College of Nurses of Ontario v. Sanderson, 2022 ONCNO 134790

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: David Edwards, RPN Chairperson Tina Colarossi, NP Member Carly Hourigan Public Member Karen Laforet, RN Member Sandra Larmour Public Member

BETWEEN:

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

• and -

DONNA M. SANDERSON Registration No. 6714182 MICHAEL B. FRALEIGH for Donna M. Sanderson CHRISTOPHER WIRTH Independent Legal Counsel

Heard: August 16, 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 August 16, 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 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 in the Discipline hearing of Donna M. Sanderson.

The Panel considered the submissions of College Counsel and Member’s Counsel and decided that there be an order preventing public disclosure and banning 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 in the Discipline hearing of Donna M. Sanderson.

The Allegations

The allegations against Donna M. Sanderson (the “Member”) as stated in the Notice of Hearing dated July 6, 2022 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 you were employed as a Registered Nurse (“RN”) by Bayshore HealthCare Limited and stationed at [ ] Nursing Station also known as [ ] Nursing Station of the [ ] First Nation, in [ ] District, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, on July 7, 2012, with respect to [the Patient] when you:

a. assessed her in the back of a police vehicle rather than having the patient brought into the nursing station;

b. failed to conduct an adequate assessment of the patient; and/or

c. inappropriately sent the patient to the police station for monitoring and/or

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(37) of Ontario Regulation 799/93, in that, while you were employed as a 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, on July 7, 2012, with respect to [the Patient] when you:

a. assessed her in the back of a police vehicle rather than having the patient brought into the nursing station;

b. failed to conduct an adequate assessment of the patient; and/or

c. inappropriately sent the patient to the police station for monitoring.

Member’s Plea

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

1. Donna M Sanderson (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse on December 15, 1966. The Member resigned her certificate of registration on December 30, 2015.

THE FACILITY

2. In 2010, the Member commenced employment with Bayshore HealthCare Limited, where she provided nursing care on remote First Nation reserves throughout Northern Ontario.

3. On June 4, 2012, The Member was placed at the [ ] Nursing Station also known as [ ] Nursing Station of the [ ] First Nation (the “Facility”). The Member was designated as a “nurse-in-charge”. There were a number of other nurses stationed at the Facility with the Member. [ ] First Nation (“[ ]”) is a remote fly-in community. There was no supervising physician present.

THE PATIENT

4. (the “Patient”) was 37 years old at the time of the incidents.

5. The Patient had a history of diabetes mellitus complicated by prior diabetic ulcerations, hypertension, right bundle branch block, obesity, prior seizures, gastroesophageal reflux, an open cholecystectomy complicated by postoperative infection, hyperlipidaemia and a ventricular septal defect. This information was unknown to the Member at the time the Patient presented, but was available in the Patient’s record at the Facility.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

6. On the evening of June 7, 2012, the Member was the on-call nurse at the Facility. That evening, the Member received a telephone call from the Facility’s security guard advising her that the police had arrived at the Nursing station with a patient.

7. The Member attended the Facility as requested (just a short distance away) and met the police outside just after 2000 hours. The Member spoke to the police officers and was told that the Patient was in the back seat of the police vehicle (a large SUV) and that she was heavily intoxicated. The Member was told by one of the police officers that the Patient had been in a physical altercation before and that they wanted her "checked out". According to both police officers, they advised the Member that the Patient was complaining of having difficulty breathing. One of the police officer’s recalls advising the Member that the Patient was also complaining of chest pain. If the Member were to testify, she would say that she did not hear anyone state that there had been complaints of chest pain.

8. If the Member were to testify, she would state that given her evaluation of the situation, she decided that it was appropriate to perform an assessment of the Patient while the Patient was in the police vehicle. The Member would further testify that she did so because of the potential physical stress to the Patient associated with moving her from the vehicle and bringing her into the Facility given that she weighed approximately 290 pounds and was heavily intoxicated. The Member would also testify that she was concerned that the Patient would be placed at a greater risk of injury when lifted in and out of the police vehicle.

9. The Member immediately went into the Facility to obtain a stethoscope and pulse oximeter and then returned to the Patient and conducted the assessment in the back of the police vehicle.

