College of Nurses of Ontario v. Johnson Jacob Bose, 2022 CanLII 125216

minicounsel

PANEL: Dawn Cutler, RN Chairperson Sylvia Douglas Public Member Sharon Moore, RN Member Fidelia Osime Public Member Terah White, RPN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) GLYNNIS HAWE for ) College of Nurses of Ontario

and - )

JOHNSON JACOB BOSE ) MICHAEL MANDARINO for Registration No. 9022120 ) Johnson Jacob Bose ) CHRISTOPHER WIRTH ) Independent Legal Counsel ) Heard: May 11, 2022

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 May 11, 2022, 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(s) of the patient(s), or any information that could disclose the identity(ies) of the patient(s), referred to orally or in any documents presented at the Discipline hearing of Johnson Jacob Bose.

The Panel considered the submissions of College Counsel and Member’s Counsel and has decided that there be an order preventing public disclosure and banning the publication or broadcasting of the name(s) of the patient(s), or any information that could disclose the identity(ies) of the patient(s), referred to orally or in any documents presented at the Discipline hearing of Johnson Jacob Bose.

The Allegations

College Counsel advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraphs 1(b), 2(a), 3(a) and 4(b) in the Notice of Hearing dated April 4, 2022. The Panel granted this request. The remaining allegations against Johnson Jacob Bose (the “Member”) are as follows:

IT IS ALLEGED THAT:

You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that, while practicing as a Registered Nurse (“RN”) at Trillium Health Partners in Mississauga, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, and in particular:

(a) on or about August 31, 2018 to September 1, 2018, you failed to complete periodic assessments of [the Patient] with appropriate frequency;

(b) [Withdrawn]; and/or

(c) on or about September 1, 2018, you documented inaccurate and/or false entries in [the Patient]’s health record, when you documented events at or about 02:29 and/or 06:56 that did not occur and/or did not occur at those times;

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, while practicing as an RN at the Facility, you failed to keep records as required, and in particular:

(a) [Withdrawn]; and/or

(b) on or about September 1, 2018, you documented inaccurate and/or false entries in [the Patient]’s health record, when you documented events at or about 02:29 and/or 06:56 that did not occur and/or did not occur at those times;

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, while practicing as an RN at the Facility, you falsified a record relating to your practice, and in particular:

(a) [Withdrawn]; and/or

You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that, while practicing as an RN at the Facility, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, and in particular:

(a) on or about August 31, 2018 to September 1, 2018, you failed to complete periodic assessments of [the Patient] with appropriate frequency;

(b) [Withdrawn]; and/or

Member’s Plea

The Member admitted the allegations set out in paragraphs #1(a), (c), #2(b), #3(b), #4(a) and (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.

Agreed Statement of Facts

College Counsel and the Member’s Counsel advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which as amended reads, unedited, as follows:

THE MEMBER

The Member registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on January 24, 1990. The Member is currently registered with CNO in the non-practising class and therefore is not entitled to practise at this time.
The Member was employed at Trillium Health Partners (the “Facility”) from 1989 until October 16, 2018.

PRIOR HISTORY

The Member has no prior disciplinary findings with CNO.

THE FACILITY

The Facility is a hospital located in Mississauga, Ontario.
At the material time, the Member worked at the Facility’s Seniors Mental Health Unit (the “Unit”).
The Unit consists of 10 beds for seniors, aged 65 and older, with a variety of mental health issues.
The Unit typically has one RN and one RPN on shift at a given time. Patients on the Unit are generally coming from home or long-term care but have been stabilized prior to being admitted.

