College of Nurses of Ontario v. Andrea Catherine Spiridi, 2018 ONCNO 130953

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Ingrid Wiltshire-Stoby, NP Chairperson Laura Caravaggio, RPN Member Catherine Egerton Public Member Deborah Graystone, NP Member Devinder Walia Public Member

BETWEEN:

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

• and -

ANDREA CATHERINE SPIRIDI Reg. No. 9400573 PHILIP ABBINK for Andrea Catherine Spiridi

CHRIS WIRTH Independent Legal Counsel

Heard: OCTOBER 9, 2018

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (“the Panel”) on October 9, 2018 at the College of Nurses of Ontario (“the College”) at Toronto.

Order Preventing Public Disclosure and Publication and Broadcasting Ban

College Counsel brought a motion pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, for an order preventing the public disclosure of the name of the patient referred to orally or in any documents presented in the Discipline hearing of Andrea Catherine Spiridi or any information that could disclose the identity of the patient, including a ban on the publication or broadcasting of these matters. Counsel for the Member did not oppose the request. The Panel made the Order as requested.

The Allegations

The allegations against Andrea Catherine Spiridi (“the Member”) as stated in the Notice of Hearing dated September 19, 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 employed as a Registered Nurse at the Bella Senior Care Residence Inc. in Niagara Falls, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as follows:

a. between on or about March 25, 2016 and May 31, 2016, you failed to respond appropriately to a report received from another member, [Nurse #1], of evidence that [the Client] had been abused while a resident at the Facility, in that:

i. you failed to immediately report any suspicion of improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care;

ii. you failed to take steps to obtain the evidence and/or otherwise corroborate the information that [the Client] had been abused; and/or

iii. you failed to take steps to prevent abuse of other clients at the Facility; and/or

b. between in or around April 14, 2016 and May 31, 2016, you failed to respond appropriately to evidence provided to you by [the Client]’s [family member], that [the Client] had been abused, in that:

i. you failed to immediately report any suspicion of improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care;

ii. you failed to immediately review the evidence of suspected abuse; and/or

iii. you failed to take steps to prevent abuse of other clients at the Facility; 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(25)(i) of Ontario Regulation 799/93, in that while employed as a Registered Nurse at the Bella Senior Care Residence Inc. in Niagara Falls, Ontario (the “Facility”), you failed to report an incident of unsafe practice or unethical conduct of a health care provider to the employer or other authority responsible for the health care provider, as follows:

a. on or about March 25, 2016, you received a report from another member, [Nurse #1], that [the Client] had been abused while a resident at the Facility, and you failed to report improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care until May 31, 2016;

b. on or about April 14, 2016, you received evidence provided to you by [the Client]’s [family member] that [the Client] had been abused, and you failed to report improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care until May 31, 2016; 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(37) of Ontario Regulation 799/93, in that while employed as a Registered Nurse at the Bella Senior Care Residence Inc. in Niagara Falls, Ontario (the “Facility”), you engaged in conduct relevant to the practice of nursing that would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, as follows:

a. between on or about March 21, 2016 and May 31, 2016, you failed to respond appropriately to a report received from another member, [Nurse #1], of evidence that [the Client] had been abused while a resident at the Facility, in that:

i. you failed to immediately report any suspicion of improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care;

ii. you failed to take steps to obtain the evidence and/or otherwise corroborate the information that [the Client] had been abused; and/or

iii. you failed to take steps to prevent abuse of other clients at the Facility; and/or

b. between in or around April 14, 2016 and May 31, 2016, you failed to respond appropriately to evidence provided to you by [the Client]’s [family member], that [the Client] had been abused, in that:

i. you failed to immediately report any suspicion of improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care;

ii. you failed to immediately review the evidence of suspected abuse; and/or

iii. you failed to take steps to prevent abuse of other clients at the Facility.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1, 2 and 3 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 admissions were 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. Andrea Catherine Spiridi (the “Member”) obtained a diploma in nursing from Mohawk College in 1993.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on August 4, 1993.

3. The Member was employed at Bella Senior Care (the “Facility”) from April 2003 until she resigned in January 2017.

THE FACILITY

4. The Facility is a long-term care home in Niagara Falls, Ontario.

5. At the time of the incidents, the Member was the Director of Care at the Facility. Her responsibilities included management of the Facility and supervising the nursing staff and personal care staff and care they provided to clients.

