College of Nurses of Ontario v. Anita Bepat, 2012 ONCNO 98098

PANEL: Zahir Hirji, RN Chairperson Agnese Bianchi, RN Member Joan King Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO NICK COLEMAN for College of Nurses of Ontario

and -

ANITA BEPAT Registration No. 9412073 CAROL STEPHENSON for Anita Bepat

Heard: February 17, 2012

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on February 17, 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 paragraph 2 of the Notice of Hearing, the allegations of disgraceful or dishonourable conduct in paragraph 3 of the Notice of Hearing and the balance of the particulars to the allegations set out in paragraphs 1 and 3 of the Notice of Hearing, other than the particulars in paragraphs 32 and 33 of the Agreed Statement of Facts [ ].

The panel granted this request. The remaining allegations against Anita Bepat (the “Member”) as set out in the Notice of Hearing dated January 16, 2012 are as follows.

IT IS ALLEGED THAT:

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(1) of Ontario Regulation 799/93, in that, while employed as a Registered Nurse at [Facilities A and B] in [ ], Ontario, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession with respect to your inadequate or inappropriate [client] care and/or charting, and/or your inappropriate and unprofessional communications with co-workers or clients, in relation to the incidents listed in Appendix A.
[Withdrawn]
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, while employed as a Registered Nurse at [Facilities A and B] in [ ], Ontario, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members of the profession as [withdrawn] unprofessional with respect to your inadequate or inappropriate [client] care and/or charting, and/or your inappropriate and unprofessional communications with co-workers or clients, in relation to the incidents listed in Appendix A.

APPENDIX A

[Facility A]

i. [Withdrawn]

ii. [Withdrawn]

iii. On or about July 30, 2008, you failed to document any details regarding the admission of [Client A];

[Facility B]

iv. On or about May 7, 2008, you arrived late for a shift, refused to accept your [client] assignments, engaged in an argument with [the charge nurse], and then left work before the end of the shift without notifying the charge nurse or the on-call manager;

v. On or about September 26, 2008, you attended at work when your ability to practi[s]e was impaired by consumption of alcohol;

vi. On or about October 24, 2008, you failed to document a significant fall suffered by [Client B];

vii. [Withdrawn]

viii. [Withdrawn]

ix. [Withdrawn]

Member’s Plea

The Member admitted the allegations set out in paragraphs numbered 1 and 3 in the Notice of Hearing as set out in paragraphs 32 and 33 of the Agreed Statement of Facts. 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

The facts agreed to by the College and the Member are as follows.

THE MEMBER

Anita Bepat (the “Member”) registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on January 19, 1994.
The Member was employed at the Senior’s Health Centre at [Facility A] in [ ] Ontario from July 14, 2008 to August 2, 2008.
The Member has been employed at [Facility B] in [ ] Ontario since January 2003.

THE FACILITIES

(A) [Facility A]

The Senior’s Health Centre at [Facility A] provides elder services including coordinating long-term care and the hospital’s Specialized Geriatric Ambulatory Services. The facility houses a [ ] long-term care home [ ], as well as short stay beds.
During the period of her 2½ weeks of employment at this facility, the Member worked primarily on the day shift.

(B) [Facility B]

[Facility B] offers complex continuing care and rehabilitation services, including a [ ] complex continuing care unit and [ ] in-patient rehabilitation unit.
The Member worked on the complex continuing care unit providing care to individuals with medically complex care needs that required the services of a multidisciplinary care team. Residents were often [completely] dependent on health professionals for all of their care needs.
The Member [was] work[ing] the night shift at [Facility B] and was assigned to approximately 12 [clients]. In addition, the RNs were required to [provide support to] any [clients who had IVs or who required IM injections] that were assigned to Registered Practical Nurses (“RPN”).

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT AT [FACILITY A]

(A) July 30, 2008

The Member admitted [Client A] to [Facility A] on July 30, 2008. The Member spent a significant amount of time with [Client A]’s family, who were tense and had arrived at the facility prior to [Client A’s admission].
The Member did not document any details of the admission or her meetings with the family in [Client A]’s progress notes. The Member made the following written notation regarding the admission on the change of shift report she completed for the nurse who was [scheduled] to care for [Client A] on the next shift:

85 years New adm. – [Client A] Hx of Dementia, confused intermittently, can be agitated and at times physically aggressive – Shower given today. Skin R. inner aspect of lower bruise noted. Hand & feet also some small bruise noted. V/S [vital signs] – See V/S sheet.

The change of shift report [did] not form part of the client’s permanent [client] record.

