College of Nurses of Ontario v. Jason Francis, 2018 ONCNO 90850

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: David Edwards, RPN Chairperson

Deborah Graystone, NP Member

Mary MacMillan-Gilkinson Public Member Ingrid Wiltshire-Stoby, RN Member Christopher Woodbury Public Member

BETWEEN:

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

• and - )

JASON FRANCIS ) SHEILA RIDDELL for Reg. No: 0315457 ) Jason Francis

) KIMBERLEY ISHMAEL

) Independent Legal Counsel

) Heard: June 8, 2018

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) on June 8, 2018 at the College of Nurses of Ontario (the “College”) at Toronto.

The Allegations

Counsel for the College advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraphs 1 (d) and 2 (d) of the Notice of Hearing dated May 28, 2018. The Panel granted this request. The remaining allegations against Jason Francis (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 The Royal Ottawa Health Care Group (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, and in particular

(a) on or about December 31, 2013, you failed to follow-up appropriately after client [Client A] discussed suicide with you;

(b) in or around July 2014, you brought client [Client B] a bottle of what you claimed was holy water, and/or you performed a “blessing” on water in order to provide the client with holy water, and/or you suggested that the client use this holy water to address evil spirits;

(c) on or around October 10, 2014, you brought to the Facility and made available to clients on the unit on which you worked movies whose content was therapeutically inappropriate for those clients;

(d) [Withdrawn];

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(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 December 31, 2013, you failed to follow-up appropriately after client [Client A] discussed suicide with you;

(b) in or around July 2014, you brought client [Client B] a bottle of what you claimed was holy water, and/or you performed a “blessing” on water in order to provide the client with holy water, and/or you suggested that the client use this holy water to address evil spirits;

(c) on or around October 10, 2014, you brought to the Facility and made available to clients on the unit on which you worked movies whose content was therapeutically inappropriate for those clients;

(d) [Withdrawn].

Member’s Plea

The Member admitted the allegations set out in paragraphs 1 (a) (b) (c), and 2 (a) (b) (c) 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. Jason Francis (the “Member”) obtained a diploma in nursing in 2003.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on August 7, 2003.

3. The Member was employed at The Royal Ottawa Hospital (the “Hospital”) from November 26, 2007 to February 2, 2015, when he resigned.

4. The Member has worked at various long term care homes, through his nursing-agency employer, since November 2015.

THE HOSPITAL

5. The Hospital is located in Ottawa, Ontario.

6. The Member worked on the Schizophrenia Inpatient Tertiary Unit (the “Unit”). Clients on the Unit ranged in age from 18 to 65 and suffered from chronic and persistent mental health illnesses, primarily schizophrenia. Most clients on the Unit were admitted involuntarily under the Mental Health Act.

7. Registered staff on the Unit were exclusively RNs. Each RN was assigned approximately six clients per shift. Most RNs worked eight hour shifts (0700-1500, 1500-2300 or 2300-0700). A few RNs were scheduled 12 hour shifts, from 0700 to 1900. When those RNs went home, the remaining RNs would absorb the extra patient load from 1900 to 2300, when the night shift RNs came on.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Client A

8. [Client A] (“Client A”) was 43 years old at the time of the incident.

9. Client A was admitted to the Unit on November 5, 2013. He had a longstanding history of admissions to the Hospital and other facilities for paranoid schizophrenia that had been worsening over the years. He was most recently admitted to Montfort Hospital on October 17, 2013, after Client A’s wife phoned the Mental Health Crisis Line to report that Client A had become agitated and aggressive, telling her that he had his power back and was ready to fight the evil in her.

10. He was discharged from Montfort Hospital on October 29, 2013. Client A’s psychiatrist phoned Client A’s wife on the date of discharge to let her know that Client A was signing himself out against medical advice, and to suggest that she consider a restraining order against him.

11. A few hours later, having returned home, Client A began screaming at his wife and muttering “you have to be broken down.” Client A’s wife locked herself in the bedroom, afraid he would hurt her. She called the Mental Health Crisis Line, who in turn called police. Client A was re-admitted to Montfort Hospital on October 30, 2013. From there, he was transferred to the Hospital on November 5, 2013.

Client A at the Hospital

12. Client A was admitted to the Hospital on an involuntary basis on November 5, 2013, and remained there under an involuntary admission until his death on January 1, 2014.

