College of Nurses of Ontario v. Oscar Albert Reimer, 2010 ONCNO 100039

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Dennis Curry, RN Chairperson Judie Coutts, RN Member Angela Verrier, RPN Member Joan King Public Member Margaret Tuomi Public Member

BETWEEN:

) CAROLINE ZAYID ) for College of Nurses of Ontario COLLEGE OF NURSES OF ONTARIO )

• and - ) ELIZABETH MCINTYRE ) for Oscar A. Reimer OSCAR ALBERT REIMER ) Registration No. 9819913 ) ) Heard: January 28, 2010

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on January 28, 2010 at the College of Nurses of Ontario (“the College”) at Toronto.

The Allegations

The allegations against Oscar Reimer (the “Member”) as stated in the Notice of Hearing dated November 27, 2009, are as follows.

1. You have committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.1 of Ontario Regulation 799/93, in that between May 2004 and March 29, 2007, while you were working as a registered nurse at [Agency A] and/or [Agency B], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, in that you:

(a) failed to take appropriate steps to ensure that blood specimens drawn by you were sent to [ ] (“the Laboratory”) for testing in a timely and/or accurate manner, or at all, including specimens from the following clients:

(i) [Client A];

(ii) [Client B];

(iii) [Client C].

(b) informed clients that test results were negative when the results had not been received because of spoiled specimens, in that;

(i) re [Client D], you advised the client that she was “clear” for STDs when in fact the specimen collected on May [ ], 2006, had been spoiled and had not actually been tested;

(ii) re [Client D], you provided the client with negative HIV results when in fact the specimen collected on May [ ], 2006, had been spoiled and had not actually been tested;

(iii) re [Client E], you advised the client in August 2006 that the Hepatitis C result was negative when in fact the specimen collected on May [ ], 2006, had been spoiled and had not actually been tested;

(iv) re [Client E], you advised the client in August 2006 that the HIV result was negative when in fact the specimen collected on May [ ], 2006, had been spoiled and had not actually been tested.

2. You have committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.13 Ontario Regulation 799/93, in that between May 2004 and March 29, 2007, while you were working as a registered nurse at [Agency A] and/or [Agency B], you failed to keep records as required, in that:

(i) re [Client A], you failed to document whether or not blood was drawn for testing on January [ ], 2007;

(ii) re [Client A], you failed to document that you did not send the sample taken on January [ ], 2007, to the lab for testing;

(iii) re [Client A], you failed to document a follow-up visit on February [ ], 2007, to have blood drawn for testing;

(iv) re [Client F], you failed to document whether or not blood was drawn for testing on January [ ], 2007;

(v) re [Client F], you failed to document that you did not send the sample taken on January [ ], 2007, to the lab for testing;

(vi) re [Client F], you failed to document that you advised the client of the untested blood sample taken on January [ ], 2007;

(vii) re [Client F], you failed to document a follow-up visit on January [ ], 2007, to have blood redrawn for testing;

(viii) re [Client F], you failed to document any follow-up visits or attempts to contact the client for follow-up after the February [ ], 2007, test results were received;

(ix) re [Client G], you failed to document whether or not blood was drawn for testing on February [ ], 2007;

(x) re [Client A], you failed to document any follow-up visits or attempts to contact the client for follow-up after the February [ ], 2007, test results were received;

(xi) re [Client D], you failed to document whether or not blood was drawn for testing on May [ ], 2006;

(xii) re [Client D], you failed to document a follow-up visit on May [ ], 2006, to have blood drawn for testing;

(xiii) re [Client D], you failed to complete the chart “sticker”, sign the chart entry, and complete the [certain] forms for the clinic visit on May [ ], 2006;

(xiv) re [Client E], you failed to document whether or not blood was drawn for testing on May [ ], 2006;

(xv) re [Client E], you failed to document a follow-up visit on May [ ], 2006, to have blood drawn for testing;

(xvi) re [Client E], you failed to document follow-up with the client after the Laboratory advised the facility on June [ ], 2006, that the specimen taken on May [ ], 2006, had been spoiled;

(xvii) re [Client H], you failed to document whether or not blood was drawn for testing on September [ ], 2005;

(xviii) re [Client H], you failed to document a follow-up visit on October [ ], 2005, to have blood drawn for testing;

(xix) re [Client H], you failed to document a follow-up visit on November [], 2005, to have blood drawn for testing;

(xx) re [Client H], you failed to document any follow-up visit to advise the client of the results of the testing done on November [ ], 2005;

(xxi) re [Client B], you failed to document whether or not blood was drawn for testing on August [ ], 2005;

(xxii) re [Client B], you failed to sign a chart entry dated August [ ], 2005;

(xxiii) re [Client B], you failed to document a follow-up visit on September [], 2005, to have blood drawn for testing;

(xxiv) re [Client B], you failed to label the specimen vials of blood drawn for testing on October [ ], 2005;

(xxv) re [Client B], you failed to document any follow-up visit or attempts to follow up to advise the client of the results of the testing done on October [ ], 2005;

(xxvi) re [Client I], you failed to document a follow-up visit on or after January [ ], 2007, to have blood drawn for testing;

(xxvii) re [Client J], you failed to document whether or not blood was drawn for testing on February [ ], 2007;

(xxviii) re [Client J], you failed to document a follow-up visit on February [ ], 2007;

(xx9) re [Client K], you failed to document whether or not blood was drawn for testing on November [ ], 2006;

(xxx) re [Client K], you failed to document a follow-up visit or attempt to follow-up after November [ ], 2006;

(xxxi) re [Client L], you failed to document whether or not blood was drawn for testing on January [ ], 2007;

(xxxii) re [Client L], you failed to sign a chart entry on January [ ], 2007;

(xxxiii) re [Client L], you failed to document any follow up or attempted follow up, with the client for retesting after the Laboratory advised the facility on February [ ], 2007, that the specimen taken on January [ ], 2007, had been spoiled;

(xxxiv) re [Client L], you failed to document clinic visits on January [ ], 2005, and/or February [ ], 2005, and/or February [ ], 2005;

(xxxv) re [Client L], you failed to complete the chart “sticker” for the clinic visit on January [ ], 2007;

(xxxvi) re [Client M], you failed to document follow-up with the client after the report came back from the Laboratory on June [ ], 2006 indicating that the client was positive for Hepatitis C and was recommended for a Hepatitis B series;

(xxxvii) re [Client M], you failed to sign the chart entry dated May [ ], 2006;

(xxxviii) re [Client N], you failed to document follow-up or attempts to follow up with the client for retesting after the Laboratory advised the facility on September [ ], 2005, that the specimen taken on August [ ], 2005, had been spoiled;

(xxxix) re [Client O], you failed to document whether or not blood was drawn for testing on October [ ], 2004;

(xl) re [Client O], you failed to document follow-up with the client after the report came back from the Laboratory in November 2004 that a sample taken from the client had tested Hepatitis C positive;

(xli) re [Client O], you failed to document any steps taken to notify relevant authorities that the client was positive for Hepatitis C;

(xlii) re [Client P], you failed to sign the chart entry dated May [ ], 2006;

(xliii) re [Client P], you failed to document whether test results were provided to the client after the test results were received by the clinic on May [ ], 2006;

(xliv) re [Client Q], you failed to complete [certain] forms for the clinic visit on February [ ], 2005;

(xlv) re [Client Q], you failed to document follow up or attempts to follow-up after the Laboratory advised the facility that the specimen taken on February [ ], 2005 had been spoiled;

(xlvi) re [Client R], you failed to document follow up with the client after the report came back from the Laboratory on October [ ], 2004, indicating that the client was Hepatitis C positive;

(xlvii) re [Client C], you failed to document that you did not send a sample taken for testing on February [ ], 2007 to the lab for testing;

(xlviii) re [Client C], you failed to document a follow-up visit or attempt to follow up after February [ ], 2007.

