College of Nurses of Ontario v. Georgy Djanashvili, 2023 CanLII 47346

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Karen Laforet, RN Chairperson Carly Gilchrist, RPN Member Tyler Hands, RN Member Sandra Larmour Public Member

BETWEEN:

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

• and - )

GEORGY DJANASHVILI ) MICHELLE GIBBS for Registration No. 0440842 ) Georgy Djanashvili ) CHRISTOPHER WIRTH ) Independent Legal Counsel ) Heard: January 12, 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 January 12, 2023, via videoconference.

The Allegations

The allegations against Georgy Djanashvili (the “Member”) as stated in the Notice of Hearing dated December 6, 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 working as a Registered Nurse at Baycrest Hospital in Toronto, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, and in particular, in or around 2011 to 2018, you submitted and/or accepted payment for false claims under the Facility’s employee group benefit plan (the “Benefit Plan”).

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(8) of Ontario Regulation 799/93, in that while working as a Registered Nurse at the Facility, you misappropriated property from a client or workplace, and in particular, in or around 2011 to 2018, you submitted and/or accepted payment for false claims under the Benefit Plan.

3. You committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(14) of Ontario Regulation 799/93, in that while working as a Registered Nurse at the Facility, you falsified a record relating to your practice, and in particular, in or around 2011 to 2018, you submitted and/or accepted payment for false claims under the Benefit Plan.

4. You committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(15) of Ontario Regulation 799/93, in that while working as a Registered Nurse at the Facility, you signed or issued, in your professional capacity, a document that you knew or ought to have known contained a false or misleading statement, and in particular, in or around 2011 to 2018, you submitted and/or accepted payment for false claims under the Benefit Plan.

5. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that while working as a Registered Nurse at the Facility, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, and in particular, in or around 2011 to 2018, you submitted and/or accepted payment for false claims under the Benefit Plan.

Member’s Plea

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

Agreed Statement of Facts

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

MEMBER

1. Georgy Djanashvili (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on October 26, 2004, and as a Registered Nurse (“RN”) on November 24, 2004. The Member resigned his registration as a RPN on December 31, 2004. He remains registered with CNO as a RN in the General Class.
2. The Member was employed as an RN in Continuing Care at Baycrest Health Sciences in Toronto, Ontario (the “Facility”), at the time of the incidents described below. By mutual agreement with the Facility, the Member resigned from his employment at the Facility on July 10, 2019 as a result of these incidents.

BENEFIT PLAN

3. The Facility offers its employees a self-insured group insurance policy by which the Facility provides coverage to employees for extended health care, dental, and other insurance benefits (the “Benefit Plan”). Coughlin & Associates Ltd (“Coughlin”) administers the Benefit Plan on behalf of the Facility. The Facility, however, is the plan sponsor for the Benefit Plan, and therefore funds the cost of claims paid out to employees under the plan. Employees contribute to the cost of the Benefit Plan as set out in their employment agreement and/or collective agreement, based on their election for individual or family coverage.
4. To submit a benefit claim, members of the Benefit Plan would complete a medical expense claim form provided by Coughlin. The medical expense claim form requires certain information, including information on the plan member, any dependents, and the nature of the claim. The plan member must certify “that the information given is true, correct and complete to the best of [their] knowledge”.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

5. Between 2011 and 2018, the Member submitted claims for physiotherapy services under the Benefit Plan totalling at least $13,940.00, though physiotherapy services were not actually provided.
6. In January 2019, the Facility uncovered benefits irregularities and conducted an internal investigation into the issue. As part of this investigation, the Member was interviewed by the Facility with respect to his claims.
7. The Facility interviewed the Member on February 8, 2019 regarding benefit claims he had submitted. The Member admitted to having retained half the funds received through benefit reimbursement, while providing the other half to another individual, who submitted claims on the Member’s behalf. The Member advised that at some point he had asked to stop participating in the fraudulent benefits scheme, but forms continued to be submitted on his behalf without him having signed them and the Member continued accepting the improper payments.
8. The Member did not pay restitution.

