College of Nurses of Ontario v. Dela Cruz, 2021 ONCNO 153188

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Tanya Dion, RN Chairperson Sylvia Douglas Public Member Lalitha Poonasamy Public Member Sherry Szucsko-Bedard, RN Member Terah White, RPN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) ALYSHA SHORE for ) College of Nurses of Ontario

• and - )

MA LUISA DELA CRUZ ) NO REPRESENTATION for Registration No. AF154947 ) Ma Luisa Dela Cruz

) CHRISTOPHER WIRTH ) Independent Legal Counsel

) Heard: August 9, 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 9, 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 the publication or broadcasting of the name of the patient, or any information that could disclose the identity of the patient, referred to orally or in any documents presented in the Discipline hearing of Ma Luisa Dela Cruz.

The Panel considered the submissions of College Counsel and the Member and decided that there be an order preventing public disclosure and banning the publication or broadcasting of the name of the patient, or any information that could disclose the identity of the patient, referred to orally or in any documents presented in the Discipline hearing of Ma Luisa Dela Cruz.

The Allegations

The allegations against Ma Luisa Dela Cruz (the “Member”) as stated in the Notice of Hearing dated May 6, 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 (the “Act”), and defined in subsection 1(1) of Ontario Regulation 799/93, in that, while a Registered Practical Nurse employed by Staff Relief Health Care Services in Richmond Hill, Ontario (the “Agency”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession with respect to [the Patient] when you:

a) failed to maintain the therapeutic boundaries of the nurse-patient relationship;

b) received a cheque in the amount of $3,029.16 from the patient in or around August 3, 2018, when the cheque should have been in the amount of approximately $329, and subsequently cashed the cheque; and/or

c) received a cheque in the amount of $2,007.95 in or around September 21, 2018, when the cheque should have been in the amount of approximately $207, and subsequently cashed the cheque;

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Act, and defined in subsection 1(7) of Ontario Regulation 799/93, in that while you were employed as a Registered Practical Nurse by the Agency, you abused [the Patient] verbally, physically, and/or emotionally when you:

a) received a cheque in the amount of $3,029.16 from the patient in or around August 3, 2018, when the cheque should have been in the amount of approximately $329, and subsequently cashed the cheque; and/or

b) received a cheque in the amount of $2,007.95 in or around September 21, 2018, when the cheque should have been in the amount of approximately $207, and subsequently cashed the cheque;

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Act, and defined in subsection 1(8) of Ontario Regulation 799/93, in that, while a Registered Practical Nurse by the Agency you misappropriated property from the [Patient] when you:

a) received a cheque in the amount of $3,029.16 from the patient in or around August 3, 2018, when the cheque should have been in the amount of approximately $329, and subsequently cashed the cheque; and/or

b) received a cheque in the amount of $2,007.95 in or around September 21, 2018, when the cheque should have been in the amount of approximately $207, and subsequently cashed the cheque; and/or

4. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Act, and defined in subsection 1(37) of Ontario Regulation 799/93, in that, while a Registered Practical Nurse employed by the Agency, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional with respect to [the Patient] when you:

a) failed to maintain the therapeutic boundaries of the nurse-patient relationship;

b) received a cheque in the amount of $3,029.16 from the patient in or around August 3, 2018, when the cheque should have been in the amount of approximately $329, and subsequently cashed the cheque; and/or

c) received a cheque in the amount of $2,007.95 in or around September 21, 2018, when the cheque should have been in the amount of approximately $207, and subsequently cashed the cheque.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1(a), 1(b), 1(c), 2(a), 2(b), 3(a), 3(b), 4(a), 4(b) and 4(c) in the Notice of Hearing. The Panel received a written plea inquiry which was signed by the Member. The Panel also conducted an oral plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Since the written Plea Inquiry, Agreed Statement of Facts, and Joint Submission on Order did not have a witness for the Member’s signature on them, the Panel requested a verbal confirmation from the Member that the signatures on these documents were hers. The Member confirmed that the signatures on these documents were hers.

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 reads, unedited, as follows:

THE MEMBER

1. Ma Luisa Dela Cruz (the “Member”) obtained a degree in nursing from Our Lady of Fatima University in 2007.

2. The Member registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse on May 6, 2016. The Member was administratively suspended from February 19, 2020 until her certificate of registration expired on April 17, 2020.

3. At the relevant time, the Member was employed by Staff Relief Health Care Services in Richmond Hill, Ontario (“the Agency”). The Member worked for the Agency from March 8, 2018 to June 24, 2019. Following the incidents described below, the Member was suspended without pay and her employment with the Agency was subsequently terminated.

