College of Nurses of Ontario v. Susanne I. Seguin, 2024 ONCNO 139304

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Tyler Hands, RN Chairperson

Samuel Jennings, RPN Member Sandra Larmour Public Member Susan Roger, RN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) ALYSHA SHORE for

) College of Nurses of Ontario

• and - )

SUSANNE I. SEGUIN ) NO REPRESENTATION for

Registration No. JB08124 ) Susanne I. Seguin

) CHRISTOPHER WIRTH

) Independent Legal Counsel

) Heard: April 23-24, 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”) commencing on April 23, 2024, via videoconference.

As Susanne I. Seguin (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 still not in attendance.

College Counsel provided the Panel with evidence that the Member had been sent the Notice of Hearing on January 17, 2024 by way of an affidavit from Samantha Harry, Prosecutions Clerk, affirmed January 19, 2024, confirming that Ms. Harry sent correspondence, which included the Notice of Hearing, on January 17, 2024 to the Member’s last known address on the College Register, as well as to an address identified via skip trace.

The Panel was 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 of the patient, or any information that could disclose their identity, referred to orally or in any documents presented at the Discipline hearing of Susanne I. Seguin.

The Panel considered the submissions of College Counsel and decided that there be an order preventing public disclosure and banning the publication or broadcasting of the name of the patient, or any information that could disclose their identity, referred to orally or in any documents presented at the Discipline hearing of Susanne I. Seguin.

The Allegations

College Counsel advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraphs 1(a) and 4(a)(i) in the Amended Notice of Hearing dated January 16, 2024. The Panel granted this request. The remaining allegations against the Member 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 Bayshore Home Solutions in Cornwall, Ontario, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession with respect to [the Patient] when, on or around June 25-26, 2019, you:

(a) [withdrawn];

(b) attempted to administer medication to the Patient via a syringe without clinical purpose and/or attempted to conceal the administration from the Patient’s family; and/or

(c) removed a syringe filled with medication from the Patient’s home;

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, in, around or on June 25-26, 2019, while employed as a Registered Practical Nurse at Bayshore Home Solutions in Cornwall, Ontario, you misappropriated property from [the Patient], in particular, you misappropriated a syringe filled with medication from the Patient’s home;

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 with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse you contravened a term, condition or limitation on your certificate of registration, as provided by section 1.5(1)1.(ii) of Ontario Regulation 275/94 of the Nursing Act, 1991, in that you failed to report charges arising in any jurisdiction relating to any offence to CNO, as follows:

(a) on or about the 26^th^ day of June in the year 2019 at the City of Cornwall in the said East Region, did steal a syringe, the property of [the Patient], of a value not exceeding five thousand dollars, contrary to Section 334(b) of the Criminal Code of Canada;

(b) on or about the 26^th^ day of June in the year 2019 at the City of Cornwall in the said East Region, did attempt to administer pain medication to [the Patient] to wit: Haldol with intent thereby to endanger the life of [the Patient], contrary to section 245(a) of the Criminal Code of Canada; and/or

(c) on or about the 26^th^ day of June in the year 2019 at the City of Cornwall in the said East Region, did in attempting to assault [the Patient], use a weapon to wit, a syringe, contrary to Section 267(a) of the Criminal Code of Canada;

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, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, as follows:

(a) while employed as a Register Practical Nurse with Bayshore Home Solution in Cornwall, Ontario, on or around June 25-26, 2019, with respect to [the Patient], you:

i. [withdrawn];

ii. attempted to administer medication to the Patient via a syringe without clinical purpose and/or attempted to conceal the administration from the Patient’s family; and/or

iii. misappropriated property from the Patient’s home when you removed a syringe filled with medication from the Patient’s home; and/or

(b) while registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse, you failed to report to CNO that you were charged with an offence, as follows:

i. on or about the 26^th^ day of June in the year 2019 at the City of Cornwall in the said East Region, did steal a syringe, the property of [the Patient], of a value not exceeding five thousand dollars, contrary to Section 334(b) of the Criminal Code of Canada;

ii. on or about the 26^th^ day of June in the year 2019 at the City of Cornwall in the said East Region, did attempt to administer pain medication to [the Patient] to wit: Haldol with intent thereby to endanger the life of [the Patient], contrary to section 245(a) of the Criminal Code of Canada; and/or

iii. on or about the 26^th^ day of June in the year 2019 at the City of Cornwall in the said East Region, did in attempting to assault [the Patient], use a weapon to wit, a syringe, contrary to Section 267(a) of the Criminal Code of Canada.