3. You have committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.37 Ontario Regulation 799/93, in that between May 2004 and March 29, 2007, while you were working as a registered nurse at [Agency A] and/or [Agency B], you engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional, in that you:

(a) failed to take appropriate steps to ensure that blood specimens drawn by you were sent to [ ] (“the Laboratory”) for testing in a timely and/or accurate manner, or at all, including specimens from the following clients:

(i) [Client A];

(ii) [Client B];

(iii) [Client C].

(b) informed clients that test results were negative when the results had not been received because of spoiled specimens, in that:

(i) re [Client D], you advised the client that she was “clear” for STDs when in fact the specimen collected on May [ ], 2006, had been spoiled and had not actually been tested;

(ii) re [Client D], you provided the client with negative HIV results when in fact the specimen collected on May [ ], 2006, had been spoiled and had not actually been tested;

(iii) re [Client E], you advised the client in August 2006 that the Hepatitis C result was negative when in fact the specimen collected on May [ ], 2006, had been spoiled and had not actually been tested;

(iv) re [Client E], you advised the client in August 2006 that the HIV result was negative when in fact the specimen collected on May [ ], 2006, had been spoiled and had not actually been tested.

(c) Failed to adequately document nursing care, in that:

(i) re [Client A], you failed to document whether or not blood was drawn for testing on January [ ], 2007;

(ii) re [Client A], you failed to document that you did not send the sample taken on January [ ], 2007, to the lab for testing;

(iii) re [Client A], you failed to document a follow-up visit on February [ ], 2007, to have blood drawn for testing;

(iv) re [Client F], you failed to document whether or not blood was drawn for testing on January [ ], 2007;

(v) re [Client F], you failed to document whether or not blood was drawn for testing on January [ ], 2007;

(vi) re [Client F], you failed to document that you did not send the sample taken on January [ ], 2007, to the lab for testing;

(vii) re [Client F], you failed to document a follow-up visit on January [ ], 2007, to have blood redrawn for testing;

(viii) re [Client F], you failed to document any follow-up visits or attempts to contact the client for follow-up after the February [ ], 2007, test results were received;

(ix) re [Client G], you failed to document whether or not blood was drawn for testing on February [ ], 2007;

(x) re [Client A], you failed to document any follow-up visits or attempts to contact the client for follow-up after the February [ ], 2007, test results were received;

(xi) re [Client D], you failed to document whether or not blood was drawn for testing on May [ ], 2006;

(xii) re [Client D], you failed to document a follow-up visit on May [ ], 2006, to have blood drawn for testing;

(xiii) re [Client D], you failed to complete the chart “sticker”, sign the chart entry, and complete [certain] forms for the clinic visit on May [ ], 2006;

(xiv) re [Client E], you failed to document whether or not blood was drawn for testing on May [ ], 2006;

(xv) re [Client E], you failed to document a follow-up visit on May [ ], 2006, to have blood drawn for testing;

(xvi) re [Client E], you failed to document follow-up with the client after the Laboratory advised the facility on June [ ], 2006, that the specimen taken on May [ ], 2006, had been spoiled;

(xvii) re [Client H], you failed to document whether or not blood was drawn for testing on September [ ], 2005;

(xviii) re [Client H], you failed to document a follow-up visit on October [ ], 2005, to have blood drawn for testing;

(xix) re [Client H], you failed to document a follow-up visit on November [], 2005, to have blood drawn for testing;

(xx) re [Client H], you failed to document any follow-up visit to advise the client of the results of the testing done on November [ ], 2005;

(xxi) re [Client B], you failed to document whether or not blood was drawn for testing on August [ ], 2005;

(xxii) re [Client B], you failed to sign a chart entry dated August [ ], 2005;

(xxiii) re [Client B], you failed to document a follow-up visit on September [], 2005, to have blood drawn for testing;

(xxiv) re [Client B], you failed to label the specimen vials of blood drawn for testing on October [ ], 2005;

(xxv) re [Client B], you failed to document any follow-up visit or attempts to follow up to advise the client of the results of the testing done on October [ ], 2005;

(xxvi) re [Client I], you failed to document a follow-up visit on [sic]

(xxvii) re [Client J], you failed to document whether or not blood was drawn for testing on February [ ], 2007;

(xxviii) re [Client J], you failed to document a follow-up visit on February [ ], 2007;

(xxix) re [Client K], you failed to document whether or not blood was drawn for testing on November [ ], 2006;

(xxx) re [Client K], you failed to document a follow-up visit or attempt to follow-up after November [ ], 2006;

(xxxi) re [Client L], you failed to document whether or not blood was drawn for testing on January [ ], 2007;

(xxxii) re [Client L], you failed to sign a chart entry on January [ ], 2007;

(xxxiii) re [Client L], you failed to document any follow up or attempted follow up, with the client for retesting after the Laboratory advised the facility on February [ ], 2007, that the specimen taken on January [ ], 2007, had been spoiled;

(xxxiv) re [Client L], you failed to document clinic visits on January [ ], 2005, and/or February [ ], 2005, and/or February [ ], 2005;

(xxxv) re [Client L], you failed to complete the chart “sticker” for the clinic visit on January [ ], 2007;

(xxxvi) re [Client M], you failed to document follow-up with the client after the report came back from the Laboratory on June [ ], 2006 indicating that the client was positive for Hepatitis C and was recommended for a Hepatitis B series;

(xxxvii) re [Client M], you failed to sign the chart entry dated May [ ], 2006;

(xxxviii) re [Client N], you failed to document follow-up or attempts to follow up with the client for retesting after the Laboratory advised the facility on September [ ], 2005, that the specimen taken on August [ ], 2005, had been spoiled;

(xxxix) re [Client O], you failed to document whether or not blood was drawn for testing on October [ ], 2004;

(xl) re [Client O], you failed to document follow-up with the client after the report came back from the Laboratory in November 2004 that a sample taken from the client had tested Hepatitis C positive;

(xli) re [Client O], you failed to document any steps taken to notify relevant authorities that the client was positive for Hepatitis C;

(xlii) re [Client P], you failed to sign the chart entry dated May [ ], 2006;

(xliii) re [Client P], you failed to document whether test results were provided to the client after the test results were received by the clinic on May [ ], 2006;

(xliv) re [Client Q], you failed to complete [certain] forms for the clinic visit on February [ ], 2005;

(xlv) re [Client Q], you failed to document follow up or attempts to follow-up after the Laboratory advised the facility that the specimen taken on February [ ], 2005 had been spoiled;

(xlvi) re [Client R], you failed to document follow-up with the client after the report came back from the Laboratory on October [ ], 2004, indicating that the client was Hepatitis C positive;

(xlvii) re [Client C], you failed to document that you did not send a sample taken for testing on February [ ], 2007 to the lab for testing;

(xlviii) re [Client C], you failed to document a follow-up visit or attempt to follow up after February [ ], 2007.

