DISCIPLINE COMMITTEE

OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Catherine Egerton, Public Member Chairperson

Terry Holland, RPN Member

Mary MacMillan-Gilkinson Public Member

Sherry Szucsko-Bedard, RN Member

Terah White, RPN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) EMILY LAWRENCE for

) College of Nurses of Ontario

- and - )

)

PATRICK LENTO ) RENÉE KOPP for

Reg. No. AA798110 ) Patrick Lento

)

) JUSTIN SAFAYENI

) Independent Legal Counsel

)

) Heard: September 27, 2017

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on September 27,

2014 at the College of Nurses of Ontario (“the College”) at Toronto.

The Allegations

Counsel for the College advised the Panel that the College was requesting leave to withdraw the

allegations set out in paragraphs 1 (b),(f); 2(b),(d); and 3(b),(f) of the Notice of Hearing dated

June 9, 2017. The Panel granted this request. Counsel for the College also advised the Panel that

they would not be calling evidence on sections of 1 (a), (e); 2(a); and 3(a) and (e) which referred

to the Member as communicating “rudely” to his Clients. Counsel for the College further advised

the Panel that they would not be calling evidence on a section of 2(a) where it states that the

Member “physically treated client [Client A] inappropriately”. Given that no evidence was

called, the Panel dismissed these portions of the allegations.

The remaining allegations against Patrick Lento (the “Member”) as stated in the Notice of

Hearing dated June 9, 2017 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(1) of Ontario Regulation 799/93, in that while working

as a Registered Practical Nurse at St. Joseph’s General Hospital, in Elliot Lake, Ontario, you

contravened a standard of practice of the profession or failed to meet the standards of

practice of the profession, with respect to the following incidents:

a. In or about January 2015 to April 2015, you communicated rudely and inappropriately with client [Client A] and/or made inappropriate comments about

client [Client A] and/or displayed an inappropriate attitude towards client [Client A];

and/or

b. [Withdrawn]; and/or

c. On or around March 22, 2015, you acted inappropriately towards client [Client B]; and/or

d. On or around April 5, 2015, you made an inappropriate comment to client [Client C]; and/or

e. On or around April 8, 2015, you communicated rudely and inappropriately with client [Client D]; and/or

f. [Withdrawn].

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(7) of Ontario Regulation 799/93, in that while working

as a Registered Practical Nurse at St. Joseph’s General Hospital, in Elliot Lake, Ontario, you

abused a client verbally, physically or emotionally, with respect to the following incidents:

a. In or about January 2015 to April 2015, you communicated rudely and inappropriately with client [Client A], and/or made inappropriate comments about

client [Client A], and/or physically treated client [Client A] inappropriately; and/or

b. [Withdrawn]; and/or

c. On or around March 22, 2015, you acted inappropriately towards client [Client B]; and/or

d. [Withdrawn]

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(37) of Ontario Regulation 799/93, in that while

working as a Registered Practical Nurse at St. Joseph’s General Hospital, in Elliot Lake,

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, with respect to the following incidents:

a. In or about January 2015 to April 2015, you communicated rudely and inappropriately with client [Client A] and/or made inappropriate comments about

client [Client A] and/or displayed an inappropriate attitude towards client [Client A];

and/or

b. [Withdrawn]; and/or

c. On or around March 22, 2015, you acted inappropriately towards client [Client B]; and/or

d. On or around April 5, 2015, you made an inappropriate comment to client [Client C]; and/or

e. On or around April 8, 2015, you communicated rudely and inappropriately with client [Client D]; and/or

f. [Withdrawn]

Member’s Plea

The Member admitted the revised allegations as set out in paragraphs 1(a),(c),(d),(e); 2(a),(c);

and 3(a),(c),(d) and (e) 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 and the Member advised the Panel that agreement had been reached on

the facts and introduced an Agreed Statement of Facts, which reads as follows.

THE MEMBER

1. Patrick Lento (the “Member”) obtained a diploma in nursing from Sault College in 2011.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Practical Nurse (“RPN”) on July 20, 2011.