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

The Member first registered with the College as a Registered Practical Nurse (“RPN”) in 2002. The Member resigned her certificate of registration in 2020. The allegations presented to the Panel date from June 2019 and, despite her resignation, the Panel continues to have jurisdiction as the allegations occurred when the Member held an active certificate of registration. It is alleged that while providing overnight care to a palliative patient,[ ], in his home, the Member attempted to give [the Patient] medications while concealing those medications, by syringe, from his family and then removing the syringe from his home.

The issues before this Panel are: (a) Did the Member fail to meet the standards of practice by attempting to administer medication to [the Patient] via a syringe without clinical purpose, attempting to conceal the administration from the Patient’s family and/or by removing a syringe filled with medication from the Patient’s home? (b) Did the Member misappropriate property from [the Patient]? (c) Did the Member fail to report charges relating to an offence to the College? and (d) Did the Member commit professional misconduct by engaging in conduct that would be considered by members of the profession to be disgraceful, dishonourable and/or unprofessional by attempting to give medications, concealing the syringe and then, when having failed to administer the medication, removed the syringe from [the Patient]’s home?

The Panel heard evidence from three fact witnesses and one expert witness, and received forty-five exhibits, including video in [the Patient]’s home, for consideration. The Panel found that the Member committed professional misconduct by failing to meet the standards of practice, misappropriating property from [the Patient], failing to report charges relating to an offence to the College and engaging in conduct that would be regarded by members of the profession to be disgraceful, dishonourable and unprofessional.

The Evidence

Witness #1 – Rebecca Ross (“Ms. Ross”), College Investigator

Ms. Ross testified that she was the College investigator assigned to the Member’s file and had prepared for the hearing by reviewing the Member’s file with the College. She described her detailed investigative process in responding to employer reports or complaints through to preparing reports and presenting findings to the Inquiries, Complaints and Reports Committee (“ICRC”). Her usual preparation includes tracking court documents until conclusion and obtaining certified copies and transcripts for hearings, if applicable.

Ms. Ross described Certified Copies of Information identified in the court proceedings whereby the Member pleaded not guilty in court to the charges of theft of a syringe belonging to a patient of value not exceeding $5,000.00, attempting to administer the contents of the syringe to a person with the intention to endanger their life, and attempting to assault a person with a syringe. Further, Ms. Ross identified Transcripts for Reasons of Judgement and Sentencing as obtained from the Court. The Member was found guilty of the charge of theft of a syringe and attempting to assault a person with a syringe.

Ms. Ross confirmed that the Member did not report these criminal charges to the College.

Ms. Ross identified the Member’s College Register Report with published findings by the Discipline Committee from March 2021. In that case the Discipline Committee found the Member had committed professional misconduct for having abused a client physically and mentally. The Member was given a reprimand, a six-month suspension and terms, conditions and limitations placed on her certificate of registration.

Witness #2 – [ ] (“[the Patient’s daughter]”), daughter of the patient

[The Patient’s daughter], her sister and mother were caring for her father (the patient) at the end of his life following a recent diagnosis of pancreatic cancer. They had been providing 24-hour care for him. [The Patient’s daughter] testified that as her father’s condition deteriorated, the family had decided to request overnight nursing agency care for their father. The family had arranged for a hospital bed in the family’s living room and [the Patient’s daughter] described the arrangements for her father made by the palliative care team of St. Elizabeth’s and Bayshore. She gave an account of syringes being prepared for her father with medications prescribed for pain, nausea and agitation. The family had a process for documenting medications that they had administered to their father/husband and any other notes on a daily sheet photocopied for their use. She told the Panel that nurses would arrange for her father’s medications and supplies that were delivered to the home. In the living room, the family had arranged the current supplies on top of a coffee table and stored additional supplies underneath. Additionally, the family had a large sofa and cot in the living room to facilitate their rest while they continued to provide care and be present with their father.

