DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Michael Hogard, RPN Chairperson Miranda Huang, RN Member Kim Jinkerson, RPN Member Catherine Egerton Public Member Abdul Patel Public Member BETWEEN: ) COLLEGE OF NURSES OF ONTARIO ) JEAN-CLAUDE KILLEY for ) College of Nurses of Ontario ) - and - ) ) NO REPRESENTATION for ) Sherese Peters SHERESE PETERS ) Registration No. II03279 ) ) ) LUISA RITACCA ) Independent Legal Counsel ) ) ) Heard: August 15, 2012 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on August 15, 2012 at the College of Nurses of Ontario ( the College ) at Toronto. As Sherese Shelby Peters (the Member ) was not present, the hearing recessed for 30 minutes to allow time for the Member to appear. Upon reconvening the panel noted that the Member was not in attendance. Counsel for the College provided the panel with evidence that the Member had been sent the Notice of Hearing on June 7, 2012. The panel was satisfied that the Member had received adequate notice and therefore proceeded with the hearing in the Member s absence. The Allegations
The allegations against Sherese Peters (the Member ) as stated in the Notice of Hearing dated June 7, 2012, are as follows. IT IS ALLEGED THAT: 1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(19) of Ontario Regulation 799/93, in that you contravened a provision of the Nursing Act, 1991, the Regulated Health Professions Act, 1991 or the regulations under either of those Acts, and in particular, at various times from about March 2010 to November 2010: a) you held yourself out as a person qualified to practise in Ontario as a [registered] practical nurse while your certificate of registration was suspended, contrary to s. 11(5) of the Nursing Act, 1991; b) you used the title registered practical nurse while your certificate of registration was suspended, contrary to s. 11(1) of the Nursing Act, 1991; and/or c) you performed controlled acts while your certificate of registration was suspended, contrary to s. 27 of the Regulated Health Professions Act, 1991. 2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(14) of Ontario Regulation 799/93, in that you falsified a record relating to your practice, and in particular, on about November 9, 2010, you submitted a false Annual Payment Card to [the Agency]. 3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(20) of Ontario Regulation 799/93, in that you failed to appear before a panel of the Inquiries, Complaints and Reports Committee to be cautioned, although you were required to do so by a decision of the Committee communicated to you by letter dated September 15, 2010. 4. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that you engaged in conduct relevant to the practice of nursing that would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, as follows: a) from about March 2010 to November 2010, you practised as a [registered] practical nurse while your certificate of registration was suspended;
b) on about November 9, 2010, you submitted a false Annual Payment Card to [the Agency]; c) you failed to appear before a panel of the Inquiries, Complaints and Reports Committee to be cautioned although you were required to do so; and/or d) you failed to comply with the terms of a specified continuing education or remediation program that the Inquiries, Complaints and Reports Committee required you to complete. Member s Plea Given that the Member was not present nor represented, she was deemed to have denied the allegations in the Notice of Hearing. The Hearing proceeded on the basis that the College bore the onus of proving the allegations in the Notice of Hearing against the Member. Overview Between April 2007 and November 2010, the Member was employed at [the Agency], a staffing agency which provides nursing staff to area hospitals. The Member was terminated in November 2010, when her employer discovered that she was suspended by the College for non-payment of fees. The Member did apply for reinstatement in May 2010, at which time she was notified in writing that she was ineligible for reinstatement, as she was the subject of an outstanding College-related inquiry or investigation. During the period between May 2010 and November 2010, she continued to work while suspended as a Registered Practical Nurse. The Issues: The Panel identified 5 issues to be considered in relation to the allegations. 1. Did the Member hold herself out to be a Registered Practical Nurse (or RPN ) after her membership was suspended for non-payment of fees between May 2010 and November 2010? 2. Did the Member use the title Registered Practical Nurse (or RPN ) while her certificate of registration was suspended? 3. Did the Member perform controlled acts while her certificate of registration was suspended? 4. Did the Member falsify her annual payment card and submit it to her employer on or about November 9 th 2010? 5. Did the Member fail to complete the requirements as set out by [the] Inquiries, Complaints and Reports Committee by the required completion date?
