DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Transcription

1 DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Lori McInerney, RN Chairperson April Cheese, RPN Member Deirdre Armstrong, RN Member Sharanjit Singh Padda Public Member Lyn Harrington Public Member BETWEEN: ) KAREN JONES for COLLEGE OF NURSES OF ONTARIO ) College of Nurses of Ontario ) ) - and - ) NO REPRESENTATION for ) Barbara Cecilioni ) ) BARBARA CECILIONI ) Registration No ) Heard: February 8, 2008 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on February 8, 2008 at the College of Nurses of Ontario (the College ) and at 130 Bloor Street at Toronto. The Allegations The allegations against Barbara Cecilioni (the Member ) as stated in the Notice of Hearing dated December 19, 200[ ] are as follows. 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(19) of Ontario Regulation 799/93, in that with respect to your treatment of a client known as [Client A] on May 29, 2005, and a client known as [Client B] on August 2, 2005, you contravened provisions of the Nursing Act, 1991, the Regulated Health Professions Act, 1991, or the regulations under either of those Acts, and in particular, you contravened: a) section 27 of the Regulated Health Professions Act, 1991; b) section 30 of the Regulated Health Professions Act, 1991; and

2 c) sections 4 and 5 of the Nursing Act, You have committed an act of professional misconduct as provided by subsection 5(2) of the Nursing Act, 1991, S.O. 1991, c. 32, in that with respect to your treatment of a client known as [Client A] on May 29, 2005, and a client known as [Client B] on August 2, 2005, you contravened subsection 5.(1) of the Nursing Act, 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(9) of Ontario Regulation 799/93, in that on May 29, 2005, with respect to a client known as [Client A], and on August 2, 2005, with respect to a client known as [Client B], you diagnosed and treated the clients in a situation in which consent is required by law, without such a consent. 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(12) of Ontario Regulation 799/93, in that with respect to your treatment of a client known as [Client A] on May 29, 2005, and a client known as [Client B] on August 2, 2005, you failed to advise the clients to obtain services from another health professional where you knew or ought to have known that the clients had conditions that were outside of your scope of practice. 5. 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 in 2005, you falsified records relating to your practice with respect to a client known as [Client A] and a client known as [Client B]. 6. 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 in 2005, you signed or issued, in your professional capacity, a document or documents that you knew or ought to have known contained false or misleading statements with respect to a client known as [Client A] and a client known as [Client B]. 7. 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 in 2005 with respect to a client known as [Client A] and a client known as [Client B], you failed to maintain the standards of practice of the profession with respect to your treatment and documentation, and, in addition, you failed to: a) be accountable by practicing nursing in a manner that was consistent with the standards of practice and legislation; b) act with integrity and/or honesty with respect to clients and your employer;

3 c) maintain professional relationship with the clients and your employer. 8. 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 you engaged in conduct or performed an act, relevant to the practice of nursing that, having regard to all of the circumstances would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, in that with respect to a client known as [Client A] and a client known as [Client B], you: a) performed acts defined as controlled acts on the clients in contravention of the Nursing Act, 1991, and Regulated Health Professions Act, 1991; and/or b) treated the clients outside the scope of practice of nursing in contravention of the Regulated Health Professions Act, 1991, and the Nursing Act, 1991; and/or c) failed to inform the clients you were treating them in contravention of the Nursing Act, 1991, and Regulated Health Professions Act, 1991, and outside the scope of practice of the profession of nursing; and/or d) failed to obtain informed consent for treatment from the clients; and/or e) falsified documentation regarding the clients; f) used [Dr. A] s name and/or letterhead and/or stationery and/or signature stamp and/or prescription scripts without his permission and/or knowledge. Member s Plea Barbara Cecilioni admitted the allegations set out in paragraphs numbered 1, 2, 3, 4, 5, 6, 7, and 8 in the Notice of Hearing. The panel conducted a plea inquiry and was satisfied that the Member s admission was voluntary, informed and unequivocal. Agreed Statement of Facts Counsel for the College advised the panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts which provided as follows. THE MEMBER 1. Barbara Cecilioni ( the Member ) became a [ ] nurse ([ ]) in 1967 and has been registered with the College of Nurses of Ontario ( the College ) since The Member worked as a cosmetics nurse for [Dr. A], (the complainant), at his dermatology office from September 30, 2004 until December 14, 2005, when she was terminated. The Member started working at the complainant s

