College of Nurses of Ontario v. Doey, 2019 ONCNO 103284

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Dawn Cutler, RN Chairperson Renate Davidson Public Member Desiree Ann Prillo, RPN Member Michael Schroder, NP Member Chuck Williams Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO EMILY LAWRENCE for College of Nurses of Ontario

• and -

JOSEPH DOEY Registration No. AD079427 SARAH ATTARDO (Student-at-Law) for Joseph Doey CHRISTOPHER WIRTH, Independent Legal Counsel

Heard: May 2, 2019

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) on May 2, 2019 at the College of Nurses of Ontario (the “College”) at Toronto.

The Allegations

College Counsel advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraph 2 of the Notice of Hearing dated February 28, 2019. The Panel granted this request.

The remaining allegations against Joseph Doey (the “Member”) are as follows:

IT IS ALLEGED THAT:

1. 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 you were employed as a Registered Practical Nurse at Chatham Kent Health Alliance in Chatham, Ontario, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession with respect to one or more of the following incidents:

a. on or around January 8 or 9, 2016, you used profanity when in the presence of staff and/or the client, [Client A], saying something similar to “I don’t know why everyone thinks he’s a nice guy. He’s an asshole to me”

b. on or around January 28, 2016, you grabbed [Client A’s] forearm and pushed it back towards the client’s head with unnecessary force, while saying something similar to “you are not going to bite me, you motherfucker” and/or failed to document or report the incident;

c. on or around March 3, 2017, you administered the incorrect medication to [Client B] and/or failed to document the incident or notify senior staff or a physician regarding the incident;

d. on or around May 23, 2016, you used a derogatory term for the Patient Care Attendant role, referring to it as “baby sitting” several times within hearing of the client and/or care providers;

e. on or around May 23, 2016, you were disrespectful to the Administrator on Call and the Charge Nurse in that your language and tone were sarcastic and unprofessional, making comments similar to “well, I may just go home” and “you’re sexist”;

f. on or around March 9, 2017, you refused to provide medication to [Client D] at the time requested by the client and/or the time provided for on the order; and/or

g. on or around June 9, 2017, with respect to [Client E], you;

i. were loud and stern when speaking with the client, saying something similar to “if you don’t leave this on, you will go to your room and have restraints put on”;

ii. transferred the client to his bed on your own without assistance of other staff when the client required 2 person transfers; and/or

iii. used excessive force and held the client down in bed by pinning the client’s arms down, while commenting something similar to “you are going to do what I say” and/or “don’t even think of hitting me”; and/or

h. on or around June 9, 2017, with respect to [Client F], you:

i. transferred the client from his chair to his bed on your own without assistance of other staff when the client requires transfers by mechanical lift or 2 persons; and/or

ii. failed to document and/or report the above incident; and/or

2. [Withdrawn]

3. 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 you were employed as Registered Practical Nurse at Chatham Kent Health Alliance in Chatham, 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 as disgraceful, dishonourable or unprofessional with respect to the following incidents:

a. on or around January 8 or 9, 2016, you used profanity when in the presence of staff and/or the client, [Client A], saying something similar to “I don’t know why everyone thinks he’s a nice guy. He’s an asshole to me”;

b. on or around January 28, 2016, you grabbed [Client A’s] forearm and pushed it back towards client’s head with unnecessary force, while saying something similar to “you are not going to bite me, you motherfucker” and then failed to document or report the incident;

c. on or around May 23, 2016, you used a derogatory term for the Patient Care Attendant role, referring to it as “baby sitting” several times within hearing of the client and/or care providers;

d. on or around May 23, 2016, you were disrespectful to the Administrator on Call and the Charge Nurse in that your language and tone were sarcastic and unprofessional, making comments similar to “well, I may just go home” and “you’re sexist”;

e. on or around March 3, 2017, you administered the incorrect medication to [Client B] and/or failed to document the incident or notify senior staff or a physician regarding the incident;

f. on or around March 9, 2017, you refused to provide medication to [Client D], at the time requested by the client and/or the time provided for on the order; and/or

g. on or around June 9, 2017, with respect to [Client E], you;

