College of Nurses of Ontario v. Peter Mark Edwards, 2011 ONCNO 99676

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Zahir Hirji, RN Chairperson Marianne Fletcher, RN Member Joan King Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO BONNI ELLIS for College of Nurses of Ontario

• and -

PETER MARK EDWARDS Registration No. 8706681 ROBERT STEPHENSON for Peter Mark Edwards

BRIAN GOVER Independent Legal Counsel

Heard: January 9, 2012

AMENDED DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on January 9, 2012 at the College of Nurses of Ontario (“the College”) at Toronto.

The Allegations

Counsel for the College advised the panel that the College was requesting leave to withdraw the allegations set out in paragraphs 3 of the Notice of Hearing dated November 24, 2011. The panel granted this request. The remaining allegations against Peter Mark Edwards (the “Member”) as set out in the 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 paragraph 1.1 of Ontario Regulation 799/93 in that, while working as a nurse at [the Facility,] you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession when,

(a) during or about the last week of May 2010, you told [the Client] that [the Client] looked gorgeous, or used words to that effect, when [the Client] returned to the unit after getting a haircut;

(b) in or about May, 2010, you hugged [the Client] on at least two occasions;

(c) on or about May 28, 2010 you told [the Client] that [the Client] was very special to you or used words to that effect and/or suggested to [the Client] that [the Client] should wave to you if [the Client] saw you in the community in your red [car]; and/or

(d) on or about May 28, 2010, you did the following in relation to [the Client] when bringing PRN medication to [the Client’s] room:

i. kissed [the Client] on the forehead;

ii. tucked [the Client] in [ ] bed;

iii. stroked [the Client’s] hip; and/or

iv. [made an inappropriate remark about the Client].

2. 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 paragraph 1.7 of Ontario Regulation 799/93 in that, while working as a nurse at [the Facility], you abused a client emotionally and, in particular,

(a) during or about the last week of May 2010, you told [the Client] that [the Client] looked gorgeous, or used words to that effect, when [the Client] returned to the unit after getting a haircut;

(b) in or about May, 2010, you hugged [the Client] on at least two occasions;

(c) on or about May 28, 2010 you told [the Client] that [the Client] was very special to you or used words to that effect and/or suggested to [the Client] that [the Client] should wave to you if [the Client] saw you in the community in your red [car]; and/or

(d) on or about May 28, 2010 you did the following in relation to [the Client] when bringing PRN medication to [the Client’s] room:

i. kissed [the Client] on the forehead;

ii. tucked [the Client] in [ ] bed;

iii. stroked [the Client’s] hip; and/or

iv. [made an inappropriate remark about the Client].

3. [Withdrawn]

4. 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 paragraph 1.37 of Ontario Regulation 799/93 in that, while working as a nurse at [the Facility], you engaged in conduct or performed an act, 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 and, in particular,

(a) during or about the last week of May 2010, you told [the Client] that [the Client] looked gorgeous, or used words to that effect, when [the Client] returned to the unit after getting a haircut;

(b) in or about May, 2010, you hugged [the Client] on at least two occasions;

(c) on or about May 28, 2010 you told [the Client] that [the Client] was very special to you or used words to that effect and/or suggested to [the Client] that [the Client] should wave to you if [the Client] saw you in the community in your red [car]; and/or

(d) on or about May 28, 2010 you did the following in relation to [the Client] when bringing RPN medication to [the Client’s] room:

i. kissed [the Client] on the forehead;

ii. tucked [the Client] in [ ] bed;

iii. stroked [the Client’s] hip; and/or

iv. [made an inappropriate remark about the Client].

Counsel for the College advised the panel that the College was not calling any evidence with respect to the allegation of disgraceful conduct as set out in paragraph 4 of the Notice of Hearing.

Member’s Plea

The Member admitted the allegations set out in paragraphs #1 (a); (b); (c); (d) (i), (ii), (iii), (iv); #2 (a); (b); (c); (d) (i), (ii), (iii), (iv); and admitted to dishonourable and unprofessional conduct in paragraph #4 (a); (b); (c); (d) (i), (ii), (iii), (iv) in the Notice of Hearing.

The panel received a written plea inquiry which was signed by the Member. The panel also 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. Peter Mark Edwards (the “Member”) received his nursing diploma [ ] in 1986 and registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on October 8 that same year.

2. The Member has been employed at the [the Facility] in [ ] Ontario since June 26, 2006 and in [the Unit], since April 11, 2010. He has worked in psychiatric nursing for most of his career.

THE FACILITY

3. At the time of the incidents described below, the Member was working as a full-time RN in [the unit] which is a Schedule-1 psychiatric unit. [The unit] provides inpatient, outpatient and mobile crisis response services as well as a 24-hour toll-free crisis line for clients suffering from acute psychiatric illness.

THE CLIENT

4. [The Client] was [ ] an inpatient at [the unit] at the time of the incidents, which occurred in or about May 2010.