13. Client A was very challenging to stabilize. He was regularly threatening to staff and sexually inappropriate, discussing violent thoughts and imagery, being grandiose, and describing bizarre delusions, including that he was of a different species. If the Member were to testify, he would say that he frequently heard Client A state that other patients and staff should kill themselves so he could resurrect them. The Member recalls that these statements became more frequent in the last few weeks before Client A’s death. The Member would acknowledge, however, that he did not document in the Interdisciplinary Progress Notes Client A making any such statements. The Member would testify that he recalls documenting these comments in the RN “shift to shift” reports which would normally be destroyed soon after each shift, as well as in the client’s care plan.

14. On November 30, 2013, Client A was placed on Constant Observation for “sexual aggression.” The Constant Observation order required 1:1 supervision of Client A by an orderly on a constant basis.

15. The order for Constant Observation was continued daily until December 16, 2013, when it was clarified to ensure Client A was observed by male staff only. The order for Constant Observation with male staff was continued daily until December 27, 2013, when it was changed to Constant Observation on days and evenings, and Intermittent Observation overnight. Intermittent Observation required 1:1 observation of the Client by an orderly every 15 minutes. This order was continued until December 30, 2013, when it was changed to Intermittent Observation for aggression.

16. The Member was Client A’s assigned nurse from at least December 16, 2013 onward.

17. On December 31, 2013, at 1830, the Member charted the following note in Client A’s Interdisciplinary Progress Notes:

I.O. aggression. Has remained calm in his room but agitated when given 1800hr meds. Tangential, Religiously preoccupied, and Grandiose. “I’m the last prophet. If I die, the world is over.” Ongoing topic of dying/committing suicide because he cannot go home to be with his wife. Negative comments made about treating physicians as well as sexually inappropriate comments and demeaning remarks. Would not follow direction, on floor kneeling and begging for mercy. Required staff to escort him back to his room. Escalates easily with little interaction.

18. After making the note in Client A’s chart, the Member did not notify anyone that Client A had discussed the topic of suicide with him, or otherwise address Client A’s suicidal ideation. In particular, the Member did not bring the Client’s comments about him dying/committing suicide to the attention of the psychiatrist on call for the Unit, or bring the issue or his note to the attention of oncoming staff when his shift ended. If the member were to testify, he would state that his charting, despite its wording, did not reflect a belief that Client A was actually a suicide risk on December 31, 2013. The Member also would say that he recalls telling the RN who took over his assignment at 1900 that Client A was telling patients and staff they should commit suicide, behaviour the Member would state was common and which the Member believes most staff had observed during Client A’s stay.

19. On January 1, 2014, the Member was assigned to care for Client A during the day shift, from 0700 to 1900.

20. Around 1100, Client A came to the nursing station. He had been asleep up to that point. He spoke with [the Colleague], RN and asked for shaving equipment. [The Colleague] gave Client A two disposable razors, and Client A went into the washroom.

21. Approximately seven minutes later, an orderly assigned to take over Client A’s Intermittent Observation opened the door to the washroom to check on Client A. He was lying face down on the floor in a pool of blood. A Code Blue was called, but Client A was unable to be resuscitated.

22. A coroner’s investigation confirmed that Client A committed suicide by removing one of the blades from one of the razors provided to him by [the Colleague], and cutting open his right jugular vein and carotid artery. The final coroner’s report listed two causes of death: (1) incised wound of the neck, and (2) schizophrenia.

23. After Client A’s death, at 1315, [the Colleague] charted in his progress notes that Client A was in a good mood, responding to humour, and generally calm and positive. She later charted that Client A “usually complies [with] this and will hand over his razors when finish [sic].”

24. The Member was on a break, having his lunch, when the razors were provided to Client A and he committed suicide. The Member immediately responded to the Code Blue, rushed to the washroom, and, upon observing the significant loss of blood, called 911. When it was determined that Client A had died, the Member and the oncoming male RN cleaned the bathroom.

25. Client A’s suicide was investigated by the Hospital and no staff members were disciplined.

26. In his interview with the College Investigator, the Member stated that he truly did not believe Client A was suicidal when he charted the comments on December 31, 2013. If the Member were to testify, he would acknowledge that his note of December 31, 2013 does not document the behaviour that he would testify he actually observed in Client A at that time, and that he is unable to explain this inaccuracy.