4 office one (1) day a week, however, by the time she stopped working at his office, she was working approximately three (3) days a week. 3. For much of the same period, (above), the Member engaged in freelance work at several spas and also had a clinic at her house where she provided Botox treatments. 4. The Member is presently working part-time as a [ ] Nurse and she has renewed her registration with the College for The Member has no prior history of discipline or other outstanding complaints at the College. DR. A S OFFICE AND [ ] CLINIC 6. The office of [Dr. A] is located in [ ], Ontario. [Dr. A] has been providing medical and cosmetic dermatology services in [ ], Ontario, Canada since Some of the medical and cosmetic dermatology services offered at [Dr. A] s office include laser treatment, Botox injections for wrinkles and hyperhydrosis (excessive sweating), treatment for acne, the removal of moles, skin tags, age spots, liver spots and cysts, as well as make-up and cosmetic skin care. 7. [The clinic] is a medical cosmetic clinic. It offers medical/laser treatment, microdermabrasion, anti-aging, and holistic medicine such as nutrition and cosmetic acupuncture. The owner of [the clinic] rents out space to other professionals who bring in their own clients. [The clinic] does not have any doctors working at the clinic. BACKGROUND 8. The Member received training to inject Botox (a drug that decreases muscle activity and which can also be used as a cosmetic treatment), Restylane (a substance used as a filler to eliminate lines and enhance facial contours), Sclerodex (a sclerosing drug that is generally used to treat small varicose veins), and permanent makeup from a number of sources, including: apprenticing with a nurse who worked as a drug company representative; apprenticing with a physician who performed cosmetic procedures; taking a course run by a pharmaceutical company; and from a friend. 9. The Member worked as a nurse for [Dr. A] from September 2004 to December She was delegated by [Dr. A] to perform[] cosmetic procedures using Botox and fillers for wrinkles, and did so on an unsupervised basis. 10. On occasion, [Dr. A] treated patients for hyperhydrosis by administering Botox. He never delegated authority to the Member to administer the injection

5 of Botox for the treatment of hyperhydrosis to his patients. He always treated patients with hyperhydrosis himself. 11. While the Member worked for [Dr. A], she also engaged in a private freelance, cosmetics practice at several spas and at her home with friends and family. [Dr. A] sold Botox and dermal fillers to the Member at cost for her freelance practice. 12. During the relevant time, [ ], a pharmaceutical company, was sponsoring the Botox Access Program ( Program ). All access to the Program was through physicians who had an agreement with [ ] Pharmacy. In order for a patient to participate in the Program: (a) (b) (c) (d) a patient had to be diagnosed by a physician as having hyperhydrosis; the physician had to prescribe Botox to treat the hyperhydrosis; the patient was given Botox injections and paid the physician for the treatment via credit card; the physician submitted a fax to the [ ] Pharmacy which included the patient s credit card number, a copy of their insurance policy, and medical information. [The] Pharmacy would review the documents and, if the patient s insurance plan covered the Botox treatment, forward the information to the insurer. If the patient s insurance policy did not cover the treatment, [the pharmaceutical company] would pay for the Botox used in the patient s first treatment. (e) if the physician used their own supply of Botox to treat the patient, [ ] Pharmacy would replace the physician s Botox at no cost. 13. Botox ordered through the Program was administered only through a physician s office or a physician. CONTROLLED ACTS AND SCOPE OF PRACTICE 14. The Regulated Health Professions Act ( RHPA ), which governs nurses and other regulated health professionals, defines certain acts as controlled acts. These acts that are considered to be potentially harmful if performed by unqualified persons. There are 13 controlled acts identified in the RHPA, and nurses are authorized to perform 3 of the acts under specified conditions: (a) (b) (c) Performing a prescribed procedure below the dermis or a mucous membrane; Administering a substance by injection or inhalation; Putting an instrument, hand or finger into a body opening or artificial opening.

