College of Nurses of Ontario v. Cuison, 2022 CanLII 135103

Discipline Committee of the College of Nurses of Ontario

Panel: Carly Gilchrist, RPN Chairperson Sylvia Douglas Public Member Karen Goldenberg Public Member Neil Hillier, RPN Member Heather Stevanka, RN Member

Between:

College of Nurses of Ontario Hailey Bruckner for College of Nurses of Ontario

• and -

Mona Cuison Registration No. JH702745 Nicole Fielding for Mona Cuison Kimberley Ishmael Independent Legal Counsel

Heard: March 21, 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 March 21, 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 Mona Cuison.

The Panel considered the submissions of College Counsel and Member’s Counsel, and 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 Mona Cuison.

The Allegations

The allegations against Mona Cuison (the “Member”) as stated in the Notice of Hearing dated February 16, 2022 are as follows:

IT IS ALLEGED THAT:

1. You have committed an act of professional misconduct as provided by subsection 51(1)(a) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, in that you were found guilty of an offence that is relevant to your suitability to practise, and in particular, on or about June 19, 2019, in the Ontario Court of Justice in Newmarket, Ontario, you were found guilty of two counts of theft of a value not exceeding five thousand dollars, contrary to s. 334(b) of the Criminal Code; 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(1) of Ontario Regulation 799/93, in that, while employed as a Registered Practical Nurse (“RPN”) at Sunrise Senior Living – Sunrise of Thornhill in Vaughan, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession as follows:

a. On October 22, 2018, you entered the private residence of [the Patient], a resident of the Facility, and stole $85 from her purse; and/or b. On October 23, 2018, you entered the private residence of [the Patient], a resident of the Facility, and stole $40 from her purse; and/or

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(8) of Ontario Regulation 799/93, in that while employed as an RPN at the Facility, you misappropriated property from a client or workplace, as follows:

a. On October 22, 2018, you entered the private residence of [the Patient], a resident of the Facility, and stole $85 from her purse; and/or b. On October 23, 2018, you entered the private residence of [the Patient], a resident of the Facility, and stole $40 from her purse; and/or

4. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(18) of Ontario Regulation 799/93, in that while registered as an RPN, you contravened a term, condition or limitation on your certificate of registration, as provided in subsections 1.5(1)1.(i) and (ii) of O. Reg. 275/94, in that you failed to provide the Executive Director of the College of Nurses of Ontario (“CNO”) with details of findings of guilt and criminal charges that you were subject to, as follows:

a. On or about June 19, 2019, in the Ontario Court of Justice in Newmarket, Ontario, you were found guilty of two counts of theft of a value not exceeding five thousand dollars, contrary to s. 334(b) of the Criminal Code; and/or b. On or about November 21, 2018, you were charged with two counts of theft of a value not exceeding five thousand dollars, contrary to s. 334(b) of the Criminal Code and one count of unlawfully entering a dwelling-house with the intent to commit an indictable offense therein, contrary to s. 349(1) of the Criminal Code; and/or

5. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that while registered as an RPN, 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 of the profession as disgraceful, dishonourable or unprofessional, as follows:

a. On October 22, 2018, you entered the private residence of [the Patient], a resident of the Facility, and stole $85 from her purse; b. On October 23, 2018, you entered the private residence of [the Patient], a resident of the Facility, and stole $40 from her purse; and/or c. You failed to provide the Executive Director of CNO with the details of findings of guilt and criminal charges that you were subject to, as follows:

i. On or about June 19, 2019, in the Ontario Court of Justice in Newmarket, Ontario, you were found guilty of two counts of theft of a value not exceeding five thousand dollars, contrary to [s. 334](https://www.canlii.org/en/ca/laws/stat/rsc-1985-c-c-46/latest/rsc-1985-c-c-46.html)(b) of the [Criminal Code](https://www.canlii.org/en/ca/laws/stat/rsc-1985-c-c-46/latest/rsc-1985-c-c-46.html); and/or
ii. On or about November 21, 2018, you were charged with two counts of theft of a value not exceeding five thousand dollars, contrary to [s. 334](https://www.canlii.org/en/ca/laws/stat/rsc-1985-c-c-46/latest/rsc-1985-c-c-46.html)(b) of the [Criminal Code](https://www.canlii.org/en/ca/laws/stat/rsc-1985-c-c-46/latest/rsc-1985-c-c-46.html) and one count of unlawfully entering a dwelling-house with the intent to commit an indictable offense therein, contrary to [s. 349(1)](https://www.canlii.org/en/ca/laws/stat/rsc-1985-c-c-46/latest/rsc-1985-c-c-46.html) of the Criminal Code.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1, 2(a), (b), 3(a), (b), 4(a), (b), 5(a), (b), (c)(i) and (ii) 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 reads, unedited, as follows:

THE MEMBER

1. Mona Cuison (the “Member”) obtained a Bachelor of Science degree in nursing from Perpetual Help College in Manila, Philippines in 1991. After moving to Canada in 1999, the Member completed additional courses in nursing with George Brown College in Toronto, Ontario, in 2007.

2. The Member first registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on March 17, 2008.

3. The Member was employed as a full-time staff nurse at Sunrise Senior Living – Sunrise of Thornhill, Ontario (the “Facility”) from April 7, 2008 until October 29, 2018. She resigned from her employment with the Facility following the incidents described below.

THE FACILITY

4. The Facility is a retirement residence in Thornhill – Vaughan, Ontario with 261 beds, divided between residents in independent living, assisted living and memory care.

5. There are three nurses on the day shift and two nurses on the evening shift at the Facility, in addition to the Resident Care Director and an Associate Care Director.

6. The Member worked evenings and weekend shifts. She provided support to all residents, as needed, in her capacity as a Wellness Nurse.

THE PATIENT

7. (the “Patient”) moved into the independent living portion of the Facility on December 15, 2014. The Patient was 74 years old at the time of the incidents described below.

INCIDENT RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

a) The Member stole $125 from the Patient

8. On October 22 and 23, 2018, the Member entered the Patient’s private resident, using her master key to the Facility, and stole $85 and $40 from the Patient’s purse.

9. On October 22, 2018, the Patient reported to the Facility that she was missing money from her room. The Patient gave the Facility consent to place a camera in her room the same day.

10. On October 25, 2018, the Patient reported to the Facility that additional money was missing from her room.

11. Staff from the Facility reviewed the video footage from the Patient’s room on October 25, 2018. The video footage from the Patient’s room on October 23, 2018 recorded the Member entering the Patient’s room, removing something from the Patient’s purse, and leaving the room.

12. On reviewing the video, the Patient called the police. The Member was arrested on October 26, 2018.

13. The Facility placed the Member on administrative leave. If the Member were to testify, she would say that she cooperated with the Facility’s investigation. On October 29, 2018, the Member resigned her employment with the Facility.

14. On November 21, 2018, the Member was charged with two counts of theft under $5000 contrary to s. 334(b) of the Criminal Code (the “Criminal Code”). She was also charged with unlawfully entering a dwelling house with the intent to commit an indictable offence therein, contrary to s. 349(1) of the Criminal Code.

15. On June 19, 2019, the Member attended the Ontario Court of Justice in Newmarket, Ontario and pled guilty to two counts of theft under $5000.

16. The Member admitted to the following facts in Court:

i. Over a two-day period, the Member stole a total of $125 from the Patient. ii. On October 22, 2018, the Patient had $85 cash in her wallet, which she left in her room while she attended dinner in the dining room. The Patient discovered the cash was missing from her wallet after she returned to her room and reported the missing money to one of the Facility directors. iii. On October 23, 2018, the Patient had $40 in her wallet before she left for dinner. When she checked her wallet after returning from dinner, the money was missing. iv. The Patient and staff at the Facility reviewed video footage from the Patient’s room taken on October 23, 2018, which recorded the Member entering the room, and rummaging through the Patient’s purse. v. As a nurse, the Member had a master key to the Facility. She was the only nurse clocked in on October 23, 2018.