i. were loud and stern when speaking with the client, saying something similar to “if you don’t leave this on, you will go to your room and have restraints put on”;

ii. transferred the client to his bed on your own without assistance of other staff when the client required 2 person transfers; and/or

iii. used excessive force and held the client down in bed by pinning the client’s arms down, while commenting something similar to “you are going to do what I say” and/or “don’t even think of hitting me”; and/or

h. on or around June 9, 2017, with respect to [Client F], you:

i. transferred the client from his chair to his bed on your own without assistance of other staff when the client requires transfers by mechanical lift or 2 persons; and/or

ii. failed to document and/or report the above incident.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1 and 3 in the Notice of Hearing. The Panel received a written plea inquiry which was signed by the Member. The Panel also conducted an oral plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Agreed Statement of Facts

College Counsel and the Member’s Representative advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads as follows:

THE MEMBER

1. Joseph Doey (the “Member”) obtained a diploma in nursing from St. Clair College in 2014.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Practical Nurse (“RPN”) on November 7, 2014. The Member was administratively suspended for non-payment of fees on February 20, 2019. The Member resigned from the College on March 22, 2019.

3. The Member was employed at Chatham Kent Health Alliance (the “Facility”) from February 9, 2015 to June 28, 2017, when his employment was terminated as a result of the incidents below.

THE FACILITY

4. The Facility is located in Chatham, Ontario.

5. The Member worked as a part-time staff nurse on the Complex Continuing Care Unit (the “Unit”).

6. The Unit housed primarily elderly clients with some younger clients with complex brain injuries and/or high-level behaviours. All clients on the Unit required a higher level of care than could be provided at a long-term care facility.

7. The Unit operated on a primary nursing care model with a client load of five per nurse in the day and seven to eight per nurse at night. Nursing shifts were 12 hours.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Incidents with Client [A]

January 8-9, 2016

8. [Client A] was [ ] years old and had suffered a stroke. He was cognitively aware, but his speech was limited. He had full range of motion on his left side, but was limited on his right side. Some of Client A’s actions were inappropriate. For example, Client A would brush against women’s breasts and then laugh about it.

9. Client A’s chart indicated that two people and a mechanical lift were required to move him from the bed to a chair, because of the lack of mobility on his right side.

10. The Member was assigned to Client A on January 8 and 9, 2016.

11. [Colleague A], RPN, and the Member were in Client A’s room giving the client a bed-bath. After the bath, [Colleague A] grabbed the maxi-lift (an electronic transfer sling) and returned it to its base at the other end of the room. While her back was turned, she overheard the Member yell, “you are not going to punch me” or something to that effect. She turned around and saw that the Member had Client A’s arms pinned to his stomach. [Colleague A] approached the Member, told him to leave the room and that she would finish with the client.

12. As the Member was leaving the room, he said something like, “I don’t know why everyone thinks he is a nice guy. He is an a-hole to me.” [Colleague A] heard the Member’s comment, but Client A did not.

13. The Member acknowledges, and the parties agree, that he breached the College’s Professional Standards, as set out below, and that his conduct was unacceptable. The Member used unprofessional language to refer to a client in the presence of a colleague, which demonstrated disrespect for the client, regardless of whether Client A heard the comment.

January 28, 2016

14. During the night shift on January 28, 2016, [Colleague B], RPN, was assigned to Client A’s care. At some point during the shift, [Colleague B] was changing Client A in his room. The Member walked into the room to assist and said to Client A, “you are not going to hit me again,” or words to that effect. Client A swung his arm at the Member, but the Member grabbed Client A’s forearm and pushed it back towards his head. Client A then tried to bite the Member, but the Member pushed Client A’s fist into his teeth to restrain him.

15. [Colleague B] told the Member to leave the room, which he eventually did.

16. If [Colleague B] were to testify, she would say that Client A looked scared after his interaction with the Member.

17. If the Member were to testify, he would state that he responded appropriately to an act of aggression by Client A using only the force necessary to restrain Client A and to keep Client A and himself safe. He does not admit to a breach of the standards of practice in respect of this interaction with Client A.

