DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Sarah Corkey, RN Tammy Hedge, RPN Shiraz Irani, RN Renate Davidson Ashleigh Molloy Chairperson Member Member Public Member Public Member BETWEEN: COLLEGE OF NURSES OF ONTARIO ) JESSICA LATIMER for ) College of Nurses of Ontario - and - ) ) SURTIE PAMAYAH ) ROBERT STEPHENSON for Registration No. 9100694 ) Surtie Pamayah ) ) ) ) Heard: December 7, 2015 DECISION AND REASONS This matter came on for hearing before a panel ( the Panel ) of the Discipline Committee on December 7, 2015, at the College of Nurses of Ontario ( the College ) at Toronto. The Allegations At the outset of the hearing, counsel for the College advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraph 2(d) of the Notice of Hearing dated August 25, 2015. The Panel granted this request. The remaining allegations against Surtie Pamayah (the Member ) as set out in the Notice of Hearing are as follows. IT IS ALLEGED THAT: 1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of Code, and defined in subsection 1(1) of Ontario Regulation 799/93, in that while engaged in the practice of nursing as a Registered Nurse and employed at [the Facility] [ ], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession by:
(a) (b) (c) on February 8, 2013, leaving a shift early and failing to transfer accountability of the clients assigned to you; on February 8, 2013, leaving a shift early and failing to report on clients assigned to you; and/or on February 8, 2013, leaving a shift early and failing to ensure that, as Charge Nurse, the Charge Nurse role was covered for the remainder of the shift. 2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Code, and defined in subsection 1(37) of Ontario Regulation 799/93, in that while engaged in the practice of nursing as a Registered Nurse and employed at [the Facility] [ ], 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 of the profession as disgraceful, dishonourable or unprofessional, by: (a) (b) (c) (d) on February 8, 2013, leaving a shift early and failing to transfer accountability of the clients assigned to you; on February 8, 2013, leaving a shift early and failing to report on clients assigned to you; on February 8, 2013, leaving a shift early and failing to ensure that, as Charge Nurse, the Charge Nurse role was covered for the remainder of the shift; and/or [withdrawn] Member s Plea The Member admitted the allegations set out in paragraphs numbered 1(a), 1(b) and 1(c) and 2(a), 2(b), and 2(c) in the Notice of Hearing. The Panel received a written plea inquiry which was signed by the Member. The Panel noted there was an error in question #3 of the written inquiry, but upon clarification with the Member, the Panel was satisfied that the Member understood the question and made a mistake in writing her answer. 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. 1. Surtie Pamayah (the Member ) obtained her diploma as a Registered Mental Health Nurse in 1973 [ ]. 2. The Member immigrated to Nova Scotia in 1975. While continuing to work as a mental health nurse, the Member obtained a diploma in nursing from [ ] in 1986 and then a Bachelor of Science in Nursing [ ] in 1989.
3. The Member registered with the College of Nurses of Ontario (the College ) as a Registered Nurse ( RN ) on October 23, 1990. The Member was suspended by an order of the Discipline Committee between August 1, 2007, and October 25, 2007. Independent of the present allegations, the Member retired from the practice of nursing and resigned from the College on February 12, 2015. 4. The Member was employed at [the Facility] from August 8, 2005, to April 9, 2013. PRIOR HISTORY 5. On August 1, 2007, the Member admitted, and Discipline Committee found, that she contravened a standard of practice or failed to meet the standards of practice when she worked a shift at a hospital shortly after working at a facility labelled as Category 2 with respect to Sudden Acute Respiratory Syndrome ( SARS ), exposing clients, colleagues, staff members and others to the risk of infection. Category 2 meant that the healthcare facility had active SARS cases within the preceding 10-day period and there had been unprotected SARS exposure but no transmission to staff or [clients]. 6. The Member also admitted, and the panel found, that she failed to disclose that she worked at a Category 2 facility when directly asked by her Manager. 7. The Member further admitted and the panel found that her conduct would reasonably be regarded as disgraceful, dishonourable and unprofessional. 8. The panel accepted the joint submission on order as proposed by the Member and the College. The Order required the Member to attend an oral reprimand and serve a 12- week suspension. As well, the following terms, conditions and limitations were imposed on her certificate of registration: successfully complete a course in nursing ethics, complete an online learning module on Infection Prevention and Control and notify her employer(s) of the Order for 12 months from the date of the Order. 9. The Member attended an oral reprimand, served her suspension and completed the terms, conditions and limitations, as ordered. THE FACILITY 10. [The Facility] is located in [ ] Ontario. 11. [The Facility] is a full-service regional hospital [ ]. 12. The Member worked full-time on the adult in-patient mental health unit (the Unit ) on the day, evening and night shift. The Member often worked shifts as Charge Nurse. 13. Clients on the Unit had diagnoses such as schizophrenia, bipolar disorder, suicidal ideation, depression and addiction issues.
