College of Nurses of Ontario v. Thistlethwaite, 2024 ONCNO 131477

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Grace Fox, NP Chairperson Sherry Szucsko-Bedard RN Member Kerrie Naylor, RPN Member Sandra Larmour Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) HAILEY BRUCKNER for ) College of Nurses of Ontario

• and - )

JORJA THISTLETHWAITE ) NO REPRESENTATION for Registration No. AA793605 ) Jorja Thistlethwaite

) CHRISTOPHER WIRTH for ) Independent Legal Counsel

) Heard: August 28, 2024, via videoconference

DECISION AND REASONS

Publication Ban

By Order of the Discipline Panel dated August 28, 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 including any personal health information that could disclose the identities of the patients or their personal health information referred to orally or in any documents presented at the Discipline hearing of Jorja Thistlethwaite.

This matter was heard by a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on August 28, 2024.

The Allegations

The allegations against Jorja Thistlethwaite (the “Member”) as stated in the Notice of Hearing dated July 24, 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 employed as a Registered Practical Nurse at Woodingford Lodge in Woodstock, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession as follows:

a. Between September 1, 2020 and October 16, 2020, you tampered with medication intended for patients at the Facility, including:

i. Patient [A];

ii. Patient [B];

iii. Patient [C];

iv. Patient [D];

v. Patient [E];

vi. Patient [F]; and/or

vii. Patient [G];

b. Between September 1, 2020 and October 16, 2020, you stole medication from patients at the Facility, including:

i. Seven 3 mg capsules hydromorphone from Patient [A];

ii. One 4.5 mg capsule of hydromorphone from Patient [A];

iii. Two 3 mg capsules of hydromorphone from Patient [B];

iv. Four 4.5 mg capsules of hydromorphone from Patient [C];

v. Three 3 mg capsules of hydromorphone from Patient [C];

vi. Five 3 mg capsules of hydromorphone from Patient [D];

vii. Five 3 mg capsules of hydromorphone from Patient [E];

viii. One 12 mg capsule of hydromorphone from Patient [F];

ix. Two 9 mg capsules of hydromorphone from Patient [F]; and/or

x. One 3 mg capsule of hydromorphone from Patient [G];

c. Between September 1, 2020 and October 16, 2020, you replaced hydromorphone intended for patients at the Facility with another medication, including:

i. Seven 3 mg capsules hydromorphone from Patient [A];

ii. One 4.5 mg capsule of hydromorphone from Patient [A];

iii. Two 3 mg capsules of hydromorphone from Patient [B];

iv. Four 4.5 mg capsules of hydromorphone from Patient [C];

v. Three 3 mg capsules of hydromorphone from Patient [C];

vi. Five 3 mg capsules of hydromorphone from Patient [D];

vii. Five 3 mg capsules of hydromorphone from Patient [E];

viii. One 12 mg capsule of hydromorphone from Patient [F];

ix. Two 9 mg capsules of hydromorphone from Patient [F]; and/or

x. One 3 mg capsule of hydromorphone from Patient [G];

d. Between September 1, 2020 and October 16, 2020, you did not intervene to prevent your nursing colleagues from administering medication that you had tampered with to patients at the Facility, including:

i. Patient [A];

ii. Patient [C];

iii. Patient [D];

iv. Patient [E]; and/or

v. Patient [G]; 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 employed as a Registered Practical Nurse at Woodingford Lodge in Woodstock, Ontario (the “Facility”), you misappropriated property from a client or workplace on the following occasions:

a. Between September 1, 2020 and October 16, 2020, you stole medication from patients at the Facility, including:

i. Seven 3 mg capsules hydromorphone from Patient [A];

ii. One 4.5 mg capsule of hydromorphone from Patient [A];

iii. Two 3 mg capsules of hydromorphone from Patient [B];

iv. Four 4.5 mg capsules of hydromorphone from Patient [C];

v. Three 3 mg capsules of hydromorphone from Patient [C];

vi. Five 3 mg capsules of hydromorphone from Patient [D];

vii. Five 3 mg capsules of hydromorphone from Patient [E];

viii. One 12 mg capsule of hydromorphone from Patient [F];

ix. Two 9 mg capsules of hydromorphone from Patient [F]; and/or

x. One 3 mg capsule of hydromorphone from Patient [G]; 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(18) of Ontario Regulation 799/93, in that while registered as a Registered Practical Nurse, you contravened a term, condition or limitation on your certificate of registration, as provided in subsections 1.5(1)1. (ii) of O. Reg. 275/94, in that you failed to provide the Executive Director of the College of Nurses of Ontario (“CNO”) with details of criminal charges that you were subject to, as follows:

a. On or about April 8, 2021, you were charged with six counts of theft of hydromorphone of a value not exceeding five thousand dollars, contrary to Section 334(b) of the Criminal Code; and/or

4. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that while registered as a Registered Practical Nurse, 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 of the profession as disgraceful, dishonourable or unprofessional, as follows:

a. Between September 1, 2020 and October 16, 2020, you tampered with medication intended for patients at the Facility, including:

i. Patient [A];

ii. Patient [B];

iii. Patient [C];

iv. Patient [D];

v. Patient [E];

vi. Patient [F]; and/or

vii. Patient [G]; and/or

b. Between September 1, 2020 and October 16, 2020, you stole medication from patients at the Facility, including:

i. Seven 3 mg capsules hydromorphone from Patient [A];

ii. One 4.5 mg capsule of hydromorphone from Patient [A];

iii. Two 3 mg capsules of hydromorphone from Patient [B];

iv. Four 4.5 mg capsules of hydromorphone from Patient [C];

v. Three 3 mg capsules of hydromorphone from Patient [C];

vi. Five 3 mg capsules of hydromorphone from Patient [D];

vii. Five 3 mg capsules of hydromorphone from Patient [E];

viii. One 12 mg capsule of hydromorphone from Patient [F];

ix. Two 9 mg capsules of hydromorphone from Patient [F]; and/or

x. One 3 mg capsule of hydromorphone from Patient [G];

c. Between September 1, 2020 and October 16, 2020, you replaced hydromorphone intended for patients at the Facility with another medication, including:

i. Seven 3 mg capsules hydromorphone from Patient [A];

ii. One 4.5 mg capsule of hydromorphone from Patient [A];

iii. Two 3 mg capsules of hydromorphone from Patient [B];

iv. Four 4.5 mg capsules of hydromorphone from Patient [C];

v. Three 3 mg capsules of hydromorphone from Patient [C];

vi. Five 3 mg capsules of hydromorphone from Patient [D];

vii. Five 3 mg capsules of hydromorphone from Patient [E];

viii. One 12 mg capsule of hydromorphone from Patient [F];

ix. Two 9 mg capsules of hydromorphone from Patient [F]; and/or

x. One 3 mg capsule of hydromorphone from Patient [G];

d. Between September 1, 2020 and October 16, 2020, you did not intervene to prevent your nursing colleagues from administering medication that you had tampered with to patients at the Facility, including:

i. Patient [A];

ii. Patient [C];

iii. Patient [D];

iv. Patient [E]; and/or

v. Patient [G]; and/or

e. You failed to provide the Executive Director of CNO with the details of criminal charges that you were subject to, as follows:

i. On or about April 8, 2021, you were charged with six counts of theft of hydromorphone of a value not exceeding five thousand dollars, contrary to Section 334(b) of the Criminal Code.

Member’s Plea

The Member admitted the allegations set out in paragraphs #1(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 1(b)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 1(c)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii) (ix), (x), 1(d)(i), (ii), (iii), (iv), (v), #2(a)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), #3(a), #4(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 4(b) (i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 4(c)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 4(d)(i), (ii), (iii), (iv), (v) and 4(e)(i) 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 and without exhibits mentioned therein, as follows:

THE MEMBER

1. Jorja Thistlethwaite (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on June 6, 2011.

2. The Member is not currently entitled to practise nursing in Ontario. Her certificate of registration was suspended by the Fitness to Practise Committee on January 17, 2024.

3. The Member was employed at Woodingford Lodge in Woodstock, Ontario (the “Facility”) from October 16, 2017 until April 5, 2021. The Facility suspended the Member’s employment on October 17, 2020 following the incidents described below. The Member did not return to work at the Facility between October 17, 2020 and her termination on April 5, 2021.

