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HomeMy WebLinkAbout1980-0298.Aberilla.81-02-18Between: Before: IN THE MATTER OF AN ARBITRATION Under The CROWN EMPLOYEES COLLECTIVE BARGAINING ACT Before THE GRIEVANCE SETTLEMENT BOARD Mr. Gaspar Aberilla and Ministry of Health (Griever) (Employer) Professor J. Robert S. Prichard - Vice-Chairman Mr. E. R. O'Kelly - Member Mr. J. Smith - Member For the Grievor: Mrs. Lillian Stevens Grievance Officer Ontario Public Service Employees Union For the Employer: Mr. I. Freedman, Counsel Legal Branch Ministry of Health Hearing: July 15th, 1980 - 2 - In this case the grievor, Mr. Gaspar Aberilla, alleges that he was dismissed without just cause. He seeks to be reinstated with full pay and benefits retroactive to the date of his discharge. At the time of his discharge the grievor was employed as a registered nurse by the Ministry of'Health in the Hamilton Psychiatric Hospital. He had been employed there since 1969. The gri'evor is 33 years of'age, married and has two children. This case represents the first time the grievor has been involved in-any disciplinary matter. The Ministry of Health dismissed the grievor alleging that on March 26th, 1980 the grievor struck a patient at the hospital. 'This is quite clearly an extremely serious allegation. If proved it could have extremely serious consequences for the grievor in terms of his employ- ment at the Hamilton Psychiatric Hospital and in terms of his career as a registered nurse. Only the question of his continued employment at the hospital is before us and it is important to stress at the outset of this award that that is the only issue we are considering. We are not constituted to make disciplinary judgments about the grievor's conduct for purposes of his professional standing as a nurse. That function is properly undertakenby the governing body of the nursing profession and not by the Grievance Settl.ement Board. Our task is limited to deciding whether the Ministry had just cause for dismissing the employee on the evidence as we heard it. Any determination of any other consequences for the grievor must be undertaken in other forums. We have no desire to pre-judge, any future proceedings of that kind in any way. In this award we must do two things. First, we must make factual determinations as to what happened on March 26th, 1980. Second, and in light of those actual findings, we must determine what discipline, if any, was called for and what remedy, if any, the grievor is entitled to. - 3 - >n order to protect the anonymity of the patient whom it is alleged.the grievor struck, we shall refer to the patient as "Mr. X" throughout this award. In those places in which we quote documents which contained the patient's name, we have substituted "Mr. X" for the true name. Mr. Jeffrey Atherton was the only witness called for the \ Ministry. -At the time of the grievor's dismissal Mr. Atherton was a registered nurse working on the ward adjoining the ward where the grievor worked. The grievor worked on Ward G-Z while Mr. Atherton worked on Ward H-Z. The two wards share a common elevator lobby where the alleged incident took place. On March 26th, 1980 just before 1:00 p.m. Mr. Atherton was working on Ward H-2 when he received a telephone call to'go to Ward G-2 to assist in removing a patient from the ward. He was advised that a patient, Mr. X, was causing a disturbance on Ward G-2 and needed to be escorted off the ward to the elevator lobby. On arriving fin Ward G-2,~Mr. Atherton and the grievor escortedFr. X to the lobby, each holding an arm of the patient. Mr. X had a rubber tipped cane at the time. Mr. Atherton testified that Mr. X presented no physical resistance or abuse as he was being escorted off the floor. However, he did testify that the patient was very abusive verbally. Mr. Atherton testified that when they reached the far wall of the lobby the patient sat down on the floor with his legs straight out and his back to the wall. Then both the grievor and Mr. Atherton turned to their respective wards leaving Mr. X on the floor. At this time Mr. X was still cursing and swearing. As Mr. Atherton reached the door of his ward he saw the grievor at the door of Ward G-2 turn and return towards the patient. Mr. Atherton testified that he then saw the grievor kick the patient in the right side,just below the shoulder with a single kick, following which the patient fell over onto the floor in the fetal position. At this point the grievor picked up the patient's cane and jabbed him in the stomach with it. Mr. Atherton described the jab as "relatively slow". The patient did not cry out upon being kicked and hit and did stop cursing. Mr. Atherton testified that after jabbing the patient with the cane the grievor walked away from the patient>~throwing the cane back towards the patient but missing him. He also stopped to pick up a package of tobacco of the grievor's and threw it towards him, hitting him in the chest. The patient had apparently been rolling a cigarette when they first left him sitting on the floor. Mr. Atherton testified that the grievor then headed back to his ward while Mr. Atherton went into Ward H-2. The entire incident of the kicking, jabbing with the cane and throwing the tobacco took no more than 30 seconds. Throughout the incident Mr. Atherton testified that he stayed motionless, disbelieving what he saw in that it was such an unexpected situation. Although