DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
PANEL:
Terry Holland, RPN Chairperson
Sylvia Douglas Public Member Lalitha Poonasamy Public Member Heather Stevanka, RN Member
Jane Walker, RN Member
BETWEEN:
COLLEGE OF NURSES OF ONTARIO ) GLYNNIS HAWE for ) College of Nurses of Ontario
- and - )
MEAGAN WILLARD ) NO REPRESENTATION for Registration No. AE116526 ) Meagan Willard
) CHRISTOPHER WIRTH
) Independent Legal Counsel
) Heard: June 26, 2020
DECISION AND REASONS
This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on June 26, 2020, via teleconference.
Publication Ban
Publication 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 identities of the patients in the Discipline hearing of Meagan Willard or any information that could disclose the patients’ identities, including a ban on the publication or broadcasting of this information. The Member had no objection to the order being made.
The Panel considered the submissions of the Parties and decided that there be an order preventing the public disclosure of the identities of the patients in the Discipline hearing of Meagan Willard or any information that could disclose the patients’ identities, including a ban on the publication or broadcasting of this information.
The Allegations
The Allegations
College Counsel advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraphs #1(f)(a) and (c); #2(d); #3(a), (b), (d), (g), (k), (l), (m), (n), (o); #4(f)(a) and #4(f)(c); #4(p); and portions of Appendix D – [Patient G] (6), (7), (8), (9), (10), (15), (17), and of Appendix F – [Patient H] (6), (11), (24), of the Notice of Hearing dated June 15, 2020. The Panel granted this request. The remaining allegations against Meagan Willard (the “Member”) are as follows:
IT IS ALLEGED THAT:
- 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 practicing as a Registered Practical Nurse with ParaMed Home Healthcare (the “Agency”) in North Bay, Ontario, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession in that:
(a) on or about November 2016 to January 2017, you intentionally misrepresented to the Agency that you would not drive yourself to scheduled appointments and/or to the Agency’s office because your driver’s license had been suspended, which you did on or about January 20, 2017;
(b) you failed to adequately assess one or more of your patients and/or failed to adequately document your assessment of one or more of your patients, on one or more of the occasions listed in Appendix “A”;
(c) you failed to attend a scheduled appointment and to provide care to [Patient A], on one or more of the 16 occasions listed in Appendix “B”;
(d) you failed to attend a scheduled appointment and to provide care to [Patient A], and/or failed to document the care you provided, on or about October 28, 2016;
(e) on or about December 2015 to January 20, 2017, you failed to complete the care management tool for [Patient A];
(f) you failed to adequately record clinical orders for [Patient A], on or about:
a) [Withdrawn];
b) January 17, 2016;
c) [Withdrawn]; and/or
d) February 28, 2016;
(g) on or about December 2015 to January 20, 2017, you failed to perform an adequate re-assessment and/or to document your re-assessment of [Patient A];
(h) on or about August 30, 2016 to January 20, 2017, you failed to update the medication profile and reconciliation sheet for [Patient A];
(i) on or about July 8, 2016 to January 20, 2017, you failed to complete the following documentation for [Patient B]:
a) medication profile and reconciliation sheet; and/or
b) safety assessment of the patient environment;
(j) you failed to attend a scheduled appointment and to provide care to [Patient C], and/or failed to document the care you provided, on one or more of the 8 occasions listed in Appendix “C”;
(k) on or about September 30, 2016 to January 20, 2017, you failed to complete the following documentation for [Patient C]:
a) medication profile and reconciliation sheet;
b) care management tool;
c) safety assessment of the patient environment;
d) generic and/or relevant standardized care path; and/or
e) generic and/or relevant standardized care path flow sheet;
(l) you failed to attend a scheduled appointment and to provide care to [Patient D], on or about:
a) November 4, 2016; and/or
b) November 17, 2016;
(m) on or about April 8, 2016, you failed to record the physician’s orders for [Patient D];
(n) on or about April 8, 2016 to January 20, 2017, you failed to complete the following documentation for [Patient D]:
a) a medication profile and reconciliation sheet;
b) safety assessment of the patient environment; and/or
c) teaching progress path;
(o) on or about July 27, 2016, you failed to adequately correct a documentation error in the clinical care update for [Patient D];
(p) you failed to attend a scheduled appointment and to provide care to [Patient E], on or about:
a) December 21, 2016;
b) December 28, 2016; and/or
c) January 18, 2017;
(q) you failed to attend a scheduled appointment and to provide care to [Patient F], and/or failed to document the care you provided, on or about:
a) January 14, 2017;
b) January 17, 2017; and/or
c) January 20, 2017;
(r) you failed to attend a scheduled appointment and to provide care to [Patient G], and/or failed to document the care you provided, on one or more of the 18 occasions listed in Appendix “D”;
(s) you failed to attend a scheduled appointment and to provide care to [Patient H], on one or more of the 11 occasions listed in Appendix “E”;
(t) you failed to attend a scheduled appointment and to provide care to [Patient H], and/or failed to document the care you provided, on one or more of the 25 occasions listed in Appendix “F”;
(u) you failed to attend a scheduled appointment and to provide care to [Patient I], on one or more of the 9 occasions listed in Appendix “G”;
(v) you failed to attend a scheduled appointment and to provide care to [Patient I], and/or failed to document the care you provided, on or about October 25, 2016;
(w) on or about September 26, 2016 to January 20, 2017, you failed to adequately assess [Patient I] and/or failed to adequately document your assessment of [Patient I];
(x) on or about September 26, 2016 to January 20, 2017, you failed to complete a medication profile and reconciliation sheet for [Patient I];
(y) you failed to sign clinical notes for [Patient I] on or about:
a) November 4, 2016; and/or
b) December 15, 2016; and/or
- 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(8) of Ontario Regulation 799/93, in that while working as a Registered Practical Nurse with the Agency, you misappropriated property from a workplace with respect to the following incidents:
(a) you were paid for a scheduled appointment with [Patient A] that you failed to attend, on one or more of:
a) October 28, 2016; and/or
b) 14 occasions listed in Appendix “H”;
