DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: April Cheese, RPN Chairperson Kris Voycey, RN Member Kim Jinkerson, RPN Member Joan King Public Member Bill Dowson Public Member BETWEEN: COLLEGE OF NURSES OF ONTARIO ) MEGAN SHORTREED for ) College of Nurses of Ontario - and - ) ) ANNA BALDIN ) BARRY ADAMS for Registration No. HF06238 ) Anna Baldin ) ) ) Heard: April 19, 2010 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on April 19, 2010 at the College of Nurses of Ontario ( the College ) at Toronto. The Allegations The allegations against Anna Baldin (the Member ) as stated in the Notice of Hearing dated February 8, 2010, 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 employed as a Registered Practical 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 with regard to your conduct toward and treatment of [the Client] on or about March 31, 2008; and/or 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 employed as a Registered Practical Nurse at [the Facility] in [ ], Ontario, you abused a client verbally, physically or emotionally with regard to your conduct toward and treatment of [the Client] on or about March 31, 2008; and/or: 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 employed as a Registered Practical Nurse at [the Facility] in [ ], Ontario, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, with regard to your conduct toward and treatment of [the Client] on or about March 31, 2008. College Counsel advised the panel that on Allegation #2, the College sought a finding that the Member s conduct constituted verbal, physical and emotional abuse. With respect to Allegation #3, the College sought a finding that the Member s conduct would reasonably be regarded by members as unprofessional. Member s Plea The Member admitted the allegations set out in paragraphs numbered 1, 2 and 3 in the Notice of Hearing. On Allegation 2, the Member admitted that the conduct consisted of verbal, physical and emotional abuse. On Allegation 3, the Member admitted that her conduct would reasonably be viewed by members as unprofessional. The panel 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. Appendix A to the Agreed Statement of Facts is not reproduced in these reasons. THE MEMBER 1. The Member, Anna Baldin (the Member ), is a Registered Practical Nurse ( RPN ). She attended and completed the Registered Nursing Assistant program []. In 1996 and 1997, she completed the Medication Course and Venipuncture/Intramuscular Course for Registered Practical Nurses [ ]. 2. The Member has been registered with the College of Nurses of Ontario (the College ) since June 27, 1986. The Member s registration is current and she is up-to-date with her annual fees.
3. The Member was employed as a full-time RPN at [the Facility] from March 31, 2002 to March 31, 2008. The Member s employment was terminated as a result of the facts set out below. THE FACILITY 4. The Facility consists of two separate buildings: the hotel and the residence. There were [ ] clients residing in the residence who required varying degrees of assistance, up to fully assisted care. 5. The Member was the Charge Nurse on the night shift [ ] in the residence building at the Facility. She was the only registered staff on site during those hours; there were two Personal Support Workers ( PSWs ) who also worked that shift. THE CLIENT 6. [The Client] was a client of the residence building at the Facility in March of 2008. [The Client] was [ ] years old at the time of the incident described below. She required fully assisted care but was mentally alert. [The Client] is now deceased. INCIDENT RELEVANT TO PROFESSIONAL MISCONDUCT 7. On or about March 31, 2008, at approximately 2130 hours, the Member entered [the Client] s room to administer medication to [the Client]. Two PSWs [ ] were also in the room at the time. 8. The Member and [the Client] argued over [the Client] taking her medication. The Member poured water over the client s head. The Member also made fun of and mocked [the Client]. 9. When confronted about this incident by her employer, the Member said that the client was nasty and calling her names so she poured a few drops of water on her head. The Member acknowledged that this action constituted abuse. ADMISSIONS OF PROFESSIONAL MISCONDUCT 10. The Member admits that she committed [ ] acts of professional misconduct as set out in Allegations 1, 2 and 3 of the Notice of Hearing, with regard to her conduct toward and treatment of [the Client] on or about March 31, 2008, in that: a. she contravened a standard of practice of the profession and failed to meet the standards of practice of the profession; b. she abused a client verbally, physically and emotionally; and
c. she 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 unprofessional. PREVIOUS FINDINGS OF PROFESSIONAL MISCONDUCT 11. A panel of the Discipline Committee of the College heard a matter involving the Member on April 20, 2001. [ ] 12. In the prior proceeding, the Member admitted that she abused a [client] verbally, physically and emotionally and, in particular, that she: Responded angrily and raised her voice to a client and called him a bugger ; Told the client that he belonged up on the third floor with all the other nutcases ; and Roughly grabbed the client s forearms, held them with more force than necessary and restrained the arms of the client to the chair. 13. The Discipline Committee found the Member committed an act of professional misconduct and made the following penalty order: a. The Member was reprimanded; b. The Member s certificate of registration was suspended for three months; c. The following terms, conditions and limitations were placed on the Member s certificate of registration: (i) (ii) The Member was to successfully complete a course or counselling program in anger and/or stress management, and The Member was to review the video and complete the One is One Too Many abuse prevention self-directed package and meet with a Practice Consultant to discuss the incident. The meeting with the Practice Consultant was to include a review of the definition of abuse and strategies to deal with aggressive clients. 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 an act of professional misconduct as alleged in paragraphs 1, 2 and 3 of the Notice of Hearing. The panel finds the Member contravened a standard of practice of the profession, abused the client
