DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Transcription

1 DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: David Bishop, Public Member Chairperson Lori McInerney, RN Member Denise Dietrich, RPN Member Marilyn Lambert, RN Member Faira Bari Public Member BETWEEN: ) KAREN JONES for COLLEGE OF NURSES OF ONTARIO ) College of Nurses of Ontario ) - and - ) CAROL STEPHENSON for ) Cheryl Hecimovich CHERYL HECIMOVICH ) Registration No. HC14262 ) ) ) Heard: June 10, 2005 AMENDED DECISION AND REASONS 1 This matter came on for hearing before a panel of the Discipline Committee on June 10, 2005 at the College of Nurses of Ontario ( the College ) at Toronto. Before the hearing proceeded, a potential conflict of interest was raised by the Chair. It was stated that some members of this panel had participated on other panels regarding allegations of Toradol misuse at [the hospital]. This hearing proceeded by way of consent by both counsel. The Allegations College Counsel informed the panel that allegation #1 was to be dismissed. The panel granted the request and dismissed allegation #1. The remaining allegations against Cheryl Hecimovich ( the Member ) as stated in the Notice of Hearing (Exhibit # 1) dated April 8, 2005 are as follows: 1 The original Decision and Reasons indicated that allegation #1 was withdrawn. However, counsel for the Member subsequently advised that in fact, the panel was informed that the allegation was to be dismissed. Counsel for the College concurred with this.

2 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(37) of Ontario Regulation 799/93, in that during the period February through April 2002, while employed as a Registered Practical Nurse by [the hospital], you engaged in conduct or performed an act, relevant to the practice of nursing that, having regard to all of the circumstances would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, and in particular on one or more occasions while on duty you received an intramuscular injection of Toradol from another nurse when there was no prescription for the Toradol and/or there was no documentation of the administration and/or the Toradol and the injection equipment belonged to your employer. 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(8) of Ontario Regulation 799/93, in that during the period February through April 2002, while employed as a Registered Practical Nurse by [the hospital], you misappropriated property from your workplace, namely Toradol and/or injection equipment. Member s Plea Cheryl Hecimovich admitted the allegations set out in paragraphs numbered 2 and 3 in the Notice of Hearing. The Panel received a written plea inquiry (Exhibit #2). 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 (Exhibit #3) which provided as follows: 1. Cheryl Hecimovich (the Member ) graduated in 1983 with a Registered Practical Nurse Certificate of Competence and registered with the College of Nurses (the College ) that same year. The following year she received her O.R. Technician Diploma with Honours. 2. The Member has worked continuously as an RPN in the operating room since The Member was hired in a full-time position in the Operating Room at [the hospital] in November, Prior to that, the Member worked at [two other hospitals]. 3. The Member was terminated by the hospital on June 25, At a grievance meeting the Member was reinstated following a two week suspension. 4. The Member does not have a prior discipline history with the College, and has had no previous complaints made against her at the College. THE INTERNAL INVESTIGATION AT THE FACILITY

3 5. In the spring of 2002, the administration at the [hospital] (the hospital ) conducted an internal investigation into allegations that some nurses on the Operating Room/Recovery Room unit were receiving and giving intramuscular injections of Toradol during Toradol is a non-steroidal anti-inflammatory analgesic. It is not a narcotic. At the time of the events giving rise to the present allegations against the Member, Toradol was a stock medication which was not counted or locked up, nor considered a controlled drug by the hospital. It was kept in an unlocked cupboard in the Recovery Room area, as well as in drawers in the Operating Room2. A prescription is needed for this medication. THE MEMBER S CONDITION 7. At the time of the events giving rise to the allegations, the Member was suffering from [a painful medical condition], which had plagued her for approximately 7 years. Her condition was quite advanced at the time of the incidents. She was receiving medical attention for her condition from her orthopaedic specialist who worked at the hospital, [ ], who had prescribed Tylenol 3 and oral Toradol for her. At the time of the incidents, the Member s daily oral Toradol was no longer effectively managing her condition. She was awaiting an appointment set for later that year to see a specialist with respect to surgery. INTERVIEWS BY THE HOSPITAL 8. As a result of the internal investigation, the Member was interviewed by hospital administration on two separate occasions. 9. The first interview occurred on May 31st, 2002, at which time the Member acknowledged that she had received a shot of Toradol after receiving a verbal order from [the orthopaedic specialist]. She said she went to see [the orthopaedic specialist], who was in the Recovery Room, and told him that she was in a lot of pain. She told [the orthopaedic specialist] she had already taken her oral Toradol which he had prescribed and that it was not controlling her pain. Another nurse standing nearby suggested she would do well with an injection of Toradol. The Member asked [the orthopaedic specialist] whether having already had oral Toradol she could have an injection of Toradol. [The orthopaedic specialist] who was sitting at the desk replied, Yes dear it s okay. The nursing colleague who was present took Toradol from the medication cabinet, drew the drug up into a syringe, and injected the Member in her hip. This incident occurred in the Recovery Room with patients and other medical staff present. 10. [The orthopaedic specialist] was subsequently interviewed by hospital administration. He stated that at no time had he ever given a verbal order to the Member for her to receive an injection of Toradol. 2 Since the incidents, the facility has placed Toradol on the Narcotic & Controlled Drug Disposition and Inventory Record. Presently it is counted and kept in a locked cupboard.

