College of Nurses of Ontario v. Andrea Annemarie Gayle, 2024 ONCNO 122852 — College of Nurses of Ontario Discipline Committee | minicounsel

PANEL: Carly Gilchrist, RPN Chairperson Lynn Hall, RN Member Tyler Hands, RN Member Carly Hourigan Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO Alysha Shore for College of Nurses of Ontario

and -

ANDREA ANNEMARIE GAYLE Registration No. 9606443 Christopher Bryden for Andrea Annemarie Gayle Christopher Wirth, Independent Legal Counsel

Heard: July 9, 2024, via videoconference

DECISION AND REASONS

Publication Ban

By Order of the Discipline Panel dated July 9, 2024, pursuant to subsection s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, no one shall publish or broadcast the names of the patients, or any information that could disclose their identities, referred to orally or in any documents presented at the Discipline hearing of Andrea Annemarie Gayle.

This matter was heard by a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on July 9, 2024.

The Allegations

College Counsel advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraphs 1, 2 and 3 in the Notice of Hearing dated June 10, 2024. The Panel granted this request. The remaining allegations against Andrea Annemarie Gayle (the “Member”) are as follows:

IT IS ALLEGED THAT:

[Withdrawn];
[Withdrawn];
[Withdrawn];
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 you were employed as a Registered Nurse at Coleman Care Centre in Barrie, Ontario, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession with respect to the following incidents:

a. on or around November 10, 2018, you documented that you administered Clobazam to Patient [A] at 0700 hours when it had not been administered;

b. on or around February 8, 2019, with respect to Patient [B], you:

i. inaccurately documented in Patient [B]’s chart that she was to receive a B12 injection every 96 hours when the order was for her to receive the injection monthly on the 15th of each month; and/or

ii. you administered a B12 injection to Patient [B] on February 8, 2019 when it was not ordered for administration until February 15, 2019;

c. on or around April 21, 2019, you completed a New Admissions Order Form for Patient [C] and included Rivastigmine when it had been discontinued;

d. on or around September 7, 2019, you failed to document a timeframe for an order of Cephalexin for Patient [D]; and/or

e. on or around October 21, 2019, when inputting the order into Patient [E]’s medication administration record for Patient [E]’s Nitroglycerin patch, you failed to document the time for removal of the patch;

You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Act, and defined in subsection 1(13) of Ontario Regulation 799/93, in that, while employed as a Registered Nurse at Coleman Care Centre in Barrie, Ontario, you failed to keep records as required with respect to the following incidents:

a. on or around November 10, 2018, you documented that you administered Clobazam to Patient [A] at 0700 hours when it had not been administered;

b. on or around February 8, 2019, with respect to Patient [B] you inaccurately documented in Patient [B]’s chart that she was to receive a B12 injection every 96 hours when the order was for her to receive the injection monthly on the 15th of each month;

c. on or around April 21, 2019, you completed a New Admissions Order Form for Patient [C] and included Rivastigmine when it had been discontinued;

d. on or around September 7, 2019, you failed to document a timeframe for an order of Cephalexin for Patient [D]; and/or

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 you were employed as a Registered Nurse at Coleman Care Centre in Barrie, Ontario, 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, with respect to the following incidents:

a. on or around November 10, 2018, you documented that you administered Clobazam to Patient [A] at 0700 hours when it had not been administered;

b. on or around February 8, 2019, with respect to Patient [B], you:

ii. you administered a B12 injection to Patient [B] on February 8, 2019 when it was not ordered for administration until February 15, 2019;

c. on or around April 21, 2019, you completed a New Admissions Order Form for Patient [C] and included Rivastigmine when it had been discontinued;

d. on or around September 7, 2019, you failed to document a timeframe for an order of Cephalexin for Patient [D]; and/or

Member’s Plea

The Member admitted the allegations set out in paragraphs 4(a), 4(b)(i), 4(b)(ii), 4(c), 4(d), 4(e), 5(a), 5(b), 5(c), 5(d), 5(e), 6(a), 6(b)(i), 6(b)(ii), 6(c), 6(d) and 6(e) 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’s Counsel advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which as amended reads, unedited and without exhibits mentioned therein, as follows:

