Complainant v. College of Registered Nurses of British Columbia

Health Professions Review Board Suite 900, 747 Fort Street, Victoria, BC V8W 3E9 Complainant v. College of Registered Nurses of British Columbia July 24, 2018 DECISION NO. 2018-HPA-058(a) In the matter of an application under section 50.6 of the Health Professions Act, R.S.B.C. 1996, c. 183, (the Act ) for review of a complaint disposition made by an Inquiry Committee BETWEEN: Complainant COMPLAINANT AND: College of Registered Nurses of British Columbia COLLEGE AND: Nurse REGISTRANT BEFORE: John H. O Fee, Q.C., Panel Chair REVIEW BOARD DATE: Conducted by way of written submissions concluding on June 20, 2018 APPEARING: For the Complainant: Self-represented For the College: For the Registrant: Jennifer Strate, Legal Counsel Self-represented I INTRODUCTION AND BACKGROUND [1] The Complainant applies under s.50.6 of the Act for review of a disposition of the Inquiry Committee of the College which was communicated to her in a letter dated March 23, 2018 (the Disposition ). [2] This complaint arises out of a single telephone conversation between the Complainant and the Registrant on September 12, 2017 (the Incident Date ). At about 6:00 a.m., the Complainant s son (also referred to as the Patient ) was brought to a hospital for mental health reasons. [3] The Registrant is an Emergency Room ( ER ) nurse. The Complainant and her spouse were seeking information from the Registrant respecting their son and his admission status to the hospital. The Complainant alleges that the Registrant was brusque and dismissive with her and her spouse regarding their enquiries as to the admission status of their son and the proposed plan of treatment. [4] The Complainant and her spouse are both healthcare professionals. The Complainant describes her thirteen year old son as a person who has high

functioning ASD [Autism Spectrum Disorder] and mental health issues. The Complainant provided a timeline of events on the Incident Date which included phone calls with an ER physician and a Ministry of Family and Child Development social worker (the Social Worker ). According to the Complainant s account, the ER physician advised that her son would be admitted to hospital for at least 48 hours. [5] During the noon hour the Complainant received a call from the Social Worker advising that her son would be discharged from the hospital immediately. This change in plans surprised her as her son had made suicidal statements as well as threats to other family members. The conduct of the Social Worker concerned the Complainant but this is not related to the matter before me. However, this helps give me some context as to the Complainant s concerns when she contacted the hospital. [6] After speaking with her spouse, the Complainant says she phoned the hospital and her call was transferred to the ER. This is when she spoke with the Registrant. The Complainant s account of the conversation is that she asked how her son was and whether or not he had seen a psychiatrist. The Complainant paraphrases the Registrant s reply as: I don t know my job is to look after his vitals and makes sure that he eats, and that she has other patients. [7] The Registrant has a different account of her interaction with the Complainant. She describes arriving on shift after the Patient had already arrived at the ER. The Registrant found him to be calm and compliant with requests she made. She provided the Patient with breakfast and offered him a newspaper or magazine. She states that she checked on the Patient frequently to ensure he was safe. [8] The Registrant states she recalls a telephone conversation with the Patient s grandmother assuring her that the Patient was doing fine and that he had his special stuffed animal with him. [9] The Registrant notes that during this time the Complainant s son was being assessed by a separate team from Intensive Youth Outreach Services ( IYOS ). The Registrant states she was advised that the Patient did not require hospitalization or to see a psychiatrist because the threats and suicidal statements he was making were behavioral versus related to a psychiatric disorder. [10] The Registrant states that, upon speaking with the Complainant in the early afternoon, she found the Complainant to be aggressive and hostile. She relayed the IYOS findings and also that the Patient s grandmother had stated she was not capable of taking him back to her residence. Accordingly, the Social Worker was formulating a go forward plan for the Patient. The Registrant says that she suggested that the Complainant and her husband contact the Social Worker for additional information.

