DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Nancy Sears, RN Chairperson Cheryl Beemer, RN Member Tammy Hedge, RPN Member Linda Bracken Public Member Gino Cucchi Public Member BETWEEN: COLLEGE OF NURSES OF ONTARIO ) EMILY LAWRENCE for ) College of Nurses of Ontario - and - ) ) ANTONELLA PACE ) GERALD PUNNETT for Registration No. 9615048 ) Antonella Pace ) ) ) Heard: November 8, 2012 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on November 8, 2012 at the College of Nurses of Ontario ( the College ) at Toronto. The Allegations The allegations against Antonella Pace (the Member ) as stated in the Notice of Hearing dated September 26, 2012 are as follows. IT IS ALLEGED THAT: 1. You have committed an act of professional misconduct as provided by subsection 51(1)(a) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, in that on April 9, 2009, in the Ontario Court of Justice in [ ] Ontario, you were found guilty of an offence relevant to your suitability to practise, and in particular, you were found guilty of an offence that: a. On or about the 8 th day of April in the year 2009 [ ], you did commit theft, contrary to s. 334(b) of the Criminal Code of Canada; and/or
2. You have committed an act of professional misconduct as provided by subsection 51(1)(a) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, in that on November 15, 2010, in the Ontario Court of Justice in [ ] Ontario, you were found guilty of an offence relevant to your suitability to practise, and in particular, you were found guilty of an offence that: a. On or about the 4 th day of September in the year 2007 [ ], you did traffic a controlled substance, namely morphine, contrary to s. 5(1) of the Controlled Drugs and Substances Act; b. On or about the 4 th day of September in the year 2007 [ ], you did knowingly commit forgery by making a false document, knowing it to be false, with intent that it should be used or acted on as genuine, contrary to s. 367 of the Criminal Code of Canada; c. On or about the 4 th day of September in the year 2007 [ ], you did knowingly utter a forged document, contrary to s. 368(1)(a) of the Criminal Code of Canada; d. On or about the 23 rd day of September in the year 2007 [ ], you did knowingly commit forgery by making a false document, knowing it to be false, with intent that it should be used or acted on as genuine, contrary to s. 367 of the Criminal Code of Canada; e. On or about the 23rd day of September in the year 2007 [ ], you did knowingly utter a forged document, contrary to s. 368(1)(a) of the Criminal Code of Canada; and/or f. On or about the 5 th day of October in the year 2007 [ ], you did knowingly utter a forged document, contrary to s. 368(1)(a) of the Criminal Code of Canada; and/or 3. You have committed an act of professional misconduct as provided by subsection 51(1)(a) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, in that on April 6, 2011, in the Ontario Court of Justice in [ ] Ontario, you were found guilty of an offence relevant to your suitability to practise, and in particular, you were found guilty of an offence that: a. On or about the 3 rd day of January in the year 2011 [ ], you did commit theft, contrary to s. 334(b) of the Criminal Code of Canada. Member s Plea The Member admitted the allegations set out in the Notice of Hearing. The panel received a written plea inquiry which was signed by the Member. The panel also conducted an oral plea inquiry and was satisfied that the Member s admission was voluntary, informed and unequivocal. Agreed Statement of Facts Counsel for the College advised the panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts which provided as follows.