The Evidence Issue #1- Did the Member hold herself out to be a Registered Practical Nurse (or RPN ) after her membership was suspended for non-payment of fees between May 2010 and November 2010? [Witness #1] was the Director at [the Agency] at the time of the Member s employment with the Agency. Her role at [the Agency] is to ensure that the company runs effectively, to oversee staff and the general manager, and to ensure that the company runs according to the College s standards. She testified that the Member provided nursing services to clients in 2010. [Witness #1] provided the Member s original employment application as a Registered Practical Nurse at [the Agency] [ ]. [Witness #1] testified that the staff routinely provides the Agency with their availability and the nurses are then placed accordingly. The timesheets from the Agency indicate that the Member worked as an RPN from June 19, 2010, to September 20, 2010, and provided nursing care during that time [ ]. The witness also identified the Member s schedule [ ] from March 2010 to November 8, 2010 and [Agency] invoices for the hospitals where the Member provided nursing services [ ], which confirmed that the Member worked as a RPN during the relevant time. The witness testified in a confident and straightforward manner, providing only the answers to the questions asked of her. The Panel found her testimony to be very clear, precise and credible. Further, her evidence was supported by the employment and staffing documents from the Agency. [Witness #2] has worked as an investigator at the College for 6 years. She was assigned cases related to incapacity and professional misconduct. She testified that she received a letter via facsimile [ ] written by the Member and confirmed receipt of this letter with the Member via telephone. The letter submitted to the College by the Member contains an admission by the Member to working shifts as a nurse without a renewed registration.... Issue#2-Did the Member use the title Registered Practical Nurse (or RPN ) while her certificate of registration was suspended? [Witness #3] has been the Customer Service Coordinator for the College since August 2007. He coordinates daily activities in the call center and coordinates paperwork for members and applicants. [Witness #3] stated that the search tool on the College s Website entitled Find a Nurse [ ] confirms that the Member was suspended for non-payment of fees on March 11, 2010. [Witness #3] s letter to the Member dated May 5, 2010, [ ] in response to her request for reinstatement, further confirms that the Member ought to have been aware of her suspension. The Member was also sent a notification of suspension by [ ] the Executive Director for the College, dated March 11, 2010 []. [Witness #2] testified that the facility documents [ ] were provided to her from the relevant facilities. [They] show that the Member used the designation RPN on various documents, including signature identification records and clinical notes from the various hospitals where she provided nursing services.
[The] Panel found the Member s signature to be consistent with the hospital clinical notes, her written response to the College, and her applications to the College and the Agency. Issue#3- Did the Member perform controlled acts while her certificate of registration was suspended? According to the Regulated Health Professions Act, 1991 (the RHPA), no person shall perform a controlled act, as set out in 27(2), in the course of providing health care services to an individual unless, 27(1) (a) the person is a member authorized by a Health Profession Act to perform the controlled act. Controlled acts include: performing a procedure on tissue below the dermis and administering a substance by injection or inhalation. [Witness #2] testified that the facility documents [ ] were provided to her by the facilities where the Member had practi[s]ed as an RPN. These documents contain medication administration records of several [clients] which confirm that the Member provided nursing care, and specifically performed controlled acts in relation to specific [clients]. These documents include the Member s signature wherein she acknowledges the performance of the controlled acts as described. Included in these documents, the Member signed that she provided inhalation treatment and administered injections. The Panel found that the evidence was clear and accurate. The Panel also found that the signatures and initials