Nurse said he would ‘do it again’ to protect other patients on road trip after patient got unruly
A traumatic experience for nurse and patient
Nurses have a heightened expectation of responsibility placed on them because of the risk of harm to patients in their care. Psychiatric nurses in particular are expected by their employers to maintain certain professional standards because the patients in their care are often unable to look after themselves.
Placing a patient in a dangerous situation could easily be grounds for termination of a nurse’s employment. But what if the nurse suffered from a mental condition that contributed to the misconduct in question?
A nurse at a British Columbia mental health facility who was fired for leaving an unruly patient by the side of the road has been reinstated to his job by an arbitrator from the B.C. Arbitration Board.
Andrey Bakushev was a nurse employed at Riverview Hospital, a facility caring for patients with mental health and addiction issues in Vancouver. Bakushev was initially hired at Riverview as an auxiliary health worker in 1995. Four years later, he received his nursing licence and took a nursing position at Riverview.
In 1999, Bakushev was in a serious car accident and his treatment involved heavy use of painkiller drugs. The following year, he was attacked by an HIV-positive patient at work and had to undergo preventative therapy. His health suffered and he began abusing alcohol and prescription medication. His addictions originally started when he was stationed in Afghanistan with the Russian military in 1989 when he went through some traumatic experiences. Over the next few years, he ran into some trouble, including a drunk driving charge that resulted in conditions placed on his nursing licence. In May 2006, Bakushev’s nursing licence was revoked and he later received a two-week suspension for misappropriating medication and not being forthright about it.
Bakushev received treatment for his substance abuse problem and he joined support groups for alcoholics, drug addicts and health care professionals with drug problems He returned to work on modified duties in April 2008 while maintaining counselling and regular visits to his doctor. He also signed an agreement with the provincial college of nurses requiring abstinence from alcohol and drugs unless prescribed by a physician.
Outing for psychiatric patients
Riverview staff often took patients on outings in the Vancouver area to help their treatment through social and therapeutic means. Usually, a few patients who were approved to leave the hospital taken in a van driven by a staff member. On April 28, 2008, Bakushev decided to take a patient out for his birthday and decided to include a few other patients as well. One of the patients he took was known to be trouble as she was unpredictable and prone to disruptive behaviour. In fact, a few days earlier the patient had fled the hospital to go downtown and used crack cocaine before being returned by police. However, the patient had been on good behaviour over the previous few days and Bakushev promised to take her on an outing as a way to help her behaviour improve.
Early on in the trip, the troublesome patient became irritated, telling the others to stop singing and told Bakushev he was talking too much. She began to use racial insults. Bakushev pulled over and allowed the patient to have a smoke break to calm down.
Bakushev drove the van to a McDonald’s restaurant so they could order something at the drive-through window. The patient began complaining that Bakushev should pay for her order and began yelling. As they left, the patient continued to shout and insult Bakushev and the others in the van. Bakushev became concerned that things were escalating out of control and the other patients were becoming upset. He stopped and tried moving them around to different seats, but the patient continued to scream and yell.
Fearing a physical altercation, Bakushev pulled the van into a park, let everyone out and told the patient if she didn’t stop, he would kick her out of the van. However, once they resumed driving, she began again and the tension in the van was palpable. Finally, Bakushev pulled over to the side of the road, opened the door, and told the patient to get out of the van. The patient hit one of the others and got out.
The patient stomped away and Bakushev tried to get her to come back, saying if she walked away she would be walking home. The patient yelled profanities at him, so Bakushev took a quick break, got back in the van, and drove to Riverview.
The patient was soon returned to Riverview by police and the patient, who was still worked up, said they should arrest Bakushev. Bakushev himself was upset over the incident and felt “spent.” He filled out a report saying the patient had gotten angry and left the van.
Word of incident spread
On Dec. 1, 2008, the nurse who had been in charge the night of the incident overheard Bakushev discussing it with other staff. He said the patient had acted up, so he kicked her out. While he said this, he was laughing. The nurse realized this was inconsistent with the report Bakushev had filed, which said the patient had gotten out of the van on her own. Another nurse also overheard Bakushev saying the patient had gotten on his nerves so he “just left to go back to the hospital.” Bakushev also reportedly said he would do it again, laughing.
The clinical services manager learned of the incident from the nurses and noted Bakushev’s report was different from what had been overheard. The patient in question didn’t want to talk, so the manager questioned a couple of the others who had been in the van. They said the patient had been causing trouble and Bakushev wouldn’t let her back in the van. This was troublesome to her because leaving a patient in such a dangerous situation raised concerns about Bakushev’s ability to be a nurse at Riverview.
On Dec. 4, 2008, Bakushev was suspended with pay pending an investigation. Five days later, management interviewed Bakushev about the incident. He explained his initial report was different because he was worked up at the time and he would leave the patient behind again to restore calm and safety for the other patients in the van.
At the end of the investigation, it was determined that Bakushev’s professional judgment was in question, he could not be trusted to perform his nurse duties at Riverview without a risk to patient safety and his lack of remorse showed “poor rehabilitation potential.” Bakushev was terminated on Dec. 12, 2008.
The arbitrator noted that it was Bakushev’s decision to go on the outing, but — as was standard practice — he ran the patient group by the nurse in charge before leaving. If there were any concerns that the troublesome patient would cause problems on the trip, something could have been said. Therefore, the decision to take the patient was not Bakushev’s alone, but rather in conjunction with the nurse in charge, said the arbitrator.
The arbitrator also found that although Bakushev may have had a “joking” manner when he described the incident to co-workers later, he did not treat it as a joke at the time and he was in an unsettled state of mind when he reported it after it happened. His account of the situation in the van being tense and the patient’s behaviour was credible, particularly since the police reported the patient continued to be unruly and troublesome when they took her back to Riverview, said the arbitrator.
While the arbitrator acknowledged there were safety considerations that may of necessitated separating the troublesome patient from the others in the van, she pointed out that Bakushev had an obligation to notify someone and ensure the patient was safe. He made a “significant error” when he failed to do this, said the arbitrator.
The arbitrator accepted that Bakushev had been through traumatic experiences while in Afghanistan and suffered from post-traumatic stress disorder (PTSD) and substance abuse. She agreed with a medical evaluation that the tension and stress of the incident in the van triggered Bakushev’s PTSD and caused him to lose his capacity for rational decision-making. In his mind, he had no other options and he had no remorse because he believed he save the lives of the other patients.
The arbitrator also found the employment relationship was still viable, as Bakushev stated he would change his approach to similar situations and screen who he takes on outings more carefully. She also noted if he lost his job his professional capacity as a nurse would be seriously damaged.
