DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

FULL-TEXT DECISION

Note: This is the full text of the decision of the Discipline Committee in this matter. Any information identifying clients, witnesses or facilities has been removed [ ]. The member's name is omitted if allegations have been dismissed or if the results are not placed on the public portion of the Register.

Panel:

MARSHA TAYLOR, RPN Chairperson JANISE JOHNSON, RN Member

PAT COLLINS, RPN Member

KAY WETHERALL Public Representative TOM CLIFFORD Public Representative

B E T W E E N:

COLLEGE OF NURSES OF ONTARIO Megan Shortreed

for College of Nurses of Ontario

• and -

JANICE B.SHAW MEMBER NOT REPRESENTED

Brian Gover, Independent legal Counsel

REASONS FOR DECISION

Heard: APRIL 2-5, 2001

This matter came on for hearing before a panel of the Discipline Committee on April 2-5, 2001. On April 2, 2001 the hearing was convened in the Gowling, Lafleur, Henderson LLP, Board Room, 50th Floor, Commerce Court West, Board Room, 50C, 199 Bay Street, Toronto, Canada. On April 3, 2001, and thereafter, the hearing continued at the College of Nurses of Ontario ("the College") at Toronto, Ontario.

The Hearing was convened and recessed to give the Member an opportunity to arrive for the hearing. The hearing reconvened at 9:30 a.m. The Member was not present nor was she represented.

The hearing proceeded on the basis that the Member's name was Janice B. Bartley. After the hearing was adjourned to permit preparation of these reasons, it came to the panel's attention that prior to the hearing's commencement, the Member had notified the College of her change of name to Janice B. Shaw.

Counsel for the College entered into evidence an Affidavit of Attempted Service (Exhibit #1) which shows that several attempts were made to serve the Member with a Notice of Hearing at two different addresses on four separate dates: November 3, 5, 8 and 19, 2000. The Affidavit of Attempted Service was sworn on November 23, 2000. Exhibit #2 is another Affidavit of Attempted Service sworn to the Commissioner at the city of [name removed] on March 19, 2001.

This affidavit shows that attempts were made to serve the Member with an Notice of Electronic Hearing and a binder of documents at two separate addresses.

The process server was unsuccessful in contacting the Member at either of the addresses stated in the Affidavits of Attempted Service to effect personal service of the Notice of Hearing and the Notice of Electronic Hearing with binder of documents.

Exhibit #3 is a Notice of Electronic Hearing dated March 14, 2001.

The Allegations

The allegations against Janice Bartley as stated in the Notice of Electronic Hearing dated March 14, 2001, are as follows:

1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(7) of Ontario Regulation 799/93, in that during the period May 16, 1999 through June 18, 1999, while working as an RPN in [the town], Ontario, you abused a client known as [Client "A"], and in particular:

a. in or about May, 1999, you emotionally and verbally abused [Client "A"] by swearing at him in a [bank] branch; and/or

b. on or about the weekend of May 22, 1999, you emotionally and verbally abused [Client "A"] by making inappropriate comments and/or gestures about his disability in his presence at a restaurant; and/or

c. in or about May and June, 1999, you emotionally and verbally abused [Client "A"] by making inappropriate comments and/or gestures about his disability in his presence during social occasions at or around the cottage where you and [Client "A"] lived in [the town]; and/or

d. in or about May or June, 1999, you emotionally and verbally abused [Client "A"] by stating in his presence to the police words to the effect of "I only brought him [Client "A"] along to pay my way into Canada"; and/or

e. on or about June 18, 1999, you emotionally and verbally abused [Client "A"] by yelling and/or swearing at him at the cottage where you and [Client "A"] lived in [the town]; and/or

