College of Nurses of Ontario v. Taylor, 2013 ONCNO 93851

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: April Plumton, RPN Chairperson Karen Laforet, RN Member Barbara Titley, RPN Member Catherine Egerton Public Member Mary MacMillan-Gilkinson Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) EMILY LAWRENCE for ) College of Nurses of Ontario

• and - )

SONIA TAYLOR ) NO REPRESENTATION for Registration No. JF675298 ) Sonia Taylor

) Heard: September 16, 2013

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on September 16, 2013, at the College of Nurses of Ontario (“the College”) at Toronto.

The Allegations

The allegations against Sonia Taylor (the “Member”) as stated in the Notice of Hearing dated May 28, 2013, are as follows.

IT IS ALLEGED THAT:

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(1) of Ontario Regulation 799/93, in that, while employed as a Registered Practical Nurse at [the Clinic] in [ ] Ontario, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession with respect to the following incidents:

a. you dispensed to [Client A], 10 Fentanyl patches without a physician’s order and/or without appropriate delegation, on or about March 21, 2010;

b. you failed to review the medical records of [Client A], before dispensing Fentanyl patches to him, on or about March 21, 2010;

c. you failed to document your dispensing of 10 Fentanyl patches to [Client A], in an electronic medical record, on or about March 21, 2010;

d. you dispensed medication to [Client B], in a dose or method other than was prescribed, in that you instructed [Client B] to cut a 50 mcg Fentanyl patch in half before applying it, on or about June 27, 2009;

e. you failed to report a medication error in respect of [Client B], to [Client B]’s physician, on or about June 27, 2009;

f. you failed to obtain confirmation of a client’s prior dose of Methadone before administering Methadone to [Client C], and/or you failed to keep a record of that confirmation, on or about June 28, 2009;

g. you administered the wrong dose of Methadone to [Client C], on or about June 28, 2009;

h. you failed to report a medication administration error in respect of [Client C], to [Client C]’s physician, on or about June 28, 2009;

i. you administered medication to [Client D], in a dose or method other than was prescribed, in that you instructed [Client D] to consume a partial dose of Methadone, on or about January 10, 2010;

j. you administered Methadone to [Client D], that was prescribed to another client and/or prescribed to [Client D] for another date, on or about January 10, 2010; and/or

k. you failed to report to the physician of [Client D] that, on or about January 10, 2010, you administered Methadone to [Client D] that was prescribed to another client and/or prescribed to [Client D] for another date, and/or that you instructed [Client D] to consume a partial dose of Methadone; 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(13) of Ontario Regulation 799/93, in that, while employed as a Registered Practical Nurse at [the Clinic] in [ ] Ontario, you failed to keep records as required, as follows:

a. you failed to document dispensing 10 Fentanyl patches to [Client A], in an electronic medical record, on or about March 21, 2010; 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 (the “Act”), and defined in subsection 1(19) of Ontario Regulation 799/93, in that, while employed as a Registered Practical Nurse at [the Clinic] in [ ] Ontario, you contravened a provision of the Act, the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, as amended (the “RHPA”), or the regulations under either of those Acts, as follows:

a. you contravened section 27(1)(b) of the RHPA by performing an unauthorized controlled act, namely, dispensing a drug, Fentanyl, to [Client A] on or about March 21, 2010, without appropriate delegation; 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(37) of Ontario Regulation 799/93, in that, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional with respect to the following incidents:

a. you dispensed to [Client A] 10 Fentanyl patches without a physician’s order and/or appropriate delegation, on or about March 21, 2010;

b. you failed to review the medical records of [Client A], before dispensing Fentanyl patches to him, on or about March 21, 2010;

c. you failed to document your dispensing of 10 Fentanyl patches to [Client A], in an electronic medical record, on or about March 21, 2010;

d. you dispensed medication to [Client B], in a dose or method other than was prescribed, in that you instructed [Client B] to cut a 50 mcg Fentanyl patch in half before applying it, on or about June 27, 2009;

e. you failed to report a medication error in respect of [Client B], to [Client B]’s physician, on or about June 27, 2009;

