College of Nurses of Ontario v. Sandra D. Munro, 2021 ONCNO 63733

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL:

Heather Stevanka, RN Chairperson

Sylvia Douglas Public Member

Terry Holland, RPN Member

Lalitha Poonasamy Public Member

Jody Whaley, RPN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) DENISE COONEY for

) College of Nurses of Ontario

• and - )

SANDRA D. MUNRO ) NO REPRESENTATION for

Registration No.: IJ00407 ) Sandra D. Munro

) CHRISTOPHER WIRTH

) Independent Legal Counsel

) Heard: April 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 April 1, 2021, via videoconference.

As Sandra D. Munro (the “Member”) was not present, the hearing recessed for 15 minutes to allow time for the Member to appear. Upon reconvening, the Panel noted that the Member was not in attendance.

College Counsel provided the Panel with evidence (Exhibit 2) that the Member had been sent the Notice of Hearing on February 22, 2021 by way of an affidavit from [College Staff Member A], Prosecutions Clerk. The affidavit, dated March 4, 2021, confirmed that [College Staff Member A] sent correspondence, which included the Notice of Hearing, on February 22, 2021 to the Member’s last known address on the College Register.

Further, the College had entered into an agreement with the Member at a time when the Member was represented by Counsel whereby both parties had agreed to all documents to be entered into evidence. However, on March 12, 2021, the Member’s Counsel advised the College that he had ceased acting on the Member’s behalf.

College Counsel provided the Panel with the Affidavit of [College Staff Member B] (Exhibit 3), Prosecutions Associate with the College. [College Staff Member B] confirmed that the Member’s Counsel previously provided College Counsel with copies of the relevant documents executed by the Member and which he had witnessed on March 10, 2021. Exhibit 3 also contained evidence that the Member emailed [College Staff Member B] on March 16, 2021 and stated that she was not going to attend the hearing on April 1, 2021 and she would like the executed copies of the settlement documents to remain final. The Member made no further contact with the College following this email.

College Counsel submitted that there was satisfactory evidence that the Member had asked for the hearing to proceed on the basis of an Agreed Statement of Facts and the Member’s plea. The Panel was satisfied that the Member had also received adequate notice of the time, date and purpose of the hearing, and that if she did not attend, it would proceed in her absence without further notice to her. The Member chose not to attend. Accordingly, the Panel decided to proceed with the hearing in the Member’s absence.

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 names of the patients, or any information that could disclose their identities, referred to orally or in any documents presented in the Discipline hearing of the Member.

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

The Allegations

The allegations against the Member as stated in the Notice of Hearing dated February 19, 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 practicing as a Registered Practical Nurse at Saint Luke’s Place in Cambridge, Ontario (the “Facility”), you contravened a standard of practice of the profession, or failed to meet the standards of practice of the profession, in that on or about April 14, 2019:

a. you took the call bell away from [Patient A] and placed it out of [Patient A]’s reach; and/or

b. you were rough and/or used excessive force with [Patient B], including:

i. placing an adult diaper on [Patient B] in a manner that caused [Patient B]’s head to rock and hit the steel bars of the bed frame;

ii. grabbing [Patient B] by the back of the neck while attempting to place [Patient B] in a lift;

iii. hitting [Patient B]’s feet with the lift; and/or

iv. handling [Patient B] in a manner that caused [Patient B] to say to you, “you are being so cruel” or words to that effect.

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(7) of Ontario Regulation 799/93, in that while practicing as a Registered Practical Nurse at the Facility, you verbally, physically, or emotionally abused a patient, in that on or about April 14, 2019:

a. you took the call bell away from [Patient A] and placed it out of [Patient A]’s reach; and/or

b. you were rough and/or used excessive force with [Patient B], including:

i. placing an adult diaper on [Patient B] in a manner that caused [Patient B]’s head to rock and hit the steel bars of the bed frame;

ii. grabbing [Patient B] by the back of the neck while attempting to place [Patient B] in a lift;

iii. hitting [Patient B]’s feet with the lift; and/or

iv. handling [Patient B] in a manner that caused [Patient B] to say to you, “you are being so cruel” or words to that effect.

