College of Nurses of Ontario v. Soos, 2024 ONCNO 140477

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Michael Hogard, RPN Chairperson Jacqueline Vlahos, RN Member Kimberly Wagg, RPN Member Lynda Carpenter Public Member Sylvia Douglas Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) JOSEPH BERGER for ) College of Nurses of Ontario

• and - )

RAJVEER SOOS ) DANIEL LIBMAN for Registration No. 10435816 ) Rajveer Soos ) CHRISTOPHER WIRTH ) Independent Legal Counsel ) Heard: October 30, 2024, via videoconference

DECISION AND REASONS

Publication Ban

By Order of the Discipline Panel dated October 30, 2024, pursuant to subsection s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, no one shall publish or broadcast the names of the patients or their family members, or any information that could disclose the identities of the patients or their family members, referred to orally or in any documents presented at the Discipline hearing of Rajveer Soos.

This matter was heard by a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on October 30, 2024.

The Allegations

The allegations against Rajveer Soos (the “Member”) as stated in the Notice of Hearing dated September 30, 2024 are as follows:

IT IS ALLEGED THAT:

1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that while working as a Registered Nurse at Anishnawbe Health Toronto, in Toronto, Ontario (the “Facility”), you contravened a standard or practice of the profession or failed to meet the standards of practice of the profession, as follows:

a. In or about September and/or October 2021, you falsely documented that your colleagues J.M. and A.M. had administered COVID-19 vaccines to patients;

b. In or about September or October 2021, you told an administrative assistant, L.G., that you had administered a COVID-19 vaccine to three members of your family, and directed L.G. to document that your colleague J.M. had administered these doses;

c. In or about September or October 2021, you requested that a nurse colleague, J.H., fraudulently sign a record indicating that they had administered the COVID-19 vaccine to you;

d. In or about October 2021, you falsely documented that your nurse colleague J.H. had administered the COVID-19 vaccine to you;

e. In or about September and/or October 2021, you provided nursing care to friends and/or members of your family, [A] [B], [C], [D], [E], [F], [G], [H], and [I];

f. In or about September and/or October 2021, you provided nursing care in non-clinical areas of the Facility.

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(14) of Ontario Regulation 799/93, in that while working as a Registered Nurse at Anishnawbe Health Toronto, in Toronto, Ontario (the “Facility”), you falsified a record relating to your practice, as follows:

a. In or about September and/or October 2021, you falsely documented that your colleagues J.M. and A.M. had administered COVID-19 vaccines to patients;

b. In or about September or October 2021, you told an administrative assistant, L.G., that you had administered a COVID-19 vaccine to three members of your family, and directed L.G. to document that your colleague J.M. had administered these doses;

c. In or about October 2021, you falsely documented that your nurse colleague J.H. had administered the COVID-19 vaccine to you;

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(15) of Ontario Regulation 799/93, in that while working as a Registered Nurse at Anishnawbe Health Toronto, in Toronto, Ontario (the “Facility”), you signed or issued, in your professional capacity, a document that you knew or ought to have known contained a false or misleading statement, as follows:

a. In or about September and/or October 2021, you falsely documented that your colleagues J.M. and A.M. had administered COVID-19 vaccines to patients;

b. In or about October 2021, you falsely documented that your nurse colleague J.H. had administered the COVID-19 vaccine to you;

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 working as a Registered Nurse at Anishnawbe Health Toronto, in Toronto, Ontario (the “Facility”), you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, as follows:

a. In or about September and/or October 2021, you falsely documented that your colleagues J.M. and A.M. had administered COVID-19 vaccines to patients;

b. In or about September or October 2021, you told an administrative assistant, L.G., that you had administered a COVID-19 vaccine to three members of your family, and directed L.G. to document that your colleague J.M. had administered these doses;

c. In or about September or October 2021, you requested that a nurse colleague, J.H., fraudulently sign a record indicating that they had administered the COVID-19 vaccine to you;

d. In or about October 2021, you falsely documented that your nurse colleague J.H. had administered the COVID-19 vaccine to you;

e. In or about September and/or October 2021, you provided nursing care to friends and/or members of your family, [A] [B], [C], [D], [E], [F], [G], [H], and [I];

f. In or about September and/or October 2021, you provided nursing care in non-clinical areas of the Facility.

