DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
PANEL: Margaret McGinn, RN Chairperson Angela Verrier, RPN Member Tracy Richardson, RN Member Gino Cucchi Public Member Abdul Patel Public Member
BETWEEN:
COLLEGE OF NURSES OF ONTARIO ) MATTHEW SAMMON for ) College of Nurses of Ontario
- and - )
PATRICIA ANN TENNANT ) NO REPRESENTATION for Registration No. 9101049 ) Patricia Ann Tennant ) CHRISTOPHER WIRTH ) Independent Legal Counsel ) Heard: April 4-8, 2011 and ) July 7, 2011
DECISION AND REASONS
This matter came on for hearing before a panel of the Discipline Committee on April 04-08, 2011 at the College of Nurses of Ontario (“the College”) at Toronto.
As Patricia Tennant (the “Member”) was not present, the hearing recessed for 20 minutes to allow time for the Member to appear. Upon reconvening the panel noted that the Member was not in attendance nor was she represented by counsel.
Counsel for the College provided the panel with evidence that the Member had been sent the Notice of Hearing on December 22, 2010. [ ] The panel was satisfied that the Member had received adequate notice and therefore proceeded with the hearing in the Member’s absence.
The Allegations
The allegations against the “Member” as stated in the Notice of Hearing dated December 20, 2010 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 Nursing Act, 1991, S.O. 1991, c.32, as amended, and defined in paragraph 1(1) of Ontario Regulation 799/93 in that you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, while working at [the Facility] in [ ] Ontario, with respect to the following incidents:
a) You failed to provide adequate training and supervision to unregulated care providers who provided care for the residents of the facility in 2008 and/or 2009; and/or
b) You inappropriately delegated nursing tasks to unregulated care providers of the facility in 2008 and/or 2009; and/or
c) You failed to provide appropriate nursing care to the residents of the facility in 2008 and/or 2009; and/or
d) You failed to properly document the care you were providing to the residents of the facility in 2008 and/or 2009; and/or
e) You improperly confined [Resident A] to his room in or around January 2009; and/or
f) You threatened to restrain or confine [Resident A] in 2008 and/or 2009; and/or
g) You restrained [Resident A], without a physician’s order and without consent, in 2008 and/or 2009; and/or
h) You directed or allowed staff at the facility to restrain or threaten to restrain [Resident A], confiscate his property, threaten him, and/or humiliate him; and/or
i) You directed or allowed staff at the facility to physically, verbally and/or emotionally abuse [Resident A] in 2008 and/or 2009; and/or
j) You failed to maintain proper sanitation and hygiene in the facility in 2008 and/or 2009;
k) You failed to provide appropriate food and nourishment to residents under your care in the facility in 2008 and/or 2009; and/or
l) You denied or withheld food from a resident or residents under your care in the facility in 2008 and/or 2009; and/or
m) You made inappropriate comments to a resident who fell in the hallway of the facility while using her walker, blaming her for the incident and telling her to “get to her room” (or words to that effect) on or about April 14, 2009; and/or
n) You encouraged or otherwise allowed residents of the facility to share or re-use needles in 2008 and/or 2009; and/or
o) You failed to provide for appropriate supervision of residents with dementia or similar conditions in 2008 and/or 2009; and/or
p) You failed to promptly report a fire in the facility to the fire department on or about April 1, 2009, and accordingly created a dangerous situation for residents of the facility.
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(2) of Ontario Regulation 799/93, in that, while working at [the Facility] in [ ] Ontario, you delegated a controlled act as set out in subsection 27 (2) of the Regulated Health Professions Act, 1991, in contravention of section 5 of the Act, by directing an unregulated care providers or providers to administer insulin injections, test residents’ blood sugar, and/or administer medication in 2008 and/or 2009.
