College of Nurses of Ontario v. Lisa Strickland, 2023 ONCNO 149370

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Ingrid Wiltshire-Stoby, NP Chairperson Mary MacNeil, RN Member Lalitha Poonasamy Public Member Kimberly Wagg, RPN Member

BETWEEN:

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

• and - )

LISA STRICKLAND ) NO REPRESENTATION for Registration No. JF659779 ) Lisa Strickland ) PATRICIA HARPER ) Independent Legal Counsel ) Heard: August 23, 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 August 23, 2023, via videoconference.

As Lisa Strickland (the “Member”) was not present, the hearing recessed for 15 minutes to allow time for the Member to appear. Upon reconvening, the Panel noted that the Member was still not in attendance.

College Counsel provided the Panel with evidence that the Member had been sent the Notice of Hearing on July 19, 2023 by way of an affidavit from Kristen Kellett, Prosecutions Clerk, dated July 31, 2023, confirming that she sent correspondence, which included the Notice of Hearing, on July 19, 2023 to the Member’s last known address on the College Register.

The Panel was satisfied that the Member had received adequate notice of the time, place and purpose of the hearing and of the fact that if she did not attend it, the hearing may proceed in her absence. Accordingly, the Panel decided to proceed with the hearing in the Member’s absence.

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 Member’s family members, or any information that could disclose their identities, referred to orally or in any documents presented at the Discipline hearing of Lisa Strickland.

The Panel considered the submissions of College Counsel and decided that there be an order preventing public disclosure and banning the publication or broadcasting of the names of the Member’s family members, or any information that could disclose their identities, referred to orally or in any documents presented at the Discipline hearing of Lisa Strickland.

The Allegations

The allegations against the Member as stated in the Notice of Hearing dated July 18, 2023 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 relevant to your suitability to practise, as follows:

(a) On February 24, 2020, in the Newfoundland Provincial Court, you were found guilty of two counts of failing to comply with a condition of recognizance, contrary to section 145(3) of the Criminal Code of Canada; and/or

(b) On January 13, 2021, in the Ontario Court of Justice, you were found guilty of criminal negligence causing death, contrary to section 220 of the Criminal Code of Canada;

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(18) of Ontario Regulation 799/93, in that while registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse:

(a) you contravened a term, condition or limitation on your certificate of registration, as provided by section 1.5(1)1.(i) of Ontario Regulation 275/94 of the Nursing Act, 1991, in that you failed to report findings of guilt arising in any jurisdiction relating to any offence to CNO, as follows:

i) On February 24, 2020, you were found guilty by the Newfoundland Provincial Court of two counts of failing to comply with a condition of recognizance, contrary to section 145(3) of the Criminal Code of Canada; and/or

ii) On January 13, 2021, you were found guilty by the Ontario Court of Justice of criminal negligence causing death, contrary to section 220 of the Criminal Code of Canada;

(b) you contravened a term, condition or limitation on your certificate of registration, as provided by section 1.5(1)1.(ii) of Ontario Regulation 275/94 of the Nursing Act, 1991, in that you failed to report charges arising in any jurisdiction relating to any offence to CNO, as follows:

i) on February 6, 2019, in Hamilton, Ontario, you were charged with manslaughter, contrary to section 236 of the Criminal Code of Canada; and/or

ii) on August 5, 2019, in Newfoundland and Labrador, you were charged with three counts of failing to comply with a condition of recognizance, contrary to section 145(3) of the Criminal Code of Canada;

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(19) of Ontario Regulation 799/93, in that while registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse:

(a) you contravened a provision of the Nursing Act, 1991, the Regulated Health Professions Act, 1991, or the regulations under either of those Acts, and in particular, section 85.6.1 of the Health Professions Procedural Code, in that you failed to report a finding of guilt of an offence to CNO, as follows:

i) On February 24, 2020, you were found guilty by the Newfoundland Provincial Court of two counts of failing to comply with a condition of recognizance, contrary to section 145(3) of the Criminal Code of Canada; and/or

ii) On January 13, 2021, you were found guilty by the Ontario Court of Justice of criminal negligence causing death, contrary to section 220 of the Criminal Code of Canada.