Member’s Plea

The Member admitted the allegations set out in paragraphs #1(a), (b), (c), (d), (e), (f), #2(a), (b), (c), #3(a), (b) and #4(a), (b), (c), (d), (e) and (f) in the Notice of Hearing. The Panel received a written plea inquiry which was signed by the Member. The Panel also conducted an oral plea inquiry and was satisfied that the Member’s admissions were voluntary, informed and unequivocal.

Agreed Statement of Facts

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

THE MEMBER

1. Rajveer Soos (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on September 20, 2010. In March 2020, the Member became registered in the Extended Class – Nurse Practitioner (“NP”). She is currently entitled to practice with no restrictions.

2. The Member was employed at Anishnawbe Health Toronto, in Toronto, Ontario (the “Facility”) from August 4, 2020, until her resignation on October 12, 2021. While employed at the Facility, the Member’s primary role was to conduct COVID-19 testing. Her duties also occasionally included administration of COVID-19 vaccines at the Facility’s mobile and on-site vaccination clinics.

3. The Member has no prior CNO disciplinary history.

THE FACILITY

4. The Facility’s COVID-19 on-site vaccination clinic was held on the first floor of the Facility. Vaccine administration took place in private first-floor offices that were set up as clinic rooms and designated specifically for vaccination administration.

5. The Facility’s upstairs floors contained private administrative staff offices. The Member had her own private administrative office on the Facility’s third floor. The Facility’s upstairs offices were not clinical settings and were not to be used for vaccination of the Facility’s patients.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

The Member’s Creation of a Fraudulent Vaccine Record for Herself

6. In or about September or October 2021, the Member sent a text message to her nurse colleague, “Colleague A”, that suggested the Member wanted Colleague A to document administering a COVID-19 vaccine to the Member, without administering one.

7. Colleague A did not agree with the Member’s suggestion and showed the Member’s text message to two senior Facility staff, before deleting the Member’s text message.

8. On or about October 7, 2021, the Member created a fraudulent vaccine record indicating that Colleague A had administered a COVID-19 vaccine to the Member.

9. The Member admits that Colleague A never administered a COVID-19 vaccine to her. The Member admits that on or about October 7, 2021, she forged Colleague A’s signature on a Facility vaccine form indicating that Colleague A had administered a COVID-19 vaccine to the Member on October 7, 2021, when this had not occurred.

The Member’s Provision of Nursing Care in Non-Clinical Areas of the Facility to her Friends and Family

10. In or about September or October 2021, multiple Facility staff observed the Member personally greet patients who appeared to be the Member’s friends and/or family members and bring these patients to the Member’s third floor office to administer COVID-19 vaccines.

11. The Member admits that in or about September or October 2021, she administered COVID-19 vaccines to members of her family in non-clinical areas of the Facility, and specifically, in her third-floor office.

12. If the Member were to testify, she would say that on the day in question she was administering COVID-19 vaccines at an off-site clinic and the clinic had additional doses that needed to be used. The Member would say that she was encouraged by staff and/or management to contact her friends and family to see if anyone could attend the Facility to receive the vaccine so that none were wasted. The Member would say that she called her family as instructed, but when they arrived none of the clinical rooms on the first floor of the Facility were available; the clinical rooms were all occupied with patients attending the Facility for primary health care and mental health care visits. The Member would testify, for that reason, she took her family members upstairs to her office and administered the vaccines to them.

The Member’s Creation of Fraudulent COVID-19 Vaccine Records for her Family Members

13. In or about September or October 2021, the Member saw three of her family members at the Facility. The Member then asked one of the Facility’s administrative assistants, “Staff Member A”, to record that COVID-19 vaccines had been administered to the Member’s family members by one of the Member’s nursing colleagues at the Facility, “Colleague B”.

14. Staff Member A was new to their role, trusted the Member’s authority as a nurse, and recorded that three COVID-19 vaccines had been administered by Colleague B to the Member’s family members, as per the Member’s request.

