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Ayres, Edna

Edna Ayres 7435688

FULL-TEXT DECISION

Note: This is the full text of the decision of the Discipline panel in this matter. Any information identifying clients, witnesses or facilities has been removed [ ]. The member’s name is omitted if allegations have been dismissed or if the results are not placed on the public portion of the Register.

Discipline Committee Of The College Of Nurses Of Ontario

Panel:

Janise Johnson, RN   Chairperson
Sandra Brewer, RN   Member
Patricia Collins, RPN   Member
Bill Weichel   Public Representative
Angus G. Taylor   Public Representative

BETWEEN

COLLEGE OF NURSES OF ONTARIO   Linda Rothstein for College of Nurses of Ontario
- and -    
EDNA AYRES
#74-3568-8
  Member Unrepresented
     
    Heard: August 7-8, 2001

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on August 7 and 8, 2001, at the College of Nurses of Ontario at Toronto.

The Member was not present, and not represented by counsel.

The hearing commenced at 0905 recessing for 30 minutes to accommodate the Member’s possible arrival. The hearing reconvened at 0935. The Member did not appear.

Counsel for the College presented an Affidavit of Service ( Exhibit 1).[Name removed], process server of the city of [city name removed], Province of Ontario, on July 11, 2001 had personally served Edna Ayers, with the Notice of Hearing and Disclosure Materials at [address removed] Ontario. He identified the person by means of verbal acknowledgement.

Witness #1 Carla Gelbloom, Discipline Coordinator, Investigations and Hearings, identified an e-mail received by the College (Exhibit #3), dated July 25, 2001, from Edna Ayres, stating, “This is to inform you and the committee members that I will not be attending the hearing scheduled Aug 7 and 8, 2001.”

The panel found that the Member had received reasonable notice of the Discipline hearing.

The Allegations

The allegations against Edna Ayres as stated in the Notice of Hearing dated June 29, 2001, are as follows:

  1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and subsection 1(37) of Ontario Regulation 799/93, in that during the period September 7, 2000 to and including November 29, 2000, while employed as a Registered Nurse for [facility 1], in the [city], in the Province of Ontario, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, namely, you were gainfully employed by [facility 2] and/or by [agency 1] while collecting sick benefits from the [facility 1] and/or you misrepresented the state of your health to your employer, the [facility 1].
  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(21) in that during the period from June 26, 2000 to the present you failed to comply with an order of a panel of the Discipline Committee dated June 26, 2000, in particular you failed to:
    1. serve and/or complete a three month period of suspension of your Certificate of Registration as directed by the Executive Director of the College to commence on the date the Order became final and to run without interruption; and/or
    2. comply with one or more of the following terms, conditions and limitations (the Conditions) imposed upon your Certificate of Registration by the Executive Director, namely:
      1. the Member shall continue in ongoing, regular therapy with her psychotherapist, [psychotherapist 1], at such frequency as her psychotherapist considers appropriate for a minimum period of two years following the Member’s return to the full time practice of nursing as defined in subparagraph (h) below, or such further period as may be recommended by her psychotherapist;
      2. the Member shall follow the treatment and monitoring advice of her psychotherapist, including use of prescription medication and attending for treatment or counselling in stress management and relaxation therapy as her psychotherapist considers appropriate;
      3. the Member shall provide her family physician with a copy of this Decision;
      4. the Member shall obtain and deliver to the College within 30 days of this Order becoming final, a letter signed by her psychotherapist in which the psychotherapist:
        1. agrees to immediately notify, in writing, the Director of Investigations & Hearings (the Director) if in her opinion, the Member’s health may interfere with her ability to practice nursing or if she has failed to comply with any of the Conditions; and
        2. agrees to cooperate with the College to provide such information as the Director shall require in order to ensure that the Member is complying with the Conditions and in particular, shall provide quarterly reports to the Director with respect to the Member’s current state of health and compliance with the Conditions;
      5. the Member shall not substitute her psychotherapist without first obtaining the agreement of the Director, or failing agreement, an Order of a Panel of the Discipline Committee. Where such substitution is made, the substituted psychotherapist must be a psychiatrist, clinical psychologist. Or physician who practices psychotherapy. Furthermore, where such substitution is made, there Conditions shall be amended to substitute the name of the replacement psychotherapist for [psychotherapist 1] and the Member’s obligation in [subparagraph (d), above] shall be fulfilled within 30 days of the date of the substitution;
      6. the Member shall not return to the practice of nursing until she has obtained and filed with the Director a written report signed by her psychotherapist, [psychotherapist 1], which report shall be prepared no earlier than April 1, 2000 in which she confirms:
        1. that she has consulted with the Member and obtained up-to-date information respecting the Member’s status prior to writing the report; and
        2. that in her opinion, the Member’s recovery has progressed to the point where she can safely return to the practice of nursing so long as she complies with the Conditions;
      7. the Member shall limit her practice to part-time employment not to exceed 16 hours per week unless and until she files with the Director the written recommendation of her psychotherapist to increase the number of hours in which she can engage in nursing, in which event this restriction shall be varied in accordance with [psychotherapist 1’s] written recommendation so long as the Member does not return to full-time nursing (35 or more hours/week) until she has practised part-time nursing for at least six months;
      8. the Member shall not engage in the practice of nursing through an agency or otherwise and shall only engage in the practice of nursing where another member (the Monitor) is available to monitor her practice. Each Monitor who monitors the Member’s practice hereunder shall:
        1. be registered with the College as a Registered Nurse in good standing and be employed at the same facility and is in the facility when the Member is working;
        2. confirm in writing to the College receipt of a copy of this Decision and agree to maintain its confidentiality;
        3. agree with the College to immediately notify, in writing, the Director if, in the Monitor’s opinion, the Member’s health is affecting her ability to practice nursing or if she has failed to comply with the Conditions;
        4. agree to cooperate with the College including providing such information as it shall require to ensure that the Member is complying with the Conditions;
      9. the Member shall advise the Director immediately, in writing, upon her obtaining employment in nursing and of any subsequent changes in employment in nursing, including the name and address of all her Employers. The Member shall also advise the Director of the name of any Monitor who is responsible for monitoring her practice; and
      10. the Member shall provide any employer with a copy of this Decision.
  3. You have committed an act of professional misconduct as provided by 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) in that during the period from June 26, 2000 to the present you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional in that you failed to comply with an order of a panel of the Discipline Committee dated June 26, 2000, in particular you:
    1. failed to serve and/or complete a three month period of suspension of your Certificate of Registration as directed by the Executive Director of the College to commence on the date the Order became final and to run without interruption, and/or
    2. failed to comply with one or more of the following terms, conditions and limitations (the Conditions) imposed upon your Certificate of Registration by the Executive Director, namely:
      1. the Member shall continue in ongoing, regular therapy with her psychotherapist, [psychotherapist 1], at such frequency as her psychotherapist considers appropriate for a minimum period of two years following the Member’s return to the full time practice of nursing as defined in subparagraph (h) below, or such further period as may be recommended by her psychotherapist;
      2. the Member shall follow the treatment and monitoring advice of her psychotherapist, including use of prescription medication and attending for treatment or counselling in stress management and relaxation therapy as her psychotherapist considers appropriate;
      3. the Member shall provide her family physician with a copy of this Decision;
      4. the Member shall obtain and deliver to the College within 30 days of this Order becoming final, a letter signed by her psychotherapist in which the psychotherapist:
        1. "agrees to immediately notify, in writing, the Director of Investigations & Hearings (the Director) if in her opinion, the Member’s health may interfere with her ability to practice nursing or if she has failed to comply with any of the Conditions; and
        2. agrees to cooperate with the College to provide such information as the Director shall require in order to ensure that the Member is complying with the Conditions and in particular, shall provide quarterly reports to the Director with respect to the Member’s current state of health and compliance with the Conditions;
      5. the Member shall not substitute her psychotherapist without first obtaining the agreement of the Director, or failing agreement, an Order of a Panel of the Discipline Committee. Where such substitution is made, the substituted psychotherapist must be a psychiatrist, clinical psychologist. Or physician who practices psychotherapy. Furthermore, where such substitution is made, there Conditions shall be amended to substitute the name of the replacement psychotherapist for [psychotherapist 1] and the Member’s obligation in [subparagraph (d), above] shall be fulfilled within 30 days of the date of the substitution;
      6. the Member shall not return to the practice of nursing until she has obtained and filed with the Director a written report signed by her psychotherapist, [psychotherapist 1], which report shall be prepared no earlier than April 1, 2000 in which she confirms:
        1. that she has consulted with the Member and obtained up-to-date information respecting the Member’s status prior to writing the report; and
        2. that in her opinion, the Member’s recovery has progressed to the point where she can safely return to the practice of nursing so long as she complies with the Conditions;
      7. the Member shall limit her practice to part-time employment not to exceed 16 hours per week unless and until she files with the Director the written recommendation of her psychotherapist to increase the number of hours in which she can engage in nursing, in which event this restriction shall be varied in accordance with [psychotherapist 1’s] written recommendation so long as the Member does not return to full-time nursing (35 or more hours/week) until she has practised part-time nursing for at least six months;
      8. the Member shall not engage in the practice of nursing through an agency or otherwise and shall only engage in the practice of nursing where another member (the Monitor) is available to monitor her practice. Each Monitor who monitors the Member’s practice hereunder shall:
        1. be registered with the College as a Registered Nurse in good standing and be employed at the same facility and is in the facility when the Member is working;
        2. confirm in writing to the College receipt of a copy of this Decision and agree to maintain its confidentiality;
        3. agree with the College to immediately notify, in writing, the Director if, in the Monitor’s opinion, the Member’s health is affecting her ability to practice nursing or if she has failed to comply with the Conditions;
        4. agree to cooperate with the College including providing such information as it shall require to ensure that the Member is complying with the Conditions;
      9. the Member shall advise the Director immediately, in writing, upon her obtaining employment in nursing and of any subsequent changes in employment in nursing, including the name and address of all her Employers. The Member shall also advise the Director of the name of any Monitor who is responsible for monitoring her practice; and
      10. the Member shall provide any employer with a copy of this Decision, and/or
  4. You have committed an act of professional misconduct as provided by 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) in that you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional in that:
    1. on or about February 6, 2000, you provided inaccurate and/or false information to an employee of the College concerning your employment status, and in particular you represented that you were not employed as a nurse, and/or
    2. during the month of September 2000, while employed as a nurse at [facility 1] in [the city], Ontario, you provided inaccurate and/or false information to your nursing manager with respect to your health status, and in particular your reason for requiring a period of sick leave.