THE MEMBER

Andrea Annemarie Gayle (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on November 10, 1995.
The Member worked at Coleman Care Centre, a long-term care home, in Barrie, Ontario (the “Facility”) from June 27, 2017 to October 25, 2019.
The Member worked at the Facility as a as a part-time charge nurse.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Patient A

The Member worked at the Facility on November 10, 2018 from 0615-1415 hours.
(“Patient A”) had an order for Clobazam to be administered at 0700 hours. On November 10, 2018, the Member documented in Patient A’s MAR that she administered Clobazam at 0700 hours.
During the medication pass later that evening, the evening nurse noticed that Patient A’s morning dose of Clobazam was still in the medication cart in its pouch. The evening nurse reported this to the Director of Nursing, who discussed it with the Member on November 12, 2018. The Director of Nursing provided the Member with guidance about taking time at the end of her shift to review her medication cart to ensure all medications had been administered.

Patient B

The Member worked at the Facility on February 8, 2019 from 0615-1415 hours.
(“Patient B”)’s medications were reviewed every three months and her order for monthly vitamin B12 injection was renewed.
The Member processed the order into the electronic system. The order was for vitamin B12 injections once per month on the 15th day of the month; however, the Member entered the order into the system for administration every 96 hours, instead of once per month.
The Member administered Patient B’s vitamin B12 injection on February 8, 2019 even though it was not due until February 15, 2019.
The Director of Nursing spoke to the Member about this error. The Member did not have an explanation.

Patient C

The Member worked at the Facility on April 21, 2019 from 1415-2215 hours.
(“Patient C”) was admitted to the Facility on April 21, 2019. Patient C’s pharmacy provided a list of all her medications over the last 6 months, some of which had been discontinued. Rivastigmine was on the list but was clearly indicated as discontinued.
The Member completed the New Admissions Order Form and included Rivastigmine on the list even though it had been discontinued. As a result, Patient C received Rivastigmine for multiple days until the error was noticed.
The Director of Nursing met with the Member to discuss the incident. The Member was required to complete training on the Facility’s electronic medication system and review CNO’s Medication Standard. The Facility also required another registered staff to review the Member’s transcribed orders for accuracy at the time they were made going forward.
If the Member were to testify, she would state that the pharmacy sent a list of medications to the Facility that included a list of medications for Patient C that went back 6 months and included discontinued medications, including Rivastigmine. This caused confusion when the Member was creating the New Admissions Order Form. The Member would further testify that she nonetheless acknowledges and regrets her error.

Patient D

The Member worked at the Facility on September 7, 2019 from 1415-2215 hours.
The Member took a telephone order for [ ] (“Patient D”) from the physician on September 7, 2019 for Keflex (Cephalexin) 500 mg PO 4 times a day. When transcribing the order, the Member failed to include the length of time of the order (1 week).
The Director of Nursing spoke to the Member about this incident and issued a one-day suspension.

Patient E

The Member worked at the Facility on October 21, 2019 from 1415-2215 hours.
The Member entered an order into [ ] (“Patient E”)’s e-MAR for a Nitroglycerin patch to be applied at 0700 hours but did not include the time the patch should be removed (which was bedtime). As a result, the system defaulted for the removal to be at 0659 hours.
Consequently, Patient E wore the Nitroglycerin patch until the following morning at which point the day-shift RN noticed that the patch from the previous day had not been removed.

CNO STANDARDS

Code of Conduct

CNO’s Code of Conduct is a standard of practice describing the accountabilities all Ontario nurses have to the public. The Code of Conduct consists of six principles including:

Nurses respect the dignity of patients and treat them as individuals;
Nurses work together to promote patient well-being;
Nurses maintain patients’ trust by providing safe and competent care;
Nurses work respectfully with colleagues to best meet patients’ needs;
Nurses act with integrity to maintain patients’ trust; and
Nurses maintain public confidence in the nursing profession.

CNO’s Code of Conduct provides, in relation to the principle requiring nurses to maintain patient’s trust by providing safe and competent care, that:

Nurses maintain complete, accurate and timely documentation of their practice; and
Nurses are accountable to, and practice under, relevant laws and CNO’s standards of practice.

