College of Nurses of Ontario v. Bartolome, 2023 ONCNO 149372

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Michael Hogard, RPN Chairperson Ahamad Mohammed, RPN Member Lalitha Poonasamy Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) JOSEPH BERGER for ) College of Nurses of Ontario

• and - ) NORA BARTOLOME ) BALRAJ DOSANJH for Registration No. 0508432 ) Nora Bartolome ) KIMBERLEY ISHMAEL ) Independent Legal Counsel ) Heard: September 29, 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 September 29, 2023, via videoconference.

The Allegations

The allegations against Nora Bartolome (the “Member”) as stated in the Notice of Hearing dated March 30, 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(1) of Ontario Regulation 799/93, in that while working as a Registered Nurse at Toronto General 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 2014 to 2016, you submitted and/or accepted payment for false claims under the Facility’s employee group 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 Nurse at Toronto General Hospital in Toronto, Ontario (the “Facility”), you misappropriated property from a client or workplace, and in particular, in or around 2014 to 2016, you submitted and/or accepted payment for false claims under the Facility’s employee group 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 Nurse at Toronto General Hospital in Toronto, Ontario (the “Facility”), you falsified a record relating to your practice, and in particular, in or around 2014 to 2016, you submitted and/or accepted payment for false claims under the Facility’s employee group 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 Nurse Toronto General Hospital in Toronto, Ontario (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 2014 to 2016, you submitted and/or accepted payment for false claims under the Facility’s employee group 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 Nurse at Toronto General Hospital in Toronto, Ontario (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 2014 to 2016, you submitted and/or accepted payment for false claims under the Facility’s employee group 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 admissions were 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. Nora Bartolome (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) in the General Class on March 16, 2005.

2. At the time of the incidents described below, the Member was employed at Toronto General Hospital in Toronto, Ontario (the “Facility”) in the Cardiovascular Intensive Care Unit.

BENEFIT PLAN

3. The Facility offers its employees a self-insured group insurance policy through employees may access coverage for extended health care, dental, and other insurance benefits (the “Benefit Plan”). Sun Life Financial (“Sun Life”) 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.

4. In order to submit a benefit claim, members of the Benefit Plan must complete a medical expense claim form provided by Sun Life. 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 all goods and services being claimed have been received by me and/or my spouse or dependents.” The plan member must go on to “certify that the information in this form is true and complete.”

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

5. Between 2014 and 2016, the Member submitted claims for products and services ostensibly received at a service provider called TheraCore Medical Inc. (“TheraCore”). The Member claimed reimbursement for, amongst other things, compression stockings, custom orthotics, and orthopedic shoe modifications.

6. In 2017, Sun Life alerted the Facility that Sun Life had uncovered what was described as a fraudulent benefit scheme which implicated TheraCore. The Facility initiated its own review of claims submitted by its employees for products or services claimed through TheraCore.

7. The Facility first interviewed the Member with respect to her claims on August 1, 2017. During that meeting, the Member advised the Facility that she had received all the products from TheraCore as claimed. In a subsequent meeting on September 29, 2017, however, the Member admitted that she had not received some of the products as claimed.

8. In particular, the Member admitted that a nursing colleague at the Facility, Edgardo (John) Carta Jr., completed all the paperwork for her claims. Mr. Carta was also the owner of TheraCore. The Member would sign blank claim forms, which were subsequently completed by Mr. Carta. Mr. Carta would then create and issue the invoices to include with the claim forms. The Member admitted that she had not seen the invoices created by Mr. Carta until the Facility’s investigation.

9. For some of the claims, the Member received reimbursement for non-medical products she purchased at TheraCore, which she believed at the time were proper medical products.

10. For other claims, Mr. Carta created false invoices to obtain reimbursement from SunLife. The Member would split the proceeds of these reimbursements with Mr. Carta.

11. The total value of the improper claims amounted to $3,150. The Member paid full restitution to the Facility.

12. If the Member were to testify, she would state that Mr. Carta induced her participation in the fraudulent benefit scheme. She did not understand at the time the some of the claims were improper as she was deceived by Mr. Carta. The Member would further testify that she did not know the products she received from TheraCore were not proper medical products until the Facility informed her of this fact during the investigation. She would express her deep remorse with her involvement in the scheme orchestrated by Mr. Carta. She would assure the Discipline Committee that she has learned from these events and that she would not engage in any such conduct in the future.

13. The Member received a five-day unpaid suspension from the Facility.

BENEFIT FRAUD CASES

14. To date, over 80 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

15. 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.

16. 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.

17. 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

18. 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.

19. 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.

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

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

ADMISSIONS OF PROFESSIONAL MISCONDUCT

22. 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 13 and 15 to 21 above.

23. 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 13 above.

24. 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 13 above.

25. 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 13 above.

