DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL:

Catherine Egerton Chairperson

Deborah Graystone, NP Member

Carolyn Kargiannakis, RN Member Heather Stevanka, RN Member Devinder Walia Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) EMILY LAWRENCE

) College of Nurses of Ontario

• and - )

SADIE ISABELLE NEWMAN ) STEFANO FORTINI for Registration No: 6124432 ) Sadie Isabelle Newman

) CHRISTOPHER WIRTH

) Independent Legal Counsel

) Heard: June 13, 2019

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) on June 13, 2019 at the College of Nurses of Ontario (the “College”) at Toronto.

Sadie Isabelle Newman (the “Member”) was present for the hearing and was represented by Counsel.

The Allegations

The allegations against the Member as stated in the Notice of Hearing dated May 8, 2019 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(15) of Ontario Regulation 799/93, in that while registered as a Registered Nurse, you signed or issued, in the member’s professional capacity, a document that you knew or ought to knew contains a false or misleading statement, in that:

a. On or about 2014, 2015, 2016, and 2017, you provided false and/or misleading information in your annual membership renewal forms for 2015, 2016, 2017 and 2018, respectively, in that you indicated that you had practiced nursing in the prior three years when you had not, and/or that you were employed in a full-time capacity as a senior manager and/or in administration at Lady Isabelle Nursing Home (“Lady Isabelle”), when you were not; 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(37) of Ontario Regulation 799/93, in that while registered as a Registered Nurse, 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, in that:

a. On or about 2015 and 2016, in your role as an officer and director of Lady Isabelle Nursing Homes Limited, you directed the administrative staff and/or accountant of Lady Isabelle to pay you a salary from the funding envelope reserved for nursing and personal care staff, when you did not provide direct care to residents of Lady Isabelle, contrary to the Lady Isabelle Nursing Homes Limited’s funding agreement with the Ministry of Health and/or to Ministry of Health funding policies;

b. On or about 2000 to 2017, you received a salary from Lady Isabelle when you did not perform nursing or administrative work for Lady Isabelle and/or you received a salary from Lady Isabelle that was disproportionate to the work you performed for Lady Isabelle;

c. Between on or about 2012 to 2017, in your role as an officer and director of Lady Isabelle Nursing Home Limited, a licensee under the Long-Term Care Homes Act, 2007 which was licensed to operate Lady Isabelle, you failed to ensure compliance with the requirements of the Long-Term Care Homes Act, 2007 which resulted in the revocation of the licence and closure of Lady Isabelle; and/or

d. On or about 2014, 2015, 2016, and 2017, you provided false and/or misleading information in your annual membership renewal forms for 2015, 2016, 2017 and 2018, respectively, in that you indicated that you had practiced nursing in the prior three years when you had not, and/or that you were employed in a full-time capacity as a senior manager and/or in administration at Lady Isabelle, when you were not.

Member’s Plea

The Member admitted to the allegations set out in paragraphs 1(a), 2(a), 2(b), 2(c) and 2(d) 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

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

THE MEMBER

1. Sadie Isabelle Newman (the “Member”) obtained a diploma in nursing from the United Kingdom.

2. The Member registered with the College of Nurses of Ontario (the “CNO”) as a Registered Nurse (“RN”) in the General Class on January 1, 1961. The Member entered the Non-Practising Class on December 30, 2018.

THE FACILITY

3. The Member is a director and officer of Lady Isabelle Nursing Home Ltd. (the “Lady Isabelle Corporation”). In particular, the Member is the President and Secretary of the Lady Isabelle Corporation.

4. The Lady Isabelle Corporation was licenced as a long-term care home under the Long Term Care Homes Act, 2007 (“LTCHA”).

5. The Lady Isabelle Corporation was licensed to run the Lady Isabelle Nursing Home (“Lady Isabelle”), a long-term care home.

