College of Nurses of Ontario v. Velasquez, 2021 ONCNO 149496

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Sherry Szucsko-Bedard, RN Chairperson Jay Armitage Public Member Donna May, RPN Member Lalitha Poonasamy Public Member Michael Schroder, NP Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) NICK COLEMAN for ) College of Nurses of Ontario

• and - )

TATIANA VELASQUEZ ) MONICA TESSIER for Registration No. 12484705 ) Tatiana Velasquez

) CHRISTOPHER WIRTH ) Independent Legal Counsel

) Heard: August 23, 2021

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 August 23, 2021, via videoconference.

The Allegations

The allegations against Tatiana Velasquez (the “Member”) as stated in the Notice of Hearing dated April 27, 2021 are as follows:

IT IS ALLEGED THAT:

1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that while working as a Registered Nurse at University Health Network – Toronto Western Hospital in Toronto, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, and in particular, in or around 2013-2016, you submitted false claims under the Facility’s employee group benefit plan (the “Benefit Plan”).

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(8) of Ontario Regulation 799/93, in that while working as a Registered Nurse at the Facility, you misappropriated property from a client or workplace, and in particular, in or around 2013-2016, you submitted false claims under the Benefit Plan.

3. You 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(14) of Ontario Regulation 799/93, in that while working as a Registered Nurse at the Facility, you falsified a record relating to your practice, and in particular, in or around 2013-2016, you submitted false claims under the Benefit Plan.

4. You 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 working as a Registered Nurse at the Facility, you signed or issued, in your professional capacity, a document that you knew or ought to have known contained a false or misleading statement, and in particular, in or around 2013-2016, you submitted false claims under the Benefit Plan.

5. 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 working as a Registered Nurse at the Facility, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, and in particular, in or around 2013-2016, you submitted false claims under the Benefit Plan.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1, 2, 3, 4 and 5 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 as amended reads, unedited, as follows:

THE MEMBER

1. Tatiana Velasquez (the “Member”) obtained a degree in nursing from Humber College in 2011.

2. The Member registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on January 3, 2012.

3. The Member has been employed as an RN at University Health Network – Toronto Western Hospital in Toronto, Ontario (the “Facility”) since 2012.

THE BENEFIT PLAN

4. The Facility’s employee benefit plan (the “Benefit Plan”) is a group insurance policy which provides coverage for extended health care, dental, and other insurance benefits. The Facility is the Plan Sponsor for the Benefit Plan and funds the cost of claims paid out under the plan. SunLife Insurance (“SunLife”) administers the Benefit Plan on behalf of the Facility.

5. The Member, as an RN at the Facility represented by the Ontario Nurses’ Association (“ONA”), was a member of the Benefit Plan through the collective agreement between ONA and the Facility. The Member’s spouse also had coverage under the Benefit Plan.

6. In relation to extended health care, the Benefit Plan provided the Member and her family with coverage for medical equipment and supplies, among other things. In particular, the Benefit Plan provided 100% reimbursement for up to 4 pairs of support stockings annually (per person), as well as braces, provided they are not solely for athletic use.

7. The Benefit Plan also provided the Member with coverage for the reasonable and customary charges for orthopaedic shoes, including modifications to stock orthopedic shoes (up to $250 per year), and for orthotics (2 pairs up to $225 per year). To be eligible, the shoes and/or orthotics must be “required for the correction of deformity of the bones and muscles and provided they are not solely for athletic use”. They must also be prescribed by a physician, podiatrist, chiropodist or chiropractor.

8. The Benefit Plan provided coverage for Transcutaneous Electrical Nerve Stimulators (“TENS”) machines, under the provision stating “reasonable and customary charges for rental, or purchase at our option” of medically necessary durable equipment that meets the patient’s basic medical needs and is approved by Sun Life”.

9. In addition, the Benefit Plan provided the Member and her family with coverage for treatment by a registered massage therapist, up to $400 per year.

