College of Nurses of Ontario v. Tatlonghari, 2024 ONCNO 118260

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Tanya Dion, RN Chairperson Susan Roger, RN Member Jeffrey Ko, RN Member Sandra Larmour Public Member

BETWEEN:

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

• and -

MARIA TERESA TATLONGHARI Registration No. JF663979 NO REPRESENTATION for Maria Teresa Tatlonghari

CHRISTOPHER WIRTH Independent Legal Counsel

Heard: July 8, 2024, via videoconference

DECISION AND REASONS

This matter was heard by a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on July 8, 2024

The Allegations

The allegations against Maria Teresa Tatlonghari (the “Member”) as stated in the Notice of Hearing dated January 25, 2024, are as follows:

IT IS ALLEGED THAT:

1. You have committed an act of professional misconduct as provided by subsection 51(1)(b.0.1) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, in that, while registered as a Registered Practical Nurse with the College of Nurses, you failed to cooperate with the Quality Assurance Committee or any assessor appointed by that committee, and in particular, you failed to participate after being selected by the Quality Assurance Committee for Quality Assurance assessment in 2022 and/or failed to complete all Quality Assurance assessment requirements in or around 2022.

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(37) of Ontario Regulation 799/93, in that, while registered as a Registered Practical Nurse with the College of Nurses, 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, in that you failed to participate after being selected by the Quality Assurance Committee for Quality Assurance assessment in 2022 and/or failed to complete all Quality Assurance assessment requirements in or around 2022.

Member’s Plea

The Member admitted the allegations set out in paragraphs #1 and #2 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 reads, unedited, as follows:

THE MEMBER

1. Maria Teresa Tatlonghari (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on July 10, 2006.

2. The Member resigned her certificate of registration on January 19, 2024. The Member is currently not entitled to practise nursing.

CNO’s Quality Assurance Program

3. CNO is required by the Health Professions Procedural Code to establish a quality assurance program. CNO’s Quality Assurance Committee (“QA Committee”) is responsible for administering CNO’s Quality Assurance Program (the “QA Program”).

4. The QA Program helps nurses engage in activities that foster lifelong learning and helps nurses maintain and improve their professional competence. Participation in the QA Program is a professional requirement.

5. The QA Program includes three kinds of assessment: self, peer, and practice assessment.

INCIDENT RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

The Member Failed to Participate in the 2022 QA Program

6. On April 25, 2022, the Member was selected for Practice Assessment as part of CNO’s Quality Assurance program. The Member was required to submit a learning plan and take objective tests by June 6, 2022. The Member failed to do so.

7. On June 8, 2022, a member of CNO’s QA Program Team spoke to the Member by telephone. The Member indicated that she was retired and did not want to submit her QA Assessment activities. The Member was advised that her options were to complete the QA Assessment activities, change her registration to non-practising class, or resign her membership.

8. On August 29, 2022, CNO wrote to the Member with a second chance to complete the Practice Assessment activities, with a new deadline of September 28, 2022. The Member failed to complete the Practice Assessment activities.

9. On September 9, 2022, a member of CNO’s QA Program Team again spoke to the Member by telephone. The Member once more indicated that she was retired and did not want to submit her QA Assessment activities. The Member was reminded again that her options were to complete the QA Assessment activities, change her registration to non-practising class, or resign her membership.

10. On October 26, 2022, CNO wrote to the Member again, requesting that she complete the Practice Assessment activities by November 24, 2022.

11. The Member provided no additional responses to CNO’s QA Program Team and did not complete the QA Assessment activities.

12. If the Member were to testify, she would say that she has not practiced nursing since 2017 and that she was unfamiliar and uncomfortable with the technology and email communications required to complete her QA activities.

13. However, the Member understands the importance of accountability to CNO as a member of a regulated profession and acknowledges that it was her professional duty to participate in the statutorily mandated QA Program.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

14. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1 of the Notice of Hearing in that she failed to cooperate with the QA Committee or any assessor appointed by that Committee, and in particular, she failed to participate after being selected by the QA Committee for practice assessment in 2022, as described in paragraphs 6 – 12 above.

15. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2 of the Notice of Hearing, and in particular, that her conduct was unprofessional, as described in paragraphs 6 – 12 above.

Final Submissions

College Counsel reminded the Panel that both allegations arise from the same underlying conduct, specifically that the Member failed to cooperate with requests from the Quality Assurance Committee (“QA Committee”) at the College. The Quality Assurance Program (“QA Program”) is a necessary requirement to practice nursing in Ontario and part of the regulatory structure for all nurses.

Counsel submitted that the Member advised the College, as early as June 2022, that she had “retired functionally”. The College advised the Member that members of the College could not maintain registration and not complete mandatory QA as directed. The Member had multiple opportunities to change her administrative obligations by virtue of converting to the non-practicing class or resigning. As the Member failed to respond to repeated correspondence from the College, she did not, therefore, attend to her professional obligations and her behaviour could therefore be characterized as a “persistent” disregard for her QA obligations.

The Member told the Panel that she had not practiced since January 2024 and that her work was not practical any longer. The Member told the Panel that she did not complete her registration renewal in 2022, as she was out of the country. The Member stated that her son had paid for her renewal, without her knowledge. She added that she had physical conditions that did not allow for her to continue to practice.

College Counsel reminded the Panel that the only facts in this matter are those that are contained in the evidence identified 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 and #2 of the Notice of Hearing. As to allegation #2, the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be 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 6 to 12 and 14 in the Agreed Statement of Facts. The Member admitted that she failed to cooperate with the QA Committee by not participating in the Quality Assurance assessment in 2022. The Agreed Statement of Facts sets out the timeline of contacts between the College and the Member and ranges from April 25, 2022 (originating request) through to November 24, 2022. The College made multiple attempts to get the Member to complete her QA assessment and granted extensions for the Member to do so. The Member advised the College in June 2022, that she was “retired”. However, the College informed her that she could not maintain registration and not complete mandatory QA as directed. The College provided her with options such as entering into the non-practicing class or resigning her registration and sought to ensure that the Member had dealt with her administrative obligations correctly. The Member provided no additional responses to the College’s QA Program Team and did not complete the QA Assessment activities.

