Employer, colleagues lost all trust in prison nurse after cover-ups of medication errors, denials and refusal to co-operate
The importance of truth
Trust is generally essential to the employment relationship, especially in highly skilled professions like medicine. If someone like a nurse violates professional standards, it can be serious misconduct due to the potential risks to patients and employer liability.
Violating professionals standards isn’t the worst thing an employee can do, however. How about trying to cover it up? When the element of dishonesty enters the equation in any employment relationship, that can often be the end of it. Even if the employee in question has a lengthy, discipline-free tenure with the employer.
Corrections Canada had just cause to fire a nurse at a British Columbia institution, but should have conducted a faster investigation while she was suspended without pay, a federal labour adjudicator has ruled.
Gloria Baptiste was a registered nurse working for Corrections Canada (CSC) at the Matsqui Institution, a federal penitentiary in Abbotsford, B.C. She was hired by CSC in April 1990 and spent most of her career at Matsqui administering health care services to inmates. She had no instances of discipline on her record, although she had been investigated following an inmate death in the late 1990s, where other inmates had accused her of killing the inmate with a lethal injection. However, a coroner’s inquiry found Baptiste was not at fault. Because of the investigation and fears for her safety, she had been transferred to another institution for several months. Other incidents had occurred at Matsqui where Baptiste had been the target of racial slurs from inmates, which caused her to become difficult at times in dealing with both inmates and colleagues.
More inmate complaints in 2004 resulted in another investigation of Baptiste, which resulted in her assignment to administrative duties for a while. The head nurse also filed a complaint with the College of Registered Nurses of British Columbia (CRNBC) about Baptiste’s capabilities, but the college was satisfied that she met her professional obligations.
Incorrect medication given to inmates
An inmate at Matsqui who was a heroin addict was prescribed back pain medication and Zoloft, an anti-depressant, as part of his treatment. The inmate was part of a segregated unit with five inmates who served meals to other inmates for a small payment. This allowed them to leave their cells earlier than other inmates.
On Sunday, Aug. 20, 2006, the inmate approached Baptiste to replenish his Zoloft prescription. Baptiste, who was the only nurse on duty for the weekend, gave him six pills in a small brown envelope, upon which she had written that that it was his prescribed amount of Zoloft. The inmate returned to his cell and took four of the pills, after which he noticed the last two didn’t look like Zoloft. As it turned out, the two remaining pills were in fact an antipsychotic used for patients with schizophrenia and bipolar disorders that was often called “baby heroin” by inmates. That night, the inmate fell off his top bunk and hurt his back.
The next day, he gave the envelope with the two remaining pills to the acting chief nurse. He also filed a complaint, claiming the incorrect medication had caused his fall. That same day, another nurse noticed Baptiste writing in the narcotic control drug record (NCDR) and asked her what was going on. Baptiste replied that she had “messed up on the weekend” and the nurse noticed the morning pill count had been changed, with Baptiste’s initials and handwriting. The change appeared to cover up the administering of incorrect medication to three inmates and replaced it with the correct medication. Changing the pill count done by other staff without advising them first was considered unprofessional and put the originator’s licence at risk, and the other nurses on duty said they lost trust in Baptiste when this change was discovered.
Baptiste denied giving the inmate anything other than Zoloft and also denied putting it in a brown envelope. She also denied altering the pill count in the NCDR when reminded it was a legal obligation to report and account for changes in the pill count.
The warden launched a disciplinary investigation and suspended Baptiste without pay on Sept. 5, 2006, pending the results of the investigation, as he felt Baptiste was a risk and the allegations were serious. Baptiste did not respond to written requests for her account of things and eventually refused to participate. It was determined that Zoloft did not come in the tablet-style pills Baptiste had given the inmate, only capsules, and Matsqui didn’t have Zoloft pills in the size of pills she put in the envelope. CSC had the envelope with her writing on it and the NCDR with her writing and signature with the pill count changes, so the warden decided there was enough evidence she had committed the misconduct and had lied about it. Since she had refused to co-operate in the investigation and didn’t seem to show any remorse, CSC felt it couldn’t trust Baptiste any longer and terminated her employment effective April 10, 2007.
Baptiste filed a grievance both for the suspension — which turned out to be seven months long up to her firing — and her termination. She argued CSC’s investigation was unfair, since it didn’t formally interview the cellmate of the inmate who received the pills — and who said the fall was minor and didn’t injure him. She claimed the inmates in the segregated unit were conspiring against her and she had nothing to gain by changing the NCDR entry. She argued staff were not handwriting experts and should not be relied upon to identify her handwriting on the envelope and in the NCDR. She also noted that other nurses had not followed standard procedure when changing the NCDR and had not been disciplined. In addition, since she had a discipline-free record, she deserved progressive discipline and not immediate termination, Baptiste argued.
The labour adjudicator found CSC had sufficient evidence to prove it was Baptiste’s writing on the envelope. Several staff were familiar enough to recognize her handwriting and a forensic document expert confirmed it. Since this was the envelope containing the pills, it could be determined that Baptiste administered the wrong medication to the inmate, said the adjudicator.
Employer lost all trust
For similar reasons, the adjudicator found Baptiste altered the NCDR to cover up a mistake. Though the mistake was because of another nurse’s transcription error, Baptiste’s attempt to disguise it rather than make staff aware of it was serious misconduct and a violation of “the legal record that the NCDR constitutes.” Though the recipients didn’t appear to suffer any ill effects from the mistake, Baptiste’s misconduct was “inconsistent with the position of trust given to a nurse.”
The adjudicator found Baptiste’s actions on Aug. 20 and 21 constituted “appalling” and unprofessional misconduct that called into question her ability to be a nurse. Her attempts to deny her misconduct compounded its severity.
“More distressing in my view is that she has denied doing what the employer alleges she did, even faced with a preponderance of evidence proving the contrary,” said the adjudicator. “Such behaviour, taken together, flies in the face of the most basic canons of professionalism, ethics and honesty that are expected of a nurse of Ms. Baptiste’s experience.”
Additionally, the adjudicator found Baptiste’s failure to provide any explanation left CSC with no choice but to “draw unfavourable inferences” and make the decision to terminate her employment.
The adjudicator also found that on the other occasions where nurses didn’t follow standard procedure after changing the NCDR, CSC ran training and information sessions to correct the behaviour. Also, the other nurses had not previously been investigated for medication-related and NCDR errors as Baptiste had. As a result, Baptiste could not argue similar misconduct by others was condoned, said the adjudicator.
As for the suspension during the investigation up to Baptiste’s termination, the adjudicator found it was a disciplinary, rather than administrative, suspension because it was without pay. Though the seriousness of the allegations made it reasonable to remove her from the workplace, the length of such a suspension was not reasonable and CSC should have been more diligent in the conduct of its investigation, said the adjudicator. It found such a suspension should have ended within six weeks.
CSC was ordered to pay Baptiste what she would have earned from Oct. 17, 2006, up to her termination on April 10, 2007. However, her termination was upheld.
“I believe that (Baptiste) has irrevocably severed the bond of trust and integrity required for her to be reinstated,” said the adjudicator.
For more information see:
•Baptiste v. Canada (Deputy Head — Correctional Service), 2011 CarswellNat 5601 (Can. Pub. Service Lab. Rel. Bd.).
