DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
PANEL: George Fieber, RN Chairperson Deirdre Armstrong, RN Member Susan Silver, RN Member Jerry Dobie Public Member Grace Isgro-Topping Public Member
BETWEEN:
COLLEGE OF NURSES OF ONTARIO ) ANIL KAPOOR for ) College of Nurses of Ontario
- and - )
THE MEMBER ) PAULA TRATTNER for Registration No. [ ] ) [the Member]
) Heard: September 8, 2006
DECISION AND REASONS
This matter came on for hearing before a panel of the Discipline Committee on September 8, 2006 at the College of Nurses of Ontario (the “College”) at Toronto.
The Allegations
The allegations against [the “Member”] as stated in the Notice of Hearing dated August 2, 2006 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 Regulated Health Professions Act, 1991, S.O. 1991, c.18, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93 in that while employed by the [institution] you failed to maintain the standards of the profession, in that:
a) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client A];
b) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client A];
c) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client B];
d) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client B];
e) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client C];
f) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client C];
g) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client D];
h) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client D];
i) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client E];
j) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client E];
k) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client F];
l) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client F];
m) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client G];
n) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client G];
o) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client H];
p) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client H];
q) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client I];
r) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client I];
s) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client J];
t) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client J];
u) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client K];
v) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client K];
w) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client L];
x) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client L];
y) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client M];
z) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client M];
aa) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client N];
bb) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client N];
cc) On or about March 16, 2004 you directed a profanity at a co-worker during a staff meeting, namely you said “How fucking dare you? How fucking dare you?” or words to that effect.
- You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Regulated Health Professions Act, 1991, S.O. 1991, c.18, as amended, and defined in subsection 1(10) of Ontario Regulation 799/93 in that while employed by the [institution] you gave information about a client to a person other than the client or his or her authorized representative without the consent of the client or his or her authorized representative or as required or allowed by law, in that:
a) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client A];
b) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client A];
c) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client B];
d) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client B];
e) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client C];
f) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client C];
g) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client D];
h) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client D];
i) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client E];
j) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client E];
k) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client F];
l) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client F];
m) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client G];
n) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client G];
o) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client H];
p) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client H];
q) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client I];
r) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client I];
s) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client J];
t) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client J];
u) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client K];
v) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client K];
w) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client L];
x) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client L];
y) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client M];
z) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client M];
aa) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client N];
bb) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client N].
- You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Regulated Health Professions Act, 1991, S.O. 1991, c.18, as amended, and defined in subsection 1(37) of the Ontario Regulations 799/93 while employed by the [institution] in that you engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, in that:
a) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client A];
b) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client A];
c) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client B];
d) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client B];
e) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client C];
f) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client C];
g) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client D];
h) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client D];
i) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client E];
j) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client E];
k) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client F];
l) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client F];
m) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client G];
n) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client G];
o) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client H];
p) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client H];
q) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client I];
r) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client I];
s) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client J];
t) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client J];
u) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client K];
v) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client K];
w) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client L];
x) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client L];
y) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client M];
z) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client M];
aa) On or about December 23, 2003 you failed to maintain the confidentiality of the health history of [Client N];
bb) On or about December 30, 2003 you failed to maintain the confidentiality of the health history of [Client N];
cc) On or about March 16, 2004 you directed a profanity at a co-worker during a staff meeting, namely you said “How fucking dare you? How fucking dare you?” or words to that effect.
Member’s Plea
[The Member] admitted the allegations set out in paragraphs numbered 1, 2 and 3 in the Notice of Hearing. 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
[The Member] has been registered with the College of Nurses of Ontario (the “College”) since January 1, 1972. The Member recently retired and is currently no longer practising as a nurse.
The Member commenced her employment with [ ] Hospital in 1974, and worked continuously for the facility until her retirement in May 2006. She began her career as a general duty staff nurse, was promoted to the position of Occupational Health Nurse in 1994 and in 1996 became the Director of Occupational Health. In 1998 her role was expanded to Director of Occupational Health and Infection Control. The Member became the Regional Co-Coordinator of Occupational Health and Infection Control for [a group of hospitals] in 2000. In July 2003 she became the Director of Occupational Health and Infections Control for the [institution], which position she held until her retirement in May 2006.