10. The assessment in the police vehicle was inadequate for a number of reasons. While the Member was able to obtain some vital signs, she was not able to detect a heartbeat given the position of the Patient. In addition, the Member did not obtain a glucometer reading, pulse-oximetry reading (as the portable machine was not functioning), or effectively determine the Patient’s level of consciousness.

11. The Member concluded based on her assessment that the Patient was medically clear to be taken to the police station and that police should observe the Patient until she was alert and sober at which time she should be brought back to the Facility for reassessment.

12. The Member acknowledges that the assessment she conducted was inadequate and incomplete and that in the specific circumstances of this case, it was an error to have attempted to evaluate the Patient in the back of the police vehicle.

13. The Member made clinical notes regarding her interaction with the police and the Patient. In particular, the Member documented that:

• The police advised her that they were called to the Patient’s home to investigate an alleged physical assault. There was an altercation between the Patient and another community member during which the Patient was hit in the mouth;

• The police stopped at the Facility on their way to the police station to have the Patient assessed;

• The Patient was lying on the back seat of the police vehicle, on her left side with her legs bent, face down, facing the floor of the vehicle with her head resting on seat. The Patient was handcuffed with her hands in front of her;

• The Patient had a past medical history of diabetes, an ulcer on abdominal wall, seizures, depression, sexual assault, open cholecystectomy with post operative infection in 2007, a diabetic ulcer on right toe and lateral side of her right foot, allergies to certain medications and morbid obesity;

• The Member assessed the Patient in the police vehicle. The Patient was semiconscious, did not open her eyes, but responded to verbal calling of her name by raising her head from the seat and dropping her head back on the seat;

• The Patient’s pulse was present, but weak, regular chest. The Member was unable to examine chest wall due to the Patient’s position in vehicle;

• The Member observed audible air entry respirations;

• The Member did not assess GI, but noted that the Patient had voided while lying in the vehicle as her clothes were damp with urine; and

• The Member’s examination determined: airway patent, breathing spontaneously, responding to verbal commands, and pulse present.

14. Assessing a patient outside the Facility (in a vehicle) or sending an intoxicated patient to the police station for observation were not part of the Facility’s practices. An unresponsive intoxicated person or one with significant risk for adverse outcomes should be observed at a medical facility and only be transferred back to police after a period of established stability. Moreover, when the Member was not able to complete a full assessment (as outlined above), she should have made the decision to bring the Patient inside the Facility to complete the assessment.

15. Shortly after leaving the Facility, the Patient was brought back as she stopped breathing in the police vehicle. At 2032 hours, the Member documented that the Patient was brought back to the Facility by police. The Patient was transferred to the emergency room and attempts at resuscitation were made but they were unsuccessful. The Patient was pronounced dead at 2110 hours.

16. The Member was interviewed by police the day after the incident. During the interview, the Member advised that:

• She did not observe any blood on the Patient or the vehicle;

• She heard the Patient snoring;

• She used her stethoscope to listen to both breathing and heartbeat;

• Given the Patient’s obesity and position lying on her side, the Member advised she was not able to detect her heartbeat using the stethoscope;

• She completed the assessment in the police vehicle because it would have been extremely difficult to move the Patient from the vehicle given her large size;

• She estimated that her assessment was approximately 10 minutes in length; and

• She was not aware of the Patient’s medical history before assessing her. She obtained this information from reading the Patient’s chart after the fact.

17. A postmortem concluded that the Patient’s cause of death was hypertensive and obesity related heart disease. Ethanol was detected in her blood at 219 mg/100 ml. It was determined that contributing factors included diabetes and intoxication with alcohol. Due to the circumstances of the Patient’s death, the Coroners Act mandated an Inquest to be conducted.

18. The Inquest concluded in 2018 and found that the Patient’s cause of death was hypertensive and obesity associated heart disease by natural causes and made a series of recommendations. The expert report in the Inquest opined that, given the setting, earlier intervention would not have changed the unfortunate outcome.

CNO STANDARDS

Professional Standards

19. 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.

