College of Nurses of Ontario v. Rebecca Blasco, 2024 ONCNO 131478

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Michael Hogard, RPN Chairperson

Andrea Arkell Public Member Jean-Laurent Domingue, RN Member Nazlin Hirji, RN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) HAILEY BRUCKNER for

) College of Nurses of Ontario

• and - )

REBECCA BLASCO ) NO REPRESENTATION for

Registration No. 0509059 ) Rebecca Blasco

) CHRISTOPHER WIRTH

) Independent Legal Counsel

) Heard: February 22, 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 February 22, 2024, via videoconference.

As Rebecca Blasco (the “Member”) was not present, the hearing recessed for 15 minutes to allow time for the Member to appear. Upon reconvening, the Panel noted that the Member was not in attendance.

College Counsel provided the Panel with evidence that the Member had been sent the Notice of Hearing (Exhibit #1) on December 7, 2023, via regular mail at the Member’s last known address and an e-mail to the Member’s last known e-mail address with instructions on how to access the Notice of Hearing through a SharePoint link. College Counsel provided the Panel with evidence in the form of an Affidavit affirmed by Ashley Yoannou (“Ms. Yoannou”) (Exhibit #2), a Prosecutions Associate with the College, that on December 18, 2023, the College sent the Member initial disclosure via courier to her last known address. A person who identified themself by the name of “Rebecca” signed for the delivery at or around 3:19 pm.

The Panel was therefore satisfied that the Member had received adequate notice of the time, place and purpose of the hearing and of the fact that if she did not attend it, the hearing may proceed in her absence. Accordingly, the Panel decided to proceed with the hearing in the Member’s absence.

Publication Ban

College Counsel brought a motion pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, for an order preventing public disclosure and banning the publication or broadcasting of the name(s) of the patient(s) and complainant(s), or any information that could disclose the identity(ies) of the patient(s) and complainant(s), referred to orally or in any documents presented at the Discipline hearing of Rebecca Blasco.

The Panel considered the submissions of the College and decided that there be an order preventing public disclosure and banning the publication or broadcasting of the name(s) of the patient(s) and complainant(s), or any information that could disclose the identity(ies) of the patient(s) and complainant(s), referred to orally or in any documents presented at the Discipline hearing of Rebecca Blasco.

College Counsel brought a further motion pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, for an order preventing the public disclosure of Exhibit #4 presented in the Discipline hearing of Rebecca Blasco, including a ban on the publication or broadcasting of this information.

The Panel considered the submissions of the College and decided that there be an order preventing the public disclosure of Exhibit #4 presented in the Discipline hearing of Rebecca Blasco, including a ban on the publication or broadcasting of this information.

The Allegations

The allegations against the Member as stated in the Notice of Hearing dated December 7, 2023 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(20) of Ontario Regulation 799/93, in that while registered as a member of the College of Nurses of Ontario, you failed to appear before a panel of the Inquiries, Complaints and Reports Committee (“ICRC”) to be orally cautioned on or about May 14, 2021, pursuant to a decision of the ICRC dated July 22, 2020; 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(37) of Ontario Regulation 799/93, in that while registered as a member of the College of Nurses of 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 of the profession as disgraceful, dishonourable or unprofessional, and, in particular, you failed to:

a. Complete a Specified Continuing Education or Remediation Program that you were ordered to complete by a decision of the ICRC dated July 22, 2020; and/or

b. Appear before a panel of the ICRC to be orally cautioned on or about May 14, 2021, pursuant to a decision of the ICRC dated July 22, 2020.

Member’s Plea

Given that the Member was not present nor represented, she was deemed to have denied the allegations in the Notice of Hearing. The hearing proceeded on the basis that the College bore the onus of proving the allegations in the Notice of Hearing against the Member.

Overview

On June 20, 2017, and on May 10, 2019, the College received Letters of Report from the Tendercare Living Centre (the “Facility”), the Member’s employer at the time, about possible concerns regarding the Member’s practice of nursing. The College investigated the complaint and submitted various pieces of information collected throughout the investigation to the College’s Inquiries, Complaints and Reports Committee (“ICRC”). After reviewing the information collected by the College and pursuant to section 26 of the Health Professions Procedural Code of the Regulated Health Professions Act, 1991 (the “Code”), the ICRC required the Member to complete a Specified Continuing Education or Remediation Program (“SCERP”). Specifically, on July 22, 2020, the ICRC ordered the Member to complete a SCERP and to appear before the ICRC to be cautioned.