FACILITY POLICIES

The Facility has a policy setting out the expectations for monitoring mental health in-patients at pre-determined intervals: Mental Health Levels of Observation policy (the “Observation Policy”). The Observation Policy applies to all the mental health in-patient units, including the Seniors Mental Health Unit.
Under the Observation Policy, routine observation is defined as the direct monitoring of the patient once per hour with documented evidence of the patient’s location on the Unit Observation Sheet. Direct monitoring requires a nurse to physically/visually check on the patient and conduct an environmental scan which involves checking the patient’s safety, breathing pattern, whether the patient is wet, and/or whether the patient requires re-positioning. Routine observation is the minimum standard for each patient unless close observation or constant observation has been implemented for the patient.
Close observation is defined as the direct monitoring of the patient once every fifteen minutes with documented evidence of the patient’s location on the Close Monitoring Form. Close observation is also referred to as a “Q15 check.” Close observation is implemented automatically for the first 48 hours following admission, for all patients in the Special Care Unit, and may also be implemented at any time by a physician or a nurse.
Continuous observation is defined as the one-to-one monitoring of one patient by one assigned staff who has no other competing responsibility.
The level of observation is determined jointly by the assigned nurse and the responsible physician for each patient and is reassessed each weekday. The level of observation selected is the least intrusive level required based on each patient’s unique risk factors including, but not limited to: risk to self; risk to others; risk of falls; risk of absence without official leave; disorganized behaviour that may put the patient or others at risk; and significant milieu disruption.

THE PATIENT

(the “Patient”) was 74 years old with diagnoses that included obesity, chronic pain, depression, and dementia. The Patient had most recently been admitted to the Unit on August 20, 2018, having had several previous admissions to the Unit since November 2017. The Patient was well known to the staff on the SMHU given her frequent stays. The Patient did not have a discharge plan in place.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

The Member worked the night shift on the evening of August 31, 2018, from 19:30 to 07:30 the following morning.
On the morning of August 31, 2018, the Patient had been assessed for risk of self-harm, which was found to be “not present.” A further assessment was conducted by the RN on shift at 17:50, who documented “no suicidal ideation noted continue to monitor.”
The day shift nurse working on the shift prior to the Member’s night shift began, documented that the Patient was cooperative and pleasant, attentive, calm, and did not demonstrate outward signs of anxiety, agitation, or perceptual or thought process disturbances. If the Member were to testify, he would state that when he began his shift on August 31, 2018, he received a report from the day shift nurse and she advised that the Patient was in good spirits and was very cooperative that day. The Member would also testify that based on the day shift nurse’s documentation and the Member’s own assessments, the Patient did not exhibit any self-harm behaviours, any risk to others, risk of elopement or risk of suicide disturbances that day.
Q15 checks had not been ordered by a physician for the Patient on the night of August 31, 2018. The level of observation for the Patient was routine observation. It was left to the nurse’s discretion whether to conduct Q15 checks on the Patient. At a minimum, in accordance with the Facility’s Observation Policy and standard practice, the Member was obligated to directly monitor the Patient at least once every hour during his shift (or to arrange for a colleague to do so while he was on break).
The Facility’s surveillance video of the Unit on the night in question confirms that the Member did not directly monitor the Patient once every hour during his shift. The surveillance video begins at 22:00 and ends at approximately 08:30 the following morning.
At 22:11, the Member left the Patient’s room and closed the door behind him.
At 23:04, the Member documented the following in the Patient’s chart:

pt went to bathroom and transferred herself from the wheelchair to the toilet voided had a moderate BM then transferred back to the wheelchair and settled herself in bed no distress noticed. S.O.B. [shortness of breath] on exertion while pt is pushing herself upward in the bed at 2200hrs sleeping at this time no distress noticed breathing normally will monitor the pt during the night at regular intervals for any change in mental status

At the same time, the Member documented conducting self-harm and suicide assessments, both of which he concluded were “not present.”
The Member documented the following entry in the Patient’s chart at 02:29:

remained sleeping since settled in bed last night checked and monitored the patient at regular intervals no distress noticed, breathing normally will continue to monitor the pt at regular intervals during the night

The Member made a further entry in the Patient’s chart at 06:56, which read:

remained sleeping since settled to sleep last night checked and monitored the patient at regular intervals no distress noticed, breathing normally remained sleeping at this time.

