DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
PANEL: Grace Fox, NP Chairperson Robert MacKay Public Member George Rudanycz, RN Member Laura Sanderson, RPN Member Devinder Walia Public Member
BETWEEN:
COLLEGE OF NURSES OF ONTARIO ) JEAN-CLAUDE KILLEY for ) College of Nurses of Ontario
- and - )
ALISTONE T. SKEPPLE ) SELF- REPRESENTATION for Registration No. 9105362 ) Alistone T. Skepple
) Heard: April 25, 2016
DECISION AND REASONS
This matter came on for hearing before a panel (“the Panel”) of the Discipline Committee on April 25, 2016 at the College of Nurses of Ontario (“the College”) at Toronto.
The Allegations
The allegations against Alistone T. Skepple (the “Member”) as stated in the Notice of Hearing dated February 5, 2016 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 practising as a Registered Nurse at [ ] (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, and in particular
(a) on or about May 1, 2012, you completed a Do Not Resuscitate Confirmation Form for [Client A], and indicated that [Client A] had a current plan of treatment in place that reflected the client’s expressed wish that CPR not be included in the client’s plan of treatment, when in fact [Client A’s] treatment plan and/or advanced directives included the opposite directive, namely that CPR was to be included in [Client A’s] treatment plan;
(b) on or about September 13, 2012, you used an inappropriate abbreviation when transcribing [Client B’s] medication orders, and/or failed to properly transcribe [Client B’s] medication orders, when you wrote “resume previous orders with the exception of the following”;
(c) on or about December 27, 2012, you incorrectly documented the admission medication orders and medication reconciliation for [Client C] by:
a) documenting that acetaminophen 500mg was covered under the Facility’s medical directives, when it was not; and
b) failing to properly document the requirement to check the client’s weight daily in order to accurately determine the client’s Furosemide dosage;
(d) on or about June 25, 2013, you fabricated documentation, namely an ADP referral form, to suggest that you had requested a wheelchair for [Client D] on June 11, 2013, when in fact you had not requested it until later;
(e) on or about June 27, 2013, you fabricated documentation, namely a late entry progress note, to suggest that you had requested a wheelchair for [Client D] on June 11, 2013, when in fact you had not requested it until later;
(f) on or about November 18, 2013, you failed to perform an assessment of [Client E] after this client had fallen;
(g) on or about February 13, 2014, you failed to properly document a physician’s order for Promogran for [Client F], and/or you failed to take the necessary steps to ensure an adequate supply of Promogran with which to treat the client;
(h) on or about February 20, 2014, you failed to notify [Client G]’s authorized representative of an incident involving inappropriate touching of [Client G] by another client;
(i) on or about February 25, 2014, you failed to perform a medication reconciliation for [Client A], and then documented that you had done so;
(j) on or about March 20, 2014, you communicated inappropriately with the daughter of [Client H] by:
a) notifying her of her [parent’s] death in a public place where you could be overheard; and/or
b) inappropriately accepting a telephone call while providing comfort to the daughter of [Client H] and/or while escorting her to see her deceased [parent];
(k) on or about April 15, 2014, you documented that Nitrospray ordered for [Client I] was covered by the Facility’s medical directives, when it was not, and required a specific order;
(l) on or about April 22, 2014, you requested and/or documented an order for a vitamin and mineral supplement for [Client C], without verifying [Client C’s] existing orders, resulting in [Client C] receiving a double-dose of the supplement for a period of time;
(m) on or about April 30, 2014, you communicated to staff at the Facility that the Facility was on isolation as a result of an outbreak of disease until May 1, 2014, without properly coordinating with Ontario Public Health about the duration of the isolation and/or outbreak status and whether that status was in fact lifted on May 1, 2014;
(n) on or about May 1, 2014, you inappropriately discussed the personal health information of [Client J] in a location and/or in circumstances in which you were likely to be overheard, namely, the lobby of the Facility;
(o) on or about May 2, 2014, you admitted and/or re-admitted [Client J] to the Facility while the Facility remained on outbreak status, without properly coordinating with Ontario Public Health about the admission;
(p) on or about May 6, 2014, you inappropriately discussed the personal health information of [Client J] in a location and/or in circumstances in which you were likely to be overheard, namely, on a speakerphone in your office with the door open.
