DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO. PANEL: Lindsay Hyslop, NP Chairperson Nancy Sears, RN Tammy Hedge, RPN Member

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1 DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Lindsay Hyslop, NP Chairperson Nancy Sears, RN Member Tammy Hedge, RPN Member Gino Cucchi Public Member Joan King Public Member BETWEEN: COLLEGE OF NURSES OF ONTARIO ) JEAN-CLAUDE KILLEY for ) College of Nurses of Ontario ) - and - ) ) NO REPRESENTATION for ) ILSE LIM ILSE LIM ) Registration No ) ) ) LUISA RITACCA ) Independent Legal Counsel ) ) ) Heard: October 31, 2012 to November 1, 2012 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on October 31, 2012 and November 1, 2012 at the College of Nurses of Ontario ( the College ) at Toronto. As Isle Lim (the Member ) was not present, the hearing recessed for 20 minutes to allow time for the Member to appear. Upon reconvening the panel noted that the Member was not in attendance. Counsel for the College provided the panel with evidence that the Member had been sent the Notice of Hearing on June 26, The panel was satisfied that the Member had received adequate notice and therefore proceeded with the hearing in the Member s absence.

2 The Allegations The allegations against Ilse Lim (the Member ) as stated in the Notice of Hearing dated June 13, 2012 (Exhibit 1) are as follows. IT IS ALLEGED THAT: 1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession with respect to the following incidents: a) while practising as a Registered Nurse at [Facility A] in [ ], Ontario, I) on about July 25, 2009, you administered a drug, namely Fentanyl, to [Client A] without an order or other authorization to administer this drug to this client; I IV) on about July 25, 2009, you failed to administer a drug, namely Fentanyl, in the correct dose to [Client B]; on about July 25, 2009, you failed to properly document the erroneous administration of a drug, namely Fentanyl, to [Client A]; on about July 25, 2009, you documented that you had administered the correct dose of a drug, namely Fentanyl, to [Client B], when in fact you had not; b) while practising as a Registered Nurse at [Facility B] in [ ], Ontario, I) on about December 4, 2009, you administered a drug by injection, namely Haloperidol, to [Client C] without an order or other authorization to administer this drug to this client; I IV) on about December 4, 2009, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client C]; on about December 10, 2009, you administered a drug by injection, namely Haloperidol, to [Client D] without an order or other authorization to administer this drug to this client; on about December 10, 2009, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client D]; V) on about December 12, 2009, you administered a drug by injection, namely Haloperidol, to [Client E] without an order or other authorization to administer this drug to this client; VI) on about December 12, 2009, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client E];

3 V on about December 12, 2009, you administered a drug by injection, namely Haloperidol, to [Client E], and told the client you were administering vitamin B-12; c) while practising as a Registered Nurse at [Facility C] in [ ], Ontario, I) on about October 14, 2010, you administered a drug by injection, namely Haloperidol, to [Client F] without an order or other authorization to administer this drug to this client; on about October 14, 2010, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client F]; 2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(13) of Ontario Regulation 799/93, in that you failed to keep records as required with respect to the following incidents: a) while practising as a Registered Nurse at [Facility A] in [ ], Ontario, I) on about July 25, 2009, you failed to properly document the erroneous administration of a drug, namely Fentanyl, to [Client A]; b) while practising as a Registered Nurse at [Facility B] in [ ], Ontario, I) on about December 4, 2009, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client C]; I on about December 10, 2009, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client D]; on about December 12, 2009, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client E]; c) while practising as a Registered Nurse at [Facility C] in [ ], Ontario, I) on about October 14, 2010, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client F]; 3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(14) of Ontario Regulation 799/93, in that you falsified a record relating to your practice, and in particular, while practicing as a Registered Nurse at [Facility A] in [ ], Ontario, on about July 25, 2009, you documented that you had administered the correct dose of a drug, namely Fentanyl, to [Client B], when in fact you had not; 4. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991,

