DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Transcription

1 DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Grace Isgro-Topping, Public Member, Chairperson Dennis Curry, RN Member Anastazia Rybak, RN Member Barbara Titley, RPN Member Linda Bracken Public Member BETWEEN: COLLEGE OF NURSES OF ONTARIO ) JEAN-CLAUDE KILLEY for ) College of Nurses of Ontario - and - ) ) HEATHER LYNN MCINNES ) ADRIENNE LIANG for Registration No ) Heather Lynn McInnes ) ) ) ) ) Heard: April 14, 2011 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on April 14, 2011 at the College of Nurses of Ontario ( the College ) at Toronto. The Allegations The allegations against Heather Lynn McInnes (the Member ) as stated in the Notice of Hearing dated March 18 th, 2011, are as follows. 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 engaged in the practice of nursing as a Registered Nurse at [the Facility] in Ontario, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, in respect of the following incident: a) on or about May 23, 2009, you handled infant client D roughly; and/or

2 b) on or about May 23, 2009, you raised your voice at infant client D, and/or used inappropriate language towards infant client D, including words to the effect of enough, enough, and/or knock it off, and/or shut the fuck up, and/or if you were my baby I would kill you. 2. 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 engaged in the practice of nursing as a Registered Nurse at the Hospital, you abused a client verbally, physically and/or emotionally in respect of the following incident: a) on or about May 23, 2009, you handled infant client D roughly; and/or b) on or about May 23, 2009, you raised your voice at infant client D, and/or used inappropriate language towards infant client D, including words to the effect of enough, enough, and/or knock it off, and/or shut the fuck up, and/or if you were my baby I would kill you. 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 engaged in the practice of nursing as a Registered Nurse at the Hospital, you engaged in conduct relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, in respect of the following incident: a) on or about May 23, 2009, you handled infant client D roughly; and/or b) on or about May 23, 2009, you raised your voice at infant client D, and/or used inappropriate language towards infant client D, including words to the effect of enough, enough, and/or knock it off, and/or shut the fuck up, and/or if you were my baby I would kill you. Member s Plea The Member admitted the allegations set out in paragraphs numbered 1(a),(b), 2(b), 3(a), and (b) in the Notice of Hearing. The Member was not admitting to allegation 2(a). The College did not lead any evidence on this allegation. The Panel received a written plea inquiry which was signed by the Member. The Panel also conducted an oral plea inquiry and was satisfied that the Member s admission was voluntary, informed and unequivocal. Agreed Statement of Facts Counsel for the College advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts which provided as follows.

3 THE MEMBER 1. Heather Lynn McInnes (the Member ) registered with the College of Nurses of Ontario (the College ) as a Registered Nurse ( RN ) on June 6, She is up-to-date with her annual fees. THE FACILITY 2. On September 8, 1995, the Member commenced her employment at [the Facility] as a full-time staff nurse in the Special Care Nursery ( SCN ) and Pediatrics Department. She was terminated on May 28, 2009 as a result of the incident described below. 3. The SCN provides care to babies who experience difficulty after birth and require additional support. The nurse to client ratio in the SCN is 1:3. THE CLIENT 4. The Client was born at the Facility [in May] On May 22, 2009, the Client was admitted to the SCN for observation because of tachypnea. The Client had feeding issues, which required that she be partially fed by a nasogastric tube. After the incident, she was diagnosed as having a congenital heart defect 6. On May 23, 2009, the Client developed a rash where her skin was in contact with the Facility s linens. THE WITNESS 7. [Witness A s] child was admitted to the SCN. At the time of the incident described below, [Witness A] was feeding her child in the SCN breast feeding quiet area, which is behind a curtain. INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT 8. On May 23, 2009, the Member was assigned to primary care in the SCN, which included care of the Client.