THE CLIENT

6. [The Client] was admitted to the Facility in or around 2010. She had dementia and difficulty communicating. She died in February 2016.

INCIDENT RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

7. In or around September 2015, the Client’s [family member] installed a video camera in the Client’s room in order to document suspected abuse of [the Client]. She did not inform anyone at the Facility that she installed the camera. If she were to testify, [the family member] would say that she installed the camera because of the Member’s continual refusal to acknowledge her concerns about abuse and neglect of [the Client] by staff at the Facility. If the Member were to testify, she would say that she did in fact follow up on some of [the family member]'s concerns with staff, but may not have communicated this clearly to [the family member].

8. The camera captured Personal Support Workers (“PSWs”) at the Facility abusing the Client.

9. In or around the third week of March 2016, after the Client’s death, [the family member] met with another nurse employed at the Facility, [Nurse #1], and reported that the Client had been abused. [The family member] showed [Nurse #1] the videos, which showed PSWs abusing [the Client], but she did not provide [Nurse #1] with copies of the videos. The video clips [Nurse #1] saw included PSWs yanking a towel away from the Client, slapping the Client on the arm, and sleeping in the Client’s bed.

10. [Nurse #1] informed [the family member] that he would have to advise the Member as she was the Director of Care. [The family member] asked him to wait a few days before informing the Member so she could get the footage together.

11. On or around March 24, 2016, [Nurse #1] met with the Member and advised that he had seen video evidence of client abuse. He described what he had seen. The Member told [Nurse #1] that she would report the incident to the Ministry of Health and Long-Term Care (the “Ministry”) and contact [the family member] to obtain copies of the videos. [Nurse #1] offered to complete a Critical Incident Report, but the Member said she would complete the report.

12. Neither [the family member] nor [Nurse #1] heard from the Member after that. Within the next 2 to 4 weeks, both [the family member] and [Nurse #1] followed up with the Member. [Nurse #1] specifically recalls reminding the Member to report the incidents to the Ministry.

13. On April 14, 2016, the Member met with [the family member] and obtained copies of the videos. The videos provided started in November 2015. The Member did not report the abuse to the Ministry after the meeting. The only step she took, at that time, was to begin to review the videos which showed abuse of the Client over a four month period.

14. On May 31, 2016, 68 days after she had received the report of abuse from [Nurse #1], the Member initiated a Critical Incident Report to the Ministry. On June 28, 2016, [the family member] reported the abuse directly to the Ministry.

15. Over the next several months, the Ministry conducted an inspection, which resulted in 23 written notifications of the Facility’s non-compliance with the Long-Term Care Homes Act, 2007, eight corrective orders and seven director referrals.

16. On September 14, 2017, the Ministry laid charges against the Member for her failure to report the suspected abuse to the Ministry. Charges were also laid against the Facility, the Facility’s management company, and the Facility’s Administrator.

17. All charges were withdrawn on January 12, 2018.

18. The Facility undertook an internal investigation after the report to the Ministry. Several PSWs were terminated and suspended. The Member received a five day suspension.

19. In the Member’s capacity as Director of Care, the Long-Term Care Homes Act, 2007, required her to immediately report any suspicion of improper or incompetent treatment or care of a resident admitted to and living in a long-term care home to the Ministry.

20. The Facility’s Resident Services Manual also required an employee with reasonable grounds to suspect improper or incompetent treatment, abuse, or unlawful conduct to report immediately to the Ministry.

21. The Member acknowledges that she should have reported the allegation that the Client had been abused to the Ministry immediately and/or she should have taken steps to corroborate the information that the Client had been abused. The Member also acknowledges that by failing to take any steps between the end of March 2016 and May 31, 2016 to investigate or discipline the abusive PSWs, she put other clients at risk of being abused.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

22. The Member admits that she committed the acts of professional misconduct as described in paragraphs 7 to 21 above, in that she contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, as alleged in the Notice of Hearing, as follows:

• 1(a), between March 25, 2016 and May 31, 2016, in that she failed to:

(i) immediately report any suspicion of improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care;

(ii) take steps to obtain the evidence and/or otherwise corroborate the information that the Client had been abused;

(iii) take steps to prevent abuse of other clients at the Facility;

• 1(b), between April 14, 2016 and May 31, 2016, in that she failed to:

(i) immediately report any suspicion of improper or incompetent treatment of care of a resident to the Ministry;

(ii) immediately review the evidence of suspected abuse;

(iii) take steps to prevent abuse of other clients at the Facility.

