College of Nurses of Ontario v. Kaitlin O’Kell-Ayers, 2021 ONCNO 152828

Discipline Committee of the College of Nurses of Ontario

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: David Edwards, RPN Chairperson Janet Adanty, RN Member Tim Crowder Public Member Tanya Dion, RN Member Sylvia Douglas Public Member

BETWEEN:

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

• and - ) KAITLIN O’KELL-AYERS ) NO REPRESENTATION for Registration No. JG693249 ) Kaitlin O’Kell-Ayers ) PATRICIA HARPER ) Independent Legal Counsel ) Heard: November 1, 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 November 1, 2021, via videoconference.

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 public disclosure and banning publication or broadcasting of the names of the patients, or any information that could disclose the identities of the patients referred to orally or in any documents presented in the Discipline hearing of Kaitlin O’Kell-Ayers.

The Panel considered the submissions of College Counsel and agreed to by the Member and decided that there be an order preventing public disclosure and banning publication or broadcasting of the names of the patients, or any information that could disclose the identities of the patients referred to orally or in any documents presented in the Discipline hearing of Kaitlin O’Kell-Ayers.

Order to Combine Proceedings

College Counsel brought a motion pursuant to subsection 9.1(1) of the Statutory Powers Procedure Act for an order to combine the proceedings so that the allegations of professional misconduct against Kaitlin O’Kell-Ayers (the “Member”) in the Notice of Hearing 1 and the Notice of Hearing 2 could be combined at a single hearing. Subsection 9.1(1) provides that, “if two or more proceedings before a tribunal involve the same or similar questions of fact, law or policy, the tribunal may … combine the proceedings or any part of them, with the consent of the parties …”, subject to certain exceptions in subsections 9.1(2) and (3), none of which apply in the circumstances.

College Counsel submitted that the two proceedings involve similar questions of fact, law and policy regarding the acts of professional misconduct committed by the Member. The College and the Member have consented to combine the proceedings, as documented in the Agreed Statement of Facts dated September 21, 2021.

The Panel considered the submissions of College Counsel, and the consent of the parties, and decided that the two proceedings should be combined for hearing. The Panel determined that because the two proceedings involve similar questions of fact, law and policy with respect to the acts of professional misconduct by the Member and the parties have consented to the two proceedings being combined, such an order was appropriate.

The Panel accordingly made an order to combine the two proceedings with respect to the allegations of professional misconduct against the Member set out in the Notice of Hearing 1 and the Notice of Hearing 2, both dated September 28, 2021.

The Allegations

The allegations against the Member as stated in the Notice of Hearing 1 dated September 28, 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, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession with respect to the following incidents:

(a) on or about April 1, 2017 and/or May 4, 2017, while employed as a Registered Practical Nurse (“RPN”) at Hotel Dieu Shaver Health and Rehabilitation Centre in St. Catharines, Ontario (“Hotel Dieu”), you,

(i) misappropriated Percocet and/or Oxycodone tablets intended for the patients listed Table A;

(ii) falsified records regarding Percocet and/or Oxycodone tablets attributed to the patients listed in Table A; and/or

(iii) failed to document administering Percocet and/or Oxycodone tablets administered to patients listed in Table A;

(b) on or about April 3 and/or 11, 2017, while employed as an RPN at Greater Niagara General Hospital in St. Catharines, Ontario (“Greater Niagara”), you,

(i) misappropriated Percocet tablets intended for the patients listed in Table B;

(ii) falsified records regarding Percocet tablets attributed to the patients listed in Table B; and/or

(iii) failed to document administering Percocet tablets to the patients listed in Table B; and/or

(c) on or about July 4, 28, 29 and/or 30, 2017, while employed as an RPN at Hotel Dieu, you failed to attend your scheduled shifts or to notify Hotel Dieu that you could not attend your scheduled shifts.

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(5) of Ontario Regulation 799/93, in that, while employed as an RPN at Hotel Dieu, you discontinued professional services that were needed which was not permitted unless i. the client requested the discontinuation, ii. alternative replacement services were arranged, or iii. the client was given a reasonable opportunity to arrange alternative or replacement services, with respect to failing to attend your scheduled shifts or to notify Hotel Dieu that you could not attend your scheduled shifts on or about July 4, 28, 29 and/or 30, 2017.

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(8) of Ontario Regulation 799/93, in that, you misappropriated property from a client or work place with respect to the following incidents:

(a) on or about April 1, 2017 and/or May 4, 2017, while employed as an RPN at Hotel Dieu, you misappropriated Percocet and/or Oxycodone tablets intended for the patients listed Table A; and/or

(b) on or about April 3 and/or 11, 2017, while employed as an RPN at Greater Niagara, you misappropriated Percocet tablets intended for the patients listed in Table B.

4. 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(13) of Ontario Regulation 799/93, in that, you failed to keep records as required with respect to the following incidents:

(a) on or about April 1, 2017 and/or May 4, 2017, while employed as an RPN at Hotel Dieu, you failed to document administering Percocet and/or Oxycodone tablets administered to patients listed in Table A; and/or

(b) on or about April 3 and/or 11, 2017, while employed as an RPN at Greater Niagara, you failed to document administering Percocet tablets to the patients listed in Table B.

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(14) of Ontario Regulation 799/93, in that, you falsified a record relating to your practice with respect to the following incidents:

(a) on or about April 1, 2017 and/or May 4, 2017, while employed as an RPN at Hotel Dieu, you falsified records regarding Percocet and/or Oxycodone tablets attributed to the patients listed in Table A; and/or

(b) on or about April 3 and/or 11, 2017, while employed as an RPN at Greater Niagara, you falsified records regarding Percocet tablets attributed to the patients listed in Table B.