Member’s Plea

At the outset of the hearing, College Counsel advised that the College was not proceeding with the allegations number 1(b)(i)-(iv), 2(v), 2(vi), 2(viii), 2(xxvi), 2(xxvii), 2(xxviii), 3(b)(i)-(iv), 3(c)(v), 3(c)(vi), 3(c)(viii), 3(c)(xxvi), 3(c)(xxvii), and 3(c)(xxviii).

Oscar Albert Reimer (“the Member”) admitted all other allegations set out in the Notice of Hearing. The panel received a written plea inquiry which was signed by the Member. The panel also conducted an oral 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 which provided as follows.

THE MEMBER

1. The Member, Oscar Albert Reimer (the “Member’), is a Registered Nurse (“RN”). He received his degree [ ] in 1998 and has been registered with the College of Nurses of Ontario (the “College”) since July 17, 1998. The Member is up-to-date with his annual fees. He is currently employed.

2. The Member secured full-time employment with [the Facility] some time in 2001. His employment was terminated on or about March [ ], 2007, as a result of the incidents that form the basis of the allegations set out below.

3. The Member has no prior discipline regarding his performance at [the] Facility nor does the Member have any prior history with the College.

4. The Member received positive comments for his work at the Facility from colleagues and community partners who praised him for his approach with vulnerable client populations. The Member has received positive performance appraisals from his current employer, most recently in December of 2009, where his performance was rated as exceeding standards in all areas.

THE FACILITY

5. The Facility is an accredited, non-profit, organization that provides essential community health service to a population of approximately 265,700 people [ ]. Programs offered by the Facility include: programs that promote healthy infant and child development, responsive parenting; programs for the prevention of cancer, heart disease, substance abuse and other health issues.

6. The Facility also offers a sexual health clinic which includes screening for Sexually Transmitted Infections (STIs) and anonymous Human Immunodeficiency Virus (HIV) testing. The Member worked at two (2) off-site locations that provided these services to clients: [Agency A and Agency B]. The off-site locations are not part of the Facility but provide space to the Facility to offer STI and anonymous HIV testing services. [ ].

7. Agency A provides services to homeless and at-risk youth [ ]. Client services provided by Agency A include: laundry/shower facilities, and a drop-in health clinic, which was staffed by the Member once per week for a two-hour session.

8. Agency B is a drug rehabilitation centre offering residential treatment to clients. It offers long-term residential addiction treatment programs for men and for women among other programs and services. A drop-in health clinic was offered separately to male and female clients at Agency B and was also staffed by the Member once per week [ ]. [ ]

9. The allegations in the present case arose at off-site Sexual Health Clinics held at Agency A and Agency B. These were walk-in clinics that did not require a scheduled appointment. Services offered to clients at these clinics included: prevention; testing for STIs and HIV; counseling (pre-and post-testing) and administration of vaccinations. The clinics took place weekly, [ ]. The Member attended at these clinics every two weeks. Facility staff who attended these clinics, including the Member, were required to be mobile and transport supplies, charts, and blood samples. There was no secure storage for client charts at either Facility A or Facility B.

10. In addition to the Member’s duties at Agencies A and B, the Member staffed off-site clinics at other locations in the vicinity. He was required to attend these clinics either weekly or every two weeks [ ]. While at the Facility, the Member was also involved in other special projects and programs including but not limited to: working with an Addiction Counsellor on a needle exchange program; a condom campaign, drug awareness and participating in various committees.

11. The Member was required to and did transport client charts in a bag when he attended off-site clinics. As it was not possible to determine which clients would attend at either Agency A or Agency B in a given week, there were instances when the Member would not have the required chart when a client attended. Further, the Member was required to transport blood samples in a cooler or specimen bag.

12. Some of the clients who attended these offsite clinics were disadvantaged and faced challenges including substance dependency, poverty, homelessness and abuse. Follow-up communication with these clients was sometimes difficult because of limited contact information or lack of response from the clients.

INCIDENTS RELEVANT TO THE ALLEGATIONS OF PROFESSIONAL MISCONDUCT

13. The Member was assigned to the Facility’s Sexual Health Team. As part of the Sexual Health Team, his duties evolved over time, and consisted of a number of different components. The Member was responsible for three off-site clinics every week and every other week he was assigned to work in the Sexual Health Clinic at the main site of the Facility.

14. Clients at the off-site clinics were offered blood work testing for specific STIs and for HIV. The Member was involved in providing clients with counselling pre- and post-testing, administration of vaccinations, as well as taking specimens (i.e. blood, urine) from clients to be forwarded to [the Laboratory] for testing. Specimens drawn for STI [and HIV] testing were forwarded to [laboratories in different locations]. In addition to his clinic duties, the Member was worked on various special projects and programs at the Facility that focussed on different aspects of health promotion and prevention.

15. On or about March [ ], 2007, the Program Manager at the Facility, [ ], was informed by a staff nurse that [the Laboratory] had contacted the Facility several times about unsuitable blood specimens. [The Laboratory] had received numerous specimens from the Facility that were unsuitable for testing because they had haemolysed. Haemolysis is the breakdown of blood cells which renders the blood specimen unusable. The Member met with [the manager] on or about March [ ], 2007. On the same date, [the manager] initiated an audit of client charts for clients assigned to the Member.

16. On or about March [ ], 2007, the Facility made a decision to suspend the Member’s work privileges with pay pending further investigation. The Member was issued a suspension notice and left the Facility. The Facility terminated the Member’s employment on March [ ], 2007, as a result of the findings from the Facility’s audit of the Member’s client charts.

RESULTS FROM AUDIT OF CLIENT CHARTS BY THE FACILITY

[Client A]

17. At the meeting between [the manager] and the Member on or about March [ ], 2007, [the manager] asked to see the chart for [Client A]. This was one of the clients for whom [the Laboratory] had contacted the Facility to advise that the blood sample sent was unsuitable for testing because it had haemolysed.

18. The Member brought the chart for [Client A] to [the manager], who reviewed the chart. According to [a form] completed by the Member for this client, the Member had seen [Client A] on January [ ], 2007, and the Member noted the following under Reason(s) for Visit: “HIV-HEP A-B-C tests”. The Member also completed an STI Counselling sticker which had been placed on the Client Care Notes and [an assessment form] for [Client A]. The Member also drew a blood sample from [Client A] on January [ ], 2007, to be sent to [the Laboratory] for testing. The Member did not complete a [requisition form] for the sample drawn, did not chart the drawing of the blood in the Client Care notes, and acknowledged that it was never sent to [the Laboratory].

