DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
PANEL: Lindsay Hyslop, NP Chairperson Grace Fox, NP Member Shiraz Irani, RN Member Abdul Patel Public Member Margaret Tuomi Public Member
BETWEEN:
COLLEGE OF NURSES OF ONTARIO NICK COLEMAN for the College of Nurses of Ontario
- and -
ANN MARIE DESROSIERS Registration No. 9403494 JANE LETTON for Ann Marie Desrosiers
Heard: June 25, 2014
DECISION AND REASONS
This matter came on for hearing before a panel of the Discipline Committee on June 25, 2014, at the College of Nurses of Ontario (“the College”) at Toronto.
The Allegations
The allegations against Ann Marie Desrosiers (the “Member”) as stated in the Notice of Hearing dated June 23, 2014, are as follows.
IT IS ALLEGED THAT:
You have committed an act of professional misconduct as provided by subsection 51(1)(b.0.1) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, in that you failed to cooperate with the Quality Assurance Committee or any assessor appointed by that committee, and in particular, you failed to participate after being selected by the Quality Assurance Committee for practice assessment in or about March-September 2011.
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) you failed to participate after being selected by the Quality Assurance Committee for practice assessment in or about March-September 2011;
(b) you failed to carry out an agreement entered into with the College regarding the alternative dispute resolution of the complaint of [the Complainant] in or about February-April 2012;
(c) you performed controlled acts for which you were not authorized when you prescribed controlled substances for clients at [the Facility] in [ ] Ontario, including:
(i) Concerta for [Client A] in or about August 2011-December 2012;
(ii) Hydromorph Contin for [Client B] in or about August 2011;
(iii) Lorazepam for [Client C] in or about November 2011-October 2012;
(iv) Percocet for [Client D] in or about August 2011; and/or
(v) Lorazepam for [Client E] in or about November 2011; and/or
(d) you falsified prescriptions for clients at [the Facility] in [ ] Ontario by adding the name of the physician to the prescriptions although the prescriptions had not been authorized by the physician for Concerta for the client, [Client A], in or about August 2011-September 2011, November 2011 and November 2012, and Lorazepam for the client, [Client C], in or about November 2011.
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 prescriptions for clients at [the Facility] in [ ] Ontario by adding the name of the physician to the prescriptions although the prescriptions had not been authorized by the physician for Concerta for [Client A] in or about August 2011-September 2011, November 2011 and November 2012, and Lorazepam for [Client C] in or about November 2011.
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 in that you falsified prescriptions for clients at [the Facility] in [ ] Ontario by adding the name of the physician to the prescriptions although the prescriptions had not been authorized by the physician for Concerta for [Client A] in or about August 2011-September 2011, November 2011 and November 2012, and Lorazepam for [Client C] in or about November 2011.
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, section 27(1) of the Regulated Health Professions Act, 1991, S.O. 1991, c. 18; section 5.1 of the Nursing Act, 1991, S.O. 1991, c. 32; and/or sections 16(2) and/or 16(4) of O.Reg. 275/94 under the Nursing Act, 1991, with respect to prescribing controlled substances for clients at [the Facility] in [ ] Ontario, including:
(a) Concerta for [Client A] in or about August 2011-December 2012;
(b) Hydromorph Contin for [Client B] in or about August 2011;
(c) Lorazepam for [Client C] in or about November 2011-October 2012;
(d) Percocet for [Client D] in or about August 2011; and/or
(e) Lorazepam for [Client E] in or about November 2011.
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(24) of Ontario Regulation 799/93, in that you failed to carry out an agreement entered into with the College regarding the complaint of [the Complainant] in or about February-April 2012.
