College of Nurses of Ontario v. Darren W.H. Gaudette, 2023 ONCNO 149346 — College of Nurses of Ontario Discipline Committee | minicounsel

PANEL: Carly Gilchrist, RPN Chairperson Tyler Hands, RN Member Jane Mathews, RN Member Lalitha Poonasamy Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) ALYSHA SHORE for ) College of Nurses of Ontario

and - )

DARREN W.H. GAUDETTE ) CHRISTOPHER BRYDEN for Registration No. 9149311 ) Darren W.H. Gaudette ) CHRISTOPHER WIRTH ) Independent Legal Counsel ) Heard: June 5, 2023

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on June 5, 2023, via videoconference.

Publication Ban

College Counsel brought a motion pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, for an order preventing public disclosure and banning the publication or broadcasting of the name(s) of the patient(s), or any information that could disclose the identity(ies) of the patient(s), referred to orally or in any documents presented at the Discipline hearing of Darren W.H. Gaudette.

The Panel considered the submissions of the College Counsel and Member’s Counsel and decided that there be an order preventing public disclosure and banning the publication or broadcasting of the name(s) of the patient(s), or any information that could disclose the identity(ies) of the patient(s), referred to orally or in any documents presented at the Discipline hearing of Darren W.H. Gaudette.

The Allegations

The allegations against Darren W.H. Gaudette (the “Member”) as stated in the Notice of Hearing dated May 8, 2023 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 you were employed as a Registered Nurse at Health Sciences North in Sudbury, Ontario, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession as follows:

a. on or around May 24, 2020, with respect to Patient A you failed to follow proper restraint techniques when you:

i. pulled the patient to the ground with your arm and/or arms around the patient’s neck;

ii. pulled and/or pushed the patient’s head to the ground with your arm and/or arms around the patient’s neck;

iii. held the patient to the ground, with one hand on the front of the patient’s neck/throat, the other hand on the patient’s head, and your knee on the back and/or side of the patient’s neck; and/or

iv. held the patient to the ground for approximately 7 minutes;

b. on or around April 19, 2020, with respect to Patient B you failed to follow proper de-escalation and/or restraint techniques when you:

i. lunged at the patient;

ii. placed your hand and/or hands on the front of the patient’s neck/throat; and/or

iii. pushed the patient back towards the wall;

c. on or around October 6, 2019, with respect to Patient C you:

i. swung the patient’s chair around, for no clinical purpose, and/or without considering the risk of the patient falling to the ground; and/or

ii. pushed the patient towards the exit with your hand on the patient’s back as she was leaving the room;

d. on or around March 20, 2019, with respect to Patient D:

i. prior to intervening, you failed to appropriately assess the patient’s state and situation, including, but not limited to when you failed to obtain relevant information from the staff present and/or assess whether removing the patient’s gown from her neck was clinically necessary at that time;

ii. you used excessive force in removing the patient’s gown from her neck;

iii. you ordered staff to restrain the patient on the bed on her stomach;

iv. in restraining the patient to the bed on her stomach, you forcefully grabbed the back of the patient’s neck and pushed her down to the bed, on more than one occasion;

v. you communicated with the patient in a non-therapeutic manner; and/or

vi. throughout the incident, you failed to cooperate with the staff present, including, but not limited to when you failed to listen to directions of the charge nurse, M.L.;

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(7) of Ontario Regulation 799/93, in that while you were employed as a Registered Nurse at Health Sciences North in Sudbury, Ontario, you abused patients verbally, physically, and/or emotionally as follows:

a. on or around May 24, 2020, with respect to Patient A you failed to follow proper restraint techniques, including when you:

i. pulled the patient to the ground with your arm and/or arms around the patient’s neck;

ii. pulled and/or pushed the patient’s head to the ground with your arm and/or arms around the patient’s neck;

iv. held the patient to the ground for approximately 7 minutes;

b. on or around April 19, 2020, with respect to Patient B you failed to follow proper de-escalation and/or restraint techniques when you:

i. lunged at the patient;

ii. placed your hand and/or hands on the front of the patient’s neck/throat; and/or

iii. pushed the patient back towards the wall;

c. on or around October 6, 2019, with respect to Patient C you:

i. swung the patient’s chair around, for no clinical purpose, and/or without considering the risk of the patient falling to the ground; and/or

ii. pushed the patient towards the exit with your hand on the patient’s back as she was leaving the room;

d. on or around March 20, 2019, with respect to Patient D you:

i. used excessive force in removing the patient’s gown from her neck;

ii. in restraining the patient to the bed on her stomach, you forcefully grabbed the back of the patient’s neck and pushed her down to the bed, on more than one occasion; and/or

iii. communicated with the patient in a non-therapeutic manner; and/or

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 a Registered Nurse at Health Sciences North in Sudbury, 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 as follows:

a. on or around May 24, 2020, with respect to Patient A you failed to follow proper restraint techniques when you:

i. pulled the patient to the ground with your arm and/or arms around the patient’s neck;

ii. pulled and/or pushed the patient’s head to the ground with your arm and/or arms around the patient’s neck;