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that during the period May 16, 1999 through June 18, 1999, while working as an RPN in [the town], Ontario, you engaged in conduct or performed an act, relevant to the practice of nursing that, having regard to all of the circumstances would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional with respect to your care and treatment of a client known as [Client "A"], and in particular:

a. in or about May, 1999, you emotionally and verbally abused [Client "A"] by swearing at him in [a bank] branch; and/or

b. on or about the weekend of May 22, 1999, you emotionally and verbally abused [Client "A"] by making inappropriate comments and/or gestures about his disability in his presence at a restaurant; and/or

c. in or about May and June, 1999, you emotionally and verbally abused [Client "A"] by making inappropriate comments and/or gestures about his disability in his presence during social occasions at or around the cottage where you and [Client "A"] lived in [the town]; and/or

d. in or about May or June, 1999, you emotionally and verbally abused [Client "A"] by stating in his presence to the police words to the effect of "I only brought him [Client "A"] along to pay my way into Canada"; and/or

e. on or about June 18, 1999, you emotionally and verbally abused [Client "A"] by yelling and/or swearing at him at the cottage where you and [Client "A"] lived in [the town]; and/or

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that during the period May 16, 1999 through June 18, 1999, while working as an RPN in [the town], Ontario, you contravened a standard of practice of the profession or failed to maintain

the standards of practice of the profession with respect to your care and treatment of a client known as [Client "A"], and in particular:

a. in or about May, 1999, you emotionally and verbally abused [Client "A"] by swearing at him in a [bank] branch; and/or

b. on or about the weekend of May 22, 1999, you emotionally and verbally abused [Client "A"] by making inappropriate comments and/or gestures about his disability in his presence at a restaurant; and/or

c. in or about May and June, 1999, you emotionally and verbally abused [Client "A"] by making inappropriate comments and/or gestures about his disability in his presence during social occasions at or around the cottage where you and [Client "A"] lived in [the town]; and/or

d. in or about May or June, 1999, emotionally and verbally abused [Client "A"] by stating in his presence to the police words to the effect of "I only brought him [Client "A"] along to pay my way into Canada"; and/or

e. on or about June 18, 1999, you emotionally and verbally abused [Client "A"] by yelling and/or swearing at him at the cottage where you and [Client "A"] lived in [the town]; and/or

4. You have committed an act of professional misconduct as provided by subsection

51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(8) of Ontario Regulation 799/93, in that during the period May 16, 1999 through August 6, 1999, while working as an RPN in [the town], Ontario and after your termination of employment by [Client "A"], you misappropriated property from a client, and in particular:

a. you charged a purchase or purchases to one or more credit cards belonging to your client [Client "A"] without his authorization; and/or

b. you used telephone(s) belonging to [Client "A"] without his authorization; and/or

c. you drove [an] automobile owed by [Client "A"] without his consent; and/or

d. you arranged for insurance for [an] automobile to be added to [Client "A's"] insurance policy without his consent; and/or

5. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that during the period May 16, 1999 through August 6, 1999, while working as an RPN in [the town], Ontario and after your termination of employment by [Client "A"], you engaged in conduct or performed an act, relevant to the practice of nursing that, having regard to all of the circumstances would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, and in particular:

a. you charged a purchase or purchases to one or more credit cards belonging to [Client "A"] without his authorization; and/or

b. you used telephone(s) belonging to [Client "A"] without his authorization; and/or

c. you drove [an] automobile owed by [Client "A"] without his consent; and/or

d. you arranged for [an] automobile to be added to [Client "A's"] insurance policy without his consent; and/or

e. you occupied [a residence in] Florida during the period June through July 1999 against the wishes of [Client "A"]; and/or

f. you called [Client "A"] at [a facility] in [the town], Ontario, using an alias; and/or

g. you provided inappropriate letters dated July 5, 1999 and July 13, 1999 to former client [Client "A"].

Counsel for the College advised that the College was not calling any evidence with respect to the allegations set out in paragraphs 1(d) and 2(d) 3(d) 4(c) 5(c)(f) of the Electronic Notice of Hearing and that the College was withdrawing allegations 1(d) 2(d) 3(d) 4(c) 5(c)(f).

Member's Plea

The Member was not present nor was she represented by legal counsel. The hearing proceeded on the basis that the Member denied the allegations.

Overview

The Member is a Registered Practical Nurse who has been registered with the College since 1979. She was hired in 1998, by a resident in the State of Florida, [Client "A"] and his siblings, to give care to their terminally ill mother, in her home, upon discharge from the hospital. Following the mother's death, in December, 1998, the Member was retained by [Client "A"] to provide care for him in the home. An oral contract was agreed upon by the client and the Member.