THE PATIENT

4. (the “Patient”) was a senior living in a retirement home. The Patient’s retirement home provided nursing care, but it was not one-on-one.

5. The Patient suffered from some short-term memory loss and discomfort from hip replacement surgery which took place in March 2018.

6. As a result of her hip surgery, the Patient decided to retain private nursing care. The Patient contacted the Agency and entered into a contract for nursing services on a full-time basis from March 2018 onward.

7. The Patient passed away in November 2019.

THE AGENCY

8. The Member was hired by the Agency to provide care to the Patient on a full-time basis, covering four shifts per week. The shifts were from 9:00 a.m. to 9:00 p.m. The Patient also had three other nurses who provided care to her on the other days of the week.

9. In her role, the Member assisted the Patient with medication and daily tasks such as dressing, grooming, ambulation, toileting, laundry and tidying. Grocery shopping was not part of the Patient’s care plan.

10. The Patient paid the Agency directly for the nursing services. The Agency has a policy that prohibits staff from receiving gratuities, gifts or money from patients for any purpose. Employees of the Agency are also not permitted to establish financial relationships with patients and/or patient families. The Member signed the acknowledgment regarding policies, including the Acceptance of Gratuities Policy on March 12, 2018.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

11. On December 13, 2018, a friend of the Patient advised the Agency that the Patient had written a cheque in a large amount made out to the Member. The Patient’s friend managed the Patient’s financial affairs and came across the cheque during the course of her regular review.

12. The cheque was dated August 3, 2018 and was in the amount of $3,029.16. When the Patient’s friend asked the Patient the purpose of the cheque, the Patient was not certain. The Patient’s friend and the Patient contacted the Patient’s bank, who informed them that the Patient had signed the cheque and it was made out to the Member. The bank confirmed that the cheque was deposited to an account owned by the Member on August 3, 2018. When the Patient’s friend questioned the Patient further about why she would write the cheque, the Patient explained that the Member would buy groceries for her and she would pay her back. The Patient’s friend assumed the amount on the cheque was simply an error. The cheque should have been in the amount of approximately $329.00.

13. On December 14, 2018, Agency staff spoke to the Patient about the matter and discovered that the Patient had asked the Member to purchase groceries for her in or around August 2018. The Member purchased the groceries, delivered them to the Patient and asked the Patient for the money back. The Patient then wrote a cheque in the Member’s name.

14. Agency staff also met with the Member on December 14, 2018 to discuss the matter. When they raised the cheque with the Member, the Member advised that she did not remember taking a cheque and cashing it in the amount of $3,029.16. At this meeting, the Member was shown a copy of the cheque made out in her name and proof that it was deposited into her bank account. The Member still denied taking the cheque and stated that she did not recall doing that. Agency staff requested that the Member return the money, in the amount of $2,700.00. Agency staff also asked the Member questions such as when the Patient asked her to purchase groceries, what kind of groceries she bought, and how often. The Member refused to answer any of the questions and advised that she needed to get a lawyer. The Member then left the meeting.

15. Agency staff were surprised the grocery bill was so high as the Patient was unlikely to need $329.00 worth of groceries since she lives in a retirement home where she receives three meals plus snacks a day. They were also concerned that the Member was providing private services to the Patient without seeking approval from her supervisor. The Member was prohibited from receiving money from patients for any duties performed. Had the Member advised her supervisor that the Patient had requested grocery service, the Agency would have made arrangements with head office to purchase and deliver groceries to the Patient. If the Member was unsure how to respond to the Patient’s request or had any confusion around work place policies, she should have raised this with her supervisor immediately.

16. Following the meeting with the Member, the Agency reported the matter to the York Regional Police.

17. The Member was placed on a suspension on December 14, 2018. Later that day, the Member called the Agency and admitted that she made a mistake and would bring the money by 5:00pm. The Member attended the Agency office that day with a bank draft made out to the Patient which was subsequently delivered to the Patient on December 15, 2018. The Patient was happy to have the money back and requested that a new nurse to be assigned to her care.

18. On January 7, 2019, the Agency received a further report from the Patient’s friend regarding another cheque written to the Member in the amount of $2,007.95 which should have been in the amount of approximately $207.00. This cheque was dated September 21, 2018 and was deposited into the Member’s bank account on September 24, 2018.

