College of Nurses of Ontario v. Binns, 2024 ONCNO 120505

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Lalitha Poonasamy, Public Member Chairperson Ramona Dunn, RN Member Carly Hourigan, Public Member Samuel Jennings, RPN Member Kimberly Wagg, RPN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO Joseph Berger for College of Nurses of Ontario

• and -

VALERIE BINNS Registration No. 9534538 No Representation for Valerie Binns

Christopher Wirth, Independent Legal Counsel

Heard: March 14, 2024

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 March 14, 2024, via videoconference.

The Allegations

The allegations against Valerie Binns (the "Member") as stated in the Notice of Hearing dated January 30, 2024 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, you contravened a standard or practice of the profession or failed to meet the standards of practice of the profession, as follows:

a. On or about May 30, July 4, 7, 13, 20, 21, 31, August 30, September 18, and September 19, 2017, you worked at St. Joseph's Health Care in London, Ontario ("St. Joseph's") during hours which you were scheduled and were paid to work at London Health Sciences Centre, in London, Ontario (the "Facility"); and/or

b. On or about May 30, July 4, 7, 13, 20, 21, 31, August 30, September 18, and September 19, 2017, you failed to notify anyone at the Facility that you received payment for hours of work which you didn't complete and/or in respect of hours when you were not actually present at the Facility; and/or

c. On or about July 4, 7, 20, and 21, you breached patient privacy and/or confidentiality by accessing approximately 75 Facility patients' records while working at St. Joseph's; and/or

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(8) of Ontario Regulation 799/93, in that while working as a Registered Nurse, you misappropriated property from a client or workplace, as follows:

a. On or about May 30, July 4, 7, 13, 20, 21, 31, August 30, September 18, and September 19, 2017, you worked at St. Joseph's Health Care in London, Ontario ("St. Joseph's") during hours which you were scheduled and were paid to work at London Health Sciences Centre, in London, Ontario (the "Facility"); and/or

b. On or about May 30, July 4, 7, 13, 20, 21, 31, August 30, September 18, and September 19, 2017, you failed to notify anyone at the Facility that you received payment for hours of work which you didn't complete and/or in respect of hours when you were not actually present at the Facility; and/or

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(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, as follows:

a. On or about May 30, July 4, 7, 13, 20, 21, 31, August 30, September 18, and September 19, 2017, you worked at St. Joseph's Health Care in London, Ontario ("St. Joseph's") during hours which you were scheduled and were paid to work at London Health Sciences Centre, in London, Ontario (the "Facility"); and/or

b. On or about May 30, July 4, 7, 13, 20, 21, 31, August 30, September 18, and September 19, 2017, you failed to notify anyone at the Facility that you received payment for hours of work which you didn't complete and/or in respect of hours when you were not actually present at the Facility; and/or

c. On or about July 4, 7, 20, and 21, you breached patient privacy and/or confidentiality by accessing approximately 75 Facility patients' records while working at St. Joseph's.

Member's Plea

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

Agreed Statement of Facts

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

THE MEMBER

1. Valerie Binns (the "Member") registered with the College of Nurses of Ontario ("CNO") as a Registered Nurse ("RN") on September 14, 1995.

2. The Member began working at London Health Sciences Centre, in London, Ontario (the "Facility") in a part-time role on May 24, 1994. The Member moved into a full-time role at the Facility in 1997.

3. The Member worked in the Facility's blood management program since 2016. The Member's scheduled hours in this role were from 8 a.m. to 4 p.m. Monday to Friday. The Member resigned from her employment with the Facility effective January 12, 2018.

4. As of November 22, 1999, the Member was also employed as an RN at St. Joseph's Health Care in London, Ontario (St. Joseph's). Initially, the Member was employed as a casual employee. This meant that she did not have a regular schedule, but rather worked shifts that were scheduled on short notice to cover sick-days or last-minute shift requests. On July 16, 2018, the Member began working at St. Joseph's on a full-time basis.

5. Since 2018, the Member has also worked at South Huron Hospital in Exeter, Ontario.

PRIOR HISTORY

6. The Member has no prior disciplinary findings with CNO.

THE FACILITY and ST. JOSEPH'S

7. Neither the Facility nor St. Joseph's had digitized clocks or sign-in/sign-out systems. The Member was not required to sign in or out for her shifts at either the Facility or St. Joseph's. However, St. Joseph's employed a departmental timekeeper who entered the Member's self-reported hours into St. Joseph's payroll system for approval by departmental leaders.