6. 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, 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 with respect to the following incidents:

(a) on or about April 1, 2017 and/or May 4, 2017, while employed as an RPN at Hotel Dieu, you,

(i) misappropriated Percocet and/or Oxycodone tablets intended for the patients listed Table A;

(ii) falsified records regarding Percocet and/or Oxycodone tablets attributed to the patients listed in Table A; and/or

(iii) failed to document administering Percocet and/or Oxycodone tablets administered to patients listed in Table A;

(b) on or about April 3 and/or 11, 2017, while employed as an RPN at Greater Niagara, you,

(i) misappropriated Percocet tablets intended for the patients listed in Table B;

(ii) falsified records regarding Percocet tablets attributed to the patients listed in Table B; and/or

(iii) failed to document administering Percocet tablets to the patients listed in Table B; and/or

(c) on or about July 4, 28, 29 and/or 30, 2017, while employed as an RPN at Hotel Dieu, you failed to attend your scheduled shifts or to notify Hotel Dieu that you could not attend your scheduled shifts.

Table A

Patient

[Patient A]

[Patient B]

[Patient C]

[Patient D]

Table B

Patient

[Patient E]

[Patient F]

[Patient G]

[Patient H]

The allegations against the Member as stated in the Notice of Hearing 2 dated September 28, 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 employed as a Registered Practical Nurse (“RPN”) at Victorian Order of Nurses-Niagara Branch in St. Catharines, Ontario (“VON”), you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession with respect to the following incidents:

a) on or about February 3, 4 and/or 5, 2020, you failed to attend at VON for scheduled orientation shifts, and/or failed to provide an adequate reason for not doing so; and/or

b) on and/or after about February 6, 2020, you failed to return to the VON property assigned to you for use as a VON nurse, including a Samsung Galaxy Note8 cell phone, charger, headphones and phone case, when your employment was terminated by VON.

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 employed as an RPN at VON, you misappropriated property from a client or work place with respect to on and/or after about February 6, 2020, you failed to return to the VON property assigned to you for use as a VON nurse, including a Samsung Galaxy Note8 cell phone, charger, headphones and phone case, when your employment was terminated by VON.

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that, while employed as an RPN at VON, 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 with respect to the following incidents:

a) on or about February 3, 4 and/or 5, 2020, you failed to attend at VON for scheduled orientation shifts, and/or failed to provide an adequate reason for not doing so; and/or

b) on and/or after about February 6, 2020, you failed to return to the VON property assigned to you for use as a VON nurse, including a Samsung Galaxy Note8 cell phone, charger, headphones and phone case, when your employment was terminated by VON.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1(a)(i), (ii), (iii), (b)(i), (ii), (iii), (c), 2, 3(a), (b), 4(a), (b), 5(a), (b), 6(a)(i), (ii), (iii), (b)(i), (ii), (iii) and (c) in the Notice of Hearing 1. Furthermore, the Member admitted the allegations set out in paragraphs 1(a), (b), 2, 3(a) and (b) in the Notice of Hearing 2. 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 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. Kaitlin O’Kell-Ayers (the “Member”) graduated with a diploma in nursing from Fanshawe College in March 2007.

2. The Member initially registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on September 26, 2007.

3. The Member was administratively suspended for non-payment of fees from February 17, 2021 to March 19, 2021, when her certificate of registration expired.

4. As a result of the non-renewal, the Member is not currently entitled to practise nursing.

THE FACILITIES

5. The Member was employed at two facilities on a part-time basis in 2017: Hotel Dieu Shaver Health and Rehabilitation Centre (“Hotel Dieu”) and the Greater Niagara General Hospital (“Greater Niagara General”) in St. Catharines, Ontario.

6. Hotel Dieu is a 134-bed facility that provides rehabilitation, complex care and palliative care. The Member began working as an RPN at Hotel Dieu in 2008.

7. Greater Niagara General is a general hospital which provides emergency care, critical care, acute care, and other services. The Member began working as an RPN at Greater Niagara General in 2010 on the Inpatient Surgical Unit. Most individuals in the Inpatient Surgical Unit are short stay (i.e., 2-3 days) surgical patients.

8. The Member’s employment was terminated at both facilities, primarily due to inappropriate narcotic access and documentation, and her failure to attend scheduled shifts without providing notice to the facility or arranging for alternative care for her assigned patients.

9. On January 10, 2020, the Member was hired as an RPN on a part-time basis by the Victorian Order of Nurses (“VON”) to provide care to a minor in a school setting.

10. The Member’s employment at the VON was terminated on February 6, 2020 after she failed to attend three scheduled orientation dates with no notice. Following her termination, the Member failed to return a cell phone and accessories belonging to the VON, despite her agreement to do so.

THE ALLEGATIONS

11. CNO’s Inquiries, Complaints and Reports Committee (“ICRC”) referred allegations of professional misconduct regarding the Member’s practice at Hotel Dieu and Greater Niagara General to the Discipline Committee on January 23, 2020. The allegations are set out in the Notice of Hearing dated February 18, 2021 (“NOH #1”).

12. A different ICRC panel referred a second set of professional misconduct allegations arising from incidents at the VON to the Discipline Committee on January 21, 2021. The allegations are set out in a separate Notice of Hearing (“NOH #2”).

13. NOH #1 and NOH #2 are being considered together on their merits and liability.

PRE-HEARING CONFERENCE ATTEMPTS

14. Despite the Member’s lack of response during both distinct investigations, CNO attempted to arrange a pre-hearing conference on multiple occasions.

15. CNO contacted the Member several times between January 2020 and January 2021 using the mailing address, email and two telephone numbers on record.

16. The Member did not respond.

17. Accordingly, a contested hearing was scheduled to deal with NOH #1 on April 6-8 and 13-14, 2021.

18. The Hearings Department first notified the Member of the hearing dates by email on October 29, 2020 and sent a formal confirmation letter by email on December 22, 2020.

19. The Professional Conduct team couriered a letter to the Member confirming the contested hearing dates, and encouraging her participation in the process, on January 12, 2021. However, the letter was returned as undeliverable.