he had sometimes seen physical restraint used with a disturbed patient, he had never seen violent action like this before. Mr. Atherton did not know the grievor other than to know that he was a member of,the nursing staff. They had not worked together previously. * After the incident Mr. Atherton returned to his ward and called the Assistant Director of Nursing since his ward supervisor was unavailable at the time. He reported the incident and was asked by the Assistant Director of Nursing, Ms. Cino, to go to her office. At Ms. Cino's office he again described the incident and was then asked to record in writing - 5 - what he had seen. He prepared the following statement: At approximately 1300 hours on March 2&h, Z980, I was called to assist escorting a young male off of Ward G-2. The person was not physically aggressive but he was verbaZZy abusive. ,A rmZe stuff member from Word G-2 and myself escorted the visitor from the ward to the area in front of the elevator, between wards G-2 and H-2. Eke visi$or seated himself on the floor with his back against the wall &d continued TV verbally abuse the other staff member and myself. At this point the other male staff member approached the visitor mzd kicked him in the right side. He then picked up the visitor's cane and jabbed him in the stomach with the rubber tipped end. He then threw the cane at the visitor. At this point I turned and entered the door for Ward H-2 and caZZed Miss Mary C&o, Assistant Director of Nursing. Signed - J. Atherton, R.N. Both in examination-in-chief and during questioning by the Chairman, Mr. Atherton testified that he did not observe any behaviour by Mr. X while in the lobby that 'called for physical restraint. During cross-examination Mr. Atherton acknowledged that as the grievor and he left Mr. X sitting in the lobby, Mr. X said something like "I'm coming back at l:OD o'clock..." in addition to continuing the verbal abuse. He also described Mr. X as being approximately 6'2" while the grievor is about 5'9". He described the kick and the jab with the cane as more than a "slight touch" but not sufficient to cause bodily harm. Finally Mr. Atherton testified that while he did not move to assist the grievor during this incident, he fett that he could have come to the grievor's assistance'if any help had been required. Mr. Atherton had been at the Hamilton Psychiatric Hospital as a nurse for eight months at the time of the,incident. Prior to that he had served asp a nursing.orderly in the Welland County General Hospital. - 6 - He had also received two years of training at the Mack Centre of Nursing in St. Catharines which included a 3-month course on psychi- atric care. As such Mr. Atherton was an experienced nurse although not experienced to the same extent as the grievor, in either general nursing or psychiatric care. Three witnesses testified on behalf of the grievor including the grievor himself, Dr. Paul DeNew and Ms. Elizabeth Eotdt Jambrovic. Their evidence provides a somewhat different picture of the incident on March 26th, 1980 and must therefore be reviewed in some detail. The grievor has been employed as a registered nurse at the Hamilton Psychiatric Hospital since August 1969 and had worked on Ward G-2 for his eleven years at the hospital. In the result he is an extremely / experienced nurse in psychiatric care having seen a full range of incidents including numerous occasions of dealing with physically aggressive patients. Indeed, only a year before his dismissal the grievor had been taken by surprise by a patient who punched him in the face and broke his arm. The grievo,r was familiar with Mr. X as Mr. X'had been a pati‘ent. at the hospital at various times over the past five years. The grievor was aware that Mr. X was engaged in a behaviour modification program in order to try to control his aggressive behaviour. At the time of the incident the patient was an out-patient and was not meant to be on Ward G-2 at that time on March 26th. On March 26th when the grievor returned from lunch he was told by Ms. Jambrovic that Mr. X was to be escorted from the ward. The grievor spoke to Mr. X and asked him to leave, telling him that if necessary, he would call extra staff to physically remove him. - 7. - The grievor testified that Mr. X had said "I~'11 hit you with the cane if you come close" at which point the grievor backed off to consult with another member of the Ward G-2 staff. After consultation they decided to.call an extra staff member who turned out.to be Mr. Atherton. When Mr. Atherton arrived he and the grievor each took one side of Mr. X and escorted him to the hall. The patient went along willingly but continued to engage insubstantial verbal abuse. After sitting the patient down in the lobby the grievor turned and returned to his ward but then heard Mr. X say that he would come back at 1:00 ' o'clock. As a result the grievor decided that he had better talk to Mr. X as he was concerned that Mr. X might be up to something and the grievor hoped to defuse a potentially violent situation.' As the grievor returned towards the patient, the patient made a slashing movement with the cane in the direction of the .grievor. Instead of backing off, the grievor then grabbed the cane from Mr.:X, twisting it out of Mr. X~'s hands. He then "nudged" the patient with his left,foot and said "Don't do it again". The grievor found that he was getting angry as he was not getting any assistance