College of Nurses of Ontario v. Pasajol, 2022 ONCNO 135430

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Karen Laforet, RN Chairperson Carly Hourigan Public Member Sandra Larmour Public Member Mary MacNeil, RN Member Donna May, RPN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO

• and - SHELLA PASAJOL Registration No. JF655773

COUNSEL: DOUGLAS MONTGOMERY for College of Nurses of Ontario REBECCA YOUNG for Shella Pasajol CHRISTOPHER WIRTH Independent Legal Counsel

Heard: September 13, 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 September 13, 2022, via videoconference.

The Allegations

The allegations against Shella Pasajol (the “Member”) as stated in the Notice of Hearing dated June 15, 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 working as a Registered Practical Nurse at Baycrest Hospital in Toronto, 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, in or around 2012, you submitted and/or accepted payment for false claims under the Facility’s employee group benefit plan (the “Benefit Plan”).

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(8) of Ontario Regulation 799/93, in that while working as a Registered Practical Nurse at the Facility, you misappropriated property from a client or workplace, and in particular, in or around 2012, you submitted and/or accepted payment for false claims under the Benefit Plan.

3. You 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 working as a Registered Practical Nurse at the Facility, you falsified a record relating to your practice, and in particular, in or around 2012, you submitted and/or accepted payment for false claims under the Benefit Plan.

4. You 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(15) of Ontario Regulation 799/93, in that while working as a Registered Practical Nurse at the Facility, you signed or issued, in your professional capacity, a document that you knew or ought to have known contained a false or misleading statement, and in particular, in or around 2012, you submitted and/or accepted payment for false claims under the Benefit Plan.

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 working as a Registered Practical Nurse 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, in or around 2012, you submitted and/or accepted payment for false claims under the Benefit Plan.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1, 2, 3, 4 and 5 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:

MEMBER

1. Shella Pasajol (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on February 8, 2006.

2. The Member was employed as an RPN at Baycrest Health Sciences (the “Facility”), located in Toronto, Ontario from 2007 to 2019. The Member’s employment at the Facility was terminated in connection with the incidents described below.

BENEFIT PLAN

3. The Facility offers its employees a self-insured group insurance policy by which the Facility provides coverage to employees for extended health care, dental, and other insurance benefits (the “Benefit Plan”). Coughlin & Associates Ltd (“Coughlin”) administers the Benefit Plan on behalf of the Facility. The Facility, however, is the plan sponsor for the Benefit Plan, and therefore funds the cost of claims paid out to employees under the plan. Employees contribute to the cost of the Benefit Plan as set out in their employment agreement and/or collective agreement, and based on their election for individual or family coverage.

4. In order to submit a benefit claim, members of the Benefit Plan would complete a medical expense claim form provided by Coughlin. The medical expense claim form requires certain information, including information on the plan member, any dependents, and the nature of the claim. The plan member must certify “that the information given is true, correct and complete to the best of [their] knowledge”.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

5. Between August and October, 2012, the Member submitted a number of false claims under the Benefit Plan for a variety of medical services and products including orthotics, orthopaedic shoe modifications, an elbow brace and compression stockings. The value of the false claims totalled $5,070.

6. The Facility conducted an internal investigation of claims submitted by employees and identified the Member as having submitted a series of claims that required review.

7. The Facility met with the Member on April 17, 2019. During the meeting, the Member admitted to participating in an ongoing benefits fraud arrangement which operated as a cash-splitting scheme. Through this scheme, the Member would sign fraudulent claim sheets provided by an employee of a service provider called North York Medical for services or products that the Member had not received. When the Member received reimbursement from the Coughlin, she would split the proceeds with the employee from North York Medical.

8. The Facility terminated the Member’s employment on July 10, 2019 as a result of this conduct. The Member did not pay restitution.

9. If the Member were to testify, she would express remorse for her actions, and that she has taken responsibility by admitting to the Facility and to CNO that she made the false claims.

BENEFIT FRAUD CASES

10. To date, a total of 58 benefit fraud cases involving substantially similar schemes as the one identified in this case, involving either cash or products not covered by the benefit plan, have been referred to the Discipline Committee. The dollar amounts of the false claims involved range from under $500 to over $45,000.

CNO STANDARDS

Professional Standards

11. 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.

12. 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 ensuring their practice is consistent with CNO’s standards of practice and guidelines as well as legislation.

