College of Nurses of Ontario v. Andrea Ennis, 2023 ONCNO 149409

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Mary MacNeil, RN Chairperson Neil Hillier, RPN Member Karen Laforet, RN Member Sandra Larmour Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO EMILY LAWRENCE for College of Nurses of Ontario

• and -

ANDREA ENNIS Registration No. AF175069 NO REPRESENTATION for Andrea Ennis

CHRISTOPHER WIRTH Independent Legal Counsel

Heard: January 24, 31 and February 1, 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") commencing on January 24, 2023, via videoconference.

As Andrea Ennis (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 August 30, 2022 by way of an affidavit from Vanessa Green, Prosecutions Clerk, dated January 17, 2023, confirming that Ms. Green sent correspondence, which included the Notice of Hearing, on August 30, 2022 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, 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 publication or broadcasting of the names of the patients and/or the names of the family members of the patients, or any information that could disclose the identities of the patients and/or the identities of the family members of the patients referred to orally or in any documents presented in the Discipline hearing of Andrea Ennis.

The Panel considered the submissions of College Counsel and decided that there be an order preventing public disclosure and banning publication or broadcasting of the names of the patients and/or the names of the family members of the patients, or any information that could disclose the identities of the patients and/or the identities of the family members of the patients referred to orally or in any documents presented in the Discipline hearing of Andrea Ennis.

The Allegations

The allegations against the Member as stated in the Notice of Hearing dated August 29, 2022 are as follows:

IT IS ALLEGED THAT:

1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that, while registered as a Registered Practical Nurse, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, in that:

(a) in or about December 2016 to April 2017, you failed to maintain the boundaries of the therapeutic nurse-patient relationship with Patient [A] and a family member of this patient, [Patient A’s Daughter], including but not limited to:

(i) making disclosures to Patient [A] and/or [Patient A’s Daughter] about your personal life without a professional or clinical purpose;

(ii) accepting and cashing a cheque for $15,000 from [Patient A’s Daughter];

(iii) accepting a gift of a dog bed from [Patient A’s Daughter];

(iv) residing in [Patient A’s Daughter]’s home;

(v) naming [Patient A’s Daughter] as your emergency contact when seeking medical care; and/or

(vi) exchanging communications of a personal nature by text message and/or telephone with [Patient A’s Daughter];

(b) in or about December 2016 to April 2017, you made statements about your personal life to [Patient A’s Daughter] that were untrue;

(c) on or about 2016 and 2017, you disclosed personal health information or other confidential information regarding the identity, treatment and/or diagnosis of Patient [A] and the identity and personal information of Patient [A]’s family members to [Patient B’s Mother] and/or [Patient B’s Father] without consent or authorization;

(d) in or about June 2017 to November 2020, you failed to maintain the boundaries of the therapeutic nurse-patient relationship with Patient [B] and the family members of this patient, [Patient B’s Mother] and [Patient B's Father], including but not limited to:

(i) making disclosures to [Patient B’s Mother] and/or [Patient B’s Father] about your personal life, without a professional or clinical purpose;

(ii) naming [Patient B’s Mother] as your emergency contact when seeking medical care in November 2017;

(iii) moving into the home of [Patient B’s Mother] and [Patient B’s Father] while providing care to Patient [B], and/or continuing to live in the residence after Patient [B]’s death; and/or

(iv) identifying yourself as a member of Patient [B]’s family, including calling [Patient B’s Mother] and [Patient B’s Father] your parents, assuming Patient [B]’s first name as your middle name, and using the family’s last name as your own;

(e) in or about June 2017 to February 2018, you misappropriated liquid Morphine prescribed to Patient [B], and/or failed to safely store this medication and protect the personal health information of Patient [B] on the medication label; and/or

(f) in or about August 2017, you misappropriated Toradol prescribed to [Patient B’s Aunt], a family member of Patient [B]; and/or

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 registered as a Registered Practical Nurse, you misappropriated property from a client or workplace, in that:

(a) in or about June 2017 to February 2018, you misappropriated liquid Morphine prescribed to Patient [B]; and/or

(b) in or about August 2017, you misappropriated Toradol prescribed to [Patient B’s Aunt], a family member of Patient [B]; and/or

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(10) of Ontario Regulation 799/93, in that while employed as a Registered Practical Nurse with Nurse Next Door in Toronto, Ontario, you gave information about a client to a person other than the client or his or her authorized representative except with the consent of the client or his or her authorized representative or as required or allowed by law, in that:

(a) on or about 2016 and 2017, you disclosed personal health information or other confidential information regarding the identity, treatment and/or diagnosis of Patient [A] and the identity and personal information of Patient [A]’s family members to [Patient B’s Mother] and/or [Patient B’s Father] without consent or authorization; 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(18) of Ontario Regulation 799/93, in that from February 22, 2017 to March 22, 2017, while employed as a Registered Practical Nurse with Nurse Next Door in Toronto, Ontario, you contravened a term, condition or limitation on your certificate of registration, and in particular, you practised nursing when your certificate of registration was suspended; and/or

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(19) of Ontario Regulation 799/93, from February 22, 2017 to March 22, 2017 while employed as a Registered Practical Nurse with Nurse Next Door in Toronto, Ontario, in that 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, you contravened subsections 11(1) and 11(5) of the Nursing Act, 1991, by using the title registered practical nurse and/or nurse, or a variation thereof, and by holding yourself out as a person who is qualified to practise nursing in Ontario, when your certificate of registration was suspended; and/or

6. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that, while registered as a Registered Practical Nurse, you engaged in conduct that would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, in that:

(a) in or about December 2016 to April 2017, you failed to maintain the boundaries of the therapeutic nurse-patient relationship with Patient [A] and a family member of this patient, [Patient A’s Daughter], including but not limited to:

(i) making disclosures to Patient [A] and/or [Patient A’s Daughter] about your personal life without a professional or clinical purpose;

(ii) accepting and cashing a cheque for $15,000 from [Patient A’s Daughter];

(iii) accepting a gift of a dog bed from [Patient A’s Daughter];

(iv) residing in [Patient A’s Daughter]’s home;

(v) naming [Patient A’s Daughter] as your emergency contact when seeking medical care; and/or

(vi) exchanging communications of a personal nature by text message and/or telephone with [Patient A’s Daughter];

(b) in or about December 2016 to April 2017, you made statements about your personal life to [Patient A’s Daughter] that were untrue;

(c) on or about 2016 and 2017, you disclosed personal health information or other confidential information regarding the identity, treatment and/or diagnosis of Patient [A] and the identity and personal information of Patient [A]’s family members to [Patient B’s Mother] and/or [Patient B’s Father] without consent or authorization;

(d) in or about June 2017 to November 2020, you failed to maintain the boundaries of the therapeutic nurse-patient relationship with Patient [B] and the family members of this patient, [Patient B’s Mother] and [Patient B’s Father], including but not limited to:

(i) making disclosures to [Patient B’s Mother] and/or [Patient B’s Father] about your personal life, without a professional or clinical purpose;

(ii) naming [Patient B’s Mother] as your emergency contact when seeking medical care in November 2017;

(iii) moving into the home of [Patient B’s Mother] and [Patient B’s Father] while providing care to Patient [B], and/or continuing to live in the residence after Patient [B]’s death; and/or

(iv) identifying yourself as a member of Patient [B’s] family, including calling [Patient B’s Mother] and [Patient B’s Father] your parents, assuming Patient [B]’s first name as your middle name, and using the family’s last name as your own;

(e) in or about June 2017 to February 2018, you misappropriated liquid Morphine prescribed to Patient [B], and/or failed to safely store this medication and protect the personal health information of Patient [B] on the medication label;

(f) in or about August 2017, you misappropriated Toradol prescribed to [Patient B’s Aunt], a family member of Patient [B]; and/or

(g) in or about February 22, 2017 to March 22, 2017, you practised nursing when your certificate of registration was suspended and/or used the title registered practical nurse and/or nurse, or a variation thereof, and held yourself out as a person who is qualified to practise nursing in Ontario, when your certificate of registration was suspended.

Member’s Plea

Given that the Member was not present and was not represented at the hearing, 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 registered with the College as a Registered Practical Nurse ("RPN") on June 4, 2016. She was employed as a Caregiver/RPN in a casual capacity on August 10, 2016 with Nurse Next Door Home Care Services ("Nurse Next Door"). On November 16, 2016 she accepted the position of Client Services Manager for the same company. The position of Client Services Manager is responsible for scheduling nurses' home and shift visits. The Member took advantage of her position and started to schedule nursing shifts for herself with Patient [A], a palliative patient. She provided care for Patient [A] from November 2016 until she died in March 2017. In the last days of Patient [A]'s life, the Member stayed at the patient's home. The Member became emotionally close to Patient [A], and her daughter, [ ] (hereinafter referred to as "the daughter" or "[Patient A's daughter]"), signing emails with "love to you both". The Member shared personal information that included false stories about her son's illness and following Patient [A]'s death, she stayed at the daughter's home, listed her as the Member's emergency contact when at the emergency department and received $15,000.00 and a dog bed from the daughter.

The Member practiced nursing while her certificate of registration was suspended from February 22, 2017 – March 22, 2017.