4 9. At approximately 1:00 pm, the Client was crying and would not settle. [Nurse A] observed the Member pick the Client up out of her isolette and scream at the Client, Enough, enough. The Member wrapped the Client up abruptly in a blanket and said, Knock it off and Shut the fuck up. The Member held the Client up with her hands around the Client s shoulder and chest area and squeezed the Client tightly. The Member said words to the effect of, If you were my baby I would kill you. 10. [Nurse A] called out to the Member to draw her attention to [Witness A s] presence in the nursery. The Member sat down, calmer, but appeared worried that [Witness A] had overheard her. 11. Shortly thereafter, [Nurse B] entered the SCN. The Member admitted to [Nurse B] that she just yelled at the baby, told her to shut the fuck up and said that she could kill her. The Member then stated, I didn t mean that I would kill this baby, only that if it was mine I would. The Member and [Nurse B] had a conversation about whether [Witness A] had overheard the incident during which time the Member said, I know she did, I feel sick about it. 12. Following the incident, the Client was assessed. No bruising or injuries as a result of the incident were found. 13. If the Member were to testify, she would say that leading up to the incident she was under significant personal stress due to tests that were being conducted in relation to her own health issues. In addition, her father was very ill and had undergone surgery twice in a short period of time. As a result of these issues, when the Member s Manager contacted her to switch shifts to cover the SCN, the Member indicated that she was feeling particularly stressed. Despite this, the Member was scheduled to work a number of shifts and was called to work on May 23, 2009, when she was not sufficiently rested for work. 14. If the Member were to testify, she would say that she did not literally mean that she would harm the Client or her own child. Following the incident, she was disturbed and horrified by her own actions and went to the bathroom and vomited. She recognizes the inappropriateness of her actions and regrets not removing herself from her workplace at an earlier point. 15. If the Member were to testify, she would say that as a result of self-reflection and counselling with a social worker, she has developed insight into monitoring and managing her stress levels, and is better equipped to recognize and deal with increased stress. As an example, she has reduced her hours to part-time at her current place of employment and ensures that she is adequately rested before each shift. ADMISSIONS OF PROFESSIONAL MISCONDUCT 16. The Member admits that she committed acts of professional misconduct as set out in allegation 1 of the Notice of Hearing, in that she contravened a standard of practice of the profession and failed to meet the standards of practice of the profession, in respect of the following incident:

5 i. on or about May 23, 2009, she handled infant client D roughly; and ii. on or about May 23, 2009, she raised her voice at infant client D, and used inappropriate language towards infant client D, including words to the effect of enough, enough, knock it off, shut the fuck up, and if you were my baby I would kill you. 17. The Member admits that she committed acts of professional misconduct as set out in allegation 2 of the Notice of Hearing, in that she abused a client verbally in respect of the following incident: ii. on or about May 23, 2009, she raised her voice at infant client D, and used inappropriate language towards infant client D, including words to the effect of enough, enough, knock it off, shut the fuck up, and if you were my baby I would kill you. 18. The Member admits that she committed acts of professional misconduct as set out in allegation 3 of the Notice of Hearing, in that she engaged in conduct relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as dishonourable and unprofessional, in respect of the following incident: i. on or about May 23, 2009, she handled infant client D roughly; and ii. on or about May 23, 2009, she raised her voice at infant client D, used inappropriate language towards infant client D, including words to the effect of enough, enough, knock it off, shut the fuck up, and if you were my baby I would kill you. Decision The Panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct and, in particular, finds that the Member committed acts of professional misconduct as alleged in paragraphs 1(a), (b), and 2(b) of the Notice of Hearing. Since the College did not lead any evidence on allegation 2(a), the panel did not make a finding on that allegation. The Panel also finds the Member engaged in conduct that would be considered dishonourable and unprofessional with respect to allegations in 3(a) and (b). Reasons for Decision The Panel deliberated and took into consideration the evidence presented including the Agreed Statement of Facts and the Standard of Practice relevant to the Therapeutic Nurse-Client relationship. The Panel finds the Member has contravened the Standard of Practice as outlined in