20. In response, CNO initiated a skip trace. The skip trace identified an alternative mailing address for the Member. No secondary email or phone numbers differing from those already in CNO’s records were found.

21. Correspondence notifying the Member of the contested hearing dates, along with NOH #1, was sent via email on February 22, 2021. The same package was successfully delivered via process server on February 24, 2021 to the new location identified in the skip trace.

22. The Member emailed CNO on February 25, 2021, asking how to resolve her discipline case and claimed that this was the first she had heard of the matter. The Member also advised CNO that she recently completed an inpatient treatment program for a substance use disorder she had for many years. She had also changed residences due to a death in the family and had not updated her address with CNO.

23. CNO subsequently followed up with the Member by email and telephone.

24. The Member did not respond.

25. In response to the Member’s continued lack of engagement, CNO prepared for the contested hearing by completing five witness interviews, as well as retaining, interviewing, and preparing an expert witness to testify.

26. In a final attempt to encourage the Member’s cooperation, the Professional Conduct team suggested that CNO co-counsel attempt to reach the Member given that attempts had been unsuccessful to date.

27. CNO co-counsel persisted with efforts to contact the Member regarding her intentions with respect to the contested hearing and proposed that dealing with NOH #1 and NOH #2 together would be more expedient than appearing before a Discipline Committee panel on two separate occasions.

28. The Member responded to co-counsel on March 14, 2021. The Member advised that she wished to take responsibility for her actions and cooperate with CNO to resolve the discipline matter on consent. The Member agreed to hearing both matters now set out in NOH #1 and NOH #2 in tandem.

29. To assist CNO and the Member in arriving at a negotiated settlement, a pre-hearing conference was scheduled for April 29, 2021.

30. Furthermore, to support her preparation in making full answer in defence, CNO re-couriered the disclosure package to the Member on March 11, 2021. The same package was also sent to the Member electronically via a secure link email. Both were successfully delivered.

31. In light of the pre-hearing conference scheduled for April 29, 2021, CNO counsel applied to adjourn the contested hearing scheduled for April 6-8 and 13-14, 2021. The Chair of the Discipline Committee granted the request and the hearing was officially adjourned on March 26, 2021.

32. CNO sent the Member further disclosure via courier and secure link email on April 5, 2021. Both were successfully delivered.

33. Ahead of the pre-hearing conference, co-counsel spoke to the Member about what to expect at the session and how discipline proceedings function at CNO. The Member told the co-counsel that she appreciated her assistance and was prepared to attend the pre-hearing to resolve the disciplinary matters on consent.

Failure to Attend Pre-hearing Conference, April 29, 2021

34. The Member did not attend the April 29, 2021 pre-hearing conference.

35. The pre-hearing was adjourned after the other participants waited approximately 45 minutes for the Member to appear via Zoom videoconference. Co-counsel called and emailed the Member during this time to assess whether she was having technical difficulties.

36. The Member did not respond and did not provide an explanation for her absence.

37. CNO counsel proposed, and the conference Chair agreed, that dates for a second pre-hearing could be circulated to the parties in a good faith attempt to resolve the matter.

Failure to Attend Pre-hearing Conference, June 25, 2021

38. Co-counsel made numerous attempts following the first pre-hearing conference to involve the Member in the process. Co-counsel also spent considerable time restating what was expected of the Member at the pre-hearing conference. The Member indicated that she understood that her attendance was necessary.

39. The Member agreed to schedule a second pre-hearing conference.

40. A second pre-hearing was scheduled via Zoom videoconference for 10:00 AM on June 25, 2021.

41. Once again, the Member did not attend.

42. After waiting approximately 20 minutes, the participants respectfully requested that the Chair adjourn the pre-hearing. The Chair exited the pre-hearing conference, while CNO counsel and the CNO Prosecutions Associate remained in the virtual conference space for another 45 minutes in case the Member logged in. The Member did not join the conference.

43. At 2:10 PM on June 25, 2021, the Member sent an email to the co-counsel, stating that she was at her cottage that day and did not have internet access.

44. On June 29, 2021, the Member emailed co-counsel, explaining that she did not wish to practise nursing anymore. Rather, she intended to return to school and pursue a different career. The Member also stated that she still wanted to take responsibility for her actions and cooperate with CNO.

45. CNO did not propose a third pre-hearing conference.

46. Instead, CNO commenced negotiations with the Member to arrive at a joint settlement on the allegations of professional misconduct in NOH #1 and NOH #2.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Hotel Dieu – Incidents Involving Inappropriate Narcotics Access and Documentation

47. In May 2016, a patient on the rehabilitation unit where the Member worked complained he had not received any pain medication, although facility records indicated that the Member had dispensed pain medication for the patient from the facility’s automated medication administration system (the “AcuDose”). About the same time, the Member’s Manager, [ ], noted that the Member began changing shifts and was preferentially working night shifts. She was also aware of other inconsistencies in the Member’s narcotic dispensing, administration and documentation. However, before the facility could investigate these issues, the Member went on an extended six-month sick leave, returning to work in January 2017.

48. In May 2017, as a result of concerns regarding the Member and her administration and documentation of narcotics, [the Member’s Manager] asked the Chief of Pharmacy to conduct a review of the Member’s narcotic use. The Chief of Pharmacy noted a significant increase in narcotic use on the unit where the Member worked after she returned to work in January 2017. The Chief of Pharmacy also found that, when the Member was on sick leave in 2016, narcotic use on the rehabilitation unit where she worked had dropped dramatically.

49. On May 4, 2017, a meeting was held with the Member regarding concerns that she may have been diverting narcotics. The Member denied diverting narcotics, and she was put on an administrative leave while the investigation was conducted.

50. Hotel Dieu management met with the Member on May 12, 2017 to review the results of its internal investigation. The focus of the investigation was analyzing patterns of the Member’s narcotic use in comparison to other nurses.

51. The Member’s explanation for her high amount of narcotic use was that she was medicating other nurses’ patients. However, when the other nurses in the rehabilitation unit were interviewed by the facility, all but two nurses denied that the Member had medicated their patients, or that they requested her to administer narcotics for their patients.

