Professional Misconduct in Nursing: Narcotics Theft

This week we explore a recent professional misconduct decision in which a nurse was found to have contravened a standard of practice of the profession or failed to meet the standard of practice of the profession after she stole pain medication that she was not supposed to be administering to patients and used it herself while on shift.

The Ontario College of Nurses

The College of Nurses of Ontario is responsible for regulating the nursing profession. As with other health colleges in Ontario, its Discipline Committee hears and adjudicates on allegations of professional misconduct. Acts of misconduct are spelled out in the Health Professions Procedural Code of the Nursing Act, and further defined in Ontario Regulation 799/93. The essential question for the committee is a determination of whether the member has contravened a standard of practice. The nurse in question in this case was was alleged to have committed a breach of the standards expected by the College by doing the following:

1. Misappropriating the narcotic, Dilaudid, intended for a patient;
2. Making a false entry in the patients record indicating that the narcotic had been administered to the patient, when in fact the nurse had misappropriated it.

What Happened?

The nurse was employed as RN Manager at a long-term care home, which cared for 160 resident patients. As RN Manager, she was in charge of the entire facility when she was the RN on duty. On the day and evening shifts, there were five Registered Practical Nurses (RPN) on shift and one RN, usually the nurse in question. On the day in question the nurse in question was working the night shift. She approached the Registered Practical Nurse (RPN), who was responsible for medication administration, and offered to deliver the medication Dilaudid to a patient who was palliative and receiving the medication for pain relief. The RPN told the nurse that she would administer the medication to the resident shortly, however, the nurse insisted on doing so herself. The RPN then watched the nurse draw up a vial of Dilaudid in a syringe and walk towards the patient’s room. The RPN followed and saw that the vial was now empty and that the nurse was pretending to administer the narcotic to the patient. The nurse then documented the administration of the narcotic on the patients Narcotic and Controlled Drug Sheet. The RPN notified the facility of her observations.

Criminal Charges Laid

The nurse was charged criminally with a series of offences related to this incident. After a trial she was convicted only of the offence of theft of the narcotic. The other charges, although made out, were withdrawn or stayed. She received a suspended sentence and two years probation.

Admissions

Given the result of the criminal trial the nurse formally admitted before the College that she had committed the alleged acts of professional misconduct. The panel of the Discipline Committee conducted an oral plea inquiry and was satisfied that the member's admission was voluntary, informed and unequivocal.

Onus and Standard of Proof

The College bears the onus of proving the allegations on a balance of probabilities based upon clear, cogent and convincing evidence. The onus was clearly met given the admissions and the agreed statement of facts. As a result, the Discipline Committee found:

That the Member’s conduct was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. Nurses are accountable for practising in accordance with the Professional Standards, practice expectations, legislation and regulations. The Member gave false and misleading information, which is dishonest and breaches the public’s trust in the profession. That the Member’s conduct was dishonourable. The Member demonstrated an element of dishonesty and deceit by approaching and offering to administer medication to the Client who was palliative and receiving Dilaudid for pain. The Member misappropriated the medication Dilaudid for her own use. The Member failed to meet the basic needs of the Client when she withheld the Client’s medication, this act in its self is neglect and morally wrong. The Member was in a position of power over not only the Client but also who was an RPN working under the Member’s direct supervision. That the Member’s conduct was disgraceful as it shames the Member and by extension the profession. The conduct of the Member resulted in her being criminally charged and convicted on August 30, 2016 in relation to the incident of theft of a value not exceeding $5,000.The fact that the Member willingly withheld/misappropriated pain medication from a palliative Clientcasts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects nursing professionals to meet. This Member demonstrated a lack of integrity, dishonesty, abuse of her power and disregard for the welfare and safety of the Client. The health profession will not tolerate this conduct. The Member’s conduct has brought shame not only on herself but also on the profession as a whole.

Penalty

The penalty in included:

• A reprimand;
• A suspension of her certificate for five months;
• Attendance at two meetings with an expert in nursing at her own expense to review

1. • The acts or omissions for which the Member was found to have committed professional misconduct,
   • The potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,
   • Strategies for preventing the misconduct from recurring,
   • The development of a learning plan in collaboration with the Expert.

How Can We Help?

Being the subject of a professional misconduct complaint is one of the most stressful events in a nurse’s career. The potential consequences of a finding of misconduct or incompetence are significant and can include a reprimand, fine, conditions and limitations on your practice, or a suspension or revocation of your license. If you are facing a complaint or disciplinary proceeding, it is strongly advised that you seek assistance from experienced legal counsel who has a thorough understanding of your regulatory College, its mandate, and its specific practices. At Wise Health Law, we rely on our significant experience before discipline panels of various regulatory Colleges to provide our clients with exceptional guidance and representation through the often-overwhelming discipline process. To find out more about how we can help, contact us online, or at 416-915-4234for a consultation.