6 allegation 1(a), and (b) of the Notice of Hearing. The Panel finds the Member has committed an act of professional misconduct with respect to allegation 2(b). The Panel also finds the Member engaged in conduct that would be reasonably be considered by members to be dishonourable and unprofessional with respect to allegation 3(a) and (b). The Member s actions clearly violated the Standards of Practice in that she verbally abused a vulnerable client by raising her voice and using inappropriate language. Penalty Counsel for the College advised the Panel that a Joint Submission as to Order had been agreed upon. The Joint Submission as to Order requests that this Panel make an order as follows: 1. Requiring the Member to appear before the Panel to be reprimanded on a date to be arranged but, in any event, within three (3) months of the date of the Order. 2. Directing the Executive Director to suspend the Member s certificate of registration for a period of one (1) month. This suspension shall take effect from the date of this Order and shall continue to run without interruption so long as the Member remits her annual membership fees on time. In the event that the Member fails to pay her annual fees and her certificate of registration becomes suspended for non-payment of fees, or for any other reason, any portion of this suspension that has not yet been served shall be served commencing on the day that the Member s certificate of registration returns to active status. 3. Directing the Executive Director to impose the following terms, conditions and limitations on the Member s certificate of registration: (a) The Member shall, at her own expense, attend two (2) sessions with a Regulatory Expert with expertise in the therapeutic nurse-client relationship (the Expert ) as approved by the Director of Professional Conduct (the Director ). The first session shall be completed within two (2) months of the date of this Order. The second session shall be completed within four (4) months of the date of this Order. (b) Prior to the commencement of the meetings with the Expert referred to in paragraph 3(a), the Member shall: (i) Provide the Expert with a copy of the Discipline Panel s Order, Notice of Hearing, Agreed Statement of Facts, Joint Submission on Order, and, if available, a copy of the Panel s Decision and Reasons. If the Panel s Decision and Reasons are not available prior to the Member s first meeting with the Expert, the Member shall deliver to the Expert a copy of the Panel s Decision and Reasons within fourteen (14) days of it becoming available.

7 (ii) Review the following College publications: Professional Standards (Revised 2002) and Therapeutic Nurse-Client Relationship (Revised 2006). The Member shall complete a Reflective Questionnaire for each publication and bring a copy of the completed Reflective Questionnaires to her sessions with the Expert. (iii)complete the College s online learning modules relating to Professional Standards and Therapeutic Nurse-Client Relationship. The Member shall complete the Online Participation Forms relevant to each module and bring a copy of the completed Online Participation Forms to her sessions with the Expert. (iv) Review and complete the College s self directed learning package, One Is One Too Many, at her own expense, including the self-directed Nurses Workbook and bring the completed Nurses Workbook to her sessions with the Expert. (v) Obtain confirmation from the Expert that he or she will provide the Director with the report referred to in paragraph 3(g). (c) The materials referred to in 3(b)(i) to (iv) should be delivered to the Expert at least seven (7) days prior to the Member s first session with the Expert. If the materials referred to in 3(b)(i) to (iv) are not received by the Expert, the Expert can cancel the first session as scheduled, even if that results in the Member breaching the terms, conditions or limitations on her certificate of registration, as set out in paragraph 3(a). (d) The subject of the sessions with the Expert shall include the following: (i) The conduct for which the Member was found to have committed professional misconduct; (ii) An in-depth review of the materials referred to in paragraphs 3(b)(ii) to (iv); (iii) The Member s understanding of the materials referred to in paragraphs 3(b)(ii) to (iv) and in particular the materials relevant to the professional misconduct she was found to have committed; (iv) The potential consequences of that conduct to her clients, colleagues, profession and herself;