THE MEMBER 1. Antonella Pace (the Member ) received her diploma [ ] in 1995. 2. The Member registered with the College of Nurses of Ontario (the College ) as a Registered Nurse ( RN ) on March 7, 1996. The Member's certificate of registration was suspended on August 26, 2008, for failure to submit to a health examination. THE FACILITY 3. Between March 5, 2007 and September 7, 2007, the Member worked at [the Facility] as a part-time RN on the day shift. 4. The Member worked on the general medical unit at the Facility. 5. In general, the Member's duties included caring for clients, dispensing medications and communicating with physicians. These duties gave the Member access to generic prescription pads which were openly kept at the nurses' stations. INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT 6. Between April 9, 2009 and April 6, 2011, in three separate proceedings, the Member was convicted of eight criminal offen[c]es that are relevant to her suitability to practise. (i) April 9, 2009 Conviction 7. On April 9, 2009, the Member entered a guilty plea and was found guilty of theft under $5,000. The Member stole approximately $775 worth of DVDs and DVD box sets from [a store]. 8. The Member was sentenced to a one-year suspended sentence and one year of probation. (ii) November 15, 2010 Convictions 9. On November 15, 2010, the Member was found guilty of six offences for events which occurred on September 4, 2007; September 23, 2007; and October 5, 2007; respectively. As a result of these convictions, the Member was sentenced to a ninemonth custodial sentence and two years of probation. 10. On September 4, 2007, the Member forged a prescription for 60 tablets of 100 mgs of MScontin and issued it to an acquaintance, [Mr. A]. The Member obtained the prescription paper from the Facility and signed the prescription using the name [of Dr. A], a doctor at the Facility. [Mr. A] filled the prescription at the pharmacy and
divided the pills with the Member. [Mr. A] ingested 19 of the MScontin tablets and was pronounced dead the following morning. 11. In relation to the September 4, 2007, incident, the Member was convicted of forgery, uttering a forged document and trafficking a controlled substance, namely morphine. 12. On September 23, 2007, the Member forged a prescription for 100 Oxycocets and issued it to [Ms B]. The Member obtained the prescription paper from the Facility and signed the prescription using the name [of Dr. A], a doctor at the Facility. [Ms B] brought the forged prescription to the pharmacy but left before it was filled. 13. In relation to the September 23, 2007, incident, the Member was convicted of forgery and uttering a forged document. 14. On October 5, 2007, the Member added 60 Percocet tablets onto an otherwise valid prescription for [Mr. C], her daughter's partner. The Member had the prescription filled on his behalf. 15. In relation to the October 5, 2007, incident, the Member was convicted of uttering a forged prescription. (iii) April 6, 2011 Conviction 16. On April 6, 2011, the Member pled guilty to theft under $5,000. The Member had stolen approximately $550 worth of clothing and boots from [a store]. 17. At the time of sentencing, the Member was already incarcerated from the November 2010 findings and was sentenced to an additional 15 days incarceration and one year of probation. ADMISSIONS OF PROFESSIONAL MISCONDUCT 18. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 1 to 3 of the Notice of Hearing, as described in paragraphs 6 to 17 above. Submissions by College Counsel College Counsel reviewed with the panel the three separate incidents of criminal convictions, each relevant to the Member s suitability to practi[s]e. There were repeated acts of dishonest behaviour which are not consistent with the practice of nursing and which [bring] the profession into disrepute. The offences were closely related to nursing practice in that the Member stole a prescription pad from her workplace and used her nursing knowledge to forge prescriptions and utter forged documents. Each finding of guilt in criminal court is consistent with professional misconduct with regard to the Member s suitability to practi[s]e. The Member s conduct was intentional and for personal gain. There is a close nexus between the finding of criminal guilt and the allegations of professional misconduct.
Counsel for the Member reiterated the Member s admissions of professional misconduct. Decision The panel considered the Agreed Statement of Facts and the Member s plea and finds that together these support findings of professional misconduct. In particular, the panel finds that the Member committed an act of professional misconduct as alleged in paragraphs 1 (a), 2 (a), (b), (c), (d), (e), (f), and 3 (a) of the Notice of Hearing. The Member was found guilty of eight criminal offences relevant to her suitability to practi[s]e, which include two convictions of theft under $5000, trafficking of a controlled substance, forgery and uttering forged documents. Reasons for Decision The facts provided in the Agreed Statement of Facts, and the Member s plea clearly supported the allegations in the Notice of Hearing [ ]. Forgery of a prescription is a serious act, especially considering the tragic outcome related to trafficking a narcotic. The Member s conduct is contrary to the expectations that the public and the College have for nurses. The three findings of criminal guilt directly reflect [on] the Member s suitability to practi[s]e. The repeated acts of dishonest behaviour are not in keeping with the character of the nursing profession and, further, [bring] the profession into a state of disrepute. Joint Submission on Order Counsel for the College advised the panel that a Joint Submission on Order had been agreed upon. The Joint Submission on Order Requested that the panel make an order: WHEREAS ANTONELLA PACE's certificate of registration is currently suspended for failing to submit to a health examination. NOW THEREFORE, THE COLLEGE OF NURSES OF ONTARIO (THE COLLEGE ) AND ANTONELLA PACE (THE MEMBER ) JOINTLY SUBMIT THAT, in view of the facts and admissions set out in the Agreed Statement of 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] that this Order becomes final. 