iv. held the patient to the ground for approximately 7 minutes;

b. on or around April 19, 2020, with respect to Patient B you failed to follow proper de-escalation and/or restraint techniques when you:

i. lunged at the patient;

ii. placed your hand and/or hands on the front of the patient’s neck/throat; and/or

iii. pushed the patient back towards the wall;

c. on or around October 6, 2019, with respect to Patient C you:

i. swung the patient’s chair around, for no clinical purpose, and/or without considering the risk of the patient falling to the ground; and/or

ii. pushed the patient towards the exit with your hand on the patient’s back as she was leaving the room; and/or

d. on or around March 20, 2019, with respect to Patient D:

ii. you used excessive force in removing the patient’s gown from her neck;

iii. you ordered staff to restrain the patient on the bed on her stomach;

iv. in restraining the patient to the bed on her stomach, you forcefully grabbed the back of the patient’s neck and pushed her down to the bed, on more than one occasion;

v. you communicated with the patient in a non-therapeutic manner; and/or

vi. throughout the incident, you failed to cooperate with the staff present, including, but not limited to when you failed to listen to directions of the charge nurse, M.L.

Member’s Plea

The Member admitted the allegations set out in paragraphs #1(a)(i), (ii), (iii), (iv), (b)(i), (ii), (iii), (c)(i), (ii), (d)(i), (ii), (iii), (iv), (v), (vi), #2(a)(i), (ii), (iii), (iv), (b)(i), (ii), (iii), (c)(i), (ii), (d)(i), (ii), (iii), #3(a)(i), (ii), (iii), (iv), (b)(i), (ii), (iii), (c)(i), (ii), (d)(i), (ii), (iii), (iv), (v) and (vi) 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 Counsel advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which as amended reads, unedited, as follows:

THE MEMBER

Darren W H Gaudette (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on August 7, 1991. The Member is registered as a nurse in Florida, United States.
The Member was employed as a part-time nurse at Health Sciences North located in Sudbury, Ontario (the “Hospital”) on the Inpatient Psychiatry Unit (the “Unit”). The Member worked at the Hospital from July 2, 2014, to July 15, 2020, when his employment was terminated as a result of the incidents described below.

THE UNIT

The Unit is a locked unit comprised of a main ward, an intensive care unit with 5 beds and a step-down unit with 7 beds. RNs can work on any part of the Unit whereas Registered Practical Nurses only work on the main ward.
Patients on the Unit have acute mental health conditions and may be aggressive and unpredictable. There is a risk of violence on the Unit, so nurses do not work alone and there is security at all times. Nurses are also provided with extensive training on non-violent crisis intervention, restraint techniques, code white procedures and verbal de-escalation.
With respect to restraints, the Hospital followed the philosophy of least restraint and the policy provides that a restraint intervention is only implemented for the benefit and safety of the person receiving care and/or when the safety of others is in danger.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Patient A

Patient A was 20 years old at the time of the incident and was diagnosed with stimulant-induced psychotic disorder, borderline personality disorder, alcohol use disorder and cannabis use disorder. Patient A was admitted to the Hospital from May 20 to 26, 2020 due to suicidal thoughts.
The Member was assigned to Patient A’s care on May 24, 2020. The day before, Patient A said he was feeling a compulsion to run and pull the fire alarm. In these circumstances, a nurse would secure Patient A in his room and provide distractions and items such as food.
On May 24, 2020, the Member placed Patient A in seclusion at points throughout the morning. Around noon, after being removed from seclusion, Patient A began threatening to pull the fire alarm again. After being directed back to his room, Patient A ran towards the fire alarm. If the fire alarm is pulled, the doors to the Unit unlock and patients can exit.
A security guard was present and used low physical control to act as a barricade between Patient A and the fire alarm. The Member ran to the area. Patient A was striking out with arms and legs flailing. In response, the Member came up behind Patient A and took a position of head control of Patient A referred to as a chokehold or a modified chokehold. Chokeholds are against the Hospital’s policy and nurses are not trained in this maneuver.
The Member was behind Patient A with his arm around Patient A’s neck and he pulled Patient A down to the floor. Patient A landed on his back. The Member pulled and/or pushed Patient A’s head to the ground with his arm around Patient A’s neck.
Another nurse stepped in almost immediately and secured Patient A’s left arm. The security guard secured Patient A’s lower limbs and right arm. If the security guard were to testify, he would state he heard the Member say words to the effect of “that’s the last time you hit/punch me” to Patient A while restraining him.
The Member held Patient A to the ground with one hand on the front of Patient A’s neck/throat, the other hand on Patient A’s head and the Member’s knee on the back and/or side of Patient A’s neck. During the interaction, Patient A’s face was turning red. Patient A almost immediately subdued, and he was not resisting or struggling.
The Member continued to have a hand placed over Patient A’s neck and head for 7 minutes and 43 seconds. During this time, the security guard was rubbing Patient A’s back telling him it was okay.
The incident was captured on video surveillance.
If the Member was to testify, he would state that he placed Patient A in a modified chokehold because he was worried Patient A might harm himself and that he restrained Patient A on the floor for the length of time based on Patient A’s past behaviour. The Member would further testify that he did not say words to the effect of “that’s the last time you hit/punch me” to Patient A while restraining him and that he instead said words to the effect of “you said you wouldn’t hit me again” to remind Patient A of their discussion the previous day. The Member would also testify that he did not act maliciously and was attempting to manage the situation but admits that the force he used was not appropriate.