(b) you contravened a provision of the Nursing Act, 1991, the Regulated Health Professions Act, 1991, or the regulations under either of those Acts, and in particular, section 85.6.4 of the Health Professions Procedural Code, in that you failed to report that you were charged with an offence to CNO, as follows:

i) on February 6, 2019, in Hamilton, Ontario, you were charged with manslaughter, contrary to section 236 of the Criminal Code of Canada;

ii) on August 5, 2019, in Newfoundland and Labrador, you were charged with three counts of failing to comply with a condition of recognizance, contrary to section 145(3) of the Criminal Code of Canada; 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(37) of Ontario Regulation 799/93, in that, while registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse, 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, in that, you failed to report charges and/or findings of guilt to CNO as follows:

(a) on February 6, 2019, in Hamilton, Ontario, you were charged with manslaughter, contrary to section 236 of the Criminal Code of Canada;

(b) on August 5, 2019, in Newfoundland and Labrador, you were charged with three counts of failing to comply with a condition of recognizance, contrary to section 145(3) of the Criminal Code of Canada;

(c) On February 24, 2020, you were found guilty by the Newfoundland Provincial Court of two counts of failing to comply with a condition of recognizance, contrary to section 145(3) of the Criminal Code of Canada; and/or

(d) On January 13, 2021, you were found guilty by the Ontario Court of Justice of criminal negligence causing death, contrary to section 220 of the Criminal Code of Canada.

Member’s Plea

Given that the Member was not present nor represented, she was deemed to have denied the allegations in the Notice of Hearing. The hearing proceeded on the basis that the College bore the onus of proving the allegations in the Notice of Hearing against the Member.

Overview

The Member initially registered with the College on July 7, 2006 as a Registered Practical Nurse (“RPN”). Her certificate of registration was suspended on February 17, 2022 and on December 22, 2022, the Member resigned. In 2018, the College was contacted by a detective with the Hamilton Police Services who reported that the Member had been charged with manslaughter in the unlawful death of her son. In 2019, the Member was also charged with 3 counts of failing to comply with bail conditions. In 2021, the Member pleaded guilty to criminal negligence causing the death of her son. The Member was also convicted on February 24, 2020 of 2 counts of failure to comply with bail conditions. The Member failed to report the charges and the convictions to the College.

The Panel was asked to consider the following issues:

1. Was the Member found guilty of an offence relevant to her suitability to practice in that she was found guilty of: a) failing to comply with a condition of recognizance; and b) criminal negligence causing death contrary to section 145(3) and section 220 respectively of the Criminal Code of Canada?

2. Did the Member fail to report to the College: a) findings of guilt; and b) charges against her as required in section 1.5(1)1.(i) and section 1.5(1)1.(ii) respectively of Ontario Regulation 275/94 of the Nursing Act, 1991?

3. Did the Member fail to report to the College: a) findings of guilt; and b) charges against her as required in section 85.6.1 and 85.6.4 respectively of the Health Professions Procedural Code?

4. Would members of the profession find the Member’s conduct to be disgraceful, dishonourable or unprofessional?

The Panel found that the College presented clear, cogent and convincing evidence of the Member’s convictions and charges and the Member’s failure to report to the College. The Panel determined that the convictions and charges were relevant to the Member’s suitability to practice and were acts of professional misconduct. The Panel found that the Member’s conduct would be regarded by members of the profession to be disgraceful, dishonourable and unprofessional.

The Evidence

College Counsel tendered 1 witness and submitted 8 exhibits into evidence, including the Public Register Report of the Member and various court documents relating to the charges and convictions.

Witness #1 – Suwetha Sulendrarajah (“Ms. Sulendrarajah”)

Ms. Sulendrarajah has been employed with the College since August 2020. In her current role as an Investigator, Ms. Sulendrarajah receives complaints against members of the College and investigates concerns by securing witness testimony and gathering documents for submission to the Inquiries, Complaints and Reports Committee. Ms. Sulendrarajah became involved in the Member’s case in October 2020 when the initial investigator went on leave. Ms. Sulendrarajah testified about and identified the following documents:

Exhibit #3: The Public Register Report for the Member. Ms. Sulendrarajah testified that the Public Register Report is a document that is up to date, accurate and used during investigations since it confirms if a member is eligible to practice nursing in Ontario. The Public Register Report for the Member indicates that she initially registered with the College on July 7, 2006 as an RPN. Since December 22, 2022, the Member is entered as ‘Resigned’ and therefore not eligible to practice.

Exhibit #4: Certified Copy of Charges against the Member of unlawfully causing the death of the Member’s son and thereby committing manslaughter contrary to the Criminal Code of Canada. On January 13, 2021, the Member pled guilty to criminal negligence causing death. Ms. Sulendrarajah testified that the Member did not report the initial charge of manslaughter nor the conviction of criminal negligence causing death to the College.