19. Further review of the chart revealed that the Member saw [Client A] again on January [ ], 2007, and redrew blood for testing at that visit. The Member documented the visit in the Client Care Notes and wrote the following: “A) Notified client of untested sample. Blood redrawn for [sic] above testing”. In addition to the entry in the Client Care Notes, the Member completed a [requisition form] dated January [ ], 2007. According to [the Laboratory] Report, the sample collected was received by [the Laboratory] on or about February [ ], 2007. On February [ ], 2007, [the Laboratory] contacted the Facility and again advised that the specimen had haemolysed and was unsuitable for testing.

20. According to the Member, he had a follow-up visit with [Client A] on February [ ], 2007. Blood was redrawn by the Member and was sent to [the Laboratory]. [The Laboratory] received the sample on February [ ], 2007. The Member admits that he did not document his visit with the client on February [ ], 2007, nor did he document that blood was drawn on that date.

[Client L]

21. [The manager] audited the file for [Client L]. She reviewed the Clinic Database which is used to track client contacts and reason for client visits, the Client’s chart, and the laboratory reports from [the Laboratory]. [An initial form] in [Client L]’s file was dated May [ ], 2004, with the Reason for Visit noted as “Testing”. A corresponding entry dated May [ ], 2004, signed by the Member, was made in the Client Care Notes indicating the following: “Never been tested. Blood sample obtained for Hep A/B/C + VDRL testing”.

22. According to the Clinic Database, [Client L] visited the Facility on January [ ], 2005, for general STI counselling. The client visited the Facility again on February [ ], 2005, to receive her test results and then on February [ ], 2005 to receive an initial dose of vaccine for Hepatitis B from the Member. The client saw the Member on all three occasions but the Member failed to document these clinic visits in the Client Care Notes.

23. An entry was made in the Client Care Notes dated January [ ], 2007. The Member did not sign this entry and he did not complete the STI Counselling sticker placed in the Client Care Notes. The Member failed to document whether blood was drawn from [Client L] despite the fact that [the Laboratory] Report indicates that a sample was collected on January [ ], 2007, and received by [the Laboratory] on February [ ], 2007.

24. [The Laboratory] contacted the Facility on February [ ], 2007, to advise them that the sample had haemolysed and was unsuitable for testing. The Facility was informed that the client would have to be recalled. The Member did not document any follow-up or attempted follow-up with [Client L] for retesting.

[Client C]

25. [Client C] first attended the Facility on February [ ], 2007, and was seen by the Member. The reason for the visit was testing for Hepatitis A and B. The Member completed a STI Counselling sticker which was placed in the Client Care Notes for the February [ ], 2007 entry. The Member indicated in the Client Care Notes that a blood sample had been obtained on February [ ], 2007.

26. [The manager] found no [Laboratory] report in [Client C]’s file. She telephoned [the Laboratory] on or about March [ ], 2007, and was advised that [the Laboratory] received no specimens for this client. The Member failed to send the sample drawn on February [ ], 2007 to [the Laboratory] for testing. There is no indication that the Member followed up with the client.

[Client K]

27. The Member saw [Client K] on November [ ], 2006 and completed [certain forms] and the STI Counselling sticker which was placed in the Client Care Notes. The Member documented in the Client Care Notes the following: “client testing to ensure status”. The Member failed to document whether blood was indeed drawn for testing on November [ ], 2006. According to [the manager]’s audit of the client’s file, there was no documentation to indicate that [the] Member had sent the sample for testing to [the Laboratory] if it had indeed been drawn.

28. If [Client K] were to testify, she would say that she recalls that a blood sample was taken. She does not recall receiving any results nor being informed that a further sample was required.

[Client D]

29. The Member saw [Client D] the first time on May [ ], 2006 for HIV and STI testing. The Member completed [an initial form] for the client indicating that the reasons for the visit were “HIV STD’s”. He placed the STI Counselling sticker in the Client Care Notes but did not complete it. The Member noted on the STI Counselling sticker that [an assessment form] was completed but no such form was found in the client’s chart.

30. A [requisition form] was completed by the Member for [Client D] and dated May [ ], 2006. A blood sample was drawn but the Member made no documentation of this on the Client Care Notes. The sample collected by the Member on or about May [ ], 2006 was received by [the Laboratory] on June [ ], 2006. [The Laboratory] contacted the Facility on June [ ], 2006, to inform them that the sample was unsuitable for testing because it had haemolysed.

31. If [Client D] were to testify, she would say that she only became aware that the sample drawn by the Member had haemolysed and could not be tested for Hepatitis when she spoke with [the manager] by telephone on or about May [ ], 2007, following [the manager]’s audit of the Member’s charts.

[Client E]

32. [Client E] was a client in the residential program at Agency B [in 2006].

33. [Client E] first saw the Member on May 24, 2006 for testing. [Certain forms] and the STI Counselling sticker in the Client Care Notes [were] completed by the Member. The Member did not chart on the Client Care Notes whether blood was drawn on May [ ], 2006.

34. A [requisition form] was completed for [Client E] and dated May [ ], 2006. A corresponding [Laboratory] Report was found in the client’s file showing that a sample was collected on May [ ], 2006 and received by [the Laboratory] on June [ ], 2006.

35. The Facility received a telephone call from [the Laboratory] on June [ ], 2006, advising them that the sample received on June [ ], 2006 had haemolysed and was unsuitable for some testing. The Facility was informed that the client would have to be recalled.

36. If he testified, [Client E] would say that he first learned that his blood samples taken in May 2006 had haemolysed and never been tested for Hepatitis when he was contacted by [the manager] in May 2007.

37. If the Member were to testify, he would say that he advised [Client E] that he had tested negative for Syphilis but would need to be retested for Hepatitis.

38. The Member failed to document any follow-up with [Client E] to inform him that the samples collected for Hepatitis testing had spoiled and could not be tested.

[Client P]

39. [Client P]’s first visit was on or about March [ ], 2006. The Member completed [an initial form] and STI Counselling sticker for the client. The Member’s entry in the Client Care notes for that date indicates that a blood sample was taken for testing. [Laboratory] Reports confirm the sample collected on March [ ], 2006, was received by [the Laboratory] on March [ ], 2006 and tested for Hepatitis A, B and C.

40. In the entry dated May [ ], 2006, in the Client Care Notes for [Client P,] the Member writes that the focus of the visit was “results”, however, there is no charting by the Member as to whether results were indeed provided to [Client P]. Further, the Member did not sign the entry at May [ ], 2006 in the Client Care Notes nor is the entry complete. If the Member were to testify, he would state that at the May [ ], 2006 visit, he communicated the test results, gave the client education material and referred the client to his physician for follow-up but acknowledges that he did not chart any of this information.

[Client M]

41. The Member saw [Client M] for the first time on May [ ], 2006. The Member completed [an initial form] and the STI Counselling sticker for the client and also charted in the Client Care Notes that a blood sample was obtained for testing. The Member did not sign the May [ ], 2006, entry in the Client Care Notes.