18. The Member did not document any of his interaction with Client A, nor did he report the incident to anyone at the Facility. He acknowledges and agrees that Client A’s behaviour, and the physical interaction between Client A and the Member was a significant event and needed to be documented in Client A’s chart and in an incident report or other report to his manager.

19. The Member acknowledges, and the parties agree, that he breached the College’s Documentation standard, in that he failed to document or report his interactions with Client A.

Client [B]

20. On March 3, 2017, the Member was assigned to provide care to [Client B]. Client B was diabetic and she had an order for her blood sugar levels to be tested four times a day, before meals and at bedtime, usually around 07:30, 11:15, 16:15 and 21:30. If Client B’s blood glucose was under four, there was an order to initiate a hypoglycemia clinical protocol.

21. Client B was to receive Novorapid (regular insulin) on a sliding scale three times a day at 07:45, 11:45 and 16:45 and then 50 units of Lantus insulin at 22:00. Novorapid is dispensed in an orange and blue pen and Lantus is dispensed in a gray and purple pen.

22. The Member administered Novorapid insulin to Client B before bed on March 3, 2017, around 22:00, instead of the Lantus insulin that was ordered. Prior to administration, Client B asked the Member if he was giving her the right type of insulin, because she was concerned it was not correct, and he assured her it was and proceeded to administer the medication.

23. Following receipt of the insulin, Client B advised the Member she was not feeling well – she was dizzy and sweating. The Member checked her blood sugar levels at 23:46, which was Client B’s fifth finger prick of the day. Her blood sugar level was low. It had dropped to 3.0, which was significantly lower than any other level in the days prior to and following the incident.

24. The Member responded appropriately by giving Client B some glucose, monitoring her more closely and checking her vitals. Client B’s sugar levels improved within a couple of hours. The following day, March 4, 2017, Client B’s blood sugar was higher than it had been over the previous week.

25. The Member did not document anything in Client B’s chart with respect to this medication error, other than the client’s blood sugar levels. He failed to document that he administered the wrong medication to Client B and that she felt unwell as a result. As well, the Member failed to report the medication error to Client B’s physician or any senior staff at the Facility.

26. The Member acknowledges, and the parties agree, that he breached the College’s Documentation standard and Medication standard, in that he administered the wrong medication to Client B and failed to document anything in the client’s chart with respect to her symptoms, his follow up, or any adverse reactions and failed to notify the client’s physician or his manager.

Incidents on May 23, 2016

27. [Client C] was [ ] years old. He was diagnosed with various mental health issues and a developmental delay. He was violent and sexually inappropriate with women. At times, security was called to assist with placing Client C in restraints. Client C needed one-on-one care, and given his inappropriate behaviour with women, male staff were typically assigned to his care.

28. On May 23, 2016, shortly after Client C was admitted to the Unit, [Colleague C], the charge nurse, assigned the Member to Client C’s care for the upcoming night shift. When the Member learned of his assignment, he refused. He told [Colleague C] that “he was not a babysitter” and that [Colleague C] and management were sexist for forcing him to watch the client due to his gender. [Colleague C] explained Client C’s needs to the Member and why she had assigned him to care for the client. The Member became angry, threatened to go home due to feeling sick and continued to refuse the assignment. The conversation was not within earshot of any clients.

29. At [Colleague C’s] request, [Colleague D], the Professional Practice Lead and administrator on call spoke to the Member. The Member made multiple comments during that call to the effect of, “I am not a babysitter,” and he threated to go home mid-shift, citing illness as the reason, when he was not, in fact, ill. Ultimately, the Member took the assignment.

30. If [Colleague D] were to testify, she would say she perceived the Member’s comments to be unprofessional and disrespectful.

31. [Colleague E] was a Patient Care Attendant at the Facility who worked with the Member. During several conversations with the Member on May 23, 2016, the Member referred to [Colleague E] as a “babysitter” and said that he did not go to school to “babysit people.” The Member’s comments to [Colleague E] were not made in the presence of a client. [Colleague E] perceived the comments as disrespectful.

32. The Member acknowledges, and the parties agree, that his conduct on May 23, 2016 was a breach of the College’s Professional Standards, in that he failed to communicate respectfully and professional[ly] with his colleagues when he disagreed with a patient assignment that was in the best interest of the client.