(b) you were paid for a scheduled appointment with [Patient C] that you failed to attend, on one or more of the 8 occasions listed in Appendix “C”;
(c) you were paid for a scheduled appointment with [Patient D] that you failed to attend, on or about:
a) November 4, 2016; and/or
b) November 17, 2016;
(d) [Withdrawn];
(e) you were paid for a scheduled appointment with [Patient F] that you failed to attend, on one or more of
a) January 14, 2017;
b) January 17, 2017; and/or
c) January 20, 2017;
(f) you were paid for a scheduled appointment with [Patient G] that you failed to attend, on one or more of the 18 occasions listed in Appendix “D”;
(g) you were paid for a scheduled appointment with [Patient H] that you failed to attend, on one or more of:
a) 11 occasions listed in Appendix “E”; and/or
b) 25 occasions listed in Appendix “F”;
(h) you were paid for a scheduled appointment with [Patient I] that you failed to attend, on one or more of:
a) October 25, 2016; and/or
b) 9 occasions listed in Appendix “G”; and/or
- 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 paragraph 1(13) of Ontario Regulation 799/93, in that, while practicing as a Registered Practical Nurse with the Agency, you failed to keep records as required, and in particular:
(a) [Withdrawn];
(b) [Withdrawn];
(c) on or about December 2015 to January 20, 2017, you failed to complete the care management tool for [Patient A];
(d) [Withdrawn];
(e) on or about August 30, 2016 to January 20, 2017, you failed to update the medication profile and reconciliation sheet for [Patient A];
(f) on or about July 8, 2016 to January 20, 2017, you failed to complete the following documentation for [Patient B]:
a) medication profile and reconciliation sheet; and/or
b) safety assessment of the patient environment;
(g) [Withdrawn];
(h) on or about September 30, 2016 to January 20, 2017, you failed to complete the following documentation for [Patient C]:
a) medication profile and reconciliation;
b) care management tool;
c) safety assessment of the patient environment;
d) generic and/or relevant standardized care path; and/or
e) generic and/or relevant standardized care path flow sheet;
(i) on or about April 8, 2016, you failed to record the physician’s orders for [Patient D];
(j) on or about April 8, 2016 to January 20, 2017, you failed to complete the following documentation for [Patient D]:
a) a medication profile and reconciliation sheet; and/or
b) safety assessment of the patient environment;
c) teaching progress path;
(k) [Withdrawn];
(l) [Withdrawn];
(m) [Withdrawn];
(n) [Withdrawn];
(o) [Withdrawn];
(p) on or about September 26, 2016 to January 20, 2017, you failed to complete a medication profile and reconciliation sheet for [Patient I]; and/or
- 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 practicing as a Registered Practical Nurse with the Agency, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, and in particular:
(a) on or about November 2016 to January 2017, you intentionally misrepresented to the Agency that you would not drive yourself to scheduled appointments and/or to the Agency’s office because your driver’s license had been suspended, which you did on or about January 20, 2017;
(b) you failed to adequately assess one or more of your patients and/or failed to adequately document your assessment of one or more of your patients, on one or more of the occasions as set out in Appendix “A”;
(c) you were paid for a scheduled appointment with [Patient A] that you failed to attend and provide care, on one or more of
a) October 28, 2016; and/or
b) 14 occasions listed in Appendix “H”;
(d) you failed to attend a scheduled appointment and to provide care to [Patient A], on or about:
a) September 29, 2016; and/or
b) October 6, 2016;
(e) on or about December 2015 to January 20, 2017, you failed to complete the care management tool for [Patient A];
(f) you failed to adequately record clinical orders for [Patient A], on or about:
a) [Withdrawn];
b) January 17, 2016;
c) [Withdrawn]; and/or
d) February 28, 2016;
(g) on or about December 2015 to January 20, 2017, you failed to perform an adequate re-assessment and/or to document your re-assessment of [Patient A];
(h) on or about August 30, 2016 to January 20, 2017, you failed to update the medication profile and reconciliation sheet for [Patient A];
(i) on or about July 8, 2016 to January 20, 2017, you failed to complete the following documentation for [Patient B]:
a) medication profile and reconciliation sheet; and/or
b) safety assessment of the patient environment;
(j) you were paid for a scheduled appointment with [Patient C] that you failed to attend and provide care, on one or more of the 8 occasions listed in Appendix “C”;
(k) on or about September 30, 2016 to January 20, 2017, you failed to complete the following documentation for [Patient C]:
a) medication profile and reconciliation sheet;
b) care management tool;
c) safety assessment of the patient environment;
d) generic and/or relevant standardized care path; and/or
e) generic and/or relevant standardized care path flow sheet;
(l) you were paid for a scheduled appointment with [Patient D] that you failed to attend and to provide care, on or about:
a) November 4, 2016; and/or
b) November 17, 2016;
(m) on or about April 8, 2016, you failed to record the physician’s orders for [Patient D];
(n) on or about April 8, 2016 to January 20, 2017, you failed to complete the following documentation for [Patient D]:
a) a medication profile and reconciliation sheet;
b) safety assessment of the patient environment; and/or
c) teaching progress path;
(o) on or about July 27, 2016, you failed to adequately correct a documentation error in the clinical care update for [Patient D];
(p) [Withdrawn];
(q) you were paid for a scheduled appointment with [Patient F] that you failed to attend and provide care, on or about:
a) January 14, 2017;
b) January 17, 2017; and/or
c) January 20, 2017;
(r) you were paid for a scheduled appointment with [Patient G] that you failed to attend and provide care, on one or more of the 18 occasions listed in Appendix “D”;
(s) you were paid for a scheduled appointment with [Patient H] that you failed to attend and provide care, on one or more of
a) 11 occasions listed in Appendix “E”; and/or
b) 25 occasions listed in Appendix “F”;
(t) you were paid for a scheduled appointment with [Patient I] that you failed to attend and provide care, on one or more of:
a) October 25, 2016; and/or
b) 9 occasions listed in Appendix “G”;
(u) on or about September 26, 2016 to January 20, 2017, you failed to adequately assess [Patient I] and/or failed to adequately document your assessment of [Patient I];
(v) on or about September 26, 2016 to January 20, 2017, you failed to complete a medication profile and reconciliation sheet for [Patient I]; and/or
(w) you failed to sign clinical notes for [Patient I] on or about:
a) November 4, 2016; and/or
b) December 15, 2016.