17. The Crown withdrew the charge against the Member for unlawfully entering the Patient’s room with the intent to commit an indictable offence.

18. The Member pled guilty to two counts of theft under $5000 on June 19, 2019. She was found guilty of these charges and sentenced to an absolute discharge.

b) The Member failed to comply with her reporting obligations

19. The Member was obligated to provide the Executive Director of CNO with details of the criminal charges and findings of guilt against her, pursuant to section 1.5(1)1.(i) and (ii) of Ontario Regulation 275/94.

20. The Member admits and acknowledges that she did not report the criminal charges to CNO at any time, nor did she report to CNO that she had been found guilty of two counts of theft under $5000 on June 19, 2019. If the Member were to testify, she would say that she understood that the Facility would report the charges, guilty plea, and findings of guilt to CNO, and believed this was sufficient to fulfill her reporting obligations.

21. The Member failed to meet her reporting obligations as a result.

c) The Member was found guilty of an offence relevant to her suitability to practice

22. It is an act of professional misconduct for a member of CNO to be found guilty of an offence that is relevant to their suitability to practice, pursuant to s. 51(1)(a) of the Health Professions Procedural Code of the Nursing Act, 1991 (the “Code”).

23. The criminal offences for which the Member was found guilty are directly related to her practice, and constitute professional misconduct.

24. The Member stole from the Patient using a master key provided to her in her capacity as a nurse employed by the Facility. The Member breached the Patient’s trust for her own personal gain, and her conduct threatened the trust the public needs to have in nurses.

CNO STANDARDS

25. 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. Nurses are accountable for conducting themselves in ways that promote respect for the profession.

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

27. CNO’s Professional Standards further provides, in relation to the Relationships standard, that nurses meet the standard by ensuring that his/her personal needs are met outside of the therapeutic nurse-patient relationship.

28. 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 based on trust, respect, empathy, professional intimacy, and requires appropriate use of the power inherent in the care provider’s role.

29. CNO’s TNCR Standard further provides that each nurse must protect patients from harm including by not engaging in activities that could result in monetary, personal or other material benefit, gain or profit for the nurse (other than the appropriate remuneration for nursing care or services), or result in monetary or personal loss for the patient.

30. The Member admits and acknowledges that by entering the Patient’s private room on two separate occasions and stealing a total of $125 from her wallet, she contravened CNO’s Professional Standards and TNCR Standard.

31. If the Member were to testify, she would state that she deeply regrets her actions. The Member took responsibility for her actions in her discussions with the Resident Care Worker and Executive Director of the Facility. The Member personally attended court to plead guilty and received an oral reprimand from the presiding Judge. The Member has since made restitution for the stolen money through the presiding Crown.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

32. The Member admits that she committed an act of professional misconduct as alleged in paragraph 1 of the Notice of Hearing, in that she was found guilty of an offence relevant to her suitability to practise, and in particular, she was found guilty of two counts of theft of a value not exceeding $5000, contrary to s. 334 (b) of the Criminal Code, in the Ontario Court of Justice in Newmarket, Ontario, on June 19, 2019, as described in paragraphs 3 to 18 above.

33. The Member admits that she committed an act of professional misconduct as alleged in paragraphs 2 (a) and (b) of the Notice of Hearing, in that she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 3 to 30 above.

34. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3 (a) and (b) of the Notice of Hearing, in that she misappropriated property from a client, as described in paragraphs 3 to 18 above.

35. The Member admits that she committed an act of professional misconduct as alleged in paragraphs 4 (a) and (b) of the Notice of Hearing, in that she failed to provide the Executive Director of CNO with details of findings of guilt and criminal charges that she was subject to, as described in paragraphs 3 to 30 above.