[Client "A"] is a 55 year old gentleman afflicted with Cerebral Palsy. He is a quadriplegic, confined to a wheel chair, and requires assistance with activities of daily living. He was totally dependent upon his caregiver.

While living in Florida, [Client "A"] was satisfied with the care provided by the Member. In May 1999, [Client "A"] and the Member left [Florida] in the client's van to vacation in Ontario. The client agreed to vacation for a month and to put all the travel expenses on his credit card. It was further agreed that upon return to Florida, they would divide the travel expenses equally. In addition, the rental of the cottage would also be shared.

Upon arrival in Ontario, Canada, the Member's disposition changed drastically. A few weeks later, the client orally terminated the Member's employment, and requested to be returned to his home in Florida.

There were numerous disruptive and humiliating incidents in the vacation community. On June 18, 1999, the Ontario Provincial Police were called to a domestic dispute at the cabin shared by the client and the Member. The police removed the client from the threatening environment. Arrangements were made to place him in a nursing home, in a nearby community. Contact was made with [a family member of the client in another State] to arrange transportation for the client's return to his home in Florida.

During the client's stay in the nursing home in Ontario, he was informed that the Member was residing in his Florida home, was using his credit card and had activated the insurance on his deceased mother's car. This was without the client's authorization. The occupation by the Member of the client's Florida residence prevented his return home, thereby requiring that he reside in a motel, and subsequently, in a nursing home.

The Member further communicated to the client by sending threatening letters to him in July, 1999.

The Evidence

The College proceeded by calling five witnesses:

Witness #1 - [Client "A"]; Witness #2 - [name removed];

Witness #3 - Constable [name removed] of the Ontario Provincial Police; Witness #4 - [name removed]; and

Witness #5 - [name removed]; R.N.

Witness #1 - [Client "A"]

[Client "A"] testified by means of electronic video communication.

[Client "A"] testified that he interviewed and subsequently hired the Member to care for his terminally ill mother. Following his mother's death, in December 1998, an oral agreement was entered into by [Client "A"] and the Member. The agreement included a weekly salary, plus room and board in the home. Her personal expenses (i.e. telephone calls, etc.) would be deducted from her salary. As part of the agreement, there was to be no consumption of alcohol or smoking in the home. Either party could terminate the agreement by giving two weeks notice.

In the spring of 1999, the Member indicated to [Client "A"] that she had to return to Canada to attend to personal business, but she could only afford the trip if it was a working holiday. The witness agreed that he needed a vacation, but had to return to Florida by the end of June. Arrangements were made to rent a cottage at [the town], Ontario. They would travel to Canada in his van. The expenses of the holiday were to be put on the witness's credit card and following the trip, the expenses would be equally shared.

Upon arrival in Canada, [Client "A"] testified that the Member's behaviour towards him became very abusive, emotionally and verbally. The Member told [Client "A"] that she was ill. Upon arrival in [the town], the Member made an appointment to see her family physician. Following this appointment the Member told [Client "A"] that she could not return to Florida in June because she had a second medical appointment July 15, 1999, and may have to be hospitalized. [Client "A"] informed the Member that this delay was unacceptable.

[Client "A"] testified that through the Member he met [Mr. "B"] and developed a friendship. [Mr. "B"] visited in [Client "A's"] home in Florida in December 1998 and at Easter 1999. This friendship was renewed in [the town], when [Mr. "B"] visited him at the cabin. During one of these visits, [Client "A"] informed [Mr. "B"] that the Member was unable to return him to his Florida home on the previously agreed date. [Mr. "B"] agreed to drive [Client "A"] to [another State] to [Client "A's"] [family member's] home, but would need a few days to make arrangements.

[Client "A"] further testified that he noticed a change in the Member's behaviour. She was consuming alcohol and becoming easily agitated.