Patient B

Patient B was 39 years old at the time of the incident and was diagnosed with schizophrenia, stimulant disorder, alcohol use disorder, cannabis use disorder and opiate use disorder. Patient B was admitted to the Hospital from April 7 to 28, 2020.
On April 19, 2020, Patient B was trying to leave the Unit. The Member, another nurse, and a security guard were trying to get Patient B back to his room. While they were talking to Patient B, Patient B dropped an item of clothing on the floor. The Member kicked the item of clothing to the side with his foot.
Patient B was cooperative and moved down the hallway. As they were heading back to Patient B’s room, Patient B bent down to pick up the dropped item. Beneath the item of clothing was a toothbrush-like item that was shaved down to a shiv. Patient B bent down to pick up the shiv.
The Member put himself between Patient B and the shiv to block Patient B. The Member tried to pick up the shiv and then lunged at Patient B. The Member placed his hand and/or hands on the front of Patient B’s neck/throat and pushed Patient B back against the wall. The other nurse heard Patient B say words to the effect of “what’s going on”.
While the Member pushed Patient B against the wall, the Member pushed Patient B into the other nurse, who was able to secure Patient B’s upper arms. A struggle ensued before Patient B relaxed and returned to his room without injury.
The incident was captured on video surveillance.
In accordance with the Hospital’s least restrictive restraint policy, it is not appropriate for staff to grab a patient’s throat when restraining a patient. In this instance, the Member’s intervention was disproportionate; he could have used soft physical control of the forearms or upper arms like the other nurse involved in the incident.
If the Member were to testify, he would state that he was terrified when he thought Patient B was reaching for the shiv. Specifically, the Member would testify that he was terrified in part as a result of a prior incident on the Unit when he was assaulted by a patient and suffered significant medical and psychological injuries, discussed in greater detail below.

Patient C

Patient C was 38 years old at the time of the incident and was diagnosed with Huntington’s Disease as well as mental health conditions. Patient C was admitted to the Hospital from August 16 to December 23, 2019. Patient C’s had difficulties with movement and coordination due to this medical condition.
On October 6, 2019, the Member was in a common room on the Unit which contained a TV. The Member initially changed the channel or a setting on the TV and then exited the room. The Member returned to the common room and did something to the TV again at which time he started to have a conversation with Patient C.
The Member and Patient C were approximately 10 feet apart during the conversation. The Member then walked over to Patient C and swung her chair around without clinical purpose and without considering the risk of Patient C falling to the ground. The chair got pulled out from under Patient C and she slipped out of the chair onto the floor. Patient C got back up and started to leave the room. As Patient C was leaving the room, the Member put his hand flat on her back and pushed her towards the door.
The incident was captured on video surveillance; however, the Hospital no longer has a copy of the video.
If the Member were to testify, he would state that Patient C was verbally aggressive towards him and patients in the common room and, as a result, he told Patient C to leave and turned her chair around. The Member would further testify that he was feeling overwhelmed at that time and needed a break. The Member would also testify that after the Hospital reviewed the video with him, he regretted his conduct and took time off to reflect on his nursing practice.