In June 2017, the Member was hired privately by a family to provide care for their disabled daughter, Patient [B]. The Member became emotionally close to the mother, [Patient B's Mother], sharing personal information regarding past abuse. This shared experience bonded the Member with [Patient B's Mother] and the Member was accepted into the family, identified herself as a member of the family, including being part of the family's Christmas photo, assumed Patient [B]'s first name as her middle name and used the family's last name as her own. The Member moved into the family residence during her position as nurse and continued to live in the residence after Patient [B]'s death.

From June 2017 to February 2018, the Member misappropriated medication and failed to store the medication to protect personal health information.

The Member engaged in deceit and subterfuge with these two families who were at their most vulnerable, intentionally told lies, intentionally took the focus away from the patients for her own gain and caused significant harm to the surviving family members.

The Panel heard evidence from six fact witnesses and one expert witness and received 33 exhibits to consider. Having considered the evidence and the onus and standard of proof, the Panel found that the Member committed acts of professional misconduct as alleged in paragraphs #1(a)(i), (ii), (iii), (iv), (v), #1(b), #1(d)(i), (ii), (iii), (iv), #1(e), #1(f), #2(a), #2(b), #4, #5, #6(a)(i), (ii), (iii), (iv), (v), #6(b), #6(d)(i), (ii), (iii), (iv), #6(e), #6(f) and #6(g) in the Notice of Hearing. With regard to allegations #6(a)(i), (ii), (iii), (iv), (v), #6(b), #6(d)(i), (ii), (iii), (iv), #6(e), #6(f) and #6(g), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be disgraceful, dishonourable, and unprofessional.

The Panel did not make findings of professional misconduct as alleged in paragraphs #1(a)(vi), #1(c), #3(a) and #6(a)(vi) and #6(c) and therefore dismissed these allegations.

The Evidence

Witness #1 – Laura Harris ("Ms. Harris")

Ms. Harris was co-owner of Nurse Next Door from 2016 to 2019. The company provides nursing services, home care and personal support to people in a home setting. Ms. Harris testified that the Member worked as a Caregiver/RPN and a Client Services Manager for the company as shown at Exhibits #4 and #5. Ms. Harris testified that the role of Client Services Manager consisted of answering phone calls, scheduling the appropriate caregiver and following up to ensure caregivers arrived when scheduled. Ms. Harris testified that the Member worked 12 hours per day, 3 days per week in that role. Ms. Harris testified that her partner allowed the Member to book nursing shifts in addition to her Client Services Manager role to make extra money and that she first became aware of this arrangement in February 2017.

Ms. Harris testified that the Member resigned from her role as Client Services Manager and chose to stay on as a nurse on February 13, 2017 (Exhibit #6) as the company determined she could not continue to do both jobs. She further testified that the Member continued to work as a nurse to care for Patient [A].

Ms. Harris testified that she and the other owner of Nurse Next Door were concerned about the Member's professional boundaries based on, the Member taking other nurse's shifts when she was Client Services Manager so she could care for Patient [A], the sharing of too many personal details between the family and the Member, and the Member working longer hours doing both assignments and interjecting more into the care than was deemed professional.

Ms. Harris testified that Nurse Next Door management intended to remove the Member from the care of Patient [A] on the premise of her being needed for an assignment elsewhere. However, they suspected that the Member mentioned something to [Patient A]'s daughter because when they approached the daughter, she refused. Ms. Harris testified that since Patient [A] was palliative, they chose not to disrupt Patient [A]'s care.

Ms. Harris testified that she saw that the Member attended Patient [A]'s funeral and sat in the front row with the family, as opposed to the other nurses who cared for Patient [A]. The Member gave a eulogy and stood in the receiving line beside the family members.

Ms. Harris testified that approximately six months after the Member left, the company received a call from someone identifying himself as the Member's father. The caller stated that the Member had died and he needed a T4 record. Ms. Harris testified that the company did not provide one.

Ms. Harris testified that about six months after Patient [A] died, her granddaughter called to let the office know she was concerned that her mother had lent money to the Member for her son's life-saving surgery. Ms. Harris further testified that the company received a call from the Member's friend who was adopting the Member's son and who asked the company to verify the Member's employment. Ms. Harris testified that the caller was informed that the Member was not employed and would not be considered for reemployment.

Ms. Harris testified that the company was not aware that the Member's certificate of registration was suspended in February 2017. Ms. Harris further testified that the Member was responsible for creating the schedule and that nurses had to log in via phone to clock in and out of each shift. Exhibits #7, #8, #9 #10 and #11 show that the Member was scheduled for shifts on February 22, 23, 25, 28, March 1, 2, 3, 2017 and received payment as an RPN for these scheduled shifts.

College Counsel asked Ms. Harris if Nurse Next Door had a policy for accepting gifts or direct payment. Ms. Harris testified that the company policy was that staff were not permitted to accept gifts or gratuities of any kind. Ms. Harris further testified that Nurse Next Door often approved gifts of less than $50.00 as long as they were notified.

College Counsel asked Ms. Harris if the Member had had a conversation with them regarding gifts from Patient [A]'s family. Ms. Harris testified that she was not aware of any conversation.

Witness #2 – David Jaciuk ("Mr. Jaciuk")

Mr. Jaciuk is married and has three children, including the Member's son. Mr. Jaciuk is an investigator and works with the serious and organized crime division of a police force. His wife is a speech pathologist. Mr. Jaciuk confirmed that he was not testifying in his official capacity.

Mr. Jaciuk testified that he met the Member in 2009 after being introduced to her by his wife, who was then his girlfriend, and who was offering the Member support. He testified that the Member was in her late teens at that time and his wife and the Member were living together in Ajax.

Mr. Jaciuk testified that the Member stated she was dealing with sex-based concerns regarding her biological parents and that is why they were not a part of her life. Mr. Jaciuk further testified that he believed those concerns were false. Mr. Jaciuk testified that the Member's son was born in February 2013.

Mr. Jaciuk testified that he and his wife were married in 2013. Mr. Jaciuk testified that the Member went to nursing school and graduated in the spring of 2016. Mr. Jaciuk testified that the Member and her son started to reside with them in 2013-2014. Ms. Jaciuk further testified that the Member's son stayed with them full-time from 2016–2017 and the Member lived with them fully by 2017, giving up her apartment.

College Counsel asked Mr. Jaciuk if the Member talked about her patients. Mr. Jaciuk testified that the Member shared quite a few details about her patients including details regarding Patient [A], her cancer, her first and last name, and the names of her family members and dog.

College Counsel asked Mr. Jaciuk what the Member's schedule was like from January to March 2017. Mr. Jaciuk testified that the Member stated her schedule was chaotic, that she was doing a lot of 24-hour care because nurses were cancelling or were sick and she was needed to cover shifts, keeping her away for an extended period. Mr. Jaciuk testified that he and his wife cared for the Member's son during that time.

College Counsel asked Mr. Jaciuk if the Member's son had any health issues. Mr. Jaciuk testified that the son was in great health. Mr. Jaciuk was asked to review a photo that the Member sent to Patient [A]'s daughter regarding her son's surgery (Exhibit #23). Mr. Jaciuk testified that he did not believe that was her son in the photo.

College Counsel asked Mr. Jaciuk if he had any discussions with the Member regarding her accepting gifts. Mr. Jaciuk testified that on the day of Patient [A]'s funeral, the Member informed him that she had received a card with a check from the daughter for $15,000.00 given to her for her exemplary care while the other nurses were receiving $5,000.00 each. Mr. Jaciuk testified that he challenged her not to lie and that if she received this due to fraudulent means he would be the first witness against her. Mr. Jaciuk testified that he was present when the Member deposited the money into her bank account.

Mr. Jaciuk testified that the Member used part of the $15,000.00 she received to attend a destination wedding in Trinidad and to pay off debts. When asked by College Counsel if the Member received any other gifts, Mr. Jaciuk testified that the Member showed up at his residence with a dog bed she confirmed belonged to Patient [A]'s dog. He took a photo of the dog bed (Exhibit #12). College Counsel asked if the Member had a dog and Mr. Jaciuk testified that she did not.

Mr. Jaciuk testified that the Member stayed at their place a lot after Patient [A] died and that she eventually found a job in late June-July 2017, through his church acquaintance, providing care for Patient [B], a disabled child. Mr. Jaciuk testified that the Member's shifts were Monday – Friday day shifts and she was to help Patient [B]'s mother take care of her daughter. The witness further testified that he and his wife had a discussion with the Member in which they indicated they were expecting her to be available in the fall of 2017 to pick her son up from the bus after school.

Mr. Jaciuk testified that during the summer of 2017 they observed that the more involved the Member became with Patient [B] and the family, the less time she stayed at the house or spent time with her son. Mr. Jaciuk confirmed that in August 2017, the Member took her son with Patient [B]'s family to New York. However, after that she spent less time with her son to the point where her son and Mr. Jaciuk's family would not see her for weeks.

Mr. Jaciuk testified that shortly after the New York trip, Patient [B]'s condition worsened and she was admitted to The Hospital for Sick Children. Mr. Jaciuk testified that they did not see the Member for weeks because the Member stated that she was needed at the hospital. Mr. Jaciuk testified that the Member stayed with the family at Ronald McDonald house since it was easier to stay with the family, be part of the hospital team and part of the family.