Exhibit #5: Recognizance of Bail document from the Ontario Court of Justice outlining terms of the Member’s bail which included that the Member had to reside with her mother in Newfoundland and only leave the residence under certain conditions and limitations.

Exhibit #6: Court Transcript of Proceedings from the Ontario Court of Justice whereby the Member pled guilty to criminal negligence causing the death of her 4-year-old son.

Exhibit #7: Probation Order from the Ontario Court of Justice indicating the offence to which the Member pled guilty, as well as the terms, conditions and limitations of her probation. Ms. Sulendrarajah testified that the Member did not report the offence of criminal negligence causing death to the College.

Exhibit #8: Certified Copy of Information from the Newfoundland and Labrador Court indicating that the Member was charged with 3 counts of failing to comply with her bail conditions. One count was dismissed but the Member was convicted on the second and third charge. Ms. Sulendrarajah testified that the Member did not report the charges nor the convictions to the College but rather, a detective with the Hamilton Police Services reported the charges to the College.

Final Submissions

College Counsel submitted that the Member is presumed to be innocent and that the burden to prove the allegations rests with the College. The College must displace the presumption of innocence with clear, cogent and convincing evidence, on the balance of probabilities, so that the Panel has confidence that the conduct is more than likely to have occurred.

College Counsel reviewed evidence from the Court Transcript whereby the Member pled guilty to criminal negligence causing death based on facts admitted during the criminal proceedings. A toxicology report indicated that the Member’s son died of hydromorphone poisoning. Her son had health issues but was in good health at the time of his death. He did not have a prescription for hydromorphone and there was no evidence to suggest it should have been found in his body. The Member’s health record showed that the Member had been prescribed hydromorphone for various painful health ailments and was physically dependent on hydromorphone. In the month before the incident, the Member had 8 doctor appointments at the medical clinic she attended and received 5 different prescriptions for hydromorphone, totalling 800 tablets. The Member admitted that she was the last person to feed, medicate and administer care to her son in the hours before his death. At trial, the Member could not explain how hydromorphone got into her son’s body. The Member shared with her son a pill crusher used for crushing medications. The theory was that she did not clean the pill crusher carefully enough and this contributed to hydromorphone being ingested by her son. At trial, the Member pled guilty to criminal negligence causing death.

College Counsel submitted that criminal offences are relevant to a member’s suitability to practice when the behaviour is harmful or jeopardizes the public and/or threatens the trust the public needs to have in members of the profession. Such conduct has relevance even if the conduct is not linked to the professional role of a nurse. College Counsel submitted that given the circumstances that her son’s death involved a lethal amount of narcotics, the Member’s conduct and conviction is relevant to her suitability to practise. The Member should have known she needed to be extremely careful with hydromorphone and should have been aware that trace amounts ingested by a 4-year-old could have serious side effects. The Member should have taken all necessary precautions to protect her son but did not. A finding of guilt in this case is therefore relevant to her suitability to practise.

College Counsel submitted the following case to the Panel to demonstrate that criminal charges can be relevant to a member’s suitability to practise:

CNO v. Lane (Discipline Committee, 2016): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member pled guilty to manslaughter in the death of her husband in that she witnessed her husband slipping into distress but did not call 911 or provide medical assistance. The member also admitted that with proper medical attention, her husband could have been resuscitated with a possibility for survival if medical attention had been sought. The panel found the evidence supported findings of professional misconduct as the member’s conduct fell below the standards of the profession and showed a disrespect for life.

With regard to allegation #1(a), a failure to comply with a condition of recognizance, College Counsel submitted that the terms of the Member’s bail were essentially house arrest. The Member could only leave her mother’s house with her mother, who was her surety. The Member was charged with 3 occasions of failing to comply with this condition; 2 of the charges resulted in a conviction and 1 charge was dismissed. College Counsel submitted that the Member’s conduct was relevant to her suitability to practise as it showed that the Member cannot be trusted to comply with a court order. The Member’s conduct also indicates a lack of integrity and inability to be governed.

College Counsel submitted the following case to the Panel to demonstrate a similar finding of misconduct related to a breach of bail:

CNO v. Mancuso (Discipline Committee, 2020): This case involved a number of charges and convictions against a member that related to assault and failure to comply with a condition of recognizance, namely, to abstain from providing any medical examinations unless under direct supervision of a medical doctor or third party with knowledge of the assault offence. The member did not comply with the bail terms when he examined a 19-year-old without a third-party present. The panel found the member guilty of professional misconduct and guilty of offences that were relevant to his suitability to practise. The member made a promise to the court through an order of recognizance but breached the promise, showing a lack of integrity and inability to be trusted. The panel in this case made a finding of professional misconduct.