APPENDIX A
Date (on or about)
[Patient]
Nature of Assessment/Documentation
December 30, 2015
[Patient A]
Nursing Wound Care Path Flow Sheet
January 2, 2016
[Patient A]
Nursing Wound Care Path Flow Sheet
January 5, 2016
[Patient A]
Nursing Wound Care Path Flow Sheet
January 7, 2016
[Patient A]
Nursing Wound Care Path Flow Sheet
January 13, 2016
[Patient A]
Nursing Wound Care Path Flow Sheet
February 14, 2016
[Patient A]
Nursing Wound Care Path Flow Sheet
February 18, 2016
[Patient A]
Nursing Wound Care Path Flow Sheet
May 4, 2016
[Patient A]
Wound Assessment Flow Chart
May 10, 2016
[Patient A]
Wound Assessment Flow Chart
July 1, 2016
[Patient A]
Wound Assessment Flow Chart
July 20, 2016
[Patient A]
Nursing Wound Care Path Flow Sheet
August 26, 2016
[Patient A]
Nursing Wound Care Path Flow Sheet
July 29, 2016
[Patient B]
Wound Assessment Flow Chart
August 4, 2016
[Patient B]
Wound Assessment Flow Chart
October 17, 2016
[Patient B]
Nursing Wound Care Path Flow Sheet
October 20, 2016
[Patient B]
Nursing Wound Care Path Flow Sheet
October 23, 2016
[Patient B]
Nursing Wound Care Path Flow Sheet
October 26, 2016
[Patient B]
Nursing Wound Care Path Flow Sheet
October 31, 2016
[Patient C]
Wound Assessment Flow Chart
October 31, 2016
[Patient C]
Nursing Wound Care Path Flow Sheet
November 2, 2016
[Patient C]
Wound Assessment Flow Chart
November 2, 2016
[Patient C]
Nursing Wound Care Path Flow Sheet
November 6, 2016
[Patient C]
Nursing Wound Care Path Flow Sheet
November 16, 2016
[Patient C]
Wound Assessment Flow Chart
November 22, 2016
[Patient C]
Wound Assessment Flow Chart
November 24, 2016
[Patient C]
Wound Assessment Flow Chart
January 2, 2017
[Patient C]
Nursing Wound Care Path Flow Sheet
September 7, 2016
[Patient D]
Care Path Flow Sheet
October 2, 2016
[Patient G]
Care Path Flow Sheet
October 7, 2016
[Patient G]
Care Path Flow Sheet
October 9, 2016
[Patient G]
Care Path Flow Sheet
October 15, 2016
[Patient G]
Care Path Flow Sheet
October 16, 2016
[Patient G]
Care Path Flow Sheet
October 19, 2016
[Patient G]
Care Path Flow Sheet
October 26, 2016
[Patient G]
Care Path Flow Sheet
October 29, 2016
[Patient G]
Care Path Flow Sheet
October 31, 2016
[Patient G]
Care Path Flow Sheet
December 5, 2016
[Patient G]
Care Path Flow Sheet
December 6, 2016
[Patient G]
Care Path Flow Sheet
December 19, 2016
[Patient G]
Care Path Flow Sheet
December 20, 2016
[Patient G]
Care Path Flow Sheet
May 11, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
May 13, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
July 23, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
August 2, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
August 4, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
October 14, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
December 4, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
December 6, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
December 18, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
December 22, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
December 26, 2016
[Patient H]
Nursing Wound Care Path Flow Sheet
January 2, 2017
[Patient H]
Nursing Wound Care Path Flow Sheet
July 15, 2016
[Patient H]
Wound Assessment Flow Chart
July 17, 2016
[Patient H]
Wound Assessment Flow Chart
July 18, 2016
[Patient H]
Wound Assessment Flow Chart
July 25, 2016
[Patient H]
Wound Assessment Flow Chart
September 21, 2016
[Patient H]
Wound Assessment Flow Chart
September 23, 2016
[Patient H]
Wound Assessment Flow Chart
September 25, 2016
[Patient H]
Wound Assessment Flow Chart
October 7, 2016
[Patient H]
Wound Assessment Flow Chart
November 14, 2016
[Patient H]
Wound Assessment Flow Chart
November 15, 2016
[Patient H]
Wound Assessment Flow Chart and/or
December 28, 2016
[Patient H]
Wound Assessment Flow Chart
APPENDIX B – [PATIENT A]
Date (on or about)
April 15, 2016
May 6, 2016
June 10, 2016
September 7, 2016
September 29, 2016
October 6, 2016
October 13, 2016
November 19, 2016
November 25, 2016
December 8, 2016
December 16, 2016
December 22, 2016
December 29, 2016
January 5, 2017
January 13, 2017 and/or
January 19, 2017
APPENDIX C – [PATIENT C]
Date (on or about)
October 27, 2016
November 20, 2016
December 16, 2016
December 20, 2016
December 26, 2016
December 28, 2016
December 30, 2016 and/or
January 19, 2017
APPENDIX D – [PATIENT G]
Date (on or about)
September 16, 2016
November 11, 2016
November 30, 2016
December 16, 2016
December 22, 2016
[Withdrawn]
[Withdrawn]
[Withdrawn]
[Withdrawn]
[Withdrawn]
January 9, 2017
January 10, 2017
January 11, 2017
January 13, 2017
[Withdrawn]
January 17, 2017 (am)
[Withdrawn] and/or
January 20, 2017
APPENDIX E – [PATIENT H]
Date (on or about)
April 27, 2016
July 19, 2016
August 14, 2016
September 30, 2016
October 12, 2016
November 2, 2016
November 16, 2016
November 20, 2016
January 6, 2017
January 13, 2017 and/or
January 18, 2017
APPENDIX F – [PATIENT H]
Date (on or about)
May 1, 2016
June 29, 2016
July 1, 2016
July 3, 2016
July 14, 2016
[Withdrawn]
July 27, 2016
July 28, 2016
July 29, 2016
September 15, 2016
[Withdrawn]
September 22, 2016
September 28, 2016
October 21, 2016
October 28, 2016
November 8, 2016
December 5, 2016
December 19, 2016
December 20, 2016
December 23, 2016
December 28, 2016
December 30, 2016
January 4, 2017
[Withdrawn] and/or
January 10, 2017
APPENDIX G – [PATIENT I]
Date (on or about)
October 14, 2016
December 6
December 9, 2016
December 30, 2016
January 6, 2017
January 9, 2017
January 13, 2017
January 17, 2017 and/or
January 20, 2017
APPENDIX H – [PATIENT A]
Date (on or about)
April 15, 2016
May 6, 2016
June 10, 2016
September 7, 2016
October 13, 2016
November 19, 2016
November 25, 2016
December 8, 2016
December 16, 2016
December 22, 2016
December 29, 2016
January 5, 2017
January 13, 2017 and/or
January 19, 2017
Member’s Plea
Member’s Plea
The Member admitted the allegations set out in paragraphs #1(a); #1(b); #1(c); #1(d); #1(e); #1(f)(b) and (d); #1(g); #1(h); #1(i)(a) and (b); #1(j); #1(k)(a), (b), (c), (d) and (e), #1(l)(a) and (b); #1(m); #1(n)(a), (b) and (c); #1(o); #1(p)(a), (b) and (c); #1(q)(a), (b) and (c); #1(r); #1(s); #1(t); #1(u); #1(v); #1(w); #1(x); #1(y)(a) and (b); #2(a)(a) and (b); #2(b); #2(c)(a) and (b); #2(e)(a), (b) and (c); #2(f); #2(g)(a) and (b); #2(h)(a) and (b); #3(c); #3(e); #3(f)(a) and (b); #3(h)(a), (b), (c), (d) and (e): #3(i); #3(j)(a), (b) and (c); #3(p); #4(a); #4(b); #4(c)(a) and (b); #4(d)(a) and (b); #4(e); #4(f)(b) and (d); #4(g); #4(h); #4(i)(a) and (b); #4(j); #4(k)(a), (b), (c), (d) and (e); #4(l)(a) and (b); #4(m); #4(n)(a), (b) and (c); #4(o); #4(q)(a), (b) and (c); #4(r); #4(s)(a) and (b); #4(t)(a) and (b); #4(u); #4(v); #4(w)(a) and (b), and Appendix A, Appendix B – [Patient A], Appendix C – [Patient C], Appendix D – [Patient G] (1), (2), (3), (4), (5), (11), (12), (13), (14), (16), (18) Appendix E – [Patient H], Appendix F – [Patient H] (1), (2), (3), (4), (5), (7), (8), (9), (10), (12), (13), (14), (15), (16), (17), (18), (19), (20), (21), (22), (23), (25), Appendix G – [Patient I] 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
Agreed Statement of Facts
College Counsel and the Member advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which as amended reads, unedited, as follows:
THE MEMBER
The Member
Meagan Willard (the “Member”) obtained a diploma in nursing from Canadore College on March 3, 2015.