Mr. Jaciuk testified that they believed the Member stayed with Patient [B]'s family at Christmas, that they did not see her during the holiday and that they rarely saw the Member between Christmas and Patient [B]'s death in February 2018.

Mr. Jaciuk testified that the Member did not return home after Patient [B]'s death. She stayed with the family to grieve along with the mother even though he and his wife told the Member that she should not be there. Mr. Jaciuk further testified that shortly after the Member had started providing care to Patient [B], she was "quasi-adopted" by the family as a fourth daughter and the Member was in the family Christmas photo.

Mr. Jaciuk testified that in February-March 2018, Durham Child Services ("DCS") conducted an investigation based on a complaint filed by Patient [B]'s family members regarding the Member's mental health. The Member informed Patient [B]'s family that she was in witness protection and was part of an RCMP investigative team, that the Jaciuks had put her in a cage, and she had been raped and that her son was being held against his will. Mr. Jaciuk testified that the Member's son was with his family. [ ].

College Counsel asked Mr. Jaciuk if there were any ramifications for him and his wife professionally as a result of the report to DCS. Mr. Jaciuk testified that the Member's "fictitious and disgusting lies" resulted in him and his wife being investigated. Mr. Jaciuk testified that he was investigated by his commanding officer and even though he was cleared, word got around and he faced some serious repercussions professionally. Mr. Jaciuk further testified that his wife, a member of the College of Audiologists and Speech-Language Pathologists, was required to self-report and this affected her professional integrity.

College Counsel inquired if there were any concerns regarding the Member's protection of personal health information. Mr. Jaciuk testified that the Member left patient charts in her car and divulged information regarding Patient [A]'s medical condition and the names of Patient [A] and her family.

College Counsel asked if there were any concerns regarding the Member's storage of medication. Mr. Jaciuk testified that one night when the Member returned to their home, she was clearing out her bag and pulled out a brown bottle. Mr. Jaciuk testified that the Member stated, "I forgot I had this, it needs to be refrigerated and I'll bring it back next time I go". Mr. Jaciuk testified that the bottle was labelled with Patient [B]'s name, medication (morphine sulfate) and dosage. Mr. Jaciuk testified that the medication stayed in the refrigerator until he disposed of it months later. Further, he testified that when they were clearing out the Member's room, they found an empty bottle of Toradol with the name on the label that the Panel notes matched the name of Patient [B]'s family member.

Witness #3 - [Patient B's Father]

[ ] is the father of Patient [B]. He works in IT and separated from his wife [Patient B's Mother] in 2019. [ ]. Patient [B] was born in [ ] and died in February 2018.

[Patient B's Father] described Patient [B]'s health. Patient [B] had Aicardi syndrome diagnosed 6 weeks post birth and her symptoms included: seizures that occurred more than 12 times per day; lowered immune system; she could not walk, talk or swallow; required suctioning and feedings and had frequent gastric reflux. [Patient B's Father] testified that she required 24-hour care since diagnosis and they had many caregivers in the home almost every day.

College Counsel asked [Patient B's Father] if he was familiar with the Member. [Patient B's Father] testified that he met the Member when she was being interviewed by his ex-wife for a summer day-time position caring for Patient [B]. [Patient B's Father] further testified that he was unaware of the contract or how the Member was paid as his ex-wife dealt with those details. [Patient B's Father] also stated that his ex-wife was a paediatric nurse but was not working at the time the Member was hired.

[Patient B's Father] testified that Patient [B] had been hospitalized 3 times: one time for approximately 7 weeks in late September 2017; the second time for a few days due to pneumonia; and the third time in December 2017 until early January 2018—roughly 3 weeks before she died.

[Patient B's Father] testified that by August 2017, the Member and [Patient B's Mother] had developed a close bond based on [Patient B's Mother]'s childhood experience with an abusive father and the Member stating that she had been trafficked as a child. [Patient B's Father] testified that he observed the Member staying at the house after her shifts ended, sometimes into the night even though they were not paying her past 4:00 pm.

College Counsel asked [Patient B's Father] to describe what happened on the August trip. [Patient B's Father] testified that his ex-wife's parents and sister joined them at a set of cabins in upstate New York. The Member was asked to join them to help with Patient [B]'s care during the day for family events and to take turns for night shifts. [Patient B's Father] testified that the Member was paid for the week, drove to the cabin in her own car since there was no room in his car, and brought her son.

College Counsel inquired if there were any changes with the Member's behaviour following the trip. [Patient B's Father] testified that by the end of August into September, the Member was constantly at their house, spending dinners, evenings and sometimes staying overnight. [Patient B's Father] testified that a night nurse would still be present when the Member stayed overnight.

College Counsel asked [Patient B's Father] if the Member made any disclosures following the trip. [Patient B's Father] testified that the Member disclosed some very detailed information during the trip that included: her parents were part of a wealthy family who sex-trafficked her until she was 9 at which time the RCMP was involved. She said that she had seen murders and was now involved with the RCMP due to her insights with sex-trafficking. [Patient B's Father] further testified that she had a close relationship with her Ontario child lawyer who was present when she was apprehended from her parents.

College Counsel asked [Patient B's Father] if either he or his ex-wife had been in contact with the RCMP or the child lawyer. [Patient B's Father] testified that neither he nor his ex-wife met the RCMP or the lawyer. Communication from the RCMP or the lawyer was always by text: with him occasionally and with his ex-wife almost daily. When he asked to meet either one, the Member informed him that she needed to initiate the contact in order to not jeopardize the case.

College Counsel asked [Patient B's Father] what the Member's role was when Patient [B] was hospitalized. [Patient B's Father] testified that during the first hospitalization, the Member helped to watch Patient [B]. Due to her constant seizures, she had to be watched all the time. [Patient B's Father] testified that the Member occasionally stayed at Ronald McDonald house but not all the time. [Patient B's Father] testified that for Patient [B]'s second hospitalization, the Member stayed at Ronald McDonald house the whole time.

College Counsel asked [Patient B's Father] to describe the Member's health into September and if there was any impact on the family. [Patient B's Father] testified that the Member started having flashbacks that presented as stiffness, eyes flickering or closed and that these episodes would last a few minutes to a few hours. [Patient B's Father] testified that [Patient B's Mother] would attempt to get her out of it by blowing on her eyelids, rubbing the Member's sternum and when the episodes became more frequent [Patient B's Mother] slept with the Member. [Patient B's Father] further testified that the Member would share information from the RCMP or child lawyer that arrests were going to happen soon, or about safety concerns for her son, all via text messages with [Patient B's Mother]. [Patient B's Father] testified that as soon as the flashbacks started, the family stopped paying the Member and she stopped nursing. [Patient B's Father] further testified that he spent more time with Patient [B] since [Patient B's Mother] transferred most of her attention to the Member.

[Patient B's Father] testified that due to the trauma the family thought she had gone through, by September she became like a daughter to them calling him 'Dad', [Patient B's Mother] 'Mom' and their daughters, sisters and she was at the house 100% of the time. [Patient B's Father] testified that in February 2018 when Patient [B] was dying she was surrounded by her immediate family and this included the Member.

College Counsel asked [Patient B's Father] how the Member's health was prior to Patient [B]'s death. [Patient B's Father] testified that the Member developed cold (flu) symptoms and eventually [Patient B's Mother] took the Member to the hospital a few days after Patient [B]'s death. [Patient B's Father] testified that at the time the family was planning a celebration of life and dealing with grief and that taking the Member to the hospital was a handful. [Patient B's Father] testified that [Patient B's Mother]'s family noticed the amount of time being spent with the Member rather than their children and attempted to speak to them shortly before Patient [B] died. [Patient B's Father] testified that at the time, they refused to listen.

College Counsel asked [Patient B's Father] if he knew when the Member changed her name. [Patient B's Father] testified that she started using the name [ ] sometime in January 2018 and had told them her original name was [ ] and he thought she was using a short form (Exhibit #14).

College Counsel asked [Patient B's Father] to describe the role the Member played in the family. [Patient B's Father] testified that the Member's behaviours and illness took the family, especially [Patient B's Mother] away from Patient [B]. The Member's health symptoms began to increase and require more hospital visits. [Patient B's Father] testified that the Member was taken to Markham Stouffville Hospital where they diagnosed her as having pseudo-seizures. [Patient B's Father] testified that he did not often go because he felt awkward as the Member was constantly looking for pain medication.

College Counsel asked [Patient B's Father] if he noted any trends in the Member's illness and if they corresponded in time. [Patient B's Father] testified that when looking back, the Member's ability to manipulate and say something to illicit a reaction had a direct impact on his ex-wife and his [ ]daughters. [Patient B's Father] further testified that when his daughters were ill, the Member's health often deteriorated as well.

[Patient B's Father] testified that his ex-wife's sister and mother, as well as Mr. Jaciuk asked for a meeting that resulted in calling the Children's Aid Society due to their concerns for the [children's] safety. [Patient B's Father] testified that at that time in April 2018, his concern was for his marriage, however, he did start to question the Member's behaviour.

