Lack of incident report also leads to dismissal
An arbitrator has upheld the dismissal of a registered practical nurse at an Ontario long-term care home after a resident suffered injuries after resisting care and the nurse failed to file an incident report.
Chester Posada was a regular, part-time registered practical nurse (RPN) at Bendale Acres, a long-term care home operated by the City of Toronto. He was hired in 2008 and worked in the behavioural response unit, a locked area housing cognitively impaired residents who potentially could act out.
On Aug. 20, 2014, Posada saw an 86-year-old resident referred to as "TS" — who suffered from dementia and several other afflictions that required him to be on blood thinners — lying in his bed “incontinent of urine and bowel movement,” with feces smeared around the room.
A couple of hours later, a cleaner asked Posada to come to TS’ room to help. TS was still lying on his bed, not talking or moving.
Posada decided to try to “redirect” TS to get up for a shower or have a bed bath. A personal care assistant (PCA) arrived to help, but they were unsuccessful.
A second PCA arrived and retrieved a shower chair while Posada continued to undress TS, and they stood TS up and put him in the shower chair.
TS became agitated and, according to the second PCA, began “hitting out, kicking out, spitting out,” while yelling and screaming. Upon arriving in the shower room, TS tried to slide out of the chair. Posada and the first PCA were on either side of the chair and secured TS’ arms, moving him back into a seating position every time he tried to slide out.
Once the shower was complete, TS calmed down and he was shaved and helped to his feet. However, he couldn’t stand and appeared to be exhausted.
Posada noticed TS had a cut on the small toe of his right foot, skin tears on his left arm and middle finger, redness on both arms, his torso and the back of his head. Posada treated the toe with a solution and a bandage.
TS was taken to the dining room in a wheelchair for lunch and Posada gave him his medications. TS’ mood seemed to be good and they wheeled TS back to his room and helped him into bed.
Less than two hours later, the night shift RPN found TS on the floor beside his bed. TS was able to speak but couldn’t stand.
The RPN assessed him and, in addition to the injuries from before, found more weakness on TS’ left side, bruising on his forearms and upper back, and observed the toe was still bleeding and the bandage was not there.
TS’ son-in-law was called and TS was sent to the hospital, where he was diagnosed with a hemorrhage in his head.
Bendale Acres reported the injuries to the police and the Ministry of Health and Long-Term Care. The police interviewed Posada but no charges were laid.
Bendale Acres conducted an internal investigation. Several employees, including Posada, were interviewed.
In an investigative interview, Posada didn’t acknowledge that TS was resisting or refusing care. Instead, he said TS engaged in “resistive behaviours” that didn’t start until he was in the shower chair. He also didn’t identify the fact that TS was on blood thinners and what the care plan for him was.
Posada also provided a written statement that acknowledged TS was “highly agitated and resistive to care.” He said he didn’t complete an incident report because he felt the injuries were minor and not a threat to TS’ health status.
Bendale Acres determined that Posada’s actions constituted resident abuse, as TS didn’t want assistance and Posada forced him to have a shower.
This was a violation of the residents’ bill of rights under the Long Term Care Homes Act, 2007, and the resident care manual, both of which stipulated a zero tolerance for resident abuse. The home also found Posada should have completed an incident report outlining TS’ injuries so the next shift would be able to follow up on his condition.
The city terminated Posada’s employment on Sept. 19, 2014. The Canadian Union of Public Employees (CUPE) grieved the dismissal.
Arbitrator Russell Goodfellow found that TS was “a frail and elderly resident” in a vulnerable position. Posada undressed him against his will, got him out of bed and took him to have a shower, even though he was protesting.
As a result, TS received minor injuries and suffered from exhaustion, which contributed to more serious injuries.
It didn’t matter that Posada characterized TS’ actions as “resistive” rather than actually refusing, said Goodfellow.
There was no malice in Posada’s behaviour and he legitimately wanted to help, said the arbitrator, but Posada made the wrong decision. It was clear TS was saying “no,” but Posada forced care on him that left him exhausted, unable to stand, bruised and bleeding. This was contrary to city policies of which Posada was aware, and constituted abuse.
Goodfellow noted that it was city policy to complete an incident report “whenever a resident is involved in a harmful or potentially harmful incident,” especially when there was “an appearance of any break in the skin, such as pressure sores, scratches, cuts, abrasions, skin tears, etc.”
Posada’s explanation that he didn’t think it was necessary was contrary to the policy, and one of the PCAs who was interviewed agreed the circumstances called for such a report.
Goodfellow determined that Posada’s forcing of care on a protesting resident and his failure to file an incident report was serious enough to warrant dismissal.
Posada was properly trained on procedures and policies and should have known how to approach the situation, the arbitrator said in dismissing the CUPE grievance.
For more information see:
• Toronto (City) and CUPE, Local 79 (Posada), Re, 2016 Carswell Ont 12702 (Ont. Arb.).