6. The LTCHA regulated the licence held by the Lady Isabelle Corporation and could require the Lady Isabelle Corporation to comply with the LTCHA. In July 2017, the Director appointed under the LTCHA (the “LTCHA Director”) revoked its licence.

7. The Member is also the sole shareholder of the Lady Isabelle Corporation, and for all intents and purpose, is the “owner” of Lady Isabelle and the “directing mind” of the Lady Isabelle Corporation.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Failure to Ensure Compliance with LTCHA

8. The LTCHA requires licensees who operate long-term care homes to develop policies and care plans, designed to help ensure that residents receive safe, consistent, high-quality, resident-centered care. The goal is to create long-term care home environments where residents feel at home, are treated with respect, and have the supports and services they need for health and wellbeing.

9. The LTCHA requires both the licensee and all officers and directors of corporate licensees to ensure compliance with the care requirements of the LTCHA.

10. In particular, section 69(1) of the LTCHA requires every officer of a corporate licensee to ensure that the corporation complies with all the requirements under the LTCHA.

11. It is a provincial offence for an officer or director of a corporate licensee to fail to ensure that a corporate licensee complies with the LTCHA.

12. Between 2012 and 2016, LTCHA inspectors found that Lady Isabelle had persistent and systemic failures to meet the requirements of LTCHA, for program development, the development of care plans for residents, protection from abuse policies, food requirements and various programs for safety, such as fall preventions and medication handling. Lady Isabelle was found non-compliant in many areas, and was subject to numerous compliance orders.

13. On April 22, 2016, the LTCHA Director ordered the Northeast Community Care Access Centre, the placement coordinator for Lady Isabelle, to cease authorizing admissions to Lady Isabelle, because of Lady Isabelle’s persistent non-compliance.

14. In September 2016, after follow-up inspections revealed that Lady Isabelle continued to be non-compliant, the LTCHA Director ordered the Lady Isabelle Corporation, as licensee, to retain independent management to operate Lady Isabelle.

15. Despite the management company put in place to manage Lady Isabelle, the LTCHA Director issued and re-issued many compliance orders from October 2016 to July 2017.

16. In July 2017, the LTCHA Director revoked the Lady Isabelle Corporation’s licence to run Lady Isabelle and appointed an interim manager for the transition to close the home.

17. In her decision to revoke the licence, the LTCHA Director cited numerous and ongoing failures to meet the requirements of the LTCHA.

18. In addition to the non-compliances with the LTCHA, the LTCHA Director relied on an inspection report from June 29, 2017 to revoke the Lady Isabelle Corporation’s licence. This report noted significant concerns about the financial management of Lady Isabelle.

19. The Member admits and acknowledges that she failed to ensure that the Lady Isabelle Corporation complied with all requirements of the LTCHA to such an extent that its licence was revoked and Lady Isabelle ultimately closed.

20. If the Member were to testify, she would state that she hired staff to manage the day-to-day operations of Lady Isabelle and was not directly responsible for ensuring compliance with the LTCHA. However, the Member admits and acknowledges that, in her role as officer, director and sole shareholder of Lady Isabelle Corporation, she had the ultimate authority to direct that the operation of Lady Isabelle compiled with the requirements of the LTCHA and the ultimate responsibility to ensure such compliant operation, and that she failed to do so.

21. The Member also admits and acknowledges that the residents of Lady Isabelle were harmed, in that Lady Isabelle had deficient programs and policies, and in that they were forced to relocate when Lady Isabelle was shuttered.

Payment from the Wrong Envelope

22. Licensed long-term care homes are funded by the Ministry of Health and Long-Term Care (the “Ministry”), through local integration agencies. Licensed long-term care homes are required to allocate funds they receive in accordance with the Ministry’s policy titled, “Eligible Expenditures for Long-Term Care Homes” (the “Policy”).

23. Lady Isabelle Corporation and the North East Local Health Integration Network (the “LHIN”) were parties to a service accountability agreement that required the Lady Isabelle Corporation to comply with the Policy.