- 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 practising as a Registered Nurse at the Facility, you failed to keep records as required, and in particular:
(a) on or about September 13, 2012, you used an inappropriate abbreviation when transcribing [Client B’s] medication orders, and/or failed to properly transcribe [Client B’s] medication orders, when you wrote “resume previous orders with the exception of the following”;
(b) on or about December 27, 2012, you incorrectly documented the admission medication orders and medication reconciliation for [Client C] by:
a) documenting that acetaminophen 500mg was covered under the Facility’s medical directives, when it was not; and
b) failing to properly document the requirement to check the client’s weight daily in order to accurately determine the client’s Furosemide dosage;
(c) on or about February 13, 2014, you failed to properly document a physician’s order for Promogran for [Client F], and/or you failed to take the necessary steps to ensure an adequate supply of Promogran with which to treat the client;
(d) on or about February 25, 2014, you failed to perform a medication reconciliation for [Client A], and then documented that you had done so;
(e) on or about April 15, 2014, you documented that Nitrospray ordered for [Client I] was covered by the Facility’s medical directives, when it was not, and required a specific order.
- 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(14) of Ontario Regulation 799/93, in that, while practising as a Registered Nurse at the Facility, you falsified a record relating to your practice, and in particular:
(a) on or about June 25, 2013, you fabricated documentation, namely an ADP referral form, to suggest that you had requested a wheelchair for [Client D] on June 11, 2013, when in fact you had not requested it until later;
(b) on or about June 27, 2013, you fabricated documentation, namely a late entry progress note, to suggest that you had requested a wheelchair for [Client D] on June 11, 2013, when in fact you had not requested it until later; and/or
(c) on or about February 25, 2014, you failed to perform a medication reconciliation for [Client A], and then documented that you had done so.
- 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(15) of Ontario Regulation 799/93, in that, while practising as a Registered Nurse at the Facility, you signed or issued, in your professional capacity, a document that you knew or ought to have known contained a false or misleading statement, and in particular:
(a) on or about May 1, 2012, you completed a Do Not Resuscitate Confirmation Form for [Client A], and indicated that [Client A] had a current plan of treatment in place that reflected the client’s expressed wish that CPR not be included in the client’s plan of treatment, when in fact [Client A’s] treatment plan and/or advanced directives included the opposite directive, namely that CPR was to be included in [Client A]’s treatment plan;
(b) on or about February 25, 2014, you failed to perform a medication reconciliation for [Client A], and then documented that you had done so.
- 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 practising as a Registered Nurse at the Facility, 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 disgraceful, dishonourable or unprofessional, and in particular:
(a) on or about May 1, 2012, you completed a Do Not Resuscitate Confirmation Form for [Client A], and indicated that [Client A] had a current plan of treatment in place that reflected the client’s expressed wish that CPR not be included in the client’s plan of treatment, when in fact [Client A’s] treatment plan and/or advanced directives included the opposite directive, namely that CPR was to be included in [Client A’s] treatment plan;
(b) on or about September 13, 2012, you used an inappropriate abbreviation when transcribing [Client B’s] medication orders, and/or failed to properly transcribe [Client B’s] medication orders, when you wrote “resume previous orders with the exception of the following”;
(c) on or about December 27, 2012, you incorrectly documented the admission medication orders and medication reconciliation for [Client C] by:
a) documenting that acetaminophen 500mg was covered under the Facility’s medical directives, when it was not; and
b) failing to properly document the requirement to check the client’s weight daily in order to accurately determine the client’s Furosemide dosage;
(d) on or about June 25, 2013, you fabricated documentation, namely an ADP referral form, to suggest that you had requested a wheelchair for [Client D] on June 11, 2013, when in fact you had not requested it until later;
(e) on or about June 27, 2013, you fabricated documentation, namely a late entry progress note, to suggest that you had requested a wheelchair for [Client D] on June 11, 2013, when in fact you had not requested it until later;