3. The Member was employed at St. Joseph’s General Hospital (the “Hospital”) from October 2, 2013 to April 16, 2015 when his employment was terminated as a result of the

incidents described below. The Member’s termination was converted to a resignation as a

result of a grievance.

THE HOSPITAL

4. The Hospital is located in Elliott Lake, Ontario.

5. The Member worked as a part-time staff nurse at the Hospital in various areas, including the Medical/Surgical Unit, the Chronic Care Unit and the Emergency Department.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL

MISCONDUCT

Client A

6. Client A was a 65 years old man at the time of the incidents. He had a long history with the Hospital. He had been admitted for months at a time on multiple occasions, often over

the winter months, in the Chronic Care Unit as a result of not being able to care for

himself. He also had a history of signing himself out of the Hospital against medical

advice and of refusing to take his medication while in Hospital.

7. Client A suffered from mental health problems but was competent with respect to care. He also had a speech impediment and was sometimes difficult to understand. Staff who

worked with Client A regularly were able to understand him if he spoke slowly.

Alternatively, staff used hand gestures and signals. Client A also had blindness in his

right eye as a result of a childhood injury.

January 22, 2015

8. On January 22, 2015, Client A arrived in the Emergency Department after passing out on the street. Around 1500, the Member was transferring Client A from the Emergency

Department to the Chronic Care Unit. Client A was ambulatory on admission to hospital,

but he was transferred to the Chronic Care Unit on a stretcher.

9. [Colleague A], RPN, questioned why Client A was on a stretcher, given that he knew Client A to be ambulatory during his previous admissions. The Member replied, in front

of Client A, that it was because Client A was “lazy” or “feeling lazy”. The Member

admits that he referred to Client A as lazy, but denies that he intended any negative

connotation.

10. The Member acknowledges that, regardless of his intent, using the word “lazy” to describe a client is disparaging and erodes the therapeutic-nurse client relationship. He

admits that referring to Client A as lazy during these interactions with Client A and

[Colleague A] was inappropriate.

February 2015

11. In or around February 2015, the Member made comments about Client A to [Colleague A] at the nursing station. According to [Colleague A], the Member said “[Client A] is a

piece of shit. He is a waste of my tax dollars and this hospital’s resources,” or words to

that effect. If the Member were to testify, he would state that he denies referring to Client

A as a “piece of shit” but acknowledges that he told colleagues that it was a “waste of tax

dollars” to have Client A in the Hospital when his mental health care needs could be

better served in a different setting. The Member acknowledges that he should not have

expressed his personal opinion about Client A in a professional setting.

12. In February 2015, during a conversation between the Member and [Colleague A], the Member encouraged [Colleague A] to “ask [Client A] if he would like a pine cone,” or

words to that effect, after telling [Colleague A] that Client A had been jabbed in the right

eye with a pine cone as a child. The Member admits and acknowledges that, although he

intended this as a joke, his comments to [Colleague A] lacked empathy and were

inappropriate.

April 3, 2015

13. On April 3, 2015, the Member was working the day shift on the Chronic Care Unit from 0700 to 1900. The Member was assigned to Client A’s care. Client A refused to take his

morning medication and stated he wanted to leave the Hospital, both of which the Client

had done in the past. The Member went to retrieve the forms to allow Client A to sign

himself out against medical advice. He stated to a colleague that he was not going to stop

Client A if he wanted to leave. The Member’s view was that Client A was engaging in

this conduct in order to obtain care from a young female nurse rather than the Member

who was assigned to his care.

14. The Member also commented to a colleague that he did not care if Client A took his medication or not and felt the Client was taking advantage of the Hospital by “playing the

system,” or words to that effect.

15. The Member documented Client A’s refusal to eat breakfast and take his medication in Client A’s chart. However, the Member failed to document Client A’s comments that he

wanted to leave the Hospital in the progress notes.

16. The Member admits that his comments to his colleague were derogatory, lacked empathy and were inappropriate. The Member also acknowledges that he should not have

expressed his personal opinion about Client A in a professional setting.

