A nurse who placed surgical tape over the mouth of a patient in a Sligo hospital has been found guilty of professional misconduct.
Bimbo Paden (42), a Filipino nurse at St John's Community Hospital, was found guilty on two charges of professional misconduct at a fitness to practise hearing before the Nursing and Midwifery Board of Ireland.
Mr Paden was found guilty before the fitness to practise inquiry with having placed surgical tape over the mouth of a highly dependent patient on June 26th, 2013, in circumstances where he knew this to be inappropriate. He was also found guilty of professional misconduct for failing to act in the best interest of his patient.
He was charged with placing a sling under the patient without the assistance of a colleague, in breach of HSE lifting procedures but the fitness to practise committee decided this was not a breach of misconduct.
The committee will send its report and recommendations to the board which will determine what sanctions, if any, to impose on Mr Paden.
Mr Paden had accepted putting the tape over the patient’s mouth amounted to professional misconduct. He accepted placing the sling under the patient was inappropriate and not in accordance with the care plan but did not accept it was professional misconduct.
The four-day hearing heard conflicting evidence from witnesses over the adequacy of staffing on the ward at the time of the incident. In his evidence today, Mr Paden said he was stressed and overworked when it happened but didn’t realise it at the time.
Neasa Bird, barrister for the board, argued that Mr Paden had breached his position of trust by carrying out a "physical assault" and "act of abuse" on a highly vulnerable patient who couldn't speak for himself.
Noel Whelan, barrister for Mr Paden, drew attention to the remorse his client had expressed from the start. His action was inexcusable but other factors, such as his “unreasonable and unsafe” workload, were highlighted in a HSE report.
“This was a single, momentary, but very serious deviation in the context of an otherwise caring career,” Mr Whelan said.
Local curate Fr Patrick Lombard, who appeared as a character witness, said Mr Paden was a kind, genuine, caring and gentle man whom he considered as a friend. Fr Lombard said he was shocked by what had happened, but he understood how a person could act because of stress. “The best of people make mistakes at times.”
Damien McKeown, the son of one of the patients in the ward, also spoke to Mr Paden’s character, saying he was always very helpful and obliging to his father.
In his evidence, Mr Paden told the hearing nothing could excuse his act.
The reason he taped the high-dependency patient’s mouth was because the man’s shouting was disturbing another patient in a nearby bed, he told Ms Bird.
The 49-year-old man, described as Patient A, had been shouting involuntarily for over an hour on the morning of the incident.
“I felt sympathy for the other patient, in a moment’s spur, it just happened,” he told the hearing.
Asked why he had decided he needed Patient A to be quiet after over an hour’s shouting, Mr Paden said he didn’t know why. He was just thinking of the other patient.
Mr Bird said it was a deliberate act; Mr Paden had had to take the tape from his pocket, tear off a strip and apply it to the patient’s mouth.
Mr Paden told counsel Patient A’s eyes were open when he put on the tape but he didn’t make eye contact. “I’m just putting it on,” he told the patient.
Ms Bird said a core part of Mr Paden’s job was the care of vulnerable patients. Patient A was immobile and highly vulnerable and his only way of communicating was by shouting. Mr Paden had deprived him of this through his actions. Mr Paden agreed.
Asked whether he agreed that no act of concern for another patient could excuse his actions, he shook his head in agreement.
Asked whether he had lost his temper, he said he hadn’t and pointed out that Patient A had been shouting for a long time by then. He removed the tape when a nursing colleague arrived and saw it in place.
Mr Paden had arranged to lift Patient A using a hoist at the time of the incident, in contravention of his care plan which required this to be done by two staff.
He said he would abide by this if there was enough staff. However, he had looked down the corridor and none of his colleagues were around to help him.
Mr Paden agreed he wasn’t treated for stress before the incident but had been attending his GP for this reason since it happened.
He said he wasn’t “the complaining type” and hadn’t realised he was under stress. He realised only afterwards his workload was excessive.