20. CNO’s Professional Standards provides, in relation to the accountability standard, that nurses are accountable to the public and responsible for ensuring their practice and conduct meets the legislative requirements and the standards 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:

• providing, facilitating, advocating and promoting the best possible care for [patients];

• advocating on behalf of [patients];

• seeking assistance appropriately and in a timely manner;

• ensuring practice is consistent with CNO’s standards of practice and guidelines as well as legislation;

• taking action in situations in which [patient] safety and well-being are compromised; and

• taking responsibility for errors when they occur and taking appropriate action to maintain [patient] safety.

21. In addition, CNO’s Professional Standards provides, in relation to the knowledge application standard, that nurses continually improve the application of professional knowledge. Nurses demonstrate this standard by actions such as:

• assessing/describing the [patient] situation using a theory, framework or evidence-based tool;

• identifying/recognizing abnormal or unexpected [patient] responses and taking action appropriately;

• recognizing limits of practice and consulting appropriately; and

• identifying and addressing practice-related issues.

22. CNO’s Professional Standards further provides, in relation to the leadership standard, that nurses demonstrate leadership by providing, facilitating and promoting the best possible care/service to the public. Nurses demonstrate this standard by actions such as role-modelling professional values, beliefs and attributes.

Therapeutic Nurse-Patient Relationship

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

24. The TNCR Standard further provides that nurses work with the patient to ensure that all professional behaviour and actions meet the therapeutic needs of the patient. Nurses meet this standard by actions such as acknowledging biases and feelings that have developed through life experiences, and that these attitudes could affect the nurse-patient relationship.

25. The Member admits and acknowledges that she contravened CNO’s Professional Standards and TNCR Standard when she assessed the Patient in the back of a police vehicle rather than having the Patient brought into the nursing station, failed to conduct an adequate assessment of the Patient, and inappropriately sent the Patient to the police station for monitoring.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

26. 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 standard of practice of the profession, as described in paragraphs 6 to 25 above.

27. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 2(a), (b) and (c) of the Notice of Hearing, and in particular her conduct was dishonourable and unprofessional, as described in paragraphs 6 to 25 above.

Submissions

College Counsel reminded the Panel that with respect to allegation #2 the Panel must satisfy itself that the conduct was relevant to the practice of nursing. College counsel submitted that in this case, the member’s conduct arose directly in the context of providing nursing case to a patient.

College Counsel added that, the Panel must also satisfy itself that Members of the profession would reasonably regard the conduct as disgraceful, dishonourable and/or unprofessional. College Counsel submitted that the Member’s conduct amounted to dishonourable and unprofessional conduct.

In support of their submissions, College Counsel provided the Panel with previous decisions of the Discipline Committee where similar conduct had occurred and resulted in findings of dishonourable and unprofessional conduct.

CNO v. Popo (Discipline Committee, 2020): This case involved a member who failed to appropriately monitor and assess a patient. This case proceeded by way of an Agreed Statement of Facts. The member admitted the allegations. The panel accepted the member’s admissions and made findings of a breach of the standards of practice as well as conduct that would be regarded by members of the profession as dishonourable and unprofessional. There was no mention by the Panel that there was an element of moral failing with respect to the Member’s conduct and therefore no findings were made on disgraceful conduct.

CNO v. White (Discipline Committee, 2020): This case proceeded by way of Agreed Statement of Facts and involved a member who failed to assess a patient appropriately and also failed to respond to changes in the patient’s condition by only checking vital signs once during the shift. The panel made findings that there was a breach of the standards of practice and that the conduct would be regarded as dishonourable and unprofessional.

CNO v. Brown (Discipline Committee, 2019): This case proceeded by way of Agreed Statement of Facts and involved a member who failed to properly assess and monitor their patient. The panel made findings of a breach of the College’s standards of practice and that the conduct would be reasonably regarded by members of the profession as dishonourable and unprofessional.

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.

Before making its decision, the Panel requested further submissions from Counsel concerning how the facts in the Agreed Statement of Facts supported a finding that the Member contravened or failed to meet the Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”).