The Member did not directly monitor the Patient after he left her room at 22:11. The Member is not seen entering the Patient’s room or approaching her door for the remainder of his shift.
The Member did not enter the rooms of any of the Unit’s other patients until 06:00.
The Member completed his shift and left the Unit at approximately 07:13 on September 1, 2018.
At 08:06 on September 1, 2018, the Patient was found in her room by another staff member at the Facility, lying in bed with a plastic bag over her head and a shoelace wrapped loosely over the plastic bag. The Patient did not respond when called by name, and no breathing or pulse was evident. The Patient had written a note, found on the bedside table, which read in part: “don’t try to save me I don’t want to live.”
The Patient was pronounced deceased at 08:35 after unsuccessful attempts at resuscitation. The exact time of death of the Patient is unknown.
If the Member were to testify, he would state that the practice on the Unit was not to directly monitor patients on routine observation overnight, notwithstanding those the Facility’s policies required otherwise. Instead, the Member would testify, it was the practice on the Unit that staff would check on patients before bedtime, during the night if they left their rooms, called for help or if their bed alarm sounded, and then again in the morning prior to shift change or when the patient awoke.
If the Member were to testify, he would state that the Patient had a particular bedtime routine that started at 21:00 and that on the night in question, she specifically informed the Member that she did not want to be disturbed from sleeping. If the Member were to testify, he would state that when he assessed the Patient while preparing her for bed, she did not appear to be in distress. He would further state that his chart entries at 02:29 and 06:56 reflected that the Patient appeared to have remained in her room without setting off the bed alarm for the duration of his shift.
Nevertheless, the Member acknowledges that he had an obligation to monitor the Patient in accordance with the Facility’s policies and the Patient’s needs, and to document his assessments accurately, which he did not do. The Member has gained insight into his practice as a result of the incident and reviewed CNO’s Professional Standards and Code of Conduct.

CNO STANDARDS

CNO’s Professional Standards provides that each nurse is accountable to the public and responsible for ensuring her or his practice and conduct meets legislative requirements and the standards of practice of the profession. A nurse demonstrates this standard by providing, facilitating, advocating and promoting the best possible care for patients.
CNO’s Professional Standards further provides, in relation to the Accountability standard, that each nurse demonstrates accountability by taking action in situations in which client safety and well-being are compromised; advocating on behalf of clients; and seeking assistance appropriately and in a timely manner.
Each nurse is expected to understand, uphold and promote the values and beliefs described in CNO’s Ethics practice standard. The Ethics standard defines truthfulness as speaking or acting without intending to deceive.
CNO’s Documentation standard requires that documentation reflect all aspects of the nursing process including, assessment, planning, intervention (independent and collaborative) and evaluation.
In accordance with the Documentation Standard, nurses are accountable for ensuring their documentation of client care is accurate, timely and complete. A nurse meets the standard by demonstrating compliance with various indicators, including, inter alia: documenting the date and time that care was provided and when it was recorded; and indicating when an entry is late as defined by organizational policies; and correcting errors while ensuring that the original information remains visible/retrievable.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 1(a) and 1(c) of the Notice of Hearing, in that he contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 8-36 above.
The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 2(b) of the Notice of Hearing, and in particular, that he failed to keep records as required, as described in paragraphs 19-24; and 33-36 above.
The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 3(b) of the Notice of Hearing, in that he falsified a record relating to his practice, as described in paragraphs 19-24; and 33-36 above.
The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 4(a) and (c) of the Notice of Hearing, and that this conduct would reasonably be regarded by members as dishonourable and unprofessional, as described in paragraphs 8-36 above.
With leave of the Discipline Committee, CNO withdraws allegations 1(b), 2(a), 3(a), and 4(b).

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), (c), #2(b), #3(b), #4(a) and (c) of the Notice of Hearing. As to allegations #4(a) and (c), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be unprofessional and dishonourable.