f. you failed to obtain confirmation of a client’s prior dose of Methadone before administering Methadone to [Client C], and/or you failed to keep a record of that confirmation, on or about June 28, 2009;

g. you administered the wrong dose of Methadone to [Client C], on or about June 28, 2009;

h. you failed to report a medication administration error in respect of [Client C], to [Client C]’s physician, on or about June 28, 2009;

i. you administered medication to [Client D], in a dose or method other than was prescribed, in that you instructed [Client D] to consume a partial dose of Methadone, on or about January 10, 2010;

j. you administered Methadone to [Client D], that was prescribed to another client and/or prescribed to [Client D] for another date, on or about January 10, 2010; and/or

k. you failed to report to the physician of [Client D], that, on or about January 10, 2010, you administered Methadone to [Client D] that was prescribed to another client and/or prescribed to [Client D] for another date and/or that you instructed [Client D] to consume a partial dose of Methadone.

Member’s Plea

The Member admitted the allegations set out in paragraphs numbered 1 (a), (b), (c), (d), (e), (f), (g), (h), (i), (j), (k); 2 (a), 3 (a), and 4 (a), (b), (c), (d), (e), (f), (g), (h), (i), (j), (k) 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

THE MEMBER

1. Sonia Taylor (the “Member”) obtained a diploma in nursing [ ] in 2006.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Practical Nurse (“RPN”) on November 30, 2006. The Member was suspended for non-payment of fees between February 15, 2011 and February 1, 2013. The Member was administratively revoked on February 1, 2013.

3. The Member was employed at [the Clinic] from April 6, 2009, to April 1, 2010.

THE CLINIC

4. The Clinic is located in [ ] Ontario.

5. The Member worked at the Clinic as a full-time, staff nurse on the day and weekend shift. [Dr. A] and [Dr. B] were physicians associated with the Clinic.

6. The Clinic provided help to clients suffering from addictions and pain management issues. The Clinic required clients to come in to have their Fentanyl patches removed and applied because there had been issues with diversion of Fentanyl patches in the past. However, some clients were permitted to carry patches (more than one at a time).

7. Nurses at the Clinic, including the Member, were delegated to administer Methadone to clients as per the Clinic’s Delegation and Acceptance Statement. There was no formal directive for Fentanyl administration, but [Dr. A] delegated the administration and dispensing of Fentanyl to nurses at the Clinic, including the Member.

8. The Clinic maintained two records for each client receiving Fentanyl patches: 1) an electronic medical record (“EMR”) and/or hard copy medical record, and 2) a medication administration record (“MAR”).

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

[Client A]

9. [Client A] was a client at the Clinic who was seeing [Dr. A] for Fentanyl patches by prescription. [Client A] regularly attended at the Clinic to have patches removed and applied.

10. Between December 2009 and February 2010, [Client A]s’ prescription was for Fentanyl 175mcg Q2d and [Client A] was permitted to take patches home from the Clinic. In January and February 2010, he was provided 4 x 100mcg and 4 x 75 mcg patches at each attendance (eight day supply).

11. In mid-February 2010, [Client A] sought an early renewal of his Fentanyl prescription but [Dr. A] denied the request.

12. On February 25, 2010, [Client A] was arrested and incarcerated. The Clinic Coordinator wrote a note in the EMR that stated, “as per dr. [sic] [B], pt has taken himself off the program and no new prescriptions will be made.” It was not noted in [Client A]’s MAR.

13. On March 21, 2010, the Member was the only nurse on staff when [Client A] arrived at the Clinic. The Member gave [Client A] ten Fentanyl patches, despite there being no valid prescription. The Member recorded the administration in the MAR but not the EMR. The Member failed to check the EMR before dispensing the patches.

14. [Client A]’s common law spouse was later found dead from an overdose while wearing the Fentanyl patches the Member provided to [Client A]. The police investigated the death.

15. If the Member were to testify, she would say that she was not informed that [Client A] had been discharged from the Clinic. She would say that, in the normal course, when a client was discharged from the Clinic, she would receive a letter from the supervisor with a signing sheet for tapering. She would then either modify or cancel the client’s prescription. In [Client A]’s case, she did not receive a signing sheet.