(f) on or about November 18, 2013, you failed to perform an assessment of [Client E] after this client had fallen;
(g) on or about February 13, 2014, you failed to properly document a physician’s order for Promogran for [Client F], and/or you failed to take the necessary steps to ensure an adequate supply of Promogran with which to treat the client;
(h) on or about February 20, 2014, you failed to notify [Client G’s] authorized representative of an incident involving inappropriate touching of [Client G] by another client;
(i) on or about February 25, 2014, you failed to perform a medication reconciliation for [Client A], and then documented that you had done so;
(j) on or about March 20, 2014, you communicated inappropriately with the daughter of [Client H] by:
a) notifying her of her [parent’s] death in a public place where you could be overheard; and/or
b) inappropriately accepting a telephone call while providing comfort to the daughter of [Client H] and/or while escorting her to see her deceased [parent];
(k) on or about April 15, 2014, you documented that Nitrospray ordered for [Client I] was covered by the Facility’s medical directives, when it was not, and required a specific order;
(l) on or about April 22, 2014, you requested and/or documented an order for a vitamin and mineral supplement for [Client C], without verifying [Client C’s] existing orders, resulting in [Client C] receiving a double-dose of the supplement for a period of time;
(m) on or about April 30, 2014, you communicated to staff at the Facility that the Facility was on isolation as a result of an outbreak of disease until May 1, 2014, without properly coordinating with Ontario Public Health about the duration of the isolation and/or outbreak status and whether that status was in fact lifted on May 1, 2014;
(n) on or about May 1, 2014, you inappropriately discussed the personal health information of [Client J] in a location and/or in circumstances in which you were likely to be overheard, namely, the lobby of the Facility;
(o) on or about May 2, 2014, you admitted and/or re-admitted [Client J] to the Facility while the Facility remained on outbreak status, without properly coordinating with Ontario Public Health about the admission;
(p) on or about May 6, 2014, you inappropriately discussed the personal health information of [Client J] in a location and/or in circumstances in which you were likely to be overheard, namely, on a speakerphone in your office with the door open.
- You are incompetent, as that term is defined by subsection 52(1) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, in that your professional care of several clients displayed a lack of knowledge, skill or judgment of a nature or to an extent that demonstrates that you are unfit to continue to practise or that your practice should be restricted and, in particular:
(a) on or about May 1, 2012, you completed a Do Not Resuscitate Confirmation Form for [Client A], and indicated that [Client A] had a current plan of treatment in place that reflected the client’s expressed wish that CPR not be included in the client’s plan of treatment, when in fact [Client A’s] treatment plan and/or advanced directives included the opposite directive, namely that CPR was to be included in [Client A’s] treatment plan;
(b) on or about September 13, 2012, you used an inappropriate abbreviation when transcribing [Client B]’s medication orders, and/or failed to properly transcribe [Client B’s] medication orders, when you wrote “resume previous orders with the exception of the following”;
(c) on or about December 27, 2012, you incorrectly documented the admission medication orders and medication reconciliation for [Client C] by:
a) documenting that acetaminophen 500mg was covered under the Facility’s medical directives, when it was not; and
b) failing to properly document the requirement to check the client’s weight daily in order to accurately determine the client’s Furosemide dosage;
(d) on or about June 25, 2013, you fabricated documentation, namely an ADP referral form, to suggest that you had requested a wheelchair for [Client D] on June 11, 2013, when in fact you had not requested it until later;
(e) on or about June 27, 2013, you fabricated documentation, namely a late entry progress note, to suggest that you had requested a wheelchair for [Client D] on June 11, 2013, when in fact you had not requested it until later;
(f) on or about November 18, 2013, you failed to perform an assessment of [Client E] after this client had fallen;
(g) on or about February 13, 2014, you failed to properly document a physician’s order for Promogran for [Client F], and/or you failed to take the necessary steps to ensure an adequate supply of Promogran with which to treat the client;