The College alleges that the Member did not complete the SCERP ordered by the ICRC and did not appear before the ICRC to be cautioned in person within the timeline provided.

The issues are as follows:

• Was the Member aware that her in-person caution was scheduled on May 14, 2021?

• Did the Member fail to attend her in-person caution on May 14, 2021?

• Was the Member aware of the ICRC decision and the SCERP requirements imposed upon her as specified in the ICRC decision?

• Did the Member fail to complete the SCERP?

• Did the Member commit professional misconduct by engaging in conduct that would be considered by members of the profession to be unprofessional, dishonourable or disgraceful by failing to complete the SCERP and attend her in-person caution?

As the Member was not present for the hearing, she was deemed to have denied the allegations against her. The College called a witness to provide evidence to the Panel and asked the Panel to make a finding of professional misconduct on allegations #1, #2(a) and (b) of the Notice of Hearing.

The Evidence

Pursuant to section 26 of the Code, on July 22, 2020, the ICRC ordered the Member to complete a SCERP and to appear before the ICRC to be cautioned. Exhibit #4 details the requirements related to the SCERP and the caution.

The College’s one witness was Mr. Parth Bhavsar (“Mr. Bhavsar”), a Monitoring Administrator at the College. Mr. Bhavsar has worked as a Monitoring Administrator since October 2019. His role includes facilitating agreements, orders and undertakings made between the ICRC of the College and members, and between the Discipline Committee of the College and members. In this role, he sent correspondence to the Member and monitored her responses in regard to the ICRC Order.

Mr. Bhavsar testified that he and his colleagues on the College’s investigation team issued and received the letters and correspondence, in Exhibits #3, #4, #5, #6, #7, #9, #10, #11, #12, #13, #14, #15, #17 and #18, to and about the Member, by way of e-mail, OneDrive (a secure document transfer system), and regular mail, as per the College’s usual practice. The Member did not reply to the numerous communication attempts made by the College.

The correspondence included:

• A letter, dated July 7, 2021, sent by Mr. Bhavsar to the College’s investigation intake team detailing the numerous unsuccessful attempts made by Mr. Bhavsar to communicate with the Member to ensure her compliance with the ICRC order;

• A letter, dated January 15, 2021, sent by e-mail to the Member by Mr. David Harris (“Mr. Harris”), Acting Team Lead of the College’s investigation team, requiring the Member to appear in person to be cautioned on April 21, 2021, and to complete the SCERP;

• A letter, dated January 18, 2021, sent via OneDrive to the Member by Mr. Bhavsar explaining to the Member how to comply with the ICRC order. The enclosure to the letter provided the Member with instructions to complete the SCERP. The letter also contained information about potential outcomes should the Member decide not to comply with the ICRC order;

• An automatic e-mail from SharePoint Online, dated January 20, 2021, sent to Mr. Bhavsar indicating that the Member had opened the OneDrive link he had sent to her on January 18, 2021;

• A letter, dated March 17, 2021, sent via OneDrive to the Member by Mr. Bhavsar as a reminder for the Member of the requirement to complete the SCERP by April 15, 2021. The letter also included information about potential outcomes should the Member decide not to comply with the ICRC order;

• An e-mail, dated April 21, 2021, sent by Samantha Harry (“Ms. Harry”), Administrative Assistant, to Mr. Bhavsar indicating that the Member’s in-person caution had been rescheduled, and was to now take place on May 14, 2021, at 0900 Hours;

• An e-mail, dated April 20, 2021, sent by Katherine du Toit (“Ms. du Toit”), ICRC Administrator, to the Member rescheduling her in-person caution. The e-mail also provided the Member with the Zoom link to attend her in-person caution;

• An e-mail, dated May 14, 2021, sent by Ms. du Toit to the College’s monitoring team, indicating that the Member failed to attend her in-person caution scheduled on May 14, 2021, at 0900 Hours;