16. The Member would further say that she was not asked to cancel [Client A]’s prescription and that his patches were at the Clinic the whole time he was incarcerated.

17. In any event, the Member acknowledges that she should have checked the EMR before dispensing the medication to [Client A] and that she knew or ought to have known that [Client A] was not entitled to receive ten Fentanyl patches.

[Client B]

18. [Client B] was a client at the Clinic who was being treated for pain management. [Client B] was prescribed Fentanyl patches.

19. On June 24, 2009, [Dr. A] increased [Client B]’s Fentanyl prescription to 125mcg q 2 days, with five patches of 100mcg and five patches of 25mcg at a time.

20. On June 27, 2009, [Client B] went to the Clinic to exchange her patches. The Member made a nursing note that there were no [25] mcg patches available. The Member gave [Client B] seven 50mcg patches and one half of a 50mcg patch as a three day supply of 125 mcg per day. She documented that she advised [Client B] to cut one of the 50mcg patches. She did not discuss or document discussing these instructions with [Dr. A].

21. On June 30, 2009, [Client B] returned to the Clinic. She returned six used 50mcg patches. She admitted to wearing half of the 50mcg and provided the other half in an envelope.

22. The incident came to light when the Member was investigated by the police regarding [Client A]. The Member had written a Medication Error/Incident Report on June 29, 2009. It said: “Pt currently on Fentanyl 125 mg, In stock – 50mcg only available. Gave pt other than what is stated on prescription.” The incident report was not signed by a physician as required by the Clinic’s policy. The Member did not otherwise report the error to [Dr. A].

23. If the Member were to testify, she would acknowledge that she made the medication administration error as alleged, but she would say that she was overworked and the Clinic did not have a strong emphasis on following policy.

[Client C]

24. Client [Client C] was on a Methadone program. He [ ] came to the Clinic on Sundays. On the other days, the pharmacy in [his town[ administered Methadone to [Client C].

25. As part of the Methadone administration, clinic nurses would contact the pharmacy to confirm the last dose given to [Client C].

26. On June 10, 2009, [Dr. A] increased [Client C]’s dose of Methadone from 100mg to 110mg per day. On June 16, 2009, the Member noted in the EMR that [Client C] was [being discharged] from the Clinic’s program. Nothing further was documented about why [Client C] was [being discharged].

27. On June 22, 2009, [Client C] advised another Clinic staff member that he had been prescribed Oxycontin and Percocet by another doctor. On June 24, 2009, another Clinic staff member advised that the Client’s prescription was to be cancelled immediately, due to “double-doctoring” (obtaining prescriptions for narcotics from two different doctors). [Dr. B] ordered that [Client C] be tapered off Methadone, by reducing the dose by 4mg per day. [Client C] and the pharmacy were advised. [Client C] was also advised to attend on July 1, 2009.

28. The Clinic prepared a revised prescription to taper the client off the Methadone:

June 25: 106mg

June 26: 102mg

June 27: 98mg

June 28: 94mg

June 29: 90mg

29. [Client C] attended at the Clinic on June 28, 2009. [Client C] was due to receive a 94mg dose. Due to a prescription error, the Clinic had 110mg in stock for [Client C] The Member failed to call the pharmacy to confirm the last dose. She administered the 110mg dose to [Client C] She then informed the pharmacy and the Clinic’s office manager.

30. She documented her error in [Client C’s] EMR the following day: “Pts dose was not in delivery. Called Methadrug as to why dose wasn’t sent and stated that they didn’t receive the prescription. Informed [ ] Methadrug that pt drank dose of 110mg. Confirmed with Methadrug, dose of @66mg for July 5th. [ ] Office Manager made aware.”

31. The incident came to light when the Member was investigated by the police regarding [Client A]. The Clinic found a Medication Error/Incident Report, dated June 28 (no year provided). The note stated:

Pt dose for Methadone was not in. Checked manifests to see if dose was delivered. ∅ drink delivered in manifest for June 27 Dose delivered by WRONG dose. Pt currently @ 95mg as of June 28th NOT 110 mg. WRONG DOSE SENT BY METHADRUG.