Client [D]

33. On March 9, 2017, the Member worked the night shift. He was assigned to provide care to [Client D]. Client D was ordered to receive Quetiapine (Seroquel) at 22:00 to help with sleep.

34. Around 21:00-22:00, the Member began conducting his evening [ ]rounds. The Member started his rounds with Client D because he was first on the Member’s list. When the Member approached Client D, he requested to have his evening medication later, around 23:00. Client D explained to the Member that he liked to stay up to watch sports and therefore he wanted his sleep aid administered at a later time.

35. The Member refused Client D’s request, arguing that it was outside the physician’s order to administer the medication at 23:00. If the Facility’s administrators were to testify, they would say that Client D’s request was reasonable and that administration of the medication at 23:00 was within an acceptable timeframe for the purposes of the order.

36. The Member documented in Client D’s Medication Administration Record (“MAR”) that he administered Seroquel at 22:00. There is nothing in the MAR or clinical notes to indicate that Client D refused the medication or requested that it be given at a later time.

37. The Member acknowledges, and the parties agree, that he breached the College’s Professional Standards and the Therapeutic Nurse-Client Relationship standard by refusing to accommodate Client D’s request to receive his medication at a later time, even though it was within the acceptable timeframe for the order. The Member recognizes that his actions put his needs, and his desire to complete his medication administration in the order on his sheet, before Client D’s needs. The Member also acknowledges that he breached the Documentation standard, in that he failed to document Client D’s request to receive his 22:00 medication at 23:00.

Client [E]

38. [Client E] was [ ] years old and was wheelchair bound. He was often loud and agitated and could get confused. Client E was also at risk for falls and required a two-person transfer.

39. On June 9, 2017, [Colleague F], RPN, was on shift with the Member. She was almost seven months pregnant at the time. [Colleague F] was assigned to care for Client E, but given his behaviour and her pregnancy, she was not comfortable with the assignment. [Colleague F] asked the Member if he would assist her with Client E during the shift.

40. Client E was in the hallway in his wheelchair with restraints. He became agitated and was trying to take his seatbelt off and get out of his chair. The Member put both his hands on Client E’s shoulders and pushed him back into the chair, using force while doing so. The Member told the client that if he did not leave his seatbelt on, the Member would place him in restraints. Client E became more upset and started shouting, “I’m being abused, get your hands off me, call the police,” or words to that effect.

41. The Member then wheeled Client E into his room and elected to transfer him to his bed without assistance, despite the order for two-person transfers.

42. While completing the transfer, the Member placed the weight of his body on Client E, pinning the client’s arms down. The Member said to Client E, “do not even think of hitting me,” or words to that effect. The Member then placed restraints on both of Client E’s arms, one leg and on his waist.

43. The Member acknowledges, and the parties agree, that he breached the College’s Professional Standards and the Therapeutic Nurse-Client Relationship in his interaction and communication with Client E, in that his communication was inappropriate, his physical interaction with Client E was inappropriate and his restraint technique was improper and contrary to the standards of least restraint. The Member also acknowledges that he breached the Decision about Procedure and Authority standard, in that he transferred Client E in a manner contrary to the physician’s order, which put the client at risk of falling.

Client [F]

44. [Client F] was [ ] years old. He had been admitted to the Unit for [ ] years. He required a two-person transfer or mechanical lift and was at risk for falls.

45. On June 9, 2017, [Colleague G], PSW, was on shift with the Member. [Colleague G] asked for assistance with transferring Client F to his bed. The Member entered the room and started to do the transfer on his own. He lifted Client F out of his chair and placed him in his bed.

46. [Colleague G] advised the Member that the client required a two-person assist and a mechanical lift. The Member ignored [Colleague G] and said that he always transferred the client on his own. As a result of the Member’s failure to follow the order, Client F’s legs were not in the correct position after the transfer and he was on the edge of the bed, at risk of falling.

47. The Member documented in Client F’s chart that Client F was moved from a chair to his bed on June 9, 2017 at 17:06 with two people and a mechanical lift. The entry was initialed by another RPN. The Member failed to document in Client F’s records that he was transferred by the Member alone.