The family had a “dog camera” in the living room that they had used to monitor their father over the course of the weeks leading up to the alleged incidents. It was linked to the mobile phone of [the Patient’s daughter] and her mother. The family felt reassured to have a camera in case their father needed their help at any time. It recorded activity in one-minute increments when activated.

On the day of the incident, [the Patient’s daughter] described her father as “relaxed”, “extremely fatigued”, and unable to get up on his own. He was able to answer questions. When the Member arrived for her shift, [the Patient’s daughter] reviewed [the Patient]’s background with her, and the Member told her that she had “worked with a lot of patients with pancreatic cancer” and that her father would “go into a coma soon”. She told [the Patient’s daughter] that her father’s “nails would go grey” and stated to [the Patient’s daughter] that “the father you knew is no longer here”.

[The Patient’s daughter] talked to the Member about her father’s swollen legs, sleeping with one leg out of the bed and that medications such as Haldol, were available if required. [The Patient’s daughter] described her father as “comfortable”. [The Patient’s daughter] did not point out the camera to the Member, as an oversight only. [The Patient’s daughter] went to her bedroom at that time.

[The Patient’s daughter] became alert to activity in the living room as the camera captured the Member “throw” her father’s legs back into bed. As a result, she continued to watch the camera throughout the night and did not feel comfortable to go to sleep. [The Patient’s daughter] recorded activity every time the Member went to her father’s bedside.

[The Patient’s daughter] reviewed 20 separate instances of video recordings for the Panel. In the video recorded at 4:12 am, [the Patient] is awake and appears to be talking with the Member. In the following recorded minutes, it appears that the Member is reviewing supplies and taking some inventory. At 4:33 am and in the following two video recordings, the Member is seen to open a syringe, attach a needle, and approach [the Patient]’s bed with the syringe partially concealed in her right hand. When [the Patient’s daughter] enters the living room at 4:34 am, the Member appears to put the syringe and the wrappers into a binder on the end of the couch.

[The Patient’s daughter] stated that she told the Member she was unable to sleep and would stay up with her father. She told the Panel that they had a pleasant conversation, and that the Member did not provide any further care for her father while she was present.

In the final recording at 6:32 am, [the Patient’s daughter] left the living room, and the Member immediately reaches into her personal bag and removes a syringe, goes to [the Patient]’s bedside, lifts his gown and then returns the syringe to her personal bag. During this interval, it was [the Patient’s daughter]’s testimony that she called out to the Member and that she stepped away from [the Patient]’s bedside without administering anything from the syringe. [The Patient’s daughter] further testified that when she confronted the Member, the Member said “nothing”. The Member packed up and left the house. [The Patient’s daughter] immediately called out for her mother and called her sister. The sister advised her to call the police and they were subsequently involved, conducted an investigation and laid criminal charges against the Member.

[The Patient’s daughter’ explained her subsequent issues with trust related to doctors and nurses. She was convinced that the Member had the intention that night to harm her father.

Witness #3 – Cindy Bennis (“Ms. Bennis”), Area Director, Bayshore Homecare Solutions

Ms. Bennis is a Registered Nurse having been registered with the College since 1998. She has worked in community/patient homes and retirement homes since 1999 and has had a progressive career from frontline nursing through management to her current position as Area Director. In June 2019, during a period of recruitment, she held a dual role as Area Director and Director, Clinical Management. In her role as Director, Clinical Management, she was engaged in the Member’s conduct complaint and the subsequent employer investigation. She met with the police and could provide no further explanation for the Member’s behaviour. She proceeded with termination of the Member’s employment as a result.

Ms. Bennis reviewed such exhibits as the Member’s schedule including her orientation shift, the original referral request for palliative care overnight in [the Patient]’s home, Care Pathway Note and the Client Dated Note for the night in question. Ms. Bennis identified the physician orders for sedation including regular and prn Haldol for nausea and agitation. She described [the Patient]’s multiple softset for multiple injection types. Ms. Bennis led the Panel to the pump metrics and daily review documentation for Morphine and Midazolam for [the Patient]. She identified the Member by name on the master signature list. She confirmed that there were no narrative notes that would indicate sedation or pain relief requirements for [the Patient] overnight.