8 (v) Strategies for preventing the unprofessional conduct from occurring again; and, (vi) The development of a learning plan. (e) During the first session with the Expert, the Member shall develop a learning plan in consultation with the Expert to address the subject of the meetings as set out in paragraphs 3(d)(i) to (v). (f) During the second session with the Expert, the Member and the Expert shall further discuss the subject of the meetings as set out in paragraphs 3(d)(i) to (v) above and the implementation of the learning plan. (g) Upon the completion of all meetings referred to in paragraph 3(a), the Member shall request and make best efforts to ensure that the Expert forward a report to the Director within forty-five (45) days of the completion of the meetings. The report from the Expert shall confirm that the Expert received and reviewed the documents referred to in paragraph 3(b)(i) to (iv), confirm the dates of the Member s meetings with the Expert and outline the Expert s assessment of the Member s insight into her behaviour. (h) For a period of twelve (12) months following the date upon which the Member returns to the practice of nursing, the Member shall: (i) Notify the Director of the name, address, and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position; (ii) Provide her employer(s) with a copy of the Panel s Order, Notice of Hearing, Agreed Statement of Facts, Joint Submission on Order, if available, the Panel s written Decision and Reasons, together with any attachments. If the Decision and Reasons are not available on the day the Member returns to nursing practice, the Member shall provide her employer(s) with a copy of the Decision and Reasons within fourteen (14) days of it becoming available; and, (iii) Only practise for an employer who agrees to, and does, write to the Director, within fourteen (14) days of the commencement or resumption of the Member s employment in any nursing position and provides the following: (A) Confirmation that the employer has received a copy of the documents

9 referred to in paragraph 3(h)(ii); and, (B) Confirmation that the employer agrees to notify the Director immediately upon receipt of any reasonable information that the Member has breached the standards of practice of the profession. 4. All deliveries and notifications to be given by or on behalf of the Member to the College, the Expert and the employer(s) pursuant to these terms are to be made by verifiable method of delivery, the proof of which the Member shall retain. Penalty Submissions Counsel for the College submitted that the Joint Submission on Order was fair and was in the best interest of the Member, the public, and the profession. The reprimand and suspension serve as a general deterrent to the membership as well as serving as a specific deterrent to the Member. The rehabilitation and remediation components of this penalty serve not only a specific deterrent to the Member but also protects the public interest. College Counsel submitted that when considering the aggravating factors, the Panel should consider the seriousness of the event, the vulnerability and the fragility of the client, as well as the setting in which the incident took place. The Member raised her voice and used inappropriate language within earshot of other clients and caregivers. College Counsel provided the Panel with a number of mitigating factors including the Member s personal health, her father s health, working a large number of shifts, causing the Member to experience with severe stress. Following the incident the Member s employment was terminated. The Member was cooperative with the College and sought help for her stress related issues. Counsel was asked if he would be providing the Panel with cases to support the penalty range. Although Counsel did not provide any case references, he stated that the penalty was appropriate, within reason considering the circumstances. Defence Counsel agreed with College Counsel s submissions. Defence Counsel reminded the Panel that the allegations were dealing only with verbal abuse, and not physical or emotional abuse, and therefore the penalty was appropriate. Penalty Decision The Panel accepts the Joint Submission as to Order and accordingly orders that: 1. The Member shall appear before the Panel to be reprimanded on a date to be arranged but, in any event, within three (3) months of the date of the Order. 2. The Executive Director is directed to suspend the Member s certificate of registration for a period of one (1) month. This suspension shall take effect from the date of this Order and

10 shall continue to run without interruption so long as the Member remits her annual membership fees on time. In the event that the Member fails to pay her annual fees and her certificate of registration becomes suspended for non-payment of fees, or for any other reason, any portion of this suspension that has not yet been served shall be served commencing on the day that the Member s certificate of registration returns to active status. 3. The Executive Director is directed to impose the following terms, conditions and limitations on the Member s certificate of registration: (a) The Member shall, at her own expense, attend two (2) sessions with a Regulatory Expert with expertise in the therapeutic nurse-client relationship (the Expert ) as approved by the Director of Professional Conduct (the Director ). The first session shall be completed within two (2) months of the date of this Order. The second session shall be completed within four (4) months of the date of this Order. (b) Prior to the commencement of the meetings with the Expert referred to in paragraph 3(a), the Member shall: (i) Provide the Expert with a copy of the Discipline Panel s Order, Notice of Hearing, Agreed Statement of Facts, Joint Submission on Order, and, if available, a copy of the Panel s Decision and Reasons. If the Panel s Decision and Reasons are not available prior to the Member s first meeting with the Expert, the Member shall deliver to the Expert a copy of the Panel s Decision and Reasons within fourteen (14) days of it becoming available. (ii) Review the following College publications: Professional Standards (Revised 2002) and Therapeutic Nurse-Client Relationship (Revised 2006). The Member shall complete a Reflective Questionnaire for each publication and bring a copy of the completed Reflective Questionnaires to her sessions with the Expert. (iii)complete the College s online learning modules relating to Professional Standards and Therapeutic Nurse-Client Relationship. The Member shall complete the Online Participation Forms relevant to each module and bring a copy of the completed Online Participation Forms to her sessions with the Expert. (iv) Review and complete the College s self directed learning package, One Is One Too Many, at her own expense, including the self-directed Nurses Workbook and bring the completed Nurses Workbook to her sessions with the Expert. (v) Obtain confirmation from the Expert that he or she will provide the Director with the report referred to in paragraph 3(g).