from anyone in dealing with the patient. Recognizing his anger he wanted to get away from the patient. He grabbed the cane, threw it down beside the patient, and then after picking up the patient's tobacco, threw it in then general direction of the patient. He then returned to Ward G-2. In examination-in-chief the grievor testified that at no time did he feel that he had abused the patient. Furthermore, he testified that he did not kick the patient although he did acknowledge nudging the patient with his foot. Furthermore, he testified that he did not hurt the patient with the cane, but rather simply engaged in wrestling the'cane away from the patient. Indeed, he testified that he would never abuse.a.patient since such behaviour was totally unacceptable. He testified that he came from a family of which many members were nurses which he regarded as a highly respected profession. The grievor explained that when he nudged the patient it was part of an attempt to disengage his feet from under the patient's legs. He indicated that the patient's legs were over his feet and that in drawing his feet away, he nudged the patient. In cross-examination the grievor testified that while he had not previously physically escorted Mr. X off the ward, he had on occasion been required to remove him from the ward. The patient had a habit of hanging around the,ward and interfering and both Dr. DeNew and Ms. Jambrovic had issued instructions that Mr. X was not to be on the ward. Two to three years previously Mr. X had tried to set~fire to the seclusion.room in the hospital and presumably this sort of behaviour contributed to some concern about his presence'on the ward at unauthorized times. The grievor was asked to'prepare a written summary of his behavour with respect to the incident and in fact he prepared two separate summaries on the day of the incident. The grievor's English is not perfect which explains the grammar in the reports. They read as follows: At approximately 1235 hours, I was calZed by Miss Boldt CsubsequentZy acquiring the married name, Jambrovicl to escort Mr. X out of the ward as he uas adamant about staying (he is a discharged patient). He threatened me with a cane and asked to have the police called if we wanted. Assistance was called and Mr. X eventually came. He was released outside the door and started to mouth off obscenities. This writer was about to enter Lxlrd when Mr. X continued obscenities. Since this writer knew Mr. X I apprbached him to enquire why he was so hostile. He s'ated swinging his cane in a side- ways motion and I therefore grabbed it ad twisted it out of his hand. I cannot remember.what happened next but I did remember nudging him with my foot and asked him not to swing his cane again. I then left inrmediatety to gain control of my emotions. - 9 - The second somewhat more complete submission read as follows: 1235 Hrs. Wed. aft. I was sunanoned to escort Mr. X off the ward. Patient ,, refused, waving cane around threatening to hit staff. Additional stuff were swmnoned. MT. Atherton came and I gave him the nod to take the other arm and I took the other arm. Mr. X then came along mouthing obscenities dong the way directed mostly at me. We deposited him o&side and he sat between two doors and between twa elevators outside of the G2 HZ wards. StiZZ mouthing obscenities ai this time. At thi$ time both myself and Mr. Atherton were ~ready. to retwn to OUT respective wards. Mr. X continued with the words S.O.B., cock-sucker, bastard. Promise to return to G2 at 1300 hrs. I therefore turned around to confront him with his behav-iour as well as to.try to resoZve his persistent behaviour of going back to the ward. I had most of the time been aHe to reason tith &. X succes- sfully and.I thought this time it might work as welZ. As I approached him Mr. X started to motion with his cane as if to hit, he was at this time seated bn the fZoor. Since his behaviour was quite unusual this day I grabbed the cane and we started to wrestle for it. At this point I lost control of my emotions (I got angry) because I did not get any assistance at all. I was able to gain cuntroL of the cane. At this point my legs were spread apart in a fencing stance and Mr. X was ha2f reclined on the floor with both his thighs ~acro$s my right foot. I therefore straightened up and brought my left foot in line with my right foot. I then nudged him in the thigh with my foot and said ‘Don’t you ever do that again". I then threw-the cane away tumzed around and innnedi- ately headed toward the ward.. As I realized 1 uas getting angry. I saw a package of cigarettes or tobacco on the floor and turned around and threw it in his general direction and then went back to the ward again. In cross-examination the grievor acknowledged that. in taking the cane away from Mr. X it was "possible" that it hit him in the stomach. However, he,testified that he did not think he hit the patient and that he could not remember hitting the patient. The most important part of.the cross-examination of, the grievor * related to his emotional state during the incident. As was noted above in the grievor's own report her described hi;mself as follows: "I cannot remember what happened next but I did remember nudging him with my foot and asked him not to swing his cane again. I then left immediately to gain control of my emotions". And in the second description: ' At this point I lost - 10 - control of my emotions (I got angry) because I did not get any assistance at all". It is quite clear from the grievor's own'description'of the incident that it amounted to more than simply grabbing the cane and nudging the patient in that it was a sufficiently serious incident as to considerably aggravate and upset the griever'., The grievor attributed his anger to the fact that no one came to ,his assistance when he was faced with an aggressive.patient. He testified that he thought Mr. Atherton should-have come to his assistance so as to help him control the patient. He testified that he,would normally have expected other staff members to rush over to his assistance and that Mr. Atherton's failure to do so upset him. When asked by the Chairman if he would have behaved differ+ ently if the same situation were to arise again, he indicated that he would not have assumed responsibility single-handedly to try to control the patient. Rather he would act more defensively, gathering other staff members before approaching the patient. At the same time he indicated that such defensive behaviour was inconsistent with his general approach to nursing which was to assume full responsibility and to not simply act as a "robot". He acknowledged that it would be highly improper to kick a patient and that it would be a breach of professional standards which could not in any way b,e defended as part of proper behaviour modification treatment or patient restraint. Or. OeNew testified as'part of the griever's case. He is the staff doctor at the Hamilton Psychiatric Hospital responsible for Ward G-2. He explained that the ward admits patients across the whole spectrum of illness from the very ill including those with aggressive and threatening physical conduct to some with less serious illnesses. He explained that Mr. X had been engaged in a behaviour modification program in order to try to improve his behaviour and reduce his aggessiveness. Dr. DeNew described the grievor - 11 - as a good member of the ward staff, testifying that he got along well with patients and that they respond well to him. He described him as a "man of good judgment". Immediately .following the incident Dr. DeNew saw Mr. X. He testified that he saw no reason to undertake a physical examination of Mr. X as he showed no ill effects of the incident. ,He also testified that the description of the incident that he received,along the lines given by Mr. Atherton did not "square" with his own estimate of the grievor since he considered it entirely out of character for the grievor based on his experience working with him. The doctor also testified that kicking a patient would be inappropriate conduct for a nurse~in that it would'not assist in gaining control of a patient and that it is contrary to social and professional norms.' The only permissible exception would be self-defence. In considering the doctor's evidence it must be stressed that the doctor was not able to give any direct evidence of the incident in question in that he was called to the ward after the incident occurred. Thus'the doctor's evidence only assisted us to the extent it provided further information about the context of the situation and about both the grievor and Mr.! X. The final witness called for the Union was Elizabeth Jambrovic who is the "team leader" of the staff on the Ward G-2, having worked at Hamilton Psychiatric Hospital for 15 years. She described Mr. X as having from time to time exhibteh.violetnt and threatening behaviour, having used abusive language, having once set a fire and having thrown furniture around the ward. He~had required physical restraint from time to time although h‘e usually appeared to have followed the orders of the staff. On March'26th he was in the ward waving his cane around and continued to do so when the grievor asked him to leave. -12- At this point Ms. Jambrovic called for help which solicited Mr. Atherton's presence. She then saw Mr. Atherton and the grievor escort Mr. X from the ward. Once Mr. Atherton and the grievor took the patient outside the ward, Ms. Jainbrovic~ was unable to see the incident start. However Ms. Jambrovic testified that the -next thing she~heard was noise outside the ward which sounded like shuffling and struggling. She did not hear any words being spoken. She then moved towards the door from which point she was able to see Mr. X leaning against the wall and the grievor standing to his right. She apparently then observed the tail-end of the incident when she saw the grievor pick up the cane and throw it down beside Mr. X and then pick up Mr. X's tobacco and throw it down in his general direction. That.is all she saw. Ms. Jambrovic testified that she had worked with the grievor since 1970 and that he had been a member of her team since 1974. She testified that he had never shown physical or verbal retaliation or any aggressiveness during situations requiring physical restraint of patients. Furthermore, she described the grievor as friendly, jovial, very likeable and a competent staff member. She indicated that he is very effective with patients and that patients "really like him".. That completes a summary of the evidence. It has .been provided insome detail because of the seriousness of the allegation and because of the discrepancies between Mr. Atherton's story and that of the grievor. - 13 - Our task now is to decide on the basis of the evidence what happened in.that 30 second period early in the