19. Agency staff telephoned the Member and advised her of the second cheque and asked her to return $1,800.00, owing to the Patient. The Member cooperated and returned the funds that day in a bank draft in the amount of $2,000.00. The Member did not provide an explanation for why the bank draft was for $2,000.00 instead of $1,800.00.

20. The Agency terminated the Member’s employment on June 24, 2019.

CNO STANDARDS

Professional Standards

21. 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.

22. 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.

23. CNO’s Professional Standards provides, in relation to the ethics standard, that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with the patient and other health care team members, and assuring privacy and confidentiality in dealings with patients.

Therapeutic Nurse-Client Relationship

24. CNO’s Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”) places the responsibility for establishing and maintaining the therapeutic nurse-patient relationship on the nurse and provides that the nurse-patient relationship is built on trust, respect, empathy, professional intimacy and requires the appropriate use of power inherent in the care provider’s role.

25. CNO’s TNCR Standard contains four standard statements which describe nurses’ accountabilities with respect to therapeutic communication, patient-centred care, maintaining boundaries and protecting the patient from abuse.

26. CNO’s TNCR Standard defines a boundary in the nurse-patient relationship as “the point at which the relationship changes from professional and therapeutic to unprofessional and personal.” CNO’s TNCR Standard places the responsibility for establishing and maintaining the limits and boundaries in the therapeutic nurse-patient relationship on the nurse. CNO’s TNCR Standard provides that:

Crossing a boundary means that the care provider is misusing the power in the relationship to meet his/her personal needs, rather than the needs of the [patient], or behaving in an unprofessional manner with the [patient].

27. CNO’s TNCR Standard provides, in relation to maintaining boundaries, that nurses meet this standard by:

• Setting and maintaining the appropriate boundaries within the relationship, and helping [patients] understand when their requests are beyond the limits of the therapeutic relationship;

• Developing and following a comprehensive care plan with the [patient] and health care team that aims to meet the [patient’s] needs

• Ensuring that the nurse-[patient] relationship and nursing strategies are developed for the purpose of promoting the health and well-being of the [patient] and not to meet the needs of the nurse, especially when considering self-disclosure, giving a gift to or accepting a gift from a [patient];

• Abstaining from engaging in financial transactions unrelated to the provision of care and services with the [patient] or the [patient’s] family/ significant other

• Continually clarifying her/his role in the therapeutic relationship, especially in situations in which the [patient] may become unclear about the boundaries and limits of the relationship;

• Ensuring that any approach or activity that could be perceived as a boundary crossing is included in the care plan developed by the health care team; and

• Consulting with colleagues and/or the manager in any situation in which it is unclear whether a behaviour may cross a boundary of the therapeutic relationship.

28. CNO’s TNCR Standard provides, in relation to protecting the patient from abuse, that nurses protect the patient from harm by ensuring that abuse is prevented or stopped and reported. Nurses demonstrate having met the standard by not engaging in activities that could result in monetary, personal or other material benefit, gain or profit for the nurse (other than the appropriate remuneration for nursing care or services), or result in monetary or personal loss for the patient.

29. In addition, CNO’s TNCR Standard provides that financial abuse includes, but is not limited to, withholding finances through trickery or theft, abusing a patient’s bank accounts and credit cards and assisting with the financial affairs of a patient without the healthcare team’s knowledge.

30. The Member admits and acknowledges that she contravened CNO’s Professional Standards and TNCR Standard when she failed to maintain the boundaries of the therapeutic nurse-patient relationship, received and cashed a cheque in the amount of $3,029.16 when it should have been in the amount of approximately $329.00 and received and cashed a cheque in the amount of $2,007.95 when it should have been in the amount of approximately $207.00.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

31. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 1 (a), (b) and (c) 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 11 to 30 above.

32. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 2 (a) and (b) of the Notice of Hearing in that she emotionally abused the Patient, as described in paragraphs 11 to 20 and 28-29 above.

33. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 3 (a) and (b) of the Notice of Hearing in that misappropriated property from the Patient, as described in paragraphs 11 to 20 above.

34. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 4 (a), (b) and (c) of the Notice of Hearing, and in particular her conduct was disgraceful, dishonourable and unprofessional, as described in paragraphs 11 to 30 above.

College Counsel provided the Panel with two previous cases of the Discipline Committee to demonstrate how other panels that heard similar cases concluded there was a breach in the Professional Standards, physical, emotional and verbal abuse along with making findings of unprofessional, dishonourable and disgraceful conduct.