Patient D

Patient D was 23 years old at the time of the incident and was diagnosed with bipolar disorder and borderline personality disorder. Patient D was admitted to the Hospital from March 19 to April 9, 2019 with suicidal ideation.
On March 20, 2019, Patient D had a disagreement with her mother and threw a chair out of her room. At that time, two nurses, the Charge Nurse and a security guard entered Patient D’s room. Patient D was pacing the room and one of the nurses attempted to speak with Patient D, but she was unresponsive. In the past, staff were able to de-escalate Patient D through verbal methods.
Patient D then climbed up onto the window ledge of her room, did not want staff to come near her and was threatening suicide.
One of the nurses left the room to go check if Patient D had any PRN medication. The nurse saw the Member at the nursing station and the Member asked the nurse what was doing on. The nurse advised that Patient D was escalating.
The Member then grabbed a pair of gloves and ran to Patient D’s room. At that point, Patient D was putting her gown around her neck in an attempt to make a noose.
The Member quickly and abruptly grabbed the gown and tore it off of Patient D’s neck using excessive force. Patient D looked up and said words to the effect of “that fucking hurt”. The Member then pushed his “spider badge” used for calling code whites and Patient D lunged off the window ledge toward the Member.
The Member did not appropriately assess Patient D’s state or the situation when he failed to obtain relevant information from the staff present and when he failed to assess whether removing Patient D’s gown from her neck was clinically necessary at that time.
Patient D was manually restrained by staff on her bed. Patient D was remorseful for lunging at the Member. Patient D was crying, saying she was scared, and begging not to be restrained. The Member ordered staff to restrain Patient D on her stomach.
Other staff arrived and began to attach restraints. At the time, Patient D was on her stomach and was pushing herself up with her hands repeatedly. The Member forcefully grabbed Patient D by her neck and push her back down to the bed on more than one occasion. Patient D screamed that the Member was hurting her or words to that effect. In response, the Member said words to the effect of “if you didn’t move I wouldn’t have to do that”.
The Member was not demonstrating anger control during the incident and he was yelling words to the effect of “stop resisting. I am going to charge you” to Patient D. As the Member increased his use of force, Patient D’s resistance and aggression increased. The Member was causing more panic rather than de-escalating the situation; he was not communicating with team members or listening to suggestions.
Staff were uncomfortable and looking to the Charge Nurse for intervention. The Charge Nurse told the Member that she wanted Patient D to de-escalate and then they would move her to another room with a locked door and other staff agreed with this plan. The Member responded with words to the effect of “No, we are restraining her and will worry about it later”.
The Charge Nurse then advised that she wanted to move Patient D to her back and slow the code down a little. The Charge Nurse was still trying to talk to Patient D and de-escalate her and Patient D’s mother was still just outside her room in the hallway. The Member failed to listen to the Charge Nurse’s repeated instructions.
It is not standard practice at the Hosptial to restrain a patient on their stomach as it can be dangerous for the patient. This type of restraint should only be used in an emergency situation.
Patient D’s bed was eventually taken to the acute unit. Patient D calmed down, rolled onto her back and was restrained and covered up. Patient D remained in restraints for less than 5 minutes.
The Member subsequently received coaching from a manager at the Hospital.
If the Member were to testify, he would state that the incident unfolded quickly and that he did not intend to use more force than necessary.

Member’s Health

If the Member were to testify, he would state that he was suffering from a health condition during the relevant time period that affected his behaviour and judgment. The Member would further testify that the health condition was a result of a physical assault by a patient on the Unit on March 16, 2017. The Member would also testify that, as a result of the physical assault, he suffered significant medical and psychological injuries and was off work for a significant amount of time in part to obtain treatment and to recover, and that when he returned, he worked in other areas of the Hospital before returning to the Unit in March 2019.
If the Member were to testify, he would state that he now understands that he was not in a position to return to the Unit as working on the Unit triggered and exacerbated his health condition that was caused by the physical assault in 2017.
The Member would also testify that he has sought treatment and worked over the last several years to address the health issues that contributed to the incidents described above.

CNO STANDARDS

Code of Conduct

CNO’s Code of Conduct is a standard of practice describing the accountabilities all Ontario nurses have to the public. The Code of Conduct consists of six principles including nurses respect the dignity of patients and treat them as individuals, nurses work together to promote patient well-being, nurses maintain patients’ trust by providing safe and competent care, nurses work respectfully with colleagues to best meet patients’ needs, nurses act with integrity to maintain patients’ trust and nurses maintain public confidence in the nursing profession.
With respect to the principle that nurses respect the dignity of patients and treat them as individuals, CNO’s Code of Conduct provides that nurses treat patients with care and compassion.
Regarding the principle that nurses maintain patients’ trust by providing safe and competent care, CNO’s Code of Conduct provides that nurses seek advice and collaborate with the health care team to uphold safe patient care and nurses are accountable to, and practice under relevant laws and CNO’s standards of practice.
With respect to the principle that Nurses work respectfully with colleagues to best meet patients’ needs, CNO’s Code of Conduct provides that nurses collaborate and communicate with colleagues in a clear, effective, professional and timely way and nurses work together with other health care experts to improve their patients’ care.

Professional Standards

CNO’s Professional Standards provides an overall framework for the practice of nursing and a link with other standards, guidelines and competencies developed by CNO. It includes seven broad standard statements pertaining to accountability, continuing competence, ethics, knowledge, knowledge application, leadership and relationships.
CNO’s Professional Standards provides, in relation to the accountability standard, that nurses are accountable to the public and responsible for ensuring their practice and conduct meets the legislative requirements and the standard of the profession. Nurses are responsible for their actions and the consequences of those actions as well as for conducting themselves in ways that promote respect for the profession. Nurses demonstrate this standard by actions such as ensuring their practice is consistent with CNO’s standards of practice and guidelines as well as legislation.
CNO’s Professional Standards further provides, in relation to the leadership standard, that nurses demonstrate their leadership by providing, facilitating and promoting the best possible care/service to the public. In addition, a nurse demonstrates the standard by role-modelling professional values, beliefs and attributes and collaborating with patients and the health care team to provide professional practice that respects the rights of patients.
CNO’s Professional Standards also provides, in relation to the relationship standard and the therapeutic nurse-patient relationship, that a nurse demonstrates this standard by demonstrating respect and empathy for, and interest in patients and recognizing the potential for patient abuse.
CNO’s Professional Standards also provides, in relation to the relationship standard and the professional relationship, that a nurse demonstrates leadership by role-modelling positive collegial relationships and using a wide range of communication and interpersonal skills to effectively establish and maintain collegial relationships.