[Patient B's Father] testified that before Patient [B] passed away he believed what the Member told him. After the situation with his mother-in-law and the CAS investigation, he began to see the manipulation. [Patient B's Father] testified that the stories the Member told were so farfetched that he began to question if anything was real. [Patient B's Father] testified that the Member continued to live with the family in 2018–2019. [Patient B's Father] testified that prior to Patient [B]'s death, medications went missing: Ativan, cannabis, his mother's sleeping pills and the Member's medications, necessitating a trip to the hospital for more. He testified that he wanted to install cameras, however, [Patient B's Mother] refused because the Member stated cameras were a trigger. [Patient B's Father] testified that he installed a lockbox instead.

College Counsel asked [Patient B's Father] to describe the impact the Member has had on his family. [Patient B's Father] testified that he separated from [Patient B's Mother] in and around October 2019. [Patient B's Father] testified that he has full custody of his daughters and [Patient B's Mother] has supervised visits as the Member continued to live with his ex-wife. [Patient B's Father] testified that one of his [ ]daughters is receiving therapy and continues to struggle with how the Member 'duped' the family. [Patient B's Father] testified that the other [daughter] is dealing with anxiety disorder and anger management. [Patient B's Father] testified that everything the Member said regarding her childhood and working with the RCMP was all fiction, her physical symptoms would increase whenever someone in the family needed support, especially from [Patient B's Mother] and she took advantage of the family at their most vulnerable time.

Witness #4 – [Patient B's Aunt]

[ ] is [Patient B's Mother]'s sister, a teacher and in 2017 went by the name of [ ]. [Patient B's Aunt] testified that she met the Member in August 2017 at the New York family vacation. [Patient B's Aunt] testified that prior to the vacation, she was very close to her sister and visited their house often. [Patient B's Aunt] testified that it was her understanding that the Member was hired to care for Patient [B] to relieve pressures for [Patient B's Mother]. [Patient B's Aunt] testified that the Member arrived at the New York family vacation in her own car and stated that she needed her own vehicle because she was undercover.

[Patient B's Aunt] testified that during the family vacation, she suffered an injury that required hospital treatment and once back in Canada, she stayed at her sister's house because the injury resulted in mobility issues and her sister's house was accessible. [Patient B's Aunt] testified that her physician prescribed Toradol for pain, and she asked the Member to pick-up the prescription. She remembers receiving a white pharmacy bag but did not receive the medication.

[Patient B's Aunt] testified that she stayed at her sister's house for 7–10 days and that during that time she felt something was not right. [Patient B's Aunt] testified that the Member was not behaving like a nurse, going beyond the boundaries of nurses who had worked there before. [Patient B's Aunt] testified that the Member started to share lots of personal information including that she was raped and abused by various people. [Patient B's Aunt] testified that she was aware of professional boundaries and standards and that the situation was odd professionally. [Patient B's Aunt] further testified that the Member was spending more time at the family's home and taking up more of [Patient B's Mother]'s attention with her medical and trauma issues.

College Counsel asked [Patient B's Aunt] if she observed any changes in behaviour or concerns with her sister at the time of Patient [B]'s death. [Patient B's Aunt] testified that the Member was considered like a daughter and they were protecting her. [Patient B's Aunt] testified that she shared her concerns with her sister regarding the information shared by the Member, including the outlandish stories, timelines not adding up, and the stories changing depending on what was in the news. [Patient B's Aunt] testified that she was concerned the Member was conning the family at their most vulnerable. She testified that she was concerned the Member was brainwashing [Patient B's Mother] by keeping her up all hours of the night, causing sleep deprivation and wearing her down by her outrageous stories. [Patient B's Aunt] testified that her sister completely believed what the Member told her.

College Counsel asked [Patient B's Aunt] if they took any steps to expose the Member. [Patient B's Aunt] testified that they contacted the child lawyer and a non-profit company the Member stated were involved in the sex-trade task force. [Patient B's Aunt] testified that the company could not verify the information provided by the Member. [Patient B's Aunt] testified that [Patient B's Mother] did not want to hear this information.

[Patient B's Aunt] testified that after Patient [B]'s funeral, the family attempted an intervention with [Patient B's Mother] but she refused to listen to anyone, cut off all contact, and continues to not speak with her parents, sister and best friends.

College Counsel asked [Patient B's Aunt] if she had met with Mr. Jaciuk. [Patient B's Aunt] testified that prior to Patient [B]'s death, the CAS met with her, Mr. Jaciuk and his wife for about 3 hours to discuss the accusations from the Member regarding Mr. Jaciuk and concerns regarding the care of the Member's son. [Patient B's Aunt] testified that the Member's comments regarding Mr. Jaciuk changed from describing him and his wife as a nice family to accusations that he was holding her hostage and raping her. [Patient B's Aunt] testified that Mr. Jaciuk's wife asked her if she had a Toradol bottle and then showed her the bottle with her name on it.

Witness #5 - Melissa Peck ("Ms. Peck")

Ms. Peck works at Mount Sinai Hospital as the Senior Manager for Patient Registration and was in this role in June 2017. Ms. Peck testified that the hospital's emergency room record was populated at registration and includes asking the patient for their emergency contact information, family physician and personal information. Ms. Peck testified and identified that Exhibit #15 was a copy of the Member's Mount Sinai Hospital emergency room record, listing [Patient A's Daughter] as her emergency contact and that Exhibit #16 was a copy of the Member's Mount Sinai Hospital emergency room record listing [Patient B] as her emergency contact.

Witness #6 – [Patient A's Daughter]

[Patient A's Daughter] appeared before the Panel following a summons and was represented by counsel, Mr. Joshua Shneer.

[ ] is Patient [A]'s daughter. [Patient A's Daughter] testified that she hired Nurse Next Door to provide daily care, medication administration and light housekeeping for her mother who had terminal cancer. [Patient A's Daughter] testified that from January to March 2017, she saw her mother before and after work every day and starting in February, took a leave of absence so she could spend more time with her mother. [Patient A's Daughter] testified that she met the Member in person when she started taking shifts in her mother's home in January 2017.

[Patient A's Daughter] testified that from January 2017 until her mother's death there were four nurses who shared the time equally until the last days of her mother's life when the Member provided the bulk of the care. [Patient A's Daughter] testified that she did not view the Member as the primary nurse although the Member did position herself as such. [Patient A's Daughter] testified that there was a set of keys available for the nurses when they took her mother out of the house.

College Counsel asked [Patient A's Daughter] if she got to know the Member personally. [Patient A's Daughter] testified that the Member shared that she was a single mother of a boy who had a neuroblastoma—a serious illness. [Patient A's Daughter] further testified that the Member shared her career goal to study medicine.

[Patient A's Daughter] testified that the Member interacted with the palliative physician occasionally regarding pain management. [Patient A's Daughter] testified that the emails received by the Member started out occasionally and then became daily. [Patient A's Daughter] testified that she could not recall how many emails she received from the Member between January and March 2017.

College Counsel asked [Patient A's Daughter] if she recalled the Member having a special affection for her mother, herself and her husband. [Patient A's Daughter] testified yes and recalled the Member saying to her that she loved her and that she expressed fondness for her mother, whom she would miss. When College Counsel referred [Patient A's Daughter] to Exhibit #18, an email from the Member where the Member writes "I just love her so much", [Patient A's Daughter] testified that she could not recall the email.

College Counsel asked [Patient A's Daughter] if there was any discussion with Nurse Next Door regarding her mother's care. [Patient A's Daughter] testified that near the end of her mother's life they wanted to introduce new nurses and it upset her since her mother had days or weeks to live. [Patient A's Daughter] further testified that the Member was at her mother's house 24 hours a day for the last three days of her life and that she was not paid for those extra hours.

College Counsel asked [Patient A's Daughter] who was with her mother when she died. [Patient A's Daughter] testified that she, her brother, the palliative care nurse for the palliative sedation, her husband, her nephew, a couple of neighbours and the Member were present leading up to her mother's death; however, [Patient A's Daughter] and the Member were the only ones present at the time of her death. [Patient A's Daughter] testified that the Nurse Next Door staff and nurses attended the funeral and that the Member read a poem (Exhibit #20).

College Counsel directed [Patient A's Daughter] to the gift of a dog bed to the Member at Exhibit #21. [Patient A's Daughter] testified that the Member had got her son a support dog and [Patient A's Daughter] offered the dog bed and crate to the Member and she accepted the dog bed.

College Counsel asked [Patient A's Daughter] if they gave the Member a gift in addition to the dog bed. [Patient A's Daughter] testified that following her mother's funeral, she gave the Member a bank draft in the amount of $15,000.00 to support her going to school (Exhibit #22). [Patient A's Daughter] testified that on March 20, 2017, she met the Member at her mother's house to give her this cheque.

[Patient A's Daughter] testified that she was aware that the Member was a single mother with a son who had brain cancer and had a therapy dog. [Patient A's Daughter] testified that she could not recall if the son had had surgery prior to the Member's email on March 24, 2017 (Exhibit #23).

[Patient A's Daughter] testified that the Member came to her house to drop something off then asked for help because she stated that she had been assaulted by her boyfriend/partner. [Patient A's Daughter] testified that they took her to a woman's crisis centre, then to Mount Sinai Hospital emergency (Exhibit #15). [Patient A's Daughter] testified that she was aware that the Member listed her as her emergency contact, that the Member stayed at her house for 1–2 nights and then they asked her to leave.

