DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
PANEL:
Tammy Hedge, RPN Chairperson
Grace Fox, NP Member Barbara Titley, RPN Member Devinder Walia Public Member
Chuck Williams Public Member
BETWEEN:
COLLEGE OF NURSES OF ONTARIO ) EMILY LAWRENCE for ) College of Nurses of Ontario
- and - )
LEE ANN ENO ) NO REPRESENTATION for Registration No. GD17934 ) Lee Ann Eno
) JOHANNA BRADEN
) Independent Legal Counsel
) Heard: January 6, 2016
DECISION AND REASONS
This matter came on for hearing before a panel (the “Panel”) of the Discipline Committee on January 6, 2016 at the College of Nurses of Ontario (the “College”) at Toronto.
The Allegations
The allegations against Lee Ann Eno (the “Member”) as stated in the Notice of Hearing dated January 6, 2016, are as follows.
- 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 standards of practice of the profession with respect to the following incidents:
(a) between November 2004 and August 2009, you failed to maintain appropriate therapeutic boundaries with [ ] the husband of your client [ ]; and/or
(b) you solicited and accepted sums of money from [your Client’s spouse] in the following amounts on the following dates:
I) $23,863.94 on or about October 26, 2005;
II) $22,000.00 on or about October 25, 2007;
III) $2,000 on or about February 29, 2008;
IV) $2,500 on or about June 6, 2008; and/or
V) $5,000 on or about August 18, 2009; and/or
(c) you failed to re-pay sums of money you accepted from [your Client’s spouse] in the following amounts on the following dates:
I) $23,863.94 on or about October 26, 2005;
II) $22,000.00 on or about October 25, 2007;
III) $2,000 on or about February 29, 2008;
IV) $2,500 on or about June 6, 2008; and/or
V) $5,000 on or about August 18, 2009.
- 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) between November 2004 and August 2009, you failed to maintain appropriate therapeutic boundaries with [your Client’s spouse]; and/or
(b) you solicited and accepted sums of money from [your Client’s spouse] in the following amounts on the following dates:
I) $23,863.94 on or about October 26, 2005;
II) $22,000.00 on or about October 25, 2007;
III) $2,000 on or about February 29, 2008;
IV) $2,500 on or about June 6, 2008; and/or
V) $5,000 on or about August 18, 2009.
(c) you failed to re-pay sums of money you accepted from [your Client’s spouse] in the following amounts on the following dates:
I) $23,863.94 on or about October 26, 2005;
II) $22,000.00 on or about October 25, 2007;
III) $2,000 on or about February 29, 2008;
IV) $2,500 on or about June 6, 2008; and/or
V) $5,000 on or about August 18, 2009.
Member’s Plea
The Member admitted the allegations set out in paragraphs numbered 1(a),1(b), 1(c) and 2(a), 2(b), 2(c) in the Notice of Hearing. The Panel conducted an oral plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.
Agreed Statement of Facts
Counsel for the College advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts which provided as follows.
THE MEMBER
Lee Ann Eno (the “Member”) obtained a diploma in nursing [ ] in 1974.
The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Practical Nurse (“RPN”) on January 1, 1974. The Member resigned on August 11, 2014.
The Member was employed at [the Facility] from September 14, 1992, until she was terminated on December 4, 2013.
THE FACILITY
The Facility is located in [ ] Ontario.
The Facility is a [ ] long term care home offering both residential and extended care.
The Member worked as a full-time nurse on the day shift.
THE CLIENT
[The Client] became a resident at the Facility on October 4, 2002. She suffered from dementia, hypertension and Alzheimer’s disease.
The Member provided care to [the Client] during her time at the Facility.
The Client was visited by her husband [ ] almost daily during the five years she lived at the Facility, until her death on August 11, 2007.
On February 17, 2013, [the Client’s spouse] passed away. He was less than five months away from his 90th birthday.
FACILITY POLICY
- The Facility had a policy called [the Facility’s] Gifts to Employees/Volunteers policy. It stated:
Employees and volunteers must not solicit and/or accept monetary gifts, or significant gifts of kind, from residents, residents’ families or residents’ significant others and from suppliers.
Questionable and unusual circumstances concerning gifts to employees or volunteers, or gifts of an excessive value, are to be referred for consideration to the Executive Director.
- The Policy went on to state: “Token gifts should not exceed $20.00 in value…”
INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT
Relationship with [the Client’s spouse]
- On November 17, 2004 (while the Client was still a resident at the Facility), the Member invited [the Client’s spouse] to dinner by giving him a note that said:
Would you like to have dinner with me Nov 23/04. I will pick you up around 5:30. You pick the place.
The note was signed, “Love Lee.”
[The Client’s spouse] kept a detailed diary of his daily activities in a calendar. He documented that he and the Member met regularly outside the Facility between 2004 and 2009. The Member and [the Client’s spouse] had coffee together, had dinner together at [the Client’s spouse]’s home, and went to social events together.
The relationship between the Member and [the Client’s spouse] was not sexual or romantic in nature. Rather it was a close platonic friendship.
Financial Transactions with [the Client’s spouse]
On October 26, 2005, the Member accepted a cheque from [the Client’s spouse] for $23,863.94 to purchase a car.
On October 25, 2007, the Member accepted a cheque from [the Client’s spouse] for $22,000 to finance a second mortgage.
On February 29, 2008, the Member accepted $2,000 from [the Client’s spouse].
On June 6, 2008, the Member accepted $2,500 from [the Client’s spouse].
On August 18, 2009, the Member accepted $5,000 from [the Client’s spouse].