(h) on or about February 20, 2014, you failed to notify [Client G’s] authorized representative of an incident involving inappropriate touching of [Client G] by another client;
(i) on or about February 25, 2014, you failed to perform a medication reconciliation for [Client A], and then documented that you had done so;
(j) on or about March 20, 2014, you communicated inappropriately with the daughter of [Client H] by:
a) notifying her of her [parent]’s death in a public place where you could be overheard; and/or
b) inappropriately accepting a telephone call while providing comfort to the daughter of [Client H] and/or while escorting her to see her deceased [parent];
(k) on or about April 15, 2014, you documented that Nitrospray ordered for [Client I] was covered by the Facility’s medical directives, when it was not, and required a specific order;
(l) on or about April 22, 2014, you requested and/or documented an order for a vitamin and mineral supplement for [Client C], without verifying [Client C’s] existing orders, resulting in [Client C] receiving a double-dose of the supplement for a period of time;
(m) on or about April 30, 2014, you communicated to staff at the Facility that the Facility was on isolation as a result of an outbreak of disease until May 1, 2014, without properly coordinating with Ontario Public Health about the duration of the isolation and/or outbreak status and whether that status was in fact lifted on May 1, 2014;
(n) on or about May 1, 2014, you inappropriately discussed the personal health information of [Client J] in a location and/or in circumstances in which you were likely to be overheard, namely, the lobby of the Facility;
(o) on or about May 2, 2014, you admitted and/or re-admitted [Client J] to the Facility while the Facility remained on outbreak status, without properly coordinating with Ontario Public Health about the admission;
(p) on or about May 6, 2014, you inappropriately discussed the personal health information of [Client J] in a location and/or in circumstances in which you were likely to be overheard, namely, on a speakerphone in your office with the door open.
Member’s Plea
The Member admitted all the allegations set out in the following paragraphs of the Notice of Hearing as numbered, and in particular admitted the following:
(a); (b); (c) subsections (a) and (b); (d); (e); (f); (g); (h); (i); (j) subsections (a) and (b); (k); (l); (m); (n); (o); (p);
(a); (b) subsections (a) and (b); (c); (d); (e);
(a); (b); (c);
(a); (b);
(a); (b); (c); subsections (a) and (b); (d); (e); (f); (g); (h); (i); (j) subsections (a) and (b); (k); (l); (m); (n); (o); (p); and
(a); (b); (c); subsections (a) and (b); (d); (e); (f); (g); (h); (i); (j) subsections (a) and (b); (k); (l); (m); (n);(o); (p).
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
Alistone T. Skepple (the “Member”) obtained a diploma in nursing from [ ] in 1990.
The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on October 17, 1990. The Member’s certificate of registration was suspended on an interim basis by the Inquiries, Complaints and Reports Committee on July 22, 2015, and remains currently suspended.
The Member was employed at [ ] (the “Facility”) from August 31, 2007, to May 15, 2014, when his employment was terminated. The Member grieved the termination and it was converted to a resignation.
THE FACILITY
The Facility is long-term care home that provides care to 128 residents. It is located in [ ], Ontario.
The Member worked as a “Geriatric Nurse Specialist” on the day shift. The Geriatric Nurse Specialist was an expert position intended to provide leadership in the development, implementation, ongoing monitoring and evaluation of nursing services. He was the charge RN on duty when he was working, and expected to act as a role model and mentor to the care team. Some of the Geriatric Nurse Specialist’s duties included demonstrating advanced knowledge and analysis of nursing practice issues pertaining to geriatrics, acting as a resource person to the nursing and interdisciplinary team, providing consultation regarding complex resident care needs to nurses, physicians and other members of the team, and various administrative duties, including ensuring an adequate supply of nursing equipment.
INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT
DNR Order
On May 1, 2012, the Member completed a Do Not Resuscitate Confirmation Form for [Client A] as she was being transferred to the hospital for assessment. The purpose of this form was to indicate to hospital staff what the client’s wishes were, as reflected in her treatment plan on file at the Facility, relating to the treatment that should be administered to her in the case of an irreversible serious illness. The Member indicated on the Do Not Resuscitate Confirmation Form that [Client A] had a current plan of treatment in place that reflected her expressed wish that CPR not be included in her plan of treatment.