afternoon on March 26th, 1980. On balance and after weighing all the evidence, we conclude that we cannot totally accept the grievor's description and characterization of his behaviour during the incident. That is, we feel compelled to find that the grievor's conduct amounted to more than simply nudging the patient with his foot and that he simply wrestled the cane away from the patient. Our conclusion is based primarily on the quality of the evidence provided by Mr. Atherton and by the self-admitted emotional state of the grievor. Mr. Atherton had absolutely no doubt as to what he saw. We do not think he was motivated in any way by any ill-will towards the grievor. He was genuinely shocked at what he saw and felt compelled to report it and testify as to what he had seen. He appeared to have a very clear recollection of what he saw and he had absolutely no doubt that he saw the grievor kick Mr. X with sufficient force to make him fall over on his side. That description simply cannot be reconciled with a simple nudging of Mr. X as was described by the grievor. There is perhaps more ambiguity with respect to the incident with the cane. It is possible-to reconcile the grievor's description of wrestling the cane away and Mr. Atherton's description of the jabbing motion by the grievor with -the cane, but, on balance, unfortunately we once again must find that the grievor's activities went beyond merely removing the cane from the patient. At the same time we must stress that the blow with the cane was not a serious one, just as the kick was not a blow likely to cause bodily injury. Indeed there was no evidence at all that there was any bodily injury suffered by Mr. X. - 14 - To this date we do not fully understand why the grievor became so upset and angry during the incident. No doubt Mr. X has been a demanding and troublesome patient over the years and his behaviour on March 26th no doubt was annoying. Hij verbal abuse of the grievor was quite'clearly quite unpleasant and his threat to return to the ward essentially immediately following his removal from the ward no doubt would cause frustration to the grievor. The grievor's explanation that his anger was caused by Mr. Atherton's failure to come to his assistance is not, _ in our view, plausible in that Mr. X's behaviour to the point where he was approached by the grievor was not conduct which would require any assistance. Wt must find that to some extent the grievor created the incident and can hardly have a cause of complaint for the absence of any assistance at that point. If he wanted assistance he should have backed. off. We must therefore find that the grievor's anger and emotion was caused by his frustration with Mr. X, a frustration that we can understand, but cannot, of course, excuse given the griever's professional nursing responsibilities. In sum, we find that the grievor kicked the patient in the side, and that he hit the patient with the rubber-tipped end of the cane. We find that he did so out of a sense of frustration with or anger towards the patient, no doubt caused by a combination of the patient's generally anti-social behaviour and the veral abuse adopted on the particular day. At the same time we find that neither the kick nor the blow with the cane were likely to cause bodily injury and that furthermore that they did not in fact cause any injury to the patient. There is. no evidence of any kind that there was any lasting - 15 - ill effect on the patient. Indeed Dr. DeNew testified that he would have expected the patient to have been more upset if'there had been a really serious, incident. At the same time, it is clear from the evidence that the kick and the jab cannot be explained as any of patie,nt treatment. patient restraint or self-defence. Indeed counsel made no attempt to justify the actions on any of these grounds. These conclusions leave us with a difficult and unpleasant task of determining the appropriate penalty to be imposed in the circumstances. Under section 18 (3) of the Cmwz EmpZorlees CoZZectiue &zr&nin~ Act, we must determine if disciplinary dismissal is excessive and if so we may substitute such other penalty as we consider just and reasonable in all the circumstances. However, this remedial authority is severely circumscribed by section 18 (3a) of the same Act. That section which was added to the statute in 1978 in response to the public controversy that arose from the case of Re: Johnson (7/781 provides that where we find that an employee has applied force.to a patient in a hospital such as the Hamilton Psychiatric Hospital greater than that necessary for self-defence or to restrain the patient, we may not provide for the reinstate- ment of the employment of that employee in a ~position that involves direct responsibility for, or an opportunity for, contact with patients. However, at the same time, we may provide for the employment of the employee in another substantially equivalent position. As a result of our findings of fact we must find that the grievor applied force to Mr.'X and that that force was greater than necessary for either self-defence or to restrain Mr. X. As such we are.