DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO. PANEL: Jim Attwood, RN Chairperson Karen Breen-Reid, RN Member Anne McKenzie, RPN Member

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1 DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Jim Attwood, RN Chairperson Karen Breen-Reid, RN Member Anne McKenzie, RPN Member Shamsul Islam Public Member David Bishop Public Member BETWEEN: ) ) COLLEGE OF NURSES OF ONTARIO ) GLYNNIS BURT for ) College of Nurses of Ontario - and - ) ) KARIN KOPP ) DAVID GOLDEN for Registration No ) Karin Kopp ) ) JOHANNA BRADEN, ) Independent Legal Counsel ) ) Heard: June 29, 2005 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on June 29, 2005 at the College of Nurses of Ontario ( the College ) at Toronto. The Allegations The allegations against Karin Kopp stated in the Notice of Hearing dated March 28, 2005, are as follows. 1. You have committed an act or acts 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 paragraph 1.1 of Ontario Regulation 799/93, in that, from in or about early 1998 until in or around June 2001, while employed as a Registered Nurse at [the facility], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, the particulars of which are set out in Appendix A. 2. You have committed an act or acts 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 paragraph 1.27 of Ontario Regulation 799/93, in that, from in or about early 1998 until in or around June 2001, while employed as a Registered

2 Nurse at [the facility], you influenced [the client] to change [the client s will] or other testamentary instrument, the particulars of which are set out in Appendix A. 3. You have committed an act or acts 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 paragraph 1.37 of Ontario Regulation 799/93, in that, from in or about early 1998 until in or around June 2001, while employed as a Registered Nurse at [the facility], you engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, the particulars of which are set out in Appendix A. Particulars to Specified Allegations APPENDIX A Karin Kopp, # While employed as a Registered Nurse at [the facility], and while holding the position of Facility Supervisor, you provided care and treatment to [the client], with whom you engaged in a personal relationship involving one or more of the following: (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) personal visits with [the client] in [the client s] room at [the facility] after your shifts had been completed; personal visits with [the client] for long periods, including late at night or early in the morning; personal visits with [the client] while [the client] was in hospital; disclosure by you to [the client] of details of your family and personal life; disclosure by you to [the client] of details of your financial circumstances; disclosure by you to [the client] of your home telephone number; giving personal photographs of yourself to [the client], which [the client] displayed by [the client s] bed; sending personal postcards and making personal telephone calls to [the client] while you were on vacation; visits with [the client] by other members of your family; staying at [the client s] personal condominium on occasion, with [the client s] permission;

3 (k) accepting gifts from [the client] including one or more of the following: (i) (ii) (iii) (iv) (v) (vi) more than one gift of cash; a camera; a cell phone; a roll-top desk; a Tilley outfit; a subscription to [a] magazine; (vii) a condominium at [ ]; (viii) (ix) a diamond ring; on [the client s] death, one or more of the following: A. Registered Retirement Income Fund valued at approximately $29,000; B. $29,000; C. a television set; and D. a grandfather clock. 2. While employed as a Registered Nurse at [the facility], and while holding the position of Facility Supervisor, you provided care and treatment to a resident, [the client], and failed to terminate the nurse-client relationship with [the client] when it became clear that [the client] was developing an emotional attachment to you that was incompatible with the therapeutic nurse-client relationship. 3. While employed as a Registered Nurse at [the facility], and while holding the position of Facility Supervisor, you provided care and treatment to a resident, [the client], with whom you engaged in a personal relationship which resulted in [the client] changing [the client s] will such that you became a beneficiary under the terms of the will. College Counsel informed the panel that it wished to withdraw allegation #2. The panel granted this request. Member s Plea Ms. Kopp admitted the allegations set out in paragraphs numbered 1 and 3 in the Notice of Hearing. The panel conducted a plea inquiry (Exhibit #2) and was satisfied that the Ms. Kopp s admission was