4 c. 32, as amended, and defined in subsection 1(19) of Ontario Regulation 799/93, in that you contravened a provision of the Act, the Regulated Health Professions Act, 1991 or the regulations under either of those Acts, and in particular, s. 5 of the Nursing Act, 1991 and s. 27 of the Regulated Health Professions Act, 1991, with respect to the following incidents: a) while practising as a Registered Nurse at [Facility B] in [ ], Ontario, I) on about December 4, 2009, you administered a drug by injection, namely Haloperidol, to [Client C] without an order or other authorization to administer this drug to this client; I on about December 10, 2009, you administered a drug by injection, namely Haloperidol, to [Client D] without an order or other authorization to administer this drug to this client; on about December 12, 2009, you administered a drug by injection, namely Haloperidol, to [Client E] without an order or other authorization to administer this drug to this client; b) while practising as a Registered Nurse at [Facility C] in [ ], Ontario, on about October 14, 2010, you administered a drug by injection, namely Haloperidol, to [Client F] without an order or other authorization to administer this drug to this client; 5. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional with respect to the following incidents: a) while practising as a Registered Nurse at [Facility A] in [ ], Ontario, I) on about July 25, 2009, you administered a drug, namely Fentanyl, to [Client A] without an order or other authorization to administer this drug to this client; I on about July 25, 2009, you failed to administer a drug, namely Fentanyl, in the correct dose to [Client B]; on about July 25, 2009, you failed to properly document the erroneous administration of a drug, namely Fentanyl, to [Client A];

5 IV) on about July 25, 2009, you documented that you had administered the correct dose of a drug, namely Fentanyl, to [Client B], when in fact you had not; b) while practising as a Registered Nurse at [Facility B] in [ ], Ontario, I) on about December 4, 2009, you administered a drug by injection, namely Haloperidol, to [Client C] without an order or other authorization to administer this drug to this client; I IV) on about December 4, 2009, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client C]; on about December 10, 2009, you administered a drug by injection, namely Haloperidol, to [Client D] without an order or other authorization to administer this drug to this client; on about December 10, 2009, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client D]; V) on about December 12, 2009, you administered a drug by injection, namely Haloperidol, to [Client E] without an order or other authorization to administer this drug to this client; VI) V on about December 12, 2009, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client E]; on about December 12, 2009, you administered a drug by injection, namely Haloperidol, to [Client E], and told the client you were administering vitamin B-12; c) while practising as a Registered Nurse at [Facility C] in [ ], Ontario, I) on about October 14, 2010, you administered a drug by injection, namely Haloperidol, to [Client F] without an order or other authorization to administer this drug to this client; and/or on about October 14, 2010, you failed to properly document the administration of a drug by injection, namely Haloperidol, to [Client F] Member s Plea Given that the Member was not present nor represented, she was deemed to have denied the allegations in the Notice of Hearing. The Hearing proceeded on the basis that the College bore the onus of proving the allegations in the Notice of Hearing against the Member. Overview

