College of Nurses of Ontario v. Linda Walschots, 2006 ONCNO 81761

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Joanne Furletti, RN Chairperson Anne McKenzie, RPN Member Karen Breen-Reid, RN Member Karen Harder Public Member

Grace Isgro-Topping Public Member

BETWEEN:

) LINDA ROTHSTEIN for

COLLEGE OF NURSES OF ONTARIO ) College of Nurses of Ontario

• and - )

LINDA WALSCHOTS ) MARY HART for

Registration No. 8905028 ) Linda Walschots

) Heard: July 31, 2006

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on July 31, 2006 at the College of Nurses of Ontario (the “College”) at Toronto.

The Allegations

College Counsel informed the panel that the allegation contained in paragraph #1 in the Notice of Hearing has been withdrawn. Consequently, the hearing proceed[ed] in relation to the following allegations against Linda Walschots (the “Member”), as stated in the Notice of Hearing dated June 29, 2006 [ ]:

1. 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 October 27, 2003, while employed as a Registered Nurse at [the] Hospital, in [ ], Ontario, you engaged in conduct and/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 the manner in which you administered medication to a client, [ ].

2. 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 October 27, 2003, while employed as a Registered Nurse at [the] Hospital, in [ ], Ontario, you engaged in conduct and/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:

(a) threatened a colleague, [Nurse A], with retaliation if she or any other colleague made statements contrary to [your] interests;

(b) indirectly threatened a former colleague, [a student nurse], whom you knew had complained to the College of Nurses of Ontario, by making known to [Nurse A] that you “would go after [the student nurse]” or words to that effect.

3. 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 March 24, 2004, while employed as a Registered Nurse at [the] Hospital, in [ ], Ontario, you engaged in conduct and/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 threatened a colleague, [Nurse B], with retaliation if she or any other colleague acted against [your] interests with respect to the allegations of [the student nurse].

Member’s Plea

Linda Walschots admitted the allegations set out in paragraphs numbered 2, 3 and 4 in the Notice of Hearing. The panel conducted an oral plea inquiry and a written plea inquiry, signed by the Member, [ ] was filed. The panel 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:

BACKGROUND

1. Linda Walschots (“the Member”) initially registered with [the] College of Nurses of Ontario (“the College) in 1982 as a Registered Practical Nurse. In 1988, she then completed her RN Diploma at [ ] in [ ], Ontario.

2. In 1989, the Member was hired at [ ] working on a part-time basis on a general medical unit before transferring to a peritoneal dialysis unit. In 1999, the Member left nursing to work in the private sector.

3. The Member returned to active nursing in December 2002, when she was hired at [the] Hospital in [ ] (“[the Hospital]”) to work as a full-time staff nurse on [the unit].

4. [The unit] is a general medical floor with 36 patient care beds. Although the unit admits all patients with medical problems, the majority of the patients are elderly.

EVENTS OF OCTOBER 24, 2003

5. On October 24, 2003, the Member’s assignment included a client known as [ ]. The Member was scheduled to work the evening shift from 15:00 to 23:00 hours.

6. At the time of the incident, [the client] was a frail [ ] female admitted to [the Hospital] because she had stopped eating and drinking. Her family was concerned about dehydration. [The client] had suffered significant cognitive decline, memory loss, and confusion in the years preceding this admission to [the Hospital].

7. At approximately 22:30 hours, [ ], a student nurse completing his clinical consolidation at [the Hospital], heard noises emerging from [the client]’s room. Upon entering the room, he discovered that [the client] was extremely agitated and was attempting to disrobe. [The student nurse] tried to calm [the client] without success.