Ms. Bennis confirmed for the Panel that supplies into [the Patient]’s home were ordered by the nurses or care coordinators. The community provider purchases the supplies for patients and they are the sole possession of the patient once they are delivered to the patient’s home. She also testified that oral tablet medications are generally sourced by the patient’s family directly while all injectables are provided by a contracted pharmacy.

Witness #4 – Meredith Muscat (“Ms. Muscat”), Expert

Ms. Muscat has been registered with the College for 25 years and has been an RN Extended Class (“EC”) since 2009. She received her Critical Care Nursing Certificate from George Brown and certified as a Nurse Practitioner following completion of her Master’s in Nursing from the University of Toronto. In 2018, she obtained her Hospice Nurses Certificate from the Canadian Nurses Association, a process which included a 4-hour examination. Throughout her career, she has worked in Intensive Care, Acute Pain Service and in 2012 entered the formal leadership career pathway as a manager in Pre-Admission and Day Surgery. In 2015 she joined the Toronto Central Local Health Integration Network (“LHIN”) in the Palliative Home service provided through Mt. Sinai Hospital. In 2018 she joined Toronto Grace Hospital as the Clinical Manager for Palliative Care. She became the Director in 2019 and in 2022 expanded her portfolio to become the Director, Clinical Programs. She has recently left the hospital sector to work for a national company in their infusion practices program. Ms. Muscat continues to teach palliative care for the Faculty of Nursing at the University of Toronto.

College Counsel asked that Ms. Muscat be qualified as an expert in the standards of nursing practice for palliative care. The Panel was satisfied with Ms. Muscat’s expertise and accepted her as an expert in nursing standards of practice, and in particular, in nursing palliative care.

Ms. Muscat referred to the Professional Standards, the Documentation Standard and the Medication Standard for the purposes of this review. She testified that the Professional Standards were the standards used by all nurses in Ontario regardless of their practice setting. The Documentation Standard sets out the expectations for nurses for complete documentation and direct communication between nurses and members of the healthcare team to ensure that all caregivers have a clear picture of the activities performed for the patient. The Medication Standard provides guidance for nurses regarding their patient assessment, knowledge of medication safety, foundational practices such as effectiveness and documentation.

Based on the hypothetical provided to Ms. Muscat, she described the following for the Panel:

• A nurse would assess a patient’s discomfort as part of their Palliative Pain Score (“PPS”) assessment. The PPS is a validated tool that assesses a patient’s strength, fragility, responsiveness, movement of all limbs and their ability to vocalize;

• A nurse would assess a patient’s discomfort by facial grimaces, changes in their breathing or by asking the family if they see a difference in the patient;

• If a patient is moving their limbs despite loss of strength the patient’s PPS is usually > 10%;

• Based on the documentation provided to her, Ms. Muscat was unable to identify any clinical indication for additional sedation or pain relief. Based on the video documentation at 4:33 am and 6:30 am, the attempted administration times, Ms. Muscat did not see any physical or behavioural need for the patient to require medication.

Ms. Muscat testified that the Member’s behaviour contravened the Professional Standards in not completing the patient assessment and subsequently determining that the patient required medication. The Medication Standard was contravened as there was no documentation, nor assessment of the patient’s condition that would suggest that he required medication. Ms. Muscat informed the Panel that the Member was not giving medications appropriately for the behaviours exhibited by the Patient at that time. She opined that the Member was not keeping the patient at the centre of care. By concealing medications, it was Ms. Muscat’s opinion that the Member contravened standards such as the Code of Conduct, the Medication Standard and the Professional Standards and her conduct was a breach that risked patient safety.

Ms. Muscat testified that the College’s Code of Conduct speaks to nurses’ accountability for their actions including integrity, honesty and professionalism in all dealings with the client.

By removing the syringe from the patient’s home, the Member breached standard 6.2 in the Code of Conduct in that she did not respect the belongings of the patient. In removing the syringe, the member further contravened the Medication Standard by creating a safety issue and creating opportunity for misuse. Nurses are accountable for secure storage and disposal of medications.

