College of Nurses of Ontario v. Hart, 2001 CanLII 62548

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Panel:

• Chairperson, RPN
• Member, RPN
• Member, RN
• Public Representative
• Public Representative

BETWEEN

COLLEGE OF NURSES OF ONTARIO Counsel for College of Nurses of Ontario

• and -

JOY L.H. HART #GA-0259-3

REASONS FOR DECISION

MEMBER NOT REPRESENTED

Heard: FEBRUARY 5, 2001

This matter came on for hearing before a panel of the Discipline Committee on February 5, 2001 at the College of Nurses of Ontario at Toronto. The Member was present but was not represented by legal counsel. Counsel for the College informed the panel that the Member’s spouse, who was in attendance, would represent Ms Hart by answering any questions the panel may have.

The Allegations

The Notice of Hearing was received as Exhibit #1. The allegations against Joy L.H. Hart (the “Member”) as stated in the Notice of Hearing dated January 3, 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(16) of Ontario Regulation 799/93, in that while registered as a Registered Practical Nurse, you inappropriately used a term, title, or designation in respect of your practice with respect to the following:

a. on or about January 14, 2000, you signed a client record for client #1 and held yourself out as “RN” when you were not registered as such; and/or

b. on or about January 18, 19, 20, 21, 22, 23, 24, 25, and 26, 2000, you signed client records for client #2 and held yourself out as “RN” when you were not registered as such; and/or

c. on or about February 3, 2000, you signed the register at Tufford Nursing Home and held your self out as “Registered Nurse” when you were not registered as such; 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 while registered as a Registered Practical Nurse, 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 the following:

a. on or about January 14, 2000, you signed a client record for client #1 and held yourself out as “RN” when you were not registered as such; and/or

b. on or about January 18, 19, 20, 21, 22, 23, 24, 25, and 26, 2000, you signed client records for client #2 and held yourself out as “RN” when you were not registered as such; and/or

c. on or about February 3, 2000, you signed the register at Tufford Nursing Home and held your self out as “Registered Nurse” when you were not registered as such.

Member’s Plea

Joy L.H. Hart admitted the allegations set out in paragraphs numbered #1 and #2 in the Notice of Hearing. The Chairperson conducted a plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Agreed Statement of Facts

Counsel for the College advised the panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, Exhibit #2, which provided as follows:

The Member

3. Ms Hart attended the two-year Nursing Program at Ryerson Polytechnical Institute from September 1968 to August 1969. After the first year, she was asked to repeat the clinical component, which she did not do. As such, she did not receive a diploma in nursing.

4. Instead, Ms Hart attended the Ontario Department of Health program and became a member of the College as a Registered Nursing Assistant in 1970. She is currently registered as a Registered Practical Nurse.

5. During the period 1970 to 1998, Ms Hart completed university programs in New York and Ontario in the areas of education, social work and health care administration.

6. Ms Hart has been employed in nursing, educational and social work areas in the past. From 1994 to 1999, she worked in Buffalo, New York, in a nursing and social work capacity with responsibility for residents and their families.

The Agency

7. Gentiva Health Services (the Agency) is an agency providing private duty and institutional replacement nursing services by both RPNs and RNs.

8. Ms Hart became employed with the Agency in November, 1999. In her interview, she provided the Agency with her RPN certificate of registration.

9. During her employment with the Agency, Ms Hart was mistakenly requested by the Agency to accept assignments as an RN. Ms Hart accepted the assignments without clarifying with the Agency that she was an RPN.

10. On February 23, 2000, Ms Hart was terminated by the Agency for the events described below.

Allegation 1(a), (b) and (c) – Inappropriate use of a term, title or designation

11. On January 14, 2000, Ms Hart cared for client #1 and held herself out as an RN by signing the client health record, attached as Exhibit #1, with the initials “RN” following her name.

12. On January 18, 19, 20, 21, 22, 23, 24, 25 and 26, 2000, Ms Hart cared for client #2

13. and held herself out as an RN by signing the client health record, attached as Exhibit #2, with the initials “RN” following her name.

14. On February 3, 2000, Ms Hart signed the register at Tufford Nursing Home, attached as Exhibit “C”, as “Registered Nurse” thus holding herself out as an RN when, in fact, she was registered as an RPN.

15. Ms Hart admits that she has committed an act or acts of professional misconduct as set out in allegations 1(a), (b) and (c) in the Notice of Hearing in that while registered as a Registered Practical Nurse, she inappropriately used a term, title or designation in respect of her practice by signing “RN” after her name on:

January 14, 2000, on the client record for client #1;

January 18, 19, 20, 21, 22, 23, 24, 25 and 26, 2000 on the client record for client #2; and February 3, 2000, on the register at Tufford nursing Home.

Allegation 2(a), (b) and (c) – Disgraceful, dishonourable and unprofessional conduct

16. Ms Hart admits that her conduct in holding herself out as an RN, when in fact she was registered with the College as an RPN, as described above in paragraphs 9, 10 and 11, amounts to professional misconduct as set out in allegations 2(a), (b) and (c) in the Notice of Hearing in that she 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 conduct.

