College of Nurses of Ontario v. Johanne Groulx, 2023 ONCNO 149488

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Susan Roger, RN Chairperson

Tim Crowder, Public Member Mary MacNeil, RN Member

Donna May, RPN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) GLYNNIS HAWE for

) College of Nurses of Ontario

• and - )

JOHANNE GROULX ) NO REPRESENTATION for

Registration No. IJ14028 ) Johanne Groulx

) PATRICIA HARPER

) Independent Legal Counsel

) Heard: November 9, 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 9, 2023, via videoconference.

Publication Ban

College Counsel brought a motion pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, for an order preventing public disclosure and banning the publication or broadcasting of the names of the patients, or any information that could disclose their identities, referred to orally or in any documents presented at the Discipline hearing of Johanne Groulx.

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

The Allegations

College Counsel advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraphs #2(a) and #2(b) in the Notice of Hearing dated October 6, 2023. The Panel granted this request. The remaining allegations against Johanne Groulx (the “Member”) 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 with the College of Nurses of Ontario as a Registered Practical Nurse and/or while employed at Bruyère Continuing Care in Ottawa, Ontario (the “Facility”), 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 August 2013, you provided your home address to [the Patient] for no clinical purpose;

b. in or about August 2013, you engaged in personal and/or sexual relationship with [the Patient];

c. between 2013 and 2018, you failed to maintain the boundaries of the therapeutic nurse-client relationship with respect to [the Patient]; and/or

d. in or about 2015, you failed to report to the Facility and/or CNO that you had information that your nursing colleague, P.R. had engaged in a personal and/or sexual relationship with a patient.

2. a. [withdrawn]; and/or

b. [withdrawn].

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(25) of Ontario Regulation 799/93, in that while registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse and/or while employed at Bruyère Continuing Care in Ottawa, Ontario (the “Facility”), you failed to report an incident of unsafe practice or unethical conduct of a health care provider to the employer or other authority responsible for the health care provider, in that in or about 2015, you failed to report to the Facility and/or CNO that you had information that your nursing colleague, P.R. had engaged in a personal and/or sexual relationship with a patient.

4. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that while registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse and/or while employed at Bruyère Continuing Care in Ottawa, Ontario (the “Facility”), you engaged in conduct that would reasonably be regarded by members as disgraceful, dishonourable or unprofessional with respect to the following incidents:

a. in or about August 2013, you provided your home address to [the Patient] for no clinical purpose;

b. in or about August 2013, you engaged in a personal and/or sexual relationship with [the Patient];

c. between 2013 and 2018, you failed to maintain the boundaries of the therapeutic nurse-client relationship with respect to [the Patient]; and/or

d. in or around 2015, you failed to report to the Facility and/or CNO that you had information that your nursing colleague, P.R. had engaged in a personal and/or sexual relationship with a patient.

Member’s Plea

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

Agreed Statement of Facts

College Counsel and the Member advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which as amended reads, unedited, without exhibits as follows:

THE MEMBER

1. Johanne Groulx (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on October 9, 1990.

2. The Member was employed at Bruyère Continuing Care - Élisabeth Bruyère Hospital, in Ottawa, Ontario (the “Facility”) at the time of the incidents. The Member worked at the Facility’s Photo Dermatology Clinic (the “Clinic”). The Clinic provides photo therapy, meaning the provision of ultraviolet treatment for various skin conditions such as eczema and vitiligo.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Relationship with [the Patient]

3. (the “Patient”) was diagnosed with vitiligo and first attended the Clinic in July 2010. He was an active patient at multiple times over the subsequent years: in July 2010, from February 2013 to August 2013, September 2015, December 2015 to June 2016, and January 2018 to July 2018.

4. Given the nature of the Patient’s chronic skin condition, although his treatments concluded at various points in time, there was an ongoing possibility of his returning to be an active patient in the future.

5. The Member provided the Patient with direct nursing care during his visits in 2013, 2016, and 2018. The Member first met the Patient at the Clinic and did not know him previously outside of the Clinic.