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 practicing as a Registered Practical Nurse at the Facility, you engaged in conduct relevant to the practice of nursing that would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, in that on or about April 14, 2019:

a. you took the call bell away from [Patient A] and placed it out of [Patient A]’s reach; and/or

b. you were rough and/or used excessive force with [Patient B], including:

i. placing an adult diaper on [Patient B] in a manner that caused [Patient B]’s head to rock and hit the steel bars of the bed frame;

ii. grabbing [Patient B] by the back of the neck while attempting to place [Patient B] in a lift; and/or

iii. hitting [Patient B]’s feet with the lift; and/or

iv. handling [Patient B] in a manner that caused [Patient B] to say to you, “you are being so cruel” or words to that effect.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1(a), 1(b)(i), (ii), (iii), (iv), 2(a), 2(b)(i), (ii), (iii), (iv), 3(a), 3(b)(i), (ii), (iii) and (iv) in the Notice of Hearing. The Panel also received a written plea inquiry which was signed by the Member in the presence of her Counsel. Given this and the circumstances identified in Exhibit 3, the Panel accepted the Member’s admissions and was satisfied that they were voluntary, informed and unequivocal.

Agreed Statement of Facts

College Counsel advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts (ASF). The ASF, without its cited appendices attached, reads, unedited, as follows:

THE MEMBER

1. Sandra D. Munro (the “Member”) obtained a diploma in nursing from Conestoga College in 1989.

2. The Member registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on October 27, 1989.

3. The Member was interim suspended by the Inquiries, Complaints and Reports Committee (“ICRC”) on July 25, 2019 in relation to the incidents of professional misconduct described below.

4. The ICRC, in its reasons provided to the Member, explained that an interim suspension was necessary in the public interest because the Member’s conduct exposed or was likely to expose patients to harm or injury. The panel considered the conduct at issue before it, as well as the demonstrated pattern and history of patient abuse toward a vulnerable patient population and the Member’s continued lack of insight into the inappropriateness of her conduct.

5. As a result, the Member remains interim suspended and not legally entitled to call herself a nurse or to practice nursing in Ontario until her current discipline matter is disposed of by the Discipline Committee.

THE FACILITY

6. St. Luke’s Place (the “Facility”) is a long-term care home located in Cambridge, Ontario. The nurse-client ratio is 1:34.

7. The Member worked as a part-time RPN at the Facility from January 28, 2010 to May 2, 2019, when her employment was terminated for cause following the incidents giving rise to these allegations of professional misconduct.

8. The Facility had a number of policies in place at the time of the incidents, including but not limited to a zero-tolerance abuse policy and safety-check protocols, which required staff to monitor breathing, assess general safety and ensure call bells were working and placed within patients’ grasp. The Member was aware of and agreed to comply with these policies.

9. The Facility also enforced the Residents’ Bill of Rights that aligns with the patient-centred care direction from the Ministry of Health and Long-Term Care. Specifically, every patient has the right to live in a safe environment and be protected from abuse.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

10. The Member was working the night shift at the Facility from April 13, 2019 2200 to April 14, 2019 0600.

11. Incidents involving [Patients A and B] occurred on that shift.

Incident Involving [Patient A]

12. [Patient A] was 67 years old at the time of the incident on April 14, 2019.

13. [Patient A] had advanced Parkinson’s disease, as well as depression, anemia, dysphasia and anxiety. He had a documented aversion to changing his daily routine.

14. [Patient A] was administered a sleeping medication nightly to help manage hallucinations or disturbed sleep as a side effect of his Parkinson’s medications.

15. Facility staff were aware of [Patient A]’s tendency to make routine use of his call bell, particularly approximately one hour before his regularly scheduled medications. [Patient A] had been doing so for years given that he is immobile without the assistance of at least two persons.