24. The Policy required the LHIN to distribute funds to long-term care homes through an ‘envelope system’ to ensure a minimum amount of funds is reserved for particular groups of goods and services.

25. The Nursing and Personal Care (“NPC”) envelope is for salaries and wages of staff who provide nursing and personal care directly to the residents.

26. The Other Accommodations (“OA”) envelope is for expenses related to the administration of the home.

27. The Member received a salary of $1300 per month as an employee of Lady Isabelle.

28. The Member’s salary was paid from the NPC envelope.

29. The Member admits and acknowledges that she did not provide any direct nursing care to residents in 2014, 2015, 2016 or 2017. If the Member were to testify, she would state that between 2014 and 2017, she did visit Lady Isabelle on occasion, to inspect the property and interact with residents and staff. She admits that she did not perform work as an employee or a nurse during these visits. She further admits that she did not perform any remunerative work as an employee in these years.

30. As an officer and director of the Lady Isabelle Corporation, the Member had access to the financial records and was responsible for ensuring that Lady Isabelle used the funds in each envelope appropriately.

31. The Member directed the Lady Isabelle Corporation to make salary payments to her, when she did not provide any remunerative work at Lady Isabelle.

32. The Lady Isabelle Corporation used funds from the NPC envelope to pay the Member. The Member did not provide any direct care to residents and was not entitled to be paid from the NPC envelope. If the Member were to testify, she would state that she was not aware that she was paid through the NPC envelope, but acknowledges that she should have been aware and that payment from this funding envelope was improper.

33. The charges were reversed and placed in the OA envelope in 2017.

Falsified Annual Renewal Forms

34. In her annual renewal forms, the Member declared the following:

a. In 2013, 2015-2017, that she was employed at Lady Isabelle in Trout Creek, Ontario as “Senior Manager” and was practicing in nursing in some capacity;

b. In 2014, that she was employed at Lady Isabelle as “President” and was practicing nursing in some capacity;

c. In 2018, that she was not employed in nursing, but was self-employed at Lady Isabelle as “Senior Manager”; and

d. From 2014 to 2018, that she had practiced nursing within the last three years.

35. The Member admits and acknowledges that she did not practice nursing from 2014 to 2018 in any capacity and she was not working as a senior manager or in any other role for Lady Isabelle from 2013 to 2018.

36. The Member admits that she made false statements in her annual reports to the CNO for the years 2015 to 2018 when she said that she was employed full-time at Lady Isabelle and had practiced nursing in the last three years.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

37. The Member admits that she committed the act of professional misconduct as alleged in paragraph 1(a) of the Notice of Hearing in that she issued a document that she knew contained a false statement when she provided false and misleading information in her annual membership renewal forms for 2015 to 2018 by indicating that she had practiced nursing in the prior three years and was employed in a full-time capacity as a senior manager when she was not, as described in paragraphs 34 to 36 above.

38. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 2(a) to (d) of the Notice Hearing, and in particular, her conduct was disgraceful, dishonourable and unprofessional, as described in paragraphs 3 to 36 above.

Decision

The College bears the onus of proving the allegations in the Notice of Hearing 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), 2(a), 2(b), 2(c) and 2(d)

in the Notice of Hearing. As to allegation 2(a), 2(b), 2(c) and 2(d), the Panel finds that the Member engaged in conduct that would reasonably be considered by members to be disgraceful, dishonorable 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, 29, and 34 to 37 in the Agreed Statement of Facts. The evidence documents that the Member gave false and misleading information on her annual membership renewal form in the following years 2015 to 2018 respectively, in that she indicated that she had practiced nursing in the prior three years when she had not. The Member admitted she did not provide any direct nursing care to residents from 2014 to 2018. The Member admitted she did not perform any remunerative work as an employee in those years. The Member was not working as a senior manager or in any role for Lady Isabelle from 2013 to 2018.

