Discipline Committee of the College of Nurses of Ontario - Notes

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL

  • Panel Members:
    • Dawn Cutler, RN - Chairperson
    • Sylvia Douglas - Public Member
    • Ian McKinnon - Public Member
    • Michael Schroder, NP - Member
    • Ingrid Wiltshire-Stoby, NP - Member

HEARING DETAILS

  • Parties Involved:
    • College of Nurses of Ontario
    • Jean-Claude Killey for College of Nurses of Ontario
    • Isabelle Cabot, Registration No. 06293753
    • Andrew Faith and Brookelyn Kirkham for Isabelle Cabot
    • Christopher Wirth - Independent Legal Counsel
  • Hearing Date: August 30, 2021

PUBLICATION BAN

  • Motion:
    • College Counsel requested an order for a ban on public disclosure of patient identities.
  • Decision: The Panel agreed to prevent public disclosure of the names or identifying information of patients.

ALLEGATIONS

  • Withdrawal of Allegations:
    • The College Counsel sought to withdraw many specified allegations from the Notice of Hearing dated June 8, 2021.
    • Granted: The request was approved by the Panel.
  • Remaining Allegations Against Isabelle Cabot:
    • Allegation 1:
    • Misconduct under Nursing Act 1991, subsection 51(1)(c):
      • Failure to maintain standards of practice in therapeutic nurse-client relationships:
      • Specific Instances:
        • a. Between April 2017 – December 2017: failed to maintain professional boundaries with Patient 1.
        • b. Between April 2017 – October 2017: failed to maintain professional boundaries with Patient 2.
        • c. to k.: Allegations withdrawn
      • Allegation 2: Withdrawn.
      • Allegation 3: Withdrawn.
      • Allegation 4: Withdrawn.
      • Allegation 5: Withdrawn.
      • Allegation 6: Misconduct related to disgraceful conduct:
        • a. – f.: Failure to maintain therapeutic boundaries associated with above misconduct.

MEMBER’S PLEA

  • Admissions:
    • Member admitted allegations in paragraphs 1(a), (b) and 6(a), (c) of the Notice of Hearing.
    • The Panel confirmed the admission as being voluntary and informed through a written plea inquiry.

AGREED STATEMENT OF FACTS

  • Personal Background of Member:

    • Isabelle Cabot:
    1. Bachelor of Nursing degree obtained in 1997 and a Master’s degree in Nursing Sciences obtained in 2005, both from the Université de Montréal.
    2. Graduate Diploma in Primary Health Care for Nurse Practitioners from the University of Ottawa, August 2016.
    3. Registered with the College of Nurses of Ontario (CNO) as a RN in September 2006 and as RN in Extended Class (NP) in November 2016.
    4. Worked as NP at community medical clinic in Cornwall Ontario from November 2016 – April 2018.
    5. Currently employed at the Centre de Santé Communautaire de l’Estrie- Cornwall.
    6. No prior discipline history with the CNO.

  • Patients:

    1. Patient [1]: [ ]-year-old with asthma, respiratory infections, dental issues.
    2. Patient [2]: [ ]-year-old with sinus infection, mental health issues.
    3. Patients were spouses with [ ] children.
    4. Member established a therapeutic relationship with both patients.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

  • Failure to Maintain Boundaries:

    1. March 22, 2017: Patient [2] sought advice from Member for Patient [1]’s condition.
    2. Member gave her personal cell number to both patients for follow-up.
    3. June - July 2017: Began exchanging personal text messages with Patient [1].
    • Examples:
      • Conversations about personal lives and marriage issues.
    1. July 11, 2017: Text message from Member declared need for professional boundary maintenance but did not terminate the therapeutic relationship with Patient [1].
    2. August 2017: Continued texting and more intimate conversations occurred, leading to Patient [2] expressing suspicion of a relationship.
    3. August 18, 2017: Patient [2] confronted Member at her home; tensions escalated.
    4. Transition of Patient [1] out of care records occurred after confrontations and concerns were mentioned by the Member but was insufficiently documented.

  • Date of Care Continuation:

    • Despite the emotional turmoil, Member continued to provide care to both patients.
    • The introduction of personal relationships led to further documentation issues and boundary violations concerning her role.

PSYCHOLOGICAL CONTEXT AND MEMBER’S ADMISSIONS OF RESPONSIBILITY

  • The Member acknowledges actions violated the trust expected in nurse-client relationships.
  • An assessment indicated the Member was a victim of emotional abuse from Patient [1], leading to diminished judgment.
  • Circumstances included personal life challenges such as marriage issues and isolation from support systems.
  • The Member admits the vulnerability was exploited and feels moral and ethical responsibility for crossing boundaries.

COMPLAINTS FROM PATIENTS

  • In April 2018, Patient [2] filed a complaint with the CNO, expressing feelings of betrayal.
  • Patient [1] also lodged a complaint in July 2018 regarding feelings of being misled.

CNO STANDARDS OF PRACTICE

  • CNO establishes clear standards for nursing practice applicable to nurses regardless of their role.
  • The specific responsibility of Nurse Practitioners, including maintaining professional boundaries, is accentuated.
  • Nurses are expected to ensure:
    1. Compliance with practice standards and guidelines set by the CNO.
    2. Maintaining patient needs as a priority in the therapeutic relationship.
    3. The prevention, recognition, and reporting of abuse.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

  • Member admits interactions with Patient [1] and Patient [2] constituted failure to maintain appropriate therapeutic relationships.
  • Recognizes the breach of CNO standards and accepts full responsibility for the misconduct acknowledged in her admissions.
  • Withdrawal of numerous allegations indicates the specificity of misconduct admitted.

DECISION AND REASONS

  • The Panel confirmed acts of professional misconduct as substantiated by evidence.
  • The connection between the Member's personal relationship with one patient while treating the other constituted clear violations of professional conduct standards.

PENALTY

  • The Panel accepted a partial Joint Submission on Order recommending the following:
    1. Mandatory reprimand appearance within 3 months.
    2. A 10-month suspension starting November 30, 2021.
    3. The following terms relating to the Member’s practice:
    • Attending meetings with a Regulatory Expert (at least 2), completion of specific CNO educational recommendations within 6 months.
    • 18-month disclosure of decision to employers and restriction against independent practice for the same period.

REASONS FOR THE PENALTY DECISION

  • The penalty reflects the necessity for public protection and nursing accountability while considering the Member's demonstrated acknowledgment and acceptance of her misconduct as a learning opportunity.
  • Cited previous cases establish a framework for the Panel’s decision, while supporting a balance between punishment and future public safety.

CONCLUSION

  • The Panel found the Member’s failure to maintain therapeutic nursing boundaries was serious and warranted disciplinary actions including a 10-month suspension, educational remediation, and stringent supervisory conditions.