CNO’s Code of Conduct further provides, in relation to the principle requiring nurses to maintain public confidence in the nursing profession, that nurses are accountable for their own actions and decisions.
Attached as Exhibit “A” is a copy of CNO’s Code of Conduct which was in force at the time of the incidents.

Professional Standards

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.
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:

providing, facilitating, advocating and promoting the best possible care for [patients];
ensuring practice is consistent with CNO’s standards of practice and guidelines as well as legislation;
taking responsibility for errors when they occur and taking appropriate action to maintain [patient] safety.

CNO’s Professional Standards further provides, in relation to the leadership standard, that nurses demonstrate their leadership by providing, facilitating and promoting the best possible care/service to the public. Nurses demonstrate this standard by role-modelling professional values, beliefs and attributes and collaborating with patients and the health care team to provide professional practice that respects the rights of patients.
Attached as Exhibit “B” is a copy of CNO’s Professional Standards that was in force at the time of the incidents and has since been retired.

Documentation Standard

CNO’s Documentation Standard explains the regulatory and legislative requirements for nursing documentation. It includes three standard statements and indicators pertaining to communication, accountability and security which describe a nurse’s accountabilities when documenting.
CNO’s Documentation standard provides, in relation to communication, that nurses ensure that documentation presents an accurate, clear and comprehensive picture of the patient’s needs, the nurse’s interventions and the patient’s outcomes. Nurses meet the standard by:

ensuring documentation is a complete record of nursing care provided and reflects all aspects of the nursing process, including assessment, planning, intervention (independent and collaborative) and evaluation; and
documenting both objective and subjective data.

CNO’s Documentation standard further provides, in relation to accountability, that nurses are accountable for ensuring their documentation of patient care is accurate, timely and complete. Nurses meet the standards by:

documenting in a timely manner and completing documentation during, or as soon as possible after, the care or event;
documenting the date and time that care was provided and when it was recorded; and
correcting errors while ensuring that the original information remains visible/retrievable.

CNO’s Documentation standard also provides, in relation to security, that nurses safeguard patient health information by maintaining confidentiality and acting in accordance with information retention and destruction policies and procedures that are consistent with the standard(s) and legislation. Nurses meet the standard by ensuring that relevant patient care information is captured in a permanent record.
Attached as Exhibit “C” are copies of the Documentation Standard that were in force at the time of the incidents.
With respect to Patient A, the Member admits and acknowledges that she contravened CNO’s Professional Standards and Documentation Standard when she documented that she administered Clobazam to Patient A at 0700 hours when it had not been administered.
With respect to Patient B, the Member admits and acknowledges that she contravened CNO’s Code of Conduct, Professional Standards and Documentation Standard when she:

inaccurately documented in Patient B’s chart that Patient B was to receive a B12 injection every 96 hours when the order was for Patient B to receive the injection monthly on the 15th of each month; and
administered a B12 injection to Patient B on February 8, 2019 when it was not ordered for administration until February 15, 2019.

With respect to Patient C, the Member admits and acknowledges that she contravened CNO’s Code of Conduct, Professional Standards and Documentation Standard when she completed a New Admissions Order Form for Patient C and included Rivastigmine when it had been discontinued.
With respect to Patient D, the Member admits and acknowledges that she contravened CNO’s Code of Conduct, Professional Standards and Documentation Standard when she failed to document a timeframe for an order of Cephalexin for Patient D.
With respect to Patient E, the Member admits and acknowledges that she contravened CNO’s Code of Conduct, Professional Standards and Documentation Standard when she input the order into Patient E’s medication administration record for Patient E’s Nitroglycerin patch and failed to document the time for removal of the patch.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 4(a), (b)(i)-(ii), (c), (d), and (e) of the Notice of Hearing in that she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 4 to 40 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 5(a)-(e) of the Notice of Hearing in that she failed to keep records as required, as described in paragraphs 4 to 26 and 31 to 40 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 6(a), (b)(i)-(ii), (c), (d), and (e) of the Notice of Hearing in that she engaged in conduct that would reasonably be regarded by members as dishonourable and unprofessional, as described in paragraphs 4 to 40 above.