8. The Facility's parking lot required that employees use a pass to enter or exit the lot. Accordingly, by reviewing the records which show when an employee used their pass to enter and exit the parking lot (the "Parking Lot Records"), the Facility can determine approximately when an employee arrived for their shift and when they left for the day.

9. The Facility and St. Joseph's also shared the same electronic health records service provider ("Cerner"). The Cerner application maintained a log of when employees of either institution logged in (the "Cerner Records").

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Time Theft: May to September 2017

10. On ten different days between May and September 2017, the Member was scheduled to work and received payment for working at the Facility despite also working at and receiving payment from St. Joseph's on the same days.

11. Specifically, on each of May 30, July 4, 7, 13, 20, 21, 31, August 30, September 18, and September 19, 2017, (the "Relevant Dates"), the Member was scheduled to work at the Facility from 8:00-16:00. The Member did not claim vacation time for any of these days. The Member was also scheduled to work at St. Joseph's on each of these days.

12. The Facility's Parking Lot Records and St. Joseph's Cerner Records confirm that on each of the Relevant Dates, the Member did not attend or did not her complete her shifts at the Facility and instead attended at St. Joseph's for scheduled shifts at corresponding times. Specifically:

a. May 30, 2017: While the Member was scheduled to work at the Facility this day, she did not park at the Facility's parking lot. The Member was scheduled to work at St. Joseph's from 8:00 to 18:00. St. Joseph's Cerner Records show the Member signed into her Cerner account from St. Joseph's at 8:03 and logged off at 17:33 that day.

b. July 4, 2017: The Member entered the Facility's parking lot at 7:56 and left at 10:28. On that same day, the Member was scheduled to work at St. Joseph's from 11:00 to 19:00. The Member signed into her Cerner account from St. Joseph's at 10:50 that morning.

c. July 7, 2017: The Member entered the Facility's parking lot at 8:25 and left at 11:53. On that same day, the Member was scheduled to work at St. Joseph's from 13:00 to 21:00. The Member signed into her Cerner account from St. Joseph's at 13:13 that afternoon.

d. July 14, 2017: The Member entered the Facility's parking lot at 8:53 and left at 11:37. On that same day, the Member was scheduled to work at St. Joseph's from 12:00 to 20:00. The Member signed into her Cerner account from St. Joseph's at 12:04 that afternoon.

e. July 20, 2017: The Member entered the Facility's parking lot at 8:34 and left at 12:20. On that same day, the Member was scheduled to work at St. Joseph's from 13:00 to 21:00. The Member signed into her Cerner account from St. Joseph's at 13:04 that afternoon.

f. July 21, 2017: The Member entered the Facility's parking lot at 8:36 and left at 11:35. On that same day, the Member was scheduled to work at St. Joseph's from 12:00 to 21:00. The Member signed into her Cerner account from St. Joseph's at 12:04 that afternoon.

g. July 31, 2017: While the Member was scheduled to work at the Facility, she did not park at the Facility's parking lot this day. The Member was scheduled to work at St. Joseph's from 8:00 to 16:00. The Member signed into her Cerner account from St. Joseph's account at 7:53 that morning.

h. August 30, 2017: The Member entered the Facility's parking lot at 8:31 and left at 11:42. On that same day, the Member was scheduled to work at St. Joseph's from 12:00 to 20:00. The Member signed into her Cerner account from St. Joseph's at 12:00 that afternoon.

i. September 18, 2017: The Member entered the Facility's parking lot at 8:07 and left at 12:22. On that same day, the Member was scheduled to work at St. Joseph's from 12:00 to 20:00. The Member signed into her Cerner account from St. Joseph's at 12:52 that afternoon.

j. September 19, 2017: The Member entered the Facility's parking lot at 8:07 and left at 14:47. On that same day, the Member was scheduled to work at St. Joseph's from 15:00 to 21:00. The Member signed into her Cerner account from St. Joseph's at 15:06 and logged off at 19:28 that evening.

13. The Facility's and St. Joseph's paystubs for the Member confirm that she was paid by both the Facility and St. Joseph's during times that she was scheduled to work at both institutions.

14. The Member admits that she was paid by both the Facility and St. Joseph's in respect of time worked on the Relevant Dates.

15. The Member did not inform the Facility that she was being paid by both institutions for simultaneous shifts. The Facility first learned about the Member's time theft when she emailed the Facility to indicate that she believed the balance of her vacation dates was incorrect. The Facility requested and reviewed the Parking Lot Records to investigate the Member's claim, at which time it discovered her time theft.