PRIOR HISTORY

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

THE FACILITY

5. Woodingford Lodge, the Facility, is a long-term care facility. The Facility has six different home areas, with 26 to 30 patient beds in each home area. One of the six home areas, Lakewood, is a secured unit for memory care patients.

6. The Facility assigns nurses to specific home areas. The Member preferred to work the night shift at the Facility. At the time of the incidents described below, she was assigned to the Pinecrest and Lakewood home areas of the Facility, but she had access to the other home areas.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

The Member tampered with, stole, and replaced patients’ hydromorphone

7. Between September 1, 2020 and October 16, 2020, the Member stole 31 capsules of hydromorphone from patients at the Facility.

8. The Member stole the hydromorphone by tampering with and replacing patients’ medication in the Facility’s medication room. She removed hydromorphone capsules from blister packs belonging to patients for her own use, and replaced the stolen hydromorphone with Effexor, an antidepressant medication, that she took from the waste bin in the medication room. The Member then resealed the blister packs by placing square covers she cut from white paper tape over the torn blister packs. She left the resealed blister packs – containing Effexor rather than hydromorphone – in the medication room to conceal her theft.

9. The Member stole 31 capsules of hydromorphone from patients and replaced these stolen capsules with Effexor. Specifically, she stole and replaced:

a) Seven 3 mg capsules hydromorphone from Patient [A];

b) One 4.5 mg capsule of hydromorphone from Patient [A];

c) Two 3 mg capsules of hydromorphone from Patient [B];

d) Four 4.5 mg capsules of hydromorphone from Patient [C];

e) Three 3 mg capsules of hydromorphone from Patient [C];

f) Five 3 mg capsules of hydromorphone from Patient [D];

g) Five 3 mg capsules of hydromorphone from Patient [E];

h) One 12 mg capsule of hydromorphone from Patient [F];

i) Two 9 mg capsules of hydromorphone from Patient [F]; and

j) One 3 mg capsule of hydromorphone from Patient [G];

The Member failed to intervene when her nursing colleagues administered Effexor, rather than hydromorphone

10. After the Member stole hydromorphone, and replaced it in the blister packs with Effexor, her nursing colleagues unknowingly administered this medication to patients.

11. The Member’s nursing colleagues did not know the Member had tampered with the blister packs or that these blister packs no longer contained hydromorphone. They believed they were giving patients authorized doses of hydromorphone, but they were actually administering Effexor.

12. Between September 1, 2020 and October 16, 2020, the Member failed to intervene to prevent her colleagues from administering Effexor that they believed was hydromorphone to Patient [A], Patient [C], Patient [D], Patient [E], and Patient [G] The following doses of Effexor were administered to these patients in place of authorized hydromorphone:

a) Two doses of Effexor to Patient [C];

b) One does of Effexor to Patient [D];

c) Three doses of Effexor to Patient [E];

d) One does of Effexor for Patient [G]; and

e) Two doses of Effexor to Patient [A].

13. The Member knew her colleagues were administering Effexor, rather than hydromorphone, because she was the one who removed the hydromorphone from these patients’ blister packs and replaced it with Effexor. Fortunately, none of the patients who received Effexor in place of hydromorphone were allergic to the medication or experienced a serious adverse reaction as a result of the Member’s conduct.

The Member failed to report criminal charges to CNO

14. The Facility first discovered that blister packs had been tampered with, and hydromorphone diverted, on October 14, 2020. The Facility reported the potential theft of hydromorphone to both the police and the Ministry of Long-Term Care immediately.

15. The Facility provided blister packs that had been tampered with to the police, who in turn provided them to Health Canada. Health Canada confirmed through testing that the blister packs that had been tampered with contained Effexor, rather than hydromorphone.

16. The Facility identified the Member as the person responsible for stealing the hydromorphone. The Member initially denied the theft, but admitted both that she had stolen the hydromorphone, and that she had replaced the stolen medication with Effexor from the waste bin in an internal interview with the Facility on April 5, 2021.

17. On or about April 8, 2021, the Member was charged with six counts of theft of hydromorphone of a value not exceeding five thousand dollars, contrary to Section 334(b) of the Criminal Code.

18. The Member was obligated to provide the Executive Director of CNO with details of the criminal charges against her, pursuant to section 1.5(1)1.(ii) of Ontario Regulation 275/94.