With regard to allegations #2(a)(i), 2(a)(ii), 2(b)(i) and 2(b)(ii), College Counsel provided the Panel with the relevant statutory obligations contained in Ontario Regulation 275/94 of the Nursing Act, 1991 requiring members to report findings of guilt or charges relating to any offence. College Counsel submitted that Ms. Sulendrarajah testified that the Member reported none of the charges nor the convictions of criminal negligence and breaches of bail terms to the College.

CNO v. Hardy (Discipline Committee, 2016): This is a similar case in which the member was convicted of 10 different offences but failed to report any of the convictions to the College. The panel in this case found the member was guilty of professional misconduct by failing to adhere to the requirements for reporting as set out in legislation.

With regard to allegations #3(a)(i), 3(a)(ii), 3(b)(i) and 3(b)(ii), College Counsel provided the Panel with the relevant statutory obligations contained in the Health Professions Procedural Code section 85.6.1 (obligation to report findings of guilt) and section 85.6.4 (obligation to report charges relating to an offence). College Counsel submitted that Ms. Sulendrarajah testified that the Member had failed to report the convictions of criminal negligence and breaches of bail terms to the College. College Counsel compared this allegation to the Hardy case which had similar misconduct findings related to a failure to report charges and offences.

With regard to allegations #4(a), 4(b), 4(c) and 4(d), College Counsel submitted that the misconduct of the Member needs to be relevant to the practice of nursing for a finding of professional misconduct to be made. College Counsel submitted that the Member's conduct was unprofessional as it showed a serious and persistent disregard for her professional obligations. The Member’s conduct was dishonourable as it demonstrated an element of dishonesty and deceit as she knowingly failed to report her charges and convictions to the College. The Member’s conduct was also disgraceful as it casts doubt on the Member’s moral fitness and ability to discharge the higher obligations of the nursing profession. The Member's conduct is also problematic as it relates to negligence in the death of a 4-year-old as well as a breach of bail conditions. College Counsel submitted that similar to the Mancuso and Hardy cases, the Panel should make findings of disgraceful, dishonourable and unprofessional conduct.

Decision

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

Having considered the evidence and the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1(a), 1(b), 2(a)(i), 2(a)(ii), 2(b)(i), 2(b)(ii), 3(a)(i), 3(a)(ii), 3(b)(i), 3(b)(ii), 4(a), 4(b), 4(c) and 4(d) of the Notice of Hearing. With respect to allegations #4(a), 4(b), 4(c) and 4(d), the Panel finds that the Member’s conduct would reasonably be regarded by members of the profession to be disgraceful, dishonourable and unprofessional.

Reasons for Decision

The Panel reviewed the exhibits and accepted the testimony of Ms. Sulendrarajah, which was supported by court documents. The Panel found the evidence to be clear, cogent, convincing and uncontested. The Panel was satisfied that on the balance of probabilities, the Member committed the acts of professional misconduct as alleged in the Notice of Hearing.

Allegations #1(a) and 1(b) in the Notice of Hearing are supported by the court documents placed into evidence, which are uncontested. The Member was found guilty of failing to comply with bail conditions and also found guilty of criminal negligence causing death. The Member’s conduct showed extremely poor decision-making and judgement when handling narcotics and this resulted in the death of a child. Even though the Member’s conduct did not happen at a nursing workplace, the tragedy of her son’s death casts serious doubt on her moral fitness and her ability to meet the high standards the public expects of nurses. The Member’s offences are also grounds for professional misconduct as set out in the Health Professions Procedural Code.

With regard to allegations #2(a)(i), 2(a)(ii), 2(b)(i), 2(b)(ii), #3(a)(i), 3(a)(ii), 3(b)(i) and 3(b)(ii), the Panel was satisfied that the Member failed to report the charges and convictions to the College as set out in legislation and therefore committed the acts of professional misconduct as alleged.

With regard to allegations #4(a), 4(b), 4(c) and 4(d), the Panel finds that the Member’s conduct of not reporting the charges and convictions to the College was clearly relevant to the practice of nursing. It was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty, moral failing and an inability to be governed by the College. 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 she was negligent to ensure the safety of her son while handling a very powerful narcotic and this negligence resulted in his death. The Member knew or ought to have known how to protect her son from harm and also take accountability with the College once charges were laid and she was convicted of her offences. Her conduct shames the profession and herself. The Member’s conduct casts serious doubt on the Member’s moral fitness and her ability to discharge the higher obligations the public expects of nurses.

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 Lisa Strickland (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 immediately revoke the Member’s certificate of registration.