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(7) of Ontario Regulation 799/93, in that, while working at [the Facility] in [ ] Ontario, you abused a client verbally, physically or emotionally with respect to the following incidents:
a) You improperly confined [Resident A] to his room in or around January 2009; and/or
b) You restrained [Resident A], without a physician’s order and without consent, in 2008 and/or 2009; and/or
c) You threatened to restrain [Resident A] in 2008 and/or 2009; and/or
d) You directed or allowed staff at the facility to restrain or threaten to restrain [Resident A], confiscate his property, threaten him, and/or humiliate him; and/or
e) You directed or allowed staff at the facility to physically, verbally and/or emotionally abuse [Resident A] in 2008 and/or 2009; and/or
f) You failed to provide appropriate food and nourishment to residents under your care in the facility in 2008 and/or 2009 ; and/or
g) You denied or withheld food from a resident or residents under your care in the facility in 2008 and/or 2009; and/or
h) You were verbally abusive to a resident who fell in the hallway of the facility while using her walker, blaming her for the incident and telling her to “get to her room” (or words to that effect) on or about April 14, 2009.
- 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(13) of Ontario Regulation 799/93 in that, while working at [the Facility] in [ ] Ontario, you failed to keep records as required, by:
a) Failing to regularly and completely document the nursing care you were providing to residents; and/or
b) Failing to appropriately document the use of restraints or confinement on a resident [Resident A]
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(16) of Ontario Regulation 799/93, in that you inappropriately used a term, title or designation in respect of your practice by holding yourself out as a nurse and engaging in the practice of nursing in 2007, 2008 and/or 2009, when your [certificate of registration] had been suspended for non-payment of fees since April 10, 2007.
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(19) of Ontario Regulation 799/93, in that you contravened a provision of the Nursing Act, the Regulated Health Professions Act, 1991 or the regulations under either of those Acts, by holding yourself out as a nurse, practi[s]ing as a nurse, and performing controlled acts in 2007, 2008 and/or 2009, when your [certificate of registration] had been suspended for non-payment of fees since April 10, 2007.
You 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 as defined in paragraph 1(37) of Ontario Regulation 799/93, in that you engaged in conduct or performed acts, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members of disgraceful, dishonourable and/or unprofessional with respect to the following incidents:
a) You failed to provide adequate training and supervision to unregulated care providers who provided care for the residents of the facility in 2008 and/or 2009; and/or
b) You inappropriately delegated nursing tasks to unregulated care providers of the facility in 2008 and/or 2009; and/or
c) You failed to provide appropriate nursing care to the residents of the facility in 2008 and/or 2009; and/or
d) You failed to properly document the care you were providing to the residents of the facility in 2008 and/or 2009; and/or
e) You improperly confined [Resident A] to his room in or around January 2009; and/or
f) You threatened to restrain or confine [Resident A] in 2008 and/or 2009; and/or
g) You restrained [Resident A], without a physician’s order and without consent, in 2008 and/or 2009; and/or
h) You directed or allowed staff at the facility to restrain or threaten to restrain [Resident A], confiscate his property, threaten him, and/or humiliate him; and/or
i) You directed or allowed staff at the facility to physically, verbally and/or emotionally abuse [Resident A] in 2008 and/or 2009; and/or
j) You failed to maintain proper sanitation and hygiene in the facility in 2008 and/or 2009;
k) You failed to provide appropriate food and nourishment to residents under your care in the facility in 2008 and/or 2009; and/or
l) You denied or withheld food from a resident or residents under your care in the facility in 2008 and/or 2009; and/or
m) You made inappropriate comments to a resident who fell in the hallway of the facility while using her walker, blaming her for the incident and telling her to “get to her room” (or words to that effect) on or about April 14, 2009; and/or
n) You encouraged or otherwise allowed residents of the facility to share or re-use needles in 2008 and/or 2009; and/or
o) You failed to provide for appropriate supervision of residents with dementia or similar conditions in 2008 and/or 2009; and/or
p) You failed to promptly report a fire in the facility to the fire department on or about April 1, 2009, and accordingly created a dangerous situation for residents of the facility; and/or
q) You failed to comply with lawful government directives with respect to the management and operation of the facility, including Community Health Protection Orders under the Health Protection and Promotion Act, in 2009.
Member’s Plea
Given that the Member was not present nor represented, she was deemed to have denied the allegations in the Notice of Hearing. The Hearing proceeded on the basis that the College bore the onus of proving the allegations in the Notice of Hearing against the Member.
