 3 (i) and (ii) and (iii) and (iv) and (vi) and (viii) as set out in the Notice of Hearing in that 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 respect of the client, [ ], in particular that the Member:

(i) was asked to assess the client who was complaining of chest pains but initially said she would not do so until her medication rounds sometime later; and/or

(ii) when the Member did attend at the cell of the client who complained of chest pains, she failed to conduct an assessment of [the client’s] medical condition; and/or

(iii) when the Member spoke to the client who complained of chest pains, she told [the client] that [the client] could not be having chest pains and must be mad, or words to that effect; and/or

(iv) when the client asked the member what [the client] should do, she responded “die”; and/or

(vi) she disparaged another R.N., [the health care coordinator] by telling her and others that she “was stupid”, and/or an “idiot”, and/or had “no brain”, and/or was “not fit to run the unit; and/or

(viii) she told [RN A], a junior nurse and other colleagues that she “hated” [RN A].

Decision

Having considered the evidence concerning the remaining allegations and the onus and standard of proof, the panel finds that the Member committed the following acts of professional misconduct:

Contravening a Standard of Practice of the Profession

The Member contravened a standard of the profession with respect to her care, treatment and communication with the client [ ] specifically:

She did not promptly assess the client who was complaining of chest pains;
When she did attend to the client, she failed to conduct an assessment of [the client’s] medical condition;
When she spoke to the client, she told [the client] that [the client] could not be having chest pains and must be mad, or words to that effect; and
When the client asked what [the client] should do she responded, “die”

Engaging in Disgraceful, Dishonourable or Unprofessional Conduct or Acts

The Member engaged in conduct or performed an act relevant to the practice of nursing that would reasonably be regarded as disgraceful, dishonourable, and unprofessional specifically:

She did not promptly assess a client who was complaining of chest pain;
When she did attend to the client, she failed to conduct an assessment of [the client’s] medical condition;
When she spoke to the client, she told [the client] that [the client] could not be having chest pains and must be mad, or words to that effect;
When client asked what [the client] should do, she responded, “die”;
She disparaged another RN, [the health care coordinator] by telling her and others that she was “stupid” and / or ‘an idiot’, and / or “had no brain’, and / or was ‘not fit to run the unit’; and
She told [RN A] and other colleagues that she “hated” [RN A].

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 provided as follows:

That the Member appear before the Panel to be reprimanded, at a date to be arranged, but in any event within three months of the date of this Order becoming final
That the Executive Director suspend the Member's Certificate of Registration for four (4) months
Direct the Executive Director to impose the following terms, conditions and limitations on the Member's Certificate of Registration:

a) Requiring that the Member successfully complete a refresher course on physical assessments approved by the Director of Investigations and Hearings at her own expense within one (1) year of the Discipline Panel’s Order becoming final;

b) Requiring that the Member review and complete the College’s self-directed learning package, One is One Too Many Program, at her own expense;

c) Requiring that the Member review the College Standards and Guidelines— Professional Standards, Therapeutic Nurse-client Relationship, Ethics and Managing Conflict (formerly Nurse Abuse);

d) Requiring that the Member complete the College’s Self-Assessment Tool, including the development of a learning plan to address how she will improve her communication difficulties, assessment skills and how she will appropriately deal with conflict or stress in the workplace;

e) Requiring the Member to meet with a Practice Consultant to discuss her self-assessment tool and learning plan, the One is One Too Many Program and the College’s Standards and Guidelines, as set out in subsection (b) and (c), within six (6) months of the Discipline Panel’s Order becoming final;

f) Requiring the Member to attend a follow-up meeting with a Practice Consultant six (6) months after the initial meeting, to review and discuss how she has implemented her learning plan;

g) Upon return to the practice of Nursing, the Member may practice 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 practices nursing within fourteen (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 Penalty Order with the Notice of Hearing, Agreed Statement of Fact, and Joint Submission on Penalty attached or, if available, a copy of the Panel's 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 above shall remain in effect until the Member has been engaged in the regular practice of nursing for a total of fifty-two (52) weeks;

Penalty Decision

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

The Member is ordered to appear before the Panel to be reprimanded, at a date to be arranged, but in any event within three months of the date of this Order becoming final
Directs the Executive Director to suspend the Member's Certificate of Registration for four (4) months
Directs the Executive Director to impose the following terms, conditions and limitations on the Member's Certificate of Registration:

b) Requiring that the Member review and complete the College’s self-directed learning package, One is One Too Many Program, at her own expense;

c) Requiring that the Member review the College Standards and Guidelines— Professional Standards, Therapeutic Nurse-client Relationship, Ethics and Managing Conflict (formerly Nurse Abuse);

d) The Member is required complete the College’s Self-Assessment Tool, including the development of a learning plan to address how she will improve her communication difficulties, assessment skills and how she will appropriately deal with conflict or stress in the workplace;

e) The Member is required to meet with a Practice Consultant to discuss her self-assessment tool and learning plan, the One is One Too Many Program and the College’s Standards and Guidelines, as set out in subsection (b) and (c), within six (6) months of the Discipline Panel’s Order becoming final;

f) The Member is required to attend a follow-up meeting with a Practice Consultant six (6) months after the initial meeting, to review and discuss how she has implemented her learning plan;

g) Upon return to the practice of Nursing, the Member may practice only in an employment setting where:

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 above shall remain in effect until the Member has been engaged in the regular practice of nursing for a total of fifty-two (52) weeks;

Counsel for the College submitted that the penalty provides for general deterrence in that it sends a message to the membership at large, it provides specific deterrence to the Member, and it serves to protect the public.

Counsel for the Member agreed with College Counsel and stated that four month suspension recognizes the seriousness of the findings. He submitted the penalty was appropriate and that the public would be protected by the provisions in the Joint Submissions on Penalty.

Reasons for Penalty Decision

The panel concluded that the proposed penalty is reasonable and in the public interest. The penalty sends a clear message to the profession that these behaviours will not be tolerated. The remedial components of this penalty offer the Member the opportunity to improve her practice. The public is protected by the provisions in this penalty.

The panel feels strongly that all clients deserve the best care, regardless of the practice setting. The panel also feels that this penalty should remind nurses of their fundamental responsibility to treat each other and colleagues with respect.

I, Denise Dietrich, 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 Claudette Drapeau, RPN Karen Harder, Public Member Faira Bari, Public Member