42. On or about June [ ], 2006, [the Laboratory] provided the Facility with a report for [Client M] indicating that the client was susceptible to Hepatitis B and that there was evidence of the Hepatitis C antibody. A note on [the Laboratory] Report from the Nurse Practitioner indicates: “Recommend Hep B series & Hep A vaccine. Inform re Hep C status.”

43. There were no further entries in the Client Care Notes by the Member nor was there any other documentation indicating that the Member had seen the client following the receipt of the test results from [the Laboratory].

44. If the Member were to testify, he would state that he wrote the word “June” in the Client Care Notes for [Client M] and recalls following up with the client in June. The Member admits that he failed to document his follow-up with the client.

[Client H]

45. The Member first saw [Client H] on September [ ], 2005, completing [an initial form] and the STI Counselling Sticker. He failed to document in the September [ ], 2005 entry in the Client Care Notes whether blood was drawn for testing. The Member charted the following: “testing to ensure status”.

46. Two separate [Laborator] Report forms were found in the client’s file. On one of the forms, the date the collection date was noted as October [ ], 2005 and [the Laboratory] received the sample on October [ ], 2005. The specimen was haemolysed and not tested by [the Laboratory]. The Member failed to document any follow-up visit with [Client H] on October [ ], 2005, or to have blood drawn for testing in the Client Care Notes. The second form showed that a sample was redrawn for testing on November [ ], 2005 and received by [the Laboratory] on November [ ], 2005. The Member failed to document the fact that he made a follow-up visit on November [ ], 2005 and on that date, blood was drawn for testing.

[Client N]

47. [Client N] first saw the Member on August [ ], 2005, as evidenced by the [initial form] and STI Counselling Sticker at the August [ ], 2005 entry in the Client Care notes. The Member charted in the Client Care Notes that on August [ ], 2005, blood had been drawn for Hepatitis A, B and C testing. [The Laboratory] Report shows that the sample was received by [the Laboratory] on September [ ], 2005.

48. [The Laboratory] contacted the Facility on September [ ], 2005, and advised them that the specimen had haemolysed and was unsuitable for testing. The Member failed to document follow-up or make any attempts to follow up with the client for retesting. The Facility attempted to follow up with the client some time in May 2007, after [the manager]’s audit of the Member’s client charts.

[Client B]

49. The documentation in [Client B]’s chart shows that the Member’s first visit with the client was on August [ ], 2005. The Member failed to document whether blood was drawn for testing on August [ ], 2005 in the Client Care Notes and did not sign the chart entry.

50. On or about September [ ], 2005, the Member saw [Client B] and a blood sample was drawn for testing, according to [the Laboratory requisition form] completed by the Member and [the Laboratory] Report. The Member did not chart this visit in the Client Care Notes nor did he chart that blood was drawn for testing. [The Laboratory] contacted the Facility on September [ ], 2005 because the specimen had haemolysed and was unsuitable for testing.

51. The Member saw the client again on October [ ], 2005 and blood was drawn for testing. The Member completed a [requisition form] but failed to label the samples drawn for testing. [The Laboratory] contacted the Facility about the unlabelled samples, which were not tested. The Member failed to document any follow-up visits or attempts to follow up to advise [Client B] that the samples drawn on October [ ], 2005, could not be tested.

[Client Q]

52. The Member saw [Client Q] on February [ ], 2005 for the first time. The Member obtained a blood sample from the client for testing. The Member further charted on the STI Counselling sticker in the Client Care Notes that he had completed [an assessment form] for the client but no form was found in the client’s file.

53. [The Laboratory] received the sample on March [ ], 2005 but it had haemolysed and could not be tested. The Member failed to document any follow-up or attempts to follow up with the client.

[Client O]

54. The Member saw [Client O] on or about October [ ], 2004, and completed STI Counselling but did not document whether or not blood as drawn for testing on that date in the Client Care Notes. The Member completed a [requisition form] for the client dated October [ ], 2004.

55. On or about November [ ], 2004, the Facility received [the Laboratory] Report indicating that the client was Hepatitis C positive. The Member attempted to contact [Client O] despite the fact that the Member did not have any contact information for the client. The Member, however, failed to document his attempts to follow up with the client concerning the positive test results. Further, if the Member were to testify, he would state he recalls following up with the Communicable Disease Team at the Facility as they had the responsibility for forwarding any positive results to the relevant provincial authorities, but did not document his follow-up efforts. Hepatitis C is a reportable disease under Ontario Regulation 559/91 and the Health Protection and Promotion Act.

[Client R]

56. The client was seen by the Member on September [ ], 2004. The Member offered STI Counselling to the client and a blood sample was obtained for testing. The sample was received by [the Laboratory] on October [ ], 2004. According to [the Laboratory] Report received by the Facility on October [ ], 2004, the client tested positive for Hepatitis C.

57. According to [the manager]’s audit of the client’s chart, the positive Hepatitis C results were reported to the appropriate provincial authorities, but the Member failed to document any follow-up with the client following the receipt of the positive Hepatitis C results from [the Laboratory].

Anonymous HIV Clients

58. [The manager] discovered from her audit that certain of the Member’s client charts for clients who had requested anonymous HIV testing revealed a number of inconsistencies.

59. The Member saw [Client F] on January [ ], 2007, according to the Client Care Notes where the Member had placed the Anonymous HIV Pre-Test Counselling sticker that he had completed. The Member failed to document whether [ ] blood was drawn for testing at the January [ ], 2007 visit.

60. The Member saw [Client F] again on January [ ], 2007, but failed to document this in the Client Care Notes. The Member completed an [anonymous HIV form] for the client and under “Date Specimen Collected”, the Member filled out 2007/01/[ ]. According to [the Laboratory] report for [Client F], the sample collected on January [], 2007 and received by [the Laboratory] on February [ ], 2007 for HIV testing had haemolysed and could not be tested.

61. The Member saw [Client G] on February [ ], 2007, and completed an anonymous HIV Pre-Test Counselling sticker for the client that was placed on the Client Care Notes. The Member failed to chart on the Client Care Notes whether blood was drawn for testing. A [Laboratory] Report was found in the client’s file reflecting that a sample was collected on February [ ], 2007 and received by [the Laboratory] on February [ ], 2007. [The Laboratory] could not test the sample as it was grossly haemolysed.

62. Given the anonymous nature of the testing, client charts did not contain contact information. In most cases, clients could not easily be located and contacted, and would only be advised of the need for a further sample if the client re-attended at a clinic with his/her confidential client number.

Policies and Procedures for STI and (anonymous) HIV Testing

63. At all relevant times, the Facility had policies and protocols relating to STI and HIV testing that nursing staff were to follow at all times. Confidential testing and treatment of STIs was offered by the Facility to all clients through the main site or at off-site locations. Clients could decide whether to have STI testing, HIV-testing (anonymous or otherwise), or both. Charts for anonymous HIV testing were maintained separately from other charts pertaining to the same client.