Overview
The facility [ ] is [a retirement] home [for] residents with complex needs requiring ongoing care. The Member assumed all nursing and administrative duties at the facility from October 2008 to June 2009.
The evidence in this case satisfied the panel that the Member, whose registration was under suspension, held herself out as a Registered Nurse, delegated tasks to unregulated care providers (UCPs) failed to document care, restrained a resident without an order, abused residents emotionally, verbally and physically and allowed others under her supervision to do so as well.
The Member hired untrained employees, who had no experience working with vulnerable clients with complex needs, promising to train them as Personal Support Workers. This training never occurred.
The Member failed to maintain proper sanitation in the facility, did not report a fire and failed to provide proper nourishment to the residents, all of which put these residents at great risk of harm.
The panel heard from ten witnesses, five of whom were employed at the facility, and received and reviewed 15 exhibits. All the evidence presented supported the allegations as set out in the Notice of Hearing.
The Evidence
The panel heard and considered the evidence [of] 10 witnesses and 15 Exhibits. The evidence supported findings on all allegations set out in the Notice of Hearing, as follows:
1.a) The panel heard oral testimony from [Witness #1], a Personal Support Worker [PSW A] who was hired by the Member and started working at the facility on January 14, 2009. On her first day, she learned that [UCP A] was assigned to orient her to the facility and the skills required to fulfill her position. Evidence presented by the College confirms that [UCP A] had no post-secondary education or training, and the Member was aware that [UCP A] had no formal orientation in the care of residents in a retirement facility.
[Witnesses #2, 3 and 4] confirmed that they were all hired by the Member to work at the facility and train to become PSWs. [The three witnesses] all confirmed that their training came from [UCP A] and [UCP B], neither of whom had any formal training. The Member was frequently absent from the facility and provided no on-site training or supervision of the staff. All problems were to be reported to [UCP A,] according to testimony presented by the witnesses that were staff of the facility.
[Dr. A], the expert witness for the College, stated the Member contravened three of the Standards of Practice of the College: the Professional Standards, the standard for Working with Unregulated Care Providers (“UCPs”), and the standard for Utilization of Unregulated Care Providers. According to [Dr. A], the Member did not comply with these Standards in that [UCP B] and [UCP A] were not registered staff and could not oversee and delegate to other UCPs. These actions by the Member exposed vulnerable residents to risk of harm and, according to [Dr. A], constituted a breach of the Standards
1.(b) [Witness #6], an employee of the College, works on the support team of the Investigations Committee. [Witness #6] was appointed by the Executive Director of the College to assist with the investigation into the Member’s conduct. She informed the panel that the Member had been suspended on April 10, 2007 for non-payment of fees and again on October 27, 2010 for failure to submit to a health examination. [ ] According to subsection 27(1) of the Regulated Health Professions Act, 1991 (“RHPA”), a person who is not a member of the College does not have the authority to delegate controlled acts. According to subsection 13(2) of the Health Professions Procedural Code (the “Code”), a person whose certificate of registration is suspended is not a member.
[Witness #7 – UCP A] testified that the Member asked her to train all new staff. The Member stated all staff [were] to participate in a PSW program starting October 2008. [UCP A] testified that she was the person that other staff members were to report to if “something really bad happened”. According to the witness, the Member was “almost never” at the facility and “was never available by phone”. In [UCP A]’s testimony, she stated that the Member delegated medication administration including blood sugar checks and subsequent insulin injections to herself and [UCP B]. She went on to state that she had received no formal instruction on the administration of insulin.
- (c) [UCP A] stated that resident [Resident B], age 88, fell twice in his room within two days. Following the second fall, [UCP A] attempted to contact the Member for an hour before the Member arrived to attend to [Resident B]. When the Member finally did attend to [Resident B], she did not carry out a thorough physical assessment. [Resident B] was in considerable discomfort and the ambulance was called. Prior to the arrival of the ambulance, the Member asked that the UCPs apply dressings to the skin tears on [Resident B]’s upper arms. On admission to hospital it was discovered that [Resident B] had fractured his hip. This testimony was corroborated by [PSW A].
