College of Nurses of Ontario v. Grace Appiah-Kubi, 2018 ONCNO 129360

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Heather Stevanka, RN Chairperson Dawn Cutler, RN Member David Edwards, RPN Member Tania Perlin Public Member Devinder Walia Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO MEGAN SHORTREED for College of Nurses of Ontario

• and -

GRACE APPIAH-KUBI Reg. No. 10431963 SOPHIA RUDDOCK for Grace Appiah-Kubi

PATRICIA HARPER Independent Legal Counsel

Heard: NOVEMBER 6, 2018

DECISION AND REASONS

This matter came on for hearing before a Panel of the Discipline Committee (the “Panel”) on November 6, 2018 at the College of Nurses of Ontario (the “College”) at Toronto.

Grace Appiah-Kubi (the “Member”) was present for the hearing and was represented by Counsel.

Publication Ban

At the request of the College and Defence Counsel, the Panel made an order pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, preventing the public disclosure of the name of the patient referred to orally or in any documents presented in the Discipline hearing of Grace AppiahKubi or any information that could disclose the identity of the patient, including a ban on the publication or broadcasting of these matters.

The Allegations

The allegations against the Member as stated in the Notice of Hearing dated October 16, 2018 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 working as a Registered Nurse at St. Michael’s Hospital in Toronto, Ontario (the “Hospital”), you contravened a standard or practice of the profession or failed to meet the standards of practice of the profession as follows:

a. in or about August, 2016, you were aware that a fellow nurse had sexual intercourse with [the Client], and you did not report this to the Hospital or the College; and/or

b. on or about August 9, 2016, when you were in the role of Charge Nurse, you did not revise the patient assignment to prevent a fellow nurse who you knew had engaged in sexual intercourse with [the Client] the previous night from being designated as [the Client]’s assigned nurse; and/or

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(19) of Ontario Regulation 799/93, in that while working as a Registered Nurse at the Hospital, you contravened a provision of the Act, the Regulated Health Professions Act, 1991 or the regulations under either of those Acts, with respect to the following incidents:

a. in or about August, 2016, you were aware that a fellow nurse had sexual intercourse with [the Client], and you did not report sexual abuse to the College, contrary to s. 85.1 of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended; and/or

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(25) of Ontario Regulation 799/93, in that while working as a Registered Nurse at the Hospital, you failed to report an incident of unsafe practice or unethical conduct of a health care provider with respect to the following incidents:

a. in or about August, 2016, you were aware that a fellow nurse had sexual intercourse with [the Client], and you did not report this to the Hospital or the College; and/or

4. 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 employed as a Registered Nurse at the Hospital, 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, as follows:

a. in or about August, 2016, you were aware that a fellow nurse had sexual intercourse with [the Client], and you did not report this to the Hospital or the College; and/or

b. on or about August 9, 2016, when you were in the role of Charge Nurse, you did not revise the patient assignment to prevent a fellow nurse who you knew had engaged in sexual intercourse with [the Client] the previous night from being designated as [the Client]’s assigned nurse.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1(a), 1(b), 2(a), 3(a) and 4(a), 4(b) in the Notice of Hearing. The Panel received a written plea inquiry which was signed by the Member. The Panel also conducted an oral plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Agreed Statement of Facts

Counsel for the College and the Member advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads as follows.

THE MEMBER

1. Grace Appiah-Kubi (the “Member”) obtained a degree in nursing from Ryerson University in 2010.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on August 30, 2010.

3. The Member has been employed at St. Michael's Hospital (the "Hospital") since October 2010.

THE HOSPITAL

4. The Hospital is located in Toronto, Ontario.

5. At the time of the incident, the Member was working full-time on the Respiratory Unit, [ ](the “Unit”).

6. The Respirology Unit at the Hospital is located at [ ] (the “Unit”). It has 15 client beds and was almost always filled to capacity. [ ]. The most common diagnosis on the Unit is Cystic Fibrosis, and clients are typically admitted for a minimum of two weeks, though some stays were longer.

7. All nurses on the Unit are RNs who work 12 hour day or night shifts from 0730 to 1930 or from 1930 to 0730. The nurse to client ratio is one nurse to five clients, which means there are always three RNs working each shift, including the Charge Nurse. During the day shift, there is an additional Resource Nurse on shift.

THE CLIENT

8. was 31-years old at the time of the incident. He was diagnosed with cystic fibrosis.

9. He was admitted to the Hospital as an inpatient on June 29, 2016 and was discharged on October 4, 2016. Between July 13 and August 4, he was temporarily moved to another unit [ ].