April 5, 2015

17. On April 5, 2015, the Member worked the day shift from 0700 to 1900 on the Chronic Care Unit. [Colleague B] and [Colleague C] also worked the day shift. The Member was

assigned to care for Client A. It was Easter Sunday.

18. Early in the shift, between 0800 and 1000, after Client A took his medication and had his breakfast, he started asking the staff about when his appointment was with the eye doctor,

and dressing to attend that appointment. Client A believed the appointment was

scheduled for that day, which it was not. The Member verified Client A’s chart and told

Client A that there was no appointment for him for that day, but took no further steps to

reassure Client A.

19. Client A raised the eye appointment with other staff. [Colleague B] checked the schedule and advised the Member and [Colleague C] that Client A’s appointment was on April 14,

2015 at 1530. [Colleague C] then advised Client A of his appointment date and time.

Client A inquired a few more times about his appointment. Each time, [Colleague C]

showed Client A his appointment in the Kardex document, which calmed Client A down.

20. The Member made statements to [Colleague B] and [Colleague C] that his tax dollars were being wasted on people like Client A who take advantage of the system.

21. The Member admits that his statements to his colleagues were derogatory, lacked empathy and were inappropriate. The Member acknowledges that he should not have

expressed his personal opinion about Client A in a professional setting.

22. Around noon, another interaction occurred between the Member and Client A. Client A suffers from obsessive compulsive behaviours. In particular, he liked to fold the clean

linens on the laundry cart and shower repeatedly in a day.

23. On that particular day, Client A was folding and unfolding the linens on the laundry cart. The Member told Client A not to touch the linens because of sanitary concerns. When

Client A did not listen, the Member gave him a few sets of linens for his personal use and

then removed the linen cart and put it in the tub room next to Client A’s room. Client A

became increasingly agitated.

24. Later in the day, around 1600, the Member entered Client A’s room for routine care. Client A repeatedly yelled at the Member to get out of his room. The Member ran from

Client A’s room, and sought the assistance of his male colleagues.

25. Client A also exited his room and came to the nursing station where [Colleague B] was located. He was very agitated. [Colleague B] asked him what happened. [Colleague D],

RPN, arrived and firmly asked Client A to go back to his room. Client A became more

agitated and struck [Colleague D] on the side of his face, causing his glasses to fly off.

26. In response, [Colleague D] and the Member took Client A by the arms and escorted him back to his room. [Colleague B] followed. Client A lay face down on the bed with

[Colleague D’s] assistance. The Member retrieved Haldol, a medication prescribed to

Client A. The Member and [Colleague D] exposed Client A’s buttocks to administer the

medication, and the Member administered the medication in the client’s buttock.

27. After the Member and [Colleague D] left the room, [Colleague B] stayed behind to talk to Client A, who was upset. He repeatedly said that the Member and [Colleague D] made

fun of him and his eye and he wanted his lawyer and the police called. The Member

denies that he “made fun of” Client A while in his room with [Colleague D] and there is

no evidence to support that he did.

28. In the course of investigating the events of April 5, 2015, a number of other concerns were raised about the Member’s conduct towards clients and co-workers.

Client B

29. On March 22, 2015, the Member was working the night shift from 1900 to 0700 on the third floor Medical/Surgical Unit. [Colleague E], RPN, was also working that shift.

30. Client B was a 95 years old woman at the time of the incident. She had dementia.

31. Around the night-time medication pass, [Colleague E] was in the nursing station. Client B was positioned in a geri-chair next to the nursing station. The Member was outside, in

front of the nursing station, facing Client B. The Member made a gesture in a “Heil

Hitler-like” manner, which [Colleague E] observed.

32. If [Colleague E] were to testify she would state that she saw the Member make this gesture at least twice. If the Member were to testify, he would state that he made the

gesture once.

33. [Colleague E] observed that Client B also saw the gesture(s), and became agitated, fidgeted in her chair and mumbled something in German.

34. If the Member were to testify, he would say that he made the gesture(s) to his colleague and did not believe Client B saw his actions or had any reaction to the gesture(s). In any

case, the Member admits that his conduct towards Client B was inappropriate, regardless

of who observed it, and that if seen by Client B, would have reasonably caused her to

become upset.