26. 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 13 and 15 to 21 above.

Submission on liability were made by College Counsel.

College Counsel asked the Panel to accept the Agreed Statement of Facts, as well as the Member’s admissions to all the allegations as set out in paragraphs 22-26 of the Agreed Statement of Facts and, on the basis of those facts and admissions, make findings of professional misconduct with respect to the allegations in the Notice of Hearing. College Counsel submitted that the Panel has taken the Member’s plea, conducted a verbal plea inquiry, and received a written plea inquiry which confirmed that the plea was voluntary, informed, and made on the advice of experienced Counsel. College Counsel submitted that based on the Agreed Statement of Facts, which specifically describes the facts in relation to the allegations, the Panel has enough evidence to find that the Member committed professional misconduct as set out in all of the allegations in the Notice of Hearing.

College Counsel reviewed allegations #1 and #5 with the Panel. With regard to allegation #1, College Counsel submitted that this allegation is supported by the Agreed Statement of Facts, which contained evidence of the relevant College standards of the profession, as well as the Member's admissions that those standards were breached. College Counsel submitted that it is on this basis that findings can be made with respect to breaching the College's standards of practice.

With regard to allegation #5, College Counsel submitted that the parties agreed that the Member's conduct is relevant to the practice of nursing and is dishonourable and unprofessional. The parties agreed that the conduct was not disgraceful. College Counsel submitted that the Member’s conduct is relevant to the practice of nursing as she submitted the false claims through the Toronto General Hospital's (the “Facility”) employee group benefit plan (the “Benefit Plan”) as part of her nursing employment at the Facility.

College Counsel submitted that the Member's conduct was unprofessional as submitting false claims to the Benefit Plan constitutes a serious and persistent disregard for her professional obligations to act with integrity and trust required of a nurse. College Counsel submitted that the Member's conduct was dishonourable because, whether intentional or not, the underlying misconduct had an element of deceit, and, regardless of intention, the Member is accountable for the claims submitted in her name.

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

The Member’s Counsel agreed with College Counsel's submissions.

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 dishonourable and unprofessional.

Reasons for Decision

The Panel considered the Agreed Statement of Facts and the Member’s plea and finds that this evidence supports findings of professional misconduct as alleged in the Notice of Hearing.

Allegation #1 in the Notice of Hearing is supported by paragraphs 5-13 and 15-22 in the Agreed Statement of Facts. The Member admitted to submitting false claims through the Facility's Benefit Plan between 2014 and 2016 for compression stockings, custom orthotics and orthopedic shoe modifications and to receiving for some of the claims non-medical products that she had purchased at TheraCore Medical Inc., which she believed were proper medical products at the time and for other claims she received money all of which amounted to $3,150.00 in relation to those false claims.

The Member contravened the College's Professional Standards and the Ethics Standard when she submitted false claims to the Benefit Plan. The College's Professional Standards require nurses to be truthful, have integrity and conduct themselves in a way that ensures respect for the nursing profession. The Ethics Standard also requires nurses to be genuine and act without intending to deceive. The Member failed to meet these standards over a period of three years when she submitted false claims to the Facility's Benefit Plan.

Allegation #2 in the Notice of Hearing is supported by paragraphs 5-13 and 23 in the Agreed Statement of Facts. The Member admitted to misappropriating property from the Facility when she submitted false claims through the Facility's Benefit Plan and received non-medical products and money in relation to those false claims. Receiving non-medical products and money with respect to false benefit claims constitutes misappropriation of property.

Allegation #3 in the Notice of Hearing is supported by paragraphs 5-13 and 24 in the Agreed Statement of Facts. The Member admitted to falsifying a record relating to her practice when she signed and submitted false claim forms to the Facility's Benefit Plan and certified that the information in the form was true and complete. The Member, as a Registered Nurse ("RN") employed at the Facility, had access to the Benefit Plan by virtue of her employment as a nursing professional and so her actions were related to her practice as a nurse. Accordingly, the facts support the allegation that the Member falsified a record relating to her practice and did so in the context of her employment as an RN at the Facility.

Allegation #4 in the Notice of Hearing is supported by paragraphs 5-13 and 25 in the Agreed Statement of Facts. The Member admitted to signing or issuing, in her professional capacity, a document that she knew or ought to have known contained a false or misleading statement. When the Member signed the medical expense claim form that required her to certify that “all goods and services being claimed have been received by me and/or my spouse or dependents” and that “the information in this form is true and complete”, she knew or ought to have known that she was signing a document that contained a false or misleading statement and that it was a false claim under the Facility's Benefit Plan. As noted above, the Member had access to the Facility's Benefit Plan by virtue of her employment as a nursing professional. When she signed and submitted the claim forms on her behalf, she did so in her capacity as an RN employee of the Facility. Accordingly, the facts support the allegation that the Member signed or issued, in her professional capacity, a document that she knew contained a false or misleading statement.