15. The Member admits that in or about September or October 2021, she asked Staff Member A to falsely record that vaccine doses had been administered by Colleague B, to three of the Member’s family members, when they had not been administered by Colleague B.

16. On or about October 11, 2021, Colleague B discovered five COVID-19 vaccine forms at the Facility dated October 11, 2021, with her name signed as the nurse who provided treatment, even though Colleague B had not interacted with any of the patients whose names were indicated.

17. Colleague B confronted the Member. The Member admitted that she had vaccinated her friends and/or members of her own family that day and did not want to put her own name on the associated vaccine forms. Colleague B demanded that the Member cross out Colleague B’s name from the vaccine forms, and replace it with the Member’s name, which the Member complied with.

18. Colleague B brought this incident to the attention of the Facility’s management.

19. The Member resigned from the Facility the following day, October 12, 2021. In her resignation letter, the Member admitted to writing the names of other Facility nurses on vaccine forms she created for her family members. The Member wrote that she recognized her actions were wrong, and she regrets her actions.

20. After the Member’s resignation, the Facility reviewed all the Facility’s hardcopy vaccine forms dating back to January 2021. The Facility discovered vaccine forms from both September and October 2021, which contained forged signatures of Colleague B, and another nurse at the Facility, “Colleague C”, in respect of patients for whom neither Colleague B nor Colleague C had provided care.

21. The Member admits that in or about September and/or October 2021, she falsely documented that Colleague B and Colleague C had administered COVID-19 vaccines to patients, when they had not.

22. All the forms identified by the Facility containing fraudulent signatures were associated with patients who were identified to be friends and/or family members of the Member.

23. The Member admits that in or about September and/or October 2021, she provided nursing care to nine patients who were also her friends and/or family members.

CNO STANDARDS OF PRACTICE

Code of Conduct

24. 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:

• 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.

25. Regarding the principle requiring nurses to maintain patients’ trust by providing safe and competent care, CNO’s Code of Conduct provides that nurses must seek and use the best available evidence to inform their practice, and nurses are required to use their knowledge, skill, and judgment when giving nursing care.

26. Regarding the principle requiring nurses to work respectfully with the health care team to meet clients’ needs, CNO’s Code of Conduct provides that nurses contribute to a safe organizational culture.

27. Regarding the principle requiring nurses to act with integrity to maintain patients’ trust, CNO’s Code of Conduct provides that nurses place their professional responsibilities ahead of their personal gain and are truthful in their professional practice.

28. Regarding the principle requiring nurses to maintain public confidence in the nursing profession, CNO’s Code of Conduct provides that nurses are accountable for their own actions and decisions.

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

Professional Standards

30. CNO’s Professional Standards provides an overall framework for the practice of nursing and a link with other standards, guidelines and competencies developed by CNO. It includes seven broad standard statements pertaining to accountability, continuing competence, ethics, knowledge, knowledge application, leadership and relationships.

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

32. CNO’s Professional Standards provides, in relation to the ethics standard, that nurses are accountable for understanding, upholding, and promoting the values and beliefs described in CNO’s Ethics practice standard. Ethical nursing care means promoting values including, among other things, respectful truthfulness and acting with integrity, honesty, and professionalism in all dealings with client and other health care team members. Nurses demonstrate this standard by actions such as identifying personal values and ensuring that they do not conflict with professional practice, and creating environments that promote and support safe, effective, and ethical practice.

33. CNO’s Professional Standards provides, in relation to the leadership standard, that leadership requires self-knowledge (understanding one’s beliefs and values and being aware of how one’s behaviour affects others), respect, trust, integrity, shared vision, learning, participation, good communication techniques and the ability to be a change facilitator. The leadership expectation is not limited to nurses in formal leadership positions and all nurses, regardless of their position, have opportunities for leadership. Nurses demonstrate this standard by actions such as role-modelling professional values, beliefs and attributes.

34. Attached as Exhibit “B” is a copy of CNO’s Professional Standards which was in force at the time of the incidents described above.