6 15. The other 10 controlled acts, which include communicating a diagnosis, and prescribing, dispensing, selling or compounding a drug, cannot be performed by a nurse unless the nurse is authorized by a health profession Act to do so, or the controlled act has been delegated to the nurse by a regulated health professional in accordance with applicable regulations. 16. Delegation is a process by which an authorized regulated health professional provides the legal authority to a nurse to perform a controlled act or activity when ordered. The order may be client specific or in the form of a medical directive. 17. According to the RHPA and Nursing Act, and the regulations made under those statutes, an RN in the General Class, such as the Member, cannot perform the controlled acts of diagnosing diseases or disorders, or prescribing drugs. A General Class registered nurse cannot administer a drug, such as Botox, by injection without a physician s order. THE MEMBER S TREATMENT OF [CLIENTS B and A] 18. The Member diagnosed hyperhydrosis, prescribed Botox, and administered Botox injections to two of her private clients, [Client B] and [Client A], without a physican s diagnosis, a prescription for the Botox, or a physician s order to administer the Botox. [CLIENT B] 19. Although [Client B] had never been diagnosed as having hyperhydrosis by a physician, she had concerns because she felt as though she sweated too easily. She saw a sign near a clinic [(the clinic)] in [ ] that advertised Botox for $9.00/unit. [Client B] called the clinic and was advised that Botox treatment would cost $ for one treatment, which included both axillae. 20. [The clinic] called the Member regarding [Client B] and advised the Member that there was a potential client who wanted Botox injections for hyperhydrosis. 21. [Client B] met with the Member at the clinic. The Member diagnosed [Client B] as having hyperhydrosis and prescribed her the drug Botox. 22. On August 2, 2005, [Client B] signed her consent to Botulinum Toxin Treatment for Hyperhydrosis on [Dr. A] s letterhead. The Member injected [Client B] several times in each axilla. 23. The Member did not inform [Client B] that her condition was outside her scope of practice and that she should have obtained services from another professional. Further, the Member did not inform [Client B] that she was not legally permitted to diagnose, prescribe or administer drugs by injection without a doctor s order.

7 24. After her Botox injections, the Member discussed the Botox Program with [Client B], and [Client B] decided to apply. 25. The Member provided [Client B] with a letter on [Dr. A] s letterhead that appeared to have been signed by [Dr. A], confirming that [Client B] was to receive Botox injections by [Dr. A] or his delegate for hyperhydrosis. The Member also provided [Client B] with a Botox Access Program form that included [Dr. A] s name, address, and contact information, which also appeared to have been signed by him. Lastly, the Member provided [Client B] with a prescription for Botox using [Dr. A] s prescription and his signature stamp. 26. Sometime after treatment, [Client B] received a receipt in the mail for the Botox she had received. The receipt had [Dr. A] s name on it. 27. In November 2006, [Client B] contacted her insurer and obtained a claim form. [Client B] asked her insurance company whether she could submit the receipt that she had obtained with [Dr. A] s name on it, but she was informed that she could not. The insurance company advised her that the form had to be completed and signed by [Dr. A]. 28. On January 9, 2006, [Client B] called [Dr. A] s office to speak to the Member and left a message with [Dr. A] s office requesting that the Member send a letter for [Client B] to her insurance carrier for the Botox injections she had received for the treatment of hyperhydrosis. 29. On January 9, 2006, [Client B] received a phone call from [Dr. A] s office, informing her that [Dr. A] had not been involved with this Botox procedure and that he had nothing to provide to [Client B], as [Dr. A] had never seen [Client B] in his practice. [Client B] was further advised that [Dr. A] did not administer the Botox injections at his office, and that he did not delegate anyone to administer Botox injections to [Client B] at another location. 30. If [Dr. A] were to testify, he would state that he always writes his name on the Botox Access Program prescriptions and does not use a signature stamp. He would also state that he had no knowledge that the Member used his signature stamp on Program forms, or that she was using his fax letterhead and his name in an insurance letter for Botox treatment. In addition, [Dr. A] would state that he recognized the Member s signature on the documents that she had provided to [Client B] in application to the Program. 31. [Client B] did not take any further steps in processing her insurance application, and as a result, she never received a refund of $ for the Botox treatment. [CLIENT A]