CNO v. Mainoo (Discipline Committee, 2020). In this case, the member participated in the hearing and an Agreed Statement of Facts was presented to the panel. The member solicited and accepted funds from a vulnerable patient on two separate occasions and implied that medication would be withheld if the patient did not provide the requested funds. The member was found to have committed professional misconduct as she failed to meet the standards of practice, verbally, physically and emotionally abused a patient and her actions were found to be disgraceful, dishonourable and unprofessional.

CNO v. Owusu-Afriyie (Discipline Committee, 2020). In this case, the member participated in the hearing and an Agreed Statement of Facts was presented to the panel. The member misappropriated property from a vulnerable patient when she used the patient’s cheques and signature stamp to write herself three cheques. The member was found to have committed professional misconduct as she failed to meet the standards of practice and her actions were found to be disgraceful, dishonourable and unprofessional. There was no finding of abuse in this case.

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), 1(b), 1(c), 2(a), 2(b), 3(a), 3(b), 4(a), 4(b) and 4(c) of the Notice of Hearing. With respect to allegations #2(a) and 2(b), the Panel finds that the Member emotionally abused the patient. As to allegations #4(a), 4(b) and 4(c), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be disgraceful, 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.

Allegations #1(a), 1(b) and 1(c) in the Notice of Hearing are supported by paragraphs 11-31 in the Agreed Statement of Facts. The Member committed an act of professional misconduct and breached the College’s Professional Standards and the Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”) when she failed to maintain the boundaries of the therapeutic nurse-patient relationship when she received and cashed 2 cheques from the Patient. The Member admitted to depositing 2 cheques that the Patient gave her in the amounts of $3,029.16 and $2,700.00 when they should have been for $329.00 and $207.00, respectively. It was not until the Patient’s friend questioned the 2 cheques made out to the Member that she responded to her employer’s questions and indicated that the cheques were for groceries she bought for the Patient. The amount of the cheques was also questioned as the Patient lived in a retirement home that provided 3 meals a day and snacks. The Member failed to meet the College’s Professional Standards as she was not honest with the Patient nor did she act with integrity. The Member crossed the nurse-patient boundary when she put her own needs ahead of the Patient.

Allegations #2(a) and 2(b) in the Notice of Hearing are supported by paragraphs 11-20, 28-29 and 32 in the Agreed Statement of Facts. The Member admitted that she emotionally abused the Patient when she used her position for her benefit and put her own needs ahead of the Patient. When the Patient was asked about the purpose of the cheque, she did not know the answer. The TNCR Standard states that accepting funds for monetary gain other than for nursing care or services is abuse. The cheques written were written for incorrect amounts, the $2,007.95 should have been $207.00 and the $3,029.16 should have been $329.00.

Allegations #3(a) and 3(b) in the Notice of Hearing are supported by paragraphs 11-20 and 33. The Member admitted to misappropriating property from the Patient. The Member accepted the 2 cheques and deposited them both into her bank. The Member knew that the amounts on the cheques were incorrect. She knew how much she had actually spent on groceries for the Patient and, after being questioned by her employer, she ultimately returned the money to the Patient.

With respect to allegations #4(a), 4(b) and 4(c), the Panel finds that the Member’s conduct was relevant to the practice of nursing and in the Panel’s opinion would be reasonably regarded by members as unprofessional as the Member contravened the standard of practice by taking money from the Patient for her own personal gain and it demonstrated a serious and persistent disregard for her professional obligations.

The Panel also finds that the Member’s conduct was dishonourable. The Member demonstrated an element of dishonesty and deceit through misappropriating property from the Patient when she deposited the 2 cheques into her bank account when she knew the amounts were incorrect, and grocery shopping was not part of the Patient’s care plan. The Member knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional.

Finally, the Panel also finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. The Member took advantage of an elderly, vulnerable patient who believed the Member was there to care for her. This conduct casts serious doubts on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects nurses to meet.

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.

2. Directing the Executive Director to suspend the Member’s certificate of registration for 5 months. This suspension shall take effect from the date the Member obtains an active certificate of registration in a practicing class 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 a minimum of 2 meetings with a Regulatory Expert (the “Expert”) at her own expense and within 6 months from the date the Member obtains an active certificate of registration in a practicing class. If the Expert determines that a greater number of sessions are required, the Expert will advise the Director of Professional Conduct (the “Director”) regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within 12 months from the date the Member obtains an active certificate of registration in a practicing class. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director in advance of the meetings;

ii. At least 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. Therapeutic Nurse-Client Relationship, and

3. Code of Conduct;

iv. Before the first meeting, the Member reviews and completes the CNO’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook;

v. At least 7 days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms and Nurses’ Workbook;

vi. 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;

vii. 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;

viii. 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 18 months from the date the Member returns to the practice of nursing, the Member will notify her employers of the decision. To comply, the Member is required to:

i. Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

ii. Provide her employer(s) with a copy of:

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.

c) The Member shall not practice independently in the community for a period of 18 months from the date the Member returns to the practice of nursing.

