College of Nurses of Ontario v. Clement Osei Tutu, 2023 ONCNO 149453

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Grace Fox, NP Chairperson Lynn Hall, RN Member Lalitha Poonasamy Public Member Emilija Stojsavljevic, RPN Member

BETWEEN:

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

• and -

CLEMENT OSEI TUTU Registration No. JI736486 NO REPRESENTATION for Clement Osei Tutu

PATRICIA HARPER Independent Legal Counsel

Heard: November 15, 2023

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on November 15, 2023, via videoconference.

The Allegations

The allegations against Clement Osei Tutu (the “Member”) as stated in the Notice of Hearing dated October 5, 2023 are as follows:

IT IS ALLEGED THAT:

1. You have committed an act of professional misconduct as provided by subsection 51(1)(b) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, in that the governing body of a health profession in a jurisdiction other than Ontario, has found that you committed an act of professional misconduct, that would be an act of professional misconduct as defined in the regulations, and in particular, on or about October 5, 2017, the Minnesota Board of Nursing found you to be in violation of Minnesota Statutes section 148.261, subdivision 1(4), (9) and (22), as a result of your failure to disclose disciplinary action against your license in Ontario, on your 2016 application for renewal of your registered nursing license with the Minnesota Board of Nursing; 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(15) of Ontario Regulation 799/93, in that you signed or issued, in your professional capacity, a document that you knew or ought to have known contained a false or misleading statement as follows:

a. On or about November 18, 2014, you provided false or inaccurate information to the College of Nurses of Ontario on your 2015 Annual Membership Renewal by indicating that you were not currently registered in the United States, at a time when you were registered as a Registered Nurse with the Minnesota Board of Nursing;

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(18) of Ontario Regulation 799/93, in that you contravened a term, condition or limitation on your certificate of registration, and in particular on or about November 5, 2017 and subsequently, you failed to disclose to the College of Nurses of Ontario that you have been the subject of a finding by the Minnesota Board of Nursing, specifically a ‘Disciplinary Action’ which suspended your license to practice professional nursing and provided that you must not engage in any act that constitutes the practice of nursing and must not imply by words or conduct that you are authorized to practice nursing; 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(19) of Ontario Regulation 799/93, in that you contravened a provision of the Act, the Regulated Health Professions Act, 1991, or regulations under either of those Acts, and in particular, on or about November 5, 2017 and subsequently, you failed to disclose to the College of Nurses of Ontario that you have been the subject of a finding by the Minnesota Board of Nursing, specifically a ‘Disciplinary Action’ which suspended your license to practice professional nursing and provided that you must not engage in any act that constitutes the practice of nursing and must not imply by words or conduct that you are authorized to practice nursing; 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(23) of Ontario Regulation 799/93, in that you failed to take reasonable steps to ensure that the requested information is provided in a complete and accurate manner where you are required to provide information to the College pursuant to the regulations under the Act, and in particular, on or about November 5, 2017 and subsequently, you failed to disclose to the College of Nurses of Ontario that you have been the subject of a finding by the Minnesota Board of Nursing, specifically a ‘Disciplinary Action’ which suspended your license to practice professional nursing and provided that you must not engage in any act that constitutes the practice of nursing and must not imply by words or conduct that you are authorized to practice nursing; 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 you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, as follows:

a. On or about December 24, 2013 and subsequently, you failed to notify the College of Nurses of Ontario that you were registered or licensed to practise nursing in another jurisdiction, at a time when you were licensed to practice nursing as a Registered Nurse with the Minnesota Board of Nursing;

b. On or about November 18, 2014, you provided false or inaccurate information to the College of Nurses of Ontario on your 2015 Annual Membership Renewal by indicating that you were not currently registered in the United States, at a time when you were registered as a Registered Nurse with the Minnesota Board of Nursing;

c. On or about November 5, 2017 and subsequently, you failed to disclose to the College of Nurses of Ontario that you have been the subject of a finding by the Minnesota Board of Nursing, specifically a ‘Disciplinary Action’ which suspended your license to practice professional nursing and provided that you must not engage in any act that constitutes the practice of nursing and must not imply by words or conduct that you are authorized to practice nursing.