10. Claims for equipment and supplies under the Benefit Plan, including orthotics, shoe modifications, braces, support stockings, and TENS were to be submitted using a paper claim form with the receipt and prescription attached. The claim form included the following declaration to be signed by the employee submitting a claim:

Authorization and Signature

I certify that all goods and services being claimed have been received by me and/or my spouse or dependents, if applicable. I certify that the information in this form is true and complete and does not contain a claim for any expense previously paid for by this or any other plan. [emphasis added]

In the event there is suspicion and/or evidence of fraud and/or Plan abuse concerning this claim, I acknowledge and agree that Sun Life may investigate and that information about me, my spouse and/or dependents pertaining to this claim may be used and disclosed to any relevant organization including regulatory bodies, government organizations, medical suppliers and other insurers, and where applicable my Plan Sponsor, for the purpose of investigation and prevention of fraud and/or Plan abuse.

11. Claims for massage therapy could be submitted online.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

12. Between 2013 and 2016, the Member submitted false claims under the Benefit Plan and received at least $11,080 in relation to the false claims.

13. Downtown Wellness and Foot Care (“DWFC”) is a supplier of orthotics, braces and compression stockings. It is connected with Elm Orthotics and Foot Care Inc. (“EOFC”).

14. In or around March 2017, SunLife conducted a secret shopper investigation of DWFC and EOFC. The investigation was initiated following a tip from a nurse manager with the University Health Network that alleged DWFC was running a scheme whereby benefit plan members would obtain designer handbags and shoes from DWFC, but DWFC would provide the benefit plan members with documentation that allowed them to submit false benefit claims for these items. During the secret shopper visit, an employee of DWFC suggested to the secret shopper that expenses could be billed in a way that did not comply with the benefit plan but would ensure that the secret shopper was not out of pocket for any costs.

15. Sunlife’s investigation resulted in a “delist” recommendation, meaning that SunLife would not pay claims from this provider due to suspicions of fraud.

16. On August 9, 2017, after the delist recommendation, University Health Network sent an email to employees in the Benefit Plan, informing them that SunLife had delisted a number of suppliers, including DWFC and EOFC, because they had reason to believe that claims were suspicious. The email also stated:

Some of you may be aware of claims that you filed or may have been filed on your behalf that were not accurate, were false or that constitute a misuse of benefits. If this is the case, it is important that you come forward now. The Hospital will review the circumstances of that claim(s) and will consider your act of coming forward and volunteering this information as a major positive consideration in the Hospital’s decision-making process. This does not mean that you will be totally exonerated, for there may be consequences such as repayment and/or some form of discipline.

If you believe that a claim(s) was filed for you or by you that was inaccurate, false or a misuse of benefits please contact one of the following HR representatives with details by August 25th.

17. On October 25, 2017, University Health Network sent another email to employees about abusing benefits coverage, which included the following statement:

I’ll close by saying that we are continuing to review benefit claims from the past and I would encourage anyone who is concerned about claims they may have made to come forward to Human Resources and discuss the matter. From this day forward, claims which take inappropriate advantage of our benefits program will not be tolerated and will result in termination of employment. This is a very tough statement to write but I need to be clear that UHN cannot tolerate abuse of our generous benefits program. Going forward, we will increase our benefit audits and will continue to work with SunLife to ensure that benefit claims are made for items which have been prescribed by family doctors and that individuals are purchasing from reputable suppliers only.

18. The Member failed to come forward to the Facility following the above-noted emails.

19. The Facility conducted an audit of claims submitted by employees and identified the Member as having submitted a series of claims involving DWFC that required review. In particular, the Member submitted a number of claims between 2013 to 2016 for products including orthotics, shoe modifications, support stockings, massage services, braces, and a TENS machine.

20. As a result, the Facility conducted multiple interviews with the Member between December 2018 and February 2019 and reviewed the claims. The Member initially denied misconduct. The Member provided contradictory information in her interview and was unable to explain the discrepancies between her answers and other information available. Specifically, the member stated that she only received one massage therapy treatment at DWFC, but multiple services for massage therapy had been submitted by and paid to her. In relation to shoe modification claims, the lab denied manufacturing the items claimed.

21. The Member subsequently admitted to submitting false claims through DWFC in order to receive store credits to be used for non-medicinal products, including shoes.

22. The Member received a five-day unpaid suspension from the Facility for her conduct. Additionally, the Member and the Facility entered into a “Payment Agreement” which required the Member to pay back $11,080 for “benefit claim abuse”. The Member did not grieve the suspension.

23. If the Member were to testify, she would express deep remorse over her choices. She does not take this matter lightly, and considers it a privilege to be a member of CNO. She is committed to meeting all of her professional and ethical obligations as a proud member of CNO.