Breach of Patient Privacy and Confidentiality: July and September 2017

16. The Member breached patient privacy and confidentiality in July and September 2017.

17. While working at St. Joseph's, the Member breached patient privacy and/or confidentiality by accessing one or more of the Facility's patients' records during times that she was not working as a nurse for the Facility but was instead acting as a nurse for St. Joseph's.

18. St. Joseph's Cerner Records show that the Member accessed records of Facility patients while working at St. Joseph's on July 4, 7, 20, and July 21, 2017. Specifically:

a. July 4, 2017: The Member was scheduled to work at St. Joseph's from 11:00 to 19:00. The Member logged onto her Cerner account from St. Joseph's at 10:50 and accessed 6 Facility patient files between 15:11-15:14.

b. July 7, 2017: The Member was scheduled to work at St. Joseph's from 13:00 to 21:00. The Member logged onto her Cerner account from St. Joseph's at 13:13 and accessed 9 Facility patient files between 18:41-18:49.

c. July 20, 2017: The Member was scheduled to work at St. Joseph's from 13:00 to 21:00. The Member logged onto her Cerner account from St. Joseph's at 13:04 and accessed 8 Facility patient files between 16:18-16:24 and 4 Facility patient files between 16:40-16:44.

d. July 21, 2017: The Member was scheduled to work at St. Joseph's from 12:00 to 21:00. The Member logged onto her Cerner account from St. Joseph's at 12:04 and accessed 48 Facility patient files between 19:12-20:06.

19. The Member contravened the Personal Health Information Protection Act, 2004 by accessing Facility patients' records, while working outside of her capacity as an "agent" nurse of the Facility, and therefore without patient consent.

20. If the Member were to testify, she would acknowledge logging in to check the files of Facility patients from St. Joseph's. The Member would state that she did not understand that it was a privacy breach to access Facility patients' records, while working at another institution.

CNO STANDARDS

21. 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.

22. 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 actions such as ensuring their practice is consistent with CNO's standards of practice and guidelines as well as legislation.

23. 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 behavior 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.

24. Attached as Exhibit "A" is a copy of CNO's Professional Standards which was in force at the time of the incidents.

25. 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 in the use of resources. It includes acting with integrity, honesty and professionalism in all dealings with the client and other health care team members.

26. 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.

27. CNO's Ethics Standard also provides, in relation to truthfulness, that truthfulness means speaking and acting without intending to deceive.

28. Attached as Exhibit "B" is a copy of CNO's Ethics Standard which was in force at the time of the incidents.

29. The Member admits and acknowledges that she contravened CNO's Professional Standards and Ethics Standard.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

30. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 1 (a)(b) and (c) of the Notice of Hearing, as described in paragraphs 10 – 29 above.

31. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 2 (a) and (b) of the Notice of Hearing, in that she misappropriated property from a client or workplace as described in paragraphs 10 – 16 and 23 – 29 above.

32. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 3(a) (b) and (c) of the Notice of Hearing, and in particular, admits that her conduct was dishonourable and unprofessional, as described in paragraphs 10 – 29 above.

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), 2(a), (b) and 3(a), (b) and (c) of the Notice of Hearing. As to allegations #3(a), (b) and (c), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be dishonourable and unprofessional.

Reasons for Decision

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

Allegations #1(a), (b) and (c) in the Notice of Hearing are supported by paragraphs 10-29 and 30 in the Agreed Statement of Facts. The Panel finds that while working full-time as a Registered Nurse ("RN") at London Health Sciences Centre (the "Facility"), as well as at St. Joseph's Health Care ("St. Joseph's") as a casual employee, the Member committed an act of professional misconduct specific to time theft when she was scheduled to work and received payment for working at the Facility despite working at and receiving payment from St. Joseph's on the same days and failed to inform both institutions, in contravention of the Professional Standards and the Ethics Standard. The Member also contravened the Professional Standards specific to breach of patient privacy and confidentiality when she accessed patient files while working outside of her capacity as a nurse of the Facility, and therefore without patient consent.

Allegations #2(a) and (b) in the Notice of Hearing are supported by paragraphs 10-16, 23-29 and 31 in the Agreed Statement of Facts. The Panel finds that the Member committed acts of professional misconduct and misappropriated property from the Facility when she worked at St. Joseph's during hours she was scheduled and was paid to work at the Facility. The Member failed to notify the Facility that she received payment for hours of work she either did not complete or was not present for at the Facility.