verbally, physically and emotionally and that the Member s conduct would reasonably be regarded by members of the profession as unprofessional. Reasons for Decision The Agreed Statement of Facts was clear and supported the allegations. 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 provides as follows: 1. Requiring the Member to appear before the Panel to be reprimanded at 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 four (4) months. This suspension shall take effect from the date of the 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, any portion of this suspension which has not yet been served shall be served commencing on the day that the Member obtains a new certificate of registration. 3. Directing the Executive Director to impose the following terms, conditions and limitations on the Member s certificate of registration: a. Requiring the Member to return her current Annual Payment Card to the College within fourteen (14) days of the date of the Order so that a new Annual Payment Card, indicating that the Member s certificate of registration is subject to terms, conditions, and limitations, can be issued upon completion of the suspension. b. The Member shall attend two (2) meetings with an Expert with expertise in therapeutic nurse-client relationships (the Expert ) who has received the prior approval of the Director, Professional Conduct (the Director ). All costs associated with these meetings shall be borne by the Member. The first meeting shall commence within three (3) months of the date of the Order. The second meeting shall take place within two (2) months of the first meeting and both meetings shall be completed within five (5) months of the date of the Order. c. Prior to attendance at the meetings referred to in paragraph 3(b) above, the Member shall: i. Provide the Expert with a copy of the 2001 Decision and Reasons related to prior findings of professional misconduct, along with this 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; iv. Review the following College Publications and complete a Reflective Questionnaire for each publication: Professional Standards, Revised 2002; Ethics; Therapeutic Nurse-Client Relationship, Revised 2006; Practice Guideline on Conflict Prevention and Management; and Fact Sheet on Preventing Client Abuse. The Member shall bring the completed Reflective Questionnaires to her first session with the Expert; Complete the College s online learning modules related to Professional Standards; Ethics; and the Therapeutic Nurse-Client Relationship and complete the online participation form relevant to each module. The Member shall print and bring the completed online participation forms to her first session with the Expert; Review and complete the College s self-directed learning package, One is One Too Many, at her own expense, including the selfdirected Nurses Workbook, and bring the completed Nurses Workbook to her first session with the Expert; and v. Review and complete the Communication in Nursing Practice web module at her own expense, including the Communication in Nursing Practice workbook, and bring the completed workbook to her first session with the Expert. d. The Member shall deliver the materials referred to in 3(c)(ii) to (v) above 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(c)(ii) to (v) above are not received by the Expert, the Expert may cancel the first session as scheduled. e. The subject of the meetings with the Expert will include the following: i. The conduct for which the Member was found to have committed professional misconduct; The potential consequences of that conduct to her clients, her colleagues, her profession and herself; The responsibilities the Member has as a regulated health professional;
iv. Strategies for making the inappropriate conduct unlikely to occur in the future; and v. The development of a learning plan. f. During the first session with the Expert, the Member will develop a learning plan in consultation with the Expert to address the subjects set out in paragraph 3(e) above. g. During the second session with the Expert, the Member and Expert shall further discuss the subjects of the sessions as set out in paragraph 3(e) above and the implementation of the learning plan. h. Once the Member has completed both meetings with the Expert, she shall ensure that the Expert delivers a report to the Director within forty-five (45) days in which the Expert confirms: i. that the Member has attended the two sessions with the Expert; iv. that the Expert received copies of the materials set out in paragraph 3(c)(ii) to (v) from the Member in advance of the sessions; that the subject of the sessions was as set out in paragraph 3(e); and the Expert s assessment of the Member s insight into her conduct. i. For the period of the suspension and 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 health care related position; Provide her employer(s) with a copy of this Panel s Order, Notice of Hearing, Agreed Statement of Facts, Joint Submission on Order, or, 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 commences employment in any health care related position, the Member shall provide her employer(s) with a copy of the Decision and Reasons within fourteen (14) days of it becoming available; Only practi[s]e for a health care related employer(s) who agrees to, and does write to the Director within fourteen (14) days of the commencement or resumption of the Member s employment and provide the Director with the following:
(a) Confirmation that the employer(s) has received a copy of the documents referred to in paragraph (ii) above; (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. j. All deliveries and notifications to be given by or on behalf of the Member to the College, the Expert or 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 College Counsel submitted that the proposed penalty met the following objectives: 1. Specific deterrence: a four-month suspension of registration is significant to specifically deter the Member. 2. General deterrence: members of the profession will recognize the seriousness of contravening a standard of practice and abusing [clients] this way. 3. Remediation: the terms, conditions and limitations on the Member s registration will assist the Member in her rehabilitation. College Counsel presented the following mitigating factors: a. The Member admitted that her conduct was abusive. b. The Member cooperated with the College. c. This was a single incident involving one client. College Counsel presented the following aggravating factors: a. The Member had a similar incident resulting in a previous disciplinary finding. b. The client was an elderly, vulnerable and dependant client. c. The conduct displayed an abuse of power, belittling the client. Defence Counsel submitted that the Member joined with the College in the preparation of the Joint Submission on Order. He submitted that the Member regrets her actions and acknowledges that the remediation process will be beneficial to the Member. Penalty Decision