CNO STANDARDS

Professional Standards

24. CNO’s Professional Standards provides an overall framework for the practice of nursing and a link with other standards, guidelines and competencies developed by CNO. It includes seven broad standard statements pertaining to accountability, continuing competence, ethics, knowledge, knowledge application, leadership and relationships.

25. CNO’s Professional Standards provides, in relation to the accountability standard, that nurses are accountable to the public and responsible for ensuring her or his practice and conduct meets the legislative requirements and the standard of the profession. Nurses are responsible for their actions and the consequences of those actions as well as for conducting themselves in ways that promote respect for the profession. Nurses demonstrate this standard by actions such as ensuring their practice is consistent with CNO’s standards of practice and guidelines as well as legislation.

26. CNO’s Professional Standards provides, in relation to the leadership standard, that leadership requires self-knowledge (understanding one’s beliefs and values and being aware of how one’s behaviour affects others), respect, trust, integrity, shared vision, learning, participation, good communication techniques and the ability to be a change facilitator. The leadership expectation is not limited to nurses in formal leadership positions and all nurses, regardless of their position, have opportunities for leadership. Nurses demonstrate this standard by actions such as role-modelling professional values, beliefs and attributes.

Ethics

27. CNO’s Ethics Standard describes ethical values that are important to the nursing profession in Ontario including patient well-being, patient choice, privacy and confidentiality, respect for life, maintaining commitments, truthfulness and fairness.

28. CNO’s Ethics Standard provides, in relation to maintaining commitments, that nurses have a commitment to the nursing profession and being a member of the profession brings with it the respect and trust of the public. To continue to deserve this respect, nurses have a duty to uphold the standards of the profession, conduct themselves in a manner that reflects well on the profession, and to participate in and promote the growth of the profession.

29. CNO’s Ethics Standard also provides, in relation to truthfulness, that truthfulness means speaking and acting without intending to deceive.

30. The Member admits and acknowledges that she contravened CNO’s Professional Standards and Ethics Standard when she submitted false claims under the Benefit Plan in or around 2013 to 2016.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

31. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1 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, as described in paragraphs 12 to 22 and 24 to 30 above.

32. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2 of the Notice of Hearing in that she misappropriated property from a workplace, as described in paragraphs 12 to 22 above.

33. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3 of the Notice of Hearing in that she falsified a record relating to her practice, as described in paragraphs 12 to 22 above.

34. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 4 of the Notice of Hearing in that she signed or issued, in her professional capacity, a document that she knew or ought to have known contained a false or misleading statement, as described in paragraphs 12 to 22 above.

35. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 5 of the Notice of Hearing, and in particular her conduct was dishonourable and unprofessional, as described in paragraphs 12 to 22 and 24 to 30 above.

Decision

The College bears the onus of proving the allegations in accordance with the standard of proof, that being the balance of probabilities based upon clear, cogent and convincing evidence.

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, 2, 3, 4 and 5 of the Notice of Hearing. As to allegation #5, the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be unprofessional and dishonourable.

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 12-22, 24-30 and 31 in the Agreed Statement of Facts. Between 2013 and 2016, the Member submitted false claims under the benefit plan and received at least $11,080.00 in relation to those false claims. The Member admitted to submitting false claims through Downtown Wellness and Foot Care (“DWFC”) in order to receive store credits to purchase non-medicinal products, including shoes. The College’s Ethics Standard, in relation to truthfulness, provides that “truthfulness means speaking and acting without intending to deceive”. The Member attempted to deceive her employer by submitting claims to the benefit plan for non-medicinal products. In relation to accountability, the College’s Professional Standards provides that “nurses are accountable to the public and responsible for ensuring her or his practice and conduct meets......the standard of the profession”. The Member demonstrated that she was not accountable to the public when she submitted claims for non-medicinal products through the benefit plan.

Allegation #2 in the Notice of Hearing is supported by paragraphs 12-22 and 32 in the Agreed Statement of Facts. The benefit plan was provided to employees of the facility for medicinal expenditures, including extended health care, dental, medical equipment and supplies. Between 2013 and 2016, the Member submitted claims for orthotics, shoe modifications, support stockings, massage services, braces, and a TENS machine. These products and services were not received by the Member. The Member misappropriated property from the workplace through submitting false claims through DWFC in order to obtain store credits to be used for non-medicinal products, including shoes and designer handbags.