Reasons for Decision

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

Allegation #1(a) in the Notice of Hearing is supported by paragraphs 8-12, 17-19, 24-25, 29-34 and 37 in the Agreed Statement of Facts. While on shift at Trillium Health Partners (the “Facility”) in the Seniors Mental Health Unit (the “Unit”), the Member was obligated to directly monitor [the Patient] at least once every hour during his shift. The Facility’s surveillance video of the Unit on the night in question confirms that the Member did not directly monitor [the Patient] once every hour during his shift. As admitted by the Member, the Panel finds his conduct breached the College’s Professional Standards. A nurse demonstrates the standard by providing the best possible care for patients. In addition, the Panel finds that his conduct breached the Ethics standard. Each nurse is expected to understand, uphold and promote the values and beliefs described in CNO’s Ethics practice standard. The Ethics standard defines truthfulness as speaking or acting without intending to deceive.

Allegation #1(c) in the Notice of Hearing is supported by paragraphs 10, 17-18, 20-24, 30-31 and 34-37 in the Agreed Statement of Facts. The Member documented an entry in [the Patient]’s chart at 02:29 and made a further entry at 06:56. However, video confirmed that the Member did not directly monitor [the Patient] after he left her room at 22:11. The Member did not enter [the Patient]’s room or approach her door for the remainder of his shift. The Panel finds that his conduct breached the College’s Documentation Standard, which provides that nurses are accountable for ensuring their documentation of client care is accurate, timely and complete. The Panel finds that his conduct also breached the Ethics standard, which defines truthfulness as speaking or acting without intending to deceive.

Allegation #2(b) in the Notice of Hearing is supported by paragraphs 10, 17-18, 20-24, 30-31, 34-35 and 38 in the Agreed Statement of Facts. The Member documented an entry in [the Patient]’s chart at 02:29 and again at 06:56. However, the Member did not directly monitor [the Patient] after he left her room at 22:11. The Member did not enter [the Patient]’s room or approach her door for the remainder of his shift. The Member did not enter the rooms of any of the Unit’s other patients until 06:00. The Member admitted, and the Panel finds, that he committed the acts of professional misconduct as alleged in paragraph #2(b) and in particular, that he failed to keep records as required.

Allegation #3(b) in the Notice of Hearing is supported by paragraphs 10, 17-18, 20-34, 30-31, 34-35 and 39 in the Agreed Statement of Facts. On or about September 1, 2018, the Member documented inaccurate or false entries in [the Patient]’s health record, when he documented events at or about 02:29 and 06:56 that did not occur or did not occur at those times. Specifically, the Member documented observations about [the Patient] that he did not in fact make.

The Panel finds that his conduct breached the Ethics standard, which defines truthfulness as speaking or acting without intending to deceive. The Panel finds that his conduct also breached the College’s Documentation Standard, which provides that nurses are accountable for ensuring their documentation of client care is accurate, timely and complete. With respect to allegations #4(a) and (c), the Panel finds that the Member’s conduct in failing to complete periodic assessments of [the Patient] with appropriate frequency was unprofessional as it demonstrated a serious and persistent disregard for his professional obligations.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit when he documented inaccurate or false entries in [the Patient]’s health record. The Member knew or ought to have known that his conduct was unacceptable and fell well below the standards of a professional.

Penalty

College Counsel and the Member’s Counsel advised the Panel that a Joint Submission on Order had been agreed upon. The Joint Submission on Order requests that this Panel make an order as follows:

Requiring the Member to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
Directing the Executive Director to suspend the Member’s certificate of registration for 3 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.
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

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

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

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
if available, a copy of the Panel’s Decision and Reasons;

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

Code of Conduct,
Professional Standards, and
Documentation;

iv. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of the completed Reflective Questionnaires;

v. The subject of the sessions with the Expert will include:

the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into his behaviour;

vii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on his certificate of registration;

b) For a period of 8 months from the date the Member returns to the practice of nursing, the Member will notify his employers of the decision. To comply, the Member is required to:

i. Ensure that CNO 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 his employer(s) with a copy of:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
a copy of the Panel’s Decision and Reasons, once available;

iii. 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 CNO, in which it will confirm:

that they received a copy of the required documents, and
that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.
All documents delivered by the Member to CNO, the Expert, or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.

Penalty Submissions

Submissions were made by College Counsel.