5. [T]he Client had admitted herself to the Facility on a voluntary basis after ending a 15-year abusive relationship. According to the Client, [the Client] hoped that the admissions would help [ ] to address this event as well as past traumatic experiences [ ].

6. The Client had previous admissions to the Facility, approximately ten years earlier, in relation to [ ] Bipolar Disorder, substance abuse and [a] history of binge drinking and bulimia. [The Client] was also noted to be an adult survivor of sexual abuse.

7. At the time of [the] May 2010 admission, [the Client] was taking 500mg Epival twice daily as a mood stabilizer as well as 100mg Luvox for depression and 0.5 mg of Clonazepam on an as needed basis (usually about three per day) for anxiety.

8. The Client remained at [the unit] until [ ] discharged [ ] with a primary diagnosis of Polysubstance Abuse Disorder (in remission) and Adjustment Disorder with Depressed Mood (resolved).

9. During [the Client’s] May 2010 admission, the Member was working on [the unit] as an RN and as Team Leader.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

10. Between May 15 and May 28, 2010, the following incidents and exchanges occurred between the Client and the Member.

11. A few days before [ ] discharge from the Facility, the Client had just had a haircut. The Member told [the Client] that [the Client] “looked gorgeous.” The comment was made in the presence of other people.

12. If the Client were to testify, [the Client] would say that the comment made [the Client] feel uncomfortable.

13. If the Member were to testify, he would say that the Client and two other clients had haircuts that day and that he had complimented all three [clients]. The Member would further state that his comment was intended to lift the Client’s self-esteem.

14. On another occasion, the Member hugged the Client in the Client’s room in the presence of another RN. If the Member were to testify, he would say that he also hugged the Client on one other occasion in the hallway of the Facility in the presence of another client. If the Client were to testify, the Client would say that the Member hugged [the Client] on several occasions, a fact that [the Client] relayed to [the Client’s] roommate.

15. If the Member and the Client’s roommate were to testify, they would say that it was not uncommon for staff to give a supportive hug to clients on the unit. The Member would say [ ] that any hugs between himself and the Client were intended to comfort [the Client].

16. If the Client were to testify, [the Client] would say that [the Client] found the hugs inappropriate, confusing and disturbing, concerns [the Client] did not express in relation to any other staff.

17. On Friday, May 28, 2010, before the Client’s scheduled Monday discharge, the Member told [the Client] that [the Client] was very special to him and that if [the Client] saw him on the street in his little red [car], [the Client] should wave.

18. If the Member were to testify, he would say that the comments were made in a joking and light-hearted manner. He would also state that he and the Client live in the same small town and that many clients know personal details about staff from the Facility, including the type of car they drive. It is also commonplace for staff to see clients in the community and for clients to know the friends, families, or acquaintances of staff members.

19. Later that evening, the Client was in [the Client’s] room and requested ibuprofen for a headache. The Member administered the medication, even though it would be unusual for him to do so as he was the Team Lead and not the designated medication nurse, who is responsible for dispensing all medications. Once the Client had taken the ibuprofen, the Member kissed the Client’s forehead, tucked [the Client] into [ ] bed, stroked [the Client’s] hip and [made an inappropriate remark about the Client].

20. If the Member were to testify, he would say that all registered staff can and do give medication during any shift if staff are busy or on break. There is no record in the automatic dispensing system of the Member administering this ibuprofen.

21. The Client reported this incident to another RN immediately after it occurred, indicating that [the Client] felt violated and unsafe. [The Client] also stated that [the Client] found the Member’s comments and actions to be insulting and degrading. The nurse who received the Client’s concerns indicated that [the Client] was crying and shaking when reporting what had occurred. The Client reported that the incident triggered flashbacks to a sexual assault [the Client] had experienced 20 years prior.

22. If the Member were to testify, he would say that he intended nothing romantic or sexual by his actions and, instead, was trying to be sympathetic after finding the Client in distress.

23. If the Client were to testify, [the Client] would say that [the Client’s] concerns regarding the Member’s conduct towards [the Client] escalated as more incidents occurred, thus causing [the Client] to feel more and more uncomfortable.

24. The Client would also say that these incidents had a significant impact on [the Client]; that [the Client] felt betrayed by the Member and struggled with [ ] emotions for some time post-discharge. In particular, the Client would say that [the Client] had voluntarily sought treatment at the Facility for past traumas but felt as though [the Client] suffered from additional trauma because of the Member’s conduct and that these events figured prominently in the follow-up counselling [the Client] received post-discharge with [an assault response & care centre], which included two initial assessment meetings and one subsequent session. The Client did not attend any of the further sessions that were offered [].

25. The Member would say that he has been accountable and forthcoming for his actions to the management at the Facility and to the College.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

26. The Member admits that he committed the acts of professional misconduct as alleged in paragraphs [1 and 2,] and dishonourable and unprofessional conduct as alleged in allegation 4 of the Notice of Hearing, as described in paragraphs 10 to 25 above.