In fact, [Client A’s] advanced directives provided the very opposite, that CPR was to be included in her treatment plan. These advanced directives were signed by the Member on January 13, 2012.
If the Member were to testify, he would say that [Client A’s] Advanced Directives were not readily available to him at the time she was transferred to the hospital.
The Member admits that by assuming the client had a “do not resuscitate” directive, when she did not, he put the client in serious risk of harm or death.
Transcribing Medication
On September 13, 2012, the Member failed to properly transcribe all of the medications ordered on a physician’s order form for [Client B] The Member wrote, “resume previous orders with the exception of the following,” rather than writing out the orders in full. In other words, the Member wrote down on the Physician Order Form a list of medications that the client was NOT ordered to receive, and failed to write out any of the medications that the client WAS ordered to receive.
The College’s Medication standard and the Facility’s policy, “Transcribing and Processing Medication Orders,” require that members avoid the use of error-prone abbreviations.
If the Member were to testify, he would say that he expected the evening RN and RPN to confirm and complete the physician’s order form in accordance with the Facility’s “double check” process.
The Member admits, however, that transcribing the medication orders in this way increased the risk of error and was contrary to the Facility’s policy and to the standards of practice.
Medication Reconciliation for [Client C]
On December 27, 2012, the Member made two errors in performing a Medication Reconciliation for [Client C].
First, the Member noted that an order for acetaminophen 500 mg was covered under the Facility’s medical directives. The directives, however, are for 2 x 325 mg.
Second, in completing this same Medication Reconciliation, the Member documented a PRN order for furosemide 40 mg, to be administered only if the client’s weight increased by 2-3 lbs in a day or 5 lbs in five days. The Member did not, however, document in the e-MAR that, as a result of this order, the client’s weight had to be checked daily. The error was not noticed until January 1, 2013, by another nurse.
If the Member were to testify, he would say that the evening RN and RPN were to confirm and complete the physician’s order form in accordance with the Facility’s “double check” process.
The Member admits, however, that he committed errors by incorrectly transcribing these orders.
Client Wheelchair Requisition for [Client D]
On June 25, 2013, the Member fabricated documentation to suggest that he had requested a wheelchair for [Client D] on June 11, 2013, when in fact he had not made the request until June 25, 2013. In particular, the Member back-dated an order form for the wheelchair to make it appear as though it was dated June 11, 2013, and created a late-entry progress note stating that he had faxed the request on June 11, 2013, neither of which was true.
On June 8, 2013, an RPN emailed the Member to request the order for the wheelchair from the occupational therapist. On June 24, 2013, the RPN asked the Member by email about the status of the request. On June 25, 2013, the Member responded to say that he would re-fax the order and that he was attaching a copy.
A screenshot of the attachment, however, shows the order form was in fact only created on June 25, 2013, at 07:16. On June 27, 2013, the Member created a late entry progress note to document that he had faxed the request on June 11, 2013. On July 4, 2013, the Member replied again to the email chain and indicated that the requisition had been faxed on June 11, 2013, and that he would follow up with the occupational therapist.
The Member admits that he did not in fact fax the request on June 11, 2013, and that he created documentation to misrepresent that he did.
Failed to Assess [Client E]
On November 18, 2013, the Member failed to perform an assessment of [Client E] after she fell. The Member did not witness the fall but was notified about it by [ ], an RPN. [The nurse] took the client’s blood pressure and noticed it was low, so she called the Member to assess the client. The Member instructed [the nurse] to monitor [Client E].
[Client E] was admitted to the hospital after the nurse on shift after the Member called an ambulance. [Client E] passed away three days later. The Member was suspended for three days as a result of this incident.
If the Member were to testify, he would say that the Facility was short-staffed for part of his shift and he was behind on his RN duties. He told the RPN to monitor the client and he reported the issue to the RN on the evening shift.
The Member admits, however, that considering the client’s fall and the request by the RPN to assess the client, he ought to have assessed the client.
Failed to Order Supplies for [Client F]
On February 10, 2014, the physician ordered wound care for [Client F], which included an order for Promogran.