6. The Member was aware of the restrictions regarding personal relationships with patients and told the Patient this. The Patient responded by stating he wanted to end his treatment and asked the Member to go out with him. Shortly after the Patient’s last 2013 treatment in August 2013, the Member and the Patient engaged in a personal and sexual relationship, the details of which are described below.

7. At some point in the fall of 2013, the Member provided the Patient with her home address, and he attended her home on one occasion. When the Patient attended the Member’s home, they engaged in sexual intercourse.

8. Before entering into a personal and sexual relationship with the Patient, the Member was required to, but did not, take steps to consider whether such a relationship would have a negative effect on the Patient’s future care, whether the relationship arose from the trust and professional intimacy developed during the nurse-patient relationship, and to clearly demarcate to the Patient and to the Clinic that their relationship was no longer therapeutic and strictly personal.

9. The Member and the Patient’s personal and sexual relationship consisted of the encounter described above and did not continue thereafter.

10. In or around 2015, the Patient attended the Clinic for treatment and while he was getting ready for treatment, he grabbed the Member’s face and kissed her. If the Member were to testify, she would state that she backed up and said this was something that could not happen.

11. In or around 2015, the Member told her nursing colleague, Patricia Ravelo (“Colleague P.R.”), about her relationship with the Patient.

12. The Member shared with her partner at the time that she had had a relationship with the Patient. The Member’s partner at the time reported to the Facility that the Member had had a relationship with the Patient, prompting the Facility’s investigation into the Member’s relationship with the Patient.

13. In May and June 2020, the Facility interviewed the Member and the Member admitted to engaging in a personal relationship with the Patient.

Failure to Report Sexual Abuse of a Patient

14. In or around 2015, Colleague P.R., told the Member that she had engaged in sexual relationship with [ ] (“Patient [B]”), another patient at the Clinic. The Member did not report Colleague P.R.’s sexual relationship with Patient [B] to the Facility or CNO at that time.

15. If the Member were to testify, she would say that Colleague P.R. did not disclose the timeframe in which her relationship with Patient [B] had taken place, so it was not clear to the Member that it had been while he was a patient. The Member would acknowledge, however, that she did not take any steps to clarify the timeframe with Colleague P.R., and that based on the information that Colleague P.R. did disclose, the Member had a duty either to report the relationship to CNO, or to obtain further information to confirm that such a report was not necessary.

16. In August 2020, the Facility interviewed the Member and she advised that she was aware that Colleague P.R., had had a sexual relationship with a patient in the past, and she had not reported it at the time.

17. As a result of the incidents described above, the Facility suspended the Member for 10 days. Prior to this disciplinary suspension, the Facility placed the Member on administrative leave with pay for approximately two months while it conducted its investigation. If the Member were to testify, she would explain that the rate of pay she received during this administrative suspension was lower than her regular rate of pay.

18. If the Member were to testify, she would state that she is incredibly sad and disappointed that she breached the code of ethics of her profession, and state she should have notified her supervisors immediately.

HEALTH PROFESSIONS PROCEDURAL CODE

19. Section 85.1(1) of the Code requires members to file a report with the College when the member has reasonable grounds, obtained in the course of practising the profession, to believe that another member of the same College has sexually abused a patient.

CNO STANDARDS

Professional Standards

20. CNO’s Professional Standards, provides an overall framework for the practice of nursing and a link with other standards, guidelines and competencies developed by CNO. It includes seven broad standard statements pertaining to accountability, continuing competence, ethics, knowledge, knowledge application, leadership and relationships.

21. CNO’s Professional Standards provides, in relation to the accountability standard, that nurses are accountable to the public and responsible for ensuring their practice and conduct meets the legislative requirements and the standards of the profession. Nurses are responsible for their actions and the consequences of those actions as well as for conducting themselves in ways that promote respect for the profession. Nurses demonstrate this standard by:

• Ensuring their practice is consistent with CNO’s standards of practice and guidelines as well as legislation;

• Reporting to the appropriate authority any health care team member or colleague whose actions or behaviours toward [patients] are unsafe or unprofessional, or indicate physical, verbal and emotional abuse; and

• Reporting sexual abuse of a [patient] by a regulated health professional to the appropriate regulatory college, as legislated in the Regulated Health Professions Act, 1991.