48. The Member acknowledges, and the parties agree, that he breached the College’s Decision about Procedure and Authority standard, in that he transferred Client F in a manner contrary to the physician’s order, which put the client at risk of falling. As well, he admits that he breached the Documentation standard by failing to document an accurate account of the care he provided to Client F, including that he transferred the client without assistance.

COLLEGE STANDARDS

Professional Standards

49. The College’s Professional Standards provides that “[e]ach nurse establishes and maintains respectful, collaborative, therapeutic and professional relationships. One way of doing so is “demonstrating respect and empathy for, and interest in clients.”

50. In terms of professional relationships, the standard sets out indicators nurses must demonstrate, including:

• nurses role-modelling positive collegial relationships;
• using a wide range of communication and interpersonal skills to effectively establish and maintain collegial relationships.

Therapeutic Nurse-Client Relationship

51. The College’s Therapeutic Nurse-Client Relationship (“TNCR”) standard requires that nurses use therapeutic communication when speaking to clients. Specifically, it states that nurses should “use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-client relationship.”

52. The TNCR also requires that a nurse be “aware of her/his verbal and non-verbal communication style and how clients might perceive it.”

Decisions about Procedures and Authority

53. The College’s Decisions About Procedures and Authority standard requires that nurses ensure that they have the appropriate authority before performing procedures, and ensuring that client records reflect the initiated procedures.

Documentation

54. The College’s Documentation standard states that:

Nursing documentation is an important component of nursing practice and the interprofessional documentation that occurs within the client health record. Documentation — whether paper, electronic, audio or visual — is used to monitor a client’s progress and communicate with other care providers. It also reflects the nursing care that is provided to a client.

55. The standard goes on to say that a nurse meets the standard by “ensuring their documentation of client care is accurate, timely and complete.”

Medication

56. The College’s Medication standard requires nurses to “prepare and administer medication(s) to clients in a safe, effective and ethical manner.”

57. It goes on to define a medication error as, “any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the health care professional, client or consumer.” It sets out the expectation that nurses will report all medication errors and near misses using formal practice-setting communication mechanisms.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

58. The Member admits that he committed the acts of professional misconduct as described in paragraphs 8 to 55 above, in that he contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, as alleged in the Notice of Hearing, as follows:

• 1(a), in that, on or around January 8 or 9, 2016, he used profanity in the presence of a colleague, when he said something similar to, “I don’t know why everyone thinks he’s a nice guy. He’s an a-hole to me,” in reference to Client A.
• 1(b), in that, on January 28, 2016, he failed to document or report an incident with Client A.
• 1(c), in that, on March 3, 2017, he administered the incorrect medication to Client B and he failed to document the incident or notify senior staff or a physician about the error.
• 1(d), in that, on May 23, 2016, he used a derogatory term for the Patient Care Attendant role, referring to it as “baby sitting” several times in the presence of the care providers.
• 1(e), in that, on May 23, 2016, he was disrespectful to the Administrator on Call and the Charge Nurse, in that his language and tone were sarcastic and unprofessional. He made comments to the effect of, “well, I may just go home,” and “you’re sexist.”
• 1(f), in that, on March 29, 2017, he refused to provide medication to Client D at the time requested by the client.
• 1(g), in that, on June 9, 2017, with respect to Client E, he:
  • (i) was loud and stern when speaking with Client E, saying something to the effect of, “if you don’t leave this on, you will go to your room and have restraints put on.”
  • (ii) transferred the client to his bed on his own without assistance, when Client E required a two person transfer.
  • (iii) held Client E down in bed by pinning the client’s arms down, while saying something to the effect of, “you are going to do what I say,” and “don’t even think of hitting me.”
• 1(h), in that, on June 9, 2017, with respect to Client F, he:
  • (i) transferred Client F from his chair to his bed on his own without assistance, when the client required a two person transfer or use of the mechanical lift.
  • (ii) failed to document and/or report that he transferred Client F without assistance.

59. The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 3 (a), (b), (c), (d), (e), (f), (g) and (h) of the Notice of Hearing, and in particular that his conduct was disgraceful, dishonourable and unprofessional, as described in paragraphs 8 to 55 above.