19. The Member did not report the criminal charges to CNO as required. She failed to meet her reporting obligations as a result.

Member’s Health

20. If the Member were to testify, she would state that she was suffering from a health condition during the relevant time period which affected her behaviour and judgment.

CNO STANDARDS

21. CNO publishes nursing standards to set out the expectations for the practice of nursing. CNO’s published standards inform nurses of their accountabilities and apply to all nurses regardless of their role, job description, or area of practice.

Code of Conduct

22. 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.

23. CNO’s Code of Conduct provides, in relation to the principle requiring nurses to work respectfully with colleagues to best meet patients’ needs, that:

• Nurses take action to stop unsafe, incompetent, unethical or unlawful practice, including any type of abuse.

24. CNO’s Code of Conduct provides, in relation to the principle requiring nurses to act with integrity to maintain patients’ trust, that:

• Nurses take prompt action to prevent and protect patients from harm.

25. 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;

• Nurses respect the property of their patients and employers;

• Nurses have a duty to report any error, behaviour, conduct or system issue that affects patient safety; and

• Nurses are responsible for maintaining their health. They seek help if their health affects their ability to practice safely.

26. Attached as Exhibit “A” is a copy of CNO’s Code of Conduct which was in force at the time of the incidents.

27. The Member admits and acknowledges that she contravened the Code of Conduct.

Professional Standards

28. 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 and indicators that illustrate how the standard may be demonstrated pertaining to accountability, continuing competence, ethics, knowledge, knowledge application, leadership and relationships.

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

30. CNO’s Professional Standards further provides, in relation to the ethics standard statement, that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with the patient and other health care team members.

31. Attached as Exhibit “B” is a copy of CNO’s Professional Standards which was in force at the time of the incidents and has since been retired.

32. The Member admits and acknowledges that she contravened CNO’s Professional Standards.

Ethics

33. 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.

34. 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.

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

36. Attached as Exhibit “C” is a copy of CNO’s Ethics Standard which was in force at the time of the incidents and has since been retired.

37. The Member admits and acknowledges that she contravened CNO’s Ethics Standard.

Medication

38. CNO’s Medication Standard requires nurses to “promote safe care and contribute to a culture of safety within their practice environments, when involved in medication practices.”

39. Nurses meet the Medication Standard by:

• Promoting and/or implementing strategies to minimize the risk of misuse and drug diversion;

• Taking appropriate action to resolve or minimize the risk of harm to a client from a medication error or adverse reaction; and

• Reporting medication errors, near misses or adverse reactions in a timely manner.

40. Attached as Exhibit “D” is a copy of CNO’s Medication Standard which was in force at the time of the incidents.

41. The Member admits and acknowledges that she contravened CNO’s Medication Standard.

Therapeutic Nurse-Client Relationship Standard

42. CNO’s Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”) places the responsibility for establishing and maintaining the therapeutic nurse-patient relationship on the nurse. The TNCR Standard provides that the nurse-patient relationship is based on trust and respect and requires appropriate use of the authority inherent in the health care provider’s role.

43. Importantly, the TNCR Standard further develops this obligation by explicitly stating that nurses must protect patients from harm by not engaging in activities that could result in monetary or other material benefit, gain or profit for the nurse (other than the appropriate remuneration for nursing care or services) or result in monetary or personal loss for the patient.

44. Attached as Exhibit “E” is a copy of CNO’s TNCR Standard which was in force at the time of the incidents.

45. The Member admits and acknowledges that she contravened CNO’s TNCR Standard.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

46. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1(a)(b)(c) and (d) of the Notice of Hearing in that she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 7 to 45 above.

47. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2(a) of the Notice of Hearing in that she misappropriated property from a client or workplace, as described in paragraphs 7 to 9 above.

48. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3(a) of the Notice of Hearing in that she contravened a term, condition or limitation on her certificate of registration, as provided in subsections 1.5(1)1. (ii) of O. Reg. 275/94, when she failed to provide the Executive Director of the College of Nurses of Ontario with details of criminal charges to which she was subject, as described in paragraphs 14 to 19 above.

49. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 4(a)(b)(c)(d) and (e) of the Notice of Hearing, and in particular her conduct was dishonourable, unprofessional, and disgraceful, as described in paragraphs 7 to 19 above.

