College of Nurses of Ontario v. Rose Hong Dang, 2017 ONCNO 50751

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Michael Hogard, RPN Chairperson David Edwards, RPN Member Grace Fox, NP Member Margaret Tuomi Public Member Devinder Walia Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) NICK COLEMAN for ) College of Nurses of Ontario

• and - ) ROSE HONG DANG ) Reg. No. 0007856 ) CAROL STREET for ) Rose Hong Dang ) Heard: March 23, 2017

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) on March 23, 2017 at the College of Nurses of Ontario (“the College”) at Toronto.

The Allegations

Counsel for the College advised the panel that the College was requesting leave to withdraw the allegations set out in paragraphs 1(a)(ii), 1(a)(iii), 1(b)(iii), 5(a)(ii), 5(a)(iii) and 5(b)(iii) of the Notice of Hearing dated December 13, 2016. The Panel granted this request. The remaining allegations against Rose Hong Dang (the “Member”) 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 (the “Act”), and defined in subsection 1(1) of Ontario Regulation 799/93, in that, while employed as a Registered Nurse by Mount Sinai Hospital in Toronto, Ontario, 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) For the client, [Client A]:

i. failing to maintain a proper nurse-client relationship, in or about May - June 2014;

ii. withdrawn;

iii. withdrawn;

iv. recommending an alternative therapy for cancer, Fucoidan, without the knowledge, skill or judgment to make such recommendation and/or contrary to treatment ordered by the medical team, in or about May - June 2014;

v. discouraging the client from discussing with his medical team the alternative therapy you recommended for cancer, Fucoidan, in or about May - June 2014; and/or

vi. holding yourself out as a doctor to the client, his mother and his family advocates, in or about May – June 2014.

b) For the client,[Client B]:

i. failing to maintain a proper nurse-client relationship, in or about May - October 2012;

ii. accessing the client’s medical records while he was not in your care, in or about August - October 2012;

iii. withdrawn;

iv. holding yourself out as a doctor to the client and his wife, in or about May – October 2012;

v. holding yourself out as a nurse practitioner to your administrator, in or about December 2012; and/or

vi. providing care to the client while acting as his Power of Attorney for Personal Care, in or about May – December 2012.

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Act, and defined in subsection 1(16) of Ontario Regulation 799/93, in that, while employed as a Registered Nurse by Mount Sinai Hospital in Toronto, Ontario, you inappropriately used a term, title or designation in respect of your practice when you held yourself out as:

a) a doctor, to your client, [Client A], his mother and his family advocates, in or about May - June 2014;

b) a doctor, to your client, [Client B], and his wife, in or about May - October 2012; and/or

c) a nurse practitioner to your administrator, in or about December 2012.

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Act, and defined in subsection 1(19) of Ontario Regulation 799/93, in that, while employed as a Registered Nurse by Mount Sinai Hospital in Toronto, Ontario, you contravened a provision of the Regulated Health Professions Act, 1991, S.O. 1991, c18, as amended, and in particular, s. 33(1) of the Regulated Health Professions Act, 1991, S.O. 1991, c18, as amended when you identified yourself as a doctor and used the title “doctor” in the course of providing health care to:

a) the client, [Client A], in or about May - June 2014; and/or

b) the client, [Client B], in or about May - October 2012.

4. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Act, and defined in subsection 1(26) of Ontario Regulation 799/93, in that, while employed as a Registered Nurse by Mount Sinai Hospital in Toronto, Ontario, you practised the profession while in a conflict of interest in that you continued to provide health care to [Client B] after being appointed his Power of Attorney for Personal Care, in or about May - October 2012.

5. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Act, and defined in subsection 1(37) of Ontario Regulation 799/93, in that, while employed as a Registered Nurse by Mount Sinai Hospital in Toronto, Ontario, 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 as disgraceful, dishonourable or unprofessional with respect to the following incidents:

a) For the client, [Client A]:

i. failing to maintain a proper nurse-client relationship, in or about May - June 2014;

ii. withdrawn;

iii. withdrawn;

iv. recommending an alternative therapy for cancer, Fucoidan, without the knowledge, skill or judgment to make such recommendation and/or contrary to treatment ordered by the medical team, in or about May - June 2014;

v. discouraging the client from discussing with his medical team the alternative therapy you recommended for cancer, Fucoidan, in or about May - June 2014; and/or

vi. holding yourself out as a doctor to the client, his mother and his family advocates, when you are not a doctor, in or about May – June 2014.

b) For the client, [Client B]:

i. failing to maintain a proper nurse-client relationship, in or about May - October 2012;

ii. accessing the client’s medical records while he was not in your care, in or about August - October 2012;

iii. withdrawn;

iv. holding yourself out as a doctor to the client and his wife, when you are not a doctor, in or about May – October 2012;

v. holding yourself out as a nurse practitioner to your administrator, when you are not a nurse practitioner, in or about December 2012; and/or

vi. providing care to the client while acting as his Power of Attorney for Personal Care, in or about May – December 2012.

Member’s Plea

The Member admitted the allegations set out in paragraphs #1(a)(i), 1(a)(iv), 1(a)(v), 1(a)(vi), 1(b)(i), 1(b)(ii), 1(b)(iv), 1(b)(v), 1(b)(vi), 2(a), 2(b), 2(c), 3(a), 3(b), 4, 5(a)(i), 5(a)(iv), 5(a)(v), 5(a)(vi), 5(b)(i), 5(b)(ii), 5(b)(iv), 5(b)(v), and 5(b)(vi) 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. Rose Hong Dang (the “Member”) obtained a diploma in nursing from Conestoga College in 1998.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on March 2, 2000.

3. The Member was employed at Mount Sinai Hospital (the “Hospital”) from November 8, 2000 to July 21, 2014, when her employment was terminated as a result of the incidents below. The Member resigned from the College on March 15, 2017.

4. The Member was originally from Vietnam and her first language is Vietnamese. When she left her country, she was working towards her medical degree. She arrived in Canada as the widowed mother of two young children. She is now 60 years old.

THE HOSPITAL

5. The Hospital is located in Toronto, Ontario.

6. The Member worked on the [the Unit] (the “Unit”) as a full-time staff nurse on day and weekend shifts.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Client A

7. [Client A] was 20 years old at the time of the incidents.

8. He was diagnosed with sarcoma and was admitted to the Hospital on May 23, 2014 for palliative care. He died shortly after the incidents described below.

9. Client A’s mother did not speak English. Two community members, [community member A] and [community member B], acted as advocates for the Client and his mother and assisted with translation (Mandarin) during his time at the Hospital.

10. At a family meeting on June 10, 2014, [community member A] and [community member B] raised a number of concerns about the Member’s care of Client A. Client A, his mother, a number of hospital staff and treating physicians were present at the meeting.

Fucoidan

11. It was stated at the meeting on June 10, 2014 that the Member had recommended that Client A and/or his mother purchase Fucoidan, a natural health product that is algae based and purports to have anti-inflammatory properties. The Member told Client A and his mother that Fucoidan has no side effects and that it “cures cancer.”

12. The Member provided Client A and his mother with the address where the product could be purchased and advised Client A to take nine pills per day. The Member told [community member A] that the product was very good and “patients were cured.”

13. The Member told Client A and his mother not to tell the medical team that she recommended Fucoidan because it was not recognized by Western medicine.

14. The Member admits that she recommended Fucoidan to Client A and his mother and that she told them it was considered an effective alternative cancer treatment. The Member further admits that she told Client A and his mother not to mention her recommendation of Fucoidan to Client A’s medical team.

Holding Out As Physician

15. During Client A’s admission to the Hospital, the Member held herself out to Client A, his mother, [community member A] and [community member B] as a physician who was in a residency program at McMaster University in Hamilton, Ontario. [Community member A] overheard the Member describing herself to Client A and his mother as a doctor during one of her visits.

16. At the family meeting, Client A was distraught and surprised when he learned that the Member was not a doctor. He requested to be transferred to another unit at the Hospital, away from the Member. Client A was transferred immediately following the family meeting.