14. The Unit was split into two areas: [a psychiatric intensive care unit ( Unit A )] and [an in-patient psychiatric unit ( Unit B ). The entire unit is locked. 15. [Unit A] was monitored by cameras at the nursing station and eight of the nine rooms could be locked from the outside. 16. During the night shift (23:30 to 07:30), the Unit was staffed with two RNs and two Registered Practical Nurses ( RPNs ). One RN and one RPN was assigned to each area. After 23:30, each registered staff, including the Charge Nurse, was assigned between six and eight clients [in] [Unit B] and four to five clients in [Unit A]. 17. One of the RNs was also assigned to be the Charge Nurse. The Charge Nurse, in addition to having the direct [client] assignments noted above, was responsible for all [ ] beds in the unit with respect to managing client assignments, assigning breaks, approving staff replacements, [client] flow and safety. [FACILITY] POLICIES 18. [The Facility s] policy required staff to notify the Clinical Support Manager if they needed to leave before the end of their shift. The Charge Nurse was also required to notify the Clinical Support Manager if there were any staffing shortages and/or replacements required. These policies were not in written form, but staff were aware of these expectations. 19. Nursing staff received 90 minutes of break time on a 12-hour shift two fifteenminute breaks and two thirty-minute breaks. 20. Breaks were to be taken separately and not combined, though it was common and accepted practice for nurses at [the Facility] to combine their breaks. It was [the Facility s] policy that staff must return to the Unit at the end of their shift to provide report, even if their break was scheduled near or at the end of their shift. This policy was not in written form, but staff were aware of this expectation. INCIDENT RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT 21. On February 7-8, 2013, the Member was scheduled to work a 12-hour shift from 19:30 to 07:30. 22. The Member was the Charge Nurse on the shift for the Unit. 23. As Charge Nurse, the Member was responsible for all [ ] beds on the Unit, including: Managing client assignments according to RN and RPN; Assigning breaks and approving staff replacements;
Client flow, including transferring clients and admitting clients from the emergency room, and; Safety, including fire alarms and code whites. 24. In addition to her Charge Nurse duties, the Member was working in [Unit A] with an RPN, and she had four to five clients assigned to her. 25. On February 8, 2013, the Member took her 90- minute combined break at the end of her shift around 06:00. Rather than stay at [the Facility], the Member left [the Facility] approximately 1.5 hours before the end of her shift. 26. The Member did not notify the Clinical Support Manager on duty that she was leaving. She did advise the RPN who was working with her in [Unit A] that she wanted to take the last break, and she told the other RPN working that shift that she was leaving, as she was putting on her coat and getting ready to leave the unit. The Member did not tell the other RN on duty that she was leaving, though that RN did overhear the Member telling another RPN that she would be leaving. 27. The Member did not ask the other RN on duty to assume the Charge Nurse role for the remainder of the shift. If the Member were to testify, she would state that she thought the other RN was aware she was leaving early and would therefore automatically assume the Charge Nurse role. 28. The Manager of the [ ] Crisis Team arrived at work around 06:00 and noticed that the Member was not on the Unit. When the Manager asked where the Member was, one of the RPNs on the night shift advised that she had already left. 29. The RPN who the Member had been working with in [Unit A] delivered the transfer of care report on all [ ] clients, including the clients that had been assigned to the Member. 30. Two RNs and five RPNs were scheduled to work the day shift, starting at 07:30 on February 8, 2013. Three of them called in to advise they could not make it due to a snowstorm. As Charge Nurse, it was the Member s responsibility to approve replacement staff. 31. If the Member were to testify, she would say that it was common practice on the Unit for nurses to take their break at the end of the shift and to leave [the Facility] early. As stated above, when this occurred, the practice was for the remaining RN to assume the Charge Nurse role. 32. The Member would further testify that she believed all of the remaining nursing staff (the two RPNs and one RN) were aware that she was leaving early, even if she did not tell them all directly.