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 failed to participate after being selected by the Quality Assurance Committee for practice assessment in or about March-September 2011;
(b) you failed to carry out an agreement entered into with the College regarding the alternative dispute resolution of the complaint of [the Complainant] in or about February-April 2012;
(c) you performed controlled acts for which you were not authorized when you prescribed controlled substances for clients at [the Facility] in [ ] Ontario, including:
(i) Concerta for [Client A] in or about August 2011-December 2012;
(ii) Hydromorph Contin for [Client B] in or about August 2011;
(iii) Lorazepam for [Client C] in or about November 2011-October 2012;
(iv) Percocet for [Client D] in or about August 2011; and/or
(v) Lorazepam for [Client E] in or about November 2011; and/or
(d) you falsified prescriptions for clients at [the Facility] in [ ] Ontario by adding the name of the physician to the prescriptions although the prescriptions had not been authorized by the physician for Concerta for [Client A] in or about August 2011-September 2011, November 2011 and November 2012, and Lorazepam for [Client C] in or about November 2011.
Member’s Plea
The Member admitted the allegations set out in paragraphs 1, 2, 3, 4, 5, 6, and 7 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 an agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads as follows.
THE MEMBER
Ann Marie Desrosiers (the “Member”) obtained a certificate in nursing [ ] in 1989. She then received a diploma in nursing [ ] in 1993 and a certificate in nursing [ ] in 2005.
The Member initially registered with the College of Nurses of Ontario (the “College”) as a Registered Practical Nurse (“RPN”) on June 23, 1989. She then registered with the College as a Registered Nurse (“RN”) on October 13, 1993. On June 8, 2006, the Member registered as a nurse in the Extended Class (Nurse Practitioner).
The Member's registration as an RPN was suspended for non-payment of fees on June 17, 1994. She resigned as an RPN on February 1, 2013.
The Member was employed as a Nurse Practitioner (“NP”) at [the Facility] from June 2011 until she resigned in December 2012, following a suspension during which further investigation of her conduct with respect to prescribing controlled substances was being completed.
THE FACILITY
The Facility is located in [ ] Ontario.
The Facility provided primary health care, health promotion and community development services to the community.
The Member worked as a full-time nurse on day shifts (with one evening shift per week).
INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT
Quality Assurance
In March 2011, the Member was randomly selected to participate in a practice assessment as part of the College’s Quality Assurance (“QA”) Program. The Member was notified that she had been selected to participate in a letter dated March 25, 2011. The Member was given until April 19, 2011, to confirm her participation online. She was given until May 10, 2011, to complete a Learning Plan and objective test.
The Member failed to respond to the notice or to complete the practice assessment as directed. In a letter dated July 22, 2011, the Quality Assurance Committee (“QAC”) extended the time for compliance until September 2, 2011, but the Member failed to respond.
On November 4, 2011, the Member was informed that her failure to complete the QA program had been reported to the College’s Inquiries, Complaints and Reports Committee (“ICRC”). The Member still did not comply with her QA obligations.
Prescribing Controlled Substances
As an NP, the Member was legally permitted to prescribe certain drugs in accordance with s. 27 of the Regulated Health Professions Act, s. 5.1(1) of the Nursing Act and Ontario Regulation 275/94. However, pursuant to ss. 13.2, 16(2) and (4) of Ontario Regulation 275/94, all members are prohibited from prescribing a controlled substance within the meaning of the Controlled Drugs and Substances Act.
Prior to October 2011, an NP was authorized to prescribe Lorazepam for an emergency purpose, pursuant to s. 19 of Ontario Regulation 275/94. However, this regulation was amended and effective October 1, 2011, the regulation expressly prohibited any nurse from prescribing a controlled substance.
While employed at the Facility, the Member prescribed four controlled substances – Concerta, Hydromorph Contin, Lorazepam and Percocet – to five clients between August 2011 and December 2012.
[Client A]
Between August 2011 and December 2012, the Member prescribed Concerta to [Client A]. On several occasions, the Member did not perform internal consults with a physician and either did not obtain the physician’s co-signature on the prescription or co-signed a physician’s name on the prescription without the physician’s knowledge or the use of “per.”
When a prescription was faxed back to the Facility by the pharmacy, [the doctor] whose name was co-signed on the prescription confirmed that he had no knowledge of the client being prescribed Concerta, and was not consulted prior to the prescription being written.