60. With leave of the Discipline Committee, the College withdraws the following allegations from the Notice of Hearing:

• 2(a)
• 2(b)
• 2(c)(i) and (ii)

Decision

The College bears the onus of proving the allegations in accordance with the standard of proof, that being the balance of probabilities based upon 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), 1(b), 1(c), 1(d), 1(e), 1(f), 1(g) (i), (ii), (iii), 1(h) (i), (ii), and 3(a), 3(b), 3(c), 3(d), 3(e), 3(f), 3(g) (i), (ii), (iii), and 3(h) (i), (ii) of the Notice of Hearing. As to allegation #3, the Panel finds that the Member engaged in conduct that would reasonably be considered by members to be disgraceful, dishonourable, and unprofessional.

Reasons for Decision

The Panel considered the Agreed Statement of Facts and the Member’s plea and finds that this evidence supports findings of professional misconduct as alleged in the Notice of Hearing.

Allegation #1(a) in the Notice of Hearing is supported by paragraphs 9, 10, 11, 12, and 13 in the Agreed Statement of Facts. The Member used profanity in the presence of a colleague when referring to Client A, demonstrating disrespect for the Client. This conduct was a breach of the College’s Professional Standards as stated in paragraphs, 49 and 50 above.

Allegation #1(b) in the Notice of Hearing is supported by paragraphs 14, 15, 16, 17, 18, and 19 in the Agreed Statement of Facts. During the night shift on January 28, 2016, the Member entered Client A’s room to assist another nurse with the care of Client A when an act of aggression occurred between Client A and the Member. The Member did not document any of his interaction with Client A or report the incident to anyone at the facility. As such, he breached the College’s Documentation Standard as stated in paragraphs 54 and 55 above.

Allegation #1(c) in the Notice of Hearing is supported by paragraphs 20, 21, 22, 23, 24, 25, and 26 in the Agreed Statement of Facts. On March 3, 2017, the Member was assigned to Client B, who was a diabetic. The Member administered Novorapid Insulin to Client B at around 22:00 instead of the Lantus which was ordered. The Client subsequently advised the Member she was not feeling well and was given some glucose to improve her blood sugar levels. The Member did not document anything in Client B’s chart with respect to the medication error, his follow up, or any adverse reactions. The Member also failed to notify Client B’s physician or his manager. The Member’s conduct was a breach of the Documentation Standard as stated in paragraphs 54 and 55 and the Medication Standard as stated in paragraphs 56 and 57 above.

Allegations #1(d) and #1(e) in the Notice of Hearing are supported by paragraphs 27, 28, 29, 30, 31, and 32 in the Agreed Statement of Facts. On May 23, 2016, the Member used a derogatory term for the Patient Care Attendant role, referring to it as “baby sitting” several times in the presence of the care providers. The Member was also disrespectful to the Administrator on Call and the Charge Nurse, in that his language and tone were sarcastic and unprofessional. The Member’s conduct breached the College’s Professional Standards as stated in paragraphs 49 and 50, in that he failed to communicate respectfully and professionally with his colleagues when he disagreed with a patient assignment that was in the best interest of the client.

Allegation #1(f) in the Notice of Hearing is supported by paragraphs 33, 34, 35, 36 and 37 in the Agreed Statement of Facts. On March 29, 2017, the Member refused to provide medication to Client D at the time requested by Client D even though it was within the acceptable timeframe for the order. The Member documented that he administered the medication at 22:00; however there was no documentation to indicate that the client refused the medication or requested it be given at a later time.

The Member breached the College’s Professional Standards as stated in paragraphs 49 and 50 and the Therapeutic Nurse-Client Relationship Standard as stated in paragraphs 51, and 52. The Member’s conduct was such that he put his needs, and his desire to complete his medication order before the needs of Client D. The Member also breached the Documentation Standard as stated in paragraph 54, when he failed to document the request from Client D to receive his medication later than scheduled.