~:forbidden by the statute from reinstating the grievor to his previous position of employment. We consider this unfortunate. The grievor has provided 11 years of apparently excellent service for the care of psychiatric patients in this Province. He i has done so according to his supervisors, with great skill and competence, developing a rapport wi‘th patients and an enviable - 16 - professional reputation. He has never been disciplined in any way. Furthermore, he is a family man with a wife and two children and he.comes from a family background which has involved numerous members of his family providing honorable service in the nursing profession. In our view this is. not a man who should be deprived of the opportunity to continue to serve as a nurse. Indeed, based on what'we have heard, to deprive the bublic of his services as a nurse is to deprive the public unnecessarily of the services of a very good man. As a result, if we were not constrained by section 18 (3a), we would have ordered the grievor reinstated although we would have done so after imposing a very substantial suspension. What we would have hoped to accomplish would have been to indicate the utter unacceptability of the grievor's conduct in the 30 second incident on March 26th, 1980,'and to send a very clear message to all persons working in similar situations as to how unacceptable such conduct is. However, we would also be recognizing that one error of this . kind is not sufficient reason to deprive a man of his career nor to deprive the province of the services of a man of such skills. This is not a man who, in our view, needs rehabilitation. This is a.man who has learned a lesson in a most costly way and whom we have absolutely no doubt will never repeat such conduct. We think if he were to return to nursing the grievor would be an even better Person and a better nurse. Despite these views, we clearly do not have the statutory authority to \ reinstate the grievor to a position of patient contact. We must therefore exercise our authority under section 18 (3a) to order that the grievor be provided with a position of employment in another substantially equivalent position. He should be given this position of employment forthwith upon the receipt of this decision. If the parties are unable to agree upon a suitable position, within six months, we will remain seized of this matter in order to make a final determination of the position. By denying the grievor compensation for the time he has been off work, we are making quite clear that based on the evidence as we found it his conduct was utterly unacceptable and that it was a very - 17 - serious breach of the professional standards which all nurses must live up to. This presumab,ly will‘serve as notice not only to the grievor (we have no doubt he has already learned his lesson) but also to all other persons in similar circumstances and to the public of Ontario whose confidence in the quality of psychiatric care must be maintained. Although we recognize the harsh economic consequences for the grievor, we believe a lengthy suspension is required in order to signal clearly this Board's attitude towards conduct of the kind described in this decision. Having exhausted our statutory power, we have no authority to do anything more for the grievor. However, we wish to add two things. First, from our vantage point, it would be entirely consistent with both the proper conduct of labour relations in the Ontario public service and fair and equitable ' treatment of the grievor, if the Ministry were to conclude upon receipt of this award that it. should reinstate the grievor to a nursing position rather than to a substantially equivalent position. While we lack the authority to do this, the Ministry quite clearly has the power to accomplish it, and in our view, if it were to so exercise its powers, it would do so wisely. Based on the evidence we heard,.~the griever': talents ~would be wasted in a position that lacked patient contact. Second to the extent the grievor's conduct is subject to scrutiny by any other tribunal, particularly by his profession:'s governing body, we must urge the greatest caution in using our conclusions of fact as a basis for any further sanction. It may well be that another jury, with somewhat different evidence, and with a greater appreciation of the context within which the grievor was working, could reach a different conclusion based on the facts. We believe we have reached the right conclusion on the facts which we have heard. However, it would, in our view, be a mistake to attach further sanctions \ - 18 - to this)man's conduct without further consideration of the facts. The grievor was undoubtedly working in a very difficult environment in which judgment calls must be made in very difficult situations. We believe the grievor misjudged the situation and acted in error, but others should reach their own conclusions on the facts as they find them. In sum, the Ministry is ordered to provide the grievor with employment in a position substantially equivalent to that which he held prior to his ' dismissal. The grievor is not entitled to any compensation from the date of his dismissal to the date of this decision. He should be given his position of employment forthwith upon the receipt of this decision. Furthermore, if the Minstry wishes to reinstate the grievor to a position involving patient contact instead of to a substantially equivalent position, it would do so with our blessings. ' We wish to thank Mr. Freedman and Ms. Stevens for their assistance in this matter. Dated at Toronto this 18th day of February, 1981 J.R.S. Prichard Vice-Chairman "I concur" Mr. E. R. O'Kelly Member "I concur" Mr. J. Smith Member /t