27. The Member acknowledges, in retrospect, that, he should have notified Client A’s interdisciplinary team, including the staff psychiatrist on call for the Unit and the oncoming nurse, that Client A had discussed suicide during his shift on December 31, 2013. The Member further acknowledges that he now understands his failure to do so was a breach of the College’s standards of practice, and in particular, the College’s published standard titled Professional Standards.

Client B

28. [Client B] (“Client B”) was 34 years old at the time of the incident. She had a diagnosis of schizophrenia. She was an inpatient on the Unit from April 3, 2014 to September 15, 2014.

29. Client B had reported that she felt unsafe in her apartment. The Social Worker and Occupational Therapist assessed her apartment and did not find any hazards. Later, on June 9, 2014, Client B stated that she believed that “Jinn” (an Arabic word that means “genies” or “spirits”) were occupying her apartment. That same day, at Client B’s request, the Member blessed a bottle of water that Client B’s mother had brought into the Unit for her to get rid of the spirits in her apartment.

30. If the Member were to testify, he would say that he did not believe that the water would rid Client B’s apartment of spirits. However, the Member felt that this action was not inconsistent with his role as a nurse, and was consistent with a holistic approach to nursing advocated for by the Hospital, including respecting Client B’s cultural/spiritual beliefs.

31. However, the Member acknowledges, in retrospect, that before he performed a blessing at the Client’s request, he ought to have consulted with Client B’s interdisciplinary team. By failing to do so, the Member acknowledges that he breached the College’s standards of practice, and in particular the College’s published standard titled Professional Standards.

Halloween Movies

32. Around Halloween, at the request of a patient, the Member planned a movie night as a social event for clients on the Unit. He brought in popcorn and a box of Halloween-themed movies, many of which were violent and religious/supernatural in nature.

33. If [the Psychiatrist], the staff psychiatrist for the Unit, were to testify, she would say that a number of the movies the Member brought to the Unit were inappropriate for the client population.

34. If the Member were to testify, he would say that clients on the Unit had access to cable television, were not censored in what they watched and that the movies the Member brought into the Unit were no more violent that what was available to clients on TV. However, the Member acknowledges that bringing horror movies to a Unit with severely ill schizophrenic clients, many of whom exhibited delusions and fantasies as part of their illnesses, involving religious and/or supernatural topics, was, at least, potentially problematic for that particular client population. The Member acknowledges that he breached the College’s standards of practice, and in particular, the College’s published standard titled Professional Standards.

COLLEGE STANDARDS & GUIDELINES

35. The College’s Professional Standards state that a nurse applies knowledge to his or her practice by “using best practices to address client concerns and needs.” It also states that a nurse demonstrates accountability by “taking action in situations in which client safety and well-being are compromised.”

36. The College’s practice guideline on Culturally Sensitive Care says that “[t]he nurse is responsible for assessing and responding appropriately to the client’s cultural expectations and needs.”

ADMISSIONS OF PROFESSIONAL MISCONDUCT

37. The Member admits that he committed the acts of professional misconduct as described in paragraphs 8 to 34 above, and as alleged in the Notice of Hearing, as follows:

• 1(a) in that he failed to follow up appropriately after Client A discussed suicide with him on December 31, 2013;

• 1(b) in that, around July 2014, he performed a “blessing” on water in order to provide Client B with holy water at her request;

• 1(c) in that, around October 2014, he brought therapeutically inappropriate Halloween movies to the Unit.

38. The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 2 (a), (b) and (c) of the Notice of Hearing, and in particular his conduct was dishonourable and unprofessional, as described in paragraphs 8 to 34 above.

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

• 1(d)

• 2(d)

Following a request for clarification from the Panel regarding 1 (b), College Counsel advised that the Member had only admitted to the second part of the allegation “you performed a ‘blessing’ on water in order to provide the client with holy water” as parts 1 and 3 of the allegation were not established in the Agreed Statement of Facts.

