Aimola, Joy

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

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 the allegations have been dismissed or if the results are not placed on the public portion of the Register.

PANEL:

Arlene Grant, RN - Chairperson
Ruth Kitson, RN - Member
Kim Pederson, RPN - Member
Marilyn Bestwick - Public Member
Fay Cole - Public Member

BETWEEN:

Heard: November 27, 2003

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on November 27, 2003 at the Mediation Place, 3rd floor, 390 Bay St., Toronto, Ontario.

The Allegations

The allegations against Joy Aimola as stated in the Amended Notice of Hearing dated November 27, 2003 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 and defined in paragraph 1(8) of the Ontario Regulation 799/93, in that in or about late November/early December 2001, while employed as a registered nurse on a casual basis with [Agency A], an agency contracted by [Agency B] to provide in-home nursing care to patients/clients [ ], you misappropriated funds belonging to your workplace, in that you recorded visits not made by you in respect of four patients/clients - [clients A, B, C and D] - for which visits you were paid.
2. You have committed an act of professional misconduct as provided by Subsection 51 (1) (c) of the Health Professions Procedural Code and defined in paragraph 1(37) of Ontario Regulation 799/93, in that in or about late November/early December 2001, while employed as a registered nurse on a casual basis with [Agency A], an agency contracted by [Agency B] to provide in-home nursing care to patients/clients [ ], you engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded by Members as disgraceful, dishonourable or unprofessional, in that you recorded visits not made by you in respect of four patients/clients - [clients A, B, C and D] - for which visits you were paid.

Counsel for the College of Nurses of Ontario (the "College") advised that the College would not be calling any evidence with respect to [clients C and D].

Member's Plea

The Member admitted to the allegations as set out in paragraphs #1 and #2 of the Amended Notice of Hearing (Exhibit #1) and recognized that the College would not be calling evidence with regards to [clients C and D]. The panel conducted a 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 an agreement had been reached on the facts and introduced an Agreed Statement of Facts, (Exhibit #2) which provided as follows:

Background

1. Joy Aimola, RN, #98-0764-5 ("the Member"), has been registered as a Registered Nurse with the College of Nurses of Ontario since 1997.
   
2. The Member began working for [Agency A] as a casual community Registered Nurse in August of 1998, and worked in that role until her employment was terminated on December 18, 2001 in connection with the incidents described below. The Member also worked occasionally as a temporary nurse for [Agency C] in that time period.

Misappropriation Of Funds From Workplace

3. Through [Agency A], the Member was assigned to the care of [clients A and B] ("the Clients").
   
4. Between the period November 17 to December 16, 2001, the Member requested payment from [Agency A] for visits that she had not made to each of the Clients by submitting fraudulent Timeslip Records.
   
5. [Client A] was a 67-year-old [ ] who had a sebaceous cyst surgically removed. [Client A] received daily dressing changes between October 30, 2001 and November 17, 2001. The Member discharged [client A] on or about November 18, 2001, but continued to bill for daily visits to [client A] up to and including December 7, 2001, even though she did not make these visits. As a result, the Member was paid for 20 visits that she did not make.
   
6. [Client B] was a 52-year-old [ ] who had a surgical resection [ ] as a result of cancer. [Client B's] doctor had ordered that [client B] receive twice-daily visits for irrigation, cleansing and re-packing of [the] surgical wound. In November, 2001, the Member determined that [client B] needed only one visit per day. However, while the Member never made more than one visit on any day in December, 2001, she submitted a Timeslip Record for payment for twice-daily visits for 10 days in December to [client B]. [Agency A] paid the Member for three of these visits, but did not pay the Member for seven of these visits, as it came to their attention that the Member had made only one visit per day.
   
7. On December 18, 2001, [client B's] physician assessed [client B's] wound. He indicated that [client B's] wound had not been irrigated or packed properly, that the dressings had not been changed frequently enough, and that the wound was messy and showed no signs of healing. [An Agency A] supervisor reassured him that [client B's] wound would be cleaned and re-dressed twice daily from that point onward.
   
8. Altogether, the Member claimed payment for 30 1-hour visits she did not make. Of these 30 visits, [Agency A] paid her for approximately 23 visits. As her payment rate was $27.25/hour, she received approximately $626.75 (gross) from [Agency A] for these visits.
   
9. Through regular book-keeping activities, [Agency A] discovered that it had billed [Agency B], and paid the Member, for visits made to [client B] after [client B] had been discharged from care. On December 18, 2001, [Agency A] interviewed the Member about these irregularities. The Member openly admitted to billing for visits to [client A] after [client A's] discharge and to billing for twice-daily visits to [client B] when she had never visited more than once per day, and signed a statement to that effect.
   
10. If the Member were to give evidence she would say that she was and is very remorseful about requesting and accepting payment for visits she did not make. She would also say that she was emotionally stressed at the time for [financial and personal reasons].
    
11. The Member has repaid [Agency A] the $626.75 referred to in paragraph 8, above.

Admissions

12. The Member admits that, on the basis of the facts set out above, and as is alleged in paragraph 1 of the Notice of Hearing, she has committed acts of professional misconduct in that in or about late November/early December 2001, while employed as a Registered Nurse on a casual basis with [Agency A] to provide in-home nursing care to clients [ ], she misappropriated funds belonging to her workplace, in that, as is set out above, she recorded 30 1-hour visits not made by her in respect of [clients A and B] - of which she was paid for 23 visits.
    
