College of Nurses of Ontario v. Jenna Watson, 2023 ONCNO 149350

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Grace Fox, NP Chairperson Tim Crowder Public Member Jean-Laurent Domingue, RN Member Shannon Mantha, RN Member Lalitha Poonasamy Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) HAILEY BRUCKNER for ) College of Nurses of Ontario

• and - )

JENNA WATSON ) NO REPRESENTATION for Registration No. AC902360 ) Jenna Watson ) CHRISTOPHER WIRTH ) Independent Legal Counsel ) Heard: November 8, 2023

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 November 8, 2023, 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 names of the patient and the complainant, or any information that could disclose the identities of the patient and the complainant, referred to orally or in any documents presented at the Discipline hearing of Jenna Watson.

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

The College Counsel brought a further motion pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, for an order preventing the public disclosure of Exhibit #5 presented in the Discipline hearing of Jenna Watson, including a ban on the publication or broadcasting of this information.

The Panel considered the submissions of the College and the Member and decided that there be an order preventing the public disclosure of Exhibit #5 presented in the Discipline hearing of Jenna Watson, including a ban on the publication or broadcasting of this information.

The Allegations

The allegations against Jenna Watson (the “Member”) as stated in the Notice of Hearing dated September 26, 2023 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(37) of Ontario Regulation 799/93, in that while registered as a member of the College of Nurses of Ontario 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, and, in particular, you failed to:

a. Complete a Specified Continuing Education or Remediation Program that you were ordered to complete by a decision of the Inquiries, Complaints and Reports Committee (ICRC), dated November 25, 2020.

Member’s Plea

The Member admitted the allegation set out in paragraph #1(a) in the Notice of Hearing. The Panel conducted an oral plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Overview

On November 25, 2020, the College’s Inquiries, Complaints and Reports Committee (“ICRC”) ordered the Member to complete a Specified Continuing Education or Remediation Program (“SCERP”) and, once the SCERP was completed, to appear before the ICRC to be cautioned.

The College alleges that the Member did not complete the SCERP ordered by the ICRC. The Member admitted that she did not complete the SCERP ordered by the ICRC.

Although the Member admitted to the allegations in the Notice of Hearing, the parties did not proceed by way of an Agreed Statement of Facts.

The issues for the Panel to decide are as follows:

(a) Was the Member aware of the ICRC decision, dated November 25, 2019, and the SCERP requirements imposed upon her as specified in the ICRC decision?

(b) Did the Member fail to complete the SCERP?

(c) Did the Member commit professional misconduct by engaging in conduct that would be considered by members of the profession to be unprofessional, dishonourable or disgraceful by failing to complete the SCERP?

College Counsel provided the Panel with the Affidavit of Ashley Yoannou (“Ms. Yoannou”), a Prosecutions Associate with the College, dated November 7, 2023, wherein Ms. Yoannou lists the various communication attempts with the Member and package deliveries to the Member in the months of August and October 2023. On October 30, 2023, the Member confirmed by email that she had received two packages, one through Purolator and one by regular mail. However, she never confirmed whether she would be present at the hearing. As the matter did not proceed on the basis of an Agreed Statement of Facts, the College called a witness to provide evidence for the Panel in support of the allegations of professional misconduct.

The Evidence

The College’s Evidence

The College’s only witness was Mr. Emmet Majchrowski (“Mr. Majchrowski”), a Monitoring Administrator at the College. Mr. Majchrowski has worked as a Monitoring Administrator for the last 3 years. His role includes facilitating agreements, orders and undertakings made between the ICRC and members, and between the Discipline Committee of the College and members. In this role, he sent correspondence to the Member and monitored her responses in this matter.

He testified that he issued the letters and correspondence in Exhibits #6, #8, #11, #13, #14, #15, #16, #20, #21, #22, #24, #25, #27, #28, #29, #31, #32, #34 and #36 to the Member by way of e-mail, OneDrive (a secure document transfer system), and regular mail, as per the College’s usual practice.

The correspondence included:

(a) A letter to the Member sent via OneDrive, dated February 8, 2021, with instructions regarding the Member’s right to appeal the ICRC’s decision within 30-days. The letter also informed the Member that following the appeal period, information regarding the SCERP and the caution ordered by the ICRC would be sent to the Member.