52. The Member was placed on a second administrative leave.

53. According to the results of the investigation, the Member had accessed a large number of narcotics from the AcuDose. For example, she withdrew 738 narcotics in one month, although she was working on a part-time basis. On average, nurses who worked in the same unit on a full-time basis dispensed an average of 63 narcotics in the same month. As well, the Member had wasted more narcotics than any other nurse in the facility. She had not documented administering narcotics she had withdrawn from the AcuDose 80% of the time. The Member had logged into the AcuDose to access narcotics in a unit she did not work on in order to dispense narcotics for patients who were not assigned to her. She had also logged onto the AcuDose prior to the start of her shift and accessed narcotics for many patients in rapid succession.

54. Hotel Dieu identified specific instances where the Member had withdrawn Percocet or Oxycodone from the AcuDose and either failed to document administering the medication to a patient or inadequately documented the administration.

55. These incidents formed the basis of the allegations of professional misconduct that were referred to the Discipline Committee by the ICRC on January 23, 2020 (NOH #1) and involve the patients identified in paragraphs 56-71 below.

[Patient A]

56. [Patient A] was a 73-year-old man who had a left below-knee amputation on January 15, 2017.

57. [Patient A] was ordered Oxycodone IR 5 – 10 mg q4h prn on February 7, 2017. He had not required Oxycodone since mid-March. Yet, according to the AcuDose Reports and the MAR, the Member removed Oxycodone from the AcuDose in April 2017 as follows, claiming that it was for [Patient A]:

• April 5, 2017: 2 occasions, not documented in the MAR
• April 6, 2017: 2 occasions, not documented in the MAR
• April 9, 2017: 2 occasions, the Member was not assigned to the patient, not documented in the MAR
• April 10, 2017: 3 occasions, not documented in the MAR
• April 13, 2017: 2 occasions, one dose documented in the MAR
• April 14, 2017: 1 occasion, documented in the MAR
• April 15, 2017: 2 occasions, not documented on the MAR
• April 16, 2017: 1 occasion, not documented in the MAR
• April 17, 2017: 1 occasion, not documented in the MAR
• April 21, 2017: 1 occasion, not documented in the MAR
• April 22, 2017: 1 occasion, documented in the MAR
• April 23, 2017: 1 occasion, documented in the MAR
• April 26, 2017: 1 occasion, documented in the MAR
• April 27, 2017: 2 occasions, not documented on the MAR
• April 28, 2017: 1 occasion, not documented in the MAR
• April 29, 2017: 2 occasions, not documented in the MAR
• May 1, 2017: 2 occasions, not documented in the MAR
• May 2, 2017: 2 occasions, 1 dose documented in the MAR
• May 3, 2017: 2 occasions, 1 dose documented on the MAR.

58. The only nurse who accessed Oxycodone for [Patient A] in April 2017 was the Member.

59. There is no documentation in the flow sheets or Interprofessional Progress Records to indicate [Patient A] was in pain such that Oxycodone was required through a physician’s order or that he was administered Oxycodone on any of these dates.

60. [The Member’s Manager] interviewed [Patient A], who was cognitively aware, as part of the facility’s internal investigation. [Patient A] denied receiving any pain medication in April 2017. He said the only time he received pain medication was the day he was admitted to the rehabilitation unit from acute care in March 2017. This was corroborated by contemporaneous documentation in the flow sheets and Interprofessional Progress Records.

[Patient B]

61. [Patient B] was a 63-year-old woman who had a total left hip replacement on March 20, 2017.

62. Starting on March 24, 2017, [Patient B] had an order for Oxycodone 10 mg CR q12 hours. There was also an order for Oxycodone 5 IR q4h prn for breakthrough pain.

63. According to the AcuDose Reports and the MAR, the Member removed Oxycodone from the AcuDose as follows, claiming that it was for [Patient B], but her AcuDose access and MAR documentation do not align:

• April 5, 2017: 2 occasions, not documented in the MAR
• April 7, 2017: 1 occasion, not documented in the MAR
• April 9, 2017: 2 occasions, not documented in the MAR
• April 10, 2017: 2 occasions, 1 dose documented in the MAR
• April 13, 2017: 2 occasions, 1 dose documented in the MAR
• April 15, 2017: 1 occasion, not documented on the MAR
• April 23, 2017: 1 occasion, documented in the MAR
• April 26, 2017: 1 occasion, documented in the MAR
• April 27, 2017: 1 occasion, documented on the MAR
• April 28, 2017: 2 occasions, not documented in the MAR
• April 29, 2017: 1 occasion, not documented in the MAR
• May 1, 2017: 1 occasion, not documented in the MAR
• May 2, 2017: 2 occasions, not documented in the MAR
• May 3, 2017: 1 occasion, not documented on the MAR.

64. There is no documentation in the flow sheets or Interprofessional Progress Records to indicate [Patient B] was in pain or required medication for breakthrough pain on those dates to support the AcuDose withdrawal frequency.

[Patient C]

65. [Patient C] was an 84-year-old man who fractured his right hip on March 22, 2017 and had surgery on it the same day.

66. He was ordered Percocet 1 – 2 tabs q 4-6 prn on March 29, 2017.

67. According to the AcuDose Reports and the MARs, the Member had 35 narcotic transactions of Percocet for [Patient C] between April 1, 2017 and April 30, 2017, yet only 8 were documented in the MAR.

[Patient D]

68. [Patient D] was a 78-year-old man who had an open reduction and internal fixation of a left hip fracture on March 10, 2017.

69. [Patient D] was ordered Oxycodone IR 5-10 mg q4h prn for breakthrough pain.