16. Facility policy required that call bells always be within patient reach for safety purposes.

17. At or around 1745 on April 13, 2019, [Patient A] fell and sustained a head wound that required him to be transported to hospital.

18. At or around 0245 on April 14, 2019, [Patient A] returned to the Facility. Instructions provided to staff upon his release from hospital included hourly checks of [Patient A]’s sutures as well as examinations for general pain and follow-up wound care. [Patient A] was also to receive his usual medications alongside a pain medication to treat his head injury.

19. After his return from hospital, [Patient A] used the call bell to request his scheduled sleep medication.

20. At or around 0330, [Colleague A], Personal Support Worker (PSW), entered [Patient A]’s room to answer the call bell. [Colleague A] then left [Patient A]’s room and asked the Member to administer the sleep medication. The Member responded in an annoyed tone of voice that, “it’s too late” or words to that effect.

21. [Colleague B], RN and Charge Nurse on shift, entered [Patient A]’s room. The Member was already in the room. [Patient A] was laying in his bed and had the call bell in his hand.

22. The Member stood beside [Patient A]’s bed and said in a raised voice, “leave it, leave it […] why are you calling all the time?” or words to that effect.

23. [Colleague B] observed that the Member took the call bell out of [Patient A]’s hand and placed it out of his reach on the side of the bed.

24. According to [Colleague B], [Patient A] appeared afraid when the Member took the call bell away from him. [Patient A] withdrew his hand and did not respond to the Member. He looked to [Colleague B] for assistance.

25. [Colleague B] told the Member that [Patient A] had just suffered a fall and reminded her that Facility policy required call bells remain within patients’ reach.

26. [Colleague B] placed the call bell back within [Patient A]’s reach.

Incidents Involving [Patient B]

27. [Patient B] was 83 years old at the time of the incidents on April 14, 2019.

28. [Patient B] had dementia, type I diabetes, hypothyroidism, anxiety and chronic kidney disease. She was also at a heightened risk of falls.

29. Between 0500 and 0530 on April 14, 2019, [Colleague C], PSW, found that [Patient B] had fallen out of her bed. [Colleague C] also observed that [Patient B] had urinated and required a change of clothes, including a new adult diaper.

30. [Colleague C] asked the Member for help moving and changing [Patient B]. The Member told [Colleague C] to ask [Colleague A] for help because the Member was “too busy” or words to that effect. [Colleague C] asked [Colleague A] for help, but the Member, nevertheless, also entered [Patient B]’s room and participated in the changing and transfer of [Patient B].

31. The Member undressed [Patient B] to remove her wet clothes and put on a new adult diaper while [Patient B] was still on the floor. The Member put the adult diaper on [Patient B] in a manner that caused [Patient B]’s head to rock and hit the steel bars of the bed frame more than once. As the Member handled her, [Patient B] said to the Member, “you are being so cruel” or words to that effect.

32. [Colleague A] positioned herself behind [Patient B] in order to brace [Patient B]’s head and neck from hitting the bed frame rails while the Member put the adult diaper on [Patient B]. [Colleague A] observed that [Patient B] was fearful, upset and distraught during the interaction.

33. Once [Patient B] was changed into dry clothes, the Member brought a Hoyer lift to [Patient B] - who was still on the floor - to transport her off the floor. The Member struck the base of the lift into the bottom of [Patient B]’s feet at least three times in a very fast motion.

34. [Colleague A] told the Member to stop because she was hitting [Patient B] with the lift. The Member stopped and placed [Patient B]’s feet onto the base of the lift.

35. While attempting the transfer, the Member grabbed [Patient B] by the back of the neck to lift her into the sling. [Colleague A] told the Member to stop. The Member did not stop.

36. [Colleague A] observed that [Patient B] was upset and attempted to reassure her. The Member did not say anything and left the room.

CNO STANDARDS OF PRACTICE

37. CNO’s Professional Standards provides that each nurse is accountable to the public and responsible for ensuring her or his practice and conduct meets legislative requirements and the standards of the profession. A nurse demonstrates this standard by providing, facilitating, advocating and promoting the best possible care for patients, by recognizing the potential for patient abuse, and preventing abuse, neglect and mistreatment whenever possible.