College Submissions on Liability

College Counsel asked the Panel to accept the Member’s admissions to all the allegations as set out in paragraphs 46 to 49 of the Agreed Statement of Facts and, on the basis of those facts and admissions, make findings of professional misconduct with respect to the allegations in the Notice of Hearing. College Counsel submitted that the Panel had taken the Member’s plea and conducted a verbal plea inquiry. The Member’s plea was voluntary.

Member’s Submissions on Liability

The Member made no submissions on liability.

Decision

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

Having considered the evidence and the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs #1(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 1(b)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 1(c)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii) (ix), (x), 1(d)(i), (ii), (iii), (iv), (v), #2(a)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), #3(a), #4(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 4(b)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 4(c)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 4(d)(i), (ii), (iii), (iv), (v) and 4(e)(i) of the Notice of Hearing. As to allegations #4(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 4(b)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 4(c)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 4(d)(i), (ii), (iii), (iv), (v) and 4(e)(i), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be disgraceful, dishonourable and unprofessional.

Reasons for Decision

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

Allegations #1(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 1(b)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 1(c)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii) (ix), (x), 1(d)(i), (ii), (iii), (iv) and (v) in the Notice of Hearing are supported by paragraphs 7 - 46 in the Agreed Statement of Facts. The Member admitted that between September 1, 2020, and October 16, 2020, while employed at Woodingford Lodge (the “Facility”) she took 31 hydromorphone capsules from 7 patients. Additionally, she tampered with the medication supply by replacing the Hydromorphone with Effexor, a different medication. She then allowed her nursing colleagues to administer the Effexor to the patients, misrepresenting it as the prescribed Hydromorphone. The Member’s conduct contravened multiple College standards. According to the College’s Code of Conduct, nurses must maintain patient trust by providing safe and competent care and protecting patients from harm. The College’s Professional Standards require nurses to act with integrity and honesty in all interactions with patients and other healthcare team members. Additionally, the Medication Standard mandates that nurses must take appropriate care to minimize the risk of harm to patients, which the Member failed to do and in fact she did the exact opposite by tampering with the medication she put the patients at risk of harm. The Member failed to adhere to these standards.

Allegations #2(a)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x) in the Notice of Hearing are supported by paragraphs 7 - 9 and 47 in the Agreed Statement of Facts. The Member admitted and the Panel finds that she committed an act of professional misconduct when she misappropriated property by stealing 31 hydromorphone capsules from 7 patients at the Facility where she worked.

Allegation #3(a) in the Notice of Hearing is supported by paragraphs 14 - 19 and 48 in the Agreed Statement of Facts. The Member failed to meet her obligation to provide the Executive Director of the College with details of the criminal charges and findings of guilt against her. The Member admitted and acknowledged that she did not report the criminal charges to the College, nor did she report to the College that she had been found guilty of six counts of theft under $5,000.00, contrary to s. 334(b) of the Criminal Code.

Allegations #4(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 4(b)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 4(c)(i), (ii), (iii), (iv), (v), (vi), (vii), (viii), (ix), (x), 4(d)(i), (ii), (iii), (iv), (v) and 4(e)(i) in the Notice of Hearing are supported by paragraphs 7 - 19 and 49 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct was relevant to the practice of nursing as she contravened the standards of practice of the profession and was found guilty of offences relevant to her suitability to practise. In particular, she was found guilty of six counts of theft under $5,000.00, which occurred at the Facility. It was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations in contravening the Code of Conduct, the Professional Standards, the Ethics Standard, the Medication Standard and the Therapeutic Nurse-Client Relationship Standard.

The Panel also finds that the Member’s conduct was dishonourable as it demonstrated an element of moral failing, dishonesty and deceit when she used her position to steal medications. The Member knew or ought to have known that stealing patient medications and concealing the theft for her own benefit was unacceptable and fell below the standards of a professional.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. The Member not only stole patient medications but also replaced them with another medication to conceal her theft. This conduct exposed patients to health risks, as they received a medication that may not have been prescribed to them. Additionally, her colleagues were administering medication that was not ordered. The Member also failed to disclose to the Executive Director of the College the details of her findings of guilt and criminal charges. Nurses are expected to uphold and demonstrate the standards of practice in their practice. By stealing and tampering with medications, the Member discredited herself and the profession, breaching these expectations. The Member’s conduct casts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet.

