College of Nurses of Ontario v. Maria Victoria Librado, 2014 ONCNO 64832

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Zahir Hirji, RN Chairperson

Spencer Dickson, RN Member Abdul Patel Public Member

Chuck Williams Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) NICK COLEMAN for

) College of Nurses of Ontario

• and - )

MARIA VICTORIA LIBRADO ) NO REPRESENTATION for

Registration No. JB05526 ) Maria Victoria Librado

) Heard: April 4, 2014

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on April 4, 2014, at the College of Nurses of Ontario (“the College”) at Toronto.

The Allegations

The allegations against Maria Victoria Librado (the “Member”) as stated in the Notice of Hearing dated March 17, 2014, are as follows.

1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that 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) while employed at [Facility A] in [ ] Ontario,

(i) you falsified annual payment cards as a Registered Nurse for 2008 and/or 2010, and/or you falsified a membership renewal receipt as a Registered Nurse for 2011;

(ii) you applied for and accepted a position as a Registered Nurse position when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011;

(iii) you held yourself out as a Registered Nurse and used the restricted title, “Registered Nurse” and/or “RN” when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011; and/or

(b) while employed at [Facility B] in [ ] Ontario, you arranged with a co-worker or co-workers to falsify time records regarding your attendance at work as a Registered Practical Nurse, in or about February 2010-Janaury 2011.

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(14) of Ontario Regulation 799/93, in that you falsified a record relating to your practice with respect to the following incidents:

(a) while employed at [Facility A] in [ ] Ontario,

(i) you falsified annual payment cards as a Registered Nurse for 2008 and/or 2010, and/or you falsified a membership renewal receipt as a Registered Nurse for 2011;

(ii) you applied for and accepted a position as a Registered Nurse position when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011;

(iii) you held yourself out as a Registered Nurse and used the restricted title, “Registered Nurse” and/or “RN” when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011; and/or

(b) while employed at [Facility B] in [ ] Ontario, you arranged with a co-worker or co-workers to falsify time records regarding your attendance at work as a Registered Practical Nurse in or about February 2010-Janaury 2011.

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(15) of Ontario Regulation 799/93, in that, you signed or issued, in your professional capacity, a document that you knew or ought to have known contained a false or misleading statement with respect to the following incidents, while employed at [Facility A] in [ ] Ontario:

(a) you falsified annual payment cards as a Registered Nurse for 2008 and/or 2010, and/or you falsified a membership renewal receipt as a Registered Nurse for 2011;

(b) you applied for and accepted a position as a Registered Nurse position when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011; and/or

(c) you held yourself out as a Registered Nurse and used the restricted title, “Registered Nurse” and/or “RN” when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011.

4. You have committed an act of professional misconduct as provided by sub-section 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and subsection 1(16) of Ontario Regulation 799/93, in that you inappropriately used a term, title or designation in respect of your practice with respect to the following incidents, while employed at [Facility A] in [ ] Ontario:

(a) you falsified annual payment cards as a Registered Nurse for 2008 and/or 2010, and/or you falsified a membership renewal receipt as a Registered Nurse for 2011;

(b) you applied for and accepted a position as a Registered Nurse position when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011; and/or

(c) you held yourself out as a Registered Nurse and used the restricted title, “Registered Nurse” and/or “RN” when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011.

5. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(19) of Ontario Regulation 799/93, in that you contravened a provision of the Act, the Regulated Health Professions Act, 1991 or the regulations under either of those Acts, and in particular, the Nursing Act, 1991, section 11, with respect to the following incidents, while employed at [Facility A] in [ ] Ontario:

(a) you falsified annual payment cards as a Registered Nurse for 2008 and/or 2010, and/or you falsified a membership renewal receipt as a Registered Nurse for 2011;

(b) you applied for and accepted a position as a Registered Nurse position when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011; and/or

(c) you held yourself out as a Registered Nurse and used the restricted title, “Registered Nurse” and/or “RN” when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011.

6. 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) while employed at [Facility A] in [ ] Ontario,

(i) you falsified annual payment cards as a Registered Nurse for 2008 and/or 2010, and/or you falsified a membership renewal receipt as a Registered Nurse for 2011;

(ii) you applied for and accepted a position as a Registered Nurse position when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011;

(iii) you held yourself out as a Registered Nurse and used the restricted title, “Registered Nurse” and/or “RN” when you were registered with the College as a Registered Practical Nurse, in or about February 2007-March 2011; and/or

(b) while employed at [Facility B] in [ ] Ontario, you arranged with a co-worker or co-workers to falsify time records regarding your attendance at work as a Registered Practical Nurse in or about February 2010-Janaury 2011.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1 a, b; 2 a, b; 3 a, b, c; 4 a, b, c; 5 a, b, c; and 6 a, b. 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 and the Member advised the panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads as follows.