Member’s Plea

The Member admitted the allegations set out in paragraphs #1, #2(a), #3, #4, #5 and #6(a), (b) and (c) in the Notice of Hearing. The Panel received a written plea inquiry which was signed by the Member. The Panel also conducted an oral plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Agreed Statement of Facts

College Counsel and the Member advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads unedited, as follows:

THE MEMBER

1. Clement Osei Tutu (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on July 13, 2009.

2. The Member is not currently entitled to practice nursing in Ontario.

MEMBERSHIP REPORTING OBLIGATIONS – LEGISLATIVE SCHEME

3. All CNO members are required to report certain information about themselves and their practice to CNO. These accountabilities are set out in legislation and bylaws. The pertinent sections were in force at all relevant times in relation to the incidents described below.

Statutory Framework

4. Section 1.5(1)1. of Ontario Regulation 275/94 pursuant to the Nursing Act, 1991 provides that every certificate of registration is subject to terms, conditions and limitations.

5. Relevant to the hearing presently before this Discipline Committee, the Member was required under ss.1.5(1)1.(iii) and (iv) to report to CNO any finding of professional misconduct, incompetence, incapacity, or any similar finding in relation to the practice of nursing in any other jurisdiction, as well as any concurrent investigation, inquiry or proceeding in relation to his nursing practice in any jurisdiction.

6. These reporting requirements are further reinforced under ss.51(1)(b) of the Health Professions Procedural Code (“Code”), which is Schedule 2 to the Regulated Health Professions Act, 1991.

7. The Code states that the Discipline Committee may consider it act of professional misconduct if a member has been found by a governing body of a health profession in a jurisdiction other than Ontario to have committed an act of professional misconduct.

By-Laws

8. Article 44.2.01 of CNO’s By-Laws (the “By-Laws”) provides that CNO shall forward it to its members each year a request for information, in a form approved by the Executive Director.

9. Article 44.2.02 states that all members must accurately complete and return this form, providing such information as may be requested including but not limited to where a member is engaged in nursing practice – whether inside or outside of Ontario – and the name, address and telephone number of each person or business for whom or through which the member engages in nursing practice.

10. When any information previously provided to CNO has changed, Article 44.2.06 requires that members notify the Executive Director of the change in writing within thirty (30) days of the date of the change.

INCIDENTS OF PROFESSIONAL MISCONDUCT

Member’s Prior CNO Proceedings

11. The Member was interim suspended by the Inquiries, Complaints and Reports Committee from April 1, 2015 until September 23, 2015 in relation to a health inquiry.

12. [ ].

13. On October 25, 2016, the FTP Committee suspended the Member’s Certificate of Registration (“Certificate”).

14. [ ].

Member Failed to Report Minnesota Board Registration to CNO

15. The Member was licensed as a registered nurse with the Minnesota Board of Nursing (the “Minnesota Board”) from December 24, 2013.

16. When the Member submitted his 2014 CNO Annual Membership Renewal (“AMR”) on October 23, 2013, he answered “no” to a declaration question asking whether he was concurrently registered as a nurse in any other jurisdiction, specifically the United States. As of the time of that submission, the Member’s statement was truthful: he was not registered in the United States until December 24, 2013.

17. Pursuant to Article 44.2.06, the Member ought to have reported his December 24, 2013 nursing license registration with the Minnesota Board to CNO no later than January 23, 2014.

18. When the Member submitted his 2015 AMR to CNO on November 18, 2014, he again answered “no” to the question asking whether he was concurrently registered as a nurse in any other jurisdiction, specifically the United States. This was a lie.

19. CNO’s 2014 and 2015 AMR forms specifically asked members to declare if they were registered as nurses in the United States, with separate questions asking about registration in other provinces, territories, or countries.

20. While completing both AMRs, the Member was prompted to make the following declaration prior to submitting the form to CNO: “I certify that the information in this form is correct and understand that providing false or misleading information to the College of Nurses of Ontario is considered professional misconduct.”

Member Failed to Report Minnesota Board’s Disciplinary Finding to CNO

21. In October 2017, the Minnesota Board informed CNO that it had taken disciplinary action against the Member by suspending his nursing license.

22. When the Member submitted the membership renewal application to the Minnesota Board on January 28, 2016, he answered “no” to questions probing whether he was under any investigation or subject to pending or past action against his nursing license in any state, territory, or country.

23. The Minnesota Board suspended the Member because he failed to declare the CNO [ ] proceedings. At the time of his renewal submission to the Minnesota Board, the FTP Committee had not yet suspended him [ ].