Pt states he *doesn’t “feel different” ∅ symptoms reported. The Medication Error/Incident Report indicated that “Doctor” and “Patient” were “notified.” Recommendations to prevent re-occurrence are “read pt’s file.

32. The Medication Error/Incident Report was signed by the Member, but not by [Dr. B] or other staff, as required.

33. If the Member were to testify, she would acknowledge that she made the medication administration error as alleged, but she would say that she was overworked and the Clinic did not have a strong emphasis on following policy.

[Client D]

34. [Client D] was on a Methadone program. He was ordered to receive 75mg of Methadone per day.

35. On January 10, 2010, [Client D] attended the Clinic. The Member was on shift. She documented administering 75mg of Methadone to [Client D] in the MAR.

36. On January 10, 2010, the Member wrote the following nursing note:

Pt had no drink in stock for January 10/10. Pt currently at 75mg. Replaced dose with Rx 9838132 of 50mg & Rx 9838133 of 50mg instructing pt to drink ONLY HALF of bottle. Pt received a dose of 75mg. Methadrug made aware.

37. The incident came to light when the Member was investigated by the police regarding [Client A]. The Clinic found a Medication Error/Incident Report, dated June 28 (no year provided).

38. The report stated: “Pt had no script for Jan. 10/10. Pt at 75mg. Replaced pts dose w/2X50mg (1 bottle each). Pt drank 1 bottle + half of other.”

39. The Medication Error/Incident Report was signed by the Member, but not by [Dr. B] or other staff, as required. The Member did not otherwise report the error to [Dr. B].

40. If the Member were to testify, she would acknowledge that she made the medication administration error as alleged, but she would say that she was overworked and the Clinic did not have a strong emphasis on following policy.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

41. The Member admits that she committed the acts of professional misconduct described above in paragraphs 9 to 40, and as alleged in the Notice of Hearing in paragraphs:

• 1(a) (in that she dispensed Fentanyl patches without a physician’s order and without appropriate delegation), (b), (c), (d), (e), (f) (in that she failed to obtain confirmation of a client’s prior dose of Methadone before administering Methadone to [Client C], and failed to keep a record of that confirmation), (g), (h), (i), (j) (in that she administered Methadone to [Client D], that was prescribed to [Client D] for another date), and (k);

• 2(a);

• 3(a);

• 4 (a) (in that she dispensed Fentanyl patches without a physician’s order and without appropriate delegation), (b), (c), (d), (e), (f) (in that she failed to obtain confirmation of a client’s prior dose of Methadone before administering Methadone to [Client C], and failed to keep a record of that confirmation), (g), (h), (i), (j) (in that she administered Methadone to [Client D], that was prescribed to [Client D] for another date), and (k), in that her conduct was disgraceful, dishonourable and unprofessional.

Decision

Having considered the evidence the panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct as stated in paragraphs 1 (a), (b), (c), (d), (e), (f), (g), (h), (i), (j), (k). The Member failed to meet the standard of practice in multiple ways, including through dispensing medication without a physician’s order or without appropriate delegation, failing to review medical records before dispensing medication, failing to document medication dispensing in electronic medical record, failing to properly report medication errors, failing to obtain confirmation of patient’s medication dose prior to administration, failing to administer the correct dose of medication, and failing to report medication errors to the physician, including giving medication prescribed for another client and for another date and instructing the client to consume a partial dose.

The facts also support a finding of professional misconduct as stated in paragraph 2 (a), in that the Member failed to document dispensing medication in an electronic medical record.

The facts support a finding of professional misconduct as stated in paragraph 3 (a), in that the Member engaged in an unauthorized controlled act, namely, dispensing a drug without appropriate delegation.

Finally, the panel finds that the facts support a finding of professional misconduct as stated in paragraph 4 (a), (b), (c), (d), (e), (f), (g), (h), (i), (j), (k) of the Notice of Hearing, in that the Member engaged in conduct that would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional by failing to dispense medication appropriately, failing to review medical records before dispensing medication, failing to document medication dispensing in an electronic medical record, failing to follow a doctor’s medication orders, failing to report medication errors, and failing to obtain confirmation of [clients’] dose prior to administration.