70. According to the AcuDose Reports and the MAR, the Member removed Oxycodone from the AcuDose as follows, claiming it was for [Patient D]:

• April 6, 2017: 2 occasions, documented in the MAR
• April 7, 2017: 2 occasions, 1 documented in the MAR
• April 9, 2017: 2 occasions, 1 documented in the MAR
• April 13, 2017: 2 occasions, 1 dose documented in the MAR
• April 14, 2017: 2 occasions, 1 dose documented in the MAR
• April 15, 2017: 1 occasion, documented in the MAR
• April 21, 2017: 1 occasion, documented in the MAR
• April 22, 2017: 2 occasions, 1 dose documented in the MAR
• April 23, 2017: 2 occasions, not documented in the MAR
• April 26, 2017: 1 occasion, not documented in the MAR
• April 27, 2017: 2 occasions, 1 dose documented in the MAR
• April 28, 2017: 2 occasions, documented in the MAR
• April 29, 2017: 2 occasions, 1 dose documented in the MAR
• May 1, 2017: 2 occasions, not documented in the MAR
• May 2, 2017: 2 occasions, not documented in the MAR.

71. There is no documentation in the flow sheets or Interprofessional Progress Records to indicate [Patient D] was in pain or required medication for breakthrough pain on those dates.

72. If the Member were to testify, she would state that she misappropriated narcotics intended for the patients identified in paragraphs 56-71 above, for her own use. At the time, she was suffering a substance use disorder.

Hotel Dieu – Incidents Involving Member’s Shift Attendance

73. The Member was scheduled to work on the day shift of July 4, 2017. Facility management scheduled a meeting with her at 8:15 AM, which she attended in her scrubs. Following the meeting, the Member did not return to her unit for her scheduled shift. When the facility became aware the Member was not on her unit, [the Member’s Manager] and other members of management searched for her in the facility and attempted to contact her by telephone or email, with no success. As a result of the Member not attending work on July 4, 2017 and leaving the facility with no notice, she was issued a 3-day suspension.

74. The Member was booked for shifts on July 28, 29 and 30, 2017. She did not attend at work for the shifts and gave no notice she would not be working the scheduled shifts. Hotel Dieu management was unable to contact her by telephone or email during that period.

75. As a result of the Member’s failure to attend at work for scheduled shifts without any notice, and her failure to respond to communications from Hotel Dieu, the Member’s employment was terminated.

Greater Niagara General

76. On April 13, 2017, Greater Niagara General Pharmacy Manager [ ] received a write-up from a nurse indicating she had discovered 16 Percocet were missing from the AcuDose on the Inpatient Surgical Unit on April 12, 2017. [The Pharmacy Manager] investigated the write up by attending at the Unit and examining the AcuDose pocket where Percocet was located. He noted that several of the unit dose bags containing Percocet had been sliced open and that Percocet was missing from 4 of the bags.

77. When [the Pharmacy Manager] reviewed the AcuDose reports for Percocet, he noted a number of anomalies in the report for April 11, 2017, all of which involved the Member accessing Percocet on an unusually frequent basis for [Patient H], as expanded below.

78. The Member was the only person who used the AcuDose on April 11, 2017 over a 7-hour period to access Percocet. She had opened the Percocet pocket several times during this period. On some occasions, she had opened the pocket and did not document taking out any Percocet. On one occasion, the number of Percocet recorded in the pocket increased after she had accessed the pocket. It was unclear to [the Pharmacy Manager] what the Member actually did after accessing the AcuDose, and how many Percocet tablets were actually missing.

79. Following his review of records, [the Pharmacy Manager] sent an email to [ ], the Member’s Manager, who reviewed the documentation. A meeting between the Member and management was held in which the Member denied cutting the Percocet bags in the AcuDose. The Member offered no explanation for why she had not documented administering Percocet in patients’ MAR.

80. In the normal course, there would have been another meeting with the Member. However, [the Member’s Manager] was unable to contact the Member via telephone or email, and the Member never returned any of [the Manager’s] calls or correspondence. The Member did not book any further shifts at Greater Niagara General and her employment was eventually terminated in 2019.

81. [The Pharmacy Manager] then looked at the health care records for 4 patients for whom the Member had withdrawn narcotics from the AcuDose. His findings regarding the 4 patients are the basis for the specified allegations set out in the ICRC decision dated January 23, 2020 (NOH #2) and involve the patients identified in paragraphs 82-100 below.

[Patient G]

82. [Patient G] was ordered Percocet, 1-2 tabs q 4-6 prn on March 29, 2017.

83. [Patient G] was not administered this medication on March 29, March 30, April 1 or April 2, 2017.

84. According to an AcuDose Report, the Member withdrew 2 Percocet tablets from the AcuDose for [Patient G] on April 3, 2017 at 8:10 AM and again at 4:21 PM.

85. There is a handwritten note on the MAR for April 3, 2017 beside the Percocet order which reads, “confusion with this”, which was written by RN [ ].

86. There is no documentation in the MAR to indicate the Member administered Percocet to [Patient G] or that [Patient G] ever received the Percocet, as ordered.

[Patient E]

87. [Patient E] was ordered Percocet, 1-2 tabs q 4-6 prn on April 1, 2017.

88. [Patient E] was not administered this medication on April 1 or 2, 2017.

89. According to an AcuDose Report, the Member withdrew 2 Percocet tablets from the AcuDose for [Patient E] on April 3, 2017.

90. There is a note in the Interdisciplinary Clinical Notes on April 3, 2017 signed by the Member, “Pain sedation given for pain, in affected leg with good effect.” There is no indication in the note regarding what pain medication was given, how much was given, when it was given, and the pain score before and after the medication administration.

91. There is also no documentation in the MAR to indicate the Member administered Percocet to [Patient E] or that [Patient E] ever received the Percocet, as ordered.

[Patient F]

92. [Patient F] was ordered Percocet, 1-2 tabs q 4-6 prn on March 30, 2017. He was not administered this medication on March 30, April 1 or April 2, 2017.

93. According to an AcuDose Report, the Member withdrew 2 Percocet tablets from the AcuDose for [Patient F] on April 3, 2017.

