Irresponsible speech: A professional right?

Andre Picard writes in the Globe and Mail that “Our system suffers when health workers are muzzled.” It’s a great headline, and a compelling story: A Canadian nurse spoke out about poor healthcare, and has been found guilty of professional misconduct by the Saskatchewan Registered Nurses Association. Her lawyer says that she has been over-punished.

It strikes me as odd that he says she’s been over-punished when the disciplinary committee hasn’t made a decision about punishment yet. He intends to appeal the punishment handed down after the guilty finding, even though he doesn’t know what the punishment will be? Is it relevant that the nurse in question declined a mild slap on the wrist (I know that I write essays about ethics for fun) and decided to proceed to a disciplinary hearing?

Reading the decision of the SRNA’s investigative committee, there are a few things which suggest that the decision against Caroline Strom might be justified.

Strom’s most substantive observation regarding the quality of care her grandfather received consisted of:

it is evident that Not Everyone is “up to speed” on how to approach end of life care.

It’s important to note here that ‘Not Everyone’ is a group that includes Strom, who admitted that she “does not have any particular expertise in palliative or end of life care”.

She also advised her readers to:

keep an eye on things and report anything you Do Not Like!

It’s good advice — advice that she should have taken. The investigative committee found that she did not attempt to report any of her concerns to the hospital where her grandfather was treated. This is very relevant, since the Code of Ethics she’s accused of breaching requires nurses to make use of official complaints channels before blowing the whistle in public.

But, comments made on your personal Facebook shouldn’t be misinterpreted as being professional statements, right? Perhaps not — but this question is addressed by the investigation, which notes that Strom said “As an RN”, and that she tweeted her Facebook post to politicians, deliberately drawing public attention.

She claims to be “an avid healthcare advocate” and there’s no doubt that she’s filled with sincere feelings that patients should be treated well, and that she wanted better care for her grandfather. But is she a skillful healthcare advocate? Did she take actions that were appropriate to the interests of her profession when using the ‘RN’ label to establish herself as an authority on healthcare issues?

The investigative committee found that she was guilty of professional misconduct — that she breached a number of provisions of the code of ethics that relate to collaborative problem-solving, respect for fellow professionals, and appropriate communications. If you rely heavily on their report (as I do), then their findings make a lot of sense; nobody seems to be challenging their interpretation of the facts or the regulations.

The question seems to come down to ‘the right to free speech’ — does Ms Strom have the right to say what she likes? Newspaper editors and free speech advocates argue that she does. And yet, Ms Strom did not substantiate her allegations. Nor did she attempt to use official channels to address her allegations. If the Facebook post was caused by a momentary lapse in judgement, then she would presumably have accepted a punishment consisting of “Do an online ethics course, write an essay, and write an apology.”

If people become reluctant to speak up about problems in healthcare, then this episode will indeed be a tragedy. If people become reluctant to attach their professional image to purely emotional statements of pain and frustration, then we’re probably better off.

Do professional bodies have the right to refuse membership to people who make unsubstantiated claims of wrongdoing in public, without making any attempt to correct the wrongdoing from within? My feeling is that they do.

Are professional bodies better off if they listen to those in their ranks who are unhappy and if they pursue improvements? Absolutely they are. The best possible outcome in my view would be if the SRNA were to provide advocacy training to their membership, helping people to see how to use the official channels to drive improvement. The worst possible outcome will be a standoff: passionate advocates versus cold bureaucrats. The quality of the conversations will determine what actually happens.