THE MEMBER

1. Maria Victoria Librado (the “Member”) obtained a diploma in nursing [ ] in 1980.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Practical Nurse (“RPN”) on June 20, 2002. The Member has never been registered with the College as a Registered Nurse (“RN”).

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

A. [Facility A]

3. The Member was employed at [Facility A] from December 31, 2004, to March 8, 2011.

4. Facility A is a long-term care facility, located in [ ] Ontario.

5. The Member was originally hired at the Facility as an RPN.

6. When a temporary RN position became available, the Member applied for and was awarded the position. She worked as an RN from February 2007 to June 2007.

7. When Facility A had to make cutbacks in 2007, the Member went back to working as an RPN.

8. The Member worked as an RN from February 2007 to June 2007, despite only being registered with the College as an RPN.

9. In 2009, when an RN position became available, the Member applied to transfer back to work as an RN. On October 3, 2009, the Member was awarded a full-time RN position on the evening shift.

10. On January 28, 2008, the Member provided management with a falsified Annual Payment Card (“APC”) as proof of her status as an RN. The registration number on the APC belonged to one of the Member’s former colleagues at another facility.

11. The following year, on December 21, 2009, the Member provided a falsified APC in support of her continued employment at Facility A as an RN. The registration number on the APC was not a valid registration number.

12. On February 27, 2011, the Member provided management with an altered electronic membership renewal receipt in support of her continued employment as an RN. The electronic renewal receipts replaced the APCs. Once again, the registration number on the renewal receipt was not a valid registration number.

13. The Member worked as an RN at Facility A from October 2009 to March 2011, despite only being registered with the College as an RPN

14. During the periods she was employed at Facility A as an RN, the Member signed and issued numerous patient progress notes and other facility documents in which she was identified as an RN, despite only being registered with the College as an RPN.

B. [Facility B]

15. The Member was employed at [Facility B] from January 5, 1999, to January 26, 2011.

16. Facility B is a retirement home, located in [ ] Ontario.

17. The Member worked as a full-time charge nurse on the day shift.

18. While working at Facility B, the Member often had to leave work early to get to her evening shift at Facility A on time. To facilitate this, the Member arranged with at least one co-worker to swipe her pass card to create a false record to make it appear as though she had remained at Facility B until the end of the work day or beyond, when in fact she had left.

19. The Member was paid for time she did not work at Facility B.

20. If the Member were to testify, she would say that she had permission from management at Facility B to leave her shift early in order to get to her shift at Facility A. However, management did not give her permission to manipulate the timecard system in order to be paid for time she did not work.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

21. The Member admits that she committed the acts of professional misconduct as described in paragraphs 3 to 20 above and as alleged in the Notice of Hearing in the following paragraphs:

• 1(a) and (b)

• 2(a) and (b)

• 3(a), (b) and (c)

• 4(a), (b) and (c)

• 5(a), (b) and (c)

• 6(a) and (b)

Decision

The panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1 a, b; 2 a, b; 3 a, b, c; 4 a, b, c; and 5 a, b, c of the Notice of Hearing. As to allegation[s] # 6 a and b, the panel finds that the Member engaged in conduct that would reasonably be considered by members to be disgraceful, dishonourable and unprofessional.

Reasons for Decision

The panel considered the Agreed Statement of Facts and the Member’s plea and finds that this evidence supports findings of professional misconduct as alleged in the Notice of Hearing.

Allegation #1 in the Notice of Hearing is supported by paragraphs 3 through 20 in the Agreed Statement of Facts. College Counsel submitted that the Member had failed to meet the standards of practice of the profession as [they relate] to both the Professional Standards revised 2002, and the Ethics Practice standard. The Member masqueraded as a RN when in fact she was an RPN with the College. Further, the Member falsified documentation both in relation to her registration with the College as well as her timecards with her employer. In doing so, the Member failed to demonstrate honesty, trustworthiness, integrity, and commitment to the profession.

Allegation #2 in the Notice of Hearing is supported by paragraphs 3 through 20 in the Agreed Statement of Facts.