Client C

35. Client C was a long term Client in the Chronic Care Unit. He was 84 years old, had dementia and was sometimes inappropriate with female nurses, which the Member knew.

36. On April 5, 2015, Client C had acted inappropriately towards a colleague, [Colleague B] by asking her to “come here, give me a hug,” then hugging her very tightly and, as she

pulled away, kissing her neck, and asking her if she had a husband and children. If

[Colleague B] were to testify, she would state that she told the Member and [Colleague

C] that this had happened and that she had told Client C that she was married and that he

could not treat his nurses that way. The Member denies receiving this information from

[Colleague B].

37. Later that day, Client C approached [Colleague B] at the nursing station and started asking her personal questions. As the Member was returning to the nursing station, he

observed [Colleague B] and Client C in conversation. The Member, while laughing, said

to Client C, “[Client C], isn’t she beautiful?” In response to the Member’s remarks,

Client C said that he wanted to marry [Colleague B] and hug and kiss her. [Colleague C]

intervened and asked the Member to stop encouraging the client. [Colleague B] was

uncomfortable.

38. The Member admits that his comment to Client C was inappropriate and placed his colleague in an uncomfortable position. He acknowledges that he encouraged Client C’s

flirtatiousness toward [Colleague B] at the nursing station. He also admits that he knew

or should have known that it was inappropriate to encourage a client to act in this manner

with his colleague.

Client D

39. On April 8, 2015, the Member was assigned to the third floor Medical/Surgical Unit for the night shift from 1900 to 0700. He was assigned to provide care to Client D who was

80 years old at the time.

40. Around 2100, Client D rang the call bell. She had wet her disposable briefs and the sheets.

41. The Member changed Client D’s sheets and her briefs. He also provided Client D with a cup of water for her dentures and he administered medication to Client D around 2200.

42. In the course of providing care, the Member spoke with Client D about whether she was able to live independently. Client D perceived the conversation as the Member being

frustrated that he had to provide her with care and criticizing her ability to care for

herself. When Client D refused to discuss alternative living arrangements, the Member

apologized for raising the topic. He did not make further attempts to ensure that the client

felt comfortable requesting further care for him.

43. Later that night, Client D wet her bed again but did not want to ring the call bell in case the Member responded. If the Member were to testify, he would state that he checked on

the Client throughout the night (which he documented) and found her sleeping at change

of shift in the morning.

44. A short time after shift change the following morning, [Colleague F], RPN, found Client D in her room crying with her bed soaked with urine.

45. The Member admits that while his intentions were to help Client D with accessing additional care in her home, the tone and content of the conversation with the Client left

her feeling upset. The Member admits that he communicated inappropriately with Client

D in the circumstances.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

46. The Member admits that he committed the acts of professional misconduct as described in paragraphs 6-45 above and as alleged in the Notice of Hearing, as follows:

1(a) in that he communicated inappropriately with client [Client A] and/or made

inappropriate comments about client [Client A] and/or displayed an inappropriate

attitude towards client [Client A];

1(c) in that he acted inappropriately towards client [Client B];

1(d) in that he made an inappropriate comment to client [Client C];

1(e) in that he communicated inappropriately with client [Client D]

47. The Member admits that he committed the acts of professional misconduct as described in paragraphs 6-10 and 29-34 above and as alleged in the Notice of Hearing, as follows:

2(a) in that he verbally and emotionally abused client [Client A] when he called

him “lazy”;

2(c) in that he emotionally abused client [Client B] when he made a “Heil Hitler-

like” salute in her presence.

48. The Member admits that he committed the acts of professional misconduct as described in paragraphs 6-45 above and as alleged in the Notice of Hearing as follows:

3(a) in that his conduct was disgraceful, dishonourable and unprofessional;

3(c) in that his conduct was dishonourable and unprofessional;

3(d) in that his conduct was unprofessional;

3(e) in that his conduct was unprofessional.