Therapeutic Nurse-Client Relationship

CNO’s Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”) contains four standard statements which describe nurses’ accountabilities with respect to therapeutic communication, patient-centred care, maintaining boundaries and protecting the patient from abuse. The TNCR Standard provides that the nurse-patient relationship is built on trust, respect, empathy, professional intimacy and requires the appropriate use of power inherent in the care provider’s role.
CNO’s TNCR Standard defines abuse as:

[T]he misuse of the power imbalance intrinsic in the nurse-[patient] relationship. It can also mean the nurse betraying the [patient]’s trust, or violating the respect or professional intimacy inherent in the relationship, when the nurse knew, or ought to have known the action could cause, or could be reasonably expected to cause physical, emotional or spiritual harm to the [patient]. Abuse may be verbal, emotional, physical,

sexual, financial or take the form of neglect.

CNO’s TNCR Standard provides that verbal and emotional abuse includes, but is not limited to, intimidation, including threatening gestures/actions and an inappropriate tone of voice such as expressing impatience. CNO’s TNCR Standard further provides that physical abuse includes, but is not limited to, hitting, pushing, using force and handling a patient in a rough manner.
CNO’s TNCR Standard requires nurses to protect the patient from harm by ensuring that abuse is prevented or stopped and reported. A nurse demonstrates having met the standard by actions such as not engaging in behaviours toward a patient that may be perceived by the patient and/or others to be violent, threatening, or intending to inflict physical harm.
With respect to Patient A, the Member admits and acknowledges that he breached CNO’s Code of Conduct, Professional Standards and TNCR Standard in that he failed to follow proper restraint techniques when he: pulled Patient A to the ground with his arm and/or arms around Patient A’s neck; pulled and/or pushed Patient A’s head to the ground with his arm and/or arms around Patient A’s neck; held Patient A to the ground, with one hand on the front of Patient A’s neck/throat, the other hand on Patient A’s head, and his knee on the back and/or side of Patient A’s neck; and held Patient A to the ground for approximately 7 minutes.
Regarding Patient B, the Member admits and acknowledges that he breached CNO’s Code of Conduct, Professional Standards and TNCR Standard in that he failed to follow proper restraint techniques when he: lunged at Patient B; placed his hand and/or hands on the front of Patient B’s neck/throat; and pushed Patient B back towards the wall.
With respect to Patient C, the Member admits and acknowledges that he breached CNO’s Code of Conduct, Professional Standards and TNCR Standard when he: swung Patient C’s chair around, for no clinical purpose and without considering the risk of Patient C falling to the ground; and pushed Patient C towards the exit with his hand on Patient C’s back as she was leaving the room.
Regarding Patient D, the Member admits and acknowledges that he breached CNO’s Code of Conduct, Professional Standards and TNCR Standard in that: prior to intervening, he failed to appropriately assess Patient D’s state and situation, including, but not limited to when he failed to obtain relevant information from the staff present and assess whether removing Patient D’s gown from her neck was clinically necessary at that time; he used excessive force in removing Patient D’s gown from her neck; he ordered staff to restrain Patient D on the bed on her stomach; he forcefully grabbed the back of Patient D’s neck and pushed her down to the bed in restraining Patient D to the bed on her stomach, on more than one occasion; he communicated with Patient D in a non-therapeutic manner; and throughout the incident, he failed to cooperate with the staff present, including, but not limited to when he failed to listen to directions of the Charge Nurse.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 1(a), (b), (c) and (d) of the Notice of Hearing in that the Member contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, as described in paragraphs 6 to 44 and 48 to 64 above.
The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 2(a), (b), (c) and (d) of the Notice of Hearing in that he abused patients verbally, physically, and emotionally, as described in paragraphs 6 to 44 and 58 to 64 above.
The Member admits that he committed the acts of professional misconduct as alleged in paragraph 3 (a), (b), (c) and (d) of the Notice of Hearing, and in particular his conduct was disgraceful, dishonourable and unprofessional, as described in paragraphs 6 to 44 and 48 to 64 above.

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)(i), (ii), (iii), (iv), (b)(i), (ii), (iii), (c)(i), (ii), (d)(i), (ii), (iii), (iv), (v), (vi), #2(a)(i), (ii), (iii), (iv), (b)(i), (ii), (iii), (c)(i), (ii), (d)(i), (ii), (iii), #3(a)(i), (ii), (iii), (iv), (b)(i), (ii), (iii), (c)(i), (ii), (d)(i), (ii), (iii), (iv), (v) and (vi) of the Notice of Hearing. With respect to allegations #2(a)(i), (ii), (iii), (iv), (b)(i), (ii), (iii), (c)(i), (ii), (d)(i), (ii) and (iii), the Panel finds that the Member verbally, physically and emotionally abused the patients. As to allegations #3(a)(i), (ii), (iii), (iv), (b)(i), (ii), (iii), (c)(i), (ii), (d)(i), (ii), (iii), (iv), (v) and (vi), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession 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.

