DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO. PANEL: Joanne Furletti, RN Chairperson Rosalie Woods, RPN Member

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1 DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Joanne Furletti, RN Chairperson Rosalie Woods, RPN Member Gino Cucchi Public Member John Bald Public Member BETWEEN: COLLEGE OF NURSES OF ONTARIO ) GLYNNIS BURT for ) College of Nurses of Ontario - and - ) ) DIANE FALCONER Registration No ) ELIZABETH MCINTYER for ) Diane Falconer ) ) ) ) Heard: February 5, 2008 & ) November 13, 2008 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on February 5, 2008 at the College of Nurses of Ontario (the College ) and November 13, 2008 at the JPR Meeting Rooms, 390 Bay Street at Toronto. The Allegations College counsel requested that the panel allow allegations #1(d) and #2(a),(b),(c),(d) to be withdrawn. The panel granted the request. The remaining allegations against Diane Falconer (the Member ) as stated in the Notice of Hearing [ ] dated November 6, 2007 are as follows. 1. You have committed an act of professional misconduct as provided by sub-section 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.1 of Ontario Regulation 799/93, in that, while employed as a nurse at [the Hospital], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession in that you: (a) On or about July 19/20, 2002, on the night shift, connected an insulin infusion to an arterial sheath with respect to [Client A], contrary to hospital policy; and/or

2 (b) (c) (d) On or about July 20/21, 2002, on the night shift, administered the wrong medication to [Client B], having administered Dextran 10% when the order was for Dextrose 5%; and/or On or about July 20/21, 2002, on the night shift, obtained a morphine cassette for PCA administration as ordered for [Client B], but did so by accessing the [client] profile for the wrong [client], namely, [Client C]; and/or [Withdrawn] 2. [Withdrawn] Member s Plea The Member admitted the allegations set out in paragraphs numbered 1(a),(b) and (c) in the Notice of Hearing. The panel conducted a plea inquiry and was satisfied that the Member s admission was voluntary, informed and unequivocal. A written plea inquiry was also provided to the panel. 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. Diane Mary Falconer ( the Member ) became a registered nurse ( RN ) in 1978 and has been registered with the College of Nurses of Ontario ( the College ) since The Member worked at [the Hospital] [ ] - since Commencing in 1990, the Member regularly worked on the [ ] Unit. The Member worked full-time night shifts in the [ ] Unit from May 2000 until The Member is presently working at [ ] a long-term care and retirement living facility. She has renewed her registration with the College for The Member has no prior history of discipline or other outstanding complaints at the College. THE FACILITY 5. [The Unit ] is located at the Hospital. It provides comprehensive, acute care for [clients] with all forms of vascular disease. Vascular disease affects the arteries and veins, and can lead to aneurysms and blockages that slow or stop blood flow to the brain, limbs and all vital organs. The [Unit] is staffed by vascular surgeons,