23. The Member admits that she committed the acts of professional misconduct as described in paragraphs 7 to 21 above, in that she failed to report an incident of unsafe practice or unethical conduct of a health care provider to the authority responsible for the health care provider, as alleged in the Notice of Hearing, as follows:

• 2(a) in that, on or about March 25, 2016, she received a report from [Nurse #1] that the Client had been abused while a resident and the Facility, and she failed to report improper or incompetent treatment or care of a resident to the Ministry until May 31, 2016;

• 2(b) in that, on or about April 14, 2016, she received evidence from [the family member] that the Client had been abused and she failed to report improper or incompetent treatment or care of a resident to the Ministry until May 31, 2016.

24. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 3(a)(i), (ii) and (iii) and (b)(i), (ii) and (iii) of the Notice of Hearing, and in particular her conduct was dishonourable and unprofessional, as described in paragraphs 7 to 22 above.

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. The Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1 (a) (i), (ii), (iii); 1 (b) (i), (ii), (iii); 2(a) and (b); of the Notice of Hearing. As to allegation 3 (a) (i), (ii), (iii); 3(b) (i), (ii), (iii) the Panel finds that the Member engaged in conduct that would reasonably be considered by members to be 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 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), 1(25)(i) and 1(37) of Ontario Regulation 799/93 as alleged in the Notice of Hearing.

Allegation 1 (a) (i) The Panel finds that the Member committed an act of professional misconduct as alleged by failing to respond immediately to a report received from another member regarding evidence of client abuse. This is supported by paragraphs 11 and 13 in the Agreed Statement of Facts. The Member was notified on or around March 24, 2016 that a video was seen that indicated evidence of client abuse. The Member advised the employee [Nurse #1] that she would report the incident to the Ministry of Health and Long Term Care. On April 14, 2016, the Member met with [the family member], and obtained copies of the videos. The Member did not report the abuse to the Ministry after the meeting. The Member did not initiate a Critical Incident Report to the Ministry until May 31, 2016

Allegation 1 (a) (ii) The Panel finds that the Member committed an act of professional misconduct as alleged by failing to take steps to obtain the evidence and/or otherwise corroborate the information that [the Client]. had been abused. This is supported by paragraphs 11 and 12 in the Agreed Statement of Facts. The Member was advised on or around March 24, 2016 by employee [Nurse #1] that there was video evidence of suspected abuse of a client. The Member was reminded within the next 2-4 weeks by the employee [Nurse #1] but still failed to report the incidents to the Ministry. The Member also failed to take steps to obtain further evidence and/or corroborate the information received.

Allegation 1 (a) (iii) The Panel finds that the Member committed an act of professional conduct by failing to take steps to prevent abuse of other clients at the Facility. This is supported in paragraphs 13, 14, and 19 in the Agreed Statement of Facts. After reviewing the video beginning April 14, 2016 – the Member failed to initiate the Critical Incident Report until May 31, 2016. In doing this the Member also failed to take steps to prevent abuse of other clients at this Facility. The Member failed to meet her obligation in her capacity as Director of Care.

Allegation 1 (b) (i) The Panel finds that the Member committed an act of professional misconduct as alleged by failing to immediately report any suspicion of improper of incompetent treatment or care of a resident to the Ministry of Health and Long Term Care. This is supported by paragraphs 13 and 14 of the Agreed Statement of Facts. The Member received video evidence of client abuse April 14, 2016. The Member failed to immediately report any suspicion of improper or incompetent treatment or care of a resident, to the Ministry of Health and Long-Term Care, after receiving video evidence of client abuse. The Member did not initiate a Critical Incident Report to the Ministry until May 31, 2016.

Allegation 1 (b) (ii) The Panel finds that the Member committed an act of professional misconduct as alleged by failing to immediately review the evidence of suspected abuse. This is supported by paragraphs 13 and 14 of the Agreed Statement of Facts. On April 14, 2016 the Member was provided video evidence of client abuse but failed to immediately review the available evidence. The Member did not report the abuse to the Ministry after the meeting. The Member failed to initiate a Critical Incident Report to the Ministry until May 31, 2016.