OTHER

With the leave of the Panel of the Discipline Committee, CNO withdraws the remaining allegations in the Notice of Hearing, which are paragraphs 1-3 of the Notice of Hearing.

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 4(a), 4(b)(i), 4(b)(ii), 4(c), 4(d), 4(e), 5(a), 5(b), 5(c), 5(d), 5(e), 6(a), 6(b)(i), 6(b)(ii), 6(c), 6(d) and 6(e) of the Notice of Hearing. As to allegations #6(a), #6(b)(i), #6(b)(ii), #6(c), #6(d) and #6(e), 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 #4(a), #4(b)(i), #4(b)(ii), #4(c), #4(d) and #4(e) in the Notice of Hearing are supported by paragraphs 4 to 41 in the Agreed Statement of Facts. The Member admitted that while working at Coleman Care Centre (the “Facility”) she contravened a standard of the profession or failed to meet the standard of practice of the profession when she documented in Patient A’s health record that she had administered Clobazam to Patient A when it had not been administered. The Member admitted that she inaccurately documented that Patient B was to receive a B12 injection every 96 hours when the order was for a B12 injection to be administered monthly on the 15th of the month. The Member admitted that she had administered a B12 injection to Patient B on February 8, 2019 when Patient B. should not have received the injection until February 15, 2019. The Member admitted that she had completed a New Admission Order Form for Patient C and included the medication Rivastigmine which had been discontinued. The Member admitted that she failed to document the length of time an order of Keflex (Cephalexin) was to be given to Patient D for. The Member admitted that she failed to document in an order the time for removal of a Nitroglycerin patch for Patient E. The Member breached the Documentation Standard by not ensuring the documentation of patient care was accurate, timely and complete. The Agreed Statement of Facts indicated that the Member breached the College’s Code of Conduct which requires nurses to maintain patient’s trust by providing safe and competent care that includes complete, accurate and timely documentation of their practice and nurses are accountable to, and practice under, relevant laws and the College’s standards of practice. The Member breached the College’s Professional Standards by not advocating and promoting the best possible care for her patients.

Allegations #5(a), #5(b), #5(c), #5(d) and #5(e) in the Notice of Hearing are supported by paragraphs 4 to 26, 31 to 40 and 42 in the Agreed Statement of Facts. The Member admitted that she failed to keep records as required. The Member documented that she had administered Clobazam to Patient A when she had not. The Member inaccurately documented in Patient B’s chart an order for vitamin B12 injections every 96 hours instead of on the 15th of each month. The Member included the medication Rivastigmine on Patient C’s New Admissions Order Form when it had been discontinued. The Member transcribed a telephone order for Patient D and did not include the length of time of the order (1 week). The Member omitted the time a Nitroglycerin patch was to be removed from Patient E, as a result the system defaulted for the removal to be at 0659 hours instead of at bedtime.

Allegations #6(a), #6(b)(i), #6(b)(ii), #6(c), #6(d) and #6(e) in the Notice of Hearing are supported by paragraphs 4 to 40 and 43 in the Agreed Statement of Facts. The Member admitted that she engaged in conduct that would reasonably be regarded by members as dishonourable and unprofessional. The Panel finds that the Member’s conduct in inaccurately documenting orders was relevant to the practice of nursing and was unprofessional as she failed to meet the standards expected of the profession and demonstrated a serious and persistent disregard for her professional obligations by breaching the Code of Conduct, the Professional Standards and the Documentation Standard.

The Panel also finds that the Member’s conduct was dishonourable in that it demonstrated an element of moral failing and she knew or ought to have known that her conduct fell below the standards of a professional.