10. The Client had previous admissions to the Hospital ([ ]).

11. The Client died in June 2018.

COLLEGE STANDARDS AND MANDATORY REPORTING REQUIREMENTS

12. The College’s practice standard, Professional Standards, states that:

Each nurse is accountable to the public and responsible for ensuring that her/his practice and conduct meets legislative requirements and the standards of the profession.

13. It goes on to state that nurse a nurse demonstrates accountability by:

…reporting sexual abuse of a client by a regulated health professional to the appropriate regulatory college, as legislated in the Regulated Health Professions Act, 1991.

14. The College’s Therapeutic Nurse-Client Relationship (TNCR) Standard states that:

Nurses protect the client from harm by ensuring that abuse is prevented, or stopped and reported…

The nurse meets the standard by:

…intervening and reporting a health care provider’s behaviours or remarks toward a client that may reasonably be perceived by the nurse and/ or others to be romantic, sexually suggestive, exploitive and/or sexually abusive;

15. The TNCR Standard goes on to state:

If a nurse witnesses another nurse or a member of the health care team abusing a client, the nurse must take action. College research indicates that when someone intervenes in an incident of abuse, the abuse stops. After intervening, a nurse must report any incident of unsafe practice or unethical conduct by a health care provider to the employer or other authority responsible for the health care provider. ...

Certain legislation requires further reporting of abuse. The Regulated Health Professions Act, 1991 requires regulated health professionals to report the sexual abuse of a client by a regulated health professional to the appropriate college.

16. The College’s Mandatory Reporting Guide states that “[a] nurse is required to file a report to the appropriate regulatory college if they believe that another health care professional has sexually abused a client.” The Guide does not set a time limit for nurses reporting sexual abuse. For facilities, it states: “Once a facility has determined that it has a reporting obligation, the report must be made to the College’s Executive Director in writing within 30 days. The report must be filed immediately if there is a concern that the nurse poses a continued risk.” (emphasis added)

17. Section 85.1 of the Health Professions Procedural Code of the Nursing Act, 1991 (the “Code”) mandates that a member shall file a report in accordance with section 85.3 if the member has reasonable grounds to believe that another member of the same or a different College has sexually abused a patient.

18. Under s. 85.3(2) of the Code, “The report must be filed within 30 days after the obligation to report arises unless the person who is required to file the report has reasonable grounds to believe that the member will continue to sexually abuse the patient…” (emphasis added).

19. The Professional Standards also state that a nurse demonstrates ethical conduct by “creating environments that promote and support safe, effective and ethical practice.”

INCIDENT RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

20. The Member was the Charge Nurse on the night shift on August 8-9, 2016. Two other RNs, M.C. and [RN #1] were also on shift.

21. Around 0245, the Member went on break.

22. Approximately one hour later, [RN #1] went to the nursing lounge and was upset. [RN #1] reported to the Member, who was on break, that she had heard noises coming from the Client’s room and she believed the Client and nurse M.C. were having sex. The Member did not respond to [RN #1]’s concern or provide her with any guidance.

23. [RN #1] left the nursing lounge to investigate the noise. When she returned to the Client’s door, [RN #1] would testify that she heard squeaking noises, which sounded like a bedframe moving. [RN #1] entered the Client’s room and witnessed M.C. and the Client having sexual intercourse. M.C. and the Client both ran to the bathroom when [RN #1] entered the room.

24. Shortly after, the Member observed [RN #1] in conversation with M.C. at the nursing station. At this time, the Client approached the Member at the nursing station and said something to the effect of, “I’m assuming you heard what happened. I’m sorry for putting you in this position. I’m in a vulnerable state right now for being in the hospital so long and [M.C.] is also in a vulnerable position in life so we just connected.” Later, the Member described this discussion as “[patient] told me they had sex.” The Client also told the Member he did not want others to know about the incident.

25. The Member did not report M.C.’s conduct to the Hospital or the College.

26. The Member worked the next night, August 9-10, 2016, along with M.C. and [RN #1]. The Member was the Charge Nurse on shift. M.C. was assigned to the Client again, as was usual since she had been assigned to him the previous night.

27. The Member spoke with the Client about having M.C. as his assigned nurse and he said it was fine with him. The Member also asked the abuser, M.C., if she was comfortable with the patient assignment. M.C. advised that she could keep her relationship with the Client professional, so the Member, despite being the Charge Nurse, did not change the nursing assignment. If the Member were to testify, she would say that she was concerned that if she switched the assignments everyone would notice and it would raise questions and invade the client's privacy.