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 (a), (b), (c), (d) ((i),(ii),(iii),(iv)) and #2 (a), (b), (c), (d) ((i),(ii),(iii),(iv)). Further, the panel finds the conduct in #4 (a), (b), (c), (d) ((i),(ii),(iii),(iv)) in the Notice of Hearing to be professional misconduct in that it would reasonably be regarded by members to be dishonourable and unprofessional.

Reasons for Decision

The evidence set out in the Agreed Statement of Facts clearly supports the allegations.

As to paragraph 4 of the Notice of Hearing the panel concluded that the Member’s actions were dishonourable and unprofessional. No evidence was presented that they were disgraceful and the Member admitted to only dishonourable and unprofessional conduct.

Penalty

Counsel for the College advised the panel that a Joint Submission as to Order had been agreed upon. The Joint Submission as to Order requests that this panel make an order as follows:

1. Requiring the Member to appear before the Panel to be reprimanded within three (3) months of the date of this Order.

2. Directing the Executive Director to suspend the Member’s certificate of registration for two (2) months. This suspension shall take effect from the date of this Order and shall continue to run without interruption.

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

a) The Member will attend three (3) sessions with a Nursing Expert (the “Expert”), at his own expense. The first session shall be within two (2) months of the date of this Order, and the remaining sessions shall be within six (6) months of the date of this Order. To comply, the Member is required to ensure that:

i. The Expert has expertise in the therapeutic nurse-client relationship and psychiatric nursing, has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings, and has confirmed he/she will provide a report following the sessions;

ii. At least 7 days before the first meeting, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Penalty, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following College publications and, if applicable, completes the associated Reflective Questionnaires and online learning modules:

1. Professional Standards (Revised 2002)

2. Therapeutic Nurse-Client Relationship (2005)

3. One is One Too Many

iv. At least 7 days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires and online participation forms;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. strategies for preventing similar misconduct from reoccurring, including the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Expert forwards his/her report to the Director, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into his behaviour;

vii. If the Member does not comply with any of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation[ ] on his certificate of registration;

b) For a period of 18 months from the date of this Order, the Member will notify his employers of this decision. To comply, the Member is required to ensure that:

(i) The Director is notified of the name, address, and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position;

(ii) Provide his employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Penalty, and

5. a copy of the Panel’s Decision and Reasons, once available;

(iii) Within fourteen (14) days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm:

1. that it received a copy of the required documents, and

2. that [it] agrees to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and

(iv) All documents delivered by the Member to the College, the Expert or the employer(s) will be made by verifiable method of delivery, the proof of which the Member will retain.

Penalty Submissions

College Counsel submitted that the Joint Submission on Order is in the public interest and in the range of orders for similar conduct made in the past. Counsel submitted that it addresses the main purposes of orders, including public protection and confidence, general and specific deterrence, and remediation.

Defense Counsel submitted that the panel should only reject the Joint Submission on Order if it were contrary to public interest and would bring the administration of justice into disrepute.

Penalty Decision

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

1. The Member shall appear before the Panel to be reprimanded within three (3) months of the date of this Order.

2. The Executive Director is directed to suspend the Member’s certificate of registration for two (2) months. This suspension shall take effect from the date of this Order and shall continue to run without interruption.

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

a) The Member will attend three (3) sessions with a Nursing Expert (the “Expert”), at his own expense. The first session shall be within two (2) months of the date of this Order, and the remaining sessions shall be within six (6) months of the date of this Order. To comply, the Member is required to ensure that:

i. The Expert has expertise in the therapeutic nurse-client relationship and psychiatric nursing, has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings, and has confirmed he/she will provide a report following the sessions;

ii. At least 7 days before the first meeting, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Penalty, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following College publications and, if applicable, completes the associated Reflective Questionnaires and online learning modules:

1. Professional Standards (Revised 2002)

2. Therapeutic Nurse-Client Relationship (2005)

3. One is One Too Many

iv. At least 7 days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires and online participation forms;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. strategies for preventing similar misconduct from reoccurring, including the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Expert forwards his/her report to the Director, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into his behaviour;

vii. If the Member does not comply with any of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation[ ] on his certificate of registration;

b) For a period of 18 months from the date of this Order, the Member will notify his employers of this decision. To comply, the Member is required to ensure that:

(i) The Director is notified of the name, address, and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position;

(ii) Provide his employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Penalty, and

5. a copy of the Panel’s Decision and Reasons, once available;

(iii) Within fourteen (14) days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm:

1. that it received a copy of the required documents, and

2. that [it] agrees to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and

(iv) All documents delivered by the Member to the College, the Expert or the employer(s) will be made by verifiable method of delivery, the proof of which the Member will 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 his actions.

The penalty provides protection for the public. It also provides general and specific deterrence and rehabilitation opportunities for the Member. The penalty sends a strong message to the profession that nurses must practi[s]e according to the standards regardless of their practice setting and that at all times appropriate boundaries in the nurse-client relationship must be maintained.

I, Zahir Hirji, 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:

Marianne Fletcher, RN Joan King, Public Member