Allegations #2(a) and #2(b) in the Notice of Hearing are supported by paragraphs 22 to 33 and 38 in the Agreed Statement of Facts. The Member was licensed to run a long-term care home and was funded by the Ministry of Health and Long-Term Care (the “Ministry”). Licensed long-term care homes are required to allocate funds they receive in accordance with the Ministry’s policy titled, “Eligible Expenditures for Long-Term Care Homes” (the “Policy”). The Policy required the North East Local Health Integration Network (the “LHIN”) to distribute funds through an ‘envelope system’ to ensure the funds where distributed correctly. One envelope was for Nursing and Personal Care (“NPC”). This envelope contained the salaries and wages for the staff who provided nursing care and personal care directly to the residents. The other envelope was for Other Accommodations (“OA”) which was for expenses related to the administration of the home. The Member directed The Lady Isabelle Corporation to make salary payments to her when she did not provide any remunerative work at Lady Isabelle. Of note, the charges were reversed and the money was placed into the OA envelope in 2017.

Allegation #2(c) in the Notice of Hearing is supported by paragraphs 8 to 21 and 38 in the Agreed Statement of Facts. The Member was aware that the Long Term Care Homes Act, 2007 (the “LTCHA”) requires licensees who operate long-term care homes to develop policies and care plans designed to help ensure that residents receive safe, consistent, high-quality, resident centered care. The goal was to create a long-term care home environment where residents would feel at home, where residents would be treated with respect and have support and services that would cater to their health and wellbeing. Between 2012 and 2016, the LTCHA inspectors found Lady Isabelle had persistent and systemic failures to meet the requirements of the LTCHA for program development, care plans for residents, protection from abuse policies, food requirements, and safety programs, such as fall preventions. Lady Isabelle was non-compliant in many areas. Northeast Community Care Access Centre, the placement coordinator for Lady Isabelle, was ordered by the LTCHA Director on April 22, 2016 to cease authorizing admissions to Lady Isabelle because of its persistent non-compliance. Due to non-compliance, Lady Isabelle’s license was revoked and it was ultimately closed.

Allegation #2(d) in the Notice of Hearing is supported by paragraphs 22 to 36 and 38 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct demonstrated a lack of integrity, dishonesty, abuse of power and disregard for the welfare and safety of her residents when she failed to meet the standards set out in the LTCHA guidelines and failed to meet the Standards of Practice by falsifying her annual renewal form to the College not once, but on at least four occasions. The nursing profession will not tolerate this conduct. The Member brought shame not only on herself, but also on the profession as a whole. The Member’s conduct is disgraceful, dishonourable and unprofessional.

The Panel finds that the Member’s conduct is unprofessional as it demonstrates a serious and persistent disregard for her professional obligations. Nurses are accountable for practicing in accordance with the Professional Standards, practice expectations, legislation, and regulations. The Member gave false and misleading information to the LTCHA and to the College which is dishonest and breaches the public’s trust in the profession.

The Panel also finds that the Member’s conduct was dishonourable. The Member demonstrated an element of dishonesty and deceit through persistent and systemic failures over a period of four years while she was the sole owner and operator of Lady Isabelle. The Member made false statements to the College and also accepted money from the NPC envelope that was intended for paying staff for care. The Member failed to meet the requirements of the LTCHA when she was found non-complaint in several areas and was subject to numerous compliance orders. Ultimately, the license was revoked and Lady Isabelle was closed, leaving the residents and their families with undue stress and worry, wondering where the residents would live and who would care for them.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. The Member demonstrated an element of dishonesty and deceit by receiving a salary of $1300.00 dollars per month as an employee of Lady Isabelle from the NPC envelope to which she was not entitled. The Member did not perform any remunerative work as an employee or as a nurse during 2014, 2015, 2016 and 2017. The Member also completed her annual renewal form for the College indicating that she was employed at Lady Isabelle from 2014 to 2018 indicating that she had practised nursing within the last three years which she had not. This conduct casts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet.