94. There is a note in the Interdisciplinary Clinical Notes at 6:00 PM, “Pain sedation given with good effect. Pt. confused.” There is no indication in the note regarding what pain medication was given, how much was given, when it was given, the pain score before and after the medication administration, and whether the medication was related to [Patient F’s] confusion.

95. There is also no documentation in the MAR to indicate the Member administered Percocet to [Patient F] or that [Patient F] ever received the Percocet, as ordered.

[Patient H]

96. On April 11, 2017, the Member accessed the AcuDose at 7:19 AM and documented withdrawing 2 tabs of Percocet for [Patient H]. Percocet had been ordered for the patient.

97. The Member then accessed the Percocet envelope in the AcuDose on 6 occasions between 1:06 PM and 2:11 PM. At the end of that period, she documented there was one less Percocet tab in the AcuDose than at the start of the shift.

98. There is a note in the Interdisciplinary Clinic Notes at 4:00 PM on April 11, 2017:

Pt lethargic all shift & no narcotics given by night shift or writer this shift. Writer concerned & spoke with chart nurse r/t lethargy and needs for B/W. Writer pulled up pt profile on acudose & read that @719 Katie Kruger dispensed ii tabs percocets - & did not approach writer regarding need to administer narcotics to pt + no documentation on MARS. Writer telephoned K. Kruger RPN and asked if narcotics were administered to pt. & K. Kruger RPN stated “He rang his bell after 0700 + asked for pain meds + administered narcotics @ 0720 to pt. [Note: The Member referred to herself as “Katie Kruger” at work].

99. There is a note in [Patient H’s] MAR for April 11, 2017:

LD 2010 9/4/17

ii given by Katie K @ 0720

Please do not give pt becomes very lethargic.

100. The Member did not document administering any Percocet to [Patient H] on April 11, 2017.

101. If the Member were to testify, she would state that she misappropriated narcotics intended for the patients identified in paragraphs 82-100 above, for her own use. At the time, she was suffering a substance use disorder.

The VON

102. On January 10, 2020, the Member was hired on a part-time basis by the VON as an RPN to provide care to a child at school.

103. The Member received orientation from the VON during the period January 13 - 17, 2020.

104. On January 22, 2020, the Member signed an Agreement and Authorization acknowledging that she would receive, and be required to use, a VON handheld device (“HHD”) (i.e., a cell phone and accessories) when working, and that she was responsible for returning the HHD in good condition to the VON forthwith if her employment was terminated.

105. On January 27, 2020, the VON provided the Member with her HHD - a Samsung Galaxy Note8 cell phone, charger, headphones and cell phone case. The retail value of these items exceeded $1,000.00.

106. The Member was scheduled to work orientation shifts on February 3, 4 and 5, 2020, during which she would shadow another nurse. However, the Member did not attend work on those days and did not contact the VON to indicate she would not be attending. The VON was unable to contact her by telephone or by email and the Member did not return any VON emails or voicemails.

107. On February 5, 2020, the Member called the VON and asked about her pay. At first, the Member indicated she had not attended work because she was moving. Later in the conversation, the Member said she had not attended work because she had no one to look after her children. Still later in the conversation, she said that the role she was offered was not what she expected. The VON asked the Member to let it know if she wanted to work for the VON. However, she did not get back to the VON, and on February 6, 2020, the VON terminated her employment.

108. In accordance with the January 22, 2020 Agreement and Authorization, the Member was required to return the HHD.

109. The Member did not return the HHD and accessories to the VON.

110. The VON attempted to recover the HHD. However, the home address the Member had provided to the VON was for a house that was gutted and uninhabitable. The VON then tried to locate the HHD as it had a built-in tracking system. The HHD was ultimately located but the phone had been deactivated.

111. The VON was unable to contact the Member about the HHD as its letters were returned to the VON, unclaimed, and the Member did not respond to any of its phone and email communications.

112. The incidents at VON formed the basis of the allegations of professional misconduct that were referred to the Discipline Committee by the ICRC on January 21, 2021 (NOH #2).

STANDARDS OF PRACTICE

113. CNO publishes nursing standards to set out the expectations for the practice of nursing. CNO’s published standards inform nurses of their accountabilities and apply to all nurses regardless of their role, job description or area of practice.

Ethics

114. The Ethics practice standard sets out the ethical values relating to nursing care, including, amongst other things, client well-being, maintaining commitments and truthfulness. Nurses are expected to uphold the standards of practice and to conduct themselves in a manner that reflects well on the profession in order to maintain the respect and trust of the public.

Code of Conduct

115. In January 2019, CNO introduced the Code of Conduct practice standard. Since the professional misconduct identified in NOH #2 is from January-February 2020, this practice standard applies to that misconduct.

116. The Code of Conduct articulates what Ontarians can expect of nurses in all practice settings and emphasizes the importance of a patient-centred care model wherein nurses respect the dignity of patients; promote patient well-being; maintain patients’ trust by providing safe and competent care; work with colleagues to best meet patients’ needs; act with integrity to maintain patients’ trust; and, maintain public confidence in the nursing profession.

117. As valued members of the healthcare team, nurses are expected to meet this practice standard by:

• advocating for patients and helping them access appropriate health care;
• seeking advice and collaborating with the health care team to uphold safe patient care;
• maintaining complete, accurate and timely documentation;
• respecting the property of their patients and employers;
• taking accountability for their own actions and decisions, without jeopardizing patient safety and the quality of care; and
• ceasing to practise when impaired and maintaining overall health and fitness if they believe their health affects their ability to practise [safely].

Documentation

118. CNO’s Documentation practice standard states that nursing documentation is an important component of nursing practice. Documentation — whether paper, electronic, audio or visual — is used to monitor a patient’s progress and communicate with other care providers. It also reflects the quality of nursing care that is provided to a patient.

119. A nurse meets the standard by “ensuring their documentation of [patient] care is accurate, timely and complete.”

Medication

120. CNO’s Medication practice standard requires nurses to “prepare and administer medication(s) to [patients] in a safe, effective and ethical manner.”