Allegation #5 in the Notice of Hearing is supported by paragraphs 5-13, 15-21 and 26 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in submitting false benefit claims was clearly relevant to the practice of nursing. It was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations in breaching the Professional Standards and the Ethics Standard. The Member ignored these standards over multiple years when she submitted false benefit claims and received money and non-medical products that the Benefit Plan did not cover.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit and showed an aspect of moral failing. The Member knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional.

Penalty

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

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 3 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;
   

   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. Inform any employer of the decision prior to commencing or prior to resuming employment in any nursing position;

   ii. 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;

   iii. 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;
   

   iv. 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.
   

4. 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.

The aggravating factors in this case were:

• The Member admitted to submitting false claims totaling $3,150.00 to the Facility's Benefit Plan between 2014 and 2016;
• The Member’s conduct showed a serious and persistent level of dishonesty and deceit for her own personal gain and at the expense of the Facility's Benefit Plan;
• The Member took advantage of the trust placed in her by the Facility and the Benefit Plan administrator; and
• The Member abused her access to the Facility's Benefit Plan, a benefit not all nurses have access to.

The mitigating factors in this case were:

• The Member has expressed remorse, and has taken responsibility by admitting to the allegations and entering into an Agreed Statement of Facts and a Joint Submission on Order with the College;
• The Member has no discipline history with the College; and
• The Member has made restitution with respect to the total amount of the false claims.

College Counsel submitted that the proposed penalty meets the goals of penalty to protect the public, maintain high professional standards within the profession and enhance public confidence in the College's ability to regulate nurses.

The proposed penalty provides for general deterrence through the 3-month suspension of the Member’s certificate of registration, which indicates to other members of the profession that this type of conduct is treated as serious and is unacceptable. General deterrence is particularly significant in this case as the Agreed Statement of Facts indicates that over 80 benefit fraud cases have been referred to the Discipline Committee. The widespread nature of this misconduct requires a clear message that dishonest conduct in this form is unacceptable.

The proposed penalty provides for specific deterrence through the oral reprimand and the 3-month suspension of the Member’s certificate of registration. The oral reprimand will help the Member understand how her actions are perceived by the public and by members of the profession. The 3-month suspension of the Member’s certificate of registration sends a strong signal to the Member that this type of conduct is unacceptable and will help ensure that she does not repeat it.

The proposed penalty provides remediation and rehabilitation through the 2 meetings with a Regulatory Expert and the review of the College's publications. These steps will prepare the Member to return to an ethical practice, which is expected of all nurses.

Overall, the public is protected through the 12 months of employer notification, which will help ensure employer oversight once the Member returns to practice.

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): In this case, the hearing proceeded by a way of an Agreed Statement of Facts and a Partial Joint Submission on Order. The member submitted false benefit claims 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. Nisbet (Discipline Committee, 2022): In this case, the hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member submitted false claims to her employer-funded benefit plan in the amount of $3,025.47. The member made restitution and served a five-day unpaid suspension. The penalty included an oral reprimand, a 3-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification.

CNO v. Im (Discipline Committee, 2023): College Counsel submitted the signed Panel Order for this case as the Decision and Reasons had not yet been released. In this case, the hearing proceeded by a way of an Agreed Statement of Facts and a Joint Submission on Order. The member submitted false benefit claims in the amount of approximately $3,727.00. The member made restitution and received a five-day unpaid suspension. The penalty included an oral reprimand, and the member signed an undertaking to permanently resign as a member of the College.

Submissions were made by the Member’s Counsel.

The Member’s Counsel agreed with College Counsel’s submissions and submitted that the proposed penalty meets the goals of penalty and is within a similar range to cases with similar facts decided by the Discipline Committee. The Member’s Counsel submitted that as part of the mitigating factors, that the Member was herself deceived by another colleague and did not realize that some of the claims were improper. The Member was remorseful, took full responsibility with the College and made full restitution for the false claims. The Member also had no prior discipline history with the College.

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 3 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;
   

   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. Inform any employer of the decision prior to commencing or prior to resuming employment in any nursing position;

   ii. 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;

   iii. 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;
   

   iv. 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.
   

4. 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. Specific deterrence is met through the oral reprimand and the 3-month suspension of the Member’s certificate of registration. General deterrence is met through the 3-month suspension of the Member’s certificate of registration. Rehabilitation and remediation are met through the 2 meetings with a Regulatory Expert and the review of the College's Code of Conduct. The penalty allows the Member to reflect on her misconduct and gain a higher degree of insight into the obligations the public expects from nursing professionals. Public protection is met through the 12 months of employer notification.

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, Michael Hogard, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.