3 vascular radiologists, specialists in internal medicine, vascular technologists and nurses. 6. From July 19 to 21, 2002, the Member worked night shifts on the Unit. Her shifts started at 1900 hours and ended at 0700 hours. 7. On July 19, 2002, the Member and another registered nurse worked the night shift with four [clients] on the Unit. On July 20, 2002, the Member and another registered nurse worked the night shift with three [clients] on the Unit. At the relevant time, the Unit had a nurse to client ratio of 1:2. INCIDENT 1 (A) CONNECTED AN INSULIN INFUTION TO AN ARTERIAL SHEATH 8. On the night shift, July 19/20, 2002, the Member was assigned to care for [Client A]. 9. At 1900 hours on July 19, 2002, the physician for [Client A] ordered that [Client A] be infused with Tissue Plasminogen Activator ( TPA, an anti-thrombolytic agent administered to dissolve blood clots) through an infusion catheter. The physician also ordered that [Client A] attend at the Radiology Department for assessment the following day, July 20, 2002, at 0800 hours. In a separate order on July 19, 2002, a physician ordered that [Client A] receive insulin intravenously ( IV ). 10. Between 1915 hours on July 19, 2002 and 0715 hours on July 20, 2002, the Member made entries at 19:15, 21:00, 22:00, 1:15, 02:00, 03:00, 04:00, 05:00, and 06:00. [ ] Some of her entries indicate the following: the Member began infusing IV insulin at 2100 hours; the Member monitored the blood sugars and readjusted the rate of infusion for the Insulin at 22:00, 02:00, and 06:00; the femoral sheath lines were assessed every two hours; at 21:00, it was oozing fresh blood. The femoral arterial line was in place for a TPA infusion. 11. On July 20, 2002, at 0800 hours, [Client A] was brought to the Radiology Department to have his arterial line reassessed and to have the effectiveness of his treatment assessed. 12. The nurse in the Radiology Department, [Nurse A], received [Client A] and discovered that his IV insulin was improperly connected to and infusing through the femoral arterial line. Upon observing this, [Nurse A] called for the charge nurse [ ]. 13. Upon reviewing the situation, the charge nurse [ ] filled out a patient incident report [ ]. [The charge nurse] filed the report during the day shift on July 20, The report stated that the Member had connected an insulin infusion to a pre-existing femoral arterial line that was in place for a TPA infusion. The incident report characterized the type of incident as minor.

4 14. The Unit s arterial line protocol at the relevant time [ ] indicated that no medications or solutions should be administered through an arterial line. 15. If the then-nursing manager of the unit [ ] were to testify, she would say: (a) only thrombolytic therapy medication should have been infused through the femoral arterial line; at no time should regular medications such as insulin have been infused through a femoral arterial line; (b) when she questioned the Member about the above incident, the Member admitted that she was unsure of the correct policy and procedure for the care and management of femoral arterial lines, and could not explain why one ought not to infuse medications other than thrombolytics via femoral arterial sheaths; (c) she explained to the Member that only medications for the benefit of thrombolytic therapy should be infused through a femoral arterial line, and that the insulin should be given intravenously, rather than arterially; and (d) the Member acknowledged her error in having connected the insulin infusion to the femoral arterial sheath, and indicated she understood that an arterial line should never be used for an infusion of regular medication or solutions. 16. If the Member [were] to testify, she would say (a) it was her perception that there was a lack of access sites for [Client A]; (b) the Member consulted with a colleague, who had previously performed the position of the Acting Nursing Manager on the [Unit], prior to connecting the IV infusion to the femoral sheath to verify compatibility with TPA, the lack of access sites for [Client A], and that the femoral sheath line could be used for the Insulin Infusion. This nurse advised the Member of the port on the arterial femoral line to which she should attach the Insulin, prior to the Member so doing. (c) the Member recalled a previous incident on the [Unit] during which a physician allowed a nurse to run an infusion through the femoral arterial line in a situation where a [client] had a lack of access sites. (d) the policy referred to in paragraph 16 was not available in the Policies & Procedural Manual on the [Unit] when the Member went to look for it immediately after the incident occurred. (e) the Member now understands that such a procedure is not permissible. She has adjusted her practice accordingly;