4 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 (Exhibit #3) which provided as follows. THE MEMBER 1. Ms. Kopp graduated from the RN Diploma Program at [ ] in Ms. Kopp worked briefly with [ ] and then, on May 27 th, 1996, she began a nursing position working at [the facility], a retirement home, in the position of a Facility Supervisor. At the time that she commenced her employment at [the facility], Ms. Kopp was [ ]. She has worked at [the facility] ever since and is now the Resident Care Coordinator, a position she has held since January 8 th, 2001, and Acting Administrator. 2. In the position of the Facility Supervisor, Ms. Kopp was responsible for a variety of duties which included, among other things, ensuring the physical and emotional well-being and safety of residents, constant surveillance of residents for physical and emotional well-being, staff supervision and guidance, maintaining positive public relations with all visitors, administering medications and drug therapies including injections, storing and ordering drugs, documenting all aspects of drug therapy, assisting residents in all aspects of personal care, obtaining and documenting vital signs as deemed necessary, answering call bells, and assisting as required. A copy of the Facility Supervisor s job description is attached (please see Appendix A ). THE FACILITY 3. [ ] THE CLIENT 4. [The client] was admitted to [the facility] on [ ] at the age of 80. [The client] was a retired [ ]. [The client] decided to enter the retirement home after [the client s spouse] had passed away and [the client s] physical condition began to deteriorate. [The client] suffered from [various medical conditions]. However, [the client] was able to administer [ ] medication and arrange [ ] appointments. During the last years of [the client s] life, [the client] was admitted to hospital on occasion and suffered the occasional bout of pneumonia. [The client] remained alert, oriented, and mentally competent until [the client] died [ ]. 5. [The client] had no children or other immediate family. While at [the facility], [the client] had few visitors and tended to isolate [ ]. [The client] enjoyed social visits from a close family friend, [ ], a couple of times per month. [The

5 client s] [relative] and [the relative s spouse] also visited approximately once a month. Otherwise, [the client] had minimal contact with staff and other residents, although [the client] did participate in some social functions at the home. 6. [The client] remained very independent at [the facility]. For instance, [the client] maintained a relationship with his own lawyer and Power of Attorney for Property and Personal Care, [the Lawyer], and an accountant with whom [the client] consulted privately regarding his financial affairs. As well, [the client] met on more than one occasion with lawyers and Estate Planning & Wills consultants at [a bank] in order to discuss [the client s] investments and changes which [the client] wanted made to [the] will. 7. At the time of [ ] admission to [the facility], [the client] had a will dated January 12 th, 1994 (please see Appendix B ). The will named [the lawyer] and [the accountant] as [ ] executors. [The family friend] was to receive [the client s] condominium. All household items and personal articles were to go to [the relative]. [The client] changed [the client s] will, effective July 9 th, 1999, and named [the relative] and [the family friend] as the designated executors. [The client] left [the client s] large television set and [ ] grandfather clock to Ms. Kopp. [The family friend] and [the friend s spouse] were bequeathed $135,000. [The relative] was to receive the remainder of [the client s] property (please see Appendix C ). FACTS RELEVANT TO THE ALLEGATIONS NURSE-CLIENT RELATIONSHIP: 8. Ms. Kopp originally worked part-time as an R.N. at the retirement home i and provided care to [the client] on many occasions [ ]. This care is documented throughout the nursing notes for [the client]. NURSE-CLIENT BOUNDARIES: 9. Ms. Kopp would, in her role as Facility Supervisor, interact with residents in an attempt to foster communication and human contact with them. She would spend a short amount of time chatting with different residents each day, including [the client]. 10. Ms. Kopp visited [the client] regularly in order to chat. She would visit [the client] before and after her shifts, often in the afternoons and sometimes late in the evening if [the client] was awake. ii [The client] clearly looked forward to seeing Ms. i Ms. Kopp commenced full-time employment on January 8, 2001 when she assumed the position of Resident Care Coordinator. ii Other nurses who worked at [the facility] were not aware of any nurses, other than Ms. Kopp in this particular situation, staying after their shifts to visit with residents.