Member’s Plea

The Member, Edna Ayres was not present to respond to the allegations set out in the Notice of Hearing. However, the e-mail (Exhibit #3) from Edna Ayres, sent on July 25, 2001 at 0827, was received by Carla Gelbloom, Discipline Hearing Coordinator, which stated, “I have no excuse for what I have done, and I am guilty of all the facts presented to your committee.” In the absence of the Member, the panel presumed that the College had to prove its case.

Overview

On June 26, 2000, the Member had appeared before a Discipline panel, at the College of Nurses (CNO), where specified terms, conditions and limitations were imposed on her Certificate of Registration (Exhibit #4: Decision and Reasons). At that hearing the Member admitted to the following allegations and that she had:

  • breached an Undertaking that she had reached with the Executive Committee (dated March 25, 1997);
  • falsified two Police Clearance Certificates, and misrepresented by omission her employment history;
  • failed to notify the CNO of change of nursing employment;
  • failed to provide the CNO with a letter from employers confirming that they were aware of her mental health condition;
  • failed to send copies of performance appraisals of her nursing practice or have the employer send letters of permission allowing the CNO to obtain same.

The penalty (Exhibit #4) applied to the Member as a result of that hearing was:

  • an oral reprimand;
  • a three month suspension of her Certificate of Registration, effective June 26, 2000;
  • the Member was ordered to continue in ongoing therapy with her psychotherapist, for at least two years, after resuming full time nursing practice. Additional requirements regarding therapy were outlined, including that the CNO would receive, within thirty days, a letter from the psycho-therapist stating the mental health status of the Member;
  • following the three month suspension, the Member was not to exceed sixteen hours a week of nursing practice, for a period of at least six months, based on the psychotherapist’s written recommendation;
  • the Member was not to engage in the practice of nursing through an agency, or otherwise, where she could not be directly monitored by another RN, present in the same facility;
  • in addition to other terms, conditions and limitations (the Conditions).

On August 10, 2000, a letter to the Member, from Gail Siskind, Acting Executive Director, CNO (Exhibit #5), confirmed the Discipline panel’s decision. In the letter the Member was asked to immediately submit her Annual Registration Payment Card to the Investigations and Hearings Department, CNO. The letter also stated, “While the suspension is in effect, you are not legally entitled to call yourself a nurse or accept employment as a nurse”.