38. CNO’s Professional Standards also provides, in relation to the Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”), that each nurse establishes and maintains respectful, collaborative, therapeutic and professional relationships. Nurses further uphold this standard by demonstrating empathy for, and interest in, patients.

39. The TNCR Standard requires that nurses use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and/or terminate the nurse-patient relationship. A nurse meets the standard by:

a. being aware of her/his verbal and non-verbal communication style and how [patients] might perceive it;

b. modifying communication style, as necessary, to meet the needs of the [patient];

c. recognizing that all behaviour has meaning and seeking to understand the cause of a [patient’s] unusual comment, attitude or behaviour; and

d. reflecting on interactions with a [patient] and the health care team and investing time and effort to continually improve communication skills.

40. CNO’s TNCR Standard places the responsibility for establishing and maintaining the therapeutic nurse-patient relationship on the nurse. Underlying the establishment of an appropriate, compassionate nurse-patient relationship is an awareness of the power imbalance inherent in the dynamic between a professional care provider and a vulnerable patient.

41. The TNCR Standard provides that abuse can take many forms, including emotional and physical abuse, and neglect. Examples of physical abuse include pushing, using force, and handling a patient in a rough manner. Examples of neglect include non-therapeutic confining or isolation, ignoring and withholding.

42. As such, the TNCR Standard requires nurses to protect patients from harm by ensuring that abuse, neglect and exploitation of the power imbalance is prevented, stopped and reported. With respect to protecting the patient from abuse, neglect and harm, a nurse meets the standard by:

a. not engaging in behaviours toward a [patient] that may be perceived by the [patient] and/or others to be violent, threatening or intending to inflict physical harm; and

b. not exhibiting physical, verbal and non-verbal behaviours toward a [patient] that demonstrate disrespect for the [patient] and/or are perceived by the [patient] and/or others as abusive.

43. The Member admits and acknowledges that her conduct towards [Patient A] and [Patient B] breached the standards of practice as set out in CNO’s Professional Standards and TNCR Standard. The Member further admits and acknowledges that her conduct amounts to abuse.

MEMBER’S PRIOR HISTORY WITH CNO

Findings of Professional Misconduct by the Discipline Committee

44. In July 2011, CNO’s Discipline Committee found the Member committed professional misconduct when she abused a patient verbally, physically and emotionally; pushed a patient, which caused a fall; threatened to hit and inappropriately restrain a patient without consent; and, failed to assess, provide care and accurately document her actions with a patient. The Discipline Committee ordered that her Certificate of Registration (“Certificate”) be suspended for three months and required her to appear before the Panel to be orally reprimanded. The Panel also imposed terms, conditions and limitations on her Certificate. A copy of the Discipline Committee’s reasons is attached at Appendix “A”.

45. In November 2010, CNO’s Discipline Committee found the Member committed professional misconduct when she contravened a standard of practice of the profession when she falsified a record and engaged in conduct that was considered dishonourable and unprofessional by administering medications to patients earlier than ordered. The Member also falsely documented the time medications had been administered. The Discipline Committee ordered that her Certificate be suspended for two months and required her to appear before the Panel to be orally reprimanded. The Panel also imposed terms, conditions and limitations on her Certificate. A copy of the Discipline Committee’s reasons is attached at Appendix “B”.

Cautions received by the Member

46. In June 2000, the Member received a letter of caution from CNO’s Executive Committee, as it was then. The Member was also requested to attend meetings with a CNO Professional Practice Consultant. CNO received a report of three incidents that occurred during the course of the Member’s employment in a long-term care home. Specifically, the Member failed to provide reassurance while a patient was experiencing distress, was unsafe with a second patient during a commode transfer and was emotionally abusive toward a third patient when the patient rang her call bell requesting medication. A copy of the Complaints Committee’s decision is attached at Appendix “C”.