• A letter, dated May 14, 2021, sent by Mr. Bhavsar via OneDrive and courier to the Member informing the Member that she had not completed her SCERP, nor did she attend her in-person caution. The letter requested that the Member provide Mr. Bhavsar with an extension request by June 4, 2021, and a list of documents necessary to be provided for such a request to be considered;

• An e-mail, dated May 27, 2021, sent by Mohsen “Matt” Aghaie (“Mr. Aghaie”), Scanning Lead with the College, to Mr. Bhavsar informing him that the letter sent to the Member by courier on May 14, 2021, had been returned to the College;

• An e-mail, dated May 14, 2021, sent by Joe Botello (“Mr. Botello”), Office Services Assistant with the College, to Mr. Bhavsar confirming that the letter dated May 14, 2021, to the Member would be expedited by Purolator Courier;

• An e-mail, dated June 2, 2021, sent by Mr. Bhavsar to the Member indicating that he had sent the Member a confidential correspondence on May 14, 2021, and inviting the Member to check her spam or junk folders for this correspondence. He requested that the Member contact him by June 10, 2021, to confirm the receipt of the letter;

• A letter, dated June 18, 2021, sent by Mr. Bhavsar to the Member via regular mail and OneDrive informing the Member that the College had not received an extension request from the Member to comply with the ICRC order, and providing the Member with another extension to submit an extension request. The new deadline for the Member to submit her extension request was July 2, 2021.

• Mr. Bhavsar testified that he never received a response from the Member to the letter of June 18, 2021 nor had the Member made any subsequent attempts to contact the College in response; and

• Mr. Bhavsar also testified that to date, the Member has not completed the SCERP or received the caution ordered by the ICRC.

Mr. Bhavsar further testified that he also attempted to communicate with the Member by telephone. Summaries of the telephone calls were included in Exhibits #8 and #16. The Member did not return Mr. Bhavsar’s telephone calls.

The telephone call summaries included:

• A summary of a telephone call conducted on April 15, 2021, stating that Mr. Bhavsar called the Member but that he was unable to leave a voicemail because he was unable to confirm that he had the correct number or that it was a confidential telephone line;

• A summary of a telephone call conducted on June 2, 2021, stating that Mr. Bhavsar called the Member at 10:49 am but that he was unable to leave a voicemail because he was unable to confirm that he had the correct number. The summary also includes a statement that Mr. Bhavar called the Member again at 3:40 pm. This time, he left a message with his name and direct phone line and requested that the Member call him back.

Final Submissions

College Counsel’s Submissions on Liability

College Counsel submitted that the evidence provided is sufficient for the Panel to make a finding of professional misconduct.

College Counsel submitted that the evidence provided by Mr. Bhavsar was clear, cogent and convincing. College Counsel reminded the Panel that it needs to assess the credibility and reliability of the evidence provided by Mr. Bhavsar. College Counsel submitted that the Panel should consider the factors delineated in Re Pitts and Director of Family Benefits Branch of the Ministry of Community & Social Services (1985) 1985 2053 (ON HCJ), 51 O.R. (2d) 302 (Divisional Court) to conduct such an assessment including, the appearance and demeanor of the witness, the extent to which the witness was able to perceive and had an opportunity to observe events being discussed, whether the witness has an interest in the litigation, whether the witness has partisanship, the probability of the story told by the witness, whether the evidence provided by the witness is consistent with previous evidence, and whether there is contradicting evidence.

College Counsel submitted that any discrepancies in evidence does not mean that such evidence should be dismissed. The Panel can accept all, some or none of the evidence presented by a witness. College Counsel submitted that Mr. Bhavsar’s evidence is supported by documentation that he either authored or was involved in, and that his testimony is therefore reliable and credible.

College Counsel submitted that the Panel heard evidence from Mr. Bhavsar that the Member failed to comply with a SCERP ordered by the ICRC on July 22, 2020. The College provided numerous reminders to the Member to comply with the ICRC order, and opportunities for the Member to request extensions to comply with the ICRC order. The Member has yet to complete a SCERP and she failed to attend the in-person caution ordered by the ICRC.

College Counsel submitted that the Panel should make findings of professional misconduct on all allegations in the Notice of Hearing.