6 Kopp and recorded many of her visits on [the client s] calendar. In contrast, [the client] did not often record visits by other nurses or staff persons at [the facility] on [the] calendar. A copy of [the client s] calendar for the year 2000 is attached (please see Appendix D ). 11. Ms. Kopp exchanged stories with [the client] about topics which were of interest to [the client], such as vacations, pets and [the client s] work as a pharmacist. Sometimes, the stories shared by Ms. Kopp with [the client] were about her own travels and family. She would call [the client] when she was not at work. At times, Ms. Kopp would telephone [the client] personally to let [the client] know that she could not attend for a scheduled shift. If Ms. Kopp were to testify, she would say that she rarely missed a scheduled shift and she telephoned [the client] only after she had reported her absence to her employer. 12. When on vacation, Ms. Kopp kept [the client] abreast of her travels, sent [the client] postcards and, on one occasion, telephoned [the client] from overseas. If she were to testify, Ms. Kopp would say that she sent the postcards out of concern for [the client s] loneliness and that she telephoned [the client] from overseas because [the client] was suffering from bronchitis and she had hoped to reduce [the client s] increased anxiety due to [this] illness. [The client] marked Ms. Kopp s vacation dates on [the client s] calendar and kept the correspondence [ ] received from her while she was on her vacations. 13. Ms. Kopp sometimes visited [the client] on her days off. In addition, Ms. Kopp would visit [the client] when [the client] was in hospital. One time, [the client] was in hospital while she was on vacation in Europe with her family. She informed [the client] by mail that she had tried to call [ ] from Europe on a few occasions (please see Appendix E ). If Ms. Kopp were to testify, she would say that she visited residents while they were hospitalized given that they would likely be returning to [the facility] after their hospital stay. 14. Ms. Kopp gave [the client] greeting cards over the four years that she provided care to [the client], to mark occasions such as [birthdays], Valentine s Day, Easter and Christmas (please see Appendix F ). 15. [The client] had Ms. Kopp s home telephone number. At times, she would speak with [the client] by telephone when she was not at [the facility]. [The client] would often record on [the client s] calendar when Ms. Kopp called [ ] (please see Appendix D ). On occasion, [the client] would call Ms. Kopp at her residence or would try to find her by calling her mother. 16. Ms. Kopp introduced her mother, grandmother and nephew to [the client] and other residents at [the facility]. If Ms. Kopp were to testify, she would say that the introductions were made while she was on a supper medication round in the home s dining room. Subsequently, Ms. Kopp s mother and grandmother visited [the client] on approximately four occasions without Ms. Kopp. Ms. Kopp s mother also

7 corresponded with [the client]. 17. On one occasion, Ms. Kopp and her mother visited with [the client], [the relative and the relative s spouse] at [the client s] condominium. [The client] visited the condominium on occasion while a resident of [the facility]. 18. At [the client s] request, Ms. Kopp provided [the client] with photographs of herself, some taken while she was in [the] condominium. One of the pictures shows Ms. Kopp in the Tilley outfit that [the client] had bought for her. Another picture shows Ms. Kopp beside the roll top desk that [the client] had bought for her. [The client] kept one of the photographs of Ms. Kopp at [the client s ] bedside at [the facility]. [The client] expressed to Ms. Kopp that the photographs gave [the client] reassurance and encouragement during the times that she was away from [the facility] (please see Appendix G ). [The client] also displayed photographs of [the niece s] family, [the family friend and the friend s spouse], and [the client s] family physician s children in [the client s] room at [the facility]. 19. Ms. Kopp s visits with [the client] and other residents occurred openly and with the knowledge and permission of the Administrator at [the facility]. [The Administrator] was a registered nurse with over 40 years of employment experience, and had been employed as [the facility s] Administrator since the home opened in 1981 until her retirement in The owner and operator of [facility] is very experienced in the industry. If he were to testify, he would say that he had complete confidence and trust in [the Administrator s] judgment and professionalism. 20. If Ms. Kopp were to testify, she would say that [the Administrator] encouraged her to continue her communication with [the client], and repeatedly commended her for [the client s] brightened spirits and positive attitude. Ms. Kopp would also say that she had received permission from [the Administrator] for members of her family to visit with [the client]. Further, Ms. Kopp would say that she trusted and relied upon [the Administrator s] advice and guidance regarding her interactions with [the client], despite concerns raised by her colleagues (see below). CASH GIFTS: 21. During the currency of their nurse-client relationship, Ms. Kopp accepted numerous monetary gifts from [the client], including the following: (a) $250 for Christmas 1997; (b) $350 for her birthday in 1998; (c) $300 for an anniversary and graduation gift in 1998; (d) $100 for Valentine s Day in 1998; (e) $825 for Christmas in 1998;

