College of Nurses of Ontario v. Rowe, 2017 ONCNO 95368

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Catherine Egerton, Public Member, Chairperson

Dawn Cutler, RN Member David Edwards, RN Member Ingrid Wiltshire-Stoby, RN Member

Devinder Walia Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) JEAN-CLAUDE KILLEY for ) College of Nurses of Ontario

• and - )

CHERYL YVONNE ROWE ) SHEILA RIDDELL for Reg. No. 8700718 ) Cheryl Yvonne Rowe

) LUISA RITACCA

) Independent Legal Counsel

) Heard: November 20, 2017

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on November 20, 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 2 a (i) and 2 b (iv) of the Notice of Hearing dated October 16 2017. The panel granted the request. The remaining allegations against Cheryl Yvonne Rowe (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, and defined in subsection 1(1) of Ontario Regulation 799/93, in that, while practising as a Registered Nurse at St. Peter’s Hospital – Hamilton Health Sciences, in Hamilton, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, and in particular:

(a) on or about November 11, 2014, you:

(i) failed to assist client [Client A] to eat and/or left food for client [Client A] to eat independently when it was not safe to leave that client to eat independently;

(ii) failed to monitor and attend to the care needs of client [Client A] when she had food on herself and/or her clothes and/or her bedding;

(iii) engaged in inappropriate communication with the daughter of client [Client A] and/or failed to engage in appropriate therapeutic communication with the daughter of client [Client A];

(iv) failed to act in accordance with client [Client A’s] care plan and/or failed to update client [Client A’s] care plan with respect to the client’s deafness in the right ear;

(b) on or about July 2, 2015, you:

(i) bent client [Client B’s] finger back while the client expressed that this was causing him pain;

(ii) hit client [Client D] across the mouth;

(iii) pulled client [Client F’s] arm between the bed rail and the mattress while the client expressed that this was causing him pain;

(iv) failed to provide an informed and timely response to the client’s daughter’s concerns about client [Client E’s] medications; and

(v) left client [Client C] unattended in a high bed position, with rails down, when the client was known to bed exit;

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(7) of Ontario Regulation 799/93, in that, while practising as a Registered Nurse at the Facility, you abused a client verbally, physically, or emotionally, and in particular:

(a) on or about November 11, 2014, you:

(i) failed to assist client [Client A] to eat and/or left food for client [Client A] to eat independently when it was not safe to leave that client to eat independently;

(ii) failed to monitor and attend to the care needs of client [Client A] when she had food on herself and/or her clothes and/or her bedding;

(b) on or about July 2, 2015, you:

(i) bent client [Client B’s] finger back while the client expressed that this was causing him pain;

(ii) hit client [Client D] across the mouth;

(iii) pulled client [Client F’s] arm between the bed rail and the mattress while the client expressed that this was causing him pain;

(iv) left client [Client C] unattended in a high bed position, with rails down, when the client was known to bed exit;

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(37) of Ontario Regulation 799/93, in that, while practising as a Registered Nurse at the Facility, 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, and in particular:

(a) on or about November 11, 2014, you:

(i) failed to assist client [Client A] to eat and/or left food for client [Client A] to eat independently when it was not safe to leave that client to eat independently;

(ii) failed to monitor and attend to the care needs of client [Client A] when she had food on herself and/or her clothes and/or her bedding;

(iii) engaged in inappropriate communication with the daughter of client [Client A] and/or failed to engage in appropriate therapeutic communication with the daughter of client [Client A];

(iv) failed to act in accordance with client [Client A’s] care plan and/or failed to update client [Client A’s] care plan with respect to the client’s deafness in the right ear;

(b) on or about July 2, 2015, you:

(i) bent client [Client B’s] finger back while the client expressed that this was causing him pain;

(ii) hit client [Client D] across the mouth;

(iii) pulled client [Client F’s] arm between the bed rail and the mattress while the client expressed that this was causing him pain;

(iv) failed to provide an informed and timely response to the client’s daughter’s concerns about client [Client E’s] medications; and

(v) left client [Client C] unattended in a high bed position, with rails down, when the client was known to bed exit.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1a (i), 1a (ii), 1a (iii), 1a (iv), 1b (i),

1b (ii), 1b (iii), 1b (iv), 1b(v), 2a (ii), 2b(i), 2b (ii), 2b (iii), 3a (i), 3a (ii), 3a (iii), 3a (iv), 3b (i), 3 b (ii), 3 b (iii), 3 b (iv), and 3 b (v) 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. Cheryl Yvonne Rowe (the “Member”) obtained a diploma in nursing from Fanshawe College in 1986.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on August 7, 1986.