The Member registered with the College of Nurses of Ontario (the “CNO”) as a Registered Practical Nurse (“RPN”) on July 30, 2015.
The Inquiries, Complaints and Reports Committee suspended the Member on August 23, 2017 for failing to submit to a health examination in connection with the incidents described below. As a result, the Member is currently suspended and not entitled to practice nursing.
The Member was employed by ParaMed Home Health Care (the “Agency”) in North Bay, Ontario, providing home care to patients, from October 9, 2015 to February 28, 2017, when she resigned her employment.
AGENCY POLICIES
Agency Policies
The Agency had three policies that were in place during the Member’s employment and that are relevant to the acts of professional misconduct.
As an employee of the Agency, the Member was required to comply with each of the policies.
First, the Agency’s Documentation, Reporting and Communication Policy (the “Documentation Policy”) required that all paper-based in-home charts contain certain standard documentation tools.
The standard documentation tools included, but were not limited to, the following:
Care Management Tool;
Safety Assessment of the Patient Environment;
Medication Profile and Reconciliation Sheet;
Generic and/or the relevant standardized Care Path Flow Sheet;
Generic and/or the relevant standardized Care Path;
Generic and/or the relevant standardized Teaching Progress Path;
Variance Tracking Record; and
Clinical notes.
The Documentation Policy required regulated staff to comply with CNO’s standards of practice in documenting objective, goal oriented, and outcome-based information regarding patient care. Nursing services were to be documented using an adapted “focus charting” methodology.
Second, the Agency’s Initial and Ongoing Client Assessments in the Nursing Program Policy (the “Client Assessment Policy”) required completion of nursing assessments and re-assessments of patients at established intervals, including every month (at minimum) and when, for example, the following situations arose:
Change in patient status;
Patient returns from hospital;
Documentation of error; and
Provide a clinical care update.
- Third, the Agency’s Standards of Conduct required that employees be honest in their dealings with clients, their families, other employees/supervisors, and the Agency. The Standards of Conduct also required that the Agency be notified of anticipated absences, lateness, or changes in their schedule, and that if an employee was required to leave a patient appointment prior to its scheduled end, the member must first obtain the permission of their supervisor and ensure the safety of the patient before leaving.
INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT
Dishonesty
Incidents Relevant to Allegations of Professional Misconduct
On November 18, 2016, the Member informed her supervisor at the Agency that her driver’s licence had been suspended for careless driving and that she had arranged for her mother to drive her to patient visits.
On January 20, 2017, the Member’s supervisor inquired about the status of her driver’s licence. The Member told her supervisor that she was still not driving and that someone had driven her to the Agency’s office that day.
Later that same day, the Member’s supervisor observed the Member leave the Agency’s office, enter her vehicle, and drive her vehicle away. When asked to return to the office, the Member told her supervisor that she would have to ask the person who was driving her whether they could bring her to the office.
When she returned to the Agency’s office, the Member’s supervisor asked the Member whether she was driving on a suspended driver’s licence. The Member admitted that she was, stating, “what else was I supposed to do?”
The Member was suspended later that day, pending an investigation by the Agency into the Member’s conduct.
The Member Failed to Attend Scheduled Visits and Was Paid For Those Visits
Following the Member’s suspension, one of the Member’s patients reported to the nurse that took over the Member’s patient assignments that she had not seen the Member for over two weeks. The Agency began an investigation into the Member’s conduct.
The Agency’s investigation revealed that the Member failed to attend a number of scheduled patient visits that the Member was paid for attending.
[Patient A]
The Member was assigned to provide home care to [Patient A] from December 2, 2015 until the Member’s suspension by the Agency on January 20, 2017. [Patient A] was diagnosed with coronary sclerosis and required weekly visits for cardio-respiratory monitoring and wound care.
The Member failed to attend [Patient A’s] home and provide care, even though she was scheduled to attend and was paid for the visits, on the following dates:
a. April 15, 2016;
b. May 6, 2016;
c. June 10, 2016;
d. September 7, 2016;
e. October 13, 2016;
f. October 28, 2016;
g. November 19, 2016;
h. November 25, 2016;
i. December 8, 2016;
j. December 16, 2016;
k. December 22, 2016;
l. December 29, 2016;
m. January 5, 2017;
n. January 13, 2017; and
o. January 19, 2017.
[Patient C]
The Member was assigned to provide home care to [Patient C] from September 30, 2016 until the Member’s suspension by the Agency on January 20, 2017. [Patient C] was diagnosed with spina bifida and required visits for wound care three times per week.
The Member failed to attend [Patient C’s] home and provide care, even though she was scheduled to attend and was paid for the visits, on the following dates:
a. October 27, 2016;
b. November 20, 2016;
c. December 16, 2016;
d. December 20, 2016;
e. December 26, 2016;
f. December 28, 2016;
g. December 30, 2016; and
h. January 19, 2017.
[Patient D]
The Member was assigned to provide home care to [Patient D] from April 8, 2016 until the Member’s suspension by the Agency on January 20, 2017. [Patient D] was diagnosed with arthritis, congestive heart failure and dementia.
The Member failed to attend [Patient D’s] home and provide care, even though she was scheduled to attend and was paid for the visits, on the following dates:
a. November 4, 2016; and
b. November 17, 2016.
[Patient F]
The Member was assigned to provide home care to [Patient F] from January 14, 2017 until the Member’s suspension by the Agency on January 20, 2017. [Patient F] required post-surgical wound care visits once every two days.
The Member failed to attend [Patient F’s] home and provide care, even though she was scheduled to attend and was paid for the visits, on the following dates:
a. January 14, 2017;
b. January 17, 2017; and
c. January 20, 2017.
[Patient G]
The Member was assigned to provide care to [Patient G] from September 6, 2016 until the Member’s suspension by the Agency on January 20, 2017. [Patient G] was a school-age child with developmental delay and intellectual disabilities. [Patient G] required support for two tube feedings daily, once in the morning (“am”) and once in the afternoon (“pm”).