121. The Medication practice standard goes on to define a medication error as, “any preventable event that may cause or lead to inappropriate medication use or [patient] harm while the medication is in the control of the health care professional, [patient] or consumer.” It sets out the expectation that nurses will report all medication errors and near misses using formal practice-setting communication mechanisms.

Professional Standards

122. CNO’s Professional Standards provides that a nurse demonstrates leadership by providing, facilitating and promoting the best possible care/service to the public. A nurse demonstrates this practice standard by actions such as role-modelling professional values, beliefs and attributes.

123. CNO’s Professional Standards further provides that ethical nursing care means promoting the values of patient well-being, respecting patient choice, assuring privacy and confidentiality, respecting the sanctity and quality of life, maintaining commitments, respecting truthfulness and ensuring fairness in the use of resources. It also includes acting with integrity, honesty and professionalism in all dealings with the patient and other health care team members.

124. In addition, CNO’s Professional Standards provides that a nurse demonstrates leadership by providing, facilitating and promoting the best possible care/service to the public. A nurse demonstrates this standard by actions such as role-modelling professional values, beliefs and attributes.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

125. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 1-6 of NOH #1 and paragraphs 1-3 of NOH #2.

NOH #1 Admissions

126. The Member admits that she contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, as alleged in paragraph 1 of NOH #1 and described in paragraphs 47-100 above.

127. The Member admits that she discontinued professional services that were needed without arranging for alternative or replacement services, as alleged in paragraph 2 of Notice of NOH #1 and described in paragraphs 73-75 above.

128. The Member admits that she misappropriated property from a workplace, as alleged in paragraph 3 of NOH #1, and described in paragraphs 47-72 and 76-101 above.

129. The Member admits that she failed to keep records as required, as alleged in paragraph 4 of NOH #1 and described in paragraphs 47-72 and 76-101 above.

130. The Member admits that she falsified a record relating to her practice, as alleged in paragraph 5 of NOH #1 and described in paragraphs 47-72 and 76-101 above.

131. The Member admits that she 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 dishonourable and unprofessional, as alleged in paragraph 6 of NOH #1 and described in paragraphs 47-101 above.

NOH #2 Admissions

132. The Member admits that she contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, as alleged in paragraph 1 of NOH #2 and described in paragraphs 102-111 above.

133. The Member admits that she misappropriated property from a workplace, as alleged in paragraph 2 of NOH #2 and described in paragraphs 102-111 above.

134. The Member admits that she 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 dishonourable and unprofessional, as alleged in paragraph 3 of NOH #2 and described in paragraphs 102-111 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(a)(i), (ii), (iii), (b)(i), (ii), (iii), (c), 2, 3(a), (b), 4(a), (b), 5(a), (b), 6(a)(i), (ii), (iii), (b)(i), (ii), (iii) and (c) of the Notice of Hearing 1. As to allegations #6(a)(i), (ii), (iii), (b)(i), (ii), (iii) and (c), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be dishonourable and unprofessional.

Furthermore, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1(a), (b), 2, 3(a) and (b) of the Notice of Hearing 2. As to allegations #3(a) and (b), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be dishonourable and unprofessional.

Reasons for Decision

The Panel considered the Agreed Statement of Facts and the Member’s plea and finds that this evidence supports findings of professional misconduct as alleged in the Notice of Hearing 1 and the Notice of Hearing 2.

Re: Notice of Hearing 1

Allegations #1(a)(i), (ii) and (iii) in the Notice of Hearing 1 are supported by paragraphs 47-81, 114, 118-124 and 126 in the Agreed Statement of Facts. While employed at Hotel Dieu Shaver Health and Rehabilitation Centre (“Hotel Dieu”) in St. Catharines, Ontario, the Member misappropriated Percocet and/or Oxycodone tablets intended for the Patients listed in Table A to the Notice of Hearing; falsified records regarding Percocet and/or Oxycodone tablets attributed to the Patients listed in Table A; and/or failed to document administering Percocet and/or Oxycodone tablets administered to the Patients listed in Table A. The Panel finds the Member’s conduct was a breach of the Documentation Standards, Ethics Standard, Medication Standards and Professional Standards.

Allegations #1(b)(i), (ii) and (iii) in the Notice of Hearing 1 are supported by paragraphs 82-100, 114, 118-124 and 126 in the Agreed Statement of Facts. While employed at Greater Niagara General Hospital (“Greater Niagara”) in St. Catharines, Ontario, the Member misappropriated Percocet tablets intended for the Patients listed in Table B; falsified records regarding Percocet tablets attributed to the Patients listed in Table B; and/or failed to document administering Percocet tablets to the Patients listed in Table B. In doing so, the Member breached the Documentation Standards, Ethics Standard, Medication Standards and Professional Standards.

Allegation #1(c) in the Notice of Hearing 1 is supported by paragraphs 73-75, 114, 122-124 and 126 in the Agreed Statement of Facts. While employed at Hotel Dieu, the Member failed to attend scheduled shifts or notify Hotel Dieu that she could not attend scheduled shifts. The Panel finds these actions to be breaches of the Ethics Standard and Professional Standards.

Allegation #2 in the Notice of Hearing 1 is supported by paragraphs 73-75 and 127 in the Agreed Statement of Facts. While employed at Hotel Dieu, the Member discontinued professional services that were needed, which was not permitted unless: i. the client requested the discontinuation, ii. alternative replacement services were arranged, or iii. the client was given a reasonable opportunity to arrange alternative or replacement services, with respect to failing to attend scheduled shifts or to notify Hotel Dieu that she could not attend scheduled shifts. The Member did not do any of these and, as a result, failed to meet the necessary requirements for discontinuing professional services.

Allegation #3(a) in the Notice of Hearing 1 is supported by paragraphs 47-72 and 128 in the Agreed Statement of Facts. While employed at Hotel Dieu, the Member misappropriated Percocet and/or Oxycodone tablets intended for the Patients listed in Table A.