64. The general procedure for STI and HIV testing was similar. At a client’s first visit, nursing staff were required to complete [an initial form and an assessment form] and to complete an STI Counseling sticker containing screening information for the client which would then be appended to the Client Care Notes. Facility staff provided pre-test counseling to clients, covering topics such as: confidentiality; the potential that positive results would have to be reported to the relevant government agencies; assessment and discussion of risk factors; obtaining information regarding prior STIs and treatments; discussion of safe practices; and discussion on how to access other services. This part of the visit also included the provision of informed consent to have blood drawn for STI/HIV testing. It was only after these requisite steps were completed, that a nurse was authorized to draw blood.

65. HIV testing involved a similar procedure prior to drawing blood, however, there was the added element that the testing was anonymous. There is a separate chart for HIV testing, which does not contain the name of the client, but a number that corresponds to a number provided to the client. A client undergoing HIV testing would be provided with [ ] a code number corresponding to the code number in the chart for each HIV test performed on the client. A [client] undergoing both STI and HIV testing would thus have two separate charts.

66. If a client visited a clinic for testing, blood was not necessarily drawn. In some cases, Facility staff nurses were unable to draw blood from clients who were IV drug users; clients would sometimes not consent to testing after counseling was provided; or there was a lack of supplies with which to draw blood.

67. The Facility’s written policy on Investigations and Treatment stated that after the physical examination was complete, specimens were to be properly labeled and placed in the proper location for delivery to [the Laboratory]. This includes completing an STI Chart Label, documenting in the client care notes, completing a laboratory requisition, and ensuring that the label placed on the specimen had the same information as on the laboratory test requisition. According to the policy, specimens to be tested for STI were to be placed in the fridge for pick-up by the courier the next day. Blood specimens can become haemolysed if not stored and handled properly. The Facility’s policies are silent on the time-frame within which blood specimens drawn for STI or HIV testing must be processed by [the Laboratory].

68. Clients were advised to contact the Facility to obtain their test results within a certain time frame which was dependent on the type of specimen drawn and the testing to be done. In the case of anonymous HIV testing, clients would be given [a number]. In order to obtain the test results, clients were required to return in person with their [number]. Anonymous HIV test results could only be communicated to clients in person, unlike results for STI test results which could be delivered over the telephone. The Facility followed strict protocols about not providing hard copies of anonymous-HIV test results to clients and not providing test results to clients who did not return with their [number].

ADMISSIONS OF PROFESSIONAL CONDUCT

69. The Member admits that he contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as set out in Allegation 1 of the Notice of Hearing in that between May 2004 and March 29, 2007, while he was working as a registered nurse at [Agency A] and [Agency B], [ ] he:

a. Failed to take the appropriate steps to ensure that blood specimens drawn by him were sent to [the Laboratory] for testing in a timely and/or accurate manner, or at all, including specimens from the following clients:

(i) [Client A];

(ii) [Client B];

(iii) [Client C],

70. The Member admits that he has committed an act or acts of professional misconduct as set out in allegation 2 of the Notice of Hearing in that between May 2004 and March 29, 2007, while he was working as a registered nurse at [Agency A] and [Agency B], he failed to keep records as required, in that:

(i) re [Client A], he failed to document whether or not blood was drawn for testing on January [ ], 2007;

(ii) re [Client A], he failed to document that he did not send the sample taken on January [ ], 2007, to the lab for testing;

(iii) re [Client A], he failed to document a follow-up visit on February [ ], 2007, to have blood drawn for testing;

(iv) re [Client F], he failed to document whether or not blood was drawn for testing on January [ ], 2007;

(vii) re [Client F], he failed to document a follow-up visit on January [ ], 2007, to have blood redrawn for testing;

(ix) re [Client G], he failed to document whether or not blood was drawn for testing on February [ ], 2007;

(x) re [Client A], he failed to document any follow up visits or attempts to contact the client for follow-up after the February [ ], 2007, test results were received;

(xi) re [Client D], he failed to document whether or not blood was drawn for testing on May [ ], 2006;

(xii) re [Client D], he failed to document a follow-up visit on May [ ], 2006, to have blood drawn for testing;

(xiii) re [Client D], he failed to complete the chart “sticker”, sign the chart entry, and complete [certain] forms for the clinic visit on May [ ], 2006;

(xiv) re [Client E], he failed to document whether or not blood was drawn for testing on May [ ], 2006;

(xv) re [Client E], he failed to document a follow-up visit on May [ ], 2006, to have blood drawn for testing;

(xvi) re [Client E], he failed to document follow-up with the client after the Laboratory advised the facility on June [ ], 2006, that the specimen taken on May [ ], 2006 had been spoiled;

(xvii) re [Client H], he failed to document whether or not blood was drawn for testing on September [ ], 2005;

(xviii) re [Client H], he failed to document a follow-up visit October [ ], 2005, to have blood drawn for testing;

(xix) re [Client H], he failed to document a follow-up visit on November [ ], 2005, to have blood drawn for testing;

(xx) re [Client H], he failed to document any follow-up visit to advise the client of the results of the testing done on November [ ], 2005;

(xxi) re [Client B], he failed to document whether or not blood was drawn for testing on August [ ], 2005;

(xxii) re [Client B], he failed to sign a chart entry dated August [ ], 2005;

(xxiii) re [Client B], he failed to document a follow-up visit on September [ ], 2005, to have blood drawn for testing;

(xxiv) re [Client B], he failed to label the specimen vials of blood drawn for testing on October [ ], 2005;

(xxv) re [Client B], he failed to document any follow-up visit or attempts to follow-up to advise [ ] the client of the results of the testing done on October [ ], 2005;

(xxix) re [Client K], he failed to document whether or not blood was drawn for testing on November [ ], 2006;

(xxx) re [Client K], he failed to document a follow-up visit or attempt to follow-up after November [ ], 2006

(xxxi) re [Client L], he failed to document whether or not blood was drawn for testing on January [ ], 2007;

(xxxii) re [Client L], he failed to sign a chart entry on January [ ], 2007;

(xxxiii) re [Client L] he failed to document any follow-up or attempted follow-up with the client for testing after the Laboratory advised the facility on February [ ], 2007, that the specimen taken on January [ ], 2007, had been spoiled;

(xxxiv) re [Client L], he failed to document clinic visits on January [ ], 2005 and February [ ], 2005 and February [ ], 2005;

(xxxv) re [Client L], he failed to complete the chart “sticker” for the clinic visit on January [ ], 2007;

(xxxvi) re [Client M], he failed to document follow-up with the client after the report came back from the Laboratory on June [ ], 2006 indicating that the client was positive for Hepatitis C and was recommended for a Hepatitis B series;

(xxxvii) re [Client M], he failed to sign the chart entry dated May [ ], 2006;

(xxxviii) re [Client N], he failed to document follow-up or attempts to follow-up with the client for retesting after the Laboratory advised the facility on September [ ], 2005 that the specimen taken on August [ ], 2005 had been spoiled;

(xxxix) re [Client O], he failed to document whether or not blood was drawn for testing on October [ ], 2004;

(xl) re [Client O], he failed to document follow-up with the client after the report came back from the Laboratory in November 2004 that a sample taken from the client had tested Hepatitis C positive;

(xli) re [Client O], he failed to document any steps taken to notify relevant authorities that the client was positive for Hepatitis C;

(xlii) re [Client P], he failed to sign the chart entry dated May [ ], 2006;

(xliii) re [Client P], he failed to document whether test results were provided to the client after the test results were received by the clinic on May [ ], 2006;

(xliv) re [Client Q], he failed to complete [certain forms] for the clinic visit on February [ ], 2005;

(xlv) re [Client Q], he failed to document follow-up or attempts to follow-up after the Laboratory advised the facility that the specimen taken on February [ ], 2005 had been spoiled;

(xlvi) re [Client R], he failed to document follow-up with the client after the report came back from the Laboratory on October [ ], 2004, indicating that the client was Hepatitis C positive;

(xlvii) re [Client C], he failed to document that he did not send a sample taken for testing on February [ ], 2007 to the lab for testing;

(xlviii) re [Client C], he failed to document a follow-up visit or attempt to follow-up after February [ ], 2007.