In relation to allegation #1, College Counsel submitted that the Panel has evidence that the Member was informed of the ICRC order and that the initial in-person caution was scheduled on April 21, 2021. College Counsel submitted that the Panel was presented with evidence that the Member’s in-person caution was subsequently rescheduled to May 14, 2021, and that the Member was provided information with the new date of her in-person caution before the ICRC. College Counsel submitted that the Member did not attend on May 14, 2021, and that the Member never reached out to the College or made attempts to reschedule the in-person caution. To date, the Member has not received the in-person caution from the ICRC.

In relation to Allegations #2(a) and (b), College Counsel submitted that the Member failed to complete a SCERP and failed to attend her in-person caution on May 14, 2021, as ordered by the ICRC. The Member received information about consequences of not complying with the order from the ICRC. College Counsel submitted that the Member never replied to correspondence sent to her.

College Counsel submitted that the Member’s conduct was relevant to the practice of nursing in that the Member failed to comply with an ICRC decision that was ordered following reports of nursing practice incidents that took place while she was employed as a nurse. College Counsel submitted that the Member’s conduct would be considered by other members of the profession to be dishonourable and unprofessional. The Member’s conduct would be considered as unprofessional because it represents a serious and persistent disregard for her professional obligations. Her conduct would also be considered as dishonourable because it includes an element of moral failing. The Member knew or ought to have known that her conduct fell well below what would be expected of nursing professionals. College Counsel submitted that the Member’s conduct, raises concerns regarding her governability.

College Counsel submitted the following case to the Panel to demonstrate that cases involving similar conduct were found to be unprofessional and dishonourable:

CNO v. Singh (Discipline Committee, 2016): In this case, the member failed to complete a Remediation Program ordered by the ICRC. The panel found that the member’s conduct was unprofessional and dishonourable as it showed a lack of professionalism and a failure to be governed by the College.

In summary, College Counsel submitted that the Panel has sufficient evidence to make a finding of professional misconduct and to find that the misconduct was unprofessional and dishonourable.

Decision

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

Having considered the evidence and the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs #1, #2(a) and (b) in the Notice of Hearing. In relation to allegations #2(a) and (b), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession as dishonourable and unprofessional.

Reasons for Decision

The Panel accepted the College’s unchallenged evidence and, based upon it, was satisfied that the Member was aware of the ICRC’s order requiring her to complete a SCERP and appear before the ICRC to be cautioned and that she failed to do so. The Panel was surprised that the College attempted to communicate with the Member on 9 occasions over a period of 12 months (e-mails, OneDrive-delivered letters, mail-delivered letters, and telephone calls combined), despite the Member’s ongoing lack of compliance with the ICRC order and her lack of substantive responses to requests for additional information from the College’s Monitoring team.

To make its findings, the Panel resolved the relevant issues related to each allegation in the Notice of Hearing.

Allegation #1

To make a finding of professional misconduct in relation to allegation #1, the Panel needed to be satisfied that: (a) the Member was aware that her in-person caution was scheduled on May 14, 2021; and that (b) the Member failed to attend her in-person caution on May 14, 2021.

The Panel was presented with evidence that the Member was informed that her in-person caution was scheduled on May 14, 2021, via e-mail, dated April 20, 2021, sent by Ms. du Toit (Exhibit #10). The e-mail also provided the Member with the Zoom link to attend her in-person caution. The Panel was satisfied that the e-mail used by Ms. du Toit was an active e-mail address that was used by the Member. It is this e-mail address that accessed the OneDrive document sent by Mr. Bhavsar to the Member via OneDrive on January 18, 2021 (Exhibit #6).

Allegations #2 (a) and (b)

To make a finding of professional misconduct in relation to allegations #2(a) and (b), in addition to being satisfied that the Member was aware that she had to attend an in-person caution by the ICRC on May 14, 2021, the Panel needed to be satisfied that the Member was: (a) aware of the SCERP requirements ordered by the ICRC; and that the Member (b) failed to complete the SCERP. The Panel also needed to be satisfied that failing to comply with an order from the ICRC, including an in-person caution and a SCERP, was (c) related to the practice of nursing; and (d) that it would be considered unprofessional and dishonourable by other members of the profession.