47. In January 1999, the Member received an oral and written caution from the Complaints Committee, as it was then. In a report to CNO from the long-term care residence at which the Member was employed as a full-time RPN, the employer reported multiple incidents involving inappropriate medication administration. A copy of the Complaints Committee’s decision is attached at Appendix “D”.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

48. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1 of the Notice of Hearing, as described in paragraphs 12-36 above, in that she failed to maintain the standards of practice of the profession in her interactions with [Patient A] and [Patient B] on or about April 14, 2019.

49. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2 of the Notice of Hearing, as described in paragraphs 12-36 above, in that she physically and emotionally abused [Patient A] and [Patient B] on or about April 14, 2019 when she:

a. took the call bell away from [Patient A] and placed it out of [Patient A]’s reach; and

b. was rough and used excessive force with [Patient B], including:

i. placing an adult diaper on [Patient B] in a manner that caused [Patient B]’s head to rock and hit the steel bars of the bed frame;

ii. grabbing [Patient B] by the back of the neck while attempting to place [Patient B] in a lift;

iii. hitting [Patient B]’s feet with the lift; and

iv. handling [Patient B] in a manner that caused [Patient B] to say to the Member, “you are being so cruel” or words to that effect.

50. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3 of the Notice of Hearing, as described in paragraphs 12-36 above, and that such conduct brings shame to herself and to the profession, and is disgraceful, dishonourable and unprofessional.

College Counsel submitted that conduct of this nature is very troubling. The Member has a history of over 20 years of abuse and incidents of professional misconduct. The Member has admitted that members of the profession would find her actions unprofessional, disgraceful and dishonourable. The conduct is unprofessional because it includes a serious or persistent disregard for the Member’s professional obligations. The conduct is dishonourable because it includes an element of moral failing and a marked departure from the standards expected of a professional. This type of conduct is also disgraceful as it has the effect of shaming the Member, and, by extension, the profession.

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)(i), (ii), (iii), (iv), 2(a), 2(b)(i), (ii), (iii), (iv), 3(a), 3(b)(i), (ii), (iii) and (iv) of the Notice of Hearing. With respect to allegations #2(a), 2(b)(i), (ii), (iii) and (iv), the Panel finds that the Member physically and emotionally abused two patients. As to allegations #3(a), 3(b)(i), (ii), (iii) and (iv), 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.

Allegation #1(a) in the Notice of Hearing is supported by paragraphs 10-26, 37-43 and 48 in the Agreed Statement of Facts. [Patient A] had just recently experienced a fall and subsequent head wound requiring a transfer to the hospital. Upon the Patient’s return to the Facility, and once the Patient was settled in bed, the Member removed [Patient A]’s call bell, leaving the Patient with no means to call for help, if the Patient needed to do so. The Agreed Statement of Facts, states that according to the Charge Nurse, [Patient A] appeared afraid when the Member took the call bell away from him.

Allegations #1(b)(i), (ii), (iii) and (iv) in the Notice of Hearing are supported by paragraphs 10, 11, 27-43 and 48 in the Agreed Statement of Facts. The Member was rough and used excessive force with [Patient B] after the Patient had fallen on the floor.

The Member’s actions, involving [Patient A] and [Patient B], are clearly a breach of the College’s Professional Standards and the TNCR Standard. Nurses are accountable to the public and to ensure their practice and conduct meets the standards of the profession. This includes demonstrating empathy and compassion. The Member should have understood the power imbalance in the nurse-patient relationship and realized her patients were vulnerable and relying on her to protect them from harm. When she handled [Patient B] in a rough manner, causing the Patient’s head to strike the bed frame, grabbing the Patient by the back of the neck and hitting the Patient’s feet with the lift, the Member was engaging in behaviours that could be perceived as threatening or intending to inflict harm.

Allegation #2(a) in the Notice of Hearing is supported by paragraphs 10-26, 27-43 and 49 in the Agreed Statement of Facts. Removing [Patient A]’s call bell and placing it out of reach falls under the definition of physical and emotional abuse. These actions would have left this vulnerable Patient without a means to call for a nurse should that be necessary.