6 The Member was an RN at three separate facilities: [ ]. On July 25, 2009, while working at [Facility A], the Member was alleged to have administered the wrong medication to a [client]; failed to give a medication to another [client]; and, in both instances, failed to document the errors and falsely documented the administration of a medication. The Member was also alleged to have administered medication to [clients] at both [Facility B] and [Facility C] without an order and failed to document the administration of medications properly. The panel heard from 11 witnesses and was presented with 33 pieces of documentary evidence [ ] including medication administration records and progress notes from the various facilities. The issues the panel was asked to consider are as follows: (1) Did the Member commit professional misconduct by failing to meet the standards of practice? (2) Did the Member commit professional misconduct by failing to keep records as required? (3) Did the Member commit professional misconduct by falsifying a record in relation to her practice? (4) Did the member commit professional misconduct by contravening a provision of the Health Professions Procedural Code of the Nursing Act in that she gave medications without an order? (5) Was the Member s conduct such that it could reasonably be regarded by members of her profession as disgraceful, dishonorable and/or unprofessional? Having considered the evidence and the onus and standard of proof, the panel found that the Member committed acts of professional misconduct as alleged in paragraphs: 1( a) (I),(I; 1(b) (I),(,(I,(IV),(V),(VI),(V; 1(c) (I) (; 2(a)(I); 2(b) (I), (, (I; 2(c) (I), 4(a) (I), (, (I; 4 (b); and 5(a)(I), (I, 5(b) (I), (, (I, (IV), (V), (VI), (V; and 5(c) (I)( in the Notice of Hearing (Exhibit 1). In particular, the Member engaged in conduct that would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional by failing to properly document medications given, misleading a client whom she was administering a medication that was not ordered, and giving medications without an order. The panel did not find that the Member has committed acts of professional misconduct as alleged in paragraphs 1 (a) ( & (IV); 3 and 5(a) ( & (IV) of the Notice of Hearing. The Evidence [The Director of Care (DOC)] at [Facility A] testified that it had been reported to her that the Member had made medication errors during her first shift at the facility. Specifically, the Member had administered two Fentanyl patches to [Client A], when no order existed and the Member had failed to administer the correct Fentanyl medication to [Client B]. [The DOC] testified that the Medication Administration Record ( the MAR ) [ ] showed the Member had initialed the MAR indicating that she gave the [Client B] the correct medication and made no

7 reference to the incorrect administration of Fentanyl to [Client A] on the MAR or elsewhere in the client s chart. This evidence was corroborated by [ ] the RN charge nurse. [The charge nurse] testified that the first error was brought to her attention by [Client A], who told her that the Member had applied a pain patch to her body even after she protested to the Member that she had never had a pain patch before. [The charge nurse] testified that the [Client B], when physically assessed by [the charge nurse] on the morning of July 26, 2009, only had 1 [Fentanyl] patch in place when two had been ordered. [The Director of Administration (DOA)] at [Facility B] testified that she had investigated reports that the Member had administered Haloperidol to 3 different clients without authorizing orders. [Client C] [The DOA] testified that the Member admitted giving Haloperidol to [Client C] but not to the other two clients. [The DOA] confirmed that after thorough investigation, the Member s employment was terminated on December 17, This event was confirmed [by] a copy of the termination letter delivered to the Member on December 17, [RPN A] provided compelling evidence regarding the administration of Haloperidol to the three clients. She testified that [Client C] was to be sent to the hospital for a blood transfusion. When the ambulance arrived, [Client C] became very agitated and refused to leave the facility. [RPN A] stated that she heard the paramedics tell the Member that they would not transfer the client if he was resisting. [RPN A] testified that she heard the Member ask the paramedics if she should haldol him. [RPN A] testified that she saw the Member inject [Client C] with a clear fluid and that the Member told her that it was Haloperidol. [RPN A] also stated that the facility only had 2 injectable medications available, Haloperidol and Vitamin B12. She described Haloperidol as being a clear fluid and Vitamin B12 as being a deep purplish colour. [RPN B] at [Facility B] testified that she assisted the Member by providing the Haloperidol to the Member by taking it from [Client B] s medication drawer. [Client B] had a PRN (as needed basis) order for Haloperidol. [Client D] [RPN A] testified that [Client D] was disturbed and making considerable noise. She testified that [Client D] was brought to the nursing station and given a PRN Ativan tablet by the RPN assigned to that unit. Shortly after, [RPN A] observed the Member injecting [Client D] with a clear fluid and heard the Member saying she was giving Haloperidol to the client. [Client E] [RPN A] testified that she observed the Member injecting [Client E] with a colorless fluid. The Member told [Client E] it was Vitamin B12, which is not a colorless fluid. The suggestion that the client was given Vitamin B12 is not supported by the evidence of [RPN B], who testified that after [Client E] received the injection, she became exceptionally drowsy and was unable to swallow pills.