[Witness #2] testified that [Resident C] had been vomiting and [Witness #2] asked the Member to assess [Resident.C]. The Member told [Resident C] that she was gray from not using her oxygen and scolded her for not using it. The Member did not assess [Resident C], take any vital signs or make any documentation of her visit. [Witness #2] testified that [Resident C] told her she was fasting due to her “religious beliefs” and the Member told staff to ignore [Resident C] as she was only attention-seeking.
[Witnesses #3, 4 and 1,] as well [as Witness #8], the Public Health inspector, all gave evidence to support these or like findings regarding the failure of the Member to provide appropriate nursing care to the residents of the facility.
[Dr. A] testified that the Member contravened the Professional Standards of Practice in Knowledge and Knowledge Application.
(d) [Dr. A] referred to the Standards for Documentation, Medications and Professional Standards [ ] and stated that the lack of documentation and lack of Medication Administration Records (“MARS”) puts residents at great risk of harm. [Witness #1 – PSW A] testified that the Member permitted staff no access to the charts of the residents. She instructed [PSW A] to do all recording in the “Log” book, but none of the staff received any instruction on what or how to document. There were incidents that were witnessed by the Member and times that she did examine a resident but did not document the incident or her intervention. One of these incidents, witnessed by the seven staff members present, was the examination of [Resident D]. The Member was demonstrating the procedure for checking [Resident D] for evidence of a yeast infection. The only documentation was that of a UCP [ ].
(e) (f) (g) (h) (i) The panel heard and relied upon testimony from [Witnesses #1, 2, 3 and 7], who confirmed that the client [Resident A] was improperly confined and restrained in his room by the Member, without a physician’s order or consent. The restraint consisted of both a lock on his door and of tying [Resident A] to his chair with a non-approved restraint.
[Witness #2] heard the Member threaten [Resident A] with removal of his smoking privileges and tell him that he would be tied up if his erratic behaviour did not improve, as “she had the power to do this”. [Witness #2] also testified that she witnessed the Member use what appeared to be cloths torn from a sheet to tie [Resident A] to his chair. The Member instructed [Witness #3] to sit in front of the door to prevent [Resident A] from coming out of his room and later locked the door by reversing the lock. The staff brought [Resident A]’s meals to his room on trays and also permitted [Resident A] to leave his room when the Member was out of the building.
[Dr. A] testified that this form of restraint is a misuse of power and absolutely contravenes the Nursing Restraint Standard, Documentation Standard and Professional Standards, in that there was no assessment, no documentation, no attempts at alternative measures and no consent for the use of restraints. The witness testified that in relation to [Resident A] this behaviour constitutes both physical and psychological abuse.
(j) [Witness #8], Public Health Inspector [ ], became involved with the facility in November 2008 after a complaint regarding sanitation. She made numerous visits to the facility over the next seven months. On the first visit, she found the dining room area “deplorable and one of the worst” she had ever seen. The entire facility was extremely dirty and smelled like a “waste water plant”. While completing the food safety inspection, she found dirty kitchen floors and a build-up of grease and debris under the dishwasher, under shelving, in and around the fryer area and along the walls. The vent over the stove was not functioning due to an accumulation of grease and dust. She stated in her report that a thorough cleaning was required and sanitary conditions maintained thereafter. A number of follow up inspections were scheduled but orders were never fully complied with. The Member was given a number of “tickets” for failure to maintain sanitary conditions in the facility and a number of Community Health Protection Orders were issued. The panel reviewed photos [ ] which showed direct evidence supporting this witness’ testimony.
(k) (l) [Witness #1 – PSW A] testified that food was scarce and at times [PSW A] and the facility’s cook, [ ], would use their own money to buy food for the facility. The Member, on several occasions, did not pay for food delivered and as a result, the company supplying food refused to unload the truck until they were paid in cash. The testimony of all witnesses corroborated that food became very scarce and residents were complaining of both the quality and quantity of the meals provided. Witnesses testified that eventually social services provided food for the residents, as, on inspection, the facility did not have enough food for even one hot meal. Several witnesses confirmed that there were rules around meal time, and if residents were late they would miss the meal, and no food was allowed in their rooms.