[Patient A's Daughter] testified that the Member's story became more convoluted and any time [Patient A's Daughter] or her husband tried to validate the information they were unable to do so. [Patient A's Daughter] testified that they drove the Member to The Hospital for Sick Children to validate if the son was there, then they reached out to Dr. Buckman to verify if the child was there and the doctor confirmed that there was no child admitted to The Hospital for Sick Children by the name the Member provided. [Patient A's Daughter] further testified that the Member told them her son had died so they called the funeral home to see if there was a child by that name and there was not.

[Patient A's Daughter] testified that they asked the Member to leave their home after finding out this information. [Patient A's Daughter] further testified that she later received a text from someone who identified themself as a friend of the Member, notifying her that the Member had committed suicide and was asked if they wanted to contribute to an obituary for her and her son.

Expert Witness – Meredith Muscat ("Ms. Muscat")

Ms. Muscat is a Registered Nurse - Extended Class, registered with the College since 1999. She is currently the Director of Clinical and Transitional Care Programs at Toronto Grace Health Centre ("TGHC") in Toronto, Ontario. She is responsible for the in-patient palliative care unit, rehabilitation/bariatric unit, critical chronic illness long term ventilation unit and community based transitional units.

Ms. Muscat's curriculum vitae, marked as Exhibit #25, outlines a long nursing career in pain management and palliative care. In 2004 she completed a Master's Degree in Nursing: Acute Care Nurse Practitioner and worked in acute care at Toronto General Hospital ("TGH") for 4 years. From 2008 - 2012 she led the pain service team at St. Michael's Hospital and then from 2012 – 2015 was responsible for perioperative day surgery programs. In 2015 she transitioned to Toronto Central Local Health Integration Network as the Nurse Practitioner for the community-based Palliative Care Team. Since 2018 she has worked at TGHC and is responsible for palliative care programs, patient care and transitional care programs.

Ms. Muscat confirmed that the opinion she would provide would be nonpartisan and objective (Exhibit #26). The Panel qualified Ms. Muscat as an expert in nursing in the areas of palliative care and College practice standards: TNCR Standard, Medication Standard, Professional Standards and Confidentiality and Privacy – Personal Health Information Standard.

Ms. Muscat was asked by College Counsel to explain the Professional Standards (Exhibit #31). Ms. Muscat stated the Professional Standards are a foundation of practice that applies to all nurses who are registered with the College and practicing, regardless of the setting. She stressed that these are not just guidelines, rather they are standards by which one is judged and measured.

Ms. Muscat was asked by College Counsel to explain in general the TNCR Standard (Exhibit #32) in relation to palliative care. Ms. Muscat highlighted that this practice standard provides the basis of care in a home setting. The home setting is more intimate where the nurse works with the patient and family in an unstructured environment therefore the nurse needs to maintain boundaries and demonstrate respect, empathy and honesty. Ms. Muscat stressed that the TNCR Standard expands on the aspects of relationships; specifically, that it works in the best interest of the client, not the needs of the nurse.

Ms. Muscat was asked by College Counsel if there was a risk if the nurse shared personal information in a home with a palliative patient. Ms. Muscat stressed the intimate nature of the home setting and the patient situation requires the nurse to be patient centric and provide care at the moment. Sharing personal information takes the focus away from the patient to the nurse.

Ms. Muscat was asked by College Counsel if it was appropriate to accept gifts in a home setting. Ms. Muscat stated that accepting gifts of any kind crosses boundaries with the patient and/or their family. She referenced page 7 of the TNCR Standard that sets out the indicators where the nurse meets the standard by recognizing there may be an increased need for vigilance in maintaining professionalism in certain practice settings—specifically "in a client's home, a nurse may become involved in the family's private life ..." and "especially circumstances that include self-disclosure or giving a gift to or accepting a gift from a client". Ms. Muscat further stated that it is incumbent on the nurse to speak with their manager and/or withdraw themself from the situation when a boundary breach has occurred.

College Counsel referred Ms. Muscat to the hypothetical scenario (Exhibit #28) Patient A, paragraphs 21–32 and asked if the nurse in this scenario had breached the standard. Ms. Muscat stated that the member breached the TNCR Standard in that she scheduled shifts specifically so she could care for the patient rather than assign staff and neglected the role she was hired to perform. The member put herself and her needs before the patient.

College Counsel took Ms. Muscat through the Notice of Hearing for her to provide her expert opinion on whether the Member contravened the standards of practice of the profession:

Allegations #1(a)(i), (ii) and (iii): Ms. Muscat stated that the Member breached the TNCR Standard and her employer's policy when she disclosed personal information about being raped and sex-trafficked, and about her son's medical condition and accepted gifts.

Allegation #1(a)(iv): Ms. Muscat stated that the Member breached professional boundaries when she stayed at her patients' home after her scheduled shifts were completed. Palliative patient care is for patients who are at end-of-life and once the patient has died, there is no longer a professional patient-nurse relationship after death.

Allegation #1(a)(v): Ms. Muscat stated that the Member breached the TNCR Standard of crossing professional boundaries when she extended the relationship beyond the patient to a family member, especially one who was in acute grief.

Allegation #1(a)(vi): Ms. Muscat stated that the Member breached the TNCR Standard when the communication extended beyond the context of patient care. Stating 'loved them both' crosses the therapeutic professional boundary.

Allegation #1(b): Ms. Muscat stated that the Member breached the Professional Standards (Exhibit #31) when she lied to the patient and their family members. These lies put undue burden on the family, took their focus away from their loved one who was dying and distracted the nurse from providing professional care to the patient.

Allegation #1(c): Ms. Muscat stated that any patient information and health information must be protected even after death. The Member disclosed specific personal health information to other patient families and to others and by so doing, breached the Confidentiality and Privacy - Personal Health Information Standard (Exhibit # 29).

Allegations #1(d)(i), (ii) and (iii): Ms. Muscat stated that the Member's decision to use a patient's family member as an emergency contact was a further breach of the TNCR Standard. The Member's choice to live at the patient's home while providing care breached professional boundaries and contravened the TNCR Standard.

Allegation #1(d)(iv): Ms. Muscat highlighted that the Member, identifying herself as a family member, transitioned her position from a contracted nurse to a personal relationship and was no longer in a position to provide professional care. This conduct blurred the nurse-client relationship and resulted in loss of the objectivity required of the nurse. Further Ms. Muscat stressed that the Member abused her power and was professionally inappropriate contravening the Professional Standards.

Allegations #1(e) and (f): Ms. Muscat stated that the Member breached the Medication Standard by inappropriately storing medication outside of the patient's treatment area (specifically their home). Further, she breached the Confidentiality and Privacy – Personal Health Information Standard when she brought Patient [B]'s medication to her home and stored it in the fridge. The Member misappropriated a medication belonging to a family member of Patient [B] and compromised personal health information as the label contained personal health information.

Closing Submissions

College Counsel asked the Panel to making findings of professional misconduct on all the allegations in the Notice of Hearing except for allegations 1(a)(vi), 1(c), 3(a) and 6(a)(vi) and 6(c) as there was no evidence presented in the hearing to support a finding on these allegations. 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 and a degree of certainty that the misconduct flows from the evidence.

College Counsel submitted that the Panel needs to assess and weigh the evidence to determine whether it is more likely than not that the Member committed the misconduct. College Counsel submitted that the evidence provided by the six fact witnesses was given in a forthright manner and established a pattern over time and provided puzzle pieces that fit together. Any gaps and inconsistencies do not discredit the witness' testimony as there are thematic disturbing patterns of the Member's behaviour.

The first theme is a persistent and shocking disregard for the therapeutic nurse-client relationship—specifically professional boundaries. The Member did not establish or maintain a professional relationship with two families. The Member told [Patient A's Daughter] a number of personal stories that were disturbing and false. The Member told [Patient A's Daughter] that she had a son with a serious illness who was dying, she accepted $15,000.00 contrary to the Professional Standards, the TNCR Standard and Nurse Next Door policy and she accepted a gift for a fabricated dog.

The Member named [Patient A's Daughter] as her emergency contact after claiming she was assaulted and then stayed at her home. The Member made a number of inappropriate communications that blurred professional boundaries before and after Patient [A] died.

Ms. Harris was very disturbed by the Member's actions and called [Patient A's Daughter], although [Patient A's Daughter] was unable to recall the conversation. Ms. Harris presented a clear and distinct memory of events that is consistent with what [Patient A's Daughter] recalled. Ms. Harris testified that the company did not want to keep the Member due to her behaviour of scheduling herself with Patient [A], her conduct at the funeral, fabricated stories and maintaining contact once the patient no longer required nursing care.

The Member outright lied to Patient [A] and [Patient A's Daughter] and Patient [B]'s family. The Member's conduct with Patient [B] and her family was competitive. [Patient B's Father] was transparent and genuine regarding the harm the Member caused him and his family. The Notice of Hearing sets out the Member's breaches with Patient [B]'s family and the context and nature of the breaches is beyond what is listed.

The Member maintained disturbingly bizarre stories that fed on Patient [B]'s family's sympathies resulting in the Member moving from nurse to family and starting to call [Patient B's Father] her 'Dad'. The Member committed a number of significant boundary breaches: she moved in with the family and rarely saw her son, they took her to the emergency department a number of times and she listed [Patient B's Mother] as her emergency contact, and she took Patient [B]'s first name as her middle name and started to use the family's last name.