8 [Client F] [RN A] at [Facility C] testified that she had investigated the conduct of the Member with regard to the administration of Haloperidol to [Client F]. She testified that the Member had been hired as nurse manager and was responsible for the night shift. [RN A] testified that on the night of October 13, 2010, [Client F] was very agitated and the Member, in the absence of an authorizing order, gave [Client F] an injection of Haloperidol. [RN A] s testimony was supported by that of [three] Personal Support Workers ( PSW ) and [RPN C]. [Two PSWs] testified that they had observed the Member giving [Client F] an injection, which the Member told them was Haloperidol. [RPN C] was the nurse who relieved the Member on the morning of October 14, She testified that the Member told her that the night had been rough and that she had given Haloperidol to [Client F] to calm him down. [RPN C] recalled asking the Member if she had received an order from the doctor. She testified that the Member then called [the doctor], but that the Member did not tell the doctor that Haloperidol had already been administered. The doctor refused to give an order for Haloperidol, but did order Trazadone PRN. [A PSW] also testified that the Member told her of the Member s administration of Haloperidol to [Client F]. The MAR for [Client F] [ ] showed no record of Haloperidol being administered but did show an order for Trazadone. The progress note for [Client F] [ ] had a note stating that the client was being monitored after Haldol was given by the nurse on the night shift. This note was authored by [RPN C], who confirmed that she had authored the note in her examination. Final Submissions The College acknowledged that it bears the onus to prove, on a balance of probabilities, that the conduct as alleged in the Notice of Hearing [ ] occurred. The College submitted that the conduct in question falls into two areas of misconduct. The first misconduct exists in relationship to two medication errors that occurred at [Facility A] and the associated documentation errors. The second misconduct involved the administration of a drug by injection without an authorizing mechanism and the associated lack of documentation of the medication administration. With respect to the first misconduct, [the DOC] testified that the Member admitted to administering two Fentanyl patches to [Client A] and that the Member recognized her error and removed them. [The DOC] testified that the Member had told her that she had mistaken the identity of [Client A] for [Client B]. Counsel for the College stated that not all mistakes are necessarily misconduct. [An] expert witness testified that this type of mistake is not one that can reasonably occur when a nurse observes the Standards of Practice for medication administration. Counsel for the College submitted that the College does not allege that the Member intentionally administered the medication to the wrong [client]. There was no physician order for [Client A] to receive Fentanyl. The expert witness testified that administration of a medication without a physicians order was a breach of the standards of practice of nurses, specifically the medication standard. [The DOC] further testified that a review of the Client Record for [Client A] did not show any documentation of this medication

9 administration. [The expert] testified that failure to document the administration of a medication is a breach of the Standard of Practice for Documentation. Also with regard to the first misconduct, [the DOC] testified that [Client B] was found to have only one Fentanyl patch rather than the expected two Fentanyl patches when examined on July 26, College Counsel described the evidence as circumstantial but that the panel can draw the inference that only one patch was applied or that a second patch had been applied and had later been removed, or had otherwise come off. [The expert] testified that the accidental loss of a Fentanyl patch was not likely but not unheard of. [The DOC] testified that an examination of the Medication Administration Record for [Client B] [ ] indicated that the Member had documented application of two Fentanyl patches. [The expert] testified that failure to document the administration of a medication is a breach of the Standard of Practice for Documentation. Also with regard to the first misconduct, [the DOC] testified that [Client B] was found to have only one Fentanyl patch rather than the expected two Fentanyl patches when examined on July 25, College Counsel described the evidence as circumstantial but that the panel could draw the inference that only one patch was applied or that a second patch had been applied and had later been removed or had otherwise come off. [The expert] testified that the accidental loss of a Fentanyl patch was not likely but not unheard of. [The DOC] testified that an examination of the Medication Administration Record for [Client B] [ ] indicated that the Member had documented application of two Fentanyl patches. With respect to the second misconduct, the deliberate administration of Haloperidol to three [clients] at [Facility B] and one [client] at [Facility C] and the lack of documentation regarding all four instances of Haloperidol administration clearly [demonstrate] professional misconduct. Counsel for the College urged the panel to put a high degree of reliance on the evidence of witness [RPN A]. This witness testified that over an eight-day period, she witnessed the Member inject a clear substance into [Clients C, D, and E], and that on each of the three occasions the Member told [RPN A] that she (the Member) was injecting Haldol and that she (the Member) was aware there was no physician s order for the medication. Similarly, [the DOA] testified that the Member told her ([the DOA]) that she intended to obtain a Haldol order for [Client C] later. Such an intention is an implicit acknowledgement that a physician s order was required for the administration of the medication. Specifically with respect to the alleged administration of Haloperidol to [Client C], two witnesses, namely, [RPN A and RPN B], testified that the Member stated that she would get an order and would Haldol the [client] to calm him down. [The DOA] testified that the Member admitted administering Haldol to [Client C]. Specifically with respect to the alleged administration of Haloperidol to [Client D], [RPN A] saw the Member inject [Client D] and the Member told [RPN A] that the injected medication was Haldol. Specifically with respect to the alleged administration of Haloperidol to [Client E], [RPN B] testified that following the Member s injection of [Client E], the client was unusually lethargic, a symptom [RPN B] testified was consistent with the administration of Haloperidol. [RPN A]