The Panel also asked College Counsel to point to relevant parts in the College’s standards, and in the College’s practice guideline on Culturally Sensitive Care which relate specifically to allegation 1 (b). College Counsel referred the Panel to sections in the Therapeutic Nurse-Client Relationship that relate to the blurring of boundaries between a nurse and his/her client. In response, Counsel for the Member stated that allegation 1 (b) was misconduct not because of a boundary violation but rather because he failed to consult with relevant staff prior to blessing the water. She stated that, in fact, the Member had followed many of the guidelines embedded in the Culturally Sensitive Care guideline. Counsel for the Member, after discussing this issue with her client, stated that he was admitting only to unprofessional conduct in regards to 2 (b) and not both dishonourable and unprofessional conduct.

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) (b) and (c) of the Notice of Hearing. As to allegation 2 (a), the Panel finds that the Member engaged in conduct that would reasonably be considered by members to be dishonourable and unprofessional. As to allegation 2 (b), the Panel finds that the Member engaged in conduct that would reasonably be considered by members to be unprofessional. As to allegation 2 (c), 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 this evidence supports findings of professional misconduct as alleged in the Notice of Hearing.

Allegation #1 in the Notice of Hearing is supported by paragraphs 8 to 34 in the Agreed Statement of Facts.

In allegation 1(a), Client A was the Member’s Client. He had paranoid schizophrenia which had been worsening over the years and which had resulted in many hospitalizations. Client A had been making on-going comments of “dying/committing suicide”. The Member charted this fact, amongst others, in Client A’s Interdisciplinary Progress Notes. He did not, however, notify the psychiatrist on-call or the oncoming staff when his shift ended. The next day [Client A] took his own life. The Panel concluded that the Member lost sight of the significance of [Client A’s] comments because he had heard them frequently and because they had been interspersed amongst other violent, sexual and bizarre thoughts and expressions. This is a breach of the principles enshrined in the Professional Standards where it says that nurses must identify/recognize any “abnormal or unexpected client responses” and take action appropriately. By breaching this standard, nursing staff and doctors did not have the opportunity to assess [Client A] in a timely manner and determine the extent to which he was serious about his suicidal ideation.

In allegation 1 (b), the Member admits that he blessed water that Client B’s mother brought in. Client B’s mother believed that the blessed water would rid her daughter’s apartment of frightening spirits or “genies”. The Member may have believed that he was providing culturally sensitive care but he did not discuss whether this was appropriate with members of the Facility’s interdisciplinary team. It is possible that by blessing the water, the Member may have given credence to his Client’s delusions. There was no risk of harm reported, however, the Panel believed that consultation with relevant staff would have provided confirmation as to whether the Member’s actions were, in fact, in his Client’s best interests.

In allegation 1 (c), the Member admits that he brought in movies for a Halloween event, at the request of a client, that were violent and had religious and supernatural content. He acknowledges that this was “potentially problematic for that particular client population.” The Member’s conduct is a breach of the College’s Professional Standards which states that it is a nurse’s responsibility to create environments that promote and support safe practice. The movies had the potential to trigger delusions, fantasies and agitation in a population that was already compromised.

Allegation #2 in the Notice of Hearing is supported by paragraphs 8 to 34 in the Agreed Statement of Facts.

With respect to Allegation 2 (a), the Panel finds that the Member’s conduct was both unprofessional and dishonourable. He demonstrated a serious disregard for his professional obligations, thereby constituting unprofessional conduct, when he failed to notify Client A’s interdisciplinary team, including the staff psychiatrist on call and the oncoming nurse, of Client A’s claims that he wanted to die/commit suicide. By not consulting with relevant staff, the Member relied solely on his own knowledge as to Client A’s intentions. The results were tragic. The Member ought to have known that his actions fell well below the standards of a professional thereby constituting dishonourable conduct..

With respect to Allegation 2 (b), the Panel finds that the Member’s conduct was unprofessional when he blessed water for Client B’s mother so that her daughter’s apartment could be cleansed from “genies”. As a professional, the Member needed to show good judgement and responsibility by consulting with Client B’s interdisciplinary team in order to ensure no harm could possibly come from such a “blessing”.

With respect to Allegation 2 (c), the Panel finds that the Member’s conduct was both unprofessional and dishonourable when he brought in movies with disturbing content for a Halloween event in a Unit dedicated to clients with chronic and persistent mental health illnesses. The Member showed a lack of good judgement in not carefully screening the movies and determining their appropriateness. This constituted unprofessional conduct. The Member ought to have known that the movies were problematic. His actions fell well below the standards of a professional thereby constituting dishonourable conduct.