5 INCIDENT 1(B) DEXTROSE/DEXTRAN ADMINISTERED WRONG MEEDICATION TO [CLIENT] 17. On the night shift of July 20/21, 2002, the Member was assigned to care for [Client B]. 18. On July 20, 2002, the physician for [Client B] ordered that [Client B] receive 5% Dextrose at 75 ml/hr. Dextrose is sugar and water, and is generally prescribed for keeping IV lines open, for administering medication, and for maintenance or replacement therapy when large amounts of fluid have been lost. 19. The nursing notes completed by the Member for the night shift of July 20/21, 2002, indicate that [Client B] received 5% Dextrose solution at the prescribed rate. The Member recorded three different entries on the [client] s 24-hour fluid infusion record. Each of them indicates that 5% Dextrose had been hung on [Client B] s intravenous line. [ ] The Member s notes [on the 24-hour fluid infusion record] are at 1950, 1950, and On the morning of July 21, 2002, following the Member s night shift, the day shift nurse, [Nurse B], discovered that the Member had hung and administered Dextran 10% solution at 75 ml/hr instead of Dextrose 5% at 75 ml/hr. Dextran is a plasma volume expander that prevents platelets from adhering to each other and has the potential to negatively affect cardiac output. 21. Upon discovering the error, [Nurse B] wrote a clinical note and recorded that the Right Cordis line and Right External Jugular line had 10% Dextran infusing rather than 5% Dextrose. The documentation indicated that one of the lines had infused at a rate of 75 ml/hour while the other line was turned off. [ ] 22. [Nurse B] also completed an Incident Report [ ]. 23. If [Nurse B] were to testify, she would say that she cannot recall how much Dextran solution the client received, and that she recalls emptying some remaining Dextran from one 500 ml bag of 10% Dextran that had been connected to [Client B] and sent it to the nurse manager [ ] in an envelope, together with a second bag of Dextran that had been hung and turned off. 24. If [the nurse manager] were to testify, she would say that when she spoke with the Member about this incident, the Member accepted that she had administered the wrong medication to [Client B], and acknowledged her error. INCIDENT 1(C) ACCESSED WRONG [CLIENT] S PROFILE TO REMOVE MEDICATION FROM MACHINE 25. On the night shift of July 20/21, 2002, the Member was assigned to care for [Client B].

6 26. The physician for [Client B] ordered that the client receive Morphine 2 mg/ml via a Patient-Controlled Analgesia Device ( PCA ), which automates the distribution, management and control of medications to an individual [client] according to each [client] s profile. 27. The pharmacy Profile report for the night shift of July 20, 2002, indicated that just after midnight, the Member removed 2 mg/ml of morphine from the Pharmacy Pyxis Medication Dispensing Machine ( Pyxis machine ), and in particular from the profile of another [client], [Client C]. [The] Profile Override Report dated 07/21/2002 [ ] shows the removal of morphine sulphate 2 mg/ml by Diane Falconer at 23:53 on July 21, 2002, under [Client C s name]. 28. [Client B] and [Client C] had the same last name, but different first names. [Client C], was no longer on the Morphine PCA, and was no longer a client on the [Unit]. 29. The Hospital was unable to locate an entry on the Pyxis machine for removal of morphine for administration to [Client B] on the night of July 20/ Instead, the Member had accessed [Client C] s [client] profile on the Pyxis machine to remove the morphine cassette for administration to [Client B], rather than removing the morphine cassette from [Client B] s [client] profile. The medication type and concentration for morphine was the same for both clients. 31. If [the nurse manager] were to testify, she would say that the pharmacist at the Hospital brought the above medication error to the attention of the nursing manager [ ]. She would further say that when she asked the Member about the incident, the Member admitted that she accessed the incorrect file on the Pyxis machine. In particular, the Member admitted that she had obtained a morphine cassette for PCA administration as ordered for [Client B], but had done so by accessing the profile of the wrong [client], [Client C]. She also stated that she understood the importance of following through with all five checks identified in the College s standards for medication administration, namely, the right medication, in the right dose, by the right route, at the right time, and to the right client. 32. If the Member were to testify, she would say that she did check that the medication, dosage, route, time of administration, and [client] to whom she was administering the medication was right. She inadvertently made an error respecting the source or [client] profile from which she accessed the medication. COLLEGE S MEDICATION ADMINISTRATION STANDARDS 33. [The] College s Standards document entitled Medication Administration Standards [ ] was in place at the relevant time. 34. [The] College s Standards document entitled Standard for the Therapeutic Nurse-Client Relationship [ ] was in place at the relevant time.