Allegations #1(a)(i), (ii), (iii) and (iv) in the Notice of Hearing are supported by paragraphs 6 to 15, 48 to 61 and 65 in the Agreed Statement of Facts. While employed as a Registered Nurse (“RN”) at Health Sciences North (the “Facility”), the Member failed to follow proper restraint techniques when he pulled Patient A to the ground with his arm and/or arms around Patient A’s neck, he pulled and/or pushed Patient A’s head to the ground with his arm and/or arms around Patient A’s neck, he held Patient A to the ground, with one hand on the front of Patient A’s neck/throat, the other hand on Patient A’s head, and his knee on the back and/or side of Patient A’s neck and held Patient A to the ground for approximately 7 minutes. The Panel was concerned with the number and intensity of the events and there was a clear disregard for the Member’s professional obligations and the needs of a vulnerable patient. The Member admitted that his conduct did not meet the standards of practice and he acknowledged that he breached the College’s Code of Conduct, the Professional Standards and the Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”). The College’s Code of Conduct requires that nurses respect the dignity of patients and treat them as individuals, and act with integrity to maintain patients’ trust. The actions displayed by the Member cause concern that Patient A was not treated in a manner that aligns with this standard.

Regarding the College’s Professional Standards, the Panel found that the Member did not conduct himself in a manner that promotes respect for the profession when he had one hand on Patient A’s neck, the other on Patient A’s head, and his knee on the back or side of Patient A’s neck and held Patient A to the ground for approximately 7 minutes. The Member’s actions did not display respect and empathy for Patient A. The College’s TNCR Standard requires nurses to protect the patient from harm, the actions of the Member were not in alignment with this standard as he did not follow proper restraint techniques.

Allegations #1(b)(i), (ii) and (iii) in the Notice of Hearing are supported by paragraphs 16 to 23, 48 to 60, 62 and 65 in the Agreed Statement of Facts. The Member committed an act of professional misconduct when he failed to follow proper de-escalation and/or restraint techniques when he lunged at Patient B, placed his hand and/or hands on the front of Patient B’s neck/throat and pushed Patient B back towards the wall. The Member ought to have known how to manage an escalated patient and proper use of restraints as he had been working with this population for six years. The Member admitted that his conduct did not meet the standards of practice. The Member did not meet the College’s Code of Conduct with respect to treating Patient B with care and compassion when he lunged at Patient B and pushed Patient B back towards the wall. The Member did not uphold the Professional Standards as he did not conduct himself in a manner that promotes respect for the profession. The Member did not meet the TNCR Standard as he used force and handled Patient B in a rough manner.

Allegations #1(c)(i) and (ii) in the Notice of Hearing are supported by paragraphs 24 to 28, 48 to 60, 63 and 65 in the Agreed Statement of Facts. The Member committed an act of professional misconduct when he failed to meet the standards of practice. The Member used excessive force when he swung Patient C’s chair around, for no clinical purpose and without considering the risk of Patient C falling to the ground and pushed Patient C towards the exit with his hand on Patient C’s back as she was leaving the room. The Member by not considering Patient C, her condition, and the vulnerable state she was in, contravened the standards of practice. The Member admitted that his conduct did not meet the standards of practice. The Member did not meet the College’s Code of Conduct with respect to treating Patient C with care and compassion when he used excessive force. The Member did not uphold the Professional Standards as he did not conduct himself in a manner that promotes respect for the profession. The Member did not meet the TNCR Standard as he used force and handled the patient in a rough manner and did not consider Patient C’s condition and her vulnerable state.

Allegations #1(d)(i), (ii), (iii), (iv), (v) and (vi) in the Notice of Hearing are supported by paragraphs 29 to 44, 48 to 60, 64 and 65 in the Agreed Statement of Facts. The Member used excessive force in removing Patient D’s gown from her neck. He failed to follow proper restraint techniques when he ordered staff to restrain Patient D on the bed on her stomach, he forcefully grabbed the back of Patient D’s neck and pushed her down to the bed, on more than one occasion he communicated with Patient D in a non-therapeutic manner and throughout the incident, he failed to cooperate with the staff present, including when he failed to listen to directions of the Charge Nurse. The Panel noted that the Member had been asked by the Charge Nurse to change his approach to the event, yet he did not listen as the Charge Nurse shared concerns for how he was managing Patient D, he did not consider Patient D and how his decisions were impacting her. The Member admitted that his conduct did not meet the standards of practice. The Member did not meet the College’s Code of Conduct with respect to treating Patient D with care and compassion when he used excessive force. The Member did not uphold the Professional Standards as he did not conduct himself in a manner that promotes respect for the profession. He did not collaborate with the health care team and Patient D to provide professional practice that respects the rights of Patient D. The Member did not meet the TNCR Standard as he communicated in a non-therapeutic manner, used force, handled Patient D in a rough manner and he did not consider Patient D’s condition and vulnerable state.