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 one session with a Nursing Expert (the Expert ), at her own expense and within five months of the date of that the Member obtains an active Certificate of Registration. To comply, the Member is required to ensure that: i. The Expert has expertise in self-regulation [and] has been approved by the Director of Professional Conduct (the Director ) in advance of the meetings; ii. At least seven days before the meeting, the Member provides the Expert with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, 3. the Agreed Statement of Facts, 4. this Joint Submission on Order, and 5. if available, a copy of the Panel s Decision and Reasons; iii. Before the meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules: 1. Professional Standards (Revised 2002), iv. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaire and online participation form; v. The subject of the session 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 publication, questionnaire and module 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 session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm: 1. the date the Member attended the session, 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 the session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration; b) For a period of 18 months from the date the Member s suspension ends, the Member will notify her employers of this decision. To comply, the Member is required to ensure that: i. The Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position; ii. [The Member provides] her employer(s) with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, 3. the Agreed Statement of Facts, 4. this Joint Submission on Penalty, and 5. 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 they received a copy of the required documents, and 2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and 4. 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 Submissions Counsel for the College reminded the panel that the Member is currently suspended for failure to submit to a health examination. The Member s conduct included multiple crimes of dishonesty including drug trafficking. These are serious allegations and closely relate to the Member s practice as a nurse. The goals of the Joint Submission include general and specific deterrence, rehabilitation, protection of the public and denunciation of the Member s conduct. The reprimand and suspension contribute to the principle of general and specific deterrence. Nurses are regularly entrusted with access to prescription pads and controlled substances. The order should reflect quite strongly that nurses are expected to take their responsibility very seriously and avoid breaching the public s expectations of them. A five month suspension is in the range of what is reasonable for the Member s conduct and is in keeping with past decisions. The terms, conditions and limitations set out in the joint submission on order [ ] will assist the Member to
rehabilitate herself and to engage in reflection on her conduct. Protection of the public will be supported through the Member s engagement with the expert. An eighteen month period of employer notification will protect the public when the Member returns to practice as the employer will understand and be aware of the findings of this case. The Joint Submission on Order was negotiated carefully and is viewed by the College as appropriate. Counsel for the Member submitted that the Member has admitted the facts and her liability and by doing so has spared the College [ ] the expense and the effort of a full hearing. The events arose from a short period of time in 2007. The Member pled guilty to the two theft charges and stood trial for the other charges. The Member had a period of incarceration during which she reflected on her conduct and helped another inmate with her education. The Member s incarceration was shortened for good behaviour. The events resulted in her loss of employment. The Member realizes the gravity of what she has done and recognizes the public and professional denunciation for this conduct. The reprimand will confer shame upon her. The rehabilitative measure of the terms, conditions and limitations will bring home to the Member how the profession and the public feel about her actions. Her meeting with an expert and the preparation required will re-educate her regarding the expectations of nurses. At the request of the panel, the Counsel for the College presented examples of past cases to assist the panel in deciding whether to accept the Joint Submission on Order. First, Counsel for the College reviewed the governing principles for consideration of Joint Submissions, most recently discussed by the Ontario Court of Appeal, [ ] as set out in R v. DeSousa, 2012 ONCA 254, at paragraphs 16 to 21. College Counsel reminded the panel of the certainty and confidence inherent in the production of a joint submission. A panel should only change a joint submission should it place the disciplinary process in disrepute or if the joint submission is contrary to the public interest. College Counsel provided the panel with three prior Discipline Committee cases to consider. The College argued that the present matter fell into the middle of the range of penalties set out in prior decisions. In the case of [Member A] 2006, the facts are somewhat similar in that professional misconduct related to breaches of the Health Professions Procedural Code and criminal convictions including theft, fraudulent impersonation, fraud, and unlawfully entering a dwelling. [Member A] had a prior disciplinary finding involving fraud and uttering a forged document. In the circumstances, the penalty imposed was a revocation of the member s certificate of registration and a reprimand. In the case of [Member B] 2006, the facts are also somewhat similar in that the professional misconduct related to breaches of the [Health Professions Procedural Code,] including misappropriation of a prescription pad, forging of prescriptions for a controlled prescriptions. In this case, the penalty consisted of a reprimand, suspension of the member s certificate of registration for three months and terms, conditions and limitations on the member s certificate of registration for a period of two years. In the case of [Member C] 2012, the facts are again somewhat similar in that the professional misconduct related to breaches of the Health Professions Procedural Code, including