on the medication administration records were consistent with other clinical notes, the Member s written response to the College, and her applications to the College and the Agency. Issue#4- Did the Member falsify her annual payment card and submit it to her employer on or about November 9 th 2010? [Witness #3] identified the Annual Payment Card for 2010 [ ], which was submitted by the Member to her employer, as [ ] not being issued by the College. In his e-mail message dated May 27, 2011, to [Witness #2], Investigator of Professional Conduct at the College [ ], [Witness #3] explains the discrepancies found between an actual annual payment card and the one provided by the Member. [Witness #3] stated to the Panel that the certificate provided by the Member dated April 1, 2010, contained the same issue date and certificate number as her certificate issued in 2009. [Witness #3] described [it] as being uncommon to have duplicate dates on cards issued in different years. He indicated that certificate numbers are unique to each certificate issued by the College. [Witness #3] also stated that the dates for suspension in 2010 had changed from 60 days to 30 days and therefore the certificate would not have been issued in April. The Witness s evidence was consistent with all submissions provided to the Panel as exhibits relevant to the issue. Issue#5-Did the Member fail to complete the requirements as set out by the Inquiries, Complaints and Reports Committee (ICRC) by the required completion date? The Panel heard evidence from [Witness #4], the Monitoring Administrator for the Professional Conduct Department at the College. [Witness #4] has been in this role for 2 years and
administers orders and ensures compliance with the orders. [Witness #4] identified [ ] the Summary of Requirements and a Specified Continuing Education or Remediation Program (SCERP) Instruction Sheet to be completed by the Member. According to the SCERP, all terms were to be completed by the Member by December 15, 2010. On December 15, 2010, the Member sent in a request by email for a one month extension [ ]. The extension was granted by [] the Director of the Professional Conduct Department at the College [ ]. In a report dated January 31, 2011, by [ ] the Monitoring Coordinator at the College [ ], there was no evidence of the SCERP having been completed nor had they received any correspondence from the Member. Final Submissions Counsel for the College reviewed the evidence. Counsel argued that together with the oral evidence, the timesheets and clinical notes confirmed that the Member did practi[s]e as a nurse from March 2010 to November 2010 while her certificate of registration was suspended for non payment of fees. Counsel also reminded the Panel that the Member had reapplied for reinstatement twice and was denied on both occasions related to an ongoing outstanding College inquiry or investigation. Decision Having considered the evidence, the onus and standard of proof, the Panel finds that the Member committed the following acts of professional misconduct as alleged in: paragraphs 1a), b) and c), 2, 3, 4a), b), c) and d) in the Notice of Hearing. In particular, the Member engaged in conduct that would reasonably be regarded by members of the profession as dishonourable and unprofessional. Reasons for Decision Issue #1- Did the Member hold herself out to be a Registered Practical Nurse after her membership was suspended for non-payment of fees between May 2010 and November 2010? Based on the evidence of [Witness #1] and the documentary evidence of the Member s work and pay schedule, the Panel was satisfied that the Member did indeed provide nursing services while suspended. The Panel also considered the letter written by the Member and submitted to the College, in which she admitted that she worked as a nurse without a renewed registration. Issue#2-Did the Member use the title Registered Practical Nurse while her certificate of registration was suspended? The Panel was satisfied that the evidence clearly showed the Member to have been using the title Registered Practical Nurse while her certificate of registration was suspended. [Witness #3] confirmed that the Member s certificate had been suspended since March 2010. The clinical records established that the Member took shifts at several different health care facilities, held herself out as a RPN, and provided nursing services, including controlled acts, after her suspension was in place.