On August 1, 2008, the Director of Care [ ] called the Member at home about the lack of documentation in the progress notes. The Member responded that she was very busy that shift and questioned whether she would have been paid overtime to stay and complete the documentation. After being directed to do so, the Member made a late entry [about the admission] in [Client A]’s progress notes on August 2, 2008, the next day she worked [ ].
If the Member testified, she would state that the shift in question was very busy and it was a challenge for her to complete her [charting]. She would explain that tasks took longer due to the fact she was new to the facility and unfamiliar with the unit. She would further state that she has a disabled child and [could not] stay late without making prior care arrangements. The Member would also acknowledge, however, that she was responsible for charting with respect to the [client] and that she should have completed the charting in the client’s permanent [client] record before she left for the day.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT AT [FACILITY B]

(A) May 7, 2008

On May 7, 2008, the Member arrived 20 minutes late for her shift. When she arrived, she complained about her client assignments to [RPN A]. According to the Member, the clients assigned to [RPN A] were too easy compared to the [clients] assigned to the Member. She also suggested to [RPN A] that the client assignments should be changed.
[RPN A] informed the Member that she would not change the client assignments because the assignments were already made and she had started her rounds.
The Member then spoke to the Charge Nurse [ ], who confirmed that he would not change the assignments. The Member argued with [the charge nurse] about the [client] assignments and did so by raising her voice to him with an angry tone and inappropriate language that could be overheard by other staff and clients.
Following the angry exchange with [the charge nurse], the Member left the shift without informing him or the on-call manager that she was leaving. The client assignments had to be adjusted amongst other nursing staff to account for the Member leaving [ ]. [RPN A] was an extra float nurse available to take on the extra [client] assignments as a result of the Member’s departure. The Member had not yet assumed care of any [clients].
If [the Member were to testify], the Member would state that she had been sick for a few days prior to this incident. She was still not feeling well when she reported for her shift on May 7, 2008. She would also state that [the charge nurse] also raised his voice against her and used inappropriate language in the course of their argument about the [client] assignments. The Member would also state that she attempted to communicate through other staff that she was leaving. The Member would acknowledge, however, that her communications with [the charge nurse] were inappropriate, regardless of how she was feeling, and that she should not have left the facility without ensuring that both the charge nurse and the on-call manager were notified.
If [RPN B were to testify, she] would also state that both [the charge nurse] and the Member raised their voices and used inappropriate language in their argument about the [client] assignments.

(B) September 26, 2008

When the Member attended her scheduled shift on September 26, 2008, she appeared to be under the influence of some substance and to be having some difficulty walking and speaking.
If the Member [were to testify], she would state that she consumed diet pills on any empty stomach prior to her shift and that the diet pills affected her demeanour and ability to walk. The physical symptoms included stomach cramps. She did not anticipate that the diet pills would have this effect. The Member acknowledges that she was not in a fit condition to work and that her ability to work was impaired when she arrived to work the shift.
The Member recovered and completed the shift without incident.

[Client B] was 86 years old when he was admitted to the complex continuing care unit on October 24, 2008.
During the night shift on October 24 - 25, 2008, the Member approached the Charge Nurse for the shift, [ ], and asked him and [RPN B] to assist her with [Client B]. The Member told [RPN B] that [Client B] was on the floor and she needed help to put him back to bed. The Member did not express any urgency in her request for assistance. The Member, [the charge nurse] and [RPN B] went to see [Client B] immediately and found him on the floor with his nose bleeding profusely, apparently from a significant injury. [The charge nurse] took [Client B]’s vital signs and noticed that his blood pressure was dropping. He agreed that the client should be transferred to the Emergency Room (“E.R.”) for emergency care. The Member called the E.R. to arrange the transfer.
[Client B] was transferred to the E.R., accompanied by the Member. [Client B]’s chart was taken with him to the E.R. [Client B] was still in the E.R. at the end of the Member’s shift.
The Member did not complete an incident report or make a note in [Client B]’s progress notes regarding the incident, nor did she contact [Client B]’s family.
At the end of the shift on the morning of October 25, 2008, the Member approached the Charge Nurse for the day shift, [ ]. If he [were to testify, the day shift charge nurse] would state that the Member advised him that [Client B] had fallen and had been sent to the E.R. during her shift. The Member asked [the day shift charge nurse] to complete an incident report and to make an entry in the client’s progress notes.
[The day shift charge nurse] suggested that the Member should complete the documentation since she was caring for [Client B] when the incident occurred. The Member responded that she did not have time to complete the documentation. [The day shift charge nurse] contacted the Manager, [ ], regarding the Member’s response.
[Client B] returned to the floor from the E.R. at approximately 09:00 on October 25, 2008.
Later that morning, a family member advised nursing staff that [Client B] had a prior history of nose bleeds. Nursing staff on the day shift charted:

Niece [ ] came to unit to see pt and says her uncle has a history of nose bleeding. All the time since wife of pt died…