Allegations #3 and #4 in the Notice of Hearing are supported by paragraphs 10, 12-22, 33 and 34 in the Agreed Statement of Facts. Between 2013 and 2016, the Member submitted claims for orthotics, shoe modifications, support stockings, massage services, braces and a TENS machine. The claim form contained a declaration in which the Member had to sign. The declaration included that “all goods and services claimed have been received by me and/or my spouse or dependents” and “I certify that the information in the form is true and complete”. The Member falsified a record relating to her practice as she did so in the context of her employment as an RN with the University Health Network (“UHN”) and signed a false or misleading statement in her professional capacity as an RN employee with UHN, when she signed the declaration, as the Member admits to instead receiving store credits which could be redeemed for non-medicinal products, including shoes and designer handbags.

With respect to allegation #5, the Panel finds that the Member’s conduct in submitting multiple false benefit claims over several years was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit through making fraudulent submissions to the employee benefit plan in the total amount of $11,080.00 for store credits which were used to purchase non-medicinal products such as shoes and designer handbags. The Member knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional.

Penalty

College Counsel and the Member’s Counsel 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:

1. Requiring the Member to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.

2. Directing the Executive Director to suspend the Member’s certificate of registration for 3 months. This suspension shall take effect from September 30, 2021 and shall continue to run without interruption as long as the Member remains in a practicing class.

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

a) The Member will attend 2 meetings with a Regulatory Expert (the “Expert”), at her own expense and within 6 months from the date that this Order becomes final. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings;

ii. At least 7 days before the first meeting, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules, decision tools and online participation forms (where applicable):

1. Professional Standards,

2. Ethics, and

3. Code of Conduct;

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:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into 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 12 months from the date this Order becomes final during which the Member is engaged continuously in the practice of nursing (i.e. not including the period during which the Member’s certificate of registration is suspended), 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:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iii. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm:

1. that they received a copy of the required documents, and

2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

3. 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

Submissions were made by College Counsel.

The aggravating factors in this case were that there were multiple claims made over a period of several years. The value of the claims was in excess of $11,000.00. The claims were accompanied by a false declaration made by the Member. The conduct is a serious breach of the Member’s professional responsibilities.

The mitigating factors in this case were that the Member accepted full responsibility for her conduct by admitting to all the allegations of professional misconduct and by agreeing to the Agreed Statement of Facts and the Joint Submission on Order. Given the large number of pending similar cases, the Member chose not to defer this proceeding until the results of the “test case” were known.

The proposed penalty provides for general deterrence through the 3 month suspension. General deterrence is an important element in this case given the significant number of pending similar cases before the Discipline Committee.

The proposed penalty provides for specific deterrence through the oral reprimand and the 3 month suspension.

The proposed penalty provides for remediation and rehabilitation through the 2 meetings with a Regulatory Expert. The Member will be afforded an opportunity to reflect on her mistakes and ensure that similar misconduct does not occur in her future practice.

Overall, the public is protected through the 12 month employer notification. The penalty sought shows that this conduct is serious and has attracted a serious penalty sanction. This penalty demonstrates to the public that this is a profession that is capable of governing itself.

The Joint Submission on Order defers the commencement of the suspension to September 30, 2021 due to the ongoing demand for health human resources related to the COVID-19 pandemic. College Counsel submitted that this deferral will allow the facility an opportunity to plan for the Member’s absence to ensure the continuation of care and is appropriate in the circumstances.

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. Kartisch (Discipline Committee, 2000): The misconduct involved a nurse claiming for and being paid for shifts that she did not work. The amount involved was $2,158.00. The nurse was terminated by the employer. The nurse paid restitution in the amount of $2,158.00. The penalty included an oral reprimand, a 60 day suspension and a course in ethics and health care.

CNO v. Craig (Discipline Committee, 1998): This misconduct involved the theft of $200.00 from the petty cash box at the Victorian Order of Nurses. The member’s employment was terminated. The member was charged criminally with a finding of guilt. The penalty included an oral reprimand and a 3 month suspension.

CNO v. Fellows-Smith (Discipline Committee, 2005, 2006): The misconduct involved the member making false claims for sick leave and/or benefits. The amount totalled $347.73. The Member paid restitution. The penalty included an oral reprimand, a 60 day suspension and a fine of $2,500.00

CNO v. Cuppage (Discipline Committee, 2005): The misconduct involved false claims for sick leave benefits. The amount was approximately $1,300.00. The member was not present at the hearing. The penalty included an oral reprimand and a 90 day suspension.