17. The Member admits that she held herself out as a doctor to Client A, his mother and his family advocates and she acknowledges that her dishonesty caused harm to Client A.

Boundary Issues with Client A

18. It was also identified at the meeting on June 10, 2014, that the Member gave Client A her personal cell phone number and contacted him on his cell phone by calling and exchanging text messages.

19. The Member admits that she provided her personal cell phone number to Client A. If the Member were to testify, she would say that she gave Client A her phone number to show him support, which she now realizes was inappropriate and a breach of the College’s Therapeutic Nurse-Client Relationship standard.

Client B

20. [Client B] suffered from heart failure and had multiple admissions to the Unit between May 2012 and January 2013 when he died.

Boundary Issues with Client B

21. The Member had become friends with both Client B and his wife several years before the incidents in question. She visited with them at their home socially a number of times in the previous years. Client B and his family were Japanese and there was a connection between their families.

22. As a result of that friendship, the Member shared her personal phone number with Client B and his wife and contacted them at home on several occasions. The Member also referred to Client B as “uncle” and “papa” and Client B’s wife as “mama” while Client B was in her care. The Member also visited Client B at home.

23. If the Member were to testify, she would say that the use of the terms “uncle,” “papa,” and “mama” was a cultural sign of respect and connection.

24. When Client B was admitted to the Hospital between May 2012 and January 2013, the Member involved herself in his care and treatment. If the Member were to testify, she would say that she did not realize her relationship with Client B and his family was inappropriate at the time. However, she now acknowledges that she breached the College’s Therapeutic Nurse-Client Relationship standard by engaging in a personal relationship with Client B and his family in the course of providing him with nursing care.

Holding Out As Physician

25. The Member told Client B’s wife she was a doctor in the Emergency Department at a hospital in Hamilton, Ontario.

26. The Member admits that she held herself out as a doctor to Client B and his wife, which she acknowledges was inappropriate, unprofessional and a breach of trust.

Breach of Privacy

27. At or around September 22/23, 2012, Doctor A (cardiology resident) was on call. The Member was not on duty.

28. The Member received a call from Client B’s wife who was concerned about her husband’s most recent blood results. The Member visited Client B and reviewed his blood results. She then asked the assigned nurse to page the cardiology resident. The Member took the phone from the assigned nurse to discuss her concerns about the blood results with Doctor A.

29. The Member also accessed Client B’s medical record on the following dates when she was not providing care to him:

• August 14, 2012 at 09:15;

• September 29, 2012 at 07:31 and 08:32;

• September 30, 2012 at 07:14 and 08:20; and

• October 1, 2012 at 08:11, 08:47 and 14:22.

30. The Member admits that she accessed and discussed Client B’s medical record when she was not providing care to Client B and that she spoke with Doctor A about Client B’s blood results when she was not on duty.

31. On September 24, 2012, a meeting was held as a result of the Member’s conduct while off duty.

Conflict of Interest

32. During the September 24, 2012 meeting, the Member advised management that, at Client B’s request, she was his Power of Attorney (“POA”) for personal care.

33. The next day, a lawyer attended the Hospital to execute a POA in the Member’s name. At the time, the Member’s Administrator, [the Administrator], advised the Member that she was to have no further access to Client B’s record, she was to leave rounds when Client B was being discussed and she was not to provide any care to Client B while on duty.

34. The Member admits that she engaged a conflict of interest when she provided care to Client B while acting as his POA.

Holding out as a Nurse Practitioner (“NP”)

35. The Member held herself out as a NP to [the Administrator].

36. [The Administrator] learned that the Member was representing herself as a NP to Client B’s niece. In a meeting on December 3, 2012, [the Administrator] asked the Member if she was holding herself out as an NP and the Member told her she was a NP. Seeking clarification, [the Administrator] asked the Member if she had completed the exam and the Member said she had not done so.

37. The Member admits that she held herself out as a Nurse Practitioner to [the Administrator] when she had neither completed the requisite education nor written the licencing examination.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

38. The Member admits that she committed the acts of professional misconduct, as described in paragraphs 6 to 37 above, and as alleged in the following paragraphs of the Notice of Hearing:

• 1(a)(i), (iv), (v) and (vi);

• 1(b)(i), (ii), (iv), (v) and (vi).

39. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 2(a), (b) and (c) of the Notice of Hearing in that she inappropriately used a term, title or designation in respect of her practice when she held herself out as a doctor to Client A and Client B and a Nurse Practitioner to her Administrator.

40. The Member further admits that she committed the acts of professional misconduct as alleged in paragraph 3(a) and (b) of the Notice of Hearing in that she identified herself as a doctor and used the term “doctor” in the course of providing health care to Client A and Client B.

41. The Member admits that she committed the act of professional misconduct as alleged in paragraph 4 of the Notice of Hearing in that she practised nursing while in a conflict of interest, in that she provided care to Client B after being appointed his Power of Attorney for Personal Care.

42. The Member admits that she committed the acts of professional misconduct, as described in paragraphs 6 to 37 above, and as alleged in the Notice of Hearing in the following paragraphs:

• 5(a)(i), (iv), (v) and (vi) & 5 (b)(i), (ii), (iv), (v) and (vi) in that her conduct was disgraceful, dishonourable and unprofessional.

43. The College withdraws allegations 1(a)(ii), (iii), 1(b)(iii), 5(a)(ii), (iii) & 5(b)(iii).

Decision

The Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1(a)(i), 1(a)(iv), 1(a)(v), 1(a)(vi), 1(b)(i), 1(b)(ii), 1(b)(iv), 1(b)(v), 1(b)(vi), 2(a), 2(b), 2(c), 3(a), 3(b), and 4 of the Notice of Hearing.

As to allegation # 5(a)(i), (iv), (v) and (vi) & 5 (b)(i), (ii), (iv), (v) and (vi), 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(a)(i), (iv), (v), and (vi) in the Notice of Hearing is supported by paragraphs 6 through 19 in the Agreed Statement of Facts. The Member held herself out to Client A and family as a physician and recommended a natural health product as a “cancer cure”. She also breached the College’s Therapeutic Nurse-Client Relationship standard in providing her personal cell phone number and exchanging text messages.

Allegation #1 (b)(i), (ii), (iv), (v), and (vi) in the Notice of Hearing is supported by paragraphs 6 and 20 through 37 in the Agreed Statement of Facts. The Member also contravened the standards of practice when she breached boundaries with Client B. She held herself out as a physician and nurse practitioner to Client B’s family. She breached privacy by accessing his chart when not in his circle of care and became power of attorney for personal care, creating a conflict of interest.

Allegation #2(a) in the Notice of Hearing is supported by paragraphs 15, 16 and 17 in the Agreed Statement of Facts, in that she held herself out to be a physician to Client A and family.

Allegation #2(b) in the Notice of Hearing is supported by paragraphs 25 and 26 in the Agreed Statement of Facts, in that she held herself out to be a physician to Client B and his wife.

Allegation #2(c) in the Notice of Hearing is supported by paragraphs 35, 36 and 37 in the Agreed Statement of Facts, in that she held herself out as a nurse practitioner to her administrator.

Allegation #3(a) in the Notice of Hearing is supported by paragraphs 15, 16 and 17 in the Agreed Statement of Facts in that she identified herself as a doctor in providing care to Client A.

Allegation #3(b) in the Notice of Hearing is supported by paragraphs 25 and 26 in the Agreed Statement of Facts, in that she held herself out as a doctor to Client B and his wife

Allegation #4 in the Notice of Hearing is supported by paragraphs 32, 33 and 34 in the Agreed Statement of Facts, in that she practiced while in a conflict of interest. She provided nursing care to a client while she was his Power of Attorney, which is a clear conflict.

Allegation #5(a)(i) in the Notice of Hearing is supported by paragraphs 18 and 19 in the Agreed Statement of Facts. Allegation #5(a)(iv) in the Notice of Hearing is supported by paragraphs 11, 12, 13 and 14 in the Agreed Statement of Facts. Allegation #5(a)(v) in the Notice of Hearing is supported by paragraphs 13 and 14 in the Agreed Statement of Facts. Allegation #5(a)(vi) in the Notice of Hearing is supported by paragraphs 15, 16 and 17 in the Agreed Statement of Facts.