13. CNO’s Professional Standards provides, in relation to the leadership standard, that leadership requires self-knowledge (understanding one’s beliefs and values and being aware of how one’s behaviour affects others), respect, trust, integrity, shared vision, learning, participation, good communication techniques and the ability to be a change facilitator. The leadership expectation is not limited to nurses in formal leadership positions and all nurses, regardless of their position, have opportunities for leadership. Nurses demonstrate this standard by actions such as role-modelling professional values, beliefs and attributes.

Ethics

14. CNO’s Ethics Standard describes ethical values that are important to the nursing profession in Ontario including patient well-being, patient choice, privacy and confidentiality, respect for life, maintaining commitments, truthfulness and fairness.

15. CNO’s Ethics Standard provides, in relation to maintaining commitments, that nurses have a commitment to the nursing profession and being a member of the profession brings with it the respect and trust of the public. To continue to deserve this respect, nurses have a duty to uphold the standards of the profession, conduct themselves in a manner that reflects well on the profession, and to participate in and promote the growth of the profession.

16. CNO’s Ethics Standard also provides, in relation to truthfulness, that truthfulness means speaking and acting without intending to deceive.

17. The Member admits and acknowledges that she contravened CNO’s Professional Standards and Ethics Standard.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

18. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1 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 5 to 9 and 11 to 17 above.

19. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2 of the Notice of Hearing in that she misappropriated property from a workplace, as described in paragraphs 5 to 9 above.

20. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3 of the Notice of Hearing in that she falsified a record relating to her practice, as described in paragraphs 5 to 9 above.

21. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 4 of the Notice of Hearing in that she signed or issued, in her professional capacity, a document that she knew or ought to have known contained a false or misleading statement, as described in paragraphs 5 to 9 above.

22. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 5 of the Notice of Hearing, and in particular her conduct was dishonourable and unprofessional, as described in paragraphs 5 to 9 and 11 to 17 above.

Submissions on liability were made by College Counsel.

College Counsel asked the Panel to accept the Agreed Statement of Facts and the Member’s admissions and to make findings of professional misconduct with respect to all allegations. The Member admitted to the allegations as set out in paragraphs 18-22 of the Agreed Statement of Facts, which also include the paragraphs referencing the facts relating to the particular admissions.

With regard to allegation #1, College Counsel submitted that the standards of practice have been placed into evidence in the Agreed Statement of Facts. Evidence of those standards, as well as the Member’s admissions that the standards of practice were breached, is the basis upon which the Panel can make a finding of professional misconduct.

With regard to allegation #5, College Counsel submitted that the Member has agreed that her conduct is relevant to the practice of nursing and would reasonably be regarded by members of the profession to be dishonourable and unprofessional. This is a resolution reached by the parties and is appropriate.

The Member’s conduct is relevant to her nursing practice as it was through the Member’s employment that she had access to a benefit plan and was able to submit the fraudulent claims as part of her employment. Conduct that is unprofessional is conduct that demonstrates a serious disregard to act with honesty and integrity and would be considered a departure from conduct expected of nurses.

The Member’s conduct is also dishonourable as it demonstrates an element of moral failing. The Member knew or ought to have known that her conduct was dishonest. She signed an attestation on the benefit claim form that the information provided was accurate and her actions amounted to a dishonest act when she signed knowing she was submitting a false document. This conduct is not acceptable to the profession.

College Counsel submitted that there was no request for the Member’s conduct to be regarded as disgraceful since her conduct did not rise to that level and the Member did not admit to this.

Submissions on liability were made by the Member’s Counsel.

The Member’s Counsel agreed with College Counsel that conduct of this nature has been found in other similar cases to be relevant to the practice of nursing. The Member’s Counsel agreed that the Member’s conduct constituted unprofessional and dishonourable conduct, but did not rise to the level of disgraceful conduct, which is a term that is used for more serious cases of professional misconduct.

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, 3, 4 and 5 of the Notice of Hearing. As to allegation #5, 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 in the Notice of Hearing is supported by paragraphs 5 to 9 and 11 to 18 in the Agreed Statement of Facts. The Member worked at Baycrest Health Sciences (the “Facility”). The Facility provided extended health care, dental and other insurance benefits (the “Benefit Plan”) to its employees through a plan administered by Coughlin & Associates Ltd (“Coughlin”). As a result of an internal investigation, the Facility met with the Member on April 17, 2019 regarding insurance claims she had submitted. During the meeting, the Member admitted to participating in an ongoing benefits fraud arrangement which operated as a cash-splitting scheme. Through this scheme, the Member would sign fraudulent claim sheets provided by an employee of North York Medical for services or products that the Member had not received. When the Member received reimbursement, she would split the proceeds with the employee from North York Medical. The Member submitted a number of false claims in this manner between August and October 2012. The false claims were for a variety of medical services and products and were valued at $5,070.00.