Penalty

College Counsel and Counsel for the Member advised the Panel that a Joint Submission on Order (“JSO”) had been agreed upon. The JSO contained an undertaking signed by the Member for her permanent resignation and 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.

Penalty Submissions

Submissions were made by College Counsel.

The aggravating factors in this case were:

• The Member made false and misleading statements to the College;

• The inability of the College to regulate the Member;

• The Member took a salary from the Ministry of Health to which she was not entitled;

• The Member used her position of power to get the money to which she was not entitled;

• The Member had ultimate control over Lady Isabelle and its operations;

• The Member did not meet the regulations of the LTCHA; and

• The Member, due to her inaction, caused the displacement of all the residents which caused them undue harm and stress.

The mitigating factors in this case were:

• The Member has been a long-standing member of the College since 1961, a total of 58 years;

• The Member has not had any previous discipline history with the College;

• The Member co-operated with the College which saved time and money by avoiding a lengthy hearing;

• The Member agreed to the facts as outlined in the Agreed Statement of Facts;

• The Member entered into a JSO and resigned her membership from the College on May 30, 2019;

• The Member will not return to the practice of nursing in the future;

• The Member took responsibility for her actions;

• The Member attended the hearing; and

• The Member expressed remorse and shame for her actions.

The proposed penalty provides for general deterrence by sending a message to the profession as a whole that this type of conduct, which includes defrauding the Ministry of Health out of funds and falsifying annual renewal forms with the College for four years, will not be tolerated.

The proposed penalty provides for specific deterrence through the oral reprimand. It sends a strong message to the nursing profession that breaches of the Practice Standards will not be tolerated. College Counsel did not request remedial or rehabilitation terms as the Member has resigned her certificate of registration and will not be practising nursing in the future.

Overall, the public is protected because the Member agreed to resign as a member of the College effective May 30, 2019.

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

CNO v. Bradley Ferris (Discipline Committee 2007). This case is similar in that the member falsified payroll records relating to himself, his sister and colleagues. The member ordered his sister to be paid for the time that she was not working for the purpose of defrauding the government’s Employment Insurance which his sister was not entitled to. The member was ordered to receive an oral reprimand, a three month suspension on his certificate of registration, and there were terms, conditions and limitations imposed on the member’s certificate of registration.

CNO v. Harry Ross Phillips (Discipline Committee 2018). This case is similar in that the member misused his power to meet his personal goals, rather than the needs of the client and her husband. The member borrowed money from the client’s husband. The member crossed a boundary in the nurse client relationship when he went from a professional and therapeutic relationship to an unprofessional and personal one. The member was ordered to receive an oral reprimand within three months of the date of the order.

The Member’s Counsel indicated that the Member agreed with the College’s submissions and submitted that the Member is an 85 year old married mother of two sons. Counsel submitted that the Member is in poor health and that she is currently caring for her husband who is unwell. The Member was born in Jamaica where she completed studies as a teacher. The Member trained as a nurse and came to Canada in 1960. The Member registered with the College on January 1, 1961 and has been a Member without incident. The Member is remorseful for her actions, she accepts responsibility and she agrees to the JSO.

Independent Legal Counsel (“ILC”) advised the Panel that the primary goals of an order were to ensure the protection of the public and to maintain confidence in nursing and self-regulation. ILC informed the Panel that it must accept the JSO unless it decided that the proposed penalty was so disproportionate to the offence that to accept it would not be in the public’s interest or would bring the administration of justice into disrepute.

Penalty Decision

The Panel accepts the JSO 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.

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. Conduct by nurses that demonstrates a lack of integrity, dishonesty, abuse of power, access and authority, or disregard for the welfare and safety of members of the public cannot be tolerated by the nursing profession.

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

I, Catherine Egerton, Public Member, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.