Decision

The panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct and, in particular, finds that the Member committed an act of professional misconduct as alleged in paragraphs #1 and #2 of the Notice of Hearing in that the Member held herself out as a Registered Nurse when she was not registered as such, in particular, the Member inappropriately used the title of Registered Nurse to sign client records and to sign the register of the Tufford Nursing Home.

Reasons for Decision

The Member admitted to Allegation #1(a),(b),(c), and Allegation #2(a),(b),(c) of the Notice of Hearing. The Agreed Statement of Facts and attachments A and B including the progress notes of client #1 dated January 14, 2000, the Narcotic Control sheet of client #2 covering the time period of January 18 to 26, 200, the progress notes of client #2 dated January 21, 22 and 24, 2000, the Medication Record for client #2 covering the time period of January 18 and 19, 2000 and the Seizure Activity Chart for January 18 to 21, 2000 of client #2. All of these documents were signed by the Member as, J. Hart, RN. The documents support Allegation #1(a)(b) and (c) of inappropriate use of a term, title or designation in respect of the Member’s practice.

The last attachment, C, of the Agreed Statement of Facts, is a form from the Tufford Nursing Home dated February 3, 2000. On the form the Member listed her College of Nurses of Ontario Certificate of Registration #GA-00259-3, she knowingly listed her designation as Registered Nurse and signed the document “C” as Reg. N.

In knowingly holding herself out as an RN, when in fact she did not hold the designation of RN, the Member engaged in dishonest conduct by using the title and accepting the RN pay rate. This action demonstrates behaviour that is disgraceful, dishonourable or unprofessional and therefore supports Allegation #2(a)(b) and (c) of the Notice of Hearing.

Penalty

Counsel for the College advised the panel that a Joint Submission as to Penalty had been agreed upon by the Member and the College of Nurses of Ontario. TheJoint submission on Penalty provided as follows:

THE MEMBER AND THE COLLEGE jointly submit that the appropriate penalty in this case is for the Discipline Committee to make the following order:

a. Directing the Executive Director to suspend the Member’s certificate of registration for a period of one month from the date the order becomes final;

b. Requiring the Member to pay a fine of $200 to the Minister of Finance within three months from the date the order becomes final;

c. Requiring the Member to appear before the panel of the Discipline Committee to be reprimanded, at a date to be arranged, but in any event within three months of the date the order becomes final; and

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

i. The Member shall successfully complete a course in Ethics, as approved by the Director, within one year of the date the order becomes final.

Counsel for the College submitted that the RN and RPN designations are not merely paper designations. There is a difference in training and a difference in the types of skills the classes carry out. The misrepresentation on behalf of the Member by using the title RN could have caused a great potential for harm both for the clients and for the institutions concerned. Counsel pointed out that the Member’s intentional and repeated conduct of signing her designation as RN and receiving remuneration as an RN was dishonest.

College counsel pointed out that this penalty would send a strong message to the Member and members of the profession that conduct of this nature would not be condoned by members of the profession.

Mitigating factors to be considered was the Member’s admission to the allegations, thereby, recognizing her wrongdoing and foregoing a lengthy hearing for the parties.

College Counsel outlined for the panel that there are three criteria that the penalty should address:

1. rehabilitative

2. specific deterrent for the Member

3. general deterrence for the membership

College counsel pointed out that this penalty would send a strong message to the Member and members of the profession that conduct of this nature would not be condoned by members of the profession.

Neither the Member nor her husband made submissions to the panel.

Penalty Decision

The panel accepts the Joint Submission as to Penalty and accordingly makes the following order:

1. Directing the Executive Director to suspend the Member’s certificate of registration for a period of one month from the date the order becomes final;

2. Requiring the Member to pay a fine of $200 to the Minister of Finance within three months from the date the order becomes final;

3. Requiring the Member to appear before the panel of the Discipline Committee to be reprimanded, at a date to be arranged, but in any event within three months of the date the order becomes final; and

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

i. The Member shall successfully complete a course in Ethics, as approved by the Director, within one year of the date the order becomes final.

Reasons for Penalty

The panel agreed that the penalty meets the objective of rehabilitation in that an oral reprimand from the Member’s peers and members of the public will assist the Member’s understanding of her wrongful conduct. A course in ethics will further assist the Member to understand appropriate behaviour and the importance of recognizing and respecting that titles are not merely paper designations. Finally, by suspending the Member’s practice for one month and a fine of $200.00 (based on excess pay received by the Member) sends a strong message to the membership that such conduct will not be condoned by members of the profession. The panel concluded that the penalty is reasonable and in the public interest. The Member has cooperated with the College by agreeing to the facts and the proposed penalty and as such has accepted responsibility for her actions.

I, [name], 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:

, Chairperson Date RPN, Chairperson, Discipline Panel

RN, Member, Discipline Panel RPN, Member, Discipline Panel Public Member, Discipline Panel Public Member, Discipline Panel