3. The Member was employed at St. Peter’s Hospital – Hamilton Health Sciences (the “Hospital”) as a full-time staff nurse from October 4, 2004 to July 23, 2015, when her employment was terminated as a result of the incidents described below. The Member filed a grievance which was later resolved.

THE HOSPITAL

4. The Hospital is located in Hamilton, Ontario.

5. The Hospital is a complex continuing care hospital that provides inpatient, outpatient and community-based programs.

6. There are four units in the Hospital – Palliative Care, Restorative Care (for those recovering from surgery), Behavioural Health Program (for clients with dementia and Alzheimer’s) and Complex Care.

7. The Member worked as a full-time relief nurse on all four units on the day, evening and night shift.

8. The incidents below occurred on the Palliative Care Unit and the Behavioural Health Unit.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Incidents on November 11, 2014 Shift

9. [Client A] (“Client A”) was 92 years old at the time of the incident. She was admitted to the Palliative Care Unit on November 7, 2014.

10. The Member worked the day shift, from 0700 to 1900, on November 11, 2014. This was her first shift caring for Client A.

11. Around 1515, Client A’s daughter, [Client A’s Daughter], visited her mother. [Client A’s Daughter] found her mother with a partially filled pudding cup and a spoon on her chest. There was pudding on her mother’s hair, face, gown, and bedding.

12. [Client A’s Daughter] called the Member, who attended at Client A’s room quickly. According to [Client A’s Daughter], the Member was defensive and argumentative, seemingly unconcerned about the Client being dirty. The Member explained that Client A had tried to bite her earlier when she tried to feed the Client, so she left her food tray off to the side in case Client A got hungry later.

13. Client A’s care plan stated that she was not to be left alone with food because she was at risk of choking.

14. According to [Client A’s Daughter], the Member did not return to clean Client A for close to three hours. In the meantime, [Client A’s Daughter] cleaned her mother herself.

15. If the Member were to testify, she would say that Client A was resistive during breakfast, pushing the Member’s hand away and pinching the Member. The Member attempted to feed the Client, but she continued to refuse food. The Member would further testify that she tried to feed Client A again at lunch. Client A took a few bites but then pushed the Member’s hand away. The Member would say that she asked Client A if she wanted the tray left for her, and Client A nodded yes.

16. Client A’s care plan documented that Client A was impaired in her hearing, and that care providers should speak loudly into her right ear, and explain who they were and what they were going to do.

17. The Member did not consult the care plan or see this note before treating Client A that day or attempting to feed her.

18. In fact, Client A was deaf in her right ear, and needed to be spoken to loudly in her left ear. Her care plan, at the time, was incorrect in that regard. [Client A’s Daughter] told the Member that Client A was deaf in her right ear. The Member did not document this in the care plan, or correct the care plan, when [Client A’s Daughter] told her this was the case. If the Member were to testify, she would say that she instead told the oncoming RN and it was added to the care plan.

19. The Member admits that she communicated inappropriately with [Client A’s Daughter] and failed to clean the pudding off Client A in a timely manner. She also admits that leaving Client A’s food tray in her room was inappropriate and contrary to her care plan, given Client A’s risk of choking. Lastly, the Member acknowledges that she should have documented that Client A was deaf in her right ear, after being informed by [Client A’s Daughter].

Incidents on July 2-3, 2015 Shift

20. On July 2, 2015, the Member worked the night shift, from 1900 to 0700, on the Behavioural Health Program unit. On this unit, RNs are paired with an RPN. The night of July 2, 2015, the Member was paired with [Colleague A] (“[Colleague A]”).

Client B & C

21. [Client B] (“Client B”) was 86 years old at the time of the incident. He suffered from dementia.