Allegation 1 (b) (iii) The Panel finds that the Member committed an act of professional misconduct as alleged by failing to take steps to prevent abuse of other clients at the Facility. This is supported by paragraphs 13, 14 and 21of the Agreed Statement of Facts. The Member failed to take steps to prevent client abuse, investigate or discipline the abusive PSWs after reviewing video evidence of client abuse on April 14, 2016. The Member acknowledges that by failing to take any steps between the April 14, 2016 and May 31, 2016 to discipline the abusive PSWs or investigate further she failed to take steps to prevent abuse of other clients at the Facility.

Allegation 2 (a) The Panel finds that the Member committed an act of professional misconduct by failing to report improper or incompetent treatment or care of a resident to the Ministry of Health and Long Term Care until May 31, 2016 after receiving a report from another member that [the Client] was abused. This is supported by paragraphs 11, 12 and 14 in the Agreed Statement of Facts. The Member was advised by employee [Nurse #1] on or around March 24, 2016 that there was video evidence of client abuse. The Member failed to report improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care until May 31, 2016.

Allegation 2 (b) The Panel finds that the Member committed an act of professional misconduct by failing to report improper or incompetent treatment or care of a resident to the Ministry of Health and Long -Term Care. This is supported by paragraphs 13 and 14 in the Agreed Statement of Facts. The Member received video evidence of client abuse on or around April 14, 2016. The Member did not file a report of improper or incompetent treatment of a resident to the Ministry of Health and Long-Term Care until May 31, 2016.

Allegation 3 The Panel finds that the Member’s conduct, in failing to report an incident of unsafe practice or unethical conduct of a health care provider in a timely manner to the authority responsible for the health care provider, was dishonourable and unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. The Panel finds that the Member committed an act of professional misconduct by engaging in conduct relevant to the practice of nursing that would reasonable be regarded by members of the profession as dishonourable and unprofessional.

Allegation 3 (a) (i) The Panel finds that the Member has committed an act of professional misconduct that is dishonourable and unprofessional by failing to immediately report any suspicion of improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care. This is supported by paragraphs 11, 12, 13, 14, 21, 22, 23 and 24 in the Agreed Statement of Facts. The Member was advised by employee [Nurse #1] on or around March 24, 2016 that video evidence was viewed of client abuse. Video evidence was reviewed by the Member on April 14, 2016. The Member failed to initiate a Critical Incident Report to the Ministry until May 31, 2016. The Member admits that her conduct was dishonourable and unprofessional.

Allegation 3 (a) (ii) The Panel finds that the Member has committed an act of professional misconduct and that her conduct was dishonourable and unprofessional by failing to immediately review the evidence of suspected abuse of a client. This is supported by paragraphs 11, 12, and 22 in the Agreed Statement of Facts. After being advised of suspected client abuse by employee [Nurse #1] on or around March 24, 2016, the Member did not investigate or try to obtain further evidence of client abuse. The Member admits that she did not take steps to obtain evidence or corroborate the information that a client had been abused.

Allegation 3 (a) (iii) The Panel finds that the Member has committed an act of professional misconduct that would be considered dishonourable and unprofessional by failing to take steps to prevent abuse of other clients at the Facility. This is supported by paragraphs 11, 13, 21, and 22 in the Agreed Statement of Facts. After being advised of client abuse on or around March 24, 2016, the Member did not implement measures to further prevent client abuse. Nor did the Member investigate or discipline the PSW’s involved. On April 14, 2016 the Member began to review the video demonstrating client abuse but did not initiate a critical Incident Report to the Ministry until May 31, 2016. The Member admits that by failing to take any steps between the end of March 2016 and May 31, 2016 she put other clients at risk of being abused.

Allegation 3 (b) (i) The Panel finds that the Member has committed an act of professional misconduct that would be considered dishonourable and unprofessional by failing to immediately report any suspicion of improper or incompetent treatment or care of a resident to the Ministry of Health and Long-Term Care. This is supported by paragraphs 13, 14, 21, 22, 23 and 24 in the Agreed Statement of Facts. The Member was advised by employee [Nurse #1] of client abuse on or around March 24, 2016. The Member reviewed video evidence of client abuse on April 14, 2016 and met with the [family member]. The Member did not initiate a Critical Incident Report to the Ministry until May 31, 2016.

Allegation 3 (b) (ii) The Panel finds that the Member has committed an act of professional misconduct that would be considered dishonourable and unprofessional by failing to immediately review the evidence of suspected abuse. This is supported by paragraphs 12, 13, 22 and 23 in the Agreed Statement of Facts. The Member was advised on or around March 24, 2016 of evidence of client abused by employee [Nurse #1]. No action was taken by the Member. The Member began to review video evidence of abuse on April 14, 2016.

