Home Arbitration/Labour Relations Toronto hospital justified in firing nurse who deliberately underdosed medication to patient: Arbitrator

Toronto hospital justified in firing nurse who deliberately underdosed medication to patient: Arbitrator

by HR Law Canada

A Toronto hospital was justified in firing a nurse who deliberately administered a lower dose of medication than prescribed by a doctor, but her conduct did not rise to the level of “wilful misconduct” — meaning she was entitled to statutory termination and severance payments, an arbitrator has ruled.

R.S. was a Registered Practical Nurse (RPN) who had more than 13 years of service at Michael Garron Hospital in east Toronto. She was dismissed following an incident on Aug. 8, 2020, where she administered a lower dose of immediate-release morphine to a patient than prescribed by the attending physician.

What happened

According to the evidence presented, she was working under the pressure of a particularly busy shift, compounded by staffing shortages due to one less RPN available for the first half of her shift. This situation left R.S. feeling significantly burdened by her workload, a factor she testified as contributing to her judgment at the time.

R.S. faced a critical decision when she realized that the supply of immediate-release morphine available on the unit was insufficient to administer the full dose prescribed to the patient. Faced with the dilemma of allocating her time between securing more medication or attending to the immediate needs of multiple patients under her care, R.S. made the contentious decision to administer only a portion of the prescribed medication.

This decision was influenced by several factors. R.S. testified that she was informed by her Team Lead that the patient was a “drug abuser,” a label that seemingly factored into her decision-making process. Furthermore, she rationalized that the patient, having already received a full dose of extended-release morphine and appearing to be in no visible distress, did not need the full amount of the additional immediate-release morphine.

This action, along with inaccuracies in medical charting and failure to properly account for drug usage on the Narcotic Control Sheet, led to her termination on Aug. 31, 2020. The hospital cited “wilful misconduct” as the basis for dismissal without statutory termination and severance payments.

The Union grieved the termination, claiming it was without just cause and in violation of the collective agreement and other applicable legislation. The arbitration process explored whether the hospital had just cause to discipline R.S., whether the discharge was within the range of appropriate penalties, and if not, whether arbitral discretion should reduce the penalty. Additionally, the entitlement of R.S. to statutory termination and severance pay was contested.

The arbitrator’s ruling

The arbitration findings highlighted the grievor’s actions as stemming from a combination of perceived patient need, the operational constraints of the moment, and a subjective assessment of the patient’s condition.

“The real question for me in determining the proper response to the Grievor’s misconduct, in my opinion are the Grievor’s motives for her misconduct and whether she knew, or ought reasonably to have known, the seriousness of her failure to act strictly within the scope of her practice in the circumstances she suddenly confronted,” the arbitrator said.

“Was the misconduct contrary to a clear expectation or rule of professional conduct to justify the strongest disciplinary response, or did it fall within a ‘grey area’ of ‘judgment’ influenced by unexpected or unusual conditions leading to lesser reasonable consequences?”

While the arbitrator recognized the pressures facing R.S., the decision to act outside the scope of her practice without seeking additional guidance or resources was ultimately deemed a significant error in judgment. This action, coupled with inaccuracies in medical charting and the improper accounting of drug usage, led to her dismissal on grounds of alleged just cause by the hospital.

The arbitrator noted that it was not a “standalone” event and determined that the hospital had just cause for disciplinary action, and dismissal was within the range of reasonable responses given the grievor’s actions and her disciplinary record.

However, the arbitrator concluded that her actions did not meet the high threshold of “wilful misconduct” under the Employment Standards Act (ESA), thereby entitling her to statutory termination and severance payments.

Simply put, her actions were not pre-planned “out of a sense of intentional malice” or vindictiveness, the arbitrator ruled, in awarding her the statutory entitlements under the ESA. It left it to the two parties to calculate the precise amount.

For more information, see Michael Garron Hospital v Service Employees International Union, Local 1 Canada, 2024 CanLII 25041 (ON LA).

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