The Member used a history of sexual trauma and health conditions to gain trust, sympathy and attention. The Member's story of sex-trafficking and flashbacks and the subsequent investigation by CAS took time and attention, so much so, that other family members took notice of it and mentioned their concerns. The Member's story to Patient [A] and [Patient A's Daughter] about her son having serious cancer was similar to Patient [A]'s situation. The Member developing seizures when with the family of Patient [B] is similar to what Patient [B] experienced. [Patient B's Father] testified that during the final week of Patient [B]'s life, the Member was taken off her care because she was too ill to care for her patient. Regardless of the Member's health or any condition, the Member engaged in a huge breach by disclosing information to the families.

The Member violated boundaries that resulted in irreparable harm to the patients and their families.

The second theme is medication misappropriation. [Patient B's Father] testified that he was uncomfortable being with the Member at the hospital because of her drug-seeking behaviour. He also testified that medications went missing on a number of occasions. [Patient B's Aunt]'s Toradol was not received and a bottle of liquid morphine sulfate was found in the refrigerator at the Jaciuk's house.

College Counsel submitted that all of these events point to professional misconduct and supported the allegations in the Notice of Hearing.

Allegations #1(a)(i), (ii), (iii), (iv), (v), #1(b), #1(d)(i), (ii), (iii), (iv) and #6(d)(i), (ii), (iii), (iv) are a breach of the Professional Standards and the TNCR Standard. The Member's conduct shows obvious breaches of the standards. Ms. Muscat stated that nurses must be diligent in maintaining professional boundaries in the home environment and especially with palliative patients. The Member violated professional boundaries when she self-disclosed personal information. Whether the information was true or not, the fact that the Member shared personal information was a breach of the TNCR Standard. The Member also breached the TNCR Standard when she accepted gifts of money, food, housing and a dog bed.

With respect to allegations 1(e), #1(f), #2(a), #2(b), #6(e) and #6(f), the Member breached the Medication Standard in that she misappropriated medication on two occasions: [Patient B's Aunt]'s Toradol and Patient [B]'s liquid Morphine. The Member failed to secure and store medications and protect personal health information. [Patient B's Aunt]'s empty Toradol bottle was found in the Member's bedroom located at the Jaciuk residence. Patient [B]'s liquid Morphine was taken from her home and placed in the Jaciuk's refrigerator and was left there until Mr. Jaciuk removed it. These behaviours demonstrate a breach of the Medication Standard, the Confidentiality and Privacy – Personal Health Information Standard and the Ethics Standard.

With respect to allegations #4 and #5, the Member continued to work as an RPN while her certificate of registration was suspended for non-payment. The evidence proves that she was suspended, Ms. Harris testified that the Member worked February 22, 2017 – March 4, 2017 and the invoices and pay submissions provide further evidence (Exhibits #7 - #11).

Allegations #6(a)(i), (ii), (iii), (iv), (v), #6(b), #6(d)(i), (ii), (iii), (iv), #6(e), #6(f) and #6(g) speak to conduct that would reasonably be regarded by members of the profession to be disgraceful, dishonourable or unprofessional. The Member's conduct was unprofessional in that she breached the Professional Standards. The Member's conduct was dishonourable in that she was repeatedly dishonest and manipulative demonstrating elements of moral failing. The Member's conduct was disgraceful in that her behaviour showed a lack of governability when she continued to work as a nurse when her certificate of registration was suspended. The Member demonstrated predatory behaviour, repeatedly seeking to meet her own needs rather than the patients' and families' needs and did so for end-of-life patients when they and their family were most vulnerable. In addition, the Member demonstrated deceptive behaviour when she misappropriated medications which she knew or ought to have known would compromise medication safety, potentially causing patient harm and increased risk of drug diversion.

College Counsel asked the Panel to make findings that the member engaged in professional misconduct on all allegations in the Notice of Hearing except for 1(a)(vi), 1(c), 3(a) and 6(a)(vi) and 6(c). College Counsel requested the Panel not make findings on allegations of disclosure of personal health information or other confidential information regarding the identity, treatment and/or diagnosis of Patient [A] without consent or authorization due to lack of evidence.

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)(i), (ii), (iii), (iv), (v), #1(b), #1(d)(i), (ii), (iii), (iv), #1(e), #1(f), #2(a), #2(b), #4, #5, #6(a)(i), (ii), (iii), (iv), (v), #6(b), #6(d)(i), (ii), (iii), (iv), #6(e), #6(f) and #6(g) of the Notice of Hearing. As to allegations #6(a)(i), (ii), (iii), (iv), (v), #6(b), #6(d)(i), (ii), (iii), (iv), #6(e), #6(f) and #6(g), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be disgraceful, dishonourable and unprofessional.

The Panel did not find that the Member committed acts of professional misconduct as alleged in paragraphs #1(a)(vi), #1(c), #3(a), #6(a)(vi) and #6(c) of the Notice of Hearing.

Reasons for Decision

In assessing the credibility of witnesses, the Panel considered the following factors where relevant:

1. the witness's appearance and demeanor;

2. the witness's opportunity to observe;

3. the witness's capacity to remember;

4. the probability or reasonability of the evidence;

5. the internal consistency or inconsistency of the evidence;

6. the external consistency or inconsistency of the evidence; and

7. the witness's interest in the outcome of the case.

The Panel also understood that it could accept all, part or none of a witness's testimony and that minor discrepancies between the evidence of different witnesses does not necessarily discredit their evidence. The Panel determined that each fact witness' testimony was credible and consistent with the other witnesses' testimony. Any gaps in memory did not detract from the consistency of the evidence when taken in its totality.

With respect to allegations #1(a)(i), (iv), (v) in the Notice of Hearing, the Panel considered the recollection and testimony of [ ], the daughter of Patient [A]. The Panel determined that the evidence provided by the witness was consistent and credible. [Patient A's Daughter] testified that the Member shared that she was a single mother of a son who had a serious illness called neuroblastoma. [Patient A's Daughter] testified that she believed the Member did stay with her mother the last days of her life outside her scheduled shifts. [Patient A's Daughter] testified that after Patient [A]'s death, the Member came to her house and asked for help stating that she had been assaulted. [Patient A's Daughter] testified that she took the Member to the crisis center and hospital and that she was aware her name was provided as the Member's emergency contact (Exhibit #15).

[Patient A's Daughter] testified that the Member sent frequent emails to her and expressed affection for her, her husband and Patient [A] Exhibits #17 and #18 provide evidence that the Member wrote to [Patient A's Daughter] that "she loved her [Patient [A]] so much" and "love to you both" in emails.

The Member breached the Professional Standards and the TNCR Standard when she failed to set and maintain professionalism and boundaries by sharing personal information and when she used the name of a patient's family member for her emergency contact, even if she had permission.

The Panel accepted the evidence of the College's expert witness, Ms. Muscat, who testified that the Member contravened the Professional Standards that require nurses to make the client's needs the focus of the relationship, one based on trust, respect and the appropriate use of power. In addition, a nurse is expected to demonstrate empathy and care in relationships with clients, families and significant others and to ensure she does not interfere with the clients, or in this case, Patient [A]'s daughter.

The Member breached the TNCR Standard when she crossed the boundary of the therapeutic relationship when she stayed at Patient [A]'s house after her shifts were completed and she maintained contact with Patient [A]'s daughter after Patient [A]'s death. Once the patient has died, the professional relationship ends. By staying at [Patient A's Daughter]'s home and asking for help, the Member shifted the once professional relationship to one that was personal. The Member's conduct violated the respect of the professional relationship causing emotional harm to the family.

Allegations #1(a)(ii), (iii) in the Notice of Hearing are supported by the testimony of Mr. Jaciuk and [Patient A's Daughter] Mr. Jaciuk testified that the Member showed up at his house with a dog bed and the Member confirmed it had belonged to Patient [A]'s dog. Mr. Jaciuk testified that he took a picture of the dog bed (Exhibit #12). [Patient A's Daughter] testified that she offered the Member the dog bed and crate for her dog and the Member accepted the dog bed (Exhibit #21).

[Patient A's Daughter] testified that she gave the Member a bank draft for $15,000.00 (Exhibit #22) to support her goal to go back to school. Mr. Jaciuk testified that the Member told him she had received a card and a check for $15,000.00 for her exemplary care and that he witnessed the Member depositing the money into her bank account.

The Member breached the TNCR Standard of giving and accepting gifts. The Member failed to follow company policy regarding accepting individual gifts and chose not to discuss this with her manager prior to accepting the gift. The TNCR Standard indicates that the nurse meets the standard of maintaining boundaries by "consulting with colleagues and/or the manager in any situation in which it is unclear whether a behaviour may cross a boundary of the therapeutic relationship, especially circumstances that include self-disclosure or giving a gift to or accepting a gift from a client."

Allegation #1(b) in the Notice of Hearing is supported by the testimony of Ms. Harris, [Patient B's Father], [Patient B's Aunt], Mr. Jaciuk and [Patient A's Daughter]. The Panel found all the witnesses to be credible, consistent and forthright in their testimonies.