10 testified that she overheard the Member inform [Client E] that she (the Member) was giving her ([Client E]) a B12 shot. Counsel for the College submits that misrepresenting the nature of the drug is a breach of the standards of practice for nursing. With respect to the allegations set out with respect to [Facility C], two witnesses, [PSW A and PSW B], saw the Member administer an injection to [Client F] and that the Member told them that the injected medication was Haldol. [PSW B] also testified that prior to administering the injection, she saw the Member on the phone but that she ([PSW B]) did not hear the telephone conversation. An from the Member [ ] to [RN A] said, so I gave [Client F] one milligram of Haldol and would call the MD in the a.m.. The inconsistency between the evidence from [the ] and the testimony of [PSW B] is of no consequence as the result of the call, if made, was that a physician s order for Haloperidol was not received. Instead, an order was received for Trazadone. [The expert] testified that, in her opinion, the administering a medication without an authorizing mechanism contravenes the standard of practice. The Member admitted this conduct in an message to [RN A], which was presented to the panel [ ]. What is of great concern to the College is that the Member ignored a prior employer disciplinary action that resulted from similar conduct. With respect to Allegation 5, the College submits that the Member s misconduct at [Facility B] and [Facility C] constitutes disgraceful, dishonourable and unprofessional conduct as it was conscious and deliberate conduct to act outside of the Member s scope of practice. It was a clear breach of the public interest. The Member s misconduct at [Facility A], falls within the range of unprofessional conduct. Decision The College bears the onus of proving the allegations in accordance with the standard of proof, that being the balance of probabilities based upon clear, cogent and convincing evidence. Having considered the evidence and the onus and standard of proof, the panel finds that the Member committed acts of professional misconduct as alleged in paragraphs: 1( a) (I),(I; 1(b) (I),(,(I,(IV),(V),(VI),(V; 1(c) (I) (; 2(a)(I); 2(b) (I), (, (I; 2(c) (I), 4(a) (I), (, (I; 4 (b); and 5(a)(I), (I, 5(b) (I), (, (I, (IV), (V), (VI), (V; and 5(c) (I)( in the Notice of Hearing [ ]. In particular, the Member engaged in conduct that would reasonably be regarded by Members of the profession as disgraceful, dishonourable and unprofessional by failing to properly document medications given, misleading a client to which she was administering a medication that was not ordered, and giving medications without an order. Having considered the evidence, the onus and standard of proof, the panel did not find that the Member committed acts of professional misconduct as alleged in paragraphs 1 (a) ( & (IV); 3 and 5(a) ( & (IV) of the Notice of Hearing. Reasons for Decision