8 32. According to [Client A], doctors had diagnosed her with hydrosomething several years before she received treatment from the Member. [Client A] was informed, at the time, that there was nothing she could do about her excessive sweating. 33. Several years later, a friend of [Client A] s recommended that she meet with the Member, as she might be able to assist [Client A] with her problem of excessive sweating. 34. On May 29, 2005, [Client A] went to a Botox Clinic in [ ], which was located at the Member s home. The Member diagnosed [Client A] as having hyperhydrosis and prescribed the drug Botox. 35. The Member performed a cornstarch and iodine test on [Client A], which indicated moderate to severe sweating and injected both her axillae with Botox. The Member used two (2) vials of Botox to treat [Client A] s hyperhydrosis. The treatment was a one-time visit. 36. The Member did not inform [Client A] that her condition was outside her scope of practice and that she should have obtained services from another professional. Further, the Member did not inform [Client A] that she was not legally permitted to diagnose, prescribe or administer drugs by injection without a doctor s order. 37. The Member discussed the Botox Program with [Client A] and [Client A] subsequently applied for it. 38. The Member provided [Client A] with a Botox Access Program form which included [Dr. A] s name, address and contact information. The Member also provided [Client A] with a letter dated August 2, 2005, confirming that [Client A] would be having Botox injections for hyperhydrosis, and that the Botox would be injected by [Dr. A] or his delegate. The signatory line on the letter indicated [Dr. A] with his credentials added after his signature. 39. The Member provided a further letter to [Client A], dated November 19, 2005, which appeared to be signed by [Dr. A]. The letter indicated that [Client A] had been treated by [Dr. A] s office for hyperhydrosis with the injection of 250 units of Botox, and that she would require additional treatment with the same dosage every 8-12 months. 40. On March 28, 2006, an agent from [Client A] s insurance company called [Dr. A] s office, inquiring into the Botox treatment [Client A] had received for the condition of hyperhydrosis. The agent requested further information from [Dr. A]. 41. [Dr. A] s office informed the agent that [Dr. A] had never seen [Client A] at his dermatology practice.

9 42. Further, [Dr. A] s office was unable to locate the patient s chart and asked the agent to fax the copy of the letter that was provided to the insurance company. It was determined that [Client A] was not [Dr. A] s patient. 43. As a result, [Client A] personally paid $ for the Botox treatment administered by the Member. She was never reimbursed. 44. If [Dr. A] were to testify, he would state that he always writes his name on Botox Access Program prescriptions and does not use a signature stamp. He would also state that he recognized the Member s signature on the documents that she had provided to [Client A] in application to the Program. POSITIONS OF [DR. A] AND THE MEMBER 45. If [Dr. A] were to testify, he would state that he never delegated authority to the Member to administer Botox for the treatment of hyperhydrosis. 46. If [Dr. A] were to testify, he would further state that neither [Client B] [n]or [Client A] were his patients, and that he had never seen them, made any diagnosis of them, or prescribed any treatment for them. 47. [Dr. A] would also say he did not know the Member was using his letterhead, prescriptions, or personal stamp signature, and that he never gave permission to the Member to use his letterhead, prescriptions or personal signature stamp. 48. If the Member were to testify, she would state that, although [Dr. A] had not delegated her to treat patients for hyperhydrosis using Botox, he had delegated to her the use of Botox for cosmetic procedures in his office. 49. The Member would also state that [Dr. A] sold her Botox and, as a result, she believed he was aware of what she was doing with it. It was her belief that, as a result of [Dr. A] s selling her Botox, he implicitly prescribed the product, endorsed its administration and was the supervising physician for her own private clients. She would specifically add, however, that she never directly advised either [Client B]or [Client A] that [Dr. A] was in fact the supervising physician. 50. The Member acknowledges that she never received [Dr. A] s permission to use his name on the Program forms. However, had she testified, she would have said she believed [Dr. A] and his staff knew that she was receiving Botox through the Program. AFTER THE INCIDENTS TOOK PLACE 51. In September 2005, [Dr. A] was advised by [a pharmaceutical company] representative that selling Botox to another person to use elsewhere was against the regulations of his College (the College of Physicians and Surgeons of Ontario). [Dr. A] had been unaware of this information. He had been selling Botox to the Member for a period of nine (9) months.