[Witness #8] also conducted food safety inspections at the facility on a number of occasions. Upon first inspection the fridge and freezer temperatures were not adequately maintained, putting contents at risk of spoilage. There was no soap dispenser in the food preparation area, raw foods were improperly stored putting the residents at risk, and many foods were well beyond their expiration date. She went on to state that she instructed the Member to remove some foods immediately, as they were spoiled. On April 15, 2009, the Member received a ticket for failure to maintain frozen foods at a temperature of -18 degrees.
(m) [Witness #8] testified that she witnessed a resident fall in the hallway and the Member was extremely rough with her, said it was the resident’s own fault and told her to “get to her room”. [Dr. A] described this behaviour as actual physical abuse, disrespect of the resident, and a contravention of both the Therapeutic Nurse Client Relationship Standard and the Professional Standards.
(n) [UCP A] testified that each of the seven diabetic residents had his/her own glucometer. After her arrival at the facility, the Member instructed staff to use one unit for all residents. [Witness #2] testified that she was taught how to check blood sugars by [UCP A] and [UCP B] Although some of the staff did change the lancet for each resident, [Witness #3] was aware that the lancet should be changed but never witnessed this being done by other staff. [Witness #4] also witnessed the same lancet being used on multiple residents and was not instructed on how to change it. When the Member was informed of this she said that it was easier and blood would not be shared if the same lancet was used. [Dr. A] testified that the Member breached professional standards when she delegated these acts to UCPs. The Member failed to provide adequate teaching and/or supervision of UCPs, putting all residents at risk.
(o) [UCP A] testified that the Member asked her to train all the new staff because the Member was “almost never at the facility”. Several witnesses said the Member did not answer her phone or cell phone when staff had concerns about resident issues. [Witness #9], while visiting his mother, heard a tapping on the outside door. The temperature was below freezing and a confused resident was locked out wearing only a night shirt and slippers. The witness went on to state that there was no staff available and he let the woman in. Her legs were bare and she had visible sores on them.
[Resident C] suffered a seizure while having her hair shampooed, and although the Member was called by the attending staff to assist, she never did come down. The Member told staff, “I did fine and was right to call 911”.
[Witness #8] witnessed a frail elderly resident going down the stairs to the dining room with her walker in order to get food. The elevator, which was frequently broken, was out of order at this time. The resident then fell in the hallway and the Member’s conduct toward her was described as abusive. The resident was sent back to her room without an assessment or food.
(p) On April 1st, 2009, [Witness #8] was with the Member when the maintenance man told her that there was a fire in the facility. The Member said that everything was fine but the witness said, “Let’s go and see”. The fire had been extinguished but the stairwell was still smoky and smelled like burnt rubber. The witness asked the Member if she had called 911 and the Member said she had not. The witness insisted she call 911. No fire or smoke alarms in the building were activated. The Fire Department was unable to gain access to the building as the doors were still locked. After this incident, it was noted that the facility had no evacuation plan and no residents were assessed for possible smoke inhalation. [Witness #8] stated that she had a conversation with the Member regarding her reluctance to call 911 and the Member told [Witness #8] she was overreacting.
The Member on a number of occasions committed acts of professional misconduct by delegating controlled acts to UCPs who were testing blood sugars, injecting insulin and administering medications without proper training. The panel relied upon the testimony of various witnesses. [Witness #3] testified that the Member was overseeing [UCP B] and [UCP A] teaching the UCPs how to check blood sugars and administer insulin. She stated the Member “was just watching” as [UCP B] and [UCP A] instructed the UCPs. On a second occasion, the Member told [Witness #3] to flush unused medication down the toilet. The Member stated that she would get in trouble if “all these medications went back to pharmacy”. [Witness #1] told the panel that the Member advised [UCP A] to train her how to do blood sugar checks and give insulin. This testimony was corroborated by [UCP A and Witnesses #2, 4 and 9].
[Dr. A] testified that in her opinion, the Member did not comply with Standards. The Member was required to teach and supervise the UCPs. The Member went against Standards again when delegating to [UCP A] and [UCP B]. With this behaviour, the Member put all residents at risk of harm.