Ms. Muscat provided that the Member’s conduct breached the College’s Therapeutic Nurse-Client Relationship standard in failing to meet the patient’s expectations that include a thorough assessment and plan for treatment. In attempting medication administration without an apparent clinical need, the Member neglected to assess and provide appropriate care for the patient.

Ms. Muscat confirmed for the Panel that nurses’ own professional accountability requires them to request assistance when they need it.

Final Submissions

College Counsel asked the Panel to make findings on all allegations and find that the Member had committed professional misconduct by failing to meet the standards of the profession, including the Code of Conduct, the Professional Standards, the Medication Standard and the Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”). The Member breached these standards in her attempt to administer medications not indicated for [the Patient], concealing the syringe from [the Patient] and/or his family member and subsequently, removing the syringe from the home. Further the Member committed professional misconduct when she misappropriated [the Patient]’s property as it relates to the syringe and failed to report criminal charges laid against her to the College. College Counsel submitted that the Member’s conduct would reasonably be regarded by members of the profession to be disgraceful, dishonourable and unprofessional.

College Counsel submitted that the findings of guilt from the criminal court, namely theft of less than $5,000.00 and findings of assault with intention to harm a patient, may be accepted as sufficient evidence of conviction in the absence of any appeal sought by the Member.

College Counsel submitted that the video evidence, specifically Exhibits #16 and #20, identify a clear intent to administer the medication. The concealment of the syringe by hiding and wrapping it and the subsequent hurried behaviour identified at the 6:30 am video supports the direct evidence provided by [the Patient]’s daughter. The video evidence demonstrated that [the Patient] was calm and resting and did not require care. Further, Ms. Muscat testified that there would be no clinical purpose for giving any medication based on the video evidence provided.

Ms. Muscat testified that several College standards were breached in that medications were prepared to be given that were not indicated and with disregard for [the Patient]’s life. Ms. Muscat described the breach of trust in public confidence in contravention of the Code of Conduct.

College Counsel submitted that sufficient factual evidence of the allegations was provided in the certified copies of the criminal case. Standards such as, the Code of Conduct, the Medication Standard and the Professional Standards, which provide that nurses must respect the property of patients, ensure appropriate security and disposal of medications and that their conduct cannot be motivated by a member’s own needs, were breached.

College Counsel referred the Panel to Section 1.5(1)1.ii. of Ontario Regulation 275/94 of the Nursing Act, 1991 which provides that: “The member shall provide to the Executive Director...A charge arising in any jurisdiction relating to any offence”. Contravening this regulation is professional misconduct. It was Ms. Ross’ evidence that the Member did not report her charges to the College while she was registered with it.

It was the College’s position that the Member’s conduct was relevant to the practice of nursing as it occurred while the Member was providing direct patient care. The College submitted that the Member’s conduct was disgraceful, dishonourable and unprofessional. College Counsel submitted that the Member demonstrated a serious disregard for her professional obligations and elements of moral failing. The Member had attempted to administer medications that were not clinically indicated for [the Patient]. In failing to report her criminal charges and subsequent conviction, the Member was deceitful and made an attempt to conceal her behaviour from her nursing regulator. The Member further breached the fundamental trust and engaged in highly suspect behaviour while engaged with a highly vulnerable patient at a time of great need. In doing so, the Member has brought shame upon herself and the profession.

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(b), 1(c), 2, 3(a), 3(b), 3(c), 4(a)(ii), (iii) and 4(b)(i), (ii) and (iii) of the Notice of Hearing. As to allegations 4(a)(ii), (iii) and 4(b)(i), (ii) and (iii), 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 testimony of the witnesses, the documentary evidence and the submissions from College Counsel and made findings of professional misconduct as alleged in the Notice of Hearing.

The Panel considered the testimony of Ms. Ross, the lead investigator for this matter. Ms. Ross admitted to the Panel that she was the third investigator assigned to this case. She was charged with collecting all relevant evidence including the patient’s chart, witness statements and other court documents required for this hearing. She completed her testimony in a factual manner and, when questioned, confidently described the documents for the Panel.