8 (f) $500 for Ms. Kopp s vacation in 1998; (g) $225 for Valentine s Day in 1999; (h) $1000 for Christmas in 1999; (i) $2000 for her birthday in 1999; (j) $200 for Ms. Kopp s vacation in 2000; (k) $1000 for Christmas 2000; (l) (m) $1000 to purchase end tables and lamps for herself; and $100 for Ms. Kopp s nephew s trip with Ms. Kopp to Stonehenge in England (please see Appendix H ). THE DIAMOND RING: 22. In April 1998, [the client] signed a Declaration of Gift evidencing his intention to give Ms. Kopp a diamond ring as a sign of [their] friendship (please see Appendix I ). The Declaration of Gift was prepared by [the lawyer]. That same month, [the client] presented Ms. Kopp with a ring containing five diamonds. The ring had a total replacement value of $2,500 iii (please see Appendix J ). If [the family friend] were to testify, she would say that when she asked Ms. Kopp about the ring, Ms. Kopp blushed and told [the family friend] that [the client] had given it to her. If Ms. Kopp were to testify she would say that she has no recollection of this incident, nor does she recall being embarrassed. THE CONDOMINIUM: 23. When [the client] moved to [the facility], [the client] did not sell the condominium where [the client and the client s spouse] had lived previously. [The client] kept it in case [the client] decided not to stay at [the facility]. 24. [The client] gave Ms. Kopp a key to [the] condominium. On occasion, during times of inclement weather, Ms. Kopp stayed at [the client s] condominium, at [the client s] invitation. [The client] was never present in the condominium when she spent the night. 25. On May 10 th, 1999, [the client] signed a Declaration of Gift evidencing [the client s] intention to give Ms. Kopp [the] condominium as a sign of their friendship. iii The Appraisal is in Ms. Kopp s name, not [the client s], and is dated March 27, The Declaration of Gift signed by [the client] is dated April 20, 1998.

9 The Declaration of Gift was prepared by [the lawyer] (please see Appendix K ). If [the relative and family friend] were to testify, they would say that [the client] told them that [the client] intended to sell [the] condominium to Ms. Kopp. The Transfer/Deed of Land effecting the sale for consideration of $2.00 was completed on July 29, 1999 (please see Appendix L ) 26. [The client] also discussed [the client s] wishes concerning the condominium on more than one occasion with a lawyer and Estate Planning & Wills consultant at [a bank]. If [the consultant] were to testify, she would say that [the client] was unequivocal in [the client s] desire to gift the condominium to Ms. Kopp. She would also say that [the client] was, in her professional opinion, acting on [the client s] own free will and was not influenced by anyone with respect to [the] decision to gift the condominium to Ms. Kopp. 27. If Ms. Kopp were to testify, she would say that her initial response when she learned that [the client] intended to gift [the] condominium to her was to insist that it be given to [the relative and the relative s] children. Ms. Kopp would also say that [the client] insisted that she accept the condominium because [the client] feared that it would be sold by [the client s] family. [The client] also insisted that [the client s late spouse] had already provided generously for their family in [the spouse s] will and thus, the family did not need the condominium. Ms. Kopp accepted and moved into the condominium, where she currently lives. VARIOUS OTHER GIFTS: 28. [The client] gave Ms. Kopp additional non-monetary gifts during their nurseclient relationship, including the following: (a) payment of the condominium fees for a period of approximately six months after Ms. Kopp had moved in; (b) a subscription to and gift from National Geographic in or about 1999 (the subscription was renewed in each of 2000 and 2001 by [the client] for Ms. Kopp); (c) payment of Ms. Kopp s CAA Membership in 2000 and 2001; (d) a roll top desk purchased for Ms. Kopp at the price of $1169; (e) furniture consisting of a leather sofa and chair, and an oak dining set, valued at approximately $4000. [The client], along with Ms. Kopp and her mother, selected these items for [the client] at his request, when he decided to move into a larger suite at [the facility]. If Ms. Kopp were to testify, she would say that [the client] provided a list of items that [the client] wanted and specified the amount [to be] spent on each item. When [the client] moved into a smaller room and no longer required the furniture, [the client] gifted it to Ms. Kopp.