Related Incidents:

Incident #1

The witness testified that due to an overpayment of the cabin rental, he and the Member went to the bank to cash a refund cheque. The Member entered the bank, the teller refused to cash the unendorsed cheque. The Member left the bank and returned to the van where she became verbally abusive to the witness, saying, " You son- of- a- bitch, I have to drag you out of the van and into the bank so they can see how bad you are" and "This damn town has no accommodation for Goddamn handicaps." Upon re-entering the bank the Member did all the talking and approaching the teller, she said; "Here is the son of a bitch, he is in his wheelchair, now, give me the money". [Client "A"] felt very humiliated and embarrassed and he apologized to the bank staff for the Member's behaviour. The Member's actions caused him to be concerned about his own safety and his ability to return to his Florida home.

Incident #2

The witness testified that while they were out having lunch in a restaurant with the Member's family, the Member became loud and boisterous using vulgar language. She stated that [Client "A"] looked like the "Hunch Back of Notre Dame". He felt humiliated and uncomfortable.

During family outings, [Client "A"] stated, the Member was always making derogatory remarks and bad jokes about his appearance.

Incident #3

At the cottage, in the morning of June 18, 1999, the Member had an appointment. The Member left [Client "A"] alone, in his bed. Prior to the Member's departure, he asked her to unplug the space heater and to leave the door ajar.

[Mr. "B"], on driving by the cabin, noticed the van was gone and the front door was left open. He checked in the cottage and spoke with [Client "A"] who then told him he wanted to return to Florida and asked if [Mr. "B"] would drive him. [Mr. "B"] agreed to take [Client "A"] to [Client "A's"] [family member in another State] but would have to make arrangements, with his employer. [Mr. "B"] indicated that he had to leave the cottage as the Member had told him that she would call the police if he came back to the cottage. The Member, however, returned while [Mr. "B"] was still

present and lost control, using vulgar and obscene language. The situation was escalating. The Member's mother arrived and attempted to calm her daughter.

The police arrived within 15-20 minutes. The Member denied that [Client "A"] was present. The police entered the cottage and checked the bedrooms finding [Client "A"] in his bed. [Client "A"] chose to be put under police protection and to have arrangements made for his return home. The Member's behaviour continued to escalate out of control, impeding [Client "A's"] departure from the cottage. The police asked [Client "A"] if he wanted to discharge the Member from his service and [Client "A"] said "yes". With the assistance of the police, [Client "A"] checked his personal belongings and found that his Master Card and Disney credit card were missing. When questioned, the Member denied having the credit cards. The police escorted [Client "A"] to the van. The Member asked [Client "A"], "do you really mean I am fired"? [Client "A"] said "Yes".

Arrangements were made by the police to have [Client "A"] temporarily admitted to a nursing home. [The client's family member] was notified of the situation. [Client "A"] remained in the nursing home for six days. [The client's family member] made arrangements to take him back to Florida.

Misappropriation of Property

College Counsel proceeded to review with the witness the misappropriation of property

1. Purchase of Cell Phone:

a. [Client "A"] and the member purchased a Bell Mobility Cell Phone in [the town] for $300.00 cash.

b. [Client "A"] and the Member found that AT and T had a better deal, they returned the Bell Cell Phone. [Client "A"] testified that he witnessed the Member receiving the $300.00 cash back from Bell.

c. The following day, the Member said she was going to the mall to shop. She returned to the van with a cell phone. The witness assumed the Member had purchased the cell phone in her name, and had purchased it with the monies they had received from Bell for the returned phone. [Client "A"] denied authorizing the purchase of a cell phone.

d. [Client "A"] started receiving bills from AT and T. Exhibit #5 is a Service Agreement for purchase of a cell phone by [Client "A"] at his address in Florida, purchased June 1, 1999. This invoice has [Client "A's"] Social Security Number and Master Card Number. The witness denied that the signature was his. [Client "A"] stated he had received a Wireless Express activation Cantel AT and T from AT and T (Exhibit #6).

e. [Client "A"] testified that he received Roger's AT and T cellular phone charges from June 3, 1999 until June 30, 1999 (Exhibit # 8). Total charges were $209. 73 which he paid.

The panel found [Client "A"] testified in a forthright manner and was a credible witness to the incidents.

Witness #2 - [name removed]

[Witness #2] was a resident of [the town] who owned two cottages, one fronting on the second. She was familiar with the Member's parents who lived a short distance away

and through them rented the front cottage to the Member and her client, [Client "A"], for the month of June, 1999.