71. The Member admits that he has committed an act or acts of professional misconduct as set out in allegation 3 of the Notice of Hearing in that between May 2004 and March 29, 2007, while he was working as a registered nurse at [Agency A] and [Agency B], he engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional, in that he:

a. Failed to take the appropriate steps to ensure that blood specimens drawn by him were sent to [the Laboratory] for testing in a timely and/or accurate manner, or at all, including specimens from the following clients:

(i) [Client A];

(ii) [Client B];

(iii) [Client C].

c. Failed to adequately document nursing care, in that:

(i) re [Client A], he failed to document whether or not blood was drawn for testing on January [ ], 2007;

(ii) re [Client A], he failed to document that he did not send the sample taken on January [ ], 2007, to the lab for testing;

(iii) re [Client A], he failed to document a follow-up visit on February [ ], 2007, to have blood drawn for testing;

(iv) re [Client F], he failed to document whether or not blood was drawn for testing on January [ ], 2007;

(vii) re [Client F], he failed to document a follow-up visit on January [ ], 2007, to have blood redrawn for testing;

(ix) re [Client G], he failed to document whether or not blood was drawn for testing on February [ ], 2007;

(x) re [Client A], he failed to document any follow-up visits or attempts to contact the client for follow-up after the February [ ], 2007 test results were received;

(xi) re [Client D], he failed to document whether or not blood was drawn for testing on May [ ], 2006;

(xii) re [Client D], he failed to document a follow-up visit on May [ ], 2006 to have blood drawn for testing;

(xiii) re [Client D], he failed to complete the chart “sticker”, sign the chart entry, and complete [certain] forms for the clinic visit on May [ ], 2006;

(xiv) re [Client E], he failed to document whether or not blood was drawn for testing on May [ ], 2006;

(xv) re [Client E], he failed to document a follow-up visit on May [ ], 2006, to have blood drawn for testing;

(xvi) re [Client E], he failed to document follow-up with the client after the Laboratory advised the facility on June [ ], 2006 that the specimen taken on May [ ], 2006 had been spoiled;

(xvii) re [Client H], he failed to document whether or not blood was drawn for testing on September [ ], 2005;

(xviii) re [Client H], he failed to document a follow-up visit October [ ], 2005 to have blood drawn for testing;

(xix) re [Client H], he failed to document a follow-up visit on November [ ], 2005 to have blood drawn for testing;

(xx) re [Client H], he failed to document any follow-up visit to advise the client of the results of the testing done on November [ ], 2005;

(xxi) re [Client B], he failed to document whether or not blood was drawn for testing on August [ ], 2005;

(xxii) re [Client B], he failed to sign a chart entry dated August [ ], 2005;

(xxiii) re [Client B], he failed to document a follow-up visit on September [ ], 2005 to have blood drawn for testing;

(xxiv) re [Client B], he failed to label the specimen vials of blood drawn for testing on October [ ], 2005;

(xxv) re [Client B], he failed to document any follow-up visit or attempts to follow up to advise [ ] the client of the results of the testing done on October [ ], 2005;

(xxix) re [Client K], he failed to document whether or not blood was drawn for testing on November [ ], 2006;

(xxx) re [Client K], he failed to document a follow-up visit or attempt to follow-up after November [ ], 2006;

(xxxi) re [Client L], he failed to document whether or not blood was drawn for testing on January [ ], 2007;

(xxxii) re [Client L], he failed to sign a chart entry on January [ ], 2007;

(xxxiii) re [Client L] he failed to document any follow-up or attempted follow-up with the client for testing after the Laboratory advised the facility on February [ ], 2007 that the specimen taken on January [ ], 2007 had been spoiled;

(xxxiv) re [Client L], he failed to document clinic visits on January [ ], 2005 and February [ ], 2005 and February [ ], 2005;

(xxxv) re [Client L], he failed to complete the chart sticker for the clinic visit on January [ ], 2007;

(xxxvi) re [Client M], he failed to document follow-up with the client after the report came back from the Laboratory on June [ ], 2006 indicating that the client was positive for Hepatitis C and was recommended for a Hepatitis B series;

(xxxvii) re Client HB0311, he failed to sign the chart entry dated May [ ], 2006;

(xxxviii) re [Client N], he failed to document follow-up or attempts to follow up with the client for retesting after the Laboratory advised the facility on September [ ], 2005, that the specimen taken on August [ ], 2005 had been spoiled;

(xxxix) re [Client O], he failed to document whether or not blood was drawn for testing on October [ ], 2004;

(xl) re [Client O], he failed to document follow-up with the client after the report came back from the Laboratory in November 2004 that a sample taken from the client had tested Hepatitis C positive;

(xli) re [Client O], he failed to document any steps taken to notify relevant authorities that the client was positive for Hepatitis C;

(xlii) re [Client P], he failed to sign the chart entry dated May [ ], 2006;

(xliii) re [Client P], he failed to document whether test results were provided to the client after the test results were received by the clinic on May [ ], 2006;

(xliv) re [Client Q], he failed to complete [certain] forms for the clinic visit on February [ ], 2005;

(xlv) re [Client Q], he failed to document follow up or attempts to follow-up after the Laboratory advised the facility that the specimen taken on February [ ], 2005 had been spoiled;

(xlvi) re [Client R], he failed to document follow-up with the client after the report came back from the Laboratory on October [ ], 2004, indicating that the client was Hepatitis C positive;

(xlvii) re [Client C], he failed to document that he did not send a sample taken for testing on February [ ], 2007 to the lab for testing;

(xlviii) re [Client C], he failed to document a follow-up visit or attempt to follow up after February [ ], 2007.

Decision

The panel makes no finding with respect to allegations 1(b)(i)-(iv), 2(v), 2(vi), 2(viii), 2(xxvi), 2(xxvii), 2(xxviii), 3(b)(i)-(iv), 3(c)(v), 3(c)(vi), 3(c)(viii), 3(c)(xxvi), 3(c)(xxvii), and 3(c)(xxviii).

As to the remaining allegations, 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 acts of professional misconduct as alleged in the Notice of Hearing in that the Member:

• contravened a standard of practice of the profession by failing to take appropriate steps regarding the handling of blood samples for three clients;

• failed to keep records as required regarding the blood samples and follow-up care for 14 clients

• Engaged in conduct relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional.