[The Manager] spoke to the Member on October 29, 2008 and asked her why she did not complete an incident report, make an entry in [Client B]’s progress notes or contact [Client B]’s family. The Member responded that she was busy.
If the Member [were to testify], she would state that [Client B] was confused and tried to climb out of bed several times. After his last attempt, the Member helped him to the floor and went to get assistance. When she and her co-workers returned to his room, they found [Client B] with his nose bleeding profusely. Given that she had left [Client B] on the floor, she does not believe that he fell from his bed. The Member would further testify that [Client B]’s chart was transferred to the E.R. with him and that she intended to make a late entry, but [Client B]’s chart was still with him in the E.R. when her shift ended. However, the Member acknowledges that she should have documented the incident during her shift.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1 of the Notice of Hearing, and in particular she contravened a standard of practice of the profession and failed to meet the standard of practice of the profession with respect to her inadequate [and] inappropriate [client] care and charting, and her inappropriate and unprofessional communications with co-workers in relation to the following incidents:

iii. On or about July 30, 2008, she failed to document any details regarding the admission of [Client A] in the client’s progress notes;

iv. On or about May 7, 2008, she arrived late for a shift, refused to accept her [client] assignments, engaged in an argument with [the charge nurse], and then left work before the end of the shift without notifying the charge nurse or the on-call manager;

v. On or about September 26, 2008, she attended at work when her ability to practi[s]e was impaired; and

vi. On or about October 24, 2008, she failed to document a significant injury suffered by [Client B].

The Member admits that she committed the acts of professional misconduct as set out in paragraph 3 of the Notice of Hearing in that she engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members of the profession as unprofessional with respect to her inadequate or inappropriate [client] care and charting, and her inappropriate and unprofessional communications with co-workers, in relation to the following incidents:

iii. On or about July 30, 2008, she failed to document any details regarding the admission of [Client A] in the client’s progress notes;

v. On or about September 26, 2008, she attended at work when her ability to practi[s]e was impaired; and

vi. On or about October 24, 2008, she failed to document a significant injury suffered by [Client B].

With leave of the Discipline Committee, the College withdraws the allegation set out in paragraph 2 of the Notice of Hearing, withdraws the allegations of disgraceful or dishonourable conduct in paragraph 3 of the Notice of Hearing and withdraws the balance of the particulars to the allegations set out in paragraphs 1 and 3 of the Notice of Hearing, other than the particulars in paragraphs 32 and 33 of the Agreed Statement of Facts, 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 numbered 1 and 3 in the Notice of Hearing, as set out in paragraphs 32 and 33 of the Agreed Statement of Facts.

Reasons for Decision

The Agreed Statement of Facts provides sufficient evidence to support a finding of professional misconduct. The Member’s conduct would reasonably be regarded by members of the profession to be unprofessional.

Penalty

The parties jointly requested that this panel ma[k]e an order as follows.

Requiring the Member to appear before the Panel to be reprimanded within three (3) months of the date of this Order.
Directing the Executive Director to suspend the Member’s certificate of registration for one (1) month. This suspension shall take effect from the date of this Order.
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend two sessions with a Nursing Expert (the “Expert”), at her own expense and within three months of the date of this Order. To comply, the Member is required to ensure that:

i. The Expert has expertise regarding the professional standards and communication, 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:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Penalty, and
if available, a copy of the Panel’s Decision and Reasons;

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

One is One Too Many (workbook to be purchased at the Member’s expense);
Professional Standards (Revised 2002);
Documentation (Revised 2008);
Therapeutic Nurse-Client Relationship (Revised 2006);
Conflict Prevention and Management;
Refusing Assignments and Discontinuing Nursing Services; and

iv. Before the first meeting, the Member completes the College of Registered Nurses of British Columbia online learning module, Communication in Nursing Practice Module, and the accompanying workbook [ ].

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

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

the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
the development of a learning plan in collaboration with the Expert;

vii. 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:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member.

Penalty Submissions

College Counsel submitted that the joint submission appropriately addressed the interests of the public, the profession and the Member. It provides for specific and general deterrence as well as rehabilitation. College Counsel provided two previous College cases of a similar nature which demonstrated that the joint submission was consistent with prior decisions of previous panels.

Penalty Decision

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

The Member shall appear before the Panel to be reprimanded within three (3) months of the date of this Order.
The Executive Director is directed to suspend the Member’s certificate of registration for one (1) month. This suspension shall take effect from the date of this Order.
The Executive Director is directed to impose the following terms, conditions and limitations on the Member’s certificate of registration:

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

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Penalty, and
if available, a copy of the Panel’s Decision and Reasons;

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

One is One Too Many (workbook to be purchased at the Member’s expense);
Professional Standards (Revised 2002);
Documentation (Revised 2008);
Therapeutic Nurse-Client Relationship (Revised 2006);
Conflict Prevention and Management;
Refusing Assignments and Discontinuing Nursing Services; and

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

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

the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
the development of a learning plan in collaboration with the Expert;

vii. 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:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member.

Reasons for Penalty Decision

The panel concluded that the proposed penalty is reasonable, in the public interest and takes into consideration a previous discipline decision involving the Member. The Order provides for both general and specific deterrence. The Order demonstrates that this conduct is not acceptable to the College or to the Discipline panel. It also provides rehabilitation to the Member through comprehensive education. The Order demonstrates that the profession is capable of regulating itself and protecting the public.

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: Agnese Bianchi, RN

Joan King, Public Member