28. Two weeks later, on August 23, 2016, [RN #1] told [RN #2], the Resource Nurse, about M.C. and the Client having sex. [RN #1] waited to report the incident until [RN #2] returned from vacation (August 23, 2016 was her first day back in the office). [RN #2] then reported to the Unit’s Clinical Leader/Manager, who asked to meet the Member to speak about the incident.

29. In her meeting with the Hospital, the Member admitted that she knew she was required to report sexual abuse, and referred specifically to the College’s Mandatory Reporting Guide. If the Member were to testify, she would say that although she looked up the reporting information on the College website after the incident, she was unsure about exactly what evidence was required to report and wanted to consult with the Resource Nurse prior to doing so.

30. The Member indicated that “[RN #1] spoke to [RN #2] first because she witnessed [the abuse]”. She also stated, “I knew I should have [changed the assignment]" but explained that she was concerned about questions being raised about it.

31. If the Member were to testify, she would say that she intended to report M.C.’s conduct to [RN #2] when she returned from vacation, but did not because [RN #1] was reporting it first.

32. In any event, the Member acknowledges that she breached the Code, the College’s practice standards, and the Mandatory Reporting guidelines by not reporting M.C.’s conduct to the Hospital in a timely way, especially given her position as the Charge Nurse on shift. In hindsight, she acknowledges that there was a continued risk of abuse requiring immediate reporting, particularly because she allowed the abuser to remain in a nurse-client relationship with the Client the next shift and over the next two weeks. The Member took no measures and made no inquiries to ensure the abuse was not ongoing.

33. The Member also acknowledges that she breached the standards of practice when she assigned M.C. to care for the Client the night after the sexual abuse occurred, thereby putting the Client at risk.

34. The Member also acknowledges that she was obliged to report the allegation of sexual abuse to the College in accordance with section 85.1 of the Code, and failed to do so.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

35. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 1(a) and (b) of the Notice of Hearing, as described in paragraphs 20 to 34 above, in that she failed to meet the standards of practice of the profession because she was aware that a fellow nurse had sex with a Client and she did not report it to the College or the Hospital, and she, as the Charge Nurse, allowed M.C. to be assigned to care for the Client the night after the alleged sexual abuse occurred.

36. The Member admits that she committed an act of professional misconduct as set out in paragraph 2(a) of the Notice of Hearing in that she failed to report sexual abuse to the College and thereby contravened section 85.1 of the Code.

37. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3(a) of the Notice of Hearing, as described in paragraphs 20 to 34, in that she failed to report an incident of unsafe practice or unethical conduct of a health care provider when she became aware that M.C. had sex with the Client and she failed to report it to the College or the Hospital.

38. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 4 (a) and (b) of the Notice of Hearing, and in particular that her conduct, as described in paragraphs 20 to 35 above, would reasonably be regarded by members as dishonourable and unprofessional.

Decision

The College bears the onus of proving the allegations in accordance with the standard of proof, that being the balance of probabilities, based upon clear, cogent and convincing evidence. Having considered the evidence and the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1(a), 1(b), 2(a), and 3(a) of the Notice of Hearing. As to allegations 4(a) and (b), the Panel finds that the Member engaged in conduct that would reasonably be considered by members of the profession to be 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) in the Notice of Hearing is supported by paragraphs 20-34 in the Agreed Statement of Facts.

Allegation 1(b) in the Notice of Hearing is supported by paragraphs 20, 25-27, 30, 32 and 33 in the Agreed Statement of Facts.

Allegation 2(a) in the Notice of Hearing is supported by paragraphs 22-25 and 27-34 in the Agreed Statement of Facts.

Allegation 3(a) in the Notice of Hearing is supported by paragraphs 22-25 and 27-34 in the Agreed Statement of Facts.

Allegation 4(a) in the Notice of Hearing is supported by paragraphs 20-34 in the Agreed Statement of Facts.

Allegation 4(b) in the Notice of Hearing is supported by paragraphs 20, 25-27, 30, 32 and 33 in the Agreed Statement of Facts.

With respect to Allegation 4(a), the Panel finds that the Member’s conduct in being aware of the fellow nurse’s inappropriate behaviour and failing to report this to the Hospital or College was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. The Panel also finds that the Member’s conduct was dishonourable as it demonstrated an element of dishonesty and deceit in that the Member ought to have known the conduct was unacceptable and fell well below the standards of the profession.