College Counsel submitted that it was important for the Panel to consider the case in the general context of where the incident took place. When the Member determined that she was unable to perform all elements of the assessment as the pulse oximeter did not work and she could not hear Patient [ ]’s heartbeat, she did not change her decision about the assessment being conducted in the police vehicle. In the College’s submission, the Member was not acting in a therapeutic way towards Patient [ ]. Further, the Member made the decision to send Patient [ ] to the police station for further monitoring rather than be given a thorough assessment and monitoring at the [ ] Nursing Station (the “Facility”) despite the Member’s observations that Patient [ ] was heavily intoxicated and obese. The Member’s decision was not made on respect and empathy. The Member’s breach of the Professional Standards was also a breach of the TNCR Standard in that she was not advocating for Patient [ ].

The Member’s Counsel questioned College Counsel’s statement that the Member made certain conclusions, such as “she’s just intoxicated”. This information is not included within the Agreed Statement of Facts. The Member’s Counsel submitted that the Panel cannot go beyond the facts in the Agreed Statement of Facts.

Independent Legal Counsel reiterated to the Panel that the case must be decided based solely on the facts set out in the Agreed Statement of Facts along with the Member’s admissions and plea. Secondly, although in the Agreed Statement of Facts the parties have set out the TNCR Standard and agreed it was applicable, it is in the Panel’s discretion to determine if they are satisfied that is the case based upon the facts set out in the Agreed Statement of Facts.

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

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), (b) and (c) in the Notice of Hearing are supported by paragraphs 6-16, 19-22, 25 and 26 in the Agreed Statement of Facts. The Member made the decision to perform a physical assessment of Patient [ ] while they were in a police vehicle based on her assessment there would be potential physical stress with moving Patient [ ] from the vehicle to the Facility given Patient [ ]’s weight and intoxication. This decision was made despite the information provided by the police that Patient [ ] complained of difficulty breathing and chest pain. The Member was unable to detect a heartbeat due to Patient [ ]’s position nor complete a glucometer reading or pulse-oximetry or effectively determine Patient [ ]’s level of consciousness. The Member determined the airway was patent, there was spontaneous breathing, response to verbal commands and a pulse present. The Member concluded that Patient [ ] was medically clear to go the police station and that the police should observe Patient [ ] until she became more alert and sober.

The Member did not follow the Facility’s practice that intoxicated individuals or persons at significant risk for adverse outcomes, should be observed at a medical facility and only be transferred back to police after a period of established stability. By failing to assess Patient [ ] at the Facility, the Member’s practice fell below the College’s Professional Standards in that she failed to ensure Patient [ ]’s safety, she disregarded the need for conducting an adequate assessment despite Patient [ ]’s current presentation and, the Member failed to recognize her limits of practice and to take appropriate action.

The Panel requested clarification with respect to the allegation of breaching or failing to meet the TNCR Standard and asked for further information to support this. College Counsel advised the Panel that it is important in this case to think about the general context for where the incident arose, the Member was employed in a very remote First Nations community, the patient involved was intoxicated and obese and a decision was made by the Member to assess the patient in the back of a police vehicle. College Counsel added that when the Member determined that she was not able to perform all elements of the assessment that she intended to, the Member did not change her decision about the assessment being conducted in the police car.

College Counsel submitted that from the College’s perspective, the Member made a decision to send a patient off to the police station for further monitoring in circumstances where the Member was unable to complete a proper assessment and while a breach of the professional standards, the conduct also breached the TNCR as the Member was not advocating for the best conditions for her patient.

The Panel considered the evidence and submissions specific to whether the Member’s conducted breached the TNCR Standard. The Panel agreed that the Member breached the TNCR Standard as supported by the evidence and clarification provided by College Counsel.

Allegations #2(a), (b) and (c) in the Notice of Hearing are supported by paragraphs 6–16 and 19-25, in the Agreed Statement of Facts. The Panel finds that the Member’s conduct was clearly relevant to the practice of nursing and was unprofessional. The Member chose to assess Patient [ ] in the back of a police vehicle instead of inside the Facility. She also failed to conduct an adequate patient assessment and proceeded to send Patient [ ] to the police station for monitoring. These actions demonstrated a serious disregard for her professional obligations, breaching the Professional Standards and the TNCR Standard.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of moral failing through her failure to conduct an adequate assessment of Patient [ ]. The Member also knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional.