49. With leave of the Panel of the Discipline Committee, the College withdraws the following allegations from the Notice of Hearing:

1(b) and (f)

2(b) and (d)

3(b) and (f)

Decision

The Panel finds that the Member committed acts of professional misconduct as alleged in

paragraphs 1(a),(c),(d),(e); and 2(a) (verbal and emotional abuse), 2(c) (emotional abuse) of the

Notice of Hearing. As to allegation 3(a), the Panel finds that the Member engaged in conduct

that would reasonably be regarded by members to be disgraceful, dishonourable and

unprofessional. As to allegation 3(c), the Panel finds that the Member’s conduct would be

reasonably be regarded by members to be dishonourable and unprofessional. As to allegation

3(d),(e) the Panel finds the Member’s conduct would reasonably be regarded by members to be

unprofessional.

Reasons for Decision

The Panel considered the Agreed Statement of Facts and the Member’s plea and finds that this

evidence supports findings of professional misconduct as alleged in the Notice of Hearing.

Allegation #1 in the Notice of Hearing is supported by paragraphs 6 – 45 in the Agreed

Statement of Facts. The evidence shows that the Member contravened the standards of practice

when he spoke about Client A in a derogatory manner and sought to make a joke of his eye

injury. The Member told a colleague, on two separate occasions, that Client A was a waste of tax

dollars. He also stated that Client A was “lazy” and “playing the system” and that he did not care

if he took his medication or not. The Member demonstrated a lack of empathy when he

encouraged his colleague to ask Client A if he wanted a pine cone. The Member was aware that

Client A’s eye was injured with a pine cone when he was a child.

Client A indicated that he felt targeted and was upset as he repeatedly stated that the Member

and a colleague had made fun of him and his eye injury. The Member admitted that it was a joke

but did recognize that his conduct lacked empathy.

The Member continued to initiate inappropriate interactions with his colleagues in their

professional setting. The Member was facing Client B when he admittedly made a “Heil-Hitler-

like” gesture to his colleague. This gesture had no professional purpose. Instead, it only seemed

to disturb Client B, who responded in an agitated fashion and mumbled in German.

In another situation, the Member laughingly goaded on Client C, an 84 year old patient with

dementia who was attracted to one of the female nurses on the unit. The Member made an

inappropriate comment to Client C about his colleague. This led Client C to say that he wanted

to marry the nurse and hug and kiss her. Again the Member’s comment had no professional

purpose and instead resulted in an escalation of an already uncomfortable situation and

essentially put the Member’s colleague at risk.

In the case of Client D, the Member’s tone and conversation caused Client D to hesitate ringing

the call bell for assistance. The Member made little outward attempts to comfort Client D and

this resulted in Client D lying in a urine soaked bed, crying and fearful of the Member coming

into her room. The Member acknowledges that he was trying to help Client D but certainly that

was not the Client’s perception. Had the Member returned to Client D and offered emotional

support, this may have been avoided.

The Member’s actions showed that he breached the standards of practice when he failed to

respect the dignity of these four elderly and vulnerable clients.

Allegation #2 in the Notice of Hearing is supported by paragraphs 6 – 10 and 29 - 34 in the

Agreed Statement of Facts. The Member admits that he verbally and emotionally abused Client

A when he told a colleague, in ear shot distance of Client A, that he was “lazy”. The Member

would say that this was his way to explain why Client A was on a stretcher instead of walking.

However, such hurtful & disparaging language, spoken in front of a client, can only serve to

erode respect and trust and ultimately cause a client to feel less valued. The Member’s “Heil-

Hitler-like” gesture in front of Client B was unnecessary and emotionally abusive. This conduct

showed profound disrespect for Client B. It was insensitive to both her heritage and her history.

The Member’s colleague believed that Client B saw the gesture because she became agitated,

started to fidget in her chair and began to mumble in German.