22. Around 2200, the Member was providing bedtime care to Client B with [Colleague A]. Client B was resistive so [Colleague A] left to get Client B PRN medication. When she returned, Client B was alone in the room and was getting out of bed. [Colleague A] called for help because the Member had already left to provide care to another client, [Client C] (“Client C”). Client C was 82 years old.

23. When the Member heard [Colleague A] calling for help and the bed alarm sounding, she went to help [Colleague A], leaving Client C in the highest bed position with the rails down.

24. Client C was known to exit her bed, and therefore, being left alone in the highest bed position was unsafe for Client C.

25. Shortly thereafter, [Colleague A] and the Member were completing Client B’s bedtime care. While Client B was in the wheelchair and being released from the sling during transfer, he was being resistive. The Member took Client B’s left index finger and bent it back to the point where [Colleague A] would testify she heard a crack. Client B was crying and screaming in pain, telling the Member to “stop it, what are you doing? You are hurting me and going to break my finger,” or words to that effect.

26. [Colleague A] checked Client B’s finger for bruising, swelling, and range of motion and observed no injuries.

27. If the Member were to testify, she would say that she may have used the Thumb Release procedure to get Client B to cooperate, which is an acceptable intervention taught in Gentle Persuasive Approaches (GPA). However, the Member admits that applying pressure to Client B’s finger, to the point that he cried out in pain, was not consistent with this accepted approach and was a breach of the standards of practice and abuse.

28. If the Member were to testify with respect to Client C, she would say that she instinctively ran to [Colleague A] when she heard her colleague call for help, thereby leaving Client C in an unsafe bed position. The Member admits this was unsafe for Client C and a breach of the standards.

Client D

29. [Client D] (“Client D”) was 68 years old at the time of the incident.

30. Around 2245, the Member and [Colleague A] were providing bedtime care to Client D in the bathroom. Client D was resistive and crying. [Colleague A] was holding the Client on the toilet while the Member was undressing and washing her. Client D tried to bite [Colleague A] but she moved her hand out of the way. In response, the Member struck Client D across the mouth and told her to “cut it out.”

31. If [Colleague A] were to testify, she would say the Member struck Client D with three fingers, and that it was “not a full blown slap.”

32. If the Member were to testify, she would acknowledge that she pushed Client D’s head away in a manner that was abusive and was not for a therapeutic purpose.

Client E

33. [Client E] (“Client E”) was 84 years old at the time of the incident.

34. Around 2230, [Client E’s Daughter], Client E’s daughter, was visiting her mother, and noticed she was behaving unusually. She was slurring her words and seemed unsteady on her feet.

35. [Client E’s Daughter] told [Colleague A] she wanted to speak to the nurse in charge, which was the Member. [Colleague A] relayed the request to the Member, who replied that she needed to sit down and would speak with [Client E’s Daughter] after she rested.

36. Approximately 20 minutes later, [Client E’s Daughter] asked [Colleague A] again to speak with the Member when she had not attended the room. Again, [Colleague A] told the Member [Client E’s Daughter] wanted to speak with her.

37. When the Member did eventually attend the room, [Client E’s Daughter] asked the Member whether her mother had been given any medication that day, to which the Member replied that the day nurse had not reported any behaviours with the patient and no PRNs were given to my knowledge.

38. In fact, the Client had received PRN medication, which is why her behaviour was unusual. The Member did not check Client E’s MAR or take any other steps to verify this before assuming that the Client had not received medication, and replying to [Client E’s Daughter] based on that assumption.

39. The Member documented this conversation at 0013, which was as much as an hour and a half after [Client E’s Daughter’s] initial request to speak with her.

40. If the Member were to testify, she would say that her feet were sore and she needed to sit for bit before speaking with [Client E’s Daughter]. The Member told [Client E’s Daughter] that when she assessed Client E she was not slurring and did not appear disoriented.

41. The Member would further testify that she told [Client E’s Daughter] that she believed Client E had not been given a PRN medication because the nurse on the evening shift administered the medication and did not inform her, which the Member would testify was contrary to standard practice on the unit.