The Member acknowledged this conduct in her letter to [Witness #2] [ ]. Issue#3- Did the member perform controlled acts while her certificate of registration was suspended? College Counsel made reference to the RHPA 27 (1)(a) and (2)5 with relation to controlled acts. The Panel was satisfied that the medication administration records provided from the individual [client] charts clearly indicated that the Member did perform controlled acts as per the RHPA 27 (1)(a) and (2) 5, specifically that she administered medication by inhalation and injection. The Panel found that the signatures and initials on the medication administration records were consistent with the Member s signature found on her written response to the College and her applications to the College and the Agency. The Panel was satisfied that these documents were signed by the Member herself, and clearly indicate that she knowingly performed controlled acts at a time when she did not have a certificate with the College. Issue#4- Did the member falsify her annual payment card and submit it to her employer on or about November 9 th 2010? [Witness #3] testified in a very specific and detailed manner regarding the College s procedure for issuing annual payment cards. The Panel was satisfied that the discrepancies pointed out by [Witness #3] in relation to the annual payment card are indicative of a falsified card. The Panel was also provided with a very unclear certificate provided by the Member dated April 1, 2010, which contained the same issue date and certificate number as her certificate issued in 2009. The Panel was satisfied with [Witness #3 s] explanation that it would be unlikely that certificates from two separate years would have duplicate issue dates on the cards. The Panel also accepted [Witness #3 s] testimony that the dates for suspension in 2010 had changed from 60 days to 30 days and therefore the certificate would not have been issued in April. Based on [Witness #3 s] clear evidence, the Panel was satisfied that the evidence established that the Member had falsified her payment card. Issue#5-Did the member fail to complete the requirements as set out by the Inquiries, Complaints and Reports Committee (ICRC) by the required completion date? The Panel was satisfied that the evidence provided by [Witness #4], was clear, accurate and sufficient. The Panel accepted that the summary of requirements and SCERP instruction sheet was provided to the Member and she was given adequate time to complete this. The Member had requested an extension in an email which confirms that she did in fact receive it and was aware of the completion due date. The Panel also accepted as evidence a report dated January 31, 2011, by [the Monitoring Coordinator] indicating that the SCERP had not been completed. The Panel was satisfied that the information provided was clear, concise and accurate. In his submissions, College counsel highlighted the Member s pattern of deliberate misconduct in [flouting] the College s regulatory procedures. Counsel noted that the Member continued to practi[s]e during an extended period of time while under suspension. The Member deliberately
misrepresented herself to her employer and further was dishonest as she provided a falsified annual payment card. [ ]. College s Submissions on Order WHEREAS the Member s certificate of registration is currently suspended for non-payment of fees; NOW THEREFORE, THE COLLEGE OF NURSES OF ONTARIO (THE COLLEGE ) SUBMITS THAT, in view of the facts and the findings of professional misconduct, the Panel of the Discipline Committee (the Panel ) should make an Order: 1. Requiring the Member to appear before the Panel to be reprimanded within three months of the date of this Order. 2. Directing the Executive Director to suspend the Member s certificate of registration for five months. This suspension shall take effect from the date the Member obtains an active certificate of registration and shall continue to run without interruption. 3. Directing the Executive Director to impose the following terms, conditions and limitations on the Member s certificate of registration: a) The Member will attend two sessions with a Nursing Expert (the Expert ), at her own expense and within six months of the date of this Order. To comply, the Member is required to ensure that: i. The Expert has expertise in nursing regulation, has been approved by the Director of Professional Conduct (the Director ) in advance of the meetings, and has confirmed he/she will provide a report following the sessions; ii. At least 7 days before the first meeting, the Member provides the Expert with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, and 3. if available, a copy of the Panel s Decision and Reasons; iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules: 1. Professional Standards (Revised 2002), 2. RHPA: Scope of Practice, Controlled Acts Model.
iv. At least 7 days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires and online participation forms; v. The subject of the sessions with the Expert will include: 1. the acts or omissions for which the Member was found to have committed professional misconduct, 2. the potential consequences of the misconduct to the Member s clients, colleagues, profession and self, 3. strategies for preventing the misconduct from recurring, 4. the publications, questionnaires and modules set out above, and 5. the development of a learning plan in collaboration with the Expert; vi. Within 30 days after the Member has completed the last session, the Expert forwards his/her report to the Director, in which the Expert will confirm: 1. the dates the Member attended the sessions, 2. that the Expert received the required documents from the Member, 3. that the Expert reviewed the required documents and subjects with the Member, and 4. the Expert s assessment of the Member s insight into her behaviour; vii. If the Member does not comply with any of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitations on her certificate of registration; b) For a period of 12 months from the date the Member s suspension ends, the Member will notify her employer(s) of this decision. To comply, the Member is required to ensure that: (i) (ii) The Director is notified of the name, address, and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position; Provide her employer(s) with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, and 3. a copy of the Panel s Decision and Reasons, once available;
