College of Nurses of Ontario v. Tsz-Yan Rachel Lam, 2023 ONCNO 149376

PANEL: Mary MacNeil, RN Chairperson Tomoko Fukushima, RN Member Sandra Larmour Public Member Jane Mathews, RN Member

BETWEEN:

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

and -

TSZ-YAN RACHEL LAM Registration No. 14070809 MICHAEL MANDARINO for Tsz-Yan Rachel Lam CHRISTOPHER WIRTH Independent Legal Counsel

Heard: September 19, 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 19, 2023, via videoconference.

The Allegations

The allegations against Tsz-Yan Rachel Lam (the “Member”) as stated in the Notice of Hearing dated July 27, 2023 are as follows:

IT IS ALLEGED THAT:

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 2015 to 2016, you submitted and/or accepted payment for false claims under the Facility’s employee group benefit plan.
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 2015 to 2016, you submitted and/or accepted payment for false claims under the Facility’s employee group benefit plan.
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 2015 to 2016, you submitted and/or accepted payment for false claims under the Facility’s employee group benefit plan.
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 at 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 2015 to 2016, you submitted and/or accepted payment for false claims under the Facility’s employee group benefit plan.
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 2015 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

Tsz-Yan Rachel Lam (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse on October 8, 2014.
At the time of the incidents described below, the Member was employed at Toronto General Hospital in Toronto, Ontario (the “Facility”).

BENEFIT PLAN

The Facility offers its employees a self-insured group insurance policy by which the Facility provides coverage to employees for extended health care, dental, and other insurance benefits (the “Benefit Plan”). SunLife Insurance (“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.
To submit a benefit claim, members of the Benefit Plan were required to 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 or services were received as claimed and that “the information provided for this claim is true and complete”, and then sign.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

In November 2015 and October 2016, the Member submitted two claims totaling $2,325 to the Benefit Plan for compression stockings, custom orthotics, shoe modifications, heel cushions, and a chiropody assessment.
In August 2017, Sun Life alerted the Facility that it had identified higher than expected costs in certain benefits categories and had conducted a review of benefits use at the Facility. Sun Life delisted a number of suppliers that it concluded had facilitated fraudulent claims. One of the service providers investigated by Sun Life was Downtown Wellness and Foot Care (“Downtown Wellness”).
The Facility initiated an internal investigation which included interviews of staff involved, including the Member, who had submitted claims from Downtown Wellness.
On July 3, 2018, the Facility interviewed the Member. During the interview, the Member admitted to having submitted claims for medical products that she did not receive and received other products that were not covered by the Benefit Plan.
The Member paid restitution in the amount of $2,325 and received a five-day suspension without pay.
If the Member were to testify, she would express her remorse for her actions, and would assure the Discipline Committee that this conduct will not be repeated. She would further testify that she made restitution to take accountability and demonstrate the insight she has gained into her obligations as a nurse.

BENEFIT FRAUD CASES

To date, at least 82 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

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.
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.
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

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.
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.
CNO’s Ethics Standard also provides, in relation to truthfulness, that truthfulness means speaking and acting without intending to deceive.
The Member admits and acknowledges that she contravened CNO’s Professional Standards and Ethics Standard.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1 of the Notice of Hearing in that she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 5 to 9 and 11 to 17 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2 of the Notice of Hearing in that she misappropriated property from a workplace, as described in paragraphs 5 to 9 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3 of the Notice of Hearing in that she falsified a record relating to her practice, as described in paragraphs 5 to 9 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraph 4 of the Notice of Hearing in that she signed or issued, in her professional capacity, a document that she knew or ought to have known contained a false or misleading statement, as described in paragraphs 5 to 9 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraph 5 of the Notice of Hearing, and in particular her conduct was dishonourable and unprofessional, as described in paragraphs 5 to 9 and 11 to 17 above.