Penalty

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

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 10 months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in a practicing class.

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

a) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) at the Member’s own expense and within 6 months from the date the Member obtains an active certificate of registration in a practicing class. If the Expert determines that a greater number of sessions are required, the Expert will advise CNO regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within 12 months from the date the Member obtains an active certificate of registration in a practicing class. 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 Practice Reflection Worksheets, online learning modules and decision tools (where applicable):

1. Code of Conduct, and

2. Medication; and

3. Therapeutic Nurse-Client Relationship Standard;

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 Practice Reflection Worksheets;

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 18 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

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

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

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

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

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

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

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

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

c) The Member shall not practice independently in the community for a period of 18 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 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. The Panel must accept the Joint Submission on Order unless doing so would be contrary to the public interest or bring the administration of justice into disrepute.

The penalty appropriately reflects the aggravating and mitigating factors in this case. It appropriately meets the goals of penalty and is consistent with prior decisions of the Discipline Committee.

The aggravating factors in this case were:

• The Member ought to have known her behaviour was wrong, as she took steps to conceal the theft;

• The Member’s conduct was dishonest and a breach of trust;

• The Member repeated the behaviour over a lengthy period and involved many patients and colleagues;

• The Member’s conduct was serious and could have resulted in patients being harmed, she put patients at risk;

• The Member’s conduct brought discredit to the profession; and

• The Member’s conduct was intentional and for her own personal gain.

The mitigating factors in this case were:

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

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

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. Mage (Discipline Committee, 2019): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member stole medication from a patient and was found guilty of theft not exceeding $5,000.00 that was not reported to the College. The panel found the member contravened the standards of practice and misappropriated property and that the member’s conduct was disgraceful, dishonourable and unprofessional. The penalty included an oral reprimand, a five-month suspension of the member’s certificate of registration, two meetings with a Regulatory Expert, 18 months of employer notification and an 18-month restriction on independent practice.

CNO v. Araya (Discipline Committee, 2021): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member entered a patient’s home for no clinical purpose other than to steal medications. The member also breached electronic health records of 318 patients without consent or authorization. The panel found the member contravened the standards of practice and misappropriated property and that the member’s conduct was disgraceful, dishonourable and unprofessional. The penalty included an oral reprimand, a seven-month suspension of the member’s certificate of registration, two meetings with a Regulatory Expert, 24 months of employer notification, three random spot audits of the member’s accesses to patients’ electronic health records and a 24-month restriction on independent practice in the community.

CNO v. Price (Discipline Committee, 2019): The member did not attend the hearing, and was deemed to have denied the allegations. The panel found that the member stole medication from approximately 75 patients over 182 occurrences, falsified health records and was found guilty of theft not exceeding $5,000.00 that was not reported to the College. The panel found the member contravened the standards of practice, misappropriated property, falsified records and failed to report a criminal conviction and that the member’s conduct was disgraceful, dishonourable and unprofessional. The penalty included an oral reprimand and revocation of the member’s certificate of registration. Since the member did not attend, the panel did not hear any mitigating factors to consider in making its decision.

Member’s Submissions on Penalty

The Member indicated that she agreed with the College’s Joint Submission on Order.

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 general deterrence through:

• The 10-month suspension of the Member’s certificate of registration.

This penalty will send a strong signal to the profession and the public that the College will not tolerate this type of conduct.

The proposed penalty provides for specific deterrence through:

• The oral reprimand; and

• The 10-month suspension of the Member’s certificate of registration.

The proposed penalty provides for remediation and rehabilitation through:

• The terms, conditions and limitations placed on the Member’s certificate of registration, including a minimum of two meetings with a Regulatory Expert, which will allow the Member to reflect on her professional standards and requirements.

Overall, the public is protected because:

• The 10-month suspension of the Member’s certificate of registration followed by 18 months of employer notification and the 18-month restriction on the Member’s independent practice once she returns to the practice of nursing addresses the principle of public protection. The penalty reinforces the expectation that members are to consistently maintain high professional and ethical standards.

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, Grace Fox, NP, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.