Allegation #5(b)(i) in the Notice of Hearing is supported by paragraphs 21 through 26 in the Agreed Statement of Facts. Allegation #5(b)(ii) in the Notice of Hearing is supported by paragraphs 27 through 31 in the Agreed Statement of Facts. Allegation #5(b)(iv) in the Notice of Hearing is supported by paragraphs 25 and 26 in the Agreed Statement of Facts. Allegation #5(b)(v) in the Notice of Hearing is supported by paragraphs 35, 36 and 37 in the Agreed Statement of Facts. Allegation #5(b)(vi) in the Notice of Hearing is supported by paragraphs 32, 33 and 34 in the Agreed Statement of Facts.

With respect to Allegation # 5, the Panel finds that the Member’s conduct was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. She lead clients to believe that she was a physician and advised a herbal care for cancer treatment. The Member failed to maintain boundaries for two clients, cared for a client when listed as his power of attorney and accessed medical records of that client when the client was not in her care.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit through holding herself out as a physician and/or nurse practitioner without the education or certification for that title.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. The conduct 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 the Member had entered into an undertaking with the Executive Director of the College signed on March 15, 2017 (the “Undertaking”). In the Undertaking, the Member undertook and agreed (among other things):

• To permanently resign as a member of the College;

• To not apply for membership with the College as a Registered Nurse or Registered Practical Nurse at any time in the future; and

• That the public portion of the College’s register will indefinitely reflect that the Member entered into an Undertaking to permanently resign as a member of the College as part of an agreed resolution of allegations of professional misconduct.

In light of the Undertaking, the parties made a Joint Submission on Order. The Joint Submission requests that this Panel make an order requiring the Member to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.

Penalty Submissions

Through the Undertaking, the Member has agreed to resign as a member of the College and not apply for membership with the College at any time in the future. The public portion of the Register of the College will indefinitely reflect the Undertaking as part of the agreed resolution of the allegations in this hearing. Because of the Undertaking, the penalty requested by the parties was different than the penalty that would be requested in other circumstances.

The parties agreed that the mitigating factors in this case were that the Member cooperated with the College, is at the end of her career and accepts responsibility for her actions.

The main aggravating factor in this case was the seriousness of the allegations.

The proposed penalty provides for general deterrence through the reprimand, the signed Undertaking, and the public portion of the College’s Register which will indefinitely reflect the Undertaking as part of an agreed resolution of the allegations. Specific deterrence and remediation are not as applicable as the Member agrees to never practice nursing in any capacity. Overall, the public is protected because the Member will not practice nursing in the future.

Counsel submitted three cases to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee, as examples of cases where panels ordered only a reprimand in matters where members had given similar undertakings.

CNO v. Hearty (Discipline Committee, 2012) related to care of a client and failure to respect the nurse/client relationship. The member admitted to the misconduct and signed an undertaking to resign and not practice nursing in the future. In light of the member’s undertaking, the panel in that case ordered a reprimand.

CNO v. Wood (Discipline Committee, 2012) and Eno v CNO (Discipline Committee, 2016) were presented as examples of serious misconduct, admitted by the members, which led to the members’ resignations and signed undertakings to never apply for registration at the College in the future. In both those cases, in light of the undertakings, the panels ordered a reprimand.

Penalty Decision

The panel accepted the Joint Submission as to Order and accordingly ordered that the Member shall appear before the Panel to be reprimanded within three months of the date this Order becomes final.

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.

In concluding that the proposed penalty is reasonable and in the public interest, the Panel relied on the Member’s Undertaking. But for that Undertaking, the Panel would have ordered a much different penalty.

In this case, the Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility. The Panel finds that the penalty combined with the Undertaking satisfies the principles of general deterrence and public protection. Given that the Member has resigned her certificate of registration, the Panel finds that sanctions addressing remediation and specific deterrence are not required.

I, Michael Hogard, 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.

Chairperson Date