Ms. Harris testified that approximately six months after Patient [A] died, her granddaughter called the office concerned that her mother had given the Member money for her son's life-saving surgery. Mr. Jaciuk testified that the Member's son was healthy.

[Patient B's Father] testified that the Member told him and [Patient B's Mother] that she was part of a wealthy family who sex-trafficked her until she was 9 when the RCMP got her, that she had witnessed murders and was now involved with the RCMP due to her insights into sex-trafficking. [Patient B's Father] testified that the Member said she was in communication with the RCMP and had a close relationship with a child lawyer. [Patient B's Father] further testified that he, [Patient B's Mother] and the Member communicated solely by text with the RCMP and the child lawyer. [Patient B's Father] testified that he uncovered a phone bill with a phone number he thought was the RCMP taskforce and confirmed it was the Member's number. He testified he was told by the Member that the child lawyer died in 2018 and that Chris Bardwell was the RCMP investigating officer. Mr. Jaciuk, [Patient B's Father] and [Patient B's Aunt] agreed that these statements of the Member were false.

[Patient B's Aunt] testified that during the August 2017 vacation, the Member began to disclose personal information which included that she had been raped and abused by various people and that she had to take her own car to the cabin because she was undercover. [Patient B's Aunt] testified that they contacted the Member's child lawyer and the non-profit company whom the Member stated were involved in the task force to help get out of the sex trade industry, but they were unable to verify the information given by the Member.

[Patient B's Aunt] testified that while she was staying with Patient [B]'s family, the Member's comments regarding the Jaciuks changed from they were a nice family to he was raping her and holding her hostage.

Mr. Jaciuk testified that the Member did not have a dog and that her son was in good health. He further testified that when the Member was working at Nurse Next Door and had shared that she was caring for Patient [A], she stated that she was doing a lot of 24-hour care because nurses were cancelling or were sick. Mr. Jaciuk testified that in February-March 2018, he and his wife were investigated by the DCS. The investigation was regarding the Member's claim that she was in witness protection, part of an RCMP investigative team, had been put in a cage and raped and her son was being held against his will. In addition, Mr. Jaciuk testified that the Member had said both he and his wife had been arrested. All this information by the Member was false.

Mr. Jaciuk testified that the Member told him the gift of $15,000.00 was for exemplary nursing care, whereas [Patient A's Daughter] testified that the money was to support the Member's education and Ms. Harris testified that the money was for the Member's son's life-saving surgery.

[Patient A's Daughter] testified that she was told that the Member's son had a serious illness called neuroblastoma and that he had a support dog (Exhibit #21). [Patient A's Daughter] testified that she was sent an email from the Member stating that her son had surgery at The Hospital for Sick Children and included a picture of her son (Exhibit #23). Mr. Jaciuk testified that he did not believe the boy in the picture was the Member's son.

[Patient A's Daughter] testified that she and her husband tried to validate the information the Member provided and this included taking the Member to The Hospital for Sick Children and reaching out to Dr. Buckman to confirm if the Member's son was in the hospital and they were told he was not. [Patient A's Daughter] testified that she was told the Member's son had died and she called the funeral home and there was no one with that name. [Patient A's Daughter] also received a text from the Member's 'friend' stating that she had committed suicide and was asked to contribute to her and her son's obituary.

The Member breached the Professional Standards of ethics and relationships when she repeatedly lied to the patients and family members. The Member repeatedly failed to respect, advocate and practice truthfulness and by doing so failed to provide a client-centered relationship based on trust, respect and appropriate use of power.

The Member breached the TNCR Standard by failing to establish and maintain client-centered care specifically to ensure all professional behaviours and actions met the therapeutic needs of the client. Nurses are expected to appropriately manage causes of stress so that the therapeutic relationship is not affected. The Member's multiple lies put undue stress and burden on the family, effectively took their focus from their loved one who was end-of-life and deprived the client of professional nursing care.

Allegations #1(d)(i), (ii), (iii), (iv) in the Notice of Hearing are supported by the testimony of [Patient B's Father], [Patient B's Aunt], Mr. Jaciuk and evidence (Exhibit #16) verified by Ms. Peck. The Panel determined that the evidence provided by the witnesses was credible and consistent.

[Patient B's Father] testified that the Member stayed at his family's house occasionally following the August 2017 vacation and then she moved into the family's house some time in December 2017 and was still living in the house in 2019. [Patient B's Father] testified that the Member shared several personal stories regarding sexual abuse, sex-trafficking, and being involved with an RCMP task force.

[Patient B's Father] testified that he and his family accepted the Member as a daughter and she started to call him "Dad" and [Patient B's Mother] "Mom" and that following Patient [B]'s death, the Member added Patient [B]'s first name as her middle name and used her last name (Exhibit #14). [Patient B's Father] testified that the Member began to have flashbacks and that [Patient B's Mother] began to move her care from Patient [B] to caring for the Member, including taking her to the emergency department where the Member listed [Patient B's Mother] as her emergency contact (Exhibit #16).

Further, the allegations of misconduct are supported by [Patient B's Aunt]'s testimony that the Member shared personal information during the August 2017 vacation and when she stayed at the family's residence in 2017. [Patient B's Aunt] testified that the Member shared personal information including that she had been raped and abused by various people. [Patient B's Aunt] testified that she observed the Member spending more time at the family's home and taking up more of [Patient B's Mother]'s attention with her medical and trauma issues.

Mr. Jaciuk testified that he believed the Member stayed with Patient [B]'s family at Christmas 2017, and that he, his wife and the Member's son rarely saw her between Christmas and Patient [B]'s death in February 2018. Mr. Jaciuk testified that the Member did not return home after Patient [B] died because she told him she was staying with the family to grieve along with the mother. Mr. Jaciuk testified that shortly after the Member started providing care to Patient [B], she was "quasi-adopted" by the family as a fourth daughter and she was in the family Christmas photo.

The Member breached the Professional Standards, "Relationships" and the TNCR Standard of client-centred care, maintaining boundaries and protecting the client from abuse when she identified herself as a family member of a Patient and used a family member of a Patient as her emergency contact.

The Panel accepted the evidence of the College's expert witness, Ms. Muscat, who testified that the Professional Standards section "Relationships" requires nurses to make the client's needs the focus of the relationship, one based on trust, respect and the appropriate use of power. In addition, nurses are expected to demonstrate empathy and care in relationships with clients, families and significant others. [Patient B's Father] testified that the Member stopped providing nursing care in Patient [B]'s final week of life indicating that the Member continued to function in a nursing capacity at the same time acting as a family member.

The Member breached the TNCR Standard when she crossed the boundary of the therapeutic relationship. The Member transitioned her position from a nurse to a personal relationship which resulted in a loss of objectivity necessary for the nurse-client relationship, she was no longer in a position to provide professional care and yet continued to do. The Member's conduct blurred the nurse-client relationship, she abused her power by destroying professional boundaries and violated the respect of the professional relationship causing emotional harm to the family.

Allegations #1(e), #1(f), #2(a) and #2(b) are supported by the testimony of [Patient B's Aunt] and Mr. Jaciuk. The Member breached the Medication Standard on two occasions with regard to [Patient B's Aunt]'s Toradol and Patient [B]'s liquid Morphine.

[Patient B's Aunt] testified that she asked the Member to pick up her prescription for Toradol and she remembered receiving the pharmacy bag and that was all she saw. Mr. Jaciuk testified that he found an empty pill bottle in the Member's bedroom located at his residence. He further testified that the medication label stated Toradol and the prescription was for [Patient B's Aunt], whose name is now [ ]. The Panel finds that the Member's actions with regard to the Toradol amount to misappropriation of property from a workplace.

Mr. Jaciuk testified that one night when the Member returned from Patient [B]'s house she emptied out her bag and she had a bottle of liquid Morphine that was labelled for Patient [B]. He testified that the Member stated, she had forgotten she had it and it needed to be refrigerated. The Member placed the bottle into the Jaciuk's refrigerator and much later it was removed by Mr. Jaciuk. The Member's actions with regard to the bottle of liquid Morphine amount to misappropriation of property from a client.

The Member breached the Medication Standard when she removed Patient [B]'s medication away from her treatment area and did not ensure appropriate storage nor disposal. The Member also breached the Medication Standard when she did not ensure safety of the medication to minimize risk of misuse or drug diversion when she brought liquid Morphine and [Patient B's Aunt]'s Toradol to the Jaciuk residence.

The Member breached the Confidentiality and Privacy – Personal Health Information Standard when she did not safeguard Patient [B]'s and [Patient B's Aunt]'s personal information and personal health information displayed on the medication labels.

Allegations #4 and #5 in the Notice of Hearing are supported by the Affidavit of Service of Ms. Green and testimony of Ms. Harris and submitted evidence.

Ms. Green's Affidavit of Service includes a true copy of the Member's College public register record (Exhibit #2). The Member was administratively suspended for non-payment of College membership fees from February 22, 2017 - March 22, 2017. Ms. Harris testified that the Member was scheduled for 8 shifts from February 22, 2017 – March 3, 2017. The Member electronically confirmed completion of the shifts and received payment for them (Exhibits #7, #8, #9, #10 and #11).

The Member committed professional misconduct when she continued to practice and represent herself as a nurse while her certificate of registration was suspended contrary to legislated requirements for members of the profession and the terms, conditions and limitations placed on her certificate of registration.