24. The Minnesota Board enclosed a copy of an Order, dated October 5, 2017, indicating the Member had been found to be in violation of Minnesota Statutes section 148.261, subdivision 1(4), (9) and (22) and had been suspended.

25. Minnesota Statutes 148.261, Subdivision 1: Grounds for Disciplinary Action stipulates that the Minnesota Board may deny, revoke, suspend, limit or condition the license and registration of a person as a result of various grounds for disciplinary action, which include the following:

(4) Revocation, suspension, limitation, conditioning, or other disciplinary action against the person's professional or practical nursing license or advanced practice registered nursing credential, in another state, territory, or country; failure to report to the board that charges regarding the person's nursing license or other credential are pending in another state, territory, or country; or having been refused a license or other credential by another state, territory, or country.

(9) Actual or potential inability to practice nursing with reasonable skill and safety to patients by reason of illness, use of alcohol, drugs, chemicals, or any other material, or as a result of any mental or physical condition.

(22) Making a false statement or knowingly providing false information to the board, failing to make reports as required […], or failing to cooperate with an investigation of the board as required […].

26. The Member failed to report to CNO that the Minnesota Board suspended his nursing license on October 5, 2017 and did not disclose any information to CNO about his interjurisdictional disciplinary proceedings. CNO only became aware of the disciplinary finding when directly contacted by the Minnesota Board.

27. Pursuant to the By-Laws, Article 44.2.06 (discussed above), the Member ought to have reported to CNO that the Minnesota Board suspended his nursing license on October 5, 2017, no later than November 5, 2017.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

28. The Member admits that he committed the acts of professional misconduct alleged in paragraphs 1, 2(a), 3, 4, 5, 6(a), 6(b) and 6(c) of the Notice of Hearing, as described in paragraphs 15 - 27 above, and in particular, that his conduct was dishonourable and unprofessional. The Member acknowledges that his conduct is unacceptable and that his actions demonstrate a pattern of disregard for his professional obligations mandated under the legislative scheme governing all CNO members in Ontario.

Decision

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

Having considered the evidence and the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs #1, #2(a), #3, #4, #5 and #6(a), (b) and (c) of the Notice of Hearing. As to allegations #6(a), (b) and (c), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be dishonourable and unprofessional.

Reasons for Decision

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

Allegation #1 in the Notice of Hearing is supported by paragraphs 7, 11-14 and 28 in the Agreed Statement of Facts. The Member admitted that he committed an act of professional misconduct in Minnesota that would be an act of professional misconduct in Ontario as defined by the regulations. The Minnesota Board of Nursing (“MBN”) found he had committed an act of professional misconduct when he failed to disclose disciplinary action against his license in Ontario on his 2016 application for renewal of his registered nursing license with the MBN and answered “no” to questions as to whether he was under any investigation or subject to pending or past action against his nursing license in any state, territory, or country. At the time of his renewal with the Minnesota Board, the Member had an undertaking agreement with the College’s Fitness to Practise Committee wherein he acknowledged that his health would not interfere with his ability to safely practise nursing and that he would report changes in his health to the College, as well as cease to practice immediately if he felt his health compromised his ability to safely practice. In 2017, the Member was found to be in violation of Minnesota Statutes section 148.261, subdivision 1(4), (9) and (22) which stipulates that the Minnesota Board may suspend a person’s license and registration if there is failure to report to the board that charges regarding the person’s nursing license are pending in another state, territory, or country and making a false statement or knowingly providing false information to the board. The Member’s failure to disclose to the MBN as described above, would be an act of professional misconduct further to the regulations if it had been committed in Ontario.

Allegation #2(a) in the Notice of Hearing is supported by paragraphs 18, 19, 20 and 28 in the Agreed Statement of Facts. The Member admitted that he signed or issued, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement. When the Member submitted his 2015 Annual Membership Renewal to the College on November 18, 2014, he answered “no” to the question asking whether he was concurrently registered as a nurse in any other jurisdiction, specifically the United States even though he was at the time registered as a Registered Nurse with the Minnesota Board of Nursing. Also, when the Member signed the Annual Membership Renewal form that required him to acknowledge that: “I certify that the information in this form is correct and understand that providing false or misleading information to the College of Nurses of Ontario is considered professional misconduct” he knew or ought to have known that he was signing a document that contained a false or misleading statement. Accordingly, the facts support the allegation that the Member signed or issued, in his professional capacity, a document that he knew contained a false or misleading statement.

