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Nurse fails to accept full responsibility for past misconduct

By Lonny Rosen & Elyse Sunshine

A nurse applied to the College of Nurses of Ontario (the College) for his revoked registration to be reinstated. Unfortunately, his minimization of his professional misconduct in another jurisdiction resulted in the denial of his application.

The nurse’s past misconduct

The nurse had previously practiced in Ontario but after his move to the United States he was administratively suspended for failure to pay fees and his registration was revoked.

After leaving Ontario, he worked as a nurse in Florida. A complaint was made to the Florida nursing board, alleging that he was prescribing controlled substances to clients, friends, neighbours, and himself, by fraudulently using the name of a doctor. He was also criminally charged.

The nurse chose not to respond to the complaint made to the Florida nursing board (or to contest the factual allegations raised therein). The Florida board found the nurse guilty of misconduct and ordered the permanent revocation of his nursing license. The nurse was provided with notice of his appeal rights, but he did not appeal this decision. His criminal charges were disposed of by a plea agreement and he was placed on probation for 18 months.

Attempt to register in Ontario

The nurse then returned to Ontario and applied for the reinstatement of his certificate of registration with the College. The Registrar of the College referred the nurse’s application to the Registration Committee of the College (the Committee), and the Committee directed the Registrar to refuse to issue a Certificate of Registration to the nurse. In order to be registered, the nurse was required to establish on a balance of probabilities that his past and present conduct “affords reasonable grounds for the belief that he or she will practise nursing with decency, honesty and integrity and in accordance with the law.” The nurse in this case failed to do so.

The Committee concluded that it could not ignore the severity of the nurse’s actions. His choice of words in describing his conduct undermined any sign or display of remorse. While the nurse admitted to writing or ordering the prescriptions described in the Florida complaint, he said he was only “technically” guilty and that his errors were “not serious” and that they were done “in good faith.” The Committee observed that he “did not seem to have a clear understanding of how he erred both legally and professionally” and that he was not sufficiently accountable for his actions. The Committee found that there was a lack of insight, remorse or appreciation for his past conduct.

The nurse sought a review of the Committee’s decision to the Health Professions Appeal and Review Board (the Board). The nurse argued that the Committee erred by accepting “as true” the depiction of events in the Florida complaint as he wasn’t given an opportunity to go on the record and answer the allegations. The Board noted that it was clear that the nurse did have the opportunity to dispute the specific allegations against him and he chose not to do so.

The Board observed it is the College’s duty to serve and protect the public interest and that the College is responsible for establishing and maintaining the standard of qualifications for persons to be issued certificates of registration. The practice of nursing in Ontario is a privilege and not a right.

The nurse’s scope of practice in Florida specifically excluded prescribing a controlled substance. The Committee further observed that this was a matter of patient protection. There was little if anything in the material before the Board which demonstrated an understanding on the part of the nurse that he appreciated that his conduct could have put patients at risk.

The Board, therefore, found that the nurse did not qualify for registration with the College, and confirmed the Committee’s order.

Takeaway

While the nurse did not hide his past discretions from the College, his response to those mistakes was his downfall. Regulators act as gatekeepers, and are required not to admit applicants to a profession where their past conduct provides evidence that they will not practise nursing with decency, honesty and integrity and in accordance with the law. Obviously nurses, and other health professionals, are human and may make mistakes, and past mistakes need not be an absolute bar to registration as a health professional. Where a health professional has engaged in some type of misconduct in the past, it is integral that he or she address this misconduct and accept full responsibility for same, in order to show that, despite these past mistakes, they can practice with decency, honesty and integrity, and in accordance with the law.

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