36. The Member admits that she committed an act of professional misconduct as alleged in paragraphs 5 (a) to (c) of the Notice of Hearing, and in particular, that she engaged in conduct that would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional, as described in paragraphs 3 to 30 above.

Decision

The College bears the onus of proving the allegations in accordance with the standard of proof, that being the balance of probabilities based upon clear, cogent and convincing evidence.

Having considered the evidence and the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1, 2(a), (b), 3(a), (b), 4(a), (b), 5(a), (b), (c)(i) and (ii) of the Notice of Hearing. As to allegations #5(a), (b), (c)(i) and (ii), 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 in the Notice of Hearing is supported by paragraphs 3 to 18 and 32 in the Agreed Statement of Facts. The Member pled guilty to and was found guilty of two counts of theft under $5,000.00 contrary to s. 334(b) of the Criminal Code on June 19, 2019 in the Ontario Court of Justice in Newmarket, Ontario. These findings of guilt are clearly relevant to her suitability to practice as the thefts were committed in her capacity as a nurse on a patient in the facility where she was employed. The Member admitted that she committed the acts of professional misconduct as alleged in paragraph 1 of the Notice of Hearing.

Allegations #2(a) and (b) in the Notice of Hearing are supported by paragraphs 3 to 30 and 33 in the Agreed Statement of Facts. The Member contravened a standard of practice of the profession or failed to meet the standards of practice of the profession when she stole from [the Patient] using a master key provided to her in her capacity as a nurse employed at the Facility. The Member breached [the Patient]'s trust for her own personal gain, and her conduct threatened the trust the public needs to have in nurses when she stole $125.00 over two separate occasions from [the Patient]'s wallet while she was having her dinner in the dining room. The College's Therapeutic Nurse-Client Relationship Standard ("TNCR Standard") states, "Nurses protect the client from harm by not engaging in activities that could result in monetary, personal or other material benefit, gain or profit for the nurse (other than the appropriate remuneration for nursing care or services), or result in monetary or personal loss for the client." Further, the College's Professional Standards state, "nurses are accountable for conducting themselves in ways that promote respect for the profession" and in relation to the Ethics Standard states, "ethical nursing includes acting with integrity, honesty and professionalism in all dealings with the client and other health care team members." The Member’s conduct clearly breached the standards. The Member admitted that she committed the acts of professional misconduct as alleged in paragraphs 2(a) and (b) of the Notice of Hearing.

Allegations #3(a) and (b) in the Notice of Hearing are supported by paragraphs 3 to 18 and 34 in the Agreed Statement of Facts. The Member misappropriated property from [the Patient]'s private residence when she stole money from her wallet on two occasions while [the Patient] was having dinner in the dining room. The Member admitted that she committed the acts of professional misconduct as alleged in paragraphs 3(a) and (b) of the Notice of Hearing.

Allegations #4(a) and (b) in the Notice of Hearing are supported by paragraphs 3 to 30 and 35 in the Agreed Statement of Facts. The Member failed to meet her obligation to provide the Executive Director of the College with details of the criminal charges and findings of guilt against her. The Member admitted and acknowledged that she did not report the criminal charges to the College, nor did she report to the College that she had been found guilty of two counts of theft under $5,000.00, contrary to s. 334(b) of the Criminal Code. She also did not report to the Executive Director of the College that she was also charged with unlawfully entering a dwelling house with the intent to commit an indictable offence therein, contrary to s. 349(1) of the Criminal Code which the Crown later withdrew. The Member admitted that she committed the acts of professional misconduct as alleged in paragraphs 4(a) and (b) of the Notice of Hearing.

With respect to allegations #5(a), (b), (c)(i) and (ii) in the Notice of Hearing, they are supported by paragraphs 3 to 30 and 36 in the Agreed Statement of Facts. The Panel finds that the Member's conduct was unprofessional when she contravened the standards of practice of the profession and was found guilty of offences relevant to her suitability to practise, in particular, she was found guilty of two counts of theft under $5,000.00. The Member's conduct was serious and demonstrated a persistent disregard for her professional obligations. The Member’s failure to maintain her professional obligations in reporting criminal charges and findings of guilt was also unprofessional.