22. CNO’s Professional Standards further provides, in relation to the ethics standard, that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with the patient and other health care team members. A nurse demonstrates having met this standard by identifying ethical issues and communicating them to the healthcare team.

23. CNO’s Professional Standards provides, in relation to the relationship standard and the therapeutic nurse-patient relationship, that a nurse demonstrates this standard by:

• Maintaining boundaries between professional therapeutic relationships and non-professional personal relationships;

• Ensuring [patients’] needs remain the focus of nurse-[patient] relationships; and

• Ensuring his or her personal needs are met outside of the therapeutic nurse-[patient] relationships.

24. In addition, CNO’s Professional Standards further provides, in relation to the leadership standard, that a nurse demonstrates leadership role-modelling professional values, beliefs and attributes.

25. Attached as Exhibit “A” are copies of CNO’s Professional Standards that were in force at the time of the incidents and have since been retired.

Therapeutic Nurse-Client Relationship

26. CNO’s Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”), contains four standard statements which describe nurses’ accountabilities with respect to therapeutic communication, patient-centred care, maintaining boundaries and protecting the patient from abuse. The TNCR Standard provides that the nurse-patient relationship is built on trust, respect, empathy, professional intimacy and requires the appropriate use of power inherent in the care provider’s role.

27. CNO’s TNCR Standard defines a boundary in the nurse-patient relationship as “the point at which the relationship changes from professional and therapeutic to unprofessional and personal.” CNO’s TNCR Standard places the responsibility for establishing and maintaining the limits and boundaries in the therapeutic nurse-patient relationship on the nurse. CNO’s TNCR Standard provides that:

Crossing a boundary means that the care provider is misusing the power in the relationship to meet his/her personal needs, rather than the needs of the [patient], or behaving in an unprofessional manner with the [patient].

28. CNO’s TNCR Standard provides, in relation to maintaining boundaries, that nurses meet this standard by:

• Setting and maintaining the appropriate boundaries within the relationship, and helping [patients] understand when their requests are beyond the limits of the therapeutic relationship;

• Abstaining from disclosing personal information, unless it meets an articulated therapeutic need of the [patient];

• Continually clarifying her/his role in the therapeutic relationship, especially in situations in which the [patient] may become unclear about the boundaries and limits of the relationship;

• 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 [patient]; and

• Ensuring that the nurse-[patient] relationship and nursing strategies are developed for the purpose of promoting the health and well-being of the [patient] and not to meet the needs of the nurse, especially when considering self-disclosure, giving a gift to or accepting a gift from a [patient].

29. CNO’s TNCR Standard requires nurses to protect the patient from harm by ensuring that abuse is prevented or stopped and reported. With respect to protecting the patient from abuse, a nurse demonstrates having met the TNCR Standard by:

• Not entering a friendship, or a romantic, sexual or other personal relationship with a [patient] when a therapeutic relationship exists; and

• Being cautious about entering into a personal relationship, such as a friendship or romantic or sexual relationship, with a former [patient] or a former [patient’s] significant other after the termination of a therapeutic relationship if:

o it is determined that such a relationship would not have a negative impact on the future care of the [patient];

o the relationship is not based on the trust and professional intimacy that was developed during the nurse-client relationship; and

o the [patient] is clear that the relationship is no longer therapeutic.

30. Attached as Exhibit “B” is a copy of CNO’s TNCR Standard that was in force at the time of the incidents.

31. The Member admits and acknowledges that she contravened Professional Standards and the TNCR Standard when she:

• Provided her home address to the Patient for no clinical purpose;

• Engaged in personal and/or sexual relationship with the Patient;

• Failed to maintain the boundaries of the therapeutic nurse-client relationship with respect to the Patient.; and

• Failed to report to the Facility and/or CNO that she had information that Colleague P.R. had engaged in a personal and/or sexual relationship with Patient [B].