Allegations #2(a)(i), (ii), (iii) and (iv) in the Notice of Hearing are supported by paragraphs 6 to 15, 48 to 61 and 66 in the Agreed Statement of Facts. The Member failed to follow proper restraint techniques, including when he pulled Patient A to the ground with his arm and/or arms around Patient A’s neck, pulled and/or pushed Patient A’s head to the ground with his arm and/or arms around Patient A’s neck, held Patient A to the ground, with one hand on the front of Patient A’s neck/throat, the other hand on Patient A’s head, and his knee on the back and/or side of Patient A’s neck and held Patient A to the ground for approximately 7 minutes. The Panel found that the Member ought to have known that restraining Patient A with his knee in the side of Patient A’s neck for 7 minutes was not an appropriate restraint, it was excessive and abusive. The Member admitted that his conduct did not meet the standards of practice.

Allegations #2(b)(i), (ii) and (iii) in the Notice of Hearing are supported by paragraphs 16 to 23, 48 to 60, 62 and 66 in the Agreed Statement of Facts. The Member failed to follow proper de-escalation and/or restraint techniques when he lunged at Patient B, placed his hand and/or hands on the front of Patient B’s neck/throat and pushed Patient B back towards the wall. The Panel found that the Member ought to have known that his conduct was abuse of a vulnerable patient as he had been working at the Facility for six years.

Allegations #2(c)(i) and (ii) in the Notice of Hearing are supported by paragraphs 24 to 28, 48 to 60, 63 and 66 in the Agreed Statement of Facts. The Member failed to follow proper de-escalation and/or restraint techniques when he swung Patient C’s chair around, for no clinical purpose, and without considering the risk of Patient C falling to the ground and pushed Patient C towards the exit with his hand on Patient C’s back as she was leaving the room. Patient C had a diagnosis of Huntington’s Disease which impacted her movement and coordination, the Member ought to have known that Patient C was vulnerable and the impact of his conduct would be significant for Patient C.

Allegations #2(d)(i), (ii) and (iii) in the Notice of Hearing are supported by paragraphs 29 to 44, 48 to 60, 64 and 66 in the Agreed Statement of Facts. The Member failed to follow proper de-escalation and/or restraint technique when he used excessive force in removing Patient D’s gown from her neck, ordered staff to restrain Patient D on the bed on her stomach, forcefully grabbed the back of Patient D’s neck and pushed her down to the bed, on more than one occasion, and communicated with Patient D in a non-therapeutic manner. The Panel found that the Member had worked at the Facility for six years he would be aware of safe and appropriate restraint management. The Member ought to have known that Patient D was in a state of vulnerability and that his conduct was abusive.

Allegations #3(a)(i), (ii), (iii), (iv), (b)(i), (ii), (iii), (c)(i), (ii), (d)(i), (ii), (iii), (iv), (v) and (vi) in the Notice of Hearing are supported by paragraphs 6 to 44, 48 to 64 and 67 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in verbally, physically and emotionally abusing more than one patient on more than one occasion was clearly relevant to the practice of nursing. It was unprofessional as it demonstrated a serious and persistent disregard for his professional obligations in contravention of the College’s Code of Conduct, the Professional Standards and the TNCR Standard.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of moral failing in that the Member disregarded the safety of the patients involved, their vulnerable state and behaved in a manner that constituted abuse of power and authority over Patients A, B, C and D. The Member knew or ought to have known that his conduct was unacceptable and fell below the standards of a professional.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. The Member’s conduct of physically, verbally and emotionally abusing four separate and vulnerable patients shows a serious and persistent disregard for the standards of practice and the impact on the patients. The Member’s conduct casts serious doubt on his moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet. The repeated abuse of vulnerable patients brought shame on the Member and the profession at large.

Penalty

College Counsel and the Member’s Counsel 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:

Requiring the Member to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
Directing the Executive Director to suspend the Member’s certificate of registration for 7 months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in a practicing class.
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend 2 meetings with a Regulatory Expert (the “Expert”), at the Member’s own expense and within 6 months from the date that this Order becomes final. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by CNO in advance of the meetings;

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, 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 Order, and
if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules and decision tools (where applicable):

Code of Conduct,
Professional Standards, and
Therapeutic Nurse-Client Relationship;

iv. Before the first meeting, the Member reviews and completes the CNO’s self-directed learning package, One is One Too Many, at the Member’s own expense, including the self-directed Nurses’ Workbook;

v. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of the completed Reflective Questionnaires and Nurses’ Workbook;

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 patients, 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 Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into the Member’s behaviour;

viii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on the Member’s certificate of registration;

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

i. Inform any employer of the decision prior to commencing or prior to resuming employment in any nursing position;

ii. Ensure that CNO is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

iii. Provide the Member’s employer(s) with a copy of:

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

iv. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to CNO, in which it will confirm:

that they received a copy of the required documents, and
that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

c) The Member shall not practice independently in the community for a period of 12 months from the date the Member returns to the practice of nursing.

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

Penalty Submissions

Submissions were made by College Counsel.

The aggravating factors in this case were:

The Member’s conduct occurred with vulnerable patients;
The Member’s conduct occurred on multiple occasions with multiple different patients, displaying a pattern of behaviour; and
The Member admitted to improper restraint techniques and use of force while caring for vulnerable patients.