7 EXPERT OPINION 35. The College sought an independent expert opinion with respect to the above matters. An opinion was obtained from [the expert]. [The expert] was the Director of Professional Practice at [a] Hospital. [ ] 36. With respect to the incident described as 1(a), above, if [the expert] were to testify, she would say: (a) the Member breached two standards of practice, namely, the medication administration standard and the professional standards; (b) the Member breached the medication administration standard in that she administered the insulin to [Client A] via the wrong route, namely, through an arterial line rather than through an intravenous line; (c) the Member breached the professional standards by failing to think critically about the proper route of administration of insulin, and by failing to apply appropriate nursing knowledge; (d) the implications of administering the insulin via an arterial line are: the medication would go into a smaller artery, rather than a bigger vein and would therefore not reach the target organ; the medication would become more concentrated in the arteries; arteries are muscles and can spasm; there is a risk of hemorrhage in administering medication (insulin) by way of an arterial line; and 37. If the Member [were] to testify, she would say she acknowledges her error. She would also say that she did consider the route of administration and took steps to consult with a colleague, however the route of administration implemented was incorrect. 38. With respect to the incident described as 1(b), above, if [the expert] were to testify, she would say: (a) the Member breached the medication administration standard in that she administered the wrong medication to the [client] in that she administered Dextran instead of 5% Dextrose as ordered by the physician; (b) administering the wrong medication is a more serious breach of the medication administration standard than administering the right medication in the wrong dose; (c) an experienced nurse in [the unit] should know that Dextrose and Dextran are different, and that Dextran can negatively affect cardiac output. 39. If the Member were to testify she would say she understands the difference between Dextrose and Dextran, and her error was careless.

8 40. With respect to the incident described as 1(c), above, if [the expert] were to testify, she would say: (a) the Member breached the medication administration standard in that she obtained the medication for [Client B] from the wrong source, [Client C]; (b) the Member breached the medication administration standard because she was not thorough in double checking the [client] s name or hospital number when accessing the Pyxis system at the Hospital; and (c) that there was a systems issue that contributed to this problem, in that the medication allocated for [Client C] who was no longer on the Unit should not have remained on the Unit. 41. If the Member were to testify, she would say that, although [Client B] received the correct medication as ordered, she acknowledges that she accessed and dispensed the morphine from the incorrect [client] profile. ADMISSIONS OF PROFESSIONAL MISCONDUCT 42. 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 while employed as a nurse at [the Toronto], she contravened a practice of the profession or failed to meet the standards of practice of the profession in that she: (a) on or about July 19/20, 2002, on the night shift, connected an insulin infusion to an arterial sheath with respect to [Client A], contrary to hospital policy; (b) on or about July 20/21, 2002, on the night shift, administered the wrong medication to [Client B], having administered Dextran 10% when the order was for Dextrose 5%; and (c) on or about July 20/21, 2002, on the night shift, obtained a morphine cassette for PCA administration as ordered for [Client B], but did so by accessing the [client] profile for the wrong [client], namely, [Client C]. 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 paragraph #1(a),(b) and (c) of the Notice of Hearing in that she failed to meet the standards of practice of the profession in that: on or about July 19/20, 2002, on the night shift, she connected an insulin infusion to an arterial sheath with respect to [Client A], contrary to hospital policy; and

9 on or about July 20/21, 2002, on the night shift, she administered the wrong medication to [Client B], having administered Dextran 10% when the order was for Dextrose 5%; and on or about July 20/21, 2002, on the night shift, she obtained a morphine cassette for PCA administration as ordered for [Client B], but did so by accessing the [client] profile for the wrong [client], namely, [Client C]. Reasons for Decision The panel deliberated and considered the Agreed Statement of Facts and finds that the facts support the finding of professional misconduct as stated in allegations #1(a),(b) and (c) in the Notice of Hearing. The panel finds that the Member s conduct failed to meet the standards of the practice. The Member admitted the allegations. Penalty Submissions Counsel for the College advised the panel that the parties had agreed upon a Joint Submission as to Penalty. The Joint Submission as to Penalty provides as follows. DIANE MARY FALCONER ( 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 Fact[s] with respect to Professional Misconduct, 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 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 paragraphs 2(b)(i), (ii), (iii) and (iv), 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) Prior to meeting with the Practice Consultant, the Member shall; i. review the College Publications: Professional Standards (2002); Nursing Documentation (2002); and Medication (2004);