10 (f) (g) (h) a Tilley outfit for Ms. Kopp s trip to England; (please see appendix G ) payment of her monthly mobile phone fees; and a camera. GIFTS RECEIVED UPON [THE CLIENT S] DEATH: 29. By hand-written correspondence dated June 16 th, 1998, [the client] advised the [financial institution] that he wished to change the beneficiary of [a] Registered Retirement Income Fund ( RRIF ) from [the client s late spouse] to Ms. Kopp. In that correspondence, [the client] provided the Bank with [ ] contact information to ensure that [the client] could be reached in the event that the Bank needed anything further to complete the change (please see Appendix M ). [ ] The Estate Planning & Wills consultant [ ] was aware that [the client] wanted to leave [the] RRIF to Ms. Kopp. If she were to testify, she would say that she advised [the client] to make Ms. Kopp the beneficiary of the RRIF so that [the client] could avoid paying the probate fees. She further advised him to contact the [ ] bank directly in order to make the change. 30. After [the client s] death, Ms. Kopp was contacted by the Estates and Trusts Department of [ ] and learned for the first time that she was the beneficiary of the RRIF left to her by [the client]. Ms. Kopp had no knowledge of the RRIF during [the client s] lifetime. The RRIF was valued at $26, on the date of [the client s] death (please see Appendix N ). Ms. Kopp has since received the funds from the RRIF. 31. In [the client s] will, [the client] left the large television set which was in [the client s] room at [the facility] to Ms. Kopp. Furthermore, a grandfather clock was expressly left to Ms. Kopp in [the client s] will. If [the relative] were to testify she would say that the grandfather clock had been promised to her son for years. 32. [The client] never disclosed to the executors of [the will about gifting the] grandfather clock to Ms. Kopp. [The client] also never disclosed [ ] that Ms. Kopp was to be the beneficiary of [the] RRIF. However, during [the client s] lifetime, [the relative] knew that [the client] had given Ms Kopp a Tilley outfit and a camera; [The family friend] knew about these gifts and the roll top desk. Neither [the relative nor the family friend] complained to anyone at [the facility] or to the College until after [the client s] death. If [the family friend] were to testify she would say that she did not think it was her place to do so, although she did raise concerns with [the client s] physician. If [the relative] were to testify she would say that she did not want to interfere with [the client s] wishes, however inappropriate she felt it was that he was giving gifts to Ms. Kopp. Both women expressed concern to [the client] about the fact that [the client] was giving gifts to Ms. Kopp, but did not know during [the client s] lifetime the extent of the gifts that [the client] gave to her.