(b) A letter to the Member sent via OneDrive, dated March 10, 2021, with detailed instructions on how to complete the SCERP ordered by the ICRC. The letter also informed the Member that the SCERP must be completed before June 10, 2021, and following such completion, the Member needed to attend her caution.

(c) A letter to the Member sent via OneDrive, dated May 12, 2021, with a reminder that the SCERP ordered by the ICRC must be completed by June 10, 2021. The letter enclosed the detailed instructions to complete the SCERP. The letter also informed the Member about the process to follow should she need an extension to complete the SCERP.

(d) A letter to the Member sent via OneDrive, dated June 14, 2021, with a statement that the Member had not completed the SCERP ordered by the ICRC by the June 10, 2021, due date. The letter asked the Member to send a request to extend the due date of her SCERP by July 5, 2021. The letter also explained the process to request this extension.

(e) An email sent to the Member, dated July 7, 2021, requesting that she provide an update regarding the letter sent to her on June 14, 2021.

(f) A letter to the Member sent via OneDrive, dated July 19, 2021, with a statement that the Member had not sent a request to extend the due date of the SCERP ordered by the ICRC as required by the letter sent to her on June 14, 2021. The letter asked the Member to send a request to extend the due date of her SCERP by August 2, 2021. The letter also explained the process to request this extension.

(g) An email sent to the Member, dated August 10, 2021, requesting that she provide an update regarding the letter sent to her on July 19, 2021.

(h) An email sent to the Member, dated August 27, 2021, in response to a request for extension sent by her on August 27, 2021. The e-mail informed the Member that her request was being reviewed, but that her request was missing a proposed date by which she would complete the SCERP. The email also requested that the Member provide the date of her meeting with a nursing expert, as required by her SCERP.

(i) An e-mail sent to the Member, dated September 16, 2021, requesting that she provide an update regarding the email sent to her on August 27, 2021.

(j) An email sent to the Member, dated October 22, 2021, in follow-up to a voicemail left for the Member on October 4, 2021, requesting that she provide an update on her extension request submitted on August 27, 2021. The email re-iterated that the Member needed to provide the date of her meeting with a nursing expert, as required by her SCERP, for her extension request to be processed.

(k) An e-mail sent to the Member, dated November 29, 2021, in follow-up to a voicemail left for the Member on November 1, 2021. The email re-iterated that the Member needed to provide the date of her meeting with a nursing expert, as required by her SCERP, for her extension request to be processed.

(l) A letter to the Member sent via OneDrive, dated November 30, 2021, with a statement that the Member had not completed the SCERP by the deadline of June 10, 2021. The letter stated the various communication attempts with the Member to extend the due date to complete her SCERP, and her lack of response to such communications. The letter asked the Member to send a request to extend the due date of her SCERP by December 14, 2021. The letter also explained the process to request this extension.

(m) A letter to the Member sent via OneDrive, dated December 17, 2021, with a statement that the Member had not submitted a request to extend the due date of her SCERP as required by the letter sent on November 30, 2021. The letter asked the Member to send a request to extend the due date of her SCERP by December 30, 2021. The letter also explained the process to request this extension.

(n) An email sent to the Member, dated December 17, 2021, explaining to the Member that correspondence being sent by OneDrive may go to the Member’s spam folder. The email provided the Member with the steps to follow to access College correspondence sent via OneDrive. The email also offered to respond if she had not received the OneDrive correspondence, in which case, the documentation would be sent to her via an alternate way.

(o) An email sent to the Member, dated January 6, 2022, in follow-up to the letter sent on December 17, 2021. The e-mail asked the Member to send a response by January 14, 2022.

(p) An email sent to the Member, dated January 14, 2022, in follow-up to an e-mail sent by the Member requesting that documentation be sent via email, instead of OneDrive. The email stated that the College could not send correspondence through e-mail and that the College would arrange to have the correspondence mailed to the Member.

(q) A document package sent to the Member via mail, dated January 17, 2022. The cover letter to the package stated that it contained the letters sent to the Member via OneDrive, dated November 30, 2021, and December 17, 2021. The letter requested that the Member respond by February 4, 2022.

(r) An email sent to the Member, dated February 7, 2022, requesting an update from the correspondence sent via mail on January 17, 2022.