42. If the Member were to testify, she would say that the next day, when the Member realized she had given inaccurate information, she apologized to [Client E’s Daughter].

43. The Member acknowledges that it was her responsibility to attend to [Client E’s Daughter’s] request to speak with her in a timely manner, that no client care or other work duties were the cause of her delay in attending to [Client E’s Daughter], and that she ought to have checked, but did not check, Client E’s MAR before advising [Client E’s Daughter] that, to the best of her knowledge, no PRN medication had been administered.

Client F

44. [Client F] (“Client F”) was 92 years old at the time of the incident.

45. Around 0515 or 0530, the Member and [Colleague A] were performing morning rounds.

46. [Colleague A] and the Member were providing care to Client F together. [Colleague A] was washing Client F’s bottom and back while the Member was holding Client F up. The Client was resisting.

47. In response, the Member held Client F’s arm down between the bedrail and the mattress. Client F cried out that the Member was hurting his arm.

48. If the Member were to testify, she would say that she did not intentionally hold Client F’s arm between the bed and the rail as described. Nevertheless, she acknowledges that she held the client’s arm down on the mattress and handled Client F in a rough and abusive way.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

49. The Member admits that she committed the acts of professional misconduct as described in paragraphs 9 to 48 above and as alleged the Notice of Hearing, as follows:

• 1(a) in that she:

o (i) left food for Client A to eat independently when it was not safe to do so;

o (ii) failed to monitor and attend to the care needs of Client A when she had food on herself, her clothes and her bedding;

o (iii) failed to engage in appropriate therapeutic communication with Client A’s daughter;

o (iv) failed to update Client A’s care plan with respect to the client's deafness in the right ear.

• 1(b) in that she:

o (i) bent Client B’s finger back while the client expressed that this was causing him pain;

o (ii) hit Client D across the mouth;

o (iii) pulled Client F’s arm between the bed rail and the mattress while the client expressed that this was causing him pain;

o (iv) failed to provide an informed and timely response to the Client E’s daughter’s concerns about the client’s medications;

o (v) left Client C unattended in a high bed position, with rails down, when the client was known to bed exit.

50. The Member admits that this conduct was contrary to the standards of practice of the profession, including those set out in the College’s published standards titled Professional Standards and Therapeutic Nurse-Client Relationship.

51. The Member admits that she committed the acts of professional misconduct as described in paragraphs 9 to 48 above and as alleged in the Notice of Hearing, as follows:

• 2(a) in that she:

o (ii) emotionally abused Client A when she failed to monitor and attend to her needs when she had food on herself, her clothes and her bedding;

• 2(b) in that she:

o (i) physically abused Client B when she bent his finger back while Client B expressed that this was causing him pain;

o (ii) physically abused Client D when she hit her across the mouth;

o (iii) physically abused Client F when she pulled his arm between the bed rail and the mattress while Client F expressed that this was causing him pain;

52. The Member admits that she committed the acts of professional misconduct as described in paragraphs 9 to 48 above and as alleged in the Notice of Hearing as follows:

• 3(a)(i) in that her conduct was unprofessional;

• 3(a)(ii) in that her conduct was unprofessional;

• 3(a)(iii) in that her conduct was unprofessional;

• 3(a)(iv) in that her conduct was unprofessional;

• 3(b)(i) in that her conduct was disgraceful, dishonourable and unprofessional;

• 3(b)(ii) in that her conduct was disgraceful, dishonourable and unprofessional;

• 3(b)(iii) in that her conduct was disgraceful, dishonourable and unprofessional;

• 3(b)(iv) in that her conduct was dishonourable and unprofessional;

• 3(b)(v) in that her conduct was dishonourable and unprofessional.

53. With leave of the panel of the Discipline Committee, the College withdraws the following allegations from the Notice of Hearing:

• 2(a)(i)

• 2(b)(iv)

Decision

The panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1a (i), (ii), (iii), (iv), 1b (i), (ii), (iii) and (iv), 2a (ii) 2b (i), (ii) and (iii) of the Notice of Hearing. As to allegations 3a (i), (ii), (iii), (iv), the panel finds the Member’s conduct was unprofessional. As to allegations 3b (i), (ii), (iii), the Panel finds the Member’s conduct was disgraceful, dishonourable and unprofessional, and as to allegations 3b (iv) and (v) the Panel finds the Member’s conduct was dishonourable and unprofessional.

