The grievor released a patient from her clinic and the patient subsequently committed suicide. The union argued that the grievor was not the only one to make mistakes in this case, but the arbitrator found that she had made several and they merited discipline.
A community health nurse was fired for providing deficient care after she discharged a patient who later committed suicide.
S.M. was an experienced nurse when she took a job in 2000 as a Community Health Nurse (CHN) working in Fort MacPherson, a remote, mostly aboriginal community of 900 people in the Northwest Territories. She received positive performance reviews and there was no discipline on her record when she was fired on Jan. 7, 2008.
The staff complement at the Health Centre was four Registered Nurses (RNs), including the nurse-in-charge. A physician spent two and one-half days at the centre every five weeks.
In addition to typical health concerns, the community also experienced a higher than average rate of alcohol-related illnesses and one or two suicide attempts per month.
The centre observed a suicide protocol developed for the community that spelled out the roles of the CHNs, the RCMP, the social service agencies and a “suicide team,” which included community members.
At about 3:30 a.m. on Aug. 27, 2007, S.M. was alerted by telephone about a possible suicide attempt. S.M. had treated the subject A.S. in the past and was aware of her previous suicide attempts. Over the phone to S.M., A.S. denied taking pills. Nevertheless, the RCMP arrived on site and removed A.S. She was detained in a cell at the detachment under the Mental Health Act.
Poison control
At 5 a.m. the detachment called the health centre and advised that A.S. was vomiting. She had reported taking pills — either Sudafed or Tylenol — and was described as being in an alcohol stupor.
S.M. directed that A.S. be brought into the centre. S.M. treated A.S. until about 7 a.m. S.M. observed A.S. closely, took her vital signs, administered medication and consulted poison control about a potential Sudafed overdose. A.S. was released to the care of the RCMP.
At 10:20 a.m., the RCMP returned A.S. to the centre. She was exhibiting respiratory difficulties and complaining of stomach pain.
S.M. treated A.S. again, administering Buscopan twice for pain along with Ativan for anxiety.
When she stabilized, S.M. discharged A.S. into the care of a relative.
A.S. died later that day.
The incident prompted an informal review, which was conducted by the manager of Community Health Services. The review made no recommendations but it was critical of a number of the decisions that S.M. made and characterized her charting as “extremely poor.”
On Oct. 11, 2007, S.M. was suspended with pay.
Centre management sought another report. A detailed report produced by outside investigators was submitted to Centre management in December 2007.
Deficient care alleged
Based on this report, which also detailed numerous alleged lapses by S.M., the Centre recommended that S.M. be terminated.
S.M. was advised of the recommendation and given an opportunity to respond to a number of specific allegations regarding deficient documentation, deficient assessment and discharge procedures and deficient follow-up.
S.M.’s response did not satisfy the Centre.
S.M. was fired. The union grieved.
The employer said that employees in the health-care sector are held to a very high standard of conduct. The evidence showed that S.M. made errors and that she had provided deficient care. In addition to the findings from its own inquiries, an Inquiry Panel appointed by S.M.’s professional association found her guilty of four charges of professional misconduct, the employer said. S.M. refused to accept responsibility for her actions. Termination was warranted, the employer said. S.M. remained defensive and unwilling to admit any wrongdoing.
The union said that S.M. was defensive because she feared being scape-goated. A number of failures and mistakes occurred, including errors committed by the RCMP and other social agencies. It was not possible to definitely say that a single decision on S.M.’s part meant the difference between life and death. S.M. was not interviewed for the Centre’s first investigation, the union said, and the decision to terminate her was made before the findings of the Inquiry Panel were issued. Even if discipline was warranted, termination was excessive, the union said.
The Arbitrator disagreed.
S.M. committed serious errors, the Arbitrator said. Her charting was deficient. She failed to adequately assess the potential of a Tylenol overdose. She did not carry out a systematic suicide risk. She failed to consult a physician and she discharged A.S. prematurely without an adequate follow-up plan.
Multiple errors
“I am satisfied that the serious nature of the errors made by the Grievor and the number of these errors justify discipline. As a community health nurse, it was incumbent on the Grievor to exercise her professional expertise at the highest standards. She fell far short of those standards in her care of A.S. and accordingly the Employer was justified in imposing discipline.”
The Arbitrator acknowledged that not all errors by health-care professionals — even errors that may contribute to the death of a patient — necessarily result in termination.
However, the Arbitrator said, this was not a case of a single isolated error in treatment. S.M. made multiple errors.
More importantly, the Arbitrator said, S.M. was unable to acknowledge that she had done anything wrong.
The Arbitrator had no doubt that S.M. was genuinely distressed over the death of A.S. but she demonstrated that she had difficulty taking responsibility for the errors she committed and she continued to attempt to deflect blame to others.
The termination was warranted. The grievance was dismissed.
Mark Rogers is a writer and editor who specializes in labour relations and occupational health and safety.