10 ii. develop and complete a learning plan that directly relates to the allegations and breached standards, and bring this learning plan with her when she meets with the College Practice Consultant; iii. complete the College s Self-Assessment Tool and accompanying questionnaire, to discuss thereafter with the Practice Consultant the Member s practice and how Professional Standards apply to her practice; iv. complete the College s online modules Professional Standards, Documentation, and Medication, and complete the online participation form relevant to each module, and then bring a copy of the completed online participation form with her when she meets with the College Practice Consultant. (c) Requiring the Member to return and meet with the Practice Consultant on two (2) subsequent occasions to review her learning plan and to discuss how her practice has changed and how she has implemented these changes since her last meeting with the Practice Consultant. The timing of these meetings shall be at the discretion of the Practice Consultant, but no later than twelve (12) months from the date of this Order becoming final. (d) Requiring the Member to, at her own expense, enrol in and successfully complete a course in medication administration acceptable to the College s Director of Investigations and Hearings ( the Director ) within twelve (12) months of the date of the Order and to provide proof of enrolment and successful completion of such course to the Director. Notification shall be in writing and through the use of a verifiable method of delivery, the proof of which the Member shall retain. (e) Until the Member has completed the remedial term, condition and limitation, set out in paragraph 2 (d) and has met with the Practice Consultant at least once to discuss her remediation, the Member shall not engage in the independent practice of nursing through an agency or otherwise and shall only engage in the practice of nursing in a setting [where] other Registered Nurses (RNs) are employed and working at the same time as the Member. (f) For a period of twelve (12) months following the date upon which the Order in respect of this matter becomes final, the Member shall: (i) In the case of existing employer(s), within fourteen days of the Order in respect of this matter becoming final, notify the Director [ ] of the name, address, and telephone number of all employer(s) in any nursing position (notification to the Director shall be in writing and through the use of a verifiable method of delivery, the proof of which the Member shall retain); (ii) In the case of new employer(s), within fourteen days of commencing employment, notify the Director [ ] of the name, address, and telephone number of all employer(s) in any nursing position (notification to the

11 Director shall be in writing and through the use of a verifiable method of delivery, the proof of which the Member shall retain); (iii)provide her employer(s) with a copy of the panel s Penalty Order, Agreed Statement of Fact[s] on Professional Misconduct (without attachments), [], Joint Submission on Penalty, together with the Notice of Hearing or, if available, the Panel s written Decision and Reasons; (iv) only practi[s]e for an employer(s) who agrees to, and does: A. in the case of existing employer(s), write to the Director within fourteen (14) days of the Order in respect of this matter becoming final, providing the Director with confirmation that the employer(s) has received a copy of the documents referred to in paragraph 2(f)(iii) above; and, B. in the case of new employer(s), write to the Director within fourteen (14) days of the Member commencing employment, providing the Director with confirmation that the employer(s) has received a copy of the documents referred to in paragraph 2(f)(iii) above. 3. Requiring the Member to return her current Annual Payment Card to the College within fourteen (14) days of the date that this Order becomes final so that a new Annual Payment Card, indicating that the Member s certificate of registration is subject to terms, conditions and/or limitations, can be issued. The Member s Annual Payment Card shall be delivered to the College by a verifiable method of delivery, the proof of which the Member shall retain. Counsel for the College submitted that the Joint Submission as to Penalty meets all the requirements of penalty: remediation of the Member, specific deterrence, general deterrence and protection of the public. Mitigating factors are as follows: although there are three incidents, they occurred over one weekend; the Member has no history of discipline issues; the Member has been a member of the College since 1979; the Member has made admissions of professional misconduct, thereby saving the tribunal and witnesses time and expense; the first incident was characterized by the hospital as minor; and the third incident related to system issues. Counsel for the Defence stated that the Member has initiated studies [ ] on medication administration [ ]. Counsel for the Defence submitted that a mitigating factor with respect to penalty is the delay in the initiation of the process. [The Hospital] only reported the incidents to the College seven months after the fact, and there was then a further delay of six months while the College appointed an investigator. The Member was not advised by the College that there was a complaint against her until April 15, 2004 [ ]. The Member started working for her current