The Panel was presented with evidence that the Member was informed of the SCERP requirements ordered by the ICRC via e-mail and OneDrive on January 15, 2021, and January 18, 2021 (Exhibits #4 and #5). The Panel was also satisfied that the Member opened the OneDrive link, to the instructions to follow to comply with the SCERP, on January 18, 2021, as evidenced by the OneDrive automatic e-mail sent to Mr. Bhavsar that states that the Member’s e-mail address accessed the documents enclosed in the OneDrive link (Exhibit #6). The Member was required to complete the SCERP by April 15, 2021.

The Panel was presented with evidence that the Member had not completed her SCERP by April 15, 2021, nor did the Member request any extensions to complete her SCERP.

The Panel finds that the Member’s conduct in failing to comply with an order from the ICRC, including an in-person caution and a SCERP, was relevant to the practice of nursing because the Member failed to comply with a decision from the College’s ICRC that was ordered following concerns related to her nursing practice.

The Panel finds that the Member’s conduct would be considered by other members of the profession to be dishonourable and unprofessional. The unprofessional nature of the Member’s conduct relates to her failure to comply with an order from the ICRC to complete a SCERP and to receive a caution. The Member’s conduct was dishonourable in that her failure to complete the SCERP and attend to be cautioned demonstrates an element of moral failing. Compliance with orders from the College’s statutory committees is key to maintaining the College’s ability to self-govern. The Member’s conduct demonstrated a lack of professionalism and an unwillingness to be governed by the College.

Penalty

Penalty Submissions

College Counsel submitted that, in view of the Panel’s findings of professional misconduct, it should make an Order as follows:

1. Requiring Rebecca Blasco (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 from the date this Order becomes final until the later of:

a) Four months from the date the suspension commences; or

b) Such time as the Member completes the specified continuing education or remediation program (the “SCERP”), and appears before a panel of the Inquiries, Complaints and Reports Committee (the “ICRC”) to be cautioned with respect to the Documentation, Medication and Therapeutic Nurse-Client Relationship standards of practice as required in the ICRC’s Decision and Reasons, dated July 22, 2020 (“ICRC Order”).

3. The suspension described in term 2 above shall continue to run without interruption as long as the Member remains in a practicing class.

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

a) The Member shall complete the SCERP, and appear before a panel of the ICRC to be cautioned with respect to the Documentation, Medication and Therapeutic Nurse-Client Relationship standards of practice, as required in the ICRC Order.

b) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) to discuss the findings of professional misconduct made by this Panel against the Member at the Member’s own expense and within 6 months from the date that this Order becomes final. 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 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, and

3. 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;

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; and

vii. If the Member does not comply with any 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.

5. 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 Counsel’s Submissions on Penalty

College Counsel submitted that the goal of penalty is to protect the public and to ensure the profession can self-regulate. College Counsel submitted that the penalty includes three elements: an oral reprimand, a 4-month suspension of the Member’s certificate of registration, and terms, conditions and limitations on the Member’s certificate of registration, including the need to complete the SCERP ordered by the ICRC and to appear before the ICRC to be cautioned. College Counsel submitted that should the Member not comply with the order of the ICRC following her 4-month period of suspension, her certificate of registration will continue to be suspended until the SCERP is completed and the Member is cautioned by the ICRC. As part of the penalty, the Member is also required to attend a minimum of two meetings with a Regulatory Expert and to review the College’s Code of Conduct.

College Counsel submitted that the proposed penalty is appropriate for three reasons: (1) it reflects the aggravating and mitigating factors of the case; (2) it meets the goals of penalty; and (3) it is consistent with prior decisions of the College’s Discipline Committee and of decisions made by other regulatory bodies.

The aggravating factors in this case were:

• The Member’s conduct was serious and intentional;

• The Member’s breach is ongoing. She has not complied with the SCERP, or the in-person caution ordered by the ICRC, and the Member continues to actively practice nursing;

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

• The Member’s conduct demonstrates a serious disregard for her professional obligations. It brings about serious concerns regarding the Member’s governability.