The Panel also finds that the Member's conduct was dishonourable as it demonstrated an element of moral failing, dishonesty and deceit when the Member used her position of power to gain access to [the Patient]'s private residence to steal from her on two occasions, knowing very well the patient was not present. The Member knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional.

Finally, the Panel finds that the Member's conduct was disgraceful as it shames the Member and, by extension, the profession. The Member failed to provide the Executive Director of the College with details of findings of guilt and criminal charges that she was subject to. She gained access to [the Patient]'s private residence by using the master key, which demonstrated a form of misuse of power in the nurse-client relationship. Nurses are expected to meet and demonstrate the Professional Standards in their practice. By stealing money from a vulnerable patient, the Member put shame on herself and the profession as these expectations were breached. The conduct casts 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 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:

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

2. Directing the Executive Director to suspend the Member’s certificate of registration for 4 months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in a practicing class.

3. Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend 2 meetings with a Regulatory Expert (the “Expert”), at her own expense and within 6 months from 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:
  1. the Panel’s Order,
  2. the Notice of Hearing,
  3. the Agreed Statement of Facts,
  4. this Joint Submission on Order, and
  5. if available, a copy of the Panel’s Decision and Reasons;
iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules, decision tools and online participation forms (where applicable):
  1. Code of Conduct,
  2. Professional Standards, and
  3. Therapeutic Nurse-Client Relationship;
iv. Before the first meeting, the Member reviews and completes the CNO’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook;
v. At least 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, online participation forms and Nurses’ Workbook;
vi. The subject of the sessions with the Expert will include:
  1. the acts or omissions for which the Member was found to have committed professional misconduct,
  2. the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,
  3. strategies for preventing the misconduct from recurring,
  4. the publications, questionnaires and modules set out above, and
  5. the development of a learning plan in collaboration with the Expert;
vii. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:
  1. the dates the Member attended the sessions,
  2. that the Expert received the required documents from the Member,
  3. that the Expert reviewed the required documents and subjects with the Member, and
  4. the Expert’s assessment of the Member’s insight into her behaviour;
viii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration;

b) For a period of 18 months from the date the Member returns to the practice of nursing following her suspension, the Member will notify her 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 her employer(s) with a copy of:
  1. the Panel’s Order,
  2. the Notice of Hearing,
  3. the Agreed Statement of Facts,
  4. this Joint Submission on Order, and
  5. a copy of the Panel’s Decision and Reasons, once available;
iii. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to CNO, in which it will confirm:
  1. that they received a copy of the required documents, and
  2. that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

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

4. 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.

College Counsel submitted that the Joint Submission on Order is the product of negotiations between the College and the Member. The Panel must accept the Joint Submission on Order unless doing so would be contrary to the public interest or bring the administration of justice into disrepute. The Member agreed to an oral reprimand, a suspension of her certificate of registration for 4 months, 2 meetings with a Regulatory Expert, 18 months of employer notification, and no independent practice for 18 months. The penalty appropriately reflects the aggravating and mitigating factors in this case. It appropriately meets the goals of penalty and is consistent with prior decisions of the Discipline Committee.

The aggravating factors in this case were:

• The Member's conduct was serious and demonstrated a persistent disregard for her obligations;
• The Member's conduct was dishonest and breached the public trust;
• The Member's conduct was intentional;
• The Member's conduct brought discredit to the profession;
• The Member repeated her conduct.

The mitigating factors in this case were:

• The Member has taken responsibility for her actions and has cooperated with the College throughout this process by entering into an Agreed Statement of Facts and a Joint Submission on Order;
• The Member has no prior disciplinary history with the College.

The goal is to protect the public and enhance public confidence in the College's ability to regulate nurses.

This is achieved through a penalty that addresses specific deterrence, general deterrence, rehabilitation, and remediation.