Allegation #3(b) in the Notice of Hearing 1 is supported by paragraphs 76-101 and 128 in the Agreed Statement of Facts. While employed at Greater Niagara, the Member misappropriated Percocet tablets intended for the Patients listed in Table B.

Allegation #4(a) in the Notice of Hearing 1 is supported by paragraphs 56-72 and 129 in the Agreed Statement of Facts. While employed at Hotel Dieu, the Member failed to document administering Percocet and/or Oxycodone tablets administered to the Patients listed in Table A.

Allegation #4(b) in the Notice of Hearing 1 is supported by paragraphs 76-101 and 129 in the Agreed Statement of Facts. While employed at Greater Niagara, the Member failed to document administering Percocet tablets to the Patients listed in Table B.

Allegation #5(a) in the Notice of Hearing 1 is supported by paragraphs 47-72 and 130 in the Agreed Statement of Facts. While employed at Hotel Dieu, the Member falsified records regarding Percocet and/or Oxycodone tablets attributed to the Patients listed in Table A.

Allegation #5(b) in the Notice of Hearing 1 is supported by paragraphs 76-101 and 130 in the Agreed Statement of Facts. While employed at Greater Niagara, the Member falsified records regarding Percocet tablets attributed to the Patients listed in Table B.

Allegations #6(a)(i), (ii), (iii), (b)(i),(ii), (iii) and (c) in the Notice of Hearing 1 are supported by paragraphs 47-101, 114, 118-124 and 126-131 of the Agreed Statement of Facts. The Panel finds that the Member’s conduct in misappropriating medication intended for patients, falsifying records regarding medication attributed to patients, failing to document administering medication, and failing to attend scheduled shifts or to notify that she could not attend scheduled shifts, 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. The Member’s misappropriation of medication intended for patients demonstrated an element of moral failing. In addition, the Member falsified records regarding medication attributed to patients, and/or failed to document administering medication administered to patients, and failed to attend scheduled shifts or notify that she could not attend. The Member’s actions contained elements of dishonesty and deceit. The Member knew or ought to have known that her conduct was unacceptable and fell well below the standards of a professional.

Re: Notice of Hearing 2

Allegation #1(a) in the Notice of Hearing 2 is supported by paragraphs 106-107, 114, 116-117 and 132 in the Agreed Statement of Facts. While employed at Victorian Order of Nurses (“VON”) Niagara Branch in St. Catharines, Ontario, the Member failed to attend at VON for scheduled orientation shifts, and/or failed to provide an adequate reason for not doing so. The Panel finds that by failing to do so, the Member breached the Ethics Standard and the Code of Conduct.

Allegation #1(b) in the Notice of Hearing 2 is supported by paragraphs 10, 102, 104, 105, 107-111, 114, 116, 117 and 132 in the Agreed Statement of Facts. While employed at VON, the Member failed to return to the VON property assigned to her for use as a VON nurse, including a Samsung Galaxy Note8 cell phone, charger, headphones and phone case, when her employment was terminated by VON. This conduct was a breach of the Ethics Standard and the Code of Conduct.

Allegation #2 in the Notice of Hearing 2 is supported by paragraphs 10, 102, 104, 105, 107-111 and 133 in the Agreed Statement of Facts. While employed at VON, the Member misappropriated property from a client or work place in that the Member failed to return to the VON property assigned to her for use as a VON nurse, including a Samsung Galaxy Note8 cell phone, charger, headphones and phone case, when her employment was terminated by VON.

Allegation #3(a) in the Notice of Hearing 2 is supported by paragraphs 102, 103, 106, 107 and 134 in the Agreed Statement of Facts. Allegation #3(b) in the Notice of Hearing 2 is supported by paragraphs 102, 104, 105 and 107-111 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in failing to attend at VON for scheduled orientation shifts, and/or failing to provide an adequate reason for not doing so, 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. Failing to return property assigned to her for use as a VON nurse demonstrated an element of moral failing. The Member knew or ought to have known that her conduct was unacceptable and fell well below the standards of a professional.

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:

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

Penalty Submissions

Submissions were made by College Counsel.

College Counsel submitted that the Joint Submission on Order also provides in Appendix “A”, an Undertaking by the Member to resign permanently as a member of the College and not apply for membership as a Registered Nurse or a Registered Practical Nurse at any time in the future.

College Counsel submitted that the Member has admitted to all allegations in NOH #1 and NOH #2 and the Panel has made findings of professional misconduct. The public interest is fully protected by her resignation, and it is consistent with the Member’s wish. Because the Member has undertaken to resign, there is no need for other terms, limitations or remedial measures. College Counsel submitted that it is a suitable and reasonable disposition of the case.

College Counsel submitted a similar case to the Panel that also involved a voluntary undertaking to resign to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee.

CNO v. Demme (Discipline Committee, 2020). This case was similar in that it involved misappropriating narcotics and items from a workplace. There was a finding of guilt on criminal charges from those actions. The member acknowledged suffering from a substance use disorder, and voluntarily resigned.

College Counsel submitted that there is the same rationale for the Panel to accept the Joint Submission on Order in this case. Alongside the Undertaking, the Joint Submission on Order is a reasonable disposition that is consistent with the Member’s wishes and fully protects the public.

The Member did not make any submissions.

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.

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 and public protection. Specific deterrence is met through the reprimand. General deterrence is achieved by sending a clear message to the membership that this type of conduct will not be tolerated. In light of the Member’s resignation, the goals of remediation and rehabilitation are not necessary. The ultimate goal to protect the public is achieved through the Member’s Undertaking to permanently resign.

The public portion of the College [Register] will reflect the Undertaking and the College may, if necessary, provide a copy of the Undertaking and its terms to another governing body that regulates nursing in Canada or elsewhere, should the Member attempt to pursue registration in another jurisdiction.

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

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