contraventions of the standard of practice with respect to the administration and documentation of narcotics. This member also had disciplinary history with the College. In this case, the penalty consisted of a reprimand, a four month suspension and terms, conditions and limitations on her certificate of registration. College counsel further submitted that the Joint Submission on Order in the present matter provides for a reprimand, a five month suspension and terms, conditions and limitations on her certificate of registration that fall within the range set out in the prior cases. It is concerning that the Member shared medications with another individual and that the second individual ultimately overdosed and died. This is a tragic outcome and is contrary to the College s continuing efforts to ensure that nurses are held in the highest esteem in the community. However, the linkage between the Member s conduct, the overdose and death, and the penalty proposed was not so intertwined to suggest that a greater penalty is necessary. The penalty is not always about outcomes. The College argued that the death in the circumstances should not be linked to the Member s conduct and the panel needs to separate out the outcome from the trafficking. A suspension of five months is a serious length of time and along with the reprimand and educational component set out in the Joint Submission on Order appropriately responds to the findings of professional misconduct and properly reflects the College s need to inform the Member that her conduct was unacceptable and will not be tolerated. The Joint Submission on Order expresses to the general membership how such conduct will be dealt [with]. The penalty proposed was negotiated carefully with the Member through her counsel. Penalty Decision The panel accepts the Joint Submission as to Order and accordingly orders: 1. The Member shall appear before the Panel to be reprimanded within three months [of the date] that this Order becomes final. 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 one session with a Nursing Expert (the Expert ), at her own expense and within five months of the date [ ] that the Member obtains an active certificate of registration. To comply, the Member is required to ensure that: i. The Expert has expertise in self-regulation [and] has been approved by the Director of Professional Conduct (the Director ) in advance of the meetings; ii. At least seven days before the meeting, the Member provides the Expert with a copy of:
1. the Panel s Order, 2. the Notice of Hearing, 3. the Agreed Statement of Facts, 4. this Joint Submission on Order, and 5. if available, a copy of the Panel s Decision and Reasons; iii. Before the meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules: 1. Professional Standards (Revised 2002), iv. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaire and online participation form; v. The subject of the session 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 publication, questionnaire and module 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 session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm: 1. the date the Member attended the session, 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 the session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration; b. For a period of 18 months from the date the Member s suspension ends, the Member will notify her employers of this decision. To comply, the Member is required to ensure that:
i. The Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position; ii. [The Member provides] her employer(s) with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, 3. the Agreed Statement of Facts, 4. this Joint Submission on Penalty, and 5. 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 they received a copy of the required documents, and 2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and 4. All [delivery of] documents [ ] 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 deliberated as to the Joint Submission on Order and had some discomfort viewing the Joint Submission on Order as falling within the range of what could be viewed as appropriate given the facts of this case. However, the panel is well aware of the principles that support and indeed encourage resolution of cases through agreement and understands that the College and the Member would not enter lightly into a joint resolution they did not believe was reasonable in the circumstances. Upon being provided with additional submissions and prior cases, the panel was comfortable to conclude 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. The suspension of five months followed by a period of employer notification addresses the principle of public protection. The terms, conditions and limitations provide for the opportunity for rehabilitation, which will enable the Member to return to her profession. The penalty also addresses general and specific deterrence in that it sends the message to the membership and the Member that such conduct will not be tolerated by this College. I, Nancy Sears, 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: Cheryl Beemer, RN Tammy Hedge, RPN Linda Bracken, Public Member Gino Cucchi, Public Member