The proposed penalty provides for general deterrence through the 4-month suspension of the Member's certificate of registration. The suspension sends a strong message to the Member and other members of the profession that theft will not be tolerated. The public can be assured that this type of behaviour is taken seriously by the College and the Discipline Committee.

The proposed penalty provides for specific deterrence through the oral reprimand and the 4-month suspension of the Member's certificate of registration which will deter the Member from engaging in similar misconduct in the future. The oral reprimand will assist the Member in gaining a better understanding of how the profession and the public perceives her actions.

The proposed penalty provides for remediation and rehabilitation through the 2 meetings with the Regulatory Expert, allowing the Member time to reflect on her errors in judgment and to learn from her experience. The Member's review of the Professional Standards, the Therapeutic Nurse-Client Relationship Standard, and the Code of Conduct will also ensure the Member gains knowledge and is able to transfer this knowledge into behaviour. The 18-month employer notification and no independent practice and review of the College's publications will provide public confidence in the ability of the nursing profession to regulate its members. This penalty will help the Member gain insight into her conduct and help ensure she is prepared to return to practice meeting all of the standards of a nurse.

Overall, the public is protected through the 18-month employer notification and the prohibition on independent practice. It sends a clear message to the professional that stealing from a vulnerable, trusting patient will not be tolerated. All three objectives are met in this case.

The proposed penalty falls in the range of similar cases from the Discipline Committee.

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. Lane (Discipline Committee, 2021): In this case, the member entered a patient's room and stole Keg gift cards worth $150.00. The patient resided in a retirement residence and was also vulnerable. There were no criminal charges in this case or findings of guilt. The penalty included an oral reprimand, a three month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert, 18 months of employer notification and no independent practice in the community for 12 months.

In the case before this Panel, the Member repeated her conduct, entering [the Patient]'s residence on 2 occasions when she was out for dinner. The Member was charged criminally and found guilty of two counts of theft under $5,000.00. The Member failed to meet her reporting obligations to the College. The Member's conduct was serious and required a higher degree of penalty to meet the goals of general deterrence, specific deterrence and public protection.

CNO v. Visca (Discipline Committee, 2017): In this case, the member was alleged to have stolen money from 2 separate patients, and it was a contested hearing. The Discipline Committee found that only allegations regarding patient B were proven. The member entered the patient's home using information she obtained while providing care. The member stole between $20.00 to $30.00 from patient B. The member did not cooperate with the College and did not take responsibility for her actions. The penalty included an oral reprimand, a five month suspension of the member’s certificate of registration, two meetings with a Nursing Expert, 24 months of employer notification and no independent practice for 18 months.

College Counsel submitted that a lower suspension is appropriate in this case. The Member has taken responsibility for her conduct, admitted the allegations against her, and cooperated with the College.

College Counsel asked the Panel to accept the proposed order as it meets the goals of penalty and reflects the aggravating and mitigating factors. The penalty is also consistent with prior decisions of the Discipline Committee.

Submissions were made by the Member's Counsel.

The Member's Counsel submitted that she agreed with the submissions of College Counsel. The Member’s Counsel submitted that the Member has taken responsibility for her actions and that the parties have worked closely to negotiate a Joint Submission on Order. The Member’s Counsel submitted that the Joint Submission on Order is on behalf of both parties and that they share the College's position on the proposed penalty. The Member’s Counsel submitted that the proposed penalty does not bring the administration of justice into disrepute, and the Panel should accept it.

The Member’s Counsel further submitted that:

• The Member has no prior disciplinary history with the College;
• The Member has been a practicing nurse for over 12 years;
• The Member has taken responsibility for her actions by entering into an Agreed Statement of Facts and a Joint Submission on Order;
• The Member cooperated with the criminal proceedings related to her conduct, and she attended the court in person to plead guilty to the charges;
• The Member waived her right to require the College prove the facts in her case;
• The Member has saved the College time and expense by not proceeding with a contested hearing;
• The Member saved witnesses the inconvenience of testifying;
• The Member cooperated in the investigation and discipline proceedings;
• The Member has conducted herself professionally and politely throughout the proceedings.