11 The panel was presented with 33 pieces of evidence to consider as well as hearing from 11 witnesses. The finding on allegation 1a) (I) and (I were supported by the evidence of the Member herself in admitting to wrongly applying the patches to [Client A]. [Documentation] clearly show[s] that this medication was not ordered for this client. There was a lack of documentation on the incident, which is a breach of the standards. The panel was unable to make a finding on allegation 1a) ( and (IV) as well as Allegation 3 and 5 (, as there was insufficient evidence as to whether or not two patches were applied and therefore whether or not the documentation was correct. With respect to the incidents at [Facility B], the panel was presented with testimony from [RPN A] who testified that she witnessed injections of Haldol on three occasions to three clients for whom the medication was not ordered. In the incident involving [Client C], the Member admitted to [RPN A] that there was not an order. The Member also admitted to [the DOA] that she gave [Client C] the injection. [RPN A] also witnessed the Member tell [Client E] that she was getting a B12 injection when in fact it was Haldol. While practicing at [Facility C] (allegation #2), the Member admitted to administering Haldol without an[ ] order to [Client F] in an to the Director of Care. The panel also made the finding of conduct that would be reasonably be regarded as disgraceful, dishonourable or unprofessional based on the testimony of the witnesses, the fact that her actions were deliberate and the clear disregard for the limits on her scope of practice bestowed on her. Order Submission Considerations in establishing the College s proposed order are the protection of the public, maintenance of public confidence in the profession, general deterrence to the membership and specific deterrence to the Member. Counsel for the College submitted that these were egregious acts that put clients at high risk. This Member was neither educated to, nor experienced in, prescribing antipsychotic medication. Neither did the Member have the authority to administer the medications. Once these medications were administered there was absolutely no trace of this activity in the clinical record. There was no way subsequent care providers would be informed that these medication administrations had occurred. Clinical records are extremely important in regard to pharmacological treatment, especially in regards to medications with lasting effects and the potential for interaction with other medications. The Member s behaviours transgress the regulatory model in Ontario and exceeded the Member s legislated scope of practice. Her training and experience allowed the Member to practi[s]e as a nurse in this province, but in performing these acts, she stepped outside nursing s scope of practice and abused the public trust. Counsel identified the following factors: The Member s conduct was deliberate;

12 The Member admitted that she knew an order was required prior to administering the medication and she chose not to get one; The misconduct occurred over a short period of time; The Member became increasingly casual in her administration; The Member misled a client; The Member was terminated by one facility for her behaviour and subsequently repeated the same behaviour at another facility less than one year later; The Member chose not to participate in the discipline process. This raises concern about her governability and the College s self-regulating mandate; and Due to the member s unwillingness to cooperate with the College, and with this panel, her potential for rehabilitation cannot be assessed. Counsel for the College submitted that the only appropriate order in this circumstance is the immediate revocation of the Member s certificate of registration. Counsel relied on two cases to support this order. Both relate to failure to accurately document and failure to meet the standards of medication administration. These cases also involved members who failed to participate in the discipline process and raise question to their governability. Orders in these cases were revocation of the members certificate of registration. Order The panel directs the Executive Director to immediately revoke the Member s certificate of registration. Reasons for Order Decision The panel finds the Member s persistent and ongoing disregard for the practice standards with regard to medications and documentation, as well as her cavalier attitude towards administering psychotropic medications, is a matter of grave concern. The fact that this misconduct occurred repeatedly and in increasingly casual circumstances brings into question the Member s governability. By practi[s]ing outside her scope of practice, the Member put a number of clients at risk of serious harm or death. Her failure to participate in the Discipline hearing process did not allow the panel to assess her rehabilitation potential. It was the unanimous decision of this panel to direct the Executive Director to immediately revoke the Member s certificate of registration.

13 I, Lindsay Hyslop, NP, 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: Chairperson Date Panel Members: Tammy Hedge, RPN Nancy Sears, RN Gino Cucchi, Public Member Joan King, Public Member