With respect to Allegation # 3(a), the Panel finds that the Member’s problematic pattern of

conduct with Client A would reasonably be regarded by members of the profession as

disgraceful, dishonourable and unprofessional. The Member referred to Client A as “lazy”. He

encouraged a colleague to taunt Client A about his serious eye injury. On two occasions, he

referred to Client A as a drain on the tax system. The Member caused Client A to feel distressed

and targeted. The Member showed a lack of professionalism and empathy. The Member ought to

have known that his conduct fell well below what is expected of nurses. Such a litany of

shameful conduct casts serious doubt on the Member’s moral fitness and his inherent ability to

be compassionate and discharge the higher obligations the public expects professionals to meet.

The Member has shamed himself and, by extension, the entire profession.

With respect to Allegation #3(c), the Panel finds that the Member’s conduct would reasonably be

regarded by members of the profession as dishonourable and unprofessional. The Member ought

to have known that making a “Heil-Hitler-like” gesture in front of an elderly client with a

German background was insensitive, extremely inappropriate and professionally unnecessary. It

demonstrates an element of moral failing.

With respect to Allegation #3(d), the Panel finds that the Member’s conduct would reasonably be

regarded by members of the profession as unprofessional. The Member showed a serious

disregard for his professional obligations when he encouraged Client C’s flirtatiousness toward

his colleague by asking him “Client C, isn’t she beautiful?” The Member’s question resulted in

an escalation of Client C’s inappropriate interactions with his nurse. The Member’s conduct

demonstrated a lack of good judgement and a failure to live up to the standards expected of him.

With respect to Allegation #3(e), the Panel finds that the Member’s conduct would reasonably be

regarded by members of the profession as unprofessional. The Member admits that he was trying

to help Client D access additional support in her home. Client D, however, perceived the

Member as being critical of her ability to care for herself and frustrated because he had to change

her sheets and her briefs. In this sensitive situation, Client D deserved to feel that she was being

treated with dignity and compassion. The Member should have been aware of his verbal and

non-verbal communication and should have monitored how it was being perceived by Client D.

Penalty

Counsel for the College and the Member advised the panel that a Joint Submission on Order had

been agreed upon. The Joint Submission requests that this panel make an order as follows.

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 that this Order becomes final

and shall continue to run without interruption as long as the Member remains in the

practising class.

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 meetings with a Nursing Expert (the “Expert”), at his own expense and within six months from the date of this Order. To comply,

the Member is required to ensure that:

i. The Expert has expertise in nursing 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 first 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 first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires,

online learning modules, decision tools and online participation forms

(where applicable):

1. Professional Standards, 2. Therapeutic Nurse-Client Relationship

iv. Before the first meeting, the Member reviews and completes the College’s self-directed learning package, One is One Too Many, at her own expense,

including the self-directed Nurses’ Workbook;

v. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online

participation forms and Nurses’ Workbook;

vi. 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;

vii. Within 30 days after the Member has completed the last session, the Member will confirm that 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 his behaviour;

viii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in

the Member breaching a term, condition or limitation on his certificate of

registration;

b. For a period of 24 months from the date the Member’s suspension ends, the Member will notify his employers of the decision. To comply, the Member is

required to:

i. Ensure that 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. Provide his 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 Order, and 5. a copy of the Panel’s Decision and Reasons, once available;

iii. Ensure that 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 delivered by verifiable method, the proof of which the Member will retain.

Penalty Submissions

Submissions were made by College Counsel and the Member’s Counsel.

The parties agreed that the mitigating factors in this case included the following:

The Member cooperated with the College in the conduct of this proceeding.

He has no prior history with the College.

He voluntarily admitted to the allegations.

He avoided a contested hearing which saved time and expense.

The Member took steps to ensure that his practice improves moving forward.

Prior to these events, the Member was considered a highly regarded employee.

The Member is remorseful.

The aggravating factors in this case were the fact that the Member’s conduct was not an isolated

incident and that it involved a number of elderly, vulnerable clients. This pattern of disrespectful,

unprofessional behaviour is viewed very seriously.

The proposed penalty provides for general deterrence through:

A five month suspension which sends a clear message to the profession that this conduct will not

be tolerated. It will also discourage other members from repeating these actions. The terms,

conditions and limitations on the Member’s certificate will signal a message to the membership,

as a whole, that this type of behaviour is significant and serious and falls well below professional

standards.