CNO v. Mohamed (Discipline Committee, 2008): The misconduct involved false claims for sick leave benefits. The amount totalled $16,581.12. The Joint Submission on Order was accepted by the panel and the penalty included an oral reprimand, a 4 month suspension, a minimum of six meetings with a counsellor, no independent practice until all terms, conditions, and limitations had been completed and a fine of $2,500.00.

CNO v. Calvano (Discipline Committee, 2015): This case involved improper access of confidential patient medical records who were not in the member’s care. This case involved 338 patients over a period of 24 months. The relevance of this case includes the widespread problem in the profession of improper access of electronic health records. The penalty included an oral reprimand, a 3 month suspension, two meetings with a Nursing Expert and 18 months of employer notification.

College of Physicians and Surgeons of Ontario v. Moore (Divisional Court, 2003): The decision of the Discipline Committee was subject to judicial review by the Divisional Court. The misconduct involved defrauding OHIP in the amount of $75,000.00 by a physician. Restitution had been paid. There was a criminal conviction. The penalty included a 12 month suspension, however, the suspension would be reduced to 6 months if certain conditions were met. The penalty included a $5,000.00 fine. The decision of the Discipline Committee was upheld in the judicial decision. General deterrence was an appropriate factor for the Discipline Committee to consider given the widespread problem of defrauding OHIP.

British Columbia Securities Commission v. Hogan (Court of Appeal, 2005): The penalty included a $25,000.00 fine in which the individual said they had no means to pay. This was subject to judicial review. The misconduct involved misrepresentations in offering investment products for sale which gave rise to $42,000.00 in improper profit. The Securities Commission’s decision was upheld on judicial review. A message of general deterrence was an appropriate consideration of the panel’s decision.

Submissions were made by the Member’s Counsel.

The oral reprimand meets the goals of specific deterrence, general deterrence, and rehabilitation and remediation and will provide an opportunity for the Member to hear from fellow members of the profession and public members about the seriousness of her misconduct.

The 3 month suspension will have a strong deterrent effect by sending an important message to the Member and the membership that this type of misconduct is not acceptable.

The meetings with the Regulatory Expert will meet the goals of rehabilitation and remediation and public protection as they will educate the Member with regards to the ethical and professional standards.

The 12 month employer notification will protect the public through ensuring the Member’s employer is aware of the misconduct. The employer will be afforded an opportunity to be vigilant in monitoring the Member’s practice on her return to the profession.

Mitigating factors include that the Member is extremely remorseful over her actions and choices. The Member has taken full responsibility at both the employer level and the College level and is 100% committed to correcting this. The Member was a new nurse at the time of the events. The Member does not have any prior discipline history with the College.

Penalty Decision

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

1. The Member is required to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.

2. The Executive Director is directed to suspend the Member’s certificate of registration for 3 months. This suspension shall take effect from September 30, 2021 and shall continue to run without interruption as long as the Member remains in a practicing class.

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

a) The Member will attend 2 meetings with a Regulatory Expert (the “Expert”), at her own expense and within 6 months from the date that this Order becomes final. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings;

ii. At least 7 days before the first meeting, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules, decision tools and online participation forms (where applicable):

1. Professional Standards,

2. Ethics, and

3. Code of Conduct;

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:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into 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 12 months from the date this Order becomes final during which the Member is engaged continuously in the practice of nursing (i.e. not including the period during which the Member’s certificate of registration is suspended), 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:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iii. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm:

1. that they received a copy of the required documents, and

2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

3. 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

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 and general deterrence are achieved through the oral reprimand and 3 month suspension which will send a clear message to both the Member and the membership that fraud directed towards employer sponsored benefits will not be tolerated. Rehabilitation and remediation will be achieved through the two meetings with the Regulatory Expert and associated coursework. The public will be protected through the 12 month employer notification which will make the employer aware of the misconduct so that the employer can appropriately monitor the Member on her return to practice. The deferral of the suspension due to the ongoing demand of health human resources stemming from the COVID-19 pandemic is in the public interest as it affords the Member’s employer an opportunity to plan for her absence to ensure the continuation of care.

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

I, Sherry Szucsko-Bedard, RN sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.