Reasons for Decision

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

With respect to the allegations in paragraph 1 of the Notice of Hearing, the evidence amply supports a finding that that Member breached the standards of the profession in her conduct. In particular, allegation #1a (i) in the Notice of Hearing is supported by paragraphs 12,13,15,17,19 and 49, in that the Member left food for Client A to eat independently when it was not safe to do so according to the care plan.

Allegation #1a (ii) in the Notice of Hearing is supported by paragraphs 11,12,14,19 and 49, when the Member failed to monitor and attend to the care needs of Client A who had food on herself, her clothes and her bedding for almost three hours.

Allegation #1a (iii) in the Notice of Hearing is supported by paragraphs 12,14,18,19 and 49, when the Member failed to engage in an appropriate therapeutic conversation with Client A’s daughter in regards to Client A’s care plan.

Allegation #1a (iv) in the Notice of Hearing is supported by paragraphs 16,17,18,19 and 49, as the Member failed to update Client A’s care plan with respect to deafness in her right ear.

Allegation #1b (i) in the Notice of Hearing is supported by paragraphs 25,26,27 and 49, in that the Member bent Client B’s index finger back while the client expressed that it was causing him pain.

Allegation #1b (ii) in the Notice of Hearing is supported by paragraphs 30,31,32 and 49. The Member hit Client D across the mouth with three fingers.

Allegation #1b (iii) in the Notice of Hearing is supported by paragraphs 47,48 and 49. The Member pulled Client F’s arm between the bed rail and the mattress; causing him pain.

Allegation #1b (iv) in the Notice of Hearing is supported by paragraphs 35 through 43 and 49, when the Member failed to provide an informed and timely response to Client E’s daughter in regard to medications.

Allegation #1b (v) in the Notice of Hearing is supported by paragraphs 22,23,24,28 and 49, when the Member left Client C unattended in a high bed position with the rails down when the client was known to bed exit.

The allegation of abuse as set out in paragraph 2 of the Notice of Hearing is supported by the admitted facts and the Member’s plea. In particular, allegation #2a (ii) in the Notice of Hearing is supported by paragraphs 11,12,14,19 and 49. The Member emotionally abused Client A in that she failed to monitor and attend to her needs when she had food on herself, her clothes and her bedding.

Allegation #2b (i) in the Notice of Hearing is supported by paragraphs 25, 26, 27 and 51, as the Member physically abused Client B causing him pain by bending his finger back.

Allegation #2b (ii) in the Notice of Hearing is supported by paragraphs 30,31,32 and 5. The Member physically abused Client D when she hit her across the mouth.

Allegation #2b (iii) in the Notice of Hearing is supported by paragraphs 47,48 and 51. The Member physically abused Client F by pulling his arm between the bed rail and the mattress, causing him pain.

Allegation #3a (i), (ii), (iii), (iv), 3b (i), (ii),(iii), (iv) and (v) are supported by paragraph 52 in the Agreed Statement of Facts. The Member admitted to conduct that would be disgraceful, dishonourable and unprofessional.

With respect to Allegation #3a (i), (ii), (iii) and (iv), the panel finds that the Member’s conduct in failing to feed a client that needed assistance, failing to clean up the client when she tried to do so herself and became covered in food, and then failing to engage in appropriate therapeutic communication with the client’s daughter demonstrated a serious and persistent disregard for her professional obligations. The conduct would certainly be regarded as unprofessional. Her failure to update the client’s care plan when she discovered that it was inaccurate was also unprofessional as it showed a clear disregard for her obligations as a nurse.

With respect to allegations #3b (i), (ii) and (iii), the panel finds that the Member’s conduct was disgraceful, dishonourable and unprofessional. The conduct, and in particular, the verbal and physical abuse of her patients demonstrated an element of serious moral failing that is not acceptable conduct for members of this College.