Allegation #3 in the Notice of Hearing is supported by paragraphs 3-10 and 21-28 in the Agreed Statement of Facts. The Member admitted that he contravened a term of his certificate of registration when he failed to disclose to the College that his license to practice had been subject to a “Disciplinary Action” by the Minnesota Board of Nursing, which suspended his license to practice. Article 44.2.01 of the College’s By-Laws provides that each year the College will forward to its members a request for information form. Article 44.2.02 states that members must accurately complete and return such form providing information on, among other things, “details of any finding of professional misconduct or incompetence or other like finding that has been made against a member by a body that governs any profession, whether inside or outside of Ontario”. Article 44.2.06 requires members to notify the Executive Director of the College of any changes that have occurred since the last Annual Membership Renewal within 30 days of the change. Accordingly, the facts support the allegation that the Member contravened a term of his certificate of registration.

Allegation #4 in the Notice of Hearing is supported by paragraphs 4-10 and 21-28 in the Agreed Statement of Facts. The Member admitted that he failed to disclose to the College that the Minnesota Board of Nursing had suspended his license to practice nursing on or about November 5, 2017. The Member was suspended for providing false information to the Minnesota Board of Nursing regarding his agreement with the Fitness to Practise Committee and his subsequent suspension. Members of the College are required to report certain information about themselves and their practice to the College at the time of the Annual Membership Renewal and subsequently any changes that take place within 30 days of a change.

Allegation #5 in the Notice of Hearing is supported by paragraphs 4-10 and 21-28 in the Agreed Statement of Facts. The Member admitted that he committed the acts of professional misconduct as alleged in paragraph 5 of the Notice of Hearing. The Panel finds the Member failed to take reasonable steps to ensure that the requested information asked for by the College was provided in a complete and accurate manner. The Member failed to disclose to the College that he had been the subject of a finding by the Minnesota Board of Nursing of a “Disciplinary Action”, which suspended his license to practice nursing. Members of the College are required to report to the College any finding of professional misconduct, or similar findings in relation to the practice of nursing in any other jurisdiction inside or outside of Ontario. Members are to report to the Executive Director within 30 days if there are any changes to information submitted on the previous Annual Membership Renewal.

Allegations #6(a), (b) and (c) in the Notice of Hearing are supported by paragraphs 15-28 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in failing to notify the College of disciplinary findings of the Minnesota Board of Nursing was clearly relevant to the practice of nursing. It was unprofessional as it demonstrated a serious and persistent disregard for his professional obligations. The Member should have recognized his professional responsibility to report any professional misconduct in any jurisdiction, including findings of professional misconduct from the Minnesota Board of Nursing.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit when he provided false information to the College on his Annual Membership Renewal form and failed to disclose to the College that there were disciplinary findings which suspended his license in another jurisdiction. The Member knew or ought to have known that his conduct was unacceptable and fell below the standards of a professional.

Penalty

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

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

2. Directing the Executive Director to suspend the Member’s certificate of registration for 4 months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in a practicing class.

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

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

i. The Expert has expertise in nursing regulation and has been approved by CNO in advance of the meetings;

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules and decision tools (where applicable):

1. Code of Conduct;

iv. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of the completed Reflective Questionnaires;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into the Member’s behaviour;

vii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on the Member’s certificate of registration;

b) For a period of 18 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

i. Inform any employer of the decision at least 14 days prior to commencing or prior to resuming employment in any nursing position;

ii. Ensure that CNO is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

iii. Provide the Member’s employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iv. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to CNO, in which it will confirm:

1. that they received a copy of the required documents, and

2. that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

3. All documents delivered by the Member to CNO, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.

Penalty Submissions

Submissions were made by College Counsel.

The aggravating factors in this case were:

• The seriousness of the Member’s conduct related to his failure to report findings of professional misconduct from another jurisdiction:

• It was dishonest as he ought to have known that he was submitting inaccurate information;

• The conduct cannot be characterized as a one off mistake or incident;

• It was in breach of a previous agreement he entered into with the Fitness to Practise Committee;

• The Member failed to disclose to the College that he was licensed as a registered nurse with the Minnesota Board of Nursing;

• The Member failed to disclose to the Minnesota Board of Nursing about the College’s [ ] proceedings against him;

• He failed to report the professional misconduct from another jurisdiction; and

• He failed to act with the integrity that the College, the public and members of the profession expect from a nurse, thereby impeding the College from discharging its responsibilities, which raises governability questions.