33. The Member would further testify that she left her shift early on February 8, 2013, in order [ ] to assume childcare responsibilities that day. ADMISSIONS OF PROFESSIONAL MISCONDUCT 34. The Member admits that leaving her shift early without informing the Clinical Support Manager, in order to ensure continuity of care, or providing report on her clients, and without ensuring the Charge Nurse role was covered, as set out in paragraphs 21 to 33 above constitutes a breach of the College s Professional Standards. The Member also admits that the same conduct was unprofessional. 35. The Member admits that she committed the acts of professional misconduct as alleged in the following paragraphs of the Notice of Hearing: OTHER 1(a), (b) and (c), in that she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession; and 2(a), (b) and (c), in that 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 of the profession as unprofessional. Decision 36. With leave of the Panel of the Discipline Committee, the College withdraws allegation 2(d) of the Notice of Hearing. 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(a), 1(b) and 1(c) and 2 (a), 2(b), and 2(c) of the Notice of Hearing in that the Member failed to meet the standards of practice and her conduct would reasonably be regarded by Members of the profession to be unprofessional. Reasons for Decision The Panel found that the allegations were supported in the agreed statement of facts as follows: Allegation 1 a) was supported by paragraph 25, 26, 27 and 32 in the Agreed Statement of Facts. Allegation 1 b) was supported by paragraphs 25, 26, 27 and 29 in the Agreed Statement of Facts. Allegation 1 c) was supported by paragraphs 25, 27, 30 and 32 in the Agreed Statement of Facts. Allegation 2a) was supported by paragraph 25, 26, 27 and 32 in the Agreed Statement of facts.
Allegation 2 b) was supported by paragraph 25, 26, 27, and 29 in the Agreed Statement of facts. Allegation 3 c) was supported by paragraph s 25, 27, 30 and 32 in the Agreed Statement of Facts. Penalty The parties presented the Panel with a written undertaking given from the Member to the College, in which the Member agreed (among other things) to permanently resign as a member [of] the College and to not apply for membership with the College at any time in the future. In light of the undertaking, the parties requested that the Panel make an order requiring the Member to appear before the Panel to be reprimanded within three (3) months of the date of this Order. Penalty Submissions College Counsel submitted that the Joint Submission on Order was negotiated carefully and was reasonable in that the Member has entered into the Undertaking with the College. The Member has resigned her membership and there is absolutely no chance of the Member seeking reinstatement. For this reason, an oral reprimand is the only sanction that reasonably applies. Panels are generally expected to accept the carefully negotiated agreements, unless doing so would put the College into disrepute. In this case the public is protected by the Member s agreement to not engage in the practice of nursing in any capacity indefinitely. This Joint Submission on order meets all the required goals of penalty. The aggravating factors submitted by College Counsel included that the conduct was serious enough to merit discipline. The Member had [clients] in her care, was the charge nurse in a psychiatric ward and took no appropriate steps to ensure continuity of care or the proper transfer of her charge nurse responsibilities by not giving a report at the end of her shift. The mitigating factors included that the Member has cooperated with the College and accepted responsibility by admitting to the allegations. The Member freely engaged in signing an undertaking with the College. Counsel submitted that the proposed order meets the goals of general deterrence in the publication of this decision and reasons, the oral reprimand and the undertaking. There are no specific provisions for rehabilitation as the Member has permanently resigned her certificate of registration with the College. The public is protected by the resignation of the Member s certificate of registration and the permanent undertaking. This order acknowledges that the Member s conduct constitutes professional misconduct, requiring sanction. Three cases were presented to the Panel for consideration. These cases were not presented for their facts, but to demonstrate cases where panels of this Discipline Committee agreed to order oral reprimands alone following findings of professional misconduct. All three decisions were from this College and all involved members who had signed an undertaking with the College that they would not engage in the practice of nursing permanently. The cases were: CNO v. Hearty
(Discipline Committee, 2012); CNO v. Heaps (Discipline Committee, 2012); and CNO v. Wood (Discipline Committee, 2012). Penalty Decision The Panel accepts the Joint Submission as to Order and accordingly orders: 1. The Member is required to appear before the Panel to be reprimanded within three (3) months of the date of this Order. 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. In particular, the Member voluntarily resigned her membership and signed an undertaking that will protect the public permanently. Given this fact, there is no need for education or remediation. The goal of general deterrence is met by the oral reprimand and the publication of this decision. I, Sarah Corkey, RN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel as listed below: Chairperson Date Panel Members: Tammy Hedge, RPN Shiraz Irani, RN Renate Davidson, Public Member Ashleigh Molloy, Public Member