10 52. As a result, [Dr. A] decided that it was inappropriate to continue to sell Botox to the Member, and he ceased doing so. 53. On September 19, 2005, [Dr. A] ed the Member and advised her that he would no longer be selling her Botox. He requested that the Member return any unused product, and he offered to provide the Member with a full refund for whatever product she returned. 54. On September 23, 2005, [Dr. A] met with the Member to discuss the fact that he would no longer sell Botox or other cosmetic drugs to the Member. 55. Subsequent to this meeting, [Dr. A] sent the Member another reiterating that he could no longer sell Botox to her and again requested that she return any remaining product to him. 56. In response, the Member advised [Dr. A] that she had no product left. 57. On December 14, 2005, [Dr. A] terminated his cosmetics practice and the Member s employment. ADMISSIONS OF PROFESSIONAL MISCONDUCT 58. The Member admits that she committed an act of professional misconduct, as provided by sub-section 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(19) of Ontario Regulation 799/93, in that with respect to her treatment of a client known as [Client A] on May 29, 2005, and a client known as [Client B] on August 2, 2005, she contravened provisions of the Nursing Act, 1991, the Regulated Health Professions Act, 1991, or the regulations under either of those Acts, and in particular, she contravened: (a) section 27 of the Regulated Health Professions Act, 1991; (b) section 30 of the Regulated Health Professions Act, 1991; (c) sections 4 and 5 of the Nursing Act. 59. The Member admits that she committed an act of professional misconduct as provided by sub-section 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c.32, in that with respect to her treatment of a client known as [Client A] on May 29, 2005, and a client known as [Client B] on August 2, 2005, she contravened subsection 5.(1) of the Nursing Act, The Member admits that she committed an act of professional misconduct, as provided by sub-section 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(9) of Ontario Regulation 799/93, in that on May 29, 2005, with respect to a client known as [Client A], and on August 2, 2005, with respect

11 to a client known as [Client B], she diagnosed and treated the clients in a situation in which consent is required by law, without such consent. 61. The Member admits that she committed an act of professional misconduct, as provided by sub-section 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(19) of Ontario Regulation 799/93, in that [ ] with respect to her treatment of a client known as [Client A] on May 29, 2005, and a client known as [Client B] on August 2, 2005, she failed to advise the clients to obtain services from another health professional where she knew or ought to have known that the client s conditions that were outside of her scope of practice. 62. The Member admits that she committed an act of professional misconduct, as provided by sub-section 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 in 2005, she falsified records relating to her practice with respect to a client known as [Client A] and a client known as [Client B] 63. The Member admits that she committed an act of professional misconduct, as provided by sub-section 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 in 2005, she signed or issued, in her professional capacity, a document or documents that she knew or ought to have known contained false or misleading statements with respect to a client known as [Client A] and a client known as [Client B] 64. The Member admits that she committed an act of professional misconduct, as provided by sub-section 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 in 2005 with respect to a client known as [Client A] and a client known as [Client B] she failed to maintain the standards of practice of the profession with respect to her treatment and documentation, and, in addition, she failed to: (a) (b) (c) be accountable by practising nursing in a manner that was consistent with the standards of practice and legislation; act with integrity and/or honesty with respect to clients and her employer; maintain professional relationship with the clients and her employer. 65. The Member admits that she committed an act of professional misconduct, as provided by sub-section 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 she engaged in conduct

12 or performed an act, relevant to the practice of nursing that having regard to all of the circumstances would reasonably be regarded by members of the profession as disgraceful, dishonourable, or unprofessional, in that with respect to a client known as [Client A] and a client known as [Client B], she: (a) (b) (c) (d) (e) (f) performed acts defined as controlled acts on the clients in contravention of the Nursing Act, 1991, and Regulated Health Professions Act, 1991; and/or treated the clients outside the scope of practice of nursing in contravention of the Regulated Health Professions Act, 1991, and the Nursing Act, 1991; and/or failed to inform the clients she was treating them in contravention of the Nursing Act, 1991, and Regulated Health Professions Act, 1991, and outside the scope of practice of the profession of nursing; and/or failed to obtain informed consent for treatment from the clients; and/or falsified documentation regarding the clients; used [Dr. A] s name and/or letterhead and/or stationery and/or signature stamp and/or prescription scripts without his permission and/or knowledge. Decision The panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct and, in particular, finds that the Member committed an act of professional misconduct as alleged in paragraphs 1, 2, 3, 4, 5, 6, 7, and 8 of the Notice of Hearing. The Member: performed controlled acts in contravention of provisions of the Nursing Act, 1991, and Regulated Health Professions Act, 1991; diagnosed and treated clients in a situation in which consent is required by law, without such a consent; failed to advise the clients who had conditions that were outside [her] scope of practice to obtain services from another health care professional; falsified records relating to her practice; signed or issued documents that contained false or misleading statements with respect to her clients; failed to maintain the standards of practice with respect to treatment and documentation and failed to be accountable, act with integrity and honesty and maintain a professional relationship with her clients and employer; and