Penalty

Counsel for the College advised the panel that a Joint Submission on Order had been agreed upon. The Joint Submission on Order requests that the panel make an Order as follows:

1. Requiring the Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within three (3) months of the date [of] this Order.

2. Directing the Executive Director to suspend the Member’s certificate of registration for a period of five (5) months. This suspension shall take effect from March 1, 2010 and shall continue to run without interruption so long as the Member maintains a current certificate of registration. In the event that the Member fails to maintain a current certificate of registration, any portion of this suspension which has not yet been served, shall be served commencing on the day that the Member reinstates, renews or obtains a new certificate of registration.

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

   a. The Member shall return his current Annual Payment Card to the College within fourteen (14) days of the date of this Order so that a new Annual Payment Card, indicating that the Member’s certificate of registration is subject to terms, conditions and/or limitations, can be issued upon completion of the suspension. The Member’s Annual Payment Card shall be delivered to the College by a verifiable method of delivery, the proof of which the Member shall retain;

   b. The Member shall attend two (2) meetings with an Expert with expertise in the College standards and professional regulation (the “Expert”) as approved by the Director, Professional Conduct. All costs associated with the meetings shall be borne by the Member. The first meeting shall commence within three (3) months of the date of the Order. The second meeting shall take place within three (3) months of the first meeting and all two (2) meetings shall be completed within six (6) months of the date of the Order.

   c. Prior to attendance at the meeting referred to in paragraph 3(b) above, the Member shall:

    i. Provide the Expert with a copy of the Discipline Panel’s Order, Notice of Hearing, the Agreed Statement of Facts, the Joint Submission on Order, and the Panel’s written Decision and Reasons, if available, delivered through the use of a verifiable method of delivery, the proof of which the Member shall retain. If the Panel’s Decision and Reasons are not available prior to the Member’s first meeting with the Expert, the Member shall deliver to the Expert, through the use of a verifiable method of delivery, the proof of which the Member shall retain, a copy of the Panel’s Decision and Reasons within 14 days of their release;
   
    ii. Review College Publications: Confidentiality and Privacy – Personal Health Information; Documentation, Revised 2008; Ethics; and Professional Standards, Revised 2002. The Member shall complete a Reflective Questionnaire for each publication and bring the completed Reflective Questionnaires to his meetings with the Expert;
   
    iii. Complete the College’s online learning modules relating to Documentation; Ethics; and Professional Standards and complete the online participation form relevant to each module, and print and bring the completed online participation form[s] to his meeting with the Expert;
   
    iv. Deliver to the Expert by a verifiable method of delivery copies of the completed Reflective Questionnaires for each publication and completed online participation form(s) as set out in paragraphs 3(c)(ii) and (iii) above, at least seven (7) days prior to his first meeting with the Expert. If the completed Reflective Questionnaires for each publication and completed online participation form(s) are not received by the Expert, the Expert can cancel the first meeting.
   

   d. The subject of the meetings with the Expert shall include the following:

    i. The conduct for which the Member was found to have committed professional misconduct;
   
    ii. The potential consequences of that conduct to his clients, his colleagues, his profession and himself;
   
    iii. The responsibilities the Member has as a regulated health professional;
   
    iv. Strategies for making the inappropriate conduct unlikely to occur in the future; and
   
    v. The development of a learning plan.
   

   e. During the first meeting with the Expert, the Member shall develop a learning plan in consultation with the Expert to address the subject of the meetings as set out in paragraphs 3(d)(i) to 3(d)(v) above;

   f. During the second meeting with the Expert, the Member and the Expert shall further discuss the subject of the meetings as set out in paragraphs 3(d)(i) to 3(d)(v) above and, if applicable, the implementation of the learning plan;

   g. Once the Member has completed all the meetings with the Expert referred to in paragraph 3(b), above, the Director shall receive from the Expert within forty-five (45) days a report, delivered through the use of a verifiable method of delivery, proof of which the Expert shall retain, in which the Expert confirms:

    i. that the Member has attended the meetings with the Expert;
   
    ii. that the subject of the meetings [was] the Member’s inappropriate conduct, the consequences of his conduct in the nursing context, the responsibilities the Member has as a regulated health professional, the strategies for making the inappropriate conduct unlikely to occur in the future and the development of a learning plan with the Member;
   
    iii. her/his assessment of the Member’s insight into his actions; and
   
    iv. that she/he received copies of the Discipline Panel’s Order, the Agreed Statement of Facts, the Joint Submission on Order, and, if available, the Panel’s Decision and Reasons;
   

   h. For a period of twenty-four (24) months following the date upon which the Member returns to the practice of nursing, the Member shall:

    i. notify the Director of the name, address, and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position. Notification shall be in writing and through the use of a verifiable method of delivery, the proof of which the Member shall retain;
   
    ii. provide his employer(s) with a copy of the Panel’s Penalty Order, the Notice of Hearing, Agreed Statement of Facts, Joint Submission on Penalty and, if available, the Panel’s written Decision and Reasons, together with any attachments. If the Decision and Reasons are not available on the day that the Member returns to [p]ractice, the Member shall provide his employer with a copy of the Decision and Reasons within fourteen (14) days of it becoming available;
   
    iii. only practi[s]e for an employer(s) who agrees to, and does write to the Director, within fourteen (14) days of the commencement or resumption of the Member’s employment, and provide the Director with the following:
   
        A. confirmation that the employer(s) has received a copy of the documents referred to in paragraph 3(h)(ii) above;
   
        B. confirmation that the employer agrees to notify the Director immediately upon receipt of any reasonable information that the Member has breached the standards of practice of the profession; and
   
        C. confirmation that the employer(s) agrees to provide the Director with written confirmation that the Member’s charts have been reviewed by the employer as set out in paragraph (iv) below;
   
    iv. The Member’s employer(s) shall conduct audits of the Member’s charts and documentation at the intervals of three (3) months, six (6) months, twelve (12) months, eighteen (18) months and twenty-four (24) months of employment. The Member’s employer(s) shall provide written confirmation to the Director that the Member’s charting and documentation has been reviewed and meet with both the College and employer(s) standards at each of the six (6), twelve (12) and twenty-four (24) month intervals.
   

Penalty Submissions

Counsel for the College submitted that the penalty offered both general and specific deterrence. It sends a strong message to the profession as a whole and a specific message to the Member that this behaviour will not be tolerated. Counsel stated that the penalty will ensure protection of the public and rehabilitation of the Member.

Counsel for the defence introduced some mitigating factors and reminded the panel that the Member accepted responsibility and acknowledged the seriousness of his conduct, actions and omissions.

Penalty Decision

The panel accepts the Joint Submission on Order.

Reasons for Penalty Decision

The panel concluded that the proposed penalty meets the principles of deterrence, both specific and general, rehabilitation, and protection of the public. The panel recognizes that the Member accepts responsibility for his actions and has cooperated with the College.

I, Dennis Curry, RN, 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

Panel Members:

Judie Coutts, RN

Angela Verrier, RPN

Joan King, Public Member

Margaret Tuomi, Public Member