The Panel considered the testimony of [the Patient’s daughter]. As the patient’s daughter, she had a personal interest in the outcome however the Panel was convinced that she, also, had a unique opportunity and line of direct sight to the events of the overnight care of her father. Her testimony was balanced by documentary evidence such as video recordings from her camera app on her personal phone, consistent recollection of the Member’s unusual behaviour, also supported by video, and her questioning of interactions with the patient that seemed to be without clinical need, such as medication administration. The Panel accepted her testimony and exhibits.

Ms. Bennis, in her dual role as Area Director and Director of Clinical Management at the time, was able to identify documents related to patient care, describe orientation and training and testify for the Panel on the related records and policies. She gave a concise account of her discussion with the police and the Member’s subsequent termination from Bayshore. The Panel accepted her testimony.

The Panel accepted Ms. Muscat as an expert and found no discrepancies in her testimony.

Allegation #1

The College’s Code of Conduct describes the principles and accountabilities that all Ontario nurses have to patients. The Code of Conduct includes six principles that include a nurse’s requirement to act with integrity to maintain patient’s trust and being obliged to maintain public confidence in the nursing profession. The video evidence provided to the Panel was comprehensive and particularly minutes timed at 4:33 am and 6:30 am clearly demonstrated the Member’s suspicious behaviour. Attempting to provide [the Patient] with an unknown medication by syringe, at a time when [the Patient] was observed to be calm and resting, was inappropriate. By concealing the syringe in her hand and further hiding the syringe and wrapping it in a binder and her purse, the Member’s behaviour raised concerns with [the Patient]’s daughter, [ ]. [The Patient’s daughter] gave convincing testimony supported by twenty video clips. She submitted the narrative to the video and provided her evidence with clarity, consistency and minimal emotion despite the disturbing nature of the evidence. The video clips persuaded the Panel of the details and facts provided. [The Patient’s daughter] expressed, as part of her testimony, that she has ongoing trust issues with healthcare professionals as a result of the interaction with the Member.

The Professional Standards contain seven broad statements and indicators that illustrate how the standard may be demonstrated pertaining to accountability, continuing competence, ethics, and others. In relation to accountability, nurses must conduct themselves in ways that promote respect for the profession. The Professional Standards further provide that, in relation to the ethics statement, nurses must act with integrity, honesty and professionalism in all dealings with patients. The Panel agreed that the Member’s deceitful behaviour in attempting to administer medication without a clinical purpose, concealing the medication syringe, and further, removing the syringe from [the Patient]’s home contravenes the principal statements of the Professional Standards.

The Member’s conduct breached the Medication Standard safety component by failing to promote safe care and minimize the risk of harm to the patient.

The basis of the College’s TNCR Standard is trust between a nurse and the patient, clearly demonstrated by the nurse ensuring that all professional interactions with a patient meet the patient’s therapeutic needs. Further, a nurse will not engage in behaviours that could be perceived to be threatening or having intention to harm the patient. The Member’s conduct was found to breach the TNCR Standard, generally and specifically with regard to this provision.

Allegation #2

The Panel heard testimony from the College Investigator, Ms. Ross in regard to the charges laid against the Member and the findings of guilt. The Panel received a Certified Copy of the Information from the Ontario Court of Justice confirming the Member’s conviction for theft of [the Patient]’s property. The Panel received transcripts from the Ontario Court of Justice which outlined that the Member was charged and subsequently convicted. Further Transcripts of Reasons for Judgement and Sentencing were provided and, those coupled with the Member’s video-documented behaviour and Ms. Bennis’ evidence, led the Panel to make findings that the Member misappropriated [the Patient]’s property.

Allegation #3

The Panel accepted the certified court documents and considered those in light of the statutory provisions in Section 22.1(1) of the Evidence Act, R.S.O. 1990, c. E.23 which provides that: “Proof that a person has been convicted...of a crime is proof, in the absence of evidence to the contrary, that the crime was committed by the person”. Section 1.5(1)1.ii. of Ontario Regulation 275/94 requires a member to report “A charge arising in any jurisdiction relating to any offence”. Despite these requirements, it was Ms. Ross’ testimony that no such report to the Executive Director had occurred in regard to the Member’s criminal charges and findings of guilt. Ms. Ross provided her evidence in a factual, straightforward way and gave accounts of the documentation in a confident and succinct manner. The Panel found Ms. Ross to be credible and her answers were consistent across all documents.