The panel accepts the Joint Submission as to Order and accordingly orders: 1. The Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within three (3) months of the date of the Order. 2. The Executive Director to suspend the Member s certificate of registration for a period of four (4) months. This suspension shall take effect from the date of the 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, any portion of this suspension which has not yet been served shall be served commencing on the day that the Member obtains a new certificate of registration. 3. The Executive Director to impose the following terms, conditions and limitations on the Member s certificate of registration: a. Requiring the Member to return her current Annual Payment Card to the College within fourteen (14) days of the date of the Order so that a new Annual Payment Card, indicating that the Member s certificate of registration is subject to terms, conditions, and limitations, can be issued upon completion of the suspension. b. The Member shall attend two (2) meetings with an Expert with expertise in therapeutic nurse-client relationships (the Expert ) who has received the prior approval of the Director, Professional Conduct (the Director ). All costs associated with these meetings shall be borne by the Member. The first meeting shall commence within three (3) months of the date of the Order. The second meeting shall take place within two (2) months of the first meeting and both meetings shall be completed within five (5) months of the date of the Order. c. Prior to attendance at the meetings referred to in paragraph 3(b) above, the Member shall: i. Provide the Expert with a copy of the 2001 Decision and Reasons related to prior findings of professional misconduct, along with this 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; Review the following College Publications and complete a Reflective Questionnaire for each publication: Professional Standards, Revised 2002; Ethics; Therapeutic Nurse-Client Relationship, Revised 2006; Practice Guideline on Conflict Prevention and Management; and Fact Sheet on Preventing Client Abuse. The Member shall bring the completed Reflective Questionnaires to her first session with the Expert; Complete the College s online learning modules related to Professional Standards; Ethics; and the Therapeutic Nurse-Client Relationship and complete
the online participation form relevant to each module. The Member shall print and bring the completed online participation forms to her first session 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 first session with the Expert; and v. Review and complete the Communication in Nursing Practice web module at her own expense, including the Communication in Nursing Practice workbook, and bring the completed workbook to her first session with the Expert. d. The Member shall deliver the materials referred to in 3(c)(ii) to (v) above 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(c)(ii) to (v) above are not received by the Expert, the Expert may cancel the first session as scheduled. e. The subject of the meetings with the Expert will include the following: i. The conduct for which the Member was found to have committed professional misconduct; iv. The potential consequences of that conduct to her clients, her colleagues, her profession and herself; The responsibilities the Member has as a regulated health professional; Strategies for making the inappropriate conduct unlikely to occur in the future; and v. The development of a learning plan. f. During the first session with the Expert, the Member will develop a learning plan in consultation with the Expert to address the subjects set out in paragraph 3(e) above. g. During the second session with the Expert, the Member and Expert shall further discuss the subjects of the sessions as set out in paragraph 3(e) above and the implementation of the learning plan. h. Once the Member has completed both meetings with the Expert, she shall ensure that the Expert delivers a report to the Director within forty-five (45) days in which the Expert confirms: i. that the Member has attended the two sessions with the Expert; that the Expert received copies of the materials set out in paragraph 3(c)(ii) to (v) from the Member in advance of the sessions; that the subject of the sessions was as set out in paragraph 3(e); and
iv. the Expert s assessment of the Member s insight into her conduct. i. For the period of the suspension and 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 health care related position; Provide her employer(s) with a copy of this Panel s Order, Notice of Hearing, Agreed Statement of Facts, Joint Submission on Order, or, 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 commences employment in any health care related position, the Member shall provide her employer(s) with a copy of the Decision and Reasons within fourteen (14) days of it becoming available; Only practi[s]e for a health care related employer(s) who agrees to, and does write to the Director within fourteen (14) days of the commencement or resumption of the Member s employment and provide the Director with the following: (a) Confirmation that the employer(s) has received a copy of the documents referred to in paragraph (ii) above; (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. j. All deliveries and notifications to be given by or on behalf of the Member to the College, the Expert or 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 penalty is reasonable and in the public interest. The Member has cooperated with the College and has agreed to the facts and a proposed penalty. I, April Cheese, 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 as listed below: Chairperson Date Panel Members:
Kris Voycey, RN Kim Jinkerson, RPN Joan King, Public Member Bill Dowson, Public Member