[11] The Registrant says the Complainant seemed upset by her son not seeing a psychiatrist. The Complainant left the Registrant with the impression that it was up to her to arrange this. The Registrant states she advised the Complainant that this was a decision of the IYOS team beyond the Registrant s control. [12] The Registrant states that the Complainant did not acknowledge what she was saying and after several times trying to clarify, the Registrant states she became frustrated and I eventually explained that my role as the bedside nurse was to keep [the Patient] safe and meet his physical needs and suggested they speak with IYOS about his assessment. [13] The Registrant further states that after her phone call with the Complainant she did relay her concerns to IYOS about the Patient not seeing a psychiatrist. The Registrant concluded I do not feel there was anything I could have done differently to change the outcome or provide better care. [14] The investigation report referenced in the Disposition accurately summarizes the initial complaint as follows: (1) Failed to provide the Complainant and her spouse with information about their son specifically: Whether there had been any change since he had been certified earlier in the day Whether he had been seen by a psychiatrist yet Whether there was an update to his care plan (2) Failed to advise them that [Patient] in fact had been de-certified and was going to be discharged (3) Responded in a brusque and irritated manner stating that her responsibilities were to take his vital signs and ensure he ate. [15] The Disposition outlines the steps taken to investigate the initial complaint and determined that the Complainant s allegations were not sufficiently supported by the evidence to demonstrate the conduct is unsatisfactory and warranting regulatory intervention. [16] The Disposition further noted that it would be impossible to determine the precise details of the single phone call between the Complainant and the Registrant that is the subject matter of her complaint. The Inquiry Committee was satisfied that the Registrant had reflected upon how the lines of communication could have been improved. II APPLICATION TO THE REVIEW BOARD [17] In her application for review, the Complainant details her experiences on the Incident Date. Referring to the Disposition and the Registrant s initial response

to the complaint the Complainant raises new concerns about the quality of the medical record relating to the Incident and the Complainant points to what she views to be factual inconsistencies including: (a) The length of her phone conversation with the Registrant; (b) Her mother would not have referred to a stuffed animal belonging to the Patient by the name used by the Registrant; and (c) The Registrant failed to advise the Complainant: (i) that there was a social worker involved. Had she done so, the Complainant states she would have contacted the social worker. (ii) that there was involvement of a Youth Mental Health clinician. (iii) that the Registrant would not share the details of the Patient s care plan due to her needing to respect the Patient s privacy. [18] The Complainant goes on to suggest that the Registrant is not suited for work in an ER setting and should instead work in extended care. The Complainant submits that I should direct the Inquiry Committee to request in writing that the Registrant undertake not to repeat her conduct, take specified educational courses and write a letter of apology to the Patient, the Complainant and her spouse. III REVIEW BOARD PROCESS [19] This matter was referred to me by the Panel Chair of the Review Board for review at a stage 1 hearing. [20] At a Stage 1 hearing I may: (a) confirm the Inquiry Committee disposition under s.50.6(8)(a) of the Act if the application for review can be fairly, properly and finally adjudicated on the merits without the need for submissions from the College and Registrant; or (b) determine that the application requires adjudication in a Stage 2 hearing, in which case no decision will be made until after requesting submissions from the College and Registrant, and further reply submissions from the Complainant. [21] Upon review of the Record and submissions from the Complainant, I find that this application for review can be fairly, properly and finally adjudicated on the merits without the need for submissions from the College or Registrant. As such, my review of the Inquiry Committee s disposition is based solely on the record of investigation provided by the College, (the Record ) and submissions from the Compainant. [22] In considering an application for review under s.50.6(1) of the Act, the Act gives clear directions to restrict the review to the adequacy of the Inquiry Committee s investigation and the reasonableness of its disposition. If I find that