The Member failed to order the dressing supplies for [Client F] on February 13, 2014, and as a result, she did not receive the prescribed treatment for eight days.
It was the Member’s responsibility to order this supply in a prompt way in order to ensure timely care for the client.
Failed to Report Abuse of [Client G]
On February 20, 2014, the Member failed to notify [Client G’s] authorized representative (POA) of an incident involving inappropriate touching of the client. The incident involved a male resident entering [Client G’s] room around 03:25, with no pants on and his genitals exposed, and placing his hand over [Client G’s] mouth. Both clients suffered from dementia.
The Member was asked specifically by the Director of Nursing to personally notify [Client G’s] family because of the sensitive nature of the incident.
If the Member were to testify, he would say that he told an RPN about the incident and had assumed the RPN would call the family. He would say that he was very busy that day, and by the end of his shift he had forgotten to check back with the RPN.
The Member admits that he did not effectively or properly delegate this task, and that having been expressly asked to do it personally, he was responsible for ensuring it was done. In the end the client’s POA was only notified of the incident on the evening of the following day.
The Member admits that he is responsible for this communication failure.
Medication Reconciliation for [Client A]
On February 25, 2014, the Member failed to perform a medication reconciliation for [Client A], and then documented that he had done so.
On February 25, 2014, the day [Client A] was admitted to the Facility, the Member documented in the progress notes that he completed a Medication Reconciliation, which was to be faxed to the pharmacy by an RPN once the medications were reviewed and confirmed by a physician. This was not true. An RN working a later shift documented, in the very next progress note, “Medication reconciliation not completed.” The Medication Reconciliation was eventually completed by another nurse.
Inappropriate Communication with Daughter of [Client H]
On March 20, 2014, [Client H] died at the facility. The Member notified the client’s daughter of her death in the lobby of the facility, rather than in a private place. As the Member was escorting [Client H’s] daughter back to the room to say goodbye to her [parent], the Member took a phone call instead of providing comfort to the client’s daughter.
If the Member were to testify, he would say that he told the client’s daughter that her [parent] had died in the lobby because she was on the phone telling someone on the other end that her [parent] was still alive, and then asked the Member whether her [parent] was okay.
He would also say that he was carrying a facility-issued phone as part of his duties as Geriatric Nurse Specialist and Charge RN, and was required to answer it.
The Member admits, however, that his communication with the client’s daughter fell below the standards of practice in all the circumstances, and in particular, that he ought to have asked the client’s daughter to accompany him to a private place before telling her of her [parent]’s death. Furthermore, the Member admits he was not required to answer the Charge RN phone at all costs.
Medication Reconciliation for [Client I]
On April 15, 2014, the Member documented, in the course of doing [Client I’s] medication reconciliation on admission, that Nitrospray ordered for [Client I] was covered by the Facility’s medical directives, when it was not, and required a specific order.
The Member documented in [Client I’s] Medication Reconciliation an entry that said: “[o]m/gravol/acetaminophen/hypoglycaemia – nitro spray once in 48 hours.” The Member then noted that the order was not to be continued and to use, “[ ] medical directive.”
A Medication Error Report was completed on April 18, 2014, to document the error.
Medication Error for [Client C]
On April 22, 2014, the Member requested and documented an order for a vitamin and mineral supplement for [Client C], without verifying his existing orders. In fact, the client already had an order for this supplement. As a result, the client received a double-dose of the supplement for a period of two weeks.
If the Member were to testify, he would say that he wrote out the order after a family member approached him with the pill bottle and said he would like the client to take the supplement. The Member says he gave the draft order to the RPN to follow up with the physician.
The Member admits, however, that it was his responsibility, as the person who transcribed the order, to verify the client’s existing orders before doing so.
Outbreak Protocol
On April 30, 2014, the Member communicated to staff that the Facility was on isolation until May 1, 2014, as a result of an outbreak of disease. The Member did not properly coordinate with Ontario Public Health about the duration of the isolation and/or outbreak status and whether that status was in fact lifted on May 1, 2014. In fact, the outbreak status was not lifted until May 5, 2014.