Allegation #2 in the Notice of Hearing is supported by paragraphs 6 to 12 and 15 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct was relevant to the practice of nursing. The Member neglected requests from her professional regulatory body to complete her QA assessment and dismissed the statutory requirements of her registration, over a period of many months. In failing to participate in the Quality Assurance assessment in 2022 after being selected by the QA Committee, the Member demonstrated a serious and persistent disregard for her professional obligations. The Panel found this conduct would reasonably be regarded by members of the profession as unprofessional.

Penalty

College Counsel and the Member advised that a Joint Submission on Order had been agreed upon and requested that the Panel make the following order:

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

College Submissions on Penalty

College Counsel made submissions which included the following:

College Counsel submitted that the Joint Submission on Order also provides in Appendix “A” an undertaking and agreement by the Member for the Member’s permanent resignation as a member of the College effective July 8, 2024 (the “Undertaking”). Pursuant to this Undertaking, the Member undertakes, acknowledges and agrees to:

a) Permanently resign as a member of the College, effective from the date that the Order made by the Discipline Committee in accordance with the Joint Submission on Order becomes final;

b) Not apply for membership with the College as a Registered Nurse or Registered Practical Nurse at any time in the future;

c) Agree that the public portion of the College’s Register will indefinitely reflect that the Member entered into an Undertaking with the Executive Director to permanently resign as a member of the College as part of an agreed resolution of allegations of professional misconduct;

d) No longer have a right to the issuance or reinstatement of a Certificate of Registration from the College;

e) No longer have a right to use the title “Nurse”, “Registered Nurse”, “Registered Practical Nurse”, “RN”, “RPN” or a variation, an abbreviation or an equivalent in another language;

f) No longer have a right to hold herself out as a Nurse, Registered Nurse, Registered Practical Nurse or as a person who is qualified to practise in Ontario as a Nurse, Registered Nurse or Registered Practical Nurse;

g) No longer have a right to engage in the practice of nursing in any capacity; and

h) Agree the College is authorized to and may, in its sole discretion, provide a copy of the Undertaking and/or its terms to a governing body that regulates nursing in Canada or elsewhere in response to an inquiry or otherwise.

The aggravating factors in this case were:

• The Member disregarded the College’s requests to resolve her mandatory QA obligations;

• The Member ignored the College’s communication for approximately seven months despite having two personal phone calls directly with the College;

• Options were presented to the Member that would have saved time, instruction and expense in order to remain in compliance with QA; and

• The Member was aware that it was wrong to ignore the options outlined to her.

The mitigating factors in this case were:

• The Member has acknowledged that her conduct was unprofessional and taken responsibility to resign her certificate of registration permanently; and

• The Member has appeared before the Panel for this hearing, made admissions, clearly demonstrated that she has taken responsibility and entered into an Agreed Statement of Facts and a Joint Submission on Order with the College.

College Counsel submitted that as the Member had agreed to an undertaking and permanent resignation, remediation and rehabilitation would have no benefit.

College Counsel submitted that at the time of the allegations, the Member was “functionally retired” and did not have any patients, therefore there was no public risk.

College Counsel submitted that an appropriate penalty order would usually include a one-to-three-month suspension of the Member’s certificate of registration, including terms, conditions and limitations, as well as an opportunity for the Member to participate in a future QA cycle.

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. Castor (Discipline Committee, 2017): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member failed to participate after being selected by the QA Committee for practice assessment. The penalty included an oral reprimand, a 1-month suspension of the member’s certificate of registration, 2 meetings with a Nursing Expert and participation in the College’s 2017 QA Program or the next available cycle.

CNO v. Keating (Discipline Committee, 2020): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member failed to participate after being selected by the QA Committee for practice assessment. The penalty included an oral reprimand, a 2-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and participation in the College’s next available QA Program.

CNO v. Naval (Discipline Committee, 2016): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member failed to participate after being selected by the QA Committee for practice assessment. The penalty included an oral reprimand, and the member signed an undertaking to permanently resign as a member of the College. This case is the most similar to the case before this Panel as the member was also functionally retired and signed an undertaking to permanently resign as a member of the College.

Member’s Submissions on Penalty

The Member had no further submissions.

Penalty Decision

The Panel accepted the Joint Submission on Order and made the order requested.

Reasons for Penalty Decision

There is a high threshold for departing from a Joint Submission on Order established by the Supreme Court of Canada in R. v. Anthony-Cook, 2016 SCC 43. Departing from a joint submission would require a finding that the proposed penalty would bring the administration of justice into disrepute or is otherwise contrary to the public interest.

The Panel concluded that the proposed penalty is not contrary to the public interest and does not bring the administration of justice into disrepute.

The Panel concluded that the proposed penalty is reasonable and in the public interest. It promotes public confidence in the ability of the College to regulate nurses.

The Panel finds that the proposed penalty satisfies the penalty goals of specific and general deterrence, and public protection.

The oral reprimand, while focused specifically on this Member and providing specific deterrence, has elements of general deterrence and demonstrates the seriousness of this conduct.

The Panel considered the fact that the Member has undertaken to resign from practice and has undertaken to never apply for registration as a nurse in Ontario or in any other jurisdiction again in the future. The Panel found that the Undertaking renders a suspension and terms, conditions and limitations unnecessary.

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

I, Tanya Dion, 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.