Therapeutic Nurse-Client Relationship Standard

35. CNO’s Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”) contains four standard statements which describe nurses’ accountabilities with respect to therapeutic communication, patient-centred care, maintaining boundaries and protecting the patient from abuse. The TNCR Standard provides that the nurse-patient relationship is built on trust, respect, empathy, professional intimacy and requires the appropriate use of power inherent in the care provider’s role.

36. Appendix B of CNO’s TNCR Standard provides that caring for a family member, friend or acquaintance should be limited to circumstances in which there are no other care providers available. The patient should be stabilized and, if possible, care should be transferred.

37. Appendix B of CNO’s TNCR Standard provides that if it is not possible to transfer care of a patient, a nurse must consider factors such as input from the patient and carefully reflect on whether they can maintain professionalism and objectivity in caring for the patient and whether the relationship interferes with meeting the patient’s needs. The nurse must discuss the situation with colleagues and their employer before making a decision.

38. In addition, with respect to maintain boundaries, when providing care to a family member, friend or acquaintance, a nurse is required to:

• Be aware of the boundary between their personal and professional role;

• Clarify the boundary for the [patient];

• Meet personal needs outside the relationship; and

• Develop and follow a care plan.

39. Attached as Exhibit “C” is a copy of CNO’s TNCR Standard which was in force at the time of the incidents described above.

Ethics Standard

40. 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.

41. 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.

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

43. Attached as Exhibit “D” is a copy of CNO’s Ethics Standard which was in force at the time of the incidents described above.

Documentation Standard

44. CNO’s Documentation Standard states that nursing documentation is an important component of nursing practice and that nurses are accountable for ensuring that their documentation is accurate and meets CNO’s practice standards.

45. The Documentation Standard indicates that nurses meet the standard by demonstrating the following, among other acts:

• ensuring that documentation presents an accurate, clear and comprehensive picture of the client’s needs, the nurse’s interventions and the client’s outcomes;

• ensuring that documentation is completed by the individual who performed the action or observed the event, except when there is a designated recorder, who must sign and indicate the circumstances; and

• clearly identifying the individual performing the assessment and/or intervention when documenting.

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

47. The Member admits and acknowledges that in engaging in the conduct described above she breached CNO’s Code of Conduct, and the following CNO Practice Standards: Professional Standards, TNCR Standard, Ethics Standard, and Documentation.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

48. The Member admits that she committed the act of professional misconduct as alleged in paragraphs 1(a), 1(b), 1(c), 1(d), 1(e), and 1(f) of the Notice of Hearing in that she failed to meet the standards of practice of the profession, as described in paragraphs 6 - 47 above.

49. The Member admits that she committed the act of professional misconduct as alleged in paragraphs 2(a), 2(b), and 2(c) of the Notice of Hearing in that she falsified a record relating to her practice, as described in paragraphs 6-9 and 13-23 above.

50. The Member admits that she committed the act of professional misconduct as alleged in paragraphs 3(a), and 3(b) of the Notice of Hearing in that she signed, in her professional capacity, a document that she knew contained a false or misleading statement, as described in paragraphs 6-9 and 13-23 above.

51. The Member admits that she committed the act of professional misconduct as alleged in paragraphs 4(a), 4(b), 4(c), 4(d), 4(e), and 4(f) of the Notice of Hearing in that she 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 described in paragraphs 6-47 above.

Decision

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

Having considered the evidence and the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs #1(a), (b), (c), (d), (e), (f), #2(a), (b), (c), #3(a), (b) and #4(a), (b), (c), (d), (e) and (f) of the Notice of Hearing. As to allegations #4(a), (b), (c), (d), (e) and (f), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be dishonourable and unprofessional. The Panel did not find that the Member’s conduct was disgraceful.

Reasons for Decision

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

Allegations #1(a), (b), (c), (d), (e) and (f) in the Notice of Hearing are supported by paragraphs 6 - 48 in the Agreed Statement of Facts. The Member admitted that while employed at Anishnawbe Health Toronto (the “Facility”) she committed an act of professional misconduct when she failed to meet the standards of practice of the profession. The Panel considered the Member’s abuse of power in her position when she asked Colleague J.H. to fraudulently sign a record indicating that they had administered the COVID-19 vaccine to her when they had not administered one and when Colleague J.H. refused, the Member forged Colleague J.H.’s signature on a Facility vaccine form thereby falsifying documents. The Member also administered COVID-19 vaccines to her family outside of the clinical setting despite being aware of the policy in place that was designed to ensure only approved clinical settings were to be used to administer COVID-19 vaccines. The Member did this repeatedly and only admitted to having done so when her conduct was reported.