- The panel found that the Member committed acts of professional misconduct when she abused clients verbally, physically and emotionally. With respect to allegations 3 a) to e), the panel relied on the following evidence to make its findings:
Testimony from [UCP A and Witnesses #1, 2 and 3] all confirmed that [Resident A] was improperly confined and restrained in his room by the Member, without a physician’s order or consent. The restraint consisted of both a reversed lock on his door and cloth strips, a non-approved restraint, which tied him to his chair.
[Witness #2] heard the Member threaten [Resident A] with removal of his smoking privileges and that he would be tied up if his erratic behaviour did not improve, as “she had the power to do this”. She also testified that she witnessed the Member use what appeared to be cloths torn from a sheet to tie [Resident A] to his chair. The Member then locked the door by reversing the lock and, prior to this, instructed [Witness #3] to sit in front of the door to prevent his coming out of his room. The staff who found this action to be improper, brought his meals to his room on a tray and also permitted [Resident A] to leave his room when the Member was out of the building.
[Dr. A] testified that this form of restraint is a misuse of power and absolutely contravenes the Nursing Restraint Standard, Documentation and Professional Standards, in that there was no assessment, no documentation, no attempts at alternative measures and no consent for their use. The witness testified that in relation to [Resident A,] this behaviour constitutes both physical and psychological abuse.
With respect to allegations 3 f) and g), the panel relied upon the following evidence to reach its findings:
[Witness #1] testified that food was scarce and at times [Witness #1] and [the] cook [(UCP B)] would use their own money to buy food. The Member on several occasions did not pay for food delivered and, as a result, the company supplying food refused to unload the truck until they were paid in cash. The testimony of all witnesses corroborated that food became very scarce and residents were complaining of both the quality and quantity of the meals provided. Witnesses testified that eventually social services provided food for the residents, as, on inspection, the facility did not have enough food for even one hot meal. Several witnesses confirmed that there were rules around meal time and if residents were late, they would miss the meal, and no food was allowed in their rooms.
[Witness #8] also conducted food safety inspections at the facility on a number of occasions. Upon first inspection the fridge and freezer temperatures were not adequately maintained, putting contents at risk of spoilage. There was no soap dispenser in the food preparation area, raw foods were improperly stored, putting the residents at risk, and many foods were well beyond their expiration date. She went on to state that she instructed the Member to remove some foods immediately as they were spoiled. On April 15, 2009, the Member received a ticket for failure to maintain frozen foods at a temperature of -18 degrees.
The panel found the Member verbally abused a resident in [the] following incident described by [Witness #8], who testified that she witnessed a resident fall in the hallway. The Member was extremely rough with the resident, said it was her own fault and told her to “get to her room”. [Dr. A] described this behaviour as actual physical abuse, disrespect of the resident, and a contravention of both the Therapeutic Nurse-Client Relationship Standard and The Professional Standards.
- a) The panel found that the Member committed an act of professional misconduct by failing to regularly and completely document the nursing care provided to residents. [UCP A and Witnesses #1 - 4] all testified that the only method of documentation was the log book. There is no evidence that the Member documented any of the interventions, treatments or assessments that she was witnessed performing. These included the assessment of [Resident B] following a fall, and the demonstration to five staff for identification of a yeast infection on [Resident D]. Further, the Member gave instructions to the staff that the names of medications and times of administration were not required to be documented. Therefore there was no way to track whether medication had been administered to and/or taken by residents. When the witnesses asked about individual resident charts, they were told by the Member that they were locked in her office and were “none of their business”.
b) The panel found that the Member failed to adhere to any of the directives contained in the Restraint Practice Standard governing when and how restraints are to be applied to a resident. Further, the Member did not document the application of the restraints, the reason for the restraints or have consent or a doctor’s order permitting the use of restraints. All five members of the staff at the facility testified to having witnessed a resident being restrained either physically or environmentally.