[Client B]
- In August 2011, the Member prescribed Hydromorph Contin to [Client B]. Although an initial consult was documented, there was no internal consult or the consult was not properly documented, including a failure to obtain the physician’s co-signature, when the Member renewed the prescription on August 26, 2011. The Member also failed to assess [Client B] in person.
[Client C]
- Between November 2011 and October 2012, the Member prescribed Lorazepam to [Client C]. There was no internal consult or the consult was not properly documented, including a failure to obtain the physician’s co-signature. The Member also co-signed a physician’s name on at least one prescription either without the physician’s knowledge or the use of “per.”.
[Client D]
- In August 2011, the Member prescribed Percocet to [Client D] without a physician consult or without adequately documenting a physician consult, including the failure to obtain a physician’s co-signature on the consult.
[Client E]
- In November 2011, the Member prescribed Lorazepam to [Client E]. The Member co-signed [the physician]’s name on the prescription without using “per.”
The Resolution Agreement
In 2011, a member of the public complained to the College about the Member’s conduct. The Member, the complainant and the College agreed to engage in the College’s alternative dispute resolution process in order to resolve the matter informally.
On February 6, 2012, the Member signed a Resolution Agreement (the “Agreement”). In the Agreement, the Member agreed to complete the Therapeutic Nurse-Client Relationship, Professional Standards, the Nurse Practitioner online learning modules and the online participation forms within 30 days.
On March 21, 2012, the ICRC approved the Agreement as an appropriate alternative dispute resolution. As a result, the ICRC did not impose any order on the Member nor did it refer the matter to the Discipline Committee. The Member was informed that the ICRC approved the Agreement in a letter dated March 30, 2012.
The Member was given a deadline of April 21, 2012 to complete the terms of the Agreement. The Agreement had previously been signed by the complainant.
The Member failed to complete the terms of the Agreement by the deadline. She also failed to respond to letters and telephone calls from the College reminding her of the deadline to complete the online learning modules.
On May 11, 2012, the College investigator attempted to follow-up with the Member on more than one occasion. On August 20, 2012, the Member was sent a letter indicating that she had a further extension to complete the terms of the Agreement on or before September 13, 2012. The Member never performed her obligations under the Agreement.
The Member’s Response
If the Member were to testify, she would say that she was going through a very difficult time in her personal life when the incident described above occurred.
In any case, the Member acknowledges that she failed to complete the terms of the Resolution Agreement and failed to complete the College’s QA Program. The Member also admits that she did not follow the Facility’s protocol and breached the standards of practice and the Nursing Act regulations when she prescribed controlled substances outside the scope of her role as an NP.
ADMISSIONS OF PROFESSIONAL MISCONDUCT
- The Member admits that she committed the acts of professional misconduct described above in paragraphs 8 to 27, and as alleged in the Notice of Hearing in paragraphs:
1
2(a), (b), (c) and (d)
3
4
5(a), (b), (c), (d) and (e)
6
7(a), (b), (c) and (d) in that her conduct was dishonourable and unprofessional.
Decision
The panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1, 2, 3, 4, 5, and 6 of the Notice of Hearing. With respect to allegation # 7, the panel finds that the Member engaged in conduct that would reasonably be considered by members to be dishonourable and unprofessional. In making this decision, the panel notes that the behaviour approaches the boundaries of disgraceful.
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 8, 9, and 10 in the Agreed Statement of Facts.
Allegation #2(a) in the Notice of Hearing is supported by paragraphs 8, 9, and 10 in the Agreed Statement of Facts.
Allegation #2(b) in the Notice of Hearing is supported by paragraphs 20, 21, 22, 23, 24, and 25 in the Agreed Statement of Facts.
Allegation #2(c) in the Notice of Hearing is supported by paragraphs 11, 12, 13, 14, 15, 16, 17, 18 and 19 in the Agreed Statement of Facts.
Allegation #2(c) (i) in the Notice of Hearing is supported by paragraphs 14 and 15 in the Agreed Statement of Facts.
Allegation #2(c) (ii) in the Notice of Hearing is supported by paragraphs 16 in the Agreed Statement of Facts.
Allegation #2(c) (iii) in the Notice of Hearing is supported by paragraph 17 in the Agreed Statement of Facts.