11 THE EMPLOYER S POLICY REGARDING GIFTS: 33. Effective September 1991, [the facility] had the following written policy regarding Receipt of Gifts from Guests : POLICY Staff may accept gifts from Guests. PROCEDURE Gifts maybe [sic] accepted providing the following criteria are met: 1. Staff person s immediate supervisor is made aware of the gift. 2. Resident is competent and able to make own decision. 3. The gift s value is not excessive. If any of the above criteria are not met and the resident still insists on giving the gifts, the documented responsible person should be contacted. It is not our intent to take away a resident s right of choice, but we must also make sure a resident is not exploited. (please see Appendix O ). ADVICE GIVEN TO MS. KOPP REGARDING GIFTS: 34. Ms. Kopp consulted with [the administrator, the owner and the lawyer] about the propriety of accepting the diamond ring and the condominium as gifts from [the client] because she was concerned about the ethical implications of same. All of them told Ms. Kopp that it was legal and permissible for her to accept these gifts. 35. On one occasion, [the Administrator] and [the client] met with [the consultant] to discuss the gifting of the ring. If [the consultant] were to testify, she would say that [the Administrator] had no problem whatsoever with Ms. Kopp accepting the gift because, in her view, Ms. Kopp had never behaved improperly in her interactions with [the client]. [The administrator] attended the meeting at [the client s] request because both of them wanted to ensure that Ms. Kopp s acceptance of the ring would be completely legal. This information is also detailed in a contemporaneous Memorandum prepared by [the consultant] dated April 14, 1998 (please see Appendix P ). 36. [The administrator] also discussed Ms. Kopp s acceptance of the ring and condominium with [the lawyer and the owner], who is also a trained lawyer. Both told her that, legally, Ms. Kopp could accept these gifts. [The administrator] also believed that [the client] was an independent and intelligent [person] who was insistent that Ms. Kopp accept the gifts. In [the Administrator s] view, it was very important to respect [the client s] wishes. She also believed that to not allow Ms.

12 Kopp to accept these gifts would take away from [the client s] individual civil liberties because she believed [the client] should be entitled to do what [the client] wanted with [the client s]possessions. 37. If [the lawyer] were to testify, he would say that he had acted as [the client s] lawyer for several years, even before [the client] moved into [the facility]. He would also say that he prepared the Declarations of Gift for the ring and the condominium, as well as the documentation regarding the transfer of the condominium, at [the client s] request. [The lawyer] would also testify that he met with Ms. Kopp and her parents and explained to them that it was perfectly legal and appropriate for Ms. Kopp to accept the gifts because [the client] was mentally competent and had chosen to make the gifts to Ms. Kopp. In [the lawyer s] view, Ms. Kopp had not done anything to solicit the gifts or influence [the client] to make them. 38. If Ms. Kopp were to testify, she would say: i) that she only accepted the gifts because she trusted the advice of an experienced nurse, her employer and [the client s] lawyer that it was proper for her to do so; and, ii) that had she known that the College of Nurses of Ontario would disapprove of the gifts, she would not have accepted them. CLIENT COMPETENCY AND WISHES: 39. [The client] was mentally competent throughout [the client s] lifetime. [The client] wished Ms. Kopp to have the gifts and was adamant that she accept them. At all times, [the client] was expressing [the client s] individual desire in giving gifts to Ms. Kopp. OTHER STAFF: 40. Other staff members were aware that [the client] and Ms. Kopp seemed to enjoy each other s company. Some felt that [the client] was clearly infatuated with Ms. Kopp because [the client] would talk about her all the time, worry about her all the time, and knew her schedule all the time. They were concerned about [the client s] perception of [the] relationship with Ms. Kopp. The other nurses would talk about Ms. Kopp s relationship with [the client] and about her accepting gifts from [the client]. While many of the nurses were unaware of [the facility s] Policy regarding gifts, they were aware from their nursing training, experience, and professional ethics that to accept gifts of such magnitude was unethical. 41. Through peer feedback as part of Quality Assurance and in meetings for reflective practice, Ms. Kopp s colleagues let her know that they were concerned about her relationship with [the client]. Ms. Kopp was given feedback about being careful in her personal relationships with residents. Her colleagues warned her about getting too close and personal with residents and suggested to her that she moderate her behaviour with residents.