Penalty

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

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

Penalty Submissions

Submissions were made by College Counsel.

College Counsel submitted that Appendix “A” to the Joint Submission on Order also provides an undertaking by the Member for the Member’s permanent resignation as a member of the College effective August 15, 2022 (the “Undertaking”). The Member undertakes to:

a) Permanently resign as a member of the CNO, effective from the date upon which the CNO accepts this Undertaking;

b) Not apply for membership with the CNO as a Registered Nurse or Registered Practical Nurse at any time in the future;

c) Agree that the public portion of the CNO’s Register will indefinitely reflect that the Member entered into an Undertaking with the Executive Director to permanently resign as a member of the CNO as part of an agreed resolution of allegations of professional misconduct; and

d) Agree to permit the CNO to provide a copy of this Undertaking and/or its terms to a governing body that regulates nursing in Canada or elsewhere in response to an inquiry or otherwise.

The aggravating factors in this case were:

• The seriousness of the Member’s conduct and the potential harm that could have resulted from the Member’s failure to follow the College’s standards and the Facility’s policy; and

• The Member’s conduct brought discredit to the profession.

The mitigating factors in this case were:

• The Member has had a long and distinguished career with the College since 1966;

• The Member has no prior discipline history with the College; and

• The Member took responsibility for her actions, cooperated with the College regarding this isolated, one-time incident and entered into an Agreed Statement of Facts and a Joint Submission on Order with the College.

Specific deterrence is not essential in this case because the Member has already undertaken to permanently resign from the practice of nursing. In such circumstances, the penalty of an oral reprimand is sufficient.

General deterrence is achieved through a message that, if the Member had not resigned, she could have expected to receive a suspension as part of a penalty. This sends a message to other members of the profession that there will be serious consequences from this type of behaviour.

Overall, the public is protected by the resignation of the Member’s certificate of registration and the ability of the College to communicate this to any governing body that regulates nursing in Canada. Accordingly, the Panel does not need to impose further conditions in order to achieve protection of the public.

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. Brown (Discipline Committee, 2019): In this case, the Member admitted that she did not take adequate steps to assess, intervene or seek assistance for the patient’s behaviour. An Agreed Statement of Facts and a Joint Submission on Order were accepted by the Panel. The penalty was an oral reprimand. The member had signed an undertaking to permanently resign as a member of the College.

CNO v. Popo (Discipline Committee, 2020): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member failed to ensure the patient received appropriate medical care. 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.

CNO v. Whyte (Discipline Committee, 2020): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member failed to monitor the patient as directed by the RN specifically for vital signs, blood glucose level, level of consciousness and medications ordered by the hospital and failed to assess and respond to changes in the patient’s condition. The penalty included an oral reprimand, a 3-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert and 24 months of employer notification.

The Member’s Counsel advised that he agreed with and supported College Counsel’s submissions. The Member’s Counsel further submitted that the Member had resigned in 2015 after a long career in nursing in which she had worked as the RN in charge. She had a long history with an unblemished registration and no prior discipline history. The Member’s conduct did not make a difference in the outcome for this patient. The Member has taken responsibility and admitted her conduct. The proposed penalty is within the range of penalties for similar conduct. It addresses specific and general deterrence and public protection and should be accepted.

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.

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 its members. In the normal course, 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.

In this case, because the Member has undertaken to permanently resign, the oral reprimand is a sufficient penalty and no other specific deterrence is required.

Furthermore, because of the Member’s resignation, it is not necessary to consider remediation and rehabilitation in determining the appropriate penalty.

General deterrence is also addressed as the Panel concluded had the Member’s situation been different and no Undertaking given, the Panel would have ordered a suspension, and terms, conditions and limitations on the Member’s certificate of registration, along with the oral reprimand which would have been in line with previous penalties.

Finally, the penalty of only a reprimand is appropriate because the public is already protected through the permanent resignation of the Member’s certificate of registration and the Undertaking to never apply to the College for registration as a nurse again in the future.

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

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