The Member failed to attend and provide care to [Patient G], even though she was scheduled to attend and was paid for the visits, on the following dates:
a. September 16, 2016;
b. November 11, 2016;
c. November 30, 2016;
d. December 16, 2016;
e. December 22, 2016;
f. January 9, 2017;
g. January 10, 2017;
h. January 11, 2017;
i. January 13, 2017;
j. January 17, 2017 (am); and
k. January 20, 2017.
[Patient H]
The Member was assigned to provide home care to [Patient H] from April 18, 2016 until the Member’s suspension by the Agency on January 20, 2017. [Patient H] was diagnosed with spina bifida and required care for a chronic wound on the coccyx.
The Member failed to attend at [Patient H’s] home and provide care, even though she was scheduled to attend and was paid for the visits, on the following dates:
a. April 27, 2016;
b. May 1, 2016;
c. June 29, 2016;
d. July 1, 2016;
e. July 3, 2016;
f. July 14, 2016;
g. July 19, 2016;
h. July 27, 2016;
i. July 28, 2016;
j. July 29, 2016;
k. August 14, 2016;
l. September 15, 2016;
m. September 22, 2016;
n. September 28, 2016;
o. September 30, 2016;
p. October 12, 2016;
q. October 21, 2016;
r. October 28, 2016;
s. November 2, 2016;
t. November 8, 2016;
u. November 16, 2016;
v. November 20, 2016;
w. December 5, 2016;
x. December 19, 2016;
y. December 20, 2016;
z. December 23, 2016;
aa. December 28, 2016;
bb. December 30, 2016;
cc. January 4, 2017;
dd. January 6, 2017;
ee. January 10, 2017;
ff. January 13, 2017; and
gg. January 18, 2017.
[Patient I]
The Member was assigned to provide home care to [Patient I] from September 26, 2016 until the Member’s suspension by the Agency on January 20, 2017. [Patient I] was diagnosed with multiple myeloma and was undergoing chemotherapy. [Patient I] required home care twice a week.
The Member failed to attend [Patient I’s] home and provide care, even though she was scheduled to attend, and was paid for the visits, on the following dates:
a. October 14, 2016;
b. October 25, 2016;
c. December 6, 2016;
d. December 9, 2016;
e. December 30, 2016;
f. January 6, 2017;
g. January 9, 2017;
h. January 13, 2017;
i. January 17, 2017; and
j. January 20, 2017.
The Member Failed to Attend Scheduled Visits
- There were other occasions on which the Member failed to attend scheduled visits but was not paid.
[Patient A]
- The Member failed to attend a scheduled appointment and provide home care to [Patient A] on the following dates:
a. September 29, 2016; and
b. October 6, 2016;
[Patient E]
The Member was assigned to provide home care to [Patient E] from November 30, 2016 until the Member’s suspension by the Agency on January 20, 2017.
The Member failed to attend a scheduled appointment and provide home care to [Patient E] on the following dates:
a. December 21, 2016;
b. December 28, 2016; and
c. January 18, 2017.
Member Failed to Perform Assessments or Re-assessments
- The Agency’s investigation also revealed that the Member regularly failed to conduct assessments or re-assessments of her patients at the intervals required by the Agency’s policies. The assessments that the Member failed to conduct on the relevant dates are as set out in Appendix “A”.
[Patient A]
- In addition to the specific assessments set out in Appendix “A”, the Member also failed to conduct a re-assessment of [Patient A] at any time during her care of [Patient A] between December 2015 and January 20, 2017.
[Patient I]
- The Member failed to conduct an assessment of [Patient I] at any time during her care of [Patient I] between September 26, 2016 and January 20, 2017.
The Member Failed to Keep Records as Required
- The Agency’s investigation revealed that the Member also frequently failed to document patient care at all during the course of her assignment to certain patients and, in many other instances, made incomplete entries in patient charts.
[Patient A]
Between December 2015 and January 20, 2017, while the Member was providing care to [Patient A], the Member did not document at all in the Care Management Tool, as required by the Agency’s Documentation Policy and Client Assessment Policy.
Between August 30, 2016 and January 20, 2017, while the Member was providing care to [Patient A], the Member did not document at all in the Medication Profile and Reconciliation Sheet, as required by the Agency’s Documentation Policy and Client Assessment Policy.
On the following dates, the Member failed to adequately document clinical orders in that she crossed out original clinical orders and wrote clinical updates on the backs of the pages of the original clinical orders instead of transcribing onto Agency forms:
a. January 17, 2016; and
b. February 28, 2016.
[Patient B]
- Between July 8, 2016 and January 20, 2017, the Member did not document at all in [Patient B’s] Medication Profile and Reconciliation Sheet or the Safety Assessment of the Patient Environment tool, as required by the Agency’s Documentation Policy and Client Assessment Policy.
[Patient C]
- Between September 30, 2016 and January 20, 2017, the Member did not document at all in the following documentation tools required by the Agency’s Documentation Policy and Client Assessment Policy for [Patient C]:
a. Medication Profile and Reconciliation Sheet;
b. Safety Assessment of the Patient Environment;
c. Care Management Tool;
d. Generic and/or the relevant standardized Care Path; and
e. Generic and/or the relevant standardized Care Path Flow Sheet.
[Patient D]
- Between April 8, 2016 to January 20, 2017, the Member did not document at all in the following documentation tools required by the Agency’s Documentation Policy and Client Assessment Policy for [Patient D]:
a. Medication Profile and Reconciliation Sheet;
b. Teaching Progress Path; and
c. Safety Assessment of the Patient Environment.
On April 8, 2016, the Member failed to record physician’s orders in [Patient D’s] chart.
On July 27, 2016, the Member made a documentation error in the clinical care update for [Patient D], which she failed to correct.
[Patient I]
Between September 26, 2016 and January 20, 2017, the Member did not document at all in the Medication Profile and Reconciliation Sheet tool, as required by the Agency’s Documentation Policy and Client Assessment Policy for [Patient I].
The Member also failed to sign the clinical notes entered for [Patient I] on the following dates:
a. November 4, 2016; and
b. December 15, 2016.
CNO STANDARDS
CNO Standards
- CNO publishes nursing standards to set out the expectations for the practice of nursing. CNO’s standards inform nurses of their accountabilities and apply to all nurses regardless of their role, job description, or area of practice.
Professional Standards
CNO’s Professional Standards provides that each nurse is accountable to the public and responsible for ensuring her or his practice and conduct meets legislative requirements and the standards of the profession.
A nurse demonstrates this standard by actions such as:
a. providing, facilitating, advocating and promoting the best possible care for patients;
b. assessing/describing the patient situation using a theory, framework or evidence-based tool and identifying/recognizing abnormal or unexpected patient responses and acting appropriately;
c. advocating on behalf of patients; and
d. ensuring practice is consistent with CNO’s standards of practice and guidelines as well as legislation.
The Professional Standards also provide that ethical nursing care includes acting with integrity, honesty and professionalism in all dealings with patients and other health care members.