13. The Member further admits that, on the basis of the facts set out above, and as is alleged in paragraph 2 of the Notice of Hearing, she has committed acts of professional misconduct in that in or about late November/early December, 2001, while employed as a registered nurse on a casual basis with [Agency A] to provide in-home nursing care to clients [ ], she engaged in conduct or performed an acts or acts relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded by Members as disgraceful, dishonourable or unprofessional, in that she recorded 30 1-hour visits not made by her in respect of [clients A and B] - of which she was paid for 23 visits.

Decision

The panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct and, in particular, finds that the Member committed an act of professional misconduct as alleged in paragraphs #1 and #2 of the Amended Notice of Hearing (Exhibit #1) in that:

1. the Member misappropriated funds belonging to her workplace, in that she recorded visits not made by her, in respect of two clients, [ ], for which visits she was paid; and
   
2. the Member engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, in that the Member recorded visits not made by her in respect of two clients, [ ], for which visits she was paid.

Reasons for Decision

The College bears the onus of proving the allegations in accordance with the standard of proof which the panel is familiar with, set out in Re Bernstein and College of Physicians and Surgeons of Ontario, (1997) 15 O.R. [2d] 477. The standard of proof applied by the panel, in accordance with the Bernstein decision, was a balance of probabilities with the qualification that the proof must be clear and convincing and based upon cogent evidence accepted by the panel.

The panel deliberated and after due consideration of all the facts and the Member's admission to the allegations, unanimously accepted the Agreed Statement of Fact (Exhibit #2), which substantiated the findings of professional misconduct made by the panel.

Penalty

Counsel for the College presented the panel with the following Submission On Penalty (Exhibit #3):

The College of Nurses of Ontario ("the College") respectfully submits that, in view of the circumstances set out in the Agreed Statement of Fact, and the Member's admissions of professional misconduct, the panel of the Discipline Committee should make an order as follows:

1. Requiring the Member to appear before the panel to be reprimanded.
   
2. Directing the Executive Director to suspend the Member's certificate of registration for 30 days. Such suspension shall commence on December 27, 2003 and shall run continuously so long as the Member maintains a current registration. In the event that the Member fails to maintain a current registration, any portion of the suspension which has not yet been served shall be served commencing on the day that the registration is renewed.
   
3. Directing the Executive Director to impose the following terms, conditions and limitations on the Member's certificate of registration:
   
   1. For the first year in which the Member is engaged in active practice following the completion of the 30-day suspension referred to in paragraph 2, above:
      
      1. the Member may only practice for an employer where she has, in
         advance of commencing or resuming practice, provided the employer's chief nursing officer, or equivalent, with a copy of the Panel's penalty order, including appendices, or, if available, the Panel's written decision and reasons, and where the Member has obtained the employer's agreement to confirm receipt of one of those documents with the College's Discipline Committee Co-ordinator in writing within 14 days of the commencement or resumption of the Member's practice; and,
      2. the Member must advise the College's Discipline Committee Co-ordinator of the names and addresses of all employers for whom she practices nursing, in writing, and such communication shall be delivered to the Discipline Committee Co-ordinator by registered mail or courier, or by other verifiable means of delivery, and the Member shall retain proof of receipt of the communication by the College of Nurses of Ontario.
         

College counsel outlined the following aggravating factors:

1. this was a deliberate act of dishonesty;
   
2. this was not a single act but 30 false claims of monies that the Member had not earned; and
   
3. it should be recognized that honesty is a cornerstone of nursing.

College counsel further outlined the following mitigating factors:

1. the incidents in question happened over a short period of time;
   
2. the Member admitted to the allegations as set out in the Notice of Hearing;
   
3. the Member was remorseful and has repaid the monies owed to the workplace; and
   
4. the Member admitted readily to her employer of this conduct.

College counsel further spoke to the fact that the monitoring of the Member's practice would ensure protection of the public.

In order to support the suspension, component of the proposed penalty, (Exhibit #3) College counsel introduced four previously decided cases from the College of Nurses to the panel for their review.
For the above reasons, counsel for the College submitted that the proposed penalty was appropriate.

Member's Submission on Penalty

The Member informed the panel that she had worked for this company for 4 years and would always come to work when needed. She further stated that she was [having personal difficulties]. The Member admitted her mistake, a dishonest mistake, said it was neither pre-planned, nor deliberate and that she had readily admitted and co-operated with her employer, from the very beginning. The Member recognized that she should have "stepped away" from work, but in order to support her family, she maintained her employment.

The Member stated that she agreed and accepted the proposed penalty, with the exception of paragraph #2 of Exhibit #3, the proposed suspension component. For the above stated reasons, the Member asked that the panel not act on College Counsel's submission as to penalty insofar as it called for a suspension of her certificate of registration.

Penalty Decision

The panel deliberated and makes an order as per the College's Submission on Penalty, as written in paragraphs #1 and #3 of Exhibit #3. The panel does not, however, make an order to direct the Executive Director to suspend the Member's certificate of registration.

Reasons for Decision

The panel considered all the evidence and the submissions made by both the Member and College Counsel.
Counsel for the College submitted that the proposed penalty would serve to protect the public, in that it would act as a general deterrent to the members of the profession by sending a clear message that this conduct would not be tolerated.

The penalty addresses the specific deterrence of this Member by requiring the Member to appear before this panel for an oral reprimand .

In reviewing the evidence, as presented, the panel was unable to conclude that the Member's conduct was intentional and deliberate. The Member indicated that she did not intentionally submit inaccurate timesheets.

The panel found the Member to be forthright, sincere and accepted the Member's explanation.

The imposed terms, conditions and limitations on the Member's certificate of registration, as set out in paragraph 3 of Exhibit #3 , will further serve to protect the public, which is the mandate of this College.

I, Arlene Grant, 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:

Ruth Kitson, RN
Kim Pederson, RPN
Marilyn Bestwick, Public Member
Fay Cole, Public Member