(s) A letter sent to the Member via mail, dated March 4, 2022, with a statement that the Member had not completed the SCERP ordered by the ICRC before the due date of June 10, 2021. The letter listed the various communication attempts made with the Member. The letter also stated that the College was willing to consider a request for an extension to complete the SCERP with a final deadline of March 19, 2022. The letter explained the process to request this extension. The letter also stated that in the event of failure to provide a request for extension with a scheduled date with a Regulatory Expert, the Executive Director of the College may launch an investigation into the Member failing to comply with an order from the ICRC.

Mr. Majchrowski testified that he also communicated with the Member by telephone. Summaries of the telephone calls were included in Exhibits #18, #23 and #26.

The telephone call summaries included:

a) A summary of a telephone call conducted on August 10, 2021, stating that a voicemail was left in follow up to correspondence sent to the Member and requesting that the Member return the phone call.

b) A summary of two telephone calls conducted on October 4, 2021, and on November 1, 2021. The summary of the phone call conducted on October 4, 2021, stated that a voicemail was left in follow up to correspondence sent to the Member on September 16, 2021, and requesting that the Member return the phone call. The summary of the phone call conducted on November 1, 2021, stated that a voicemail was left with the Member requesting that she return a phone call regarding submitting an extension request.

c) A summary of a telephone call conducted on December 17, 2021, stating that a voicemail was left that requested that the Member return the phone call in follow up to several attempts to reach her.

Mr. Majchrowski also testified that he received correspondence from the Member in Exhibits #7, #9, #19 and #30, by email.

The correspondence included:

a) An email sent by the Member, dated February 8, 2021, with a statement that she received notice sent by the College on February 8, 2021.

b) An email sent by the Member, dated March 10, 2021, with a statement that she received the correspondence sent by the College on March 10, 2021.

c) An email sent by the Member, dated August 17, 2021, with a request for an extension for the SCERP ordered by the ICRC.

d) An email sent by the Member, dated January 7, 2022, with a statement indicating that she was unable to open the OneDrive documents and giving the College permission to send the correspondence directly via email.

The Member’s Evidence

The Member did not present any evidence.

Final Submissions

College Counsel’s Submissions on Liability

College Counsel submitted that the Panel heard the Member admit to the allegation and that the Member’s admission was voluntary and informed. College Counsel submitted that the Panel also heard evidence from a witness that the Member failed to comply with a SCERP ordered by the ICRC on November 25, 2020.

College Counsel submitted that the evidence provided is sufficient for the Panel to make a finding of professional misconduct.

College Counsel submitted that the evidence provided by Mr. Majchrowski was clear, cogent and convincing. College Counsel reminded the Panel that it needs to assess the credibility and reliability of the evidence provided by Mr. Majchrowski. College Counsel submitted that the Panel should consider the factors delineated in Re Pitts and Director of Family Benefits Branch of the Ministry of Community & Social Services (1985) 1985 2053 (ON HCJ), 51 O.R. (2d) 302 (Divisional Court) to conduct such an assessment including, the appearance and demeanor of the witness, the extent to which the witness was able to perceive and had an opportunity to observe events being discussed, whether the witness has an interest in the litigation, whether the witness has partisanship, the probability of the story told by the witness, whether the evidence provided by the witness is consistent with previous evidence, and whether there is contradicting evidence.

College Counsel submitted that any discrepancies in evidence does not mean that such evidence should be dismissed. The Panel can accept all, some or none of the evidence presented by a witness. College Counsel submitted that Mr. Majchrowski’s evidence is supported by documentation that he either authored or was involved in creating, processing or receiving.

In relation to allegation #1(a), College Counsel submitted that the Member engaged in professional misconduct when she failed to comply with an order of the ICRC. The Member admitted to the allegation. College Counsel submitted that several documents were provided to the Panel, including due dates, requirements of the SCERP, and consequences of failing to comply with an order of the ICRC. The Panel heard from Mr. Majchrowski that the Member was given multiple opportunities to meet the requirements of the SCERP, and why her request for an extension was lacking. Mr. Majchrowski left the Member four voicemails, and the Member never called him back. As of the date of the hearing, the Member had not completed the SCERP.