The standards of practice that were breached are clearly defined in:

o Exhibit A – Code of Conduct: The Member violated the Code of Conduct when she forged the signature of her colleagues knowingly and repeatedly which reflects a lack of respect for the profession, her colleagues and her accountability to the profession.

o Exhibit B – Professional Standards: The Member violated professional standards specific to accountability and leadership when she requested her colleagues to sign off on care that was not provided and forged their signatures when they refused while she was in a leadership role.

o Exhibit C – Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”): The Member violated the TNCR standard specific to communication and boundaries when she administered medication outside of a clinical setting, using the power of her position to meet her own personal needs.

o Exhibit D – Ethics Standard: The Member violated the Ethics Standard when she forged her colleagues' signature, failed to maintain her commitment to her colleagues, and to quality practice settings.

o Exhibit E – Documentation Standard: The Member violated this standard when she falsified records related to herself and her patients.

Allegations #2(a), (b) and (c) in the Notice of Hearing are supported by paragraphs 6 – 9, 13 - 23 and 49 in the Agreed Statement of Facts. The Member admitted that she falsified a record relating to her practice. The Member contravened the Facility’s policy when she brought three of her family members to her office outside of the clinical setting to administer COVID-19 vaccines and asked an administrative assistant to record that Colleague J.M. had administered the COVID-19 vaccines to her family members. The Member also asked Colleague J.H. to falsely document that they had administered the COVID-19 vaccine to her and when Colleague J.H. refused, the Member forged Colleague J.H.’s signature on a Facility vaccine form. This demonstrated that the Member deliberately and knowingly attempted to have her colleagues falsify records, and that she falsified a record relating to her practice when she forged Colleague J.H.’s signature on a Facility vaccine form when Colleague J.H. refused her request.

Allegations #3(a) and (b) in the Notice of Hearing are supported by paragraphs 6 - 9, 13 - 23 and 50 in the Agreed Statement of Facts. The Member admitted that she signed, in her professional capacity, a document that she knew contained a false or misleading statement. The Member documented that Colleague J.M. and Colleague A.M. had administered COVID-19 vaccines to patients, who were friends and/or family members of the Member, when they had not and forged their signatures on the vaccine forms. The Member also, by forging Colleague J.H.’s signature on the vaccine form, falsely documented that Colleague J.H. had administered the COVID-19 vaccine to her when Colleague J.H. had not.

Allegations #4(a), (b), (c), (d), (e) and (f) in the Notice of Hearing are supported by paragraphs 6 - 47 and 51 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct was relevant to the practice of nursing and having regard to all the circumstances, would reasonably be regarded by members as unprofessional as it demonstrated a serious and persistent disregard for her professional obligations in contravening the Code of Conduct, the Professional Standards, the TNCR Standard, the Ethics Standard and the Documentation Standard, when she:

a. Falsely documented that her colleagues had administered COVID-19 vaccines to patients;

b. Told an administrative assistant that she had administered a COVID-19 vaccine to three members of her family, and then directed them to document that her colleague had administered these doses;

c. Requested that a nurse colleague fraudulently sign a record indicating that they had administered the COVID-19 vaccine to her when they had not;

d. Falsely documented that her nurse colleague had administered the COVID-19 vaccine to her by forging their signature and submitting the document;

e. Provided nursing care to nine friends and/or members of her family; and

f. Provided nursing care in non-clinical areas of the Facility.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty, deceit and moral failing in that she forged her colleagues’ signatures and instructed an administrative assistant to include false data. The Member knew or ought to have known that her conduct was unacceptable and fell well below the standards of a professional.