The aggravating factors in this case were that there was a risk of harm to [the Patient] and the outcome was serious, although the College is not alleging the Member caused [the Patient]’s death.

The mitigating factors in this case were that the Member has no disciplinary history with the College; he was a long-term employee; he has taken steps to educate himself on the issues; he acknowledged his misconduct; and he cooperated with the College and entered into an Agreed Statement of Facts and a Joint Submission on Order.

The proposed penalty provides for specific deterrence through the oral reprimand and the 3-month suspension of the Member’s certificate of registration. The oral reprimand demonstrates public and member disapproval of the Member’s misconduct and discourages him from repeating it.

The proposed penalty also provides for general deterrence through the 3-month suspension of the Member’s certificate of registration, which sends a clear signal to the profession that failure to meet one’s professional obligations can result in serious disciplinary action.

The proposed penalty provides for remediation and rehabilitation through the 2 meetings with a Regulatory Expert, the review of relevant College publications, and the completion of Reflective Questionnaires and online learning modules. These requirements will allow the Member to gain insight and prevent the misconduct from occurring again.

Overall, the public is protected through the 8 months of employer notification of this decision thereby ensuring employers are aware of the Member’s misconduct.

College Counsel submitted the following cases to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee.

CNO v. Nkwelle (Discipline Committee, 2018): In this case, the member failed to ensure required checks of the patient were carried out, and documented checks that were not done. The patient was found to have committed suicide on the member’s shift. The penalty included an oral reprimand, a three-month suspension of the member’s certificate of registration and terms, conditions and limitations, including two meetings with a Nursing Expert and 12 months of employer notification.

CNO v. Popo (Discipline Committee, 2020): In this case, the member failed to appropriately monitor the patient and failed to ensure that the patient received appropriate medical treatment. The member documented that she performed checks on the patient when she had not. The member’s conduct was found to be dishonourable and unprofessional. The penalty included an oral reprimand, a three-month suspension of the member’s certificate of registration, a minimum of two meetings with a Regulatory Expert, and 18 months of employer notification.

College Counsel submitted that the proposed penalty in the case before this Panel is reasonable, in line with the goals of penalty, and falls within the range of penalties ordered in similar cases.

Submissions were made by the Member’s Counsel.

The Member’s Counsel submitted that mitigating circumstances include that this was the Member’s first issue with the College in his 30-year career. The Member cooperated with the College, accepts responsibility for his conduct, is deeply remorseful, has gained insight, and is committed to not repeating this conduct when he returns to practice.

Penalty Decision

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

The Member is required to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
The Executive Director is directed to suspend the Member’s certificate of registration for 3 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.
The Executive Director is directed to impose the following terms, conditions and limitations on the Member’s certificate of registration:

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

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
if available, a copy of the Panel’s Decision and Reasons;

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

Code of Conduct,
Professional Standards, and
Documentation;

iv. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of the completed Reflective Questionnaires;

v. The subject of the sessions with the Expert will include:

the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into his behaviour;

b) For a period of 8 months from the date the Member returns to the practice of nursing, the Member will notify his employers of the decision. To comply, the Member is required to:

i. Ensure that CNO 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 his employer(s) with a copy of:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
a copy of the Panel’s Decision and Reasons, once available;

iii. 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 CNO, in which it will confirm:

that they received a copy of the required documents, and
that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.
All documents delivered by the Member to 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 deterrence is achieved through the oral reprimand and a 3-month suspension of the Member's certificate of registration. General deterrence is addressed by the 3-month suspension of the Member’s certificate of registration which will send a clear message to the profession that failure to meet one’s professional obligations will not be tolerated. Rehabilitation and remediation will be achieved through 2 meetings with a Regulatory Expert and various learning activities. Public protection is achieved through the 8 months of employer notification that will make the employer aware of the misconduct so the employer appropriately monitors the Member on his return to practice.

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

I, Sylvia Douglas, Public Member, sign this decision and reasons for the decision on behalf of the Chairperson of this Discipline panel and on behalf of the members of the Discipline panel.