With respect to Allegation 4(b), the Panel finds that the Member’s conduct in not revising the patient assignment after knowing the fellow nurse had engaged in sexually inappropriate behaviour with the patient the previous night was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. The Panel also finds that the Member’s conduct was dishonourable as it demonstrated an element of dishonesty and deceit and has brought shame onto the nursing profession.

Penalty

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

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

2. Directing the Executive Director to suspend the Member’s certificate of registration for two 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,

3. Mandatory Reporting: A Process Guide for Employers, Facility Operators and Nurses;

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;

4. 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 and the Member’s Counsel.

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

1. The Member has expressed remorse,

2. The Member has cooperated with the College, and

3. The Member has no prior discipline history with the College.

The aggravating factors in this case were:

1. The Member was the Charge Nurse on shift the evening of the incident and the following night,

2. The Member was one of 3 nurses on shift at the time of the incident, the 1st was the abuser, the 2nd did report and the 3rd was the Member who did not report,

3. The Member waited 2 weeks until after the other nurse reported the incident, resulting in the sexual abuser continuing to work with the patient for that length of time,

4. Being a Charge Nurse on shift, misconduct also occurred in not reassigning the nurse the next night, and

5. Finally, the Member admitted that she took no measures and made no inquiries to make sure the abuse was not ongoing.

The proposed penalty provides for general deterrence through the suspension which will discourage other members of the profession from engaging in similar conduct by reminding them of the importance of their professional obligations.

The proposed penalty provides for specific deterrence through the suspension. The proposed suspension is significant enough to dissuade the Member from engaging in the same conduct in the future. The proposed penalty provides for remediation and rehabilitation through the reprimand and the terms, conditions and limitations imposed on the Member. The meeting with the nursing expert provides the Member with opportunities to reflect on the incident and learn.

Overall, the public is protected because the penalty is in line with similar cases of professional misconduct and meets the tests for a proposed penalty.

Counsel for the Member was provided an opportunity to make penalty submissions and added that the Member’s action in this incident were an anomaly to her nursing practice. Counsel added that the Member continues to work at the Hospital, and in 2012 she was presented with the Customer Service Award for Nursing Care. Counsel for the Member continued by advising the Panel that the Member, in hindsight, sees her actions were not appropriate and she has educated herself on the standards and mandatory reporting requirements set out by the College.

Counsel for the Member agreed with College Counsel that the Joint Submission on Order meets the tests and also agreed that the proposed order is reasonable to similar cases.

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

The first case was CNO v. L. Van De Walle, (Discipline Committee, 2017). This case proceeded by way of contested hearing and the member whose conduct was under review denied all the allegations set out in the Notice of Hearing. In this case it was found that the member failed to meet reporting requirements when the member did not report an incident of unsafe practice were a client had been physically abused by a colleague. The member’s conduct was also deemed to be dishonourable and unprofessional. In a separate Decision and Reasons on Penalty, the panel ordered a reprimand, 2 month suspension and terms, conditions and limitations on the member’s certificate with 2 nursing expert visits and 12 months of employer notification.

The second case was CNO v. R. Fisher (Discipline Committee, 2017). This case proceeded by way of Agreed Statement of Fact. In this case the member was found to have committed acts of professional misconduct in that the member failed to accurately report an incident of abuse by a fellow colleague. The member’s conduct was deemed to be disgraceful, dishonourable and unprofessional and the panel ordered a reprimand, 1 month suspension and terms, conditions and limitations on the member’s certificate, including 2 meetings with a nursing expert.

The final case submitted was CNO v. A. Spiridi (Discipline Committee, 2018). This case proceeded by way of Agreed Statement of Fact and the official decision and reasons continues to be drafted by the panel who attended the hearing. In this case the member failed to take steps to prevent abuse and failed to report the abuse to the Ministry of Health and Long Term Care. The member was found to have committed acts of professional misconduct and her actions were deemed to be disgraceful, dishonourable and unprofessional. The member was ordered a reprimand, 2 month suspension and terms, conditions and limitations on her certificate, including 2 meetings with a nursing expert.

Penalty Decision

The Panel accepts the Joint Submission on Order and accordingly orders:

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

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

3. The Executive Director is directed to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend 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,

3. Mandatory Reporting: A Process Guide for Employers, Facility Operators and Nurses;

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;

4. 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 through the reprimand and general deterrence through the suspension. Finally, the Panel finds the penalty satisfies the principles of rehabilitation and remediation, and public protection through the terms, conditions and limitations placed on the nurse’s certificate of practice.

The penalty is in line with what has been ordered in previous cases.

I, Heather Stevanka, RN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.

Chairperson Date