Allegation #4

The Panel finds that the Member’s conduct, which occurred at [the Patient]’s bedside, was relevant to the practice of nursing. It was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations in contravening the College’s Code of Conduct, the Professional Standards, the Medication Standard and the TNCR Standard.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated elements of deceit and moral failing by attempting to administer a medication, conceal the syringe and then removing the syringe from [the Patient]’s home. The Member knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional. The Panel agreed that the Member’s conduct was deceitful – both in interactions with [the Patient] and in failing to report criminal charges to the College as required.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. This 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

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 SUSANNE I. SEGUIN (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 immediately revoke the Member’s certificate of registration.

College Counsel submitted that the Member had engaged in very unusual and highly concerning behaviour. The Member did not avail herself of the opportunity to provide any explanation for her conduct at the bedside of an extremely vulnerable patient; conduct which led to a criminal conviction. College Counsel asked the Panel to make an order that is the only appropriate response for this behaviour and considering that the Member appeared to be unwilling to take accountability for her actions. In this context, College Counsel asked the Panel to consider its preeminent duty to protect the public and its obligations in relation to nursing as a self-regulating profession.

The aggravating factors in this case were:

• This is extremely serious conduct in that the Member attempted to administer medication to a dying patient and conceal that administration from the family;

• College Counsel described this conduct as “sinister” and, if the camera had not been engaged, it is highly unlikely that the Member’s conduct would have been discovered;

• The Member has not provided any explanation of her conduct to her employer, the Court or to the College;

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

• [The Patient]’s daughter described layers of impact to the family at a most stressful time; and

• The Member has a previous disciplinary history with the College and has findings of patient abuse and disgraceful, dishonourable and unprofessional conduct dating back to March 2021.

There are no mitigating factors as the Member did not participate in the proceedings. There is no information to consider regarding her personal circumstances, nor any evidence she has learned, has insight and responds to the College’s process. Public protection and deterrence are the primary considerations. Revocation will send a strong message.

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. Wardlaw (Discipline Committee, 2018): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member failed to administer pain medication to a client, misappropriated a client’s pain medication for her own use, practised nursing while impaired by a substance and failed to report the criminal charges against her to the College. The penalty included an oral reprimand and revocation of the member’s certificate of registration.

CNO v. Amponsa (Discipline Committee, 2018): In this case, the member was not present at the hearing. The member was criminally charged and convicted of sexually assaulting a co-worker in a nursing residence, which is relevant to his suitability to practice nursing. The penalty included revocation of the member’s certificate of registration.

CNO v. Laviolette (Discipline Committee, 2018): In this case, the member was not present at the hearing. The member was criminally charged and convicted of sexually touching and sexually abusing a minor, which is relevant to his suitability to practice nursing. He failed to report the charges and convictions to the College and failed to report his bail conditions to his employer. The penalty included an oral reprimand and revocation of the member’s certificate of registration.

The Wardlaw and Laviolette cases included failing to report criminal charges to the College which resulted in revocation of the members’ certificates of registration as a result of the highly concerning allegations.

Given the Member’s conduct and her failure to explain it, this shows that rehabilitation and remediation of her is not possible.

Penalty Decision

The Panel makes the following order as to penalty:

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

2. The Executive Director is directed to immediately revoke the Member’s certificate of registration.

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 and possible, rehabilitation and remediation.

The Panel concluded that the proposed penalty is reasonable and in the public interest.

The Panel agreed that the Member’s conduct was outside of any acceptable nursing behaviour and demonstrated a worrying lack of concern for patient safety. The Panel accepted College Counsel’s summary of the aggravating and mitigating factors. Any discussion of remediation or rehabilitation could not be undertaken in the absence of the Member. The Panel concluded that the Member demonstrated a total disregard for the welfare of [the Patient] and for governance of her by the College.

In carrying out its duty, the Panel’s paramount concern is to protect the public and further, to preserve public confidence in the College’s ability to regulate itself. The Panel agreed with the proposed penalty. Revocation sends a strong message to the profession that this type of conduct has no place in nursing practice.

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

I, Tyler Hands, RN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.