The mitigating factors in this case were:

The Member cooperated with the College by admitting to the allegations;
The Member accepted responsibility for his actions by entering into an Agreed Statement of Facts and a Joint Submission on Order with the College;
The Member conveyed remorse for his conduct;
The Member has no prior disciplinary history with the College; and
The Member had a medical condition which impaired his ability to respond appropriately to triggering events.

The proposed penalty provides for general deterrence through:

The 7-month suspension of the Member’s certificate of registration, which will signal to the membership that the College takes abusive conduct seriously and that there are significant consequences for engaging in this type of behaviour.

The proposed penalty provides for specific deterrence through:

The oral reprimand; and
The 7-month suspension of the Member’s certificate of registration, which will deter the Member from engaging in similar misconduct in his future practice.

The proposed penalty provides for remediation and rehabilitation through:

The 2 meetings with a Regulatory Expert, which will allow the Member to reflect on his professional standards and requirements.

Overall, the public is protected through:

The 12 months of employer notification and the 12 months of no independent practice in the community, which will allow future employers to be vigilant on the Member’s return to practice.

College Counsel submitted the following cases to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee:

CNO v. Kaley (Discipline Committee: 2020): In this case, the member failed to meet the standards of practice when he used improper restraint techniques by pushing his body weight onto the patient and holding him down, grabbing the patient forcefully and pushed him onto the bed. There was emotional, verbal and physical abuse. The panel found the conduct to also be disgraceful, dishonourable and unprofessional. The penalty included an oral reprimand, a 6-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert, 18 months of employer notification and 18 months of no independent practice in the community. This case involved one patient.

CNO v. Ebuzo (Discipline Committee: 2021): In this case, the member failed to meet the standards of practice when he was found to be verbally aggressive, making threatening gestures, and failed to apply proper restraint techniques. He placed his knee on the patients back and neck like in the case before this Panel. The panel found the member’s conduct to be a breach of the standards of practice, physical abuse, and disgraceful, dishonourable, and unprofessional. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert and 18 months of employer notification. This case involved one patient.

CNO v. Johnston (Discipline Committee: 2022): In this case, the member failed to meet the standards of practice when she used improper restraint techniques and/or excessive force with respect to one patient. Security guards had raised concerns regarding the restraints to the member, which she dismissed, resulting in reduced circulation to the patient’s arm, the restraints were subsequently adjusted a few minutes later. The member had suffered a similar prior physical attack as the Member in the case before this Panel, she had an undiagnosed medical condition that impacted her judgement and conduct similar to the case before this Panel. The panel found that the member’s conduct amounted to a breach in the standards, abuse, and found the conduct to be unprofessional. The penalty included an oral reprimand, a 3-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification. This case also involved one patient.

Submissions were made by the Member’s Counsel.

The Member’s Counsel agreed with College Counsel’s submissions and submitted that the Member has been a nurse since 1991 with no prior disciplinary history, is remorseful, has cooperated with the College and that the Member was previously assaulted by a patient in 2017 and suffered significant medical and psychological injuries.

Penalty Decision

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

The Member is required to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
The Executive Director is directed to suspend the Member’s certificate of registration for 7 months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in a practicing class.
The Executive Director is directed to impose the following terms, conditions and limitations on the Member’s certificate of registration:

i. The Expert has expertise in nursing regulation and has been approved by CNO in advance of the meetings;

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, 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 Order, and
if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules and decision tools (where applicable):

Code of Conduct,
Professional Standards, and
Therapeutic Nurse-Client Relationship;

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 patients, 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 Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into the Member’s behaviour;

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

i. Inform any employer of the decision prior to commencing or prior to resuming employment in any nursing position;

ii. Ensure that CNO is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

iii. Provide the Member’s employer(s) with a copy of:

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

iv. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to CNO, in which it will confirm:

that they received a copy of the required documents, and
that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

c) The Member shall not practice independently in the community for a period of 12 months from the date the Member returns to the practice of nursing.

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

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 specific and general deterrence, rehabilitation and remediation, and public protection. Specific deterrence is achieved through the oral reprimand and the 7-month suspension of the Member’s certificate of registration, which will deter the Member from engaging in similar misconduct on his return to practice. General deterrence is achieved through the 7-month suspension of the Member’s certificate of registration, which sends a clear message to the membership that this conduct is not acceptable and will result in severe penalty. Remediation and rehabilitation are achieved through the 2 meetings with a Regulatory Expert, which will allow the Member to reflect on his professional standards and requirements. The public is protected through the 12 months of employer notification and the 12 months of no independent practice in the community, which will allow future employers to be vigilant when the Member returns to practice. The Panel recognizes and acknowledges the hardships and challenges nurses face on a daily basis. The Member took accountability for his actions which he related to a significant medical and psychological condition. It is the hope with this penalty that the Member gains knowledge, skills and judgement and returns to safe practice.

The penalty is also in line with what has been ordered in previous cases in similar circumstances as demonstrated by the cases submitted and referred to by College Counsel.

I, Carly Gilchrist, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.