8. A short time later the Member attended in [the client]’s room in order to administer a medication to calm her.

9. [The student nurse] accompanied the Member to the room and was present throughout the administration of the medication. [The client] was extremely agitated, thereby making the administration of medication difficult. The Member administered the medication to [the client] in a manner which deviated from professional standards. Immediately following the placement of Zyprexia Zydis in the client’s mouth, she became significantly more agitated and grabbed the Member’s uniform. The Member acknowledges that her assessment of the patient’s cognitive state may not have been accurate and that a more cautious approach to the administration of this medication would have been prudent. In particular, the Member acknowledges that consent to the administration of medication is a fundamental component of medication administration practice. [The student nurse] would testify that he did not assist the Member with administering medication to [the client] because he disagreed with her approach. Troubled by the Member’s behaviour, [the student nurse] left the room. The Member has learned a great deal from this experience and is able to say that she agrees with the College that [the student nurse]’s response to this troubling situation was reasonable and appropriate in the circumstances.

10. Shortly afterwards, the Member sought out [the student nurse] in a hallway. She was visibly angry at what she perceived to be his lack of assistance. The Member did not seek out [the student nurse]’s preceptor so that the three of them could discuss the issues. Rather, the Member loudly accused [the student nurse] of failing to assist her.

11. Shortly thereafter, the Member spoke with various other staff members including those arriving for the night shift. She told them that [the student nurse] had “abandoned her” while she was being physically assaulted by a patient. [The student nurse]’s reputation amongst some of the staff members on [the unit] suffered as a result of the Member’s accusations.

EVENTS OF OCTOBER 27, 2003

12. On Monday October 27, 2003, the Member complained to the Nurse Manager that [the student nurse] had abandoned her while dealing with an unsafe patient. The Nurse Manager called a meeting with [the student nurse] to discuss the events of the preceding Friday. The Nurse Manager invited the Member to attend the meeting.

13. At the meeting, the Member disputed [the student nurse]’s version of events. She did not acknowledge that she had behaved in a manner that deviated from professional standards when administering medication to [the client]. The Member maintained that [the student nurse] had abandoned her while she was being assaulted by [the client]. [The student nurse] was verbally reprimanded at the meeting as a result.

14. On December 17, 2003, [the student nurse] made a formal complaint to the College in relation to the Member’s conduct in her care of [the client], as well as her treatment of him.

EVENTS OFMARCH 23, 2004

15. On March 23, 2004, [Nurse B], a nurse co-worker of the Member’s, received a phone call from a CNO investigator. [Nurse B] approached her manager to inquire as to what the call was about. She then queried the Member.

16. The Member advised [Nurse B] that the call was likely related to her, as [the student nurse] had complained to the College and an incident was being investigated.

17. The Member then informed [Nurse B] that if the situation “hit the fan” she would “take people down with her.” [Nurse B] perceived this comment as being generally of a threatening nature. She did not, however, perceive the comment to be a personal threat towards her. [Nurse B] and the Member continued to work together without incident or conflict until the Member’s resignation on December 3, 2004.

EVENTS OF APRIL 5, 2004

18. On April 5, 2004, the Member shared a dinner break with nurse co-worker [Nurse A]. Although the Member does not specifically recall this conversation, she acknowledges that it is certainly possible that while speaking to [Nurse A], she asked [Nurse A] about [the student nurse], and [Nurse A] indicated that [the student nurse] was doing well.

19. In addition, the Member asked [Nurse A] whether or not it was true that [Nurse A] had made negative comments about her in relation to the incident in October. The Member added that if anyone was saying anything about her, she would “go after them”. She added that she was going after [the student nurse] and she did not care how much it cost. She was willing to spend $20,000 to $30,000 [in legal fees] because what [the student nurse] was doing to her was defamation of character.

20. [Nurse A] responded that this appeared to be revenge on the Member’s part. The Member replied that it was not revenge, but that [the student nurse] “better have all his ducks in a row and you can tell him that.”

21. [Nurse A] felt threatened by the Member’s comments at the time. There were no further discussions between them related to this issue and [Nurse A] and the Member continued to work together without incident or conflict until the Member’s resignation on December 3, 2004.

