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

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)Investigation conducted, which may include execution of a search warrant 2) Laying of the Information: The Charges 3)Service of the Summons 4)Disclosure obligations 5)First Appearance: Set a date for trial or guilty plea 6)Summons to Witnesses 7) The Trial: Onus of Proof 8)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, 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