the investigation is inadequate or the disposition unreasonable, I have a range of powers through the Act to make an order to address this matter. IV THE ADEQUACY OF THE INVESTIGATION [23] Review Board Decision No. 2009-HPA-0001(a) to 0004(a) serves as a benchmark for panel chairs in determining what constitutes an adequate investigation. It has been cited many times and often serves as a starting point for determining the legal test to assess the adequacy of an investigation. The core premise behind this and the many decisions that follow it is that an investigation does not have to be perfect or exhaustive to be adequate and that adequacy has to be viewed in the context of the seriousness of the harm alleged. Review Board Decision 2013-HPA-010(a) at para. [18] describes adequacy as a level of diligence varying based on the circumstances. [24] The Record indicates that the College appointed an investigator (the Investigator ) who sought and received responses from the Complainant, her spouse, and the Registrant. In addition, the Investigator reviewed the IYOS assessment, the Patient s medical records related to his admission to hospital and an internal Patient Care Quality Office ( PCQO ) report that was completed after the Incident Date. [25] While I appreciate this was a very stressful and difficult circumstance for the Complainant, the Record does not point to the Registrant compromising the care of the Patient or causing the Patient to suffer any particular harm by virtue of the care she provided. This gives me some context as to what would constitute an adequate investigation. The Complainant relates a situation where she, as a concerned parent seeking information about her child, had an abrupt conversation with a busy ER nurse. [26] There is a dispute in the factual narrative provided by the Complainant and the Registrant respecting their phone conversation. This was explored by the investigator appointed by the College who determined that there was little likelihood that the two perspectives of the interaction could be reconciled. While the Complainant raises a concern in her application for review regarding the quality of the medical record keeping respecting the Incident, this was not part of her initial complaint and the Investigator makes no mention of the Record failing to meet acceptable standards. [27] The Record shows that the Inquiry Committee took reasonable steps in the circumstances to obtain relevant information concerning this complaint. The report of the Investigator details the events of the Incident Date as well as matters leading up to and subsequent to it. I am satisfied that the Inquiry Committee made the inquiries and reviewed the information necessary to establish an adequate investigation of this complaint. V THE REASONABLENESS OF THE DISPOSITION [28] The previously cited Review Board Decision No. 2009-HPA-0001(a) to 0004(a) as well as a body of subsequent Review Board decisions also guides

panel chairs on what constitutes a reasonable disposition of a complaint. In summary, I must give some reasonable deference to medical colleges in determining an appropriate standard of care and my focus should be whether or not the Inquiry Committee s disposition falls within the range of acceptable and rational solutions, viewed in the context of the whole Record and is sufficiently justified, transparent and intelligible to be sustained. [29] Review Board Decision 2015-HPA-088(a) at para. [12] adds to this by stating that a decision is reasonable if it falls within a range of possible, acceptable outcomes which are defensible in respect of the facts and law. [30] In Review Board Decision 2012-HPA-169(a) at para. [27] I explored the expectations of a medical professional in a busy ER setting and distinguished them from what one might reasonably expect during a non-urgent visit with a health care professional. I recognize that nurses and other staff members in an ER setting are facing multiple demands on their time from patients requiring various degrees of urgent care, as well as, the families of those patients seeking information about their loved ones. This stress colours both sides of a conversation. [31] The Complainant and her spouse have obviously faced challenges in attending to their son s needs as he progresses through his life journey. The Patient is fortunate to have the Complainant and her spouse as his advocates. The Disposition outlines a rational, intelligible and justified conclusion to the complaint. The Record indicates that the Registrant met an expected standard of medical care respecting the Patient. It is impractical if not impossible to determine the precise details of the conversation between the Registrant and the Complainant. I find that the Inquiry Committee of the College has reached a reasonable disposition. VI DECISION [32] For the reasons outlined above I dismiss the application for review and confirm the disposition of the Inquiry Committee. [33] In making this decision I have considered all of the information and submissions before me whether or not I have specifically referenced them. John H. O Fee John H. O Fee, Panel Chair Health Professions Review Board