During the course of the present Discipline hearing, evidence was presented that indicated that the Member continued to work regularly as an RN, starting with a night shift at [the health centre] (through an agency, [agency 1]) on June 26 and 27, 2000.

In addition to [the health centre], evidence was submitted indicating other continuous concurrent employment as follows:

  • [facility 1] – June 15 to November 29, 2000 (full time hours)
  • [facility 2] – July 24 to November 15, 2000 (full time hours)
  • [agency 2] – November 23, 2000 (one shift)

In addition the Member breached the Conditions of the penalty decision from the prior Discipline hearing as follows:

  • The Member did not submit her Certificate of Registration to the CNO.
  • There was no evidence that any psychotherapy was continued by the Member.
  • There was no evidence that the family physician had been supplied with a copy of the Discipline hearing decision.
  • No letter was received by the CNO from the Member’s psychotherapist, within the prescribed 30 days.
  • The Member returned to the full-time practice of nursing without ever obtaining and filing the specified written report signed by her psychotherapist.
  • The Member did engage in the practice of nursing through agencies, where she could not be directly monitored by an RN, as stipulated by the penalty.
  • The Member did not inform the CNO of any employment in nursing.

Additional allegations brought forward at the present hearing were:

  • While collecting sick benefits from [facility 1], the Member was gainfully employed by [facility 2] and/or [agency 1]
  • The member provided inaccurate or false information to a member of the CNO by indicating that she was not employed as a nurse (Exhibit #10).
  • The member provided inaccurate or false information to her nursing managers.

The Evidence

Witness # 1 – Carla Gelbloom (CG)

The panel found that CG was a credible witness

.

In the course of CG’s testimony the following Exhibits were presented:

  • Exhibit #5 – CNO letter to the Member (August 10, 2000), signed by Gail Siskind, RN, Acting Executive Director. This letter was an official notification of the decision of the Discipline panel of June 26, 2000, which enclosed its Decision and Reasons (Exhibit #4). The letter stated, “ … your Certificate of Registration (will) be suspended for three months, commencing June 26, 2000. While the suspension is in effect, you are not legally entitled to call yourself a nurse or accept employment as a nurse. Please submit your annual Registration Payment Card to the attention of the Investigations and Hearings Department immediately. Specified terms, conditions and limitations were imposed on your Certificate of Registration. The College will be in contact with you to administer the terms, limitations and conditions … We note that, at the conclusion of the hearing, you signed a waiver and the oral reprimand was administered”.
  • Exhibit #8 – CNO letter to the Member (November 30, 2000), signed by CG. This letter was a reminder of the terms, limitations and conditions imposed on the Member by the Discipline panel of June 26, 2000. The letter stated, that the suspension was lifted as of September 26, 2000, being the assumed end of the three month imposed suspension. The letter continues, “Please be reminded that you are not to return to the practice of nursing until we have received a report from [psychotherapist 1], stating that she has consulted and obtained up-to-date information respecting your status prior to writing this report; and that in her opinion, your recovery has progressed to the point where you can safely return to the practice of nursing so long as you comply with the Conditions.At present we ask that you return your Annual Payment Registration Card to my attention, in order that it may be stamped, “Conditions”, to reflect that you are subject to certain terms, conditions and limitations. As per terms 3(d)(i)(ii)(iii) of the panel’s order, we are awaiting a letter from your psychotherapist. Please have [psychotherapist 1] forward this letter to my attention as soon as possible”.
  • Exhibit #9 – CNO letter to the Member (February 2, 2001), signed by CG, also includes a photocopy of the Members Annual Payment Registration Card for 2001, showing the stamp “CONDITIONS” on the card. The letter states, “We are in receipt of your Annual Payment Form for 2001. Enclosed is your Annual Payment Registration Card. You have indicated on your renewal Form that you are currently employed as a Registered Nurse and working at [Institution “B”]”. The letter concluded “Under these circumstances the College of Nurses of Ontario feels that you are in breach of your conditions, in that you have continually remained employed in the field of nursing; that you have not served your three month suspension, nor have you complied with conditions as ordered by the panel of the Discipline Committee. The College will be taking further steps to review this information and will take the necessary action. You will be contacted in the near future with regards to this matter. In the meantime, you should not be employed in nursing”.
  • Exhibit #10 – Transcript of a voice mail message left by the Member, to CG, dated February 6, 2001. The Member stated, “Hello Carla its Edna Ayres calling. I received your letter of February 2. This is the first correspondence I have received from the CNO since I have seen them on June 26, 2000. My annual registration does say that I was employed at [facility 2]. That was the last employment, I am currently employed as a chambermaid in a local hotel. I am not employed as a nurse. Thank you very much”.