(iii) Within 14 days of the commencement or resumption of the Member s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm: 1. that it received a copy of the required documents, and 2. that [it] agrees to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and (iv) All documents delivered by the Member to the College, the Expert or the employer(s) will be made by verifiable method of delivery, the proof of which the Member will retain. Penalty Decision The Panel makes the following order: 1. The Member shall appear before the Panel to be reprimanded within three months of the date of this Order. 2. The Executive Director is directed to suspend the Member s certificate of registration for five months. This suspension shall take effect from the date the Member obtains an active certificate of registration and shall continue to run without interruption. 3. The Executive Director is directed to impose the following terms, conditions and limitations on the Member s certificate of registration: a. The Member will attend two sessions with a Nursing Expert (the Expert ), at her own expense and within six months of the date of this Order. To comply, the Member is required to ensure that: i. The Expert has expertise in nursing regulation, has been approved by the Director of Professional Conduct (the Director ) in advance of the meetings, and has confirmed he/she will provide a report following the sessions; ii. At least 7 days before the first meeting, the Member provides the Expert with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, and 3. if available, a copy of the Panel s Decision and Reasons; iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules:
1. Professional Standards (Revised 2002), 2. RHPA: Scope of Practice, Controlled Acts Model. iv. At least 7 days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires and online participation forms; v. The subject of the sessions with the Expert will include: 1. the acts or omissions for which the Member was found to have committed professional misconduct, 2. the potential consequences of the misconduct to the Member s clients, colleagues, profession and self, 3. strategies for preventing the misconduct from recurring, 4. the publications, questionnaires and modules set out above, and 5. the development of a learning plan in collaboration with the Expert; vi. Within 30 days after the Member has completed the last session, the Expert forwards his/her report to the Director, in which the Expert will confirm: 1. the dates the Member attended the sessions, 2. that the Expert received the required documents from the Member, 3. that the Expert reviewed the required documents and subjects with the Member, and 4. the Expert s assessment of the Member s insight into her behaviour; vii. If the Member does not comply with any of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitations on her certificate of registration; b. For a period of 12 months from the date the Member s suspension ends, the Member will notify her employer(s) of this decision. To comply, the Member is required to ensure that: (i) (ii) The Director is notified of the name, address, and telephone number of all employer(s) within fourteen (14) days of commencing or resuming employment in any nursing position; Provide her employer(s) with a copy of:
1. the Panel s Order, 2. the Notice of Hearing, and 3. a copy of the Panel s Decision and Reasons, once available; (iii) Within 14 days of the commencement or resumption of the Member s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm: 1. that it received a copy of the required documents, and 2. that [it] agrees to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and (iv) All documents delivered by the Member to the College, the Expert or the employer(s) will be made by verifiable method of delivery, the proof of which the Member will retain. Reasons for Penalty Decision The Panel considered the following aggravating and mitigating factors. Aggravating factors included that the Member provided a falsified annual payment to her employer, received adequate notice that her certificate of registration was suspended for non payment of fees, and admitted to working as a nurse while suspended. The panel also considered that the Member did not complete her SCERP as ordered by the ICRC in the time allotted despite being granted an extension at the Member s request. Mitigating factors include that the Member has no previous discipline history with the College, and it appears that no clients were harmed. It is the opinion of the Panel that this penalty meets the goal of protecting the public by ensuring that the [Member] understands the importance of participating effectively in self-regulation. It increases the accountability of the Member to her employer, and in turn the employer to the College. The Panel agreed that a suspension was necessary to ensure that the Member, and the profession at large, understands that providing false or misleading information to the College will not be tolerated. After reviewing other cases of a similar nature, the panel decided that a [5-month] suspension was within an appropriate range. The Panel also agreed that the remediation and rehabilitation goals are met through the specific conditions required before the Member meets with the Nursing Expert. The penalty fulfills the mandate of the College to protect the public interest; it is aimed at remediation. It provides a general deterrent to members of the profession, as well as a specific deterrent to the Member to appreciate the privilege she has of being able to provide health care pursuant to the provisions of the RHPA.
I, Michael Hogard, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline panel and on behalf of the members of the Discipline panel as listed below: Chairperson Date Panel Members Miranda Huang, RN Kim Jinkerson, RPN Catherine Egerton, Public Member Abdul Patel, Public Member