- & 6. The panel found that the Member committed acts of professional misconduct in that she held herself out as a nurse and performed controlled acts while her [certificate of registration] was under suspension. The evidence that the panel relied upon in reaching these findings was that [UCP A, Witnesses #1 - 4 and Witness #8] all testified that the Member represented herself as a Registered Nurse to them. On numerous occasions, the Member would introduce herself as a Registered Nurse, as confirmed by the witnesses.
The evidence clearly showed that this was not an honest representation of her status. [The] Member’s certificate has been suspended since April 10, 2007. The Member should have been aware that she was not to use the title Nurse, Registered Nurse or hold herself out as a Registered Nurse providing services as shown in the letter sent to the Member [ ] by the College on April 10, 2007. She clearly misrepresented herself as giving nursing care in a memo that she posted in the facility in December 2008. It was proven that the memo was altered and “Nursing Care” was crossed out, as testified to by [UCP A, Witness #2 and Witness #3].
By representing herself as a nurse, the Member was in violation of the Code and the RHPA. Section 13(2) of the Code clearly states that “a person whose certificate is suspended is not a member”.
[Witness #1] testified that the Member gave B-12 injections to residents in the facility. The Member was in violation of the RHPA and the Nursing Act, 1991, in that administering a substance by injection is [ ] authorized only by members of the College.
- The panel found the Member committed acts of professional misconduct, that having regard to all the circumstances would reasonably be regarded by members of the profession to be disgraceful, dishonourable and unprofessional when she:
a. failed to provide adequate training and supervision to those who provided care for the residents of the facility;
b. inappropriately delegated nursing tasks to unregulated care providers
c. failed to provide appropriate nursing care to the residents
d. failed to properly document the care [she was] providing to the residents
e. improperly confined [Resident A];
f. threatened to restrain or confine [Resident A] ;
g. restrained [Resident A], without a physician’s order and without consent;
h. directed and allowed staff at the facility to restrain, threaten to restrain [Resident A], confiscate his property, threaten him, and humiliate him;
i. directed and allowed staff at the facility to physically, verbally and emotionally abuse [Resident A];
j. failed to maintain proper sanitation and hygiene in the facility;
k. failed to provide appropriate food and nourishment to residents under [her] care;
l. denied or withheld food from residents under [her] care;
m. made inappropriate comments to a resident who fell in the hallway of the facility while using her walker, blaming her for the incident and telling her to “get to her room”;
n. encouraged or otherwise allowed residents of the facility to share or re-use needles;
o. failed to provide for appropriate supervision of residents with dementia or similar conditions;
p. failed to promptly report a fire in the facility to the fire department and accordingly created a dangerous situation for residents of the facility; and
q. failed to comply with lawful government directives with respect to the management and operation of the facility, including Community Health Protection Orders under the Health Protection and Promotion Act
Credibility
The relevant substance of the witnesses’ testimony is described above. In determining whether to accept and rely upon this testimony, the panel considered whether the witnesses were credible. The panel used the criteria for assessing the credibility of witnesses as set out in Pitts v. Ontario (Ministry of Community and Social Services), (1985) 1985 2053 (ON HCJ), 51 O.R. (2d) 302 (Div. Ct.).
[Witness #6], an employee of the College since August 2006, presented documents confirming that the Member had been suspended by the College since 2007. She interviewed the Member at the facility. The panel found her to be a credible witness.
[Witness #10], President of [another facility], gave testimony regarding the Member’s employment at [that facility]. The witness verified that the Member was aware that she had been suspended for non-payment of fees but continued to hold herself out as a nurse, assuring the witness that she had been reinstated. This witness was not aware that the Member’s registration was not renewed. The panel found this witness to be credible.
[UCP A and Witnesses #1 - 4] were all employees of the facility. The witnesses gave consistent testimony regarding the Member’s conduct and each had observed some or all of the incidents that occurred. They all verified the deplorable conditions in the facility. All witnesses testified separately over different dates, and their evidence was consistent. The panel accepted their testimony as credible.
[Witness #9], the son of a resident, gave evidence in relation to the treatment and care of his mother. He also witnessed the incident that occurred when the elderly, confused resident was locked out of the facility. His testimony was found to be credible.
[Witness #8] verified [an exhibit] as being accurate and produced by herself. Her clear and concise testimony, supported by her extensive documentation, was found to be credible.