College Counsel submitted that the goals of penalty are not to punish members but to protect the public and maintain public confidence in the College’s ability to self-regulate its members. This is achieved through specific deterrence and general deterrence, as well as remediation and rehabilitation of members where appropriate. In meeting the goals of penalty, the Panel should consider the member’s circumstances including any aggravating or mitigating factors for each case.

The aggravating factors in this case were:

• The Member’s conduct is extremely serious, i.e. criminal negligence causing death of a 4-year-old child;
• The Member breached bail on two occasions thereby breaching a court order which is demonstrative of someone who lacks governability; and
• The Member’s conduct brought shame on herself and the profession at large.

The mitigating factors in this case were:

• The Member has no prior discipline history with the College.

The proposed penalty provides for general deterrence through the revocation of the Member’s certification of registration, which sends a strong message to all members of the profession that this type of conduct has significant consequences.

The proposed penalty provides for specific deterrence through the oral reprimand and the revocation of the Member’s certificate of registration, which allows the Member to gain insight into her behaviour from members of the profession as well as members of the public and shows the Member that there are serious consequences for this type of conduct.

Overall, the public is protected as the Member’s certificate of registration has been revoked and she will no longer be practicing as a Registered Nurse.

College Counsel submitted that the Member was involved with an extremely tragic situation, but she has chosen not to appear before the Panel to give evidence that she understands the role she played. Her absence leaves the Panel with no evidence that she is willing to remediate or be a responsible and safe practitioner. College Counsel submitted the findings of professional misconduct do not fall under a mandatory order for revocation, although the cases presented to the Panel during the hearing have resulted in revocation. In the Lane case, the member pled guilty via an Agreed Statement of Facts and the penalty was presented as a Joint Submission on Order. In the Hardy and Mancuso cases, the members did not appear before the panel but the panel accepted the proposed revocation put forth by the College. In the Mancuso case, the member had criminal charges related to patient assaults, as well as charges flowing from breaches of bail conditions. The panel concluded that revocation was appropriate considering the significant criminal convictions against the member. The member had also not put forward any evidence of rehabilitation and showed disdain and unwillingness in emails to the College to be regulated by the College. In the Hardy case, the Member had a number of charges and convictions that she failed to report to the College and the panel in that case found the member violated the honesty, integrity and trustworthiness expected of the profession.

College Counsel submitted that the penalty in this case was appropriate given the Member’s refusal to participate in the proceedings and the lack of evidence that she has taken accountability and can be governed by the College. The Member knew about the hearing, she asked for an adjournment for the previously scheduled date and then ignored further communication from the College. Failing to comply with bail conditions is demonstrative of a failure to be governed. Criminal negligence is obviously a serious conviction that would bring the profession into disrepute and also cause the public to be concerned about the ability of the Member to practice safely and according to her professional obligations. College Counsel submitted that the penalty was appropriate considering the Member’s conduct.

Penalty Decision

The Panel accepts the College’s 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 immediately revoke the Member’s certificate of registration.

Reasons for Penalty Decision

The Panel deliberated and agreed with College Counsel that the Member showed an element of ungovernability. She failed to report both her charges and convictions, showing disrespect for her professional obligations. Because nurses work with vulnerable people as part of a self-regulated profession, it is imperative that nurses act with integrity, honesty and trustworthiness. Inherent in this responsibility is that nurses are required to report charges and convictions. Failure to do so threatens the entire profession because public trust in the profession is impacted. Additionally, because the Member chose not to participate in the hearing, the Panel has no evidence that the Member has taken responsibility for her actions and is willing to be held accountable.

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 finds that the penalty satisfies the principles of specific and general deterrence, rehabilitation and remediation, and public protection. Specific deterrence is achieved through the oral reprimand and the revocation of the Member’s certificate of registration. General deterrence is achieved through the revocation of the Member’s certificate of registration, which sends a strong message to other members of the profession that this type of conduct will not be tolerated. Overall, the public is protected as the Member’s certificate of registration has been revoked and she will no longer be practicing as an RPN in Ontario.

Remediation and rehabilitation are not necessary or appropriate in these circumstances given the revocation of the Member’s certificate of registration.

The Panel concluded that the penalty of revocation is reasonable and appropriate given the serious nature of the Member’s conduct.

The penalty is also in line with what has been ordered in previous cases in similar circumstances as demonstrated by the cases submitted and referred to by College Counsel.

I, Mary MacNeil, RN, sign this decision and reasons for the decision on behalf of the Chairperson and members of the Discipline Panel.