Penalty

College Counsel and the Member’s Counsel 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 3 months of the date that this Order becomes final.
Directing the Executive Director to suspend the Member’s certificate of registration for 2 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.
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:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
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):

Code of Conduct,
Documentation, and
Medication;

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:

the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
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:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into the Member’s behaviour;

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

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

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

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

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

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
a copy of the Panel’s Decision and Reasons, once available;

iv. Only practice nursing for an employer who agrees to, and does, forward a report to CNO within 14 days of the commencement or resumption of the Member’s employment in any nursing position, confirming:

that they received a copy of the required documents,
that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession, and
that they agree to perform 4 random spot audits of the Member’s practice at the following intervals and provide a report to CNO regarding the Member’s practice after each audit:

a. the first audit shall take place within 3 months from the date the Member begins or resumes employment with the employer,

b. the second audit shall take place within 6 months from the date the Member begins or resumes employment with the employer,

c. the third audit shall take place within 9 months from the date the Member begins or resumes employment with the employer, and

d. the fourth audit shall take place within 12 months from the date the Member begins or resumes employment with the employer;

v. The audits shall, on each occasion, involve the following:

reviewing a random selection of at least 5 the Member’s charts to ensure they meet both CNO and employer standards.
All documents delivered by the Member to CNO, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.

College Submissions on Penalty

College Counsel made submissions which included the following:

College Counsel submitted that the Joint Submission on Order is the product of negotiations between the College and the Member and asked the Panel to accept it as it is in the public interest, is appropriate, reflects the aggravating and mitigating factors meets the goals of penalty and is consistent with prior decisions of this Discipline Committee.

The aggravating factors in this case were:

The Member’s conduct was repeated over time with 5 different patients, after receiving coaching from her manager;
The Member’s conduct could have led to potential harm to a patient receiving a medication early or not receiving a medication that was ordered; and
The Member’s conduct was a discredit to the profession and showed disregard for her professional obligations.

The mitigating factors in this case were:

The Member accepted responsibility for her conduct by entering into an Agreed Statement of Facts and a Joint Submission on Order with the College;
The Member has no prior disciplinary history with the College;
There was evidence of remorse by the Member; and
The Member is a longstanding member with the College.

The proposed penalty provides for specific deterrence through the oral reprimand and the 2-month suspension of the Member’s certificate of registration. The oral reprimand will help the Member understand how her conduct is perceived by the public and by members of the profession. The 2-month suspension of the Member’s certificate of registration will deter the Member from committing this type of conduct in the future.

The proposed penalty provides for general deterrence through the 2-month suspension of the Member’s certificate of registration and the 12 months of employer notification, which sends a message to the profession that this type of conduct will not be tolerated.

The proposed penalty provides for rehabilitation and remediation through 2 meetings with a Regulatory Expert and the review of the College’s Code of Conduct, Documentation Standard and the Medication Standard, which will assist the Member with the tools that she may need to meet the requirements of nursing practice.

Overall, the public is protected through the Joint Submission on Order, in its totality, as it is geared toward public protection and sends a message to nurses that there are consequences for their behavior and to the public of the profession’s ability to self-regulate and through the 12 months of employer notification, which will provide a heightened level of employer oversight on the Member’s return to nursing practice. As well, 4 random spot audits of the Member’s practice will ensure that the Member is monitored for a significant amount of time after she returns from the suspension.

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. Robinson (Discipline Committee, 2021): In this case, the hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. One incident was related to concerns in documentation and care completed. The member failed to keep accurate records. 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, 18 months of employer notification and 4 random spot audits of the member’s documentation. This case is not exactly like the case before this Panel as the penalty is more severe because there was an altercation with a colleague.

CNO v. Lucier-Harkai (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 documented inaccurately and administered the wrong dose of a medication. The penalty included an oral reprimand, a 3-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert, 12 months of employer notification and 12 months of no independent practice in the community. The penalty was more severe as there were narcotics involved.

Member’s Submissions on Penalty

The Member’s Counsel made submissions which included the following:

The Member is a long-standing member of the College;
The Member has no prior disciplinary history with the College; and
The Member cooperated with the College by entering into a Joint Submission on Order.

The Member’s Counsel indicated that he agreed with College Counsel’s 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, rehabilitation and remediation, and public protection.

The proposed penalty provides for specific deterrence through the oral reprimand and the 2-month suspension of the Member’s certificate of registration.

The proposed penalty provides for general deterrence through the 2-month suspension of the Member’s certificate of registration and the 12 months of employer notification.

Overall, the public is protected through the 12 months of employer notification and the 4 random spot audits of the Member’s practice.

The Panel acknowledges that the Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility, which is a mitigating factor.

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, Carly Gilchrist, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.