4 11. The Member was under the misapprehension [the orthopaedic specialist] had authorized the injection. THE SECOND INTERVIEW 12. During a second interview on June 7 th, 2002, the Member admitted to having received a second injection of Toradol in late March, She acknowledged that she did not have a physician s order for this injection of Toradol. She told the hospital that it was the middle of her shift, and she was in extreme pain. She did not have her prescribed pain medication with her. The Member asked another nurse for an injection of Toradol. That nurse took a vial of Toradol from the medication cabinet, drew the drug up into a syringe and injected the Member. 13. The Member admitted that she was aware of the fact that a medical record was not created in either instance, nor was the administration of the Toradol documented in any hospital record. ADDITIONAL INFORMATION 14. The Member has since undergone [surgery] and no longer has pain management issues. 15. As a result of its internal investigation the hospital terminated five nurses, including the Member, who was subsequently the only employee to be re-instated. 16. The Member met with a hospital nurse educator on April 21st, 2004 to review and discuss issues regarding the standards and ethical behaviour, as requested by the hospital. She has reviewed and reflected on the Professional Standards, and written a brief paper reflecting on the same which she submitted to her nurse manager. 17. The Member has expressed to the hospital and the College remorse for her actions. 18. Subsequent to her reinstatement, the Member returned to work at the hospital. There have been no further incidents involving the Member. ADMISSIONS 19. The Member agrees that she committed an act of professional misconduct during the period of February through April, 2002, when she engaged in conduct relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional in that she, on two occasions while at the hospital and on duty, received from another nurse intramuscular injections of Toradol when there was no prescription for the Toradol, no documentation of the medication administration, and the Toradol and injection equipment belonged to her employer. 20. The Member also agrees that she committed an act of professional misconduct when, during the period of February through May, 2002, while employed as a Registered

5 Decision Practical Nurse by [the hospital], she misappropriated property from her workplace, namely Toradol and injection equipment. The Panel considered the Agreed Statement of Facts and finds that the Member committed an act of professional misconduct as alleged in paragraphs number 2 and 3 of the Notice of Hearing. Reasons for Decision The Panel deliberated and after due consideration of all the facts and the Members admission to the allegations, unanimously accepted the Agreed Statement of Facts as presented, which substantiated the findings of professional misconduct. Penalty Submissions Counsel for the College advised the panel that a Joint Submission (Exhibit # 4) as to Penalty had been agreed upon. The Joint Submission on Penalty invited us to make an order: 1. Requiring the Member to appear before the panel to be reprimanded; and 2. Directing the Executive Director to suspend the Member s certificate of registration for 30 days; and 3. Directing the Executive Director to impose the following terms, conditions, and limitations on the Member s certificate of registration: i. That the Member provide evidence of successful completion of a course in ethics that has been approved by the Director of Investigations and Hearings, within 12 months of the date of the panel s decision in this matter; ii. That the Member meet with a Practice Consultant to review the College s Professional Standards and Ethical Framework, and to discuss the issues that arose in this case as they relate to the Member and her practice, at a date mutually agreeable with both the Member and the Practice Consultant, and no later than within 12 months of the Member having completed the course referred to in paragraph 3(i). Counsel for the College submitted that the penalty is appropriate given that the Member admitted the allegations and is willing to cooperate with the College. The penalty sends a message to the public and the membership that stealing is unacceptable conduct. Counsel for the Member submitted that: this was an isolated incident in 22 years of practice;

6 the Member admitted her mistake; the hospital has continued to employ the Member; the Member has expressed remorse; this incident occurred three years ago without any further incidents; and the penalty provides both specific and general deterrence and protects the public. Penalty Decision The panel accepts the Joint Submission on Penalty and accordingly orders: 1. The Member to appear before the panel to be reprimanded; and 2. The Executive Director to suspend the Member s certificate of registration for 30 days; and 3. The Executive Director to impose the following terms, conditions, and limitations on the Member s certificate of registration: i. That the Member provide evidence of successful completion of a course in ethics that has been approved by the Director of Investigations and Hearings, within 12 months of the date of the panel s decision in this matter; ii. That the Member meet with a Practice Consultant to review the College s Professional Standards and Ethical Framework, and to discuss the issues that arose in this case as they relate to the Member and her practice, at a date mutually agreeable with both the Member and the Practice Consultant, and no later than within 12 months of the Member having completed the course referred to in paragraph 3(i). Reasons for 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 determined that the penalty meets the goals of deterrence, rehabilitation and providing protection to the public. The panel concluded that the penalty sends a strong message to the Membership that using employer purchased medication and supplies for personal use is always unacceptable. I, David Bishop, 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: Chairperson Date

7 Panel Members: Lori McInerney, RN Denise Dietrich, RPN Marilyn Lambert, RN Faira Bari, Public Member