Finally, with respect to allegations #3b (iv) and (v), the panel finds that the Member’s conduct was dishonourable and unprofessional. She ought to have been more timely in her communications with her patient’s daughter and she should have known not to leave her patient’s bed rails down, as the patient was prone to exiting her bed. The Member’s disregard for her patient’s well-being and her obligations as a nurse shames the Member and by extension the profession. The conduct casts serious doubt on the Member’s inherent ability to discharge the higher obligations the public expects health 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.

Joint Submission on Order

The College Of Nurses Of Ontario (the “College”) and Cheryl Yvonne Rowe (the “Member”) jointly submit that, in view of the facts and admissions set out in the Agreed Statement of Facts and the findings of professional misconduct, the Panel of the Discipline Committee (the “Panel”) should make an Order:

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 six 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 two meetings with a Nursing Expert (the “Expert”), at her own expense and within six months from 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, online learning modules, decision tools and online participation forms (where applicable):

1. Professional Standards,

2. Therapeutic Nurse-Client Relationship,

iv. Before the first meeting, the Member reviews and completes the College’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook;

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

vi. 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;

vii. 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;

viii. 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 returns to the practice of nursing, 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’s Counsel indicated that she agreed with the College’s submissions.

The parties agreed that the mitigating factors in this case were as follows:

(a) The Member admitted to her wrongdoing and as such a contested hearing was not required; and

(b) The Member had no previous complaints or reports to the College.

No aggravating factors were presented by Counsel

Counsel submitted that the proposed penalty provides for general deterrence as the publication of this decision and penalty will send a strong signal to the profession and the public at large that the College will not tolerate this sort of behaviour and in particular behaviour involving abuse of patients.

The proposed penalty also provides for specific deterrence through the significant suspension, through the required meetings with the Nursing Expert, and through the various terms and conditions that will be imposed on the Member’s certificate upon her return to practice. These elements of the penalty will also encourage the Member to remediate and to improve her practice.

Overall, the public is protected by this proposed penalty because it provides a specific deterrence and a general deterrence. The proposed penalty demonstrates that that the College takes matters of patient abuse seriously.

Counsel submitted cases to the panel to demonstrate that the proposed penalty falls within the range of similar cases from this Discipline Committee.

Cases presented by College Counsel:

CNO v Lewis (Discipline 2013)

The Member was given a reprimand, a six month suspension, was required to attend three meetings with the Nursing Expert and employer notification for twenty four months in the case of rehire. This member’s transgressions did not include physical abuse but did include speaking in a rude or condescending manner to clients and denying them medication that was ordered.

CNO v George (Discipline 2014)

The Member received a reprimand, a six month suspension, two meetings with a Nursing Expert and will be required to notify her employers for eighteen months of her terms and conditions. Again there were no instances of physical abuse, but verbal and emotional abuse of patients and family members, and medication discrepancies.

CNO v Gilford (Discipline 2017)

The member received a reprimand, a seven month suspension, two meetings with the Nursing expert and eighteen month terms and conditions. This incident involved forcing a patient to take a pill, and administering the wrong medication. The Member did not attend the hearing.

Cases presented by Counsel for the Member:

CNO v Gibson (Discipline 2014)

The Member received a reprimand, a three month suspension, three meetings with the Nursing expert and terms and conditions for twelve months. This case included physical, emotional and verbal abuse of clients.

CNO v Andrews (Discipline 2009)

The Member received a reprimand, a seven month suspension, three meetings with the Nursing expert and terms and conditions for twenty-four months upon rehire. This instance involved physical abuse of one single patient on one occasion only.

Penalty Decision

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

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

2. Directing the Executive Director to suspend the Member’s certificate of registration for six months. This suspension shall take effect from the date 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 two meetings with a Nursing Expert (the “Expert”), at her own expense and within six months from 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, online learning modules, decision tools and online participation forms (where applicable):

1. Professional Standards,

2. Therapeutic Nurse-Client Relationship,

iv. Before the first meeting, the Member reviews and completes the College’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook;

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

vi. 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;

vii. 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;

viii. 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 returns to the practice of nursing, 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.

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 co-operated 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 deterrence and general deterrence, rehabilitation and remediation. The penalty is in line with what has been ordered in previous cases.

I, CATHERINE EGERTON, 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