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 to 9, 11 to 17 and 19 in the Agreed Statement of Facts. The Member admitted that she committed professional misconduct when she submitted two false claims through the Toronto General Hospital’s (the “Facility”) employee group benefit plan (the “Benefit Plan”) in November 2015 and October 2016, for medical products that she did not receive and to receiving other products that were not covered by the Benefit Plan totalling $2,325.00. The Member contravened the College’s Professional Standards and the Ethics Standard when she submitted the false claims to the Benefit Plan. The College’s Professional Standards require nurses to be accountable to the public and responsible for ensuring their practice meets the standards of the profession. Nurses are responsible for conducting themselves in ways that promote respect for the profession. Nurses demonstrate adherence to the Professional Standards through their actions, ensuring their practice is consistent with the College’s standards of practice and guidelines as well as legislation. The College’s Professional Standards provide that leadership requires self-knowledge, respect, trust and integrity. Nurses demonstrate this standard through actions such as role-modelling professional values, beliefs and attributes. The College’s Ethics Standard describes the ethical values which are important to the nursing profession in Ontario including but not limited to maintaining commitments, truthfulness and fairness. Being a member of the nursing profession, brings a certain level of respect and trust expected by the public and when the Member submitted false claims, she breached that trust and acted dishonestly and in so doing, failed to meet the standards.

Allegation #2 in the Notice of Hearing is supported by paragraphs 5 to 9 and 20 in the Agreed Statement of Facts. The Member admitted to misappropriating property from the Facility when she submitted two false claims through the Facility’s Benefit Plan and received products not covered by the Benefit Plan for a monetary value of $2,325.00. Receiving products not covered by the Benefit Plan with respect to false benefit claims constitutes misappropriation of property.

Allegation #3 in the Notice of Hearing is supported by paragraphs 5 to 9 and 21 in the Agreed Statement of Facts. The Member admitted to falsifying a record relating to her practice when she signed and submitted false medical expense claim forms to the Facility’s Benefit Plan. As a Registered Nurse (“RN”) employed at the Facility, the Member 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. The Member admitted to submitting two false claims, collecting a total of $2,325.00. By submitting the false claims, the Member falsified a record relating to her practice. The Panel finds that access to the Benefit Plan was due to her employment status as an RN at the Facility thereby the Member falsified a record relating to her practice.

Allegation #4 in the Notice of Hearing is supported by paragraphs 5 to 9 and 22 in the Agreed Statement of Facts. 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 claim forms on her behalf, she did so in her capacity as an RN employee of the Facility. The Member knew or ought to have known that she was misleading the Facility’s Benefit Plan when she submitted claims for items she did not receive. Accordingly, the facts support the allegation that the Member signed or issued, in her professional capacity, a document that she knew contained false or misleading statements.

Allegation #5 in the Notice of Hearing is supported by paragraphs 5 to 9, 11 to 17 and 23 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in submitting false claims to the Facility’s Benefit Plan was clearly relevant to the practice of nursing. It was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations as the Member failed to meet the College’s Professional Standards and the Ethics Standard. The Member failed to act with honesty and integrity, she did not demonstrate attributes fitting with the profession, her behaviour poorly reflected on the nursing profession.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated elements of dishonesty and deceit when she submitted false claims to the Facility’s Benefit Plan for her own personal financial gain on two separate occasions over a period of almost two years. This was not a single event. The Member’s conduct lacked integrity and truthfulness. Having trust in the nursing profession is necessary as the public rely on nurses to hold themselves to a standard fitting with the profession.

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:

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

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
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):

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:

the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
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:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
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:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
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:

that they received a copy of the required documents, and
that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.
All documents delivered by the Member to CNO, the Expert or the Member’s employer(s) will be delivered by verifiable method, the proof of which the Member will retain.

Penalty Submissions

Submissions were made by College Counsel.

College Counsel asked the Panel to accept the Joint Submission on Order, submitting that it met all the goals of penalty and was the product of negotiations by experienced Counsel.