[ ] The panel was given a copy of [Dr. A’s] CV, Counsel for the College presented her as an expert witness in Nursing Professional Standards and Procedures, and the panel qualified her as such. The panel found her to be professional, knowledgeable and experienced in work with UCPs. The panel found her to be a credible witness. The facts on which her opinion was based were proven by the College. Her expert opinion was accepted by the panel.
Decision
The College bears the onus of proving the allegations on the balance of probabilities, using clear, cogent and convincing evidence.
Having considered the evidence and the onus and standard of proof, the panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1, a), b), c), d), e), f), g), h), i), j), k), l), m), n), o), p), #2, #3 a), b), c), d), e), f), g), h), #4 a) and b), #5, #6, and #7 a), b), c), d), e), f), g), h), i), j), k), l), m), n), o), p), and q) of the Notice of Hearing. As to allegation 7, the Member engaged in conduct that would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional in that she:
a. failed to provide adequate training and supervision to providers who provided care for the residents of the facility;
b. inappropriately delegated nursing tasks to unregulated care providers;
c. failed to provide appropriate nursing care to the residents;
d. failed to properly document the care [she was] providing to the residents;
e. improperly confined [Resident A];
f. threatened to restrain or confine [Resident A] ;
g. restrained [Resident A], without a physician’s order and without consent;
h. directed and allowed staff at the facility to restrain, threaten to restrain [Resident A], confiscate his property, threaten him, and humiliate him;
i. directed and allowed staff at the facility to physically, verbally and emotionally abuse [Resident A];
j. failed to maintain proper sanitation and hygiene in the facility;
k. failed to provide appropriate food and nourishment to residents under [her] care;
l. denied or withheld food from residents under [her] care;
m. made inappropriate comments to a resident who fell in the hallway of the facility while using her walker, blaming her for the incident and telling her to “get to her room”;
n. encouraged or otherwise allowed residents of the facility to share or re-use needles;
o. failed to provide for appropriate supervision of residents with dementia or similar conditions;
p. failed to promptly report a fire in the facility to the fire department and accordingly created a dangerous situation for residents of the facility; and
q. failed to comply with lawful government directives with respect to the management and operation of the facility, including Community Health Protection Orders under the Health Protection and Promotion Act.
The reasons for the panel’s decision are as set out above in the description of the evidence led and the assessment of credibility. The evidence was clear, cogent and convincing with respect to all allegations in the Notice of Hearing.
Penalty Submissions
College Counsel submitted that the only appropriate penalty would be an oral reprimand and revocation of the Member’s certificate of registration. The Member’s conduct showed severe neglect, abuse and dishonesty. The Member showed an utter lack of regard for the regulatory process and self-regulation. The Member did not attend the hearing or accept any responsibility for her conduct and shows a complete disregard for nursing standards. This Member has made no attempt to remediate herself and is a danger to the public if allowed to continue nursing of any kind.
Penalty Decision
The panel makes the following order as to penalty:
The Member shall appear before the Panel to be reprimanded on a date to be arranged, but, in any event, within three (3) months of the date of the Order.
The Executive Director is directed to revoke the Member’s certificate of registration.
Reasons for Penalty Decision
The panel’s paramount concern was for protection of the public. The findings of professional misconduct were numerous. The Member’s misconduct could have caused very serious harm. The Member’s breach of the standards is completely contrary to the values of the nursing profession, which holds public trust, honesty and integrity as cornerstones of the profession.
No mitigating circumstances were presented, but the Member’s ongoing use of the title of Registered Nurse, her lack of remorse or desire for remediation as evidenced by her failure to appear and her complete disregard for the orders of the Health Inspector demonstrate the Member to be ungovernable. Revocation is the sole option for the panel.
This penalty will provide a general deterrence to the membership of the College, sending the message that this behaviour will not be tolerated. The penalty also serves the mandate of the College to protect the public by ensuring high ethical standards of professional practice.
I, Margaret McGinn, 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:
Angela Verrier, RPN
Tracy Richardson, RN
Gino Cucchi, Public Member
Abdul Patel, Public Member