Lastly, the Member's Counsel submitted the following case to the Panel outlining the importance of upholding the Joint Submission on Order.

R. v. Anthony-Cook (Supreme Court of Canada, 2016): The Member’s Counsel submitted that this case sets out the key legal test on the Joint Submission on Order and pointed out that this case was a seminal one that tested the Joint Submission on Order. The Member's Counsel submitted that the Panel must accept the Joint Submission on Order unless doing so would be contrary to the public interest or bring the administration of justice into disrepute. The Member’s Counsel added that a Joint Submission on Order warranting rejection would be so out of the expectations that any person aware of the case and the circumstances would view it as a breakdown of a functioning system. The high threshold test encourages resolutions that both sides find reasonable, and the Joint Submission on Order benefits all parties involved in the regulatory system.

The parties have negotiated and considered the proposed Joint Submission on Order and find it is appropriate with case law.

The Member's Counsel submitted that the proposed penalty is well within the penalty range as set out by the cases presented to the Panel. The Member is remorseful for her actions, and the Member is committed to learning from this experience which her cooperation with the disciplinary process has demonstrated.

Penalty Decision

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

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

2. The Executive Director is directed to suspend the Member’s certificate of registration for 4 months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in a practicing class.

3. The Executive Director is directed to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend 2 meetings with a Regulatory Expert (the “Expert”), at her own expense and within 6 months from 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:
  1. the Panel’s Order,
  2. the Notice of Hearing,
  3. the Agreed Statement of Facts,
  4. this Joint Submission on Order, and
  5. if available, a copy of the Panel’s Decision and Reasons;
iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules, decision tools and online participation forms (where applicable):
  1. Code of Conduct,
  2. Professional Standards, and
  3. Therapeutic Nurse-Client Relationship;
iv. Before the first meeting, the Member reviews and completes the CNO’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook;
v. At least 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, online participation forms and Nurses’ Workbook;
vi. The subject of the sessions with the Expert will include:
  1. the acts or omissions for which the Member was found to have committed professional misconduct,
  2. the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,
  3. strategies for preventing the misconduct from recurring,
  4. the publications, questionnaires and modules set out above, and
  5. the development of a learning plan in collaboration with the Expert;
vii. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:
  1. the dates the Member attended the sessions,
  2. that the Expert received the required documents from the Member,
  3. that the Expert reviewed the required documents and subjects with the Member, and
  4. the Expert’s assessment of the Member’s insight into her behaviour;
viii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration;

b) For a period of 18 months from the date the Member returns to the practice of nursing following her suspension, the Member will notify her 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 her employer(s) with a copy of:
  1. the Panel’s Order,
  2. the Notice of Hearing,
  3. the Agreed Statement of Facts,
  4. this Joint Submission on Order, and
  5. a copy of the Panel’s Decision and Reasons, once available;
iii. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to CNO, in which it will confirm:
  1. that they received a copy of the required documents, and
  2. that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

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

4. 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 met through the oral reprimand and the 4-month suspension of the Member’s certificate of registration. General deterrence is met through the 4-month suspension of the Member’s certificate of registration. Rehabilitation and remediation are met through the 2 meetings with a Regulatory Expert, allowing the Member to reflect on the issues that brought her before the College. The Member will gain insight and improve her practice in the future. Public protection is met through the 18 months of employer notification and no independent practice in the community for 18 months.

The Joint Submission on Order is consistent with past Discipline decisions, and is in a reasonable range of penalties. Although, the Joint Submission on Order falls in the lower range of the scale, the Member took responsibility for her actions, pleaded guilty, paid restitution and worked with the College in its resolutions of this case.

Accordingly, the penalty is in line with what has been ordered in previous cases in similar circumstances.

I, Carly Gilchrist, 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.