There is no evidence that the Member repaid these amounts to [the Client’s spouse]. If the Member were to testify, she would say that she accepted money from [the Client’s spouse] as loans but paid him back in cash instalments of between $400 and $500 over time.
The Member acknowledges that accepting these amounts from [the Client’s spouse], either as loans or gifts, was contrary to [the Facility]’s policies.
ADMISSIONS OF PROFESSIONAL MISCONDUCT
The Member admits that entering into a personal relationship with [the Client’s spouse] and accepting money from him in the amounts of $23,863.94, $22,000, $2,000, $2,500 and $5,000 constitutes a breach of the College’s standards, as set out in paragraphs 13 to 23 above, and as alleged in paragraphs 1(a), (b) and (c) of the Notice of Hearing.
The Member further admits that she committed the acts of professional misconduct as alleged in paragraphs 2 (a), (b) and (c) of the Notice of Hearing, and in particular, her conduct was disgraceful, dishonourable and unprofessional, as described in paragraphs 13 to 23 above.
The Panel noted that the Member signed the Agreed Statement of Facts December 8, 2015 and the witness to the signing signed on December 15, 2015. The Panel clarified that the witness did oversee the Member signing the Agreed Statement of Facts and was satisfied with the explanation.
Decision
The Panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct. In particular, the Panel finds that the Member committed an act of professional misconduct as alleged in paragraphs 1(a), 1(b), 1(c) and 2(a), 2(b), 2(c) of the Notice of Hearing in that she breached the standards of practice by failing to maintain a therapeutic nurse-client relationship with [the Client’s spouse] and [the Client] and accepted sums of money from [the Client’s spouse] which she failed to repay. The Panel finds that the Member’s conduct would reasonably be considered as disgraceful, dishonourable and unprofessional by members of the profession.
The Panel specified that the findings were made on the basis of the evidence that the Member accepted the funds from [the Client’s spouse]. The Panel makes no finding on the allegations in the Notice of Hearing that the Member solicited said funds.
Reasons for Decision
Allegation 1(a ) was supported by paragraphs: 13, 14,15 and 16 in the Notice of Hearing.
Allegation 1(b ) was supported by paragraphs: 17, 18, 19, 20 and 21 in the Notice of Hearing.
Allegation 1(c ) was supported by paragraphs: 22 and 23 in the Notice of Hearing.
Allegation 2(a ) was supported by paragraphs: 13, 14,15,16 and 24 in the Notice of Hearing.
Allegation 2(b ) was supported by paragraphs: 17, 18, 19, 20, 21 and 24 in the Notice of Hearing.
Allegation 2(c ) was supported by paragraphs: 22, 23 and 25 in the Notice of Hearing.
The Member’s conduct demonstrated a persistent breach of boundaries. The Member’s conduct was dishonourable in that she ought to have known that her conduct fell well below the standards of the profession. It is not acceptable for a nurse to enter into a personal relationship with a client or their family members, especially for her own personal gain.
The Panel found the Member’s conduct to be disgraceful in that she accepted a significant amount of money on a number of occasions. To compound the breach of the therapeutic nurse client relationship more was the fact that the monies were not repaid. This illustrates deceit and a moral failing of the Member.
The Panel found the Member’s conduct to be unprofessional as she showed a repeated lack of judgement.
Penalty
The parties submitted a signed copy of a written undertaking the Member had given to the College (the “Undertaking”). The Undertaking includes the Member’s promise to permanently resign as a member of the College and to not apply for membership with the College as a Registered Nurse or a Registered Practical Nurse at any time in the future.
Counsel for the College advised the Panel that a Joint Submission as to Order had been agreed upon. In light of the Undertaking, the Joint Submission as to Order requests that the Panel make an order requiring the Member to appear before the Panel to be reprimanded within three (3) months of the date of this Order.
Penalty Submissions
College Counsel submitted that an oral reprimand was appropriate on the basis that the Member had signed the Undertaking with the College to permanently resign her certificate of registration with no opportunity to reapply for registration in the future. The Member resigned her certificate of registration on August 11, 2014. In addition, Undertaking provides that the College is authorized to provide a copy of the Undertaking to other governing bodies that regulate nursing.
College Counsel stated that in the usual circumstances, in light of the findings the College would have sought a more comprehensive penalty package. However, in this case, the Undertaking and reprimand meet the overriding goal of the protection of the public and maintain the high standards of the nursing profession.
The College presented the case of CNO v. Hearty (Discipline Committee, 2012). The facts in this case were similar in that there were boundary issues related to the therapeutic nurse-client relationship. The member in Hearty admitted to the allegations and entered into an agreement and undertaking, thus ending her career with no opportunity to reapply for licensure in the future. She was ordered by the panel of the Discipline Committee to receive a reprimand.
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 (3) months of the date of this Order.
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 the proposed penalty, has accepted responsibility for her actions. The Panel took into consideration the Undertaking when accepting the Joint Submission as to Order. This Order is appropriate because it clearly indicates to members of the profession that conduct such as this is not acceptable.
As the Member has signed the Undertaking there is no need for the education, remediation and rehabilitation component to the penalty. The Member will not be practising in the future. The findings this Panel made will be available on the public registry. The Panel has concluded that all of the expected elements of an Order have been met: protection of the public through providing general deterrence and specific deterrence. These are achieved and supported by the Joint Submission as to Order and the Undertaking.
I, Tammy Hedge, 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:
Grace Fox, NP
Barbara Titley, RPN
Devinder Walia, Public Member
Chuck Williams, Public Member