Allegations #3(a), (b) and (c) in the Notice of Hearing are supported by paragraphs 10-29 and 32 in the Agreed Statement of Facts. The Panel finds that the Member's conduct in repeatedly breaching patient privacy and confidentiality and committing time theft was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations in contravening 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 within the Member's professional scope of practice, as well as with the public as is reflected specifically in paragraph 25 of the Agreed Statement of Facts. The Member knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional.

Penalty

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

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

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

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

a) The Member will attend 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. 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. Confidentiality and Privacy – Personal Health Information, and

3. Circle of Care: Sharing Personal Health Information for Health-Care Purposes as released by the Information and Privacy Commissioner of Ontario;

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 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.

c) The Member shall not practice independently in the community for a period of 12 months from the date the Member returns to the practice of nursing.

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

Penalty Submissions

College Counsel's Submissions

The aggravating factors in this case were:

• The Member's conduct was serious professional misconduct;
• The Member's conduct breached the trust of the Facility;
• The Member's conduct was inherently dishonest;
• The Member's conduct was a discredit to the profession of nursing;
• The Member's conduct was a disregard for her professional obligations specific to confidentiality; and
• The Member directly benefitted financially as a result of her conduct.

The mitigating factors in this case were:

• The Member has no prior discipline history with the College and has practiced ethically throughout her career;
• The Member has taken responsibility for her conduct by entering into an Agreed Statement of Facts and a Joint Submission on Order with the College and has admitted to professional misconduct; and
• The Member has shown remorse and has taken accountability in the early stages of the hearing.

As such the penalty outlined is imposed with the goal to protect the public, to maintain high professional standards, to provide specific deterrence to prevent recurrence and to provide rehabilitation and remediation.

The proposed penalty provides for general deterrence through the 4-month suspension of the Member's certificate of registration and the employer notification, which sends a message to other members of the profession that there are serious consequences to professional misconduct.

The proposed penalty provides for specific deterrence through the oral reprimand and the 4-month suspension of the Member's certificate of registration. The oral reprimand will allow the Member to gain insight into her conduct through the lens of the public and members of the profession.

Rehabilitation and remediation are provided for by the 2 meetings with an expert and the review of the Practice Standards. The employer notification will provide 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. Zhou (Discipline Committee, 2018): In this case, the hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member engaged in professional misconduct when on 83 occasions she committed time theft by calling in sick to one facility while working at another facility and accepted wages in the form of sick benefits and wages from both facilities. The penalty included an oral reprimand, a 7-month suspension of the member's certificate of registration, 2 meetings with a Nursing Expert, and 24 months of employer notification.

CNO v. Frater (Discipline Committee, 2020): In this case, the hearing proceeded by way of a partial Agreed Statement of Facts. The member engaged in professional misconduct when on 43 occasions she committed time theft by calling in sick to one facility while working at another facility and accepted wages in the form of sick benefits and wages from both facilities. The penalty included an oral reprimand, a 4-month suspension of the member's certificate of registration, a minimum of 2 meetings with a Regulatory Expert and 18 months of employer notification.

CNO v. Ventenilla (Discipline Committee, 2022): In this case, the hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member engaged in professional misconduct when on 13 occasions he committed time theft by submitting home care visits for patients that were not in receipt of the service. The penalty included an oral reprimand, a 3-month suspension of the member's certificate of registration, 2 meetings with a Regulatory Expert, 12 months of employer notification and 6 months of no independent practice.

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 the 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. Confidentiality and Privacy – Personal Health Information, and

3. Circle of Care: Sharing Personal Health Information for Health-Care Purposes as released by the Information and Privacy Commissioner of Ontario;

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 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.

c) The Member shall not practice independently in the community for a period of 12 months from the date the Member returns to the practice of nursing.

4. All documents delivered by the Member to CNO, the Expert or the 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.

The proposed penalty provides for general deterrence through the 4-month suspension of the Member's certificate of registration, which sends a message to other members of the profession that there are serious consequences to professional misconduct.

The proposed penalty provides for specific deterrence through the oral reprimand which will allow the Member to gain insight into her conduct through the lens of the public and members of the profession. As well, the 4-month suspension of the Member's certificate of registration, will send a signal to the Member that her conduct is unacceptable.

The proposed penalty provides for rehabilitation and remediation through the 2 meetings with a Regulatory Expert which will also prevent a recurrence of this conduct. Notification to the College upon completion adds an additional layer of protection to the public.

Overall, the public is protected through the 12 months of employer notification and the 12 months of no independent practice in the community allowing for the maintenance of high professional standards and transparency within the profession.

This 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, Lalitha Poonasamy, Public Member, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.