College Counsel submitted that by failing to comply with an order of the ICRC, the Member engaged in conduct relevant to the practice of nursing that would generally be considered unprofessional and dishonourable. The Member’s conduct is relevant to the practice of nursing because the Member failed to comply with an order from the ICRC. Members of the profession would find the Member’s conduct to be unprofessional as it demonstrated a serious disregard for her professional obligations to address concerns brought forth by the ICRC. The Member’s conduct is also dishonourable as it includes an element of moral failing in that she knew or ought to have known that her conduct was unprofessional. College Counsel submitted that the Member’s conduct raises concerns about her governability and the College’s ability to meet its function of regulating members of the profession.

College Counsel submitted the following case to the Panel to demonstrate that cases involving similar conduct were found to be unprofessional and dishonourable:

CNO v. Singh (Discipline Committee, 2016): In this case, the member failed to complete a Remediation Program ordered by the ICRC. The panel found that the member’s conduct was unprofessional and dishonourable as it showed a lack of professionalism and a failure to be governed by the College.

In summary, College Counsel submitted that the Member admitted the allegation of professional misconduct and the Panel has sufficient evidence to make such a finding.

Member’s Submissions on Liability

The Member did not make any submissions on liability.

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 an act of professional misconduct as alleged in paragraph #1(a). In particular, 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 accepted the College’s unchallenged evidence and based upon it, was satisfied that the Member was aware of the ICRC’s order requiring her to complete a SCERP and that she failed to do so. The Panel was surprised that the College attempted to communicate with the Member on 23 occasions over a period of 13 months (emails, OneDrive-delivered letters, mail-delivered letters, and telephone calls combined), despite the Member’s ongoing lack of compliance with the ICRC order and her lack of substantive responses to requests for additional information from the College’s monitoring team.

The Member admitted to allegation #1(a) in the Notice of Hearing. The Panel finds that the Member’s conduct in failing to comply with an order from the ICRC to complete a SCERP, was unprofessional and dishonourable. The conduct in question was related to the practice of nursing because the Member failed to comply with an order from the College’s ICRC. The unprofessional nature of the Member’s conduct relates to her failure to comply with an order from the ICRC to complete a SCERP. The dishonourable nature of the Member’s conduct related to her failure to complete a SCERP as ordered by the ICRC despite significant correspondence with the College’s monitoring team. The Member knew or ought to have known that her conduct was unacceptable and well below the standards of a professional.

Compliance with orders from the College’s statutory committees is key to maintaining the College’s ability to self-govern. The Member’s conduct demonstrated a lack of professionalism and an unwillingness to be governed by the College.

Penalty

Penalty Submissions

College Counsel submitted that, in view of the Panel’s findings of professional misconduct, it should make an Order as follows:

1. Requiring JENNA WATSON (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 shall complete the specified continuing education or remediation program (the “SCERP”), and appear before a panel of the Inquiries, Complaints and Reports Committee (the “ICRC”) to be cautioned with respect to the Professional Standards, Therapeutic Nurse-Client Relationship, Documentation, and Code of Conduct, as required by the ICRC’s Decision and Reasons, dated November 25, 2020 (“ICRC Decision”), by April 8, 2024.

b) If the Member does not comply in full with term 3(a) of this Order by April 8, 2024, the Member’s certificate of registration shall be suspended until such time as she completes the SCERP, and appears before a panel of the ICRC to be cautioned with respect to the Professional Standards, Therapeutic Nurse-Client Relationship, Documentation, and Code of Conduct, as required by the ICRC Decision.

c) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) to discuss the findings of professional misconduct made by this Panel against the Member at the Member’s own expense and within 6 months from the date that this Order becomes final. If the Expert determines that a greater number of sessions are required, the Expert will advise CNO regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within 12 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, and

3. 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;

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; and

vii. If the Member does not comply with any 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.

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.

College Counsel’s Submissions on Penalty

College Counsel submitted that the goal of penalty is to protect the public and to ensure the profession can self-regulate. College Counsel submitted that the penalty includes three elements: an oral reprimand, a 4-month suspension of the Member’s certificate of registration, and terms, conditions and limitations on the Member’s certificate of registration, including the need to complete the SCERP ordered by the ICRC and to appear before the ICRC to be cautioned. College Counsel submitted that should the Member not comply with the order of the ICRC before April 8, 2024, her certificate of registration will continue to be suspended until the SCERP is completed and the Member is cautioned by the ICRC. As part of the penalty, the Member is also required to attend a minimum of two meetings with a Regulatory Expert and review the College’s Code of Conduct.