13 engaged in conduct that would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional. Penalty Counsel for the College advised the panel that a Joint Submission as to Penalty had been agreed upon. The Joint Submission as to Penalty provides as follows: BARBARA CECILIONI ( THE MEMBER ) AND THE COLLEGE OF NURSES OF ONTARIO (THE COLLEGE ) SUBMIT that, in view of the circumstances set out in the Agreed Statement of Facts, the Member s admissions of professional misconduct and the Panel s findings of professional misconduct, the Panel of the Discipline Committee ( the Panel ) should make an Order as follows: 1. Requiring the Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within one (1) month of the date this Order becomes final; 2. Directing the Executive Director to suspend the Member s Certificate of Registration for one (1) month. The suspension shall take effect from the date that this Order becomes final and shall run continuously without interruption; 3. Requiring the Member to sign an undertaking to the College in a form acceptable to the College that she will only practise nursing within the scope of practice of the profession, including only performing controlled acts and nursing procedures and treatments permitted by law; 4. Directing the Executive Director to impose the following terms, conditions and limitations on the Member s Certificate of Registration: a. Requiring the Member to meet with a Practice Consultant at the Practice Consultant s convenience within three (3) months of the date this Order becomes final. The circumstances of meeting with the Practice Consultant are at the discretion of the Executive Director. The Member will meet with the Practice Consultant to discuss the materials referred to in paragraph 4(c)(i) below, as they relate to the conduct for which the Member was found to have committed professional misconduct and to discuss how to prevent such conduct from occurring in the future. b. At this meeting, the Practice Consultant and the Member will review the learning plan that the Member developed set out in s. 4(c)(iii) (below), and will also review the incidents set out in the Agreed Statement of Facts, Discipline Committees reasons and decision, within three (3) months of the date of this decision, or at such later date approved by the Director. c. Prior to meeting with the Practice Consultant, the Member shall:

14 i. review the College Standards and Guidelines: Professional Standards (2002); Decisions About Procedures and Authority (2006); Nursing Documentation (2004); Ethics (2004); Consent (2004); Independent Practice (2004); and RHPA: Scope of Practice, Controlled Acts Model (2004); and ii. iii. complete the College s on-line learning module, Professional Standards and Consent, and complete the on-line participation form relevant to each module and/or any other exercises that the Practice Consultant may suggest; and develop and complete a learning plan that directly relates to the allegations and breached standards, that she will then bring with her when she meets with the College Practice Consultant set out in s.4(b), (above). d. Requiring the Member, within nine (9) months of the date that she first met with the Practice Consultant, to return and meet with the Practice Consultant again to review her learning plan, and the notes and changes that she has made since her last meeting with the Practice Consultant. e. Until the Member has completed the remedial terms, conditions and limitations, set out in 4 (a), (b) and (c), (above) and has met with the Practice Consultant to discuss her remediation, the Member shall not perform any controlled acts; 5. For a period of twelve (12) months following the date upon which the Member returns to the practice of nursing, the Member shall: a. notify the Director of the name, address, and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position. Notification shall be in writing and through the use of a verifiable method of delivery, the proof of which the Member shall retain; b. provide her employer(s) with a copy of the panel s Penalty Order together with the Notice of Hearing or, if available, the Panel s written Decision and Reasons, together with any attachments; c. only practise for an employer(s) who agrees to, and does write to the Director, within fourteen (14) days of the commencement or resumption of the Member s employment providing the Director with the following: i. confirmation that the employer(s) has received a copy of the documents referred to in paragraph 5 ii. above; and