Allegations #6(a)(i), (ii), (iii), (iv), (v), #6(b), #6(d)(i), (ii), (iii), (iv), #6(e), #6(f) and #6(g) in the Notice of Hearing are supported by the Member's:

(a) failure to maintain therapeutic boundaries with two palliative end-of-life patients and their families who were at their most vulnerable;

(b) acceptance and cashing of a cheque for $15,000.00 and accepting the gift of a dog bed when she did not have a dog;

(c) telling of multiple lies about her personal life;

(d) residing in the patient's daughter's home after Patient [A] had died and residing in Patient [B]'s family's home before and after her death;

(e) misappropriation of medication on two occasions; and

(f) practising nursing and using the title RPN when her certificate of registration was suspended.

The Member's conduct was clearly relevant to the practice of nursing and was unprofessional as she demonstrated a persistent disregard for her professional obligations when she repeatedly breached the Professional Standards of accountability, ethics and relationships and breached the Medication Standard of safety by misappropriating controlled medications, improperly storing and disposing of said medications thereby increasing the risk of drug diversion.

The Member's conduct was dishonourable as she demonstrated a moral failing by repeated dishonesty, lies, and manipulation of her patients' families. The Member changed her name to '[ ]' prior to Patient [B]'s death, and after her death took Patient [B]' first name as her middle name and also took her last name.

The Member's conduct was disgraceful as it showed a level of moral failing to such a high degree that it brings the nursing profession into disrepute. The Member practiced in a clinical setting where patients were palliative and where family members and loved ones were highly vulnerable. The Member repeatedly crossed therapeutic and professional boundaries and disregarded the best interests of Patient [A] and Patient [B], intentionally choosing to put her own needs first. The Member's abuse of power calls into question her judgement and suitability to practice and shows a blatant, serious disregard for the standards of the profession.

Allegations #1(a)(vi), #1(c), #3(a), #6(a)(vi) and #6(c) in the Notice of Hearing were dismissed as College Counsel did not provide evidence in the hearing to support a finding on these allegations. The Panel did not find sufficient evidence the Member shared personal health information via text or disclosed personal health information, or confidential information regarding identity, treatment or diagnosis of Patient [A] in any manner.

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 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.

[ ]. The Panel has the authority to make the penalty as submitted despite the Member's certificate of registration being suspended.

College Counsel submitted that given the unique facts in this case, the proposed penalty provides the only option to protect public safety, is appropriate in that it addresses the appalling and egregious conduct and meets the goals of specific and general deterrence. Most importantly, the penalty protects the public.

College Counsel submitted that there are no mitigating factors in this case. The Member has not participated in this process or the hearing. The Member has shown no remorse and the evidence shows she is still living with [Patient B's Mother]. Although the Member does not have any prior history with the College, the Member registered with the College in 2016 and the misconduct began within months of her entering the profession, and therefore the fact that she has not previously appeared before the Discipline Committee is not a mitigating factor.

College Counsel submitted that the aggravating factors in this case were:

• The Member's misconduct was prolonged. It occurred over many months and involved two patients and their families;

• The misconduct spanned almost the entirety of the Member's nursing career;

• The findings in this case are multiple and varied;

• There was egregious violation of professional boundaries for two patients:

  • moving into their homes;

  • adopting the family's last name;

  • referring to family members as parents and sisters;

  • listing patient family members as emergency contacts;

  • grossly oversharing details of her personal life to elicit sympathy;

  • lying about her son's health;

  • accepting a dog bed for a fictional support dog;

  • accepting a $15,000.00 gift;

• The Member misappropriated controlled medications: Toradol from [Patient B's Aunt] and Morphine from Patient [B]; and

• The Member continued to practice nursing while her certificate of registration was suspended.

College Counsel submitted that any of these acts in isolation would require denunciation and a significant response from the Panel. College Counsel further stated that in this case the extensive and egregious acts when taken together should leave the Panel to question if the Member has any place in the nursing profession as the public is not safe.

College Counsel submitted that the Member's conduct was predatory as she committed significant boundary violations by moving in with one patient's family and with one patient's daughter and family. Both families had lost a family member. The Member should have been more vigilant in dealing with deeply vulnerable people. Instead, the Member preyed on them. [Patient B's Father] testified that the Member took advantage of them at their most vulnerable time. The Member's conduct is serious and at the highest end of culpability. Her conduct showed deceitfulness, dishonesty and ethical defects and showed no regard for ethical or professional boundaries.

College Counsel submitted that the Member's conduct harmed the patients and their families by putting her needs first and by doing so, diverting the family's attention to her rather than their loved one during the last days of their life. [Patient B's Father] testified that he and his surviving daughters were still recovering from the emotional wounds inflicted by the Member, including significant emotional disorders which he attributes to the Member's behaviour and conduct.

College Counsel submitted that the Member benefited from her misconduct. Her actions and behaviours were aimed at meeting her needs rather than those of the patient and family. The Member had a free place to stay, received $15,000.00 and was enriched by her misconduct.

Section 51(2) of the Health Professions Procedural Code ("Code") authorizes the Panel to require the Member to appear to be reprimanded and/or to direct the Registrar to revoke or suspend the Member's certificate of registration for a specified period of time and/or impose specified terms, conditions and limitations on the Member's certificate of registration for a specified or indefinite period of time and/or require the Member to pay a fine. The Member's conduct is extremely troubling and at the highest end of culpability with multiple findings of breach of the Professional Standards and the TNCR Standard and findings of dishonourable, disgraceful and unprofessional conduct. Due to the predatory nature of the Member's misconduct, the Member caused harm to dying patients and their families for her own emotional and financial benefit. The Member's gains came at great expense to the families she was supposed to help. Therefore, public protection can only be achieved by immediate revocation of the Member's certificate of registration.

To meet the goals of penalty, the College submitted that rehabilitation and remediation was not applicable. The Member has not shown any willingness to be governed by the College and there was no evidence that any penalty besides revoking the Member's certificate of registration would deter her from repeating or stopping the misconduct. Remediation and rehabilitation need not be considered given that the Member will be removed from nursing practice.

The proposed penalty provides for specific deterrence through the oral reprimand and the revocation of the Member's certificate of registration, which will send a message to the Member that this type of behaviour is unacceptable.

The proposed penalty provides for general deterrence through the revocation of the Member's certificate of registration, which sends a strong message to members of the profession that this type of conduct will not be tolerated. The public cannot be protected without revoking the Member's certificate of registration.

College Counsel submitted that the primary goal of penalty is public protection and the proposed penalty achieves this goal.

The Panel expressed concerns that the proposed penalty was insufficient as a deterrent considering the financial gain the Member received from her misconduct. The Panel asked the College if a penalty order which included a fine would be appropriate and if so, in what amount.

College Counsel submitted that it is generally not the practice to seek costs and with respect to a fine, the imposition of a fine is generally considered punitive and not in keeping with the goals of penalty unless individuals have been harmed. In this case, a fine may be considered a deterrent, not a punishment, and signal to the Member and to the profession that this conduct will not be tolerated. In addition, the fine would increase public confidence.

College Counsel submitted that the Code provides the Panel with the authority to order a fine up to but not exceeding $35,000.00 payable to the Minister of Finance. While the Code is broad, the College recommended a quantum of less than or equal to $15,000.00 specific to the proceeds of the Member's professional misconduct. Further, College Counsel submitted that the order be made enforceable and payable within a period of 60–90 days once the order becomes final. The Member should also be required to notify the Director of Professional Conduct with proof that the fine was paid.

Independent Legal Counsel ("ILC") provided advice to the Panel regarding the proposed penalty and fine and stated that section 51(2) of the Code authorizes the Panel to order the Member to pay a fine. The purpose of the fine in this case is not restitutionary, rather it is intended to remove the benefit for the Member from her misconduct. Further, ILC reiterated that the primary goals of penalty are to protect the public, preserve public confidence and maintain the high standards of the profession.

Penalty Decision

The Panel makes the following order as to penalty:

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.

3. The Member is required to pay a fine in the amount of $15,000 to the Minister of Finance, payable within 60 days of the Order becoming final.

4. Once the fine has been paid, the Member is required to notify the Director of Professional Conduct at the College with proof of payment.

Reasons for Penalty Decision

The Panel understands that the penalty ordered should protect the public and enhance public confidence in the College's ability to govern its members. This is achieved through a penalty that addresses specific deterrence, general deterrence and, where appropriate, rehabilitation and remediation.

The Panel concluded that the proposed penalty is in the public interest and is appropriate in this case. The Member has not participated in the hearing and has not shown remorse or any willingness to be governed by the College.

The public is protected through the revocation of the Member's certificate of registration as the Member is no longer a risk to the public. 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. As the Member's certificate of registration is revoked, the penalty need not address rehabilitation and remediation.

The fine ordered by the Panel will deprive the Member of the proceeds of her misconduct. The Panel makes this order recognizing the egregious nature of the Member's conduct and the unique opportunity this case presents to send a significant message of specific deterrence to this Member as well as a strong message of general deterrence to other members of the profession. The Panel hopes this deterrence will also add an additional layer of protection to the public sending a strong message that this type of professional misconduct will not be tolerated.

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.