On May 2, 2014, the Member re-admitted [Client J] to the Facility while the Facility remained on outbreak status, without properly coordinating with Ontario Public Health about the admission. Because the Facility was still in outbreak status, [Client J] should not have been admitted until the outbreak status was lifted.
The Member’s error was discovered when the Director of Nursing contacted Ontario Public Health on May 2, 2014, to confirm that the outbreak status was indeed lifted, something the Member ought to have done before then, but did not do. Had the Member done so, this error would have been avoided.
Disclosure of Personal Information about [Client J]
- On May 1 and May, 6 2014, the Member inappropriately discussed [Client J’s] personal health information in an area that was not private – the first incident was in the lobby of the Facility and the second was on speakerphone with his office door open. Both times, the error was discovered because the Member’s conversations were overheard.
ADMISSIONS OF PROFESSIONAL MISCONDUCT
- The Member admits that he committed the acts of professional misconduct as described in paragraphs 6 to 50 above and as alleged in the following paragraphs of the Notice of Hearing, in that he contravened a standard of practice of the profession or failed to meet the standards of practice of the profession:
1(a), (b)
1 (c) subsections (a) and (b)
1 (d), (e), (f), (g), (h), (i)
1 (j) subsections (a) and (b)
1(k), (l), (m), (n), (o) and (p);
- The Member admits that he committed the acts of professional misconduct as described above and as alleged in the following paragraphs of the Notice of Hearing, in that he failed to keep records as required:
2(a),
2 (b) subsections (a) and (b)
2 (c), (d) and (e);
- The Member admits that he committed the acts of professional misconduct as described above and as alleged in the following paragraphs of the Notice of Hearing, in that he falsified a record relating to his practice:
- 3(a), (b) and (c);
- The Member admits that he committed the acts of professional misconduct as described above and as alleged in the following paragraphs of the Notice of Hearing, in that he signed or issued, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement:
- 4(a) and (b);
- The Member admits that he committed the acts of professional misconduct as described above and as alleged in the following paragraphs of the Notice of Hearing, in that his conduct was disgraceful, dishonourable and unprofessional:
5(a), (b)
5 (c) subsections (a) and (b)
5 (d), (e), (f), (g), (h), (i)
5 (j) subsections (a) and (b)
5(k), (l), (m), (n), (o) and (p);
- The Member admits that he committed the acts of professional misconduct as described above and as alleged in the following paragraphs of the Notice of Hearing, in that he is incompetent:
6(a), (b)
6 (c) subsections (a) and (b)
6 (d), (e), (f), (g), (h), (i)
6 (j) subsections (a) and (b)
6 (k), (l), (m), (n), (o) and (p);
Decision
The Panel considered the Agreed Statement of Facts and found that the facts support a finding of professional misconduct and, in particular, found that the Member committed acts of professional misconduct as alleged in the Notice of Hearing at paragraphs:
1.(a); (b); (c) subsections (a) and (b); (d); (e); (f); (g); (h); (i); (j) subsections (a) and (b); (k); (l); (m); (n); (o); (p);
2.(a); (b) subsections (a) and (b); (c); (d); (e);
3.(a); (b); (c);
4.(a); (b);
- (a); (b); (c); subsections (a) and (b); (d); (e); (f); (g); (h); (i); (j) subsections (a) and (b); (k); (l); (m); (n); (o); (p) in that the conduct was disgraceful, dishonourable and unprofessional; and
Further, the Panel finds that the Member is incompetent as alleged in the Notice of Hearing in paragraphs 6.(a); (b); (c); subsections (a) and (b); (d); (e); (f); (g); (h); (i); (j) subsections (a) and (b); (k); (l); (m); (n);(o); (p).