On the date of the incident, the witness testified that while working on the outside of the back cottage, she heard a loud voice coming from the cottage and saying, "You fucking retard".

The witness stated that she recognized the Member's voice and on becoming very alarmed, asked her husband to go the Member's parents' cottage and ask them to come to the rented front cottage to calm their daughter down.

[Witness #2] testified in a clear and concise manner. The panel found her to be a credible witness.

Witness #3 - Constable [name removed] ["the Constable"], OPP

[The Constable] testified that he was serving at the [area] Ontario Provincial Police detachment in June, 1999, which

included the [town] area. He further testified that his transcription of notes (Exhibit 16) was an accurate description of the incident involving the Member and [Client "A"]. On his arrival at the cottage, the witness was met by the Member at the door. He informed the Member that the detachment had been notified of a domestic dispute at that address. The Member denied that [Client "A"] was present at the cottage, but she allowed the witness to enter the cottage. Two policemen were present for this domestic complaint. [The Constable] entered the back bedroom, where he found [Client "A"] in bed, while the other Constable remained in the front room with the Member.

The witness had a conversation with [Client "A"] about his return to Florida and his personal safety. The witness was concerned about [Client "A's"] well being and offered him protective custody. The witness testified about the repeated attempts by the Member to give personal care to [Client "A"], who refused. When packing his belongings, [Client "A"] discovered his credit cards were missing and when [Client "A"] confronted the Member, she denied having possession of the cards. The witness testified that the Member was in a very tense and emotional state. The police gave [Client "A"] personal care and removed him from the cottage via wheelchair and [Client "A's"] van to the [town] detachment.

Arrangements were made for [Client "A"] to be admitted on a temporary basis to [a facility]. The police notified [the client's family member in another State] of the incident and of [Client "A's"] current location, advising him to make arrangements to transport [Client "A"] back to Florida.

The panel found this witness to be a reliable, forthright, caring witness, and found his testimony credible.

Witness #4 - [name removed]

This witness was a bank teller at [a bank branch] in [the town]. She described an incident in which the Member attempted to cash an unendorsed cheque. The cheque was made payable to [Client "A"], and the witness told the Member that she was unable to cash the cheque. At this point the Member became agitated and verbally abusive toward the witness. She grabbed the cheque and went out to the van to bring [Client "A"] into the bank. The Member entered the bank aggressively, with [Client "A"] in his wheelchair, and continued to use vulgar language, saying, "see here is the son- of- a- bitch look at how bad he is". The teller proceeded to cash the cheque.

Upon leaving the bank, [Client "A"] apologized to the bank staff for the Member's behaviour. The panel found this witness credible.

Witness # 5 - [name removed] RN, BSc.N.; MSc.

Counsel for the College tendered the Curriculum Vitae (Exhibit #19) of [Witness #5] to the panel. Counsel further submitted a hypothetical scenario (Exhibit #20) along with a letter (Exhibit #21) expressing the opinion of [Witness #5] with regard to the hypothetical scenario.

Upon review of Exhibits #19, #20 and #21, the panel ruled that the witness, [Witness #5], was qualified as an expert in relation to the standards of practice and nurse-client boundaries arising in this case.

The witness testified on the breach of power, trust, and respect of a client.

The witness stated that a nurse must be very diligent in maintaining therapeutic boundaries in a live-in arrangement, and emphazied the nurse must not use her knowledge of the client's vulnerability to meet her own needs. Further, a nurse must be diligent in her communication with a client so as not to cross the boundaries of the nurse-client relationship.

Decision

Having considered the evidence and the onus and standard of proof, the panel finds that the Member committed professional misconduct as alleged in Allegation #1(a)(b)(c)(e), Allegation #2(a)(b)(c)(e), Allegation #3(a)(b)(c)(e), Allegation #4(a)(b)(d), Allegation #5 (a)(b)(d)(e)(g). In particular, to Allegation #1(a)(b)(c)(e), the panel finds that the Member, in May and June, 1999 emotionally and verbally abused the client [Client "A"] at [the bank branch], a

restaurant and on several social occasions in [the town], Ontario.