Allegation 3 (b) (iii) The Panel finds that the Member has committed an act of professional misconduct that would be considered dishonourable and unprofessional by failing to take steps to prevent abuse of other clients at the Facility. This is supported by paragraphs 13, 14, 21, 22, and 24 in the Agreed Statement of Facts. The Member was advised of evidence of client abuse on or around March 24, 2016. The Member began reviewing videos on April 14, 2016. No steps were taken to further investigate, corroborate evidence or discipline the PSWs involved thereby failing to take steps to prevent abuse of other clients. The Member acknowledges that other clients were put at risk by failing to investigate or discipline the abusive PSWs.

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. 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 Counsel for the Member.

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

1. The Member has cooperated with the College of Nurses and has appeared before the Panel.

2. The Member has admitted to the allegations.

The aggravating factors in this case were:

1. The Member was the Director of Care and responsible for overseeing the work of PSWs and has knowledge of her obligation to report suspicion of abuse to the Ministry of Health and Long Term Care.

2. The Member was advised on or around March 24, 2016 of video evidence of client abuse.

3. The Member advised her employee that she would file a Critical Incident Report to the Ministry of Health and Long Term Care on or around March 24, 2016.

4. The Member obtained video evidence of client abuse on April 14, 2016.

5. The Member failed to investigate further or obtain corroborating evidence and therefore failed to discipline the abusive PSWs thereby putting other clients at risk.

6. The Member did not initiate a Critical Incident Report to the Ministry of Health and Long Term Care until May 31, 2016 - 68 days after learning of the abuse.

7. By failing to report client abuse the Member failed to meet her Statutory Requirements to report suspicion of client abuse to the Ministry of Health and Long Term Care.

The proposed penalty provides for general deterrence through the 2 month suspension of the Member’s certificate. This sends a strong message to other nurses in similar positions about their obligations and that a breach of their Statutory Requirement to report evidence of client abuse to the Ministry of Health and Long Term Care will not be tolerated.

The proposed penalty provides for specific deterrence through the suspension of the Member’s certificate for 2 months. This will specifically deter this Member from similar behaviour in the future.

The proposed penalty also provides for remediation and rehabilitation through meetings with the Nursing Expert and having to appear before the Panel, within 3 months of the date that this Order becomes final, for an oral reprimand. These penalties provide the Member with an opportunity to reflect and learn from this incident.

Rehabilitation through review of the Professional Standards and the Mandatory Reporting: A Process Guide for Employers, Facility Operators and Nurses should help the Member to learn from her failure to report and minimize the risk of reoccurrence.

Overall, the public is protected because the Member will be suspended from employment as a nurse for 2 months. The Member should, through meetings with the Nursing Expert and review of the Professional Standards, gain insight into potential risks to clients by her failure to report and lack of completing a Critical Incident Report in a timely manner.

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

CNO v Van De Walle (Discipline Committee July 18-20 and September 5-6, 2017) This case involved a member’s failure to report an incident of abuse. Although not identical, the similarities of this case involves the professional member’s duty to report incidences of abuse. The varying factor was the member in the Van De Walle case was present and observed the abuse. In this case the member also received a 2 month suspension of her certificate.

CNO v Fisher (Discipline Committee March 10, 2017) This case also involved a nurse’s failure to report evidence of client abuse. The differing factors were that this member initially denied observing the abuse, but later admitted to observing the actions of her colleague. The member’s certificate in this case was suspended for 1 month.

Penalty Decision

The Panel accepts the Joint Submission as to 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. 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 and general deterrence, rehabilitation and remediation, and public protection. Specific deterrence will be attained through a 2 month suspension, the Member’s review of Mandatory Reporting and Professional Standards Learning Modules. This suspension also sends a clear message to other members of the profession and the public that failure to report suspicion or evidence of abuse in a timely fashion will not be tolerated. Expert Meetings, review of Professional Standards and Mandatory Reporting Modules will send a message to the public and other members of the profession that rehabilitation and remediation was addressed to better protect the public and minimize the risk of re-occurrence.

College Counsel presented cases similar but not identical to this case. The two cases presented involved a member’s failure to report client abuse. The differentiating factor was that the Member in this case was Director of Care and was responsible to oversee other health care providers. The penalty is in line with what has been ordered in previous cases although no exact precedents had been set.

I, Ingrid Wiltshire-Stoby, NP, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.

Chairperson Date