12 employer in September Her current employer was not made aware of the allegations when the Member commenced employment, because the Member herself was not aware of the allegations. In reply, College Counsel submitted that the delay in the initiation of the discipline process is not a mitigating factor as to 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 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 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 paragraphs 2(b)(i), (ii), (iii) and (iv), 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) Prior to meeting with the Practice Consultant, the Member shall; i. review the College Publications: Professional Standards (2002); Nursing Documentation (2002); and Medication (2004); ii. develop and complete a learning plan that directly relates to the allegations and breached standards, and bring this learning plan with her when she meets with the College Practice Consultant; iii. complete the College s Self-Assessment Tool and accompanying questionnaire, to discuss thereafter with the Practice Consultant the Member s practice and how Professional Standards apply to her practice; iv. complete the College s online modules Professional Standards, Documentation, and Medication, and complete the online participation form relevant to each module, and then bring a copy of the completed online participation form with her when she meets with the College Practice Consultant. (c) Requiring the Member to return and meet with the Practice Consultant on two (2) subsequent occasions to review her learning plan and to discuss how her practice has changed and how she has implemented these changes since her last meeting with the Practice Consultant. The timing of these meetings shall be at the discretion of the

13 Practice Consultant, but no later than twelve (12) months [from] the date of this Order becoming final. (d) Requiring the Member to, at her own expense, enrol in and successfully complete a course in medication administration acceptable to the College s Director of Investigations and Hearings ( the Director ) within twelve (12) months of the date of the Order and to provide proof of enrolment and successful completion of such course to the Director. Notification shall be in writing and through the use of a verifiable method of delivery, the proof of which the Member shall retain. (e) Until the Member has completed the remedial term, condition and limitation, set out in paragraph 2 (d) and has met with the Practice Consultant at least once to discuss her remediation, the Member shall not engage in the independent practice of nursing through an agency or otherwise and shall only engage in the practice of nursing in a setting [where] other Registered Nurses (RNs) are employed and working at the same time as the Member. (f) For a period of twelve (12) months following the date upon which the Order in respect of this matter becomes final, the Member shall: (i) In the case of existing employer(s), within fourteen days of the Order in respect of this matter becoming final, notify the Director [ ] of the name, address, and telephone number of all employer(s) in any nursing position (notification to the Director shall be in writing and through the use of a verifiable method of delivery, the proof of which the Member shall retain); (ii) In the case of new employer(s), within fourteen days of commencing employment, notify the Director [ ] of the name, address, and telephone number of all employer(s) in any nursing position (notification to the Director shall be in writing and through the use of a verifiable method of delivery, the proof of which the Member shall retain) ; (iii)provide her employer(s) with a copy of the panel s Penalty Order, Agreed Statement of Fact[s] on Professional Misconduct (without attachments), [ ], Joint Submission on Penalty, together with the Notice of Hearing or, if available, the Panel s written Decision and Reasons; (iv) only practi[s]e for an employer(s) who agrees to, and does: A. in the case of existing employer(s), write to the Director within fourteen (14) days of the Order in respect of this matter becoming final, providing the Director with confirmation that the employer(s) has received a copy of the documents referred to in paragraph 2(f)(iii) above; and, B. in the case of new employer(s), write to the Director within fourteen (14) days of the Member commencing employment, providing the Director with confirmation that the employer(s) has received a copy of the documents referred to in paragraph 2(f)(iii) above.

14 3. the Member to return her current Annual Payment Card to the College within fourteen (14) days of the date that this Order becomes final so that a new Annual Payment Card, indicating that the Member s certificate of registration is subject to terms, conditions and/or limitations, can be issued. The Member s Annual Payment Card shall be delivered to the College by a verifiable method of delivery, the proof of which the Member shall retain. Reasons for Penalty Decision The panel concluded that the proposed penalty is reasonable and in the public interest. The Member has cooperated 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 is sufficiently tailored to the misconduct to provide deterrence to the Member and to the profession, it provides for the Member s remediation and it protects the public. I, Joanne Furletti, 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: Rosalie Woods, RPN Gino Cucchi, Public Member John Bald, Public Member