13 42. If Ms. Kopp were to testify, she would say that in response to some of her colleagues concerns she sought guidance from [the Administrator]. Ms. Kopp never sought guidance from a College of Nurses Practice Consultant with respect to her colleagues concerns because [the Administrator] approved of and encouraged her relationship with [the client]. As well, [the Administrator, the owner and the lawyer] had assured her that she could accept the gifts. THE CNO S STANDARDS 43. In March of 1999 the College of Nurses of Ontario published a document entitled Standard for the Therapeutic Nurse-Client Relationship, which deals specifically with the nurse-client relationship (please see Appendix Q ). This document was sent out to all Members of the College at that time. It points out that it is the responsibility of the nurse, regardless of her intent, to set and maintain appropriate boundaries of the nurse-client relationship for the duration of the relationship, regardless of the wishes of the client. The document provides a list of warning signs regarding boundary issues. Although this document would not have been received by Ms. Kopp until almost three years after she met [the client], and some time after she accepted several gifts from him, a previous publication of the College emphasized the need to maintain a professional nurse-client relationship and the need to ensure that behaviour did not cross the boundaries of the therapeutic relationship. iv 44. In the March 1997 edition of the Communiqué, a College of Nurses of Ontario publication, an article was published regarding the issue of accepting gifts from clients and when the boundaries of the therapeutic nurse-client relationship may be crossed. A copy of this article, which Ms. Kopp would have received at the time as a Member of the College of Nurses of Ontario, is attached as Appendix R. EXPERT EVIDENCE 45. [An expert] would testify that Ms. Kopp failed to meet or contravened the standards of practice of the profession, and engaged in conduct which, in all of the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, in that she failed to recognize a breach of the boundaries of the therapeutic nurse-client relationship with [the client], and that she accepted gifts of more than modest value from [the client]. Further, [the expert] would say that Ms. Kopp breached the professional standards, which trump an inadequate and inconsistent policy regarding gifts, as well as any advice which Ms. Kopp may have received from others, including [the Administrator]. ADMISSIONS OF MISCONDUCT iv Guidelines for Professional Behaviour, College of Nurses of Ontario, 1995.

14 Decision 46. Ms. Kopp admits that she committed acts 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 paragraph 1.1 of Ontario Regulation 799/93, in that, from in or about early 1998 until in or around June 2001, while employed as a Registered Nurse at [the facility], she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, in that she failed to maintain the acceptable boundaries of a therapeutic relationship with a resident, [ ], while providing care and treatment to [the client], she failed to terminate the nurse-client relationship when acceptable boundaries of the therapeutic relationship had been breached, and she accepted inappropriate gifts from [the client], the particulars of which are set out in Schedule A. 47. Ms. Kopp admits that she has committed acts 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 paragraph 1.37 of the Ontario Regulation 799/93, in that, from in or about early 1998 until in or around June 2001, while employed as a Registered Nurse at [facility], she engaged in conduct or performed acts relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded by members as unprofessional, including failing to maintain the acceptable boundaries of a therapeutic relationship with a resident, [ ], failing to terminate the nurse-client relationship when acceptable boundaries of the therapeutic relationship had been breached, and by accepting inappropriate gifts from [the client], the particulars of which are set out in Schedule A. 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 and 3 of the Notice of Hearing in that Ms. Kopp: 1. committed an act or acts 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 paragraph 1.1 of Ontario Regulation 799/93, in that, from in or about early 1998 until in or around June 2001, while employed as a Registered Nurse at [the facility], she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, the particulars of which are set out in Appendix A ; and 3. committed an act or acts 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 paragraph 1.37 of Ontario Regulation 799/93, in that, from in or about early 1998 until in or around June 2001, while employed as a Registered Nurse at [the facility], she engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded

15 by members as disgraceful, dishonourable or unprofessional, the particulars of which are set out in paragraphs 1 and 3 of Appendix A, (reprinted above at pages 2-3). Reasons for Decision The panel unanimously accepted the Agreed Statement of Facts as outlined above. Specifically, the member developed a personal relationship with the client that went beyond the therapeutic nurse client relationship. She visited with the client when off duty; she communicated with the client from vacations through telephone calls, cards and letters; she had photographs taken of herself in the client s condominium which [the client] displayed by [the client s] bed; she gave the client her home telephone number; she accepted personal gifts of significant monetary value on several occasions for herself and specific gifts to family members; and she never declined or redirected these gifts. Penalty Counsel for the College advised the panel that a Joint Submission on Penalty (Exhibit #4) had been agreed upon. The Joint Submission on Penalty asks that this panel: 1) reprimand the Member;. 2) direct the Executive Director to suspend the Member s Certificate of Registration for a period of five (5) months from the day the Member s appeal rights end as a result of exhaustion, expiry or waiver; and 3) direct the Executive Director to impose the following terms, conditions and limitations on the Member s Certificate of Registration: A. Within one year of the imposition of the above penalty, the Member shall: (a) (b) successfully complete a community college level course of study in ethics and/or professional boundaries as applied to the health care provider/ client relationship that has been previously approved by the Director of Investigations and Hearings of the College, and must provide proof of successful completion of the course to the Director; and meet with a Practice Consultant of the College to review ethical issues in the nurse-client relationship and the College s Standards with respect to gifts and the allegations that gave rise to these proceedings; B. Within one week of the imposition of any penalty with respect to this matter, the Member shall provide a copy of the Agreed Statement of Facts and Joint Submission on Penalty or, if available, the Panel s Decision and Reasons and Penalty Order, to the current owner(s)of [the facility] as well as to the Administrator of [the facility]. C. For a period of two years following the completion of any suspension with respect to this matter, the Member shall:

16 (a) (b) (c) only accept employment with an employer who will agree to notify the College of any suspected breaches of the Nursing Act and/or its regulations by her; provide any and all employers with a copy of the Decision and Reasons and the Penalty Order; and, shall work only for an employer who agrees to provide to the College of Nurses of Ontario a performance appraisal every six (6) months which specifically addresses the issue of the maintenance of appropriate boundaries with clients. The Member made no submission regarding the Joint Submission on Penalty. 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. 2) the Executive Director to suspend the Member s Certificate of Registration for a period of five (5) months from the day the Member s appeal rights end as a result of exhaustion, expiry or waiver. 3) the Executive Director to impose the following terms, conditions and limitations on the Member s Certificate of Registration: A. Within one year of the imposition of the above penalty, the Member shall: (a) (b) successfully complete a community college level course of study in ethics and/or professional boundaries as applied to the health care provider/ client relationship that has been previously approved by the Director of Investigations and Hearings of the College, and must provide proof of successful completion of the course to the Director; and meet with a Practice Consultant of the College to review ethical issues in the nurse-client relationship and the College s Standards with respect to gifts and the allegations that gave rise to these proceedings; B. Within one week of the imposition of any penalty with respect to this matter, the Member shall provide a copy of the Agreed Statement of Facts and Joint Submission on Penalty or, if available, the Panel s Decision and Reasons and Penalty Order, to the current owner(s)of [the facility] as well as to the Administrator of [the facility]. C. For a period of two years following the completion of any suspension with respect to this matter, the Member shall:

17 (a) (b) (c) only accept employment with an employer who will agree to notify the College of any suspected breaches of the Nursing Act and/or its regulations by her; provide any and all employers with a copy of the Decision and Reasons and the Penalty Order; and, shall work only for an employer who agrees to provide to the College of Nurses of Ontario a performance appraisal every six (6) months which specifically addresses the issue of the maintenance of appropriate boundaries with clients. Reasons for Decision on Penalty The panel concluded that the proposed penalty is reasonable and provides a specific deterrent to this Member and a general deterrent to other members of the profession, indicating such behaviour will not be tolerated. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions. The requirement for completion of an ethics course of study and meeting with a Practice Consultant of the College is rehabilitative in nature and will assist the Member to safely return to the practice of nursing, thereby upholding the public interest. I, Jim Attwood, 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 as listed below: Chairperson Date Panel Members: Karen Breen-Reid, RN Anne McKenzie, RPN Shamsul Islam, Public Member David Bishop, Public Member