Reasons for Decision

The Member breached medication standards of practice by dispensing medication without a physician’s order or proper delegation and by not adhering to College standards related to client treatment and medication regimes. The Member’s actions went beyond an error in [judgment] and constituted disregard for the Member’s obligations. As a nurse, it is imperative to respect the fundamentals of medication administration.

Penalty

The Counsel for the College advised the panel that a Joint Submission as to Order has been agreed upon which takes into account that the Member’s certificate of registration is currently revoked administratively pursuant to section 10.4(1) of Ontario Regulation 275/94. The Joint Submission requests this panel make an order as follows.

1. Requiring the Member to appear before the panel to be reprimanded within three months from the date this Order becomes final.

2. Directing the Executive Director to suspend the Member’s certificate of registration for six months. This suspension shall take effect from the date the Member obtains an active certificate of registration and shall continue to run without interruption.

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

a) The Member will attend two meetings with a Nursing Expert (the “Expert”), at her own expense and within six months of the date of this Order. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings;

ii. At least seven days before the first meeting, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules:

1. Professional Standards,

2. Medication, and;

3. Documentation.

iv. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into her behaviour;

vii. If the Member does not comply with any of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration;

b) For a period of 24 months from the date the Member returns to clinical nursing practice, the Member will notify her employers of the decision. To comply, the Member is required to:

i. Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

ii. Provide her employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iii. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm:

1. that they received a copy of the required documents, and

2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and

3. All documents delivered by the Member to the College, the Expert or the employer(s) will be [delivered] by verifiable method of delivery, the proof of which the Member will retain.

Penalty Submissions

College Counsel submitted that the objectives of a penalty should include specific deterrence, general deterrence and rehabilitation.

As to mitigating factors, College Counsel noted that the Member cooperated in good faith with the College, avoided a contested hearing, has no history of discipline and took responsibility for her actions. She was overwhelmed at the clinic and had attempted to make things work there. Unfortunately, her efforts at a “work-around” were in breach of the College’s standards and regulations.

As to aggravating factors, College Counsel submitted these included the nature of the misconduct, the repetition of the misconduct, that she worked while unsupervised and did not follow the policies that were in place. The Member was working with vulnerable and manipulative populations, and did not properly balance the need to provide empathetic care while being diligent.

Penalty Decision

The panel accepts the Joint Submission as to Order and accordingly orders:

1. The Member is required to appear before the panel to be reprimanded within three months from the date this Order becomes final.

2. The Executive Director is directed to suspend the Member’s certificate of registration for six months. This suspension shall take effect from the date the Member obtains an active certificate of registration and shall continue to run without interruption.

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

a) The Member will attend two meetings with a Nursing Expert (the “Expert”), at her own expense and within six months of the date of this Order. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings;

ii. At least seven days before the first meeting, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules:

1. Professional Standards,

2. Medication, and;

3. Documentation.

iv. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into her behaviour;

vii. If the Member does not comply with any of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration;

b) For a period of 24 months from the date the Member returns to clinical nursing practice, the Member will notify her employers of the decision. To comply, the Member is required to:

i. Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

ii. Provide her employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iii. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm:

1. that they received a copy of the required documents, and

2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and

3. All documents delivered by the Member to the College, the Expert or the employer(s) will be [delivered] by verifiable method of delivery, the proof of which the Member will retain.

Reasons for Penalty Decision

The panel concluded that the proposed penalty is reasonable and in the public interest. The Member has cooperated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions.

The reprimand and suspension in particular is meant in this case to inform members of the profession and the public that this conduct is serious and will not be tolerated.

While the panel finds the six-month suspension is on the higher side of the appropriate range, it is clearly within the range and allows for public protection and maintenance of public confidence. Over all, the penalty as a whole, including the six-month suspension, 24-month employment notification period and the remediation provisions, provides a clear deterrent to this Member and to others.

I, April Plumton, 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

Panel Members:

Karen Laforet, RN

Barbara Titley, RPN

Catherine Egerton, Public Member

Mary MacMillan-Gilkinson, Public Member