Allegation #2(c) (iv) in the Notice of Hearing is supported by paragraph 18 in the Agreed Statement of Facts.
Allegation #2(c) (v) in the Notice of Hearing is supported by paragraph 19 in the Agreed Statement of Facts.
Allegation #2(d) in the Notice of Hearing is supported by paragraphs 11, 12, 13, 14, 15, 16, 17, 18 and 19 in the Agreed Statement of Facts.
Allegation #3 in the Notice of Hearing is supported by paragraphs 11, 12, 13, 14, 15, 16, 17, 18 and 19 in the Agreed Statement of Facts.
Allegation in #4 the Notice of Hearing is supported by paragraphs 11, 12, 13, 14, 15, 16, 17, 18 and 19 in the Agreed Statement of Facts.
Allegation #5 in the Notice of Hearing is supported by paragraphs 11, 12, 13, 14, 15, 16, 17, 18 and 19 in the Agreed Statement of Facts.
Allegation in #5(a) the Notice of Hearing is supported by paragraphs 14 and 15 the Agreed Statement of Facts.
Allegation #5(b) in the Notice of Hearing is supported by paragraph 16 in the Agreed Statement of Facts.
Allegation #5(c) in the Notice of Hearing is supported by paragraph 17 in the Agreed Statement of Facts.
Allegation #5(d) in the Notice of Hearing is supported by paragraph 18 in the Agreed Statement of Facts.
Allegation #5(e) in the Notice of Hearing is supported by paragraph 19 in the Agreed Statement of Facts.
Allegation #6 in the Notice of Hearing is supported by paragraphs 20, 21, 22, 23, 24, and 25 in the Agreed Statement of Facts.
With respect to Allegation # 7, the panel finds that the Member’s conduct in failing to participate in the mandatory quality assurance assessment, prescribing controlled substances, falsifying prescriptions, and failing to complete the terms of an agreed alternative dispute resolution process contract was unprofessional. 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 prescribing controlled substances without appropriate authority, and not performing the obligations of a signed agreement for alternative dispute resolution.
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.
Requiring the Member to appear before the Panel to be reprimanded within three months [of the date] that this Order becomes final.
Directing the Executive Director to suspend the Member’s certificate of registration for nine 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.
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:
the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
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:
Professional Standards
Therapeutic Nurse-Client Relationship
Nurse Practitioner
RHPA Scope of Controlled Acts Model
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:
the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
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:
the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
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 18 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:
the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
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:
that they received a copy of the required documents, and
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
c) The Member shall participate in the College’s 2015 Quality Assurance program (or the next available cycle), including the practice assessment component and a clinical assessment, and must provide proof of participation to the Director within 24 months from the date that participation in the Quality Assurance program commences.
- 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’s Counsel indicated that she agreed with those submissions.
The parties agreed that the mitigating factors in this case were as follows.
The Member has admitted and did not contest the allegations.
The Member has accepted responsibility for her behaviour.
The Member is willing to comply with the Joint Submission on Order.
The Member has gained new employment which is very supportive. Her practice is being monitored and the current employer has provided a witnessing signature on the Joint Submission on Order.
The aggravating factors in this case were as follows.
- The Member demonstrated that she was ungovernable in multiple ways.
a) It is an act of professional misconduct to fail to participate/cooperate in the Quality Assurance assessment process. This is defined in Section 51 of the Health Professions Procedural Code of the Nursing Act.
b) The Member’s behaviour illustrates contempt for the system, as the Member failed to comply with the standards of practice, ignored quality assessment obligations, failed to comply with the obligations of a signed agreement for alternative dispute resolution.
c) The Member prescribed controlled substances not within the scope of a nurse practitioner’s practice numerous times and documented in some instances that these were approved by a physician.
d) The Member’s failure to comply with the Alternative Dispute Resolution process puts the College’s process in disrepute as it was an agreement that had been brokered by the College, endorsed by ICRC and signed by the Member. The Member ignored repeated attempts by the College to remind her of the deadlines.