BENEFIT FRAUD CASES

9. To date, a total of at least 83 benefit fraud cases involving substantially similar schemes as the one identified in this case, involving either cash or products not covered by the benefit plan, have been referred to the Discipline Committee. The dollar amounts of the false claims involved range from under $500 to over $45,000.

CNO STANDARDS

Professional Standards

10. 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.
11. 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 standard of the profession. Nurses are responsible for their actions and the consequences of those actions as well as for conducting themselves in ways that promote respect for the profession. Nurses demonstrate this standard by actions such as ensuring their practice is consistent with CNO’s standards of practice and guidelines as well as legislation.
12. CNO’s Professional Standards provides, in relation to the leadership standard, that leadership requires self-knowledge (understanding one’s beliefs and values and being aware of how one’s behaviour affects others), respect, trust, integrity, shared vision, learning, participation, good communication techniques and the ability to be a change facilitator. The leadership expectation is not limited to nurses in formal leadership positions and all nurses, regardless of their position, have opportunities for leadership. Nurses demonstrate this standard by actions such as role-modelling professional values, beliefs and attributes.

Ethics

13. CNO’s Ethics Standard describes ethical values that are important to the nursing profession in Ontario including patient well-being, patient choice, privacy and confidentiality, respect for life, maintaining commitments, truthfulness and fairness.
14. CNO’s Ethics Standard provides, in relation to maintaining commitments, that nurses have a commitment to the nursing profession and being a member of the profession brings with it the respect and trust of the public. To continue to deserve this respect, nurses have a duty to uphold the standards of the profession, conduct themselves in a manner that reflects well on the profession, and to participate in and promote the growth of the profession.
15. CNO’s Ethics Standard also provides, in relation to truthfulness, that truthfulness means speaking and acting without intending to deceive.
16. The Member admits and acknowledges that he contravened CNO’s Professional Standards and Ethics Standard when he submitted false claims under the Benefit Plan.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

17. The Member admits that he committed the acts of professional misconduct as alleged in paragraph 1 of the Notice of Hearing in that he contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 5 to 8 and 10 to 16 above.
18. The Member admits that he committed the acts of professional misconduct as alleged in paragraph 2 of the Notice of Hearing in that he misappropriated property from a workplace, as described in paragraphs 5 to 8 above.
19. The Member admits that he committed the acts of professional misconduct as alleged in paragraph 3 of the Notice of Hearing in that he falsified a record relating to his practice, as described in paragraphs 5 to 8 above.
20. The Member admits that he committed the acts of professional misconduct as alleged in paragraph 4 of the Notice of Hearing in 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, as described in paragraphs 5 to 8 above.
21. The Member admits that he committed the acts of professional misconduct as alleged in paragraph 5 of the Notice of Hearing, and in particular his conduct was dishonourable and unprofessional, as described in paragraphs 5 to 8 and 10 to 16 above.

Submissions on liability were made by College Counsel.

College Counsel reviewed allegation #1 and allegation #5 with the Panel. College Counsel submitted that allegation #1 is supported by the Agreed Statement of Facts, which contained evidence of the relevant College standards of the profession, as well as the Member’s admissions that those standards were breached.

In regard to allegation #5, College Counsel submitted that the parties agreed that the Member’s conduct was relevant to the practice of nursing and was dishonourable and unprofessional. College Counsel submitted that this conduct is relevant to the practice of nursing because the Member was only entitled to participate in the Benefit Plan by virtue of his nursing employment. The false claims were submitted through the Facility’s Benefit Plan and the Member took advantage of the Facility.

College Counsel submitted that the Member’s conduct would be regarded as unprofessional because the Member’s professional obligation is to act with honesty and integrity. By submitting false claims through the Facility’s Benefit Plan the Member’s conduct constituted a serious disregard for his professional obligations. College Counsel submitted that the Member’s conduct was also dishonourable as the conduct involved dishonesty and deceit. College Counsel submitted that the Member’s actions carried on over eight years and were not a one-time error in judgment. College Counsel submitted that the Member could have stopped participating in the benefit fraud scheme and taken accountability for his actions. College Counsel submitted that the Member failed to act with the integrity the public expects of nurses and that the Member’s conduct brings shame on the profession.