The mitigating factors in this case were:

• The Member accepted responsibility for his conduct by entering into an Agreed Statement of Facts and a Joint Submission on Order with the College;

• The Member has no prior disciplinary history with the College; and

• The Member participated in an uncontested hearing.

The purpose of general deterrence is to demonstrate that acts of professional misconduct are taken seriously by panels of the Discipline Committee and there will be consequences for those that engage in such misconduct. The proposed penalty provides for general deterrence through: The 4-month suspension of the Member’s certificate of registration.

Specific deterrence dissuades the Member from committing acts of professional misconduct in the future. The proposed penalty provides for specific deterrence through: The oral reprimand and the 4-month suspension of the Member’s certificate of registration.

The purpose of remediation and rehabilitation is to help equip the Member with the tools needed to meet the requirements of nursing practice. The proposed penalty provides for remediation and rehabilitation through: A minimum of 2 meetings with a Regulatory Expert and the review of the College’s Code of Conduct.

Overall, the public is protected through: The 18 months of employer notification and the Joint Submission on Order, in its totality, as it is geared toward public protection. The order sends a message to nurses that there are consequences for their behavior, and to the public of the profession’s ability to self-regulate.

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

CNO v. Davis (Discipline Committee, 2020): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member did not meet the standards in that he provided inadequate patient care, failed to keep records and failed to notify the College of a finding of guilt related to the use of a forged document. The penalty included an oral reprimand, a 6-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert, 18 months of employer notification, random spot audits of the member’s practice, 12 months of mentorship and 18 months of no independent practice in the community.

CNO v. Lucier-Harkai (Discipline Committee, 2022): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member did not meet the standards in that she failed to report to the College findings of professional misconduct and breached the Medication Standard. The penalty included an oral reprimand, a 3-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert, 12 months of employer notification and 12 months of no independent practice in the community.

CNO v. Toth (Discipline Committee, 2019): The member was not in attendance at the hearing. The member did not meet the standards of the Health Professions Procedural Code of the Nursing Act, 1991, as she was found guilty of two criminal offences and failed to report findings of guilt in another jurisdiction to the College. The penalty included an oral reprimand, a 5-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Nursing Expert and 18 months of employer notification.

Penalty Decision

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

1. The Member is required to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.

2. The Executive Director is directed to suspend the Member’s certificate of registration for 4 months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in a practicing class.

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

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

i. The Expert has expertise in nursing regulation and has been approved by CNO in advance of the meetings;

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules and decision tools (where applicable):

1. Code of Conduct;

iv. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of the completed Reflective Questionnaires;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into the Member’s behaviour;

vii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on the Member’s certificate of registration;

b) For a period of 18 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

i. Inform any employer of the decision at least 14 days prior to commencing or prior to resuming employment in any nursing position;

ii. Ensure that CNO is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

iii. Provide the Member’s employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iv. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to CNO, in which it will confirm:

1. that they received a copy of the required documents, and

2. that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

3. All documents delivered by the Member to CNO, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.

Reasons for Penalty Decision

The Panel understands that the penalty ordered should protect the public and enhance public confidence in the ability of the College to regulate nurses. This is achieved through a penalty that addresses specific deterrence, general deterrence and, where appropriate, rehabilitation and remediation. The Panel also considered the penalty in light of the principle that joint submissions should not be interfered with lightly.

The Panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility.

The Panel finds that the penalty satisfies the principles of specific and general deterrence, rehabilitation and remediation, and public protection. General deterrence is met through the 4-month suspension of the Member’s certificate of registration, which will send a message to members of the profession that this conduct is not acceptable. Specific deterrence is achieved through the oral reprimand and the 4-month suspension of the Member’s certificate of registration, which will convey to the Member the seriousness of his conduct. Remediation and rehabilitation are met through a minimum of 2 meetings with a Regulatory Expert and the review of the College’s Code of Conduct. The public is protected through the 18 months of employer notification.

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

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