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Director of Proceedings v Dieudonne - Nurse

Health Practitioners Disciplinary Tribunal,  Nur09/115D

In a decision dated 31 July 2009 the Health Practitioners Disciplinary Tribunal found Registered Nurse Mr Ian Dieudonne guilty of professional misconduct. This case concerned the care provided by Mr Dieudonne to an 82-year-old resident in the Dementia Unit (the Bush Wing) of the Churchill Complex in Christchurch. At the time of the incident, Mr A had recently been admitted to the Bush Wing from Canterbury District Health Board after a failed placement in a rest home. The Bush Wing is a unit that specialises in the care of dementia patients. Mr A was classified as requiring rest home level care and as a D3 patient. He did not want to be in the Bush Wing and was initially very unsettled.

The charge, comprising three particulars, alleged that when Mr A presented to Mr Dieudonne in an agitated state early one morning, Mr Dieudonne responded with the use of unreasonable force by pushing Mr A in the chest with a clenched fist causing Mr A to fall to the floor. Mr Dieudonne then failed to adequately assess Mr A for injury and failed to assist Mr A from the floor in a timely manner. The charge also alleged that Mr Dieudonne failed to document adequately what had happened.

The expert witness called by the Director of Proceedings gave evidence about the appropriate nursing standards referring specifically to a number of Nursing Council competencies. The expert witness concluded that Mr Dieudonne's use of physical force in dealing with Mr A was a serious departure from accepted professional standards, as was his failure to adequately assess and assist Mr A off the floor.

The Tribunal found that Mr Dieudonne did respond to Mr A with the use of unreasonable force and noted that there were other options he could have taken. The Tribunal stated that the responsibilities of a professional registered nurse working in these situations is to behave in a way that is exemplary, and not to react as Mr Dieudonne did here using such significant force against Mr A as to cause him to fall. The use of force alone amounted to professional misconduct.

The Tribunal held that while the visual observations taken by Mr Dieudonne of Mr A following his fall were not ideal, his failure to undertake a full assessment did not amount to professional misconduct on its own.

The Tribunal was critical of Mr Dieudonne's failure to assist Mr A off the ground in a timely manner, stating that an elderly man should not be left lying on the floor for a significant period of time unless the nurse is actively seeking assistance for him. The Tribunal considered that it was clearly inappropriate for Mr Dieudonne to let Mr A lie on the floor for 30 minutes, as Mr Dieudonne had an obligation to get him off the ground urgently or to ask someone else to assist. While the Tribunal gave careful thought as to whether this particular on its own would warrant disciplinary sanction, it ultimately determined that it demonstrated conduct that lay just below the threshold for disciplinary sanction.

The Tribunal agreed that the notes were less than ideal as they were written in the third person, did not identify the exact time of the incident, or the critical observations made by Mr Dieudonne, or many other facts that had subsequently been given in evidence. However, the notes did exist, were contemporaneous, and were supported by an incident form and, therefore, while less than adequate, were such that a disciplinary sanction was not warranted against Mr Dieudonne for this particular. His conduct with regard to the notes alone fell just below the threshold for disciplinary sanction.

The Tribunal then considered the particulars of the charge individually and cumulatively and held that Particular 1 on its own was a significant event and on its own would clearly amount to professional misconduct under section 100(1)(a) and (b). However, when taken cumulatively, particulars 1, 2 and 3 also added up to a picture of substandard care of Mr A by Mr Dieudonne, which amounted to professional misconduct.

The Tribunal imposed the following penalty on Mr Dieudonne:

(1)   Suspension for a period of 8 weeks.

(2)   Conditions on practice including:

(a)   that he undertake a course of study approved by the Nursing Council of New Zealand in managing challenging situations, calming and de-escalation;

(b)   that he undertake a course of study approved by the Nursing Council of New Zealand in the care of elderly patients with dementia;

(c)    that he not practise in a sole charge and/or supervisory position for a period of two years after returning to practice;

(d)   that he undertake professional supervision by a clinical supervisor appointed by the Nursing Council of New Zealand for a period of one year after returning to practice.

(3)   A fine of $500.

(4)   25% of the Director's costs.

The Tribunal also recommended that at the completion of the required study courses outlined above, and after his return to practice, the Nursing Council require Mr Dieudonne to undertake a competence assessment against the RN competencies by a Nursing Council approved assessor.

The Tribunal's full decision can be found at:

http://www.hpdt.org.nz/Default.aspx?tabid=231