Reasons for Decision
The Member admits that he committed acts of professional misconduct as described in paragraphs 6 to 50 above and as alleged in the following paragraphs of the Notice of Hearing, in that he contravened a standard of practice of the profession or failed to meet the standards of practice of the profession:
1(a), (b)
1 (c) subsections (a) and (b)
1 (d), (e), (f), (g), (h), (i)
1 (j) subsections (a) and (b)
1(k), (l), (m), (n), (o) and (p);
The Member admits that he committed the acts of professional misconduct as described above and as alleged in the following paragraphs of the Notice of Hearing, in that he failed to keep records as required:
2(a),
2 (b) subsections (a) and (b)
2 (c), (d) and (e);
The Member admits that he committed the acts of professional misconduct as described above and as alleged in the following paragraphs of the Notice of Hearing, in that he falsified a record relating to his practice:
- 3(a), (b) and (c);
The Member admits that he committed the acts of professional misconduct as described above and as alleged in the following paragraphs of the Notice of Hearing, in that he signed or issued, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement:
- 4(a) and (b);
The Member admits that he committed the acts of professional misconduct as described above and as alleged in the following paragraphs of the Notice of Hearing, in that his conduct was disgraceful, dishonourable and unprofessional:
5(a), (b)
5 (c) subsections (a) and (b)
5 (d), (e), (f), (g), (h), (i)
5 (j) subsections (a) and (b)
5(k), (l), (m), (n), (o) and (p);
The Panel considered the Agreed Statement of Facts and also finds that the facts support a finding of incompetence and finds that the Member is incompetent as alleged in paragraphs:
6 (a), (b)
6 (c) subsections (a) and (b)
6 (d), (e), (f), (g), (h), (i)
6 (j) subsections (a) and (b)
6 (k), (l), (m), (n), (o) and (p).
In reaching its decision, the Panel relied exclusively on the evidence presented at the hearing as contained in the Agreed Statement of Facts [ ]. That evidence was sufficient to make the findings of professional misconduct and incompetence alleged by the College and agreed to by the Member.
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:
Requiring the Member to appear before the Panel to be reprimanded within three months of the date that this Order becomes final; and
Directing the Executive Director to immediately revoke the Member’s certificate of registration.
Penalty Submissions
Submissions were made by College Counsel about the need of the penalty to protect the public, and enhance public confidence in the ability of the College to regulate nurses. The penalty should have elements of general deterrence, to send a clear message to the profession as whole, and specific deterrence to deter the Member.
College Counsel presented R. v Haufe, 2007 ONCA 515 to show that the Panel should accept the Joint Submission on Order unless it is contrary to the public interest and the sentence would bring the administration of justice into disrepute.
To show the range of penalties available in these kinds of cases, College Counsel submitted the following.
CNO v Kaastra (Discipline Committee, 2011) – the member failed to respond appropriately to a [Client I]n distress and failed to assess, document and administer a medication. This case warranted a finding of disgraceful, dishonourable and unprofessional behaviour as well as incompetence leading to revocation.
CNO v Powell (Discipline Committee, 2011) - the broad range of incidents in different aspects of nursing care, which were similar to this case, led to a reprimand and revocation of the member’s certificate of registration.
CNO v Sircar (Discipline Committee, 2014) - although the facts are not similar to the present case, the allegations related to deceitful conduct leading to revocation.
Finally, College Counsel presented two previous Discipline Committee cases involving the Member (CNO v Skepple, (2006), (2008)) to illustrate a lack of ability to remediate.
The aggravating factors in this case were: the seriousness of incidents, the length of time over which the incidents have occurred, and the variety of subject areas involved in providing nursing care. Prior attempts at remediation have not been successful.
Penalty Decision
The Panel accepted the Joint Submission as to Order and accordingly orders:
The Member is required to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.
The Executive Director is directed to immediately revoke the Member’s certificate of registration.
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 his actions.
The penalty of revocation of the Member’s certificate of registration and an oral reprimand provides for general and specific deterrence and is in the public interest. The penalty sends a message to the public and members of the profession that this type of behaviour is unacceptable and will not be tolerated. Due to the repeated unprofessional behaviour and breaches of professional standards, the Panel found that the Member lacks the capacity for remediation.
I, Grace Fox, NP, 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:
Robert MacKay, Public Member
George Rudanycz, RN
Laura Sanderson, RPN
Devinder Walia, Public Member