The mitigating factors in this case were:

• The Member has no prior history with the College’s Discipline Committee, although she does have the prior ICRC order.

The proposed penalty provides for general deterrence through the oral reprimand, the lengthy 4-month suspension of the Member’s certificate of registration, and the requirement to complete the SCERP before resuming the practice of nursing. The proposed penalty sends a message to members of the profession that they cannot disregard orders and decisions issued by the ICRC. The penalty sends the message to members of the profession that the conduct in which the Member engaged will not be tolerated by the College.

The proposed penalty provides for specific deterrence through the oral reprimand, the lengthy 4-month suspension of the Member’s certificate of registration, and the requirement to complete the SCERP and be cautioned by the ICRC before resuming the practice of nursing. The oral reprimand will help the Member understand how her conduct affects the profession. The 4-month suspension of the Member’s certificate of registration will demonstrate to the Member that her conduct is not acceptable.

The proposed penalty provides for rehabilitation and remediation through a minimum of two meetings with a Regulatory Expert and the review of the Code of Conduct. College Counsel submitted that the proposed penalty is designed to help the Member meet the standards and to comply with the ICRC’s order.

College Counsel submitted that the proposed penalty is required to protect the public and to maintain the College’s ability to self-govern the profession.

College Counsel submitted the following case to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee:

CNO v. Singh (Discipline Committee, 2016): In this case, the member was not present during the hearing. The member engaged in conduct similar to that of the Member in the case before this Panel in that he failed to complete a Remediation Program ordered by the ICRC. The panel made findings of professional misconduct to the extent that the member engaged in conduct that would be considered as unprofessional and dishonourable by members of the profession. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration and a minimum of two meetings with a Nursing Expert.

College Counsel submitted that the penalty in the Singh case is similar to the one being sought in the case before this Panel. However, the penalty in the Singh case does not include a provision for the suspension to extend beyond 4-months should the member not comply with the ICRC order as the College is requesting in the case before this Panel.

College Counsel submitted that there was only one recent case that was heard by the Discipline Committee (i.e. CNO v. Watson, 2023) that included a provision that a member’s certificate of registration be suspended on an ongoing basis, beyond the 4-month timeframe, should the Member not comply with the ICRC order. College Counsel submitted that only the order in the case is available as the reasons have not yet been released. In this case, the member was found to have engaged in conduct that would be considered to be dishonourable and unprofessional by other members of the profession in that she failed to complete a Remediation Program ordered by the ICRC. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration and, in the event the member did not comply with the ICRC order within that 4-month period, the suspension would continue until she complied. A minimum of 2 meetings with a Regulatory Expert was also ordered. College Counsel submitted that this penalty is identical to what is being sought in the case before this Panel.

College Counsel submitted that such an order is necessary and that although the Watson case was the first time this type of penalty had been ordered by the College, other Colleges have made similar orders. College Counsel further submitted that Section 51(2)(2) of the Code gives this Panel the power to suspend a member for a specific period of time and to set criteria to be met for the lifting of the suspension.

College of Physicians and Surgeons of Ontario (“CPSO”) v. Achiume (Discipline Committee, 2015): In this case, the panel found that the member, a physician, engaged in professional misconduct in that he failed to comply with a decision of the ICRC which ordered him to engage in remediation on medical record keeping. The penalty included an oral reprimand, a suspension of the member’s certificate of registration commencing January 15, 2015, until the later of: (a) February 15, 2015; or (b) proof that the member had completed the remediation program ordered by the ICRC. In its decision, the panel emphasized that it was critical for physicians to recognize CPSO’s responsibility to protect the public and its ability to self-regulate the profession through orders issued by the ICRC. College Counsel submitted that this is also true for the College in the case before this Panel.

CPSO v. Bailey (Discipline Committee, 2020): In this case, the panel found that the member, a physician, engaged in professional misconduct in that he failed to comply with a decision of the ICRC which ordered him to engage in a Remediation Program. The penalty included an oral reprimand and a suspension of the member’s certificate of registration until the later of: (a) a 4-month period, or (b) proof that the member had completed the Remediation Program ordered by the ICRC. The panel was explicit in stating that the physician’s successful completion of the Remediation Program ordered by the ICRC would ensure the protection of the public and the rehabilitation of the physician.