ADMISSIONS

22. The Member acknowledges that she 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, while employed as a Registered Nurse at [the] Hospital, in [ ], Ontario, she engaged in conduct and/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 and unprofessional, in that she:

(a) on or about October 24, 2003 administered medication to a client [ ] in a manner which deviated from the standards of practice;

(b) on or about April 5, 2003 (sic) she told a nurse colleague, [Nurse A], that she would retaliate with legal action if [Nurse A] or any other colleague made statements contrary to her interests;

(c) on or about April 5, 2003 (sic) she indirectly threatened [ ], a student nurse, whom she knew had complained to the College of Nurses of Ontario, by making known to [Nurse A] that she would take legal action to “go after [the student nurse]” or words to that effect;

(d) on or about March 24, 2004, she spoke inappropriately to a nurse colleague, [Nurse B], by indicating that “she would drag everyone with her” or words to that effect if [Nurse B] or any other colleague acted against her interests with respect to the allegations of [the student nurse].

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 the paragraphs numbered 2, 3, and 4 of the Notice of Hearing in that:

• on October 24, 2003, the Member administered a medication to [the client] in a manner which deviated from the professional standards of practice;

• shortly afterwards, the Member was visibly angry and accused [the student nurse] of failing to assist her when the patient was aggressive;

• the Member took advantage of her power and authority over the nursing student by complaining about him to her manager and other staff members, so that he was reprimanded for something he did not do;

• after [the student nurse] reported the Member to the College on December 17, 2003, the Member made indirect threats to [the student nurse] through other nurse co-workers; and

• in conversations with [Nurse A] and [Nurse B], the Member threatened to retaliate against any co-workers who acted against her interests.

Reasons for Decision

The panel deliberated and after due consideration of all the facts and the Member’s admission to the allegations contained in the paragraphs numbered 2, 3, and 4, unanimously decided to accept the Agreed Statement of Facts as presented, which substantiated the findings of professional misconduct.

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:

Linda Walschots (“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 (“the Panel”) should make an Order as follows:

1. Requiring the Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within three months of the date that the Order becomes final.

2. Directing the Executive Director to suspend the Member’s certificate of registration for a period of 4 months commencing on the date the Order becomes final. The suspension shall run continuously so long as the Member maintains a current registration. In the event that the Member fails to maintain a current registration, any portion of the suspension which has not yet been served, shall be served commencing on the day that the registration is renewed.

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

(i) The Member shall meet with the Director of Investigations and Hearings (“the Director”), or the Director’s designate, on or before August 31, 2006 to discuss:

(a) the conduct for which she was found to have committed professional misconduct;

(b) the potential consequences of that conduct to her clients, her colleagues, her profession, and herself; and

(c) the importance of accountability in a self-regulated profession.

(ii) Prior to the Member’s attendance at the meeting referred to in paragraph 3(i), above, the Member shall review the College fact sheet entitled Practice Guidelines: Working with Students as well as the Professional Standards, focusing on the accountability, ethics, leadership and professional relationships sections and shall reflect upon, and be prepared to discuss, the application of these documents to the conduct for which she was found to have committed professional misconduct.

(iii) For the first eighteen (18) months after the Member returns to the practice of nursing, the Member shall:

(a) advise the Director, in writing, of the name, address and telephone number of any employer(s) for whom the Member is employed as a nurse within fourteen (14) days of commencing her employment through the use of registered mail, courier service, or another verifiable method of delivery;

(b) provide any employer with a copy of the Panel’s Penalty Order (including the Agreed Statement of Facts and Joint Submission on Penalty) or, if available, a copy of the Panel’s Decision and Reasons in this matter; and

(c) when practising nursing, only work for an employer who agrees to:

(A) write to the Director within seven (7) days of the Member commencing employment indicating that the Employer has received a copy of the Panel’s Penalty Order (including the Agreed Statement of Facts, and Joint Submission on Penalty) or, if available a copy of the Panel’s Decision and Reasons in this matter; and

(B) the employer agrees to notify the Director immediately, in writing, upon receiving any reasonable information that the Member has committed an act of professional misconduct.

Counsel for the College submitted that the Joint Submission on Penalty was reasonable under the following circumstances:

Aggravating circumstances

• The Member administered medication to a weak, cognitively impaired elderly person, [the client,] without her consent. These actions were witnessed by [the student nurse] who did not assist and left the room because he did not agree with the Member’s actions. The Member did not speak with the student or his preceptor about the event but accused him of “abandoning her” when the client “physically assaulted her.”