The proposed penalty provides for specific deterrence through a suspension of five months

which is a weighty and significant suspension. The oral reprimand will assist the Member in

gaining a greater understanding of the impact of his conduct.

The terms, conditions and limitations on his license will provide for monitoring of the Member’s

practice and conduct.

The proposed penalty provides for remediation and rehabilitation through a combination of self-

reflection, review of the CNO standards, and a review of the One is One Too Many learning

package.

Overall, the public is protected because, after the suspension ends, the Member is required to

notify his employers of this decision for 24 months. The meetings with the Nursing Expert will

help the Member to gain insight into his actions and to remediate his conduct.

Counsel did not submit any previous case law to the Panel. Both College Counsel and Defence

Counsel reviewed several cases but did not find one case that was analogous to the issues and the

particular conduct at issue in this case. Both College Counsel and Defence Counsel were

experienced and well placed to negotiate the order that was agreed upon. They engaged in

lengthy conversations to come up with an order that was reasonable given the circumstances.

Both Counsel agreed that the 5-month suspension was in the higher range on the spectrum of

cases but it did reflect the seriousness of the conduct. Independent Legal Counsel to the Panel

advised that the Panel should give strong weight to the Joint Submission on Order.

Penalty Decision

The Panel accepts the Joint Submission as to Order and accordingly orders:

1. The Member is required to 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 that this Order becomes final and

shall continue to run without interruption as long as the Member remains in the practising

class.

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 meetings with a Nursing Expert (the “Expert”), at his own expense and within six months from the date of this Order. To comply, the

Member is required to ensure that:

i. The Expert has expertise in nursing 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 first 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 first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires, online

learning modules, decision tools and online participation forms (where

applicable):

1. Professional Standards, 2. Therapeutic Nurse-Client Relationship

iv. Before the first meeting, the Member reviews and completes the College’s self-directed learning package, One is One Too Many, at her own expense,

including the self-directed Nurses’ Workbook;

v. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation

forms and Nurses’ Workbook;

vi. 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;

vii. Within 30 days after the Member has completed the last session, the Member will confirm that 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 his behaviour;

viii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the

Member breaching a term, condition or limitation on his certificate of

registration;

b. For a period of 24 months from the date the Member’s suspension ends, the Member will notify his employers of the decision. To comply, the Member is required to:

i. Ensure that 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. Provide his 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 Order, and 5. a copy of the Panel’s Decision and Reasons, once available;

iii. Ensure that 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 delivered by verifiable method, the proof of which the Member will retain.

Reasons for Penalty Decision

The Panel understands that the penalty ordered should protect the public and enhance public

confidence in the ability of the College to regulate nurses. This is achieved through a penalty that

addresses specific deterrence, general deterrence and, where appropriate, rehabilitation and

remediation. The Panel also considered the penalty in light of the principle that joint submissions

should not be interfered with lightly.

The Panel concluded that the proposed penalty is reasonable and in the public interest. The

Member has co-operated with the College and, by agreeing to the facts and a proposed penalty,

has accepted responsibility. He avoided the need for a contested hearing.

The Panel finds that the penalty satisfies the principles of specific and general deterrence,

rehabilitation and remediation, and public protection. It sends a strong message to the Member,

and the membership as a whole, that actions and words which disrespect clients will not be

tolerated. Members must ensure that all communication with clients and colleagues, in a

professional setting, is client focused, meaningful and professional. There is no tolerance for

inappropriate comments or interactions that demean clients and violate the valued principles of

trust, respect and empathy.

The public is protected by the fact that the Member has accepted responsibility for his actions

and will be rehabilitated by the suspension and the meetings with the expert. There is also a

significant period of employer notification that will ensure that when the Member returns to

practice, he obtains appropriate supervision.

I, Catherine Egerton, Public Member, sign this decision and reasons for the decision as

Chairperson of this Discipline panel and on behalf of the members of the Discipline panel.

______________________ ______________________

Chairperson Date