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

The Member’s Counsel submitted that the facts contained in the Agreed Statement of Facts support the admissions of professional misconduct and that the Panel should make findings of professional misconduct in accordance with the facts and admissions set out in the Agreed Statement of Facts.

Decision

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

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

Reasons for Decision

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

Allegation #1 in the Notice of Hearing is supported by paragraphs 5-8 and 10-17 in the Agreed Statement of Facts. The Member admitted to submitting false claims through the Facility’s Benefit Plan between 2011 and 2018 for physiotherapy services that were not provided and to receiving at least $13,940.00 in relation to those false claims. The Member admitted to having retained half the funds received through the benefit reimbursement and providing the other half to another individual who submitted the claims on the Member’s behalf. In doing so, the Member breached the College’s Professional Standards and the Ethics Standard. The College’s Professional Standards provide that “Each nurse is accountable to the public and responsible for ensuring that her/his practice and conduct meets legislative requirements and the standards of the profession. Nurses are responsible for their actions and the consequences of those actions. Leadership requires self-knowledge (understanding one’s beliefs and values and being aware of how one’s behaviour affects others), respect, trust and integrity …. A nurse demonstrates the standard by: role-modelling professional values, beliefs and attributes”. The College’s Ethics Standard provides that “Being a member of the profession brings with it the respect and trust of the public. Truthfulness means speaking or acting without intending to deceive”.

Allegation #2 in the Notice of Hearing is supported by paragraphs 5-8 and 18 in the Agreed Statement of Facts. The Member admitted to misappropriating property from the Facility when he allowed false claims to be submitted on his behalf through the Facility’s Benefit Plan and received money for those false claims. Receiving money with respect to false benefit claims constitutes misappropriation of property.

Allegation #3 in the Notice of Hearing is supported by paragraphs 5-8 and 19 in the Agreed Statement of Facts. The Member admitted to falsifying a record relating to his practice when he submitted false claims to the Facility’s Benefit Plan. The Member had access to the Benefit Plan by virtue of his employment as a nursing professional. Accordingly, the facts support the allegation that the Member falsified a record relating to his practice and did so in the context of his employment as a Registered Nurse (“RN”) at the Facility.

Allegation #4 in the Notice of Hearing is supported by paragraphs 5-8 and 20 in the Agreed Statement of Facts. The Member admitted to signing or issuing, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement. In order to submit a claim under the Facility’s Benefit Plan the Member had to complete a medical expense claim form which required certain information, including information on the plan member, any dependents, and the nature of the claim. The Member had to certify, “that the information given is true, correct and complete to the best of [their] knowledge”. Claim forms were submitted for physiotherapy services under the Benefit Plan totalling at least $13,940.00, though no physiotherapy services were actually provided. The Member admitted that he would retain half the funds received through the benefit reimbursement and provide the other half to another individual who submitted the claims on the Member’s behalf. As noted above, the Member had access to the Facility’s Benefit Plan by virtue of his employment as a nursing professional. When he allowed false claims to be submitted on his behalf, he did so in his capacity as an RN employee of the Facility. Accordingly, the facts support the allegation that the Member signed or issued, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement.

Allegation #5 in the Notice of Hearing is supported by paragraphs 5-8, 10-16 and 21 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in submitting false claims was clearly relevant to the practice of nursing and was unprofessional as it demonstrated a serious and persistent disregard for his professional obligations as set out in the Professional Standards and the Ethics Standard.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit over a period of eight years in which the Member had another individual submit false benefit claims on his behalf to the Facility’s Benefit Plan in the amount of at least $13,940.00. Only when the Member’s conduct was investigated by the Facility did the Member admit his misconduct. Being a member of the profession brings with it a certain level of respect and trust of the public. The Member breached this trust when he acted in a manner to gain financial reward without actually receiving services. The Member’s repeated misconduct demonstrates an element of moral failing and a lack of integrity. 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’s Counsel advised the Panel that a Joint Submission on Order had been agreed upon. The Joint Submission on Order requests that this Panel make an order as follows:

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

2. Directing the Executive Director to suspend the Member’s certificate of registration for 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 2 meetings with a Regulatory Expert (the “Expert”), at Member’s own expense and within 6 months from the date that this Order becomes final. To comply, the Member is required to ensure that:

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

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

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

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

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

1. Code of Conduct,

2. Professional Standards, and

3. Ethics;

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 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 Member’s employer(s) of the decision. To comply, the Member is required to:

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

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

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

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

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

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

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

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

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

Penalty Submissions

Submissions were made by College Counsel.

College Counsel submitted that the Panel should accept the Joint Submission on Order, unless doing so would be contrary to the public interest or would bring the administration of justice into disrepute. College Counsel submitted that the Joint Submission on Order was the product of negotiations between the College and the Member who was represented by experienced legal Counsel. College Counsel submitted that the College and the Member are adverse in interests, which should give the Panel confidence that the agreement reached is fair and balanced for both parties. College Counsel submitted that the proposed order was not contrary to the public interest and would not bring the administration of justice into disrepute. College Counsel submitted that the proposed order appropriately took into account the aggravating and mitigating factors, and the goals of penalty, and was consistent with previous penalty orders of the College’s Discipline Committee.

The aggravating factors in this case were:

• The Member’s conduct involved submitting false claims in the amount of at least $13,940.00 over a period of 8 years from 2011 to 2018.

• The Member’s misconduct was dishonest, was carried out for the purpose of his own personal financial gain and came at the expense of an employer funded Benefit Plan. The Member took advantage of his position as a nurse and the trust placed in him by the Facility. In doing so, the Member took advantage of an employer funded Benefit Plan.

The mitigating factors in this case were:

• The Member has taken responsibility for his actions by admitting to the allegations;

• The Member entered into an Agreed Statement of Facts and Joint Submission on Order with the College, which shows the Member’s remorse and accountability for his misconduct; and

• The Member has no prior discipline history with the College.

College Counsel submitted that the goals of penalty are to ultimately protect the public and enhance public confidence in the College’s ability to regulate its nurses. College Counsel submitted that the proposed penalty assists the College to meet these goals and addresses specific and general deterrence, rehabilitation and remediation.

The proposed penalty provides for general deterrence through the 4-month suspension of the Member’s certificate of registration, which sends a clear message to other members of the profession that such misconduct will not be tolerated.

The proposed penalty provides for specific deterrence through the oral reprimand and the 4-month suspension of the Member’s certificate of registration, which will deter the Member from repeating this type of misconduct again in the future.

College Counsel submitted that these elements of the penalty send a message to the Member and the membership at large that this type of misconduct is treated seriously by the College. The oral reprimand will assist the Member in gaining greater understanding of how his actions are perceived by the profession and the public and in doing so will help protect the public. The 4-month suspension of the Member’s certificate of registration sends a strong signal to the Member and other members of the profession that this kind of misconduct of engaging in benefit fraud is unacceptable and will help ensure that this type of misconduct will not be repeated.

The proposed penalty provides for remediation and rehabilitation through the 2 meetings with a Regulatory Expert to review specified College publications. College Counsel submitted that it is the hope that these sessions will help the Member return to ethical practice and help him keep the standards expected of nurses when he returns to practice.

Overall, the public is protected through the 12 months of employer notification, which will ensure that when the Member returns to practice there will be some additional employer oversight.

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. White-Veira (Discipline Committee, 2022): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member committed acts of professional misconduct when she was involved in similar benefit fraud that took place over a few years from 2013 to 2016. The member received approximately $12,095.00 in false claims. The member did not make restitution. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification.

CNO v. Nica (Discipline Committee, 2022): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member committed acts of professional misconduct when she was involved in similar benefit fraud that took place over several years from 2011 to 2015. The member received at least $9,620.00 in false claims. The member did not make restitution. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification.