ADMISSIONS OF PROFESSIONAL MISCONDUCT

32. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 1(a), (b), (c) and (d) of the Notice of Hearing in that she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 3 to 31 above.

33. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3 in that she failed to report an incident of unsafe practice or unethical conduct of a health care provider to the employer or other authority responsible for the health care provider or to CNO, as described in paragraphs 14 to 19 above.

34. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 4 (a), (b), (c) and (d) of the Notice of Hearing, and in particular her conduct was disgraceful, dishonourable and unprofessional, as described in paragraphs 3 to 31 above.

OTHER

35. With the leave of the Panel of the Discipline Committee, CNO withdraws the remaining allegations in the Notice of Hearing, which are as follows:

• 2(a)

• 2(b)

Submissions on liability were made by College Counsel.

College Counsel asked the Panel to accept the Agreed Statement of Facts, as well as the Member’s admissions to all the allegations that were not withdrawn as set out in paragraphs 32-34 of the Agreed Statement of Facts and, on the basis of those facts and admissions, make findings of professional misconduct with respect to the allegations in the Notice of Hearing. College Counsel submitted that the Panel has taken the Member’s plea, conducted a verbal plea inquiry, and received a written plea inquiry which confirmed that the plea was voluntary and informed, as it reflects a resolution that is fair and protects the public interest. College Counsel submitted that based on the Agreed Statement of Facts, which specifically describes the facts in relation to the allegations, the Panel has enough evidence to find that the Member committed professional misconduct as set out in all the allegations in the Notice of Hearing.

College Counsel reviewed allegations #1 and #4 with the Panel. With regard to allegation #1, College Counsel submitted that this allegation is supported by the Agreed Statement of Facts, which contained evidence of the relevant College standards of the profession, as well as the Member’s admissions that those standards in effect at the time were breached. This provides a factual and evidentiary basis to make findings for allegation #1.

With regard to allegation #4, College Counsel submitted that the Panel needs to be satisfied that the Member’s conduct is relevant to the practice of nursing. In this case, the Member would not have known [the Patient] were it not for her employment at Bruyère Continuing Care – Élisabeth Bruyère Hospital (the “Facility”) in the Photo Dermatology Clinic (the “Clinic”) where she provided nursing care to him. In one instance, the relationship was also manifested with physical affection from [the Patient] toward the Member while he was attending the Facility’s Clinic for treatment. College Counsel submitted that the Member also failed to report a sexual relationship that Colleague P.R. had with a patient, which the Member became aware of while working at the Facility with Colleague P.R. Together, these factors indicate that the Member’s conduct was relevant to the practice of nursing. The Panel also needs to be satisfied that members of the profession would regard the Member’s conduct to be disgraceful, dishonourable and/or unprofessional. The Member admitted in the Agreed Statement of Facts that her conduct was disgraceful, dishonourable and unprofessional. The Member’s conduct was unprofessional as it displayed a serious disregard for her professional obligations. The Member’s conduct was dishonourable as she knew or ought to have known that her conduct fell below the standards of a professional. The Member also showed an element of moral failing by engaging in a sexual relationship with [the Patient]. Disgraceful conduct has the effect of shaming the profession and impacts the Member’s ability to discharge the duties the public expects of nurses. The Member admitted that her conduct was also disgraceful.

College Counsel asked the Panel to accept the Member’s admissions in the Agreed Statement of Facts and make findings on all remaining allegations.

The Member made no submissions on liability.

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), (b), (c), (d), #3 and #4(a), (b), (c) and (d) of the Notice of Hearing. As to allegations #4(a), (b), (c) and (d), 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.