15 ii. confirmation that the employer agrees to notify the Director immediately upon receipt of any reasonable information that the Member has breached the standards of practice of the profession. Counsel for the College submitted that this penalty fulfilled the goals of penalty which include specific deterrence, general deterrence, remediation and protection of the public. The Member acknowledged her actions and cooperated fully, thereby accepting responsibility for her conduct. Counsel submitted that these circumstances were unique and were primarily a result of miscommunication and misunderstanding between the Member and a physician. There was no intent by the Member to commit these acts with deceit or dishonest intent. However, these circumstances do not exonerate the Member from taking responsibility for her conduct and her own practice. Counsel submitted that had there not been extenuating circumstances, the penalty being sought would have been more severe. Penalty Decision The panel accepts the Joint Submission as to Penalty and accordingly orders: 1. the Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within one (1) month of the date this Order becomes final; 2. the Executive Director to suspend the Member s Certificate of Registration for one (1) month. The suspension shall take effect from the date that this Order becomes final and shall run continuously without interruption; 3. the Member to sign an undertaking to the College in a form acceptable to the College that she will only practise nursing within the scope of practice of the profession, including only performing controlled acts and nursing procedures and treatments permitted by law; 4. the Executive Director to impose the following terms, conditions and limitations on the Member s Certificate of Registration: a. requiring the Member to meet with a Practice Consultant at the Practice Consultant s convenience within three (3) months of the date this Order becomes final. The circumstances of meeting with the Practice Consultant are at the discretion of the Executive Director. The Member will meet with the Practice Consultant to discuss the materials referred to in paragraph 4(c)(i) below, as they relate to the conduct for which the Member was found to have committed professional misconduct and to discuss how to prevent such conduct from occurring in the future. b. At this meeting, the Practice Consultant and the Member will review the learning plan that the Member developed set out in s. 4(c)(iii) (below), and will also review the incidents set out in the Agreed Statement of Facts, Discipline Committees reasons and decision, within three (3) months of the date of this decision, or at such later date approved by the Director. c. Prior to meeting with the Practice Consultant, the Member shall:

16 i. review the College Standards and Guidelines: Professional Standards (2002); Decisions About Procedures and Authority (2006); Nursing Documentation (2004); Ethics (2004); Consent (2004); Independent Practice (2004); and RHPA: Scope of Practice, Controlled Acts Model (2004); and ii. iii. complete the College s on-line learning module, Professional Standards and Consent, and complete the on-line participation form relevant to each module and/or any other exercises that the Practice Consultant may suggest; and develop and complete a learning plan that directly relates to the allegations and breached standards, that she will then bring with her when she meets with the College Practice Consultant set out in s.4(b), (above). d. Requiring the Member, within nine (9) months of the date that she first met with the Practice Consultant, to return and meet with the Practice Consultant again to review her learning plan, and the notes and changes that she has made since her last meeting with the Practice Consultant. e. Until the Member has completed the remedial terms, conditions and limitations, set out in 4 (a), (b) and (c), (above) and has met with the Practice Consultant to discuss her remediation, the Member shall not perform any controlled acts; 5. For a period of twelve (12) months following the date upon which the Member returns to the practice of nursing, the Member shall: a. notify the Director of the name, address, and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position. Notification shall be in writing and through the use of a verifiable method of delivery, the proof of which the Member shall retain; b. provide her employer(s) with a copy of the panel s Penalty Order together with the Notice of Hearing or, if available, the Panel s written Decision and Reasons, together with any attachments; c. only practise for an employer(s) who agrees to, and does write to the Director, within fourteen (14) days of the commencement or resumption of the Member s employment providing the Director with the following: i. confirmation that the employer(s) has received a copy of the documents referred to in paragraph 5 ii. above; and ii. confirmation that the employer agrees to notify the Director immediately upon receipt of any reasonable information that the Member has breached the standards of practice of the profession. Reasons for Penalty Decision

17 The panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions and has avoided unnecessary expense to the College. The penalty meets the goals of general deterrence, specific deterrence, remediation and protection of the public. The panel recognizes that this Member has been a member of the College since 1968 and has had an unblemished record during that period of time. The Member, nearing the end of her career, could have chosen to resign. Instead, she accepted responsibility and faced her colleagues and the public by accepting responsibility for her actions and accepting the penalty ordered by this panel. The panel accepts that the mitigating circumstances involved in these allegations were unique, however, there must be a clear message to the public and the membership that every member of the College must practise within the standards and scope of practice of their classification. I, Lori McInerney, sign this decision and reasons for the decision as Chairperson of this Discipline panel and on behalf of the members of the Discipline panel as listed below: Chairperson Date Panel Members: April Cheese, RPN Deirdre Armstrong, RN Sharanjit Singh Padda, Public Member Lyn Harrington, Public Member