11 (c) The materials referred to in 3(b)(i) to (iv) should be delivered to the Expert at least seven (7) days prior to the Member s first session with the Expert. If the materials referred to in 3(b)(i) to (iv) are not received by the Expert, the Expert can cancel the first session as scheduled, even if that results in the Member breaching the terms, conditions or limitations on her certificate of registration, as set out in paragraph 3(a). (d) The subject of the sessions with the Expert shall include the following: (i) The conduct for which the Member was found to have committed professional misconduct; (ii) An in-depth review of the materials referred to in paragraphs 3(b)(ii) to (iv); (iii) The Member s understanding of the materials referred to in paragraphs 3(b)(ii) to (iv) and in particular the materials relevant to the professional misconduct she was found to have committed; (iv) The potential consequences of that conduct to her clients, colleagues, profession and herself; (v) Strategies for preventing the unprofessional conduct from occurring again; and, (vi) The development of a learning plan. (e) During the first session with the Expert, the Member shall develop a learning plan in consultation with the Expert to address the subject of the meetings as set out in paragraphs 3(d)(i) to (v). (f) (g) (h) During the second session with the Expert, the Member and the Expert shall further discuss the subject of the meetings as set out in paragraphs 3(d)(i) to (v) above and the implementation of the learning plan. Upon the completion of all meetings referred to in paragraph 3(a), the Member shall request and make best efforts to ensure that the Expert forward a report to the Director within forty-five (45) days of the completion of the meetings. The report from the Expert shall confirm that the Expert received and reviewed the documents referred to in paragraph 3(b)(i) to (iv), confirm the dates of the Member s meetings with the Expert and outline the Expert s assessment of the Member s insight into her behaviour. For a period of twelve (12) months following the date upon which the Member returns to the practice of nursing, the Member shall:

12 (i) Notify the Director of the name, address, and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position; (ii) Provide her employer(s) with a copy of the Panel s Order, Notice of Hearing, Agreed Statement of Facts, Joint Submission on Order, if available, the Panel s written Decision and Reasons, together with any attachments. If the Decision and Reasons are not available on the day the Member returns to nursing practice, the Member shall provide her employer(s) with a copy of the Decision and Reasons within fourteen (14) days of it becoming available; and, (iii) Only practise for an employer who agrees to, and does, write to the Director, within fourteen (14) days of the commencement or resumption of the Member s employment in any nursing position and provides the following: (A) Confirmation that the employer has received a copy of the documents referred to in paragraph 3(h)(ii); and, (B) Confirmation that the employer agrees to notify the Director immediately upon receipt of any reasonable information that the Member has breached the standards of practice of the profession. 4. All deliveries and notifications to be given by or on behalf of the Member to the College, the Expert and the employer(s) pursuant to these terms are to be made by verifiable method of delivery, the proof of which the Member shall retain. Reasons for Penalty Decision The Panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions. The Panel accepts that this penalty is appropriate as it achieves both general and specific deterrence to the Member and to the profession. This penalty is in line with the College s mandate to protect the public and it also provides rehabilitation and remediation for the Member. I, GRACE ISGRO-TOPPING, Public Member, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel as listed below:

13 Chairperson Date Panel Members: Dennis Curry, RN Anastazia Rybak, RN Barbara Titley, RPN Linda Bracken Member Member Member Public Member