Reasons for Decision

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

Allegations #1(a), (b), (c) and (d) in the Notice of Hearing are supported by paragraphs 3-32 in the Agreed Statement of Facts. The Member provided direct nursing care to [the Patient] during his visits to the Clinic for treatment and therefore knew [the Patient[ through a therapeutic nurse-patient relationship. Despite this, the Member provided [the Patient] with her home address and, on one occasion, when [the Patient] attended the Member’s home, the Member and [the Patient] had sexual intercourse. This was a clear boundary violation of the Therapeutic Nurse-Client Relationship (“TNCR Standard”). The TNCR Standard requires that nurses not enter a romantic, sexual or other personal relationship with a patient when a therapeutic relationship exists. The TNCR Standard also states that nurses abstain from disclosing personal information. This would include sharing a personal address. Sharing her personal address and having sexual intercourse with [the Patient] was a breach of the TNCR Standard. The Member’s conduct was also a breach of the Professional Standards which requires nurses to act with integrity, professionalism, maintain boundaries and ensure personal needs are met outside the therapeutic nurse-patient relationship. The Member failed to meet these standards.

The Member also had knowledge that her Colleague P.R., engaged in a sexual relationship with a patient and failed to act on this knowledge by clarifying the timeframe for this relationship and also failed to report the conduct to the College or obtain further information to confirm that such a report was not necessary. This was also a violation of the TNCR Standard and the Professional Standards since nurses are required to consult in any situation in which it is unclear whether a behavior may cross a boundary of a therapeutic relationship and/or report behaviour of a health care team member whose actions are unprofessional. The Member did not consult with her manager or the College when Colleague P.R. disclosed her sexual relationship with a patient and was therefore in breach of both the TNCR Standard and the Professional Standards.

Allegation #3 in the Notice of Hearing is supported by paragraphs 14-19 and 33 in the Agreed Statement of Facts. Colleague P.R. told the Member in or around 2015 that she had engaged in sexual relations with a patient at the Clinic. Despite being unsure of the timeframe of the sexual relations, the Member had a duty to act on this knowledge by consulting and reporting this to her manager or the College. As per the Health Professions Procedural Code, nurses are required to report such incidents of unethical behaviour. By failing to report Colleague P.R.’s conduct, the Member committed an act of professional misconduct.

Allegations # 4(a), (b), (c) and (d) in the Notice of Hearing are supported by paragraphs 3-31 and 34 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in sharing her personal address, engaging in sexual relations with [the Patient] and failing to report unethical behaviour of Colleague P.R. was clearly relevant to the practice of nursing. It was unprofessional as it showed extremely poor judgement and demonstrated a serious and persistent disregard for her professional obligations in breaching the Professional Standards and the TNCR Standard.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit as her behavior only came to light due to a report from her partner five years after the patient interaction. The Member failed to report her conduct to her manager or the College and also failed to report similar unprofessional behavior of Colleague P.R. The Member knew or ought to have known that she and Colleague P.R. crossed a significant boundary with their patients and should have taken accountability for it in a forthright manner. The Member knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. Deciding to ignore the professional nurse-patient boundary and have sexual intercourse with [the Patient] and ignore similar behaviour from Colleague P.R., casts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet.

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 9 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, and

2. Therapeutic Nurse-Client Relationship;

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

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

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

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

3. strategies for preventing the misconduct from recurring,

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

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

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

1. the dates the Member attended the sessions,

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

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

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

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

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

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

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

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

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

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

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

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

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

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 on penalty were made by College Counsel.

The aggravating factors in the case were:

• The Member’s conduct involved a breach of trust between the Member, [the Patient] and the profession;

• The Member’s conduct was motivated by personal gain; and

• The Member’s conduct involved an element of potential harm to [the Patient].

The mitigating factors in the case were:

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

• The Member has expressed deep remorse for her conduct; and

• The Member has cooperated with the College throughout the process by entering into an Agreed Statement of Facts and a Joint Submission on Order with the College.

College Counsel submitted that the proposed penalty meets the goals of penalty. Specific deterrence is met through the oral reprimand and the 9-month suspension of the Member’s certificate of registration. The oral reprimand will give the Member a greater understanding of the disapproval of members of the profession and the public of this type of conduct. The 9-month suspension of the Member’s certificate of registration is also a significant suspension to deter the Member from participating in similar conduct in the future.

The 9-month suspension of the Member’s certificate of registration will similarly act as a general deterrence to the profession by showing members of the profession that there are serious consequences of such behavior.