Allegation #1(g)(i) is supported by paragraphs 38, 39, 40 and 43 in the Agreed Statement of Facts. On June 9, 2017, another nurse who was almost seven months pregnant and on the shift with the Member asked the Member to help her with the care of Client E who was wheelchair bound as this client was often loud and agitated, could get confused and also was at risk for falls. When Client E became agitated and tried to take his seatbelt off and get out of his chair, the Member was loud and stern and told the client that he would have to take him to his room and place him in restraints if he did not leave his seatbelt on. The Member breached the College’s Professional Standards as stated in paragraphs 49 and 50 above and the Therapeutic Nurse-Client Relationship Standard as stated in paragraphs 51 and 52 above, in that his interaction and communication with Client E was inappropriate, his physical interaction with Client E was inappropriate, and his restraint technique was improper and contrary to the standards of least restraints. The Member also breached the Decision about Procedures and Authority Standard as stated in paragraph 53 above when he transferred Client E in a manner contrary to the physician’s order, which put the client at risk of falling.

Allegation #1(g)(ii) in the Notice of Hearing is supported by paragraphs 38, 39, 42 and 43 in the Agreed Statement of Facts. On June 9, 2017, following the interaction with Client E, the Member transferred the Client to his bed on his own without assistance of other staff even though the Client required a two person transfer. This was a breach of the Decision about Procedures and Authority Standard as stated in paragraph 53 above and contrary to the physician’s order.

Allegation #1(g)(iii) in the Notice of Hearing is supported by paragraphs 38, 39, 42 and 43 in the Agreed Statement of Facts. On June 9, 2017, while completing the transfer of Client E, the Member held Client E down in bed by pinning the client’s arms down, while saying something to the effect of “do not even think of hitting me”. The Member’s conduct breached the College’s Professional Standards as stated in paragraphs 49 and 50 and the Therapeutic Nurse-Client Relationship Standard as stated in paragraphs 51 and 52 above, in that his communication was inappropriate, his physical interaction with Client E was inappropriate and his restraint technique was improper.

Allegation #1(h)(i) in the Notice of Hearing is supported by paragraphs 44, 45, 46, 47 and 48 in the Agreed Statement of Facts. On June 9, 2017, the Member transferred Client F from his chair to his bed on his own without assistance, when in fact the client required a two person transfer or use of the mechanical lift. This was a breach of the Decision about Procedures and Authority Standard as stated in paragraph 53 above, in that the Member transferred Client F in a manner that was contrary to the physician’s order, which put the client at risk of falling.

Allegation #1(h)(ii) in the Notice of Hearing is supported by paragraphs 44, 45, 47 and 48 in the Agreed Statement of Facts. The Member failed to document an accurate account of the care he provided to Client F, including that he transferred the Client without assistance. As such, he breached the College’s Documentation Standard as set out in paragraph 54 above.

Allegation #3 and all its subsections in the Notice of Hearing are supported by paragraphs 8 to 55 in the Agreed Statement of Facts.

The Member’s conduct involved breaches of the Professional Standards and a disregard of the foundational principles of the therapeutic nurse-client relationship. The Member failed to communicate respectfully and professionally with both his colleagues and his clients. He failed to accommodate a client’s request to receive his medication at a later time that was well within the acceptable timeframe of the order. In doing so, he put his needs before those of the client. The Member transferred a client in a manner that was contrary to the physician’s order which put the client at risk of falling. The Member administered the wrong medication to a client, he failed to document this in the client’s chart and failed to notify the client’s physician and his manager.

The Member’s conduct demonstrated a serious and persistent disregard for his professional obligations and casts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects health professionals to meet. The Panel finds that the conduct of the Member was disgraceful, dishonourable and unprofessional.

Penalty

College Counsel and the Member’s Representative advised the Panel that a Joint Submission on Order had been agreed upon. The Joint Submission on Order requests that this Panel make an order as follows:

1. Requiring the Member to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.

Penalty Submissions

College Counsel stated that the Member resigned from the College effective March 22, 2019 and has signed an Undertaking with the College in which he undertakes as follows:

1. to permanently resign as a member of the College, effective from the date upon which the College accepts this Undertaking; and

2. to not apply for membership with the College as a Registered Nurse or Registered Practical Nurse at any time in the future.