The College’s Professional Standards provide an overall framework for the practice of nursing. It includes several broad standard statements that guide nursing practice related to accountability, ethics and leadership. In relation to the accountability standard, it states that nurses are accountable to the public and responsible to ensure their conduct meets the standards of the profession, thereby promoting respect for the profession. While the Member took accountability by admitting to the false insurance claims during the Facility investigation, she failed to report the scheme to the Facility between 2012 and 2019. Her misconduct was only uncovered as a result of the Facility’s investigation. Making false claims and a failure to report is evidence of failing to take accountability and a breach of the Professional Standards. With regard to the leadership standard, nurses are required to have self-knowledge and also instill trust, have integrity and role model professional values and attributes. By submitting a number of false claims in order to commit insurance fraud the Member did not show integrity and also violated the trust inherent in the employer-employee relationship. She did not role model professional values and attributes and thereby breached the Professional Standards. The College’s Ethics Standard also requires nurses to be truthful and conduct themselves without intending to deceive. The Member admitted to signing fraudulent claims and also splitting the proceeds with someone else. In this way, the Member’s actions were deliberately deceptive for the purpose of financial gain and a breach of the Ethics Standard. The Panel accepted the Member’s admission that she committed an act of professional misconduct by failing to meet the standards of practice of the profession.

Allegation #2 in the Notice of Hearing is supported by paragraphs 5 to 9 and 19 in the Agreed Statement of Facts. The Member misappropriated property from the Facility by submitting false claims under the Facility’s Benefit Plan between August and October 2012. The false claims were submitted for a variety of medical services and products including orthotics, orthopaedic shoe modifications, an elbow brace and compression stockings. The value of the false insurance claims was $5,070.00. Receiving money with respect to false benefit claims constitutes misappropriation of property.

Allegation #3 in the Notice of Hearing is supported by paragraphs 3, 5 to 9 and 20 in the Agreed Statement of Facts. As a Registered Practical Nurse (“RPN”) employed at the Facility, the Member had access to the Benefit Plan. The Member falsified a record relating to her practice when she submitted false insurance claims whereby she signed fraudulent claim sheets and split the insurance money with an employee from North York Medical. By completing and submitting false claims, the Member falsified a record relating to her practice, as she had access to the Benefit Plan in the context of her employment as an RPN at the Facility.

Allegation #4 in the Notice of Hearing is supported by paragraphs 3, 4, 5 to 9 and 21 in the Agreed Statement of Facts. The Member signed or issued, in her professional capacity, a document that she knew or ought to have known contained a false or misleading statement when she signed a number of false insurance claim forms between August and October 2012. In order to submit a benefit claim, the Member had to complete a medical expense claim form in which she certified that the information submitted was true and correct. The false claims were submitted for a variety of medical services and products including orthotics, orthopaedic shoe modifications, an elbow brace and compression stockings. By admitting that the claims were false and misleading, the Member showed she was aware the document she signed contained a false or misleading statement. As she had access to the Benefit Plan in the context of her employment as an RPN at the Facility, the facts support and the Panel finds, that the Member signed or issued, in her professional capacity, a document that she knew contained a false or misleading statement.

With respect to allegation #5, the Panel finds that the Member’s conduct was unprofessional. This is supported by paragraphs 3 to 9, 11 to 17 and 22 in the Agreed Statement of Facts. Submitting and accepting payments for false claims under the Facility’s Benefit Plan was clearly relevant to the practice of nursing and demonstrated a serious and persistent disregard for her professional obligations. By participating in a benefit fraud arrangement that operated as a cash-splitting scheme, the Member’s conduct breached the Professional Standards and the Ethics Standard and was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations.

The Member’s conduct was also dishonourable. It demonstrated an element of dishonesty and deceit through the submission of a number of false insurance claims between August and October 2012. The Member’s expression of remorse makes it clear that she knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional. The Member only acknowledged accountability for her actions and showed remorse once she was caught during the investigation. The Member’s conduct was dishonourable as it indicated an element of moral failing.

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 the Member’s 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 and decision tools (where applicable):

1. Code of Conduct,

2. Professional Standards, and

3. Ethics;

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:

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;

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:

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 the Member’s 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 the Member’s certificate of registration;

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employer(s) 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 the Member’s 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.

3. All documents delivered by the Member to CNO, the Expert or the Member’s 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 asked the Panel to accept the Joint Submission on Order which was a product of negotiations between the experienced counsel of the parties. College Counsel reminded the Panel that a Joint Submission on Order should be accepted unless it was contrary to the public interest or brought the administration of justice into disrepute, which was not the situation with this case.