Rehabilitation and remediation are achieved through a minimum of 2 meetings with a Regulatory Expert and the review of the College’s Code of Conduct and TNCR Standard, allowing the Member to learn from this experience and gain insight into her conduct with an overall goal of ensuring public protection when she returns to practice. Overall, the public is protected through the 12 months of employer notification, which will provide for a heightened level of employer oversight on the Member’s return to practice.

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

CNO v. Appiah-Kubi (Discipline Committee, 2018): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member was aware that a colleague had sexual relations with a patient and did not report this to the facility or the College. The member, who was in a Charge Nurse position, also failed to revise a patient assignment to prevent her colleague from being assigned to the patient with whom the colleague had a sexual relationship. This case is similar to the case before this Panel in that it involved a failure to report a sexual relationship between a nurse and a patient. Aggravating and mitigating factors were also similar. The penalty included an oral reprimand, a two-month suspension of the member’s certificate of registration and two meetings with a Nursing Expert. College Counsel submitted that this case provides the precedent for allegation #1 in the current case before this Panel.

CNO v. Cabot (Discipline Committee, 2021): This case proceeded by way of an Agreed Statement of Facts and a partial Joint Submission on Order. The allegations heard by the panel related to a breach of the therapeutic-nurse client relationship boundary. This case involved 2 patients who were spouses. While treating both patients, the member became involved with patient #1 via romantic text messages and later, entered into a sexual relationship. The member continued to be in a nurse-patient relationship with patient #2, patient #1’s spouse. The panel found that the member breached the therapeutic nurse-client relationship boundary, committed professional misconduct and that her conduct was disgraceful, dishonourable and unprofessional. The penalty included an oral reprimand, a 10-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert, 18 months of employer notification and 18 months of no independent practice. Submissions were made regarding the length of the suspension. Considering significant mitigating circumstance, the panel ultimately ordered a 10-month suspension of the member’s certificate of registration to demonstrate the seriousness of failing to maintain the therapeutic-nurse client relationship boundaries.

CNO v. Hohban (Discipline Committee, 2020): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member faced allegations of failing to maintain boundaries of the nurse-client relationship. The member had a personal and romantic relationship with a patient, communicating via Facebook, text and phone and meeting outside the normal nurse-patient appointments, including a trip together to Montreal. The Panel found the member contravened the standards, had sexually abused a patient and that the conduct was disgraceful, dishonourable and unprofessional. The aggravating and mitigating factors were similar to the case before this Panel. The patient was vulnerable and seeking treatment for addiction issues. While the case before this Panel does not involve issues of addiction, College Counsel submitted that there is always an inherent power difference between nurses and patients. The penalty included an oral reprimand, a 6-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 18 months of employer notification.

College Counsel submitted that these three prior decisions demonstrate that allegations involving inappropriate relations with a patient can, by themselves, warrant a suspension of between 6-10 months along with an oral reprimand, meetings with a Regulatory Expert and employer notifications. Allegations of failing to report an improper relationship with a patient can also warrant a suspension of 2 months, along with an oral reprimand and meetings with a Regulatory Expert. College Counsel submitted that taking these cases together, the agreement is reasonable, in line with the goals of penalty and falls within the range of penalties previously ordered by the Discipline Committee.

The Member submitted that she understood the penalty being proposed.

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 9 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, and

2. Therapeutic Nurse-Client Relationship;

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

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

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

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

3. strategies for preventing the misconduct from recurring,

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

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

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

1. the dates the Member attended the sessions,

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

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

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

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

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

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

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

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

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

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

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

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

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

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.

The proposed penalty provides for general deterrence through the 9-month suspension of the Member’s certificate of registration, which is a lengthy suspension and indicates to members of the profession that conduct of this nature will have serious consequences.

The proposed penalty provides for specific deterrence through the oral reprimand and the 9-month suspension of the Member’s certificate of registration.

The proposed penalty provides for remediation and rehabilitation through a minimum of 2 meetings with a Regulatory Expert allowing the Member to gain insight and learn from her mistakes. The 12 months of employer notification will ensure the public is protected.

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, Susan Roger, 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.