As the Director of Occupational Health and Infection Control for the [institution] the Member was responsible for infection control for 180 beds and occupational health for 1100 staff in the [institution]. [ ]
The ICU and Telemetry Units [ ]
The ICU and Telemetry Units at the [ ] Hospital [ ] of the [institution] (collectively the “Units”) were open and attached to one another. The ICU consisted of 5 beds. The Telemetry Unit had 8 beds and 2 flex beds. Patients in both units shared washroom facilities with the exception of one private room with a bathroom.
The ICU did not allow for the practice of infection control, with the exception of the private room. The patients were separated by curtains and there was no ante-room where staff could clean off before entering or exiting the Unit.
Normal staffing of the Units were as follows:
3 RNs on staff at all times in the ICU;
2 RNs on staff at all times in the Telemetry Unit;
1 Clinical Nurse on shift during the day for 8 hours, who was shared between the ICU and Telemetry Unit.
In December 2003, the Units were staffed by 16 full-time nurses, 10 job-sharing nurses, 8 regular part-time nurses and approximately 8 casual part-time nurses. Some of the ICU staff worked simultaneously in other facilities in the area.
In December 2003, the Units had one Clinical Resource Nurse for eight hours, Monday to Friday. The charge duties for the rest of the shifts were assigned to other Registered Nurses. It is the Member’s recollection that in the period from December 24, 2003 – January 2, 2004, at least 6 other Registered Nurses were required to be in charge of the Units over those days.
Hospital Policy
- The [institution] required that hospital staff be immunized on an annual basis.
Allegations 1 (a), (c), (e), (g), (i), (k), (m), (o), (q), (s), (u), (w), (y), (aa); 2(a), (c), (e), (g), (i), (k), (m), (o), (q), (s), (u), (w), (y), (aa)
On December 23, 2003, the Member issued an email addressed to [ ] (a group which would include all of the Units’ Registered Nurses and Clerks) and [ ], Program Director, Medical Critical Care. In that email the Member listed the names of fourteen staff members whom she believed had not received an influenza vaccination and who would therefore not be able to work in the event of an outbreak. The Member explained in the email that she was about to go on holidays and wished to ensure that those staff members who had not been vaccinated were not called for shifts in the event of an influenza outbreak. The Member would not be able to attend at the Hospital to access the list of staff who had not been immunized due to her vacation plans.
The Member received several emails from staff members between December 24 – 25, 2003, complaining that her email of December 23, 2003 was a possible breach of confidentiality, including one from [Nurse Z]. [Nurse Z] had been employed as an RN in the Units for four years at the time of this incident.
[Nurse Z] was not one of the staff members listed in the December 23rd email as not having received an influenza vaccination.
The email from [Nurse Z], dated December 25, 2003, began with the following statement:
“It was with great dismay that I read the attached e-mail. It would seem that a breach of confidentiality has occurred, which, according to the College of Nurses, is Professional Misconduct…”
- [Nurse Z]’s email of December 25th was not only sent to the Member and all those who had received the Member’s email of December 23rd but also [the institution]’s Chief Executive Officer and Vice President of Clinical Practice.
Allegations 1(b), (d), (f), (h), (j), (l), (n), (p), (r), (t), (v), (x), (z), (bb); 2(b), (d), (f), (h), (j), (l), (n), (p), (r), (t), (v), (x), (z), (bb)
- In response to the emails complaining of a possible breach of confidentiality, the Member sent a second email on December 30, 2003, which was again copied to all of the Units’ Registered Nurses and Clerks. In her second email the Member stated, “There is no breach of confidentiality because none of the nurses on the list had a medical reason for not getting vaccinated.”
Allegation 1(cc)
- [Nurse Z] prepared a letter dated January 2, 2004, which was signed by seven of the Unit’s nurses. The January 2, 2004 correspondence was a written complaint that both the first email of December 23, 2003 and the second email sent December 30, 2003 constituted a breach of confidentiality. The January 2, 2004 correspondence was addressed to the Member and copied to all of the Units’ Registered Nurses and Clerks as well as [the institution]’s Chief Executive Officer and Vice President of Clinical Practice. The final paragraph of the January 2, 2004 correspondence stated:
“Acknowledgement of the breach of confidentiality and Professional Misconduct must be forthcoming. It is hoped that a satisfactory conclusion can be reached within our own institution.”
In response to the January 2, 2004 correspondence, [the institution] arranged a staff meeting which took place on March 16, 2004. [ ], the Vice President of Human Resources; [ ], Program Director, Medical Critical Care; [ ], President ONA Local Chapter; [Nurse D]; [Nurse Y]; and [Nurse Z] were in attendance.