CG testified that until the College received the Member’s annual payment form for 2001, she and the College assumed the Member was following the Discipline panel’s order (Exhibit #8).

CG explained that the procedure that would have been followed was that the Member would be asked to return the Member’s Annual Payment Registration Card for a three month period, then the card would be returned to the Member and stamped “CONDITIONS – Contact Investigations and Hearings Department for details”.

CG stated that she never received a response from the Member to the letter dated November 30, 2000 (Exhibit #8), nor was any letter from the psychotherapist ever received by the CNO.

The Member’s 2001 Registration request was referred to CG. The Member’s request for registration indicated that the Member’s current employer was [facility 2]. Consequently, CG sent a letter (Exhibit #9) on February 2, 2001. CG stated that the letter was sent by courier to the Member and would have been received by the Member the following day (February 3, 2001). CG received a voice mail message from the Member on February 6, 2001 at 1418 (Exhibit #10).

CG indicated that all letters were sent to the Member at [address removed]. No letters sent to the Member were returned to the CNO. Any returned mail is filed.

Witness # 2 – [Name removed]

[Witness 2] is an RN who has been the Nurse Manager of the Emergency Department at the [facility 1] since July, 2000. Prior to that she worked as a staff nurse in that unit. She has worked with the Member since April, 1999.

The panel found that this witness was credible.

In the course of [Witness 2’s] testimony the following Exhibits were presented:

  • Exhibit #11 – daily work schedule for full time staff from June 15, 2000 to November 29, 2000 for the Emergency Department of [facility 1] which included the Member’s name. The schedule indicates that the Member worked full time from June 28, 2000 to Sept 6, 2000. She was off on “sick time” on September 7, 2000, until November 28, 2000.
  • Exhibit #12 – A transcription of a telephone message, dated September 2, 2000, from the Member to [Witness 2] which is to update [Witness 2] on her sick time and that her scheduled time for return to work is November 20, 2000.

[Witness 2] testified that the Member had confided in her around the end of June, 2000 that she had breast cancer and would require surgery and radiation. It was agreed by [facility 1] that the Member would be in receipt of sick benefits from September 7 to November 20, 2000. The Member called [Witness 2] on Sept 2 at 12:11pm (Exhibit #12). When [Witness 2] learned that the Member was working at [the health centre], she called the Nurse Manager who confirmed that the Member was employed at [the health centre]. Consequently, the Member’s sick benefits were stopped on November 15, 2000. The Member was suspended without pay and terminated from [facility 1] on December 20, 2000, and was informed by registered letter.

Witness #3 [name removed]

[Witness 3] is an RN who is the Nurse Manager for [facility 2], which provides emergency services in [the airport]. Nurses in this position operate independently with written medical directives.

The panel found that [Witness 3] was a credible witness.

In the course of [Witness 3’s] testimony, the following Exhibits were presented:

  • Exhibit #13 – The Member’s resume, which was faxed to [facility 2] on June 23, 2000.
  • Exhibit #14 – Daily work schedule for the Member, as compiled by the witness, [Witness 3].. The schedule is from July 24, 2000 to November 15, 2000, and indicates that the Member was working full time for [facility 2].
  • Exhibit #15 – Letter dated November 15, 2000, to the Member, from [Witness 3], expressing concern that the Member had many incidents of arriving late for her day shifts, which could jeopardise the company’s contract with the airport.
  • Exhibit #16 – Hand written letter dated November 15, 2000, from the Member, to [Witness 3], resigning her position immediately.
  • Exhibit #17 – photocopy of Member’s pay stubs from [facility 2].

[Witness 3] testified that the Member did not indicate any CNO proceedings or limitations to her practice. The Member willingly showed [Witness 3] her Certificate of Registration. The Member was offered a full time position, which she began on September 1, 2000. She had four orientation shifts in July and was scheduled to work six (6) shifts in August 2000. She called in sick for her first shift following orientation, but did work the 5 remaining shifts on her rotation in August 2000. [Witness 3] said that she was not aware that the Member was receiving sick benefits from another employer, or working double shifts with [the health centre]. [Witness 3] indicated that she had concerns about the Member’s sick time and lateness for work.