The panel makes a further finding of professional misconduct in relation to Allegation #2 (a)(b)(c)(e), in that she had engaged in conduct and performed acts relevant to her care and treatment of the client [Client "A"] that would be regarded by members of the profession as disgraceful, dishonourable and unprofessional.

With respect to Allegation #3(a)(b)(c)(e), the panel finds the Member failed to maintain the standards of practice of the profession with respect to her care and treatment of client [Client "A"] in that she emotionally and verbally abused the client on several occasions in May and June of 1999.

With respect to Allegation #4(a)(b)(d), the panel makes a finding of professional misconduct, in that the Member during a period of employment and after termination of that employment, May 16, through August 6, 1999, misappropriated property belonging to the client, [Client "A"], in that she charged purchases on his credit card without authorization, used his telephone without authorization and arranged insurance coverage on a vehicle belonging to the client's deceased mother, without the client's authorization. The panel makes a finding of professional misconduct in relation to Allegation #5(a)(b)(d)(e)(g), in that the Member's conduct and acts relevant to her practice would be regarded as disgraceful, dishonourable, or unprofessional.

Reasons for Decision

The onus is upon the College to present clear, cogent and convincing evidence to the panel in support of the allegations. Following deliberation, the panel found the Member violated the standards of practice of the profession, which state that the professional nurse:

a. is responsible for setting, managing and maintaining the nurse-client relationship and setting boundaries;

b. does not meet her own personal needs within the nurse-client relationship;

c. is vigilant in her practice to not use verbal or non verbal behaviours that demonstrate disrespect for the client or perceived by the client to be verbally or emotionally abusive;

d. is accountable for her practice and must provide safe, non threatening, quality client care to establish and maintain professional boundaries; and

e. must maintain the standards of practice of the profession

Penalty

Counsel for the College submitted a recommended penalty. However, due to some concerns of the panel, counsel further submitted revised submissions on penalty as follows:

The College submits that, in view of the facts proven at the Hearing into this matter and the Panel's findings of professional misconduct, the panel of the Discipline Committee should make an order as follows:

1. Requiring the Member to appear before the panel to be reprimanded.

2. Directing the Executive Director to impose the following terms, conditions and limitations on the Member's certificate of registration:

a. the Member not practice in the community, except where she does so as an employee of a nursing agency, or other health care service, and may not practice with respect to a person with whom she shares a residence;

b. the Member must purchase and complete the College's abuse prevention program One is One Too Many by viewing the video and completing the workbook;

c. the Member must, after completing the One is One Too Many Program, meet with a College Practice Consultant in person on four occasions, or where agreed to by both the Member and the Practice Consultant, on as few as two occasions, to discuss the One is One Too Many program, and the College's Standard for the Nurse Client Therapeutic Relationship, their application to her practice, and her conduct for which she was found to have committed professional misconduct by the panel of the Discipline

Committee; and

d. before the conclusion of the meetings with the Practice Consultant, the Member must, with the input of the Practice Consultant, develop a written plan for addressing the Member's practice deficits.

3. Directing the Executive Director to suspend the Member's certificate of registration from the time the order becomes final until:

a. such time as the Member appears before the panel to be reprimanded, and complies with the terms and conditions set out at subparagraphs 2(b) and 2(c) and 2(d), above, and

b. in any case, a minimum of six consecutive months.

Penalty Decision

The panel accepted the revised submissions on penalty and also recommends that the State Board of Florida be notified of the suspension effective on the Member's certificate. The panel ordered that the penalty be effective as of April 5, 2001.

Reasons for Penalty Decision

The panel believes that the penalty is fair and meets the public interest in that it serves as a general deterrent to the membership and as a specific deterrent to the Member. The panel feels the penalty addresses the heightened breach of power and trust of vulnerable clients that was established in this hearing.

I, Marsha Taylor, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel as listed below:

Signed: Date:

Marsha Taylor, Public Member, Chairperson, Discipline Panel Janise Johnson, Member, Discipline Panel

Pat Collins, Member, Discipline Panel

Kay Wetherall, Public Member, Member, Discipline Panel Tom Clifford, Public Member, Member, Discipline Panel