Ontario (College of Pharmacists) v. Patel (Discipline Committee, 2018): In this case, the member, a pharmacist, failed to comply with a Remediation Program ordered by the ICRC. The penalty included an oral reprimand, a 12-month suspension of the member’s certificate of registration, and a provision for the suspension to continue until the member complied with the ICRC order. It also included, a minimum of 3 meetings with a Consultant, completion of programs and an exam, prohibition for a period of 24 months from acting as a Designated Manager in a pharmacy and monitoring by the College by means of practice reviews for a period of 24 months.

College Counsel submitted that the College has many Discipline Committee decisions of members failing to participate in the Quality Assurance Program or in remediation actions following their participation in the Quality Assurance Program. In these cases, members were ordered to participate in the College’s next Quality Assurance cycle. College Counsel submitted that this means that the Panel has the authority to order a member to comply with an order made by a statutory committee. College Counsel submitted that CNO v. Bridge (Discipline Committee, 2021) is an example of such an order.

College Counsel submitted that the proposed penalty is consistent with case law, and the Watson order. College Counsel submitted that the penalty falls within the range of penalties for similar conduct, it meets the goals of penalties, and the provision that the suspension should continue until the Member complies with the ICRC order is consistent with decisions made by other health professions Colleges in Ontario.

Penalty Decision

The Panel makes the following order as to penalty:

1. Rebecca Blasco (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 from the date this Order becomes final until the later of:

a) Four months from the date the suspension commences; or

b) Such time as the Member completes the specified continuing education or remediation program (the “SCERP”), and appears before a panel of the Inquiries, Complaints and Reports Committee (the “ICRC”) to be cautioned with respect to the Documentation, Medication and Therapeutic Nurse-Client Relationship standards of practice as required in the ICRC’s Decision and Reasons, dated July 22, 2020 (“ICRC Order”).

3. The suspension described in term 2 above shall continue to run without interruption as long as the Member remains in a practicing class.

4. The Executive Director is directed to impose the following terms, conditions, and limitations on the Member’s certificate of registration:

a) The Member shall complete the SCERP, and appear before a panel of the ICRC to be cautioned with respect to the Documentation, Medication and Therapeutic Nurse-Client Relationship standards of practice, as required in the ICRC Order.

b) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) to discuss the findings of professional misconduct made by this Panel against the Member at the Member’s own expense and within 6 months from the date that this Order becomes final. 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 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, and

3. 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;

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; and

vii. If the Member does not comply with any 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.

5. 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.

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. To come to its decision, the Panel reviewed the proposed penalty submitted by the College, the aggravating and mitigating factors in the case, and the numerous Discipline Committee decisions submitted to the Panel by College Counsel.

General deterrence is provided for through the lengthy 4-month suspension of the Member’s certificate of registration or until such time that the Member completes the SCERP and appears before a panel of the ICRC to be cautioned. The proposed penalty sends a message to members of the profession that they cannot disregard orders of the ICRC. The penalty sends the message to members of the profession that the conduct which the Member engaged in will not be tolerated by the College.

Specific deterrence is provided for through the oral reprimand, the lengthy 4-month suspension of the Member’s certificate of registration, and the terms, conditions and limitations on her certificate of registration requiring her to complete the SCERP and to appear before a panel of the ICRC to be cautioned, failing which, her certificate of registration will be suspended until she does so. The oral reprimand will help the Member understand how her conduct affects the profession. The 4-month suspension of the Member’s certificate of registration will demonstrate to the Member that her conduct is not acceptable.

Rehabilitation and remediation are provided for through a minimum of two meetings with a Regulatory Expert and the review of the Code of Conduct.

The Panel agreed with the College that a provision had to be included in the penalty to extend the suspension of the Member’s certificate of registration beyond the 4-month period should the Member continue to fail to conform to the ICRC’s order beyond her 4-month suspension period. The Panel is authorized by Section 51(2)(2) of the Code to do so. The Panel found that this provision was particularly necessary because of the Member’s history of ungovernability to the extent that she was contacted on 9 occasions by the College’s Monitoring team and did not reply to the College.

I, Michael Hogard, 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.