Allegations #2(b)(i), (ii), (iii) and (iv) in the Notice of Hearing are supported by paragraphs 10, 11, 27-43 and 49 in the Agreed Statement of Facts. The Member admitted to physically and emotionally abusing [Patient B] when she handled the Patient in a rough manner, resulting in a number of actions that could have harmed the Patient. The Patient had just fallen and was already in a very vulnerable state and was relying on the Member to provide compassionate care. Instead, the Member handled the Patient roughly to the extent that the Patient actually said to her “you are being so cruel”. These actions clearly meet the definition of physical and emotional abuse.

Allegations #3(a), 3(b)(i), (ii), (iii) and (iv) are supported by paragraphs 10-43 and 50 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in removing the call bell from [Patient A] and being rough and using excessive force with [Patient B] 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 fact that the Member removed [Patient A]’s call bell, leaving the Patient with no means to contact a nurse demonstrated an element of moral failing. Furthermore, the Member gravely mistreated [Patient B] by roughly handling the Patient after the Patient had fallen. The Member knew or ought to have known that her conduct was unacceptable and fell well below the standards of the profession.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. The Member physically and emotionally abused her patients to the point where [Patient B] actually commented on it. The Member did not act with empathy or kindness, nor in a therapeutic manner. The Member’s colleagues witnessed the events and observed both patients to be fearful, upset, and distraught during the interaction. Instead of providing support, the Member provided no reassuring words and left the room. These actions cast serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet.

Penalty

College Counsel 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 provided the Panel with a Joint Submission on Order and submitted that it also provides in Appendix “A”, an Undertaking by the Member for the Member’s permanent resignation as a member of the College effective April 1, 2021. The Undertaking includes the Member’s commitment not to apply for membership with the College as a Registered Nurse or Registered Practical Nurse at any time in the future. College Counsel submitted that the Member’s permanent resignation allows for a limited penalty with no need for terms, limits or conditions or suspension of the Member’s certificate.

College Counsel submitted that the Member had been advised to obtain independent legal advice and did so. College Counsel noted that the Joint Submission on Order was signed voluntarily in the presence of the Member’s Counsel at the time.

College Counsel submitted that the Joint Submission on Order was very much in the public interest and fulfills the goals of public protection. The Joint Submission on Order further provides a provision for the College to inform regulators in other jurisdictions should the Member attempt to pursue registration elsewhere.

The Member’s agreement to resign as a member of the College provides the ultimate form of public protection by removing her from practice. The Undertaking should inspire public confidence in the College’s ability to regulate the profession. Further, the information will be publicly available on the College’s website and the public will thereby know that the Undertaking was given in the context of professional misconduct.

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

CNO v. Doane (Discipline Committee, 2020). This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member admitted to transferring a patient that was at a high risk for falls in an unsafe manner, pulling the patient down the hall and into the patient’s room, where the member turned off the lights in the room without ensuring the patient got safely to bed. The panel made findings of a breach of College standards and abuse. The penalty was an oral reprimand based on an undertaking that the member had given to the College to permanently resign.

CNO v. Groulx (Discipline Committee, 2019). This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member admitted to making unprofessional and inappropriate comments to the patient and the patient’s family, disregarded physicians' orders and handled patients in a rough manner. The member admitted the allegations. The penalty was an oral reprimand based on an undertaking that the member had given to the College to permanently resign.

College Counsel submitted that the Joint Submission on Order alongside the Undertaking, will restore public confidence in the College and is the ultimate form of public protection, particularly due to the Member’s lengthy history with the disciplinary arm of the College.

Penalty Decision

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

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

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. Because of the Undertaking, a reprimand without further penalty sanctions is acceptable. General deterrence is met by sending a clear message to the membership that this type of egregious conduct will never be tolerated. In light of the Member’s permanent 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 Member had an extensive history of discipline proceedings with the College over the course of many years. 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, Heather Stevanka, 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.