Transcript No Slide Title

So You Call Yourself a
Licensed Practitioner?
How the College of Nurses of
Ontario Investigates Impostors
CLEAR Conference
San Antonio, September 2001
Dean Benard, Investigator
Megan Shortreed, Legal Counsel, Paliare Roland
Rosenberg Rothstein, LLP
Pam Marshall, Manager, Investigations
Agenda
• What is the
problem?
• Who are
impostors?
• How do we
investigate?
• Legal remedies
• Case Studies
• Prevention
What is the College of
Nurses of Ontario?
• Regulator for 140,000 nurses
– standards, quality assurance
• Protection of the public
– investigations and hearings
• Leadership to the profession
– collaborate
• Legislation
– Nursing Act
– Regulated Health Professions Act (RHPA)
The Problem
• Unqualified
people working
as nurses
• Incidence
increasing
• Public risk
• Liability to other
healthcare
professionals
Who Are They?
Three classifications:
• Educated in another
jurisdiction
• Former Ontario
registration
• Partial or No nursing
education
The Numbers
8
7
6
Educated in
other
jurisdictions
Former Ontario
Registration
5
4
3
Partial / No
Nursing
Education
2
1
0
1999
2000
2001
How Are They Discovered
• Statutory obligation of employers
to check registration
• Observations of co-workers or
supervisors leads them to inquire
about the impostor
– lack of skills
– lack of knowledge
– strange or odd behavior
• Statutory obligation to report
termination
• Public complaint
The Investigation
• Determine type of impostor
– Influences our approach
• Make contact with employer
– address their concerns
– establish how information will be
accessed
• Gather evidence on three
offence types
– Holding oneself out as a nurse
– using title RN or RPN
– performing controlled acts
The Evidence
• Documentary Evidence
– Health records
– Payroll / time sheets
– Human resources documents
• Statements
– Co-workers
– Employers / supervisors
– Clients
Challenges
• Facility
– Not allowing access to documentation
– Not providing information in a timely
manner
• Search warrants
• Reassurance
• Witnesses
– Locating
– Ensuring cooperation
• Various databases, internet, CPIC
• Interview techniques
• Reassurance
• Legal bureaucracy
Controlling Imposters In the
Public Interest
4 Possibilities:
1. Internal Mechanisms:
a) Legal Undertakings
b) Registration Committee
2. Civil Injunctions and Contempt
of Court Remedies
3. Criminal Prosecutions for
Assault / Fraud
4. Quasi-criminal Private
Prosecutions by the College
Internal Mechanisms
• Legal Undertakings
– promise by the wrongdoer not to
commit the wrongful act in the future
– useful for conduct that is not serious
enough to require a full prosecution
– Include recognition that the regulator
will be able to use the undertaking
against the accused if future
misconduct occurs
Example:
a single use of the title "R.N." on a job
application for a non-medical position by a
retired member of the College.
Internal Mechanisms
Registration Committee
• Placing conditions on granting
status
– ethical or other additional training
– have potential registrant demonstrate why he
/ she should be registered
– time penalties on granting registration
• May be useful when dealing with
a person who was practicing prior
to being properly registered
Civil Injunctions and
Contempt of Court Remedy
• Application for an injunction
directing that the imposter not
violate the provisions of the relevant
statutes
• Violation of the Court
– Regulator can bring a motion asking the Court
to find the imposter in contempt of court
– May lead to fines and jail
• Main Benefit
– usually proceeds on consent, as Order is
simply a direction to comply with the law in the
future
Criminal Prosecutions
• Fraud
• Assault
• Potential Problems
Private Prosecution for
Violating Governing Statutes
Nursing Act
– Prohibits non-members of the College from
holding themselves out as qualified to practice
in Ontario as a Nurse
– prohibits non-members from using the title
Registered Nurse, or an abbreviation thereof
(Equivalent provisions for other professions exist)
Regulated Health Professions Act
– Prohibits performance of "Controlled Acts” by
those not authorised by statute;
Provincial Offences Act
– Provides procedural framework for prosecution
Private Prosecution for
Violating Governing Statutes
Benefits
• Regulator prosecutes the matter before the Courts
– fulfills its mandate to regulate the profession in the
public interest
• Matter prosecuted by Counsel
– familiar with the interests of the Regulator and the
seriousness of this misconduct to public confidence
in the profession rather than Crown attorney (District
Attorney) more familiar with criminal law issues and
interests
• Penalties are serious enough to create specific
and general
deterrence
• Regulator gains access to search warrant powers
not provided by its governing statute
Private Prosecution for
Violating Governing Statutes
Overview of Procedure
1)
2)
3)
4)
5)
6)
7)
8)
Investigation conducted, which may
include execution of a search warrant
Laying of the Information: The
Charges
Service of the Summons
Disclosure obligations
First Appearance: Set a date for trial or
guilty plea
Summons to Witnesses
The Trial: Onus of Proof
Conviction and Sentencing
Private Prosecution for
Violating Governing Statutes
Miscellaneous Issues:
• Special Court Dates and Pretrial
Conferences
• Limitation Period
• Usefulness of Registrar's
Certificate
Private Prosecution for
Violating Governing Statutes
• Factual submissions on Guilty
Plea
• Available penalties:
-fines
-imprisonment
-probation orders
-other orders
Case Study #1
• Never educated or registered
as a nurse
• Obtained employment as RN in
3 doctors offices
• Performed many controlled
acts
• Search warrant conducted
• 40 charges laid
• $22,000 Fine 2 years probation
Case Study #2
•
•
•
•
Registration revoked
Opened nursing agency
Employed 10 RN’s
Provided nursing care &
supervised the 10 RN’s
• Search warrant conducted
– seized records and computer
• Numerous interviews
• Convicted of 80 charges
• $19,000 fine 2 years probation
Case Study #3
• Registration revoked 6 years prior
• Obtained registration 3 other
jurisdictions under false
pretences (forgery)
• Came back to Ontario
• Stolen, doctored registration card
• Community care nursing
• Reported by employer
• Convicted of 31 charges
• $10,000.00 Fine
Prevention
• Limit opportunities for
deception
• Educate the employers
– Check ALL licenses
– Accept only originals
– Make record of all information and
cross reference yearly
• Educate the licensee’s
– unless required don’t carry your license
/ registration with you
– report lost or stolen cards
• Database creation