[Witness 3] said that she realized that the Member had restrictions on her Certificate of Registration after the Member had resigned. The College informed [Witness 3], in February, 2001, that the Member had used [facility 2]as her last employer on her 2001 Registration renewal.

Witness #4 [Name removed]

[Witness #4] is a paramedic who is the manager of [agency 2.] The company contracts nurses, physicians, and paramedics to cover entertainment venues and accompany medically fragile individuals from abroad.

[Witness #4] was considered by the panel to be a credible witness.

In the course of his testimony the following Exhibits were presented:

  • Exhibit #18 – Member’s resume, faxed to [agency 2] on October 24, 2000
  • Exhibit #19 – Aeromedical Call Report from [agency 2] for November 23, 2000, which represents a report of a patient’s condition en route from Florida to Ottawa. The notes are signed by Edna Ayres, RN.
  • Exhibit #20 – Photocopy of a pay check to Edna Ayres, dated November 29, 2000, from [Institution “E”], including a copy of the Member’s endorsement of the cheque.

[Witness #4] testified that his first contact with the Member was via the telephone on October 25, 2000, following which the Member faxed her resume. [Witness #4] said that the Member did not indicate that there were any restrictions on her practice and that he was not shown a decision from the Discipline Committee. He agreed to retain her as an RN for on call duty. She was retained for one 11.5 hour flight (see Exhibits #19 and #20). He stated that had he been provided with information about her professional status he would not have retained her, since all of their nurses work unsupervised.

Witness #5 – Christine Schmidt (CS)

CS is a Prosecution Case Coordinator at the CNO.

The panel found that CS was a credible witness.

During CS’s testimony the following Exhibits were presented:

Exhibit #21A – Email, dated August 1, 2001, from CS to the Member. The Email acknowledged receipt of the earlier Email from the Member, dated July 25, 2001 (Exhibit #3). The Email (Exhibit #21A) stated that the hearing will proceed on August 7 and 8, 2001, even though the Member has indicated that she will not attend. The Member was also informed in this Email that if the Committee made findings of professional misconduct, the legislation required that a summary of the decision be published, along with the Member’s name.

Exhibit #21B – Email dated August 7, 2001, from the Member to CS, in which the Member states, “I am willing to adhere to any decision the College sets out for me.”

CS confirmed that there were no other communications from the Member.

Witness # 6 – [Name removed]

[Witness 6] is the Nursing Staffing Coordinator for [agency 1]. She is responsible for recruiting nurses as independent contractors to hospital Emergency units. [Witness 6] is not a member of the CNO.

The panel found that [Witness 6] was a credible witness.

Exhibit #22 – Daily staffing schedule for [the health centre] from June, 2000 to March, 2001, on which the Member’s work schedule is recorded from June 12, 2000 to March 17, 2001. The schedule shows that the Member worked full time hours.

[Witness 6] testified that the Member was contracted to work through [agency 1] at [the health centre] unit starting on June 12, 2000. [Witness 6] stated that the Member did not show her the decision of the Discipline hearing and never indicated that she had any limitations, restraints, or conditions to her practice. [Witness 6] stated that if she had known about the Conditions she would not have been able to enter into a contract with the Member.

[Witness 6] said that the Member gave “numerous” excuses for not producing her 2001 Certificate of Registration when this was requested.

Another staff nurse notified [Witness 6] that she had read the summary of the Discipline decision for the Member in the March 2001 Communique, pages 37 and 38 (later submitted as Exhibit #23). [Witness 6] then called her supervisor, an RN, who directed her to call the CNO. The CNO faxed the Communique to [Witness 6] on March 15, 2001. [Witness 6] reiterated that this was the first time that she was aware of the Conditions applied to the Member’s practice.

[Witness 6] recounted that, when she confronted the Member on March 17, 2001, that the Member responded that the incident had occurred about two years ago, and that her lawyer was dealing with it, and “not to worry about it”.

The Member was terminated on March 17, 2001.