The aggravating factors in this case were:

• The Member’s conduct demonstrated serious dishonesty at the expense of the Facility’s Benefit Plan;

• The Member submitted false claims over a number of months which demonstrates, not a single lapse in judgment, but a pattern of misconduct;

• The Member had sufficient time to reconsider her actions but did not;

• The Member took advantage of the trust placed in her by her employer; and

• The Member took advantage of the privilege to have access to an employer funded benefit plan.

The mitigating factors in this case were:

• The Member expressed remorse for her actions;

• The Member took responsibility before her employer and admitted to her misconduct;

• The Member took responsibility with the College by admitting to the allegations and entering into an Agreed Statement of Facts and a Joint Submission on Order with the College; and

• The Member has been practicing for fifteen years and has no prior discipline history with the College.

College Counsel submitted the Joint Submission on Order strikes a balance that meets the objectives of penalty and maintains high professional standards. It also maintains public confidence in the profession.

The proposed penalty provides for specific deterrence through the oral reprimand and the 4-month suspension of the Member’s certificate of registration. Specific deterrence deters this particular Member from repeating this conduct. The oral reprimand will help the Member gain an understanding of how her actions are perceived by the public and the profession. The 4-month suspension of the Member’s certificate of registration will also send a message to the Member that her conduct is unacceptable.

The proposed penalty provides for general deterrence through the 4-month suspension of the Member’s certificate of registration. General deterrence is meant to deter other members from engaging in similar conduct, particularly considering the almost 60 insurance benefit fraud cases referred to the College. There is a strong need to send a message that insurance fraud is unacceptable and will not be tolerated.

The proposed penalty provides for remediation and rehabilitation through the terms, conditions and limitations imposed upon the Member. The 2 meetings with a Regulatory Expert and review of the various College publications will help prepare the Member to return to an ethical practice that will meet the expectations of her practice.

Overall, the public is protected through the 12 months of employer notification that will protect the public by providing an additional layer of employer oversight.

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. Verde-Balayo (Discipline Committee, 2021): This case involved a similar scheme whereby the fraudulent claims were made in the amount of $7,982.50. The member did not make restitution. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification.

CNO v. Gepilano (Discipline Committee, 2022): This case involved similar conduct with similar quantities of benefit misuse. The fraudulent claims were in the amount of $4,695.00 and the member did not make restitution. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification.

CNO v. Cumba (Discipline Committee, 2022): This decision is pending release but the Panel was provided with the signed Order. This case was also a benefit fraud case and involved $4,710.00 in benefit claims. The member did not make restitution. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification.

Submissions were made by the Member’s Counsel.

The Member's Counsel submitted that the cases presented by College Counsel showed that the penalties were similar for similar cases that have come before the Discipline Committee previously. The Joint Submission on Order also meets the goals of penalty.

The Member’s Counsel submitted the following mitigating factors:

• The Member lost her employment of 12 years;

• The Member faced punishment and reputational harm;

• The benefit fraud was widespread and normalized at the Facility and staff were encouraged to join by the ringleader;

• At the time of the benefit fraud, the Member was in a difficult financial place. She had 4 children and her husband was off work;

• The benefit fraud committed by the Member represents a relatively small amount in terms of claims before the Discipline Committee;

• There has been a significant passage of time since the benefit fraud took place and the Member has had no complaints to the College since then;

• The Member has reflected on her conduct and moved forward in her professional practice;

• The Member has taken responsibility by making admissions of professional misconduct and has cooperated with the College; and

• The Member has expressed remorse with her employer. From start to finish during the investigation and College proceedings, the Member has cooperated which is the most significant sign of her remorse.

The Member’s Counsel reminded the Panel that the Joint Submission on Order was reached in agreement with College Counsel and that a high threshold has been set to not accept a Joint Submission on Order.

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 the Member’s 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 and decision tools (where applicable):

1. Code of Conduct,

2. Professional Standards, and

3. Ethics;

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:

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;

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:

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 the Member’s 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 the Member’s certificate of registration;

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employer(s) 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 the Member’s 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.

3. All documents delivered by the Member to CNO, the Expert or the Member’s 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. Specifically, the oral reprimand and the 4-month suspension of the Member’s certificate of registration provides for specific deterrence. The 4-month suspension of the Member’s certificate of registration provides for general deterrence. The 2 meetings with a Regulatory Expert will allow for rehabilitation and remediation and the 12 months of employer notification will ensure the public is protected.

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

I, Karen Laforet, RN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.