College Counsel submitted that the proposed penalty is appropriate for three reasons: (1) it reflects the aggravating and mitigating factors of the case; (2) it meets the goals of penalty; and (3) it is consistent with prior decisions of the College’s Discipline Committee and of decisions made by other regulatory bodies.

The aggravating factors in this case were:

• The Member’s conduct is serious and intentional in that she willfully refused to comply with an ICRC order despite many extensions and communications;

• The Member’s breach is ongoing;

• The Member’s conduct has brought discredit to the profession; and

• The Member’s conduct demonstrates a serious disregard to the profession and undermines the College’s ability to self-regulate its members.

The mitigating factors in this case were:

• The Member admitted the allegations. However, she did not inform the College that she would be present at the Discipline Committing hearing, nor did she negotiate with the College despite the College’s efforts to contact her.

The proposed penalty provides for general deterrence through an oral reprimand, a lengthy suspension of the Member’s certificate of registration, and the requirement to complete the Remediation Program before resuming the practice of nursing. The proposed penalty sends a message to members of the profession that they cannot disregard orders and decisions issued by the ICRC and that this type of conduct will not be tolerated by the College.

The proposed penalty provides for specific deterrence through an oral reprimand, a 4-month suspension of the Member’s certificate of registration and the requirement to complete the SCERP and be cautioned by the ICRC before resuming the practice of nursing. The oral reprimand will help the Member understand how her conduct affects the profession. The 4-month suspension of the Member’s certificate of registration will demonstrate to the Member that her conduct is not acceptable. The requirement to complete the SCERP and be cautioned by the ICRC, will send a strong signal to the Member that there are consequences when she does not comply with orders from the ICRC.

The proposed penalty provides rehabilitation and remediation through a minimum of 2 meetings with a Regulatory Expert and the review of the Code of Conduct. College Counsel submitted that the proposed penalty is designed to help the Member meet the standards and to comply with the ICRC’s order.

College Counsel submitted that the proposed penalty is required to protect the public, to maintain the College’s ability to self-regulate the profession and is consistent with prior decisions of the College’s Discipline Committee.

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

CNO v. Singh (Discipline Committee, 2016): In this case, the member was not present during the hearing. The member engaged in conduct similar to that of the Member in the case before this Panel in that he failed to complete a Remediation Program ordered by the ICRC. The panel made findings of professional misconduct to the extent that the member engaged in conduct that would be considered as unprofessional and dishonourable by members of the profession. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration and a minimum of two meetings with a Nursing Expert.

College Counsel submitted that the penalty in the Singh case is similar to the one being sought in the case before this Panel. However, the penalty in the Singh case does not include a provision for the suspension to extend beyond 4-months should the member not comply with the ICRC order as the College is requesting in the case before this Panel.

College Counsel submitted that it could not provide the Panel with decisions made by the Discipline Committee to support the provision of extending the suspension beyond the 4-months should the Member not comply with the ICRC order. However, College Counsel submitted that other regulators have ordered such penalties.

College Counsel submitted the following cases to the Panel to demonstrate that Discipline Committees of other Health Profession Regulatory Colleges have ordered ongoing suspensions should members not comply with ICRC orders:

College of Physicians and Surgeons of Ontario (“CPSO”) v. Achiume (Discipline Committee, 2015): In this case, the panel found that the member, a physician, engaged in professional misconduct in that he failed to comply with a decision of the ICRC which ordered him to engage in remediation on medical record keeping. The penalty included an oral reprimand and a suspension of the member’s certificate of registration commencing January 15, 2015, until the later of: (a) February 15, 2015, or (b) proof that the member has completed the Remediation Program ordered by the ICRC. In its decision, the panel emphasized that it is critical for physicians to recognize CPSO’s responsibility to protect the public and its ability to self-regulate the profession. College Counsel submitted that this is also true for the College in the case before this Panel.