Pursuant to the Undertaking, the Member also confirms, acknowledges and agrees that:

3. The public portion of the Register maintained by the College will indefinitely reflect that I entered into an Undertaking with the Executive Director to permanently resign as a member of the College as part of an agreed resolution of allegations of professional misconduct heard by a Panel of the Discipline Committee, in addition to any other information that is required to be posted;

4. By permanently resigning as a member of the College, I will no longer have a right to:

a) the issuance of reinstatement of a Certificate of Registration from the College;

b) use the title “Nurse”, “Registered Nurse”, “Registered Practical Nurse”, “RN”, “RPN” or a variation, an abbreviation or an equivalent in another language;

c) to hold myself out as a Nurse, Registered Nurse, Registered Practical Nurse or as a person who is qualified to practise in Ontario as a Nurse, Registered Nurse or Registered Practical Nurse; and/or

d) to engage in the practice of nursing in any capacity;

5. The College is authorized to and may, in its sole discretion, provide a copy of this Undertaking and/or its terms to a governing body that regulates nursing in Canada or elsewhere in response to an inquiry or otherwise;

6. The Panel is not obliged to accept any agreement entered into between the College and myself, including any order that we jointly request.

College Counsel submitted that this undertaking has been jointly agreed to by the parties and in this case, the reprimand and the facts of the resolution make this decidedly in the public interest. College Counsel submitted that mitigating factors considered were that the Member had no past disciplinary record, that he has co-operated in coming to an Agreed Statement of Facts that resulted in avoiding a lengthy contested hearing.

College Counsel submitted that the aggravating factors in the case were the seriousness of the Member’s conduct which showed patterns of disrespectful conduct to staff, colleagues and clients, using physical force, patterns of documentation insufficiencies and disregard in terms of the two person transfer requirements. College Counsel submitted when this conduct is viewed as a whole, it is very serious especially because of the type of clients being cared for in a complex care setting.

College Counsel submitted that these patterns of behaviour require a serious regulatory response to provide deterrence to the Member and the membership. In light of the Undertaking, College Counsel submitted that the proposed penalty order supported general deterrence, and protection of the public.

College Counsel submitted two cases to the Panel to demonstrate that panels of this Discipline Committee have accepted alternatively-structured penalties when a member enters into an Undertaking to permanently resign his or her certificate of registration that resulted in the ultimate goal of penalties, i.e. public protection.

CNO v. Smith (Discipline Committee, 2017)

In this case, the member failed to meet the Therapeutic Nurse-Client Relationship Standard of Practice and physically abused the client when she grabbed the client’s blouse and shook her. The resulting penalty was an oral reprimand and the member also entered into an undertaking with the College to resign.

CNO v. O’Neill (Discipline Committee, 2016)

In this case, the member contravened the Professional Standards, Ethics, and Therapeutic Nurse-Client Relationship Standard of Practice when she attempted to compel the client to take medications without her consent and by pinching the client when she refused. The resulting penalty was an oral reprimand and the member also entered into an undertaking with the College to resign and never reapply for registration in Ontario or any other jurisdiction as a nurse in the future.

Penalty Decision

The Panel accepts the Joint Submission on Order and accordingly orders:

1. The Member is required to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.

Reasons for Penalty Decision

The Panel understands that the penalty ordered should protect the public and enhance public confidence in the ability of the College to regulate nurses. This is achieved through a penalty that addresses specific deterrence, general deterrence and, where appropriate, rehabilitation and remediation. The Panel also considered the penalty in light of the principle that joint submissions should not be interfered with lightly.

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. The Panel finds that the penalty satisfies the principles of general deterrence, and public protection. The Panel considered the fact that the Member has undertaken to permanently resign which meets the ultimate goal of public protection by removing the Member from the profession and practice. The transparency of posting the Member’s resignation and reprimand on the College’s register will maintain public confidence and demonstrate the College’s ability to regulate nurses.

The Panel acknowledges that the penalty does not address remediation. However, the Panel does not identify any need for this aspect of the penalty as the Member has permanently resigned from the profession.

The penalty is in line with what has been ordered in previous cases.

I, Dawn Cutler, 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.