The [M]ember admits that her dishonesty with the Agency with respect to her driver’s licence, her failure to attend scheduled patient visits and the fact that she was paid for several of the visits that she did not attend, and her failure to perform assessments or re-assessments of patients was a breach of the Professional Standards.
Documentation Standard
CNO’s Documentation Standard helps nurses understand the importance of accurate and timely documentation, and how to apply the standards to their individual practice.
CNO’s Documentation Standard provides that nurses are accountable for ensuring their documentation of patient care is “accurate, timely and complete.” The standard further clarifies that a nurse meets the standard by:
a. ensuring documentation is a complete record of nursing care provided and reflects all aspects of the nursing process, including assessment, planning, intervention (independent and collaborative) and evaluation;
b. documenting in a timely manner and completing documentation during, or as soon as possible after, the care or event; and
c. ensuring that relevant patient care information is captured in a permanent record.
- The Member admits that her failure to document patient care at all, or failure to complete appropriate documentation was a breach of the Documentation Standard.
ADMISSIONS OF PROFESSIONAL MISCONDUCT
Admissions of Professional Misconduct
The Member admits that she committed the acts of professional misconduct, as described in paragraphs 12-50 above, and as alleged in paragraphs 1 (a)-(e), (f) b) and d), (g)-(y) of the Notice of Hearing, in that she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession.
The Member admits that she misappropriated property from the Agency, as described in paragraphs 17-32 above, and as alleged in paragraphs 2(a)-(c), (e)-(h) of the Notice of Hearing.
The Member admits that she failed to keep records as required, as described in paragraphs 40-50 above, and as alleged in paragraphs 3(c), (e), (f), (h), (i), (j), and (p) of the Notice of Hearing.
The Member admits that she committed the acts of professional misconduct as described in paragraphs 12-50 above, and as alleged in paragraphs 4(a)-(e), (f) b) and d), (g)-(o), (q)-(w) of the Notice of Hearing, and, in particular, that her conduct was disgraceful, dishonourable and unprofessional.
With leave of the Discipline Committee, the CNO withdraws the following allegations in, and particular visits referenced in certain appendices attached to, the Notice of Hearing:
a. 1(f) a) and c);
b. 2(d);
c. 3(a), (b), (d), (g), (k), (l), (m), (n), (o);
d. 4(f) a) and 4(f) c);
e. 4(p); and
f. visits 6-10, 15, and 17 in Appendix “D”; and
g. visits 6, 11, and 24 in Appendix “F”.
APPENDIX A
Date (on or about)
[Patient]
December 30, 2015
[Patient A]
January 2, 2016
[Patient A]
January 5, 2016
[Patient A]
January 7, 2016
[Patient A]
January 13, 2016
[Patient A]
February 14, 2016
[Patient A]
February 18, 2016
[Patient A]
May 4, 2016
[Patient A]
May 10, 2016
[Patient A]
July 1, 2016
[Patient A]
July 20, 2016
[Patient A]
August 26, 2016
[Patient A]
July 29, 2016
[Patient B]
August 4, 2016
[Patient B]
October 17, 2016
[Patient B]
October 20, 2016
[Patient B]
October 23, 2016
[Patient B]
October 26, 2016
[Patient B]
October 31, 2016
[Patient C]
October 31, 2016
[Patient C]
November 2, 2016
[Patient C]
November 2, 2016
[Patient C]
November 6, 2016
[Patient C]
November 16, 2016
[Patient C]
November 22, 2016
[Patient C]
November 24, 2016
[Patient C]
January 2, 2017
[Patient C]
September 7, 2016
[Patient D]
October 2, 2016
[Patient G]
October 7, 2016
[Patient G]
October 9, 2016
[Patient G]
October 15, 2016
[Patient G]
October 16, 2016
[Patient G]
October 19, 2016
[Patient G]
October 26, 2016
[Patient G]
October 29, 2016
[Patient G]
October 31, 2016
[Patient G]
December 5, 2016
[Patient G]
December 6, 2016
[Patient G]
December 19, 2016
[Patient G]
December 20, 2016
[Patient G]
May 11, 2016
[Patient H]
May 13, 2016
[Patient H]
July 23, 2016
[Patient H]
August 2, 2016
[Patient H]
August 4, 2016
[Patient H]
October 14, 2016
[Patient H]
December 4, 2016
[Patient H]
December 6, 2016
[Patient H]
December 18, 2016
[Patient H]
December 22, 2016
[Patient H]
December 26, 2016
[Patient H]
January 2, 2017
[Patient H]
July 15, 2016
[Patient H]
July 17, 2016
[Patient H]
July 18, 2016
[Patient H]
July 25, 2016
[Patient H]
September 21, 2016
[Patient H]
September 23, 2016
[Patient H]
September 25, 2016
[Patient H]
October 7, 2016
[Patient H]
November 14, 2016
[Patient H]
November 15, 2016
[Patient H]
December 28, 2016
[Patient H]
Decision
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 Allegations #1(a); #1(b); #1(c); #1(d); #1(e); #1(f)(b), (d); #1(g); #1(h); #1(i)(a), (b); #1(j); #1(k)(a), (b), (c), (d), (e); #1(l)(a), (b); #1(m); #1(n)(a), (b), (c); #1(o); #1(p)(a), (b), (c); #1(q)(a), (b), (c); #1(r); #1(s); #1(t); #1(u); #1(v); #1(w); #1(x); #1(y)(a), (b); Allegations #2(a)(a), (b); #2(b); #2(c)(a), (b); #2(e)(a), (b), (c); #2(f); #2(g)(a), (b); #2(h)(a), (b); Allegations #3(c), (e); #3(f)(a), (b); #3(h)(a), (b), (c), (d), (e); #3(i); #3(j)(a), (b), (c); #3(p), and Appendix A in its entirety, Appendix B – [Patient A] – in its entirety, Appendix C – [Patient C] – in its entirety, Appendix D – [Patient G] (1), (2), (3), (4), (5), (11), (12), (13), (14), (16), (18), Appendix E – [Patient H] – in its entirety, Appendix F – [Patient H] (1), (2), (3), (4), (5), (7), (8), (9), (10), (12), (13), (14), (15), (16), (17), (18), (19), (20), (21), (22), (23), (25), Appendix G – [Patient I] – in its entirety, in the Notice of Hearing.
As to Allegations #4(a); #4(b); #4(c)(a), (b); #4(d)(a), (b); #4(e); #4(f)(b), (d); #4(g); #4(h); #4(i)(a), (b); #4(j); #4(k)(a), (b), (c), (d), (e); #4(l)(a), (b); #4(m); #4(n)(a), (b), (c); #4(o); #4(q)(a), (b), (c); #4(r); #4(s)(a), (b); #4(t)(a), (b); #4(u); #4(v); #4(w)(a), (b) the Panel finds that the Member engaged in conduct that would reasonably be considered by members to be disgraceful, dishonourable and unprofessional.