• The Member also spoke about [the student nurse] with various other staff, negatively affecting his reputation on the unit.

• The Member was in a position of power when dealing with the student and took advantage of this position by reporting him to the Nurse Manager three days later. Even then, the member did not acknowledge that she did not follow standards and allowed the student to be reprimanded by the Nurse Manager.

• Two months later, the student made a complaint to the College. This was another opportunity for the Member to acknowledge her wrong-doing. Instead, when she learned of the investigation, she made threatening remarks to those involved in the investigation.

• The Member did not follow the tenets of the profession which include admission of errors, self reflection, and to support learning nurses.

Mitigating factors

• The Member eventually accepted responsibility for her unprofessional and unfair actions in relation to the student.

• The Member wrote an apology to [the student nurse] [ ] which will be sent to [the student nurse] by the College upon completion of this hearing.

Counsel for the Member concurred and also submitted that:

• The Member has been a member of the profession for over 20 years and is proud of her contributions to the profession and to patient care during this time.

• For [the] past 2½ years, the Member’s professional and personal lives have been disrupted by the events, the investigation and the discipline proceedings.

• The Member has grown and learned from this experience. The Member has a deeper understanding of the role of the nurse and is wiser, calmer and more open as a result.

Penalty Decision

The panel accepts the Joint Submission as to Penalty [ ] and accordingly makes an order containing the following elements:

1. Requiring the Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within three months of the date that the Order becomes final.

2. Directing the Executive Director to suspend the Member’s certificate of registration for a period of 4 months commencing on the date the Order becomes final. The suspension shall run continuously so long as the Member maintains a current registration. In the event that the Member fails to maintain a current registration, any portion of the suspension which has not yet been served, shall be served commencing on the day that the registration is renewed.

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

(iv) The Member shall meet with the Director of Investigations and Hearings (“the Director”), or the Director’s designate, on or before August 31, 2006 to discuss:

(a) the conduct for which she was found to have committed professional misconduct;

(b) the potential consequences of that conduct to her clients, her colleagues, her profession, and herself; and

(c) the importance of accountability in a self-regulated profession.

(v) Prior to the Member’s attendance at the meeting referred to in paragraph 3(i), above, the Member shall review the College fact sheet entitled Practice Guidelines: Working with Students as well as the Professional Standards, focusing on the accountability, ethics, leadership and professional relationships sections, and shall reflect upon and be prepared to discuss the application of these documents to the conduct for which she was found to have committed professional misconduct.

(vi) For the first eighteen (18) months after the Member returns to the practice of nursing, the Member shall:

(a) advise the Director, in writing, of the name, address and telephone number of any employer(s) for whom the Member is employed as a nurse within fourteen (14) days of commencing her employment, through the use of registered mail, courier service, or another verifiable method of delivery;

(b) provide any employer with a copy of the Panel’s Penalty Order (including the Agreed Statement of Facts and Joint Submission on Penalty) or, if available, a copy of the Panel’s Decision and Reasons in this matter; and

(c) when practising nursing, only work for an employer who agrees to:

(A) write to the Director within seven (7) days of the Member commencing employment indicating that the Employer has received a copy of the Panel’s Penalty Order (including the Agreed Statement of Facts, and Joint Submission on Penalty) or, if available a copy of the Panel’s Decision and Reasons in this matter; and

(B) the employer agrees to notify the Director immediately, in writing, upon receiving any reasonable information that the Member has committed an act of professional misconduct.

Reasons for Penalty Decision

The panel considered the Joint Submission on Penalty and the submissions of both counsel. 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 her actions and has avoided unnecessary expense to the College. The suspension and the imposed terms, conditions and limitations, provide specific deterrence to the Member and general deterrence to the membership. The reporting requirement of the penalty order provide protection for the public. The requirement that the Member participate in self-reflection and remedial education will ensure rehabilitation and provide protection to the public.

I, Joanne Furletti, 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

Karen Breen-Reid, RN

Karen Harder, Public Member

Grace Isgro-Topping, Public Member

GRACE ISGRO-TOPPING Public Member