The aggravating factors in this case were:

The Member’s conduct in submitting two false claims totalling $2,325.00 was not a one-time mistake, it was repeated misconduct;
The Member’s conduct was dishonest and was for her own personal benefit;
The Member’s conduct was at the expense of her employer-funded Benefit Plan;
The Member knew or ought to have known what she was doing was wrong;
The Member took advantage of the trust placed in her by the Facility and the Benefit Plan; and
The Member took advantage and abused the privilege of having an employer-funded Benefit Plan.

The mitigating factors in this case were:

The Member has accepted responsibility for her actions by admitting to the allegations and entering into an Agreed Statement of Facts and a Joint Submission on Order with the College, saving the College time and resources that would otherwise be spent prosecuting this matter and this Panel’s time adjudicating this case;
The Member made restitution;
The Member has expressed her remorse; and
The Member has no prior discipline history with the College.

The proposed penalty provides for specific deterrence through the oral reprimand and the 3-month suspension of the Member’s certificate of registration.

The proposed penalty provides for general deterrence through the 3-month suspension of the Member’s certificate of registration.

The proposed penalty provides for rehabilitation and remediation through the 2 meetings with a Regulatory Expert and review of the Code of Conduct, which will assist the Member with her return to ethical nursing practice and to meet the standards of practice expected of nurses.

Overall, the public is protected through the 12 months of employer notification, which will allow for the Member’s employer to have greater oversight over her practice upon her return to nursing 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. Avena (Discipline Committee, 2023): 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 his employer-funded benefit plan totalling $2,000.00. 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. This penalty is similar to what was proposed in the case before this Panel.

CNO v. Soosaipillai (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 totalling $2,150.00. The member received a five-day unpaid suspension and entered into a payment agreement with the Facility to pay back the $2,150.00. 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. This penalty is also similar to what was proposed in the case before this Panel.

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 totalling $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.

Submissions were made by the Member’s Counsel.

The Member’s Counsel submitted the following mitigating factors:

The Member acknowledged her conduct when raised by the Facility;
The Member accepted responsibility for her actions by admitting the allegations and entering into an Agreed Statement of Facts and a Joint Submission on Order with the College;
The Member is remorseful;
The Member gained insight into her practice;
The Member made restitution which is a sign of accountability and insight; and
The Member has no prior discipline history with the College.

The Member’s Counsel also reviewed the principles concerning Joint Submissions on Order and asked the Panel to accept it.

Penalty Decision

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

The Member is required to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
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.
The Executive Director is directed to impose the following terms, conditions and limitations on the Member’s certificate of registration:

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:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
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):

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:

the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
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:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into the Member’s behaviour;

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:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
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:

that they received a copy of the required documents, and
that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.
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.

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 assist the member in gaining a greater understanding of how her conduct is perceived by members of the profession and members of the public. The 3-month suspension of the Member’s certificate of registration sends a strong signal to the Member that her conduct is unacceptable and will deter her from repeating this conduct in the future thereby protecting the public.

The proposed penalty provides for general deterrence through the 3-month suspension of the Member’s certificate of registration, which sends a signal to other members of the profession that this type of conduct is unacceptable. The Agreed Statement of Facts states at least 82 cases of benefit fraud have been referred to the Discipline Committee. Given the number of cases there is a clear need to send a signal to the profession and the public that this kind of misconduct and dishonesty is unacceptable and will be met with harsh consequences.

Overall, the public is protected as the penalty will assist the Member in gaining additional insight and knowledge into her practice in order to inform her future practice. The public is also protected through the 12 months of employer notification whereby the Member is required to notify her employers of the Panel’s decision. This penalty sends a message to the public about the profession’s ability to self-regulate and to ensure this conduct is not repeated in the Member’s future practice. The public must have confidence that the Member's conduct as it relates to her nursing practice can be trusted, even in the absence of direct patient care.

The penalty sends a strong message to the nursing profession and the public that benefit fraud amounts to professional misconduct and it is taken seriously and will not be tolerated. Nurses are held to a high standard and deceitful, dishonest behaviour reflects negatively on the profession. Nurses are required to act with integrity and honesty to facilitate trust in the profession.

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 as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.