Reasons for Decision
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 12 to 50 and 59 in the Agreed Statement of Facts. The Panel found the Member to be deceitful and dishonest when she lied directly to her manager at the Agency when she was asked if she was driving on a suspended license. The Member failed to attend scheduled appointments leaving sick, vulnerable patients with no care and lastly, the Member failed to perform assessments and keep records as required by the Agency and the College. The Member breached the College’s Practice Standards titled Professional Standard[s], Documentation Standard and the Therapeutic Nurse-Client Relationship Standard (the “TNCR Standard”). These Standards clearly outline the expectations for the practice of nursing and informs nurses of their accountabilities to their patients and their profession, which clearly outlines the expectations for the practice of nursing. The Standards inform nurses of their accountabilities that apply to all nurses. The Member deliberately left eight patients to care for themselves. The patients had a multitude of severe and life-threatening health issues that required a competent and skilled nurse. The evidence shows this Member is neither of those things. The public expects and deserves excellent nursing care with each interaction they have with a nurse. The Panel found this Member put all of these patients in danger when she decided not to provide care.
Allegation #2 in the Notice of Hearing is supported by paragraphs 17 to 32 and 60 in the Agreed Statement of Facts. The Panel found the Member misappropriated property when she failed to provide care for eight different patients and was paid on multiple occasions.
Allegation #3 in the Notice of Hearing is supported by paragraphs 40 to 51, 56-58 and 61 in the Agreed Statement of Facts. The Panel found the Member failed on multiple occasions to document care given to several patients. The Member failed to document care in the Care Management Tool, per the Agency’s policy. The Member failed to document in the Medication Profile and the Reconciliation Sheet, and lastly the Member failed to document clinical orders adequately; instead, the Member crossed-out original orders and wrote the clinical updates on the backs of pages of the original instead of transcribing onto the Agency’s forms. The Member put each patient at risk of harm when she failed to document care given. The Member breached the Documentation Standard, which states “nurses are accountable for ensuring their documentation of patient care is accurate, timely and complete, and reflects all aspects of the nursing process, including assessment, planning, intervention and evaluation.” The Member failed in each of those areas.
Allegation #4, in the Notice of Hearing is supported by paragraphs 12 to 50 and 62 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct would be considered by members of the profession to be disgraceful, dishonourable and unprofessional when the Member misrepresented to the Agency that she would not drive herself to appointments because her license was suspended, while the Member was observed to be driving by her manager. The Member reported and was paid for multiple patients scheduled appointments that she had not attended. The Member frequently failed to document patient care, and, in many instances, she made incomplete entries in patient charts. Trust, honesty and respect are at the heart of the Standards. The Member displayed a moral failing and a complete disregard for her professional obligations.
The Panel finds the Member’s conduct was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. The Member put her patients at risk of harm when she failed to document what she had done. Nurses are accountable for practicing in accordance with the College’s Practice Standards, legislation and regulations.
The Panel finds the Member’s conduct was dishonourable as it demonstrated an element of dishonesty, deceit and moral failing when the Member knowingly accepted pay for scheduled appointments she failed to attend. The Member failed to provide care to multiple patients and failed to document in accordance with the professional standards. The Member knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional.
Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. The Member’s conduct put eight vulnerable patients in danger. The Member failed to keep scheduled appointments, and in some incidents, patients were left for many days without the care they expected and deserved. The Member demonstrated a lack of integrity, dishonesty, abuse of power and disregard for the welfare and safety of multiple vulnerable patients. This behaviour casts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet.
Penalty
Penalty
College Counsel and the Member advised the Panel that a Joint Submission on Order had been agreed upon. The Joint Submission on Order requests that this Panel make an order as follows:
Requiring the Member to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
Directing the Executive Director to suspend the Member’s certificate of registration for 12 months. This suspension shall take effect from the date the Member’s current suspension ends and shall continue to run without interruption as long as the Member remains in the practicing class.
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 2 meetings with a Regulatory Expert (the “Expert”) at her own expense and within 6 months from the date the Member’s suspension ends. If the Expert determines that a greater number of sessions 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 12 months from the date the Member’s suspension ends. To comply, the Member is required to ensure that:
i. The Expert has expertise in 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:
the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
if available, a copy of the Panel’s Decision and Reasons;
iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules, decision tools and online participation forms (where applicable):
Professional Standards,
Code of Conduct, and
Documentation;
iv. At least 7 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:
the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
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:
the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into her 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 her certificate of registration;
b) For a period of 24 months from the date the Member returns to the practice of nursing, the Member will notify her employers of the decision. To comply, the Member is required to:
i. Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;
ii. Provide her employer(s) with a copy of:
the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
a copy of the Panel’s Decision and Reasons, once available;
iii. Only practice nursing for an employer who agrees to, and does, forward a report to the Director within 14 days of the commencement or resumption of the Member’s employment in any nursing position, confirming:
that they received a copy of the required documents,
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
that that they agree to perform six random spot audits of the Member’s documentation at the following intervals and provide a report to the Director regarding the Member’s practice after each audit:
a. the first audit shall take place within three months from the date the Member begins or resumes employment with the employer,
b. the second audit shall take place within six months from the date the Member begins or resumes employment with the employer,
c. the third audit shall take place within nine months from the date the Member begins or resumes employment with the employer,
d. the fourth audit shall take place within 12 months from the date the Member begins or resumes employment with the employer,
e. the fifth audit shall take place within 15 months from the date the Member begins or resumes employment with the employer, and
f. the sixth audit shall take place within 18 months from the date the Member begins or resumes employment with the employer.
iv. The audits shall, on each occasion, involve the following:
a. reviewing a random selection of at least 10 of the Member’s charts to ensure that they meet both CNO and employer standards; and
b. discussing (by telephone or in person), with at least three of the Member’s clients, to ensure that the Member provided the necessary/required care to the patient and that her documentation accurately reflects the care provided.
c) The Member shall not practice independently in the community for a period of 24 from the date the Member returns to the practice of nursing.
- All documents delivered by the Member to the CNO, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.
Penalty Submissions
Penalty Submissions
Submissions were made by College Counsel.
The aggravating factors in this case were:
The Member’s conduct was serious;
The Member failed to document care, which put patients at risk;
The Member was dishonest with the Agency;
The Member disregarded her obligations to her patients;
The Member’s conduct occurred over a period of time, and her actions increased in frequency;
The Member had total disregard for the profession and patients;
The Member breached the trust of her employer, patients and the profession;
The Member misappropriated time and money from the Agency;
The Member did not provide home care to multiple patients knowing no other nurse would be going to their homes;
The Member failed to co-operate in the investigation and pre-hearing stage with the College.
The mitigating factors in this case were:
The Member had no previous history with the College;
Following the pre-hearing, the Member co-operated with the College;
The Member attended the hearing;
The Member participated and accepted responsibility for her actions;
The Member agreed to the Agreed Statement of Facts and the Joint Submission on Order.