CNO v. Pavlovych (Discipline Committee, 2022): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member committed acts of professional misconduct when she was involved in similar benefit fraud that took place over a few years from 2013 to 2018. The member received at least $11,040.00 in false claims. The member did not make restitution. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification.

Submissions were made by the Member’s Counsel.

The Member’s Counsel submitted that the Joint Submission on Order meets the goals of public protection, which is the Panel’s paramount concern, specific deterrence to the Member, general deterrence to other Member’s of the nursing profession and rehabilitation and remediation of the Member.

The Member’s Counsel submitted that the first component of the Joint Submission on Order is the oral reprimand. The Member’s Counsel submitted that with regard to the suspension of the Member’s certificate of registration, the proposed 4-month suspension will have a strong deterrent effect not only to the Member, but will also send a very strong message to his peers that this type of professional misconduct is completely unacceptable and will not be tolerated by the College or the public.

The Member’s Counsel submitted in respect of the terms, conditions and limitations on the Member’s certificate of registration, that these terms entail two in depth meetings with an approved Regulatory Expert that will be at the Member’s expense and there are detailed learning activities that he must complete in advance.

The Member’s Counsel submitted that a second component of the Joint Submission on Order involves 12 months of employer notification. The Member’s Counsel submitted that it is an onerous responsibility not only for the employer, but for the Member. The Member’s Counsel submitted that employer notification promotes public protection in that the Member’s employer(s) will be knowledgeable of the misconduct and monitor the Member’s conduct and report any concerns to the College to the extent that the Member may be in breach of the standards of the profession in the future. The Member’s Counsel submitted that the sessions with the Regulatory Expert are also an important way to protect the public by educating the Member in a way that is specifically targeted at the issues of the subject of his misconduct, including addressing the Professional Standards, the Code of Conduct, the Ethics Standard and all of the Member’s accountability. The Member’s Counsel submitted that this requirement will allow the Member to engage in guided discussions by a Regulatory Expert to review his insights regarding his misconduct and to reinforce his understanding of the College’s expectations and how the Member is to conduct himself in the future with professionalism and integrity.

The Member’s Counsel submitted that the mitigating factors in this case were:

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

• The Member admitted to the Facility and to the College that he acted inappropriately regarding his benefit claims made to the Facility’s Benefit Plan;

• As a result of his conduct the Member resigned from his long-standing successful employment by mutual agreement with the Facility;

• The Member has demonstrated his accountability and his remorse by coming before the Panel with admissions of professional misconduct.

• The Member has been registered with the College for 18 years and has no prior discipline history.

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 2 meetings with a Regulatory Expert (the “Expert”), at Member’s own expense and within 6 months from the date that this Order becomes final. To comply, the Member is required to ensure that:

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

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

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

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

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

1. Code of Conduct,

2. Professional Standards, and

3. Ethics;

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 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 Member’s employer(s) of the decision. To comply, the Member is required to:

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

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

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

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

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

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

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

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

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

Reasons for Penalty Decision

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

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

The Panel finds that the penalty satisfies the principles of specific and general deterrence, rehabilitation and remediation, and public protection. Specific deterrence is achieved through the oral reprimand and the 4-month suspension of the Member’s certification of registration. General deterrence is addressed by the 4-month suspension of the Member’s certificate of registration. Rehabilitation and remediation are addressed through the 2 meetings with a Regulatory Expert. This will give the Member the opportunity to review appropriate standards of the profession and gain insight into his misconduct ensuring that it will not be repeated again. Public protection is met through the 12 months of employer notification. This will alert the employer of the Member’s misconduct and allow for further monitoring of the Member’s practice which will ensure that the Member is meeting and maintaining the high expectations of practice that the public expects and deserves. This penalty sends a strong message to the nursing profession and members of the public that benefit fraud is taken seriously, and it amounts to professional misconduct. When nurses act in a deceitful manner, trust is broken. The public needs to be able to trust that the nursing profession will uphold honesty and high ethical integrity.

The penalty is also in line with what has been ordered in previous cases in similar circumstances.

I, Karen Laforet, 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.