Despite the Member’s admission leaving it open to the Panel to characterize her conduct as also being disgraceful, the Panel did not find that the Member’s conduct was disgraceful. While the Member ought to have known her conduct was unacceptable, her response when her conduct was called into question, showed remorse and accountability by immediate resignation and acknowledgement of the wrongdoing. The Panel found this response to her conduct represented an understanding of the expectations of the public and the obligations to her profession.

Penalty

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

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

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

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

a) The Member will attend 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. 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. Documentation;

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

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

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

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

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;

3. 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:

The aggravating factors in this case were:

• The Member’s intentional dishonesty;

• The Member implicated her colleagues in her deception when she asked them to provide false documents;

• The Member provided false documents by way of forging signatures; and

• The Member’s conduct was repeated and involved nine patients.

The mitigating factors in this case were:

• The Member entered into an Agreed Statement of Facts and a Joint Submission on Order with the College;

• The Member has accepted responsibility for her conduct; and

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

College Counsel submitted that the Member showed a serious and persistent disregard for her professional obligations to maintain accurate documentation. This was described as a demonstration of moral failing and intentional dishonesty, particularly when she attempted to conceal her actions by asking her colleagues to sign for care which was not given and when she subsequently forged their signatures when they refused.

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. Danilovic (Discipline Committee, 2023): In this case, the member did not attend the hearing. The member forged the signatures and/or initials of her nursing colleagues as witnesses on Individual Narcotic and Controlled Drug Count Sheets when wasting narcotics as per the facility’s policy. The panel found the member’s conduct to be disgraceful, dishonourable and unprofessional. The penalty included an oral reprimand, a five-month suspension of the member’s certificate of registration, a minimum of two meetings with a Regulatory Expert, 24 months of employer notification, eight random spot audits of the member’s practice and 24 months of no independent practice in the community. Although similar to the penalty proposed in the case before this Panel, the penalty in Danilovic was a slightly higher penalty as there were no mitigating factors since the member did not attend the hearing.

CNO v. Khan (Discipline Committee, 2023): In this case, the member did not attend the hearing. The member prepared and forged a colleague’s signature on Vulnerable Sector Check request letters. The panel found the member’s conduct to be dishonourable and unprofessional. The penalty included an oral reprimand, a two-month suspension of the member’s certificate of registration, a minimum of two meetings with a Regulatory Expert and 12 months of employer notification. This penalty was similar to the penalty proposed in the case before this Panel. However, it was a slightly lower penalty as the conduct did not involve patients, was not repeated nor did the member implicate others.

CNO v. Mohamed (Discipline Committee, 2008): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member altered an Attending Physician’s Report specific to sick leave and modified work duties. This allowed the member to collect sick leave benefits which amounted to misappropriation of benefits and funds from the facility. The penalty included an oral reprimand, a four-month suspension of the member’s certificate of registration, a minimum of six meetings with a Counsellor in Ethics, a fine of $2,500.00 and 18 months of employer notification. This penalty was also similar to the penalty proposed in the case before this Panel.

Member’s Submissions on Penalty

The Member’s Counsel submitted that he agreed with College Counsel’s submissions regarding the Joint Submission on Order. The Member’s Counsel also referred to R. v. Anthony-Cook, 2016 SCC 43 and Bradley v. Ontario College of Teachers, 2021 ONSC 2303 as to the principles applicable to Joint Submissions 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 specific deterrence through the oral reprimand and the four-month suspension of the Member’s certificate of registration. The oral reprimand will allow the Member to hear directly from the public and representative members of her professional body and reflect on her conduct. The four-month suspension of the Member’s certificate of registration acts as a deterrent by limiting her ability to practice and providing time for remediation activities.

The proposed penalty provides for general deterrence through the 4-month suspension of the Member’s certificate of registration, which will deter other members of the profession from engaging in similar conduct.

The proposed penalty provides for remediation and rehabilitation through terms, conditions and limitations placed upon the Member’s certificate of registration, including a minimum of two meetings with a Regulatory Expert, which will provide the support and appropriate insight necessary to ensure remediation and prevent the Member from engaging in similar conduct in the future.

Overall, the public is protected through the 12 months of employer notification, which will allow for the Member’s employer to have greater oversight over her practice upon her return to nursing practice.

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

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

I, 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.