CPSO v. Bailey (Discipline Committee, 2020): In this case, the panel found that the member, a physician, engaged in professional misconduct in that he failed to comply with a decision of the ICRC which ordered him to engage in a Remediation Program. The penalty included an oral reprimand, a suspension of the member’s certificate of registration until the later of: (a) a four-month period, or (b) proof that the member has completed the Remediation Program ordered by the ICRC. College Counsel submitted that this suspension is the same as what is being sought in the case before this Panel.

Ontario College of Pharmacists v. Patel (Discipline Committee, 2018): In this case, the member, a pharmacist, failed to comply with a Remediation Program ordered by the ICRC. The penalty included a suspension of the member’s certificate of registration for a period of twelve-months, and included a provision for the suspension to continue until the member complies with the ICRC order.

College Counsel submitted that the College has many Discipline Committee decisions of members failing to participate in the Quality Assurance Program or in remediation actions following their participation in the Quality Assurance Program. In these cases, members were ordered to participate in the College’s next Quality Assurance cycle. College Counsel submitted that this means that the Panel has the authority to order a member to comply with an order made by a statutory committee. College Counsel submitted that CNO v. Bridge (Discipline Committee, 2021) is an example of such an order.

College Counsel submitted that the proposed penalty is necessary to protect the public and asked the Panel to order a penalty consistent with it.

The Member’s Submissions on Penalty

The Member did not make submissions on penalty.

Penalty Decision

The Panel makes the following order as to penalty:

1. JENNA WATSON (the “Member”) is required to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.

2. a) 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.

b) If the Member does not comply in full with term 3(a) of this Order by April 8, 2024, the Member’s certificate of registration shall be suspended until such time as she completes the SCERP, and appears before a panel of the ICRC to be cautioned with respect to the Professional Standards, Therapeutic Nurse-Client Relationship, Documentation, and Code of Conduct, as required by the ICRC Decision.

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

a) The Member shall complete the specified continuing education or remediation program (the “SCERP”), and appear before a panel of the Inquiries, Complaints and Reports Committee (the “ICRC”) to be cautioned with respect to the Professional Standards, Therapeutic Nurse-Client Relationship, Documentation, and Code of Conduct, as required by the ICRC’s Decision and Reasons, dated November 25, 2020 (“ICRC Decision”), by April 8, 2024.

b) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) to discuss the findings of professional misconduct made by this Panel against the Member at the Member’s own expense and within 6 months from the date that this Order becomes final. If the Expert determines that a greater number of sessions are required, the Expert will advise CNO regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within 12 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, and

3. 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;

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; and

vii. If the Member does not comply with any 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.

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. To come to its decision, the Panel reviewed the proposed penalty submitted by the College, the aggravating and mitigating factors in the case, and the numerous Discipline Committee decisions submitted to the Panel by College Counsel.

The penalty ordered provides for general deterrence through the 4-month suspension of the Member’s certificate of registration, or until such time that the Member completes the SCERP and appears before a panel of the ICRC to be cautioned. The proposed penalty sends a message to members of the profession that they cannot disregard orders of the ICRC. The penalty sends the message to members of the profession that the conduct which the Member engaged in will not be tolerated by the College. The penalty provides for specific deterrence through the oral reprimand, the 4-month suspension of the Member’s certificate of registration, and the terms, conditions and limitations on her certificate of registration requiring her to complete the SCERP and to appear before a panel of the ICRC to be cautioned by April 8, 2024, failing which, her certificate of registration will be suspended until she does so. The oral reprimand will help the Member understand how her conduct affects the profession. The 4-month suspension of the Member’s certificate of registration will demonstrate to the Member that her conduct is not acceptable. The requirement to complete the SCERP and be cautioned by the ICRC will send a strong signal to the Member that there are consequences when she does not comply with orders from the ICRC. The proposed penalty provides for rehabilitation and remediation through a minimum of 2 meetings with a Regulatory Expert and the review of the Code of Conduct.

The Panel agreed with the College that a provision had to be included in the penalty to extend the suspension of the Member’s certificate of registration beyond the 4-month period should the Member continue to fail to conform to the ICRC’s order beyond April 8, 2024. The Panel found that this provision was particularly necessary because of the Member’s history of ungovernability to the extent that she was contacted on 23 occasions by the College’s monitoring team and only replied on four occasions with incomplete information.

I, Grace Fox, NP, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.