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 three 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 a minimum of two meetings with a Nursing Expert (the “Expert”) at his own expense and within six months from the date of this Order. If the Expert determines that a greater number of session are required, the Expert will advise the Director of Professional Conduct (the “Director”) regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within one year 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 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. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, and online participation forms;

v. 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;

vi. 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 his behaviour;

vii. 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 his certificate of registration;

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify his 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 his 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 and the Member’s Counsel.

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

• The Member has expressed feelings of remorse.

• The Member has accepted responsibility for his conduct.

• He has admitted the misconduct.

• The Member’s conduct does not show evidence of a moral failing.

• He has no previous disciplinary history with the College

The aggravating factor in this case is the serious consequence of the Member not reporting Client A’s suicidal ideation to relevant staff.

The proposed penalty provides for general and specific deterrents through the suspension and the oral reprimand. The suspension demonstrates to this Member and other members of the profession that these types of conduct will not be tolerated.

The proposed penalty provides for remediation and rehabilitation through the two meetings with the Nursing Expert. These meetings will help to ensure that the Member has greater insight into his practice when he returns to nursing.

Overall, the public is protected because of the suspension and the fact that the Member will have to notify his employer of this decision for a 12 month period when he returns to work. This will ensure that the Member will be monitored.

College Counsel submitted three cases to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee. Counsel for the Defence submitted one case for the panel to review.

The College submitted the case of CNO v. Jude Nzuonkwelle Nkwelle (Discipline Committee, 2018). This was a tragic case which involved the suicide of a client. The member did not do the required Q15 checks on a client who was psychotic, disturbed and who had expressed suicidal ideation. The member also did not ensure that the Q15 checks were done by another staff member in his absence. The member’s certificate was suspended for three months. He was also required to notify his employer of the decision for 12 months.

The College submitted the case of CNO v. Lancelot Williams (Discipline Committee, 2014). The member failed to provide “constant observation” to a client who had anxiety attacks. The member did provide Q15 and hourly checks on the client but had another staff member document them. Even though the client was found with vital signs absent, the member did not initiate CPR or a Code Blue. The client was pronounced dead. The member was suspended for two months and was given a 24 month employer notification requirement.

The College submitted the case of CNO v. Sandra Lewis (Discipline Committee, 2013). This case resulted in a more serious 6 month suspension as it involved a number of aggravating factors including physical and emotional abuse. One allegation was that the member documented Q15 observations that she did not perform. She pre-signed the Q15 record, left her shift early and then left the facility. The member was given a 6 month suspension and a 24 month employer notification requirement.

Counsel for the Defence submitted the case of CNO v. Cristina Victoria Stefanescu (Discipline Committee, 2015) which is a counterpart to the Lancelot Williams’ case. The member documented hourly checks that she had not personally done. Her documentation on two occasions was illegible. She also failed to provide appropriate measures (e.g. CPR) to a client who had vital signs absent. The member was not in attendance, had resigned and did not cooperate with the College. She was given a two-month suspension, which was to take effect from the date the member obtained an active certificate of registration.

Independent Legal Counsel reminded the Panel that its mandate is to determine the appropriate order, to ensure that the public is protected and that confidence is preserved in the regulatory process. She reiterated that the Panel should accept this carefully negotiated Joint Submission on Order unless to do so would bring the administration of justice into disrepute or be contrary to the public interest. If it had such concerns or questions, in this rare circumstance, the Panel should notify both Counsel so that they would have an opportunity to respond.

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 three 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 a minimum of two meetings with a Nursing Expert (the “Expert”) at his own expense and within six months from the date of this Order. If the Expert determines that a greater number of session are required, the Expert will advise the Director of Professional Conduct (the “Director”) regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within one year 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 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. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, and online participation forms;

v. 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;

vi. 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 his behaviour;

vii. 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 his certificate of registration;

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify his 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 his 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 and general deterrence, rehabilitation and remediation, and public protection. Members of the profession will be reminded of the need to follow professional standards. They will also be reminded of the importance of communicating and consulting with relevant staff. Failure to do so, has the potential to result in tragic and irreversible consequences.

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

I, David Edwards, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.

Chairperson Date