Decision

Having considered the evidence and the fact that the College bears the onus of proving the allegations in accordance with the standard of proof as set out in Re Bernstein and the College of Physicians and Surgeons of Ontario (1977), 15 O.R. (2d) 447, 470, namely, that proof must be clear and convincing and based on cogent evidence, the panel found that the College had proven that the Member was in breach of an order of the Discipline Committee of the College of Nurses of Ontario.

Allegation #1

The panel unanimously found that the Member committed an act of professional misconduct in that the Member’s behaviour was disgraceful, dishonourable and unprofessional as alleged in paragraph #1 of the Notice of Hearing.

Allegation #2

The panel concluded that the Member committed an act of professional misconduct, in that she failed to comply with an order of a panel of the Discipline Committee, dated June 26, 2000, and in particular, failed to:

  1. Serve and complete the required three month suspension;
  2. Deliver the required letter to the CNO from her psychotherapist;
  3. Deliver the required report from her psychotherapist prior to returning to nursing practice;
  4. Limit her practice to part time employment;
  5. Work in a setting where her practice of nursing could be monitored;
  6. Notify the Director in writing upon obtaining employment in nursing;
  7. Provide any employer with the Decision, dated June 26, 2000.

The panel found that there was not clear, cogent and convincing evidence to prove the following allegations: #2 (ii) (a), (b), (c), (e).

Allegation #3

The panel unanimously found that the Member committed an act of professional misconduct in that the Member’s behaviour was disgraceful, dishonourable and unprofessional in that she failed to:

  1. Serve and complete the required three month suspension;
  2. Deliver the required letter to the CNO from her psychotherapist;
  3. Deliver the required report from her psychotherapist prior to returning to nursing practice;
  4. Limit her practice to part time employment;
  5. Work in a setting where her practice of nursing could be monitored;
  6. Notify the Director in writing upon obtaining employment in nursing;
  7. Provide any employer with the Decision, dated June 26, 2000.

The panel concluded that there was not clear, cogent and convincing evidence to prove the following allegations: #3 (ii) (a), (b), (c), (e).

Allegation #4

The panel unanimously found that the Member committed an act of professional misconduct in that the Member’s behaviour was disgraceful, dishonourable and unprofessional in that:

  1. on or about February 6, 2001, she provided inaccurate and/or false information to an employee of the College concerning her employment status and in particular she represented that she was not employed as a nurse; and
  2. during the month of September, 2000, while employed as a nurse at the [facility 1] in[the city], Ontario, she provided inaccurate and/or false information to her nursing manager with respect to her health status, and in particular her reason for requiring a period of sick leave.

Reasons for Decision

The panel was satisfied on the evidence of Witness #1 – CG, which evidence was uncontradicted, that: Exhibit #5 was a letter sent to the Member requesting the Member’s Registration Payment Care be sent to the College Investigations and Hearings Department and the Member was not legally entitled to call herself a nurse or accept employment as a nurse for the suspension period of three months. CG testified that she assumed the Member had complied with the three-month suspension penalty dated June 26, 2000.

Exhibit #8 was a letter from CG sent to the Member dated November 30, 2000 reminding the Member of the terms, limitations and conditions imposed on her by the panel of the College Discipline Committee on June 26, 2000. This letter informed the Member that the CNO had not received a report from her psychotherapist regarding the Member’s health status and that she was not to return to the practice of nursing until this report was received. The Member was informed in this letter that her suspension of three months was lifted as September 26, 2000. The Member was asked to return her Annual Payment Registration Card to the CNO as they may stamp “conditions” on it to reflect the terms, conditions and limitations.

Exhibit 9 was a letter sent to the Member from CG regarding the Member’s Annual Payment for 2001. The Member has indicated on her renewal form that she was employed as a Registered Nurse.

The panel found this evidence proof that the Member had not complied with the terms, limitations and conditions of the Discipline panel penalty decision of June 26, 2000. The Member had worked as a Registered Nurse while under suspension.

The panel was satisfied on the evidence of Witness #2 – [initials removed], which evidence was uncontradicted, that:

Exhibit #11 a daily work schedule of the Emergency Department of [facility 1] indicated the Member worked full time from June 28, 2000 to September 6, 2000.

The panel found this evidence proof that the Member had worked full-time as a Registered Nurse following her Discipline penalty decision of June 26, 2000, where the Member’s Certificate of Registration was suspended for three months.

[Witness 2] testified that the Member would be in receipt of sick benefits from [facility 1] from September 7 to November 20, 2000. [Witness 2] discovered that the Member was working [at the health centre], while collecting sick benefits from [facility 1].