The Member read a prepared statement during the meeting, in which she stated that it was her understanding that she had not breached confidentiality as there was no nurse/patient relationship between her and the individuals listed in the December 23, 2003 email. The Member stated that she received confirmation from the College of Nurses of Ontario that she had not breached confidentiality as she had not given the individuals listed in the December 23, 2003 email an influenza vaccination and had therefore not “treated” them.
The Member became very emotional while reading her prepared statement during the meeting. She looked at [Nurse Z] and stated, “How fucking dare you?” She approached [Nurse Z] and repeated her comment. She then left the room. The Member was out of the room for approximately twenty minutes. After composing herself, the Member returned to the room and apologized to each individual in attendance for using inappropriate language during the meeting and offered to send a written apology to each of them. The Member understood that her verbal apology had been accepted by each individual in attendance, including [Nurse Z].
Facility Response
[The institution’s] administration supported the Member and demanded a written apology from [Nurse Z] to the Member.
[Nurse Z] went off on stress leave [ ] on March 17, 2004.
By letter dated June 21, 2004, [Nurse Z] resigned from her position with the [institution] effective July 4, 2004, following which she wrote her letter of complaint to the College of Nurses on July 11, 2004.
On March 18, 2005 the Member sent a written letter of apology to [Nurse Z]. [ ]
On March 29, 2005, [Nurse Z] sent the Member a letter confirming receipt of her letter of March 18, 2005. [ ]
Admissions
The Member acknowledges that she committed acts of professional misconduct as set out in allegation 1 of the Notice of Hearing, in that she contravened a standard of practice of the profession or failed to meet the standard of practice of the profession regarding the maintenance of confidentiality of the private health information of her clients, the fourteen staff members of the Units whose names were listed in her email of December 23, 2003, and in that she directed a profanity at another member during a staff meeting.
The Member acknowledges that she committed acts of professional misconduct as set out in allegation 2 of the Notice of Hearing, in that she failed to maintain confidentiality of the private health information of her clients, the fourteen staff members of the Units whose names were listed in her email of December 23, 2003.
The Member’s acknowledgment with respect to having contravened a standard of practice of the profession or failed to meet the standard of practice of the profession regarding the maintenance of confidentiality of the private health information of her clients, the fourteen staff members of the Units whose names were listed in her e-mail of December 23, 2003, relates only to the manner and scope of the disclosure of the private health information of her clients, the fourteen staff members of the Units whose names were listed in her email of December 23, 2003, and not the fact of the disclosure.
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, 2 and 3 of the Notice of Hearing in that:
[She] failed to maintain the standards of the profession;
[She] gave information about a client to a person other than the client or his or her authorized representative without the consent of the client or his or her authorized representative or as required or allowed by law; and
[She] engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
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:
[The Member] and the College of Nurses of Ontario respectfully submit that, in view of the circumstances set out in the Agreed Statement of Fact, the Member’s admissions of professional misconduct, and the submissions of counsel for the College of Nurses of Ontario and counsel for the Member, the Panel of the Discipline Committee (“the Panel”) should make an Order as follows:
- 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 of the order.
The Member’s counsel made a submission that the Member’s name not be published for the following reasons:
the Panel can exercise its discretion as to whether or not the Member’s name should be published;
patient safety was the Member’s primary concern during all the events outlined in the Agreed Statement of Facts;
the Member has retired and a serious medical condition will not allow her to return to the profession of nursing, therefore there is no likelihood of reoffending;
the Member has demonstrated remorse for her professional misconduct; and
her serious medical condition may have contributed to this isolated episode of aberrant behaviour.
Penalty Decision
The panel accepts the Joint Submission as to Penalty and accordingly orders: The Member will appear before the Panel to be reprimanded. The Member’s name will not be published.
Reasons for Penalty Decision
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. After hearing submissions from the Member’s counsel and College Counsel regarding the publication of the Member’s name, the Panel has decided to exercise its discretion and not publish the Member’s name. The reprimand alone, in light of the arguments for mitigation provided by the Member’ counsel is sufficient to protect the public interest.
I, George Fieber, 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
Panel Members:
Deirdre Armstrong, RN Member
Susan Silver, RN Member
Jerry Dobie Public Member
Grace Isgro-Topping Public Member