Allegation #3 in the Notice of Hearing is supported by paragraphs 3 through 14 in the Agreed Statement of Facts.

Allegation #4 in the Notice of Hearing is supported by paragraphs 3 through 14 in the Agreed Statement of Facts.

Allegation #5 in the Notice of Hearing is supported by paragraphs 3 through 14 in the Agreed Statement of Facts.

With respect to Allegation[s] # 6 a and b, the panel finds that the Member’s conduct as it relates to the Professional and Ethics Standard[s] was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. The panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit through misrepresenting herself as an RN when she was an RPN. She actively altered College documentation to support her deception. The Member also falsified timecards with her employer.

Finally, the panel finds that the Member’s conduct was disgraceful as it shames the Member and, by extension, the profession. The persistent and sustained premeditated misconduct casts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet.

Penalty

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

1. Requiring the Member to appear before the Panel to be reprimanded within three months [of the date] that this Order becomes final.

2. Directing the Executive Director to suspend the Member’s certificate of registration for four months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in the practising class.

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 three meetings with a Nursing Expert (the “Expert”), at her own expense and within nine 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;

iv. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires [and] 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 [one or more] 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 12 months from the date the Member’s suspension ends, 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, the proof of which the Member will retain.

Penalty Submissions

Submissions were made by College Counsel. The Member stated she agreed with those submissions.

The parties agreed that the mitigating factors in this case were that this was the Member’s first discipline finding, the Member cooperated with the College in the investigation of the matter and, by admitting the allegations, has accepted responsibility for her actions.

The aggravating factors in this case were as follows. The Member’s misconduct was not a simple lapse in judgment but rather a persistent and premeditated pattern of deception. The Member actively attempted to cover-up her deception through the use of falsified documents, and engaged another person to assist in her misconduct related to her attendance.

The proposed penalty provides for general deterrence through the reprimand, suspension, meeting with the nursing expert and the employer notification provisions. This proposed order will demonstrate to members of the profession that this type of misconduct is taken seriously and will not be tolerated.

The proposed penalty provides for specific deterrence through the oral reprimand, suspension and employer notification in that it will impress upon the Member the seriousness of her misconduct.

The proposed penalty provides for remediation and rehabilitation through the meeting with the expert and the review of the professional standards as well as the employer notification. The Member will be provided the opportunity to develop a deeper understanding of her professional obligations and will have support through the employer notification process to ensure practice issues are addressed in a timely manner.

Overall, the public is protected because the public will be confident that the profession is able to govern itself and prevent other members of the profession from engaging in such misconduct.

Counsel submitted the following cases to the panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee:

• CNO v. Peters (Discipline Committee, 2012)

• CNO v. Henry (Discipline Committee, 2003)

• CNO v. Gamble (Discipline Committee, 2012)

• CNO v. Pinsonneault (Discipline Committee, 2012)

These cases were germane to the finding of misconduct in that they involved falsification of College records as well as the misrepresentation of the member’s practice category. College counsel submitted that the proposed penalty was within the range of orders made by previous panels of the Discipline Committee, as reflected in these cases.

Penalty Decision

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

1. The Member shall appear before the Panel to be reprimanded within three months [of the date] that this Order becomes final.

2. The Executive Director is directed to suspend the Member’s certificate of registration for four months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in the practising class.

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 three meetings with a Nursing Expert (the “Expert”), at her own expense and within nine 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. [the] 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;

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

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 [one or more] 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 12 months from the date the Member’s suspension ends, 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. [the] 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, the proof of which the Member will retain.

Reasons for Penalty Decision

The panel understands that the penalty ordered should protect the public and enhance public confidence in the ability of the College to regulate nurses. This is achieved through a penalty that addresses specific deterrence, general deterrence and, where appropriate, rehabilitation and remediation. The panel also considered the penalty in light of the principle that joint submissions should not be interfered with lightly.

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. The panel finds that the penalty satisfies the principles of specific and general deterrence, rehabilitation and remediation, and public protection. The order acts as a specific deterrent for the Member and a general deterrent for other nurses. The penalty serves to protect the public interest and provides the public with confidence in the College’s ability to self-regulate. The order provides the Member with an opportunity for remediation and to return to the practice of nursing. The penalty is in line with what has been ordered in previous cases.

I, Zahir Hirji, 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:

Spencer Dickson, RN

Abdul Patel, Public Members

Chuck Williams, Public Member