The Manitoba regulator issued its decision months after the College of Registered Nurses of Manitoba raised concerns about the 'incompetence' of some RNs who were educated overseas.Graham Hughes/The Globe and Mail
Manitoba’s nursing regulator has cancelled the licence of a foreign-trained registered nurse who incorrectly injected a patient with medications that could have killed him had a paramedic not intervened, according to the sentencing report of a disciplinary panel released Thursday.
The decision in the case of now-former RN Nipaben Patel was published eight months after the College of Registered Nurses of Manitoba went public with concerns about the “incompetence” of some RNs who were educated overseas and first licensed in other provinces.
In June of last year, the regulator said it hoped to persuade Manitoba’s NDP government to let it keep extra layers of scrutiny for new labour mobility applicants, as nurses first licensed elsewhere in Canada are known.
But the province ordered those measures scrapped, calling them unnecessary barriers that violated the Canadian Free Trade Agreement and hurt Manitoba’s efforts to recruit desperately needed nurses.
The disciplinary panel concluded that, had Ms. Patel been subjected to those precautions when she applied for a Manitoba licence in 2023, “these tragic events and this proceeding might have been avoided in their entirety.”
Manitoba Premier Wab Kinew took issue with the regulator’s decision.
Speaking at an unrelated event Thursday, he told The Globe and Mail that his government is willing to meet with the college to discuss the issue.
“But I’m not convinced that what they had to say [Thursday] is a reflection of what took place, and maybe not just more reflection of their own policy view,” Mr. Kinew said.
Over the years, the Premier added, the college has been asked repeatedly to “modernize and get with the times.” But he believes they have struggled to make those changes, worsening a shortage of nurses in Manitoba.
“A report like this is certainly tough, but you can’t discard the years of people advocating for this particular college to open up more opportunities for nurses to work in our province,” he said.
Ms. Patel, who was educated in India, had not practised as a registered nurse in 13 years when she began working as an RN for private nursing agencies in Manitoba in 2023.
She did, however, have recent experience as a licensed practical nurse, a designation that requires less education and carries less responsibility than an RN.
While living and working in Manitoba, Ms. Patel took her RN licensing exam in New York State, passed and secured a licence there. Her New York licence allowed her to swiftly gain a licence in Ontario, which she used to obtain a near-automatic licence in Manitoba.
Late on the morning of Nov. 6, 2024, Ms. Patel was working in the emergency room of a hospital in Lynn Lake, a small town in northwestern Manitoba, when paramedics brought in a 55-year-old man with blood around his mouth and on his shirt. He was having trouble breathing.
The lone physician on-site decided the patient should be flown to a hospital in Winnipeg. He needed to be intubated – meaning a tube had to be inserted into his windpipe to help him breathe – for the transfer, though not urgently.
According to the report, Ms. Patel, apparently misunderstanding the doctor, proceeded to inject the patient with succinylcholine – a paralytic agent – and fentanyl, in the wrong order to prepare for intubation.
The report said she didn’t ask for clarification, double-check the medications or document her actions properly. She gave the drugs without the doctor present or the intubation supplies ready.
The patient went into cardiac arrest and only survived because a paramedic intervened to perform CPR, according to a summary of the case presented by David Swayze, a lawyer for the regulator’s complaints investigation committee.
Amber Harms, Ms. Patel’s lawyer, told the disciplinary panel that her client was in over her head in a chaotic situation and panicked. She had never worked in an emergency room before.
But Ms. Patel admitted to administering the medication, took accountability, co-operated with the investigation, and pleaded guilty to the majority of the allegations, Ms. Harms emphasized, according to a summary of the case she presented at the hearing. Ms. Patel had no discipline history with the regulator.
The ruling said Ms. Patel’s lawyer “argued that it is in the public interest for Manitoba to have more RNs working in the province even if they have made a mistake.”
She urged the college to suspend her client rather than cancelling her licence. The disciplinary panel disagreed and stripped Ms. Patel of her licence.
Ms. Patel, in an e-mail to The Globe, said that while she respected the decision, she is disappointed the college refused to entertain any of the “restrictive and remedial options” she proposed.
“I have taken full responsibility for the mistakes that I made on the day in question and expressed my sincere commitment to improving and returning to practice as a better and more educated and experienced nurse,” she said. “Unfortunately, I was not given that second chance.”
Deb Elias, chief executive officer of the College of Registered Nurses of Manitoba, said in a statement Thursday that, in light of the case, her organization would seek a meeting with the province to discuss the “currency of practice” standard the government quashed last year.
Nurses can demonstrate currency of practice by asking an employer in the province where they were originally licensed to provide proof they worked a certain number of hours. They can also undergo a clinical competence assessment or take remedial education.
A previous Manitoba Progressive Conservative government ordered the standard scrapped in 2022 because it violated a provision in the 2017 Canadian Free Trade Agreement.
The college restored the policy in December of 2024, but the NDP killed it last spring.