- The seriousness of the behaviour. Nurse Practitioners have the most responsibility and autonomy and the least amount of supervision. There is an expectation that Nurse Practitioners will supervise themselves within the Nurse Practitioner’s scope of practice
The proposed penalty provides for general deterrence.
The penalty gives a message to all members that this type of behaviour will be treated seriously by the College.
A reprimand and suspension of 9 months sends a clear message that the conduct is serious and will be treated as such.
It puts all members on notice that there is a professional responsibility to comply with the QA program and an alternative dispute resolution agreement.
It makes it clear that there are limits to the scope of practice of Nurse Practitioners with regard to prescriptive authority and controlled substances are not within these.
The proposed penalty provides for specific deterrence through sending a definite message to the Member not to repeat these acts of misconduct.
The proposed penalty provides for remediation and rehabilitation.
The proposed penalty includes terms, conditions and limitations that will improve the Member’s understanding and the significance of the misconduct by reviewing the College’s standards.
It will assist the Member in developing coping strategies.
The notice to employers permits employers to observe and oversee the Member’s conduct related to past difficulties and misconduct and report to the College any further misconduct.
There is a sufficient amount of time to complete the requisites including the clinical assessment.
Overall, the public is protected as the College and the Member have illustrated respect for the Quality Assessment process. Entering into a signed resolution agreement and not completing the required obligations is a serious offence requiring significant remedial education. The Member will learn to understand the impact of her decisions and conduct on others. The proposed penalty shows that the profession is able to self-govern and addresses acts of misconduct seriously and fairly.
Counsel submitted cases to the panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee.
- CNO v. McLaughlin (Discipline Committee, 2009)
In this case the member failed to complete specified remedial measures following a Practice Review Written Assessment with the Quality Assurance Committee. The member was not present for the hearing. The panel ordered a reprimand, three-month suspension (which would continue until completion of the QA) and meeting with a nursing expert
- CNO v. Kaastra (Discipline Committee, 2011)
The member failed to comply with the Quality Assurance directive and was given a six month suspension (to continue until the QA measures were completed) and a notice to employers for 12 months.
- CNO v. Fabro (Discipline Committee, 2014)
The member failed to complete the terms of a Resolution Agreement. The conduct in this case was deemed only unprofessional. The member was given a two-month suspension, and ordered to complete online learning modules on certain College standards and to meet with a nursing expert twice.
- CNO v. Lim (Discipline Committee, 2012)
The member repetitively administered medications without a doctor’s order, including Fentanyl, and failed to properly document the administration of the drugs. The member did not attend the hearing and her licence was revoked. The aggravating factor was that the member had been previously disciplined by her employer and continued to repeat the conduct.
- CNO v. Cecilioni (Discipline Committee, 2013)
The member intended to give a patient Botox injections. The patient was a reporter and the Botox was not administered. The member failed to document interactions with the patient. The member had retired prior to the hearing. The penalty ordered was a reprimand, a four-month suspension, meetings with a nursing expert and notification to future employers.
Of note, all the members in the above cases before the Discipline Committee were in the RN class.
Penalty Decision
The panel accepts the Joint Submission as to Order and accordingly orders:
The Member is required to appear before the Panel to be reprimanded within three months [of the date] that this Order becomes final.
The Executive Director is directed to suspend the Member’s certificate of registration for nine 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.
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:
the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
[the] Joint Submission on Order, and
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:
Professional Standards
Therapeutic Nurse-Client Relationship
Nurse Practitioner
RHPA Scope of Controlled Acts Model
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:
the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
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:
the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
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 18 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:
the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
[the] Joint Submission on Order, and
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:
that they received a copy of the required documents, and
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
c. The Member shall participate in the College’s 2015 Quality Assurance program (or the next available cycle), including the practice assessment component and a clinical assessment, and must provide proof of participation to the Director within 24 months from the date that participation in the Quality Assurance program commences.
- 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.
I, Lindsay Hyslop, NP, 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:
Lindsay Hyslop, NP, Chairperson Date
Panel Members:
Grace Fox, NP
Shiraz Irani, RN
Abdul Patel, Public Member
Margaret Tuomi, Public Member