The proposed penalty provides for general deterrence through the Member’s suspension and oral reprimand sending a clear message to the profession as a whole that misappropriating funds, not keeping scheduled appointments and not documenting care is a serious breach of the standards and will not be tolerated.
The proposed penalty also provides for specific deterrence through the oral reprimand and 12-month suspension which will take effect from the date the Member’s current suspension ends.
The terms, conditions and limitations on the Member’s certificate provide that the Member will have 2 meetings with a Regulatory Expert at the Member’s expense, a 24-month employer notification and 6 random spot audits. The Member will have 3 random patients who will give feedback on the care the Member has provided, and lastly, the Member will not work independently in the community for 24 months. These send a strong message to the profession that this behaviour will not be tolerated.
The proposed penalty also provides for remediation and rehabilitation through the meetings with the Regulatory Expert. It will provide the Member with the opportunity to improve her practice by re-education in the areas of Professional Standards, and specifically the Therapeutic Nurse-Client Relationship Standard, Documentation Standard and Code of Conduct. The Member will have time to reflect on her errors in judgement and learn from this experience.
Overall, the public is protected by the 24-month employer notification and by the Member not working independently in the community for 24 months and because all aspects of the penalty address the most critical issues of public protection, and the penalty sends a powerful message to the public that this behaviour is not acceptable and will not be tolerated by the profession. The Member will have an opportunity to reflect on her conduct, gain insight into her actions and improve her practice. The nurse-client relationship is built on trust and respect, and patients have the right to be cared for professionally.
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 Stojiljkovic (Discipline Committee, September 2019). This case involved the member’s failure to assess/reassess multiple patients. The member failed to document adequately; he copied previous notes and passed them off as his own. Multiple times he failed to follow-up with patients. The penalty imposed upon this member included an oral reprimand, a 3-month suspension, 2 meetings with the Regulatory Expert, a 36-month employer notification requirement, and 18-months of random spot audits. As well, the member would have no independent practise in the community for 36-months.
CNO v Simeone (Discipline Committee, March 2017). This case involved the member’s failure to provide appropriate care. This member delegated a nursing task to a non-registered staff member, a PSW. This member failed to document phone conversations, wound care, medication errors and failed to provide pain management. The penalty imposed upon this member included an oral reprimand, a 5-month suspension, 2 meetings with a Regulatory Expert, an 18-month employer notification, 4 random spot audits, 3 patient feedbacks from patients receiving care from this member. Further, the member would have no independent practise in the community for 18-months.
CNO v Nugent (Discipline Committee, May 2015). This case involved the member falsifying documents. The member failed to complete wound care, signed and issued a document that they knew was false and misleading, and was cautioned 3 times by ICRC (1998, 1999 and 2004). The penalty imposed upon this member included an oral reprimand, a 6-month suspension, 2 meetings with a Regulatory Expert, an 18-month employer notification, 3 random spot audits and random feedback from 3 patients regarding the care provided to them.
CNO v Zhou (Discipline Committee, March 2018). This case involved the member’s misappropriation of time and money. The member called in sick at one employer and was paid, while she worked at another employer and was paid. This member took emergency time unpaid at one employer while she worked at the other employer. The penalty imposed upon this member included an oral reprimand, a 7-month suspension, 2 meetings with a Regulatory Expert and a 24-month employer notification.
CNO v Hearty (Discipline Committee, October 2012). This case is vastly different in that the member failed to provide care to 380 patients. The member failed to assess or reassess patients, failed to document care and wound changes, and failed to document medical orders properly. This member breached the nurse-client relationship when she shared personal information, borrowed two thousand dollars from a patient and lastly failed to communicate with the health care team. The penalty imposed upon this member included an oral reprimand and the member resigned permanently from the College.
The Member made no penalty submissions.
Penalty Decision
Penalty Decision
The Panel accepts the Joint Submission on Order and accordingly orders:
The Member is required to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
The Executive Director directed to suspend the Member’s certificate of registration for 12 months. This suspension shall take effect from the date the Member’s current suspension ends and shall continue to run without interruption as long as the Member remains in the practicing class.
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 2 meetings with a Regulatory Expert (the “Expert”) at her own expense and within 6 months from the date the Member’s suspension ends. If the Expert determines that a greater number of sessions 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 12 months from the date the Member’s suspension ends. To comply, the Member is required to ensure that:
i. The Expert has expertise in 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:
the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
if available, a copy of the Panel’s Decision and Reasons;
iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules, decision tools and online participation forms (where applicable):
Professional Standards,
Code of Conduct, and
Documentation;
iv. At least 7 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:
the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
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:
the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into her 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 her certificate of registration;
b) For a period of 24 months from the date the Member returns to the practice of nursing, the Member will notify her employers of the decision. To comply, the Member is required to:
i. Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;
ii. Provide her employer(s) with a copy of:
the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
a copy of the Panel’s Decision and Reasons, once available;
iii. Only practice nursing for an employer who agrees to, and does, forward a report to the Director within 14 days of the commencement or resumption of the Member’s employment in any nursing position, confirming:
that they received a copy of the required documents,
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
that that they agree to perform six random spot audits of the Member’s documentation at the following intervals and provide a report to the Director regarding the Member’s practice after each audit:
a. the first audit shall take place within three months from the date the Member begins or resumes employment with the employer,
b. the second audit shall take place within six months from the date the Member begins or resumes employment with the employer,
c. the third audit shall take place within nine months from the date the Member begins or resumes employment with the employer,
d. the fourth audit shall take place within 12 months from the date the Member begins or resumes employment with the employer,
e. the fifth audit shall take place within 15 months from the date the Member begins or resumes employment with the employer, and
f. the sixth audit shall take place within 18 months from the date the Member begins or resumes employment with the employer.
iv. The audits shall, on each occasion, involve the following:
a. reviewing a random selection of at least 10 of the Member’s charts to ensure that they meet both CNO and employer standards; and
b. discussing (by telephone or in person), with at least three of the Member’s clients, to ensure that the Member provided the necessary/required care to the patient and that her documentation accurately reflects the care provided.
c) The Member shall not practice independently in the community for a period of 24 from the date the Member returns to the practice of nursing.
- All documents delivered by the Member to the CNO, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.
Reasons for Penalty Decision
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 is met through the Member’s suspension and oral reprimand. General deterrence is also met through the suspension and the oral reprimand. Rehabilitation and remediation are accomplished through the terms, conditions and limitations on the Member's certificate to practice, including the Member’s meeting with the Regulatory Expert, giving her the opportunity to reflect on the issues that brought her before the College, gain insight and improve her practice going forward. Public protection is accomplished through all of these goals and through the employer notification, audits, and monitoring requirement. The Member will not be able to practice independently in the community for a significant length of time which will protect the public while the Member improves her practice.
I, Terry Holland sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.