4. 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:

• The Member’s misconduct was very serious as it involved theft from a patient;

• The Member’s misconduct was intentional and was for personal gain;

• There was a significant breach in trust with a patient;

• The Member’s misconduct brings discredit to the profession as a whole; and

• The Member’s misconduct showed a serious disregard for her professional obligations.

The mitigating factors in this case were:

• The Member had no prior history of discipline with the College;

• The Member admitted and accepted responsibility for her actions by agreeing to the Agreed Statement of Facts and the Joint Submission on Order;

• The Member showed remorse for her actions; and

• The Member cooperated with the College and the investigation.

The proposed penalty provides for specific deterrence through:

• The 5 month suspension; and

• The oral reprimand.

The proposed penalty provides for general deterrence through:

• The 5 month suspension.

The proposed penalty provides for remediation and rehabilitation through:

• The terms, conditions and limitations placed on the Member’s certificate of registration, including two meetings with a Regulatory Expert which will allow the Member to reflect on her professional standards and requirements.

Overall, the public is protected because the Member will be required to notify her employers of the decision of the Discipline Committee for 18 months and will not be permitted to practice independently in the community for 18 months from the date she returns to practice.

College Counsel submitted the same two cases as earlier provided and one additional case to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee.

CNO v. Owusu-Afriyie (Discipline Committee, 2020). In this case, the member committed an act of professional misconduct when she accepted $2,100.00 from a patient and failed to meet the standards of practice. The member was given a penalty including an oral reprimand, a 5 month suspension, 2 meetings with a Regulatory Expert, 18 months of employer notification and not being able to practice independently for 18 months from the date of her return to practice.

CNO v. Mainoo (Discipline Committee, 2020). In this case, the member committed an act of professional misconduct when she implied, she would withhold medication from a patient unless money was given to her. The member admitted that she failed to meet the standards of practice when she emotionally abused the patient and misappropriated property from the patient. The member was given a penalty including an oral reprimand, a 6 month suspension, 2 meetings with a Regulatory Expert, 18 months of employer notification and not being able to practice independently for 18 months from the date of her return to practice. This case was more serious than the case being heard due to the member withholding medication unless the patient gave her money.

CNO v. Lane (Discipline Committee, 2021). In this case, the member committed an act of professional misconduct when she misappropriated restaurant gift cards from a patient in the amount of $150.00. The member was given a penalty including an oral reprimand, a 3 month suspension, 2 meetings with a Regulatory Expert, 18 months of employer notification and not being able to practice independently for 12 months from the date of her return to practice.

The Member made no submissions on penalty.

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 5 months. This suspension shall take effect from the date the Member obtains an active certificate of registration in a practicing class 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 a minimum of 2 meetings with a Regulatory Expert (the “Expert”) at her own expense and within 6 months from the date the Member obtains an active certificate of registration in a practicing class. If the Expert determines that a greater number of sessions are required, the Expert will advise the Director of Professional Conduct (the “Director”) regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within 12 months from the date the Member obtains an active certificate of registration in a practicing class. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director in advance of the meetings;

ii. At least 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. Therapeutic Nurse-Client Relationship, and

3. Code of Conduct;

iv. Before the first meeting, the Member reviews and completes the CNO’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook;

v. At least 7 days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms and Nurses’ Workbook;

vi. 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;

vii. 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;

viii. 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 18 months from the date the Member returns to the practice of nursing, the Member will notify her employers of the decision. To comply, the Member is required to:

i. Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

ii. Provide her employer(s) with a copy of:

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.

c) The Member shall not practice independently in the community for a period of 18 months from the date the Member returns to the practice of nursing.

4. 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 is achieved through the suspension and oral reprimand. The 2 meetings with a Regulatory Expert will satisfy the goal of rehabilitation and remediation as this will allow the Member to reflect on her behaviour. The suspension of 5 months followed by an 18 month employer notification and being unable to work independently for 18 months once the Member starts to practise nursing addresses the principle of public protection. The penalty reinforces the expectation that members are to consistently maintain high professional and ethical standards when caring for patients.

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

I, Tanya Dion, 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.