The panel found this evidence proof that the Member collected sick benefits while working at another agency. She misrepresented the state of her health to her employer, [facility 1]. This is an act of professional misconduct and would be reasonably be regarded by members as disgraceful, dishonourable and unprofessional. The panel was satisfied on the evidence of Witness #3 –[initials removed], which evidence was uncontradicted, that:

Exhibit #14 was the daily work schedule for the Member as compiled by the witness, [Witness 3], indicating that the Member worked as a Registered Nurse full-time for [facility 2]from July 24, 2000 to November 15, 2000. The panel found this evidence proof that the Member had worked full-time for three months from a Penalty Decision of the Discipline panel dated June 26, 2000.

The panel was satisfied on the evidence of Witness #4 – [initials removed], which was evidence uncontradicted, that:

Exhibit #19 a Aeromedical Medical Report for November 23, 2000 which represented a report of a patient’s condition, signed by the Member using the R.N. designation following her signature.

The panel found this evidence proof that the Member worked as a Registered Nurse when she had not completed her three month suspension from the Discipline panel penalty decision of June 26, 2000.

The panel deliberated and accepted the evidence of the witnesses and exhibits and finds that the College has proven that the Member breached a penalty decision of a Discipline panel of the College of Nurses. The Member has engaged in conduct that would reasonably be regarded by members as disgraceful, dishonourable and unprofessional.

Penalty

Counsel for the College submitted that we must protect the public. This Member was found to have breached an Undertaking. The College has attempted to rehabilitate the Member. However, the Member failed to be accountable for her own rehabilitation and is, therefore, ungovernable. Revocation of the Member’s Certificate of Registration is the only choice the panel can make to uphold the mandate of public protection.

Penalty Decision

After carefully deliberating, the panel unanimously determined to direct the Registrar to immediately revoke the Member’s Certificate of Registration.

Reasons for Penalty Decision

The panel unanimously concluded that the College appears to be powerless to protect the public from this Member, other than by revoking the Member’s Certificate of Registration. The Member’s behaviour has been ungovernable, unaccountable, unreliable, untrustworthy, and dishonest, as evidenced by:

  1. her failure to meet, or attempt to meet, the Undertaking imposed by the Executive Committee on March 25, 1997, which had been set in an attempt to rehabilitate the Member.

    The Member entered into an Undertaking with the Executive Committee which was to be in effect from March 25, 1997 to March 25, 1999.

    The Member was found to have breached this Undertaking at a Discipline Hearing held at the College of Nurses of Ontario on June 26, 2000.

    The Member was to notify the College of her intentions thirty (30) days prior to changing nursing employment and to undergo independent health assessment if she returned to active nursing in a hospital setting, clause 4 (ii) in the Undertaking. The Member undertook to provide the College with any appraisal or evaluation of her nursing practice for the duration of the Undertaking, clause 4 (iv).

    At the time of the Undertaking, the Member was working as a Registered Nurse for [a homecare agency]. The Member also worked for[four other agencies].

    The Member failed to notify the College of any of these changes in her employment. She also failed to provide the College with evaluations of her nursing practice from most of these employers.

  2. the fact that the Member did not comply with the penalty of the Discipline Committee decision from June 26, 2000, which was imposed again, in the attempt to rehabilitate the Member, in particular:
    • She worked while under a three month suspension
    • There is no evidence that she sought medical care.
    • There is no evidence that she communicated with her employers about her professional status.
    • She did not supply the required documents to the College, regarding her health and employment status.
    • Following the mandated date of the end of suspension she did not confine her nursing practice to part time hours, nor seek monitored practice.
    • She engaged in employment while collecting sick benefits from another employer.
    • She falsely informed the College of her employment status (Exhibit #10).
    • She did not take responsibility for her own rehabilitation.
    • She reapplied for her Certificate of Registration for 2001, although she had not adhered to any pre-conditions of the Discipline Committee decision.

With respect to the Member’s request that her name not be published in the Communique, the panel is restricted by the legislation of the Regulated Health Professions Act, section 5(b) subsection (2)(a).

I, Janise Johnson, 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

Sandra Brewer, RN
Patricia Collins, RPN
Bill Weichel, Public Representative
Angus G. Taylor, Public Representative

Page mise à jour le septembre 28, 2010